M C2004000 1197 U.S.

ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL AMEDD NONCOMMISSIONED OFFICER ACADEMY 91B TECHNICAL TRAINING Establishment and Operation of a Casualty Decontamination Station (4 periods) COURSE PRESENTED TO: 6-8-C40 (91B), Basic Noncommissioned Officer Course (91B Technical Training). PLACE: Classroom.

REFERENCES: FM 8-10-7, Health Service Support in a Nuclear, Biological, and Chemical Environment. 22 April 1993. FM 8-285, Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries. April 1990. Medical Management of Chemical Casualties NCO Handbook. USAMRICD. Aberdeen Proving Ground, MD, September 1994. RELATED SOLDIER'S MANUAL/CRITICAL TASK(S): 081-833-0082, 081-833-0093, 081-833-0095. STUDY ASSIGNMENT: Read mimeo prior to class. STUDENT UNIFORM AND EQUIPMENT: Duty uniform. TOOLS, EQUIPMENT, AND MATERIALS: Annex C PERSONNEL: 91B/91C instructor and assistant instructor. INSTRUCTIONAL AIDS: Establishment and Operation of a Casualty Decontamination Station (see Annex A), Triage and Treatment of a Casualty on an Integrated Battlefield (see Annex B). 081-833-0094,

TROOP REQUIREMENTS: None. TRANSPORTATION REQUIREMENTS: RISK ASSESSMENT LEVEL: Low. None.

SAFETY REQUIREMENTS: None. METHOD OF INSTRUCTION: Practical Exercise (2 periods). I. INTRODUCTION (5 min). 1. Opening Statement: 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

LP 2004000 1197 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). B. Objectives. 1. Terminal Learning Objective. Given a scenario, establish and operate a casualty decontamination station IAW cited references. 2. Enabling Learning Objectives. None

C. Class Procedure and Lesson Tie-in: This is the last class you will receive on NBC. Here you will combine all the information from the previous four classes as the patient is decontaminated and processed further for more extensive medical treatment. II. PRACTICAL EXERCISE (230 min).

A. Casualty Decontamination Station Components (Figure 1) 1. Triage station. a. Function--to receive patients from the ambulance and conduct triage. 2

LP 2004000 1197 b. c. Location--area located near the contaminated ambulance drop off point. Description. (1) Senior medic oversees the unloading of the ambulances, performs triage, stabilizes patients, and provides treatment.

(2) Personnel in MOPP level 4 (Figure 2). (3) Ambulatory patients routed through a parallel decontamination line. Non-medic is assigned to assist ambulatory patients with decon process. d. Equipment. (1) M8 Chemical Detection Paper (Figure 3). (2) M9 Chemical Detection Paper (Figure 4).

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(3) Chemical Agent Monitor (CAM). 2. Contaminated emergency treatment area (CETA). a. b. c. Function--to stabilize patients with life threatening injuries prior to decontamination. Location--optional area, adjacent to the triage station. Description. (1) If the CETA is used, a second medic (not the senior medic) will perform patient treatment. (2) Patient must be stabilized prior to being decontaminated. The decontamination process takes approximately 20 minutes per patient to complete. Once started, there will be no available medical personnel to perform stabilization functions. d. Equipment. (1) Suction apparatus (battery operated and manual). (2) Oxygen tank with a delivery system. (3) Field dressing, cravats, and tourniquets. (4) Nerve agent antidote kits (MARK I NAAK). (5) Convulsant antidote nerve agent injectors (CANA). (6) IV supplies. 3. Decontamination area. 4

LP 2004000 1197 a. Function--consists of a clothing removal station and a skin decontamination station. (1) Clothing removal station--removal of all clothing and equipment, except for protective mask, dressings, bandages, splints, and tourniquets. Clothing and equipment are cut one layer at a time. NOTE: After clothing has been removed, the patient is transferred to a decontamination litter via a three person log roll. (2) Skin decontamination station--completely decontaminate the patient's skin and protective mask. Decontaminate or replace medical items such as the protective mask, dressing, bandages, splints, and tourniquets. NOTE: Calcium hypochlorite: 0.5% is used to decontaminate the skin at 5% is used for clothing and equipment. b. Location--on "dirty" side of the "hotline".

