US Army, NBC DECONTAMINATION, FM 3-5, Survival Medical Manual, Army Field Manual
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Nonmedical personnel conduct search and rescue operations for the injured or wounded; they provide immediate first aid and decontamination. See FM , for detailed information on personnel and equipment decontamination operations. See FMs Cover and concealment is extremely important; they increase protection for operating the MTF.
One trauma specialist supervises patient decontamination and manages patients during the decontamination process. Two trauma specialists work on the clean side of the hot line and manage the patients until they are placed in the clean treatment area or are sent into the CBPS for treatment. When the BAS or DCS are receiving NBC contaminated patients, they require at least eight nonmedical personnel from supported units to perform patient decontamination procedures. These facilities are only staffed to provide patient care under conventional operational conditions.
Without the augmentation support, they can either provide patient decontamination or patient care, but not both.
A patient decontamination station is established to handle contaminated patients see Appendix G. The station is separated from the clean treatment area by a "hot line" and is located downwind of the clean treatment area or CPS. The patient decontamination station should be established in a contamination-free area of the battlefield.
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However, it may be necessary to establish a patient decontamination station that is collocated with an MTF that is employing a CBPS, in a chemical vapor hazard area in order to decontaminate patients and clear the battlefield before moving the MTF to a clean area. When CPS systems are not available, the clean treatment area is located upwind 30 to 50 meters of the contaminated work area.
When personnel in the clean working area are away from the hot line, they may reduce their MOPP level. Chemical monitoring equipment must be used on the clean side of the hot line to detect vapor hazards due to slight shifts in wind currents; if vapors invade the clean work area, HSS personnel must re-mask to prevent low-level CW agent exposure and minimize clinical effects such as miosis.
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Civilian casualties may become a problem in populated or built-up areas, as they are unlikely to have protective equipment and training. However, aid to civilians will not be undertaken without command approval, or at the expense of health services provided to US personnel. The HSS mission must continue in a nuclear environment; protected shelters are essential to continue the support role. Well-constructed shelters with overhead cover and expedient shelters reinforced concrete structures, basements, railroad tunnels, or trenches provide good protection from nuclear attacks see Appendix H.
Armored vehicles provide some protection against both the blast and radiation effects of nuclear weapons. Patients generated in a nuclear attack will likely suffer multiple injuries combination of blast, thermal, and radiation injuries that will complicate medical care.
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Nuclear radiation patients fall into three categories:. Medical units operating in a radiation fallout environment will face three problems:. Decontamination of most radiological contaminated patients and equipment can be accomplished with soap and water. Soap and water will not neutralize radioactive material. However, it will remove the material from the skin, hair or material surface. See Appendix G for specific patient decontamination procedures.
The waste can become a concentrated point of radiation and must be managed and monitored. Commanders and leaders must consider the radiation exposure levels for themselves, their staffs, and patients when operating in or determining if the unit will enter a radiologically contaminated  area. The commander and leader must establish an operational exposure guide for their unit and personnel. The operational exposure guide OEG is established for either battlefield exposures as shown in Table or for exposures in stability operations and support operations as shown in Table The tables present radiation exposure status RES categories; however, they can be used to establish OEGs based on the same exposure criteria.
Medical Triage Medical triage is the classification of patients according to the type and seriousness of illness or injury; this achieves the most orderly, timely, and efficient use of HSS resources. However, the triage process and classification of nuclear patients differs from conventional injuries.
A biological attack such as the enemy use of bomblets, rockets, spray or aerosol dispersal, release of arthropod vectors, and terrorist or insurgent contamination of food and water may be difficult to recognize. Frequently, it does not have an immediate effect on exposed personnel. Passive defensive measures such as immunizations, good personal hygiene, physical conditioning, using arthropod repellents, wearing protective mask, and practicing good sanitation will mitigate the effects of many biological agent intrusions.
http://investor-school.kovalev.com.ua/assets/15.php The HSS commanders and leaders must enforce contamination control to prevent illness or injury to HSS personnel and to preserve the facility. Incoming vehicles, personnel, and patients must be surveyed for contamination. Decontamination of most BW contaminated patients and equipment can be accomplished with soap and water.
Soap and water will not kill all biological agents; however, it will remove the agent from the skin or equipment surface. Treatment of BW agent patients may require observing and evaluating the individual to determine necessary medications, isolation, or management. See FM for specific treatment procedures for BW agent patients.
Medical surveillance is essential. Most BW agent patients initially present common symptoms such as low-grade fever, chills, headache, malaise, and coughs. More patients than normal may be the first indication of biological attack. Daily medical treatment summaries, especially DNBI, need to be prepared and analyzed. Trends of increased numbers of patients presenting with unusual or the same symptoms are valuable indicators of enemy employment of BW agents.
- HEALTH SERVICE SUPPORT IN A NUCLEAR, BIOLOGICAL, AND CHEMICAL ENVIRONMENT?
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Daily analysis of medical summaries can provide early warnings of BW agent use, thus enabling commanders to initiate preventive measures earlier and reduce the total numbers of troops lost due to the illness. See FM for preventive, protective, and treatment procedures. Consider that all patients generated in a CW agent environment are contaminated.
If there is liquid agent contamination, or a continued vapor hazard, the MTF should be moved and be decontaminated, mission permitting. Initial triage, EMT, and decontamination are accomplished on the "dirty" side of the hot line. Life-sustaining care is rendered, as required, without regard to contamination. Secondary triage, ATM, and patient disposition are accomplished on the clean side of the hot line.
When treatment must be provided in a contaminated environment outside the CPS, the level of care may be greatly reduced because medical personnel and patients are in MOPP Level 3 or 4. However, lifesaving procedures must be accomplished.
See FM for specific treatment of CW agent patients. Decontamination of most chemically contaminated patients and equipment requires the use of materials that will remove and neutralize the agent. See FM for equipment decontamination procedures and Appendix G for specific patient decontamination procedures. For a more detailed discussion on NBC aspects of urban terrain, mountain, snow and extreme cold, jungle, and desert operations, see FMs In mountain operations, passes and gorges may tend to channel the nuclear blast and the movement of chemical and biological agents.
Ridges and steep slopes may offer some shielding from thermal radiation effects. Close terrain may limit concentrations of troops and fewer targets may exist; therefore, a lower patient load may be anticipated. However, the terrain will complicate patient evacuation and may require patients to be decontaminated, treated, and held for longer periods than would be required for other operational areas. The effects of extreme cold weather combined with NBC-produced injuries have not been extensively studied.
- HEALTH SERVICE SUPPORT IN A NUCLEAR, BIOLOGICAL, AND CHEMICAL ENVIRONMENT.
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However, with traumatic injuries, cold hastens the progress of shock, providing a less favorable prognosis. Thermal effects will tend to be reinforced by reflection of thermal radiation from snow and ice-covered areas. Care must be exercised when moving chemically contaminated patients into a warm shelter. A CW agent on the patient's clothing may not be apparent. As the clothing warms to room temperature, the CW agent will vaporize off-gas , contaminating the shelter and exposing occupants to potentially hazardous levels of the agent. A three-tent system is suggested for processing patients in extreme cold operations.
The first tent unheated is used to strip off potentially contaminated clothing. The second heated is used to perform decontamination, perform EMT and detect off gassing. The third heated is used to provide the follow on care and patient holding. In rain forests and other jungle environments, the overhead canopy will, to some extent, shield personnel from thermal radiation.