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This article is about a concept, not a mask. This article has been written about something that is not a specific model of mask, but a concept relating to CBRN warfare or the engineering behind gas masks. |
Mark I Nerve Agent Antidote Kit (NAAK)[]
The Mark I Nerve Agent Antidote Kit (NAAK) is a US military issue countermeasure (antidote) for nerve agent
poisoning. The Mark I NAAK consists of four separate components: the atropine sulfate autoinjector, the pralidoxime chloride autoinjector, the plastic clip, and the foam envelop (carrying case). The kit was normally only issued when the threat of nerve agent attack was anticipated. The autoinjectors are filled with pre-measured nerve agent antidotes with an automatic, spring-loaded needle injection system. Each auto-injector is disposable and can be used only once. Three kits were normally carried by military personnel. The Mark I NAAKs have to be protected from freezing as the expanding ice inside the kit damaged the automatic injection system.
Atropine Sulfate Auto-Injector[]
The atropine sulfate auto-injector is the smaller of the two injectors and is labeled "1" on the plastic clip, indicating that it was the first to be administered when a service member was showing signs of nerve agent poisoning. The auto-injector is designated as the AtroPen by its manufacturer.[1] The primary purpose of the atropine sulfate is to break the bond between the nerve agent and the acetylcholine esterase enzyme, allowing the enzyme to resume its function of removing acetylcholine from the receptors on neurons. This will often lead to a dramatic halt of nerve agent poisoning symptoms such as convulsions and runny nose. A side effect of the atropine sulfate is dry mouth, blurred vision, lack of sweating, and rapid heartbeat.[2] Training documents urge that the atropine sulfate auto-injector be given within ten minutes of the onset of nerve agent poisoning to avoid "hardening" of the nerve agent to the acetylcholine esterase, a particular problem with GD (Soman) nerve agent. The auto-injector delivers 2 mg of atropine sulfate in 0.7mL of liquid.
Pralidoxime Chloride (2-PAM Chloride)[]
Unused NAAK Pralidoxime Chloride (PC) auto-injector. The Pralidoxime Chloride cartridge shown here was manufactured by Meridian Medical Technologies Inc. and STI Military Systems.
The pralidoxime chloride auto-injector is the larger of the two injectors and is labeled "2" on the plastic clip indicating that it should be administered only after the atropine sulfate auto-injector. The 2-PAM chloride auto-injector is designated as the ComboPen by its manufacturer. [1] The primary purpose of the 2-PAM chloride is to bind with the nerve agent and render it harmless and allow it to eventually be excreted from the body. The atropine sulfate and 2-PAM chloride work together to help nerve agent casualties recover from nerve agent poisoning. The auto-injector delivers 600 mg of 2-PAM chloride in 2 mL of liquid.
Self and Buddy Use[]
Self Use[]
The atropine sulfate auto-injector is the first to be used when nerve agent poisoning symptoms are felt. The injection site for administration is normally in the outer thigh muscle. It is important that the injections be given into a large muscle area, or, if the individual is thinly built, then the injections should be administered into the upper outer quadrant of the buttocks.[1] Once the auto-injector is pulled from the clip, the injector is "armed." The auto-injector green tip is then placed against the injection site and is activated with firm pressure. The auto-injector is held in place for at least 10 seconds for the full amount of the antidote to injected into the injection site. Once the atropine chloride auto-injector is administered, the 2-PAM chloride auto-injector is administered in a similar fashion. The auto-injectors are designed to allow administration through clothing and chemical protective clothing. Once the injections are administered, the area may be massaged to help the bolus of medicine absorb into the body.
If nerve agent poisoning symptoms persist 15 minutes after the first round of NAAK injections, a second NAAK may be used. If symptoms persist after the second NAAK, a third may be administered, but three is the limit of self-aid. Any further treatment must be done by medical professionals.
Buddy Use[]
If a nerve agent casualty is found unresponsive on the battlefield, buddy-aid is required. The unresponsive casualty should be administered all three NAAKs immediately. The casualty's NAAK should be used for this treatment and not the NAAKs of the person that found the casualty. The casualty should then be evacuated to a medical evacuation consolidation point. The expired auto-injectors should be attached to a flap of clothing to indicate to medical professionals how many NAAKs have been administered. Care must be used when bending the needles to prevent puncturing protective gear and possibly transmitting blood born diseases.
Mark I NAAK Trainer[]
NAAK trainers were available for non-combat training exercises and would react as a real NAAK with the exception of deploying a needle and injecting the antidotes. The NAAK trainers made an audible and tactile click when simulating operation. The training NAAKs could be reset and reused.
Developments[]
The Mark I NAAK was eventually augmented with the Convulsant Antidote for Nerve Agent (CANA), an auto-injector version of Diazepam (Valium). This medicine calmed convulsions associated with nerve agent poisoning.
The Mark I NAAK has been replaced with the Antidote Treatment Nerve Agent Autoinjector (ATNAA). The new system, unlike the NAAK, consists of only one auto-injector which administers both atropine sulfate and 2-PAM chloride in one application.
Cultural Impact[]
Actor Nicholas Cage portrays Dr. Stanley Goodspeed in the 1996 film, The Rock. The scene portrays Goodspeed injecting himself in the heart with a comically large atropine auto-injector. A real auto-injector would deploy the needle only after it was in contact with the injection site. Additionally, intracardiac atropine injection is not recommended for nerve agent poisoning.
In the movie "The Rock" (featuring Nicolas Cage and Sean Connery) the Atropine is presented as a giant auto-injector that is to be directly injected to the heart to prevent death in the event of VX nerve agent poisoning. Near the end of the movie, Nicolas Cage, having been contaminated with VX, uses an atropine auto-injector in this manner. This is only for drama enhancement as the NAAK, in real life, would be administered into the victim's thigh and not directly into the heart. Administering an auto-injector intracardially (into the heart) is nearly impossible in field conditions as body armor and other military equipment must be removed quickly and the auto-injector properly positioned to avoid the sternum and rib cage while suffering possible convulsions and dim vision due to miosis. Additionally, administering an auto-injector intracardially can be extremely painful.