NOTE: After skin decontamination, the patient is checked with M8 paper or the CAM, then moved to the shuffle pit. c. Description. (1) All activities in this area are overseen by one medic. (2) Non-medical augmentees are utilized to perform the functions in this area. (3) Areas must be set aside for the storage of decontamination litters and waste receptacles. (4) 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. d. Equipment. (1) Each station has two litter stands. NOTE: Two personnel are assigned for each litter stand that is set up. (2) Two buckets - one with 0.5% and the other with 5% calcium hypochlorite. (3) One sponge per bucket. (4) A minimum of two pairs of scissors per station. 4. Shuffle pit. a. Function--litter exchange from contaminated to uncontaminated side. Patient is then retriaged by the senior medic of the clean side.

LP 2004000 1197 NOTE: The field medical card is copied on the "clean" side, and the "dirty" one is destroyed. b. c. Location--actual line between the Clean Treatment and the Decontamination areas. Description. (1) The medic located on the uncontaminated side supervises personnel at the shuffle pit. (2) 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 "hotline." (3) The hotline separates the dirty side from the clean side. Contaminated personnel and equipment are not allowed to cross the hotline. (4) 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. d. Equipment. (1) Litter stands. (2) Super Tropical Bleach. 5. Treatment area. a. Function--consists of a clean treatment area and a collective protective shelter. (1) Clean treatment area--to re-triage casualties by the clean side medic. (2) Collective protective shelter (CPS)--physician treats patients with serious injuries. b. c. Location--between shuffle pit and evacuation area on the clean side. Description. (1) Clean treatment area--treat the ambulatory patients with minor injuries and send them to disposition point for evacuation rearward or returned to duty. (2) Collective protective shelter. (a) Patients are routed directly to the CPS from the shuffle pit if they have serious injuries. (b) Physician or physician's assistant located in CPS provide care. (c) 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.

LP 2004000 1197 d. 6. Equipment--no special equipment required.

Evacuation/holding area. a. b. Function--patient waiting area for evacuation to rearward medical facility. Location. (1) Area is placed under a cover which overlaps both the clean treatment area and the CPS. (2) The clean ambulance pick-up point is located upwind of the evacuation/holding area. c. d. Description--patient waiting area for evacuation. Equipment--no special equipment required.

Objective 2. Given a scenario, select the considerations and correct triage categories for casualties at a casualty decontamination station (CDS) IAW cited references. B. Triage Considerations and Categories. NOTE: Refers soldiers to Annex B and inform them that this process would occur prior to arrival at the CDS. 1. Triage considerations. a. b. The senior medic performs triage on all the patients immediately upon arrival at the CDS. All patients are screened with the chemical agent monitor (CAM) to determine the following: (1) If an exposure to a chemical agent has occurred. (2) The type of chemical agent exposure. NOTE: Patients that are not contaminated are routed directly to the clean treatment area. 2. Triage categories. a. Immediate. (1) Patient has signs and symptoms of severe, life-threatening wounds or injuries without any chemical injuries. (2) Signs and symptoms may include: shock; burns on the face, neck, hands/feet, perineum, genitalia; obstructed airway; respiratory failure. b. Chemical immediate.

LP 2004000 1197 (1) Patient has signs and symptoms of life-threatening chemical injuries without any conventional injuries. (2) Signs and symptoms may include: labored breathing, coughing, vomiting, profuse sweating, weak pulse, and marked salivation. c. Delayed. (1) Patients with conventional injuries that are not life-threatening. Also, they exhibit mild signs and symptoms of chemical agent poisoning. (2) 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. d. Minimal. (1) Patient has no signs and symptoms of chemical agent poisoning, but they do have minor conventional injuries. (2) 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. Expectant. (1) 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. (2) 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. C. Questions from Students. III. SUMMARY (5 min). A. Review of Main Points. 1. 2. Casualty decontamination station components. Triage considerations and categories.

e.

