First-Due Response at a Nerve Gas Release

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由Lance C. Peeples撰写

叙利亚最近发生的事件强调了需要消防员准备回应chemicalattack using nerve agents here in the United States. The Obama administration reports that the long standing dictator Bashar al-Assad used the nerve agent Sarin to attack civilian targets resulting in the deaths of approximately 1,400 people including children. Sarin is a semi-volatile chemical that presents both liquid and vapor hazards when disseminated.

Syria has the world’s third largest stockpile of chemical weapons after the United States and Russia. Assad is engaged in a three-way civil war with moderate rebels and radical Islamist fundamentalist who are waging jihad to remove Assad in hopes of establishing an Islamic caliphate and mandating Sharia law in Syria. As a result, there is a real possibility that chemical and possibly生物weapons may fall into the hands of radical Islamists if the Assad regime falls. If this occurs, it is entirely possible that these agents will be smuggled into the United States and firefighters will find themselves responding to an intentional nerve agent release.

早期公司的第一个问题是，公司的面孔是他们甚至可能不知道他们正在对化学剂释放做出回应。对于第一次来的消防员来说，这可能是一个问题terroristAum Shinrikyo组织于1995年在东京地铁系统中发布了Sarin Gas。最初的报告可能只表明许多受害者突然患病了。因此，任何涉及多个受害者的事件都应被认为是恐怖袭击，直到另行证明。在回应“多个受害者”，“爆炸”的报告时，公司官员和消防员必须谨慎行事。

(1) Firefighters responding to an incident where there has been an actual or suspected release of nerve agent must be protected with Level Apersonal protective equipment(PPE)。在这里,firefighters train on using this equipment. Structural firefighting PPE with SCBA will provide some minimal protection to allow for a retreat if firefighters themselves unexpectedly exposed.不要故意进入只有结构消防服和SCBA保护的沙林燃气场景！188金博网网址多少（作者照片。）

Although the nature and location of the reported emergency may provide some clues as to the possibility of a chemical attack, most first-due companies will not have available any type of detection equipment capable of identifying神经毒剂。因此，您必须注意以下预防措施：

  1. 接近scenefrom upwind.
  2. 警报辅助设备。
  3. 当您接近任何可能可疑的场景时，穿着完整的独立呼吸器（SCBA）和门票式装备。显然，该设备不会为神经毒剂提供全面保护。（有关神经剂攻击中的门口装备的更全面讨论，请单击HERE。）我建议仅在初步调查中佩戴它，而神经剂释放的“潜力”。如果风险似乎高于“潜力”，则消防员应撤退，直到危险品船员到达。任何怀疑实际释放神经剂的人都应提示rapid撤退。如果您死了，您将无法帮助任何人！
  4. Be alert for multiple patients with respiratory symptoms, dead or dying birds or animals, and possibly discolored vegetation.
  5. Do not enter汽clouds.
  6. Avoid contact with liquids.
  7. Resist the unbearable urge to rush in to help. If the patient has been immediately incapacitated by a nerve agent to the point where they are incapable of self-evacuation, it is highly likely that they will die despite any intervention you are able to provide.
  8. Direct patients capable of self-evacuation to a collection area for gross decon. Large numbers of patients can be deconned by separating the sexes and instructing them to strip to their underwear and then using a fog nozzle attached to an engine discharge to provide a gross decon shower.
  9. 迪登（Gross Decon）之后，分类the victims to appropriate treatment areas.

可能在恐怖袭击中使用的神经因素包括Sarin（GB），Tabun（GA），Soman（GD），GE，VE，VE，VG，VM，VM，VR，VR，VS和VX。1All of these agents work by interfering with the inhibition of the enzyme acetylcholinesterase (AChE).2这会导致肌肉过度刺激神经递质乙酰胆碱（ACH）。（2）。Inhalation of these agents may result in the onset ofsymptoms在30秒至两分钟内，透皮吸收可能会导致症状发作从30分钟到长达18小时，这取决于浓度。（2）

使用首字母缩写Sludgem可以记住症状：

S- 唾液

L- 泪（撕裂）

U- 排尿

D- 排便

G– Gastrointestional upset

E– Emesis

M减数分裂(查明学生)

患者似乎有补品癫痫发作活动；死亡是由于呼吸瘫痪而导致的。

Treatment consists of removing the victim to a safe area; rapid gross decon; respiratory support (do not perform mouth to mouth; this may result in injury/death to the rescuer); and the administration of atropine, which works by antagonizing the effects of acetylcholine. Pralidoxime chloride (2PAM) reactivates AChE, thus reversing the effects of nerve agents. Atropine and 2PAM are often provided in an autoinjector that should be available to all firefighters serving inhigh-risk（在最低城市地区安全计划i）城市。

(Note: Unfortunately, qualitycontrol问题导致制造商暂停这些汽车喷油器的生产。显然，测试时一小部分未能发射。因此，如果症状无法缓解，则可能有必要从不同的汽车注射器中服用第二剂剂量。没有计划召回设备的计划。）3

将这些自动注射器存储在消防屋中而不是在初始到达的公司中，如果有的话，几乎没有做得多。这些反转代理必须在几分钟之内提供exposure如果他们有任何影响。

Given the recent events in the world, it is increasingly likely that firefighters will find themselves responding to an intentional release of a chemical weapon including the possibility of nerve agents. Firefighters arriving first-due at incidents involving such agents can minimize death and injury by maintaining high situational awareness. They should wear SCBA and turnout gear when investigating any incident with the potential for a possible nerve agent release and retreat immediately if any evidence suggests that there has been an actual release. Direct ambulatory victims to leave the danger area and undergo a gross decon.受害者who are too ill to self-evacuate will most likely die. Victims should be triaged and provided with supportive care. Atropine and 2PAM can be used to antagonize the effects of nerve agents, but it must be given as soon as possible for maximum effect. Ativan or valium may be used to control seizure activity.

REFERENCES

  1. Burke R. Counter-Terrorism for Emergency Responders. 2ndEd. Taylor and Francis Group. Boca Raton. 2007. pp. 68-98.
  2. Geoghegan J，Tong JL。化学战剂。Continuing Education in Anaesthesia, Critical Care and Pain.2006年12月1日。2006; 6（6）：230-234。
  3. www.ecbc.army.mil/downloads/cwirp/ECBC_ffpe_scba_rescue_ops.pdf.

免责声明: The opinions expressed herein are those of the author and do not reflect the position of St. Louis University or the Insitute of Biosecurity.

长矛C. Peeples是圣路易斯大学生物安全与灾难研究所的兼职教职员工。他拥有三十多年的火/EMS经验。Peeples拥有俄克拉荷马州立大学消防和应急管理管理局的MS学位。

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