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Medical Management of Chemical Warfare Casualties Main Clinical Signs and Symptoms Medical personnel should familiarise themselves聽with the main clinical signs and symptoms of chemical warfare casualties. This will allow聽them to determine a clinical diagnosis and start the triage process, assigning priority for decontamination and medical treatment. 聽 Clinical Manifestations Vary The nature and timing of these clinical manifestations will vary聽with the duration and concentration of exposure, and聽with the route of exposure, which should be considered in the differential diagnosis and triage process. Example:聽nerve agents and cyanides (blood agents) absorbed by inhalation have rapid onset of effects and need immediate treatment. Indirect Effects of Chemical Exposure Differential diagnosis should also consider the indirect effects of chemical exposure, including heat stress from wearing protective equipment, psychological effects, and even side effects from antidotes. This is particularly important聽when exposure to an agent has not taken place but antidotes have been administered. Example:聽auto-injectors with nerve agent poisoning antidotes. Differential diagnosis and triage may also be complicated in cases of mixed casualties who have both conventional and chemical injuries. Antidotes Antidotes are available for some chemical warfare聽agents, however, their availability will depend on local, regional and national medical doctrines, policies, and regulations. When specific antidotes are not available, therapy will be limited to supportive care. Triage In a chemical mass casualty situation medical resources will be overwhelmed. Triage is a medical decision process used to arrange patients in聽order of priority, to ensure the most effective use of limited medical resources and minimise morbidity and mortality. Triage is used to assign priority for treatment, evacuation, and decontamination. One of the most commonly used systems for chemical triage聽contains four categories: Immediate, Delayed, Minimal, and Expectant. Practical Guide for Medical Management The OPCW鈥檚 Practical Guide for Medical Management of Chemical Warfare Casualties聽includes information on specific antidotes for chemical weapon agent poisoning, triage of chemical casualties, and聽other useful information regarding medical management of chemical weapons victims.
Medical Management of Chemical Warfare Casualties Main Clinical Signs and Symptoms Medical personnel should familiarise themselves聽with the main clinical signs and symptoms of chemical warfare casualties. This will allow聽them to determine a clinical diagnosis and start the triage process, assigning priority for decontamination and medical treatment. 聽 Clinical Manifestations Vary The nature and timing of these clinical manifestations will vary聽with the duration and concentration of exposure, and聽with the route of exposure, which should be considered in the differential diagnosis and triage process. Example:聽nerve agents and cyanides (blood agents) absorbed by inhalation have rapid onset of effects and need immediate treatment. Indirect Effects of Chemical Exposure Differential diagnosis should also consider the indirect effects of chemical exposure, including heat stress from wearing protective equipment, psychological effects, and even side effects from antidotes. This is particularly important聽when exposure to an agent has not taken place but antidotes have been administered. Example:聽auto-injectors with nerve agent poisoning antidotes. Differential diagnosis and triage may also be complicated in cases of mixed casualties who have both conventional and chemical injuries. Antidotes Antidotes are available for some chemical warfare聽agents, however, their availability will depend on local, regional and national medical doctrines, policies, and regulations. When specific antidotes are not available, therapy will be limited to supportive care. Triage In a chemical mass casualty situation medical resources will be overwhelmed. Triage is a medical decision process used to arrange patients in聽order of priority, to ensure the most effective use of limited medical resources and minimise morbidity and mortality. Triage is used to assign priority for treatment, evacuation, and decontamination. One of the most commonly used systems for chemical triage聽contains four categories: Immediate, Delayed, Minimal, and Expectant. Practical Guide for Medical Management The OPCW鈥檚 Practical Guide for Medical Management of Chemical Warfare Casualties聽includes information on specific antidotes for chemical weapon agent poisoning, triage of chemical casualties, and聽other useful information regarding medical management of chemical weapons victims.
