(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.