FM 4-02.7 MULTISERVICE TACTICS, TECHNIQUES, AND PROCEDURES FOR HEALTH SERVICE SUPPORT IN A CHEMICAL, BIOLOGICAL, RADIOLOGICAL, AND NUCLEAR ENVIRONMENT (JULY 2009) - page 4

 

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FM 4-02.7 MULTISERVICE TACTICS, TECHNIQUES, AND PROCEDURES FOR HEALTH SERVICE SUPPORT IN A CHEMICAL, BIOLOGICAL, RADIOLOGICAL, AND NUCLEAR ENVIRONMENT (JULY 2009) - page 4

 

 

(3) Allow the FMC to fall into a self-sealing plastic bag.
(4) Seal the plastic bag and decontaminate the outside of the bag.
(5) Place the plastic bag under the back of the patient’s mask head harness straps.
f.
Remove Personal Articles from Pockets of the Overgarment.
(1) Have the patient remove all items from the overgarment jacket and trousers and
place them in a self-sealing plastic bag.
(2) Mark the bag with a name and identifying number and then moved with the patient
to the next step in the ambulatory decontamination line.
(3) The patient must decontaminate their gloves before and after handling the bag.
g. Removal of Patient’s Overgarment Jacket.
(1) The patient is standing and can hold on to a support such as a chair or litter stand
(except for on the deck of a ship where these extra items are not permitted).
(2) The individual with a cutting tool stands in front of the patient and cuts the patient’s
protective ensemble.
(3) First, cut around all bandages and tourniquets. The augmentee will supervise the
patients to cut one another’s overgarments.
(4) Cut the hook and pile wrist closures.
(5) Cut the BDO jacket drawstring or the JSLIST draw-cord at the jacket bottom. On
the BDO, unsnap the 3 snaps that connect the back of the BDO jacket and pants.
(6) Cut the overgarment jacket starting at the waist and cut toward the collar in a line
parallel to the zipper or unfasten the hook and pile and unzip the zipper. If cutting the front is
not possible, cut from the collar down the back of the BDO; or with the JSLIST continue the cut
from the hood down the back and center of the jacket. This is best done using a long handled
seat belt cutter.
(7) To help pull off the jacket, the augmentee moves behind the patient if the jacket is
unzipped or cut at the front. If the jacket is cut down the back then the augmentee moves to the
front of the patient.
(8) If the jacket was unzipped or cut at the front, instruct the patient to clench his fists
and stand with his arms held down and extended backward at about a 30-degree angle. If the
jacket was cut along the rear have the patient extend his arms forward at about a 30-degree
angle.
(9) The patient positions his feet shoulder width apart.
(10) Grasp the jacket collar at the sides of the neck.
(11) Peel his jacket off the shoulders in a down and away motion, smoothly pulling the
jacket inside out over the patient’s fists.
(12) Place the overgarment jacket on the ground with the black side up.
Note: The patient’s identification tags stay around the patient’s neck throughout
the decontamination process. They are decontaminated with soap and water,
M291, M295, or 0.5 percent (1/2 percent) hypochlorite solution.
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FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
15 July 2009
h. Remove the Trousers by Cutting.
(1) One augmentee should stand behind the patient and, if available, another at the
front of the patient. The patient should have an object to help steady himself such as a chair or
litter stand.
Note: Do not cut the trouser suspenders until the end of the process so that the trousers
do not fall during cutting and get in the way of the cutter.
(2) The easiest way to cut the pants is from the front:
• Keep the pants zipped.
• Unfasten hook and pile ankle fasteners and begin cutting at the ankle. Cut
along the inseam moving up toward the waist of the trousers.
• After cutting both trouser legs from ankle to waist, cut each suspender and allow
the trousers to fall to the ground.
• Take the trousers and lay them on the ground, black side up, next to the patient.
• Later the patient will step onto this as he removes his overboots.
(3)
An alternate method is to cut the trousers from the rear.
• In this case, first unfasten the hook and pile waist tabs.
• Start the cut at the ankle and move to the waist.
• Once the cuts on both legs are complete from ankle to waist, cut the
suspenders below the suspender cross points and then above the cross points
allowing the trousers to fall to the ground.
• Lay the trousers on the ground, black side up, next to the patient.
i.
Remove the Overboots.
(1) Unfasten all boot closures.
(2) Step on the heel of the boot and have the patient step out of the overboot and step
onto the black side of the cut trousers and overgarment top that are lying on the ground.
(3) Repeat this process for both boots. These overboots can be decontaminated and
issued to other individuals.
(4) If the overboot will not come off, cut the boot from top to bottom along the
centerline of the boot until the boot comes off.
j.
Remove Outer Gloves.
(1) Decontamination team member decontaminate their gloves with the M295, M291,
or 5 percent hypochlorite solution.
(2) The patient’s gloves are decontaminated with the M291, M291, or
5 percent
hypochlorite solution.
(3) Instruct the patient to hold his arms up, if possible, and away from his upper body.
If the patient can not do this, then hold his gloves at the fingers.
(4) Grasp the cuff of the glove.
(5) Pull the cuff over the fingers, turning the glove inside out.
(6) Dispose of the contaminated gloves by placing them in the designated trash bag.
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FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
V-33
(7) Decontamination team members then decontaminate their own gloves again with
the M295, M291, or 5 percent hypochlorite solution.
k. Remove Inner Gloves (Glove Liners). The patient should remove the liners to reduce
the possibility of spreading contamination. The decontamination team member instructs the
patient to remove the white glove inner liner using the following guidance:
(1) Grasp the heel of glove liner without touching exposed skin.
(2) Peel liner downward and off.
(3) Drop it into the designated trash bag.
(4) Remove the remaining liner in the same manner.
(5) Drop it into the designated trash bag.
(6) The patient then moves to the monitoring station.
l.
Remove Personal Effects from BDU/ACU.
(1) Have the patient remove all items from his BDU/ACU and deposit them into a self-
sealing plastic bag.
(2) Check for contamination. If not contaminated, the personal items remain with the
patient. If contaminated they are moved to a contaminated item holding area.
m. Remove Inner Clothing/BDU/ACU.
(1) Cut or unbuckle belt.
(2) Cut the BDU/ACU pants following the same procedures as for the overgarment
trousers.
(3) Cut the BDU/ACU jacket following the same procedures as for the overgarment
jacket.
n. Remove Undergarments (Contaminated).
(1) Remove the patient’s T-shirt.
• Dip cutting devices in 5 percent hypochlorite solution, scrub them with the
M295, or wash thoroughly with soap and water between each cut.
• Cut around bandages or splints, leaving them in place.
• Cut up the front (or back) of the patient’s T-shirt from the waist up to the collar.
• Cut both sleeves from the elbow to the shoulder and then to the collar.
• Next, peel the T-shirt away from the body to avoid spreading contamination.
(2) Remove the patient’s brassiere.
• Cut it between the cups.
• Cut both shoulder straps where they attach to the cups and remove the
brassiere.
(3) Remove the patient’s under shorts/panties.
• Cut from the lower side of the hip to the waist on both sides.
• The decontamination team member places the undergarments into the
contaminated trash bag, along with the overgarments and other contaminated
items from the patient.
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FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
15 July 2009
14. Wound Decontamination and Trauma Management Procedures
a. Wound Decontamination.
(1) Only trained medical personnel will change patient bandages, tourniquets, and
splints.
(2) During decontamination, the clothing around bandages, tourniquets, and splints is
cut and, if possible tourniquets and splints are left in place.
(3) Cloth or other debris in the wound can hold contaminants. If contaminated, irrigate
large wounds with sterile water or IV saline solution to dislodge debris and wash out
contaminants. Remove the debris using forceps or butyl rubber gloves. Then cover the
wounds with a large dressing and plastic if there is a fear of additional contamination getting
into the wound.
b. Trauma Management during Decontamination.
(1) Contaminated tourniquet is replaced only by the medical personnel. The new
tourniquets are placed 1 inch proximal to the original tourniquet and then the old, contaminated
tourniquet is removed and put in the contaminated waste bag.
(2) Chemically contaminated splints remain in place and are decontaminated with the
M291 or saturated to the skin with soapy water to include the padding and cravats. This can be
performed by a decontamination team member if supervised by medical personnel. If the splint
cannot be saturated (air splint or canvas splint), it must be removed or replaced by the medical
personnel to enable everything under it to be decontaminated. Splints will only be removed by
a physician or by other medical personnel under the supervision of a physician.
WARNING
DO NOT apply the M291 or irrigate wounds in the
abdominal and thoracic cavities or intracranial
(head)
injuries. DO NOT remove splints unless permitted by a
physician or other medical personnel under the
supervision of a physician.
(3) Intravenous Lines. Removal of IV bags and tubing during decontamination is at the
discretion of the medical officer supervising decontamination operations. The IV bags can be
wiped down with soap and water if there is a concern about their contamination. The IV lines
should be protected during patient litter transfer.
15. Establishing a Patient Decontamination Site
a. Patient Thorough Decontamination.
(1) Minimal equipment.
(a) Decontamination of contaminated patients is essential before allowing them
into MTFs. The following guidelines should be followed for patient decontamination when
minimal decontamination equipment is available. These procedures are most applicable to
mobile hospital units who have limited transport capability for carrying decontamination tents
and roller systems.
Note: Standard Army MESs for decontamination and medical treatment are designed
for use with a PDS with minimal equipment. One decontamination MES has
15 July 2009
FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
V-35
enough supplies to decontaminate 60 individuals. One chemical treatment MES
has enough medical supplies to treat 30 patients.
(b) The establishment of a PDS should be one of the first priorities once an MTF
is established in an area where the threat of CBRN weapons is imminent.
(c) The PDS can be collocated with a troop decontamination unit if adequate
medical transportation assets and medical staffing are available.
(d) The PDS can also be located adjacent to the MTF and not collocated with a
troop decontamination unit. In this instance the PDS must be located 30 meters or more away
from the MTF as wastewater runoff can potentially contaminate the area. If there is an
adequate means to collect wastewater runoff, such as the use of a plastic water collection berm
and pumps to remove the water, then the PDS facility can be located closer to the MTF.
(2) Roller system.
(a) These procedures are most applicable to stationary hospital units who have an
ample water supply. This procedure can be used by mobile units if there is a capability to
transport water such as the use of a water tanker and a decontamination roller system if
available.
(b) These systems allow for more complete decontamination of patients and help
to reduce injury and conserve manpower of decontamination team personnel.
Note: This publication does not supersede such documents as AFTTP 3-42.33, USAF
CONOPS for In-Place Patient Decontamination Capability, or other specific
Service guidance or equipment manufacturer’s guidance.
It provides
supplemental instruction to help streamline processes when this type of
equipment is used.
b. Preparing the Site Prior To Patient Arrival.
(1) Site selection. The PDS is initially set up in an uncontaminated (clean) area. It only
becomes a warm hazard area once contaminated patients begin to arrive. The greatest threats
to decontamination team members are from liquid or dry agents on a patient’s protective
ensemble and from chemical agent vapor that is trapped in clothing and hair or coming from
liquid on clothing.
Note: Planning and preparation for the establishment of a PDS must take place long
before it is to be employed.
(2) Select a site that has the following characteristics:
• Access to a road network for easy movement of patients to and from the PDS
and for trucks to maneuver dropping off or refilling water bladders, if used.
• Ground that is downhill or slopes away from the MTF or clean side, if possible,
for PDS with minimal equipment. For PDS with a roller system, ground is
preferably level for tent set-up. The use of water bladders eliminates the need
to locate the decontamination system downhill from the MTF.
• Downwind (prevailing winds) from the MTF or clean side.
• In an area where wastewater runoff will not contaminate existing water
resources or ground near the MTF.
• Offers adequate security for decontamination personnel.
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FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
15 July 2009
• Has adequate space to establish a drop-off point with associated warm side
triage and treatment areas that can be quickly and easily expanded to handle
more than the anticipated number of casualties.
