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

Medical Aspects of Chemical WarfareTriage and Treatment Area (Clean Side)The triage and treatment area (clean side) is partof the cold zone, located near the vapor controlline (OSHA refers to this area as the hospital postdecontaminationzone). The recently decontaminatedpatients are retriaged in this area, and waitfor processing into an ambulance, if this occurs at adecontamination station separate from an MTF, orto await movement into an MTF from an adjacentdecontamination station.Additional AreasOther areas that may be necessary, but not in allsituations, include the following:• contaminated waste dump to store contaminatedwaste until proper removal;• fresh and waste water bladders if decontaminationtent systems are used;• warm side disposition areas used by the military,where casualties in protective gear havebeen provided operational decontaminationand await dirty evacuation;• a warm side temporary morgue for storage ofthe contaminated remains of those who dieduring field management;• a warm side weapons and contaminatedpersonal affects storage area for storage andeventual disposition of patient items;• litter decontamination area for military decontaminationoperations with minimal equipment;• a warm side rest area for decontaminationcrews and medical team members;• a clean side supply point where medical anddecontamination supplies can be apportionedas necessary; and• a clean side disposition area for staging decontaminatedpatients for transport to anotherlocation.SUMMARYField management of chemical casualties involvesongoing triage, treatment, and patient movementthrough the medical system to obtain the most appropriatecare available given the situation and resources.Conducting field management in a chemicallycontaminated environment requires that medical anddecontamination personnel wear the equivalent ofOSHA level C protective ensemble for protection fromcontaminants on patients and hazardous vapors emittedby the contaminants.The military’s immediate medical response to achemical event on the battlefield is identical acrossthe services, using self and buddy aid. This responsediffers from the civilian response, because of lack oftraining in self-decontamination and treatment andlack of readily available resources. Unprotected militarypersonnel (without PPE and individual decontaminantsor antidotes) exposed to a chemical releasewould encounter some of the same challenges as thecivilian population.Civilian casualties unable to flee the scene of a chemicalrelease must wait until HAZMAT teams and firedepartments arrive on the scene. This initial responsetypically takes 10 minutes or longer, and victims maynot encounter a medical care provider for 30 minutesor more after their initial exposure. Typically medicaltreatment is not provided until after the victim hasundergone decontamination. This process is changingfor civilian medical responders, particularly in largermetropolitan communities; many fire departmentmedical responders wearing PPE are now preparedto provide early life saving medical triage and care tocontaminated casualties before decontamination. Thisalignment of civilian and military medical responseshould improve response capabilities and patient outcomesin the event of a mass casualty incident.Although the positioning of up-front medical carein the warm zone may differ, the process of patientdecontamination is similar for civilian and military.It includes the following: accounting for patientvaluables, clothing removal, washing, and movementacross the hot line; evidence recognition and properchain of custody procedures; recognition of secondaryexplosive devices; clean side triage and treatment;and patient disposition from the decontaminationsite. The procedures may vary slightly dependingon the decontamination platform (land vs sea) andtype of equipment used (eg, buckets and sponges vsrobust plumbed systems or designated permanentdecontamination facilities). Decontamination typicallytakes from 5 to 20 minutes, depending on the medicalcondition of the casualty, the type of decontaminationequipment, and the level of training of the decontaminationteam.506