Health Service Support in a Nuclear, Biological, and Chemical Environment

Chapter XXVIII: Section II: Patient Decontamination Procedures

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G-10. Decontaminate a Litter Chemical Agent Patient

Before contaminated patients receive medical treatment in the clean treatment area, they must be decontaminated. Place the cutting device in a container of 5 percent hypochlorite solution between each use. Each decontamination team member decontaminates his gloves and apron with the 5 percent hypochlorite solution frequently to prevent spreading any contamination to patient's skin. Decontaminate the patient's skin, bandages, wounds, mask, identification tags with chain, and splints with a 0.5 percent hypochlorite solution. The litter patient is decontaminated and undressed as follows:

NOTE

Litter patients requiring EMT or ATM in the clean area of the
MTF will be completely decontaminated. A patient not requiring
clean EMT or ATM at the MTF, but requiring further evacuation
(for example: a stable patient with a partial amputation of a
lower extremity) should only have his wound area and MOPP spot
decontaminated to remove any gross contamination. The patient
should be evacuated in his MOPP.

_a._ =Step 1. Physically remove gross contamination.= Use any stiff material (stick, cardboard, plastic strip, metal banding strap) to physically remove gross contamination from the patient's MOPP ensemble. Much of the CW agent contamination can be removed through physical means.

_b._ =Step 2. Decontaminate the patient's mask and hood.= The patient has been triaged and stabilized (if necessary) by the senior trauma specialist in the patient decontamination area. A two-man decontamination team moves him to the litter stands at the clothing removal station.

(1) =Decontaminate the mask and hood.= Use the SDK, or use a
5 percent hypochlorite solution or household bleach to sponge
down the front, sides, and top of the mask hood. Decontaminate
spots with the SDK or the 5 percent hypochlorite solution.

(2) =Remove hood.= Remove the hood by cutting the hood. Before
cutting the hood, dip the cutting device in a 5 percent
hypochlorite solution. For the M17-series mask, cut the neck
cord and the small string under the voicemitter. Release or cut
the hood shoulder straps and unzip the hood zipper. Cut the
hood, close to the filter inlet cover and eye-lens outsert,
upward to the top of the eye-lens outsert, and across the
forehead to the outer edge of the other eye-lens outsert.
Proceed downward toward the patient's shoulder, staying close
to the eye-lens, then across the lower part of the voicemitter
to the zipper. After dipping the cutting device in the 5
percent hypochlorite solution, cut the hood from the center
of the forehead over the top of the head (see Figure G-3).
Fold the left and right sides of the hood to the side of the
patient's head, laying the sides of the hood on the litter. For
the M40-series protective mask cut the hood shoulder straps,
then cut the quick-doff hood from the front bottom center to
the chin through the elastic band under the chin. Fold the left
and right sides of the hood over the shoulders away from the
head.

(3) =Decontaminate the protective mask and exposed skin.=
Using the SDK, soap and water, or a 0.5 percent hypochlorite
solution, wipe the external parts of the mask. Cover the mask
air inlet(s) with gauze or your hand to keep the mask filter
dry. Continue by wiping the exposed areas of the patient's
face, including the neck and behind the ears.

(4) =Remove the Field Medical Card.= Cut the patient's FMC tie
wire, allowing the FMC to fall into a plastic bag. Seal the
plastic bag and rinse the outside of the bag with a 5 percent
hypochlorite solution. Place the plastic bag with the FMC under
the back of the protective mask head straps. The FMC will
remain with the patient.

_c._ =Step 3. Remove gross contamination from the patient's overgarment.= Remove all visible gross contamination by scraping with a stick or other device.

_d._ =Step 4. Remove the patient's personal effects and protective overgarment.=

(1) =Remove patient's personal effects.= Remove the patient's
personal effects from his protective overgarment and BDU
pockets. Place the articles in a plastic bag, label with the
patient's identification, and seal the bag. If the articles are
not contaminated, return them to the patient. If the articles
are contaminated, place them in the contaminated holding area
until they can be decontaminated, and then return them to the
patient.