• Large areas, one on the clean side and the other on the dirty, for the staging of
dirty and clean patients for evacuation.
c. Staffing of the PDS with Minimal Equipment. The following is the staffing required for
one work cycle. More individuals are needed to ensure adequate work/rest cycle rotation.
Refer to Table V-5 for suggested information on minimal staffing for one work cycle.
Table V-5. Suggested Minimal Staffing for One Work Cycle
Duty
Minimal
Roller System
Command and Control Cell
Officer in charge.
1
1
Noncommissioned officer in charge. (May also serve as safety
1
1
officer or another individual can be designated.)
Entry Control Point
Entry control point security detail.
2 (optional)
Augmentees to unload litter patients (2 teams of 4).
8
8 (4 if NATO litter
carriers are used)
Security personnel to guard arrival point and perform pat-down search.
2 (optional)
2 (optional)
Road guides and lookouts (night operations).
3 (optional)
3 (optional)
Augmentee trained to use various contamination check tools.
1 (optional)
Triage and Emergency Medical Treatment Area (Warm Side)
Senior health care NCO or other primary triage officer (PA, nurse).
1
1
Health care specialist to administer treatment.
1
1
Augmentees to serve as litter bearers (2 teams of 4 personnel).
8
Litter Decontamination Area (Per Litter Lane)
Augmentees who decontaminate the casualties and perform patient lifts.
4
They wear TAP apron.
Medical personnel.
1
1
Augmentee to clean litters.
1 (optional)
Clothing removal area of roller system.
2
Body wash area of roller system.
2
Final check area of roller system.
1
Ambulatory Decontamination Area (Per Lane)
Augmentee to assist patients.
1 (optional)
1 (optional)
Medical personnel.
1
1
Contamination Check Area
Augmentee trained to use various contamination check tools.
1
Hot Line Patient Reception (Members on the Clean Side of the Hot Line)
Augmentees on clean side of the hot line who move litter patient across hot
2
2 (1 if NATO litter
line.
carriers are used)
Medic on clean side of hot line.
1
1
Total medical
5
5
Total augmentees/others
25-34
14-23
Total personnel for one work cycle
30-39
19-28
Note: This minimal staffing does not include MTF security detail.
15 July 2009
FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
V-37
Note: At a very small Role I MTF, patient decontamination requires a minimum of eight
nonmedical personnel (augmentees) from the supported unit. A dramatically
reduced decontamination operation less than the recommendation above may be
necessitated. In this instance it is critical to have one or two individuals who can
adequately triage, stabilize, and evacuate dirty casualties who cannot be cared
for at that facility. Those who can be seen there must have their clothing
carefully removed by a team of four augmentees, supervised by a medical
personnel. This must be performed before the patient is moved across an
improvised hot line. At the hot line, the patient is received by another set of
augmentees and a medical personnel wearing MOPP Level 4. Only then is the
patient moved inside a clean area where medical staff are not wearing protective
ensemble. Contaminated patients must be given adequate decontamination
before entering an enclosed area so that unprotected medical personnel are not
made ill. The key here will be for the small Role I MTF to reroute contaminated
patients to other facilities if they are overwhelmed.
d. Establishing a Patient Decontamination Site.
(1) Mark off areas for dirty dump, drop-off point, triage, dirty EMT, litter lane,
ambulatory lane, contamination check, hot line, dirty litter decontamination, dirty side shaded
rest area, clean side supply, clean side triage and treatment, clean side transport area to MTF,
temporary morgue holding area, and patient weapons storage area. The environmental control
units (ECUs), water heater, power source, water bladders in a PDS with plumbed tentage can
also be marked.
(2) Set up the PDS so that it can be easily marked with chemical lights and negotiated
in night conditions. Remove debris along the routes between the dropoff point, triage and
treatment areas, and decontamination lanes.
• The immediate patients are moved to the warm (dirty) side EMT. This area is
located between patient triage (closer to triage to minimize the time it takes to
move from triage to dirty EMT) and the entrance to the litter decontamination
lanes. This way they can be moved to litter decontamination without interfering
with the traffic flow from other patient groups.
• The delayed patient area should be positioned nearer to the entrance to both
the litter and ambulatory decon lines. This way delayed patients can be
processed through either the litter or ambulatory lanes when the lanes become
available.
Minimal patients should be positioned near the ambulatory patient area so that if
medical care on the clean side of the hot line is needed they can process
through the ambulatory lane when it becomes available and will not interfere
with the flow to the litter lanes.
Expectant patients should be located near the EMT area, but farther away from
the decontamination lanes, so that they can be retriaged and stabilized for
decontamination if the EMT area no longer has patients in it.
Note: More than one patient litter decontamination lane is needed, especially for larger
MTFs, as the process takes time and is labor intensive.
(3) Establish a security perimeter around the PDS. This should be done by erecting
barriers such as concertina wire. Using vehicles as barriers may not be appropriate if access to
V-38
FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
15 July 2009
these vehicles will be required during patient decontamination operations and the vehicles will
be located in the potential warm area of the PDS. These measures will be dictated by METT-
TC.
(4) Dig a dirty dump at least 75 meters downwind from the arrival point. The dump
should be at least 6 feet deep and large enough to accommodate large numbers of filled
contaminated trash bags (one for every two decontaminated patients). The dump should be
deep enough so that bags can be covered once the PDS is evacuated or closed down.
Note: Preparing a dirty dump while the area is uncontaminated is much easier as
workers will not have to assume MOPP Level 4. Once contaminated material is
placed in the dump then any expansion of the dump will have to be performed by
individuals digging the dump while at MOPP Level 4. It is best to coordinate this
with an engineer unit so they can use their earth-moving equipment to dig the
holes for dirty dump and construction of wastewater diversion gullies.
(5) Dig water runoff gullies (approximately one foot deep) or berms (approximately one
foot high) around the litter and ambulatory decontamination areas to trap any water flow and
route it away from the decontamination area if plastic berms are not available. These should
direct water to a larger pit where wastewater can be collected and if it is a chemical or biological
hazard neutralized it with 5 percent hypochlorite slurry.
Note: A hard surface area is ideal for the location of a decontamination area as it allows
for water runoff without creating a muddy surface; however, these materials
(concrete or asphalt) will hold some agents for hours to days. Because of this, a
PDS should not be set up on a hard surface road that will be needed later for
vehicle movement.
(6) Shuffle pits are NOT prepared when using a plumbed tent system. With these
systems, decontamination team members remain inside the tent during operations so they do
not track in contamination from the triage areas. Their boots can also be easily decontaminated
inside the tent using the handheld sprayers if necessary.
(7) A PDS with minimal equipment must prepare a shuffle pit at the hot line at the litter
patient decontamination line, and another at the ambulatory patient decontamination line or one
shuffle pit can be made for both litter and ambulatory lanes.
• Both shuffle pits are located at and should straddle the hot line.
• The litter patient shuffle pit must be large enough to accommodate one litter and
four personnel with enough space for them to move around the litter when
placed on litter stands located inside the pit.
• The ambulatory shuffle pit must be large enough to accommodate two standing
individuals.
• Each pit is dug to a depth of 6 inches. The soil is then returned to the pit and
mixed with STB at a ratio of 3 parts soil to 2 parts STB.
• Personnel preparing the STB/soil mixture must assume MOPP Level 4.
• If a boot rinse is used instead of a shuffle pit, then a plastic berm that can
contain water is used. It is filled to at least 5 inches deep with a 5 percent
hypochlorite solution. It should be replenished every 5 to 10 patients. It should
be large enough for decontamination team members to enter and place a litter
patient on a pair of litter stands inside the boot rinse area and perform a litter
transfer.
15 July 2009
FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
V-39
• Concertina wire or another barrier should be placed along areas of the hot line
that do not include the shuffle pits. The shuffle pits should be the only areas
along the hot line where it can be crossed. This will ensure that movement
across the hot line is controlled.
(8) It is suggested that only a portion of one MES needs to be moved to the triage area
to meet the needs of the number of expected casualties. During operations, additional medical
supplies can be moved across the hot line from the clean side supply area as needed. This will
reduce the possibility of unused supply items becoming contaminated resulting in their waste.
The allocation of decontamination equipment resources is suggested in Tables V-6 through
V-8.
(9) In a PDS with minimal equipment, the rest area is establish in a shaded area on the
warm side of the hot line so PDS workers on the warm side of the hot line can rest, while at
MOPP Level 4, without having to process across the hot line.
(10) It is recommended that some type of marking system be incorporated to identify
PDS workers. One suggestion is that all decontamination team members have their protective
overgarments marked with wide masking tape with their name and team member position
clearly marked on their uniform so that they can be readily identified (for example, arrival, triage,
security, medical, or decontamination). Instead of tape this can also be done by writing directly
on the overgarment if it can be easily seen. Another recommendation is for medical personnel
to wear an arm band or have a tape cross on the arm of their overgarment.
(11) Locate water resources, water cans, water buffalo, water bladder, or water tanker
with easy access to the decontamination lanes.
(a) In a PDS with minimal equipment, ideal location is to have containers of water
that will be used for decontamination located near the warm side rest area. This will reduce any
contamination of these containers. Other supplies can be located on the clean side of the hot
line in the supply area. Ensure wastewater runoff from the decontamination lanes does not flow
toward the water resource area or the medical treatment areas. Water usage can be roughly
calculated as follows:
• One patient will require (on the average) 1.5 gallons of soapy water (or 0.5
hypochlorite solution, if used), 1.5 gallons of rinse water, and 2 gallons of
water with 5 percent hypochlorite mixture for equipment and decontami-
nation team glove wipe down.
• One patient will require 5 gallons of water (18.92 liters).
• Twenty patients will require 100 gallons (379 liters) of water.
Note: When decontamination pails/buckets (12-16 quarts) are filled this is roughly
enough liquid for two patients. With every second patient, the liquid that remains
in the pails/buckets will be emptied into the garbage bag that contains the cut off
garments of the second patient. The pails/buckets are then refilled.
• Decontamination using only dry decontaminants, the M291 (SDK) will
require 1 to 3 kits per patient as well as IV saline solution for irrigation of
wounds.
(b) In a PDS with roller systems, there must be adequate water pressure to
operate the water sprayer. Adequate water pressure can only be obtained through the use of
water pumps which typically need some type of power source.
V-40
FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
15 July 2009
(c) Set up the water collection system, tentage, and plumbing as dictated by the
manufacturer’s instructions. Ensure that there is an adequate way to dispose of wastewater
runoff, such as a water bladder, so that it does not contaminate the ground around the
decontamination system. A water runoff gully
(approximately
1 foot deep) or berm
(approximately 1 foot high) can be constructed around wastewater bladders to contain spills. If
the runoff water poses a chemical or biological hazard it can be neutralized with 5 percent
hypochlorite solution.
Note: Test pumps, water flow, soap mixers, water and air heaters to ensure they are
operational.
(d) To reduce cross-contamination, fresh water and wastewater bladders must
NOT be positioned next to one another. Ideally they should be on opposite sides of the
decontamination tent, with the wastewater bladder downhill from the fresh water bladder and
decontamination tent. It is critical that there is an easy access route for a water pumper truck to
fill the clean water bladder and a route for a vehicle to pump out the contents of the wastewater
bladder or for a forklift to move a specially designed transportable wastewater bladder (if used)
to the back of a truck for movement out of the PDS.
(e) Systems that incorporate water sprayers require a large water supply. The
supply must provide enough pressure to operate the system. Water pumps are usually required
and these require water sources. Ample water supplies are needed for expected number of
casualties. A 2,000 gallon water storage container such as a tanker truck or water bladder will
allow the decontamination of approximately 200 patients. It is estimated that on the average 10
gallons of water is used per patient with these plumbed systems.
(f)
Operators must be aware of the importance of conserving water while still
providing adequate decontamination. This will ensure that water supplies are not depleted and
wastewater collection systems are not overwhelmed. Water can best be controlled by using
hand held sprayers that will allow water flow to be turned off when not in use. Water flow
should be adjusted to have moderate-to-low pressure with high flow for brief periods when the
sprayer handle is pressed.
