Главная Manuals FM 4-02.7 MULTISERVICE TACTICS, TECHNIQUES, AND PROCEDURES FOR HEALTH SERVICE SUPPORT IN A CHEMICAL, BIOLOGICAL, RADIOLOGICAL, AND NUCLEAR ENVIRONMENT (JULY 2009)
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Note: When monitoring with ICAM on the flight deck, strong winds can affect the
ICAM’s ability to detect. The ICAM nozzle must be held the proper distance from
the surface, about one-half inch, and must be swept over the surface at a slow
rate (about one-half foot per second) to monitor most effectively. The ICAM/CAM
is also susceptible to false positive readings in the presence of Aqueous Film
Forming Foam and Jet Propulsion-5 fuel.
(10) Once all monitoring outside the decontamination station is completed, ICAM
operators will unmask and secure the ICAMs.
e. Disposal of Contaminated Garments. Contaminated garments, bandages, splints, and
other items removed from patients in the decontamination process are placed in double
contaminated trash bags and sealed by double knotting the necks of the bags. Once the
decontamination operations are completed and the flight deck has been cleared, these bags
are taken aft, remaining outside the skin of the ship, to the biological materials incinerator.
36. Moving an Ambulatory Patient Through a Patient Decontamination Station on
a Water Vessel
a. The ambulatory patient is escorted and assisted through the process by a member of the
decontamination team. As with litter patient decontamination, contaminated ambulatory patients
are initially processed in the open air of the flight deck where they are triaged and outer clothing
is removed; they are then brought to the first compartment where inner clothing is removed and
decontamination takes place; after this they are 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 with litter patients.
b. The flight deck personnel direct the patient from the helicopter across the yellow line to
the on deck triage area. 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.
c. The Medical Officer performs triage once ordnance is cleared.
d. On Deck Procedures—Removing the Ambulatory Patient’s Protective Ensemble.
(1) Clothing removal procedures are based upon the assumption that patients arrive
wearing protective mask, overgarment, gloves, and overboots.
(2) Remove and Secure Personal Articles From the Overgarment Pockets. See
paragraph 33 above.
(3) Decontamination team members direct the ambulatory casualties to remove mask
hood (if worn) and outer protective ensemble garments for litter patients. Patients can assist
one another in this process if they are able. The patients are then directed toward the first
compartment. Ambulatory patients can accompany litter patients into the compartment, or
move to the compartment in groups.
(4) Decontamination team members on the flight deck gather contaminated equipment,
clothing, and other items placing them in a contaminated trash bag. The team members
decontaminate their rubber gloves in preparation for the next patient.
(5) Once all patients have been taken into the passageway, all equipment and
decontamination supplies are placed inside the first set of doors of the passageway. Handles
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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
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.
e. Procedures to be Performed in First Compartment.
(1) Remove inner garments to the skin and decontaminate the skin. Decontamination
personnel assist ambulatory patients by cutting off undergarments.
(2) Old tourniquets, bandages, and splints are bagged with contaminated clothing.
f. Cleaning Wounds. Follow procedures in paragraph 6 of this chapter to clean wounds,
change splints and tourniquets.
g. Decontaminate the skin, hair and litter. Sponge soap and water over the patient’s body,
including his hair, working from head to toe. The patient should lower their head when washing
the hair so that any agent in the hair does not get washed into the eyes and airway. Each
individual should shower from 2 to 5 minutes. Decontamination members can help supervise
the patients to make sure they wash every area of the body starting with the head and working
toward the feet while standing.
h. Procedures to be performed at 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 door and taking the patient into next compartment for
monitoring. More than one ambulatory patient can be brought into the monitoring compartment
at a time to speed up the process.
(2) Discarded clothing is bagged. It 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 to that
compartment.
(4) Decontamination team members wash down their TAP aprons starting from the top
and working down. They also wash their gloves with 5 percent hypochlorite (full strength
household liquid hypochlorite) solution and ensure all cutting tools are placed in the bucket
containing 5 percent hypochlorite solution.
(5) The now nude ambulatory patients will stand with their legs spread at shoulder
width and arms held out to the sides. Monitoring for chemical contamination will be performed
with the ICAM/CAM, and for radiological contamination, the AN/PDR 77 RADIAC meter, which
is currently available on the ship (4 each per ship). There is no real-time monitoring capability
for BW agents. The individual’s personal articles that are in plastic bags can also be monitored
for contamination. If contaminated, the items are decontaminated and returned to the individual
at a later date. If uncontaminated they can remain with the ambulatory patient. The patient’s
identification tags are always worn by the patient.
i.
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.
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(2) After removing mask, clean the face. Pass the bagged mask back to the first
compartment when the door is opened for the next group of patients to enter.
37. Procedures for Closing Down the Patient Decontamination Station on Board a
Water Vessel
a. Procedures for Decontaminating the Facility and the Decontamination Team.
(1) Once all patients have been processed through the decontamination station, the
CBR-D coordinator will direct the team members in decontaminating themselves, the
decontamination station, and the flight deck.
(2) 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 is removed
from the flight deck. They then decontaminate scissors, V-blade rescue knives, and aprons
and place these reusable items in the entry passageway.
(3) 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 rinsed with water.
(4) 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:
• Using the buddy-method, each will cut the back of the overgarment smock with
a long handled seat belt cutter, 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. They turn the arms inside out as the
smock is removed, roll the cut smock inside out, and place it in a contaminated
trash bag.
• Each 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 sealed into contaminated trash bags.
(5) 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. They empty buckets of decontamination solution. They then
remove their overgarments as described above. They remove overboots last and leave them in
the room to aerate.
(6) While still wearing mask and gloves, they place the bagged overgarments near the
entrance to the compartment and proceed into the monitoring compartment to undergo an
ICAM check.
(7) 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.
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(8) 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.
(9) The team members next remove their overboots and leave them in the
compartment to aerate. Wearing mask and gloves the team members precede into the
monitoring compartment once the preceding they have vacated it.
(10) Once monitoring, if chemical or radiological agent is suspected, has found 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.
(11) 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.
Note: When monitoring with ICAM on the flight deck, strong winds can affect the
ICAM’s ability to detect. The ICAM nozzle must be held the proper distance from
the surface, about one-half inch, and must be swept over the surface at a slow
rate (about one-half foot per second) to monitor most effectively. The ICAM is
also susceptible to false positive readings in the presence of Aqueous Film
Forming Foam and JP-5 fuel.
(12) Once all monitoring outside the decontamination station is completed, ICAM
operators will unmask and secure the ICAMs.
b. Disposal of Contaminated Garments. Contaminated garments, bandages, splints, and
other items removed from patients in the decontamination process are placed in double
contaminated trash bags and sealed by double knotting the necks of the bags. Once the
decontamination operations are completed and the flight deck has been cleared, these bags
are taken aft, remaining outside the skin of the ship, to the biological materials incinerator.
38. Night Operations
a. Night operations make patient movement through a PDS more challenging than other
operations primarily because of the visual limitations imposed by darkness. Floodlights will
typically not be appropriate in a battlefield situation where blackout conditions are imposed to
limit tactical vulnerability. Safety and site organization will be critical to successful operations.
Blackout conditions will definitely place limits on the following:
• Safe movement of patients and personnel in the area of the drop-off point.
• Safe movement of litter crews through patient triage and treatment areas.
• Ability of medical personnel to visualize patient medical signs which is already made
difficult where patients are in protective ensemble.
• Ability of decontamination team to see what they are doing during patient
decontamination.
b. Reducing the risk of accident during night operations. To reduce the incidence of
accident the following measures are suggested:
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(1) Set up the decontamination site during the day, with the aim of having its lay out
simple enough and well understood so that it can be used just as well at night.
(2) Lanes for movement from the different triage areas are marked with cloth tape,
caution tape, or other markings at waist height, so that litter teams will know where to go.
(3) Routes through the PDS are clear of debris and holes.
(4) Adequate flashlights, with red lens filters, are available at the arrival point, triage
area, treatment areas, decontamination lanes, and hot line.
(5) Operators have their name and decontamination team member job clearly marked
in large letters on tape which is on the front and back of their protective ensemble.
(6) Operators have voice amplifiers on their protective masks.
(7) Use chem-lights and, or, construction tape, place at waste level to mark travel
routes within the decontamination site.
(8) Provide personnel at the drop-off point with night vision devices so that they can
identify approaching vehicles.
(9) Be certain of vehicle offload procedures and ensure that patients are moved out of
the drop-off point before offload vehicles are allowed to move again.
(10) Only wheeled vehicles with ground guides are allowed to move in the drop-off point
and speed limits of 5 miles per hour (mph) (walking speed) are enforced.
(11) Mark concertina wire with chem-lights, especially along the hot line, to prevent
accidental movement into the wire.
(12) Rehearse patient movement and processing while there is still sunlight.
39. Activities during Night Operations
a. Entry Control Point.
(1) Vehicle marking. Attach the chem-light to the front end of the vehicle, below the
level of the hood, to preclude its interference with the driver’s night vision.
(2) The individuals manning the ECP should be equipped with a radio, a pair of
binoculars, and night vision goggles for standoff inspection of the approaching evacuation
vehicle.
(3) Once the vehicle halts at the ECP, the ECP personnel should conduct a cautious
approach of the vehicle. They should note the MOPP level the evacuation vehicle crew is in
and, regardless of MOPP level, question the crew about the numbers and types of casualties
they have and what type of agent the patients were exposed to if they know.
(4) Individuals manning the ECP use M8 or M9 paper to make a rapid and accurate
determination of whether or not a liquid chemical agent is present on, or in, a vehicle. Use the
ICAM to detect vapors coming from any liquid contamination on, or in, a vehicle. Visually
inspect the vehicle at the ECP and test any suspect liquids on the vehicle with M8 paper. Areas
likely to have liquid contamination are the vehicle’s wheel well areas, tires, and rear portion of
the vehicle.
(5) Information is relayed from the ECP, preferably by radio, to the decontamination
OIC or NCOIC. The personnel manning the ECP are in MOPP Level 4. The OIC or NCOIC
informs the triage officer and others at the PDS as well as those at the receiving MTF. Knowing
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the agent can help care providers better focus their diagnosis and care. It will also help the
decontamination team members to know if they need to remain at MOPP Level 4.
(6) Litter teams may be utilized to transfer casualties from the ECP to the arrival point,
but this is highly labor intensive and not recommended. The contaminated evacuation vehicle
may be routed into the drop-off point on a route that has minimal impact on other vehicle
movement into the area.
(7) Ground guides meet vehicles at the ECP who are traveling to the drop-off point.
The guides must be equipped with red lens flashlights. Litter bearers, if adequate numbers are
available, can serve as ground guides or assistant vehicle commanders can be asked to
perform this function. Assistant vehicle commanders can be asked to perform this function.
Ground guides will walk no more than five meters in front of the vehicle. Every vehicle must
have a ground guide at night. Speed limits of 5 mph (walking pace) must be enforced so that
personnel are not run over by vehicles.
b. Triage and Treatment Areas.
(1) Patients are off-loaded from the ambulances, given a pat-down search, and taken
to the triage point. The patients are triaged and visibly marked with prepared tags, adhesive
tapes. These colors can be used to denote the patients current medical triage category. It is
important to remember that triage categories will change as the patient processes through the
PDS.
• Immediate - Red
• Delayed - Yellow
• Minimal - Green
• Expectant - Black
(2) The use of these colors can extend into night operations with the use of “chem-
lights” in the colors mentioned above, with the exception that the “expectant” patient would be
marked with a blue chem-light.
(3) Triage areas will need to be marked with chem-lights, appropriate for the triage
category, attached to engineering tape. Medical personnel (medic, corpsman, EMT) must be
equipped with red filtered flashlights. Augmentees may need to assist aid men by holding lights
for the aid men while they work.
c. Decontamination Lanes.
(1) Site preparation will require time for shuffle pit preparation, dirty dump preparation,
and removal of any ground obstacles. If there is time to accomplish any of this labor-intensive
work prior to activating a PDS, it will greatly improve PDS operations.
(2) If preparation prior to actual use cannot be done, at the very least a ground
reconnaissance must take place prior to site activation. All vehicle movement routes must be
marked, points along the route requiring direction indicators identified, and any ground
obstacles identified for removal.
(3) Both the litter decon and ambulatory decon areas must be surveyed to ensure ease
of movement for litter teams, and decontamination and medical personnel. The ambulatory
decon area must be evaluated for direction indicators that might facilitate easy movement of
ambulatory patients through the various steps and likewise for any obstacle that might impede
foot traffic.
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d. Personnel Requirements. Night operations will require additional personnel to fill such
jobs as ground guides and individuals to assist medical personnel by holding red lens filter
flashlights during triage and emergency procedures in the dirty side triage and EMT areas.
