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

Medical Aspects of Chemical Warfarewearing a butyl rubber toxicological agent protectiveapron over IPE or wearing IPE that is impermeableto water (eg, Tyvek F [DuPont, Wilmington, Del]).These impermeable garments, however, increasethe heat load on the worker. Protective aprons serveseveral purposes: they allow team members to easilydecontaminate themselves between patients, keepundergarments free from contaminated moisture, andallow workers the option to remove this layer and moreeasily cool themselves in a rest area.Military decontamination team members may wearthe standard military M40 series, MCU2P, or new jointservice general-purpose mask (see Chapter 17, ChemicalDefense Equipment, for more information). An alternativeis to wear a powered-air purifying respirator,which has a blower motor that pulls air through filtersand into the mask hood (Figure 16-4). The circulatedair blown into the mask hood helps keep the wearercool, eliminates the effort to inhale air through filters,and reduces carbon dioxide buildup in the mask duringheavy work. Produced by several companies, thesemasks must be rated at a protective factor of 1,000, perOSHA first receiver guidance, and should be approvedby the National Institute of Occupational Safety andHealth. 44 OSHA also dictates that all individuals mustbe medically cleared to wear full-face protective masksand equipment. 73 A variety of voice amplifiers that fitto the mask, throat or voice-activated microphones thatwork with head-mounted radios, and other types ofcommunications systems that improve communicationwith mask use are available on the market.Transport EquipmentOnly litters or backboards made of plastic materialthat can be readily and thoroughly decontaminatedshould be used to hold contaminated patients. Clothlitters will hold agent, cannot be decontaminated effectively,and rapidly deteriorate when decontaminatedwith bleach solution.Detection DevicesDetectors and monitors can be used at the arrivalpoint, to assess which patients require decontamination,or after the decontamination process, to check forthoroughness of decontamination. In some instancesthe thoroughness of the decontamination process maymake detectors less necessary (for example, whenplumbed tent systems are used and ample suppliesof soapy water and rinse water are available). Theuse of detectors is dictated by unit operating plansand specific service concepts of operation and tactics,techniques, and procedures.Currently fielded chemical warfare agent detectionand monitoring equipment does not identify all possibleCWAs or toxic industrial chemicals (see Chapter17, Chemical Defense Equipment for more detail).Existing military chemical detectors that can be usefulduring patient decontamination operations include M8chemical detector paper, M9 chemical detector paper,the ICAM, the M22 automatic chemical agent detectoralarm, and the HAPSITE Smart Chemical IdentificationSystem (INFICON, East Syracuse, NY). 55Decontamination SheltersDecontamination equipment varies from the simpleuse of buckets and sponges, or the use of fire trucks tospray down victims, to the more complex deploymentof pop-up shelters or patient decontamination systemsbuilt on existing medical facilities. The variety of decontaminationequipment has dramatically expandedsince the terrorist events of September 11, 2001. Mostdecontamination systems use soap and water as theprimary decontaminant. Some examples are shownin Figures 16-5 through 16-7. Shelters differ in construction,method of erection, plumbing, and systemfor moving litters. All of these factors can impact onoverall system weight, durability, ease of set-up andtear down, and shelter footprint.Decontamination shelters are useful for a variety ofreasons. They protect decontamination workers andpatients from wind and poor weather conditions, aswell as providing privacy for patients during the decontaminationprocess. Shelters provide a frameworkto support built-in plumbing, which makes set-upand processing of patients faster and easier than usingbuckets and sponges. Some degree of water pressure isnecessary to operate the systems. Each system requirementis different, but the ideal system incorporates ahigh volume of water at low pressure. 2 Air and waterheaters should be added to improve patient comfort.Roller systems can be incorporated to more rapidlyprocess litter patients while reducing the incidenceof musculoskeletal injuries among decontaminationworkers. Roller systems also reduce the number ofworkers necessary to perform decontamination procedures.A crew of 12 is recommended by the Air Forcefor decontamination shelter operations, but the processcan be performed with a staff (not including medicalpersonnel) of four individuals for the litter line, onefor the ambulatory line, and two for the clean (cold)side of the hot line (or liquid control line). 74,75 Moreindividuals, encompassing several shifts, are neededto insure adequate rest cycles to reduce injury to decontaminationoperators. A variety of roller systemsthat differ in weight, ease of portability, and ease of544