ATTACHMENT 2 EMDT TTP 7 Apr 05.pdf

BY ORDER OF

THE SECRETARY OF THE AIR FORCE

AIR FORCE TACTICS, TECHNIQUES, AND

PROCEDURES 3-42.33

APR 7 2005

Tactical Doctrine

EXPEDITIONARY MEDICAL DECONT AMINA TION TEAM

NOTICE: This publication is available digitally on the sa WWW site at:

h ttps:1 /kx.afms.mil.

OPR: ACC/SGX Certified by: HQ USAF/SGG (Maj Gen Joseph E. Kelley)

Pages: 23 Distribution: F

PURPOSE: The Air Force Tactics, Techniques, and Procedures (AFTTP) 3-42 series of publications is the primary reference for medical combat support capability. This document, AFTTP 3-42.33, provides tactics, techniques, and procedures (TTP) for the Expeditionary Medical Decontamination Team (EMDT).

APPLICATION: This publication applies to all Air Force military and civilian personnel (including Air Force Reserve Command [AFRC] and Air National Guard [ANG] units and members). The doctrine in this document is authoritative but not directive.

SCOPE: The primary mission of the EMDT is to provide capability to remove, neutralize, or lower the levels of chemical, biological, radiological and nuclear (CBRN) agents, as well as toxic industrial chemicals and materials (TICs/TIMs) from patients, immediately prior to being permitted into a Medical Treatment Facility (MTF) in a deployed environment. Ensure that all records created by this TTP are maintained and disposed of lAW AFMAN 37-139, "Records Disposition Schedule."

USAF, MC, CFS

V Assistant Health Care Operations

Office of the Surgeon General

AFTTP 3-42.33 2

TABLE OF CONTENTS

Chapter 1—INTRODUCTION

1.1. Purpose

1.2. Background

1.3. Roles and Responsibilities

1.4. Threat

Chapter 2—DESCRIPTION AND CAPABILITY

2.1. Mission/Tasks

2.2. Description

2.3. Capabilities

Chapter 3—OPERATIONS

3.1. Introduction

3.2. Employment

3.3. Deployment/Re-Deployment

Chapter 4—ADDITIONAL INFORMATION

4.1. Command and Control

4.2. Intelligence Support

4.3. Communications/Information System Support

4.4. Integration/Interoperability with Other System

4.5. Security

4.6. Training

4.7. Logistics

ATTACHMENT 1—GLOSSARY OF REFERENCES AND SUPPORTING

INFORMATION

ATTACHMENT 2—CASUALTY PROCESSING

AFTTP 3-42.33 3

Chapter 1

INTRODUCTION

1.1. Purpose. This document describes the tactics, techniques, and procedures for the Expeditionary Medical Decontamination Team (EMDT), Unit Type Code (UTC) FFGLB. The EMDT provides capability to remove, neutralize or lower the levels of chemical, biological, radiological, and nuclear agents from casualties prior to admission to a Medical Treatment Facility (MTF) in a deployed environment.

1.2. Background. For this TTP, decontamination is defined as the removal, neutralization or lowering of external toxic industrial chemicals/toxic industrial materials (TICs/TIMs), radioactive particles, biological warfare agents, and chemical warfare agents to levels that allow the treatment of casualties without contaminating medical facilities or unprotected medical personnel. Decontamination does not imply absolute removal of contaminants. Definitive decontamination of casualties exposed to radioactive particles (fallout) may be required in the course of treatment. Such definitive levels of radiation monitoring and wound/internal decontamination are appropriate for third and fourth echelon MTFs and are beyond the scope of this TTP.

1.3. Roles and Responsibilities.

1.3.1. HQ USAF/SG serves as the Air Force OPR for providing resources, establishment of doctrine, procedures, and training requirements for medical decontamination.

1.3.2. HQ ACC/SG serves as the Manpower and Equipment Force Packaging System (MEFPAK) manager for FFGLB and FFGLA UTCs.

1.3.3. Deployed Medical Commander (DMC).

1.3.3.1. Ensures operational contingency plans include appropriate provisions to conduct and support medical decontamination when appropriate.

1.3.3.2. Activates the decontamination team and facility based on introduction of CBRN agents as well as TICs/TIMs weapons or threat assessment. Deactivates when the threat conditions allow.

1.3.3.3. Establishes procedures to determine if patients presenting to the Deployed Medical Facility (DMF) need to be decontaminated. For example, in the case of the Air Forces counter-chemical warfare concept of operations, patients coming from uncontaminated sectors may not need to be decontaminated.

1.3.3.4. Determines pre-decontamination triage priorities and to what extent definitive medical treatment will be administered to contaminated casualties prior to and during decontamination.

