Medical Treatment Facility

Direction and control communications evacuation and sheltering medical treatment facilities resource management cleanup and disposal decontamination and documentation. 

IMMEDIATE A casualty classified as immediate has an injury that will be fatal of he does not receive immediate care. In a non-mass casualty situation, he would be the first casualty to receive care. However, in a mass casualty situation, particularly in a far-forward medical treatment facility, he may not receive this care. The required care may not be available at that echelon (e.g., a casualty may need major chest surgeryjor the time needed to provide the care may be so prolonged that other casualties would suffer. 

EXPECTANT The expectant casualty is one for whom medical care cannot be provided at the medical treatment facility and cannot be evacuated for more advanced care in time to save his life. This category is used only during mass casualty situations. This category does not mean that these casualties will receive medical care. 

Eye Contact Immediately flush eyes with water for ten to fifteen minutes, then don respiratory protective mask. Although miosis (pinpointing of the pupils) may be an early sign of agent exposure, an injection will not be administered when miosis is the only sign present. Instead, the individual will be taken immediately to a medical treatment facility for observation. 

The other types of radioactive materials cited in this section (medical industry and food industry sources) produce significantly lower activity levels than fuel from a nuclear power plant. However, these sources of radioactive materials may be appealing to terrorists because they are far more accessible. Thousands of hospitals, medical treatment facilities, and food industry plants scattered across the U.S. are protected by relatively low levels of security. 

Primary medical treatment facilities may be damaged or inoperable thus, assessment and emergency restoration to necessary operational levels is a basic requirement to stabilize the medical support system. 

Note-. Follow all of these actions with full decontamination at a medical treatment facility. 

Mustard-related death occurs in about 3% of the casualties who reach a Medical Treatment Facility of those who die, most die 4 or more days after exposure (Gilchrist, 1928). Of the casualties who died, 84% required at least 4 days of hospitalization. The causes of death are pulmonary insufficiency from airway damage, superimposed infection, and sepsis. Rarely, the amount of mustard will be overwhelming and cause death within 1-2 days in these circumstances, death will be due to neurological factors or massive airway damage (Graef et al., 1948 Heully and... 

If any mustard remains on the skin, thorough decontamination later will prevent the further spreading to other areas. After several hours, spreading will have occurred because oily substances flow on warm skin. Decontamination now, however, will prevent mustard from spreading to personnel who handle the casualty and possible contamination of medical treatment facilities (MTFs). By the time skin lesions develop, most mustard will have been absorbed and fixed to tissue. Unless the site was occluded, the remaining unabsorbed agent will have evaporated. 

If the medical treatment facility (MTF) or hospital becomes contaminated with chemical agent, not only does it become useless to render care, but it also exposes the staff and all other patients to chemical contamination. All precautions must be used to avoid this issue. Only very limited access to the hospital or MTF should be permitted. At most, only one or two entrances to the hospital should be used by incoming patients and employees. At these entrances, proof of decontamination or noncontamination, in the form of checking the individual with a chemical agent monitor (CAM) for contamination, must be presented before admission. AU other entrances must be locked down. Security guards posted on the inside of aU entrances would prevent unauthorized entrance from outside. Remember, people exiting the hospital could hold the door open to admit contaminated individuals from the outside. 

Plan to have an alternative medical treatment facility (AMTF) for those patients who do not require life-sustaining levels of care. 

FIGURE 24.2 Representative diagram of a casualty treatment site. (From U.S. Army Medical Research Institute of Chemical Defense, Chemical Casualty Care Division, June 2001.) Hot Line= possible hquid contamination downwind (left side of line), negative liquid contamination upwind (right side of line). N.B. Possible positive vapor present on either side of hot line. VCL — vapor-control line possible positive vapor on downwind side of line (left side of line), negative vapor on upwind side of line (right side of line). EMT, emergency medical treatment MTF, medical treatment facility. 

The first rule for medical personnel must be that they protect themselves. Failure to use appropriate procedures or protective equipment places the individual, health care workers and the medical treatment facility at risk. During a mass casualty incident, many people require medical care neither health care personnel nor health care facilities can be compromised. 

