CBRN medical supportof 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 SatoryService de santé des armées

** Groupe d’intervention de la Gendarmerie Nationale

What is GIGN? The French Groupe d’Intervention de la Gendarmerie Nationale (GIGN)

A police special force unit from the military Its main missions are:

– Counter terrorism, multiple hostage– Fight against the organized crime– Protection and security of vital keypoints of the nation and state

Missions in France and overseas as well

Trained to work under CBRN conditions

GIGN medical support Physicians and nurses

Trained in military and emergency medicine

Knowledge of intervention techniques

Part of the intervention teams

Same equipments and protections

Following them as near as possible

Provides immediate advanced life support

Conventional and CBRN main risks Conventional wounds

Chemical:

– Nerve agents

– Vesicants

– Cyanic agents

– Suffocants gases

(Biological)

(Radiological)

Preventives measures Personal protective equipment (PPE)

– Filter or waterproof suits– Filter or isolated respiratory devices

Antidotes carried by soldier: bi-compartmented auto-injector Ineurope®

– Atropin– Pralidoxim– Diazepam

Diphoterine® carried by soldier: chemical burns

Main difficulties1. 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 Important physiological restraints

Importance of adjusted size gloves

Risk of contamination transfer between patients

Problem with kneeling (to intubate…)

Interest of elevated stretcher for tracheal intubation

Possible therapeutics Summary decontamination, Foulon’s earth

O2 with high concentration mask and aerosols

Intra-muscular or bone injections

Peripheral venous access

Tracheal intubation and ventilation with disposable resuscitators

Interest of tracheal aspiration for nerve agents intoxications

Specific therapeutics O2 and ß mimetic aerosols for suffocating symptoms

For nerve agents intoxication:– Atropin– Pralidoxim– Diazepam, midazolam or clonazepam

Hydroxocobalamin for cyanidric poisoning

Main goal is to maintain the respiratory function

Venous access Skin disinfection with Dakin Cooper® solution

The simplest site is the best

Carrier: Ringer lactate or saline

Catheter fixation with Elastoplaste®

Tracheal intubation For acute respiratory distress uncontrolled by O2 + ß mimetic aerosol + atropine

With general anesthesia by midazolam and ketamin IM or IV, then sufentanil

Ventilation with disposable resuscitator, then portable ventilator

Training

Decontamination Not a medical activity

Many physiological constraints

Preliminary adapted medical management for serious injuries

If venous access: remove infusion and place shutter

If tracheal access: manual ventilation with disposable resuscitator(s), relay ongoing decontamination

Conclusion

Risks knowledge

Individual an collective protection measures

Medical knowledge

Organized medical support, adapted pharmacopoeia