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

Field Management of Chemical CasualtiesTable 14-4Comparison of military battlefield and civilian casualty care anddecontaminationProcess Military on Chemical Battlefield Civilian or Unprepared MilitaryImmediate Immediate decontamination takes place upon Casualties may wash contaminated areas ifdecontamination contamination using M291, RSDL, or other kit. knowledgeable, otherwise they must wait forHAZMAT crews and first respondersOperational patient Contaminated patients, wearing protective gear, Local vehicles may have to be used if available.decontamination can be transported on designated vehicles to Ambulance services may be hesitant todecontamination facilities.transport contaminated patients.Emergency medical Care can begin on the battlefield. Initiated by the Medical care is delayed in all instances bycare individual or a buddy. Unit medics can also minutes. Care may not be initiated until theprovide lifesaving care while they are wearing patient is moved from the incident site andprotective equipment.then decontaminated. Care may be initiatedearlier if medical personnel are trained toprovide assistance while wearing protectiveequipment.Thorough patient Performed before patient enters the MTF, whether a Performed before patient enters the MTF,decontamination small or large facility. May have gross contam- whether a small or large facility. May haveinants removed at a centralized facility outside gross contaminants removed at a centralizedthe hot zone with continued decontamination at facility outside the hot zone with continuedthe hospital decontamination area if indicated. decontamination at the hospital decontaminationarea if indicated.HAZMAT: hazardous materialsMTF: medical treatment facilityRSDL: reactive skin decontamination lotionin the military and civilian setting.The majority of civilians are not aware of the characteristicsof chemical agents or the steps to take forimmediate decontamination. Many, appropriately,would probably attempt immediate decontaminationof a visible or symptomatic agent by washing orwiping. They might effectively perform immediatedecontamination by washing with copious amounts ofwater from a sink or hose, or by using bottled water.Wiping could be performed using frequently carriedmoistened disposable baby wipes. Liquid agent couldbe wiped from the skin using any nontoxic absorbentmaterial such as clean dry sand, bread, flour, or babypowder, followed by wet wipes. 40 If the individualdoes not perform any of these procedures, then decontaminationmay not take place until the arrival offirst responders, who may be delayed. Also, civiliancasualties, unlike military personnel, would not haveimmediate access to nerve agent antidotes (or wouldnot know how to use them). The casualties wouldneed to wait until treated by appropriately suppliedfirst responders.In the civilian sector, HAZMAT crews and fire departmentscan take 15 minutes or longer to assess thehot zone and establish patient decontamination lanesin the warm zone 23 ; during this time civilian casualtieswould remain contaminated and untreated. If the toxinis an organophosphate nerve agent, then antidoteswould be provided, if available, by the civilian firstresponder. Under the best of situations in a civiliansetting, casualty treatment is often administered onlyafter the patient is evacuated by HAZMAT crews tothe warm zone triage area. Local civilian EMTs couldbe trained to provide stabilizing patient care whilewearing PPE in the warm zone’s patient collection areabefore decontamination. In an optimal situation, firstresponder EMTs in PPE could accompany HAZMATcrews into a contaminated area and begin triage andtreatment of victims as they are being evacuated. 26 Inthe military battlefield scenario, of course, initial careand decontamination is provided at the incident site, inthe hot zone, before and during patient evacuation.Patient operational decontamination would probablynot be done in the civilian sector because most contractambulance services will not take contaminated patientson their vehicles. Some semblance of operational decon-501