40. Cold Weather Operations
a. While it is difficult to deploy many CW warfare agents during cold weather, they can be
formulated to exist as liquids at cold temperatures presenting primarily a liquid or frozen liquid
hazard as opposed to a vapor hazard. As the liquid contaminated individual is moved into a
warm environment then liquid agents may begin to present more of an off gassing hazard.
Radiological particles present a hazard at any temperature. In cold temperatures biological
agents present only a limited hazard, though sporulating agents can still be hazardous if
inhaled. Cold temperatures greatly increase the risk of patient cold shock and hypothermia.
Patients who are medically compromised because of blood loss, exposure to a chemical agent,
or severely ill from a biological or radiological exposure have little energy reserve to maintain
their core body temperature and therefore they are more susceptible to developing hypothermia.
b. Where Cold Temperature Challenges Exist. Any environment where the ambient air
temperature drops below 65°F (18°C) can present a chill hazard to the medically compromised
patient and creates an environment where the use of unheated water for outdoor
decontamination is perceived as very uncomfortable by most individuals. A fall or winter climate
will present a challenge as will as desert environment that can become very cool once the sun
sets. Rainy climates can pose a temperature hazard for patients as well as air conditioned
decontamination tents which allow workers longer work cycles, but can create an environment
that may be very cool for the medically compromised patient. Medically compromised patients,
such as those affected by a significant nerve agent exposure or blood loss, have a greater
chance of developing hypothermia, especially in cooler climates.
c. Protecting Decontamination Team Members.
(1) While the risk of heat injury is greatly reduced for the decontamination team
members wearing full protective ensemble, heat injury can occur if individuals wear excessive
thermal undergarments under their protective ensemble and do not anticipate the heat that their
bodies generate once they begin to work.
(2) While protective ensemble will offer some warmth, it is not sufficient to keep an
individual warm in colder climates. Wearing a complete uniform under the overgarment will
increase the insulation effect. Thin long underwear that can wick sweat away from the body,
such as Polypro, can also help when temperatures go below 30°F (-1°C). Keeping active also
warms the body.
(3) Decontamination team members should layer clothing under their protective
ensemble so that it can be removed if needed. It is best to have a warming tent on the warm
side of the hot line where decontamination team members can warm themselves when needed.
If a heated warming tent is not available then blankets should be available for staff in the rest
area. Just as rest breaks to cool individuals are needed in warm temperatures, rest breaks to
warm workers are needed in cold climates.
Note: Team members should train at various temperatures to gain a better
understanding of the amount of layered under clothing that is appropriate for their
work level at the PDS so that they are not overheated while working.
(4) Wool glove liners can be worn under butyl rubber gloves in freezing climates. In
any cool condition, the cotton liners should be worn under the rubber gloves to help insulate the
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hands. Wearing wool or cotton glove liners will reduce the individual’s tactile sensation at the
finger tips, but the team member’s hands must be protected as butyl rubber gloves offer no
insulative properties against the cold.
(5) If possible, heated triage and treatment tents or heated buildings should be used.
This will reduce both staff and patient exposure to the cold. If contaminated clothing worn by
patients has not been removed from them prior to their being brought into these areas, then the
areas must be well ventilated so HAZCHEM vapors do not build up inside the enclosed space.
Ideally patient clothing should be removed just inside or outside the entrance to these facilities.
(6) In a cold environment, individuals may not feel as thirsty as they would in warm
weather, they will fail to drink the amount of water they need, and will then become dehydrated.
The recommended daily water intake per individual is from 3 to 6 quarts (3 to 6 canteens).
(7) At freezing temperatures, slips and falls on ice can pose a real hazard to patients
and decontamination team members, especially around decontamination tents where soap and
water is used. Rock salt, or similar material, should be carried to place on ice patches around
decontamination tents.
d. Cold Shock and Hypothermia.
(1) Cold shock. This is a patient’s sudden physiological response to cold which can
rapidly elevate blood pressure and can result in sudden death in susceptible individuals. The
risk is greater for those with preexisting heart disease and the aged. Cold shock can be
minimized by inquiring about preexisting medical conditions before decontamination, if the
situation permits; by encouraging patients to gradually get wet, rather than suddenly stepping
into a cold stream of water; or by ensuring that water used for decontamination operations is
adequately heated.
(2) Hypothermia. This is a condition of deep body cooling that usually takes longer to
develop than one would normally encounter during decontamination operations. Most
individuals can tolerate 55°F (13°C) water, but will experience discomfort and shiver severely.
This may, however, impact on the individual who is already medically compromised. Shivering
becomes the source of self generated heat for people who are exposed to the cold. A cold and
shivering individual is generating body heat and this in and of itself is not a sign for alarm.
Blood that circulates through the head, arms, hands, legs, and feet cools near the skin surface
and will eventually cool the core of the body over a period of time which can lower the core
temperature to dangerous levels. The body’s vasoconstriction slows heat loss through this
process to some degree. Every effort should be made to reduce the amount of time that a
patient is exposed to the cold to conserve the patient’s body heat, and maintain their core body
temperature and their energy. A simple way that medical personnel can assess if a
decontaminated patient is experiencing hypothermia is for the medical personnel to place an
ungloved hand on the chest or back of the patient. If the skin feels warm, then hypothermia is
unlikely. Core temperature is more accurately measured with a hypothermia assessment
thermometer which is inserted rectally and can read as low as 70°F (23°C).
• Mild hypothermia. This is characterized by shivering and the person may report
that they feel cold. They may have goose bumps on the skin. Individuals may
not be able to perform fine motor tasks with their fingers, such as buttoning a
button.
• Moderate hypothermia. The individual may be ill tempered and slow moving.
They may stumble, slur their speech, shiver intensely, not be able to use their
hands effectively, and act inappropriately. Shivering stops when the body core
temperature decreases to 86°F (30°C).
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• Severe hypothermia. This is a life threatening situation where the core body
temperature has reached dangerously low levels. There is a lack of shivering,
unresponsiveness, pupil dilation, and cloudy consciousness. The person may
be unable to move. If not warmed immediately the individual will progress to
respiratory failure, cardiac arrest, and death.
• Refer to Table V-13 for stages and symptoms of hypothermia.
Note: Patient decontamination still remains critical during cold weather operations.
Every effort should be made to reduce the amount of time that a patient is
exposed to the cold during decontamination to conserve the patient’s body heat,
to conserve their energy, and to maintain their core body temperature.
Table V-13. Stages and Symptoms of Hypothermia
Stage
Core Temp
Status
Symptoms
°C
°F
Normal
35.0 to 37.0
95.0 to 98.6
Muscle and mental control
Cold sensation; shivering
Mild
32.0 to 35.0
89.6 to 95.0
and responses to stimuli
Physical
(fine and gross
fully active
motor) and mental
(simple
and complex) impairment
Moderate
28.0 to 32.0
82.4 to 89.6
Muscle and mental control
86°F (-30°C) shivering stops;
and responses to stimuli
loss of consciousness
reduced or cease to function
Severe
< 28.0
< 82.4
Responses absent
Rigidity; vital signs reduced or
absent; risk of ventricular
fibrillation/cardiac
arrest
(especially
with
rough
handling)
< 25.0
< 77.0
Spontaneous ventricular fibrillation; cardiac arrest
Source: Giesbrecht, GG, Prehospital Treatment Of Hypothermia (2001) and Guidelines for Cold Weather Mass
Decontamination During a Terrorist Chemical Agent Incident (Revision 1, August 2003).
e. Use of Detectors in Cold Weather Operations.
(1) Chemical vapor detectors such as the ACADA and ICAM will not work effectively in
cold weather as agents give off few vapors in cold climates. The life of the battery is also
significantly reduced, especially at temperatures below freezing.
(2) The RADIAC meters will still be effective in colder climates, but battery strength, as
with the chemical vapor detectors, will also be an issue. The AN/PDR 77 and AN/VDR 2 can
operate to -40°C and -51°C, respectively.
(3) In freezing climates, chemical vapor detectors can be placed in rest tents that are
warm, to measure any vapors in these areas.
f. Patient Decontamination Strategies for Cold Weather Operations.
(1) One method for the selection of appropriate cold weather decontamination is based
on ambient temperature. The closer the ambient temperature is to freezing the more patient
operations are conducted inside a heated enclosure.
(2) Regardless of the ambient temperature, individuals who have been exposed to a
known life-threatening level of chemical contamination should disrobe, undergo
decontamination, and be sheltered as soon as possible.
(3) Refer to Table V-14 for decontamination methods based on ambient temperature.
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Table V-14. Decontamination Methods Based on Ambient Temperature
Temperature
Method
Warm
Clothes
Decon Water
After Decon Patient
Side
Removed
Temperature
Moved To:
Triage
and
Treat
65°F
(18°C) and
1
Outside
Outside
Decon outside
Outside clean side triage
above
area
2
Outside
Outside
Decon outside
Heated clean side triage
area
64° to 36°F
(17° to 2°C)
3
Outside
Inside
Heated
decon
Heated clean side triage
enclosure
area
35°F
(1.6°C) and
below
4
Inside
Inside
Dry decon
(flour,
Transport to indoor heated
sand, paper towel,
decon area, preferably in a
M291) for imme-
building
diate decon
Method 1 is the easiest and method 2 is the most complex.
Grey areas are where activities are performed inside a heated enclosure.
Adapted from Guidelines for Cold Weather Mass Decontamination During a Terrorist Chemical Agent Incident
(Revision 1, August 2003).
• Method 1. These are standard patient thorough decontamination operations
conducted without special heating tents or water heating apparatus.
Decontamination operations that are conducted in the temperature range of
65°F
(18°C) and above can be performed in this manner using existing
equipment.
• Method 2. Here, standard patient thorough decontamination operations are
conducted, but the patient is quickly transferred to a clean side area that is
heated. This is typically conducted when temperatures are in the 64° to 50°F
(18° to 10°C) range.
• Method 3. Patients are triaged and given lifesaving treatment outside, but are
decontaminated in a heated tent with heated water and then moved to a heated
enclosure on the clean side of the hot line. This is appropriate when
temperatures are in the 50° to 35°F (10° to 2°C) range.
• Method 4. Patient triage, decontamination, and clean side treatment are
conducted in a warm area
(heated tents, vehicles, or buildings). Dry
decontamination is used initially, inside a decontamination tent, until the patient
can be transported to a warm facility where the water is heated and the patient
remains inside the warm enclosure for treatment. This is appropriate when
temperatures are below 35°F (2°C).
g. Steps to Take to Attempt to Reduce the Incidence of Patient Cold Injury and
Hypothermia.
(1) Patient protective ensemble should not be removed until the patient appears to be
medically stable enough to undergo decontamination.
(2) If temperatures are near freezing, use a dry decontaminant (sand, paper towel,
M291, M295) for immediate (gross) decontamination and then move the patient inside a warm
tent or room before clothing is removed. Outer protective clothing is removed in a ventilated
area immediately outside or near the entrance to the heated room if the garments are heavily
contaminated.
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V-81
(3) If the patient does not need to have their entire body washed, then remove the
clothing and decontaminate only those areas not covered by the clothing. Remember that
thicker winter clothing, if worn at the time of exposure, will offer some degree of protection
against chemical agents as compared with thin summer clothing. Thicker clothing should offer
adequate protection against dry particles and spores.
(4) Once the process of clothing removal begins, make the decontamination process
as fast as possible so that the patient can be covered again with a blanket.
(5) If available, conduct patient thorough decontamination operations inside a heated
building or heated tent. Use warm soapy water for decontamination if possible.
(6) Have ample supplies of blankets on hand to cover the patient as soon as they are
decontaminated.
(7) In cold conditions, blankets may have to be available on the warm side of the hot
line, in the decontamination area, to cover the patients in between patient lifts if the temperature
is cold. These blankets would stay on the warm side of the hot line and could be used for other
patients. There is a hazard that contamination could be transferred on the blankets so they
should not be reused if they touch the contaminated ground. Ideally, a better solution is to bring
the patient into a heated tent and remove clothing, decontaminate, and cover the clean patient
as quickly as possible.
(8) If decontamination operations are typically conducted in a location where the
ambient temperature is 65°F (18°C) or below, use a PDS system that heats the water used for
decontamination and also heats the air inside the decontamination tent. Water may have to be
heated to 100°F (38°C) or greater so that it is comfortably warm, but not hot, by the time it
reaches the patient.
(9) A PDS with plumbed tentage and sprayers that is operating in a climate where the
temperatures are near or below freezing must have heaters for the fresh and wastewater
storage bladders so that these do not freeze. Water transport lines should also be covered and
insulated to prevent freezing along these narrow areas. Power generators should remain on or
kept warm so that they do not freeze.