Symptoms and Signs of Exposure to Different Classes of Chemical Weapon Agents Target Organs Classes of Agent Central Nervous System Seizures, coma, hypoxemia, hyperthermia 聽 Blood/ Nerve/ Blister/ BZ Eye, Nose and Skin Constricted pupils Dilated pupils Dry mouth and skin Eye irritation Blistering skin Cyanosis 聽 Nerve BZ/Blood BZ Blister/ RCAs/Lung Irritants Blister Blood/ Lung/ Nerve/ Blister Respiratory Tract Asphyxiation Copious secretions Respiratory distress Pulmonary oedema 聽 Blood / Lung / Blister / Nerve Nerve Nerve / Lung /Blister Lung / Nerve /Blister Digestive Tract Nausea Diarrhoea 聽 Lung / RCAs / Blood /Nerve Nerve Muscoskeletal Fasciculation 聽 Nerve
Symptoms and Signs of Exposure to Different Classes of Chemical Weapon Agents Target Organs Classes of Agent Central Nervous System Seizures, coma, hypoxemia, hyperthermia 聽 Blood/ Nerve/ Blister/ BZ Eye, Nose and Skin Constricted pupils Dilated pupils Dry mouth and skin Eye irritation Blistering skin Cyanosis 聽 Nerve BZ/Blood BZ Blister/ RCAs/Lung Irritants Blister Blood/ Lung/ Nerve/ Blister Respiratory Tract Asphyxiation Copious secretions Respiratory distress Pulmonary oedema 聽 Blood / Lung / Blister / Nerve Nerve Nerve / Lung /Blister Lung / Nerve /Blister Digestive Tract Nausea Diarrhoea 聽 Lung / RCAs / Blood /Nerve Nerve Muscoskeletal Fasciculation 聽 Nerve
Long-Term Consequences of Exposure to Chemical Warfare Agents The clinical symptoms and signs shown in the diagram are intended to provide preliminary guidance to the type of chemical warfare聽agent that a casualty may have been exposed to. This is聽based on the commonly expected symptoms caused by聽different classes of chemical warfare聽agents. Patients may present differently Exposure to uncommon chemical warfare agents and聽many toxic chemicals聽could result in聽additional symptoms and signs being exhibited.聽 Medical practitioners should consult OPCW鈥檚 Practical Guide for Medical Management of Chemical Warfare Casualties聽for further information to help them make聽clinical diagnosis. Other Symptoms Other symptoms聽and signs not mentioned in the table may also be exhibited, clinical and otherwise. For example, exposure to very high concentrations of sulphur mustard may also cause CNS- effects, and exposure to the blood agent cyanogen chloride (CK) causes eye irritation as well as cyanosis.
Long-Term Consequences of Exposure to Chemical Warfare Agents The clinical symptoms and signs shown in the diagram are intended to provide preliminary guidance to the type of chemical warfare聽agent that a casualty may have been exposed to. This is聽based on the commonly expected symptoms caused by聽different classes of chemical warfare聽agents. Patients may present differently Exposure to uncommon chemical warfare agents and聽many toxic chemicals聽could result in聽additional symptoms and signs being exhibited.聽 Medical practitioners should consult OPCW鈥檚 Practical Guide for Medical Management of Chemical Warfare Casualties聽for further information to help them make聽clinical diagnosis. Other Symptoms Other symptoms聽and signs not mentioned in the table may also be exhibited, clinical and otherwise. For example, exposure to very high concentrations of sulphur mustard may also cause CNS- effects, and exposure to the blood agent cyanogen chloride (CK) causes eye irritation as well as cyanosis.
OPCW History
History was made on 29 April 1997 with the entry into force of the Chemical Weapons Convention (CWC)鈥攖he world鈥檚 first multilateral disarmament agreement to provide for the elimination of an entire category of weapons of mass destruction within a fixed time frame.聽 The Chemical Weapons Convention entered into force on 29 April 1997. The event marked both the culmination of many years of painstaking negotiations in the Conference on Disarmament and Preparatory Commission as well as聽the birth of an international chemical weapons disarmament regime headed by the Organisation for the Prohibition of Chemical Weapons (OPCW). The OPCW strives to fulfil the Convention鈥檚 mandate to end the development, production, stockpiling, transfer and use of chemical weapons; to prevent their re-emergence;聽to ensure the elimination of existing stocks of such weapons; and, in so doing, to make the world safe from the threat of chemical warfare.
What to do in a chemical emergency
Symptoms What to do How to decontaminate Chemical agents are most often poisonous gasses or liquids that have toxic effects on people, animals, or plants. If inhaled, swallowed, or absorbed through the skin, chemical agents can cause serious health effects, or even death. Download and share this video resource to inform local populations about how to stay safe during a chemical emergency. Download the video Horizontal format Arabic聽Chinese聽English聽French聽Russian聽Spanish聽Ukrainian 聽 Vertical format Arabic聽Chinese聽English聽French聽Russian聽Spanish聽Ukrainian 聽 Symptoms of toxic chemical exposure聽 Unexplained skin or eye irritation Nausea Disorientation Breathing difficulties Burning in the nose, throat and lung Animals may show similar symptoms when exposed to toxic chemicals What to do in a chemical emergency If you recognise a chemical threat, get away immediately and follow these steps:聽 Cover your nose and mouth If you are outdoors, move up-wind away from the source. Find the closest building to shelter-in-place. Shelter in an internal room without windows, if possible. Avoid basements or cellars. Toxic gasses may be heavier than air and accumulate in low areas. Close all doors and windows and turn off all ventilation, including furnaces, air conditioners and fans. Seal the room. Duct tape and plastic sheeting is best, but other items like plastic trash bags and towels can be used if necessary. Listen for official instructions from authorities on the radio, TV or online. Do not leave the safety of a shelter to go outdoors to help others until authorities say it is safe to do so. If you are affected by a chemical agent, decontaminate yourself and help others decontaminate. How to decontaminate聽聽聽 Remove all clothing. Cut off clothing normally removed over the head to avoid contact with the eyes, nose and mouth. Do not remove clothing if it is stuck to the skin. Flush irritated eyes with water. Put contaminated items into a plastic bag and seal it. Wash skin with soap and water. Following these steps will help you stay safe, but always seek professional medical treatment as soon as possible.
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