(g) Ideally units should incorporate a water heater to increase water temperature
and reduce the incidence of patient hypothermia for those undergoing decontamination. Soap
mixers can also be added which make dispensing soap from the sprayer possible. This is
usually easier than using buckets of soap in the small confines of most tent systems. These
heating and soap dispensing units, along with the water pumps, also require a power source.
(h) Collection of contaminated wastewater is critical, especially for biological
sporulating agents (anthrax) and radioactive particles. Wastewater collection is also important
to limit runoff and ground contamination in the decontamination area, especially if the
decontamination tent is close to the MTF. A wastewater bladder is used to collect the runoff.
Wastewater is pumped from the collection area of the tent and into the bladder. In cold climates
the water and wastewater bladder must be heated to prevent freezing. It is critical that the
wastewater bladder be the same size, or larger, than the water storage source. For every
patient decontaminated, calculate 10 gallons of wastewater runoff. Wastewater, once collected,
is treated with
5 percent hypochlorite solution until chemical hazards are neutralized or
biological spores are killed. Radioactive waste can not be diluted in this way. One gallon of
water weighs 8 pounds, so a filled 2,000 gallon water bladder will weigh 16,000 pounds
(8 tons).
15 July 2009
FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
V-41
Note: Bleach and soap solutions should be prepared in advance during site
preparations and should be in sealed containers and clearly marked as to their
contents. Five gallon covered water cans or larger jerrycans are ideal for this as
they can be carried to a position near the decontamination line and used to refill
pails/buckets.
CAUTION
Hypochlorite solution and soap solutions prepared in storage
containers MUST be clearly marked as to their contents so that
they are not mistaken for drinking water and
5 percent
hypochlorite solutions are not confused with soap or water
solutions.
(i)
Open NATO litter carriers if available. These two wheeled carriers allow two
individual to easily move a litter patient. They work well on hard ground but may pose difficulty
in sand. Several should be positioned at the drop-off point and at least two at the clean side of
the hot line (in the final check area).
(j)
When not setting up the decontamination site, augmentees can receive
additional JIT training on such topics as: basic medical signs and symptoms of chemical agents;
safe patient litter transfer techniques; roles and responsibilities; the use of detection devices (for
example, the ICAM, M8 paper, and RADIAC meters as indicated by the threat), the importance
of work/rest cycles; and prevention of heat injuries.
(k) Suggested decontamination equipment and supplies distribution for a PDS
with minimal equipment.
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15 July 2009
Table V-6. Equipment and Supplies Needed for a Decontamination Lane
Equipment and Supplies
Nonambulatory
Ambulatory
Large trash bags for contaminated waste.
1 box as needed
1 box as needed
Pail/bucket of decontamination, 5 percent
1
1
hypochlorite solution.
Pail/bucket of decontamination, soap and water
1
1
solution (0.5 hypochlorite [least preferred]).
Bandage scissors or long-handle seat belt cutter with
4 +
4 +
blade replacements (minimum, more are needed as
they dull).
Self-sealing plastic bags for field medical cards and
1 box of 50
1 box of 50
for personal effects found in outer and inner
garments.
Sponges.
2+
2+
Decontamination apron (TAP).
4
2
One decontaminable litter for exchange (per patient
2+
expected).
M291 SDK (1 to 3 kits per patient).
1 box
1 box
M295 EDK (1 per patient).
1 box
1 box
Liquid soap (mix in water storage area).
As needed
Litter stands (pair).
1
1 to steady patients
Supplies to replace bandages, tourniquets, and
As anticipated
As anticipated
splints (if necessary).
Optional items not found in decontamination
equipment set, but useful.
Trash can to hold large garbage bags (if transport
1
1
and storage space available).
Pail/bucket of rinse water.
1
1
Additional canteens of water for decontamination
4+
4+
team members.
3- x 5-inch card and pen (to mark personal effects per
1 box
1 box
patient) or permanent markers to mark outside of
personal affects self-sealing plastic bags.
Chairs to steady patients while standing.
2
NOTE: Additional quantities of soap and bleach decontamination solutions must be prepared and
stored in sealed containers to refill pails/buckets.
Table V-7. Equipment and Supplies Required for the Contamination
Check Area at a Patient Decontamination Site With Minimal Equipment
Equipment and Supplies
Per Lane
ICAMs with lithium batteries
2
Spare lithium batteries
8
M8 paper
1 book
M291 for decontamination of small areas
1 box
Bucket of soap and water for small area decontamination
1
Sponge
2
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V-43
Table V-8. Equipment and Supplies Required for the Hot Line at a Patient
Decontamination Site With Minimal Equipment
Equipment and Supplies
Per Lane
Large trash bags for contaminated waste
1 box
FMCs (on clean side of hot line)
1 book
Large plastic bag for patient’s mask once removed at VCL
1 box
Ballpoint pen (Black) to fill out clean FMC
As needed
STB to replenish shuffle pit
1 container
Optional items not found in decontamination equipment set, but
useful
Blankets (on clean side of hot line)
1 per patient
Trash can to hold large garbage bags (if transport and storage
1
space available)
16. Actions to Take Upon Notification of Patient Arrival
a. Immediately upon notification that contaminated patients are to be received, the
decontamination team leader or NCOIC will alert the team members.
b. Patient decontamination site OIC/NCOIC will assign augmentees decontamination team
their duties and responsibilities at the PDS.
c. All triage, EMT treatment, and decontamination team members assume MOPP Level 2
when the arrival of contaminated casualties is expected, as dictated by the commander. They
then assume MOPP Level 4 prior to patient arrival at the ECP. Those who will be
decontaminating patients will don their TAP aprons. Mask carriers can be worn or clearly
marked with the decontamination team member’s name and stored in an organized fashion at
the rest area or another location designated by the OIC/NCOIC. Mark protective overgarments
with some type of marking system to easily identify PDS workers.
d. Turn on the ICAMs. Once the ICAMs are warmed up, perform confidence checks on
each CAM per the technical manual. Activate M22 ACADA if available. It should be positioned
at the VCL.
e. All decontamination team members on the warm, (dirty) side of the hot line, as well as
those receiving patients on the clean side of the hot line, keep their protective masks on until all
patients are decontaminated and the PDS area is determined to be free from hazardous
vapors.
17. Actions to Take When Contaminated Patients Arrive
a. Security personnel at the ECP meet transport vehicles and quickly ask the driver as to
the numbers and types of casualties and the types of contamination if known. They relay this
information by radio to the drop-off point and to PDS OIC/NCOIC. They then direct the vehicle
to the drop-off point.
b. Patients are unloaded and whether ambulatory or litter, are given a quick but thorough
pat-down search for any ordnance or other explosive devices. The inside of mask carrier can
also be checked. Weapons are removed and stored in an area on the dirty side of the hot line.
These procedures can be performed by augmentees designated as drop-off point security or by
the augmentees who are serving as litter bearers. Suggested pat down steps include—
• Remove the patient’s weapons and load bearing equipment/load carrying equipment
web gear.
• Check inside the patient’s mask carrier for any munitions.
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• Try to keep the mask carrier with the patient for triage so that unused antidotes can
be administered if nerve agent exposure is suspected or if the patient displays signs
and symptoms of nerve agent poisoning.
• Move your hands down the patient’s torso while feeling through the overgarment
pockets for anything that could be ordnance. If ordnance (ammunition, grenades,
magazines, claymore mines) are found, remove them or alert the OIC/NCOIC.
• Do NOT remove the patient’s protective mask, the patient’s personal items at this
point, nor remove the patient’s identification tags at any time while the patient is in
the PDS.
• The contaminated patient is then brought to the warm (dirty) side triage area.
c. At the triage area, the patient is triaged and moved to a treatment area (immediate,
minimal, delayed, expectant, dirty evacuation) designated by the triage officer. All immediate
patients are brought to the dirty EMT area for stabilization.
d. Those patients who need to see the medical providers inside the MTF and are stable
enough for decontamination are moved to the decontamination lanes by litter teams or, if
ambulatory, directed by an augmentee. The triage officer or EMT treatment officer will direct
patient priority for decontamination.
• Patients requiring minimal care should remain on the dirty side of the hot line, remain
in their protective ensemble, be treated there, and then returned to their unit without
going through thorough patient decontamination and crossing the hot line.
• Only those patients needing care at this MTF should go through patient thorough
decontamination.
• Patients with physical injury (that prevents them from going through the ambulatory
lane) or that are mentally impaired
(COSR) are automatically considered litter
patients.
• For more information on triage see Chapter III.
18. Moving a Litter Patient Through a Patient Decontamination Site
a. Patient Thorough Decontamination. Decontamination of contaminated patients is
essential before allowing them into an MTF. The following guidelines should be followed for
patient decontamination:
(1) Prior to Litter Patient Decontamination.
(a) Any time gross contamination is noted and it needs to be removed as soon as
possible. Use any stiff material (such as stick, cardboard, plastic strip, or metal banding strap)
to physically remove gross chemical contamination from the patient’s protective ensemble.
Much of the CW agent contamination can be removed through physical means.
(b) Dusty and dry chemical, biological, and radiological contamination should be
carefully dusted or vacuumed (using a vacuum with HEPA filter) from the overgarment. The
patient is then moved out of this dust off area while still in the protective ensemble. The dust off
area must be far downwind from the drop-off point so that dust that might be blown into the air
does not contaminate other areas of the PDS. If a manually operated, compressed air sprayer
is available, garments can be lightly misted with water to reduce particle aerosolization prior to
protective ensemble removal. Caution must be used in this process to not aerosolize the agent
with a direct flow of air or water when misting the dry material. Every effort should be made to
keep aerosolized dust to a minimum.
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V-45
(c) The patient is then triaged and moved by litter team to the warm side EMT
area. The patient is then medically stabilized (if necessary) by the medical personnel in the
area.
(d) Once stable for decontamination, a decontamination team moves the patient
to the pair of litter stands in the decontamination area (minimal equipment) or to the ambulatory
and nonambulatory patient lane (roller system) decontamination tent.
(e) The patient’s litter is placed on the litter stands. Decontamination team
members carefully remove the patient’s protective ensemble and clothing so that contamination
is contained in and on the protective ensemble.
(2) Transferring a Patient to a Litter. The patient’s litter is placed on the litter stands.
Decontamination team members carefully remove the patient’s protective ensemble and
clothing so that contamination is contained in and on the protective ensemble.
b. Minimal Equipment.
(1) After the patient’s clothing has been cut away, he is transferred to a clean litter.
This is either a decontaminable litter or a canvas litter with a plastic sheeting cover.
CAUTION
Workers must decontaminate each other’s TAP aprons
with the M291, M295, soap and water, or 0.5 percent
hypochlorite solution before any patient lifting. They
must dip their gloves in the
5 percent hypochlorite
solution and rinse them with water. This is done as team
members stand with arms spread out to the sides,
allowing the other team member to get into all the folds of
the TAP apron front and sleeves.
(2) The decontamination team members and a dirty side medical personnel
decontaminate their gloves and aprons with the appropriate decontamination solution.
(3) One decontamination team member moves to one side of the patient. The medical
personnel, if present, moves to the head of the litter. The other three team members move to
the other side of the patient. The decontamination team members are wearing butyl rubber
TAP aprons or a garment that can be adequately wiped down during patient lifts.
(4) The litter decontamination team members log roll the patient to his side, toward the
lone decontamination team member. This technique may need to be modified based on the
patient’s injuries. Stabilizing the head and neck is particularly critical if some type of spinal
injury is suspected. This is done by the following steps.
(a) The individual at the patient’s head
(preferably the dirty side medical
personnel), ensures that his gloves are decontaminated, and places his hands on both sides of
the patient’s head, with the palms over the ears and fingers to support the patient’s jaw to
stabilize the patient’s head.