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15 July 2009
Chapter VI
VETERINARY SERVICE SUPPORT AND
FOOD AND WATER SAFETY
1. General
Food may become contaminated from enemy employment of CBRN weapons/agents or
from terroristic contamination of food procurement facilities and food supplies. The CBRN
agents may be introduced during production or in the storage area of the procurement facility;
while the product is in transit; at the military storage facility; or at the unit food service facility.
Regardless of where the agent is used, the effect is the same; personnel will become ill or die if
they consume the contaminated food.
2. Veterinary Service Support
a. The US Army Veterinary Corps under the direction of Secretary of the Army and
supervision of The Surgeon General of the Army is the DOD Executive Agent for veterinary
service for all DOD Components (US Army, US Marine Corps, US Navy, and US Air Force).
Refer to DODD 6400.4 for more information.
b. The Secretary of the Air Force provides the food inspection program at Air Force bases
and may develop locally approved lists of food suppliers from which food products are procured
only for individual Air Force installations.
Note: The heads of the other DOD components will coordinate with the DOD Executive
Agent on related matters under their areas of cognizance.
c. The US Army Veterinary Corps’ mission is to execute veterinary service support
essential for HSS and sustain a healthy and medically protected force; train, equip, and deploy
the veterinary force; and promote the health of the military community. In some instances
veterinary service support is provided to allies/coalition partners and/or host nation agencies.
The US agencies that may be provided this support include—
• Department of Agriculture.
• Department of Commerce.
• Department of Transportation.
• Department of Homeland Security (DHS) (Transportation Security Agency, USCG,
US Customs, US Border Patrol, and US Secret Service), and the Department of
Justice (Drug Enforcement Agency).
• Department of State.
• Federal Bureau of Investigation (FBI).
• Central Intelligence Agency.
d. The veterinary services and support mission areas are—
• Food safety, food security and quality assurance.
• Veterinary medical care.
• Veterinary preventive medicine (combines aspects of both food safety and defense
and veterinary medical care).
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3. Food Safety and Security and Quality Assurance
a. To ensure food safety, veterinary personnel inspect and monitor food from its
procurement until it is issued to the consumer. Throughout the AO, all Services logistics and
food service personnel must take precautions to protect subsistence from contamination.
b. Some of the functions of veterinary personnel—
(1) Perform surveillance inspections of operational rations.
(2) Perform sanitation audits of commercial facilities that produce such items as dairy
products, seafood (fish and other waterfoods), red meats, poultry, eggs, pork, baked goods,
fresh fruits and vegetables, bottled water, and block or packaged ice. See AR 40-657/NAVSUP
4355.4H/MCO P10110.31H and the most current version of Military Standard (MIL-STD) 3006A
for definitive information on sanitation audits of commercial food establishments.
(3) Perform surveillance inspections of all Service-owned subsistence received, stored,
issued, sold, or shipped from/to military installations (including those items received from depots
and supply points). See AR 40-656/NAVSUPINST 4355.10A/MCO 10110.48 for definitive
information on veterinary surveillance inspections.
(4) Conduct basic food screening and microbiological laboratory procedures to ensure
adherence to food safety standards and to identify potential foodborne pathogens.
(5) Advise theater logistics units (sustainment brigade; area support medical company;
multifunctional medical battalion; brigade support battalion; ration breakdown point; and dining
facilities [DFACs]) on storing subsistence to minimize the threat of CBRN contamination.
(6) Inspect, monitor, and submit laboratory samples of subsistence or food-producing
animals that are contaminated or suspected of being contaminated by CBRN agents.
(7) Provide units with guidance and instructions for the proper handling or
decontamination of subsistence.
(8) Protect the financial interests of the government as it affects the use and disposition
of safe, government-owned subsistence.
(9) Participate in humanitarian and civic assistance or disaster relief actions as
directed.
(10) Provide food surveillance inspections of DFACs for security and storage of food
products.
c. The security of food from the point of origin until it is consumed by stateside or deployed
US forces must be maintained. Security and proper storage are key factors in preventing
deliberate contamination of food and water. To mitigate the risk for foodborne illnesses, all units
must use the basic principles of risk management. See FM 5-19 or Marine Corps Order
3500.27B for definitive information on risk management. The basic principles for risk
assessment should be the guide for developing techniques and procedures for ensuring food
defense. See USACHPPM TG 188 for definitive information.
d. All planners must integrate risk management for food and water into the mission
planning, preparation, and execution of all operations. They must answer the questions about
what needs to be done to ensure our food and water is secure, protected, and safe for
consumption. The medical planner should identify all food defense and safety issues as they
develop the medical annexes to operations orders. The veterinary staff officer provides input on
all food safety and food defense issues to the medical planner for inclusion in the medical
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15 July 2009
annexes of the HSS plan. See Appendix B for more information on HSS annex. Commanders
must be aware that food defense is part of the overall HSS effort.
e. Make risk decisions at the appropriate levels in the chain of command. The
responsibility for food defense and safety must be assigned and or identified by TSOPs.
Commanders are ultimately responsible for food safety and security.
f.
Do not accept any unnecessary risk when it comes to the safety of food and water.
4. Veterinary Medical Care
a. Provide comprehensive veterinary medical care for all MWDs in the AO.
b. Provide limited veterinary care to other DOD-owned animals and other government-
owned animals (GOAs) when time and resources permit and to indigenous animals, as directed.
c. Veterinary personnel are concerned with the protection of GOAs and animals procured
for consumption. Animals must be protected from CBRN contamination, whenever possible. If
feasible, animals should be moved into enclosures to protect them as much as possible from
contamination. Protective equipment is not available for MWDs; however, protection of the
animal’s feet and body must be considered. When MWDs must cross a contaminated area,
improvise foot protection by using butyl rubber material and consider placing MWDs in vehicles
to avoid contamination.
d. Since CBPS systems are not available, animal treatment facilities must be established in
contamination free areas. Veterinary treatment personnel must remain in MOPP Level 4 when
caring for CBRN animal casualties until the animals have been decontaminated.
The
decontamination and treatment of MWD CBRN casualties is detailed in FM 4-02.18.
e. Veterinary personnel must be practical when considering evacuation requests and
handling contaminated animals; the foremost concern is safety of unit and support personnel.
5. Veterinary Preventive Medicine
a. Veterinary preventive medicine is essential for the identification and control of those
diseases that can be transmitted from food, water, or ice and those diseases transmitted from
animals to man.
(1) Support prevention and control programs to protect Service members from food-
and waterborne diseases.
(2) Evaluate zoonotic disease data collected in the AO and advise PVNTMED elements
and higher headquarters on potential hazards to humans.
(3) Establish animal disease prevention and control programs to protect Service
members and their families and other DOD and allied personnel from zoonotic diseases.
(4) Assess the presence of animal diseases that may impact the CONUS agriculture
system if contaminated equipment or personnel are allowed to redeploy (such as foot-and-
mouth disease).
(5) Perform investigations of unexplained animal deaths to include livestock and wildlife
and submit samples for identification, if applicable.
b. Animals can serve as sentinels (markers) of CBRN contamination or exposure. Military
personnel should report unexpected death or illness of wild or indigenous animals to their
supporting veterinary unit, especially if the onset is sudden and large numbers of animals are
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VI-3
affected in a short period of time. This is especially true for BW agents, as most agents cause
similar clinical signs in animals and people.
6. Veterinary Unit Operations in a CBRN Environment
a. The primary function of the veterinary unit, while it is in the contaminated area, is
concentrated on protection and decontamination of organic personnel, equipment, and MWDs.
When possible, the mission and duties of the contaminated unit/personnel may be transferred to
other operational veterinary units/personnel by the commander.
b. The availability of noncontaminated subsistence/Class I items in an AO depends upon
the amount of planning taken for the protection of subsistence from CBRN warfare. An
adequate defense posture for a CW attack will also protect food against BW contamination and
radiological fallout.
c. The commanders of veterinary units, develop contingency plans and TSOPs required for
the veterinary teams in a CBRN environment (see Appendix B for a sample format for the
veterinary support portion of the HSS plan). Plans and TSOPs include procedures for—
• Protecting veterinary personnel in the CBRN environment.
• Training veterinary personnel to function in the CBRN environment.
• Monitoring the security and protection of subsistence in the CBRN environment.
• Maintaining assigned CBRN equipment.
• Inspecting subsistence in the CBRN environment.
• Monitoring the decontamination of CBRN-contaminated subsistence, MWDs, and
other GOAs.
• Treating MWDs and other GOAs that become CBRN casualties.
• Reporting intelligence data through command channels.
• Ensuring the security of veterinary equipment, supplies, and personnel.
• Using veterinary personnel to support assigned CBRN missions.
d. Upon receipt of a CBRN warning, veterinary leaders place contingency plans into
operation and direct veterinary personnel to assume the appropriate MOPP level. After
assumption of the directed MOPP level, veterinary personnel, within limits dictated by the
tactical situation, ensure that actions are taken to protect subsistence items, MWDs, and other
GOAs.
e. If subsistence items have not been protected according to CBRN protection plans and
procedures or if the plans/procedures need modification, a recommendation for corrective action
is initiated by veterinary personnel.
f.
Following a CBRN attack, all subsistence within the boundaries of the contaminated
area is considered contaminated and managed accordingly until testing determines which foods
are safe for consumption. As a method of control, subsistence items located in contaminated
storage facilities/areas are restricted from issue or use until necessary CBRN testing can be
completed. Access to subsistence storage facilities/areas will be restricted based on their level
of contamination.
g. In most instances, decontamination of subsistence does not begin until the surrounding
area and storage facility are decontaminated. Veterinary teams provide technical guidance on
food decontamination procedures to unit decontamination teams.
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15 July 2009
7. Veterinary Support for Subsistence
a. Veterinary personnel support commanders in developing readiness plans and TSOPs for
the protection, decontamination, and use of subsistence items in the CBRN environment. This
assistance is either in the form of direct or indirect veterinary support.
(1) Direct veterinary support is provided to commanders by assignment of veterinary
personnel at Class I activities. This support consists of technical advice to aid the commander
in formulating plans and procedures pertaining to the storage, decontamination, and use of
subsistence that may become exposed to a CBRN agent.
(2) Indirect veterinary support is provided to unit commanders by disseminating
information and guidance pertaining to CBRN contamination of subsistence.
b. Veterinary personnel inspect subsistence at the user level on an area support basis.
8. Veterinary Survey of Storage Facilities and Subsistence
a. Veterinary Personnel.
(1) Veterinary personnel conduct surveys of CBRN-contaminated subsistence and
storage facilities to obtain data for the veterinary assessment of the situation. The designated
MOPP level must be adhered to while conducting the surveys.
(2) Veterinary personnel use available CBRN-detection equipment for the survey. The
survey is conducted, if possible, in conjunction with CBRN detection or survey teams.
b. Survey of Storage Facility.
(1) A preliminary inspection is made to determine the effectiveness of the storage
facility and other protective measures in preventing entrance of a CBRN agent into the facility.
An inspection of the structural integrity of the facility is made, checking for such damage as
broken windows and holes. The inspector notes any damages and the overall condition of the
facility. Other subsistence items will be closely monitored and tested, as needed. Veterinary
personnel examine chemical detection tapes for indication of activation by chemical agents.
The area surrounding the facility is also examined for the presence of animals, rodents, birds,
and insects acting unusual or whose death is unusual or unexplained.
(2) A survey of the storage facility is conducted using CBRN alarms/detectors/monitors
to determine the presence of a CBRN agent. The inspection determines if a CBRN agent or
residue remains in the facility using the detector paper, tape, and other detection equipment.
(3) Specimens are collected for submission to the supporting laboratory. Recorded
symptoms of contaminated Service members or animals, gross pathology, CBRN equipment
readings, and other observations are reported. This information, when combined with
histopathology and other medical laboratory tests, aids in identifying the nature, level, and type
of CBRN agent.
c. Survey of Subsistence Items.
(1) A survey of subsistence items must be conducted to determine the presence of a
CBRN agent on or in the item and the extent of damage caused by the contamination.
Veterinary personnel select those subsistence items most likely to have been contaminated for
testing. The items will be located near entrances, near ventilation inlets, and near aisles.
(2) Packaging materials are tested for the presence of CBRN agents. The presence of
unusual liquids or stains is noted. The degree of biological contamination, however, can only be
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VI-5
determined by laboratory analysis. Results of the survey of packaging and packing materials
are recorded. If a CBRN agent is present, then this information is included in the survey.