(2) =Cut the patient's overgarment.= The overgarment jacket and
trousers may be cut simultaneously. Two persons may be cutting
clothing at the same time. =Cut around bandages, tourniquets,
and splints, leaving them in place.=

NOTE

A cut is a separation of material by use of a cutting device
that cuts material into two pieces. EXAMPLE: Cutting the sleeve
from the cuff to the jacket collar is one cut.

+-----------------------------------------------------------+
| CAUTION |
| |
| Bandages may have been applied to control severe bleeding |
| and are treated like tourniquets. Only medical personnel |
| remove bandages, tourniquets, and splints. |
+-----------------------------------------------------------+

(3) =Remove overgarment jacket.= Make two cuts, one up each
sleeve from the wrist up to the shoulder, and then through
the collar (Figure G-4). Do not allow the gloves to touch the
patient along the cut line. Dip the cutting device in the 5
percent hypochlorite solution before making each cut to prevent
contamination of the patient's uniform or underclothing. Keep
the cuts close to the inside of the arms so that most of the
sleeve material can be folded outward. Unzip the jacket; roll
the chest sections to the respective sides, with the inner
surface outward. Continue by tucking the clothing between
the arm and chest. Roll the cut sleeves away from the arms,
exposing the black liner.

(4) =Remove overgarment trousers.= Cut both trouser legs
starting at the ankle as shown in Figure G-5. Keep the cuts
near the inseams to the crotch. With the left leg, continue
cutting to the waist, avoiding the pockets. With the right leg,
cut across at the crotch to the left leg cut. Place the cutting
device in the 5 percent hypochlorite solution. Fold the cut
trouser halves away from the patient and allow the halves to
drop to the litter with contaminated (green) side down. Roll
the inner leg portion under and between the legs.

(5) =Remove outer gloves.= This procedure can be done with one
person on each side of the patient working simultaneously.
The decontamination team will decontaminate their gloves in 5
percent hypochlorite solution. Next, lift the patient's arms
up and out of the cutaway sleeves unless detrimental to the
patient's condition. Grasp the fingers of the glove, roll the
cuff over the fingers, turning the glove inside out. Do not
remove the inner cotton glove liners at this time. Carefully
lower the arms across the chest after the outer gloves have
been removed (Figure G-6). Do not allow the patient's arms to
come into contact with the exterior of his overgarment. Drop
his gloves into the contaminated waste bag. Dip your gloves in
the 5 percent hypochlorite solution.

(6) =Remove overboots.= Cut the overboot laces and fold the
lacing eyelets flat outwards. If the green vinyl overboot
(GVO) is worn, first try to remove the overboot without
cutting; if necessary, cut the boot along the front. While
standing at the foot of the litter, hold the heel with one
hand, pull overboot downwards, and then pull towards you to
remove the overboot over the combat boot heel. Remove the
two overboots simultaneously. This reduces the likelihood of
contaminating one of the combat boots. While holding the heels
off the litter, have a decontamination team member wipe the
end of the litter with the 5 percent hypochlorite solution to
neutralize any liquid contamination that was transferred to the
litter from the overboots. Lower the patient's heels onto the
decontaminated litter. Place the overboots in the contaminated
waste bag. Decontamination personnel dip their gloves in the 5
percent hypochlorite solution.

_e._ =Step 5. Remove patient's battle dress uniform.=

(1) =Remove battle dress uniform.= Cut the BDU jacket and
trousers as described above for the protective overgarment.
Roll the jacket and trousers as described for the protective
overgarment.

(2) =Remove combat boots.= Cut the bootlaces along the tongue.
Remove the boots by pulling them towards you. Place the boots
in the contaminated waste bag. Do not touch the patient's skin
with contaminated gloves when removing his boots.

(3) =Remove undergarments.= Remove the patient's tee shirt.
Dip the cutting device in the 5 percent hypochlorite solution
between each cut. Cut both sleeves from the inside, starting
at the elbow, up to the armpit. Continue cutting across the
shoulder to the collar. Cut around bandages or splints, leaving
them in place. Next, peel the tee shirt away from the body to
avoid spreading contamination. If the patient is wearing a
brassiere, cut it between the cups. Cut both shoulder straps
where they attach to the cups and lay them back off of the
shoulders. Remove the patient's under shorts/panties by cutting
from the lower side of the hip to the waist on both sides. Fold
the front flap of the shorts/panties down between the patient's
legs onto the litter. Do not allow the outside of the garment
to touch the patient's skin. Remove the socks and cotton glove
liners. Do not remove the patient's identification tags.