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1.3.3.5. Reports suspected and/or confirmed CBRN contamination of personnel, equipment and/or facilities to higher headquarters medical authority and to base operational facility/nuclear, biological and chemical (NBC) cell or equivalent.

1.3.3.6. Ensures the EMDT has appropriate expeditionary combat support (ECS). This includes but is not limited to water, electricity, security, billeting and subsistence.

1.3.3.7. Ensures bioenvironmental engineering personnel evaluate contamination avoidance and contamination control procedures to ensure the DMF does not become contaminated. Bioenvironmental engineering personnel will advise on detection, identification and neutralization issues as they pertain to the EMDT operations.

1.3.4. In-Garrison MTF Commanders with EMDTs.

1.3.4.1. Ensures the EMDT is appropriately manned, trained and equipped. Personnel appointed to the EMDT should be of sufficient physical stature to perform frequent litter carries and strenuous manual labor in full NBC/TIM protective ensemble.

1.3.4.2. Ensures the EMDT team chief and alternate team chief attend the USAFSAM Contingency/Counter-terrorism DECON course (B3AZYDECON-000). Information on this course can be found on their website at http://wwwsam.brooks.af.mil/. Members may also attend the courses provided by The United States Army Medical Research Institute for Chemical Defense (USAMRICD). Information on these courses can be found on their website at the AF Link https://ccc.apgea.army.mil/air_force/afhome or Army Link at https://ccc.apgea.army.mil/.

1.3.5. EMDT Team Chief.

1.3.5.1. Ensures EMDT training is accomplished as required and the team is able to perform according to the capabilities and operations described in chapter 2 and chapter 3.

1.3.5.2. Directly supervises EMDT operations and ensures they are incorporated into the DMTF operations.

1.3.5.3. Identifies manning/equipment/supply shortfalls and/or limiting factors to the DMC for resolution within 6 hours of arrival. Provides status of shortfalls/limiting factors at regular intervals or as directed.

1.3.5.4. Secures ECS for the EMD:

1.3.5.4.1. Ensures plans are in place to fill water bladders, provide electrical power, leveling and grading of tent area, and dispose of gray water, and contaminated materials within 24 hours of arrival at deployed location.

1.3.5.4.2. Coordinates water storage/disposal with the Preventive Medicine (PAM) Team and Civil Engineers (CE).

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1.3.5.4.3. Ensures ECS shortfalls are briefed to the DMC within 6 hours.

1.4. Threat. The National Air Intelligence Center-developed “Threat Compendium, Worldwide Threat to Air Bases: 1995-2005,” NAIC-2660F-265-95, 1 Sep 94, is the baseline threat reference for air base operability. Because of the wide variety of possible operating locations and potential adversaries, a broad range of air and ground threats can be expected. These include a mix of iron bombs, precision guided munitions, anti-personnel/vehicle mines, chemical/biological weapons, nuclear radiation/fallout, saboteurs, special operations forces and general-purpose offensive ground forces.

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Chapter 2

DESCRIPTION AND CAPABILITY

2.1. Mission/Tasks. The primary mission of the EMDT is to safeguard the DMF’s medical capability by decontaminating casualties so they do not pose a significant threat to medical providers and staff as well as the facility. The secondary mission of the EMDT is to save life and limb of contaminated casualties by decontaminating them and providing lifesaving medical care during the decontamination process. The need for decontamination (DECON) capabilities must be included in the deliberate planning process for deployable and forward-based DMFs when Operational Plans (OPLANs) envision the receipt of contaminated casualties. UTCs FFGLA and FFGLB must be represented in Time Phased Force Deployment Documents (TPFDDs) for these OPLANs.

2.2. Description.

2.2.1. Manpower: UTC FFGLB is composed of a 19-member team led by a Physician Assistant (AFSC 042G3). Two teams should be provided for each DMF where a CBRN/ TICs/TIMS threat exists. Maximum substitution level of 50% identified in Annex F of WMP-1 may be exceeded. The 42G3 may only be substituted with an EMT certified 4N071.

No substitutions authorized for 4N071s. All other positions may be substituted by any AFSC 4XXXX. Notes: Personnel appointed to this UTC must be of sufficient stature and physical condition to perform frequent litter carries and strenuous manual labor in full NBC/TIM protective ensemble. All EMDT members are responsible for the full scope of team activities as directed by the Team Chief.

2.2.2. Equipment and Supplies: UTC FFGLA is the equipment package required to provide wet decontamination of casualties. The FFGLA allowance standard also provides limited wound and airway management supplies.