(3) At the completion of the initial survey of the storage facility and subsistence by
veterinary personnel, the findings are provided to the commanders. These findings will be as
definitive and timely as possible. These survey findings must address the following points—
(a) Survey method and inspection procedures used to obtain data, to include type
of detection equipment used.
Data obtained from support units, such as medical
laboratory/chemical units, should be included, noting the source of the data.
(b) Estimate of the quantity of food contaminated or suspected of being
contaminated by the CBRN agent. The quantity of contaminated subsistence is reported by the
amount in each of the following categories:
• Individual operational rations; meal, ready-to-eat (MRE).
• A-Rations.
• Unitized group rations (UGR)-heat and serve (H&S).
• Semiperishable ration components.
• Perishable items.
• Medical diet field feeding supplement (not a stand-alone ration; it must be
used in combination with the UGR).
(c) The recommendation as to advisability and feasibility of conducting a
decontamination operation should include an estimate of the amount (percent) of contaminated
subsistence that can be recovered if decontamination is accomplished.
(d) Some subsistence items may require upgraded protective storage in an
enclosed facility with controlled temperature and/or relative humidity versus storage in an open
area protected by barrier covers. The decontamination process may materially reduce the
storage life of the subsistence, thus requiring accelerated movement through the supply system.
A determination is made as to type of precautionary markings required on subsistence
containers. These precautionary markings aid personnel involved in the storage, issue, receipt,
and preparation of the subsistence.
9. Testing, Screening, and Collecting Food Samples in the Field
a. The testing capabilities in veterinary units focus on screening capabilities for the
presence of foodborne pathogens, biological threat agents
(BTAs), and limited chemical
contaminants. If a sample tests positive on the initial screening, more definitive testing can be
completed by the area medical laboratory (AML), DOD Veterinary Food Analysis and Diagnostic
Laboratory (FADL), or to the US Army Veterinary Laboratory, Europe.
Note: For definitive information on how samples are prepared for shipment to the
supporting laboratory, see the applicable food laboratory sample guide or refer
to Chapter VII of this publication.
b. Collecting food samples for laboratory analysis can be accomplished during
procurement, receipt, or surveillance of food items. Either veterinary or PVNTMED personnel
may collect food samples from food procurement establishments or dining facilities. Food
samples will be split so that a portion of the original sample is preserved until the field testing is
completed. Perishable samples should be maintained at a temperature of 1° to 4°C during
transport.
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c. Containers must be approved by the International Air Transportation Association and
must contain sufficient material to absorb the entire contents in the event of a leak.
The
technical escort unit
(TEU) should be requested to transport food samples suspected of
containing BW or CW agents. For more information on TEUs, refer to FM 3-11.20.
d. Random sampling, however, is not very effective at identifying microbial pathogens in
solid food unless the level of contamination is relatively high. If microbial pathogens are present
in food, they are usually in very low levels and contamination is found in localized areas rather
than uniformly distributed. Thus, screening for pathogens that are present in low levels is
usually not an effective means of ensuring the safety of foods. When possible, it is better to test
for indicators such as total plate counts, coliforms, or generic E. coli that are likely to be present
in higher levels when food is contaminated with pathogens.
e. A documented chain of custody using Department of the Army
(DA) Form 4137
(Evidence/Property Custody Document) or OPNAV Form 5580/22 (Evidence/Property Custody
Receipt) must accompany all samples suspected of being intentionally contaminated or
containing pathogens. These samples will not be split prior to arrival at the first receiving
laboratory. This will prevent accidental contamination of the samples and ensure that valid
samples arrive at the destination laboratory.
Note: DD Form 1911 (Materiel Courier Receipt) has been rescinded however, there is
an ongoing initiative to have this form reinstated to be used as one of the chain of
custody documents.
f.
Preventive medicine, hospital and medical laboratory personnel should follow the same
basic guidelines how and where to submit samples.
10. Subsistence Decontamination
a. The commander determines if subsistence is to be decontaminated. Veterinary
personnel provide technical advice to the commander to assist him in making this decision. The
commander concerned determines how subsistence is provided to affected units and what
actions, if any, are taken to decontaminate supplies. The commander and his staff coordinate
priorities for large-scale decontamination operations.
b. Decontamination removes the contaminant and provides food that is safe for
consumption. Food salvage operations require extensive efforts to assess, identify, and
evaluate. These efforts are further compounded if food supplies are suspected of being
compromised by CBRN contaminants. Decontamination efforts require even more elaborate
procedures that impact labor, time, and supplies of operational forces. The use of appropriate
decontamination must be emphasized to fit the situation and the mission. That is,
decontaminate just enough to sustain operations and keep fighting, rather than to try and control
or create a contamination-free environment. Normally, decontamination efforts will be limited to
the scope and nature of the packaging and packing materials.
In addition, food
decontamination, if deemed necessary, would only occur in critical situations where other food
supply options are not available. Most decontamination is performed in or very near the AO.
c. There are three levels of decontamination for subsistence. These are individual, unit,
and support levels. These levels are dictated by who has control or responsibility for the item.
(1) Individual decontamination. The individual Service member performs this level of
decontamination.
Individual decontamination of subsistence is performed by each Service
member on those subsistence items in his possession at the time of the attack. This is
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VI-7
performed in conjunction with individual/equipment decontamination procedures as soon as
possible after a CBRN attack. Individual decontamination of subsistence is limited to
operational rations that are in the original containers that do not permit or have not allowed
CBRN penetration. The decision to decontaminate subsistence, however, rests with the
individual’s commander and not with the individual, except when the Service member is
separated from his unit. Decontamination procedures are conducted as outlined in the unit
TSOP or as modified by the unit commander. At the individual level, decontamination
procedures are employed to the extent that the CBRN hazard to the subsistence is adequately
reduced or eliminated, thus allowing for continuation of the mission.
(2) Unit decontamination. Unit personnel under the supervision of CBRN-trained
personnel organic to the unit perform this level of decontamination. Decontamination
procedures for subsistence items in possession of the unit are performed as soon as possible
after an CBRN attack and in conjunction with area decontamination procedures.
Decontamination is attempted only on subsistence items that are in original, intact containers
that do not permit or have not allowed CBRN penetration. Decontamination procedures are
conducted by unit personnel in accordance with TSOPs and supervised by unit CBRN-trained
personnel. Special decontamination requirements and/or advisability of decontamination efforts
are relayed to unit commanders through command or medical channels, as required. The
decontamination procedures employed are aimed at adequately reducing or eliminating the
CBRN hazard presented by the subsistence.
(3) Support decontamination.
Specially trained and specially equipped
decontamination units/teams accomplish this level of decontamination. The decision to
decontaminate subsistence items at this level rests with the commander responsible for
supplies. Support decontamination of subsistence is accomplished at major subsistence
storage facilities/areas, such as the GS Class I activities in the theater. At the support level,
veterinary personnel advise on technical matters pertaining to the decontamination operations
involving subsistence items. Veterinary personnel also monitor the decontamination results and
recovery operations. They make recommendations if procedures need modification or
correction and ensure that decontaminated subsistence is wholesome and suitable for issue.
The support decontamination procedures must eliminate or reduce the CBRN hazard presented
by subsistence to as low a level as possible.
d. Disposition of Subsistence. The responsible veterinary officer has final approval for
determining whether decontaminated subsistence is wholesome and is fit for human
consumption. Subsistence supplies meeting wholesomeness standards should be identified
and returned to a protective posture. Subsistence supplies not meeting the standards set for
human consumption will be disposed of as directed by the senior veterinary authority.
11. Treatment of Military Working Dogs Exposed to a Chemical, Biological,
Radiological, and Nuclear Environment
a. Chemical Agent Protection. The information in this publication and in FM 4-02.285/
MCRP 4-11.1A/NTRP 4-02.22/AFTTP (I) 3-2.69 on human casualties of chemical agents
generally applies to all animals. Chemical protective doctrine for animals is incomplete, and
there is no chemical protective equipment in the current inventory for MWDs. Equipment and
doctrine for animals are under development but pending its availability, any degree of protection
of the MWD in a CW agent environment will, at best, be extremely difficult. The information
given herein applies particularly to the MWD, although these principles can be applied to other
animals.
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b. Protection of Military Working Dog Rations and Equipment. Bagged MWD food and
MWD equipment such as leather leashes and collars and leather or plastic muzzles are subject
to contamination and may be difficult to decontaminate or replace in a timely manner. One set
of MWD handling equipment and a short-term supply, 1 to 4 weeks, of food should be stored in
an impervious and easily decontaminated container for each MWD. Tightly sealed plastic cans
(NSN 7240-01-094-4305) may be used or these items may be stored in a nearby chemical
protective shelter or protected vehicle.
c. Protective Shelter for the Individual Military Working Dog at the Duty Site. In the
absence of MWD protective garments or shelters, it will be difficult to protect a MWD if it cannot
be placed in a field expedient protective shelter or in an available collective protection shelter. If
chemical attack is likely, the only reliable method of MWD protection is movement from the
area. If the MWD must remain on site to perform necessary duty, limited protection may be
provided by—
(1) Moving the MWD into an existing structure or vehicle that has been sealed with
tape, tarps, or tentage to prevent inflow of contaminated air.
Note: In some AOs, the risk of heat injury for an MWD in a sealed vehicle may be
higher than the risk of chemical or biological injury during a potential attack.
(2) Placing the MWD in its transport kennel and covering the kennel with tarps, tent, or
plastic sheets to limit contamination by droplet or liquid agent.
(3) Placing the MWD in a chemical protective shelter with the handler and other
personnel when space is available. This is the preferred method when possible.
(4) Placing chemical impervious barriers on the MWD’s paws if the dog must walk
through a contaminated area. It is best that an MWD not be walked through any area with
ground contamination but this may be necessary in some circumstances. If this occurs, the
following items may provide limited protection if placed over the feet and taped at the carpus or
tarsus. None of these items are of a design to be walked on, so the ground contact surface may
need to be protected with a more durable material such as—
• Tape or canvas over wrap.
• Mylar (polyethylene terephthalate) specimen bags.
• Outer bag from MRE.
• Extra butyl rubber protective gloves from MOPP garments or JSLIST gloves.
d. Pretreatment of Military Working Dogs to Limit Chemical Agent Absorption and Toxicity.
There is no specific preexposure therapy that has been evaluated in MWDs; however, some of
the protective measures for military personnel may be implemented.
e. Prophylactic Medication. The effectiveness of the soman nerve agent pretreatment
pyridostigmine (SNAPP) tablet is not well-documented in dogs and the effect of this medication
on the performance of MWDs has not been evaluated. The DOD MWD Veterinary Service does
not recommend the use of SNAPP in MWDs because its effect on MWD detection performance
has not been evaluated; however, the use of SNAPP in the MWD may be authorized by the
responsible veterinarian and MWD unit commanders.
(1) If SNAPP is used, the handler must evaluate the ability of the MWD to perform in
assigned tasks prior to performance of assigned duties. Treated MWDs should be identified as
under the influence of the pyridostigmine prior to entry into a contaminated environment and
other protective measures should be taken when possible. When used, the recommended
SNAPP regimen is ½ tablet (15 milligrams [mg]) every 8 to 12 hours. All precautions regarding
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VI-9
SNAPP utilization as delineated in FM 4-02.285/MCRP 4-11.1A/NTRP 4-02.22/AFTTP (I) 3-2.69
should be followed in MWDs.
(2) If the MWD on SNAPP is unable to perform its mission due to adverse effects of the
medication, the dose and frequency should be reduced. If the performance decrement
continues on the reduced dose, the MWD must be removed from duty and from the high risk
area, or the SNAPP treatments must be discontinued.
(3) Adverse effects of SNAPP may mimic nerve agent toxicity including: salivation,
nausea, vomiting, abdominal cramps and pain, diarrhea, miosis and lacrimation, increased
respiratory secretions, weakness, muscle twitching, and respiratory distress. If any of these are
seen, the dose and frequency of SNAPP must be decreased or the SNAPP must be
discontinued.
(4) Skin Exposure Reduction Paste Against Chemical Warfare Agents. The use of
SERPACWA on MWDs may provide protection against cutaneous absorption of chemical
agents. When applied to the nonhaired portions of the MWD’s abdomen, groin, and axillae
(armpits), SERPACWA may provide some protection for up to 4 hours. The use of SERPACWA
will also ease decontamination when using M291 SDK, RSDL, or soap and water.
