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Lesson 2.

Medical and tactical characteristics


of damage sites caused by urgent and exigent
cases
Kanan Yusif-zada, MD, PhD, MBA

Content
1 Medical and tactical characteristics of bacteriological
(biological) lesion focus.
2 Medical and tactical characteristics of chemical lesion focus.
Strong poisonous substances.

Medical and tactical characteristics of nuclear lesion focus.

4 Medical and tactical characteristics of combined lesion focus .

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Assessment of the established situation of the medical service allows to:

clarify the number of the injured;


accurately determine duties of the medical service, type and volume of the
medical aid;

determine the demand in the medical service forces and means;


select more effective form of treatment and evacuation measures for
elimination of established sites of ES.

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Mass destruction sites fall into 4 groups:

bacteriologic
chemical
nuclear
combined destruction sites

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1 Medical and tactical characteristics of bacteriological


(biological) lesion focus.

Bacteriological weapons pathogenic microorganisms used for the


contamination of human beings, animals and plants, their toxins, as well as
means of their delivery to the target.
Applied by several methods:

by using an aerosol, through infected insects and rodents;


through subversive actions (water and food);
toxic substances with bacterial toxins

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Specific peculiarities of bacteriological weapon:

High efficiency potential (capable of infecting human beings and animals with
small doses).

Latent stage.
Contagiosity (transmissibility from a sick to a healthy individual).
Long-term impact and resistance to environment.
Determination of difficulties in detection, relation to food environment and
resistance to antibiotics.

Large number of agents.


Strong psychological effect.
Low costs of preparation (as compared with nuclear and chemical weapons).
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A number of factors shall be considered in the assessment of the


situation established in the bacteriologic damage site:

type and method of application of applied infectious agents;


timely detection;
area of the contaminated zone and expected area of contamination;
meteorological situation;
season;
number and density of the population;
nature of constructions;
provision of population with protective equipment;
number of the vaccinated population;
provision of the population with non-specific and specific means of prevention
and treatment.
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Calculation of expected medical losses in case of application of a


bacteriological weapon becomes complicated for several reasons:
I.

Agents of several infectious diseases may be applied at the same time.

II. Different resistance of different people to contagion and specific features of


each microorganism and virulence factor.
III. Increase of sanitary losses due to transmission (secondary) of the disease
from the thick to healthy individuals. This makes it possible to make
accurate calculation of sanitary losses.
25-50% of the general number of the population may initially
become infected in the result of exposure to bacteriological
means.
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When it detects signs of the use of these weapons


immediately put on gas masks (respirators, masks, as
well as a means to protect the skin).

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2 Medical and tactical characteristics of chemical lesion focus.


Strong poisonous substances.

Toxic substances (TS), means of their delivery (transportation) to the target


and application are called chemical weapons.
Specific properties of TS:
easily spread in environment;
continuous damaging effect;
diversity of the clinical picture and development dynamics of intoxication;
Partial penetration of TS into organism through respiratory, digestive and
transcutaneous ways;
dependence of development of intoxications on the ways of penetration of TS into
organism;
psychoemotional effect;
necessity to use protective equipment
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Classifications of toxic substances


Classification of TS based on leading clinical symptoms:
Nerve agents (organophosphorous substances- POS) - sarin, soman, Vx-gases.
Asphyxiating - phosgene, diphosgene etc.
Skin-resorptive - yprite, lewisite etc.
Psychochemical (psychotomimetics) - "BZ", LSD etc.
Irritants - adamsite, chloracetophenone, chloropicrin etc.
Blood and nerve - cyanic acid, chlorine cyanide etc.
Classification of TSs based on the impact:
Killing TS - sarin, soman, Vx-gases etc.
Temporarily disabling TS - adamsite, chloropicrin, BZ, LSD etc.

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Chemical contamination site mass damage to people, animals and


plants caused by the chemical weapon and area seriously contaminated with
toxic substances.

Chemical situation situation caused by the use of the chemical weapon.


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Assessment of chemical situation shall be carried out based on the


following initial information:

Type and time of application of TS


Means of application of TS
Area of application of TS
Wind speed and direction
Air and soil temperature
Sanitary losses among the population present in the chemical
damage site may be up to 80-90%

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After the assessment of the chemical situation Civil Defense


Medical Service (CDMS) head and chief of the staff:

inform CDMS agencies about the contamination of the area and air with

toxic substance;
analyse and make conclusions regarding the working ability of population
and agencies for the elimination of chemical damage sites;
determine the most suitable activity options;
select safer regions for the accommodation of the population and
agencies;
determine the time within which it is necessary for people to remain in
protective equipment;
determine the rules of sanitary cleansing of people contaminated with TS
and decontamination of machinery.
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CDTS agencies' staff shall perform the following in chemical


damage site:
chemical and medical survey;
first medical aid to the injured and their evacuation from the site;
sanitary cleansing of persons contaminated with TS;
decontamination of the used machinery, property, as well as clothes of the
injured for medical purposes and other works.

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3 Medical and tactical characteristics of nuclear lesion focus.

Nuclear weapon ordnance having damaging nuclear energy impact


in the result of nuclear explosion reaction.
Damaging effects of a nuclear explosion is based on the energy released
in nuclear reactions explosive.

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In August 1945,
American pilots were
dropped atomic
bombs on the
Japanese cities of
Hiroshima and
Nagasaki.
In total, killed more
than 200 thousand
people.

