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

Decontamination of Chemical Casualtiesbe purchased. Decontaminating one individual isestimated to take 10 gallons of water, so a 200-gallonwater bladder will become full sometime during thedecontamination of the 20th patient. Bladders in avariety of sizes are made by several manufacturers;some models are now available with handles that canbe lifted onto a truck. Site plans should include thestaging of additional bladders so that an empty bladderis always available when needed. Training waterdecontamination crews to turn off water sprayerswhen they are not needed will keep bladders fromfilling as quickly. Procedures for cleaning bladdersand disposing of waste material should be practiced.Written contracts should be made with hazardouswaste disposal agencies before an incident occurs.Handling PatientsWritings by Foroutan 65 and others 63,79 note the importanceof triage and treatment to stabilize patientsbefore they undergo more thorough decontamination.Medical facilities must also be prepared forwalk-in contaminated casualties who have bypassedemergency response teams. These patient triage andtreatment areas should be established at the frontof patient thorough decontamination operations.Decontamination can take time, typically from 10 to20 minutes for litter patients and at least 5 minutesfor ambulatory patients. In mass casualty situationsmedical personnel will be needed to manage patientsawaiting decontamination. Because patients can alsobecome medically unstable during decontamination,medical personnel are also needed to follow patientsthrough the decontamination line.Whether shelters, fixed facilities, or buckets andsponges are used, the thorough decontaminationprocess is similar: patient arrival, triage, medicalstabilization, securing of personal effects, clothingremoval, washing, checking for any remaining contamination(where dictated), crossing the hot line,drying and re-clothing or covering the patient, andfinally disposition of the patient to the medical treatmentarea on the clean side of the hot line. See Chapter14, Field Management of Chemical Casualties, formore information.Removal of contaminated IPE from patients shouldbe done by carefully cutting and rolling the ensembleaway from the patient’s underclothing and skin. Thisprocess helps to contain any agent on the garment andprevents cross contamination of the patient’s undergarmentsand now unprotected skin. If the patientis not wearing protective clothing, the containmentof contamination is not as critical, and the clothingshould be cut off as quickly as possible. During asuspected terrorist incident, clothing should be individuallybagged and labeled for forensic investigationby law enforcement agencies.Sharp, long-handled seat belt cutters (not listedin medical equipment sets) and bandage scissors areideal for quickly cutting off clothing and IPE; however,they typically become dull after cutting three to fivegarments, so operators should have a dozen or more ofeach cutter available (placed in a bucket of 5% bleach).To reduce the possibility of cross contamination, thecutting tools should be dipped into the bleach or exchangedafter every long cut.Additionally, litters used on the warm side shouldnot cross the hot line. Rather, the patient is transferredto a clean litter at the hot line, and the warm-side litteris cleaned and reused. This process further reducesany cross-contamination hazard. Medical informationshould be transferred from contaminated patienttriage cards to clean ones as the patient is movedacross the hot line. A variety of patient card systemsare available. In the battlefield, the military currentlyuses the field medical card (DD Form 1380).Night OperationsNight operations make patient triage, treatment,and decontamination more challenging. Floodlightsare not appropriate in a battlefield situation whereblackout conditions are imposed, but in a noncombatenvironment their use should be encouragedto enhance visibility. Also, fluorescent light sets areavailable for use inside decontamination shelters toimprove visibility.To reduce the incidence of accidents under lightrestrictedconditions, decontamination lanes shouldbe set up during daylight hours, if possible. The lanesshould be clearly marked with reflective tape or waisthigh,hanging chemical lights that glow in the dark.Lanes must be kept free from debris and should befamiliar to litter bearers. Effective traffic control andoff-load procedures are critical at the arrival point toprevent vehicles from hitting patients or operators.To help identify personnel, operators should havetheir names and job clearly marked on the front andback of their protective ensemble. If available, reflectivevests are ideal and serve to both enhance visibilityand identify personnel. Voice amplifiers or othercommunication devices fitted to protective masks willhelp communications. Adequate flashlights, with redlens filters, are essential for operators during tacticalscenarios.Night operations require careful planning and additionalresources; even in optimal weather conditionssuch operations pose great challenges. To minimize547