Transcript CBRN medical support of French GIGN

CBRN medical support
of French
Groupe d’Intervention de la
Gendarmerie Nationale
Hertgen P*, Peyrefitte S*, A. Virgile**, Le Vaillant Y*, Castel F*, Legonidec E*, Houzé B*
* Centre médical de Satory
Service de santé des armées
** Groupe d’intervention de la Gendarmerie Nationale
What is GIGN?
The French Groupe d’Intervention de la Gendarmerie Nationale
(GIGN)
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A police special force unit from the military
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Its main missions are:
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Counter terrorism, multiple hostage
Fight against the organized crime
Protection and security of vital keypoints of the nation and state
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Missions in France and overseas as well
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Trained to work under CBRN conditions
GIGN medical support
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Physicians and nurses
Trained in military and emergency
medicine
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Knowledge of intervention techniques
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Part of the intervention teams
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Same equipments and protections
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Following them as near as possible
Provides immediate advanced life
support
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Conventional and CBRN main risks
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Conventional wounds
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Chemical:
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Nerve agents
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Vesicants
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Cyanic agents
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Suffocants gases
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(Biological)
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(Radiological)
Preventives measures
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Personal protective equipment (PPE)
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Filter or waterproof suits
Filter or isolated respiratory devices
Antidotes carried by soldier: bi-compartmented autoinjector Ineurope®
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Atropin
Pralidoxim
Diazepam
Diphoterine® carried by soldier: chemical burns
Main difficulties
1. Major restraints due to PPE
2. Material contamination problems
3. Degraded conditions for medical activity
4. Care must be adapted and simplified
5. Material must be ready to use
6. Communications are difficult
Caregiver’s PPE
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Important physiological restraints
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Importance of adjusted size gloves
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Risk of contamination transfer between patients
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Problem with kneeling (to intubate…)
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Interest of elevated stretcher for tracheal intubation
Possible therapeutics
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Summary decontamination, Foulon’s earth
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O2 with high concentration mask and aerosols
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Intra-muscular or bone injections
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Peripheral venous access
Tracheal intubation and ventilation with disposable
resuscitators
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Interest of tracheal aspiration for nerve agents
intoxications
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Specific therapeutics
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O2 and ß mimetic aerosols for suffocating symptoms
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For nerve agents intoxication:
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Atropin
Pralidoxim
Diazepam, midazolam or clonazepam
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Hydroxocobalamin for cyanidric poisoning
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Main goal is to maintain the respiratory function
Venous access
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Skin disinfection with Dakin Cooper® solution
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The simplest site is the best
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Carrier: Ringer lactate or saline
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Catheter fixation with Elastoplaste®
Tracheal intubation
For acute respiratory distress uncontrolled by O2 +
ß mimetic aerosol + atropine
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With general anesthesia by midazolam and ketamin IM
or IV, then sufentanil
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Ventilation with disposable resuscitator, then portable
ventilator
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Training
Decontamination
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Not a medical activity
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Many physiological constraints
Preliminary adapted medical management for serious
injuries
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If venous access: remove infusion and place shutter
If tracheal access: manual ventilation with disposable
resuscitator(s), relay ongoing decontamination
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Conclusion
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Risks knowledge
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Individual an collective protection measures
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Medical knowledge
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Organized medical support, adapted pharmacopoeia