12. Protection Against Nerve Agents
a. Nerve agents dispersed either by aerosol, vapor, or spray can be absorbed through a
dog’s respiratory tract, eyes, mouth, gastrointestinal tract, and skin. Currently, there is no
means of protecting a MWD’s respiratory tract. Respiratory absorption may occur after
dispersal of aerosol, vapor or liquid agents and is of greatest concern because of the speed of
absorption and toxicity. Absorption of nerve agent through the mouth may occur simultaneously
with respiratory exposure. However, oral and gastrointestinal absorption is of greater concern
when a dog ingests nerve agent by eating contaminated food, drinking contaminated water, or
licking its own fur that is contaminated with a nerve agent. Because of the combination of hair
covering and lack of sweat glands, the risk of nerve agent absorption through the skin is of less
concern in dogs than in people; however, the risk is still significant. Absorption through the skin
via the MWD’s paws is of the greatest concern since pads of the MWD’s paws have sweat
glands, no hair, and will absorb nerve agents.
b. Military working dogs should be protected from direct contamination by liquid and
droplets agents. There is no current equipment in the inventory to protect a MWD from
inhalation exposure.
c. Liquid nerve agents or vapors of nerve agents can poison food and water. Military
working dogs should not be permitted to drink from waterholes or trenches in contaminated
areas or to drink surface water that has run off from contaminated areas. Water suspected of
being contaminated should be tested by PVNTMED personnel and only water found to be safe
should be approved for consumption. Contaminated food or food that is suspected of being
contaminated should not be fed to MWDs unless approved by veterinary personnel.
d. Food and water packaged in sealed, airtight cans, bottles, or other impermeable
containers can be decontaminated according to information provided above.
13. Signs of Nerve Agent Intoxication in Military Working Dogs
a. All nerve agents generally produce similar effects, although the onset and severity of
signs may vary depending upon the route and degree of exposure.
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b. Exposure to nerve agent vapors produces local ocular (eye) and respiratory effects
before other effects. These signs usually appear within 5 minutes after exposure. The initial
ocular effect is pupillary constriction (miosis). Respiratory exposure is manifested by a rapid,
panting respiration and an increase in upper respiratory secretions resulting in watery nasal
discharge. Increased upper respiratory secretions, with bronchoconstriction which may occur
shortly afterward, will cause coughing, rattling sounds in the throat, wheezing, and respiratory
distress. More severe exposures may cause eye pain and visual impairment.
c. Systemic absorption of enough nerve agent through the respiratory or gastrointestinal
system will increase the severity of local effects and will also cause generalized systemic
effects.
Respiratory distress becomes marked due to profuse bronchial secretions,
bronchoconstriction, and airway obstruction. The distressed animal will gasp and the mucous
membranes of the mouth will become blue (cyanotic) as a result of decreased oxygenation.
Other effects which may occur are slowing of the heart rate, profuse salivation and frothing, loss
of fecal and urinary control, and increased peristalsis and abdominal pain. Muscular effects
occur with other systemic effects and the animal will exhibit muscular weakness, twitching
muscles, and trembling. As weakness and paralysis of the respiratory muscles progress,
breathing becomes increasingly labored, shallow, rapid, and finally intermittent, with the animal
quickly becoming oxygen deficient. In severe exposures, the onset and progression of signs
are very rapid. The animal may tremble violently, become uncoordinated, collapse, and go into
generalized convulsive seizures. Loss of consciousness may ensue with a total loss of reflexes.
Convulsions may become intermittent, with the animal showing a rapid panting respiration
between convulsive episodes. Marked generalized convulsions are usually followed by
complete flaccid paralysis, central respiratory and circulatory depression, asphyxiation, and
death.
d. The symptoms of cutaneous exposure to liquid nerve agents are similar to respiratory
exposure to nerve agent vapors. One difference is that the initial signs take longer to develop
and the transition from mild to severe symptoms may be slower. With fatal cases, the survival
period may be hours, whereas in inhalation poisoning most deaths occur in a few minutes.
Cutaneous exposure causes local twitching at the site of contamination, increased
gastrointestinal activity, salivation, miosis, generalized tremors, prostration, and convulsions.
Dyspnea is not a pronounced symptom of early cutaneous poisoning, which differs from the
inhalation route. Hypopnea occurs during the prolonged convulsive phase. A lethal factor in
cutaneous poisoning is the very rapid rise in body temperature to heatstroke levels caused by
the prolonged convulsions.
14. Nerve Agent Decontamination Procedures
a. Following contamination of the hair coat, skin, or eyes, the animal should be
decontaminated as quickly as possible to prevent or reduce any further absorption of the agent.
CAUTION
All persons who handle animals contaminated with nerve
agents must be in MOPP Level 4.
b. Hair and Skin.
(1) Since the hair coat delays penetration of liquid agents to the skin and cutaneous
absorption requires several minutes, effective decontamination of the hair and skin may be
carried out before any significant absorption has occurred. Decontamination is not a substitute
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for treatment. When the animal shows signs of exposure to a nerve agent, specific therapy
should be initiated.
(2) The entire animal (except eyes and periocular area) may be decontaminated by
using M291 SDK pads, RSDL and/or with soap and water.
(3) Initial MWD decontamination with the M291 SDK or RSDL should be completed as
soon as possible after nerve agent exposure. The entire MWD should be wiped down using the
M291 pads or RSDL, except for eyes and the area around the eyes, which should be rinsed with
water.
Note: The MWD handlers should carry several extra M291 SDK or RSDL (replacing the
M291 SDK) for decontamination of the MWD and an extra M295 Individual
Equipment Decontamination Kit (IEDK) for decontamination of MWD equipment.
(4) Definitive decontamination of the MWD should be completed by thoroughly washing
the hair coat and the skin with soap (Castile Soap Liquid [NSN 8520-01-519-0776] or available
nonmedicated veterinary shampoo) and water. It is important that all body surface areas are
saturated with the soap and water and gently scrubbed and washed. After the washing is
completed, the hair coat and skin should be rinsed and the soap residue removed from the dog.
If soap is not available, rinsing with large amounts of water is the next best method of
decontamination. The preferred method of decontaminating the MWD is by first using the M291
SDK pads or RSDL then thoroughly washing and rinsing the MWD to ensure all contaminants
are removed.
CAUTION
Personnel performing the decontamination of the MWD must
be careful and prevent any of the SDK pad residue from
getting into the MWD’s eyes. The decontamination solution
could cause injury to the eyes and should not be used on or
around the eyes. Ocular contamination should be removed
with copious water irrigation of the eyes.
(5) The leash, collar, and muzzle should be removed from the MWD and
decontaminated as soon as possible. They may be decontaminated using the M295 IEDK
wipe-down mitts or by using a 5 percent hypochlorite solution or with
5 percent sodium
carbonate solution (G-agents only). Additional guidance for decontamination of equipment is
contained in FM 3-11.5/MCWP 3-37.3/NTTP 3-11.26/AFTTP(I) 3-2.60.
(6) Any amount of liquid nerve agent getting into the eyes of an animal requires prompt
action to prevent conjunctival absorption, which can occur very rapidly. The eyes can be
decontaminated by irrigation with copious amounts of water until all agents have been removed.
Avoid using any components from the M291 SDK or RSDL in the eyes. Petroleum-based eye
ointment must not be placed in the eyes prior to completion of decontamination process as it
may absorb and concentrate nerve agent and cause additional eye damage and toxicity. After
decontamination is complete, the eyes may be treated with appropriate ointments as noted
below.
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15. Treatment of Military Working Dog Casualties of Nerve Agents
a. Emergency Therapy Procedures. Initial first aid provided by the MWD handler depends
on the severity of the poisoning and the type of nerve agent antidote kit that is issued to the
MWD handler.
(1) For mildly poisoned MWD, administer a total of three (3) ATNAA injections (atropine
and 2-pralidoxime chloride [2-PAM Cl] in a single autoinjector) (carried by the MWD handler)
into the back of the thigh of the dog. The initial dosage of atropine is 4 mg and the dosage for
2-PAM Cl is 1200 mg. The Mark I is being replaced as supplies are exhausted with the new
ATNAA which has the atropine and 2-PAM Cl in a single injector.
(2) For severely-poisoned MWDs, administer three additional injections of atropine with
one injection of CANA (diazepam). This is similar to the buddy aid a Service member provides
another Service member suffering from severe nerve agent poisoning.
CAUTION
The MWDs should not need additional 2-PAM Cl injections.
Note: Each MWD handler will be issued 2 extra Mark I kits or 3 extra ATNAA plus 5
additional Atropens and 4 CANA for treatment of the MWD.
b. Follow Up Handler First Aid for Severe Nerve Agent Poisoning.
(1) Single atropine injections of 2 mg are continued every 10 to 20 minutes until the
nerve agent effects have subsided or signs of atropinization appear (see paragraph below).
This is equivalent to CLS aid or enhanced first aid for Service members with severe nerve agent
poisoning. The MWD must be monitored for heat stress. The atropine dries the mucous
membranes thus preventing the MWD from expelling body heat.
(2) The initial dosage of 2-PAM Cl in the dog is 20 mg/kilogram (kg). Three ATNAA
injectors should provide sufficient amount of 2-PAM Cl.
CAUTION
As stated above, the initial dosage of 2-PAM Cl in the
dog is 20 mg/kg. Three ATNAA injectors should provide
sufficient amount of 2-PAM Cl. This is the treatment
protocol that is to be adhered to.
(3) If a MWD is still showing signs of seizure after initial treatment (above) and the first
dose of CANA, the handler may give up to 3 additional CANA autoinjections at 5 to 10 minute
intervals until the seizures are gone.
(4) Maintain a clear airway by removing respiratory secretions and saliva obstructing
the airway. Loosen or remove the muzzle.
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CAUTION
When clearing the MWD airway, the handler and
veterinary personnel must use great care to avoid being
bitten.
Even a minor MWD bite could compromise
personnel MOPP status resulting in human nerve agent
exposure.
(5) In severe nerve agent exposure, the animal’s respiration is markedly depressed and
extreme muscular weakness or paralysis is present. In such cases, assisted ventilation is
required to effectively resuscitate the animal.
(6) Adequate atropine and 2-PAM Cl should bring about an improvement or restoration
of spontaneous respiration and also improve blood circulation. However, the effectiveness of
2-PAM Cl is lost after a short period of time. The 2-PAM Cl varies in its effectiveness against
nerve agents. It is least effective against GD nerve agent. If signs of nerve agent poisoning
persist or recur, veterinary personnel may need to administer additional 2-PAM Cl every 8 to 12
hours for up to 3 days.
(7) Signs of effective atropinization include dry mouth and mucous membranes,
increased heart rate, and increased body temperature. Signs of excessive atropinization and
atropine toxicity may include: vomiting, thirst, difficulty eating, constipation, difficulty urinating,
altered mental status which may be either depression or excessive stimulation, ataxia, seizures,
decreased breathing rate, increased heart rate with possible arrhythmias, and abnormal blood
pressure (decreased with shock and circulatory collapse or increased). Atropine administered
systemically may not overcome local ocular effects so that the absence of pupillary dilation does
not necessarily indicate the need for further atropine administration. Canine nerve agent
casualties can tolerate much greater doses of atropine than would a normal dog that has not
been exposed to a nerve agent. However, repeated doses of atropine will markedly increase its
effects, especially in animals that have received only a minimal exposure.
c. Supportive Therapy Procedures.
(1) Maintain a clear, unobstructed airway. Assisted ventilation may be required.
(2) Complete decontamination if not already performed.
(3) Provide supportive treatment, as indicated.
Note: As previously stated, atropine is usually sufficient to control CNS signs, but if
convulsions persist or occur intermittently and further interfere with respiration,
they may be controlled by the administration of CANA intramuscularly.
16. Protection Against Incapacitating Agents (BZ Type)
a. Absorption and Protection. Significant absorption of BZ, an incapacitating agent, is most
likely to occur through the animal’s respiratory tract, but effective percutaneous and
gastrointestinal absorption can occur. The protective measures for nerve agent poisoning can
be applied to incapacitating agents.
b. Signs of Intoxication.
(1) The incapacitating agent BZ is an anticholinergic agent with pharmacological effects
similar to those of atropine, although it has a greater effect on the CNS than atropine. The
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onset of signs following a moderate respiratory exposure can be expected to occur within 10 to
20 minutes. In general, the greater the dose, the shorter the time for the onset of symptoms.
(2) In the MWD, early effects of moderate exposures to BZ include increased heart
rate, pupillary dilation, impaired vision, dry mouth, and a decrease in physical endurance while
working. Marked rises in body temperature do not usually occur. The agent’s predominant
effects are on the CNS, resulting in incoordination, behavioral changes, confusion, and a lack of
normal responses to commands. These exposures can be expected to incapacitate animals
and make them unfit for service.
(3) There is a large margin of safety between incapacitating and lethal exposures to
BZ. Overwhelming exposures, however, can result in prostration and convulsions, with death
occurring rapidly. Moderate exposures may cause altered mental status, failure of the MWD to
follow commands, and spontaneous aggressive behavior.
c. Treatment.
