A Turkish Medical Rescue Team against Nuclear, Biological, and Chemical Weapons

Military Medicine, Feb 2004 by Kenar, Levent, Karayilanoglu, Turan

Medical aid is one of the primary responses given in the deliberate release of weapons of mass destruction for both military and terrorist purposes. From this point of view, a nuclear, biological, and chemical (NBC) Medical Rescue Team was established in the structure of Gulhane Military Medical Academy. The staff in the team is composed of physicians, nurses, and paramedics who are assigned in Medical Intervention Units, Medical Nursing Units, and Decontamination Units, respectively. The main aim of this team is to give a medical response including first aid, airway, breathing, and circulation resuscitation, decontamination, and triage under any NBC attack. For this purpose, the communication and coordination between the team members were standardized. Moreover, the team was equipped with the required protective clothing, masks, antidotes, and other drugs and agents used for victims exposed to NBC weapons. Within this concept, the personnel in the team were trained with respect to first aid and treatment of NBC casualties in both theoretical and practical scenario. all of this background information was used in a practical operation held in Gulhane Military Medical Academy under a chemical attack scenario given.

Introduction

Nuclear, biological, and chemical (NBC) warfare agents, socalled weapons of mass destruction, have been accepted as a mean of threat that all health care facilities must be prepared for. This increasing threat can also be used on a civilian population in an act of domestic terrorism. Up to recent cases, the civilian population became one of the direct targets of military attacks with chemical and biological weapons. Although the response against a NBC attack needs to be performed in collaboration between all the related organizations, health consequences of incidents involving NBC agents possess a great priority different than seen in conventional injuries.1 From this point of view, a medical response activity should be present among the countermeasures that are to be taken by all other governmental and academic organizations when the geographical and strategical position of our country is taken into consideration.

Concept of NBC Medical Team

Because of the necessity of a NBC medical response, Gulhane Military Medical Academy (GMMA), the top level military medical organization of our country, decided to establish a medical team specific for NBC agents. Therefore, in the beginning of 2001, the NBC Medical Rescue Team was organized within the GMMA structure.

This team is composed of military physicians (primarily working in the NBC-related medical departments like Emergency Medicine, Microbiology, Public Health, etc.), military nursing staff to perform the nursing and medical care, and paramedics assigned specifically to conduct decontamination and other procedures related to medical response. GMMA NBC Medical Rescue Team, in which 30 health care providers are assigned, is supposed to be a NBC team giving medical care. Therefore, the aim of this team is to carry out medical first aid and medical procedures including detection, sampling, decontamination, and triage after a suspected event involving weapons of mass destruction. They are also able to evaluate the signs and symptoms of any affected persons and to correlate clinical findings with any other information such as readings from chemical agent detector devices. Within this conjunction, all of the tasks and working sites (zones) of the staff were determined according to the specification of each zone (Fig. 1).

In addition, the communication network and operational flow chart were established between the members, so wireless hand radios were supplied for the team to make the calls for the operation. On the other hand, as a connection with the incident site, isolation and zone establishment through the site for effective lifesaving medical care must be set up by the team along with other first responders like firefighters, civil defense, and security forces as soon as the event occurs. To fulfill the most effective medical intervention for immediate casualties (triage numbered Tl), protective equipment and decontamination vehicles were supplied. Besides, the equipment required in the medical intervention for a NBC casualty were purchased and listed in the following:

* Protective suits (from level A to level C) including mask,

* Decontamination agents (aluminum silicate powder, magnesium silicate powder, Fuller's earth, diluted hypochlorite solutions, etc.),

* Detector papers and chemical agent monitor,

* Radiation survey meter,

* Decontamination vehicles,

* Medical antidotes and drugs (autoinjector containing 2 mg of atropine sulfate and 220 mg of obidoxime chloride, pyridostigmine tablets, sodium nitrite ampoulles, sodium thiosulfate, etc.), and

* Decorporation agents for radionuclides (like potassium iodine tablets),

Following the staff assignment and equipment procurement, the members of the team received training about topics related to medical management of NBC casualties like effects of agents, detection, and identification of the agents, treatment, and decontamination of the victims exposed to NBC agents. A team response plan was developed that defined the roles and responsibilities for the health personnel basically. After this theoretical training and planning given by the NBC instructors, the team was practically trained via operational theaters in GMMA (Fig. 2). In addition to that, the team conducted exercises and drills that involved simulated casualties from a chemical attack. In this practice, a chemical attack was simulated in a scenario and the medical response given by the team was examined with respect to the first aid, zone establishment, patient transport, triage, decontamination, and application in each decon stations, which was the first aid station establishment in the outer region called cold zone.