1. BLISTER AGENT EXPOSURE
CA147

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

3. 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

4. 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

5. 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 hours
Immediate pain for Lewisite
CA151

6. ROUTES OF EXPOSURE
Direct Contact
Inhalation
Ingestion
CA152

7. 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

8. 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

9. 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

10. SULFUR MUSTARD
CA156

11. 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

12. 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

13. FACTORS AFFECTING SULFUR MUSTARD SIGNS AND SYMPTOMS
Characteristically delayed
may appear within 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. LEWISITE
CA166