A. Patient decontamination
B. Casualty receiving area
C. Personnel Decontamination Station
D. Toxicity Data
E. Physical-Chemical Data
F. Medical Equipment Set Contents
G. Summary Chart
H. Glossary of Terms
Patient decontamination is personnel, time, and equipment
intensive. Nevertheless, with a little ingenuity and attention to
just a few basic principles, an effective litter decontamination
procedure can be accomplished with minimal cost. The first part
of this appendix briefly discusses considerations in establishing
a decontamination site, and this is followed by step-by-step
The decontamination site is part of the medical treatment
facility, and the same considerations for establishing the
treatment facility apply to the decontamination area. The
decontamination area is located about 50 yards downwind from the
treatment area (i.e., wind blowing from the clean treatment area
to the dirty decontamination area).
The important considerations of personnel and equipment
requirements are discussed in other publications.
Wind direction is important because a vapor hazard may be
present downwind from a liquid contaminated area (i.e., patient
arrival/triage area). Patient decontamination is always performed
upwind, or at least not downwind, from the patient arrival area.
The decon site will initially be set up to take advantage of
the prevailing wind; however, setup should be adaptable to allow
for quick rearrangement when the wind comes from another
If the wind changes direction by more than 45o the
decontamination site will need to be adjusted accordingly. A wait
of 15 to 20 minutes to determine if the change is permanent
should preceed the move. When the site is moved, it must be moved
at least 75 meters upwind from any contaminated area. Personnel
working in the old "clean" area when the wind shifts
must insure that all casualties remain masked. This scenario
points out that the ideal decon setup should include two separate
decon sites approximately 75 meters apart, when possible.
Security of Decon Site
When choosing a decontamination site, the same security
considerations must be given as any other site chosen for medical
operations. The decontamination site is at the same potential
risk from attack as is the actual medical treatment facility.
Area Control of Decon
An entry control point (ECP) can be established to control
movement of clean and contaminated vehicles to the Medical
Treatment Facility (MTF) or the Decon Site. The ECP should be
located at a distance far enough from the MTF to keep vapor
hazard from contaminated vehicles to the minimum.
Traffic control at the decon site involves routing a clearly
marked one-way course from the ECP to the decon site.
Control of personnel movement is necessary to ensure that
contaminated walking personnel do not accidentally contaminate
clean areas. The hot line must be secured. Concertina wire works
well to keep personnel in the desired areas and a clearly marked
one-way route helps to ensure that correct entry and exit points
Two people are required per litter patient. These two augmentees will link up with one litter patient in the triage area and work with that same litter patient until hand-off at the "hot line." These two people conduct both clothing removal and any required skin decontamination. To assist these two augmentees, two other augmentees will be needed: one to assist the first two augmentees in picking up the patient from the clothing removal litter and the second to remove the contaminated clothing and litter and to replace it with a clean litter. These four augmentees will conduct all patient decontamination and movement of the patient while in MOPP level 4 and the Toxicological Agent Protective (TAP) apron.
Personnel working in the patient decon area will be at MOPP
level 4 plus the Toxicological Agent Protective (TAP) apron. At
least two people from this area will move to the triage area and
carry the patient from this area to the first decontamination
Two different concentrations of chlorine solution are used in
the patient decontamination procedure. A 0.5% chlorine solution
is used for all patient washing procedures and for the mask
decon. The 5% chlorine solution is used to decon the scissors,
the TAP aprons and the gloves on personnel working in patient
decon area, and the casualty's hood. The chlorine solutions are
placed in buckets for use in this area. The buckets should be
distinctly marked because it is very difficult to tell the
difference between the 5% chlorine solution and the 0.5%
solutions. These solutions may be made using the 6 ounce Calcium
Hypochlorite (HTH) containers that come with the Chemical Agent
Decon Set. The 0.5% solution can be made adding one (1) six (6)
ounce container of calcium hypochlorite to 5 gallons of water.
The 5% Cl solution can be made by adding eight (8)-six (6) ounce
containers of calcium hypochlorite to 5 gallons of water. These
solutions evaporate quickly at high temperatures so if they are
made in advance they should be stored in closed containers.
1. Decontaminate the mask and hood: Sponge down front, sides,
and top of hood with 5.0% calcium hypochlorite solution, or wipe
off with the M258A1 or the M291 Decon Kit.
2. Remove hood
a. Dip scissors in 5% HTH solution.
b. Cut off hood.
(1) Release or cut hood shoulder straps.
(2) Cut/untie neck cord.
