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Chem Bio Rad Nuc by the numbers

An infographic called: CBRN by the numbers, breaking down CBRN medical literature into easy to digest statistics.
Mike Shertz MD/18D

🕖 Reading Time, 9 minutes

The use of chemical warfare agents is not only relegated to WWI: The US  Department of Homeland Security – FEMA, Co-TCCC, are both currently working on chemical warfare/agent casualty management guidelines, and the Committee for Tactical Emergency Casualty Care published guidelines on 16 August 2021. With the offensive use of chlorine, sulfur mustard, and nerve agents in Syria & Iraq over the last several years, chemical warfare is a current problem.  This new course from Crisis Medicine covers agents of concern, how they generate casualties, their clinical presentation, and exactly what to do to optimally manage and treat the casualty in front of you.

An infographic called: CBRN by the numbers, breaking down CBRN medical literature into easy to digest statistics.
Short Description: An infographic called: CBRN by the numbers, breaking down CBRN medical literature into easy to digest statistics. Long Description: 30 ... The number of minutes RSDL was 100% effective when used to decontaminate the skin of Hartley guinea pigs dermally exposed to a 5x LD50 of VX nerve agent.
Short Description: An infographic called: CBRN by the numbers, breaking down CBRN medical literature into easy to digest statistics. Long Description: 1,920... Male Hartley guinea pigs used to test a variety of oximes (2-PAM, Obidoxime, H!-6, and TMB-4) against 5 chemical warfare nerve agents (tabun, sarin, soman, cyclosarin, and VX) ad several organophosphates pesticides.
CBRN by the numbers: 684 Hartley gin pigs were used to test the effectiveness of RSDL, 0.5% bleach, and 1% soapy water for decontamination of skin challenged with VX nerve agent
CBRN by the numbers: 5 years past its expiration dates how long RSDL stored in a climate-controlled lab was still effective for decontamination of guinea pigs dermal exposed to VX nerve agent. Note, your life saving results might vary
CBRN by the numbers: 42-60 tons of chlorine gas accidently released from a train collision on Jan 6, 2005 in Granitesville, SC. In total, 597 people seek care, 90% on the day it occurred. 10% require intubation.
CBRN by the numbers: 1915 the first year phosgene gas was used in combat at Ypres, Belgium. It remains a toxic industrial chemical used plastic & insecticide manufacturing. It is felt to be 2-6 times more toxic than chlorine gas.
CBRN by the numbers: 8 cm H2) PEEP optimal for ventilation of phosgene induced pulmonary edema
CBRN by the numbers: 130 hostage deaths when Russian security forces used a mixture of carfentanil/remifentanil and halothane gas to subdue armed Chechens as they stormed the Durovka theater in Moscow in 2002. EMS & receiving hospitals had no idea what was used & it took hours before they identified effective treatments
CBRN by the numbers: 10 mg intranasal naloxone may be required in a carfentanil overdose
CBRN by the numbers: 2004 the year an Islamic terrorist cell in London collected several thousand household smoke detectors, each containing a tiny amount of americium-241, which is an a-radiation emitter, only dangerous if inhaled or ingested
CBRN by the numbers: 0 number of hospital medical providers who have become seriously ill from caring for non-decontaminated casualties after a radiation accident
CBRN by the numbers: 4 times heavier than air, which is why sulfur mustard agents settle in low places like WWI trenches
CBRN by the numbers: 2.2%, the US WWI fatality rate from sulfur mustard agent exposures
CBRN by the numbers: 9% the number of HAZMAT incidents involving casualties. Unfortunately, when casualties occur 89% of the time it involves an average of 4.5 casualties. 5% of those ultimately dying from a HAZMAT event are first responders.
CBRN by the numbers: 15 minutes regular firefighter PPE and SCBAs will protect you in an environment with a maximal nerve agent vapor risk. Can be increased to 2-3 minutes with self taping
CBRN by the numbers: 30-40 percent, the degradation to hand dexterity using chemical protective gloves
CBRN by the numbers: 10-15 degrees F the increased heart burden wearing chemical protective clothing
CBRN by the numbers: 223 seconds, the time it takes to apply a SAM junctional tourniquet while wearing Mopp 4
CBRN by the numbers: 1 second slower to place a tibial IO using the EZIO while the provider is in level C PPE
CBRN by the numbers: 2800 ampoules of atropine were administered at one hospital during the Tokyo subway sarin attack in 1995
CBRN by the numbers: 2017 Kim Jon Nam (older brother of North Korean leader) is killed in Malaysia Airport when two women who thought they were hired to do a prank smeared VX nerve agent on his face
CBRN by the numbers: A-242 & A-262 are the first solid nerve agents at room temperature. Both are 4th get "A" series or Novichok nerve agents
CBRN by the numbers: 5% of Tokyo subway sarin casualties had diarrhea
CBRN by the numbers: 10 hours is how long a dermal exposure of VX nerve agent on your torso might take to manifest effects
CBRN by the numbers: 2 minutes is how long it takes for woman to irreversibly bind to the casualty's acetylcholinesterase receptors. Sarin takes 5 hours
CBRN by the numbers: 2x faster atropine peak concentration with auto injector administration versus traditional intramuscular administration
CBRN by the numbers: 5-15 mg is the typical atropine dose required before an apnea nerve gent casualty will resume breathing
CBRN by the numbers: 50 mg IV every 5 minutes, the "heroic" atropine doses frequently given to nerve agent casualties during the Iran Iraq war
CBRN by the numbers: 0 pediatric patients with serious effects accidentally given too high of a dose of atropine by auto injector
CBRN by the numbers: 19.5 minutes for maximum serum concentration of atropine after auto injector administration in hypotensive pigs. It was 6.6 minutes in normotensive animals
CBRN by the numbers: 6 different nerve agents were used on guinea pigs to show midazolam was superior for seizure control compared to diazepam
CBRN by the numbers: 1028 guinea pigs were studied to determine midazolam was much more effective than diazepam in controlling seizures from six different nerve agents
CBRN by the numbers: 5x faster maximum serum concentration of midazolam given IV/IO compared to IM
CBRN by the numbers: 70 cm H2O airway pressures from bronchoconstriction associated with severe nerve agent poisoning
CBRN by the numbers: 136 Ems responders became casualties during the Tokyo subway sarin attack
CBRN by the numbers: 12, 22, 10 number of mice, rabbits, pigs cyanide poisoned and treated with IM sodium nitrite & sodium thiosulphate in one study
CBRN by the numbers: 15 & 20 minutes is the duration of hydrogen cyanide gas exposures mice were subjected to simulate a 15 minute Fire/EMS response time
Short Description: An infographic called: CBRN by the numbers, breaking down CBRN medical literature into easy to digest statistics.
Tactical CBRN