2.2.3. Decontamination Site: Medical Decontamination Facility is constructed near the MTF (future enhancements will allow the two facilities to be connected through a Bump-thru-Door Airlock) and will be fully operational within six hours of arrival contingent on ECS. Optimal requirements for a Medical Decontamination Facility site include a 100 ft x 100 ft graded pad near the supported MTF. Medical Decontamination Facility site preparation/erection should be prioritized as part of installation bed-down planning based on the threat and achieving full operational capability (FOC) within 6 hours. The Medical Decontamination Facility will be located downwind or crosswind (using prevailing wind direction), and oriented so arriving vehicles/casualties can reach it without approaching the MTF.

2.3. Capabilities. UTC FFGLB is fully capable of:

2.3.1. Deploying with the FFGLA assemblage to support a deployed, forward-based, or other fixed MTF.

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2.3.2. Deploying independently of the FFGLA to strengthen or replace a currently deployed FFGLB or to link-up with a pre-positioned FFGLA or forward-based decontamination facility.

2.3.3. Being permanently assigned as members of a forward-based MTF. The 19 member EMDT is designed to operate one 12-hour shift, if 24-hour operations are required, a second FFGLB should be deployed.

2.3.4. When possible, one of the deployed EMDTs (personnel and equipment packages) should be attached to deployed MTF from the same home station. Team integrity and equipment ownership will enhance mission accomplishment.

2.3.5. One 19-member EMDT can simultaneously process an average of 15 non-ambulatory and 15 ambulatory casualties per hour. This rate may be affected by environmental conditions and duration of operations.

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Chapter 3

OPERATIONS

3.1. Introduction. Personnel UTC FFGLB consists of a 19-member team led by a Physician Assistant (PA) or a second EMT certified 4N071. Equipment UTC FFGLA provides wet decontamination for patients. Throughput rates average 15 non-ambulatory and 15 ambulatory patients per hour. Two personnel packages and one equipment package are deployed in direct support of DMFs operating in NBC-threat environments. The DMC activates the team when NBC or TICs/TIMs have been threatened or employed. Casualties will be decontaminated using accepted procedures.

3.2. Employment.

3.2.1. When activated, arriving casualties are directed to the medical decontamination triage area where an EMDT member ascertains if contamination is present. This is based on patient’s M-8 paper, symptoms, local intelligence, sector of the base from which patient originated. Use the M291 Skin Decontamination Kit to remove obvious contamination from the patient.

3.2.2. The EMDT and MTF personnel unload contaminated casualties at the entrance of the medical decontamination facility. Casualties are triaged, administered nerve agent antidote (when appropriate by the PA or senior 4N), then decontaminated. Contaminated casualties are directed through the medical decontamination facility. Non-contaminated casualties are directed around the medical decontamination facility to the MTF. Litter and ambulatory patients can be processed simultaneously. Triage and wound/airway management must continually be reassessed throughout the decontamination process.

3.2.3. Decontamination is accomplished by clothing removal and skin washing. EMDT members are dressed in Kappler Chemically Protective Fabric suits and PAPRs when performing decontamination operations. Testing conducted at Dugway Proving Grounds determined that using the equipment and proper procedures established in this document reduce contamination to negligible levels.

3.2.4. Following successful decontamination, casualties are moved by EMDT members from the medical decontamination facility to the patient exchange point immediately outside the exit. Upon exit from the medical decontamination facility the casualty is turned over to MTF personnel as appropriate. After decontamination, triage must be reaccomplished as patient status may change during the decontamination process.

3.2.4.1. When the MTF is not collectively protected, the patient will be transported across the vapor hazard buffer before removing the casualty mask. The mask will be placed in a plastic bag and will remain with the patient or stored for quick retrieval in the event of a future chemical attack. The casualty then enters through the normal MTF triage process.

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3.2.4.2. When the MTF is collectively protected, the EMDT will place the patient in the air lock between the medical decontamination facility and the Collectively Protected EMEDS/Air Force Theater Hospital (CPEMEDS/AFTH). At the CPEMEDS/AFTH the patient is processed through the purge cycle of the litter air lock, the inner door of the air lock is opened, and the mask is then removed. The mask will be placed in a plastic bag and will remain with the patient or stored for quick retrieval in the event of a future chemical attack. The patient is subsequently moved from the air lock into the MTF facility for triage and further treatment.

3.2.5. Step-by-step patient decontamination procedures for medical decontamination are outlined in Attachment 2.

3.3. Deployment/ReDeployment. EMDTs are deployed in direct support of DMFs operating in CBRN/TIC/TIM threat environments. These teams are assigned to the supported MTF.

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Chapter 4

ADDITIONAL INFORMATION

4.1. Command and Control. EMDTs are assigned to the supported MTF. The MTF Commander is responsible for ensuring EMDTs are manned, trained and equipped to perform their mission. The EMDT chief is responsible for administration and oversight of all EMDT training and operations. The MTF will summarize manning, material, equipment, and other relevant issues as part of the MEDRED-C when local resolutions are unavailable.