(3) Cut/remove zipper cord.
(4) Cut/remove drawstring under the voicemitter.
(5) Unzip the hood zipper.
(6) Cut the cord away from the mask.
(7) Cut the zipper below voicemitter.
(8) Proceed cutting upward, close to the inlet valve covers and eye lens outserts.
(9) Cut upward to top of eye lens outsert.
(10) Cut across forehead to the outer edge of the next eye lens outsert.
(11) Cut downward toward patient's shoulder staying close to the eye lens outsert inlet valve cover.
(12) Cut across the lower part of the voicemitter to the zipper.
(13) Dip scissors in HTH.
(14) Cut from center of forehead over the top of the head.
(15) Fold left and right sides of the hood to the side of the patient's head, laying sides on the litter.
c. The Quick Doff Hood is loosened and removed.
3. Decontaminate protective mask/face
a. Use M258A1, M291, or 0.5% hypochlorite.
b. Cover both inlet valve covers with gauze or hands.
c. Wipe external parts of mask.
d. Uncover inlet valve covers.
e. Wipe exposed areas of patient's face.
(3) Back of ears
4. Remove Field Medical Card
a. Cut FMC tie wire.
b. Allow FMC to fall into a plastic bag.
c. Seal plastic bag and wash with 0.5% hypochlorite.
d. Place plastic bag under back of mask head straps.
5. Remove all gross contamination from patient's overgarment.
a. Wipe all evident contamination spots with M258A1 Decon Kit, M291, or 5% hypochlorite.
b. Wipe external parts of mask with M258A1 Decon Kit, or M291.
c. Use wipe 1 then wipe 2, to clean exterior of mask; use wipe 2 then wipe 1 to clean interior.
6. Cut and remove overgarments. Cut clothing around tourniquets, bandages, and splints. Two persons will be cutting clothing at the same time. Dip scissors in 5% hypochlorite solution before doing each complete cut to avoid contaminating inner clothing.
a. Cut overgarment jacket.
(1) Unzip protective overgarment.
(2) Cut from wrist area of sleeves, up to armpits, and then to neck area.
(3) Roll chest sections to respective sides with inner surface outward.
(4) Tuck clothing between arm and chest.
(5) Repeat procedure for other side of jacket.
b. Cut overgarment trousers.
(1) Cut from cuff along inseam to waist on left leg.
(2) On right overgarment leg, cut from cuff to just below zipper and then go sideways into the first cut.
(3) Allow trouser halves to drop to litter with contamination away from patient.
(4) Tuck trouser halves to sides of body and roll the camouflage sides under between the legs.
7. Remove outer gloves. This procedure can be done with one aidman on each side of the patient working simultaneously. Do not remove inner gloves.
a. Lift the patient's arms by grasping his gloves.
b. Fold the glove away from the patient over the sides of the litter.
c. Grasp the fingers of the glove.
d. Roll the cuff over the finger, turning the glove inside out.
e. Carefully lower the arm(s) across the chest when the glove(s) is removed.
(Do not allow the arms to contact the exterior (camouflage side) of the overgarment.)
f. Dispose of contaminated gloves.
(1) Place in plastic bag.
(2) Deposit in contaminated dump.
g. Dip your own gloves in HTH.
8. Remove overboots.
a. Cut laces.
b. Fold lacing eyelets flat outward.
c. Hold heels with one hand.
d. Pull overboots downwards over the heels with other hand.
e. Pull towards you until removed.
f. Place overboots in contaminated disposal bag.
9. Remove personal articles from pockets.
a. Place in plastic bags.
b. Seal bags.
c. Place in contaminated holding area.
10. Remove combat boots without touching body surfaces.
a. Cut boot laces along the tongue.
b. Pull boots downward and toward you until removed.
c. Place boots in contaminated dump.
11. Remove inner clothing.
a. Unbuckle belt.
b. Cut BDU pants following same procedures as for overgarment trousers.
c. Cut fatigue jacket following same procedures as for overgarment jacket.
12. Remove undergarments following same procedure as for
fatigues. If patient is wearing a brassiere, it is cut between
cups. Both shoulder straps are cut where they attach to cups and
laid back off shoulders.
13. Clothing removal to skin decontamination: 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 apron
with the 5% hypochlorite solution. One member places his hands
under the small of the patient's legs and thigh; a second member
places his arms under the patient's back and buttocks; and the
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 decon team member removes the litter
from the litter stands and another member replaces it with a
decontamination (clean) litter. The patient is carefully lowered
onto the clean litter. Two decon members carry the litter to the
skin decontamination station. The contaminated clothing and
overgarments are placed in bags and moved to the decontaminated
waste dump. The dirty litter is rinsed with the 5%
decontamination solution and placed in a litter storage area.
