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

Field Management of Chemical Casualtiesusing any available materials such as bottled water,baby wipes, or reactive skin decontamination lotion.For more thorough decontamination, civilian casualtiesare provided with gross decontamination in thewarm zone by the fire department, using fire enginewater spray or water from plumbed decontaminationtents (Figure 14-11), and more complete decontaminationat the MTF prior to entry into the facility. For themilitary casualty, thorough decontamination occurs atthe patient decontamination station, which is locatedoutside the military MTF. In both the civilian and militarydecontamination station, a patient moves througha sequence of substations to account for valuables,remove clothing, and wash. These same stations areestablished whether decontamination takes place inan area with limited resources, such as an Army BASor civilian fire department decontamination line,or a facility with more robust capabilities, such as amoderate sized or larger military or civilian hospital(Figure 14-12). OSHA documents refer to the areaoutside an MTF, where contaminated patients arriveand are triaged and decontaminated, as the hospitaldecontamination zone. 27Once the patients are decontaminated, they moveacross the hot line into the hospital postdecontaminationzone. Name designations for each area may differdepending on the setting, but the sequence of steps inthe process is similar. The areas described below areadopted from several sources. 3,7,8,14,27,33,42,43Entry Control Point and Arrival AreaThe entry control point is the doorway to the decontaminationarea. This entrance is typically barricadedin some way to regulate traffic flow and is usuallystaffed by security personnel wearing protective ensemble.Ambulances, other vehicles, and ambulatorycasualties go through this control point on their wayHazMat Incident Medical Treatment Site SetupHazardous MaterialsIncident SiteIncidentCommand PostFirst Responder FlowCasualty FlowIncidentEmergencyOperationsCenter (EOC)EMSDecon’edon scene(> 10 minute)Self Reporting(> 10 minute)EMS TransportConfirmedCleanWaste WaterWaterSourceWaterHeaterCasualtyCollection&Decon DecontaminationTriage ZoneAmbulatoryDeconSecure PerimeterNon-ambDecon1st ReceiverDecon LanePost-DecontaminationTriage, Treatment, &Patient AdmissionWindDownslopeEntry/ExitControlPointPost-DecontaminationZoneTriage and Treatment GroupsHospital Incident Command Post&Emergency Operations Center (EOC)StagingAreaReconstitution ofsupplies/equipmentand personnelFig. 14-11. This is one example of the layout of a civilian hazardous materials incident patient decontamination area at theperiphery of the hot zone or at the entrance to the medical facility. This model takes into consideration a 10-minute lag timebetween incident occurrence and the self-reporting of patients. It follows the same sequence of steps noted in Fig. 14-12.EMS: emergency medical serviceDiagram: Courtesy of Commander Duane Caneva, US Navy.503