4.2. Intelligence Support. EMDT Chief is responsible for coordinating with the Medical Intelligence Officer/NCO (MIO/NCO) and NBC Medical Defense Officer (MDO) to secure current intelligence on CBRN/TIC/TIM threats, delivery systems, and probability of attack.

4.3. Communications/Information Systems Support. A landline (telephone) or radio must be supplied to facilitate communication between the Medical Decontamination site and the MTF during operations.

4.3.1. The EMDT Chief maintains constant communication with the MTF during contamination control activities to advise of patient rates, injury types, CBRN/TIC/TIM agents identified, resupply needs and additional manpower requirements.

4.3.2. The EMDT Chief should gather necessary information from Deployed MIO and MDO to increase understanding of actual threat.

4.4. Integration/Interoperability with other systems. The EMDT integrates with the DMF or other deployed medical unit. The DMF/CC may utilize EMDT personnel to perform other duties as required. All equipment and shelters are compatible with CPEMEDS and EMEDS/AFTH.

4.5. Security. The Medical Decontamination Facility must be encompassed by the DMF security perimeter. Approaches to the perimeter must be controlled to prevent theft of assets and accidental NBC/TIM agent contamination.

4.6. Training. All MTFs will comply with the contingency training requirements of AFI 41- 106, Medical Readiness Planning and Training and MAJCOM supplements for decontamination team training.

4.6.1. Decontamination training will be conducted using the actual War Reserve Material (WRM), as specified in AFI 41-106. The training should be realistic and include the impacts of shift rotation and heat stress. Units assigned a FFGLB personnel package without access to an FFGLA must develop a training plan to meet the intent of the regulation.

4.6.2. MTFs with UTC FFGLA will conduct an annual inventory and familiarization training session in conjunction with medical logistics personnel. This process will include actual shelter erection, equipment operation/serviceability checks, and replacement of expired supply items.

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4.7. Logistics. There are several logistical considerations that must be coordinated prior to arrival at the EMDT set up area. The EMDT team chief must ensure the following ECS is available.

4.7.1. Water must be available from ECS to keep the water storage bladder full.

Up to 3000 gallons of gray water may be temporarily stored in the gray water confinement bladder. All contaminated material must be managed and disposed of in accordance with Status of Forces Agreements (SOFA), Final Governing Standards or the Overseas Baseline Environmental Governing Standards and installation policies as applicable. NOTE: PAM team and Civil Engineering can advise and provide assistance on final disposal of contaminated waste.

4.7.2. Coordinate all modifications or support requirements through the MTF Commander with appropriate ECS agencies.

4.7.3. Movement of the FFGLA equipment pallets to the Medical Decontamination site will require 13K all terrain forklift support.

4.7.4. Coordinate a toxic waste dump area for contaminated bandages and clothing as well as a process for cleaning up the dump area during and after the operation.

4.7.5. Coordinate all power and electrical requirement.

4.7.6. Base supply will provide the equipment to the medical facility out of existing protective equipment stocks or from deployed forces equipment.

4.7.7. Coordinate with MTF for adequate medical supplies and antidotes.

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Attachment 1

GLOSSARY OF REFERENCES AND SUPPORTING INFORMATION

Abbreviations and Acronyms ACC Air Combat Command AFSC Air Force Specialty Code AFTH Air Force Theater Hospital BDO battle dress overgarment BDU battle dress uniform BW biological warfare CE civil engineer CFMN craftsman CONOPS concept of operations CONPLAN contingency plan CW chemical warfare DECON decontamination DOC designed operation capability ECS expeditionary combat support EMDT expeditionary medical decontamination team EMT emergency medical technician EMEDS expeditionary medical support GCE ground crew ensemble JNMN journeyman JSLIST Joint Service Lightweight Integrated Suit Technology LHA liquid hazard area MEFPAK manpower and equipment force packaging MERIT medical evaluation of readiness in individual training MOPP mission oriented protective posture MTF medical treatment facility NAIC national air intelligence center NARP nuclear weapon accident procedures NATO North Atlantic Treaty Organization NBC/TIM Nuclear, Biological, Chemical/Toxic Industrial Materials OPLANS operational plans OPR office of primary responsibility PAM preventive and aerospace team SF security forces SSPDS small shelter patient decontamination system TA table of allowance TIC/TIM toxic industrial chemical/toxic industrial material UTC unit type of code VHA vapor hazard area WMP-1 war mobilization plan WRM war reserve material

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Attachment 2

CASUALTY PROCESSING

A.2.1. Decontaminate an Ambulatory Patient

A.2.1.1. All ambulatory patients requiring medical care inside the EMEDS will be decontaminated. All ambulatory patients must be triaged outside the medical decontamination facility prior to entry.

