a. Select sites for the BAS and DCS that are located away from likely enemy target areas. Cover and concealment is extremely important; they increase protection for operating the MTF.
b. Operating a CBPS System in the CB mode at the BAS requires at least eight medical personnel. The senior NCO performs patient triage and limited EMT and minor injury care in the patient decontamination area. One trauma specialist supervises patient decontamination and manages patients during the decontamination process. Two trauma specialists work on the clean side of the hot line and manage the patients until they are placed in the clean treatment area or are sent into the CBPS for treatment. They also manage the patients that are awaiting MEDEVAC to the DCS. The physician, physician assistant, and two trauma specialists provide ATM in the clean treatment area or inside the CBPS. See [Appendix F] for CPS entry/exit procedures.
c. When the BAS or DCS are receiving NBC contaminated patients, they require at least eight nonmedical personnel from supported units to perform patient decontamination procedures. These facilities are only staffed to provide patient care under conventional operational conditions. Without the augmentation support, they can either provide patient decontamination or patient care, but not both.
d. A patient decontamination station is established to handle contaminated patients (see [Appendix G]). The station is separated from the clean treatment area by a "hot line" and is located downwind of the clean treatment area or CPS. Personnel on both sides of the "hot line" assume a MOPP level commensurate with the threat agent employed (normally MOPP Level 4). The patient decontamination station should be established in a contamination-free area of the battlefield. However, it may be necessary to establish a patient decontamination station that is collocated with an MTF that is employing a CBPS, in a chemical vapor hazard area in order to decontaminate patients and clear the battlefield before moving the MTF to a clean area. When CPS systems are not available, the clean treatment area is located upwind 30 to 50 meters of the contaminated work area. When personnel in the clean working area are away from the hot line, they may reduce their MOPP level. Chemical monitoring equipment must be used on the clean side of the hot line to detect vapor hazards due to slight shifts in wind currents; if vapors invade the clean work area, HSS personnel must re-mask to prevent low-level CW agent exposure and minimize clinical effects (such as miosis).
3-11. Civilian Casualties
Civilian casualties may become a problem in populated or built-up areas, as they are unlikely to have protective equipment and training. The BAS and DCS may be required to provide assistance when civilian medical resources cannot handle the workload. However, aid to civilians will not be undertaken without command approval, or at the expense of health services provided to US personnel.
3-12. Nuclear Environment
a. The HSS mission must continue in a nuclear environment; protected shelters are essential to continue the support role. Well-constructed shelters with overhead cover and expedient shelters (reinforced concrete structures, basements, railroad tunnels, or trenches) provide good protection from nuclear attacks (see [Appendix H]). Armored vehicles provide some protection against both the blast and radiation effects of nuclear weapons. Patients generated in a nuclear attack will likely suffer multiple injuries (combination of blast, thermal, and radiation injuries) that will complicate medical care. Nuclear radiation patients fall into three categories:
- The irradiated patient is one who has been exposed to ionizing radiation, but is not contaminated. They are not radioactive and pose no radiation threat to medical care providers. Patients who have suffered exposure to initial nuclear radiation will fit into this category.
- The externally contaminated patient has radioactive dust and debris on his clothing, skin, or hair. This radioactive debris can cause burns if not removed quickly. This usually presents a "housekeeping" problem to the MTF, similar to the lice-infested patient arriving at a peacetime MTF. However, an accumulation of radioactive debris, from several patients admitted to the MTF, may present a threat to other personnel. The externally contaminated patient is decontaminated at the earliest time consistent with required medical care. Lifesaving care is always rendered, when necessary, before decontamination.
- The internally contaminated patient is one that has ingested or inhaled radioactive material, or radioactive material has entered the body through an open wound. The radioactive material continues to irradiate the patient internally until radioactive decay and/or biological elimination removes the radioactive isotope. Attending medical personnel are shielded, to some degree, by the patient's body. Inhalation, ingestion, or injection of quantities of radioactive material sufficient to present a threat to health care providers is highly unlikely.