As a general rule, in the aftermath of an NBC attack, dental treatment operations cease until deliberate decontamination of the unit and its equipment has been accomplished. Only maxillofacial injuries of an immediate life-threatening nature should be considered for treatment. After an attack, the resources of the dental treatment facility (DTF) are redirected toward support of any mass casualty situation that may have been generated at an adjacent MTF, or toward decontamination and relocation to a noncontaminated area.
5-18. Patient Treatment Considerations
The only category of dental treatment appropriate in an NBC environment is emergency; and then, only those emergencies of an extreme nature which demand immediate attention. The most likely condition requiring such attention would be maxillofacial trauma and would most likely be treated at an MTF rather than a DTF. Although the likelihood of a requirement to treat dental patients in an NBC environment is extremely low, DTFs must have a plan in the event that such patients do present.
a. Patient Decontamination. Decontamination of patients, dental patients included, is an absolute requirement before admission into a clean MTF. Contaminated patients are triaged and decontaminated before treatment (except for life- or limb-saving care). Both triage and decontamination should be accomplished as far forward as possible. Specific details on patient decontamination are in [Appendix G]. It is important to note that normally patient decontamination is not performed by medical or dental personnel. Initial decontamination at the basic skill level is accomplished at the casualty's unit. Detailed patient decontamination is accomplished by the patient decontamination teams (made up of nonmedical personnel from the supported units) that are supervised by medical personnel at the MTF.
b. Patient Decontamination at Dental Treatment Facilities. Neither dental units nor their DTFs are equipped for patient decontamination. Any contaminated patients arriving at a DTF requiring urgent attention must be directed or evacuated to the nearest MTF with a patient decontamination capability.
5-19. Patient Protection
Dental treatment facilities must also consider the need to protect patients in their care in the event of an NBC attack, or when the threat of an attack is high. Special consideration must be made for maxillofacial patients whose condition prevents them from wearing their protective mask.
a. Immediate Response. In the event of an attack or when the alarm sounds, dental treatment providers immediately cease work and mask. The patients should do likewise. Only after putting on their own masks, do the dental treatment providers assist the patient, if necessary, by removing materials that impede the patient's masking. Only those materials that impede masking or may compromise the airway (such as rubber dam frames or impressions) are removed, the rest are left in place until the all clear is sounded. Special attention must be given to patients who may have been medicated into a less than fully conscious state, or are otherwise incapacitated.
b. Mission-Oriented Protective Posture Considerations. The MOPP level should be taken into account when determining the category and extent of dental treatment to be provided. Patients, including those seated in the dental chair, should be at the MOPP level prescribed for the DTF by its parent headquarters. Dental treatment at MOPP Levels 3 and 4 is, of course, impossible because of the requirement to wear the protective mask; however, treatment is still possible at MOPP Levels 0, 1, and 2. Treatment at MOPP Level 2 should be limited only to emergency care requiring urgent attention. At MOPP Level 1, most types of dental emergencies can be accommodated; however, only minimal essential treatment should be undertaken in order to reduce risk of the patient being caught in a compromised state. At MOPP Level 0, the provision of dental treatment generally is not limited. However, the degree of the NBC threat forecast for the area should be considered before undertaking extensive treatment.
c. Maxillofacial Injuries. Patients with maxillofacial injuries that prevent proper fit and seal of the individual protective mask must be placed in a PPW. Though patients with these types of injuries are most likely to be found only in MTF channels, DTFs should nevertheless be prepared in the event a patient presents to the DTF. Since the DTF does not have any PPWs; these patients should be immediately evacuated to the adjacent MTF for treatment.