Awareness, protection, decontamination,treatment.
This manual is intended
for paramedical personnel and it is limited to awareness, prevention and
treatment with locally and presently available means, of five possible
chemical and biological agents in North Iraqi Kurdistan. It is not intended
to face military medical circumstances, nor military defense operations.
It is for paramedical teams assisting small number of civilian population
some time after the eventuality of an attack, giving them first aid treatment,
referring and /or transferring them to hospital.
Decontamination procedure,
prophylaxis and treatment are given keeping in mind what is conceivably
available and feasible at the present in the area. The best high standard
method of dealing with some of the issues is given for cultural and awareness
reasons only since it is not presently available. Such is the case, for
instance, of the anthrax vaccination, which is not available, or the uses
of oximes for nerve agents which are also not available, just as preventive
assumption of carbamate pyridostigmine which is also not available, and
so on.
The armamentarium is what
is available, lots of water, water and soap, hypochlorite solution, baby
shampoo, saline solution, Atropine injection. Atropine and antibiotic eye
ointment, diazepam, for "gas" attacks. Ciprofloxacin and doxycyclin (only
oral) for anthrax. The lack of toxoid vaccine and equine serum antitoxin
against Botulinum toxins it is compelling to describe Clostridium Botulinum
toxins attack only as an awareness to limit its damage. Knowledge and awareness
is a powerful defense in these circumstances.
The five agents are Anthrax
spores, Botulinum toxins, Mustard agent, Lewisite, and nerve agents. Though
Mustard and nerve agents are often referred as gas, they are really liquid
which would be spread as aerosol on explosion of the vector, a shell or
a rocket, and they will behave like a gas only for a short time because
they will eventually fall on the ground. All this is of some importance
because a simple defense would be, under attack, to avoid the area contaminated
by these aerosol for the few hours in which they will behave like gas.
The same is true for anthrax spores and botulinum toxins in case they should
be spread in the air.
It is well known that gas
masks given to an entire population have more a psychological reassurance
benefit rather than offering real protection against the so called "gas".
Mustard, Lewisite and nerve agents (Tabun Sarin Soman and Vx) do penetrate
through the skin and protection is given only by full gear total body suit
with hood and overboots. This is possible, worldwide, only for special
military decontamination unit. Again awareness and simple measure are not
only commendable but perhaps in some circumstances more useful. In fact
masks alone to untrained people, by giving a false sense of security, could
be lethal.
Health team leaders should
assure the availability of plenty of water where decontamination procedure
will possibly be carried out. They should also assure to have plenty of
plastic bags to dispose of contaminated items, and fresh clothing or pajamas
or both to re dress the decontaminated individuals.
Giorgio G. Francia, MD
Specialist Surgeon
Qandil Senior Consultant
in Trauma and War Surgery
Relief International Head
of Mission
Erbil and Sulaymany, February
2003
Translated in to Kurdish
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