CBRN medical support of French Groupe d’Intervention de la Gendarmerie Nationale

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CBRN medical supportof FrenchGroupe
dIntervention 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 dintervention de la Gendarmerie
  Nationale

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What is GIGN?

• The French Groupe dIntervention 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

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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

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Conventional and CBRN main risks

• Conventional wounds
• Chemical
• Nerve agents
• Vesicants
• Cyanic agents
• Suffocants gases
• (Biological)
• (Radiological)

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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

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Main difficulties

• Major restraints due to PPE
• Material contamination problems
• Degraded conditions for medical activity
• Care must be adapted and simplified
• Material must be ready to use
• Communications are difficult

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Caregivers 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

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Possible therapeutics

• Summary decontamination, Foulons 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

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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

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Venous access

• Skin disinfection with Dakin Cooper solution
• The simplest site is the best
• Carrier Ringer lactate or saline
• Catheter fixation with Elastoplaste

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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

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Training
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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

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Conclusion

• Risks knowledge
• Individual an collective protection measures
• Medical knowledge
• Organized medical support, adapted pharmacopoeia