B. Closing Statement: 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.

LP 2004000 1197 ANNEX A Establishment and Operation of a Casualty Decontamination Station ELEMENT: TREATMENT SQUADS/TREATMENT TEAM TASK: Treat NBC-Contaminated Casualties (7-3-1602) (FM 3-100) (FM 3-3) (FM 3-4) (FM 3-5) (FM 8-230) (FM 8-9) M 2004000 1197

ITERATION TRAINING STATUS

2 T

3 P

4 U

(circle) (circle)

CONDITION: The battalion aid station received a warning order from the battalion HQ to prepare for treatment/decontamination of NBC casualties with an ETA of 30 minutes. A treatment/decontamination area outside the battalion aid station area was previously identified in the layout plan and is being established to receive the casualties. Protective equipment and NBC supplies, to include antidotes, are available. Personnel have been ordered to the appropriate MOPP level by the battalion commander. The battalion NBC team is prepared to assist with monitoring/screening nuclear and chemical casualties for contamination. A helicopter landing area for NBC casualties and an ambulance/contaminated vehicle turnaround point has been identified. A hot line has been constructed. This task is performed in all environmental conditions. The battalion aid station is subject to NBC attack or radiological fallout. TASK STANDARD: 1. The treatment squad/team establishes NBC treatment/decontamination area prior to the arrival of casualties. 2. The treatment squad/team decontaminates patients and provides treatment IAW appropriate reference publications, tactical SOP, and existing capabilities of the battalion aid station. 3. The treatment squad/team clearly marks as contaminated those casualties who receive partial decontamination prior to their evacuation to the supporting medical company. TASK STEPS and PERFORMANCE MEASURES +1. Treatment squad/team establishes treatment/decontamination area. a. Positions equipment. b. c. d. e. f. Establishes dirty helicopter landing area. Marks contaminated ambulance/vehicle turnaround point. Marks hot line. Posts warning markers. Designates personnel for specific functions to perform during the treatment/decontamination process. GO NO GO

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LP 2004000 1197 g. h. Designates collection point for contaminated waste. Notifies platoon HQ when area is operational.

+2. Treatment squad/team treats/decontaminates nuclear-contaminated casualties. a. b. c. d. e. f. g. h. i. j. k. Triages all patients to determine extent of injuries/contamination. Initiates/updates FMC. Surveys all patients with AN/PDR-27 to determine level of radiation contamination. Discards contaminated articles into designated containers. Decontaminates patients with soap and water IAW TM 8-215. Treats traumatic injuries. Treats radiation sickness symptomatically. Coordinates additional ground ambulance evacuation support through battalion S3, with supporting medical company. Requests/coordinates for air evacuation support through battalion S3 with supporting DISCOM. Evacuates patients, as required. Coordinates all RTDs with battalion S1.

*3. Treatment squad/team treats/decontaminates chemically contaminated casualties. a. Triages all patients to determine level of agent poisoning injury. b. Identifies chemical agent. c. Administers antidotes as required. d. Treats/decontaminates patients IAW FM 8-285. e. Initiates/updates FMC. f. Discards contaminated articles into designated container. g. Coordinates additional ground ambulance evacuation support through battalion S3, with supporting medical company. h. Requests/coordinates for air evacuation support though battalion S3 with supporting DISCOM. i. Evacuates patients, as required. j. Coordinates all RTDs with battalion S1. +4. Treatment squad/team treats biologically contaminated casualties.

