bags. Seal the top of the bags to prevent spillage, odors, or
spread of infections/disease. NEVER overfill the bags; always
leave enough room in the bag to make a good seal. Place the
sealed bags in the supply air lock. Inside personnel close the
inner door to the air lock. Outside personnel check to ensure
that the inner air lock door is closed before opening the
outside door. Remove the bags and take them to the designated
waste collection/disposal site. Disposal may be by burial
on site or by transport to a designated disposal facility.
Transport may be by organic vehicles or contractor support
vehicles. The specific technique for disposal will be outlined
in the unit TSOP.
· All liquid waste produced within the CP DEPMEDS is collected
through a piped liquid waste system to a central collection
container. The waste container for the latrines may be used to
collect the liquid waste from the operational areas of the CP
DEPMEDS. The container is emptied and the waste disposed of as
outlined in the unit TSOP.
[Illustration: _Figure F-5. Sample layout of a medical force 2000
combat support hospital unit base employing chemically protected
deployable medical system._]
[Illustration: _Figure F-6. Sample layout of an 84-bed medical
reengineering initiative hospital employing chemically protected
deployable medical system._]
[Illustration: _Figure F-7. Sample layout of a 164-bed medical
reengineering hospital employing chemically protected deployable
medical system._]
F-7. Chemically/Biologically Protecting the International
Organization for Standardization Shelter
To chemically/biologically protect the ISO shelters, seal all seams
and openings of the ISO to prevent the entry of CB agents. The
seals connecting the various sides and floor of the shelter may be
a CB protected material; thus providing a seal to the shelter. When
the seals are not of a CB protected material, the seams must be
taped to provide a CB protected barrier over the soft seals. Any
openings not being used for introduction of support power lines,
water lines or waste water lines must be sealed to prevent entry
of CB agents. All access panels must be securely closed to prevent
entry of vapors.
F-8. Chemically/Biologically Protecting the Vestibules
The vestibules connect TEMPERs to TEMPERs, ISOs to ISOs, and ISOs
and TEMPERs. To harden the vestibules, install the CB liners inside
and fasten the ends to the liners of the TEMPER or to the doors of
the ISOs. Vestibule liner connectors are provided for use at the
entry of each ISO.
F-9. Chemically/Biologically Protecting Air Handler Equipment
_a._ The FDECU is chemically/biologically protected. The system
can be operated without the CB filters. When required to operate
in the CB mode, the fresh air intake on the FDECU is closed and
the CB filter blower is turned on drawing fresh air through the
filters to support the FDECU and to provide clean air for the CPS.
Additionally, recirculation filters are placed within the shelter
system to remove any agent that may have entered through any of the
entry/exit areas or through breaches in the shelter system.
_b._ When heaters are required, they must be
chemically/biologically protected to prevent entry of
contamination. The CB filter units are connected to the fresh air
intake side of the heater and the heated air discharge side of the
heater is connected to the air supply of the TEMPER/ISO.
F-10. Establish Collective Protection Shelter Using the M20
Simplified Collective Protection System
The M20 is used to establish a CPS within a room of opportunity, or
inside a tent; however, the available space will be limited by tent
poles and other components of the tent. Currently this system only
provides ambient temperature air. See the TM and manufacturer's
publication provided with the system and system components for
details.
NOTE
The M20 does not have a litter air lock. Only staff or
ambulatory patients can enter. See the TM provided with the
system for setup procedures.
F-11. Casualty Decontamination
Patients admitted into the MTF must be contamination free.
Therefore, a casualty decontamination area must be established
near the MTF. The casualty decontamination area should be provided
with an overhead cover as described for the CBPS system, except
that it does not overlap the entry to the hospital. Also,
consideration must be given to the location of other operations at
the hospital site when establishing the casualty decontamination
area. However, the area must be close enough to the entry/exit of
the CPS to protect the patients from the environment and reduce
their exposure to recontamination. Keep in mind that under NBC
conditions personnel outside of the CPS are at MOPP Level 4
(except decontaminated patients; they have their mask on), thus
increasing the stress load and reducing their overall performance
capabilities. The entry/exit area must have overhead cover to
protect patients awaiting access to the CPS. See Appendix I for
setting up a casualty decontamination area and for decontamination
procedures.
Section IV. OPERATIONS, ENTRY, AND EXIT GUIDELINES
F-12. Operations
These operations, entry, and exit guidelines may be used to prepare
a unit SOP for the operation of CPS systems in your unit.
_a._ When using these guidelines, the following should be
considered:
· Location of the shelter (flat, hilly, rocky ground).
· General climate of the AO (high and low temperature
variations during operation).
_b._ Information on setting up, striking, and operating the CPS is
contained in the equipment publications. Where applicable, special
procedures are provided in these publications for setting up in
both clean and CB vapor hazard areas. However, the CP DEPMEDS is
NOT set up in a CB vapor hazard area. The commander will determine
which procedures to use.
_c._ During operations, periodic checks are made of the atmosphere
within the shelter. These checks are made by using available
chemical agent detection equipment and material to determine if
chemical agent penetration has occurred. Should chemical agent
penetration occur, all personnel must mask; then ensure that
patients are protected until the agent has been purged from the
shelter.
F-13. Decontamination of Entrance Area
_a._ Normally, the MTF will not operate in a CB vapor hazard
environment. However, if the MTF must remain in an area on a
temporary basis and liquid agent contamination is present, the
immediate area around the entrance must be decontaminated.
_b._ To decontaminate the area around the entrance, use one or more
of the following methods:
· Turn over about 2 inches of soil.
· Remove the top 1-inch layer of soil containing the liquid
agent. Use the CAM or M8 detector paper to check the area after
the topsoil is removed to ensure complete agent removal.
· Add several inches of clean soil or sand.
· Mix STB into the top 1/2 to 1 inch of soil.
· Use DS2 on contaminated hard-surfaced areas or frozen ground.
F-14. Procedures Prior to Entry
All personnel (staff and patients) must be decontaminated before
they are permitted entry into the CPS.
· Use chemical detection equipment to check for the presence of
contamination on individuals and their equipment; also check
for presence of contamination on individual weapons if they
are allowed in the CPS. Normally, weapons will not be allowed
in the patient care areas, but will be stored outside near the
entry/exit. Thorough decontamination is critical in preventing
contamination transfer into the CPS.
· When a chemical agent is detected, follow the procedures
in Appendix C for patient decontamination and FM 3-5 for
other personnel decontamination before entering the CPS.
All contaminated clothing and equipment are placed in the
contaminated dump. Weapons should not have been evacuated with
patients. However, if weapons are evacuated with the patient,
they are decontaminated and held by the MTF (administrative
personnel or hospital supply) for disposition instructions.
· Decontamination must be thorough; procedures must be strictly
followed. Failure to do so can contaminate the interior of the
MTF and injure medical treatment personnel; thus reducing their
mission support capabilities.
+-------------------------------------------------+
| =WARNINGS= |
| |
| 1. ALWAYS PURGE THE AIR LOCK BEFORE OPENING |
| THE INNER DOOR, IF THE OUTER DOOR HAS BEEN |
| OPENED. |
| |
| 2. WHEN OPERATING IN A TOXIC ENVIRONMENT, NEVER |
| OPEN THE OUTER AND INNER DOORS OF THE AIR LOCKS |
| AT THE SAME TIME. |
| |
+-------------------------------------------------+
F-15. Entry/Exit for the Collective Protection Shelter System
_a. Ambulatory Personnel._
(1) _Entry procedures._
(_a_) Ambulatory patients and others remove their MOPP (except
their mask), BDUs, and boots outside the air lock. This
procedure reduces the amount of possible contamination entering
the air lock.
(_b_) A check is made to ensure that the ambulatory air lock is
empty and the inner door is closed.
(_c_) The individual enters the air lock and closes the outer
door.
(_d_) The air lock is purged for 3 minutes. At the end of
the purge cycle, the individual checks for contamination. If
contaminated, the individual must return to the outside and
decontaminate his skin; then return to the air lock and repeat
the purge cycle and contamination check. If no contamination
is detected, the protective mask is removed and placed in
a plastic bag. The plastic bag is sealed and labeled. The
individual opens the inner air lock door and enters the CPS;
the plastic bag is carried into the shelter with the individual.
(2) _Exit procedures._
(_a_) A check is made to ensure that the ambulatory air lock is
empty and the outer door is closed.
(_b_) The individual enters the air lock and closes the inner
door.
(_c_) The individual puts on his protective mask; then exits
through the outer door.
(_d_) The individual puts on his BDU and boots then assumes the
established MOPP level before departing the immediate area of
the exit door.
+-------------------------------------------------+
| =WARNING= |
| |
| DO NOT OPEN THE OUTER DOOR UNTIL THE PROTECTIVE |
| MASK HAS BEEN PUT ON. |
+-------------------------------------------------+
NOTES
1. Ambulatory patients that enter the CBPS become litter
patients and are placed in PPW when released because the MTF
does not have replacement MOPP ensembles for patient issue.
2. Exits must be spaced so that at least a 3 minute purge of
the air lock is accomplished before the inside door is opened.
Only open the doors long enough to permit passage.
_b._ _Litter Patients._
(1) _Entry procedures._
(_a_) An outside aidman notifies an inside aidman that a litter
patient is ready for admission.
(_b_) The inside aidman ensures that the inner litter air lock
door is closed. The outside aidmen open the outer air lock door
and place the litter on the litter rails; they push the patient
into the air lock headfirst; then they close the outer door.
After a purge time of 3 minutes, an aidman inside the CPS opens
the inner door and checks the patient to ensure that he is
contamination free. The patient is checked by placing the CAM
nozzle near absorptive surfaces, such as the patient's hair.
If no contamination is found, the aidman removes the patient's
mask and places it in a plastic bag. The inside aidmen remove
the patient from the air lock and position him on treatment
litter stands, or move him to the treatment area as directed by
supervisory personnel.
(_c_) Patients received at the treatment facility in the PPW
are checked for contamination; if they are contamination free,
they may be processed through the litter air lock in the PPW.
The inside aidmen ensure that the inner litter air lock door
is closed. The outside aidmen open the outer air lock door
and place the litter on the litter rails and push the patient
into the litter air lock headfirst, then close the outer door.
Purge the air lock for 3 minutes. After the purge time, an
aidman inside of the CPS opens the inner air lock door and
uses the CAM to check the patient to ensure that he is free
of contamination. If no contamination is found, the inside
aidmen remove the patient from the air lock. (If the patient is
wearing a protective mask, the mask is removed and placed in a
plastic bag before the patient is moved from the air lock.) As
the patient is removed from the air lock, the PPW is opened and
rolled inside out so that any desorbing vapors are adsorbed by
the charcoal layer. The inside aidmen remove the patient from
the air lock and position him on litter stands. The patient
is transferred to a clean litter; then moved to the treatment
area as directed by supervisory personnel. The receiving litter
and PPW is returned to the outside; dispose of the PPW in the
contaminated waste dump. Decontaminate the litter and return it
to the litter pool.
NOTE
Should contamination be found when monitoring the air lock in
(_b_) or (_c_) above, repeat the purge cycle, then retest for
contamination. All vapor hazards must be eliminated before
the patient is moved into the CPS. Repeating the purge cycle
may NOT be possible if the patient is in need of immediate
lifesaving care. The patient may have to be returned to the
outside treatment area for immediate care.
(2) _Exit procedures._
(_a_) The litter patient is placed in a PPW. A battery operated
blower unit with a CB filter may be attached to the PPW to
provide fresh air to the patient; thus reducing the heat load
on the patient and the carbon dioxide buildup inside the PPW.
(_b_) An inside aidman notifies an outside aidman that the
patient is ready to exit the shelter. An outside aidman ensures
that the outer air lock door is closed. The patient is placed
in the litter air lock feet first. The inner air lock door is
closed. The outside aidmen open the outer door and remove the
patient.
(_c_) Hospital staff, visitors, or ambulatory patients exit
through the ambulatory air lock. Before entering the air lock,
each individual must ensure that the outer air lock door is
closed. The individual enters the air lock and closes the
inner door; puts on his protective mask and exits through the
outer door. The individual puts on his BDU and boots, and
then assumes the established MOPP level before departing the
immediate area of the exit door.
