5-15. General
Dental service support is provided in the AO at Levels II, III,
and IV. Because of their location close to main supply routes
and other support assets, dental units are vulnerable to an NBC
strike. Nuclear, biological, and chemical operations have an impact
at all levels; thus, dental units must be prepared to survive on
the integrated battlefield. Defense against NBC weapons must be
included in the dental unit's TSOP. Individual and collective tasks
must be intensely trained on a regular basis; survival depends on
the ability of personnel to use basic survival skills against an
NBC attack. For details on provision of dental services, see FM
4-02.19.
5-16. Mission in a Nuclear, Biological, or Chemical Environment
The overall mission of dental units to provide dental services is
greatly affected in the aftermath of an NBC attack. First, the
unit must survive the attack and rapidly recover from its effects.
Secondly, in the event of mass casualties, the dental patient care
effort must be redirected from dental treatment to the alternate
wartime role of augmenting the adjacent MTF. Dental units do
not possess CPS; therefore, providing dental services in an NBC
environment will be limited to the treatment of maxillofacial
emergencies requiring immediate attention. This care will be
provided at an MTF with a CPS.
5-17. Dental Treatment Operations
As a general rule, in the aftermath of an NBC attack, dental
treatment operations cease until deliberate decontamination of the
unit and its equipment has been accomplished. Only maxillofacial
injuries of an immediate life-threatening nature should be
considered for treatment. After an attack, the resources of the
dental treatment facility (DTF) are redirected toward support
of any mass casualty situation that may have been generated at
an adjacent MTF, or toward decontamination and relocation to a
noncontaminated area.
5-18. Patient Treatment Considerations
The only category of dental treatment appropriate in an NBC
environment is emergency; and then, only those emergencies of an
extreme nature which demand immediate attention. The most likely
condition requiring such attention would be maxillofacial trauma
and would most likely be treated at an MTF rather than a DTF.
Although the likelihood of a requirement to treat dental patients
in an NBC environment is extremely low, DTFs must have a plan in
the event that such patients do present.
_a._ _Patient Decontamination._ Decontamination of patients, dental
patients included, is an absolute requirement before admission into
a clean MTF. Contaminated patients are triaged and decontaminated
before treatment (except for life- or limb-saving care). Both
triage and decontamination should be accomplished as far forward
as possible. Specific details on patient decontamination are
in Appendix G. It is important to note that normally patient
decontamination is not performed by medical or dental personnel.
Initial decontamination at the basic skill level is accomplished
at the casualty's unit. Detailed patient decontamination is
accomplished by the patient decontamination teams (made up of
nonmedical personnel from the supported units) that are supervised
by medical personnel at the MTF.
_b._ _Patient Decontamination at Dental Treatment Facilities._
Neither dental units nor their DTFs are equipped for patient
decontamination. Any contaminated patients arriving at a DTF
requiring urgent attention must be directed or evacuated to the
nearest MTF with a patient decontamination capability.
5-19. Patient Protection
Dental treatment facilities must also consider the need to protect
patients in their care in the event of an NBC attack, or when the
threat of an attack is high. Special consideration must be made for
maxillofacial patients whose condition prevents them from wearing
their protective mask.
_a._ _Immediate Response._ In the event of an attack or when the
alarm sounds, dental treatment providers immediately cease work and
mask. The patients should do likewise. Only after putting on their
own masks, do the dental treatment providers assist the patient,
if necessary, by removing materials that impede the patient's
masking. Only those materials that impede masking or may compromise
the airway (such as rubber dam frames or impressions) are removed,
the rest are left in place until the all clear is sounded.
Special attention must be given to patients who may have been
medicated into a less than fully conscious state, or are otherwise
incapacitated.
_b._ _Mission-Oriented Protective Posture Considerations._ The
MOPP level should be taken into account when determining the
category and extent of dental treatment to be provided. Patients,
including those seated in the dental chair, should be at the MOPP
level prescribed for the DTF by its parent headquarters. Dental
treatment at MOPP Levels 3 and 4 is, of course, impossible because
of the requirement to wear the protective mask; however, treatment
is still possible at MOPP Levels 0, 1, and 2. Treatment at MOPP
Level 2 should be limited only to emergency care requiring urgent
attention. At MOPP Level 1, most types of dental emergencies can
be accommodated; however, only minimal essential treatment should
be undertaken in order to reduce risk of the patient being caught
in a compromised state. At MOPP Level 0, the provision of dental
treatment generally is not limited. However, the degree of the
NBC threat forecast for the area should be considered before
undertaking extensive treatment.
_c._ _Maxillofacial Injuries._ Patients with maxillofacial injuries
that prevent proper fit and seal of the individual protective
mask must be placed in a PPW. Though patients with these types of
injuries are most likely to be found only in MTF channels, DTFs
should nevertheless be prepared in the event a patient presents
to the DTF. Since the DTF does not have any PPWs; these patients
should be immediately evacuated to the adjacent MTF for treatment.