_f._ =Step 6. Transfer the patient to a decontamination litter.= After the patient's clothing has been cut away, he is transferred to a decontamination litter or a canvas litter with a plastic sheeting cover. Three decontamination team members decontaminate their gloves and aprons with the 5 percent hypochlorite solution. One member places his hands under the patient's legs at the thighs and Achilles tendons, a second member places his arms under the patient's back and buttocks, and a third member places his arms under the patient's shoulders and supports the head and neck. They carefully lift the patient using their knees (not their backs) to minimize back strain. While the patient is elevated, another decontamination team member removes the litter from the litter stands and replaces it with a decontaminated (clean) litter. The patient is carefully lowered onto the clean litter. The contaminated clothing and overgarments are placed in bags and moved to the contaminated waste dump. The dirty litter is rinsed with the 5 percent hypochlorite solution and placed in the litter storage area.

_g._ =Step 7. Decontaminate skin.=

(1) =Spot decontamination.= With the patient in a supine
position, spot decontaminate the skin using the SDK or a 0.5
percent hypochlorite solution. Decontaminate areas of potential
contamination. Include areas around the neck, wrists, and lower
parts of the face. Decontaminate the patient's identification
tags and chain, if necessary.

NOTE

Complete body wash is not appropriate and may be injurious to
the patient. During complete body wash, the patient would have
to be rolled over to reach all areas of the skin. This is not
necessary for adequate decontamination.

(2) =Trauma specialist care.= During decontamination, the
clothing around bandages, tourniquets, and splints was cut and
left in place.

· The trauma specialist replaces the old tourniquet by placing
a new tourniquet ½ to 1 inch above the old one. He then removes
the old tourniquet and decontaminates the patient's skin using
the M291 pads or a 0.5 percent hypochlorite solution.

· The trauma specialist gently cuts away bandages and
decontaminates the area around the wound; dusts the wound
with the SDK, or irrigates soft tissue wounds with the 0.5
percent hypochlorite solution. If bleeding begins, the
trauma specialist replaces the bandage with a clean one.
The trauma specialist ensures splints are not removed, but
are decontaminated in place by applying the 0.5 percent
hypochlorite solution to them, to include the padding and
cravats. Splints will only be removed by a physician or under
the supervision of a physician.

(3) =Check patient for completeness of decontamination.= The
patient is checked with the CAM or with M8 detector paper for
completeness of decontamination.

NOTE

Other monitoring devices may be used when available.

(4) =Dispose of contaminated waste.= Dispose of contaminated
bandages and coverings by placing them in a contaminated waste
bag. Seal the bag and place it in the contaminated waste dump.

_h._ =Step 8. Transfer the patient across the shuffle pit.=

(1) The patient's clothing has been cut away; his skin,
bandages, and splints have been decontaminated. Now the litter
is transferred to the shuffle pit and placed upon the litter
stands. The shuffle pit is wide enough to prevent the patient
decontamination team members from straddling it while carrying
the litter. Four decontamination team members transfer the
patient to a clean treatment litter in the shuffle pit. A
member of the patient decontamination team removes the bagged
FMC and holds it so that a trauma specialist on the clean side
of the hot line can read it. A trauma specialist on the clean
side of the hot line prepares a new FMC before the patient is
moved to the clean area. The old FMC is disposed of with other
contaminated waste.

(2) Decontamination team members rinse or wipe down their
aprons and gloves with the 5 percent hypochlorite solution.

(3) Three decontamination team members lift the patient off the
decontamination litter (see Step 6 for lifting procedures).

(4) While the patient is elevated, another decontamination
team member removes the litter from the stands and returns
it to the decontamination area. A trauma specialist from the
clean side of the shuffle pit replaces the litter with a clean
one. The patient is lowered onto the clean litter. Two trauma
specialists from the clean side of the shuffle pit move the
patient to the clean treatment area. The patient is treated
in this area or waits for processing into the CPS. The litter
removed by the decontamination team member is wiped down with
the 5 percent hypochlorite solution in preparation for reuse.

