Health Service Support in a Nuclear, Biological, and Chemical Environment / Tactics, Techniques, and Procedures

by United States. Department of the Army

Section III. EMPLOYMENT OF THE CHEMICALLY PROTECTED DEPLOYABLE MEDICAL SYSTEMS AND SIMPLIFIED COLLECTIVE PROTECTION SYSTEMS

F-6. Collective Protection in a Deployable Medical System-Equipped Hospital

a. When the threat of NBC action is anticipated in the AO, the CP DEPMEDS components must be set up as the hospital is being established. The system cannot be set up in a hospital that has already been established; to do so requires the hospital to be closed, all TEMPERs be struck, and erected with the M28 liners installed during the erection process. To establish CPS in a DEPMEDS-equipped hospital, follow the procedures as described in TM 10-5410-283-14&P. Training Circular 8-13 provides instructions on establishing a US Army DEPMEDS-equipped hospital (without CPS). [Figure F-5] presents one layout of the DEPMEDS-equipped patient care area of a MF2K CSH HUB employing the CP DEPMEDS with an internal water supply system. [Figure F-6] presents a layout of the patient care area of the DEPMEDS-equipped portion of an 84-bed MRI hospital. [Figure F-7] presents a layout of the patient care area of the DEPMEDS-equipped portion of a 164-bed MRI hospital.

b. When employing CP DEPMEDS, provisions for waste disposal and protected water and food supplies within the system are established. Additionally, Class VIII supplies must be protected from contamination. Supplies not in use or needed in the protected operational areas are stored in medical chests, shipping containers, or wrapped in layers of plastic that are inside covered areas, such as closed MILVANs or tents. When contamination is present, only open these storage areas for operational area emergency resupply. Use plastic sheeting or other leak-proof material to provide an additional barrier between the supplies and the contamination. Wrap supplies in plastic or other barrier material for movement from the storage area to the resupply air lock of the CP DEPMEDS.

• A water supply system with distribution hoses is established inside the CP DEPMEDS areas ([Figure F-5]). Pumps continuously circulate the water from the storage tank through the hose system back to the storage tank. The continuous circulation ensures that the chlorine residual is maintained in the water supply. Personnel in areas that are not included in the continuous flow system must draw water from the system and carry it to their work areas in 5-gallon water cans or other containers. Water resupply is accomplished by passing a hose through the utility port at the end of the TEMPER and M28 liner for a connection to the water transport vehicle. The ends of both hoses must be decontaminated with a 5 percent chlorine solution before connecting them together. The vehicle must have a tank or water supply container that is NBC protected to ensure that the water supplied is free of NBC contamination.
• Rations, as determined by the hospital commander, should be available within the protected area for personnel and patients. Under emergency conditions the commander can authorize feeding patients MRE rations for limited periods of time (up to 72 hours), if they are able to chew and swallow. However, attempts must be made to ensure the required types of rations for patient feeding are available in the CPS. The rations can be stored in any available space; however, the rations must be protected from exposure to possible contaminants, especially liquids. Ration control measures are established to ensure that the rations are only consumed as provided for in the hospital TSOP.
• Two CB protected latrine systems are included in the CP DEPMEDS. The latrines contain bedpan wash areas. The waste from the latrines is collected in an outside receiving container. The waste is removed from the container and disposed of as outlined in the unit TSOP.
• Solid waste (including medical) must be placed in plastic bags. Seal the top of the bags to prevent spillage, odors, or spread of infections/disease. NEVER overfill the bags; always leave enough room in the bag to make a good seal. Place the sealed bags in the supply air lock. Inside personnel close the inner door to the air lock. Outside personnel check to ensure that the inner air lock door is closed before opening the outside door. Remove the bags and take them to the designated waste collection/disposal site. Disposal may be by burial on site or by transport to a designated disposal facility. Transport may be by organic vehicles or contractor support vehicles. The specific technique for disposal will be outlined in the unit TSOP.
• All liquid waste produced within the CP DEPMEDS is collected through a piped liquid waste system to a central collection container. The waste container for the latrines may be used to collect the liquid waste from the operational areas of the CP DEPMEDS. The container is emptied and the waste disposed of as outlined in the unit TSOP.

Figure F-5. Sample layout of a medical force 2000 combat support hospital unit base employing chemically protected deployable medical system.

Figure F-6. Sample layout of an 84-bed medical reengineering initiative hospital employing chemically protected deployable medical system.

Figure F-7. Sample layout of a 164-bed medical reengineering hospital employing chemically protected deployable medical system.

F-7. Chemically/Biologically Protecting the International Organization for Standardization Shelter

To chemically/biologically protect the ISO shelters, seal all seams and openings of the ISO to prevent the entry of CB agents. The seals connecting the various sides and floor of the shelter may be a CB protected material; thus providing a seal to the shelter. When the seals are not of a CB protected material, the seams must be taped to provide a CB protected barrier over the soft seals. Any openings not being used for introduction of support power lines, water lines or waste water lines must be sealed to prevent entry of CB agents. All access panels must be securely closed to prevent entry of vapors.

F-8. Chemically/Biologically Protecting the Vestibules

The vestibules connect TEMPERs to TEMPERs, ISOs to ISOs, and ISOs and TEMPERs. To harden the vestibules, install the CB liners inside and fasten the ends to the liners of the TEMPER or to the doors of the ISOs. Vestibule liner connectors are provided for use at the entry of each ISO.

F-9. Chemically/Biologically Protecting Air Handler Equipment

a. The FDECU is chemically/biologically protected. The system can be operated without the CB filters. When required to operate in the CB mode, the fresh air intake on the FDECU is closed and the CB filter blower is turned on drawing fresh air through the filters to support the FDECU and to provide clean air for the CPS. Additionally, recirculation filters are placed within the shelter system to remove any agent that may have entered through any of the entry/exit areas or through breaches in the shelter system.

b. When heaters are required, they must be chemically/biologically protected to prevent entry of contamination. The CB filter units are connected to the fresh air intake side of the heater and the heated air discharge side of the heater is connected to the air supply of the TEMPER/ISO.

F-10. Establish Collective Protection Shelter Using the M20 Simplified Collective Protection System

The M20 is used to establish a CPS within a room of opportunity, or inside a tent; however, the available space will be limited by tent poles and other components of the tent. Currently this system only provides ambient temperature air. See the TM and manufacturer's publication provided with the system and system components for details.

NOTE

The M20 does not have a litter air lock. Only staff or ambulatory patients can enter. See the TM provided with the system for setup procedures.

F-11. Casualty Decontamination

Patients admitted into the MTF must be contamination free. Therefore, a casualty decontamination area must be established near the MTF. The casualty decontamination area should be provided with an overhead cover as described for the CBPS system, except that it does not overlap the entry to the hospital. Also, consideration must be given to the location of other operations at the hospital site when establishing the casualty decontamination area. However, the area must be close enough to the entry/exit of the CPS to protect the patients from the environment and reduce their exposure to recontamination. Keep in mind that under NBC conditions personnel outside of the CPS are at MOPP Level 4 (except decontaminated patients; they have their mask on), thus increasing the stress load and reducing their overall performance capabilities. The entry/exit area must have overhead cover to protect patients awaiting access to the CPS. See [Appendix I] for setting up a casualty decontamination area and for decontamination procedures.