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

Medical Aspects of Chemical WarfareDirty SideArrivalPointTriageMinimal/DelayedTriageImmediateContaminatedEMTTriageExpectantArrival Point 50-75 Meters from Hot LineContaminatedDispositionAmbulatoryDeconLitterDeconContaminated Weapons/Personal EffectsTemporary Storage AreaDecontaminationCheckDecontaminationCheckHot LineShuffle PitShuffle PitVapor ControlLineHot LineResupplyPointMTF 30-50 Meters20x25’OverheadCoverClean SideTreatmentClean SideWind DirectionMTFDumpContaminatedTemporaryMorgueRest/Re-hydration Point50 Meters perpendicular todecon area 5 meters fromHot LineWaterStorageCleanDispositionClean EvacuationContaminated Dump 75-100 MetersFig. 14-12. Another, more detailed, example of the layout of a patient decontamination site at a medical treatment facility(military or civilian). Note the relative positioning of specific triage areas, the waste dump, rest/rehydration points, areasfor storage of personal effects, hot line, and vapor control line.EMT: emergency medical treatmentMTF: medical treatment facilityDiagram: Courtesy of the US Army Medical Research Institute for Chemical Defense, Chemical Casualty Care Division,Aberdeen Proving Ground, Md.to the arrival area. On land the entry control pointwould be located well in front of the decontaminationarea, and at sea it would be at the transport aircraft orwatercraft casualty loading area located on land. Atthe arrival area vehicles are unloaded and patientsare brought to the adjacent triage area. Maintainingtraffic discipline in this area is critical to ensure unimpededflow of patients and vehicles. The arrivalpoint on land must be large enough to accommodateever expanding numbers of casualties; at sea the arrivalpoint would be the aircraft or watercraft landingarea. At this point monitoring devices may be used tocheck for contamination on patients. All personnel inthese areas wear a MOPP level 4 or level C equivalentprotective ensemble.Triage Area (Warm Side)Patients are moved to the triage area from the arrivalpoint, where a triage officer (trained physician, nurse,EMT, physician’s assistant, dentist, or veterinarian)quickly triages the patient, who is then moved to arespective immediate treatment area (also known asthe warm side emergency medical treatment station).Patients are triaged according to their priority formedical treatment (immediate, delayed, minimal, orexpectant); level of decontamination (high or low);and further medical evacuation required (urgent, priority,or routine). See Chapter 15, Triage of ChemicalCasualties, for more detailed information. Medicalworkers in this area wear a level C equivalent protectiveensemble.The immediate treatment area should be locatednear the entrance to the litter decontamination lanesto allow direct access for patients who will be litterborne.Expectant patients are located adjacent to thedirty side emergency treatment station, but fartheraway from the litter decontamination lanes, so thatthese patients can be retriaged and stabilized fordecontamination when the dirty side no longer has504