Chemical casualties decontamination

Cancio, L.C. (1993). Chemical casualty decontamination by medical platoons in the 82nd airborne division. Mil. Med. 158 1-5. 

The M291 resin kit and 0.5% hypochlorite for chemical casualty decontamination are currently fielded by the U.S. military. The M291 kit is new, whereas hypochlorite solution has been around since World War I. The M291 kit is our best universal dry decontaminant for skin. Fresh 0.5% hypochlorite solution with an alkaline pH is our universal liquid decontaminating agent and is recommended for all biological agents. 

Guidelines for Mass Casualty Decontamination During a Terrorist Chemical Agent Incident. Prepared by U.S. Army Soldier and Biological Chemical Command (SBCCOM). Aberdeen Proving Ground, MD (January) 2000. 

CBIRF s mission statement indicates that it has capabilities for nuclear, biological, and chemical (NBC) detection, identification, and reconnaissance casualty extraction casualty decontamination technical rescue provision of medical trauma supplies and explosive ordnance disposal. It works best if it can be pre-positioned. Its strengths include these ... 

A new course, Field Management of Chemical and Biological Casualties (FCBC), began in 1999. The focus of this course is on pre-hospital emergency treatment and casualty decontamination. It is available in both on-site and off-site versions. 

USAMRICD s Field Management of Chemical Casualties. This handbook provides concise supplemental reading material for attendees at the Field Management of Chemical and Biological Casualties. It includes the effects of chemical and biological agents and decontamination. 

The basic threat to and management principles for chemical casualties have not changed since World War I. To survive and to accomplish the mission on the chemical battlefield, medical care providers must be able to respond quickly and effectively. Soldiers must be trained in first-aid procedures. Decontamination procedures must be practiced. And medical care providers must know how to perform their mission in a chemical environment. Continued, careful attention to each of these requirements will significantly reduce the chemical threat to our military personnel. 

Specific medications and items of equipment to treat chemical casualties will be carried by units operating in an area of chemical threat. When collective protection systems are not available, casualties will be taken upwind 100 m or more to permit treatment to occur in a shirtsleeve environment. Chemical agent detection equipment, such as the chemical agent monitor (CAM), should be available to determine (a) if agent vapors have been absorbed on surfaces of the casualty s clothing or equipment before entering a treatment area, and (b) if decontamination procedures have been properly accomplished. 

Medical facilities treating chemical casualties must divide their operations into two categories contaminated (dirty) and uncontaminated (clean). Contaminated operations include triage, emergency treatment, and patient decontamination. Uncontaminated operations include treatment and final disposition. All activities conducted in the Casualty Decontamination Center (CDC) and not inside a collective protection shelter must be conducted at MOPP 4. Operational flexibility is essential. Therefore, the number and arrangement of functional areas will be adapted to both medical and tactical situations. 

The most important care for a chemical casualty is that provided within the first few minutes. This cannot be provided by medical personnel and must be done by each individual. This self-aid includes decontamination and the self-administration of the antidote kit if exposure was to a nerve agent. 

As discussed in greater detail in Chapter 14, Triage of Chemical Casualties, the triage officer must know the natural history of the injuries he faces, including chemical injuries. He must also have knowledge of evacuation capabilities and the facilities at higher echelons of care as well as his own decontamination capabilities and assets for medical care. 

Diagram Adapted from Combat Casualty Care Office. Medical Management of Chemical Casualties ffandbook. Aberdeen Proving Ground, Md US Army Medical Research Institute of Chemical Defense 1994 194. Photographs Reproduced electronically from US Army Chemical Decontamination of Nonambulatory Casualties. Fort Sam Houston, Tex Health Sciences Media Division, US Army Medical Department Center and School 1995. Training videorecording 710175 TVT 8-252. 

At the first echelon of medical care, the chemical casualty is contaminated and both he and the triage officer are in protective clothing. Furthermore, the first medical care given to the casualty is in a contaminated area, on the hot or dirty side of the hotline at the emergency treatment station (see Figure 13-1 in Chapter 13, Field Management of Chemical Casualties). This is unlike the clean side of the hotline at any echelon of care where casualties are decontaminated before they enter, or un-... 

It must be remembered that triage refers to priority for medical or surgical care, not priority for decontamination. All chemical casualties require decontamination. One might argue that a casualty exposed to vapor from a volatile agent, such as cyanide or phosgene, or from some of the volatile nerve agents does not need to be decontaminated. However, one can seldom be certain that in a situation in which vapor and liquid both exist, some liquid is not also present on the casualty. 

It is extremely unlikely that immediate decontamination at the first echelon of medical care will change the fate of the chemical casualty or the outcome of the injury. Various estimates indicate that the casualty usually will not reach the first echelon of care for 15 to 60 minutes after the injury or onset of effects, except when the MTF is close to the battle line or is under attack and the injury occurs just outside. The casualty is unlikely to seek care until the injury becomes apparent, which is usually long after he becomes contaminated. For example, mustard, a vesicant, may be on the skin for many hours before a lesion becomes noticeable. Thus, it is likely that the agent has been completely absorbed or has evaporated from the skin by the time the casualty reaches the MTF. The small amount unabsorbed or the amount absorbed during a wait for decontamination is very unlikely to be significant. 

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