+-------------------------------------------------+
| =WARNING= |
| |
| DO NOT OPEN THE OUTER DOOR UNTIL THE INNER DOOR |
| HAS BEEN CLOSED. |
+-------------------------------------------------+
NOTE
Exits must be spaced at least 3 minutes apart to allow for a
complete purge cycle of the air lock.
F-16. Resupply of Protected Areas
Resupply of protected areas is accomplished by placing
contamination-free supplies or equipment on a litter and passing
it through the litter air lock, or processing it through the
supply air lock. The litter air lock must be purged for 3 minutes.
The supplies must be checked for contamination before they are
removed and placed within the CPS. The supply air lock must be
purged for the stated time as outlined in the supporting technical
manual; usually 45 minutes. Again the supplies must be checked for
contamination before they are removed and placed within the CPS.
APPENDIX G
PATIENT DECONTAMINATION
Section I. INTRODUCTION
G-1. General
_a._ Patient decontamination presents special problems for units
and HSS personnel. Nuclear, biological, and chemical contaminated
patients create increased hazards to rescuers and HSS personnel;
thus, causing delays in providing essential first aid and medical
treatment for injuries from sources other than the exposure to NBC
weapons/agents. Casualty decontamination procedures are performed
by each individual, as buddy aid, or at a unit decontamination
station prior to the arrival of medical personnel. See FM 3-5 for
procedures on individual, buddy aid, and unit decontamination.
Patient decontamination procedures are normally performed at an MTF
under medical supervision. Patient decontamination stations may be
established (collocated) at central unit decontamination faculties,
if medical support is available. However, augmentation medical
support must be requested to provide patient care and supervise
the patient decontamination process. Because, when the unit is
undergoing decontamination operations, organic medical personnel
must also decontaminate their equipment and personnel. Therefore,
they are not available to provide medical support for operating the
patient decontamination station that is collocated with the central
unit decontamination facility.
_b._ The term "decontamination" as used herein means the removal
or neutralization of radioactive particles, BW agents, and
CW agents to levels low enough that patients may be treated
without contaminating the MTF and without posing health risks to
unprotected medical providers. "Decontamination" does not imply
absolute removal of contaminants.
NOTE
The decontamination procedures described below are for NBC
contaminated patients. These procedures may also be used for
most TIM contaminated patients. However, soap and water will
suffice for most TIMs; but some TIMs react with water. For
those TIMs another material must be used to decontaminate
patients. For detailed information on decontamination of TIM
contaminated patients, see FM 8-500.
_c._ Physical removal of contaminants is the primary method of
decontamination. Physical removal does not require vigorous
scrubbing; in fact, vigorous scrubbing can force some agents deeper
into the skin; thus, increasing the agent effect rather than
reducing its effects. The use of a M291 skin decontaminating kit
(SDK) neutralizes/reduces the effects of an agent, but physical
removal is of utmost importance. When a SDK is not available, the
use of soap and water should be considered as the next best method.
However, the use of soap and water requires large amounts of water
that may not be available because the soap must be rinsed from
the skin to reduce skin irritation from the soap. An alternate
skin decontaminant is a hypochlorite solution; but it should
only be used when SDKs and/or sufficient quantities of water are
not available. Use a 0.5 percent hypochlorite solution on the
protective mask and skin. A 5 percent hypochlorite solution can be
used on the mask hood, gloves, and other outer garments.
+-------------------------------------------------------+
| CAUTION |
| |
| Do not use the 5 percent solution on the skin; it can |
| cause severe skin irritation. |
+-------------------------------------------------------+
G-2. Immediate Decontamination
Decontamination must begin at the platoon and company level
with the individual soldier, prior to the arrival of medical
personnel. The soldier himself or members of his team must perform
immediate decontamination. When the casualty's condition and the
mission permits, they may go through a MOPP gear exchange at
their unit before evacuation (see FM 3-5). Performing a MOPP gear
exchange at the unit before evacuation will reduce the amount of
contamination that can be transferred to the MEDEVAC vehicle.
However, the MOPP gear exchange must not cause further injury
to the casualty. First aid for CW agent must be administered;
such as administering nerve agent antidotes (such as nerve agent
antidotes and convulsant antidote for nerve agent [CANA]), as
required. Enter the time and type of contamination on a field
expedient NBC casualty card (Figure G-1). Use the CAM, M8 chemical
agent detector paper, or M9 tape to determine the type of chemical
contamination. Use a radiation detection meter/device to determine
the level of radioactive contamination, if required. Currently,
there are no BW agent detectors that can be used to check patients
for BW agent contamination. Therefore, all patients suspected of
being contaminated with a BW agent must be decontaminated. When
medical personnel arrive, they should enter the time and type
of contamination and number of antidote injections that were
administered as first aid on the Department of Defense (DD) Form
1380 (Field Medical Card [FMC]).
[Illustration: _Figure G-1. Field expedient nuclear, biological,
and chemical patient card._]
G-3. Patient Decontamination and Thorough Decontamination
Collocation
_a._ Collocating patient and thorough decontamination operations in
the BSA may provide several advantages (Figure G-2). It--
· Preserves the principle of limiting the spread of
contamination.
· Reduces confusion on the battlefield.
· Reduces demand on logistics support elements.
· Improves contamination control and reporting: One location
and one person in charge.
· Reduces overall security requirements.
· Speeds PDS closure by using the thorough decontamination site.
_b._ An identified disadvantage is the increased size of the
site and the requirement for medical support augmentation (a
treatment squad from another organization with required patient
decontamination and treatment MESs) to operate the PDS.
NOTE
Organic medical personnel must not be used to perform the
HSS mission at the collocated site. They must go through the
decontamination process with their unit.
_c._ These operations do not require that both patient
decontamination and unit thorough decontamination be executed
simultaneously. The PDS can be running while the thorough
decontamination site is being prepared. Patient decontamination
cannot be delayed since patients may be suffering life-threatening
injuries as well as exposure to NBC agents. Therefore, the PDS must
be established and operational before the first patients arrive.
The wind direction must be common to both sites.
_d._ The decontamination platoon leader is responsible for
establishing the combined decontamination site. The medical unit
commander/surgeon coordinates with the decontamination platoon
leader for the location of the patient receiving, PDS, and MTF.
The lowest level at which this operation will usually be planned
is brigade. This operation requires extensive planning and must
involve the brigade chemical officer, brigade S4, and the medical
company commander/brigade surgeon. Decontamination support for
special operation forces, other unique operational organizations,
or for nonlinear operations may require execution at a lower level.
The supporting medical personnel operate the PDS. Nonmedical
personnel perform patient decontamination procedures under medical
supervision. Patient decontamination procedures are described below.
NOTE
Patient decontamination differs from thorough decontamination
in that the patients' medical status must be monitored and
medical treatment must be provided during the decontamination
process.
_e._ Although a PDS may be collocated with thorough
decontamination, a PDS must be operational at Levels I, II, III,
and IV MTFs. Contaminated patients may present directly to the
MTF for care, or patients previously decontaminated may become
contaminated en route. Therefore, all patients arriving at an MTF
must be checked for contamination. If contaminated, they must be
decontaminated before they are admitted to the MTF.
[Illustration: _Figure G-2. Thorough decontamination site
collocated with patient decontamination station, without collective
protection shelter._]
G-4. Patient Decontamination at the Battalion Aid Station (Level I)
_a._ When battle conditions prevent patient decontamination
procedures forward or the patient is contaminated en route, the
patient may have to be decontaminated at the BAS. Contaminated
patients arriving at the BAS must be decontaminated before
admission into the clean treatment area.
_b._ Patient decontamination is performed by eight nonmedical
personnel from the supported unit at the BAS. The patient
decontamination personnel operate as two-man teams to perform the
patient decontamination procedures. The patient decontamination
teams operate under the supervision of medical personnel to
ensure that no further injury is caused to the patient by the
decontamination process. Each team receives a patient from
the triage point and performs both clothing removal and skin
decontamination procedures. The team requires assistance from
another team to perform litter changes; see details below.
G-5. Patient Decontamination at the Medical Company Clearing
Station (Level II)
The medical company clearing station may receive patients from the
BAS or directly from other areas who have not been decontaminated.
The clearing station must also have a patient decontamination area.
As with the BAS, the clearing station must have a minimum of eight
nonmedical personnel from the supported units to perform patient
decontamination. Procedures for patient decontamination at the
clearing station are the same as for the BAS.
G-6. Patient Decontamination at a Hospital (Level III or IV)
To the maximum extent possible, hospitals are located away
from tactical or logistical targets. Contaminated patients
will arrive from forward MTFs and units located within the
geographical area of the hospital. Patient decontamination is
done by at least 20 nonmedical personnel from units located in
the geographical area/base cluster of the hospital. Procedures
for patient decontamination at the hospital are the same as for
the BAS. However, several patient decontamination stations can be
operated simultaneously at the hospital patient decontamination
site. Further, all patients arriving at the hospital will be
decontaminated and receive full treatment within the capabilities
of the hospital.
G-7. Prepare Hypochlorite Solutions for Patient Decontamination
An alternative patient decontamination agent is a hypochlorite
solution; however, the hypochlorite solution must be prepared.
Two concentrations of the hypochlorite solution are required.
A 5 percent hypochlorite solution to decontaminate gloves,
aprons, litters, cutting devices, the patient's mask hood, and
other nonskin contact areas. The patient's mask, skin, splints,
and tourniquets and their wounds are irrigated using a 0.5 (½)
percent hypochlorite solution. To prepare the solutions, use
calcium hypochlorite (HTH) granules (supplied in 6-ounce jars in
the chemical agent patient treatment and chemical agent patient
decontamination MES), bulk HTH, or sodium hypochlorite (household
bleach). Prepare the required solutions as shown in Table G-1
below.
_Table G-1. Preparation of Hypochlorite Solutions for Patient
Decontamination_
==================================================================
HTH HTH MRE HOUSEHOLD PERCENT IN 5
OUNCES SPOONFULS BLEACH GALLONS OF WATER
------------------------------------------------------------------
6 [*]5 2 QUARTS 0.5
48 40 [**] 5.0
------------------------------------------------------------------
[*] THESE MEASUREMENTS ARE USED WHEN BULK HTH IS USED. TO MEASURE
THIS PREPARATION, USE THE PLASTIC SPOON SUPPLIED WITH YOUR MEAL,
READY-TO-EAT (MRE). THE AMOUNT OF HYPOCHLORITE TO BE USED IS A
HEAPING SPOONFUL (THAT IS, ALL THAT THE SPOON WILL HOLD). DO NOT
SHAKE ANY GRANULES OFF OF THE SPOON BEFORE ADDING TO THE WATER.
[**] DO NOT DILUTE IN WATER; HOUSEHOLD BLEACH IS 5 TO 6.25 PERCENT
SOLUTION; IT IS USED FULL STRENGTH FOR 5 PERCENT APPLICATIONS.
==================================================================
+------------------------------------------------------+
| CAUTIONS |
| |
| 1. Do not use the 5 percent hypochlorite solution |
| on the patient's skin. The 5 percent solution can |
| burn the skin. |
| |
| 2. Only wipe the skin when applying the 0.5 percent |
| hypochlorite solution. Vigorous scrubbing may force |
| the agent into the skin. |
+------------------------------------------------------+
G-8. Classification of Patients
On the NBC battlefield, two classifications of patients will be
encountered--contaminated and uncontaminated. Those contaminated
may suffer from the effects of an NBC agent, of a conventional
wound, or both. Some may suffer combat stress or heat injuries
induced by the stress of NBC conditions and extended time spent
in MOPP Level 4. It is important to follow proper decontamination
procedures to limit the spread of contamination to others and
equipment. The most important decontamination is performed at the
site of contamination. Decontamination at a later time may be too
late to prevent injury to the individual, especially when exposed
to vesicants. All agents should be promptly removed from the skin.
G-9. Patient Treatment
_This appendix only describes patient decontamination procedures._
For NBC treatment procedures, refer to FM 4-02.283, FM 8-284, and
FM 8-285.