(b) The lone decontamination team member crosses the patient’s leg, the one that
will be on the top when the patient is lying on his side after the log roll. The decontamination
team member then places one hand on the patient’s shoulder and the other on the patient’s hip.
(c) Throughout the log roll, the lone decontamination team member is positioned
against the litter to ensure that the patient does not roll forward too far and roll off the litter.
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(d) The other three team members help to roll the patient toward the lone member
in a controlled, slow manner.
(e) The individual holding the patient’s head ensures that the patient’s head is
turned slightly during the roll, so that it stays in a straight line with the spine.
(5) Once the patient has been log rolled to the side lying position, the three
decontamination team members place their forearms on the litter in a forklift fashion, each at a
different part of the body.
(a) First team member places his forearms to support the patient’s shoulders and
the waist.
(b) Second team member places his the forearms to support the patient’s hip and
thighs.
(c) Third team member places his forearms to support the patient’s knees and
ankles.
(d) The lone decontamination team member then slowly rolls the patient back
onto the three decontamination team members forearms. The medical personnel provide
supervision and will provide head and neck stabilization.
(6) The decontamination team members lift the patient. Before and during the lift, the
individual at the patient’s head explains to the patient exactly what is going to happen. The
team member who is stabilizing the patient’s head gives the command PREPARE TO LIFT.
When the three decontamination team members are ready they respond READY. If all team
members report that they are ready, the individual at the patient’s head then gives the
command LIFT. On that command the patient is lifted off of the litter by the three
decontamination team members while they roll the patient slightly inwards, against their chests.
This lift technique helps to make holding up the patient less of an effort and it best supports the
patient. During the lift, the decontamination team members should ensure that they bend at
their knees, not at their hips, and try to keep their backs straight and perpendicular to the
ground. This will reduce back strain for the lifters.
(7) The lone team member, who is not involved in lifting the patient, takes the dirty litter
and the contaminated clothing on it from the litter stands and puts it to the side. He then takes
a clean decontaminable litter and places it on the litter stands. If decontaminable litters are not
available use plastic sheeting on a clean canvas litter.
(8) The decontamination team member at the patient’s head then gives the command
PREPARE TO LOWER. If ready, the three team members holding the patient respond
READY. The command LOWER is then given and the patient is slowly lowered onto the clean
litter.
(9) The cut overgarments and undergarments are placed in the designated
contaminated trash bag with the other waste (for example, contaminated bandages) from the
patient.
(10) The dirty litter is sent to the litter decontamination area and decontaminated with an
M295 or 5 percent hypochlorite solution, allowed to sit for 10 minutes, and then rinsed with
clean water. The litter remains on the warm (dirty) side of the hot line and does not cross the
hot line, but instead is rotated between the drop-off point and the hot line.
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V-47
Note: Contaminated material from two litter patients can be placed into one 35-gallon
trash bag. The remaining 5 percent hypochlorite solution and soapy water (if
used) can be poured into the bags. The bag must be tightly secured and
transported to the dirty dump.
c. Roller System.
(1) Some roller systems are designed to accommodate a standard decontaminable
litter or designated to accommodate only a backboard.
(2) If the roller system will accommodate a decontaminable litter, the litter can be
placed directly on the roller system. It will be decontaminated as it travels with the patient.
(3) The patient must be transferred to another litter at the end of the decontamination
line to ensure that no contamination that could be on the bottom of the litter enters the MTF.
The litter is then rotated back through the roller system and washed before used again on the
warm side.
(4) If the roller system only accommodates a backboard, the patient must be
transferred from his litter to the backboard for movement down the roller system.
(5) The easiest way to transfer the patient from the litter to the backboard involves the
following steps:
(a) Position the litter outside the entrance to the decontamination roller system.
(b) Remove the patient’s load bearing equipment, mask carrier, and helmet if
worn.
(c) Log roll the patient to their side on the litter.
(d) Place the backboard along the back of the patient.
(e) Roll the patient back onto the backboard.
(f)
Lift the patient on the backboard and hand the backboard, now containing the
patient, to the decontamination personnel at the head of the roller system.
Note: When lifting a plastic backboard ensure that staff are holding on to the center
handles to keep the backboard from bowing which could cause the patient to fall
off.
(6) If another transfer technique is used, then it must be one that is easy for the
decontamination team members even with the heaviest of patients and one that will not cause
further harm to the patient.
Note: All transfer techniques should be practiced by the decontamination team using
personnel or sand bags. These techniques will have to be modified based on the
injuries of the patient.
19. Clothing Removal Station
a. Once on a litter or the roller system, the patient’s mask is decontaminated and clothing is
removed as outlined in paragraph 13 above.
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Note: The patient’s mask filter must be covered while undergoing decontamination,
especially when using water sprayers. This can be done with a lightly cupped
hand or gauze that does not block air flow. Other improvised devices, such as
cylindrical containers (such as compact disk 50 disk canisters) can be placed
over the filter as long as they do not block air flow.
b. Once protective ensemble, boots, clothing, and underwear have been cut off of the
patient the patient is rolled to his side. The garments are rolled up to the patient’s back. All
garments MUST be rolled inward so that only the black filter side of the protective ensemble is
next to the patient’s skin. The patient is then rolled in the opposite direction and the garments
are rolled inward and then carefully folded to hold in any contamination. The garments are then
passed toward the dirty end of the roller system tent where they are placed in a contaminated
trash bag.
c. The decontamination team members who removed the patient’s clothing roll the patient
along the roller system and then decontaminate their aprons and gloves with soap and water or
0.5 hypochlorite solution.
Note: If plumbing and an ample water supply are not available, then the procedures
and decontaminants used for field decontamination should be followed as the
patient is moved along the roller system. In this case, buckets of soap and water
or M291 kits are used.
20. Decontaminate the Patient
a. Minimal Equipment.
(1) The patient is now decontaminated with soap and water, M291 decontamination kit,
or 0.5 percent hypochlorite solution (least preferred).
(2) If the patient is in full protective ensemble the best method is to decontaminate only
those skin areas where there was a break in the ensemble (for example, around wounds, areas
where the underlying uniform is wet with agent, or where there is a tear in the overgarment).
(3) If the patient is not wearing protective ensemble or had significant uniform tears, or
underlying uniform is damaged, an alternate method is to decontaminate the entire skin surface
by wiping the skin with a sponge copious amounts of soapy water with a water rinse.
(4) In the case of a full body wash (litter patient), begin washing the patient from the
midline outward, constantly washing, making sure not to place a dirty sponge back on a clean
area without first rinsing the sponge. The complete topside of the patient is washed in this
manner, paying particular attention to hairy areas of the body (groin and auxiliary regions) and
sweaty areas (belt-line, just above the boots, the crease of the buttocks, and wrists).
Note: When using 0.5 percent hypochlorite (1/2 percent, dilute household hypochlorite)
solution
(least preferred), do not do a full body wash. Only decontaminate
contaminated areas.
(5) Then log roll the patient to his side. With the patient lying on his side, wash the
backside of the patient working from the higher areas of the backside and washing down toward
the litter. Ensure not to miss any areas. The side of the litter that the patient was rolled away
from is then decontaminated prior to rolling the patient onto their back on the litter.
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V-49
CAUTION
Log rolling and washing the back of some patients may be
difficult and dangerous for the patients depending on their
injuries. Procedures will need to be modified in these cases.
The supervising medical personnel should be consulted in
these cases and should guide the decontamination of these
patients closely.
(6) The patient is then moved to their back and now log rolled to their opposite side.
Wash the opposite side of the patient in exactly the same manner as above. Decontaminate
the litter as above before rolling the patient onto their back on the litter.
(7) After the patient is decontaminated, the medical personnel remove the dressings
and replace them if dressings are suspected or found to be contaminated with agent.
CAUTION
Review guidance for cold weather operations if the ambient
temperature is 65°F (18°C) or below.
(8) Superficial wounds are deconned and flushed with soapy water.
b. Roller System.
(1) After the patient’s clothing has been cut away, he is moved down the roller system
to the area where the shower hoses dispensing warm soapy water are located. This area is
manned by two individuals who spray the patient’s body with soapy water and wipe the body
using cloths or sponges. They must wipe toward the backboard.
(2) The patient is washed from head-to-toe and then turned on the side so that the
patient’s back can be washed as well as the top of the litter/backboard.
(3) The patient is then moved along the roller system to the rinse area where the soap
is rinsed off of the patient moving from head to toe. The patient is rolled to the side and the
patient’s back and backboard are rinsed.
Note: Water should be conserved as much as possible to reduce the need to refill
water storage and reduce the frequency that the wastewater bladder must be
emptied.
(4) Decontamination team members wash their aprons, gloves, and sponges
thoroughly between patients.
(5) Decontamination team members working in these areas should protect their mask
filters from moisture as much as possible. Additional filters should be on hand for the staff to
change out damp filters. Team members wearing PAPR can keep their filters dry by wearing
the blower motor and filters under waterproof aprons to keep filter units dry.
(6) Once the patient is washed and rinsed, the patient is then moved to the clean end
of the roller system where they are checked for contamination and then dried.
Note: Bandages, splints, and tourniquets are only changed by medical personnel.
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c. Occupational, environmental, and incident exposure data must be documented,
recorded, and archived. Reports from OEH or CBRN exposure incidents that result in an acute
illness or that have the potential to cause latent illness will be included in the patient records of
those individuals affected or possibly exposed. Refer to DODI 6490.03 for more information.
21. Check Patient for Completeness of Decontamination
a. After decontamination, the patient is brought to the contamination check area. The
patient is checked with the CAM/ICAM or with M8 detector paper (if patient is fully dry) for
completeness of decontamination and checked with appropriate RADIAC meter (preferably one
that can detect small areas of alpha and beta contamination) on the body if radioactive
contamination is suspected. Other approved monitoring devices may be used when available.
There is no detector currently available to measure the completeness of decontamination for
biological agents.
Note: Decontamination is typically not indicated for biological agents if the person has
bathed in the days since initial exposure. If the individual has been exposed to
anthrax spores, and has not bathed, then thorough decontamination is important.
In this instance, clothing should be carefully removed to reduce the spread of the
spores. The skin should be washed with soap and water and runoff water
collected/neutralized.
b. Dispose of contaminated bandages and coverings by placing them in a designated
contaminated waste bag with the contaminated overgarments. Seal the bag and place it in the
contaminated dirty dump.
22. Movement of the Patient to the Hot Line
a. Minimal Equipment.
(1) Decontamination team members rinse or wipe down their TAP aprons and gloves
with the 0.5 percent hypochlorite solution for chemical and biological agents and soap and water
for radiological agents. They then move the patient on the litter to the hot line.
(2) The shuffle pit containing STB is only necessary for chemical agents and
sporulating biological agents such as anthrax. They are not necessary for radiological agents
although a hot line is still indicated.
(3) At the hot line, a pair of litter stands is positioned inside the shuffle pit. At this point,
the patient’s clothing has already been cut away; his skin and splints have been
decontaminated and contaminated bandages have been replaced. Now the decontamination
team members place the patient and litter on the litter stands inside the shuffle pit. The shuffle
pit should be wide enough to allow decontamination team members to move around the pit to
position the litter inside the pit.
(4) The decontamination team members who brought the patient to the shuffle pit
position themselves in the pit around the litter patient on the litter stands. They are still wearing
their butyl rubber TAP aprons. If available, the medical personnel from the dirty side
accompany the patient to the hot line. Staffing on the clean side of the hot line is made up of at
least three reception team members. One of these clean side reception team members must
be a medical person (health care specialist/corpsman) and the other two can be augmentees.
These members assume MOPP Level 4 but are not wearing TAP aprons.
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V-51
(5) A member of the decontamination team removes the bagged FMC and holds it so
that a medical person on the clean side of the hot line can read it and transfer the information to
a clean FMC. After transcribing the information, the clean side medical person attaches the
new FMC using the card wire to the patient’s mask harness before the patient crosses the hot
line to the clean area. The old FMC is disposed of in a trash bag on the dirty side of the hot
line.