NOTE

Before decontaminating another patient, each decontamination
team member drinks approximately one-half quart of water.
The exact amount of water consumed is increased or decreased
according to the temperature (see Table G-2 below).

_Table G-2. Heat Injury Prevention and Water Consumption._

===========+=========+===============+================+===============
| | EASY WORK | MODERATE WORK | HARD WORK
| +-------+-------+-------+--------+-------+-------
HEAT | WBGT | WORK/ | WATER | WORK/ | WATER | WORK/ | WATER
CATEGORY | INDEX | REST | INTAKE| REST | INTAKE | REST | INTAKE
|DEGREES F| MIN | QT/HR | MIN | QT/HR | MIN | QT/HR
-----------+---------+-------+-------+-------+--------+-------+-------
1 (WHITE) | 78-81.9 | NL | ½ | NL | ¾ | 40/20 | ¾
2 (GREEN) | 82-84.9 | NL | ½ | 50/10 | ¾ | 30/30 | 1
3 (YELLOW)| 85-87.9 | NL | ¾ | 40/20 | ¾ | 30/30 | 1
4 (RED) | 88-89.9 | NL | ¾ | 30/30 | ¾ | 20/40 | 1
5 (BLACK) | >90 | 50/10 | 1 | 20/40 | 1 | 10/50 | 1
-----------+---------+-------+-------+-------+--------+-------+-------

THE WORK/REST TIMES AND FLUID REPLACEMENT VOLUMES WILL SUSTAIN
PERFORMANCE AND HYDRATION FOR AT LEAST 4 HOURS OF WORK IN THE
SPECIFIED HEAT CATEGORY.

NL=NO LIMIT TO WORK TIME PER HOUR.

REST MEANS MINIMAL PHYSICAL ACTIVITY (SITTING OR STANDING) ACCOMPLISHED
IN SHADE, IF POSSIBLE.

CAUTION: HOURLY FLUID INTAKE SHOULD NOT EXCEED 1 QUART.

DAILY FLUID INTAKE SHOULD NOT EXCEED 12 QUARTS.

WEARING BODY ARMOR ADDS 5° F TO WBGT INDEX.

WEARING ALL MOPP OVERGARMENTS ADDS 10° F TO WBGT INDEX.

+----------------------------------------------------------+
| =WARNING= |
| |
| Do not exceed a fluid intake of 1 quart per hour. Do not |
| exceed a fluid intake of 12 quarts per day. |
| |
+----------------------------------------------------------+

G-11. Decontaminate an Ambulatory Chemical Agent Patient

_a._ All ambulatory patients requiring EMT or ATM in the clean area of the BAS will be decontaminated. A member of the decontamination team or other ambulatory patients will assist the patient in removing his clothing and decontaminating his skin.

_b._ Patients requiring only minimal care will undergo spot decontamination of their MOPP gear as required for their medical treatment. They will be treated in the contaminated EMT area and returned to duty. They will undergo decontamination and a MOPP gear exchange with their unit.

_c._ Stable patients not requiring treatment at the BAS, but requiring evacuation to a higher level of care for treatment (example: A patient with a broken arm) should be evacuated in MOPP Level 4 by any available transportation. However, before evacuation, spot remove all thickened/persistent agents from protective clothing.

NOTES

1. Remember, do not remove clothing from an ambulatory patient
unless he requires treatment in the clean treatment area of the
BAS or clearing station. Only spot decontaminate the patient's
clothing and evacuate him to the next level of care.

2. Place cutting device used in this procedure in a container
of 5 percent hypochlorite solution when not in use. Most
ambulatory patients will be treated in the contaminated
treatment area and returned to duty. Upon removal of an
ambulatory patient's clothing, he becomes a litter patient. The
BAS and clearing station do not have clothing to replace those
cut off during the decontamination process. The patient must
be placed in a PPW for protection during evacuation. 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
carbon dioxide buildup inside the PPW (Figure G-7).

_d._ =Step 1. Remove load-carrying equipment.= Remove load-carrying equipment (LCE) by unfastening/unbuttoning all connectors or tie straps; then place the equipment in a plastic bag. Place the plastic bag in the designated storage area for later decontamination.