Section II. PATIENT DECONTAMINATION PROCEDURES
G-10. Decontaminate a Litter Chemical Agent Patient
Before contaminated patients receive medical treatment in the
clean treatment area, they must be decontaminated. Place the
cutting device in a container of 5 percent hypochlorite solution
between each use. Each decontamination team member decontaminates
his gloves and apron with the 5 percent hypochlorite solution
frequently to prevent spreading any contamination to patient's
skin. Decontaminate the patient's skin, bandages, wounds, mask,
identification tags with chain, and splints with a 0.5 percent
hypochlorite solution. The litter patient is decontaminated and
undressed as follows:
NOTE
Litter patients requiring EMT or ATM in the clean area of the
MTF will be completely decontaminated. A patient not requiring
clean EMT or ATM at the MTF, but requiring further evacuation
(for example: a stable patient with a partial amputation of a
lower extremity) should only have his wound area and MOPP spot
decontaminated to remove any gross contamination. The patient
should be evacuated in his MOPP.
_a._ =Step 1. Physically remove gross contamination.= Use any stiff
material (stick, cardboard, plastic strip, metal banding strap)
to physically remove gross contamination from the patient's MOPP
ensemble. Much of the CW agent contamination can be removed through
physical means.
_b._ =Step 2. Decontaminate the patient's mask and hood.= The
patient has been triaged and stabilized (if necessary) by the
senior trauma specialist in the patient decontamination area. A
two-man decontamination team moves him to the litter stands at the
clothing removal station.
(1) =Decontaminate the mask and hood.= Use the SDK, or use a
5 percent hypochlorite solution or household bleach to sponge
down the front, sides, and top of the mask hood. Decontaminate
spots with the SDK or the 5 percent hypochlorite solution.
(2) =Remove hood.= Remove the hood by cutting the hood. Before
cutting the hood, dip the cutting device in a 5 percent
hypochlorite solution. For the M17-series mask, cut the neck
cord and the small string under the voicemitter. Release or cut
the hood shoulder straps and unzip the hood zipper. Cut the
hood, close to the filter inlet cover and eye-lens outsert,
upward to the top of the eye-lens outsert, and across the
forehead to the outer edge of the other eye-lens outsert.
Proceed downward toward the patient's shoulder, staying close
to the eye-lens, then across the lower part of the voicemitter
to the zipper. After dipping the cutting device in the 5
percent hypochlorite solution, cut the hood from the center
of the forehead over the top of the head (see Figure G-3).
Fold the left and right sides of the hood to the side of the
patient's head, laying the sides of the hood on the litter. For
the M40-series protective mask cut the hood shoulder straps,
then cut the quick-doff hood from the front bottom center to
the chin through the elastic band under the chin. Fold the left
and right sides of the hood over the shoulders away from the
head.
[Illustration: _Figure G-3. Cutting the M17 protective mask hood._]
(3) =Decontaminate the protective mask and exposed skin.=
Using the SDK, soap and water, or a 0.5 percent hypochlorite
solution, wipe the external parts of the mask. Cover the mask
air inlet(s) with gauze or your hand to keep the mask filter
dry. Continue by wiping the exposed areas of the patient's
face, including the neck and behind the ears.
(4) =Remove the Field Medical Card.= Cut the patient's FMC tie
wire, allowing the FMC to fall into a plastic bag. Seal the
plastic bag and rinse the outside of the bag with a 5 percent
hypochlorite solution. Place the plastic bag with the FMC under
the back of the protective mask head straps. The FMC will
remain with the patient.
_c._ =Step 3. Remove gross contamination from the patient's
overgarment.= Remove all visible gross contamination by scraping
with a stick or other device.
_d._ =Step 4. Remove the patient's personal effects and protective
overgarment.=
(1) =Remove patient's personal effects.= Remove the patient's
personal effects from his protective overgarment and BDU
pockets. Place the articles in a plastic bag, label with the
patient's identification, and seal the bag. If the articles are
not contaminated, return them to the patient. If the articles
are contaminated, place them in the contaminated holding area
until they can be decontaminated, and then return them to the
patient.
(2) =Cut the patient's overgarment.= The overgarment jacket and
trousers may be cut simultaneously. Two persons may be cutting
clothing at the same time. =Cut around bandages, tourniquets,
and splints, leaving them in place.=
NOTE
A cut is a separation of material by use of a cutting device
that cuts material into two pieces. EXAMPLE: Cutting the sleeve
from the cuff to the jacket collar is one cut.
+-----------------------------------------------------------+
| CAUTION |
| |
| Bandages may have been applied to control severe bleeding |
| and are treated like tourniquets. Only medical personnel |
| remove bandages, tourniquets, and splints. |
+-----------------------------------------------------------+
(3) =Remove overgarment jacket.= Make two cuts, one up each
sleeve from the wrist up to the shoulder, and then through
the collar (Figure G-4). Do not allow the gloves to touch the
patient along the cut line. Dip the cutting device in the 5
percent hypochlorite solution before making each cut to prevent
contamination of the patient's uniform or underclothing. Keep
the cuts close to the inside of the arms so that most of the
sleeve material can be folded outward. Unzip the jacket; roll
the chest sections to the respective sides, with the inner
surface outward. Continue by tucking the clothing between
the arm and chest. Roll the cut sleeves away from the arms,
exposing the black liner.
[Illustration: _Figure G-4. Cutting the overgarment jacket._]
(4) =Remove overgarment trousers.= Cut both trouser legs
starting at the ankle as shown in Figure G-5. Keep the cuts
near the inseams to the crotch. With the left leg, continue
cutting to the waist, avoiding the pockets. With the right leg,
cut across at the crotch to the left leg cut. Place the cutting
device in the 5 percent hypochlorite solution. Fold the cut
trouser halves away from the patient and allow the halves to
drop to the litter with contaminated (green) side down. Roll
the inner leg portion under and between the legs.
[Illustration: _Figure G-5. Cutting the overgarment trousers._]
(5) =Remove outer gloves.= This procedure can be done with one
person on each side of the patient working simultaneously.
The decontamination team will decontaminate their gloves in 5
percent hypochlorite solution. Next, lift the patient's arms
up and out of the cutaway sleeves unless detrimental to the
patient's condition. Grasp the fingers of the glove, roll the
cuff over the fingers, turning the glove inside out. Do not
remove the inner cotton glove liners at this time. Carefully
lower the arms across the chest after the outer gloves have
been removed (Figure G-6). Do not allow the patient's arms to
come into contact with the exterior of his overgarment. Drop
his gloves into the contaminated waste bag. Dip your gloves in
the 5 percent hypochlorite solution.
[Illustration: _Figure G-6. Remove outer gloves and position arms
after glove removal._]
(6) =Remove overboots.= Cut the overboot laces and fold the
lacing eyelets flat outwards. If the green vinyl overboot
(GVO) is worn, first try to remove the overboot without
cutting; if necessary, cut the boot along the front. While
standing at the foot of the litter, hold the heel with one
hand, pull overboot downwards, and then pull towards you to
remove the overboot over the combat boot heel. Remove the
two overboots simultaneously. This reduces the likelihood of
contaminating one of the combat boots. While holding the heels
off the litter, have a decontamination team member wipe the
end of the litter with the 5 percent hypochlorite solution to
neutralize any liquid contamination that was transferred to the
litter from the overboots. Lower the patient's heels onto the
decontaminated litter. Place the overboots in the contaminated
waste bag. Decontamination personnel dip their gloves in the 5
percent hypochlorite solution.
_e._ =Step 5. Remove patient's battle dress uniform.=
(1) =Remove battle dress uniform.= Cut the BDU jacket and
trousers as described above for the protective overgarment.
Roll the jacket and trousers as described for the protective
overgarment.
(2) =Remove combat boots.= Cut the bootlaces along the tongue.
Remove the boots by pulling them towards you. Place the boots
in the contaminated waste bag. Do not touch the patient's skin
with contaminated gloves when removing his boots.
(3) =Remove undergarments.= Remove the patient's tee shirt.
Dip the cutting device in the 5 percent hypochlorite solution
between each cut. Cut both sleeves from the inside, starting
at the elbow, up to the armpit. Continue cutting across the
shoulder to the collar. Cut around bandages or splints, leaving
them in place. Next, peel the tee shirt away from the body to
avoid spreading contamination. If the patient is wearing a
brassiere, cut it between the cups. Cut both shoulder straps
where they attach to the cups and lay them back off of the
shoulders. Remove the patient's under shorts/panties by cutting
from the lower side of the hip to the waist on both sides. Fold
the front flap of the shorts/panties down between the patient's
legs onto the litter. Do not allow the outside of the garment
to touch the patient's skin. Remove the socks and cotton glove
liners. Do not remove the patient's identification tags.
_f._ =Step 6. Transfer the patient to a decontamination litter.=
After the patient's clothing has been cut away, he is transferred
to a decontamination litter or a canvas litter with a plastic
sheeting cover. Three decontamination team members decontaminate
their gloves and aprons with the 5 percent hypochlorite solution.
One member places his hands under the patient's legs at the thighs
and Achilles tendons, a second member places his arms under the
patient's back and buttocks, and a third member places his arms
under the patient's shoulders and supports the head and neck. They
carefully lift the patient using their knees (not their backs)
to minimize back strain. While the patient is elevated, another
decontamination team member removes the litter from the litter
stands and replaces it with a decontaminated (clean) litter.
The patient is carefully lowered onto the clean litter. The
contaminated clothing and overgarments are placed in bags and moved
to the contaminated waste dump. The dirty litter is rinsed with the
5 percent hypochlorite solution and placed in the litter storage
area.
_g._ =Step 7. Decontaminate skin.=
(1) =Spot decontamination.= With the patient in a supine
position, spot decontaminate the skin using the SDK or a 0.5
percent hypochlorite solution. Decontaminate areas of potential
contamination. Include areas around the neck, wrists, and lower
parts of the face. Decontaminate the patient's identification
tags and chain, if necessary.
NOTE
Complete body wash is not appropriate and may be injurious to
the patient. During complete body wash, the patient would have
to be rolled over to reach all areas of the skin. This is not
necessary for adequate decontamination.
(2) =Trauma specialist care.= During decontamination, the
clothing around bandages, tourniquets, and splints was cut and
left in place.
· The trauma specialist replaces the old tourniquet by placing
a new tourniquet ½ to 1 inch above the old one. He then removes
the old tourniquet and decontaminates the patient's skin using
the M291 pads or a 0.5 percent hypochlorite solution.
· The trauma specialist gently cuts away bandages and
decontaminates the area around the wound; dusts the wound
with the SDK, or irrigates soft tissue wounds with the 0.5
percent hypochlorite solution. If bleeding begins, the
trauma specialist replaces the bandage with a clean one.
The trauma specialist ensures splints are not removed, but
are decontaminated in place by applying the 0.5 percent
hypochlorite solution to them, to include the padding and
cravats. Splints will only be removed by a physician or under
the supervision of a physician.
+----------------------------------------------------+
| =WARNINGS= |
| |
| 1. DO NOT apply the SDK or irrigate wounds in the |
| abdominal and thoracic cavities or intracranial |
| head injuries. |
| |
| 2. DO NOT remove splints. |
+----------------------------------------------------+
(3) =Check patient for completeness of decontamination.= The
patient is checked with the CAM or with M8 detector paper for
completeness of decontamination.
NOTE
Other monitoring devices may be used when available.
(4) =Dispose of contaminated waste.= Dispose of contaminated
bandages and coverings by placing them in a contaminated waste
bag. Seal the bag and place it in the contaminated waste dump.
_h._ =Step 8. Transfer the patient across the shuffle pit.=
(1) The patient's clothing has been cut away; his skin,
bandages, and splints have been decontaminated. Now the litter
is transferred to the shuffle pit and placed upon the litter
stands. The shuffle pit is wide enough to prevent the patient
decontamination team members from straddling it while carrying
the litter. Four decontamination team members transfer the
patient to a clean treatment litter in the shuffle pit. A
member of the patient decontamination team removes the bagged
FMC and holds it so that a trauma specialist on the clean side
of the hot line can read it. A trauma specialist on the clean
side of the hot line prepares a new FMC before the patient is
moved to the clean area. The old FMC is disposed of with other
contaminated waste.
