7-8. First Aid for Nerve Agent Poisoning

Table of Contents

First aid for nerve agent poisoning consists of administering the MARK I or ATNAA and CANA.

• a. Injection Site. The injection site for administering the antidotes is normally in the outer thigh muscle. The thigh injection site is the area about a hand’s width above the knee to a hand’s width below the hip joint (Figure 7-3). It is important that the injection be given into a large muscle area. If the individual is thinly built, then the injections should be administered into the upper outer quarter (quadrant) of the buttock (Figure 7-4). Injecting in the buttocks of a thinly built individual avoids injury to the thighbone.
• b . Self-Administer MARK I. If you experience any or all of the nerve agent MILD symptoms (paragraph 7-7a), you must IMMEDIATELY put on your protective mask and self-administer one MARK I (Figure 7-2A). Follow the procedure given in Table 7-1. The MARK I is carried in your protective mask carrier, pocket of the MOPP overgarment, or other location as specified in your unit tactical standing operating procedure (TSOP). (In cold weather, the MARK I should be stored in an inside pocket of your clothing to protect the antidote from freezing. A frozen MARK I cannot be immediately used to provide you with antidote, when needed. (However, the MARK I can still be used after complete thawing.)

Table 7-1. Self Aid for Nerve Agent Poisoning

Figure 7-5. Removing the atropine autoinjector from the MARK I clip.

CAUTION

DO NOT cover or hold the needle end with your hand, thumb, or fingers — you might accidentally inject yourself. An accidental injection into the hand WILL NOT deliver an effective dose of the antidote, especially if the needle goes through the hand.

Figure 7-6. Thigh injection site for self-aid.

NOTE

If you are thinly built, inject yourself into the upper outer quadrant of the buttock (Figure 7-7). There is a nerve that crosses the buttocks; hitting this nerve can cause paralysis. Therefore, you must only inject into the upper outer quadrant of the buttock.

Figure 7-7. Buttocks injection site for self-aid.

Figure 7-8. Removing the 2 PAM Cl autoinjector from the MARK I clip.

Figure 7-9. One set of used MARK I autoinjectors attached to pocket flap.

NOTES

1. DO NOT give yourself another set of injections. If you are able to walk without assistance, know who you are, and where you are, you WILL NOT need the second set of injections. (If not needed, giving yourself a second set of MARK I injections or ATNAA may create a nerve agent antidote overdose, which could cause incapacitation [inability to perform mission or defend yourself].)

2. If you continue to have symptoms of nerve agent poisoning, seek someone else (a buddy) to check your symptoms and administer the additional sets of injections, if required.

• c. Buddy Evaluation and Buddy Aid. Service members may seek assistance after self-aid (self-administering one MARK I or ATNAA) or may become incapacitated after self-aid. A buddy must evaluate the individual to determine if additional antidotes are required to counter the effects of the nerve agent. Also, service members may experience SEVERE symptoms of nerve agent poisoning (paragraph 7-7b); they will not be able to treat themselves. In either case, other service members must perform buddy aid as quickly as possible. Before initiating buddy aid, determine if one set of MARK I autoinjectors has already been used so that no more than three sets of the antidote are administered. Buddy aid also includes administering the CANA with the third MARK I or ATNAA to prevent convulsions. Follow the procedures indicated in Table 7-2.

WARNING

Squat, DO NOT kneel, when masking the casualty or administering the nerve agent antidote to the casualty. Kneeling may force the chemical agent into or through your protective clothing.

CAUTION

DO NOT use your own MARK I, ATNAA, or CANA on a casualty. If you use your own, you may not have any antidote if needed for self-aid.

WARNING

DO NOT inject into areas close to the hip, knee, or thighbone.

Table 7-2. Buddy Aid/Combat Lifesaver Aid for Nerve Agent Casualty.