_e._ =Step 2. Decontaminate the patient's mask and hood.= After the patient has been triaged and treated (if necessary) by the senior trauma specialist in the PDS, the patient (assisted by another ambulatory patient or a member of the patient decontamination team, if necessary) begins the clothing removal process.

(1) =Decontaminate and remove mask hood.= Sponge down the
front, sides, and top of the hood with a 5 percent hypochlorite
solution. Remove the hood by cutting (Figure G-3) or, with
the quick-doff hood or other hoods, by loosening the hood
from the mask attachment points. Before cutting the hood, dip
the cutting device in the 5 percent hypochlorite solution.
Begin by cutting the neck cord and the small string under the
voicemitter. Next, release or cut the hood shoulder straps and
unzip the hood zipper. Proceed by cutting the hood upward,
close to the filter inlet cover and eye-lens outserts, to the
top of the eye-lens outsert, across the forehead to the outer
edge of the other eye-lens outsert. Proceed downward toward
the patient's shoulder, staying close to the eye-lens and
filter inlet. Cut across the lower part of the voicemitter to
the zipper. After dipping the cutting device in the 5 percent
hypochlorite solution again, cut the hood from the center of
the forehead over the top of the head and fold the right and
left sides of the hood away from the patient's head, removing
the hood.

(2) =Decontaminate the mask and patient's face.= Decontaminate
the mask and the patient's face by using the SDK or a 0.5
percent hypochlorite solution. Wipe the external parts of the
mask; cover both mask air inlets with gauze or your hands to
keep the mask filters dry. Continue by wiping the exposed areas
of the patient's face, to include the neck and behind the ears.

_f._ =Step 3. Remove Field Medical Card.= Cut the FMC tie wire, allowing the card to fall into a plastic bag. Seal the plastic bag and rinse it with the 5 percent hypochlorite solution. Place the plastic bag under the back of the protective mask head straps.

_g._ =Step 4. Remove all gross contamination from the patient's overgarment.= Remove all visible contamination spots by using the SDK (preferred method) or a sponge dipped in a 5 percent hypochlorite solution.

_h._ =Step 5. Remove overgarments.=

(1) =Remove the patient's personal effects.= Place the
patient's personal effects in a clean bag and label with the
patient's identification. If they are not contaminated, give
them to him. If his personal effects are contaminated, place
the bagged items in the contaminated storage area until they
can be decontaminated, then return them to the patient.

(2) =Remove overgarment jacket.= Have the patient stand with
his feet spread apart at shoulder width. Unsnap the jacket
front flap and unzip the jacket. If the patient can extend his
arms, have him clinch his fists and extend his arms backward
at about a 30° angle. Move behind the patient, grasping his
jacket collar at the sides of the neck, peel the jacket off
the shoulders at a 30° angle down and away from the patient.
Avoid any rapid or sharp jerks that can spread contamination.
Gently pull the inside sleeves over the patient's wrists and
hands. If the patient cannot extend his arms, you must cut the
jacket to aid in its removal. Dip the cutting device in the 5
percent hypochlorite solution between each cut. As with the
litter patient, cut both sleeves from the inside, starting
at the wrist, up to the armpit. Continue cutting across the
shoulder to the collar. Cut around bandages or splints, leaving
them in place. Next, peel the jacket back and downward to avoid
spreading contamination. Ensure that the outside of the jacket
does not touch the patient or his inner clothing.

(3) =Remove overgarment trousers.= Unfasten or cut all ties,
buttons, or zippers before grasping the trousers at the waist
and peeling them down over the patient's combat boots. Again,
the trousers are cut to aid in removal. If necessary, cut both
trouser legs starting at the ankle, keeping the cuts near the
inside of the legs, along the inseam, to the crotch. Cut around
all bandages, tourniquets, or splints. Continue to cut up both
sides of the zipper to the waist and allow the narrow strip
with the zipper to drop between the legs. Place the cutting
device in the 5 percent hypochlorite solution. Peel or allow
the trouser halves to drop to the ground. Have the patient step
out of the trouser legs, one at a time. Place the trousers in
the contaminated disposal bag.

