Chapter XXVI: Section IV: Operations, Entry, and Exit Guidelines

F-12. Operations

These operations, entry, and exit guidelines may be used to prepare a unit SOP for the operation of CPS systems in your unit.

_a._ When using these guidelines, the following should be considered:

· Location of the shelter (flat, hilly, rocky ground).

· General climate of the AO (high and low temperature
variations during operation).

_b._ Information on setting up, striking, and operating the CPS is contained in the equipment publications. Where applicable, special procedures are provided in these publications for setting up in both clean and CB vapor hazard areas. However, the CP DEPMEDS is NOT set up in a CB vapor hazard area. The commander will determine which procedures to use.

_c._ During operations, periodic checks are made of the atmosphere within the shelter. These checks are made by using available chemical agent detection equipment and material to determine if chemical agent penetration has occurred. Should chemical agent penetration occur, all personnel must mask; then ensure that patients are protected until the agent has been purged from the shelter.

F-13. Decontamination of Entrance Area

_a._ Normally, the MTF will not operate in a CB vapor hazard environment. However, if the MTF must remain in an area on a temporary basis and liquid agent contamination is present, the immediate area around the entrance must be decontaminated.

_b._ To decontaminate the area around the entrance, use one or more of the following methods:

· Turn over about 2 inches of soil.

· Remove the top 1-inch layer of soil containing the liquid
agent. Use the CAM or M8 detector paper to check the area after
the topsoil is removed to ensure complete agent removal.

· Add several inches of clean soil or sand.

· Mix STB into the top 1/2 to 1 inch of soil.

· Use DS2 on contaminated hard-surfaced areas or frozen ground.

F-14. Procedures Prior to Entry

All personnel (staff and patients) must be decontaminated before they are permitted entry into the CPS.

· Use chemical detection equipment to check for the presence of
contamination on individuals and their equipment; also check
for presence of contamination on individual weapons if they
are allowed in the CPS. Normally, weapons will not be allowed
in the patient care areas, but will be stored outside near the
entry/exit. Thorough decontamination is critical in preventing
contamination transfer into the CPS.

· When a chemical agent is detected, follow the procedures
in Appendix C for patient decontamination and FM 3-5 for
other personnel decontamination before entering the CPS.
All contaminated clothing and equipment are placed in the
contaminated dump. Weapons should not have been evacuated with
patients. However, if weapons are evacuated with the patient,
they are decontaminated and held by the MTF (administrative
personnel or hospital supply) for disposition instructions.

· Decontamination must be thorough; procedures must be strictly
followed. Failure to do so can contaminate the interior of the
MTF and injure medical treatment personnel; thus reducing their
mission support capabilities.

+-------------------------------------------------+
| =WARNINGS= |
| |
| 1. ALWAYS PURGE THE AIR LOCK BEFORE OPENING |
| THE INNER DOOR, IF THE OUTER DOOR HAS BEEN |
| OPENED. |
| |
| 2. WHEN OPERATING IN A TOXIC ENVIRONMENT, NEVER |
| OPEN THE OUTER AND INNER DOORS OF THE AIR LOCKS |
| AT THE SAME TIME. |
| |
+-------------------------------------------------+

F-15. Entry/Exit for the Collective Protection Shelter System

_a. Ambulatory Personnel._

(1) _Entry procedures._

(_a_) Ambulatory patients and others remove their MOPP (except
their mask), BDUs, and boots outside the air lock. This
procedure reduces the amount of possible contamination entering
the air lock.

(_b_) A check is made to ensure that the ambulatory air lock is
empty and the inner door is closed.

(_c_) The individual enters the air lock and closes the outer
door.

(_d_) The air lock is purged for 3 minutes. At the end of
the purge cycle, the individual checks for contamination. If
contaminated, the individual must return to the outside and
decontaminate his skin; then return to the air lock and repeat
the purge cycle and contamination check. If no contamination
is detected, the protective mask is removed and placed in
a plastic bag. The plastic bag is sealed and labeled. The
individual opens the inner air lock door and enters the CPS;
the plastic bag is carried into the shelter with the individual.

(2) _Exit procedures._

(_a_) A check is made to ensure that the ambulatory air lock is
empty and the outer door is closed.

(_b_) The individual enters the air lock and closes the inner
door.

(_c_) The individual puts on his protective mask; then exits
through the outer door.

(_d_) The individual puts on his BDU and boots then assumes the
established MOPP level before departing the immediate area of
the exit door.

