Page 104 - Journal of Special Operations Medicine - Fall 2015

Figure 7 Prolonged field care kit. smoke following an intense flash burst. The first step
is immediate copious irrigation, followed by removal
of any remaining visible WP particles by brushing or
forceps. WP depends on oxygen to burn, thus wounds
must be isolated from air exposure to retard activation
of remaining and absorbed phosphorus. Water-soaked
dressings may be used, but run the risk of drying out
during transport, with resultant re-initiation of burning.
Mud is a field-expedient method but comes with obvi-
ous infection risks. The preferred option is the use of hy-
drogel dressings that will not rapidly dry out and whose
sole indication for use is burn care. Of the commercially
available hydrogel dressings, only Water-Jel (Water-Jel
Technologies; www.waterjel.com) has been tested spe-
cifically with WP and has been proven to extinguish it.
14
WP chelates calcium from the body; therefore, levels
should be monitored and repleted as possible.

Electrical injury may result from exposure to either direct
(DC) or alternating (household) current (AC). Lightning
strikes are a subtype of DC injury. Remove the casu-
alty from the source of electricity, taking care to avoid
Special Considerations
injury to rescuers. More internal tissue damage is pres-
Several circumstances require specific attention during ent than external burn wounds may indicate, as current
burn care. These include burn wounds caused by chemi- follows along the path of least resistance through the
cals, WP, electrical injuries, and smoke inhalation. body. While DC may result in a discrete entry and exit
point, AC’s polarity cycling results in far more insidious
Corrosive substances such as cleaning solutions, labo- damage. Cardiovascular injury must be assumed, with
ratory agents, and rocket fuels, among others, are cardiac monitoring performed as able. Some casualties
frequently encountered in the military environment. Pro- may present with cardiac arrest. The most common ar-
viders should pay attention to personal protective equip- rhythmia will be ventricular fibrillation, which must be
ment to safeguard themselves from exposure. A casualty treated with defibrillation. While most aspects of care
who has been exposed to a corrosive agent should have will be the same as other burns, greater attention than
all clothing removed and have areas of contact copiously usual must be paid to the prevention of renal failure due
irrigated with water. Alkaline substances damage tissue to rhabdomyolysis from muscle injury along the current
by liquefaction necrosis and thus will continue to injure track. If urine is red or brown, resuscitation fluid-infu-
until expended. Acid burns occur via coagulation necro- sion rates must be increased by one-third each hour to
sis that results in a protective eschar, and are generally obtain urine output of 1.5mL/kg per hour (75–100mL/h
less severe. While knowledge of the specific agent in for the average adult). If the urine does not clear, 12.5g
question is useful, the safest course of action is to irri- of mannitol may be added to each liter of resuscitation
gate extensively without delay. There is no indication for fluid to increase urine output. Slow infusion of sodium
attempting to neutralize the agent. If the chemical is a bicarbonate may also be added to alkalinize the urine.
dry powder (such as lime or water purification agents),
the provider should brush as much agent off as possible Smoke inhalation typically results from a fire within an
prior to irrigation. Following comprehensive decontami- enclosed space, such as a vehicle or building. Heated
nation, the burns can be debrided and cared for in the gases may result in direct injury to the pharynx, al-
usual fashion. though the glottis provides a very effective barrier to
direct heat injury of the lower respiratory tract. Carbon
Accidental exposure or intentional use of WP munitions monoxide is a product of combustion, with higher affin-
results in severe burns that require specific handling. ity for hemoglobin than oxygen; carbon monoxide levels
WP is an elemental form of phosphorus that reacts vio- are generally elevated in these casualties. The treatment
lently on exposure to air. WP can be used for smoke for smoke inhalation and carbon monoxide poisoning
generation as well as antipersonnel purposes. WP mor- is high-concentration oxygen preferably using a de-
tar, artillery, and tank rounds, as well as hand grenades, mand valve resuscitator or the Oxylator (CPR Medical
are common among Soviet-supplied states. WP muni- Devices Inc.; www.cprmedic.com) stocked in the SOF
tions use can be identified as white, dense, luminescent medical equipment set. A nonrebreather mask may be

92 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2015