Note: Direct physical contact between the decontamination team and receiving team
should be minimized to reduce any risk of cross-contamination.
(6) A second litter transfer is performed at the hot line to ensure that no contamination
on the litter passes the hot line. Decontamination team members must ensure that they have
properly decontaminated their gloves and aprons prior to performing any litter transfer
procedures.
(7) The clean side team members stand outside the shuffle pit. The decontamination
team members from the dirty side of the hot line position themselves around the patient as they
did at the litter patient decontamination area. Two suggested techniques are described below.
(a) The litter transfer can occur as previously described at the litter patient
decontamination area. Important points are—
• The clean litter would be provided by staff on the clean side of the hot line
and the dirty litter would remain on the dirty side of the hot line and brought
to the dirty side litter cleaning area, once it is removed.
• As the patient is lifted, a member of the clean side team places a blanket, if
available, on the litter.
• The patient is then laid on the blanket and wrapped in it. The blanket is
used to warm the patient.
(b) Once the litter transfer is completed by the decontamination team, they step
out of the shuffle pit. Then members from the receiving team, on the clean side of the hot line,
step in to the shuffle pit and move the patient and litter to the clean side triage area or into the
MTF. Now that their job is done, the decontamination team members drink water from their
canteens (while remaining in MOPP Level 4) and move back to the litter lane. If a rest break is
indicated they do not go across the hot line to the clean side, but instead they report to the
warm side rest area and remain in full ensemble. Once rested, the decontamination team
members are rotated back to the litter decontamination area.
Note: Before decontaminating another patient, each decontamination team member
drinks approximately one-half quart of water. The exact amount of water
consumed is increased or decreased according to the temperature but should not
exceed 12 quarts a day.
b. Roller System.
Once decontaminated, the patient is transferred from the roller system litter or
backboard to a clean litter at the hot line. The roller system litter is then sent back through the
decontamination tent and washed down. Once on the clean litter, the patient is moved to the
MTF or to a clean ambulance.
Note: Potentially contaminated backboards and litters must be rotated on the dirty side
of the hot line. Clean litters are rotated and remain on the clean side of the hot
line.
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23. Movement of the Patient on the Clean Side of the Hot Line
a. Minimal Equipment.
(1) The patient’s mask remains on the patient until he crosses the VCL where there is
no vapor hazard.
(2) The patient is moved by the reception team to the treatment and triage area on the
clean side of the hot line. They are then moved to a clean ambulance for transport to the MTF
or carried directly into the MTF if the decontamination line is collocated with the MTF.
(3) A litter decontamination area is established on the dirty side of the hot line. Dirty
litters are rotated for use on the dirty side only and are not brought across the hot line to the
clean side. Clean-side litters do not need to be decontaminated as they are only rotated on the
clean side of the hot line.
(4) In the event of CW or BW agent contamination, augmentees decontaminate
decontaminable (plastic mesh) litters by scrubbing with a 5 percent hypochlorite solution over
the entire surface of the litter, including the handles. They then should allow the litter to dry for
10 minutes and then rinse it with water. This wait time will allow the solution to neutralize any
chemical agent on the litter.
(5) If canvas litters are used, the augmentees will remove any barrier materials (plastic
sheeting) used to protect the wooden handles and canvas cover and place these materials in a
contaminated trash bag. If the barrier material is in short supply, the plastic sheeting can be
scrubbed with 5 percent hypochlorite solution, allowed to dry for 10 minutes, and then rinsed
with water. The canvas litter handles will be wiped with a 5 percent hypochlorite solution. Do
not use the hypochlorite solution directly on the canvas as it will destroy the material.
Contaminated canvas litters cannot be thoroughly decontaminated as the wood and canvas will
absorb chemical agents.
(6) When not decontaminating a litter, two of the augmentees will transport the
contaminated waste to the dirty dump.
b. Roller System.
(1) Once the decontamination process is complete and the patient is transferred to a
clean litter, the patient is then moved across the hot line. The hot line is located at or near the
clean end of the roller system.
(2) A shuffle pit is NOT required for a roller system as team members remain at their
roller system stations and are not traveling from the triage area to the hot line.
Note: The decontamination team members assume MOPP Level 4 or OSHA Level C
with protective aprons to keep the protective ensemble dry during
decontamination. They remain on the dirty side of the hot line and do not cross
to the clean side of the hot line unless their protective overgarments are
removed. The receiving team members also wear MOPP Level 4 or OSHA
Level C but they do not wear protective aprons. Direct physical contact between
the decontamination team and receiving team should be minimized to further
reduce any risk of cross-contamination.
24. Moving an Ambulatory Patient Through Patient Decontamination
a. The step-by-step procedure outlined below is the prescribed procedures for
decontaminating an ambulatory patient, but it is by no means the only method. Following this
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procedure ensures that the correct steps are not omitted. The focus must be to carefully
remove the overgarment so that any cross-contamination from the protective ensemble to the
patient’s skin is prevented.
b. Minimal Equipment.
(1) The M291 SDK or a soap and water solution are used for chemical decontamination
on the skin. The least desired alternative for skin decontamination is 0.5 percent hypochlorite
solution. The 0.5 percent hypochlorite solution if used for skin decontamination will irritate and
burn the skin, allowing agents to enter the skin more rapidly.
(2) The M295 Individual EDK is used to remove obvious contamination from the
protective ensemble and equipment and to help to control the spread of contamination from it to
other areas. If it is not available, then either soap and water solution, 5 percent hypochlorite
solution or a field-expedient adsorbent material, such as clean dry earth or flour, can be
substituted.
c. Roller System.
(1) Soap and water is the decontaminant used in a shower based decontamination
system. The M295 or 5 percent hypochlorite solution can be used to decontaminate the mask
prior to overgarment removal.
(2) The shower line is composed of three stations:
• Undressing area.
• Shower area.
• Final check area (contamination levels can be checked depending on particular
Service policy. In this area, the patient dries himself and dons a disposable
garment, blanket, or sheet).
(3) Minimal staffing is required for the ambulatory patient line as the patients can
usually assist one another. A minimum of one medical person is needed to help those with
medical conditions and an augmentee to direct traffic flow.
(4) Patients are directed through the process and are observed by the medical
personnel or augmentee to ensure that they wash from the head down, cleaning all areas of
their body, and spending approximately 2 to 5 minutes washing.
(5) Patient time in the showers should be limited to 5 minutes to conserve water and
limit wastewater volume as it must be collected in the wastewater bladder.
d. Prior to Ambulatory Patient Decontamination
(1) Physically remove gross contamination.
(a) Use any stiff material (such as stick, cardboard, plastic strip, or metal banding
strap) to physically remove gross chemical contamination from the patient’s protective
ensemble. Much of the CW agent contamination can be removed through physical means.
(b) Dusty chemicals and dry biological and radiological contamination should
carefully be dusted or vacuumed (using a vacuum with a HEPA filter, if available) from the
overgarment. The patient is then moved out of this dust off area while still in the protective
ensemble. The dust off area must be far downwind from the drop-off point so that dust that
might be blown into the air does not contaminate other areas of the PDS. Every effort should
be made to keep aerosolized dust to a minimum.
(2) The patient is then directed to the triage area where triage is performed.
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(3) From the triage area, the patient is directed to the appropriate warm-side medical
treatment area. Once treated the patient may be returned to his unit without undergoing
decontamination, moved to the dirty evacuation area, or directed to the ambulatory lane of the
PDS/decontamination tent if further treatment is required on the clean side of the hot line at this
particular MTF. If directed to the ambulatory lane the patient will move to that lane and await
clothing removal and decontamination.
25. Processing Through the Ambulatory Decontamination Line
a. Minimal Equipment.
(1) Remove mask hood, overgarment, and overboots.
(2) Replace any contaminated bandages and tourniquets. This is only performed by a
medical personnel (health care specialist/corpsman or medical provider).
(3) At this time (the patient is only wearing combat boots and protective mask), the
patient is monitored for contamination. Use ICAM or M8 detection paper to monitor for
chemical agents and a RADIAC meter for radiological contaminants. Check all areas of the
patient's body, mask and combat boots. Pay particular attention to—
• Combat boots.
• Protective mask.
• Bandages and splints.
• Hair and neck area.
• Wrist and ankle areas.
(4) If no contamination is found then send the patient to the hot line.
(5) If contaminated skin areas are found then decontaminate using the M291 or soap
and water.
(6) Check all personal items that were removed from the patient and placed in a self-
sealing plastic bag by using the appropriate detector inside the bag opening. If the items are
not contaminated, have the patient bring them through the decontamination line. If they are
contaminated then ensure that the bag is marked with the patient’s name and the bag and its
contents are placed in a secure holding area for decontamination or proper disposal.
Note: The patient remains in his protective mask until he cross the VCL.
b. Movement Across the Hot Line.
(1) Process the patient as quickly as possible across the hot line.
(2) The augmentee instructs the patient to move across the shuffle pit/hot line.
(3) The patient shuffles/moves through the shuffle pit wearing his combat boots.
Note: The ambulatory patient shuffle pit should be wide enough for the ambulatory
patient and one augmentee.
(4) An augmentee from the clean side meets the patient and opens a blanket or other
covering for the patient (appropriate for the environmental conditions). Once across the VCL
the ambulatory patient removes his mask.
(5) In the clean treatment area, the patient is retriaged, treated, and evacuated.
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V-55
Note: In a hot climate, the patient will probably be significantly dehydrated; the
rehydration process must begin immediately.
(6) Overhead cover should be provided for casualties in the clean-side holding area.
c. Roller System.
(1) Actions in the undressing area. Patient undressing can be performed just outside
the ambulatory lane of the shower tent if adequate room is not available inside the tent.
(a) The patient’s mask is decontaminated, but remains on the patient. The filter
inlet should be covered lightly to prevent moisture from entering the filter canister.
(b) The patient’s overgarments (to include boots) and undergarments are cut-off or
removed and placed in a contaminated trash bag located near the entrance to the tent.
(c) Once nude but still masked, the patient is directed to the shower area.
(2) Actions in the shower area.
(a) The patient enters the shower area with no clothes or boots/shoes on.
(b) The patient is given a maximum of 5 minutes to thoroughly wash and rinse his
body.
(c) The patient is directed to soap up their body, starting with the hair. They must
bend his head forward so that runoff water from his hair does not get in the eyes. They then
soap and wash quickly from head to foot (approximately 3 minutes) including skin folds such as
the arm pits and groin. If available they should be given a paper wash cloth or sponge to help
scrub the body.
(d) The patient is then directed to rinse (approximately 2 minutes).
Note: Replacement of any contaminated bandages and tourniquets is only performed
by medical personnel (health care specialist/corpsman or medical provider).
d. Actions in the Final Check Area.
(1) After washing and rinsing, the patient moves to the final check area in the tent.
Depending on the particular Service CONOPS, the patient can be checked for thoroughness of
decontamination using an ICAM or M8 paper for chemical exposure or a RADIAC meter for
radioactive particle exposure.
(2) Once washed and rinsed, the patient is given assistance to dry if they are having
difficulty. They can then don a disposable garment, blanket, or sheet.
(3) If time allows, check all personal items that were removed from the patient and
placed in a self-sealing plastic bag. This is performed by using the appropriate detector inside
the bag opening. If the items are not contaminated, have the patient bring them through the
decontamination line. If they are contaminated ensure that the bag is marked with the patient’s
name and they are placed in a secure holding area for decontamination or proper disposal.
(4) A member of the decontamination team removes the bagged and holds it so that a
medical person on the clean side of the hot line can read it and transfer the information to a
clean FMC. Information such as type of injury, treatment given, or time/type of exposure must
be transcribed to the clean FMC. After transcribing the information, the clean side medical
personnel attaches the new FMC using the card wire to the patient’s mask harness before the
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patient crosses the hot line to the clean area. The old FMC is disposed of in a contaminated
trash bag on the dirty side of the hot line.
