- Varying levels of treatment received prior to arrival at the hospital.
- Caring for combined conventional wounds and NBC agent effects.
- Managing heat-related complications associated with MOPP/PPW use.
- Controlling psychological effects caused by biological and chemical agents, the impact of NBC weapons, or the isolation of MOPP gear or PPWs.
- Having EMT personnel working at the arrival point, decontamination site, and in the hospital EMT area.
- Conducting triage and providing patient care while in MOPP gear.
- Supervising supported units decontamination augmentation personnel. These personnel will most likely be of any military occupational specially (MOS), except medical. They will use hospital equipment and supplies to decontaminate patients.
b. Contaminated patients must be triaged in the decontamination area that is established at the hospital. Contaminated patients WILL NOT be brought into the clean EMT area until decontaminated. All patients are screened for contamination. Based on the findings, the patient is routed to the contaminated triage station, or to the clean triage station. Contaminated patients are triaged, then routed to the decontamination area, or to the contaminated treatment area. Patient admission to the clean treatment area may be delayed; however, life- or limb-saving care is provided in the contaminated treatment area before decontamination.
4-5. General Medical Services
The provision of general medical services in the hospital will be continued with minimal interruptions in the NBC environment. The noninvasive nature of these services allows their continuation at most MOPP levels. However, some general medical services will be constrained by MOPP Levels 3 and 4 and the mask-only posture. These constraints may include, but not be limited to—
- Communication limitations.
- Loss of the oral route for administering medications to patients.
- Limited ability to accurately evaluate the eyes, nose, and mouth of patients wearing a protective mask.
- Reduced ability to perform examination/assessment of patients in PPW or MOPP Levels 3 and 4.
- Inability to provide oxygen therapy or ventilator support to a patient in a vapor hazard environment, unless a CB filter-supported respirator is available.
- Logistical constraints based upon the fact that key areas such as dietetics, supply, and laundry are not in the CPS. These services may be reduced or delayed in the NBC environment. See [Appendix F] for Information on patient feeding under NBC conditions.
4-6. Surgical Services
a. Surgical services will be severely limited in the NBC environment. At any level above MOPP Level 0, without a CPS system surgical services are halted except for life- or limb-saving expedient procedures. Surgery cannot be safely performed outside a CPS due to a variety of factors including—
- Lack of protected ventilation for patients during and after surgery.
- Inability to maintain a sterile field while using MOPP gear.
- Direct access for agents through open wounds to the circulatory and respiratory systems.
- Decreased dexterity and vision resulting from MOPP gear use.
- Inability to quickly place the patient in a PPW should the need arise.
b. Due to the relatively high number of trauma cases, hospital services may be severely constrained by NBC contamination. The hospital location and the possible need for relocation are two major planning considerations for the command staff.
c. Patient accounting and medical regulating are critical factors in the transfer of patients from a hospital without a CPS that must move out of an NBC environment. Hospitals without CPS stop receiving patients when a persistent hazard is identified; patients on hand are protected and transferred to a clean MTF.