A.2.1.1.1. Patients requiring only minimal care will undergo spot decontamination of their MOPP/JSLIST as required for their medical treatment, treated, and returned to their unit.

A.2.1.1.2. Do not remove clothing from an ambulatory patient unless he requires treatment in the EMEDS or needs to be decontaminated for evacuation by USAF aeromedical assets.

A.2.1.2. Remove load bearing equipment

A.2.1.2.1. Patient’s remove load-carrying equipment prior to entering the medical decontamination facility. Place the equipment in a plastic bag. Place the plastic bag in a designated storage area for later decontamination.

A.2.1.2.2. Normally, weapons/ammunition of patients who present to the medical decontamination facility will be immediately provided to a member of the patient’s unit.

When this is not possible, the EMDT may temporarily store the weapons until the patient’s unit or AEW/AEG armory can accept responsibility. To minimize threat to patients and staff, a weapons clearing barrel should be placed outside the main entrance.

Personnel should not be allowed to enter the medical decontamination facility with a loaded weapon. The EMEDS Allowance Standard includes a heavy gauge chain and lock to secure the weapons.

A.2.1.3. A member of the decontamination team or other ambulatory patients will assist the patient in removing his clothing and decontaminating his skin.

A.2.1.4. Patient wears their protective mask throughout their time in the medical decontamination facility.

A.2.1.5. Decontaminate and remove mask hood.

A.2.1.5.1. Decontaminate the mask and hood. Use decontamination solution (soap and water or a 0.05 hypochlorite solution) to sponge down the front, sides, and top of the mask hood and mask. Cover the mask air inlet with gauze or your hand to keep the mask filters dry.

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A.2.1.5.2. Remove hood. Remove hood without cross-contaminating the patient. If this is not possible remove the hood by cutting the hood. Before cutting the hood, dip the cutting device in decontamination solution. For the M40 and MCU2P series hooded 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. For the JSLIST, cut the hood starting at the front center and continue cutting across the top of the head to the base of the neck. Fold the left and right sides of the hood away from the head.

A.2.1.6. Field Medical Card (FMC). Assistant dips gloves in a bucket of decontamination solution and then removes the FMC. Cut the patient’s FMC tie wire, allowing the FMC to fall into a clean plastic bag. Seal the plastic bag. Place the plastic bag with the FMC under the back of the protective mask head straps. The FMC will remain with the patient.

A.2.1.7. Remove and secure personal articles from the overgarment pockets, and place in plastic bag.

A.2.1.7.1. Contaminated items that can be decontaminated should be dipped in a bucket of decontamination solution or washed with soap and water before being placed in the plastic bag. Label the bag with the patient’s name and social security number (information can be written on the bag, or written on a 3 x 5-inch card or piece of paper that is then placed into the plastic bag). Seal the bags then wipe with decontamination solution.

A.2.1.8. Remove Overgarments.

A.2.1.8.1. 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 fist and extend his arms backward at 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.

A.2.1.8.2. If the patient cannot extend his arms, you must cut the jacket to aid in its removal. Dip the cutting device in the decontamination solution between each cut. 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.

A.2.1.8.3. An alternate method is to cut the back of the overgarment jacket from the neck down the back. The patient then holds their arms 30° to the front, clenches their fists, and the cut jacket is removed from the front. Remember to decontaminate cutting device between cuttings.

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A.2.1.8.4. Place overgarement jacket in contaminated disposal bag.

A.2.1.9. Remove overgarment trousers.

A.2.1.9.1. Unfasten or cut all ties, buttons, zippers and/or suspenders before grasping the trousers at the waist and peeling them down over the patient’s overboots and combat boots.

A.2.1.9.2. The trousers maybe 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 (groin) to the waist and allow the narrow strip with the zipper to drop between the legs. Place the cutting device in the decontamination 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.

A.2.1.9.3. An alternate method is to cut the trousers from the waist to the ankles and allow the pants to fall away.

A.2.1.9.4. Having a chair available for the individual to sit in while undressing is helpful.

Insure that the individual only sits on the inside, black side, of their protective overgarment and uniform while in the chair. Clean the chair seat with decontamination solution frequently.

A.2.1.10. Remove overboots. Remove the overboots without cutting; if necessary, cut the overboot along the front. If the overboots are in good condition, they can be decontaminated and reissued as time permits. Place cut overboots in contaminated disposal bag.

A.2.1.11. Remove the patient’s gloves.

A.2.1.11.1. 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 or if in good condition place aside for later decontamination and reissue. Do not allow the patient to touch his clothing or other contaminated objects with his exposed hands.

A.2.1.11.2. 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.

A.2.1.11.3. Place both glove inserts in the contaminated waste bag.

A.2.1.12. Remove Patient’s Battle Dress Uniform.

