Section I. INTRODUCTION

G-1. General

a. Patient decontamination presents special problems for units and HSS personnel. Nuclear, biological, and chemical contaminated patients create increased hazards to rescuers and HSS personnel; thus, causing delays in providing essential first aid and medical treatment for injuries from sources other than the exposure to NBC weapons/agents. Casualty decontamination procedures are performed by each individual, as buddy aid, or at a unit decontamination station prior to the arrival of medical personnel. See FM 3-5 for procedures on individual, buddy aid, and unit decontamination. Patient decontamination procedures are normally performed at an MTF under medical supervision. Patient decontamination stations may be established (collocated) at central unit decontamination faculties, if medical support is available. However, augmentation medical support must be requested to provide patient care and supervise the patient decontamination process. Because, when the unit is undergoing decontamination operations, organic medical personnel must also decontaminate their equipment and personnel. Therefore, they are not available to provide medical support for operating the patient decontamination station that is collocated with the central unit decontamination facility.

b. The term "decontamination" as used herein means the removal or neutralization of radioactive particles, BW agents, and CW agents to levels low enough that patients may be treated without contaminating the MTF and without posing health risks to unprotected medical providers. "Decontamination" does not imply absolute removal of contaminants.

NOTE

The decontamination procedures described below are for NBC contaminated patients. These procedures may also be used for most TIM contaminated patients. However, soap and water will suffice for most TIMs; but some TIMs react with water. For those TIMs another material must be used to decontaminate patients. For detailed information on decontamination of TIM contaminated patients, see FM 8-500.

c. Physical removal of contaminants is the primary method of decontamination. Physical removal does not require vigorous scrubbing; in fact, vigorous scrubbing can force some agents deeper into the skin; thus, increasing the agent effect rather than reducing its effects. The use of a M291 skin decontaminating kit (SDK) neutralizes/reduces the effects of an agent, but physical removal is of utmost importance. When a SDK is not available, the use of soap and water should be considered as the next best method. However, the use of soap and water requires large amounts of water that may not be available because the soap must be rinsed from the skin to reduce skin irritation from the soap. An alternate skin decontaminant is a hypochlorite solution; but it should only be used when SDKs and/or sufficient quantities of water are not available. Use a 0.5 percent hypochlorite solution on the protective mask and skin. A 5 percent hypochlorite solution can be used on the mask hood, gloves, and other outer garments.

CAUTION

Do not use the 5 percent solution on the skin; it can cause severe skin irritation.

G-2. Immediate Decontamination

Decontamination must begin at the platoon and company level with the individual soldier, prior to the arrival of medical personnel. The soldier himself or members of his team must perform immediate decontamination. When the casualty's condition and the mission permits, they may go through a MOPP gear exchange at their unit before evacuation (see FM 3-5). Performing a MOPP gear exchange at the unit before evacuation will reduce the amount of contamination that can be transferred to the MEDEVAC vehicle. However, the MOPP gear exchange must not cause further injury to the casualty. First aid for CW agent must be administered; such as administering nerve agent antidotes (such as nerve agent antidotes and convulsant antidote for nerve agent [CANA]), as required. Enter the time and type of contamination on a field expedient NBC casualty card ([Figure G-1]). Use the CAM, M8 chemical agent detector paper, or M9 tape to determine the type of chemical contamination. Use a radiation detection meter/device to determine the level of radioactive contamination, if required. Currently, there are no BW agent detectors that can be used to check patients for BW agent contamination. Therefore, all patients suspected of being contaminated with a BW agent must be decontaminated. When medical personnel arrive, they should enter the time and type of contamination and number of antidote injections that were administered as first aid on the Department of Defense (DD) Form 1380 (Field Medical Card [FMC]).

Figure G-1. Field expedient nuclear, biological, and chemical patient card.

G-3. Patient Decontamination and Thorough Decontamination Collocation

a. Collocating patient and thorough decontamination operations in the BSA may provide several advantages ([Figure G-2]). It—

b. An identified disadvantage is the increased size of the site and the requirement for medical support augmentation (a treatment squad from another organization with required patient decontamination and treatment MESs) to operate the PDS.

NOTE

Organic medical personnel must not be used to perform the HSS mission at the collocated site. They must go through the decontamination process with their unit.

c. These operations do not require that both patient decontamination and unit thorough decontamination be executed simultaneously. The PDS can be running while the thorough decontamination site is being prepared. Patient decontamination cannot be delayed since patients may be suffering life-threatening injuries as well as exposure to NBC agents. Therefore, the PDS must be established and operational before the first patients arrive. The wind direction must be common to both sites.

d. The decontamination platoon leader is responsible for establishing the combined decontamination site. The medical unit commander/surgeon coordinates with the decontamination platoon leader for the location of the patient receiving, PDS, and MTF. The lowest level at which this operation will usually be planned is brigade. This operation requires extensive planning and must involve the brigade chemical officer, brigade S4, and the medical company commander/brigade surgeon. Decontamination support for special operation forces, other unique operational organizations, or for nonlinear operations may require execution at a lower level. The supporting medical personnel operate the PDS. Nonmedical personnel perform patient decontamination procedures under medical supervision. Patient decontamination procedures are described below.

