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

Medical Aspects of Chemical Warfaretamination might occur for those civilian casualties whoare evacuated to hospitals in privately owned vehiclesbefore first responders reach the area and establishboundaries. The vast majority of casualties in the Tokyosubway incident were evacuated by taxi or other privatevehicles. 17 One author estimates that individuals whoflee the incident area would take at least 10 minutesto locate transportation and get to an MTF, unless thefacility was adjacent to the release site. 41 It is expected,however, that those who flee would try to go to thenearest medical facility they know of.Thorough decontamination in the civilian sectorwould be initiated by decontamination teams immediatelyoutside the hot zone, typically the fire department,which performs gross decontamination byhosing down the victims. Thorough decontaminationwould also be provided at hospital decontaminationareas established outside the doors of receiving hospitals.Hospitals require these decontamination capabilitiesbecause, historically, many patients self-report tothe hospital before emergency personnel arrive on theincident scene and bypass the fire department grossdecontamination. 21,22 Fire department gross decontaminationefforts may also not be completely effective.Processing PatientsWhether military or civilian, all field managementoperations dealing with chemical casualties have thesame key components, arranged approximately in linearfashion (Figure 14-10). Patients are provided withinitial treatment in or on the periphery of the hot zone.In the military, individual patient decontamination canbe carried out by the exposed individual or a buddy. Ina civilian situation, although initial treatment wouldprobably be delayed, it may be carried out by emergencyfirst responders in or at the periphery of the hotzone, or by the victims themselves under instruction,Fig. 14-10. The linear fashion of a patient decontamination area. This illustrates a US Army field management operation, butthe same sequence of events occurs in other military services and in the civilian sector, although equipment may differ. (1)Patient arrival, (2) patient triage, (3) patient treatment for stabilization, (4) patient evacuation to larger facility or movementthrough existing decontamination facility, (5) accounting for valuables and ordinance on patients during decontamination, (6)crossing the hot line, (7) crossing the vapor control line, (8) patient mask removal, (9) treatment in the clean (contaminationfree)area and evacuation.EMT: emergency medical treatmentDiagram: Courtesy of the US Army Medical Research Institute for Chemical Defense, Chemical Casualty Care Division,Aberdeen Proving Ground, Md.502