BLISTER AGENT EXPOSURE CA147

OBJECTIVES Identify the specific signs and symptoms of sulfur mustard agent exposure Identify the specific signs and symptoms of Lewisite exposure CA148

BLISTER AGENTS Destroy individual cells in target tissue Blisters (vesicles) most noticeable effect Sulfur mustard and Lewisite in Army’s inventory Lewisite stored only at Deseret Chemical Depot Blister CA149

HOW BLISTER AGENTS WORK Designed to inflict wartime casualties Affect skin tissue and especially harsh on soft membranes eyes – lung tissue mouth tissue – throat tissue Sulfur mustard greatest effect on warm, moist surfaces mucous membranes – armpits groin – buttocks knees and elbows creases – fold of neck CA150

BLISTER AGENT EXPOSURE Liquid and vapors create extreme hazards The greater absorbed dose, the greater severity of skin and tissue damage Delayed reaction with little or no pain Burning, stinging, redness, or blisters usually delayed between 2 to 36 hours for sulfur mustard usually apparent between 4 - 8 hours Immediate pain for Lewisite CA151

ROUTES OF EXPOSURE Direct Contact Inhalation Ingestion CA152

INHALATION OF BLISTER AGENT Vapors enter body through respiratory system Direct access to lining of nose, throat, and bronchial tubes warm, moist membranes most vulnerable Prolonged exposure destroys mucous membrane lining internal inflammation bleeding that may lead to later infection of airways and lungs Most damage to upper airways with heavy exposure, lung’s air sacs are injured and fill with fluids Damage to air sacs may cause lungs to fill with fluids CA153

DIRECT CONTACT WITH BLISTER AGENT Skin surface or eye touches liquid agent, surface where agent was deposited, or agent vapor Broken blister fluid non-irritating Does not cause blistering upon contact with skin Warmth and moisture increase effects between toes behind knees groin armpits behind ears CA154

INGESTION OF BLISTER AGENT Swallowing contaminated food, drink, placing contaminated items in mouth, or incidental hand-to-mouth contact Unlikely agent will contaminate food or drink CA155

SULFUR MUSTARD CA156

SULFUR MUSTARD SIGNS AND SYMPTOMS Severity of symptoms and how rapidly they develop greatly influenced by weather conditions hot, humid weather increases action of sulfur mustard Signs and symptoms characteristically delayed for hours CA157

SIGNS AND SYMPTOMS OF SULFUR MUSTARD EXPOSURE Eye Irritation/Inflammation Photophobia Reddening of Exposed Skin Blisters Inflammation of Respiratory Tract Gastrointestinal Effects Systemic Effects CA158

FACTORS AFFECTING SULFUR MUSTARD SIGNS AND SYMPTOMS Characteristically delayed may appear within 1 - 2 hours with large exposure or if weather hot and humid Reaction time depends on the type of agent amount of agent person has been exposed to dose (how much a person has absorbed) duration of exposure route of exposure sensitivity of person’s system CA159

FACTORS AFFECTING SULFUR MUSTARD SIGNS AND SYMPTOMS Inhalation of sulfur mustard causes quicker reaction than direct contact exposure agent absorbed much faster in warm, moist areas of respiratory tract, nose, mouth, bronchial tubes Effects greatest in warm, moist areas of respiratory tract CA160

FACTORS AFFECTING SULFUR MUSTARD SIGNS AND SYMPTOMS Inhalation exposure effects occur after few hours accompanied by sneezing, coughing, and inflammation of trachea and bronchi Direct contact exposure effects usually delayed absorption may continue for hours even after decontamination Not all signs and symptoms may appear . . . Dose, duration, and route of exposure make a difference CA161

OTHER POSSIBLE CAUSES Signs and symptoms may also be caused by hay fever burns (chemical, thermal, sun) tear gas exposure poison ivy, poison oak, and other contact allergies certain drugs CA162

INITIAL FIRST AID TREATMENT FOR SULFUR MUSTARD EXPOSURE Immediate removal from source of exposure Decontamination through washing and diluting Airway management may be needed as signs/symptoms develop CA163

TREATMENT FOR EYE CONTACT Speed Critical irreversible eye damage may be done very quickly flush eyes immediately with water tilt head to side pulling eyelids apart with uncontaminated fingers pouring water slowly into eyes Do not cover eyes with bandages Dark or opaque glasses shield eyes from light and provide relief from photophobia CA164

TREATMENT FOR SKIN CONTACT WITH SULFUR MUSTARD Decontaminate, paying special attention to around the ears inside nose inside mouth groin eyelids neck creases armpits behind knee between toes CA165

LEWISITE CA166