Interested in more Tactical-Chem-Bio-Rad-Nuc?

Why is CBRN relevant now?
Chemical weapons have been plentiful throughout the world, with many countries that could never enter the nuclear arena having robust chemical weapons programs.
Read
Nerve Agent MCI: Tokyo 1995
On March 20,1995, in Tokyo, Japan, a “doomsday cult” called Aum Shinrikyo manufactured and deployed 10 liters of dilute sarin nerve agent in the Tokyo subway system.
Read
Novichok: An Emerging Nerve Agent Threat
On March 4, 2018, in Salisbury, England, former Russian Military Intelligence officer Sergei Skirpal and his daughter were found slumped on a public bench, the victims of nerve agent poisoning.
Read
USSR Civil Defense CBRN Kits “Aptechka”
The AI-2 “aptechka” was an individual CBRN kit issued by the USSR for Civil Defense beginning in the late 1970s in a chemical, biological, radiological, or nuclear attack.
Read
Why Guinea pigs, White Rabbits, Yorkshire Pigs, and Beagles in CBRN Tests?
Animal models are often used when trying to study the possible effects of a medication or treatment and subsequently extrapolated to humans. Which species is selected depends on what is being studied.
Read
T-CBRN Journal
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Mike Shertz MD/18D

Dr. Mike Shertz is the Owner and Lead Instructor at Crisis Medicine. Dr. Shertz is a dual-boarded Emergency Medicine and EMS physician, having spent over 30 years gaining the experience and insight to create and provide his comprehensive, science-informed, training to better prepare everyday citizens, law enforcement, EMS, and the military to manage casualties and wounded in high-risk environments. Drawing on his prior experience as an Army Special Forces medic (18D), two decades as an armed, embedded tactical medic on a regional SWAT team, and as a Fire Service and EMS medical director. Using a combination of current and historical events, Dr. Shertz’s lectures include relevant, illustrative photos, as well as hands-on demonstrations to demystify the how, why, when to use each emergency medical procedure you need to become a Force Multiplier for Good.