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

Medical Aspects of Chemical Warfareto heat. Effective measures include enforcing work–rest cycles; providing shaded work and rest areas;reducing the amount of protective ensemble worn (eg,wearing level C during decontamination operations oronly respiratory protection if the principal chemicalhazard is vapor); and maintaining adequate suppliesof potable water and encouraging its consumption bydecontamination team members.A safety officer must be appointed whose primaryduty during decontamination operations is to monitorthe health status of decontamination team members inIPE. This individual enforces safe patient lifting techniques,insures the decontamination area is free fromdebris that can cause a tripping hazard, manages teammember work–rest cycles, stays abreast of temperatureconditions, and insures that adequate fluids are availableand used by decontamination team members.Occupational Safety and Health Administration(OSHA) first receiver guidance suggests that medicalmonitoring of decontamination personnel should beconducted before protective ensemble is donned orsoon after, during rest breaks in the warm area, andafter decontamination operations. These measuresare particularly important when temperatures in thework area exceed 70°F (21°C). Monitoring may not bepractical on the battlefield or in the fast-paced masscasualty environment; however, it is a useful measureto prevent heat injury during training and should beTABLE 16-4American Heart Association recommendedvalues for safe cardiovascularfunctionFunctionBlood pressure (max)Pulse rate (max)Temperaturebpm: beats per minuteValue140 bpm systolic / 100 bpmdiastolic100 bpmmin: 98.0°F (36.6°C)max: 99.2°F (37.3°C) or +/- 0.6°F(1.08°C) from normalintegrated into exercises when feasible. The AmericanHeart Association–recommended safe limits are notedin Table 16-4. Automated wrist cuffs are now availablethat make ongoing blood pressure monitoring ofworkers in IPE much easier. Readings taken throughIPE, however, may not be accurate. Individuals withelevated readings who are not under work or anxietyduress should receive particular attention. 44In the field, a more practical way to reduce bothheat and musculoskeletal injury is to distribute theEXHIBIT 16-3Occupational Safety and Health Administration LEVELS OF PERSONAL PROTEC-TIVE EQUIPMENTLevel ALevel BLevel CLevel DProvides the greatest level of skin and respiratory protection. Level A consists of a totally encapsulatingsuit with gloves and boots attached. A self-contained breathing apparatus (SCBA) is worn inside the suit,or a supplied-air system (with escape SCBA) is used for respiratory protection.Used when the highest level of respiratory protection is necessary, but a lesser level of skin and eye protectionis needed. This level consists of nonencapsulating, chemical-resistant suits, often called splash suitsor rain suits. The SCBA or a supplied-air system is worn either inside or outside the suit, depending onthe configuration.Worn when the concentration and type of airborne substance is known and the criteria for using air purifyingrespirators are met. The level C ensemble consists of a full facepiece, an air-purifying respirator,and a chemical agent-resistant suit. Military MOPP 4 is similar to level C. Level C is the preferred IPE fordecontamination operators (first receivers).A work uniform affording minimal protection. The military battle dress uniform, Army combat uniform,or coveralls meet the requirements for level D protection.IPE: individual protective ensembleMOPP: mission-oriented protective postureSCBA: self-contained breathing apparatusAdapted from: US Departments of the Army, Marine Corps, Navy, and Air Force, and Marine Corps. Multiservice Tactics and Procedures forNuclear, Biological, and Chemical (NBC) Protection. Washington, DC: DoD; 2003. FM 3-11.4, MCWP 3-37.2, NTTP 3-11.27, AFTTP (I) 3-2.46.542