(4) =Remove overboots.= Remove the patient's overboots by
cutting the laces with cutting device dipped in the 5 percent
hypochlorite solution. Fold the lacing eyelets flat on the
ground. Step on the toe and heel eyelets to hold the overboot
on the ground and have the patient step out of it. Repeat this
procedure for the other overboot. If the GVO are worn, first
try to remove the overboots without cutting; if necessary, cut
the overboots along the front. If the overboots are in good
condition, they can be decontaminated and reissued.

(5) =Remove the patient's outer gloves.= Grasp the heel of the
glove, peel the glove off with a smooth downward motion. Place
the contaminated gloves in a plastic bag with the overgarment
jacket. Do not allow the patient to touch his clothing or other
contaminated objects with his exposed hands.

(6) =Remove the patient's cotton glove liners.= Have the
patient remove his cotton glove liners to reduce the
possibility of spreading contamination. Have the patient grasp
the heel of one glove liner with the other gloved hand, peeling
it off of his hand. Hold the removed glove by the inside and
grasp the heel of the other glove, peeling it off of his hand.
Place both glove inserts in the contaminated waste bag.

_i._ =Step 6. Remove patients BDU.=

(2) =Remove BDU jacket.= Have the patient stand with his feet
spread apart at shoulder width. Unbutton the front flap of the
jacket. If the patient can extend his arms, have him clinch
his fists and extend his arms backward at about a 30° angle.
Move behind the patient, grasping his jacket collar at the
sides of the neck, peel the jacket off the shoulders at a 30°
angle down and away from the patient. Avoid any rapid or sharp
jerks that can spread contamination. Gently pull the inside
sleeves over the patient's wrists and hands. If the patient
cannot extend his arms, you must cut the jacket to aid in its
removal. Dip the cutting device in the 5 percent hypochlorite
solution between each cut. As with the litter patient, cut
both sleeves from the inside, starting at the wrist, up to the
armpit. Continue cutting across the shoulder to the collar. Cut
around bandages or splints, leaving them in place. Next, peel
the jacket back and downward to avoid spreading contamination.
Ensure that the outside of the jacket does not touch the
patient or his inner clothing.

(3) =Remove BDU trousers.= Unfasten or cut all ties, buttons,
or zippers before grasping the trousers at the waist and
peeling them down over the patient's combat boots. Again, the
trousers are cut to aid in removal. If necessary, cut both
trouser legs starting at the ankle, keeping the cuts near the
inside of the legs, along the inseam, to the crotch. Cut around
all bandages, tourniquets, or splints. Continue to cut up both
sides of the zipper to the waist and allow the narrow strip
with the zipper to drop between the legs. Place the cutting
device in the 5 percent hypochlorite solution. Peel or allow
the trouser halves to drop to the ground. Have the patient step
out of the trouser legs, one at a time. Place the trousers in
the contaminated disposal bag.

(4) =Remove undergarments.= Remove the patient's tee shirt.
Dip the cutting device in the 5 percent hypochlorite solution
between each cut. Cut both sleeves from the inside, starting
at the elbow, up to the armpit. Continue cutting across the
shoulder to the collar. Cut around bandages or splints, leaving
them in place. Next, peel the tee shirt away from the body to
avoid spreading contamination. If the patient is wearing a
brassiere, cut it between the cups. Cut both shoulder straps
where they attach to the cups and lay them back off of the
shoulders. Remove the patient's under shorts/panties by cutting
from the lower side of the hip to the waist on both sides.
Allow the shorts/panties to fall to the ground. Do not remove
the patient's identification tags.

_j._ =Step 7. Check patient for contamination.= After the patient's BDU and underwear has been removed check the skin for contamination by using M8 detector paper or the CAM. Carefully survey all areas of the patient's skin, paying particular attention to areas around the neck, wrist, ears, and dressings, splints, or tourniquets.

_k._ =Step 8. Decontaminate skin.=

(1) =Spot decontamination.= Use the SDK or the 0.5 percent
hypochlorite solution to spot decontaminate exposed neck
and wrist areas, splints, other areas where the protective
overgarment was damaged, and where dressings or bandages were
removed. Decontaminate the patient's identification tags, if
necessary. Have the patient hold his breath and close his
eyes. Have him, or assist him, lift his mask at the chin. Wipe
his face with the M291 pad or the 0.5 percent hypochlorite
solution. Wipe quickly from below the top of one ear, being
careful to wipe all folds of the skin, top of the upper lip,
chin, dimples, earlobes, and nose. Continue up the other side
of the face to the top of the other ear. Wipe the inside of the
mask where it touches the face. Have the patient reseal and
check his mask.