(2) Decontamination team members rinse or wipe down their
aprons and gloves with the 5 percent hypochlorite solution.
(3) Three decontamination team members lift the patient off the
decontamination litter (see Step 6 for lifting procedures).
(4) While the patient is elevated, another decontamination
team member removes the litter from the stands and returns
it to the decontamination area. A trauma specialist from the
clean side of the shuffle pit replaces the litter with a clean
one. The patient is lowered onto the clean litter. Two trauma
specialists from the clean side of the shuffle pit move the
patient to the clean treatment area. The patient is treated
in this area or waits for processing into the CPS. The litter
removed by the decontamination team member is wiped down with
the 5 percent hypochlorite solution in preparation for reuse.
NOTE
Before decontaminating another patient, each decontamination
team member drinks approximately one-half quart of water.
The exact amount of water consumed is increased or decreased
according to the temperature (see Table G-2 below).
_Table G-2. Heat Injury Prevention and Water Consumption._
===========+=========+===============+================+===============
| | EASY WORK | MODERATE WORK | HARD WORK
| +-------+-------+-------+--------+-------+-------
HEAT | WBGT | WORK/ | WATER | WORK/ | WATER | WORK/ | WATER
CATEGORY | INDEX | REST | INTAKE| REST | INTAKE | REST | INTAKE
|DEGREES F| MIN | QT/HR | MIN | QT/HR | MIN | QT/HR
-----------+---------+-------+-------+-------+--------+-------+-------
1 (WHITE) | 78-81.9 | NL | ½ | NL | ¾ | 40/20 | ¾
2 (GREEN) | 82-84.9 | NL | ½ | 50/10 | ¾ | 30/30 | 1
3 (YELLOW)| 85-87.9 | NL | ¾ | 40/20 | ¾ | 30/30 | 1
4 (RED) | 88-89.9 | NL | ¾ | 30/30 | ¾ | 20/40 | 1
5 (BLACK) | >90 | 50/10 | 1 | 20/40 | 1 | 10/50 | 1
-----------+---------+-------+-------+-------+--------+-------+-------
THE WORK/REST TIMES AND FLUID REPLACEMENT VOLUMES WILL SUSTAIN
PERFORMANCE AND HYDRATION FOR AT LEAST 4 HOURS OF WORK IN THE
SPECIFIED HEAT CATEGORY.
NL=NO LIMIT TO WORK TIME PER HOUR.
REST MEANS MINIMAL PHYSICAL ACTIVITY (SITTING OR STANDING) ACCOMPLISHED
IN SHADE, IF POSSIBLE.
CAUTION: HOURLY FLUID INTAKE SHOULD NOT EXCEED 1 QUART.
DAILY FLUID INTAKE SHOULD NOT EXCEED 12 QUARTS.
WEARING BODY ARMOR ADDS 5° F TO WBGT INDEX.
WEARING ALL MOPP OVERGARMENTS ADDS 10° F TO WBGT INDEX.
+----------------------------------------------------------+
| =WARNING= |
| |
| Do not exceed a fluid intake of 1 quart per hour. Do not |
| exceed a fluid intake of 12 quarts per day. |
| |
+----------------------------------------------------------+
G-11. Decontaminate an Ambulatory Chemical Agent Patient
_a._ All ambulatory patients requiring EMT or ATM in the clean area
of the BAS will be decontaminated. A member of the decontamination
team or other ambulatory patients will assist the patient in
removing his clothing and decontaminating his skin.
_b._ Patients requiring only minimal care will undergo spot
decontamination of their MOPP gear as required for their medical
treatment. They will be treated in the contaminated EMT area and
returned to duty. They will undergo decontamination and a MOPP gear
exchange with their unit.
_c._ Stable patients not requiring treatment at the BAS, but
requiring evacuation to a higher level of care for treatment
(example: A patient with a broken arm) should be evacuated in
MOPP Level 4 by any available transportation. However, before
evacuation, spot remove all thickened/persistent agents from
protective clothing.
NOTES
1. Remember, do not remove clothing from an ambulatory patient
unless he requires treatment in the clean treatment area of the
BAS or clearing station. Only spot decontaminate the patient's
clothing and evacuate him to the next level of care.
2. Place cutting device used in this procedure in a container
of 5 percent hypochlorite solution when not in use. Most
ambulatory patients will be treated in the contaminated
treatment area and returned to duty. Upon removal of an
ambulatory patient's clothing, he becomes a litter patient. The
BAS and clearing station do not have clothing to replace those
cut off during the decontamination process. The patient must
be placed in a PPW for protection during evacuation. A battery
operated blower unit with a CB filter may be attached to the
PPW to provide fresh air to the patient; thus reducing the
carbon dioxide buildup inside the PPW (Figure G-7).
[Illustration: _Figure G-7. Chemical warfare agent protective
patient wrap._]
_d._ =Step 1. Remove load-carrying equipment.= Remove load-carrying
equipment (LCE) by unfastening/unbuttoning all connectors or
tie straps; then place the equipment in a plastic bag. Place
the plastic bag in the designated storage area for later
decontamination.
_e._ =Step 2. Decontaminate the patient's mask and hood.= After the
patient has been triaged and treated (if necessary) by the senior
trauma specialist in the PDS, the patient (assisted by another
ambulatory patient or a member of the patient decontamination team,
if necessary) begins the clothing removal process.
(1) =Decontaminate and remove mask hood.= Sponge down the
front, sides, and top of the hood with a 5 percent hypochlorite
solution. Remove the hood by cutting (Figure G-3) or, with
the quick-doff hood or other hoods, by loosening the hood
from the mask attachment points. Before cutting the hood, dip
the cutting device in the 5 percent hypochlorite solution.
Begin by cutting the neck cord and the small string under the
voicemitter. Next, release or cut the hood shoulder straps and
unzip the hood zipper. Proceed by cutting the hood upward,
close to the filter inlet cover and eye-lens outserts, to the
top of the eye-lens outsert, across the forehead to the outer
edge of the other eye-lens outsert. Proceed downward toward
the patient's shoulder, staying close to the eye-lens and
filter inlet. Cut across the lower part of the voicemitter to
the zipper. After dipping the cutting device in the 5 percent
hypochlorite solution again, cut the hood from the center of
the forehead over the top of the head and fold the right and
left sides of the hood away from the patient's head, removing
the hood.
(2) =Decontaminate the mask and patient's face.= Decontaminate
the mask and the patient's face by using the SDK or a 0.5
percent hypochlorite solution. Wipe the external parts of the
mask; cover both mask air inlets with gauze or your hands to
keep the mask filters dry. Continue by wiping the exposed areas
of the patient's face, to include the neck and behind the ears.
_f._ =Step 3. Remove Field Medical Card.= Cut the FMC tie wire,
allowing the card to fall into a plastic bag. Seal the plastic bag
and rinse it with the 5 percent hypochlorite solution. Place the
plastic bag under the back of the protective mask head straps.
_g._ =Step 4. Remove all gross contamination from the patient's
overgarment.= Remove all visible contamination spots by using
the SDK (preferred method) or a sponge dipped in a 5 percent
hypochlorite solution.
_h._ =Step 5. Remove overgarments.=
(1) =Remove the patient's personal effects.= Place the
patient's personal effects in a clean bag and label with the
patient's identification. If they are not contaminated, give
them to him. If his personal effects are contaminated, place
the bagged items in the contaminated storage area until they
can be decontaminated, then return them to the patient.
(2) =Remove overgarment jacket.= Have the patient stand with
his feet spread apart at shoulder width. Unsnap the jacket
front flap and unzip the jacket. If the patient can extend his
arms, have him clinch his fists and extend his arms backward
at about a 30° angle. Move behind the patient, grasping his
jacket collar at the sides of the neck, peel the jacket off
the shoulders at a 30° angle down and away from the patient.
Avoid any rapid or sharp jerks that can spread contamination.
Gently pull the inside sleeves over the patient's wrists and
hands. If the patient cannot extend his arms, you must cut the
jacket to aid in its removal. Dip the cutting device in the 5
percent hypochlorite solution between each cut. As with the
litter patient, cut both sleeves from the inside, starting
at the wrist, up to the armpit. Continue cutting across the
shoulder to the collar. Cut around bandages or splints, leaving
them in place. Next, peel the jacket back and downward to avoid
spreading contamination. Ensure that the outside of the jacket
does not touch the patient or his inner clothing.
(3) =Remove overgarment trousers.= Unfasten or cut all ties,
buttons, or zippers before grasping the trousers at the waist
and peeling them down over the patient's combat boots. Again,
the trousers are cut to aid in removal. If necessary, cut both
trouser legs starting at the ankle, keeping the cuts near the
inside of the legs, along the inseam, to the crotch. Cut around
all bandages, tourniquets, or splints. Continue to cut up both
sides of the zipper to the waist and allow the narrow strip
with the zipper to drop between the legs. Place the cutting
device in the 5 percent hypochlorite solution. Peel or allow
the trouser halves to drop to the ground. Have the patient step
out of the trouser legs, one at a time. Place the trousers in
the contaminated disposal bag.
(4) =Remove overboots.= Remove the patient's overboots by
cutting the laces with cutting device dipped in the 5 percent
hypochlorite solution. Fold the lacing eyelets flat on the
ground. Step on the toe and heel eyelets to hold the overboot
on the ground and have the patient step out of it. Repeat this
procedure for the other overboot. If the GVO are worn, first
try to remove the overboots without cutting; if necessary, cut
the overboots along the front. If the overboots are in good
condition, they can be decontaminated and reissued.
(5) =Remove the patient's outer gloves.= Grasp the heel of the
glove, peel the glove off with a smooth downward motion. Place
the contaminated gloves in a plastic bag with the overgarment
jacket. Do not allow the patient to touch his clothing or other
contaminated objects with his exposed hands.
(6) =Remove the patient's cotton glove liners.= Have the
patient remove his cotton glove liners to reduce the
possibility of spreading contamination. Have the patient grasp
the heel of one glove liner with the other gloved hand, peeling
it off of his hand. Hold the removed glove by the inside and
grasp the heel of the other glove, peeling it off of his hand.
Place both glove inserts in the contaminated waste bag.
_i._ =Step 6. Remove patients BDU.=
(1) =Remove the patient's personal effects.= Place the
patient's personal effects in a clean bag and label with the
patient's identification. If they are not contaminated, give
them to him. If his personal effects are contaminated, place
the bagged items in the contaminated storage area until they
can be decontaminated, then return them to the patient.
(2) =Remove BDU jacket.= Have the patient stand with his feet
spread apart at shoulder width. Unbutton the front flap of the
jacket. If the patient can extend his arms, have him clinch
his fists and extend his arms backward at about a 30° angle.
Move behind the patient, grasping his jacket collar at the
sides of the neck, peel the jacket off the shoulders at a 30°
angle down and away from the patient. Avoid any rapid or sharp
jerks that can spread contamination. Gently pull the inside
sleeves over the patient's wrists and hands. If the patient
cannot extend his arms, you must cut the jacket to aid in its
removal. Dip the cutting device in the 5 percent hypochlorite
solution between each cut. As with the litter patient, cut
both sleeves from the inside, starting at the wrist, up to the
armpit. Continue cutting across the shoulder to the collar. Cut
around bandages or splints, leaving them in place. Next, peel
the jacket back and downward to avoid spreading contamination.
Ensure that the outside of the jacket does not touch the
patient or his inner clothing.
(3) =Remove BDU trousers.= Unfasten or cut all ties, buttons,
or zippers before grasping the trousers at the waist and
peeling them down over the patient's combat boots. Again, the
trousers are cut to aid in removal. If necessary, cut both
trouser legs starting at the ankle, keeping the cuts near the
inside of the legs, along the inseam, to the crotch. Cut around
all bandages, tourniquets, or splints. Continue to cut up both
sides of the zipper to the waist and allow the narrow strip
with the zipper to drop between the legs. Place the cutting
device in the 5 percent hypochlorite solution. Peel or allow
the trouser halves to drop to the ground. Have the patient step
out of the trouser legs, one at a time. Place the trousers in
the contaminated disposal bag.
(4) =Remove undergarments.= Remove the patient's tee shirt.
