Mark I Auto Injector Administration

Nerve Gas Autoinjector Administration (DRAFT) 

1. INTRODUCTION: Nerve Gas auto-injectors are to be used when EMS personnel are exposed to 

nerve agents (Sarin, Suman, Tabun, Vx) and have signs and symptoms of nerve agent exposure, 

or when ALS personnel treat victims in an MCI situation in the hot zone. 

2. EQUIPMENT 

2.1 Mark I autoinjector antidote kit containing: 

] Atropine autoinjector (2 mg in 0.7 cc’s) 

] Pralidoxime chloride autoinjector - 2-PAM (600 mg in 2 cc’s) 

2.2 Additional atropine (2 mg) autoinjectors 

3. PROCEDURE: If you experience any or all of the nerve agent poisoning symptoms, 

you must IMMEDIATELY self-administer the nerve gas antidote 

(see policy # 7150 for signs and symptoms) 

3.1 Injection Site Selection 

MARK I antidote kit 

] The injection site for administration is normally in the outer thigh muscle (Figure 1). It is 

important that the injections be given into a large muscle area. 

] If the individual is thinly-built, then the injections should be administered into the upper outer 

quadrant of the buttocks (Figure 2). 

Figure 1 - Thigh injection site 

Figure 2 - Buttocks injection site 

3.2 Arming The Autoinjector: 

] Immediately put on your protective 

mask. 

] Remove the antidote kit 

] With your nondominant hand, hold 

the autoinjectors by the plastic clip 

so that the larger autoinjector is on 

top (Figure 3A) and both are 

positioned in front of you at eye 

level. 

] With your dominant hand grasp the 

atropine autoinjector (the smaller 

of the two) with the thumb and first 

Figure 3 - Removing atropine autoinjector from the clip. 

Nerve Gas Autoinjector Administration

Procedure: 


two fingers (Figure 3B). DO NOT cover or hold the needle end with your hand, thumb, or 

fingers-you might accidentally inject your self. An accidental injection into the hand WILL 

NOT deliver an effective dose of the antidote, especially if the needle goes through the 

hand. 

] Pull the injector out of the clip with a smooth motion (Figure 3C). The autoinjector is now 

armed. 

3.3 Administering the antidote to yourself: 

] Hold the autoinjector with your thumb and two fingers (pencil writing position). Be careful 

not to inject yourself in the hand! 

] Position the green (needle) end of the injector against the injection site (thigh or buttock) 

(Figure 4). DO NOT inject into areas close to the hip, knee, or thigh bone. 

Figure 4: Thigh and buttock sites for self-administration 

] Apply firm, even pressure (not jabbing motion) to the injector until it pushes the needle into 

your thigh (or buttocks). Using a jabbing motion may result in an improper injection or injury to 

the thigh or buttocks. 

] Hold the injector firmly in place for at least 10 seconds. Firm pressure automatically triggers 

the coiled spring mechanism. This plunges the needle through the clothing into the muscle and 

at the same time injects the antidote into the muscle tissue. 

] Carefully remove the autoinjector from your injection site. 

] Next pull the 2 PAM Cl injector 

(the larger of the two) out of the 

clip (Figure 5) 

] Inject yourself in the same 

manner as the steps above, 

holding the black (needle) end 

against your outer thigh (or 

buttocks) (Figure 4). 

] Massage the injection sites, if 

time permits. 

Figure 5 - Removing 2 PAM autoinjector from clip. 

] After administering the first set of injections, wait 5 to 10 minutes. After administering one set 

of injections, you should initiate decontamination procedures, as necessary, and put on any 

remaining protective clothing. 


Procedure: Date: 12/01/01 


] Atropine only may be repeated every 10 - 15 minutes as needed. (Note: multiple doses of 

atropine may be needed.) 

3.4 Administering the antidote to another in the Hot Zone: 

] Squat, DO NOT kneel, when masking the casualty or administering the nerve agent antidotes 

to the casualty. Kneeling may force the chemical agent into or through your protective clothing. 

] Mask the casualty. 

] Position the casualty on his or her side (swimmers position). 

] Position yourself near the casualty's thigh. 

] The procedure for site selection and medication administration is the same as 3.1 – 3.3 above. 

] Atropine only should be repeated as needed. (Note: multiple doses of atropine may be 

needed – see section 4.) 

Figure 6: Thigh and buttock administration to a casualty 

4. DOSAGE SCHEME FOR MARK I ADMINISTRATION - via autoinjector for self administration or 

use in the hot zone 

Signs & Symptoms Onset # of autoinjectors to use: 

Vapor: small exposure 

] Pinpoint pupils 

Seconds 

] Runny nose 

] Mild SOB 

Liquid: small exposure 

] Sweating 

] Twitching 

] Vomiting 

] Feeling weak 

Both: large exposure 

] Convulsions 

] Apnea 

] Copious secretions 

Minutes to 

Hours 

Seconds 

to Hours 

MARK I autoinjector antidote kit – 1 dose initially 

(containing atropine and 2-PAM) 

May repeat x1 in 10 minutes 

MARK I autoinjector antidote kit – 1 dose initially 


May repeat x1 in 10 minutes 

MARK I autoinjector antidote kit – 3 doses initially 


Additional atropine may be needed until a positive response is achieved 

(decrease in bronchospasm and/or respiratory secretions)

Mark I Auto Injector Administration

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