J R Army Med Corps 2002; 148: 395-397 J R Army Med Corps: first published as 10.1136/jramc-148-04-11 on 1 December 2002. Downloaded from Smokes, Fuels, and Incendiary Materials SMOKES Clinical-Pathological Effects Introduction Toxicity Smokes are used to obscure troops and The production of grey-white smoke clouds equipment on the battlefield. They are liquid is based on the reaction between powdered or solid particulate aerosols that diffuse zinc or zinc oxide and hexachloroethane at electromagnetic radiation at wavelengths the point of combustion of the pyrotechnic ranging from the infrared through the visible mixture. The reaction produces a number of to the ultraviolet end of the spectrum. They compounds including zinc chloride and zinc achieve this by absorption of atmospheric oxychloride. Phosgene may also be produced water. although the concentration in the cloud is Not all smokes are hazardous at concen- likely to be low. Other intermediates and trations necessary for obscuration. However, products may include hydrogen chloride, exposure to heavy smoke concentrations for tetrachloroethylene, carbon tetrachloride and extended periods, particularly if near the carbon monoxide. Many of these products source of emission, may cause ill-effects or and intermediates have been implicated in even death. Medical personnel should be the toxic reactions seen following exposure to prepared to treat reactions to military smokes such smokes but experimental studies clearly once they have been introduced to the indicate that zinc chloride and oxychloride battlefield. With the exception of oil smoke, inhalation produce a pattern of pulmonary high concentrations of smoke generated in injury that is identical to that seen following closed spaces are extremely dangerous. High smoke inhalation. concentrations of zinc oxide/hexachloroe- thane (HC) smoke under these conditions Acute Effects have caused fatalities. Under no circum- In high concentration or following prolonged stances should HC munitions be used exposure, HCE smoke is highly irritating and indoors or in closed compartments. generalised chemical pneumonitis has been http://militaryhealth.bmj.com/ In the open air, the air passages should be reported following accidental overexposure protected by a respirator if the smoke of human subjects. Symptoms following irritates the airway, if it is very thick or if a inhalation of high concentrations of HCE stay of longer than 5 minutes in a diluted smoke include dyspnoea, hoarseness of the cloud is necessary. The standard respirator voice, retrosternal pain, cough, lacrymation gives the respiratory tract and eyes adequate and occasionally haemoptysis. In many cases protection against all smokes and should reported in the literature, the latter always be worn when smokes are used in development of pulmonary oedema has been confined spaces. However, it will not protect a consistent finding. against carbon monoxide, a common by- Chronic Effects on October 2, 2021 by guest. Protected copyright. product of smoke generation. Following the resolution of the initial pulmonary inflammatory reaction and Zinc Oxide/Hexachloroethane oedema, there is evidence of several (HC) Smokes additional chronic effects following Several methods of producing smoke by inhalation of HCE smoke. These include dispersing fine particles of zinc chloride have focal atelectasis, bronchiolar-alveolar hyper- been developed.The mixture in common use plasia and pulmonary fibrosis. More recently, contains zinc oxide and hexachloroethane. concerns have been raised regarding the Upon burning, the mixture produces zinc possible mutagenicity/carcinogenicity of chloride, zinc oxychlorides and HCl vapour some of the components of the smoke, and in which rapidly absorb moisture from the air to particular unburnt hexachloroethane and form a greyish white smoke. HC mixtures tetrachloroethylene. Studies of both in vitro can be dispersed by several methods, and in vivo unscheduled DNA synthesis including grenades, candles, smoke pots, have, however, confirmed an overall lack of cartridges, and air-delivered bombs. genotoxic effects in smoke condensates. Protection Treatment Some countries require the use of a The casualties should put on their respirator respirator whenever HC smokes are used. or be removed from the source of exposure. 