Dip the cutting device in the 5 percent hypochlorite solution
between each cut. Cut both sleeves from the inside, starting
at the elbow, up to the armpit. Continue cutting across the
shoulder to the collar. Cut around bandages or splints, leaving
them in place. Next, peel the tee shirt away from the body to
avoid spreading contamination. If the patient is wearing a
brassiere, cut it between the cups. Cut both shoulder straps
where they attach to the cups and lay them back off of the
shoulders. Remove the patient's under shorts/panties by cutting
from the lower side of the hip to the waist on both sides.
Allow the shorts/panties to fall to the ground. Do not remove
the patient's identification tags.
_j._ =Step 7. Check patient for contamination.= After the patient's
BDU and underwear has been removed check the skin for contamination
by using M8 detector paper or the CAM. Carefully survey all areas
of the patient's skin, paying particular attention to areas around
the neck, wrist, ears, and dressings, splints, or tourniquets.
_k._ =Step 8. Decontaminate skin.=
(1) =Spot decontamination.= Use the SDK or the 0.5 percent
hypochlorite solution to spot decontaminate exposed neck
and wrist areas, splints, other areas where the protective
overgarment was damaged, and where dressings or bandages were
removed. Decontaminate the patient's identification tags, if
necessary. Have the patient hold his breath and close his
eyes. Have him, or assist him, lift his mask at the chin. Wipe
his face with the M291 pad or the 0.5 percent hypochlorite
solution. Wipe quickly from below the top of one ear, being
careful to wipe all folds of the skin, top of the upper lip,
chin, dimples, earlobes, and nose. Continue up the other side
of the face to the top of the other ear. Wipe the inside of the
mask where it touches the face. Have the patient reseal and
check his mask.
+-----------------------------------------------+
| CAUTION |
| |
| Keep the decontamination solution out of the |
| patient's eyes. |
+-----------------------------------------------+
(2) =Trauma specialist care.= During clothing removal, the
clothing around bandages, tourniquets, and splints was cut and
left in place.
· The trauma specialist replaces the old tourniquet by placing
a new one ½ to 1 inch above the old tourniquet. When the old
tourniquet is removed, the skin is decontaminated with the SDK
or the 0.5 percent hypochlorite solution.
· _Do not remove splints._ Decontaminate them by thoroughly
rinsing the splint, padding, and cravats with the 0.5 percent
hypochlorite solution.
· Usually, the trauma specialist will gently cut away bandages.
The area around the wound is dusted with the M291 pad or rinsed
with the 0.5 percent hypochlorite solution, and the trauma
specialist applies the M291 pad or irrigates the soft tissue
wound with the 0.5 percent hypochlorite solution. If bleeding
begins, the trauma specialist replaces the bandage with a clean
one.
_l._ =Step 9. Dispose of contaminated waste.= Dispose of
contaminated bandages and coverings by placing them in a plastic
bag and sealing the bag with tape. Place the plastic bags in the
contaminated waste dump.
_m._ =Step 10. Proceed through the shuffle pit to the clean
treatment area.= Have the decontaminated patient proceed through
the shuffle pit to the clean treatment area. Make sure that the
patient's boots are thoroughly decontaminated by stirring the
contents of the shuffle pit with his boots as he crosses it. The
patient will remove his combat boots and socks at the entrance of
the clean treatment area or CPS; remove the protective mask at the
entrance to the clean treatment area or inside the ambulatory air
lock of the CPS.
G-12. Biological Patient Decontamination Procedures
The decontamination station as established for chemical agent
patients is also used for biologically contaminated patients. The
eight-man patient decontamination team is required for biologically
contaminated patient decontamination procedures.
G-13. Decontaminate a Litter Biological Agent Patient
_a._ =Remove the patient's personal effects.= Place the patient's
personal effects in a clean bag and label with the patient's
identification. If they are not contaminated, give them to him. If
his personal effects are contaminated, place the bagged items in
the contaminated storage area until they can be decontaminated, and
then return them to the patient.
_b._ =Remove the Field Medical Card.= Remove the FMC by cutting the
tie wire and allowing the FMC to drop into a plastic bag. Keep the
FMC with the patient.
_c._ =Remove the patient's clothing.= Patient decontamination
team members first apply the 5 percent hypochlorite solution to
the patient's clothing and the litter. Then, remove the patient's
clothing as in decontamination of chemical agent patients.
Bandages, tourniquets, and splints are not removed. Move patient
to a clean litter as described for a chemical agent patient. Place
patient's clothing in a plastic bag and dispose in the contaminated
waste dump.
_d._ =Decontaminate the patient's skin.= Bathe the patient with
soap and warm water or apply the 0.5 percent hypochlorite solution.
The trauma specialist places a new tourniquet ½ to 1 inch above
the old tourniquet, and then he removes the old one. The trauma
specialist removes bandages and decontaminates the skin and wound
with the 0.5 percent hypochlorite solution; he replaces the
bandage, if needed, to control hemorrhage. Splints are disinfected
by soaking the splint, cravats, and straps with the 0.5 percent
hypochlorite solution.
NOTE
Use a 0.5 percent hypochlorite solution to decontaminate
patients suspected of being contaminated with mycotoxins.
_e._ =Transfer patient to hot line.= Two decontamination team
members move patient to the hot line. Request assistance from
two other decontamination team members to transfer him to a
clean litter as described for chemical agent patients. Place the
patient's FMC in the plastic bag on the clean litter with him. Two
trauma specialists from the clean side of the hot line move the
patient from the hot line to the clean treatment/holding area.
G-14. Decontaminate an Ambulatory Biological Agent Patient
_a._ =Remove the patient's personal effects.= Place the patient's
personal effects in a clean bag and label with the patient's
identification. If they are not contaminated, give them to him. If
his personal effects are contaminated, place the bagged items in
the contaminated storage area until they can be decontaminated,
then return them to the patient.
_b._ =Remove the Field Medical Card.= Remove the FMC by cutting the
tie wire and allowing the FMC to drop into a plastic bag. Keep the
FMC with the patient.
_c._ =Remove the patient's clothing.= Patient decontamination
team members first apply the 5 percent hypochlorite solution to
the patient's clothing. Then remove the patient's clothing as in
decontamination of chemical agent patients. Bandages, tourniquets,
and splints are not removed. Place patient's clothing in a plastic
bag and dispose in the contaminated waste dump.
_d._ =Decontaminate the patient's skin.= Have the patient bathe
with soap and warm water or apply the 0.5 percent hypochlorite
solution. If the patient is unable to bathe himself, a member of
the decontamination team must bathe him. The trauma specialist
places a new tourniquet ½ to 1 inch above the old tourniquet,
and then he removes the old one. The trauma specialist removes
bandages and decontaminates the skin and wound with the 0.5 percent
hypochlorite solution; he replaces the bandage, if needed, to
control hemorrhage. Splints are disinfected by soaking the splint,
cravats, and straps with the 0.5 percent hypochlorite solution.
NOTE
Use a 0.5 percent hypochlorite solution to decontaminate
ambulatory patients suspected of being contaminated with
mycotoxins.
_e._ =Direct patient across hot line.= Direct the patient to
cross the hot line to the clean treatment area. His boots must be
decontaminated at the hot line before he enters the clean treatment
area.
NOTES
1. Remember, do not remove clothing from an ambulatory patient
unless he requires treatment in the clean treatment area of the
BAS or clearing station. Only spot decontaminate the patient's
clothing and evacuate him to the next level of care.
2. Place cutting device used in this procedure in a container
of 5 percent hypochlorite solution when not in use. Most
ambulatory patients will be treated in the contaminated
treatment area and returned to duty. Upon removal of an
ambulatory patient's clothing, he becomes a litter patient. The
BAS and clearing station do not have clothing to replace those
cut off during the decontamination process. The patient must be
placed in a PPW for protection during evacuation (Figure G-7).
G-15. Decontaminate Nuclear-Contaminated Patients
The practical decontamination of nuclear-contaminated patients is
easily accomplished without interfering with the required medical
care.
NOTE
Patients must be monitored by using a radiac meter (AN/VDR2,
AN/PDR27, or AN/PDR77) before, during, and after each step of
the decontamination procedure.
G-16. Decontaminate a Litter Nuclear-Contaminated Patient
_a._ =Remove patient's personal effects.= Patient decontamination
team members remove the patient's personal effects and place them
in a plastic bag. Place plastic bag in a clean holding area.
_b._ =Remove patient's clothing.= Patient decontamination team
members remove the patient's outer clothing as described for
chemical agent patients. Do not remove bandages, tourniquets, or
splints. Move the patient to a clean litter. Place the patient's
contaminated clothing in a plastic bag and move the bagged clothing
to the contaminated waste dump.
NOTE
Patients arriving at the MTF in MOPP will only have their MOPP
removed. They can remain in their BDU unless contamination is
found on it.
_c._ =Spot decontaminate patient's skin.= Wash exposed skin
surfaces with soap and warm water. Wash the hair with soap and warm
water, or clip the hair and wash the scalp with soap and warm water.
_d._ =Transfer patient to hot line.= Move the patient to the hot
line. Two trauma specialists from the clean side of the hot line
move the patient into the clean treatment area.
G-17. Decontaminate an Ambulatory Nuclear-Contaminated Patient
_a._ =Remove patient's personal effects.= Have the patient remove
his personal effects and place them in a plastic bag.
_b._ =Remove patient's outer clothing.= Have the patient remove
his outer clothing (or have a decontamination team member assist
him). Place his contaminated clothing in a plastic bag and move the
bagged clothing to the contaminated waste dump.
NOTE
Patients arriving at the MTF in MOPP will only have their
MOPP removed. They can remain ambulatory in their BDU unless
contamination is found on it.
_c._ =Spot decontaminate patient's skin.= Have the patient wash his
exposed skin surfaces with soap and warm water. Wash his hair with
soap and water, or clip the hair and wash the scalp with soap and
water.
_d._ =Transfer patient to hot line.= Direct the patient to move to
the hot line. Decontaminate his boots by stirring the shuffle pit
contents with his feet before he crosses into the clean treatment
area.
NOTE
If a new protective overgarment is not available, after
treatment, the ambulatory patient must be placed in a PPW for
protection during MEDEVAC to the next level of care MTF. Thus,
he becomes a litter patient for evacuation.
APPENDIX H
FIELD EXPEDIENT PROTECTIVE SYSTEMS AGAINST NUCLEAR, BIOLOGICAL, AND
CHEMICAL ATTACK
H-1. General
Medical units must have protection from NBC attack and
contamination to survive and function effectively. The extent of
protection provided is only limited by the resources available and
efforts of unit personnel. Protection as simple as an individually
dug foxhole or as elaborate as the subbasement of a concrete
building may be used. Expedient protection from the effects
of biological and chemical agents are usually much less labor
intensive.
H-2. Protection Against Radiation
The level of protection from radiation is expressed in terms
of shielding. Material is available on the battlefield to
construct/prepare expedient fallout shelters that offer substantial
shielding against gamma radiation (see Table H-1). Generally,
the denser or heavier the material, the better shielding it
offers. The degree of protection afforded by a fallout shelter is
expressed as a "protection factor," or a "transmission factor."
The protection factor is simply the fraction of the available
radiation dose that penetrates the shelter and reaches those inside
compared to the radiation received by an unprotected person. Thus,
a protection factor of 2 indicates that an individual in the
shelter receives one-half of the radiation dose he would receive
if unprotected. A protection factor of 100 (associated with about
six half-value thicknesses) indicates that only 1/100 or 1 percent
of the radiation dose reaches the inside. Transmission factors
are expressed in percentages, or in decimals. Either refers to
that fraction of the ambient unshielded dose that is received by
personnel within the shelter. Fallout gamma transmission factors
for some common shelters are shown in Table H-2.
_Table H-1. Shielding Potential of Common Materials--Fallout Gamma
Protection_
=============================================================
MATERIAL 1/2 VALUE LAYER THICKNESS[*]
-------------------------------------------------------------
STEEL 1.8 CM (.7")
CONCRETE 5.6 CM (2.2")
EARTH 8.4 CM (3.3")
WATER 12.2 CM (4.8")
WOOD 22.4 CM (8.8")
-------------------------------------------------------------
[*] 1/2 VALUE LAYER THICKNESS--THICKNESS OF A GIVEN MATERIAL
WHICH REDUCES THE DOSE OR DOSE RATE TO APPROXIMATELY ONE-HALF
OF THAT FALLING UPON IT.