It must be remembered that for immediate field treatment most soldiers are equipped with only three 2 mg autoinjectors of atropine (as well as oxime, and possibly anticonvulsant injectors) for administration by themselves or a buddy . Most medical treatment doctrines call for oxime administration only with the first three autoinjectors of atropine. Additional oxime beyond this initial treatment will be administered under direction of a physician at a medical treatment facility. Additional atropine and anticonvulsant treatment is carried by the medic/corpsman in most West-em/NATO forces and will be absolutely required in cases of severe poisoning. US medical treatment guidelines call for the administration of the first CANA anticonvulsant (10 mg of diazepam)... 

Additional atropine beyond the initial 6 mg carried by the service member will most assuredly be needed promptly in a severely poisoned casualty. Sided (1997) recommends that an additional 4 mg of atropine be given immediately, for a total initial dose of 10 mg. If the patient is in a medical treatment facility, the atropine should be given IV if that is possible and... 

B. Treat NBC Casualties. Medical treatment facilities should be prepared to treat the wide range of injuries and the possible large number of casualties from NBC weapons. 

A. Upon entering a medical treatment facility, patients from a contaminated area should be decontaminated and monitored for radiation. Monitoring by trained health physics personnel may be required to determine when it is proper to discontinue isolation techniques. Such personnel are usually located at the medical group level (see section 3.1). 

The USACHPPM is responsible for providing bioassay support. Specimens for bioassay are collected at medical treatment facilities by occupational health professionals and sent to USACHPPM for analysis and dose assessments. 

A dose assessment report is produced and sent to the medical treatment facility that initiated the request and submitted the specimen, the NRC license manager, and the USAIRDC. The report sent to the medical treatment facility is placed into the individual s medical record. The report sent to the NRC license manager is archived. The report sent to the USAIRDC is combined with any external dose in order to provide the NRC annual dose history. The USAIRDC archives the report for at least 75 years. 

A. General. Medical Treatment Facilities (MTFs) will establish decontamination areas. When casualties arrive at the MTF, they must be seen at a triage point and evacuated to the proper area. The triage officer must determine if the patients have a surgical or medical condition that requires priority over decontamination. Ninety to ninety-five percent of all decontamination can be accomplished by removing the outer clothing and shoes. This can usually be accomplished before admission without interfering with medical treatment. Several unique aspects must be considered. 

Mission Provide medical/technical advice and detection equipment for the treatment of radiologically contaminated patients to on-scene health care or medical treatment facilities. 

FM 8-50. Prevention and Medical Management of Laser Injuries. 8 August 1990. This field manual provides basic preventive, protective, and diagnostic information on laser injuries. The treatment procedures described herein are for use by combat medics, battalion aid station personnel, and other medical treatment facilities without an Ophthalmologist. Also, an evaluation matrix is provided for use by combat lifesavers and combat medics. 

Second, the risk of chemical contamination of medical equipment and medical treatment facilities is an added threat, and precautions need to be taken to ensure that patients are properly decontaminated before being brought into designated uncontaminated treatment areas. Frontline medics faced with many casualties can only be expected to administer lifesaving procedures, such as opening the airway or preventing further hemorrhage decontamination can be expected to be minimal. 

Finally, the medical logistical requirements will be increased. It has been stated that up to 40% more transport is required to move a typical field hospital in a chemical environment, and the fuel necessary to power air pumps, special filtration units, and air conditioners is an added requirement.35 Water requirements may also be increased in a chemical environment. Medical treatment facility planners should recognize the importance of environmental factors within a chemical warfare theater. For example, the MOPP gear may not be designed for the climatic conditions on the battlefield. Tests have shown that perspiration compromises the ability of the battledress overgarment to protect the wearer from chemical agents36 and may actually predispose an individual to injury.32... 

Echelon II possesses an increased medical treatment capability plus emergency and sustaining dental care, radiology, laboratory, optometry, patient holding, preventive medicine, mental health, and medical supply capabilities. However, these capabilities do not exceed levels dictated by immediate necessity. Nondivisional units in the division sector receive medical support on an area basis from the nearest medical treatment facility (MTF). In the division, Echelons I and II medical care will not be bypassed, although this may occur in the corps area. Echelon III The Corps Level... 

A clearing company or a clearing company team will set up ambulance exchange points, which have a treatment squad to perform first aid and the capability to perform patient decontamination before further evacuation. As a rule, contaminated ambulances operate from the FLOT, transporting contaminated casualties back to the exchange point, while clean vehicles transport decontaminated casualties to Echelon III medical treatment facilities. 

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