081-831-1044 (SL1) - Perform First Aid for Nerve Agent Injury

Note.  The ATNAA
system is a nerve agent antidote
device that will be used by the armed
forces. 
A single ATNAA delivers both
the atropine and 2 Pam Cl. 
The ATNAA will replace the MARK
I when supplies are exhausted. 
Procedures for administering
ATNAA will be contained in FM 4-25.11
(FM 21-11) and FM 8-285.

1.   Identify mild signs and symptoms of nerve agent
poisoning.

a.
Unexplained runny nose.

b.
Unexplained sudden
headache.

c.
Excessive flow of saliva
(drooling).

d.
Tightness of the chest
causing breathing difficulties.

e.
Difficulty seeing
(blurred vision).

f. 
Muscular twitching around
area of exposed or contaminated
skin.

g.
Stomach cramps.

h.
Nausea.

Note.  For the
above signs and symptoms first aid is
considered to be self-aid.

2.   React to the chemical hazard.

a.
Put on your protective
mask.

Note.  Seek
overhead cover or use a poncho to
provide cover, mission permitting. 
Do not put on additional
protective clothing at this time. 
Give yourself the nerve agent
antidote first. 
Then, decontaminate exposed
skin areas and put on remaining
protective clothing.

b.
Give the alarm.

3.   Administer nerve agent antidote to self (self-aid),
if necessary.

a.
MARK I.

(1) 
Prepare to administer
one atropine injection.

(a)  
Remove one set of
MARK I from your protective mask
carrier, from the pocket of the
MOPP suit, or from another
location as specified by your
unit SOP.

(b)  
With one hand, hold
the set of injectors by the
plastic clip with the big
injector on top.

(c)  
With the other hand,
check the injection site in
order to avoid buttons and
objects in pockets where
injecting. 
For injections into the
thigh, grasp the trouser cargo
pocket and pull forward,
clearing possible obstructions
from the site.

(d)  
Grasp the small
injector without covering or
holding the needle (green) end,
and pull it out of the clip with
a smooth motion.

(e)  
Form a fist around
the autoinjector with the needle
end (green) extending beyond the
little finger end of the fist.
Be careful not to inject
yourself in the hand.

Note.  If the
injection is accidentally given in the
hand, another small injector must be
obtained and the injection given in
the proper site.

(f)   
Place the needle end
of the injector against the
outer thigh muscle. 
For injections into the
thigh, grasp the trouser cargo
pocket and pull forward,
clearing possible obstructions
from the site.

Note.  The
injection can be given in any part of
the lateral thigh muscle from about a
hand’s width above the knee to a
hand’s width below the hip joint.

CAUTION:
When injecting antidote in the
buttocks, be very careful to inject
only into the upper, outer quarter of
the buttocks to avoid hitting the
major nerve that crosses the buttocks. 
Hitting the nerve may cause
paralysis.

(2) 
Administer the atropine
injection.

(a)  
Push the injector
into the muscle with firm, even
pressure until it functions.

Note.  A jabbing
motion is not necessary to trigger the
activating mechanism.

(b)  
Hold the injector
firmly in place for at least 10
seconds.

(c)  
Remove the injector
from your muscle and carefully
place the used injector between
two fingers of the hand holding
the plastic clip.

(3) 
Prepare to administer
one 2 PAM Cl injection.

(a)  
Pull the large
injector out of the clip and
form a fist around the
autoinjector with the needle end
extending beyond the little
finger.

(b)  
Place the needle
(black) end of the injector
against the injection site.

(4) 
Administer the 2 Pam Cl
injection.

(a)  
Push the injector
into the muscle with firm, even
pressure until it functions.

(b)  
Hold the injector
firmly in place for at least 10
seconds.

b.
ATNAA.

(1) 
Prepare to administer
one ATNAA.

(a)  
Remove one ATNAA from
your protective mask carrier,
from the pocket of the MOPP
suit, or from another location
as specified by your unit SOP.

(b)  
Remove the
autoinjector from the pouch.

(c)  
With your dominant
hand, hold the ATNAA in your
closed fist with the green
needle end extending beyond the
little finger in front of you at
eye level.

(d)  
With your nondominant
hand, grasp the safety (gray)
cap with the thumb and first two
fingers.

CAUTION:
Do not cover or hold the needle
end with your hand, thumb, or
fingers.  You may accidentally inject yourself.