=============================================================
_Table H-2. Transmission factors for Nuclear Radiation[*]_
==================================================================
INITIAL
ENVIRONMENTAL SHIELDING NEUTRONS GAMMA RESIDUAL
------------------------------------------------------------------
BUILT-UP CITY AREA (IN OPEN) 1.0 0.5 0.7
FOXHOLES 0.3 0.2 0.1
FRAME HOUSE:
FIRST FLOOR 1.0 0.9 0.5
BASEMENT 0.5 0.3 0.1
MULTISTORY BUILDINGS:
TOP FLOOR 1.0 0.9 0.1
INTERMEDIATE FLOORS 0.9 0.9 0.02
LOWER FLOOR 0.9 0.5 0.1
BASEMENT 0.5 0.3 0.01
SHELTER, CLOSED 91 CM (3 FT)
(EARTH COVER) 0.05 0.02 0.005
ARMORED VEHICLES:
ARMORED PERSONNEL CARRIER 0.3 0.2 0.1
TANKS 0.3 0.2 0.1
WOODED FOREST 1.0 1.0 0.8
------------------------------------------------------------------
[*] INSIDE DOSE = TRANSMISSION FACTOR TIMES OUTSIDE DOSE.
==================================================================
H-3. Expedient Shelters for Protection Against Radiation
_a._ In many cases it will be unnecessary to construct field
expedient or other types of fallout shelters. There are many
structures and terrain features available that afford a degree of
fallout protection. Existing fallout shelters are tunnels, caves,
culverts, overpasses, ditches, ravines, and man-made structures.
The best existing shelters are basements. Figure H-1 shows typical
protection provided in buildings. Windows can be sandbagged or
covered with dirt from the outside to provide additional protection.
[Illustration: _Figure H-1. Typical shelter protection provided in
buildings._]
_b._ Planners should attempt to locate HSS units near existing
shelters, whenever possible. However, if an HSS unit is already
established, or must be established where fallout shelters are not
available, then a shelter must be constructed. Elaborate shelters
are not required, since they usually only need to be occupied for a
few days. There are a number of field expedients that will serve to
save personnel and patients even though they may not be comfortable
for those few days.
_c._ When engineer support is available, a bulldozer trench about
2.7 meters (9 feet) wide and 1.2 meters (4 feet) deep can be dug
(Figure H-2). The length of the trench will be determined by the
number of patients/personnel to be sheltered. About 0.6 meter (2
feet) length of trench is required for each person to be sheltered.
These trenches reduce exposure of personnel lying on the floor to
about 20 to 30 percent of the radiation that they would receive in
the open. Protection and comfort can be improved, as time permits,
by digging the trenches deeper; undercutting the walls (care must
be taken in this option; the earth may cave in); erecting tents
over the trenches; and providing improved flooring. When used with
other individual and collective protection measures, bulldozer
trenches provide adequate fallout shelters for most situations;
they can be provided in a minimum of time and effort. Trenches
should not be dug in areas subject to flooding during rainstorms;
a berm should be formed on the uphill side of the trench to direct
water around the trench in the event rainfall occurs in the area.
Undercutting will not be possible in sandy soil; also some form of
support to keep the walls from caving in is required.
[Illustration: _Figure H-2. Dozer trench._]
_d._ Dug-in tents (Figure H-3) for hospitals provide more comfort
and require less movement than the bulldozer trench; however, they
have two drawbacks. First, they offer far less radiation protection
than the bulldozer trench, and second, they require considerably
more engineer effort. This option should work well with GP tents,
but will probably be hard to accomplish with the TEMPER.
[Illustration: _Figure H-3. Dug-in tents._]
_e._ Sandbagged walls around the hospital tents, as shown in
Figure H-4, or lightly constructed buildings provide protection
from fallout. Sandbagged walls 1.2 meters high give significant
protection (20 to 40 percent transmission factor); however,
the effort required to achieve the protection is such that it
is marginally feasible. Sandbagging is an effective means for
supplementing other shelters by--
· Bolstering the shielding at weak points.
· Forming baffles at entryways.
· Blocking open ends of trenches.
· Covering windows and gaps.
_f._ When other shelters are not available, HSS units must
prepare foxholes and trenches for patients and unit personnel.
As time permits, improve these shelters by deepening, covering,
undercutting, and sandbagging.
[Illustration: _Figure H-4. Sandbag walls around tents._]
H-4. Expedient Shelters Against Biological and Chemical Agents
_a._ When CPS systems are not available, well-sealed shelters
(TEMPER, ISO, and GP) can significantly minimize or prevent the
entry of CB agents. The ventilation system must be turned off, and
kept off, before, during, and after the attack. The shelter must be
totally sealed during this time to maximize protection. Table H-3
provides examples of protection values for well-sealed shelters.
For example, a well-sealed TEMPER will only permit 1/60 of the
CB agent outside to enter the shelter. If a persistent agent is
used, be aware of agent off-gassing hazards. Persistent agents can
penetrate TEMPER fabric and create a vapor hazard inside. In a CB
agent attack, ensure that all staff and patients are protected by
wearing their MOPP or are in PPWs.
_Table H-3. Ratio at Nonpersistent Agent Concentrations
(Inside/Outside) for Different Shelters_
=================================================================
SHELTER RATIO INSIDE/OUTSIDE
-----------------------------------------------------------------
TEMPER TENT 1:60[*]
GENERAL PURPOSE TENT, MEDIUM, WITH COTTON LINER 1:50
GENERAL PURPOSE TENT, LARGE, WITH COTTON LINER 1:30
ISO SHELTER 1:60
-----------------------------------------------------------------
[*] THE VENTILATION SYSTEM MUST BE TURNED OFF ON ALL SHELTERS TO
PROVIDE THIS LEVEL OF PROTECTION.
=================================================================
_b._ Sealing shelters to prevent entry of CB agents does not
require elaborate materials or procedures.
(1) Materials needed for sealing shelters include, but are not
limited to the following:
· Duct tape (or similar tape) for sealing.
· Velcro kits for TEMPER.
· Sand/dirt to seal base of GP tents.
· Plastic sheeting and tape to seal large openings, such as
doors and windows of GP tents.
(2) All vulnerable areas must be sealed. Seal--
· Joints in ISO shelters and GP tents with tape. Tape does not
work very well on TEMPER fabrics; use Velcro kits.
· Base of GP tents with sand/dirt.
· Stove pipe openings with tape and plastic.
· Windows of GP tents with tape and plastic. Seal TEMPER tent
windows by aligning and securing the Velcro border tightly;
tape may be applied to the seams to provide some additional
barrier.
· All ISO shelter doors that do not have CB protective seals,
with tape. Seal GP tent doors with plastic sheeting and tape.
· All windows, doors, and other openings of fixed sites with
plastic and tape.
· All air ventilation system vents.
NOTES
1. Do not allow any entries/exits to shelters during a CB
attack.
2. In hot climates the heat load will rise in sealed shelters
with the ventilation system turned off. Personnel must
carefully monitor each other and the patients. All personnel
must drink plenty of water to prevent heat injuries; see FM
21-10.
APPENDIX I
DETECTION AND TREATMENT OF NUCLEAR, BIOLOGICAL, AND CHEMICAL
CONTAMINATION IN WATER
I-1. General
Water supplies in areas with NBC contamination and in surface
water supplied by runoff from such areas will most likely be
contaminated. The contamination of water, whether intentional or
inadvertent, may reach concentrations that will produce casualties.
By special methods of analysis, the presence of contamination can
be determined. Treatment of contaminated water requires chemicals
and equipment that are only available to quartermaster water
purification units; individuals or units should not attempt to
treat their water. Decontamination of water is only undertaken
when uncontaminated sources are not available; then ONLY with the
approval of the medical authority (PVNTMED or surgeon).
I-2. Detection of Contamination in Water
_a._ Detection of nuclear contamination in water is accomplished by
using the AN/PDR77, AN PDR/27 or AN VDR/2 radiac meters.
+------------------------------------------------------+
| CAUTION |
| |
| DO NOT allow the probe to come into contact with the |
| water source; allow at least one inch of air space |
| between the probe and water surface. |
+------------------------------------------------------+
_b._ Detection of BW agents in water is accomplished by the use of
field biological water test kits and specially designed collection
and detection kits. The specialty kits will be provided as needed,
and will be available to PVNTMED and supporting medical laboratory
personnel. When required for the President and Secretary of Defense
purpose, samples must be collected and prepared for shipment to the
supporting medical laboratory. A chain of custody document must be
prepared by the collector and maintained as the sample(s) is being
transported to the supporting medical laboratory and throughout
its transit to the CONUS laboratory. See Appendix F for details
on suspect BW sample collection, packaging, chain of custody, and
handling.
_c._ The Chemical Agent Water Testing Kit, M272, provides a rapid
field test to detect chemical agent contamination in water. The
test must be conducted before the water is treated with chlorine;
the chlorine will affect the accuracy of the test for chemical
agents.
I-3. Procedures on Discovery of Contamination in Water
When contamination is discovered the following actions are taken:
_a._ Mark the water source, using the standard NBC contamination
markers, and ensure that personnel do not consume the water until
approved.
_b._ Notify the commander that the water source is contaminated and
unfit for drinking, food preparation, and personal hygiene.
_c._ Notify the supporting water production unit, such as the
quartermaster water production and distribution unit of the
contaminated water source.
_d._ The commander establishes safeguards to prevent personnel from
using the contaminated water supply.
_e._ An alternative source of uncontaminated water is sought
and used. The primary source for obtaining water is from
quartermaster-operated water production and distribution points.
Other sources are considered only when quartermaster-operated
faculties are not available. Alternative sources that may be
considered include--
· Ground water sources that are least likely to be contaminated.
· Local fixed facility water supplies. However, these supplies
must be tested before use. If NBC contamination is found do not
use.
· Using another location to obtain an uncontaminated water
source, when the tactical situation permits.
_f._ Contaminated water must not be used until it has been treated
by quartermaster water production and distribution units or other
equally capable water purification units and approved for use by
the medical authority.
I-4. Treatment of Contaminated Water
Contaminated water requires additional equipment and supplies to
remove the contamination. Quartermaster water purification and
distribution units are equipped to perform these duties. See FM
10-52 for details.
APPENDIX J
FOOD CONTAMINATION AND DECONTAMINATION
J-1. General
_a. Food Susceptibility._ Stored, transported, and prepared food
is susceptible to NBC contamination throughout the TO. Planning
for any battle or operation must include food protection from
contamination; food contamination detection; and contaminated food
disposition (decontaminate or destroy).
_b. Countermeasures._ There are three primary countermeasures to
overcome or reduce the NBC hazard to food:
(1) Contamination avoidance.
(2) Nuclear, biological, and chemical agent detection.
(3) Nuclear, biological, and chemical agent decontamination.
_c. Priorities._ The priorities for conducting NBC countermeasures
are--
(1) _Contamination avoidance._ Contamination avoidance
includes using natural and fabricated barriers to prevent, or
significantly reduce the spread of contamination. Also, using
specific procedures for entry and exit between contaminated
and uncontaminated areas reduce the potential for spreading
contamination. Use of these barriers and procedures may reduce
the subsequent need for detection and decontamination.
(2) _Detection, measurement, and identification._ These
activities are essential for determining the presence, extent,
and nature of NBC contamination. This information is essential
in identifying the existence of uncontaminated supplies, or
decontamination requirements.
(3) _Decontamination._ Decontamination removes the contaminant
and provides food that is safe for consumption.
_d. Decontamination._ Decontamination efforts require an
extensive amount of labor, time, and supplies. The use of hasty
decontamination is emphasized. That is, decontaminate just enough
to sustain operations and keep fighting, rather than to make a
contamination-free environment. Normally, decontamination efforts
will be limited to the packaging and packing materials. Food
decontamination will only occur in critical situations where
other food supplies are not available. Most decontamination is
performed in or very near the AO. Before beginning decontamination
procedures, divide exposed food items into groups based on
protection of item at time of exposure. These groups establish
priorities based on ease of decontamination and the ability to
monitor the food.