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A.2.1.12.1. In most cases, if the patient is still ambulatory than the underlying battle dress uniform has very little contamination on it. The uniform must still be removed prior to entry into the DMF.

A.2.1.12.2. Contaminated items that can be decontaminated should be dipped in a bucket of decontamination solution or washed with soap and water before being placed in the plastic bag. Label the bag with the patient’s name and social security number (information can be written on the bag, or written on a 3 x 5-inch card or piece of paper that is then placed into the plastic bag). Seal the bags then wipe with decontamination solution.

A.2.1.12.3. The uniform jacket and trousers are quickly removed in the same way as the protective ensemble. Place uniform jacket and trousers in the contaminated disposal bag.

A.2.1.12.4. Remove undergarments. Remove the patient’s tee shirt. Dip the cutting device in the decontamination 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 let fall to the ground. Remove the patient’s under shorts/panties by cutting from the lower side of the hip to the waist on both sides. Allow the under shorts/panties to fall to the ground. Do not remove the patient’s identification tags.

A.2.1.12.5. Patient removes combat boots. Cut laces and the individual steps out of the boots. Remove patient’s socks by grasping at the top and folding down. Patient quickly steps into the shower area, or they may need to sit in a chair. Boots and socks are placed in contaminated waste bag.

A.2.1.13. The patient proceeds into the ambulatory shower area of the medical decontamination facility.

A.2.1.13.1. They are completely naked, only wearing their protective mask.

A.2.1.13.2. The patient showers soaps and rinses beginning with their hair and mask and always cleaning in a direction working down their body, from head to toe.

A.2.1.14. The check area

A.2.1.14.1. Patient dries off, and is given a paper gown and slippers or blanket to wear.

A.2.1.15. Movement from the medical decontamination facility to the DMF.

A.2.1.15.1. Patient’s may remove their mask once they cross the vapor hazard buffer.

The mask will be placed in a plastic bag and will remain with the patient or stored for

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quick retrieval in the event of a future chemical attack.

A.2.1.16. Trauma specialist care.

A.2.1.16.1. During decontamination, the clothing around bandages, tourniquets, and splints is cut and left in place.

A.2.1.16.2. The medical specialist replaces the old tourniquet by placing a new tourniquet 1/2 to 1 inch above the old one. He then removes the old tourniquet and decontaminates the patient’s skin using decontamination solution or SDK(M291).

A.2.1.16.3. The trauma specialist cuts away bandages and decontaminates the area around the wounds with soapy water.

A.2.1.16.4. Splints can remain on the patient during decontamination, but those performing washing must insure that splints are cleaned, to include the padding and cravats. Contaminated splints can be replaced by a physician or by other medical personnel under the supervision of a physician.

A.2.1.16.5. 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.

A.2.2. Decontaminate a litter patient

A.2.2.1. Before contaminated patients receive medical treatment in the clean treatment area, they must be decontaminated. The patient may have on the MOPP overgarments or the Joint Service Lightweight Integrated Suit Technology (JSLIST) and hood. The decontamination and removal of both these garments are the same with the exception of the hood. The differences are noted in the text. If the patient does not have a complete protective ensemble, the processing will be performed in the same order specified: removal of outer layer of clothing followed by inner layer of clothing.

A.2.2.2. Remove load bearing equipment

A.2.2.2.1. Patient’s remove load-carrying equipment prior to entering the medical decontamination facility. Place the equipment in a plastic bag. Place the plastic bag in a designated storage area for later decontamination.

A.2.2.2.2. Patient’s remove load-carrying equipment prior to entering the medical decontamination facility. Place the equipment in a plastic bag. Place the plastic bag in a designated storage area for later decontamination.

A.2.2.2.3. Normally, weapons/ammunition of patients who present to the medical decontamination facility will be immediately provided to a member of the patient’s unit.

When this is not possible, the EMDT may temporarily store the weapons until the patient’s unit or AEW/AEG armory can accept responsibility. To minimize threat to

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patients and staff, a weapons clearing barrel should be placed outside the main entrance.

Personnel should not be allowed to enter the medical decontamination facility with a loaded weapon. The EMEDS Allowance Standard includes a heavy gauge chain and lock to secure the weapons.

A.2.2.3. All litter patients must be triaged and stabilized (if necessary) by the medical personnel outside the medical decontamination facility. The patient is moved on a NATO wheeled letter to the end of the roller system.

A.2.2.4. Clothing cut off is conducted while the patient is on the NATO litter carrier. At least two individuals (cutters) are assigned to cut off clothing. The litter patient is decontaminated and clothing cut off as follows:

A.2.2.4.1. Decontaminate the mask and hood. Use decontamination solution (soap and water or a 5 percent hypochlorite solution) to sponge down the front, sides, and top of the mask hood and mask. Cover the mask air inlet with gauze or your hand to keep the mask filters dry.

