Medical Management of Chemical and Biological Casualties (MCBC) Course

Starting yesterday, ridiculously early in the morning, I got up to drive to Aberdeen Proving Ground for the first half of the Medical Management of Chemical and Biological Casualties course, or MCBC. The course is three days of chemical warfare at the United States Army Medical Research Institute for Chemical Defense (USAMRICD, and no, I don't know how to pronounce that acronym), followed by three days of biologic agents at the United State Army Medical Research Institute of Infectious Disease (USAMRIID, which is pronounced u-sam-rid) at Ft. Detrick.

I was kinda dreading the chemical half of the course, because chemical agents aren't nearly as exciting as bioterrorism, but it's been pretty interesting so far. We started with a lecture on the history of using chemicals in warfare, which began with the Chinese using arsenic smoke to suppress peasant revolts, back in 1000 BC. Way to be innovators, China.

Modern use of chemical warfare really began with WWI, and it was the Germans who started it. A chemical engineer, Fritz Haber, masterminded the use of chlorine gas at Ypres (1915), and at the end of the battle, there were 800 fatalities from chlorine gas and over 10,000 Allies injured. Chlorine gas was effective, until the Allies started getting good at making gas masks (by the time the US joined the war, we had it figured out). Chlorine, like the other pulmonary chemical warfare agents, doesn't have a specific antidote; treatment is pretty much just getting to an ICU for monitoring and intubation.

Here's a picture of a WWI gassing:

The next class of chemical warfare agents we talked about was the blood agents, of which cyanide is the typical example. It was also used in WWI, but by the French. Unfortunately, like many things done by the French, it was pretty ineffective. Cyanide is lighter than air, so it didn't do a very good job of getting down into the German trenches. However, by WWII, the Japanese and Germans both figured out how to use it (mainly, by using it indoors). The gas Vyklon B in concentration camp gas chambers is a cyanide gas. Unlike chlorine, there is an antidote to cyanide--inhaled amyl nitrite, IV sodium nitrite, and IV sodium thiosulfate. You have to work fast, though, because about three minutes after a inhaled cyanide attack, your casualty is going to be dead.

The cyanide turned the walls of the concentration camp gas chambers a bit blue. Here's a picture:

The next to make it into the game was the blistering agents, such as mustards and Lewisite. They were first used (by the Germans) in July 1917, because the Allies had figured out the gas mask issue. Just like it sounds, these cause blisters on the skin. They didn't kill too many people, but they did take people out of the fight for quite a long time (average convalescence time was 42 days). Many of the casualties thought that they were blind, due to the swelling around the eyes, but the actual numbers of people who went blind from mustards was pretty low. The treatment for these is immediate decontamination (in the first few minutes after exposure, before it completely goes into the skin), and then burn treatments for blisters, including skin grafts, if necessary.

Here's a picture from Bari, Italy, where an American ship filled with containers of Lewisite was blown up by the Germans in 1943. There were a lot of civilian and military casualties, made worse by the fact that they wrapped everyone in blankets, which were also contaminated with Lewisite.

The most recent addition to the arsenal of chemical warfare agents is the nerve agents, first used in battle by Iraq during the Iraq-Iran war in 1980 (and we wonder why we thought Iraq had unconventional weapons...). Most of the nerve agents were developed by (drumroll, please...) Germany, and thus have codes of GA, GB, GD, and GF (no idea what happened to GC or GE), which correspond to tabun, sarin, and soman (GF doesn't have a name, as far as I know). VX is also in this category. Like cyanide, these will kill you pretty quickly if you don't treat. The antidote is atropine, 2-PAM chloride, and diazapam (Valium) for seizures. We have autoinjectors for these that an exposed soldier can give to himself or a buddy in the case of an attack. Here's what the autoinjectors look like:

And in case you don't remember VX from the movie The Rock, here's a reminder:

After all those lectures, we practiced putting on our chemical protective gear and gas masks in preparation of our casualty exercise tomorrow. No, this isn't me.