(1) Group I--Canned or packaged items exposed only to a
chemical agent vapor.
(2) Group II--Canned or packaged items that are contaminated on
the outside with a liquid chemical agent, a biological agent,
or radioactive fallout.
(3) Group III--Unpacked or poorly packaged items that have been
exposed to any NBC agent.
(4) Group IV--Food contaminated through the food chain.
J-2. Protection of Food from Contamination
An adequate defensive posture for a chemical attack will also
protect food against biological contamination and radiation fallout.
_a. Operational Rations._ Operational rations include, but are not
limited to, MREs; unit group ration (UGR), A; unit group ration,
heat and serve; and medical diet supplement.
(1) Packaging materials and storage methods normally protect
these rations. The packaging and packing of operational rations
protect the contents from deterioration. As a result, the
contents are protected from moisture, to include chemical
liquids, chemical vapors, and biological agents. Operational
rations delivered to an AO will usually have increased levels
of packaging and/or packing protection. Operational rations are
substantially protected while contained in the shipping cases,
especially if protected with an overlay of fiberboard, shrink
wrap, or film wrap.
(2) Enclosed storage is used whenever possible. Refrigerated
warehouses, cold storage rooms, and even prefabricated
refrigerators and trailers provide excellent protection.
Underground shelters, caves, and tunnels that can be made
airtight provide maximum NBC protection. Buildings provide
protection depending on how well they can be closed and sealed.
The basement of a building is a good storage place. However,
keep in mind that chemical vapors tend to seek out low-lying
areas. Storing rations indoors will protect them from liquid
droplet and fallout contamination unless the building is
damaged by an attack. Complete protection against chemical
vapors is only offered by airtight closed spaces like cold
storage facilities.
(3) Chemical protective measures are to be integrated into
daily logistical operation to avoid the contamination of
operational rations. Maximum use is made of alarm and
detection equipment, overhead shelter, shielding materials,
and protective covers. Back up stocks of operational rations
should be dispersed to minimize the risk of destruction or
contamination.
(4) An NBC Protective Cover or similar equipment will help
greatly. The NBC Protective Cover is discarded and replaced
upon becoming contaminated; it reduces overall decontamination
requirements; and it improves the survivability of supplies and
equipment. The NBC Protective Cover provides 24-hour protection
against liquid chemical contamination. Detection paper used on
the NBC Protective Cover will rapidly identify a contaminated
cover.
_b. Bulk and Fresh Foods._
(1) Field expedient or improvised storage may be the only
choice available under high-risk conditions. Expedient storage
for food supplies may be a natural or man-made depression
lined to protect contents against moisture, and then covered
with earth and sod. The earth gives good protection against
all forms of chemical or biological contamination and nuclear
fallout.
(2) Foods are only stored outdoors or in partially protected
areas when absolutely necessary. Only cases of foods packed in
cans, bottles, or airtight foil or film wraps, and foods packed
in sealed boxes or multilayered wrappings can be subjected to
exposed storage. Partial protection is provided by open sheds,
temporary roofing, or tents. When subsistence must be stored
in the open, give as much protection as possible. Protection
material may include NBC Protective Covers, tarpaulins,
tarpaulin sheds, or any other available covering such as
plastic sheeting. Tarpaulins and other treated or waterproof
coverings do not prevent contamination by chemical vapors,
but they do reduce contamination from liquid agents. Canvas
will keep out more than 95 percent of liquid contamination for
a short period of time after the attack. The canvas must be
removed soon after the attack to prevent the agent from seeping
through onto the subsistence; placement of spacers between the
covering and the food will greatly reduce this problem. Even
the thinnest material will offer some protection and is better
than nothing at all. Therefore, food supplies must be covered
by whatever material is available.
J-3. Nuclear
_a. Contamination._
(1) Following a nuclear detonation, food can become
contaminated in three ways:
· _Direct contamination._ Direct contamination results by
fallout collecting on plants, animals, and stored food (surface
contamination). Fallout has two effects. First, it produces
a gamma radiation field over the fallout area. Second, it
contaminates the surface of anything on which it is deposited.
The whole-body gamma irradiation hazard to an individual far
outweighs any potential hazard from food contamination. The
basic rule is: If you can safely be in the area to salvage the
food, then the food salvaged is safe to use (although slightly
contaminated).
· _Indirect contamination._ This form of contamination can
be spread throughout the food chain. Humans can ingest
contamination by eating plants that have absorbed radioactive
isotopes; products (milk or meat) from animals allowed to graze
on contaminated pastures; or fish from contaminated water.
· _Induced radiation._ It is possible that food will be
exposed to sufficient neutron flux (an increase in the number
of free neutrons) as the result of a nuclear explosion to
produce considerable induced radioactivity in food without
it being destroyed by blast and heat. This is possible with
enhanced radiation weapons in the energy range of 1 KT where
the radiation kill radius exceeds the blast destruction zone.
The elements that are most prominently involved are sodium,
potassium, sulfur, copper, bromine, zinc, and especially
phosphorous. Thus, in an area of induced radiation, foods
requiring the most caution are dairy products, high salt
content foods, dry beans, raisins, and ready-mixed cake and
biscuit flours. The radioactivity has a short half-life;
therefore, the radiation will decay very rapidly. It should be
possible to consume foods containing induced radiation within
a week or two. Cans, particularly those with "C" enamel, may
incur a high level of induced radiation (from zinc in the
enamel, not from iron in the can). Glass, because of its high
salt content, will show very high levels of activity; clear
glass will turn brown. Container radioactivity has no bearing
on the food, it is safe to use. The radioactivity is not
transferred to the contents. No significant toxic by-products
are formed in the exposed canned food.
(2) Consumption of food contaminated with radioactive fallout
may cause a risk of radiation injuries from internal radiation;
that is, radiation from radioactive sources within the body.
Most isotopes will pass through the digestive tract or be
excreted very quickly. However, the intestinal tract may
receive a considerable dose. Some isotopes are more hazardous
because they are absorbed from the digestive tract and enter
the metabolism of man and animals.
· Strontium-89 (Sr-89) and Strontium-90 (Sr-90) are beta
emitters and have half-lives of 51 days and 28 years,
respectively. Therefore, Sr-90 is the greatest radiation hazard
in the long term. These two isotopes are absorbed in the body
and used in the same way as calcium. They accumulate in bone,
where bone marrow with its blood forming cells is vulnerable.
Milk and other dairy products are the primary sources of Sr-89
and Sr-90 in the human diet.
· Iodine-131 (I-131) is a beta and gamma emitter and has
a short physical half-life of approximately 8 days. It is
efficiently absorbed and used by the body. Iodine-131 will
contaminate plants that will be eaten by grazing animals.
Smaller amounts can also be absorbed by breathing contaminated
air. Cattle will excrete a large amount of I-131 in milk. Milk
and other dairy products are the primary sources of I-131
intake. One can also get smaller amounts by eating contaminated
fruits and vegetables. Iodine-131 will be concentrated in the
thyroid gland. The intake of I-131 will have its greatest
impact the first few days to weeks following a nuclear
explosion.
· Cesium-137 (Cs-137) is a beta emitter and has a half-live
of 30 years, but is eliminated relatively quickly from the
body. The biological half-live is 70 to 140 days. Cesium-137
is found in most tissues of the body, but it will concentrate
in muscle tissue. Cesium-137 is absorbed and used the same way
as potassium. Meat and milk are the primary sources of Cs-137.
Much precipitation, lack of minerals in the soil, and extensive
cultivation increase the plants' absorption of Cs-137; thus,
the contamination of plant products.
(3) Operational rations are safe when surface decontamination
is performed before breaking the package. Operational rations
stored close to ground zero may become radioactive from induced
radiation. It is more likely, however, that the food will be
damaged or destroyed by the blast and thermal effects of the
nuclear explosion.
(4) Bulk and fresh food stored in the open without protection
will be contaminated. Decontamination is very difficult and
time-consuming. Efforts should be made to ensure proper packing
to prevent food contamination from radioactive fallout. Packing
made from hard and nonporous materials, such as plastic or
multilayer cardboard with a smooth surface, should be used.
In addition, storage facilities should be enclosed to avoid
the entry of fallout. Any material used as a protective cover
will give some protection against nuclear fallout. Protection
against induced radiation, blast, and thermal effects requires
a hardened shelter or underground storage.
(5) Food supplies require protection throughout the chain of
production or procurement. Protection of the civilian-based
food supply includes countermeasures along the production
chain. Meats and milk are the most vulnerable products because
of the possibility for concentration of radioactive isotopes
(Strontium, Cesium, and Iodine). The primary, and possibly the
only, protection of animal products is to keep the animals
indoors and to avoid contaminated fodder. Immediate slaughter
of food animals is recommended if there is a shortage of
uncontaminated fodder. Also, food animals exposed to fallout
should be considered fit for consumption and slaughtered using
routine procedures. Unharvested crops cannot be protected.
_b. Inspection and Monitoring._
(1) Fallout close to ground zero, especially after a surface
burst, may be visible as dust. The presence of dust is an
immediate indicator of contamination. Fallout on unprotected
food produces a grittiness that is unpleasant and warns against
eating the food. The degree and means of food protection
(packaging and storage faculties) must be considered. Food
in a building that remains intact should not receive enough
contamination to be dangerous when eaten.
(2) Veterinary units have the AN/VDR2 Radiac Set and UDR13
dosimeter to conduct ground or aerial surveys for gamma
radioactive contamination levels in an area. The measurement
of the external gamma radiation in the fallout area is an
indication, but not a quantitative measure, for the degree
of hazard from food contamination. These units also use the
AN/VDR2 Radiac Set for point detection of gamma and beta
radiation sources. Food monitoring is conducted in an area with
low background radiation. If the storage area is contaminated,
the food must be moved to a cleaner area for monitoring. With
the AN/VDR2, the initial food monitoring is performed with
the probe cover in place and the probe passed approximately 6
inches from the surface. If the reading is twice the background
dose rate, the food is considered contaminated. If the reading
is not above the background level but contamination is still
suspected, place the probe closer to the food with the beta
probe cover off. Monitor meat and fish with the probe cover
off; pass the probe approximately one-half inch from the
surface of the food.
(3) Monitoring food contaminated through the food chain is
more complicated; depending on the detection instrument
used, special procedures must be followed. Gamma and beta
emitting radionuclides in small volumes may be detected using
radiac sets such as the AN/VDR2; however, alpha emitting ones
cannot. They are rough instruments and may be used only for
screening surface contaminated food. To evaluate the hazards;
the isotopes contributing to the radioactivity must be
identified. Surface contaminated food will contain a mixture of
isotopes with some more hazardous than others, depending upon
whether they are used by the body. Milk will contain mostly
I-131, Cs-137, Sr-89, and Sr-90. Meat and fish will contain
mostly Cs-137. To verify I-131, Cs-137, Sr-89, and Sr-90
contamination, samples must be sent to laboratories equipped to
analyze the samples.
(4) All newly selected food supplies must be surveyed. Begin
continuous monitoring immediately following receipt of a
fallout warning, or when increased levels of radiation are
detected by periodic monitoring.
(5) Periodic monitoring is needed to establish baseline levels
of background radiation in the environment and various food
products. This monitoring is performed during peacetime, when
possible, and throughout the time US forces are deployed in a
TO.
NOTE
The AN/VDR2 is being replaced by the AN/PDR77 Radiac Set.
_c. Decontamination._ There are two methods for nuclear
decontamination: aging and removing. Aging is the process of
allowing natural radiation decay to occur. The time necessary for
this decay to take place depends upon the isotopes present; each
has a different decay rate (half-life). Aging may not be possible
when there is a short food supply. In some instances, such as with
induced radioactivity, it may be the only way to decontaminate.
Removing nuclear contamination from areas, personnel, food, or
moving equipment to another location eliminates the immediate
hazard. To determine which decontamination method is required, food
supplies are divided into groups. See Table J-1 for additional
information on food items and decontamination.
