NOTES
1. Normally, patients will not be held at the DCS under NBC conditions unless evacuation cannot be accomplished. They should be RTD or evacuated to a clean MTF, as soon as the mission permits.
2. The CBPS can also be employed as the DCS in the conventional mode. Employment in either mode still requires GP tentage for patient holding to meet total patient holding requirements.
b. The DEPMEDS-equipped patient care areas of the US Army Force XXI hospital and the hospital unit base (HUB) of the Medical Force 2000 (MF2K) will employ the CP DEPMEDS. It will not protect personnel or patients from the thermal, blast, and initial radiation effects of nuclear weapons; however, it will provide some protection against fallout effects. Areas of the hospital that are not included in the chemically protected (CP) DEPMEDS are MF2K general hospital unit medical (HUM), MF2K field hospital unit holding (HUH), MF2K combat support and general hospital unit surgical (HUS), minimum care wards, administrative areas, food service, supply (including Class VIII), and staff quarters. The system includes—
c. The M20 simplified collective protection system is another system that is available. It consists of a chemically protected room liner, a CB filter blower, and an ambulatory air lock. However, it does not have a litter air lock making it unsuitable for litter patient care. The M20 may be used to protect medical staffs at the DCS, FST, and hospitals, patients held in the GP tents at the DCS and in the minimum care wards and staff quarters of the hospitals. Thus providing additional CB protection for staffs and patients.
To establish a BAS in a CBPS, use one CBPS per treatment team for conventional operations in a split-team mode. When operating in a squad configuration and in the conventional mode, the two CBPS systems may be complexed to provide more workspace. However, keep in mind that the treatment squad is not staffed to operate the two systems in the CB mode. Therefore, when the two systems are complexed and the treatment squad must convert and operate in the CB mode, they may want to close the complexing door and only use one system. When initially setting up the CBPS for operations in the CB mode, only one CBPS is setup; see Note 2 below. Set up the system as described in TM 10-5410-228-10. To be operational as a BAS, set up medical supplies and equipment as required or as designated in the TSOP. A PDS consisting of a contaminated ambulance point, contaminated triage point, a patient decontamination area, and a contaminated treatment area is established on the downwind (prevailing wind) side of the CBPS. An overhead cover of plastic sheeting (approximately 20 feet wide by 50 feet long) is set up over the PDS, the hot line, and the clean treatment/waiting area; the cover overlaps the air locks. The clean treatment/waiting area should have an area at least 20 feet wide by 15 feet long to allow space for placing patients into the litter air lock without crossing the hot line. A second area covered with 20 × 25 feet of plastic sheeting (the evacuation holding area) is set up beside the shelter on the opposite side from the generator. The clean treatment area is separated from the decontamination area by a hot line with a shuffle pit. Only clean (decontaminated) patients or personnel are allowed to cross the hot line into the clean treatment area, or are admitted into the CBPS. Figure F-1 presents one layout of a BAS using the CBPS. See TM 10-5410-228-10 for complete details on setting up, operating, and maintaining the CBPS. Each CBPS provides 300 square feet of work area.
1. The overhead cover is not needed when the wind speed exceeds 10 knots per hour. The plastic will not stay in place.
2. Although each treatment team of the BAS has a CBPS; only one system is set up when operating in the CB mode. This is due to the lack of authorized personnel to operate all systems at one time in the CB mode. Eight medical personnel are required to operate the BAS (employing one CBPS) in the CB mode. At least eight nonmedical personnel are required to perform patient decontamination under medical supervision. Also, only setting up one system in the CB mode provides the BAS the ability to retain its flexibility in order to maintain its support mission of being where it is needed and when it is needed. The CBPS can be used as the treatment shelter in the conventional mode as well. When the treatment squad is operating in the split-team mode, each team will have a CBPS for use as its treatment shelter. When operating one system in the CB mode, the other system provides a replacement in the event the one in use in the CB mode is damaged beyond repair. This ensures continued HSS to the command.
Figure F-1. Battalion aid station using the chemically biologically protected shelter.