(1) After a MWD has had a moderate exposure to BZ, effects may persist 24 hours or
more. Although the MWD’s life is not immediately threatened, therapy can be administered to
hasten recovery and return the animal to duty as quickly as possible. However, the MWD
should be examined and its work performance evaluated before it is returned to duty.
(2) General therapy for BZ exposure should include decontaminating the hair and the
skin with warm soapy water, restricting activity, and keeping drinking water available.
(3) Physostigmine salicylate (0.02 to 0.025 mg/kg) 1 to 1.5 mg per MWD is given by
slow IV or intramuscular injections. Repeated doses of physostigmine can be given at intervals
of 1 to 2 hours until effective, and then redosed every 2 to 4 hours if signs of BZ exposure
persist or recur. Continuous therapy may not be necessary since the effects of the exposure
gradually disappear. If continuous administration is required, it should be carried out at reduced
dosage levels to avoid an overdose of physostigmine. The signs of physostigmine overdose
include pupillary constriction, muscle weakness, twitching, vomiting, diarrhea, respiratory
distress, slowed heart rate, and convulsions. If toxicity is noted, further administration of
physostigmine should be discontinued and one atropine injector should be given intramuscularly
to control severe effects of overdose.
(4) Anesthetics, tranquilizers, and sedatives tend to potentiate the effects of
incapacitating agents and are contraindicated in the treatment of MWDs exposed to BZ.
17. Protection Against Blister Agents
a. The terms blister agent or vesicant are misnomers when applied to MWDs since
vesiculation (blistering) generally does not occur in dogs or in most other animal species.
Despite the lack of blistering, these agents do injure any part of the body they contact. The
preventive measures used for nerve agents can also be used for blister agents. If a MWD must
transit a contaminated area, it is best if it is placed in the transport kennel and carried. If a
MWD must walk through a contaminated area, its paws should be protected to prevent the
blister agent from reaching the skin. The effects of specific blister agents and their treatment
and decontamination procedures are described in paragraphs below.
b. Distilled HD is a colorless to a dark brown oily liquid with a garlic-like odor. It is used as
a delayed-action casualty agent. The persistency depends upon the munitions used and the
weather. Although HD is not persistent at high temperatures (100° to 120°F), mustard vapor
becomes a major hazard. In addition, with an increase in temperature (90°F) and humidity,
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there is a marked decrease in the effective dosage. Also, wet skin absorbs more mustard than
dry skin.
(1) Effects.
(a) Liquid mustard or mustard vapors produce delayed effects on the skin and
eyes following exposure. The long hair of dogs does not prevent injury to the skin, but it does
impede the penetration of liquids and vapors.
(b) Contamination of the skin is followed by a latent period, which varies in length
with the degree of exposure. Within 1 hour after exposure, piloerection (erection of the hair)
occurs at the site of exposure and may last for an hour or more. Two to three hours after that,
redness and edema of the skin develop, increasing in intensity for 24 hours and then subsiding.
In mild exposures, edema is followed by exfoliation of the epidermis of the skin. Severe
exposures form ulcerated lesions. The lesions heal if secondary infection can be prevented or
treated adequately. The skin of the abdomen, axilla, face, and feet are more susceptible to
damage from HD and this sensitivity is not directly related to the length of hair protecting the
rest of the MWD’s body.
(c) The eye is most sensitive to mustard’s corrosive effects. Liquid mustard or
heavy vapor exposures can be extremely damaging to the entire eye. Mild ocular exposures
are followed by conjunctivitis and conjunctival edema, usually appearing within 1 or 2 hours,
edema of the eyelids, corneal opacity and inflammation of the cornea, corneal roughening, and
pain. More severe exposures can produce more serious lesions, resulting in necrotic
conjunctivitis, corneal erosions or deep ulcerations, deep ophthalmic inflammation, and
permanent corneal opacification due to scarring. These lesions predispose the eye to
secondary bacterial infections.
(d) Mild to severe exposures to mustard vapor damage the respiratory tract.
Inhalation of blister agent vapors will produce sloughing and ulceration of the tracheobronchial
mucosa first. Profuse inflammatory exudation and edema may cause respiratory distress. More
severe exposures produce involvement of the lung tissue, pulmonary edema, and acute
pulmonary alveolar emphysema, and may become complicated by secondary purulent
bronchopneumonia. The effects of respiratory exposures tend to develop over several days.
The signs of respiratory involvement include cough, nasal discharge, respiratory difficulty, fever,
and tracheal and pulmonary rales.
(e) Ingestion of contaminated food and water or the licking of contaminated body
areas may produce ulceration of the alimentary mucous membranes, resulting in oral ulceration,
abdominal pain, vomiting, bloody diarrhea, and prostration.
(f)
Systemic absorption of mustard can result from extremely high skin or
respiratory exposures or from absorption of the agent from the intestines. It may produce
systemic effects involving the CNS, cardiovascular system, and hematopoietic system. The
possibility of severe leukopenia and susceptibility to infection also exists. These effects are
manifested by excitation, salivation, slowed heart rate, decreased count of white blood cells and
platelets, bloody diarrhea, and shock.
(2) Decontamination.
(a) All persons who receive and handle contaminated MWDs must be in MOPP
Level 4.
(b) Because of the insidious action of mustard vesicants (where effects are not
immediately apparent), decontamination may not be entirely effective. Yet, it is essential to
decontaminate MWDs promptly after exposure to prevent more serious injuries and to mitigate
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the effects of exposure where possible. Decontamination should be carried out within the first
minute or two after contamination with vesicants to prevent injury and before treatment is
begun.
CAUTION
Decontamination should be accomplished as soon as
possible to prevent contamination of handlers and
treatment area.
(c) Before redness and edema appear, localized areas of the skin can be
decontaminated by using the M291 SDK (or RSDL) as described in FM 4-02.285/MCRP
4-11.1A/NTRP 4-02.22/AFTTP (I) 3-2.69 and washing the MWD with soap and water as
described above. Collars, muzzles, and leashes are also decontaminated by using the M295
IEDK wipe-down mitt or by using a 5 percent hypochlorite solution.
(d) The eyes must be decontaminated by copious water irrigation immediately
after exposure. The M291 SDK or RSDL should not be used in or around the eyes as it may
cause additional ocular injury. Ophthalmic ointments should not be applied to the eye until
decontamination is completed as they may absorb mustard agents and prolong corneal
exposure thus increasing eye injury.
(3) Treatment. The treatment for either local or systemic effects of mustard blister
agents is primarily symptomatic and similar to the treatment described in FM 4-02.285/MCRP
4-11.1A/NTRP 4-02.22/AFTTP (I) 3-2.69 for human casualties. Specific systemic and/or topical
antibiotic therapy should be administered when indicated. Supportive therapy may be required
to maintain the animal’s nutritive and fluid status. With eye injuries, the degree of corneal
damage should be determined with fluorescein stain and treated accordingly with antibiotic or
antibioticsteroid ointments. The possibility of leukopenia, lung damage, sepsis, or others
injuries may also exist.
c. Nitrogen Mustards (HNs) is a colorless liquid when pure with a faint fishy or soapy odor.
It is used as a delayed-action casualty agent that has a delay of hours or more before skin-
damaging symptoms are felt. The eyes are very susceptible to low concentrations of HN, while
a high concentration is required to significantly damage the skin or respiratory tract insofar as
single exposure is concerned. Liquid and vapor exposures to HN are less damaging to the skin
of MWDs than are equal concentrations of mustard or arsenical blister agents. Exposures of
the eye to HN, however, produce more serious lesions than HD exposures do. The respiratory,
gastrointestinal, and systemic effects of HN are similar to those effects caused by HD.
Decontamination and therapy for HN are similar to those for HD.
d. Arsenical Vesicant Agents.
(1) Arsenical vesicant agents are more damaging as liquids than as vapors. Exposure
to liquid arsenical blister agents is immediately painful and the exposed MWD becomes very
restless. Lesions produced by these agents are more severe and develop faster than those
produced by mustard. Liquid arsenicals on the skin and their inhaled vapors are readily
absorbed into the systemic circulation, producing signs of arsenic poisoning manifested by
restlessness, vomiting, bloody diarrhea, shock, weakness, anemia, and pulmonary edema.
(2) Decontamination. Procedures for decontamination are the same as those applied
for mustard.
(3) Treatment. The treatment protocol provided below is based on the availability of
British anti-Lewisite (BAL) ointment and BAL injectable (dimercaprol) that are not currently in the
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chemical agent patient treatment set but efforts are underway to procure these items for future
sets. If available, the treatment protocols for the ointment and the BAL injectable are provided
below.
(a) The treatment of lesions induced by arsenical blister agents is similar to that
for other blister agents. To treat localized skin exposures, BAL ointment can be rubbed into the
contaminated areas, allowed to remain 5 minutes, and then washed off. Any other protective
ointment on the skin must be removed before application of BAL ointment. When BAL ointment
is applied, it will penetrate and neutralize arsenical blister agents.
(b) Systemic treatment for arsenical blister agents is indicated when there is
extensive skin exposure which has not been decontaminated within 15 minutes, when a very
rapid onset of effects follows exposure, or when systemic signs of arsenic poisoning appear.
Systemic therapy consists of the administration of BAL injectable (dimercaprol) at 2.5 to 5.0
mg/kg by intramuscular injection. Dosage can be repeated every 4 hours for 2 days and then
two times per day for the next 10 days or until recovery is apparent. Supportive therapy should
also be administered, as indicated.
18. Lung-Damaging Agents (Choking Agents)
a. Chemical agents that primarily cause pulmonary edema by attacking lung tissue have
traditionally been classified as lung-damaging agents
(choking agents), or pulmonary
edematogenic agents. They include CG, DP, chlorine, and PS. Best known of these agents is
CG.
b. The effects of CG in MWDs are similar to its effects in humans. One difference is
cyanosis (which is so prominent in human casualties of phosgene) is masked in MWDs. For
exposed MWDs, extreme exertion is dangerous, especially when pulmonary edema develops.
Military working dogs in shock should be kept comfortably warm and given oxygen, if available.
If pneumonia develops, treatment with antibiotics is indicated.
(1) Irritant agents. Under field conditions, the irritant agents bromobenzyl cyanide
(CA), chloroacetophenone (CN), and O-chlorobenzylidene malononitrile (CS) have little effect
on MWDs. O-chlorobenzylidene malononitrile may cause increased respiration and
hyperactivity. Liquid or solid agents in direct contact with the eyes will cause severe irritation;
the eyes should, therefore, be flushed with saline or water. For skin decontamination, a 0.25
percent solution of sodium sulfite is more effective than saline or water in dissolving and
neutralizing the irritant agent and should be used if available.
(2) Smoke and incendiary agents. Burning particles of white phosphorus (WP) cause
deep burns on contact with the skin. The smoke is generally not toxic. Since WP burns
spontaneously when exposed to air, oxygen must be excluded to stop the burning. This may be
done by submerging the burn or wound in water or by covering it with a water-soaked dressing.
At the earliest opportunity, all WP should be removed from the skin as follows: bathe the
affected part in a bicarbonate solution
(no more than a 0.5 percent solution of sodium
bicarbonate) to neutralize phosphoric acid, which then allows removal of visible WP. Remaining
fragments will be observed in dark surroundings as luminescent spots. The burn should be
debrided promptly if the MWD’s condition will permit, to remove bits of phosphorus which might
be absorbed later and possibly produce systemic poisoning. An ointment with an oily base
should not be applied until it is certain that all phosphorus has been removed. Further treatment
should be carried out as for thermal burns. Treatment with ultraviolet light is both palliative and
therapeutic. If the eyes are affected, treatment should initially be commenced by irrigation,
using water or saline. The lids must be separated and a local anesthetic instilled to aid in the
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removal of all imbedded particles. In eyes with severe ulceration, atropine ophthalmic ointment
should be instilled once all particles have been removed.
c. Sulfur trioxide-chlorosulfonic acid solution (FS), titanium tetrachloride, and a chemical
mixture hexachloroethane (HC). Field concentrations of these agents usually are not harmful to
MWDs, but the liquid may cause burns on the skin and in the eyes. After the eyes are irrigated,
they are treated the same as for thermal burns.