396 J R Army Med Corps: first published as 10.1136/jramc-148-04-11 on 1 December 2002. Downloaded from Oxygen should be administered in cases of Skin hypoxia. Bronchospasm should be treated Irritated skin or skin burns should be washed appropriately. Early steroid therapy has been with water and then with sodium bicarbonate considered efficacious by some and when solution; the burns should then be treated as used, should be given in high doses. thermal burns. Adequate analgesia is recommended. Prognosis Prognosis The skin burns, conjunctival lesions and The prognosis is related entirely to the extent respiratory irritation heal readily. Corneal of the pulmonary damage. All exposed erosions are more serious and may lead to individuals should be kept under observation residual scarring. for 8 h. Most individuals recover in a few days. At moderate exposures, some Titanium Tetrachloride (FM) symptoms may persist for 1 to 2 weeks. In This is a yellow non-inflammable and severe exposures, survivors may have corrosive fluid which on contact with damp reduced pulmonary function permanently if air gives off a heavy dense white cloud. It is pulmonary fibrosis results. The severely disseminated by aircraft for the production of exposed patient may progressively develop vertical smoke curtains extending down to pulmonary oedema, resulting in dyspnoea, ground and sea level. The smoke consists of cyanosis and possibly death. fine particles of free hydrochloric acid and titanium oxychloride. The smoke is Chlorosulphonic Acid (CSA) unpleasant to breathe. Goggles or a Chlorosulphonic acid (CSA) is a heavy, respirator should be worn when the spray is strongly acidic liquid which, when dispersed falling due to the risk of droplets entering the in air, absorbs moisture to form a dense eyes. Full protective clothing should be worn white fog consisting of small droplets of when handling the liquid to avoid hydrochloric and sulphuric acids. In contamination of eyes and skin. moderate concentrations it is highly irritating Mode of Action to the eyes, nose and skin. The respirator Liquid FM produces acid burns of the skin should be worn in all concentrations which or eyes. are sufficient to cause any cough, irritation of the eyes or prickling of the skin. A risk exists when CSA comes in contact with water due FLAME MATERIALS AND to the generation of intense heat and the INCENDIARIES scattering of acid in all directions. It is highly corrosive and careful handling is required. Introduction Incendiary weapons are used for antipersonnel and antimateriel operations http://militaryhealth.bmj.com/ Symptoms and military operations in urban territory. An The symptoms are usually limited to a incendiary agent is a chemical, or mixture of prickling sensation of the skin. Exposure to chemicals, that liberates a large quantity of high concentrations or long exposures to heat upon combustion. The reaction is that lower concentrations (such as may occur in of a fuel with oxygen; the oxygen the field), may result in severe irritation of the incorporated into the agent in the form of an eyes, skin and respiratory tract. Conjun-ctival oxidizing agent or drawn from the air. irritation and oedema, lachrymation and mild Incendiary agents can be classified photophobia may occur. Mild cough and according to their composition: soreness in the chest and moderate chemical - hydrocarbon fuels with or without dermatitis of the exposed skin are on October 2, 2021 by guest. Protected copyright. occasionally seen. Splashes of liquid in the eye thickeners - normally gasoline with a are extremely painful and cause acid burns napalm aluminum soap thickener (mixed with corneal erosions. Liquid CSA solution aluminum soap co-precipitated from a on the skin may cause painful acid burns. mixture of coconut oil and oleic and naphthenic acids) with or without polymer Treatment thickeners. - metal fuels (magnesium incendiaries, Eye thermite or thermate incendaries). The contaminated eye should be irrigated - hydrocarbon-metal fuel combinations. with water or saline as soon as possible, and - pyrophoric aluminum alkyls with the cornea examined for erosion by staining thickeners (e.g. triethylaluminum it with fluorescein. If corneal erosion is thickened with polyisobutylene). present, the casualty should be transferred to - white phosphorus. the care of an ophthalmologist. If this is not - experimental or improvised compositions. practicable, mydriasis should be induced by Thickeners are added to fuels to increase the use of atropine sulphate eye drops or the range of flamethrowers, to impart slower ointment. Conjunctival lesions should heal burning properties, to impart clinging readily, but corneal erosions may lead to qualities and to cause flames to rebound off residual scarring. surfaces and go around corners. 397 J R Army Med Corps: first published as 10.1136/jramc-148-04-11 on 1 December 2002. Downloaded from Management Medical Aid The principal action of flame and incendiary At the earliest opportunity all phosphorus weapons is to cause burns. Casualties should should be removed from the skin and placed be treated as burn casualties not as chemical in a container to prevent further contam- casualties. ination