To establish a DCS using the CBPS, set up four shelters as described in the TM. To be operational, medical supplies and equipment are set up as outlined in the unit TSOP. The four shelters are complexed as shown in Figure F-2. With four CBPS systems set up and operational, a total of 1,200 square feet of work area is available. The contaminated triage, decontamination, and contaminated treatment areas are separated from the clean treatment/waiting area by a hot line with a shuffle pit. Overhead covering is provided as described for the BAS. Patients are admitted through the EMT litter or ambulatory air lock. Patients are released through the patient holding air locks. This aids in controlling entry and exits; thus preventing the introduction of contamination into the systems. At least eight nonmedical personnel from supported units are required to perform patient decontamination under medical supervision at the DCS.
NOTE
In the event that the overpressure system fails on a system that is in use with entry/exit air locks, move to the available shelter with an entry/exit air lock in the same direction for use as the entry/exit until the failed system can be restored. Example 1: At the DCS the EMT system fails, move to the ATM shelter to receive patients until the EMT system has been restored. Example 2: At the DCS the patient hold system fails, move exits to the dental/lab/x-ray shelter until the patient hold system can be restored. Example 3: At the FST the postoperative system fails, use the preoperative shelter until the postoperative system can be restored. These options will allow patient care operations to continue until the failed systems can be restored.
Figure F-2. Chemically biologically protected shelter configuration as a division clearing station.
To establish a FST using the CBPSs, follow the procedures for the DCS except set up three CBPSs. All equipment is set up inside the CBPS as required by your unit TSOP. With three CBPSs set up and operational, a total of 900 square feet of work area is available (Figure F-3). When the FST is forward in support of a medical company and operating in the CB mode, the FST systems are connected to the DCS of the supported medical company. Figure F-4 shows the FST and DCS connected. When operating in the CB mode with the medical company, all patients are received through the EMT air lock of the DCS. The patients are triaged in the DCS and, based upon their injuries, they are routed to the DCS treatment area or to the FST for surgical care. Patients released from the FST for evacuation are placed in a PPW and processed through the litter air lock in the FST recovery section. Patient decontamination is performed at the PDS operated by the DCS. The FST cannot operate in a CB environment without being complexed with the DCS. They do not have any patient decontamination capabilities.
Figure F-3. Forward surgical team configuration for operations in conventional mode.
Figure F-4. Forward surgical team and division clearing station configuration for operations in a nuclear, biological, chemical environment.
a. When the threat of NBC action is anticipated in the AO, the CP DEPMEDS components must be set up as the hospital is being established. The system cannot be set up in a hospital that has already been established; to do so requires the hospital to be closed, all TEMPERs be struck, and erected with the M28 liners installed during the erection process. To establish CPS in a DEPMEDS-equipped hospital, follow the procedures as described in TM 10-5410-283-14&P. Training Circular 8-13 provides instructions on establishing a US Army DEPMEDS-equipped hospital (without CPS). Figure F-5 presents one layout of the DEPMEDS-equipped patient care area of a MF2K CSH HUB employing the CP DEPMEDS with an internal water supply system. Figure F-6 presents a layout of the patient care area of the DEPMEDS-equipped portion of an 84-bed MRI hospital. Figure F-7 presents a layout of the patient care area of the DEPMEDS-equipped portion of a 164-bed MRI hospital.
b. When employing CP DEPMEDS, provisions for waste disposal and protected water and food supplies within the system are established. Additionally, Class VIII supplies must be protected from contamination. Supplies not in use or needed in the protected operational areas are stored in medical chests, shipping containers, or wrapped in layers of plastic that are inside covered areas, such as closed MILVANs or tents. When contamination is present, only open these storage areas for operational area emergency resupply. Use plastic sheeting or other leak-proof material to provide an additional barrier between the supplies and the contamination. Wrap supplies in plastic or other barrier material for movement from the storage area to the resupply air lock of the CP DEPMEDS.
Figure F-5. Sample layout of a medical force 2000 combat support hospital unit base employing chemically protected deployable medical system.
Figure F-6. Sample layout of an 84-bed medical reengineering initiative hospital employing chemically protected deployable medical system.
Figure F-7. Sample layout of a 164-bed medical reengineering hospital employing chemically protected deployable medical system.
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.
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.
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.
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.
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.
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:
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.
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:
All personnel (staff and patients) must be decontaminated before they are permitted entry into the CPS.
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.
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.
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.
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.
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]).
Figure G-1. Field expedient nuclear, biological, and chemical patient card.
a. Collocating patient and thorough decontamination operations in the BSA may provide several advantages (Figure G-2). It—
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.