Destroyed city of Hiroshima

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Nuclear explosion may result in the


appearance of 5 kinds of harmful
impacts:

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Blast wave
Consists of severely compressed and heated air flow spreading to all
directions at a speed higher that sound speed.

Hearth of nuclear destruction, depending on the pressure in the shock front is divided into
zones of destruction.
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Thermal (light) radiation


Light radiation is a strong visible ultraviolet and infrared radiation emitted by a
fireball appearing in case of nuclear explosion.

Emission of Thermal Radiation in Two Pulses in an Air Blast


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Thermal (light) radiation


The burns are in degrees:
1st: Not serious painful and reddening of skin.
Continues for minutes to hour.
2nd: Dermal tissue damage Pain and reddening with
blisters. Regenerating ability, no scars. Possible
infection.
3rd: Tissue death throughout skin No regeneration
w/o grafting. Scarring, serious risk of infection, and
serious fluid loss.
4th: Destroys tissue below skin, muscle, connective
tissue Can cause exposed flesh to flash into
steam, flaying exposed body area to the bone.

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Penetrating (ionizing) radiation


Penetrating radiation consists of invisible gamma rays and neutrons spreading
around the explosion site in case of nuclear explosion.
Impact of penetrating radiation is assessed as a swallowed dose and measured in
Grays (Gr), Roentgen (R), and rad units of measurement. Lasts only 10-25
seconds. Within this short period, unprotected people and animals may get
radiation injury.
Severity degrees of radiation disease:

Clinical course of acute radiation disease:

Dose 1-2 Gr I (mild) degree


Dose 2-4 Gr II (medium degree of severity)
Dose 4-6 Gr III (severe) degree
Dose 6 Gr IV (very severe) degree

1 period of initial reactions (min to hours);


2 latent period (1-6 days);
3 acute period;
4 convalescence period (complex
treatment or bone transplantation
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Penetrating (ionizing) radiation

The action of ionizing radiation:


a - on the human body (penetrate through);
b - on various materials.
Half attenuation of penetrating radiation
provides:
a layer of concrete thickness of 10 cm (1);
a brick (2);
a normal soil 14 cm thick (3);
30 cm thick wood (4)
a)

b)

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Radioactive contamination of land


The extent of radioactive contamination depending on the distance from the epicenter:
1. moderate infection zone
(length of approximately
300-400 km);
2. severe infection zone
(150-200 km);
3. dangerous infection zone
(90-100 km);
4. zone of extremely
dangerous infection
(9-10 km)

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Effects of Nuclear Radiation On the Human Body


Most critical organs are divided into 3 groups by
sensitivity:
Red bone marrow and genital glands.
Thyroid gland, liver, kidneys, lungs and muscular system.
Skin cover and done tissue

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Electromagnetic impulse

Overvoltage caused by explosions are able to:

destroy electrical and


radio devices

cause burnout elements of electricity


and radio or mass operation protection

striking staff
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Electromagnetic impulse
To determine the nature of destructions, amount and condition of rescue
operations, damage site is divided into four circular areas

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*Source: Nuclear Weapons, 1959


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Electromagnetic impulse
Assessment of the conditions in the nuclear damage site shall consider
radiation situation which is one of the main elements of the site.
Assessment of radioactive situation allows to:

calculate the expected radiation dose;


determine term of operation of agencies in damage zones;
determine time of entrance of agencies into damage zones;
determine the time of escape from sites;
choose the most favorable option of operation for economic entities
and medical facilities.

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Table 1. Estimated losses among unprotected population of a nuclear damage site


Destruction
zones
Complete
Severe
Moderate
Light

General losses, %
90
50
40
15

Nonrecoverable
losses, %
80
35
10

Sanitary losses, %
10
15
30
15

Table 2. Structure of estimated sanitary losses in case of application of a nuclear weapon


Damages
Thermal burns

Amount (%)
26.4.-25.

Mechanical injuries

26.4.-50.

Radiation damages

26.4.-15.

Combines damages

45-55

Note

Including central
nervous system (CNS)
disorders

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4 Medical and tactical characteristics of combined lesion focus

In modern times, there is a risk of simultaneous and successive application of


nuclear, chemical and bacteriological weapons may be applied in the following
combinations:

nuclear and chemical;


nuclear and bacteriological;
chemical and bacteriological;
nuclear and bacteriological;
mass destruction weapon (MDW) and conventional weapons.

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Combined damages in the result of impact of several weapons on human


organism:

mechanical injuries, burns, radiation damages;


mechanical injuries, intoxications, infectious diseases;
radiation damages, mechanical injuries, burns etc.

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Unlike peace time, activity of CDMS in wartime is very complex and severe:

frequent changes in general conditions requiring changes in the method, mode

and place of work;


mass sanitary losses occurring within short period of time (among which
combined damages, multiple trauma and joint injuries will prevail);
increase of the risk of appearance and spread of ordinary infectious diseases in
connection with decrease in the sanitary-epidemiologic and financial and living
conditions of residential areas;
aggravation of the course of a number of pathologic processes (pneumonia,
gastric ulcer, pulmonary tuberculosis etc.);
psychological effect of modern weapons, especially, MDW, on people;
significant increase of rear pathologies in peace time (radiation disease, trench
foot, ttnus etc.).
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Thank you!

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