a. An NBC environment forces the unit leadership to consider to what extent he will commit MEDEVAC assets to the contaminated area. If the battalion or task force is operating in a contaminated area, most or all of the organic medical platoon MEDEVAC assets will operate there. However, efforts should be made to keep some ambulances free of contamination. For conventional MEDEVAC operations see FM 8-10-6 and FM 8-10-26.
b. We have three basic modes of evacuating patients (personnel [litter bearers], ground vehicles, and aircraft). Using litter bearers to carry the patients involves a great deal of stress. Cumbersome MOPP gear, added to climate, increased workload, and the fatigue of battle, will greatly reduce personnel effectiveness. If personnel must enter a radiologically contaminated area, an OEG must be established (see [Table 3-1]). Radiation exposure records are maintained by the NBC NCO and made available to the commander, staff, and medical leader. The exposure is entered into the individual's medical record. Based on the OEG, the commander and leaders will decide which MEDEVAC assets will be sent into the contaminated area. Again, every effort is made to limit the number of MEDEVAC assets that are contaminated. Medical evacuation considerations should include the following:
(1) A number of ambulances will become contaminated in the course of battle. Optimize the use of resources; use those already contaminated (medical or nonmedical) before employing uncontaminated resources.
(2) Once a vehicle or aircraft has entered a contaminated area, it is highly unlikely that it can be spared long enough to undergo thorough decontamination. However, operational decontamination should be performed to the greatest extent possible. This will depend upon the contaminant, the tempo of the battle, and the resources available to the MEDEVAC unit. Normally, contaminated vehicles (air and ground) will be confined to dirty environments. See FM 3-5 for details on decontamination procedures.
(3) Use ground ambulances instead of air ambulances in contaminated areas; they are more plentiful, are easier to decontaminate, and are easier to replace. However, this does not preclude the use of aircraft. If an air ambulance is deployed into a contaminated area, use it for repeated MEDEVAC missions rather than sending other clean aircraft into the area.
(4) The relative positions of the contaminated area, forward line of own troops (FLOT), and threat air defense systems will determine where helicopters may be used in the MEDEVAC process. One or more helicopters may be restricted to contaminated areas; use ground vehicles to cross the line separating clean and contaminated areas. The ground ambulance proceeds to an MTF with a patient decontamination station (PDS); the patient is decontaminated and treated. If further MEDEVAC is required, a clean ground or air ambulance is used. The routes used by ground vehicles to cross between contaminated and clean areas are considered dirty routes and should not be crossed by clean vehicles, if mission permits. Consider the effects of wind and time upon the contaminants; some agents will remain for extended periods of time.
(5) Keep the helicopter rotor wash in mind when evacuating patients, especially in a contaminated environment. The intense rotor wash will disturb the contaminants and further aggravate the condition. The aircraft must be allowed to land and reduce to flat pitch before patients are brought near. This will reduce the effects of the rotor wash. Additionally, a helicopter must not land too close to a decontamination station (especially upwind) because any trace of contaminants in the rotor wash will compromise the decontamination procedure.
c. Immediate decontamination of rotor wing aircraft and ground vehicles is accomplished to minimize crew exposure. Units include decontamination procedures in their standing operating procedures (SOP). A sample aircraft decontamination station that may be tailored to a unit's needs is provided in FM 3-5.
d. Evacuation of patients must continue, even in an NBC environment. The HSS leader must recognize the constraints NBC places on operations; then plan and train to overcome these deficiencies.