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

Field Management of Chemical CasualtiesFig. 14-7. North Atlantic Treaty Organization wheeled littercarrier. This device allows a litter to be easily handled byone or two individuals, which reduces staffing requirementsand worker fatigue.Photograph: Courtesy of US Army Medical Research Institutefor Chemical Defense, Chemical Casualty Care Division,Aberdeen Proving Ground, Md.must be in a high level of protection, OSHA level Aor B (see Chapter 17, Chemical Defense Equipment,for a description of these protective levels), at leastuntil the agent is known, after which lower levels maybe appropriate. MTFs located in this area typicallycease operations, shelter in place, and do not receivepatients. The exception is the military collectivelyprotected MTF which, although initially set up ina clean area, can continue to operate for a limitedamount of time if the area it is in becomes contaminated.These structures have protective, chemicallyresistant liners and environmental control units thatfilter contaminated air.Warm ZoneThe warm zone is outside the hot zone. The levelof contamination here is significantly lower than thatfound in the hot zone. Contamination in the warmzone is only that which is on the unprotected skin,clothing, and equipment of those entering from the hotzone. If the event was a release of chemical vapors (agas plume or other passive release of vapors as in theTokyo subway attack), the primary hazard is from theoff-gassing of vapors trapped in patient clothing andhair. If the event is from a dry solid or liquid chemicalrelease, then the contamination hazard would be fromsolids and liquids on clothing, equipment, and skin,as well as vapors coming from any liquid residue. AsFig. 14-8. A variety of cutting tools are available for the rapidremoval of clothing. These include (from bottom to top) thetwo-bladed seat belt cutter and bandage scissors.Photograph: Courtesy of US Army Medical Research Institutefor Chemical Defense, Chemical Casualty Care Division,Aberdeen Proving Ground, Md.noted previously, an event involving a solid or liquidhazard would require a more intense decontaminationeffort.Once an MTF begins to receive patients, the areawhere contaminated patients are received would bedesignated as part of the warm area. In the warmarea medical and decontamination team membersMTFMTF patienttriage & deconCOLD ZONE (4)GrossDecontaminationWARM ZONE (2)Fig. 14-9. Zones of contamination after a chemical release. (1)Hot zone: contaminated area of chemical release; (2) warmzone: contaminated individuals enter from the hot zone;(3): evacuation corridor: contains patient decontaminationstations; (4) cold zone: area free of solid, liquid, and vaporcontamination.MTF: medical treatment facilityDiagram: Courtesy of US Army Medical Research Institutefor Chemical Defense, Chemical Casualty Care Division,Aberdeen Proving Ground, Md.(3)HOTZONE(1)499