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

Field Management of Chemical CasualtiesTable 14-1 continuedDefinitive Care CapabilityCompares to a stateside level V.Definitive care, which is normally providedin the continental United States,Department of Veterans Affairs hospitals,or civilian hospitals with committedbeds for casualty treatment as part of theNational Defense Medical System. Mayalso be provided by overseas allied orhost nation MTFsCare rendered to conclusively manage apatient’s condition, includes the full rangeof acute, convalescent, restorative, andrehabilitative care sites outside the theaterof operations.Includes the full range of acute convalescent,restorative, and rehabilitativecare.Same as for level IV plus:• Longer term respiratorytherapy.• Full rehabilitative servicesfor mental health, cognitive/memory retraining, retrainingin activities of daily living/lifeskills, prevocational services,and post traumatic stress counseling.This incorporates a teamof rehabilitation professionssuch as physical, occupational,speech, and mental healthservices as needed based onthe severity of exposure andresulting disability, if any.*Taxonomy of care terms are in italics.FRC: forward resuscitative careHSS: health service supportIV: intravenous2-PAM: 2-pyridine aldoxime methyl chlorideRTD: return to dutyData sources: (1) US Department of Defense. Health Service Support in Joint Operations. Revision, Final Coordination. Washington, DC: DoD;2005. Joint Publication 4-02. (2) US Department of Defense. Doctrine for Health Service Support in Joint Operations. Washington, DC: DoD;2001. Joint Publication 4-02.liners liners and and fitted fitted with with air air filtering units. units.Land-based Naval units are divided into broadwarfare areas including expeditionary warfare, forcesthat move to a theater of operations, and naval installations.4 Expeditionary units include construction forces,logistic support personnel, special warfare units,and fleet hospitals. Expeditionary forces on land aretypically deployed in support of USMC units. Theseusually include land-based FRC (level II) capability,which may initially contain as few as 10 beds but canbe expanded to 500 beds with a theater hospitalizationcapability (ie, a combat zone fleet hospital). 1Casualties from these facilities can then be evacuatedto land-based facilities of other services or to hospitalships. Expeditionary medical units deploy as part of alanding force, with CBRN defense capabilities for individualprotection, self-decontamination, and limitedequipment decontamination.Naval installations such as fleet hospitals, on theother hand, are more permanent, fixed facilities thatoffer FRC capabilities at level III or greater. Installationplanning at these facilities involves disaster preparedness,including coordination with local authorities.Plans for operations in a contaminated environmentinclude using shelter-in-place procedures, individualprotective gear, and various types of detection equipment.The installation disaster officer directs emergency-responseteams, coordinates decontaminationoperations, and assists in the command and controloperations center. 4 In addition to triage and treatingcasualties from an incident, the medical departmentalso organizes medical supplies; provides food andwater inspection; conducts disease monitoring; distributesantidotes and medications as needed for CBRNincidents; and provides training on CBRN hazards,self aid, and first aid as part of FHP. 4The approximately 175,000-member USMC is anintrinsic part of the Department of the Navy; medicalsupport to the Marine Corps is provided by the NavyMedical Department. USMC personnel may augmentNavy medical patient decontamination operations.First responder capability (level I) is provided throughself aid and buddy aid as well as by Navy corpsmenassigned to USMC units. The Marines, at this level,also utilize their intrinsic BASs, or USMC wing supportsquadron aid stations, staffed by Navy medical personnel.Unique to the USMC is the Chemical/BiologicalIncident Response Force (CBIRF) with first respondermedical capabilities. CBIRF deploys domestically, particularlyin the National Capital Region of Washington,DC, or overseas to pre-position or respond to a CBRNincident. Composed of USMC and Navy personnel,CBIRF has the capability to monitor, detect, identify,and analyze toxic industrial chemicals (TICs), toxic489