© 1999 Lockheed Martin Energy Research Corporation
• Identify the specific signs and symptoms of sulfur mustard agent exposure
• Identify the specific signs and symptoms of Lewisite exposure
CA148
OBJECTIVES
© 1999 Lockheed Martin Energy Research Corporation
BLISTER AGENTS
• Destroy individual cells in target tissue
Blisters (vesicles) most noticeable effect
• Sulfur mustard and Lewisite in Army’s inventory– Lewisite stored only at Deseret
Chemical Depot
CA149
Blister
© 1999 Lockheed Martin Energy Research Corporation CA150
• Designed to inflict wartime casualties• Affect skin tissue and especially harsh on soft
membranes– eyes – lung tissue
– mouth tissue – throat tissue
• Sulfur mustard greatest effect on warm, moist surfaces– mucous membranes – armpits
– groin – buttocks
– knees and elbows creases – fold of neck
HOW BLISTER AGENTS WORK
© 1999 Lockheed Martin Energy Research Corporation CA151
BLISTER AGENT EXPOSURE
• Liquid and vapors create extreme hazards• The greater absorbed dose, the greater severity of skin
and tissue damage• Delayed reaction with little or no pain• Burning, stinging, redness, or blisters usually delayed
between 2 to 36 hours for sulfur mustard– usually apparent between 4 - 8 hours
• Immediate pain for Lewisite
© 1999 Lockheed Martin Energy Research Corporation CA152
ROUTES OF EXPOSURE
• Inhalation
• Ingestion
• Direct Contact
© 1999 Lockheed Martin Energy Research Corporation CA153
INHALATION OF BLISTER AGENT
• Vapors enter body through respiratory system• Direct access to lining of nose, throat, and bronchial tubes
– warm, moist membranes most vulnerable
• Prolonged exposure destroys mucous membrane lining– internal inflammation
– bleeding that may lead to later infection of airways and lungs
• Most damage to upper airways– with heavy exposure, lung’s air sacs
are injured and fill with fluidsDamage to air sacs may cause
lungs to fill with fluids
© 1999 Lockheed Martin Energy Research Corporation CA154
DIRECT CONTACT WITH
BLISTER AGENT• Skin surface or eye touches liquid agent, surface where agent was deposited, or agent vapor
• Broken blister fluid non-irritating– Does not cause blistering
upon contact with skin
• Warmth and moisture increase effects– between toes– behind knees– groin– armpits– behind ears
© 1999 Lockheed Martin Energy Research Corporation
INGESTION OF BLISTER AGENT
• Swallowing contaminated food, drink, placing contaminated items in mouth, or incidental hand-to-mouth contact
• Unlikely agent will contaminate food or drink
CA155
© 1999 Lockheed Martin Energy Research Corporation
SULFUR MUSTARDSIGNS AND SYMPTOMS
• Severity of symptoms and how rapidly they develop greatly influenced by weather conditions– hot, humid weather increases action of sulfur mustard
• Signs and symptoms characteristically delayed for hours
CA157
© 1999 Lockheed Martin Energy Research Corporation
SIGNS AND SYMPTOMS OFSULFUR MUSTARD
EXPOSURE
• Eye Irritation/Inflammation• Photophobia• Reddening of Exposed Skin• Blisters• Inflammation of Respiratory Tract• Gastrointestinal Effects• Systemic Effects
CA158
© 1999 Lockheed Martin Energy Research Corporation
FACTORS AFFECTING SULFUR MUSTARD SIGNS AND
SYMPTOMS• Characteristically delayed– may appear within 1 - 2 hours with large exposure or if
weather hot and humid
• Reaction time depends on the– 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
CA159
© 1999 Lockheed Martin Energy Research Corporation
FACTORS AFFECTING SULFUR MUSTARD SIGNS AND
SYMPTOMS• Inhalation of sulfur mustard causes quicker reaction than direct contact exposure– agent absorbed much faster in
warm, moist areas of respiratory tract, nose, mouth, bronchial tubes
CA160
Effects greatest in warm, moist areas of respiratory tract
© 1999 Lockheed Martin Energy Research Corporation
FACTORS AFFECTING SULFURMUSTARD SIGNS AND
SYMPTOMS• Inhalation exposure effects occur after few hours
– accompanied by sneezing, coughing, and inflammation of trachea and bronchi
• Direct contact exposure effects usually delayed– absorption may continue for hours even after
decontamination
CA161
Not all signs and symptoms may appear . . .
Dose, duration, and route of exposure make a difference
© 1999 Lockheed Martin Energy Research Corporation CA162
OTHER POSSIBLE CAUSES
• Signs and symptoms may also be caused by– hay fever
– burns (chemical, thermal, sun)
– tear gas exposure
– poison ivy, poison oak, and other contact allergies
– certain drugs
© 1999 Lockheed Martin Energy Research Corporation
• Immediate removal from source of exposure• Decontamination through washing and diluting• Airway management may be needed as
signs/symptoms develop
CA163
INITIAL FIRST AID TREATMENT FOR
SULFUR MUSTARD EXPOSURE
© 1999 Lockheed Martin Energy Research Corporation CA164
TREATMENT FOR EYE CONTACT
• Speed CriticalSpeed Critical– irreversible eye damage may be done very quickly
– flush eyes immediately with water
• tilt head to side
• pulling eyelids apart with uncontaminated fingers
• pouring water slowly into eyes
• Do not cover eyes with bandages• Dark or opaque glasses shield eyes from light and
provide relief from photophobia
© 1999 Lockheed Martin Energy Research Corporation
TREATMENT FOR SKIN CONTACT
WITH SULFUR MUSTARD
around the ears
inside nose
inside mouth
groin
eyelids
neck creases
armpits
behind knee
between toes
CA165
Decontaminate, paying special attention toDecontaminate, paying special attention to