Decontaminated litters are returned by ambulance to the maneuver
14. Skin decontamination: The areas of potential contamination
should be spot decontaminated using the M258A1 kit, the M291 kit,
or 0.5% hypochlorite. These areas include the neck, wrists, lower
face, and skin under tears or holes in the protective ensemble.
After the patient is deconned his dressings and tourniquet are
changed. Superficial (not body cavities, eyes or nervous tissue)
wounds are flushed with the 0.5% Cl solution and new dressings
applied as needed. Cover massive wounds with plastic or plastic
bags. New tourniquets are placed 0.5 to 1 inch proximal to the
original tourniquet, then the old tourniquets are removed.
Splints are not removed but saturated to the skin with 0.5% Cl
solution. If the splint cannot be saturated (air-splint or canvas
splint) it must be removed sufficiently so that everything below
the splint can be saturated with the 0.5% Cl solution. The
patient, his wounds, and the decontaminable stretcher have now
been completely deconned.
15. Final monitoring and movement to treatment area: The
patient is monitored for contamination using the CAM, the M8
paper or M9 paper. The contents of the M258A1 kit (pad 1 and pad
2 when used separately or together) and hypochlorite on the skin
do not affect the CAM. However, pad 1 of the M258A1 kit causes M8
paper to turn dark green (V agent), pad 2 causes no color change,
and the pads used together cause M8 paper to turn yellow (G
agent). Each pad causes the M9 paper to react (turn red). Once
the casualty is confirmed clean of chemical agent he is
transferred via a shuffle pit over the hot line. The shuffle pit
is composed of two parts Super Tropical Bleach (STB) and 3 parts
earth or sand. The shuffle pit should be deep enough to cover the
bottom of the protective overboots. The buddy system wash of the
TAP apron and gloves in 5.0% hypochlorite solution precedes the
transfer of the patient to a new clean canvas litter if the
decontaminable stretchers are in limited supply. A three-person
patient lift is again used as the litter is switched. If the
litter as well as the patient was checked both patient and the
same litter can be placed over the hot line.
AMBULATORY PATIENT DECON
Casualties who are decontaminated in an ambulatory area are
those who (a) require treatment that can be supplied in the
emergency treatment area, or (b) require resupply of their
protective overgarments in the clean area before return to duty.
Those who require clothing removal use the litter decontamination
procedure as removal of clothing is not done in this area.
Personnel from the decontamination station might assist the
casualty, or the casualties might assist each other during this
process under close supervision.
Decontamination of ambulatory patients follows the same
principles as for litter patients. The major difference is the
sequence of clothing removal, listed below, to lessen the chance
of patient contaminating himself and others.
The first five steps are the same as in litter patient
decontamination and are not described in detail.
1. Remove load bearing equipment
2. Decontaminate mask and hood and remove hood
3. Decontaminate skin around mask
4. Remove Field Medical Card and put it into a plastic bag
5. Remove gross contamination from the outergarment
a. Removal and bag personal effects from overgarment
6. Overgarment Jacket Removal
a. Instruct patient to:
(1) Clench his fist.
(2) Stand with arms held straight down.
(3) Extend arms backward at about a 30 degree angle.
(4) Place feet shoulder width apart.
b. Stand in front of patient.
(1) Untie drawstring
(2) Unsnap jacket front flap.
(3) Unzip jacket front.
c. Move to the rear of the patient.
(1) Grasp jacket collar at sides of the neck.
(2) Peel jacket off shoulders at a 30 degree angle down and away from the patient.
(3) Smoothly pull the inside of sleeves over the patient's wrists and hands.
d. Cut to aid removal if necessary.
7. Removal of Butyl Rubber Gloves
a. Patient's arms are still extended backward at a 30 degree angle.
(1) Dip your gloved hands in 5% hypochorite solution.
(2) Use thumbs and forefingers of both hands.
(a) Grasp the heel of patient's glove at top and bottom of forearm.
(b) Peel gloves off with a smooth downward motion. This procedure can easily be done with one person or with one person on each side of the patient working simultaneously.
(c) Place gloves in contaminated disposal bag.
b. Tell the patient to reposition his arms, but not to touch his trousers.