NOTE

If the casualty is thinly built, inject the antidote into the buttock. Only inject the antidote into the upper outer portion of the casualty’s buttock (Figure 7-11). This avoids hitting the nerve that crosses the buttocks (Figure 7-4). Hitting this nerve can cause paralysis.

Figure 7-10. Injecting the casualty’s thigh (Mark I or CANA).

Figure 7-11. Injecting the casualty’s buttocks (Mark I or CANA).

Figure 7-12. Preparing CANA or ATNAA for injection.

Figure 7-13. Three sets of used MARK I autoinjectors and one CANA autoinjector attached to pocket flap.

• d. Self-Administer Antidote Treatment Nerve Agent Autoinjector. If you experience any or all of the nerve agent MILD symptoms (paragraph 7-7b), you must IMMEDIATELY self-administer one ATNAA following the procedure given Table 7-1.

NOTE

If you are thinly-built, inject yourself into the upper outer quarter (quadrant) of the buttock (Figure 7-15). There is a nerve that crosses the buttocks; hitting this nerve can cause paralysis. Therefore, you must only inject into the upper outer quarter (quadrant) of the buttocks.

Figure 7-14. Self-administration of ATNAA (thigh).

Figure 7-15. Self-administration of ATNAA (buttock).

NOTE

If you continue to have symptoms of nerve agent poisoning, seek someone else (a buddy) to check your symptoms and administer your remaining sets of injections, if required.

Figure 7-16. Used ATNAA attached to clothing.

• e . Buddy Assistance. Service members may seek assistance after self-aid (self-administering one ATNAA) or may become incapacitated after self-aid. A buddy must evaluate the individual to determine if additional antidotes are required to counter the effects of the nerve agent. Also, service members may experience SEVERE symptoms of nerve agent poisoning (paragraph 7-7b); they will not be able to treat themselves. In either case, other service members must perform buddy aid as quickly as possible. Before initiating buddy aid, determine if one ATNAA has already been used so that no more than three ATNAA are administered. Buddy aid also includes administering the CANA with the third ATNAA to prevent convulsions. Follow the procedures indicated in Table 7-2.

WARNING

Squat, DO NOT kneel, when masking the casualty or administering the nerve agent antidotes to the casualty. Kneeling may force any chemical agent on your overgarment into or through your protective clothing.

Figure 7-17. Buddy injecting casualty’s outer thigh (ATNAA or CANA).

NOTE

If the casualty is thinly built, inject the antidote into the buttocks (Figure 7-18). Only inject the antidote into the upper outer portion of the casualty’s buttocks. This avoids hitting the nerve that crosses the buttocks (Figure 7-4). Hitting this nerve can cause paralysis.

WARNING

DO NOT inject into areas close to the hip, knee, or thighbone.

Figure 7-18. Buddy injecting casualty’s buttocks (ATNAA or CANA).

Figure 7-19. Three used ATNAAs and one CANA autoinjector attached to clothing.

• f. Combat Lifesaver.
• • (1) The combat lifesaver must check to verify if the individual has received three sets of MARK I or ATNAAs. If not, the combat lifesaver performs first aid as described for buddy aid above. If the individual has received the initial three sets of MARK I, then the combat lifesaver may administer additional atropine injections at approximately 15 minute intervals until atropinization is achieved (that is a heart rate above 90 beats per minute, reduced bronchial secretions, and reduced salivations). Administer additional atropine at intervals of 30 minutes to 4 hours to maintain atropinization or until the casualty is placed under the care of medical personnel. Check the heart rate by lifting the casualty’s mask hood and feeling for a pulse at the carotid artery. Request medical assistance as soon as the tactical situation permits.
  • (2) The CLS should administer additional CANA to casualties suffering convulsions. Administer a second, and if needed, a third CANA at 5 to 10 minute intervals for a maximum of three injections (30 milligrams diazepam). Follow the steps and procedures described in buddy aid for administering the CANA. DO NOT give more than two additional injections for a total of three (one self-aid plus two by the CLS).