TOPICS > Health

Chemicals on the Battlefield

March 20, 2003 at 12:00 AM EDT
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SPOKESPERSON: What happened?

PERSON ROLE PLAYING: I don’t know. I can’t breath.

PERSON ROLE PLAYING: You can’t breath?

PERSON ROLE PLAYING: No, I can’t breathe!

BETTY ANN BOWSER: These military doctors and nurses are learning how to treat American soldiers in the event of a chemical or biological attack. Here at the Medical Research Institute for Chemical Defense in Aberdeen, Maryland, clinicians from all military services go through a series battlefield scenarios, each one designed to help them recognize what different chemical agents do to the human body.

PERSON ROLE PLAYING: Quickly, quickly, 30 seconds! Get some good notes now! 30 seconds!

BETTY ANN BOWSER: In the exercise, each team has just two minutes to size up the patient’s injuries and decide what the treatment should be. Symptoms vary, depending on what kind of chemical is used, but for the most part, the doctors will see dramatic conditions, everything from seizures, vomiting, to respiratory failure resulting in death.

PERSON ROLE PLAYING: Yeah, you know, we came under attack, and I had to run and get my mask on. I got all my gear on, and then I fell.

PERSON ROLE PLAYING: Okay.

BETTY ANN BOWSER: In this case, a soldier pretended he was exposed to a liquid nerve agent.

PERSON ROLE PLAYING: He’s had a mask on already. He had some twitting.

SPOKESPERSON: You’re coughing. Are you having a hard time breathing?

PERSON ROLE PLAYING: Just a little bit. I’ve… my breathing’s a lot better now. I have, like, a real bad runny nose, you know.

BETTY ANN BOWSER: If the team of doctors gets the diagnosis right, the patient should be given a nerve agent antidote immediately, then fully decontaminated. Later, each team’s performance is reviewed by the institute doctors, who are supervised by Dr. Gary Hurst.

DR. GARY HURST: They need to kind of sketch out in their own mind, real quick, what the overall prognosis is, ’cause they’re going to have to “do I give this guy a little bit of time or do I do a full-court press? If I give a full-court press, am I going to save him or am I going to waste my time so that others that I could have saved would die?”

SPOKESMAN: I decontaminated the side of his face.

SPOKESMAN: Yeah. That’s good.

BETTY ANN BOWSER: A full-court press is not an easy thing to do. Doctors have to work in a contaminated site with contaminated patients, a so- called dirty environment.

SPOKESMAN: They’ll only come in with just their mask on. They’ll be purged with air.

BETTY ANN BOWSER: Navy physician Eric Flach found the decontamination process to be one of the most complicated parts of training.

LT. ERIC FLACH, U.S. Navy Physician: Taking the patient from a dirty situation and making them clean, so the decontamination process of going from what they call a line that’s actually dirty to the actual clean side of that, and that probably has the greatest potential for, for problems.

BETTY ANN BOWSER: But for most medical professionals who go through the training, the biggest challenge is the very thing designed to keep them safe in a chemical attack: The protective suits issued to all military personnel in the Persian Gulf. Dr. Mark Dalton is an internist for the army.

BETTY ANN BOWSER: How hard is it to do those things with all the protective gear on?

CAPT. MARK DALTON, U.S. Army Internist: Oh, it’s extremely difficult. The outer garment on top of your regular clothes are very hot. People get dehydrated very quickly, and in addition, you’re wearing these bulky gloves that make your procedures very difficult that you take for granted every day, such as starting IV’s and intubation.

BETTY ANN BOWSER: Do you think you could do it now, with the training, function with all that gear on?

CAPT. MARK DALTON: I believe we could.

SPOKESPERSON: If the mask doesn’t collapse…

BETTY ANN BOWSER: Col. Joann Hollandsworth, an army nurse for 22 years, found the mask and gloves created a cumbersome barrier between her and the patient.

COL. JOANN HOLLANDSWORTH, U.S. Army Nurse: The things that you rely on– your being able to see your patient when your impaired with a mask, your hands, all your tactical senses– you’re not able to use.

DR. GARY HURST: I liken it to swimming through molasses or something, but you can function, though. The students practice putting IV’s in, doing the intubation, the tube into the airway. They all do it.

BETTY ANN BOWSER: In fact, Col. Jonathan Newmark, one of the Research Institute’s physician instructors, believes the most important message out of the Aberdeen training is that ability to succeed.

COL. JONATHAN NEWMARK: We want them to realize that this is not something you throw up your hands with, that chemical casualties can be treated, that if you administer proper therapy in a timely fashion, that there are things you can do for people; you will; save lives.

BETTY ANN BOWSER: But that optimism is not shared by everyone. While this training at Aberdeen may be the gold standard, the Government Accounting Office in 2001 found only 2.2 percent of medical officers had completed the full seven-day course in medical management of chemical and biological casualties, and, it summarized, “medical readiness for chemical and biological scenarios cannot be ensured.” Connecticut Republican Congressman Christopher Shays requested the GAO report.

REP. CHRISTOPHER SHAYS: If you’ve been shot or exposed to shrapnel, been in the way of cannon fire, you’re going to get the best medical attention that you could possibly hope for. That’s where we excel. But if you were exposed to parasites, exposed to certain environmental chemicals, we may not discover it. Now, we have more doctors and nurses and others who are being trained in this area, but we have a ways to go.

DR. GARY HURST: This guy is in bad shape. Real bad shape.

BETTY ANN BOWSER: Dr. Hurst thinks the low numbers from the GAO report may be misleading.

DR. GARY HURST: If the right people are trained, you know, it’s only a small percentage of people in those field hospitals are where the action is. If those people, if enough of those people have the training, that’s all you need. I’ll bet you there’s a cadre, at least a cadre, in every field hospital that has had this training and is proficient.

BETTY ANN BOWSER: Is that enough?

DR. GARY HURST: Yes, it is.

SPOKESPERSON: I got shot!

BETTY ANN BOWSER: The proficiency of that training could be tested soon, as American soldiers move closer to war with Iraq.