Note: The patient remains in their protective mask until they cross the VCL which is
located outside of the decontamination tent and beyond the hot line.
(5) A decontamination team member instructs the patient to move out of the tent and
across the hot line (which is located at the immediate rear of the tent). With a shower system, a
shuffle pit is not needed as contamination is contained within the tent.
26. Procedures for Closing Down a Patient Decontamination Site
a. Once all patients have been processed through the PDS, the OIC will direct the team
members to close down the PDS or disestablish it if it needs to be moved to a new location.
The closure of the PDS will pose challenges due, in large part, to the fatigued condition of the
PDS personnel. During PDS closure, it is critical that PDS personnel maintain adequate water
intake so that workers do not become dehydrated.
b. Medical team members from the triage area will begin PDS closure procedures first, as
their portion of the process ends first. They consolidate unused, but uncontaminated, medical
supplies and place them in their appropriate containers/boxes. These must be checked with
the appropriate monitoring device before consolidation so that other supplies are not cross-
contaminated. All waste materials are placed in contaminated trash bags and sealed by double
knotting the necks of the bags. The bags are then transported to the dirty dump. The drop-off
point personnel will also assist with this effort. Any contaminated medical supplies that cannot
be decontaminated will be placed in the contaminated trash bags and discarded in the dump.
c. Supplies and equipment that can be decontaminated will be sent through the
decontamination line either on a backboard or litter. If the PDS is not going to be relocated,
these items can be stored in the shade on the warm side of the hot line after they have been
decontaminated.
d. All cutting devices are allowed to sit in a bucket of 5 percent hypochlorite solution (if
chemical or biological agents were encountered) for 30 minutes and then rinsed thoroughly if
they are to be reused. If radiological contamination was encountered, cutting tools only need to
be rinsed thoroughly. Blades are then replaced if they are to be reused. Dull bandage scissors
or other cutting devices are bagged with other waste and sent to the dirty dump.
e. Any weapons or patient personal affects which have not been decontaminated by this
time are decontaminated, checked for contamination, and passed across the hot line. Personal
effects that can not be decontaminated, such as paper items, are also placed in the
contaminated trash bags and disposed of in the dirty dump.
f. Once all supplies and equipment have been stored and washed then the inside walls of
the roller system decontamination tent should be sprayed down with soapy water and then
rinsed.
g. Arrangements are made to have the water containers topped off and the wastewater
containment neutralized and emptied or properly disposed of.
h. See Table V-9 for equipment needed for the closure of a PDS.
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V-57
Table V-9. Equipment and Supplies Required for the Closure/Disestablishment
of a Patient Decontamination Site
Equipment and Supplies
Per Lane
Per Lane
Minimal
Roller
System
Large trash bags for contaminated waste
As needed
As needed
A slurry mixture of STB or a
5 percent hypochlorite
(full strength
As needed
household liquid bleach) solution (in buckets)
Pails/buckets for STB slurry or hypochlorite solution
2 to 4
2 to 4
Pails/buckets for rinse water
2 to 4
2 or more as
Sponges or rags
needed
Butyl rubber TAP aprons
As needed
Entrenching tools
2 to 4
27. Equipment and Supply Recovery
a. If the agent was chemical or biological, prepare the STB slurry mixture or 5 percent
hypochlorite solution and place them in pails/buckets. The STB is prepared with four parts STB
to 6 parts water (by weight). For example, 6 parts of water weighs 42 pounds (1 gallon weighs
8 pounds) and mixed with 28 pounds of STB, provides the required slurry mixture. If the agent
was radiological then a soap and water mixture is more appropriate.
b. If the PDS is to be disestablished and moved to another area, then move all large
equipment to an equipment decontamination area about
50 meters to the side of the
decontamination lanes.
c. If the PDS is to remain in the same place, then keep equipment except for high value
items such as the ICAMs and medical supplies in place and scrub them down in place. They
must also be checked to ensure they are free from contamination.
d. The STB slurry or 5 percent hypochlorite solution is allowed to remain in contact with the
equipment for 30 minutes. After 30 minutes the items are then flushed with clean water. For
radiological contamination no wait time is required and soap and water is used.
e. After each item has been scrubbed and flushed, then it is checked carefully with the
appropriate monitoring device. No detector is yet available that will give rapid enough results
so that the site can be closed within a short amount of time. The surface of these items should
be monitored with special attention to cracks, joints and seams, bolts, porous material, and any
openings in the equipment.
f. While waiting for the 30 minute contact time to occur, do the following tasks:
(1) All waste items
(for example, contaminated medical supplies, dirty bandages,
garments cut off the patients, patient mask carriers, used sponges, dull scissors and cutting
blades) are placed in contaminated trash bags and taken to the dirty dump.
(2) Unused, uncontaminated, medical supplies are monitored for contamination and if
clean are placed into a covered or metal container. The outside of the container is
decontaminated and rinsed. These are then positioned for movement across the hot line when
determined to be free of contamination.
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(3) Any items in the weapons and contaminated personal affects storage area are
decontaminated and moved across the hot line. Personal effects that cannot be
decontaminated, such as paper items, are disposed of in the dirty dump.
(4) In the PDS with minimal equipment, the shuffle pits are camouflaged and covered
with dirt.
(5) The dirty dump is backfilled with dirt. A small section of the dump is left open for
disposal of bagged PDS personnel overgarments. The dump is marked with the NATO CBRN
marking set.
(6) Personnel conduct a thorough police call of the PDS area.
Note: A thorough police call, camouflage, and clean up is conducted to reduce hazards.
g. Movement of Equipment Across the Hot Line. Any equipment or supply item that is to
be passed across the hot line to the clean side must be checked for contamination using the
appropriate monitors.
28. Decontamination Team Personnel Recovery (Technical Decontamination)
a. Technical decontamination refers to the deliberate decontamination of responders/PDS
personnel and their equipment. Technical decontamination is conducted with the emphasis on
deactivation/neutralization of the agent with speed not being a factor. Terms that are commonly
associated with technical decontamination are detailed, deliberate, and responder
decontamination.
b. Once equipment and supply recovery is accomplished, then all PDS personnel will
conduct technical decontamination, except for two individuals.
Note: It is strongly suggested that the remaining two individuals be detailed from those
who have been working on the clean side of the hot line.
c. The PDS NCOIC/OIC will select a technical decontamination location/station.
d. All PDS detailed personnel will perform technical decontamination and the two remaining
personnel will put all discarded protective overgarments, gloves, liners, and boots into
designated contaminated trash bags and place them in the dirty dump. If possible, boots
should be decontaminated and reused.
e. Once items have been placed in the dump, the two remaining individuals will complete
back fill or complete camouflage of the dirty dump and complete marking of the dump with the
NATO CBRN marking set. They will then move back to the hot line and perform technical
decontamination. Their sets of protective ensemble are placed in contaminated trash bags and
left in place and camouflaged. If the site is to be used later, then the next team to operate it can
place these two discarded protective ensembles in the dirty dump.
f. Higher headquarters must be notified of the location of the dirty dump. This can be done
through a CBRN 5 report. Every effort should be made to have engineers in protective
ensemble to cover the dirty dump using their heavy equipment if the PDS is relocating or the
dump is full and a new one needs to be dug. The area must be marked so friendly forces will
not use it and if the tactical situation allows, it should be guarded to prevent local nationals from
scavenging the dirty dump.
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29. Establishing a Patient Decontamination Station on a Water Vessel
a. General. This paragraph specifies the procedures for receiving, decontaminating, and
monitoring limited numbers of patients who have been exposed to CBRN agents and are
transferred to naval vessels or hospital ships (T-AH). Information is compiled from NTTP 3-
20.31.470 and FM 3-11.5/MCWP 3-37.3/NTTP 3-11.26/AFTTP[I] 3-2.60.
b. Shipboard Decontamination of Ground Force Personnel. In general, the best approach
to decontaminating contaminated ground force personnel is to provide them support and a
suitable location to execute their standard change out procedures either on land before
transport to the ship or, if they arrive dirty to decontaminate them on the deck of the ship.
Ideally, patient should be thoroughly decontaminated before they are transported to a ship, but
this may not always be the case. Patients may be evacuated dirty by water or rotary-wing
aircraft after undergoing only operational decontamination. It is assumed that the steps of
gross decontamination to remove liquid or solid contamination
(patient operational
decontamination) have been applied before casualties are transported to a naval vessel.
WARNING
Immediate
(gross) and operational decontamination
procedures for contaminated ground force personnel are
not adequate to allow them to enter inside the ship.
Individuals
must
have
undergone
thorough
decontamination.
c. The PDS acts as a transition area, allowing clothing removal, skin decontamination and
chemical agent monitoring to take place in the controlled environment of the ship without
releasing contaminants into the ship’s ventilation system.
d. Ship Ventilation Consideration.
(1) Ship’s course. To receive contaminated patients, the ship will steer into the wind,
as normally occurs during helicopter operations. This is necessary because the main air intakes
of the ship’s ventilation system are not filtered and are forward of areas where decontamination
will occur.
(2) Oxygen generation station. Compressors in the oxygen generation station, located
immediately aft of the flight deck, must be turned off during the decontamination operation and
remain off for a period of one-half hour after the decontamination operations end. The
ventilation system of the flight deck decontamination station maintains the entry passageway at
a negative pressure and provides a flow of clean air from the elevator passageway, through the
decontamination compartments, and out an exhaust fan in the entry passageway. The vents
are sized for proper flow velocity to prevent the release of airborne contaminants to the rest of
the ship.
(3) Airflow rate. The airflow rate of the ventilation system produces one air change
every 1.5 minutes in each compartment, so airborne contaminants will be purged rapidly,
preventing release of contaminants to the staging area when doors are opened for moving
patients.
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WARNING
The exhaust fan overhead in the passageway must
be operating for decontamination operations and for
using the shipboard PDS for screening/holding
patients who may have infectious diseases. The
airflow induced by this fan is critical to
contamination containment. This fan is not used
during other operations.
e. Control of doors. At no time should two doors of the same compartment be opened
simultaneously, nor should the forward and aft doors of the airlock in the entry passageway be
opened simultaneously when processing contaminated patients. Failing to observe this
precaution will result in an interruption of the airflow and possible release of contaminants.
Doors leading into the elevator passageway are controlled by the decontamination team in the
compartments adjacent to the passageway and should be opened only when the chemical
monitor (that is, ICAM) indicates it is safe to do so.
f.
Dwell Time in Compartments. The compartments are designed for a residence time of
10 minutes; that is, the time between closing the first door and opening the second door of each
compartment should be 10 minutes when contaminated patients are being processed.
g. Communication.
Doors should be opened only for movement of patients.
Communication among the compartments should be made with radios, an intercom system, or
by writing notes (such as a grease pencil on writing board) visible through the windows between
compartments.
h. Monitoring of contamination. The ICAM is employed in the monitoring station to ensure
that the patient is free of chemical contaminants when ready to go inside the ship. A secondary
use of the ICAM is to monitor decontamination team personnel, equipment, and the area of the
flight deck used for decontamination after the processing is completed. A RADIAC meter with a
pancake probe is used to monitor patients potentially contaminated with radioactive particles.
There is currently no device available to readily monitor biological contaminants.
i.
Heat stress. The decontamination team members must recognize the potential for heat
injury when wearing their protective clothing for extended periods. Compartments may become
warm during decontamination operations and the team leader must ensure that members drink
liquids before, during, and after the operations. Canteens or camelbacks with drink tubes
should be placed in the compartments to allow team members to drink through the mask during
the operations.
30. Actions to Take Prior to Arrival of Patients
a. Prepare the Ship for Receiving Contaminated Patients.
(1) Immediately upon notification that contaminated patients are to be received, the
chemical, biological, and radiological defense (CBRD) coordinator will activate the ventilation
system of the shipboard PDS and ensure that general ship preparations are being made for
receipt of contaminated patients
(windward direction and securing the oxygen generation
station).