A.2.2.4.2. Remove hood. Remove hood without cross-contaminating the patient. If this is not possible remove the hood by cutting the hood. Before cutting the hood, dip the cutting device in decontamination solution. For the M40 and MCU2P series hooded 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. For the JSLIST, cut the hood starting at the front center and continue cutting across the top of the head to the litter.

Fold the left and right sides of the hood away and from the head.

A.2.2.4.3. Field Medical Card (FMC). Assistant dips gloves in a bucket of decontamination solution and then removes the FMC. Cut the patient’s FMC tie wire, allowing the FMC to fall into a clean plastic bag. Seal the plastic bag. Place the plastic bag with the FMC under the back of the protective mask head straps. The FMC will remain with the patient.

A.2.2.4.4. Remove and secure personal articles from the overgarment pockets, and place in plastic bag.

A.2.2.4.4.1. Contaminated items that can be decontaminated should be dipped in a bucket of decontamination solution or washed with soap and water before being placed in the plastic bag. Label the bag with the patient’s name and social security number (information can be written on the bag, or written on a 3 x 5-inch card or piece of paper that is then placed into the plastic bag). Seal the bags then wipe with decontamination solution.

A.2.2.4.5. 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. Cut all drawstrings and pile fasteners on the JSLIST.

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A.2.2.4.6. Remove overgarment jacket.

A.2.2.4.6.1. Make two cuts, one up each sleeve from the wrist up to the shoulder, and then through the collar. An alternative is to start at the collar and cut down each sleeve to the wrists. Do not allow the cutter’s gloves to touch the patient along the cut line.

A.2.2.4.6.2. Dip the cutting device in the decontamination 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.

A.2.2.4.6.3. Unzip the jacket or make a cut up the front of the JSLIST jacket from the waist through the collar; roll the chest sections to the respective sides, with the inner surface outward.

A.2.2.4.6.4. Continue by tucking the clothing between the arm and chest.

A.2.2.4.6.5. Roll the cut sleeves away from the arms, exposing the black liner.

A.2.2.4.7. Remove overgarment trousers.

A.2.2.4.7.1. Cut both trouser legs starting at the ankle. 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. An alternative is to cut from the waist to the ankles following the same path.

A.2.2.4.7.2. Place the cutting device in the decontamination solution.

A.2.2.4.7.3. Fold the cut trouser halves away from the patient and allow the halves to drop to the litter with contaminated (outer) side down.

A.2.2.4.7.4. Roll the inner leg portion under and between the legs exposing black liner.

A.2.2.4.8. Remove outer gloves.

A.2.2.4.8.1. This procedure can be done with one person on each side of the patient working simultaneously. The decontamination team will decontaminate their gloves in decontamination 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. Alternately, grasp the glove at the fingertips and pull straight off.

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A.2.2.4.8.2. Do not remove the inner cotton glove liners at this time; however if the gloves fall off inadvertently, leave them off.

A.2.2.4.8.3. Carefully lower the arms across the chest after the outer, rubber, gloves have been removed. 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.

A.2.2.4.9. Remove overboots.

A.2.2.4.9.1. 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.

A.2.2.4.9.2. Remove the two overboots simultaneously. This reduces the likelihood of contaminating one of the combat boots.

A.2.2.4.9.3. While holding the heels off the litter, have a decontamination team member wipe the end of the litter with decontamination solution to wash away any liquid contamination that was transferred to the litter from the overboots. Lower the patient’s heels onto the decontaminated litter.

A.2.2.4.9.4. Place the overboots in the contaminated waste bag. Decontamination personnel dip their gloves in the decontamination solution.

A.2.2.4.9.5. If the older laced overboot is worn, then cut the overboot laces and fold the lacing eyelets flat outwards and then remove the boot as noted above.

A.2.2.4.10. Remove Patient’s Battle Dress Uniform.

A.2.2.4.10.1. Remove the patient’s personal effects from his BDU pockets. Place these in the plastic bag where items from the protective overgarment were placed.

Reseal the bag. If the articles are not contaminated, return them to the patient. If the articles are contaminated, place them in the contaminated holding area until they can be decontaminated, and then return them to the patient.

A.2.2.4.10.2. 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.

A.2.2.4.10.3. 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.

A.2.2.4.10.4. Remove undergarments.

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A.2.2.4.10.4.1. Remove the patient’s tee shirt. Dip the cutting device in the decontamination 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.

A.2.2.4.10.4.2. 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.

A.2.2.4.10.4.3. 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.

A.2.2.4.10.4.4. Remove socks and cotton glove liners. Place in the contaminated waste bag. Do not remove the patient’s identification tags.

