“Preparedness is the key to effective Chemical Agents Note: Mustard agents have delayed incident management.” signs/symptoms from 2-24 hours after exposure, depending on concentration and if • Nerve vapor or liquid. Managing the GA GB • Choking (Pulmonary) GD Consequences of a CG GF PS VX Chemical Agent Cl All are heavier than air and can be absorbed Note: All are heavier than air and phosgene through the eyes, lungs and skin. Attack may have delayed signs and symptoms. Exposure Signs & Symptoms Exposure Signs & Symptoms Pinpoint pupils (miosis) Mild irritation of eyes, nose, throat Runny nose (rinorrhea) … a Quick Reference (immediate) Chest tightness, coughing Shortness of breath, coughing, frothy Jerking and twitching secretions (2-24 hours after exposure) Difficulty breathing to assist first responders in Nausea, vomiting, pulmonary edema Nausea, vomiting, & diarrhea Note: agents have more severe the management of a terrorist Sudden loss of consciousness irritant effects on the eyes, nose and throat, Convulsions, apnea incident involving the release with shortness of breath and coughing of a chemical agent(s). immediately after exposure. • Blister H Sulfur Mustard • Blood (Cyanide) HD Distilled Mustard a AC *** HN CK chloride L ***AC is the only chemical agent that is H/L Mustard/Lewisite lighter than air. CX b Exposure Signs & Symptoms a Becomes a solid at 57 oF Headaches b Does not cause blisters. Strong stimulated breathing Exposure Signs & Symptoms Loss of consciousness Reddening of eyes/gritty irritation Convulsions, apnea Reddening of skin (erythema) Note: normal pupil size, no secretions. CK Severe itching/burning of skin January 2002 may cause burning or stinging on contact Blisters with/without pain Gordon Aoyagi , Fire Administrator with eyes, exposed skin or respiratory tract. Sore throat, hoarseness Roger Strock, Chief Dry cough, nausea & vomiting Division of Fire and Rescue Services

Points to Remember • A terrorist incident involving a chemical • Immediately decontaminate victims who agent is still a hazardous materials have chemical agent liquid deposition on • Alert hospitals immediately of possible incident. skin, clothing, or both. contaminated casualties. • Plan for decontamination of mass • For liquid contamination, remove • Be knowledgeable of potential terrorist casualties. clothing of victims, apply copious targets. • Consider benefit of using PPV, foam, or quantities of or soap and water, if • An explosion may involve the release of both to dilute or suppress chemical agent immediately available. Protect victim’s a chemical or biological agent or vapors. eyes and face. Soap and water is radioactive materials. • A terrorist event is a federal crime scene. preferred, but the application of water should not be delayed, if soap is not • Request the Hazardous Incident Coordinate activities with law readily available. Response Team and Bomb Squad if they enforcement including the FBI, in the have not already been dispatched. interest of safety, security and the • Review the Gross Decontamination Options quick reference guide. • Request more resources if the incident preservation of evidence. has already exceeded the capability of on • Plan for the coordination and • Consider using RSDL, M291 kit (if scene resources to manage or it is likely management of additional resources, available) to remove localized liquid to escalate. requested or not. contamination. • Nerve, blister, choking and blood agents • For victims with vapor exposure only or are heavier than air, except for hydrogen On Scene as a precautionary measure, victims cyanide. should remove their clothing down to their underwear and be rinsed with water • The “G” nerve agents are non-persistent • Approach location and place emergency or soap and water. (usually evaporate within hours). vehicles upwind and upgrade. • Consider benefit of using chemical • Choking and blood agents are very • Use SCBA, turnout gear and butyl masks during long-term decontamination non-persistent (usually evaporate almost gloves. operations. immediately). • Carry radiation alert pager if available. • Do not transport contaminated victims to • VX and blister agents are persistent • Be alert for signs of secondary devices. hospitals. (usually remain for days or longer) • Avoid contact with any pool of liquid. • Alert hospitals immediately of possible • The immediate and ongoing use of • Isolate the area immediately and deny contaminated casualties. SCBA and turnout gear will ensure entry.

survivability in a vapor hazardous • Observe and report signs and symptoms ©December 1996 Revised January 2002 environment. of chemical agent exposure to the Montgomery County, Maryland • Monitor weather conditions and Incident Commander. Fire and Rescue Service remember that warmer air temperatures • Ask victims about their signs and will increase volatility of chemical symptoms, where they were located and Prepared by agents. what they saw when the event occurred. Deputy Chief Ted Jarboe • Consider the threat of nearby and • Triage, decontaminate and treat victims. and District Chief Bob Stephan downwind spread of chemical agent However, weigh treating victims with vapors. life-threatening injuries first.