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Guidelines for Military Mass Casualty Decontamination Operations During a Domestic HAZMAT/Weapon of Mass Destruction Incident completed decontamination and are seeking medical care. Every effort should be made to ensure that health care professionals and officials are intimately involved with and part of MCD planning, training and operations. In addition, an MCD approach that only considers decontamination from the incident site alone will not be effective in the face of casualties self-presenting to health care facilities rapidly and in high numbers. The principles of decontamination should guide all processes and priorities when planning and performing decontamination. 15 Table 5 compares the fundamentals and priorities listed in Field Manual 3-11.5 for military operations to those listed in the DHS TCL/UTL and USACBRNS/ECBC guidelines for civilian operations. 1,11,15 Note that the three lists complement each other. The DHS’ TCL/UTL and USACBRNS/ECBC recommendations are more operational. The FM 3-11.5 recommendations are more academic. Table 6consolidates these basic principles and associates them to specific USACBRNS collective tasks. Table 5: Comparison of the Decontamination Fundamentals Between FM 3-11.5, DHS TCL/UTL, and the USACBRNS/ECBC Guidelines, Volumes I & II. FM 3-11.5 DHS TCL/UTL* USACBRNS/ECBC* 1. Speed. Personnel should conduct decontamination operations as quickly as possible. Direct exposure to CBRN agents or toxic industrial materials will create casualties and could be fatal within minutes. The sooner equipment is decontaminated, the less likely it is to absorb the agent or spread to other surfaces. 2. Need. Decontaminate only what is necessary. Personnel have a limited amount of resources available and should expend resources only where they are needed. 3. Priority. Decontaminate the most essential items first; foremost will be the skin if contact occurs. Once wearing protective equipment, personnel should begin decontamination operations on clothing, equipment, and vehicles. 4. Limited Area. Personnel should perform decontamination near the area where the contamination occurs. This limits the spread of contamination to other areas and reduces the time spent traveling. 1. Test and identify all likely hazardous substances onsite. 2. Establish decontamination site for victims. 3. Implement emergency decontamination operations. 4. Screen affected persons. 5. Decontaminate victims exposed to CBRNE materials. 6. Implement plans, procedures, and protocols to ensure on-site individual gross decontamination of persons and household pets affected by the incident. 7. Readily identify people who have received gross decontamination. 8. Implement technical decontamination for injured, contaminated victims. 9. Monitor exit points for contaminant movement outside the isolation zone. 10. Monitor clean areas within the contamination control line. 1. Disrobing is the most critical step and removes up to 90% of physical contamination. 2. Neither should disrobing nor set up of a high-volume, lowpressure water shower be delayed to introduce a soap water solution or to set up tents. 3. Triage victims for decontamination before the water shower. 4. Victims should be washed between 30 seconds and 3 minutes. 5. Decontamination of chemical vapors, biological material or radiological substances can be aided by rubbing hands or cleans cloths across the skin. 6. Rubbing should start with the head and proceed down the body to the feet. 7. Use victim observation areas to watch for delayed symptom onset. 8. Perform additional secondary decontamination as necessary. * These Guidelines use the term “casualty” instead of “victim” or “patient.” However, cited references may use the terms “victim” and/or “patient.” These terms will not be changed to “casualty” when quotes are taken from the cited references. 26 Original
Guidelines for Military Mass Casualty Decontamination Operations During a Domestic HAZMAT/Weapon of Mass Destruction Incident The MCD principals presented in these Guidelines are derived from the DHS TCL/UTL, USACBRNS/ECBC Guidelines, Field Manuals 3-11.5, 3-11.21, 4-02.7, and other sources. They are designed to impart a sense of order to an ill-defined and complex operation. A large scale intentional or unintentional release of a chemical, biological, or radiological hazard is likely to lead to scores of casualties and fatalities. The rapid implementation of effective MCD process will be vital to optimizing casualty survivability and responder safety. Exactly how this process should be conducted is neither well known nor extensively studied. USACBRNS and USARNORTH have invested significant resources and time to develop MCD training standards and a process that reflects a worst case scenario. These standards are largely anecdotal and developed around 1) young healthy soldiers and 2) traditional HAZMAT/CBRN response techniques. The standards alone are not appropriate for all situations and may need to be adjusted to improve the unified military and civilian MCD response capability. The key is to know the standards and incorporate best practices and lessons learned into the planning process to be able to conduct optimum MCD operations that are adaptable to evolving conditions. Figure 4: Planning for MCD Operations Using Standards and Best Practices. Evolving Conditions Know the Standards Plan for the MCD Mission Tactics, Technique, and Procedures MCD Operations Incorporate Best Practices The MCD principles presented in Table 6 should be considered and appropriately integrated from initial planning to the actual conduct of MCD operations. MCD is both a medical procedure and crowd management operation. Speed and efficiency are critical elements of MCD operations. Section numbers are provided in parentheses where these principals are explained in greater detail in this document. Original 27 Table of Contents Introduction MCD Equipment Comparison Decontamination Overview MCD Operations Summary Appendix A References Appendix B Acronym List Appendix C Glossary Appendix D MCD Cross- Reference Guide Appendix E CBR Guide Appendix F MCD Decision Trees Appendix G ARNORTH Guidance
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