A-2

LP 2004000 1197 a. Triages patients to determine severity of illness. b. Initiates/updates FMC. c. Treats patients symptomatically until agent is identified. d. Forwards NBC 6 report to the battalion HQ. e. Coordinates with supporting medical company for preventive medicine support. f. Forwards specimen as directed to area support laboratory. g. Isolates contaminated patients. h. Coordinates additional ground ambulance evacuation support through battalion S3, with supporting medical company. i. Requests/coordinates for air evacuation support through battalion S3 with supporting DISCOM. j. Evacuates patients, as required. k. Coordinates all RTDs with battalion S1. +5. Treatment squad/team prepares to resume non-NBC operations. a. Coordinates with battalion HQ for deliberate decontamination. b. Disestablishes decontamination/treatment site. c. Decontaminates treatment/decontamination personnel IAW tactical SOP. d. Requests replacement of equipment and medical supplies, as required. e. Reports location of contaminated area to battalion headquarters. NOTE * Indicates a leader task. NOTE + Indicates a critical task. TASK PERFORMANCE SUMMARY BLOCK ITERATION TOTAL TASK STEPS & PERFORMANCE MEASURES EVALUATED TOTAL TASK STEPS & PERFORMANCE MEASURES "GO" SUPPORTING OFFICER'S TASKS 03-8310.00-8002 SUPPORTING SOLDIER'S MANUAL TASKS 081-831-0033 INITIATE A FIELD MEDICAL CARD 081-831-0047 EVALUATE A PATIENT A-3 1 2 3 4 5 TOTAL

LP 2004000 1197 081-833-0082 081-833-0083 081-833-0084 081-833-0085 081-833-0086 TRIAGE CASUALTIES ON AN INTEGRATED BATTLEFIELD TREAT A NERVE AGENT CASUALTY IN THE FIELD TREAT A BLOOD AGENT (CYANIDE) CASUALTY IN THE FIELD TREAT A CHOKING AGENT CASUALTY IN THE FIELD TREAT A BLISTER AGENT CASUALTY (MUSTARD, LEWISITE, PHOSGENE OXIME) IN THE FIELD

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ANNEX B INSTRUCTIONAL AIDS

M 2004000 1197

Triage and Treatment of a Casualty on an Integrated Battlefield A. Survey a Casualty. 1. 2. Survey casualty for conventional injuries. Survey casualty for signs and symptoms of chemical agent poisoning. a. Determine if the casualty responds to commands. (1) (2) b. B. Observe whether or not the casualty responds to simple directions (e.g., hold up your right hand). Ask casualty to describe symptoms.

Check for symptoms of chemical agent poisoning.

Establish Priorities for Treatment.

NOTE: Treatment categories are explained under the section "Route a Casualty through the Casualty Decontamination Station" in the text of the lesson. 1. 2. 3. 4. 5. C. Immediate. Chemical immediate. Delayed. Minimal. Expectant.

Initiate Treatment. 1. 2. 3. Treat in order of triage priority. First, treat the chemical agent poisoning and second, the conventional injuries a patient exhibits. Utilize patients with minor injuries and minimal chemical exposure as assistants for the severely injured patients.

4. E.

Record Observations and Treatment on the Field Medical Card. Evacuate Patient for More Definitive Care.

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ANNEX C Equipment List Name 1. *Medical Equipment Set Chemical Agent Patient Decontamination *Medical Equipment Set Chemical Agent Patient Treatment Tent, GP small Camouflage system Medical Equipment Set Trauma Field NSN Quantity

6545-01-176-4612

2.

6545-01-176-9469 8340-00-470-1616 1080-00-108-1173 6545-01-191-8972 B-2 1 2 1

3. 4. 5.

LP 2004000 1197 6. Surgical Instrument & Supply Set (M17 Aid Bag with Class VIII)