+-------------------------------------------------+
| =WARNING= |
| |
| DO NOT OPEN THE OUTER DOOR UNTIL THE PROTECTIVE |
| MASK HAS BEEN PUT ON. |
+-------------------------------------------------+

NOTES

1. Ambulatory patients that enter the CBPS become litter
patients and are placed in PPW when released because the MTF
does not have replacement MOPP ensembles for patient issue.

2. Exits must be spaced so that at least a 3 minute purge of
the air lock is accomplished before the inside door is opened.
Only open the doors long enough to permit passage.

_b._ _Litter Patients._

(1) _Entry procedures._

(_a_) An outside aidman notifies an inside aidman that a litter
patient is ready for admission.

(_b_) The inside aidman ensures that the inner litter air lock
door is closed. The outside aidmen open the outer air lock door
and place the litter on the litter rails; they push the patient
into the air lock headfirst; then they close the outer door.
After a purge time of 3 minutes, an aidman inside the CPS opens
the inner door and checks the patient to ensure that he is
contamination free. The patient is checked by placing the CAM
nozzle near absorptive surfaces, such as the patient's hair.
If no contamination is found, the aidman removes the patient's
mask and places it in a plastic bag. The inside aidmen remove
the patient from the air lock and position him on treatment
litter stands, or move him to the treatment area as directed by
supervisory personnel.

(_c_) Patients received at the treatment facility in the PPW
are checked for contamination; if they are contamination free,
they may be processed through the litter air lock in the PPW.
The inside aidmen ensure that the inner litter air lock door
is closed. The outside aidmen open the outer air lock door
and place the litter on the litter rails and push the patient
into the litter air lock headfirst, then close the outer door.
Purge the air lock for 3 minutes. After the purge time, an
aidman inside of the CPS opens the inner air lock door and
uses the CAM to check the patient to ensure that he is free
of contamination. If no contamination is found, the inside
aidmen remove the patient from the air lock. (If the patient is
wearing a protective mask, the mask is removed and placed in a
plastic bag before the patient is moved from the air lock.) As
the patient is removed from the air lock, the PPW is opened and
rolled inside out so that any desorbing vapors are adsorbed by
the charcoal layer. The inside aidmen remove the patient from
the air lock and position him on litter stands. The patient
is transferred to a clean litter; then moved to the treatment
area as directed by supervisory personnel. The receiving litter
and PPW is returned to the outside; dispose of the PPW in the
contaminated waste dump. Decontaminate the litter and return it
to the litter pool.

NOTE

Should contamination be found when monitoring the air lock in
(_b_) or (_c_) above, repeat the purge cycle, then retest for
contamination. All vapor hazards must be eliminated before
the patient is moved into the CPS. Repeating the purge cycle
may NOT be possible if the patient is in need of immediate
lifesaving care. The patient may have to be returned to the
outside treatment area for immediate care.

(2) _Exit procedures._

(_a_) The litter patient is placed in a PPW. A battery operated
blower unit with a CB filter may be attached to the PPW to
provide fresh air to the patient; thus reducing the heat load
on the patient and the carbon dioxide buildup inside the PPW.

(_b_) An inside aidman notifies an outside aidman that the
patient is ready to exit the shelter. An outside aidman ensures
that the outer air lock door is closed. The patient is placed
in the litter air lock feet first. The inner air lock door is
closed. The outside aidmen open the outer door and remove the
patient.

(_c_) Hospital staff, visitors, or ambulatory patients exit
through the ambulatory air lock. Before entering the air lock,
each individual must ensure that the outer air lock door is
closed. The individual enters the air lock and closes the
inner door; puts on his protective mask and exits through the
outer door. The individual puts on his BDU and boots, and
then assumes the established MOPP level before departing the
immediate area of the exit door.

+-------------------------------------------------+
| =WARNING= |
| |
| DO NOT OPEN THE OUTER DOOR UNTIL THE INNER DOOR |
| HAS BEEN CLOSED. |
+-------------------------------------------------+

NOTE

Exits must be spaced at least 3 minutes apart to allow for a
complete purge cycle of the air lock.

F-16. Resupply of Protected Areas

Resupply of protected areas is accomplished by placing contamination-free supplies or equipment on a litter and passing it through the litter air lock, or processing it through the supply air lock. The litter air lock must be purged for 3 minutes. The supplies must be checked for contamination before they are removed and placed within the CPS. The supply air lock must be purged for the stated time as outlined in the supporting technical manual; usually 45 minutes. Again the supplies must be checked for contamination before they are removed and placed within the CPS.

APPENDIX G

PATIENT DECONTAMINATION