NOTE: When performing first aid on a casualty, seek medical aid as soon as possible. Do not stop the first aid, but, if the situation allows, send another person to find medical aid.

1. Identify mild signs and symptoms of nerve agent poisoning.

a. Unexplained runny nose.

b. Unexplained sudden headache.

c. Excessive flow of saliva (drooling).

d. Tightness of the chest causing breathing difficulties.

e. Difficulty seeing (blurred vision).

f. Muscular twitching around area of exposed or contaminated skin.

g. Stomach cramps.

h. Nausea.

 

NOTE: For the above signs and symptoms first aid is considered to be self-aid.

2. React to the Chemical Hazard.

a. Put on your protective mask.

 

NOTE: Do not put on additional protective clothing at this time. Give yourself the nerve agent antidote first. Then, decontaminate exposed skin areas and put on remaining protective clothing.

b. Give the alarm.

3. Administer nerve agent antidote to self (Self-Aid), if necessary.

a. Prepare to administer one atropine injection.

(1) Obtain one set of your autoinjectors.

 

NOTE: If you have the M17-series protective mask, the autoinjectors will normally be stored in the mask carrier. The M40-series mask carrier does not have room for storage of autoinjectors; unit SOP dictates storage location, usually the BDU pocket.

 

NOTE: If you have the M17-series protective mask, the autoinjectors will normally be stored in the mask carrier. The M40 Series mask carrier does not have room for storage of autoinjectors; unit SOP dictates storage location, usually the BDU pocket.

(2) With one hand, hold the set of injectors by the plastic clip with the big injector on top.

(3) With the other hand, check the injection site in order to avoid buttons and objects in pockets where injecting.

(4) Grasp the small injector without covering or holding the needle (green) end, and pull it out of the clip with a smooth motion.

(5) Hold the injector between the thumb and first two fingers without covering or holding the needle (green) end.

(6) Place the needle end of the injector against the outer thigh muscle.

 

NOTE: The injection can be given in any part of the lateral thigh muscle from about a hand's width above the knee to a hand's width below the hip joint.

NOTE: Very thin soldiers should give the injection in the upper outer part of the buttocks. CAUTION: WHEN INJECTING ANTIDOTE IN THE BUTTOCKS, BE VERY CAREFUL TO INJECT ONLY INTO THE UPPER, OUTER QUARTER OF THE BUTTOCKS TO AVOID HITTING THE MAJOR NERVE WHICH CROSSES THE BUTTOCKS. HITTING THE NERVE MAY CAUSE PARALYSIS.

b. Administer the atropine injection.

(1) Push the injector into the muscle with firm, even pressure until it functions.

 

NOTE: A jabbing motion is not necessary to trigger the activating mechanism.

(2) Hold the injector firmly in place for at least 10 seconds.

(2) Hold the injector firmly in place for at least 10 seconds.

(3) Remove the injector from your muscle and carefully place this used injector between two fingers of the hand holding the plastic clip.

c. Prepare to administer one 2 PAM Cl injection.

(1) Pull the large injector out of the clip and hold it between the thumb and first two fingers as you did with the small injector.

(2) Place the needle (black) end of the injector against the injection site.

d. Administer the 2 Pam Cl injection.

(1) Push the injector into the muscle with firm, even pressure until it functions.

(2) Hold the injector firmly in place for at least 10 seconds.

4. Secure the used injectors.

4. Secure the used injectors.

a. Drop the plastic clip without dropping the used injectors.

b. Push the needle of each used injector (one at a time) through one of the pocket flaps of the protective overgarment.

c. Bend each needle to form a hook without tearing protective gloves or clothing.

5. Decontaminate skin if necessary.

NOTE: Information on this step is provided in task Decontaminate Yourself and Individual Equipment Using Chemical Decontamination Kits, task number 031-503-1013.

6. Put on remaining protective clothing.

NOTE: Information on this step is covered in task Protect Yourself From NBC Injury/Contamination With the Appropriate Mission-Oriented Protective Posture (MOPP) Gear, task number 031-503-1015. WARNING: IF, WITHIN 5 TO 10 MINUTES AFTER ADMINISTERING THE FIRST SET OF INJECTIONS, YOUR HEART BEGINS BEATING RAPIDLY AND YOUR MOUTH BECOMES VERY DRY, DO NOT ADMINISTER ANOTHER SET OF INJECTIONS.

7. Seek buddy-aid or medical aid.

NOTE: After you have given yourself the first set of injections, you most likely will not need additional antidote if you are ambulatory and know who and where you are. If needed, second and third sets of injections will be given only by a buddy or by medical personnel.

8. Identify severe signs and symptoms of nerve agent poisoning.

a. Strange and confused behavior.

b. Gurgling sounds made when breathing.

c. Severely pinpointed pupils.

d. Red eyes with tearing.

e. Vomiting.

f. Severe muscular twitching.

g. Loss of bladder and/or bowel control.

h. Convulsions.

i. Unconsciousness or stoppage of breathing.