(2) The ventilation system of the PDS is activated by turning on the switch near the
forward end of the passageway. The exhaust fan is located overhead in this passageway and
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V-61
the fire damper for the fan must be in the open position for air to be drawn through the
decontamination station. This should be checked visually by examining the fan. Excessive
noise of the fan is an indication that the fire damper is in the wrong (closed) position. Other
preparations of the decontamination facility are as follows:
• Check the elevator passageway, to ensure the spool piece is removed and
blanks are mounted in the exhaust system overhead. The ceiling panels
normally conceal this duct.
• Close the fire damper in the elevator passageway exhaust system 03-37-1.
Open the fire damper and the watertight closure for the natural supply duct.
• Ensure that the dampers (three total) located in the vents between each set of
compartments are open. These are located in the centerline bulkhead of the
decontamination station, about 5 feet above the floor. The damper handles are
located in the elevator passageway on the portside bulkhead.
• Check to ensure that supplies and equipment specified below are available in
each compartment.
• Check that floor drains in the decontamination compartments are open and
unclogged.
• Close all doors of the decontamination station.
b. Prepare Supplies and Equipment.
(1) Chemical agent monitors. Turn on the ICAMs in each of the three monitoring
compartments if the agent is unknown or chemical agent contamination is suspected. These
are to be operated on alternating current and will have four batteries in each of the D-cell
adapters to which the alternating current power is connected. Once the ICAMs are warmed up,
perform confidence checks on each ICAM per the technical manual.
(2) Decontaminant. Prepare pails/buckets of decontaminant. Each station will have
pails/buckets filled with 5 percent hypochlorite (full strength household liquid bleach) solution
(for cutting tools and to wipe down equipment) or soap and water mixture (to use on patient’s
skin). The pails/buckets must be color coded (for example, orange or red for hypochlorite
mixtures and a more subtle color for the soap and water mixture). This will help team members
to distinguish the contents. The pails/buckets of the two solutions should be allocated as
follows:
• Flight deck. Two pails/buckets per station/one 5 percent and one soap and
water (maximum 6 pails).
• Skin decontamination compartment. Two pails/buckets per compartment—one
5 percent and one soap and water.
• Monitoring compartment. One pail/bucket per compartment—soap and water
solution.
(3) Supplies for flight deck: Position the supplies and equipment inside the entry
passageway. It will not be taken onto the flight deck until the flight deck director so directs.
There are two types of cutting instruments that should be used: the V-Blade Safety Rescue
Knife (National Stock Number [NSN] 5110-00-524-6924) or similar long handled seat belt
cutting tool will be used for rapidly cutting most areas of the garments. The blades of these
knives should be checked for sharpness before the operation and be replaced as necessary.
The bandage scissors will be used to cut shoelaces, hoods, and other areas not appropriate for
the V-blade knife. The team leader will ensure that these supplies and those listed for each
compartment are in place.
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(4) Wet the flight deck: To minimize the possibility of agent absorption into the surface
of the flight deck, prewet the flight deck (from the entrance of the decontamination station to 15
feet aft of the yellow line) with the fire hose 5 to 10 minutes before the contaminated patients
arrive by helicopter.
c. Prepare the Decontamination Team and Flight Deck Personnel.
(1) Overgarments and protective masks of the decontamination team should be stored
in a readily accessible area and should be marked with the name of each team member for
rapid access.
(2) The flight deck personnel will wear the protective mask and protective gloves when
supporting the landing and takeoff of the helicopter and when transporting the patient to the
deck area forward of the yellow line.
(3) Decontamination team members will be fully dressed in their protective ensemble
(MOPP Level 4) by the time the helicopter lands on the deck or a water vessel carrying
contaminated casualties docks with the ship. Those who are to perform procedures on the
flight deck will wait in the entry passageway. Mask carriers will not be worn but will be left
inside the decontamination station. All personnel will wear voice amplifiers on their protective
masks. They will check that each amplifier has a working battery installed before operations
begin.
(4) The CBRD coordinator or his designee will check each team member to ensure
that the mask and protective clothing are donned and fitted properly.
(5) The medical director of decontamination and the CBRD coordinator each will wear
a white band with red cross on the left arm. Each team member will wear a strip of tape on the
front of the uniform with his name marked on it.
(6) All other ship’s personnel will remain inside enclosed areas of the ship during and
for one half hour after the end of decontamination operations.
(7) When not setting up the decontamination site, team members can receive
additional hip pocket or JIT training on such topics as: basic medical signs and symptoms of
chemical agents; safe patient litter transfer techniques; roles and responsibilities; the use of
detection devices (for example, the ICAM, M8 paper, and RADIAC meters as indicated by the
threat); correct litter patient lift techniques; the importance of work/rest cycles; and prevention of
heat injuries.
d. Staffing for PDS on a water vessel. Table V-10 is an example of minimal staffing for one
work cycle at a PDS on a water vessel. More individuals are needed to ensure adequate
work/rest cycle rotation.
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V-63
Table V-10. Minimal Staffing for One Work Cycle at a Patient Decontamination
Site on a Water Vessel
Per
For
Job
Lane
Three
Lanes
Command and Control Cell
Officer in charge.
1
1
Master-at-arms (May also serve as safety officer, or another individual can
1
1
be designated. The master-at-arms also performs pat-down search and
secures ordnance, and personal affects.)
On Deck Arrival Point
Augmentees to remove litters (1 team of 4).
4
12
Primary triage officer (physician, PA, nurse, or senior corpsman).
1
1
Corpsman to administer treatment.
1
3
Augmentees to perform protective overgarment cut-off procedures. They
2
6
wear TAP aprons.
First Compartment Decontamination Area
Augmentees who cut off underclothing and decontaminate the patient. They
4
12
wear TAP aprons.
Corpsman.
1
3
Second Compartment Contamination Check Area
Augmentee trained to use various contamination check tools.
1
3
Corpsman.
1
3
Hot Line Patient Reception
Augmentees to move litter patient out of second compartment across hot
2
6
line.
Corpsman on clean side of hot line outside second compartment.
1
3
Total Medical
5
13
Total Augmentees, Others
15
41
Total Personnel For One Work Cycle
20
54
31. Procedures to be Performed on the Flight Deck
a. Equipment should be staged in the entry passageway. When the helicopter landing
operation is complete and the patients have been checked for ordnance, take the equipment
onto the flight deck and position the pails/buckets of decontamination solution containing
scissors and long handled seat belt cutters at the yellow line near the entrance to the
decontamination station.
(Up to three stations are set up, one station for each patient requiring
decontamination, so that three patients can be processed simultaneously.)
b. Tables V-11 and V-12 list recommended quantities of equipment and supplies required
for each compartment of the shipboard decontamination process.
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FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
15 July 2009
Table V-11. Equipment and Supplies Required for Patient Decontamination
Procedures Conducted on the Flight Deck
Per
For
Equipment and Supplies
Lane
Three
Lanes
Trash can with trash bag insert (extra bags placed beneath first bag).
1
3
Pail/bucket of decontamination (5 percent hypochlorite solution).
1
3
Pail/bucket of decontamination (soap and water solution).
1
3
Bandage scissors.
4
12
Long-handled seat belt cutter (minimum, more are needed as they dull).
2
6
Self-sealing plastic bags for FMC.
2
6
Sponges.
2
6
Decontamination apron (TAP).
4
12
Canteens of water (in passageway).
4
12
One decontaminable litter for exchange.
1
3
3- x 5-inch card and pen (to mark personal effects).
3
9
Self-sealing plastic bag for FMC and for personal effects found in
6
18
outer garments.
Fire hose, 1.5-inch diameter, multipurpose nozzle.
1
1
Table V-12. Equipment and Supplies Required for Patient Decontamination
Procedures Conducted in First Compartment
Per
For
Equipment and Supplies
Lane
Three
Lanes
Trash can with trash bag insert (extra bags placed beneath first
1
3
bag).
Pail/bucket of decontamination (5 percent hypochlorite [full
1
3
strength household liquid bleach] solution).
Pail/bucket of decontamination (soap and water) solution.
1
3
Containers of bleach.
2
6
Measuring cup for dilution of bleach.
1
3
Bandage scissors (minimum, more are needed as they dull).
2
6
Long-handled seat belt cutter (minimum, more are needed as they
2
6
dull).
Self-sealing plastic bags (box) for FMC.
2
6
Sponges.
2
6
Decontamination apron (TAP).
4
12
Self-sealing plastic bags (for personal effects).
One per Patient
Canteens of water (in compartment).
4
12
Sharps container.
1
3
Pad of paper and ballpoint pen.
1
3
Clock or timer for 10 minute dwell time.
1
3
Felt marker/grease pencil with writing board (for communicating
1
3
through window).
15 July 2009
FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
V-65
32. Moving a Litter Patient Through a Patient Decontamination Station on a Water
Vessel
a. Contaminated patients are initially processed in the open air of the flight deck where they
are triaged and outer clothing is removed. The patients are then brought to the first
compartment where inner clothing is removed and decontamination takes place. They are then
taken to the second compartment where contamination monitoring is performed and the patient
is brought inside the ship. There are three pairs of decontamination compartments (three
parallel lanes) that allow up to three patients to be processed concurrently.
b. The flight deck personnel carry the patient from the helicopter across the yellow line and
secure the litter on the deck. They return a folded clean litter (obtained from the ramp area) to
the helicopter immediately, leaving the contaminated litter to be decontaminated and retained
on the ship.
c. The master-at-arms removes all battle dress items, ordnance, and weapons. Weapons
should be secured outside the skin of the ship or within the entry passageway of the
decontamination station until they can be monitored to determine that they are free of
contamination.
d. The medical officer performs triage once ordnance is cleared. All procedures on the
flight deck are done with litters resting on the deck. Litter stands will NOT be used.
e. On Deck Procedures Removing the Litter Patient’s Protective Ensemble.
(1) Clothing removal procedures are based upon the assumption that patients arrive on
ship wearing protective mask, overgarment, gloves, and overboots.
Note: If the patient does not have a complete protective ensemble, the processing will
be performed in the same order specified: removal of outer layer of clothing
followed by inner layer of clothing. If the patient has no protective mask, he
should be positioned with his head toward the bow of the ship, into the wind,
while his clothing is removed on the flight deck.
(2) Remove the patient’s personal articles from pockets. Place all items in a plastic
bag for later decontamination or destruction. Label the bags with the patient’s name and social
security number (information will be written on a 3- x 5-inch card or piece of paper and then the
card will be placed into the plastic bag). Seal the bags then wipe with 5 percent hypochlorite
solution. They will then be secured in an area outside the skin of the ship until the items can be
decontaminated in a
5 percent hypochlorite solution, rinsed, dried and checked for
contamination. Nondecontaminable items will be inventoried and destroyed. Decontaminated
items that are contamination free will be bagged and returned to the patient.
(3) Remove mask hood (if worn) and outer protective ensemble garments for litter
patients as outlined in paragraph 13 above. Then perform a litter transfer to place the patient
wearing their inner garments (for example, BDU/ACU) and protective mask on a clean litter.
(4) Patient lifts are performed with the litters on deck, not on litter stands. To do this,
the patient’s outer protective garments are removed and are lying under the patient on the litter.
The patient is log rolled to the side. A clean litter is placed on top of the cut off clothing along
the patient’s back. The patient is then rolled back on to the clean litter. The litter containing the
contaminated clothing is taken to the first compartment to be washed and the contaminated
garments are bagged on the deck.
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FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
15 July 2009
(5) Procedures on the deck require four personnel with at least one nurse or medical
corpsman per lane. Up to three lanes can be established for the concurrent processing of
patients. Personnel are at MOPP Level 4 with decontamination TAP aprons and a voice
amplifier on the mask.
(6) Decontamination aprons are worn so that team members can decontaminate
themselves before lifting the patient and also to keep the knees of their protective overgarment
dry if they must kneel on the deck. Decontaminate TAP aprons and gloves between each
patient.
