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Preparing for disaster

Roy Soto never experienced warfare during his seven years as an Air Force doctor. Instead he served as a general practitioner for military personnel.

Though Soto, an assistant professor in USF’s Department of Anesthesiology, is done with his military career, his expertise in chemical and biological weapons could help save soldiers in combat.

His years as a former flight doctor for the Air Force included teaching soldiers about the effects different weapons of mass destruction can have on a person and how to treat infected victims.

“The perfect (warfare) weapon is not one that kills soldiers, but one that slows them down and makes them too sick to continue fighting,” Soto, 37, said.

Chemical weapons, such as choking agents like chlorine and phosgene, are visible clouds of gas, when released, Soto said. Those agents make those affected unable to breathe.

Soto said chlorine gas was used for the first time by the Germans in 1915 during World War I, who held containers of the gas in front of fans facing allied soldiers.

“There were 15,000 casualties from the chlorine gas,” Soto said.

Soto added that there was “no ground gained by the Germans” because the gas remained in the air, forcing the German troops to leave the area so they would not be affected by their own agent. After the war, the Geneva Protocol was created prohibiting the use of chemical weapons. Soto said they weren’t used after that ruling, however, if soldiers encountered such attacks each person’s system would have different reactions.

“(Choking agents) affect people differently,” Soto said. “It depends on how healthy a person is and how long (he or she) was exposed to the agent.”

Soto said the best treatment for people exposed to a choking agent is a “breath of fresh air.”

Nerve agents, such as sarin, soman, tabun and VX, are also classified as weapons of mass destruction. Unlike choking agents, nerve agents are clear and undetectable. The first-stage effects a person experiences from a nerve agent is known as SLUDGE, which stands for salivation, lacrimation, urination, defecation, gastrointestinal upset and emesis.

Soto said the second stage of nerve agent exposure is muscle twitching and weakening, which leads to paralysis.

There are two treatments a person can receive for nerve agent exposure: atropine and 2-PAM chloride. Children who have ingested insecticide poison, Soto said, are given those same treatments.

“What treatment someone gets depends on the symptoms (he or she) has,” he said.

If infected with a nerve agent, the soldiers would have to stick a needle in their thigh with the proper treatment Soto said. The soldiers would then display the syringe in their shirt pocket so rescuers would know what treatment the soldiers had given themselves, Soto said.

He added that treatments for nerve agent exposure have side effects, such as delusions, dehydration and redness of the skin.

“There is a saying, and it goes: mad as a hatter, dry as a bone and red as a beet,” Soto said.

Soto described biological weapons of mass destruction, such as anthrax and smallpox, as being “easily dispersed.”

Soto said anthrax is a spore-forming bacterium that naturally exists in domestic animals such as cattle and goats in warmer climates. People could be infected with anthrax if they are exposed to the infected animals or their tissue. However, Soto said there is only a slight chance of that happening. He said anthrax is obtained in at least three ways by people with the intent of using the spores as a weapon of mass destruction.

“Anthrax could be stolen from a lab, stolen by a disgruntled (lab) employee or could be bought from another country,” Soto said.

Once anthrax is dispersed, symptoms will occur within seven days. Soto said the symptoms resemble those of a common cold. If caught early enough, exposure to anthrax can be cured with antibiotics.

Unlike anthrax, smallpox is a virus, and cannot be treated with antibiotics. Soto said in order to be immune to smallpox, the person would have to have been vaccinated against it. Soto said for the last 20 years, the vaccine has not been offered because “the disease was completely eradicated and everyone figured there was nothing to worry about.”

“Some countries (including the United States) kept samples of the virus in labs,” Soto said. “Rumors are that (the virus) was stolen, sold or smuggled.”

The best treatment for smallpox is resting, drinking plenty of fluids, taking vitamins and having supportive care.

“If (the person) has a healthy immune system and is treated appropriately, (he or she) will probably do OK,” he said.

Soto said other threatening weapons of mass destruction include blistering agents, such as mustard gas and lewisite. Both of these agents cause blisters on exposed skin, and, if the blisters are not treated, the skin will peel off.

“It takes a few hours for the symptoms (to occur),” he said. “Treatment is like treating a normal burn. Keep it covered and moist with antibiotics.”

Soto referred to the blistering agents as being similar to oil.

“It won’t spread. It just stays in one spot,” he said.

Soto joined the Air Force after completing medical school at Uniformed Services University in Bethesda, Md.

During his time in the Air Force, Soto trained soldiers how to determine which treatment to use based on a patient’s symptoms. Soto was stationed at Edwards Air Force Base in California, which is an Air Force flight test base. He tested Air Force members for hearing problems that occur from being on loud runways all day and also checked them for chemical exposure from fumes.

“I got to know pilots and gain their trust (as their physician),” Soto said.

The war in Iraq has raised fears of a biological weapon attack, but Soto believes that “on a large scale a chemical attack will not be likely.”