(1) Group II--Food in sealed and dust-proof packing such
as cans, jars, fiberboard, and cellophane. These products
are easily decontaminated by removing the radioactive dust
covering the packing; brush, wash with soap and water,
or remove the packing (depending on the type of packing
material). If radiation is still detected after removing
the dust, repeat the brush/wash procedure and remonitor. If
radiation is still present, the food itself is then considered
radioactive (induced radiation) and is unfit for consumption.
Decontamination of induced radiation is possible only through
aging. After aging one to two weeks, the food should be safe
for consumption. After surface decontamination, the contents
are safe to eat unless the food has induced radiation.
(2) Group III--Unprotected food. The method chosen to
decontaminate unprotected food items will depend upon whether
or not the food supply is critical. If the food supply is not
critical, the contaminated items are isolated and allowed to
decontaminate by aging. If the food supply is critical, food
with surface contamination can, in principle, be decontaminated
by removing the contaminated surface, or by washing.
(3) Some products can be decontaminated by washing, peeling,
or trimming the outer skin or leaves. Decontaminate potatoes
and hard-skinned fruits and vegetables by washing or scrubbing
under running water, followed by peeling or scraping, then
washing again. Potatoes, carrots, beets, and turnips can be
washed at the supply depot. However, do not wash beans, rice,
and onions until they are delivered to the field kitchen;
washing reduces their storage quality and shelf life. Citrus
fruits, pineapples, corn, peas, beans, melons, pumpkins,
cabbage, and nuts can be peeled. Decontaminate cucumbers,
tomatoes, cherries, cranberries, grapes, pears, plums, and
thin-skinned squash by soaking in a water or detergent
solution and rinsing with vigorous agitation or brushing.
Apricots, peaches, most berries, asparagus, broccoli, and leafy
vegetables cannot be satisfactorily decontaminated because of
fuzzy surfaces, irregular shapes, or small size, which makes
washing difficult.
· Fresh carcass meat, sausages, and fish can be decontaminated
by several washings with cold water. The exterior layer of the
food item is removed if radioactivity is still present. There
is, however, a risk of contaminating the inner parts of the
foodstuff in the process. Cooking with several changes of water
is the last step in decontamination.
_Table J-1. Decontamination of Food Supplies_
========================================================================
|
| TYPE OF CONTAMINATION
SURFACE +---------------+----------------------+-----------------
OR | | |
MATERIAL | CHEMICAL | BIOLOGICAL | NUCLEAR
----------------+---------------+----------------------+-----------------
| | |
CANNED, BOTTLED,|IMMERSE IN |WASH WITH SOAP AND |WASH WITH SOAP
OR PROTECTED BY |BOILING, |WATER, THEN IMMERSE |AND WATER, RINSE.
IMPERMEABLE |SOAPY WATER |IN DISINFECTANT |
CONTAINER. |FOR 30 MINUTES |SOLUTION. (IMMERSE IN |BRUSH, WIPE
|AND RINSE. |BOILING WATER FOR 30 |CHLORINE, FOOD
| |MINUTES. FOOD DIS- |CONTAMINATION
| |INFECTANT, OR 1/3 |FROM SURFACE OF
| |CANTEEN CUP OF HOUSE- |CONTAINER.
| |HOLD BLEACH IN 10 GAL |
| |OF WATER). |
| | |
|SPRAY WITH | |
|DS2 AND RINSE | |
| | |
|WASH IN HOT, |BOIL IN WATER 15 |
|SOAPY WATER, |MINUTES; NOT EFFECTIVE|
|RINSE, AND |ON TOXINS AND SOME |
|AERATE. |SPORES. |
| | \
| |IMMERSE IN 5% SODIUM \
| |CARBONATE (4 LB WASHING |
| |SODA IN 10 GAL WATER), |
| |RINSE WITH POTABLE WATER.|
| | |
| |IMMERSE IN HOUSEHOLD |
| |BLEACH SOLUTION (1/2 GAL |
| |BLEACH IN 25 GAL WATER) |
| |FOR 30 MINUTES THEN RINSE|
| |AND AERATE FOR 10 |
| |MINUTES. |
| | |
| |IMMERSE IN HTH SOLUTION |
| |(1/2 LB IN 25 GAL WATER) |
| |20 MINUTES, THEN RINSE. |
| | |
| |IMMERSE IN STB SOLUTION |
| |(1 LB IN 25 GAL WATER) |
| |30 MINUTES, THEN RINSE. |
| | |
| |IMMERSE IN 2% PERACETIC |
| |ACID FOR 10 MINUTES, |
| |RINSE, AND AERATE FOR |
| |10 MINUTES. |
| | |
NOT CANNED OR |FOOD KNOWN OR |BOIL IN WATER 15 MINUTES.|WASH OR TRIM
IMPERMEABLE |SUSPECTED TO |COOK. |CONTAMINATION
CONTAINER. |BE CONTAMINATED| |FROM UNPACK-
|SHOULD NOT BE |IMMERSE IN OR SPRAY WITH |AGED FOOD.
|CONSUMED UNTIL |2% HOUSEHOLD BLEACH |
|APPROVED BY |SOLUTION. PACKAGED, |
|VETERINARY |PEELED, OR PARED FOOD MAY|
|PERSONNEL. |BE IMMERSED OR SPRAYED. |
=========================================================================
· Decontaminate hard cheeses, margarine, and butter by cutting
off the outer layer to a depth of 2.5 to 3 cm.
· Let cooking oils stand for 3 to 5 days, then pour off the
contaminated layer; use a funnel to control spillage.
· Nonperishable items that are hard to decontaminate, such
as flour, sugar, and salt, can be set aside allowing natural
radioactive decay. When supplies are short, dilute the
contamination by mixing with uncontaminated food. This will
reduce the total amount of radioactive exposure in foods
prepared using these contaminated items.
· Decontaminate air permeable, double-sacked goods by removing
the outer sack. If the inner sack is free of radiation, double
sack the food again to restore protection. However, when
contamination is present on the inside bag, the food in contact
with the bag is likely to be contaminated. Three methods can be
used to handle this type of contaminated product. The easiest
method involves spraying the bag of dry goods (except sugar
or salt) with water. This will wet a layer of the food inside
the bag. The wet layer can be removed when the bag contents
are emptied. The uncontaminated contents are scooped back
into clean packaging. Another method involves using melted
paraffin to uniformly coat the outside of the bag. The paraffin
solidifies after 30 to 40 minutes, and then the bag with the
radioactive contamination can be removed from the contents.
Although this method will seal the radioactive substance in
the wax, it probably will not remove the layer of contaminated
food product inside the bag. For the third method, form a piece
of sheet metal into a cylinder the same height as the bag
and 4 to 6 cm smaller in diameter. Insert the cylinder into
the bag, then remove the top 3 to 4 cm of the contaminated
product. Carefully scoop the remaining product out into a
clean sack. With the cylinder still in place, fold the bag
down catching the contaminated product on plastic sheeting, or
a tarpaulin. When using this method, mixing the contaminated
portion with the uncontaminated portion is a problem. Check for
contamination remaining in the product.
· Boiling or cooking has no effect on radioactive contamination.
(4) Group IV--Food contaminated through the food chain. It is
not practical to decontaminate this food. Meat and milk are the
two most common foodstuffs contaminated in this way.
· Milk may be decontaminated to a safe level by a complicated
ion exchange process. The I-131 activity will decline rapidly
during storage of milk and milk-products, although the Cesium
and Strontium activity will remain almost constant for years.
In an area with high-level fallout, milk is withdrawn from
human consumption. The duration of withdrawal will be dependent
upon the type of fallout and levels.
· Meat may be decontaminated to a safe level by soaking in
water or brine. Cesium is loosely bound in the meat. By
repeated soaking of meat cut in small pieces, most of the
Cesium activity will be removed. Traditional meat preserving,
such as salting with brine, will remove up to 60 to 70 percent
of the Cesium activity. See Table J-2.
· Fruits, vegetables, root crops, and grain products may also
contain hazardous amounts of radioactivity if ingested.
(5) Food animals. Food animals that have been exposed
to fallout should be considered fit for consumption and
slaughtered using routine inspection and slaughter procedures.
In those cases where the animal has been exposed to fallout,
but is not scheduled for immediate slaughter, the radiation
burden can be reduced by moving the animal to an uncontaminated
area (barn if available) and washing it with soap and water.
Mild radiation sickness does not necessarily mean that the
animals cannot be used for food. If the animals have been
exposed to an internal radiation hazard, the meat can be eaten
if the internal organs are discarded. Chickens that have eaten
radioactive material may lay contaminated eggs, but most of the
radioactivity will be concentrated in the shells. The white
and yolk will be free of harmful amounts of radiation and can
be eaten. Chickens will not lay eggs if the radioactive body
burden is large enough that their eggs are unfit to eat.
_Table J-2. Traditional Salt Preserving Brine_
======================================================================
MEAT, WHOLE 4-5 KG
25% NaCl (SALT) BRINE 5-LITER BRINE PER KG.
KEEP MEAT IN BRINE FOR 3 WEEKS, TEMPERATURE BELOW 10°C.
SOAK IN WATER FOR 1-2 DAYS.
65-70% OF CS ACTIVITY WILL BE REMOVED.
----------------------------------------------------------------------
MEAT, CUT 1-2 KG
25% NaCl BRINE 5-LITER BRINE PER KG.
KEEP MEAT IN BRINE FOR 4 DAYS.
SOAK IN WATER FOR 4 HOURS.
65-70% OF CS ACTIVITY WILL BE REMOVED.
----------------------------------------------------------------------
MUTTON/LAMB RIB
PIECE OF RIB 1-5 KG.
25% NaCl BRINE 5-LITER BRINE PER KG.
KEEP IN BRINE FOR 2 DAYS.
SOAK IN WATER FOR 2 HOURS.
AIR-DRYING FOR 10 DAYS.
SOAK IN WATER FOR 2 HOURS.
BOIL IN WATER FOR 3 HOURS.
85-90% CS ACTIVITY WILL BE REMOVED.
----------------------------------------------------------------------
DECONTAMINATION OF COARSELY CHOPPED MEAT
0.9% NaCl SOLUTION. 2-LITER SOLUTION PER KG.
SOAK IN NaCl SOLUTION FOR 10 MIN.
60-70% CS ACTIVITY WILL BE REMOVED.
REPEATED PROCEDURES WILL REMOVE THE SAME PERCENTAGE OF CS ACTIVITY.
SIX TIMES REPEATED TREATMENT WILL REMOVE NEARLY 100% OF CS ACTIVITY.
======================================================================
_d._ _Considerations When Decontamination is Not Possible._ When
food cannot be decontaminated, sealing the product in a wrapping
material or container may be needed. Sealing the product can
reduce or shield the emanation of the contamination and/or fix the
contamination in place. The hazard from contaminated food is small
compared with that from external gamma radiation. Hungry people
or animals should not be denied food because of possible fallout
contamination. It is not practicable or desirable to preset maximum
permissible limits of gross fallout radioactivity as a basis for
judging whether or not food should be used. Common sense must be
applied in establishing priorities for distribution of available
food. For example, use the least contaminated and the most
protected food first; hold milk products for 1 to 2 weeks before
use.
J-4. Biological
_a. Contamination._ Biological warfare agents exist in the form
of toxins and microorganisms. The normal packaging and packing of
food (to protect against moisture, dust, and bacterial or other
contamination) provides protection against most biological agents.
The exception may be toxins and biologically derived substances.
However, the protective methods used for chemical agents will also
protect against toxins and derived substances. Food in freezers,
refrigerators, and in refrigerated trucks or rail cars will be safe
if these containers remain sealed until the outer surfaces are
decontaminated.
(1) It is unlikely that a biological agent will affect the
appearance, taste, or smell of the food enough for the change
to be apparent.
(2) Packaging and packing materials are not life supportive to
pathogenic agents and are, therefore, self-decontaminating with
the exception of spore-forming organisms.
(3) Most operational rations are packaged in metal containers,
or encased in heavy aluminum laminated plastics that can
withstand boiling water; also, they are impervious to arthropod
penetration. This food is highly resistant to biological agents.
(4) The use of unpackaged items (unwrapped meats, fresh fruits,
and vegetables) should be restricted; use only operational
rations. Unprotected fresh food stored in the open and close to
the source of dissemination will become contaminated.