2. © 1999 Lockheed Martin Energy Research Corporation CA128 NERVE AGENT EXPOSURE

3. © 1999 Lockheed Martin Energy Research Corporation OBJECTIVE Identify the specific signs and symptoms of nerve agent exposure CA129

4. © 1999 Lockheed Martin Energy Research Corporation CA130 HOW NERVE AGENTS WORK Attack nervous system –nervous system controls body functions through use of chemicals which act as “instructions” to nerves, muscles and glands Nerve agents interfere with normal chemical instructions Nerve synapse

5. © 1999 Lockheed Martin Energy Research Corporation CA131 NORMAL NERVOUS SYSTEM At nerve ending, acetylcholine is released Acetylcholine crosses synapse between nerve endings –if junction with skeletal muscle, muscles cells contract –if junction with smooth muscles, muscles move rhythmically –if junction with gland, glandular cells secrete Acetylcholine is inactivated by acetylcholinesterase Normal activity at nerve synapse

6. © 1999 Lockheed Martin Energy Research Corporation HOW NERVE AGENTS WORK Nerve agents block acetylcholinesterase so it cannot destroy acetylcholine –acetylcholine accumulates and continue to stimulate target nerve –muscles twitch uncontrollably and repetitively –excess secretions of glands CA132 Nerve agent interferes with normal synapse activity

7. © 1999 Lockheed Martin Energy Research Corporation CA133 ROUTES OF EXPOSURE Inhalation Ingestion Direct Contact

8. © 1999 Lockheed Martin Energy Research Corporation Nerve agents enter through respiratory system Rapidly and effectively enter into blood stream Respiratory failure chief cause of death after severe exposure CA134 INHALATION Nerve agent inhaled into respiratory system

9. © 1999 Lockheed Martin Energy Research Corporation CA135 DIRECT CONTACT Skin or eyes are touched with agent vapor or liquid Nerve agents absorbed through skin –VX remains on skin and absorbed more completely –GB evaporates quickly, but still a threat Scrapes, cuts or other skin damage offer direct entry points –freshly shaven skin, sunburn, insect bites, rashes Eyes most sensitive organ for nerve agent vapor effects

10. © 1999 Lockheed Martin Energy Research Corporation CA136 INGESTION Ingestion of contaminated food or drink, incidental hand to mouth or eye contact, smoking Unlikely that agent will contaminate food or drink Gastrointestinal system

11. © 1999 Lockheed Martin Energy Research Corporation SIGNS AND SYMPTOMS Signs are objective evidence of a medical condition Signs are observed (runny nose, drooling) Symptoms are subjective evidence Symptoms are verbally communicated (headache, eye pain) CA137 Not all signs and symptoms may appear... Dose, duration, and route of exposure make a difference

12. © 1999 Lockheed Martin Energy Research Corporation CA138 SIGNS AND SYMPTOMS OF NERVE AGENT EXPOSURE Miosis Dim or blurred vision Respiratory trouble Difficulty in breathing Increased oral/nasal secretions Localized sweating Nausea and vomiting Abdominal cramping Involuntary urination or bowel movements Heartbeat irregularities Generalized weakness Twitching or muscles spasms Convulsions and coma

13. © 1999 Lockheed Martin Energy Research Corporation CA139 OTHER SIGNS AND SYMPTOMS OF NERVE AGENT EXPOSURE May result from early or mild exposure: –headache –anxiety –restlessness –giddiness –irritability

14. © 1999 Lockheed Martin Energy Research Corporation CA140 FACTORS AFFECTING NERVE AGENT SIGNS AND SYMPTOMS Signs and symptoms may appear immediately or be delayed Reaction time depends on –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

15. © 1999 Lockheed Martin Energy Research Corporation Immediateifmoderate to large amounts are inhaled ifmoderate to large amounts are spilled onto the skin Delayedifsmall amounts are involved ifagent has been absorbed through skin in small localized area CA141 FACTORS AFFECTING NERVE AGENT SIGNS AND SYMPTOMS

16. © 1999 Lockheed Martin Energy Research Corporation CA142 INHALATION PEAK EFFECTS FROM NERVE AGENT Effects can occur after single breath Immediate response within seconds Peak effects usually within 15 - 20 minutes After about 20 minutes, effects usually maximized and will not worsen Respiratory system

17. © 1999 Lockheed Martin Energy Research Corporation CA143 DIRECT CONTACT PEAK EFFECTS FROM NERVE AGENT Absorption may continue for hours even after decontamination Effects may not occur for 1 to 18 hours –effects usually not lethal

18. © 1999 Lockheed Martin Energy Research Corporation CA144 OTHER POSSIBLE CAUSES Signs and symptoms may also be caused by –epilepsy –gastroenteritis –exposure to agricultural insecticides –emphysema –strokes –head trauma –drug overdose –heat illnesses –allergies –upper respiratory illnesses

19. © 1999 Lockheed Martin Energy Research Corporation CA145 INITIAL FIRST AID TREATMENT Immediate removal from source of exposure –severity directly proportional to absorbed dose Decontamination –preferred decontamination solution is undiluted household bleach Antidote administration with airway management support as necessary Must be provided by properly trained and equipped personnel

20. © 1999 Lockheed Martin Energy Research Corporation CA146 NERVE AGENT ANTIDOTE Atropine –administered to block receptor sites of acetylcholine 2-PAM Chloride –restores acetylcholinesterase Two-part nerve agent antidote