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

Field Management of Chemical Casualtieson the base. When collectively protected, a smallshelterpatient decontamination system package isadded to provide the capability to decontaminate largenumbers of patients before they enter the collectivelyprotected EMEDS. 8,9For all services, evacuation of land casualties is performedby the facility at the next higher level of care,which sends evacuation assets forward to retrieve thepatient. Patient movement is typically carried out byrotor-winged aircraft or ground vehicles. In theater thisis normally the responsibility of either the service componentcommand that operates the particular facilityor Army rotor-wing medical evacuation (MEDEVAC)units. 1,5 These units may have to designate certainassets to transport contaminated casualties from achemical battlefield to an FRC or theater hospital.Fixed-wing Air Force aeromedical assets used for intertheaterevacuation are usually reserved for patientswho have been decontaminated. 1,5Sea-Based ForcesSea-based forces are comprised primarily of Navyand Coast Guard assets. Medical evacuation to Navalvessels operating offshore must certainly be consideredfor chemical casualties with airway compromiseor significant trauma. Army air ambulance, Navy, orUSMC casualty evacuation helicopters provide therotor-wing assets for these vessels (Figure 14-3). 1 Inthe Navy, the major designated casualty receiving andtreatment ships are the dozen multipurpose large-deckamphibious landing helicopter dock assault ships ofthe USS Wasp class, such as the USS Bon Homme Richardor USS Kearsage. 10 These large, 40,000-ton vessels, 823feet long, are designed to operate offshore in supportof amphibious operations and can serve as FRC (levelII) facilities. 5 They support intense helicopter activitiesand are designed around large, self-contained “welldecks” for small boat transfers within the protectedhull of the ship. Extensive command, control, communication,and computer capabilities allow forMEDEVAC coordination and patient regulating. Thenewly commissioned landing platform dock 17, SanAntonio-class amphibious ships have similar capabilitiesbut a smaller size. 10 These Naval platforms, connectedlocally with helicopter assets, can be combinedwith the extended 1,500-mile range of the V-22 Ospreyvertical takeoff and landing aircraft to bring multiplecapabilities for medical response to the severely injured,whether they have chemical or physical trauma.The medical facilities on Navy aircraft carriers provideFRC (level II) capability, although their space is limitedcompared with that of the casualty receiving andtreatment ships. 5 The casualty receiving and treatmentamphibious assault vessels are large floating facilities,with FRC (level II) capability available to land-basedforces or civilian casualties during presidentially authorizedmilitary support to civil authorities.Although they lack an enclosed “well deck” for efficientsmall boat transfers, the two 70,000-ton hospitalships USNS Comfort and USNS Mercy (Figure 14-4)have large helicopter landing pads and offer completetertiary care capabilities, including 12 operating rooms,80 intensive care beds, and 50 ventilators, providing theservices of a theater hospital (level III). Naval facilitiesFig. 14-3. Unloading a patient from Army MEDEVAC to aNavy ship for treatment.Reproduced from: US Department of Defense. Health ServiceSupport in Joint Operations. Revision, Final Coordination.Washington, DC: DoD; 2005. Joint Publication 4-02.Fig. 14-4. Hospital ship USNS Mercy.Reproduced from: US Department of Defense. Health ServiceSupport in Joint Operations. Revision, Final Coordination.Washington, DC: DoD; 2005. Joint Publication 4-02: III-12.491