19. Cyanide Compounds (Blood Agents)
a. Cyanide Compounds. Cyanide compounds (blood agents) affect bodily functions by
inactivating the cytochrome oxidase system; this poisoning prevents cell respiration and the
normal transfer of oxygen from the blood to body tissues. Hydrogen cyanide and CK are the
important agents in this group. Cyanogen agents are highly volatile and, therefore,
nonpersistent even at very low temperatures. Exposures at high concentrations cause effects
within seconds and death within minutes in unprotected personnel and MWDs. Cyanogen
chloride also produces central and peripheral pulmonary effects on the respiratory tract because
of its chlorine component.
b. Toxic Effects. These agents produce toxic effects after absorption. Inhalation is the
usual route of entry. Artillery shells, mortar rounds, rockets, a sprayer mounted on aircraft, or
bombs can disperse these agents.
c. Effects and Treatment.
(1) Hydrogen cyanide causes asphyxiation of the tissues, especially the respiratory
center of the CNS. In addition to cyanide effects, CK causes marked local irritant effects on the
respiratory system that can lead to pulmonary edema.
(2) Treatment is difficult under field conditions. It should consist of oxygen therapy
under positive pressure ventilation and injections of antidote medications.
(3) Initial treatment for MWDs less than 85 pounds is intravenous injection of one
sodium nitrite 10 milliliter (ml) (3 percent) ampule containing 300 mg of sodium nitrite, followed
by one 50 ml (25 percent) ampule containing 12.5 grams of sodium thiosulfate IV. Military
working dogs over 85 pounds should receive an initial dose of two ampules of sodium nitrite, a
total of 600 mg, and two ampules of sodium thiosulfate, a total of 25 grams. Sodium nitrite and
sodium thiosulfate must be administered slowly through an IV (over 3 to 5 minutes).
(4) If signs of intoxication continue additional medication may be needed. A small
amount of venous blood should be examined visually. If the blood is chocolate brown, give an
additional injection of sodium thiosulfate at one-half the initial dose quantity. If the venous blood
is red, give additional injections of both sodium nitrite and sodium thiosulfate at one-half the
initial dose quantity.
Note: The initial dosage of sodium nitrite is approximately 4 to 7 mg/pound IV, followed
immediately by sodium thiosulfate at approximately 150 to 300 mg/pound. If
additional treatment is required, check the blood for methemoglobin (chocolate-
brown color). If the blood is not brown, give sodium nitrite and sodium thiosulfate
at one-half the initial dose. If the blood is brown, give only sodium thiosulfate at
one-half the initial dose, since there should be sufficient methemoglobin present
from the original dose of sodium nitrite.
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VI-19
20. Biological Warfare Agents
a. Disease produced by the offensive use of BW agents against US forces could be lethal
and/or disabling. These BW agents could also infect the animal population within the
contaminated area; however, most of the diseases that are likely to be used in BW are unlikely
to cause illness in MWDs. This is primarily due to varied species susceptibility between dogs
and humans for most BW agents. For definitive information on BW agents, see FM 8-
284/NTRP 4-02.23/AFMAN (I) 44-156/MCRP 4-11.1C.
b. The veterinary medical response to the threat or use of biological weapons may be
different depending on whether veterinary medical measures are employed prior to exposure or
whether exposure has already occurred and/or symptoms are present. If provided before
exposure, active immunization or prophylaxis with antibiotics may prevent illness in those
MWDs that are exposed. Active immunization may be effective against several potential BW
agents, in man, but there are no approved canine immunizations for likely BW agents. The best
modality for future protection of MWDs against a wide variety of biological threats is the use of
prophylactic antibiotics and appropriate decontamination procedures. Of the diseases
considered to be likely BW agents, MWDs are likely to be susceptible to only plague (Yersinia
pestis), tularemia, brucellosis, Q-fever, and anthrax. In all of these diseases the MWD is
believed to be less susceptible than man.
c. The DOD MWD Veterinary Service currently recommends that all MWDs deployed to
areas with high risk of natural tickborne rickettsial disease be placed on prophylactic
doxycycline at 6 mg/kg/day. Doxycycline is generally considered efficacious against each of the
diseases of concern and this prophylactic dose may provide additional protection for MWDs
against BW agents. Decontamination should be completed with soap and water as previously
described. Military working dog equipment should be decontaminated with
5.0 percent
hypochlorite solution, or according to FM 3-11.5/MCWP 3-37.3/NTTP 3-11.26/AFTTP(I) 3-2.60.
Note: Doxycycline at 6 mg/kg/day is routinely prescribed for MWDs to help prevent
natural tickborne rickettsial infections. It may also provide additional protection
for MWDs against likely BW agents.
21. Nuclear and Radiological Weapons
a. A proliferation of CBRN capabilities beyond the lines of the major powers has increased
the likelihood of CBRN use in a conflict. The number of Third World countries seeking the
technology for nuclear weapons and advanced surface-to-surface missiles has increased.
Many Third World or developing nations have current or near-term access to the materiel
needed to produce nuclear weapons. With current trends in nuclear proliferation, the nuclear
threat now and in the future will be global. The proliferation of nuclear-capable nations in all
contingency regions increases the likelihood of US forces being targets of a nuclear attack.
b. If US forces are attacked with nuclear weapons, MWDs will present the same types of
medical problems as seen with human patients. These medical problems will include blast,
thermal, and radiation injuries and radiation sickness depending on the amount of radiation
received. Veterinary care will be based upon the clinical condition of the MWD and its
prognosis for recovery. For definitive information on the medical effects of nuclear weapons,
diagnosis, treatment, and prognosis, see FM 4-02.283/NTRP 4-02.21/AFMAN 44-161(I)/MCRP
4-11.1B.
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15 July 2009
22. Water Safety and Management
a. During military operations, the contamination of water, whether intentional or inadvertent,
may reach concentrations that will and could produce mass casualty proportions, not only for
US and coalition forces, but also, all civilians, plants, and animals in the AO.
b. Water supplies directly affect the combat efficiency, morale, general health, and welfare
of Service members in battle. It is required for consumption, sanitation, construction, and
decontamination, as well as for vehicle operation and maintenance. The quantity required
depends upon the regional climate and the type and scope of operations. The quality
necessary depends on the intended use of the supply. Water requirements are significantly
greater in sustainment areas, where there is heavy demand for aircraft and vehicle washing,
medical treatment, laundry and bath facilities, and construction projects. Patient and equipment
decontamination requires large amounts of water.
c. The presence of contamination can be determined only by special methods of analysis.
Water samples for identification or verification of biological agent contamination are collected by
PVNTMED personnel. The supporting laboratory should provide guidance on sampling
procedures and collecting kits (for example, Sep-Pak™) for use in collecting the samples.
d. Treatment of contaminated water requires chemicals and equipment that are only
available to logistics water units. Individual Service members or units should not attempt to
treat their water. Contaminated water may be decontaminated only when clean sources are not
available. These decontamination operations must have the approval of the medical authority
(PVNTMED personnel or command surgeon).
23. Detection of Contaminated Water
a. The military standard issue of CBRN detection, protection, and decontamination
equipment provides the unit with the ability to detect and protect against a number of CBRN
agents. For more information refer to TB MED 577; Navy NAVMED P 5010-9; and Air Force
Occupational Safety and Health Standard 48-7.
(1) Detection of nuclear contamination in water is accomplished by using the AN/VDR-
2 RADIAC Set/RADIAC meters. However, harmful levels of radiation can exist in drinking water
that cannot be detected with the VDR-2. The VDR-2 will detect if water poses an external
exposure hazard or if it contains extremely high levels of radiation. It will not however detect
levels of contamination above safe drinking water levels. Refer to TM 11-6665-251-10 for more
information.
(2) Detection of biological agents in water is accomplished by the use of field biological
water test kits and specially designed collection and detection kits. The specialty kits will be
provided as needed and will be available to PVNTMED and supporting laboratory personnel.
(3) The Chemical Agent Water Testing Kit, M272, provides a rapid field test to detect
chemical agent contamination in water. The test must be conducted before the water is treated
with chlorine; the chlorine will affect the accuracy of the test for chemical agents. An updated
version of this kit may also detect toxins.
(4) Water Quality Analysis Set—Preventive Medicine (WQAS-PM). The WQAS-PM
provides a PVNTMED Team, providing Roles 2 and 3 PVNTMED support, the equipment and
capabilities to perform field presumptive analysis of potable water according to TB MED 577
and all associated laboratory support equipment. This set also contains equipment for the
bacteriological analysis of potable water for total coliform, presence/absence.
b. When contamination is discovered the following actions are taken:
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VI-21
(1) Mark the water source, using the standard contamination markers, and ensure that
personnel do not consume the water until it has been approved by the PVNTMED personnel.
(2) Notify the command surgeon and the commander that the water source is
contaminated and unfit for drinking, food preparation, and personal hygiene. The commander
establishes safeguards to prevent personnel from using the contaminated water supply.
(3) If the contamination is such that it cannot be removed or avoided, engineering,
quartermaster, and PVNTMED personnel will find an alternative source of uncontaminated
water.
(4) The primary source for obtaining water is from logistics-operated water production
and distribution points. Other sources are considered only when logistics-operated facilities are
not available. Alternative sources that may be considered include—
• Ground water source which is least likely to be contaminated.
• Local fixed facility water supplies.
• Movement to another location to obtain an uncontaminated water source, when
the tactical situation permits.
• Individual water treatment techniques such as iodine tablets and Chlor-Floc®.
(5) Avoid using contaminated water until it has been treated by logistics water
purification units and approved for use by the medical authority.
24. Treatment of Contaminated Water
a. Contaminated water requires additional equipment and supplies to remove the
contamination. Logistics water purification and distribution units are equipped to perform these
duties.
b. Commanders and their staffs at all levels must be concerned about maintaining water
support to allow completion of the unit’s mission. To ensure adequate support, commanders
and their staffs should address planning for tactical water support in all operation plans and
orders.
c. Water is supplied as either a packaged or bulk product. A packaged product is
manufactured and procured, stored, transported, and supplied in a container. Water in larger
quantities is a bulk commodity.
25. Engineer Support
a. Site Selection. Final selection of a fixed decontamination site is the responsibility of the
local commander, usually assisted by the CBRN unit in charge. Direct coordination with an
engineer unit must be done so the engineer commander is aware of the requirements for such
an area. A fixed decontamination site should be easily accessible but out of contamination
range of populated areas. It should be large enough to accommodate planned operations and
have drainage and soil characteristics favorable for operations and storage of contaminated
materials. Water is an integral part of the decontamination process. Though nonpotable water
is used, it must be available and uncontaminated in sufficient quantities or the decontamination
operation will cease to function. The site should also be favorable for camouflage and
concealment.
b. Site Preparation. The work required to prepare and maintain the site is determined by
the CBRN unit responsible for the site, but can be expected to include clearing and grading,
drainage analysis, and construction of drainage facilities and hazardous waste holding facilities.
Horizontal construction and maintenance of showers, wash racks, and other structures as
VI-22
FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
15 July 2009
required and hardening of the site are engineer tasks. Well drilling, water source improvement,
and other support may be required to help the logistics unit supply potable water for the
decontamination site.
c. Storage of Contaminants. A large decontamination site generates quantities of
contaminated water and materials. The CBRN unit in charge of the site plan is responsible for
permanent disposal of these materials. Engineers, however, are involved in temporary storage
of these materials, particularly contaminated water. Extreme care must be taken to prevent
escape of contaminated water or materials into the surrounding area, especially into potable
water sources and sanitation systems.
d. Responsibilities. The Army service component command
(ASCC) commander is
responsible for the control and distribution of water to US Army forces, to other US Services,
and, as required, to allied support elements. The ASCC Deputy Chief of Staff for Logistics has
the overall responsibility for developing the water distribution plan for the theater and
supervising the ASCC commander’s priorities and allocation procedures. Logistical personnel
or host nation support, if available, operate and perform organizational maintenance on
semipermanent and permanent water purification utilities at fixed installations.
e. Logistics Organizations.
The logistics organizations are responsible for the
management, control, purification, storage, and distribution of water, including organizational
maintenance of water equipment. Initially existing developed and surface sources are used
before ground water resources are tapped. The employment of CBRN munitions can
contaminate surface water supplies over a wide area. Subsurface water supplies are unlikely to
be contaminated at first. Earth and rock layers are effective in diminishing contamination. In an
CBRN emergency, it may be necessary to use a subsurface water supply.
f.
Environmental Effects on Planning. Environmental conditions determine the location of
water sources and how much water is needed for subsistence. For more information on field
water supply, see FM 3-34.400. Refer to Tables VI-1, VI-2, VI-3, and VI-4 for environmental
factors advantages and disadvantages. Specific guidance regarding environmental factors is
found in FM 3-34, FM 90-3, and FM 90-5.
g. Contamination Prevention. Once a well is completed by installing casings, screens, and
pumps, it is turned over to logistics water units for use. To prevent contamination, wells must be
capped when they are no longer needed. In order to expedite reopening of closed wells,
agreements have been made between many host nations to standardize capping and labeling.