A.2.2.4.10.5. Change out decontamination solution in buckets used for cutting tools and gloves between patients so that build up of dilute chemical agent does not occur.

A.2.2.5. Transfer the patient from the NATO litter to the backboard and rollers.

A.2.2.5.1. After the patient’s clothing has been cut away, he is transferred to the rollers.

If available a backboard is used with the rollers. The transfer can be performed several ways with the purpose to safely move the patient from the litter containing the contaminated clothing without worsening their condition or injuring decontamination team members.

A.2.2.5.2. Three decontamination team members decontaminate their gloves and suits with decontamination 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 places the backboard on the rollers. The team members lower the patient onto the backboard and remove the litter with the contaminated clothing out of the medical decontamination facility. The contaminated clothing is bagged and moved to the dump. The litter is decontaminated (washed) with soap and water.

A.2.2.5.3. An alternative is to roll the patient to their side while on the litter and lying on top of the cut off clothing. The backboard is placed along the patient’s back. The patient and backboard are then rolled back on the clothing. The backboard is lifted by decontamination team members off of the clothing and onto the roller system.

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A.2.2.5.4. A third alternative is to follow procedure 3), but this is done with the litter positioned along the side of the roller system so that the patient is moved laterally onto the roller system.

A.2.2.6. Decontamination, body wash

A.2.2.6.1. Cover the mask filter inlet with gauze or a hand to keep the patient’s filter dry.

A.2.2.6.2. Washing team members use decontamination solution to wash the patient’s body. A sponge can be used to further scrub contaminated areas with decontamination solution.

A.2.2.6.3. The patient’s mask and hair should be washed.

A.2.2.6.4. After the top portion of the patient’s body is soaped and scrubbed, the casualty must be rolled to the side to clean their back and the back board.

A.2.2.6.5. Cutters should relay suggestions to those who are washing to let them know of potential areas of skin contamination, particularly areas where the protective overgarment was breached.

A.2.2.7. Decontamination, body rinse

A.2.2.7.1. The patient is moved to the rinse portion of the roller system where soap is rinsed off of the patient.

A.2.2.7.2. The patient is rolled to the side so that their back and backboard can be rinsed off.

A.2.2.8. Transfer to a clean litter

A.2.2.8.1. The patient while on the backboard is moved laterally onto a clean NATO litter carrier at the check end of the roller system. The patient is then rolled to their side while on the litter and the backboard is removed to be rinsed off and moved to the front of the roller system for reuse.

A.2.2.8.2. Another alternative is to follow procedure 1), but position the litter at the end of the roller system and move the patient and backboard on to the litter and then roll them to the side, while on the litter, to remove the back board.

A.2.2.8.3. A blanket or garment is placed over the decontaminated patient to keep them warm.

A.2.2.9. Movement from the medical decontamination facility to the DMF.

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A.2.2.9.1. Patient’s mask is removed after he crosses the hot line and vapor control line.

The Vapor Control Line is defined as a line across which there is no agent vapor hazard.

The Hot Line is defined as the line across which there is no liquid agent contamination hazard.

A.2.2.9.2. The mask will be placed in a plastic bag and will remain with the patient or stored for quick retrieval in the event of a future chemical attack. The casualty then enters through the normal MTF triage process.

A.2.2.10. Trauma specialist care.

A.2.2.10.1. During decontamination, the clothing around bandages, tourniquets, and splints is cut and left in place.

A.2.2.10.1.1. The medical specialist replaces the old tourniquet by placing a new tourniquet 1/2 to 1 inch above the old one. He then removes the old tourniquet and decontaminates the patient’s skin using decontamination solution or SDK (M291).

A.2.2.10.1.2. The trauma specialist cuts away bandages and decontaminates the area around the wounds with soapy water.

A.2.2.10.1.3. Irrigate wounds with normal saline or water. If bleeding begins, the trauma specialist replaces contaminated bandages with clean ones.

A.2.2.10.1.4. Splints can remain on the patient during decontamination, but those performing washing must insure that splints are cleaned, to include the padding and cravats. Contaminated splints can be replaced by a physician or by other medical personnel under the supervision of a physician.

A.2.2.10.1.5. 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.

A.2.2.10.1.6. Many patients exposed to chemical agents, and needing lifesaving care, will need to be intubated prior to entry into the medical decontamination facility.

Once stabilized enough to undergo decontamination they may need to be continually hand ventilated during the decontamination process. In this case a resuscitation device individual chemical (RDIC) should be used if available as vapors inside the medical decontamination facility may contain chemical agent.

A.2.2.11. Heat injury prevention and water consumption

A.2.2.11.1. The EMDT team chief will ensure each team member drinks adequate fluids to prevent heat injury/illness.