Note: All transfer techniques should be practiced by the decontamination team using
personnel or weighted mannequins. These transfer techniques will need to be
modified based on the injuries of the patient.
CAUTION
Bandages may have been applied to control severe bleeding
and are treated like tourniquets. Only medical personnel
remove bandages, tourniquets, and splints. Cut around
bandages during clothing removal. Bandages should remain
on the patient until the skin decontamination station.
(7) Decontamination team members on the flight deck gather contaminated equipment,
clothing, and other items placing them in a contaminated trash bag for removal. They
decontaminate their rubber gloves in preparation for the next patient.
(8) Once all patients have been taken into the passageway, all equipment and
decontamination supplies are placed inside the first set of doors of passageway 03-39-4. The
handles of the doors leading into the decontamination station are also decontaminated. Outer
garments from the patients are gathered up, along with discarded bandages, and are placed in
designated contaminated trash bags. These bags are secured temporarily in the passageway
so that helicopter operations can resume. Cutting teams decontaminate their own gloves,
aprons, hoods, and masks.
(9) Decontamination team members must take frequent water breaks.
33. Procedures to be Performed in First Compartment
a. Remove Inner Garments to the Skin and Decontaminate the Skin. This requires four
personnel with at least one nurse per compartment. Up to three lanes may be established per
compartment for the simultaneous processing of patients. Personnel are at MOPP Level 4 with
decontamination TAP aprons and a voice amplifier on the mask.
(1) Prepare for Decontamination Operations.
(a) All cutters have decontaminated their gloves, scissors, and stainless steel work
tables (work stands) with decontamination solution. All clothing from the previous patient has
been bagged for return to the entry passageway.
(b) Flight deck team leader passes patient’s treatment status and injuries to the
leader of team in first compartment.
(c) The patient remains on the clean decontaminable litter as it is placed on the
stainless steel table in the first compartment. Doors to the compartment should remain closed.
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FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
V-67
(2) Remove Patient’s Uniform.
(a) Decontamination personnel dip their gloves in the
5 percent hypochlorite
solution.
(b) Remove the patient’s personal effects from his uniform pockets. Place these
in the plastic bag. Reseal the bag. If the articles are not contaminated, return them to the
patient. If the articles are contaminated, place them in the contaminated holding area until they
can be decontaminated and then return them to the patient.
(c) Remove uniforms and undergarments following the same procedures outlined
in paragraph 13 above.
(d) Removal of IV bags and tubing is at the discretion of the medical director of
decontamination. The IV lines should be protected during patient litter transfer.
(e) Old tourniquets, bandages, and splints are bagged with contaminated clothing.
b. Cleaning Wounds. Follow procedures in paragraph 6 of this chapter to clean wounds,
and change splints and tourniquets.
c. Decontaminate the Skin, Hair and Litter. Sponge soap and water over the patient’s body
including his hair, as the hair readily absorbs agent if it is exposed to agent vapor. Exercise
care not to get decontaminant in the patient’s eyes (if they are not wearing their mask). Log roll
the patient to one side to apply the decontaminant to his back. Apply the decontaminant
thoroughly to the litter while the patient is rolled to the side. Rinse the patient and litter
completely with the spray device.
d. Transfer the Patient to the Second Monitoring Compartment.
(1) The decontamination team members check to see that the second compartment,
the monitoring compartment, is ready (outer door closed and compartment not occupied by
another patient) before opening the door and taking the patient into next compartment for
monitoring.
CAUTION
A period of 10 minutes is required for a complete purge of
airborne contaminants in the compartment; that is, the door
into the monitoring compartment cannot be opened until 10
minutes after the door into the skin decontamination
compartment was last opened.
(2) Discarded clothing is bagged and is passed back to the passageway only after the
patient has been taken to the next compartment and the door has been closed.
(3) Once the door is opened to the monitoring compartment move the patients on their
litters to that compartment.
(4) Decontamination team members wipe down their TAP aprons starting from the top
and working down using the 0.5 hypochlorite solution or soap and water. They also wash their
gloves with 5 percent hypochlorite solution and ensure all cutting tools are placed in the bucket
containing 5 percent hypochlorite solution. The steel table is also washed off with the 5 percent
hypochlorite solution before the next patient enters.
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FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
15 July 2009
34. Procedures to be Performed in Second (Monitoring) Compartment
a. This requires two personnel per compartment. Personnel are in mask only (voice
amplifier on mask), with gloves (7-mil thickness) and apron.
b. Prepare for Monitoring Operations.
(1) Monitoring for chemical contamination will be performed with the ICAM and for
radiological contamination with the AN/PDR 77 RADIAC meter. There are currently 4 each per
ship. There is no real-time monitoring capability for BW agents.
(2) For CW agent monitoring, the ICAM should be turned on as soon as the team is
alerted that a chemically contaminated patient is to be received. Pressing the on/off switch on
its left side and waiting for the display to clear in the H mode turns it on. It should be warmed
up, preferably for 30 minutes, using its alternating current adapter. It must be warmed up and
cleared before it can be used effectively for monitoring. Information on using the ICAM is found
in TM 3-6665-331-10/TO 11H2-20-1.
(3) The ICAM must be turned on or off in the H mode only. If it is not in the H mode
when you turn it on, turn it off momentarily, change modes and turn it back on. The ICAM’s
computer must be in the H mode to perform its automatic initialization routine.
(4) Perform confidence checks on both modes. Also perform confidence checks after
monitoring each patient.
• Apply the confidence tester to the ICAM/CAM inlet for only 1 second, then pull it
away. Longer than this will require much longer for the ICAM display to clear.
• If the ICAM is working properly, the confidence check should cause a response
of at least 3 bars, preferably 5 bars. If not, try the confidence test again. If a
minimum of a 3-bar response is not obtained, the ICAM should be replaced (or
be run for an extended period to improve its response).
(5) Before the patient arrives, unplug the ICAM so that it operates on battery power
and the length of the alternating current power cord does not restrict its movement. Unplugging
causes a momentary interruption in power and requires about 1 minute to initialize the ICAM
again. The ICAM can be operated in the battery power mode either with the D-cell adapter
(which allows for alternating current operations) or with the special lithium battery (NSN 6135-
01-362-1368). Monitoring should be initiated with fresh batteries to prevent interruptions.
c. Monitor the Patient and his Personal Articles.
(1) Monitor with the ICAM in each mode if the agent is unknown. If two ICAMs are
available, set one on the H mode and one on the G mode and monitor with both concurrently. If
there is certainty of the type of agent the patient was exposed to (for example, based upon M8
detector paper readings prior to patients’ arrival onboard the ship or the patient’s medical signs
and symptoms) monitor with both ICAMs on the same mode. Monitor the—
• Person.
• Litter, particularly the handles.
• Bag of personal effects.
• Field medical card.
• Identification tags.
• Intravenous bag and tubing.
(2) Keep the ICAM inlet about one half inch from the skin. The greater the distance,
the less likely it is to respond to the contamination.
15 July 2009
FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
V-69
(3) Move the ICAM slowly over the surface; about 1 foot every 2 seconds and follow a
pattern that ensures the person is monitored thoroughly.
(4) As soon as any bar readings appear, pull the ICAM away and/or put on cap.
(5) Check first the areas that would most likely be contaminated: near wounds where
the garment was broken and at the neck, ankles, and waist. Also monitor the areas that might
adsorb agent vapor, such as the hair.
(6) If contamination is found, stop monitoring and note the general location. Use the
decontaminant to spot decontaminate where the ICAM indicates there is contamination.
(7) Replace the black cap on the ICAM nozzle between patients, even though the
display may be showing no bars.
(8) Before switching channels (or turning off the ICAM), always clear it by putting on
the inlet cover and waiting for a zero bar reading.
Note: It is acceptable to switch from G to H with one bar showing, but to switch from H
to G, the display must first show no bars.
(9) If the letters “BL” appear on the display, it means the battery is low; replace the D-
cell batteries if this occurs. Three dots mean it is momentarily confused by what it is sensing.
d. Remove the Mask.
(1) Once monitoring is complete and there is no contamination present, remove the
patient’s mask. Place the mask in a small trash bag and close it by knotting the neck. This
mask does not proceed into the ship’s MTF with the patient.
(2) After removing the mask, clean the face. Pass the bagged mask back to the first
compartment when the door is opened for the next patient to enter.
e. Transport the Patient from the Decontamination Station. Cover the patient with a clean
sheet and transport him to the clean staging area in the elevator passageway.
CAUTION
A period of 10 minutes is required for a complete purge of
airborne contaminants in the compartment; that is, the door
into the clean staging area cannot be opened until 10 minutes
after the door from the skin decontamination compartment was
last opened.
35. Procedures for Decontaminating the Facility and the Decontamination Team
a. Once all patients have been processed through the decontamination station, the CBRD
coordinator will direct the team members in decontaminating themselves
(technical
decontamination), the decontamination station, and the flight deck.
b. Team members from the flight deck will begin decontaminating first, as their portion of
the process ends first. They apply 5 percent hypochlorite solution to areas of the flight deck
upon which litters were placed during the processing. They place all discarded material in
bags, seal them by double knotting the necks of the bags, and ensure all debris are removed
from the flight deck. They then decontaminate scissors, long-handle seat belt cutting device,
rescue knives, and aprons and place these reusable items in the entry passageway.
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FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
15 July 2009
c. As soon as the last patient has been transported out of the skin decontamination
compartment, the team members in that compartment bag all discarded items, then
decontaminate
(with
5 percent hypochlorite solution) the patient table, cutting devices,
bulkheads, and deck. These items and the room are then to be rinsed with water.
d. Team members from the flight deck then decontaminate their gloves and overboots and
proceed into the entry passageway to remove overgarments. The team members will remove
their overgarments in the passageway as follows:
(1) Using the buddy-method, each member will cut the back of the overgarment smock
with a long-handle seat belt cutting device, or scissors. The overgarment jacket is cut upward
from the waist through the hood or in the reverse direction. The overgarment is removed from
the front. The overgarment arms are turned inside out as the smock is removed, roll the cut
smock inside out, and place it in a contaminated trash bag.
(2) Each member then removes the overgarment trousers by cutting each leg from the
back, starting at the ankle, and proceeding through the waist. The cut trousers are also to be
sealed into contaminated trash bags.
(3) The team members of the first compartment decontaminate the exposed areas of
their masks, aprons, overboots, and gloves in order. The team members then remove their
TAP aprons and hang them up. The team members empty buckets of decontamination
solution. Then remove their overgarments as described above. The team members remove
overboots last and leave them in the room to aerate.
(4) While still wearing mask and gloves, the team members place the bagged
overgarments near the entrance to the compartment and proceed into the monitoring
compartment to undergo an ICAM check.
(5) Once the ICAM check shows they are clean, the team members remove their
masks, then their gloves, leaving both in the compartment to aerate, and proceed into the clean
staging area.
Note: Scrubs may be pre-positioned here for team members to change into upon
completion of the decontamination process.
(6) Once the team members from the skin decontamination station have moved into
the monitoring compartment, the flight deck team members move from the entry passageway to
the skin decontamination compartment wearing their masks, gloves, and overboots. The team
members first place the bagged garments left in the compartment into the entry passageway
and shut the door.
(7) The team members next remove their overboots and leave them in the
compartment to aerate. Wearing mask and gloves they precede into the monitoring
compartment once the preceding team members have vacated it.
(8) Once monitoring, if chemical or radiological agent is suspected, has established
that each team member to be cleaned, he removes the mask, then gloves, and leaves both
items on the patient table to aerate and exits into the clean staging area.
(9) Once the detector operators have monitored all personnel and cleared them to exit
the decontamination station, they will move out, back through the decontamination station,
making checks to ensure the areas and equipment have been decontaminated. On the flight
deck, they will monitor areas of the deck that have been decontaminated and the weapons that
have been taken from the patients.
15 July 2009
FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
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