 

NOTE: If the casualty is exhibiting severe symptoms, assistance (buddy-aid) is required by the individual to complete first aid treatment.

9. Mask the casualty if necessary.

 

WARNING

DO NOT KNEEL AT ANY TIME WHILE PROVIDING AID TO THE CASUALTY. CONTACT WITH THE GROUND COULD FORCE THE CHEMICAL INTO OR THROUGH THE PROTECTIVE CLOTHING. NOTE: Reposition the casualty on his or her back if necessary to mask the individual.

a. Place the mask on the casualty.

b. If the casualty can follow directions, have him or her clear the mask.

c. Check for a complete mask seal by covering the inlet valves of the mask.

d. Pull the protective hood over the head, neck, and shoulders of the casualty.

e. Position the casualty on the right side, similar to a swimmer position, with head slanted down so that the casualty will not roll back over.

10. Administer first aid to a nerve agent casualty (Buddy-Aid).

a. Prepare to administer one atropine injection.

(1) Remove all three sets of autoinjectors and the single CANA autoinjector from the casualty's mask carrier or BDU pocket.

(2) With one hand, hold the set of injectors by the plastic clip with the big injector on top.

(3) With the other hand, check the injection site to avoid buttons and objects in pockets.

(4) Grasp the small injector and pull it out of the clip with a smooth motion.

(5) Hold the injector between the thumb and first two fingers without covering or holding the needle (green) end.

(6) Place the needle end of the injector against the casualty's outer (lateral) thigh muscle.

 

NOTE: The injection can be given in any part of the lateral thigh muscle from about a hand's width above the knee to a hand's width below the hip joint.

NOTE: Very thin soldiers should be given the injections in the upper outer part of the buttocks. WARNING: WHEN INJECTING ANTIDOTE IN THE BUTTOCKS, BE VARY CAREFUL TO INJECT ONLY INTO THE UPPER, OUTER QUARTER OF THE BUTTOCKS TO AVOID HITTING THE MAJOR NERVE WHICH CROSSES THE BUTTOCKS. HITTING THE NERVE MAY CAUSE PARALYSIS.

b. Administer the atropine injection.

(1) Push the injector into the muscle with firm, even pressure until it functions.

(2) Hold the injector in place for at least 10 seconds.

(3) Carefully place the used injector between two fingers of the hand holding the clip.

c. Prepare to administer one 2 PAM Cl injection.

(1) Pull the large injector out of the clip and hold it between the thumb and first two fingers as you did with the small injector.

(2) Place the needle (black) end of the injector against the injection site.

d. Administer the 2 Pam Cl injection.

(1) Push the injector into the muscle with firm, even pressure until it functions.

(2) Hold the injector in place for at least 10 seconds.

(3) Drop the clip without dropping injectors.

(4) Lay the used injectors on the casualty's side.

 

NOTE: Repeat steps 10a through 10d until the casualty has received a total (including self-administered) of three sets of antidote injections.

e. Prepare to administer the CANA injection.

(1) Tear open the protective plastic packet and remove the injector.

(2) Grasp the injector with the needle (black) end extending beyond the thumb and two fingers (index plus next finger).

(3) With the other hand, pull the safety cap off the injector base to arm the injector.

 

CAUTION

DO NOT TOUCH THE BLACK (NEEDLE). YOU COULD ACCIDENTALLY INJECT YOURSELF.

(4) Place the black end of the injector against the casualty's injection site.

f. Administer the CANA injection.

(1) Push the injector into the muscle with firm, even pressure until it functions.

(2) Hold the injector in place for at least 10 seconds.

11. Secure the used injectors.

a. Push the needle of each used injector (one at a time) through one of the pocket flaps of the casualty's protective overgarment.

b. Bend each needle to form a hook without tearing protective gloves or clothing.

12. Decontaminate the casualty's skin if necessary.

NOTE: This information is covered in task Decontaminate Yourself and Individual Equipment Using Chemical Decontamination Kits, task number 031-503-1013.

13. Seek Medical Aid.

Brief Soldier: For self-aid, tell the soldier to state, in any order the mild symptoms of nerve agent poisoning. The soldier must state seven of the eight symptoms to be scored GO. Then, tell the soldier that he or she has mild symptoms and to take appropriate action. After the soldier completes step 4, ask what should be done next. Then ask what he or she should do after putting on all protective clothing. Score steps 5 through 7 based upon the soldier's responses. For buddy-aid, tell the soldier to state, in any order, the severe symptoms of nerve agent poisoning. The soldier must state eight of the nine symptoms to be scored GO. Tell the soldier to treat the casualty for nerve agent poisoning. After the soldier completes step 11, ask what else he or she should do. Score steps 12 and 13 based upon the soldier's responses.

Score the soldier GO if all the steps are passed. Score the soldier NO GO if any of the steps are failed. If the soldier scores NO GO, show what was done wrong and how to do it correctly.