1. CBRN medical support of French Groupe d’Intervention de la Gendarmerie Nationale Hertgen P*, Peyrefitte S*, A. Virgile**, Le Vaillant Y*, Castel F*, Legonidec E*, Houzé B* * Centre médical de Satory Service de santé des armées ** Groupe d’intervention de la Gendarmerie Nationale

2. What is GIGN? The French Groupe d’Intervention de la Gendarmerie Nationale (GIGN) A police special force unit from the military Its main missions are: – Counter terrorism, multiple hostage – Fight against the organized crime – Protection and security of vital keypoints of the nation and state Missions in France and overseas as well Trained to work under CBRN conditions

3. GIGN medical support Physicians and nurses Trained in military and emergency medicine Knowledge of intervention techniques Part of the intervention teams Same equipments and protections Following them as near as possible Provides immediate advanced life support

4. Conventional and CBRN main risks Conventional wounds Chemical: – Nerve agents – Vesicants – Cyanic agents – Suffocants gases (Biological) (Radiological)

5. Preventives measures Personal protective equipment (PPE) – Filter or waterproof suits – Filter or isolated respiratory devices Antidotes carried by soldier: bi-compartmented auto- injector Ineurope ® – Atropin – Pralidoxim – Diazepam Diphoterine ® carried by soldier: chemical burns

6. Main difficulties 1.Major restraints due to PPE 2.Material contamination problems 3.Degraded conditions for medical activity 4.Care must be adapted and simplified 5.Material must be ready to use 6.Communications are difficult

7. Caregiver’s PPE Important physiological restraints Importance of adjusted size gloves Risk of contamination transfer between patients Problem with kneeling (to intubate…) Interest of elevated stretcher for tracheal intubation

8. Possible therapeutics Summary decontamination, Foulon’s earth O2 with high concentration mask and aerosols Intra-muscular or bone injections Peripheral venous access Tracheal intubation and ventilation with disposable resuscitators Interest of tracheal aspiration for nerve agents intoxications

9. Specific therapeutics O2 and ß mimetic aerosols for suffocating symptoms For nerve agents intoxication: – Atropin – Pralidoxim – Diazepam, midazolam or clonazepam Hydroxocobalamin for cyanidric poisoning Main goal is to maintain the respiratory function

10. Venous access Skin disinfection with Dakin Cooper ® solution The simplest site is the best Carrier: Ringer lactate or saline Catheter fixation with Elastoplaste ®

11. Tracheal intubation For acute respiratory distress uncontrolled by O2 + ß mimetic aerosol + atropine With general anesthesia by midazolam and ketamin IM or IV, then sufentanil Ventilation with disposable resuscitator, then portable ventilator

12. Training

13. Decontamination Not a medical activity Many physiological constraints Preliminary adapted medical management for serious injuries If venous access: remove infusion and place shutter If tracheal access: manual ventilation with disposable resuscitator(s), relay ongoing decontamination

14. Conclusion Risks knowledge Individual an collective protection measures Medical knowledge Organized medical support, adapted pharmacopoeia