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.
Figure G-2. Thorough decontamination site collocated with patient decontamination station, without collective protection shelter.
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.
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.
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.
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 OUNCES | HTH MRE SPOONFULS | HOUSEHOLD BLEACH | PERCENT IN 5 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.
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.
This appendix only describes patient decontamination procedures. For NBC treatment procedures, refer to FM 4-02.283, FM 8-284, and FM 8-285.
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.
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.
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.
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.
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.
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 CATEGORY | WBGT INDEX DEGREES F | WORK/ REST MIN | WATER INTAKE QT/HR | WORK/ REST MIN | WATER INTAKE QT/HR | WORK/ REST MIN | WATER INTAKE 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.
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).
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.