6545-01-141-9470

* End items are attached to this annex

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1 MEDICAL EQUIP. SET CHEM AGENTS PT DECON Item Description AAC BAG PLASTIC POLYOLEFIN .00801N SINGLE WALL65X5 0G PENCIL BLACK 6.251N LONG ROUND EXTRA THICK GLAZEG CALCIUM HYPOCHLORITE 60Z D APRON TOXICOLOGICAL AGENTS PROTECTIVE: CTN CLOTHD APRON TOXICOLOGICAL AGENTS PROTECTIVE: CTN CLOTHD APRON TOXICOLOGICAL AGENTS PROTECTIVE: CTN CLOTHD PLASTIC SHEET POLYTHYLENE 12001N LONGX192 IN WIDG SUPPORT LITTER FOLDING LIGHTWEIGHT 31.50 INCHES D PAIL UTILITY CORROSION RESISTING STEEL 12 QT 12 D SPONGE CELLULOSE RECTANGULAR 6.25LONG 4.250W 2G CHEST MEDICAL INSTRUMENT AND SUPPLY SET: FLD NO D CHEST MEDICAL INSTRUMENT & SUPPLY SET ALUMINUM ND SCISSORS BANDAGE 7.25 LG ANG TO HDL 1.50 CUT LD GLOVE SET CHEMICAL PROTECTIVE MENS 1 PR SIZE SMAD GLOVE SET CHEMICAL PROTECTIVE MENS 1 PR SIZE MEDD GLOVE SET CHEMICAL PROTECTIVE MENS 1 PR SIZE LARD GLOVE INSERTS CHEM PROTECTIVE MAN&WOMAN WHITE 13D GLOVE INSERTS CHEM PROTECTIVE MAN&WOMAN WHITE COD PAPER CHEMICAL AGEN D DECONTAMINATING KIT SKIN D SYRINGE HYPO GP 50-6OML CAP LUER LOCK TIP W/O NDY UI RO DZ BT EA SA EA RO PR EA EA EA EA EA SE SE SE PR PR RO BX PG

PEC NSN 8105-00-191-3902 7510-00-240-1526 6810-00-255-0471 8415-00-281-7813 8415-00-281-7814 8415-00-281-7815 8135-00-618-1783 6530-00-660-0034 7240-00-773-0975 7920-00-884-1115 6545-00-914-3490 6545-00-914-3510 6515-00-935-7138 8415-01-033-3517 8415-01-033-3518 8415-01-033-3519 8415-01-138-2494 8415-01-138-2495 6665-01-226-5589 6850-01-276-1905 6515-01-280-2320

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MEDICAL EQUIP. SET CHEMICAL AGENT PT TX PEC NSN Item Description AAC UI 6515-00-687-8052 AIRWAY PHARYNGEAL BERMAN DSGN LARGE ADULT 100MM D BX 6515-00-754-0412 SYRINGE HYPO GP 1OML CAP LUER SLIP W/O NDL CONCED PG 6515-00-754-2834 NEEDLE HYPO C13A GP 18GA 1.438-1.562 LG LIJER LOD PG 6545-00-914-3490 CHEST MEDICAL INSTRUMENT AND SUPPLY SET: FLD NO D BA 6505-00-926-1440 ATROPINE SULFATE OPHTHALMIC OINTMENT USP 1% 1/BO L PG 6505-00-926-9083 ATROPINE INJECTION AQUEOUS TYPE 0.7ML SYRINGE WIA EA 6515-00-958-2232 AIRWAY PHARYNGEAL BERMAN DESIGN CHILD SIZE 80MM D BX 8465-01-079-9875 BAG,CASTJALTY,CHEMICAL PROTECTIVE Y EA 6505-01-125-3248 PRALIDOXIME CHLORIDE INJECTION 300MG/ML 2ML AUTO A EA 8415-01-138-2503 GLOVES CHEMICAL PROTECTIVE RUBBER LARGE BLACK 14 D PR 6505-01-206-6009 SODIUM NITRITE INJECTION USP 300MG 1OML AMPUL 5 X PG 6505-01-274-0951 DIAZEPAM INJECTION USP 5MG/ML 2ML SYRINGE-NEEDLEA BA 6515-01-280-2320 SYRINGE HYPO GP 50-6OML CAP LUER LOCK TIP W/O NDY PG 6515-01-284-8704 SUCTION APPAR OROPHARYNGEAL TRACHEAL PORTABLE BAW EA 6505-01-332-1281 ATROPINE SULFATE INHALATION AEROSOL 240 ACTUATIOD PG 6505-01-334-8781 SODIUM THIOSULFATE INJECTION USP 5OML AMPUL 20 AL PG 6515-01-338-6602 RESUSCITATOR HAND OPERATED HAND PUMP PORTABLE INL BA 6515-01-339-0628 ADMINISTRATION SET WINGED SCAM VEIN PED 23GAXO. D PG

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