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

Medical Aspects of Chemical Warfaretion operations near an incident site, pop-up sheltersor covered configurations of fire trucks that allow forprivacy and some protection from the elements arepreferred.ESTABLISHING A PATIENT THOROUGH DECONTAMINATION AREAPatient thorough decontamination areas are establishedin locations considered to be free fromcontamination. Once contaminated patients arrive,these areas become designated as warm areas becauselow levels of dry, liquid, and vapor contaminationmay be brought in on the clothing, equipment, hair,and skin of patients admitted to the area. The directhazard to workers is much reduced compared to thehot zone, but decontamination team members mustwear protective ensemble because vapors and particles,even in small amounts, pose a hazard to thoseworking directly with the contaminated patients. Formore information on zones of contamination and therelationship of the decontamination area to triage andtreatment areas see Chapter 14, Field Management ofChemical Casualties.Water ConcernsDecontamination operations may use dry decontaminants,such as the M291 kit or diatomaceous earth;prepackaged wet decontaminants such as RSDL; soapand water; or chemical decontaminants such as 0.5%hypochlorite solutions. Critical to operations usingsoap and water is the availability of an adequatesupply of water and a way to collect waste waterrun-off. Water trucks or water buffalos are neededfor locations where water is scarce and fire hydrantsare not available. In an urban setting, such as thecivil response to a homeland incident, ample wateris usually available through access to fire hydrants.Water is typically, however, not easily available in abattlefield situation.If casualties are wearing full MOPP ensemble, as ina battlefield environment, the need for a comprehensivewashing of the whole body is reduced, becausemuch of the body is protected by the IPE. Casualtieswithout protective clothing will have greater dermalexposure, because liquid chemical agents penetrateregular clothing, and subsequently will usually requirewashing of the whole body.The disposition of waste water is an issue both onthe battlefield and during homeland operations. Failureto contain contaminated waste water will pollutean area and prevent its later use. Federal regulationsthat apply to homeland operations in emergency situationsallow for water run-off, as long as the actionis not performed intentionally as a way of ignoringwaste disposal regulations. Environmental ProtectionAgency regulation 550-F-00-009, 77 which addressesfirst responder liability to mass decontaminationrun-off, considers the release of chemical or biologicalwarfare agents from a terrorist event to be the sameas a HAZMAT event and therefore covered under theComprehensive Environmental Response, Compensation,and Liability Act of 1980, section 107. 77 Thisact notes that under the good Samaritan provision,which would apply to emergency response HAZMAToperations, “No person shall be liable under this subchapter for costs or damages as a result of actionstaken or omitted in the course of rendering care, assistance,or advice in accordance with the NationalContingency Plan or at the direction of an on-scenecoordination with respect to an incident creating adanger to public health or welfare or the environmentas a result of any release of a hazardous substance orthe threat thereof.” 77The decontamination of patients with largeamounts of water is expected to result in waste waterrun-off containing a minimal concentration ofchemical agent. 78 Currently most response agencieshave received funding to purchase adequate decontaminationequipment, which would include the useof waste water containment systems. In the UnitedStates in particular, failure to use these systems couldbe seen as negligence, if a response agency washedcontamination down a sewer as an alternative toavoiding the extra costly and sometimes problematiceffort of appropriate waste water collection anddisposal using containment berms and bladders.The provisions cited above do not protect an agencyagainst failing to develop a plan for collection anddisposal of contaminated water during an incident.Plans may be overcome by events, but if no plansexist, a unit could be liable for damages. Even whenprotected by the Comprehensive Environmental Response,Compensation, and Liability Act, agencies canstill be sued by state agencies, private agencies, andprivate individuals or groups. Tort reform is differentin each state, so it is important for response agenciesto participate in their local area planning committeeearly to work out these issues in writing. 77 It is criticalthat military units responding to homeland eventsfollow these guidelines.Training exercises should be used to determine thenumber of waste water bladders needed for expectedmass casualty decontamination operations. If bladdersare filling during exercises, additional ones should546