8. Remove patient's overboots
a. Cut overboot laces with scissors dipped in 5% hypochlorite.
b. Fold lacing eyelets flat on ground.
c. Step on the toe and heel eyelet to hold eyelets on the ground.
d. Instruct patient to step out of the overboot onto clean area. If in good condition, the overboot can be decontaminated and reissued.
9. Remove overgarment trousers
a. Unfasten or cut all ties, buttons, or zippers.
b. Grasp trousers at waist.
c. Peel trousers down over the patient's boots.
d. Cut trousers to aid removal if necessary.
(1) Cut around all bandages and tourniquets.
(2) Cut from inside pant leg ankle to groin.
(3) Cut up both sides of the zipper to the waist.
(4) Allow the narrow strip with zipper to drop between the legs.
(5) Peel or allow trouser halves to drop to the ground.
e. Tell patient to step out of trouser legs one at a time.
f. Place trousers into contaminated disposal bag.
10. Remove glove inner liners. Patient should remove the liners since this will reduce the possibility of spreading contamination.
a. Tell patient to remove white glove liners.
(1) Grasp heel of glove without touching exposed skin.
(2) Peel liner downward and off.
(3) Drop in contaminated disposal.
(4) Remove the remaining liner in the same manner.
(5) Place liners into contaminated disposal bag.
11. Final monitoring and decontamination
a. Monitor/test with M8 Detection Paper or CAM.
b. Check all areas of patient's clothing.
c. Give particular attention to
(a) Discolored areas
(b) Damp spots
(c) Tears in clothing
(f) Around dressings
d. Decontaminate all contamination on clothing or skin by cutting away areas of clothing or using 5% hypochlorite, the M291, or the M258A1 for clothing or 0.5% hypochlorite and the M291, or the M258A1 for skin
12. The medical corpsman should remove bandages and tourniquets and decontaminate splints, using the procedures described in the decontamination of a litter patient, during overgarment removal.
13. The patient is decontaminated and ready to be moved inside the hot line. Instruct patient to shuffle his feet to dust his boots thoroughly as he walks through the shuffle pit.
In the clean treatment area the patient can now be re-triaged,
treated, evacuated, etc. In a hot climate the patient will
probably be significantly dehydrated and the rehydration process
The clean area is the resupply point for the patient
decontamination site. Water is needed for rehydration of persons
working in the decon area. The resupply section should have an
adequate stock of canteens with the chemical cap.
A location is needed in each decon area (75 meters from the
working decon site) to allow workers, after they have deconned
their TAP aprons, to remove their masks and rehydrate. There are
generally not enough BDOs available to allow workers to remove
them during the rest cycle and don new gear before going back to
work. If these clean/shaded rest areas are not provided, the
workers must remain in MOPP 4 even during rest periods, and water
must be drunk through the mask via the drinking port. If all
water consumption is by mask there must be a canteen refill area
adjacent to the vapor/clean line in which empty canteens can be
deconned and placed for refill and clean full canteens are
present for rehydration.
(The above procedures were adapted from FM 8-10-4 and FM
Casualty Receiving Area
The diagram (not yet available) shows
a setup for casualty reception in a contaminated environment. The
chapter on casualty management describes the stations.
The actual setup of this area may vary depending on the assets
Personnel Decontamination Station
The following foldout (not yet
available) is a diagram of the Personnel
Decontamination Station. This is a decontamination procedure for non-casualty
personnel. It is not a medical specific procedure, but a
procedure that all units in the military--including medical
Using this procedure, contaminated non-casualty personnel can
move from the contaminated (dirty) area across the hot line to
the non-contaminated (clean) area. In a medical unit this
procedure would be followed by those working in the dirty area
(such as the triage officer, the decontamination team) to move to
the clean area.
A related procedure (not shown) is the MOPP exchange station.
In this station personnel who have been wearing contaminated MOPP
gear longer than the recommended time can exchange their dirty
protective garments for clean garments.
(Taken from FM 3-5.)