(2) =Trauma specialist care.= During clothing removal, the
clothing around bandages, tourniquets, and splints was cut and
left in place.

· The trauma specialist replaces the old tourniquet by placing
a new one ½ to 1 inch above the old tourniquet. When the old
tourniquet is removed, the skin is decontaminated with the SDK
or the 0.5 percent hypochlorite solution.

· _Do not remove splints._ Decontaminate them by thoroughly
rinsing the splint, padding, and cravats with the 0.5 percent
hypochlorite solution.

· Usually, the trauma specialist will gently cut away bandages.
The area around the wound is dusted with the M291 pad or rinsed
with the 0.5 percent hypochlorite solution, and the trauma
specialist applies the M291 pad or irrigates the soft tissue
wound with the 0.5 percent hypochlorite solution. If bleeding
begins, the trauma specialist replaces the bandage with a clean
one.

_l._ =Step 9. Dispose of contaminated waste.= Dispose of contaminated bandages and coverings by placing them in a plastic bag and sealing the bag with tape. Place the plastic bags in the contaminated waste dump.

_m._ =Step 10. Proceed through the shuffle pit to the clean treatment area.= Have the decontaminated patient proceed through the shuffle pit to the clean treatment area. Make sure that the patient's boots are thoroughly decontaminated by stirring the contents of the shuffle pit with his boots as he crosses it. The patient will remove his combat boots and socks at the entrance of the clean treatment area or CPS; remove the protective mask at the entrance to the clean treatment area or inside the ambulatory air lock of the CPS.

G-12. Biological Patient Decontamination Procedures

The decontamination station as established for chemical agent patients is also used for biologically contaminated patients. The eight-man patient decontamination team is required for biologically contaminated patient decontamination procedures.

G-13. Decontaminate a Litter Biological Agent Patient

_a._ =Remove the patient's personal effects.= Place the patient's personal effects in a clean bag and label with the patient's identification. If they are not contaminated, give them to him. If his personal effects are contaminated, place the bagged items in the contaminated storage area until they can be decontaminated, and then return them to the patient.

_b._ =Remove the Field Medical Card.= Remove the FMC by cutting the tie wire and allowing the FMC to drop into a plastic bag. Keep the FMC with the patient.

_c._ =Remove the patient's clothing.= Patient decontamination team members first apply the 5 percent hypochlorite solution to the patient's clothing and the litter. Then, remove the patient's clothing as in decontamination of chemical agent patients. Bandages, tourniquets, and splints are not removed. Move patient to a clean litter as described for a chemical agent patient. Place patient's clothing in a plastic bag and dispose in the contaminated waste dump.

_d._ =Decontaminate the patient's skin.= Bathe the patient with soap and warm water or apply the 0.5 percent hypochlorite solution. The trauma specialist places a new tourniquet ½ to 1 inch above the old tourniquet, and then he removes the old one. The trauma specialist removes bandages and decontaminates the skin and wound with the 0.5 percent hypochlorite solution; he replaces the bandage, if needed, to control hemorrhage. Splints are disinfected by soaking the splint, cravats, and straps with the 0.5 percent hypochlorite solution.

NOTE

Use a 0.5 percent hypochlorite solution to decontaminate
patients suspected of being contaminated with mycotoxins.

_e._ =Transfer patient to hot line.= Two decontamination team members move patient to the hot line. Request assistance from two other decontamination team members to transfer him to a clean litter as described for chemical agent patients. Place the patient's FMC in the plastic bag on the clean litter with him. Two trauma specialists from the clean side of the hot line move the patient from the hot line to the clean treatment/holding area.

G-14. Decontaminate an Ambulatory Biological Agent Patient

_b._ =Remove the Field Medical Card.= Remove the FMC by cutting the tie wire and allowing the FMC to drop into a plastic bag. Keep the FMC with the patient.