(e)  
Pull the safety cap
off the bottom of the injector
with a smooth motion and drop it
to the ground.

(f)   
With the nondominant
hand, check the injection site
in order to avoid buttons and
objects in pockets where
injecting. 
For injections into the
thigh, grasp the trouser cargo
pocket and pull forward,
clearing possible obstructions
from the site.

(g)  
Hold the ATNAA in
your closed fist with the green
needle end pointing out by your
little finger.

(h)  
Place the needle end
of the injector against the
outer thigh muscle.

Note.  Very thin soldiers should give the injection in the upper
outer part of the buttocks.

CAUTION:
When injecting antidote in the
buttocks, be very careful to inject
only into the upper, outer quarter of
the buttocks to avoid hitting the
major nerve that crosses the buttocks. 
Hitting the nerve may cause
paralysis

(2) 
Administer the
injection.

(a)  
Push the injector
into the muscle with firm, even
pressure until it functions.

Note.  A jabbing
motion is not necessary to trigger the
activating mechanism.

(b)  
Hold the injector
firmly in place for at least 10
seconds.

(c)  
Remove the injector
from your muscle.

4.   Secure the used injectors.

a.
Drop the plastic clip
(MARK I) without dropping the used
injectors.

b.
Use a hard surface to
bend each needle to form a hook
without tearing protective gloves or
clothing.

c.
Push the needle of each
used injector (one at a time)
through one of the pocket flaps of
the protective overgarment.

5.   Decontaminate skin if necessary.

Note.  Information
on this step is provided in Task
031-503-1013.

6.   Put on remaining protective clothing.

Note.  Information
on this step is covered in Task
031-503-1015

WARNING:
If, within 5 to 10 minutes after
administering the first set of
injections, your heart begins beating
rapidly and your mouth becomes very
dry, do not administer another set of
injections

7.   Seek buddy-aid or medical aid.

Note.  After you
have given yourself the first set of
MARK I injections or one ATNAA, you
most likely will not need additional
antidote if you are ambulatory and
know who and where you are. 
If needed, additional
injections will be given only by a
buddy, a combat lifesaver, or medical
personnel.

8.   Identify severe signs and symptoms of nerve agent
poisoning.

a.
Strange and confused
behavior.

b.
Gurgling sounds made when
breathing.

c.
Severely pinpointed
pupils.

d.
Red eyes with tearing.

e.
Vomiting.

f. 
Severe muscular
twitching.

g.
Loss of bladder and/or
bowel control.

h.
Convulsions.

i.  
Unconsciousness or
stoppage of breathing.

Note.  If the
casualty is exhibiting severe
symptoms, assistance (buddy-aid) is
required by the individual to complete
first aid treatment.

9.   Mask the casualty if necessary.

WARNING:
Do not kneel at any time while
providing aid to the casualty. 
Contact with the ground could
force the chemical into or through the
protective clothing

Note.  Reposition the casualty on his back, if necessary, to mask
the individual.

a.
Place the mask on the
casualty.

b.
If the casualty can
follow directions, have him clear
the mask.

c.
Check for a complete mask
seal by covering the inlet valves of
the mask.

d.
Pull the protective hood
over the head, neck, and shoulders
of the casualty.

e.
Position the casualty on
the right side, similar to a swimmer
position, with the head slanted down
so the casualty will not roll back
over.

10. Administer first aid to a nerve agent casualty (buddy-aid).

a.
MARK I.

(1) 
Prepare to administer
one atropine injection.

(a)  
Position yourself
near the casualty’s thigh.

(b)  
Remove all three sets
of autoinjectors and the single
CANA autoinjector from the
casualty’s mask carrier, BDU
pocket, or from another location
as specified by your unit SOP. 
Place the autoinjectors
and CANA on the casualty’s side. 
DO NOT place the unused
devices on the ground.

(c)  
With one hand, hold
the set of injectors by the
plastic clip with the big
injector on top.

(d)  
With the other hand,
check the injection site to
avoid buttons and objects in
pockets. 
For injections into the
thigh, grasp the trouser cargo
pocket and pull forward (toward
you), clearing possible
obstructions from the site.

(e)  
Grasp the small
injector and pull it out of the
clip with a smooth motion.

(f)   
Hold the injector in
your closed fist with the green
needle end pointing out by your
little finger without covering
the needle end.

(g)  
Place the needle end
of the injector against the
casualty’s outer (lateral) thigh
muscle.

