(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

G-13. Decontaminate a Litter Biological Agent 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.

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

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.

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.

G-15. Decontaminate Nuclear-Contaminated Patients

G-16. Decontaminate a Litter Nuclear-Contaminated Patient

G-17. Decontaminate an Ambulatory Nuclear-Contaminated Patient

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.

APPENDIX H

FIELD EXPEDIENT PROTECTIVE SYSTEMS AGAINST NUCLEAR, BIOLOGICAL, AND CHEMICAL ATTACK

H-1. General

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

Table H-2. Transmission factors for Nuclear Radiation[*]

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.

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.

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.

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.

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

APPENDIX I

DETECTION AND TREATMENT OF NUCLEAR, BIOLOGICAL, AND CHEMICAL CONTAMINATION IN WATER

I-1. General

I-2. Detection of Contamination in Water

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

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

APPENDIX J

FOOD CONTAMINATION AND DECONTAMINATION

J-1. General

(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

(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

• 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.