NOTE

Patient decontamination differs from thorough decontamination in that the patients' medical status must be monitored and medical treatment must be provided during the decontamination process.

e. Although a PDS may be collocated with thorough decontamination, a PDS must be operational at Levels I, II, III, and IV MTFs. Contaminated patients may present directly to the MTF for care, or patients previously decontaminated may become contaminated en route. Therefore, all patients arriving at an MTF must be checked for contamination. If contaminated, they must be decontaminated before they are admitted to the MTF.

Figure G-2. Thorough decontamination site collocated with patient decontamination station, without collective protection shelter.

G-4. Patient Decontamination at the Battalion Aid Station (Level I)

a. When battle conditions prevent patient decontamination procedures forward or the patient is contaminated en route, the patient may have to be decontaminated at the BAS. Contaminated patients arriving at the BAS must be decontaminated before admission into the clean treatment area.

b. Patient decontamination is performed by eight nonmedical personnel from the supported unit at the BAS. The patient decontamination personnel operate as two-man teams to perform the patient decontamination procedures. The patient decontamination teams operate under the supervision of medical personnel to ensure that no further injury is caused to the patient by the decontamination process. Each team receives a patient from the triage point and performs both clothing removal and skin decontamination procedures. The team requires assistance from another team to perform litter changes; see details below.

G-5. Patient Decontamination at the Medical Company Clearing Station (Level II)

The medical company clearing station may receive patients from the BAS or directly from other areas who have not been decontaminated. The clearing station must also have a patient decontamination area. As with the BAS, the clearing station must have a minimum of eight nonmedical personnel from the supported units to perform patient decontamination. Procedures for patient decontamination at the clearing station are the same as for the BAS.

G-6. Patient Decontamination at a Hospital (Level III or IV)

To the maximum extent possible, hospitals are located away from tactical or logistical targets. Contaminated patients will arrive from forward MTFs and units located within the geographical area of the hospital. Patient decontamination is done by at least 20 nonmedical personnel from units located in the geographical area/base cluster of the hospital. Procedures for patient decontamination at the hospital are the same as for the BAS. However, several patient decontamination stations can be operated simultaneously at the hospital patient decontamination site. Further, all patients arriving at the hospital will be decontaminated and receive full treatment within the capabilities of the hospital.

G-7. Prepare Hypochlorite Solutions for Patient Decontamination

An alternative patient decontamination agent is a hypochlorite solution; however, the hypochlorite solution must be prepared. Two concentrations of the hypochlorite solution are required. A 5 percent hypochlorite solution to decontaminate gloves, aprons, litters, cutting devices, the patient's mask hood, and other nonskin contact areas. The patient's mask, skin, splints, and tourniquets and their wounds are irrigated using a 0.5 (½) percent hypochlorite solution. To prepare the solutions, use calcium hypochlorite (HTH) granules (supplied in 6-ounce jars in the chemical agent patient treatment and chemical agent patient decontamination MES), bulk HTH, or sodium hypochlorite (household bleach). Prepare the required solutions as shown in Table G-1 below.

Table G-1. Preparation of Hypochlorite Solutions for Patient Decontamination

HTH
OUNCES		HTH MRE
SPOONFULS		HOUSEHOLD
BLEACH		PERCENT IN 5
GALLONS OF WATER
6[*]52 QUARTS0.5
4840[**]5.0

[*] THESE MEASUREMENTS ARE USED WHEN BULK HTH IS USED. TO MEASURE THIS PREPARATION, USE THE PLASTIC SPOON SUPPLIED WITH YOUR MEAL, READY-TO-EAT (MRE). THE AMOUNT OF HYPOCHLORITE TO BE USED IS A HEAPING SPOONFUL (THAT IS, ALL THAT THE SPOON WILL HOLD). DO NOT SHAKE ANY GRANULES OFF OF THE SPOON BEFORE ADDING TO THE WATER.

[**] DO NOT DILUTE IN WATER; HOUSEHOLD BLEACH IS 5 TO 6.25 PERCENT SOLUTION; IT IS USED FULL STRENGTH FOR 5 PERCENT APPLICATIONS.

CAUTIONS

1. Do not use the 5 percent hypochlorite solution on the patient's skin. The 5 percent solution can burn the skin.

2. Only wipe the skin when applying the 0.5 percent hypochlorite solution. Vigorous scrubbing may force the agent into the skin.

G-8. Classification of Patients

On the NBC battlefield, two classifications of patients will be encountered—contaminated and uncontaminated. Those contaminated may suffer from the effects of an NBC agent, of a conventional wound, or both. Some may suffer combat stress or heat injuries induced by the stress of NBC conditions and extended time spent in MOPP Level 4. It is important to follow proper decontamination procedures to limit the spread of contamination to others and equipment. The most important decontamination is performed at the site of contamination. Decontamination at a later time may be too late to prevent injury to the individual, especially when exposed to vesicants. All agents should be promptly removed from the skin.

G-9. Patient Treatment

This appendix only describes patient decontamination procedures. For NBC treatment procedures, refer to FM 4-02.283, FM 8-284, and FM 8-285.