The following tables provide estimated human toxicity data on
the agents discussed in this Handbook.
|Effect||Ct50 (mg-min/m3)||Liquid on skin|
|Death||~1500 inhalation||40-50 mg/kg|
The following tables provide physical-chemical data on the
agents discussed in this Handbook.
|Liquid density||[email protected]
|Volatility||34.3 @20oC||0.71 @25oC|
MEDICAL EQUIPMENT SET
CHEMICAL AGENT PATIENT TREATMENT
|NOMENCLATURE / NSN||AMOUNT|
|Atropine Inj. 0.70L 6505-00-926-9083||500 ea|
|Pralidoxime Chloride 6505-01-125-3248||100 ea|
|Boric Acid 5% 6505-01-153-3012||36 tu|
|Sodium Nitrite 6505-01-206-6009||12 pg|
|Sodium Thiosulfate 6505-01-206-6010||12 pg|
|Diazepam 6505-01-274-0951||3 pg|
|Atropine Sulfate 6505-01-332-1281||1 pg|
|Infusion Set Size:2 6515-00-089-2791||60 ea|
|Airway Pharyn LGE 6515-00-300-2900||6 ea|
|Airway Pharyn SM 6515-00-300-2910||6 ea|
|NOMENCLATURE / NSN||AMOUNT|
|Syringe Hypo 10ml 6515-00-754-0412||.6 pg|
|Needle Hypo 18ga 6515-00-754-2834||1.2 bx|
|Suction Apparatus 6515-01-076-3577||4 ea|
|Resuscitator Hand 6515-01-338-6602||4 ea|
|Syringe Hypo 50ml 6515-01-280-2320||1 pg|
|Chest No. 4 6545-00-914-3490||3 ea|
|Gloves Chem 8415-01-138-2502||2 pr|
|Gloves Chem. 8415-01-138-2503||2 pr|
|Bag Chem Cas. 8465-01-079-9875||12 ea|
MEDICAL EQUIPMENT SET
CHEMICAL AGENT PATIENT DECONTAMINATION
|NOMENCLATURE / NSN||AMOUNT|
|M291 SDK 4230-01-276-1905||2 bx|
|Bandage Scissors 6515-00-935-7138||6 ea|
|Syringe Hypo 6515-01-280-2320||.6 pg|
|Litter Support 6530-00-660-0034||4 pr|
|Chest No. 4 6545-00-914-3490||1 ea|
|Chest No. 6 6545-00-914-3510||1 ea|
|M9 Chem Agt Paper 6665-01-049-8982||1 ro|
|Calcium Hypo 6810-00-255-0471||48 bo|
|12 qt Pail 7240-00-773-0975||10 ea|
|Sponge Cellulose 7920-00-884-1115||6 ea|
|Bag Plastic 8105-00-191-3902||2 ro|
|Plastic Sheet 8135-00-618-1783||2 ro|
|Work Gloves MED 8415-00-268-8353||25 pr|
|Work Gloves SM 8415-00-258-8354||25 pr|
|Black Pencils 7510-00-240-1526||2 dz|
|NOMENCLATURE / NSN||AMOUNT|
|TAP Apron SM 8415-00-281-7813||2 ea|
|TAP Apron MED 8415-00-281-7814||4 ea|
|TAP Apron LRG 8415-00-281-7815||2 ea|
|Chem Prot Glove 8415-01-033-3517||2 ea|
|Chem Prot Glove 8415-01-033-3518||4 ea|
|Chem Prot Glove 8415-01-033-3519||2 ea|
|Decon Litter 6530-01-290-9964||4 ea|
Fold out chart
(not yet available)
The enclosed chart is intended to serve as a reminder of the
agents, their effects, first aid measures, detection, and skin
It is in no way complete, nor is it intended to be complete.
Consult the appropriate chapter for further details.
Glossary of Terms
ACAA: Automatic Chemical Agent Alarm
AMEDD: Army Medical Department
BDO: Battle Dress Overgarment
BDU: Battle Dress Uniform
CAM: Chemical Agent Monitor
CANA: Convulsive Antidote, Nerve Agent
CARC: Chemical Agent Resistant Coating
CDC: Chemical Decontamination Center
CBPS: Chemical and Biological Protective Shelter
CPS: Chemical Protective Shelter
DBDO: Desert Battle Dress Overgarment
DTD: Detailed Troop Decontamination
ECP: Entry Control Point
FMC: Field Medical Card
GREGG: Graves Registration
HTH: High Test Hypochlorite
KPH: Kilometer Per Hour
LBE: Load Bearing Equipment
LCL: Liquid Control Line
MES: Medical Equipment Set
MOPP: Mission Oriented Protective Posture
MTF: Medical Treatment Facility
MTO&E: Modified Table of Organization and Equipment
NAAK: Nerve Agent Antidote Kit
NATO: North American Treaty Organization
NCO: Non-Commissioned Officer
NCOIC: Non-Commissioned Officer-in-Charge
SDK: Skin Decontamination Kit
TAP: Toxicological Agent Protective, e.g., TAP apron
TC: Training Circular
VCL: Vapor Control Line