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

Field Management of Chemical Casualtiespatients. The delayed treatment area is located nearthe entrances of both the litter and ambulatory patientdecontamination lanes; delayed patients can beprocessed through either lane when available. Finally,the minimal patient triage treatment area should bepositioned nearer to the ambulatory decontaminationlane because these patients can walk throughthe lane with minimal assistance. In the military,minimal patients are typically sent back to their unitsafter receiving medical care without needing to bedecontaminated or crossing to the clean side, wherethe MTF is located. In the civilian sector, the movementof these patients should not interfere with theprocessing of more serious casualties through thedecontamination line.The warm side emergency treatment station (orimmediate patient treatment area) is where life savingcare is provided to stabilize the patient for decontaminationor transport. Care given at this station includesthe administration of antidotes, quick decontaminationof contaminated skin areas, intubation, and intravenousadministration of fluids. Medical staff in thisarea are trained in these procedures and capable ofperforming them while wearing OSHA level C protectiveensemble.Decontamination AreaLanes are established in the decontamination areafor litter and ambulatory patients. The number of staffrequired for a decontamination team is dictated, asdiscussed earlier, by ambient and WBGT temperaturein the field management operations area, number ofcasualties, type of chemical agent, level of fitness ofpersonnel wearing protective ensemble, and decontaminationequipment used. Minimum staffing levelsare two decontamination workers per litter patient,who must have their clothing cut off, and one perambulatory patient, who can undress and decontaminatethemselves under supervision. If only oneor two patients need decontamination, it can be donewith a garden hose, buckets and sponges, or built-inshower. Larger numbers of casualties require moreefficient decontamination procedures. More specificsuggestions for personnel are found in Chapter 16,Decontamination of Chemical Casualties.In the Army and Navy (in support of USMC units),decontamination is carried out by nonmedical personnelfrom the supported military units who are supervisedby medical personnel. In Air Force and someNavy shipboard decontamination teams, all the teammembers come from the medical unit. These personnelwear OSHA level C PPE or the military equivalent. Iftheir garments are not completely water resistant, theyalso wear water repellent toxicological agent protectiveaprons to keep the protective overgarments dry andallow for apron decontamination before performingpatient lifts.The decontamination process usually takes up to 10to 20 minutes for a litter patient and 5 to 10 minutesfor an ambulatory patient, depending on the type ofdecontamination equipment and the team traininglevel. Plumbed equipment that dispenses soap andwater and roller systems for litter patients are moreefficient than the more labor-intensive processes usingminimal equipment such as buckets and sponges.A final check for thoroughness of contamination isoften incorporated at the end of the decontaminationprocess. This check is more critical when water-conservativemethods, such as washing with buckets andsponges, are used. In these situations, some areas of theskin might remain incompletely washed. Decontaminationequipment that incorporates a large volume but alow-pressure flow of water provides a more thoroughwash and can reduce the necessity for a final check.Warm water, and warm decontamination areas, aremore likely to ensure thorough patient compliance andminimize the development of patient hypothermia.Hot LineThe hot line is located at the end of the decontaminationline, before the clean area. At this point, all liquidcontamination has been removed from patients anddecontamination team (it is sometimes referred to asthe liquid control line). Patients are typically nude atthis point, and decontamination station workers haveremoved their protective overgarments. In the civiliansector, patients undergoing gross decontamination bya fire department might still have on their undergarments.If clean covering garments are available, victimsshould be strongly encouraged to doff their wetundergarments, which could hold agent, particularlyif exposed to liquid or potent aerosol. Patients enteringan MTF should be nude but covered by a hospitalgown, to insure that contamination does not enter thefacility and allow for patient privacy.Vapor Control LineThe vapor control line delineates the location whereno vapor hazard remains from clothing that has beenremoved in the decontamination area. Although notrequired for biological and radiological contamination,this line is critical for chemical contamination. Thevapor contol line is approximately 10 feet beyond thehot line as the patient proceeds toward the clean side.In the military, the air in this area may be monitoredby a stationary vapor monitor such as the automaticchemical agent detector alarm.505