Note.  The
injection can be given in any part of
the lateral thigh muscle from about a
hand’s width above the knee to a
hand’s width below the hip joint.

WARNING:
When injecting antidote in the
buttocks, be very careful to inject
only into the upper, outer quarter of
the buttocks to avoid hitting the
major nerve that crosses the buttocks. 
Hitting the nerve may cause
paralysis.

(2) 
Administer the atropine
injection.

(a)  
Push the injector
into the muscle with firm, even
pressure until it functions.

(b)  
Hold the injector in
place for at least 10 seconds.

(c)  
Remove the injector
from the muscle and carefully
place the used injector between
two fingers of the hand holding
the clip.

(3) 
Prepare to administer
one 2 PAM Cl injection.

(a)  
Pull the large
injector out of the clip and
hold the injector in your closed
fist with the black needle end
pointing out by your little
finger without covering the
needle end.

(b)  
Place the needle
(black) end of the injector
against the injection site.

(4) 
Administer the 2 PAM Cl
injection.

(a)  
Push the injector
into the muscle with firm, even
pressure until it functions.

(b)  
Hold the injector in
place for at least 10 seconds.

(c)  
Drop the clip without
dropping injectors.

(d)  
Lay the used
injectors on the casualty’s
side.

Note.  Repeat
steps 10a (1) through 10a (4) until
the casualty has received a total
(including self-administered) of three
sets of antidote injections.

b.
ATNAA

(1) 
Prepare to administer
one ATNAA.

(a)  
Obtain three or all
remaining ATNAAs and one CANA
from the casualty’s protective
mask carrier, from the pocket of
the MOPP suit, or from another
location as specified by your
unit SOP.

(b)  
Remove one ATNAA from
the pouch.

(c)  
With your dominant
hand, hold the ATNAA in your
closed fist with the green
needle end pointing out by your
little finger, in front of you
at eye level.

(d)  
With your nondominant
hand, grasp the safety (gray)
cap with the thumb and first two
fingers.

CAUTION:
Do not cover or hold the needle
end with your hand, thumb, or
fingers.  You may accidentally inject yourself

(e)  
Pull the safety cap
off the bottom of the injector
with a smooth motion and drop it
to the ground.

(f)   
With the nondominant
hand, check the injection site
in order to avoid buttons and
objects in pockets where
injecting. 
For injections into the
thigh, grasp the trouser cargo
pocket and pull forward,
clearing possible obstructions
from the site.

(g)  
Hold the ATNAA in
your closed fist.

(h)  
Place the needle end
of the injector against the
outer thigh muscle.

Note.  The
injection may be given in any part of
the lateral thigh muscle from about a
hand’s width above the knee to a
hand’s width below the hip joint.

CAUTION:
When injecting antidote in the
buttocks, be very careful to inject
only into the upper, outer quarter of
the buttocks to avoid hitting the
major nerve that crosses the buttocks. 
Hitting the nerve may cause
paralysis

(2) 
Administer the
injection.

(a)  
Push the injector
into the muscle with firm, even
pressure until it functions.

Note.  A jabbing
motion is not necessary to trigger the
activating mechanism.

(b)  
Hold the injector
firmly in place for at least 10
seconds.

(c)  
Remove the injector
from the muscle.

(d)  
Place the used
injector on the casualty’s side.

(3) 
Repeat the procedure
for a total of three ATNAAs.

11. Administer the anticonvulsant, CANA.

a.
Prepare to administer the
CANA injection.

(1) 
Tear open the
protective plastic packet and
remove the injector.

(2) 
With your dominant
hand, hold the injector in your
closed fist with the black needle
end pointing out by your little
finger.

(3) 
With the other hand,
pull the safety cap off the
injector base to arm the injector.

CAUTION:
Do not touch the black (needle)
end. 
You could accidentally
inject yourself.

(4) 
Place the black end of
the injector against the
casualty’s injection site.

b.
Administer the CANA
injection.

(1) 
Push the injector into
the muscle with firm, even
pressure until it functions.

(2) 
Hold the injector in
place for at least 10 seconds.

12. Secure the used
injectors.

a.
Using a hard surface bend
each needle to form a hook without
tearing protective gloves or
clothing.

b.
Push the needle of each
used injector (one at a time)
through one of the pocket flaps of
the casualty’s protective
overgarment.

13. Decontaminate the casualty’s skin, if necessary.

Note.  This
information is covered in Task
031-503-1013.

14. Seek medical aid.