_c._ =Remove the patient's clothing.= Patient decontamination team members first apply the 5 percent hypochlorite solution to the patient's clothing. Then remove the patient's clothing as in decontamination of chemical agent patients. Bandages, tourniquets, and splints are not removed. Place patient's clothing in a plastic bag and dispose in the contaminated waste dump.

_d._ =Decontaminate the patient's skin.= Have the patient bathe with soap and warm water or apply the 0.5 percent hypochlorite solution. If the patient is unable to bathe himself, a member of the decontamination team must bathe him. The trauma specialist places a new tourniquet ½ to 1 inch above the old tourniquet, and then he removes the old one. The trauma specialist removes bandages and decontaminates the skin and wound with the 0.5 percent hypochlorite solution; he replaces the bandage, if needed, to control hemorrhage. Splints are disinfected by soaking the splint, cravats, and straps with the 0.5 percent hypochlorite solution.

NOTE

Use a 0.5 percent hypochlorite solution to decontaminate
ambulatory patients suspected of being contaminated with
mycotoxins.

_e._ =Direct patient across hot line.= Direct the patient to cross the hot line to the clean treatment area. His boots must be decontaminated at the hot line before he enters the clean treatment area.

NOTES

2. Place cutting device used in this procedure in a container
of 5 percent hypochlorite solution when not in use. Most
ambulatory patients will be treated in the contaminated
treatment area and returned to duty. Upon removal of an
ambulatory patient's clothing, he becomes a litter patient. The
BAS and clearing station do not have clothing to replace those
cut off during the decontamination process. The patient must be
placed in a PPW for protection during evacuation (Figure G-7).

G-15. Decontaminate Nuclear-Contaminated Patients

The practical decontamination of nuclear-contaminated patients is easily accomplished without interfering with the required medical care.

NOTE

Patients must be monitored by using a radiac meter (AN/VDR2,
AN/PDR27, or AN/PDR77) before, during, and after each step of
the decontamination procedure.

G-16. Decontaminate a Litter Nuclear-Contaminated Patient

_a._ =Remove patient's personal effects.= Patient decontamination team members remove the patient's personal effects and place them in a plastic bag. Place plastic bag in a clean holding area.

_b._ =Remove patient's clothing.= Patient decontamination team members remove the patient's outer clothing as described for chemical agent patients. Do not remove bandages, tourniquets, or splints. Move the patient to a clean litter. Place the patient's contaminated clothing in a plastic bag and move the bagged clothing to the contaminated waste dump.

NOTE

Patients arriving at the MTF in MOPP will only have their MOPP
removed. They can remain in their BDU unless contamination is
found on it.

_c._ =Spot decontaminate patient's skin.= Wash exposed skin surfaces with soap and warm water. Wash the hair with soap and warm water, or clip the hair and wash the scalp with soap and warm water.

_d._ =Transfer patient to hot line.= Move the patient to the hot line. Two trauma specialists from the clean side of the hot line move the patient into the clean treatment area.

G-17. Decontaminate an Ambulatory Nuclear-Contaminated Patient

_a._ =Remove patient's personal effects.= Have the patient remove his personal effects and place them in a plastic bag.

_b._ =Remove patient's outer clothing.= Have the patient remove his outer clothing (or have a decontamination team member assist him). Place his contaminated clothing in a plastic bag and move the bagged clothing to the contaminated waste dump.

NOTE

Patients arriving at the MTF in MOPP will only have their
MOPP removed. They can remain ambulatory in their BDU unless
contamination is found on it.

_c._ =Spot decontaminate patient's skin.= Have the patient wash his exposed skin surfaces with soap and warm water. Wash his hair with soap and water, or clip the hair and wash the scalp with soap and water.

_d._ =Transfer patient to hot line.= Direct the patient to move to the hot line. Decontaminate his boots by stirring the shuffle pit contents with his feet before he crosses into the clean treatment area.

NOTE

If a new protective overgarment is not available, after
treatment, the ambulatory patient must be placed in a PPW for
protection during MEDEVAC to the next level of care MTF. Thus,
he becomes a litter patient for evacuation.

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Health Service Support in a Nuclear, Biological, and Chemical EnvironmentChapter XXVIII: Section II: Patient Decontamination Procedures

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