These procedures are covered by NATO STANAG 2885.
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VI-23
Table VI-1. Environmental Factors—Temperate Regions
Temperate Regions
Advantages
Disadvantages
Abundant resources.
Surface sources easily contaminated by
Lakes.
CBRN munitions.
Streams.
Natural contamination possible by organics,
disease-bearing organisms, and inorganic
Rivers.
salt.
Existing wells.
Environmental
pollution
from
local
Local water systems.
development such as septic fields
may
Sources convenient to locate, develop, and
contaminate ground water.
access.
Water sources can be purified at small unit level.
Drinking water does not require cooling.
Table VI-2. Environmental Factors—Tropical Regions
Tropical Regions
Advantages
Disadvantages
Water resources available but more scattered.
Surface sources easily contaminated by CBRN
Lakes.
munitions.
Streams.
Dense vegetation may make access difficult.
Rivers.
Increase of natural contamination.
Existing wells.
Presence of waterborne diseases and parasites
capable of transmitting disease may make water
Local water systems.
unsuitable for bathing and laundry use until
Water sources can be purified at small unit level.
disinfected.
Higher water use needed because of high
humidity and heat.
Table VI-3. Environmental Factors—Frigid Climates
Frigid Climates
Advantages
Disadvantages
Water resources may be abundant, but frozen.
Increased consumption to prevent dehydration.
Lakes.
Water purification, storage, and distribution system
must be protected from freezing.
Rivers.
Snow and ice are impractical to melt for other than
Streams.
very small units due to excessive fuel needed for
Existing wells.
melting.
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15 July 2009
Table VI-4. Environmental Factors—Arid Regions
Arid Regions
Advantages
Disadvantages
None.
Surface fresh water almost nonexistent.
Available water sources limited and widely dispersed.
Increases water use to prevent heat casualties.
May dictate the tactical scenario. Lack of water makes
extensive storage and distribution system vital.
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FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3
VI-25
Chapter VII
MEDICAL LABORATORY SUPPORT
1. General
a. Medical laboratory services must continue their support role even under CBRN
conditions. For the provision of patient care
(diagnostic laboratory support), medical
laboratory support is located in the field hospital. The facility must be located in a
contamination-free area or be inside collective protection. Other designated laboratories
within the theater will analyze environmental CBRN samples/specimens (including in-theater
field confirmatory identification of BW agents by evaluating specimens from symptomatic
patients and animals and environmental samples collected in the AO).
b. At Role 2, medical laboratory support is extremely limited; it consists of clinical
laboratory procedures in direct support of MTF and FST activities. Laboratory personnel
prepare collected suspect CBRN specimens for submission to the supporting area
laboratory for analysis; the specimens are forwarded to supporting medical laboratories and
chain of custody is maintained.
c. At Role 3, medical laboratory support in a field hospital is intended for providing
clinical laboratory support and is primarily in support of acute surgical cases, blood services,
and immediately (STAT) services required for intensive care operations. Microbiology
services are also available to include cultures and sensitivity testing. Patients with
documented or suspected exposure to CBRN weapons/agents will be medically evaluated,
specimens will be collected, packaged, and a chain of custody will be established. For
specimens that cannot be handled in the field hospital laboratory, specimens can be
forwarded through technical channels to the supporting medical laboratory for analysis. In a
mature theater, most of the hospitals will have JBAIDS PCR so field confirmation may be
available and that the specimens will be only forwarded through technical channels for
definitive analysis.
(1) Field laboratories.
(a) Area medical laboratory. The AML is the Army’s specialized theater
laboratory that provides field confirmatory laboratory support. Its mission is, on order, to
deploy worldwide in tailored teams to conduct health threat detection, confirmation and
medical surveillance for CBRN occupational/environmental health and endemic diseases
and consequence management to protect and sustain the health of the force across full
spectrum operations. It is organized as follows:
• Headquarters section. This section provides command, control, and
communications support for the unit and accomplishes all required
administrative functions of the unit.
• Chemical, biological, radiological, and nuclear section. This section
conducts analytical chemistry support by providing confirmation level
analysis for the identification of CW agents and other chemical threats in
air, water, soil or other matrices.
• Endemic disease section. The endemic disease section provides field
confirmatory analysis of BW agents in environmental and clinical samples
using multiple methodologies; provides diagnostic capability to identify
outbreaks of regionally specific endemic diseases; and serves as a
resource of information for higher command medical personnel.
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VII-1
• Environmental/occupational health section. This section provides
theater-level environmental threat assessments, by conducting air, water,
entomological, epidemiological, and radiological surveillance while serving
as a resource of information for theater medical personnel. This section
also provides radiological monitoring and detection devices, along with
laboratory analysis of specific isotopes.
(b) Biological augmentation team
(BAT). The BAT is a USAF asset that
provides expertise in biological identification and risk analysis. This capability may be
utilized to augment existing and future medical UTCs such as EMEDS and Air Force
Theater Hospitals
(AFTHs). In addition, it may augment the capabilities of the
bioenvironmental engineering (BEE) teams, prevention and aerospace medicine (PAM)
teams, and theater epidemiology teams (TET).
(c) Forward deployable preventive medicine units (FDPMUs). The FDPMUs
(the Navy’s environmental theater laboratory) are rapid-response, specialized preventive
medicine platforms that identify, evaluate, and assess operational risks of environmental
health hazards, including CBRN and toxic industrial threats, and
recommend
countermeasures to reduce risk for troops. The FDPMU provides specialized PVNTMED
support and HSS to operational commanders and joint task forces and can deploy within 96
hours. The FDPMU is a modularized and flexible team to include chemical, microbiological,
vector, PVNTMED, environmental health, and logistics components.
(d) Seabasing platforms. Medical departments on aircraft carriers
(CVs);
aircraft carriers (nuclear) (CVNs); large deck amphibious assault ships (general purpose)
(LHA); hospital ships (T-AHs); and command ships are also equipped to provide laboratory
testing capability for environmental samples from other ships assigned to a carrier strike
group and expeditionary strike group.
(e) Other assets.
If these specialized assets are unavailable, clinical
specimens may be forwarded to the nearest CONUS reference laboratory including the
OCONUS locations at Landstuhl Regional Medical Center, Tripler Medical Center, and 121st
General Hospital.
d. At Role 4 (CONUS), designated Role 4 medical laboratories such as USAMRIID,
CDC, and NMRC perform analyses to provide definitive identification of suspect BW and
CW agents for the President and the Secretary of Defense (SecDef) purposes. The
definitive identification of suspect BW/CW agents also aids commanders in the AO in
maintaining the health of their command.
2. Samples/Specimen Collection and Management of Chemical, Biological,
Radiological, and Nuclear Contaminants
a. The means to initiate a CBRN sample/specimen collection and analysis mission
include—
• Routine operating procedures.
• Chemical samples from chemical units.
• Presumptive biological samples from biological detection systems.
• Combat injuries.
• Symptomatic individuals.
• Commander requests for information through C2 channels.
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15 July 2009
b. The decision makers and initiators of a CBRN sample/specimen collection and
analysis mission include Joint and Service-specific commanders, command surgeons, and
their supporting medical and CBRN staff elements.
c. Collection of environmental and food samples is conducted by PVNTMED
detachment/personnel, chemical operations specialists, damage control personnel,
veterinary personnel, PVNTMED officers, public health officers, technical intelligence
collection teams, or BEE. Medical personnel in a clinical or hospital setting will collect
clinical specimens (for example, serum, blood, and other body fluids) and provide these to
the laboratory for analysis. The collection team provides transportation of samples
between the collection site and the laboratory analysis site. The laboratory team provides
consultation, as needed, regarding the types and sources of samples/specimens to collect.
Procedures for collection, labeling, chain of custody, and transport of CBRN samples can
be found in FM 3-11.19/MCWP 3-37.4/NTRP 3-11.29/AFTTP(I) 3-2.44. For any CBRN
specimen or sample, the supported unit’s CBRN staff may specify a TEU to receive and
transport the sample. The staff will need to be supplied with the results of the analysis in a
timely manner to aid in rapid decisionmaking.
d. Samples are collected and initially packaged by the unit obtaining the sample. The
sample is properly labeled, double-bagged, and prepared for evacuation. Ensuring that the
chain-of-custody is maintained, the sample is evacuated to a sample transfer point for
further evacuation, or possibly to a ship-based medical laboratory for field confirmatory
identification. It is critical that the sample be maintained at 1° to 4°C during storage and
transport. If a sample transfer point is used, a sample courier receives the sample for
transport to an in-theater medical laboratory or ship-based laboratory for field confirmatory
identification to support any appropriate treatment decisions. If there is an in-theater AML,
the sample can be split for in-theater field confirmatory analysis and evacuation to CONUS
for analysis and definitive identification. A portion of the initial sample will ultimately be
evacuated to CONUS for definitive identification. If background samples are requested by
an in-theater laboratory or ship-based laboratory, for whatever reason, evacuation will be
conducted in the same manner ensuring that the chain of custody is maintained throughout
the transfer or evacuation process. Sampling and evacuation procedures for BW samples
are discussed in detail in FM 3-11.86/MCWP 3-37.1C/NTTP 3-11.31/AFTTP(I) 3-2.52.
Notes:
1. The term “sample” refers to nonhuman and nonanimal origin. The term
“specimen” refers to human and animal origin.
2. Always consider that chemical agents may have been employed. Check
for chemical agents before collecting a biological sample/specimen.
Chemical agents can damage or destroy biological agents. Also, chemical
agents not identified in the sample/specimen can pose a hazard to the
receiving laboratory personnel. Mark all samples that are potentially
contaminated with chemical agents as such.
3. Precautions should be taken to protect the sample/specimen collector
from potential BW agents; at a minimum, respiratory protection and rubber
gloves must be worn. Additional care must be taken when collecting
samples/specimens to prevent cross-contamination. Gloves must be
changed or decontaminated between sample/specimen collections.
4. Samples will not be delivered to the clinical laboratory of an MTF for
analysis. They must be delivered to the designated supporting medical
laboratory for processing. This will prevent accidentally spreading a
biological agent in the MTF.
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VII-3
e. The CCDR must ensure it has an executable plan to get the samples to the
supporting laboratories. In some cases, dedicated TEU assets are used to escort samples.
The priority for dedicated TEU assets will likely go to escorting samples from the theater
back to the CONUS-based nationally recognized reference laboratories for definitive
analysis and identification.
f.
Samples suspected of containing BTA must be collected and transported using
accepted chain-of-custody procedures (such as DA Form 4137, OPNAV Form 5580/22, or
other form acceptable to law enforcement and federal agencies) to ensure sample-handling
integrity for legal purposes. The Judge Advocate General’s Office provides guidance and
reviews on chain-of-custody procedures. See FM
3-11.86/MCWP 3-37.1C/NTTP 3-
11.31/AFTTP(I)
3-2.52 and JBAIDS CONOPS for policy details. Chain-of-custody
procedures are used to track all holders of the sample until the sample is destroyed.
Note: DD Form 1911 (Materiel Courier Receipt) has been rescinded however; there
is an ongoing initiative to have this form reinstated to be used as one of the
chain of custody documents.
g. A strict chain-of-custody must be maintained for every sample or specimen
collected. The chain-of-custody document must accompany the sample or specimen
during transport from the point of collection to the receiving medical laboratory to the final
disposition of the sample. Each time the sample or specimen is transferred to another
individual, the receiving person must sign the document to show that he received the
sample or specimen and state what happened to it while in his custody. The document will
provide answers to the following questions about the sample or specimen:
(1) Who collected the sample?
(2) When it was collected?
(3) Who has maintained custody of it?
(4) What has been done with it at each change of custody?
h. The samples or specimens must be appropriately packaged, labeled, and evacuated
to the designated medical and/or environmental laboratory for confirmation of a biological
attack. The standard chain-of-custody for the evacuation could be as follows:
• Sampling unit.
• Sample courier or other command-designated courier personnel.
• In-theater supporting laboratory.
• Designated CONUS laboratory.
i.
For clinical specimens, routine clinical laboratory custody procedures will be
employed until the presence of a BTA is suspected based on prior intelligence or initial
laboratory testing at which time chain-of-custody procedures will be initiated. Chain-of-
custody forms may be initiated prior to determining the presence of a BTA, if desired.
j.
Chain-of-custody forms are employed when moving samples to different locations
within the same laboratory facility, upon shift changes, and when shipping/transporting
samples to another laboratory. Every aliquot of sample MUST be accounted for on the
chain-of-custody forms until approved for disposal or destruction by the FBI or commander.
VII-4
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15 July 2009
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