Establishment and Operation of a Casualty Decontamination Station
The current battlefield features heavily armed and highly mobile units that have and will continue to utilize chemical weapons. The introduction of chemical weapons can cause rapid degradation of unit effectiveness because the personal chemical protective equipment (MOPP) reduces the acuity of all senses. Chemical agents have the capability to severely incapacitate and inflict numerous casualties on a unit. The medical specialist must understand the procedures for decontaminating a patient to promote the effectiveness of treatment of a chemical casualty while continuing to conserve the fighting strength. The information presented here will describe operations at either the battalion aid station (BAS) or the division treatment station (DTS).
The challenges of operating a casualty decontamination station are: working in MOPP gear, starting IV's and open contaminated wounds. Understanding procedures of decontamination will enable you to prevent degradation of unit, prevent severely incapacitated unit and limit number of casualties.
(1) Function - to receive patients from the ambulance and conduct triage
(2) Location - area located near the contaminated ambulance drop off point
(3) Description
(a) Senior medic oversees the unloading of the ambulances, performs triage, stabilizes patients, and provides treatment
(b) Personnel in MOPP level 4
(c) Ambulatory patients routed through a parallel decontamination line. Non-medical personnel is assigned to assist ambulatory patients with decon process
(4) Equipment
(a) M8 chemical detection paper
(b) M9 chemical detection paper
(c) Chemical agent monitor
(1) Function - to stabilize patients with life threatening injuries prior to decontamination
(2) Location - optional area, adjacent to the triage station
(3) Description
(a) Senior medic oversees the unloading of the ambulances, performs triage, stabilizes patients, and provides treatment
(b) Personnel in MOPP level 4
(c) Ambulatory patients routed through a parallel decontamination line. Non-medical personnel is assigned to assist ambulatory patients with decon process
(i) If CETA is used, a second medic (not senior) will perform patient treatment
(ii) Patient must be stabilized prior to being decon
(4) Equipment
(a) M8 chemical detection paper
(b) M9 chemical detection paper
(c) Chemical agent monitor
(d) Suction apparatus (battery operated and manual)
(e) Oxygen tank with a delivery system
(f) Airway adjuncts
(g) Resuscitator, hand operated
(h) Field dressing, cravats, and tourniquets
(i) Nerve agent antidote kits
(j) Atropine auto injectors
(k) Convulsant antidote nerve agent injectors
(l) IV supplies (Fluids, tubing, catheters, iodine pads, tape, constricting bands)
(1) Function - consists of a clothing removal station and a skin decontamination station
(a) Clothing removal station - removal of all clothing and equipment, except for protective mask, dressings, bandages, splints, and tourniquets
(i) Clothing and equipment are cut one layer at a time
(ii) After clothing has been removed, the litter patient is transferred to a decontamination litter via a three-person log roll
(b) Skin decontamination station - completely decontaminate the patient's skin and protective mask
(i) Decontaminate or replace medical items such as the protective mask, dressing, bandages, splints, and tourniquets
(ii) Calcium hypochlorite - 0.5% is used to decontaminate the skin and 5% is used for clothing and equipment
(2) Location - on "dirty" side of the "hot line"
(3) After skin decontamination, the patient is checked with M8 paper or the CAM, then moved to the shuffle pit
(4) Description
(a) All activities in this area are overseen by one medic
(b) Non-medical personnel are utilized to perform the functions in this area
(c) Areas must be set aside for the storage of decontamination litters and waste receptacles
(d) Personnel are dressed in MOPP level 4 and wear butyl rubber aprons over their battle dress overgarments to protect themselves from the patient's contamination
(5) Equipment
(a) Each station has two litter support stands
(b) Two personnel are assigned for each litter stand that is set up
(c) Two buckets - one with 0.5% chlorine (CI) solution for all skin decontamination and the other with 5% chlorine solution personal equipment
(d) One sponge per bucket
(e) A minimum of two pairs of 7.25" angled bandage scissors per station
(f) Chemical protective gloves for each soldier
(g) Butyl rubber apron for each soldier
(h) M8 chemical detection paper booklets
(1) Function - litter exchange from contaminated to uncontaminated side
(a) Patient is then retriaged by the senior medic of the clean side
(b) The field medical card is copied on the "clean" side, and the "dirty" one is destroyed
