Medical Aspects of Chemical Warfare (2008) - The Black Vault

Medical Aspects of Chemical WarfareTable 14-1comparison of taxonomy of care capabilities with levels (echelons) of careparticular to chemical casualty management*Care Capability / Level of Care Care Rendered Care Particular to Chemical CasualtiesFirst Responder CapabilityCompares to level I care at the unitlevel.Prepares patient for return to duty ortransport to the next level of care.Forward Resuscitative Care CapabilityThis compares to level II physician-directedemergency care at a small medicalfacility in the theater of operations.Treat patient for RTD or stabilize formovement to a larger medical treatmentfacility capable of providing care.En Route Care CapabilityTheater Hospitalization CapabilityCompares to level III and IV capabilitiesFacility in theater that is larger thanFRC (level II). Care requiring expandedclinical capabilities such as restorativesurgery. Treat patient for RTD or beginrestorative surgery and prepare formovement to a higher level of care.Level IVLargest facility found in mature theaters.Rehabilitates those who can RTDin theater and prepares more seriouscasualties for movement to level V.Initial essential stabilizing medical carerendered at the point of injury.Self aid, buddy aid, examination, emergencylifesaving (eg, maintain airway,control bleeding, prevent shock). Useof IV fluids, antibiotics, applying splintsand bandages.Forward advanced emergency medicaltreatment performed as close to the point oninjury as possible, based on current operationalrequirements.Resuscitation and stabilization, can includeadvanced trauma management,emergency medical procedures, andforward resuscitative surgery.May have capability (depending onmilitary service) for basic laboratory,limited radiograph, pharmacy, type Oblood transfusion, and temporary holdingfacilities.Involves the medical treatment of injuriesand illnesses during patient movementbetween capabilities in the continuum ofessential care.Includes theater hospitals with modularconfigurations to provide in-theater supportand includes the HSS assets needed to supportthe theater.Resuscitation, initial wound surgery,and postoperative treatment. This is thefirst level that offers restorative surgeryand care rather than just emergencycare to stabilize the patient. Has largervariety of blood products than level II.Provides restorative surgery, like levelIII, and also rehabilitative and recoverytherapy.Same as care rendered plus:• Decontamination of the skin andequipment.• Providing antidotes (atropine/2PAM/diazepam) to chemicalagents.Same as responder capability (level I)plus:• Emergency contaminated shrapnelremoval.• Intubation.• Ventilatory support (though limited).• Wound debridement.• Informal stress counseling.New term not used in former doctrine.Includes support of airway, controllingbleeding, and administration of antidotesand seizure medications, if neededand available during transport.Same as for FRC (level II) plus:• Exploratory surgery.• Initial burn care .• Bronchoscopy.• Intubation.• Ventilatory support (more assetsthan level II).• More extensive wound debridement.• Eye care.• Respiratory therapy.• Formal stress counseling.Same as for level III plus:• Physical and occupationaltherapy rehabilitation for thosewith limited vesicant burns.• Full respiratory therapy .• Ventilatory support (more assetsthan level III).• More extensive eye care.• Psychological counseling.(Table 14-1 continues)488