(2) Location - actual line between the clean treatment and the decontamination areas
(3) Description
(a) The medic located on the uncontaminated side supervises personnel at the shuffle pit
(b) Area is large enough so that both the litter bearers can completely stand within its boundaries. It is dissected in half by an imaginary line referred to as the "hot line"
(c) The hot line separates the dirty side from the clean side. Contaminated personnel and equipment are not allowed to cross the hot line
(d) The top 3-6 inches of the surface soil in the shuffle pit is mixed with super tropical bleach (STB), at the ratio of two parts STB to three parts soil
(4) Equipment
(a) Litter stands
(b) Super tropical bleach
(1) Function - consists of a clean treatment area and a collective protective shelter
(a) Clean treatment area - to re-triage casualties by the clean side medic
(b) Collective protective shelter (CPS) - MD/PA treats patients with serious injuries
(2) Location - between shuffle pit and evacuation area on the clean side
(3) Description
(a) Clean treatment area - treat the ambulatory patients with minor injuries and send them to disposition point for evacuation rearward or returned to duty
(b) Collective protective shelter (CPS)
(i) Patients are routed directly to the CPS from the shuffle pit if they have serious injuries
(ii) MD/PA located in CPS provide care
(iii) Patients enter and exit through an air lock so as to keep contamination out of the CPS. Personnel inside the CPS are in MOPP level 0. The CPS can be an open-air facility with overhead cover that is at least 45-50 meters upwind from the shuffle pit. Patients leaving the CPS will be in patient protective wrap
(4) Equipment - no special equipment required
(1) Function - patient waiting area for evacuation to rearward medical facility
(2) Location
(a) Area is placed under a cover which overlaps both the clean treatment area and the CPS
(b) The clean ambulance pickup point is located upwind of the evacuation/holding area
(3) Description - patient waiting area for evacuation
(4) Equipment - no special equipment required
(1) The senior medic performs triage on all the patients immediately upon arrival at the CDS
(2) All patients are screened with the chemical agent monitor to determine the following
(a) If an exposure to a chemical agent has occurred
(b) The type of chemical agent exposure
(3) Patients that are not contaminated are routed directly to the clean treatment area
(1) Immediate
(a) Patient has signs and symptoms of severe, life-threatening wounds or injuries without any chemical injuries
(b) Signs and symptoms may include - shock; burns on the face, neck, hands/feet, perineum, genitalia; obstructed airway; respiratory failure
(2) Chemical immediate
(a) Patient has signs and symptoms of life-threatening chemical injuries without any conventional injuries
(b) Signs and symptoms may include - labored breathing, coughing, vomiting, profuse sweating, weak pulse, and marked salivation
(3) Delayed
(a) Patients with conventional injuries that are not life-threatening. Also, they exhibit mild signs and symptoms of chemical agent poisoning
(b) Signs and symptoms may include - severe eye injuries, open wounds to the chest without respiratory distress, open/penetrating abdominal injuries without shock, open wounds/fractures, and second/third degree burns over 20% of the body
(4) Minimal
(a) Patient has no signs and symptoms of chemical agent poisoning, but they do have minor conventional injuries
(b) Following are examples of patients in this category - sprains, strains, closed fractures, minor lacerations and contusions, minor combat stress, individuals that only require treatment by the medic, individuals that can be returned to duty within 48-72 hours, and individuals that can receive full treatment at CDS
(a) Patients whose injuries are so extensive that even if they were the only casualty and had the benefit of intensive and thorough medical treatment, their survival would still be unlikely
(b) Examples of these types of injuries would be - Massive head injuries with signs of impending death, second/third degree burns over more than 85% of the body, cardiac arrest patients (unless personnel resources are available to assist them), and patients with both severe chemical agent poisoning and conventional life-threatening injuries
SUMMARY
As the medical specialist, you will be responsible for directing patient decontamination procedures. It is important for you to both understand and follow the proper methods for running a CDS in order to prevent the further contamination of the patient, yourself, and fellow personnel who will be working with you. The care of contaminated casualties, although more complicated than the care of conventional casualties, must not stop the ongoing medical mission.