(MCD) Guidelines

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Guidelines for Military Mass Casualty Decontamination Operations During a Domestic HAZMAT/Weapon of Mass Destruction Incident • Deceased (Black Triage Tag). Casualty unlikely to survive given severity of injuries, level of available care, or both. Palliative care and pain relief should be provided. • Immediate (Red Triage Tag). Casualty can be helped by immediate intervention and transport. Requires medical attention within minutes for survival (up to 60). Casualty’s airway, breathing, and circulation have been compromised. • Delayed (Yellow Triage Tag). Casualty’s transport can be delayed. Has serious and potentially life-threatening injuries, but status not expected to deteriorate significantly over several hours. • Minor (Green Triage Tag). Casualty has relatively minor injuries. Status unlikely to deteriorate over days. May be able to assist in own care. Also known as walking wounded. To identify casualties in the different triage categories, affix a commercially available triage tag to each casualty. The commercially available tags are perforated for easy ripping. The bottom-most color of the tag indicates the triage category of the casualty. Some tags may also have barcoded strips that can be detached and included in a bag of personal effects or retained by the Triage Officer. The barcodes make tracking, documentation, and accountability processes easier for casualty management. To separate the Triage Staging Area within the MCD corridor, lay colored tarps on the ground or place small colored flags in an area. Direct or place the casualties accordingly. The colors of the tarps and/or flags should correlate to the triage categories of Red, Yellow, Green, and Black. 2 8.1.10. Treatment Versus Decontamination INTENT: Determine which casualties should receive treatment before they receive decontamination. Most medical treatment is delivered in the cold zone, after decontamination has occurred and been verified. However, in some cases, advanced-level skills are needed in the warm or hot zone before or during decontamination activities. In such a situation, the need for life-saving care should be weighed against the need to remove the contaminant. Before giving medical care, consider the nature and severity of the incident, the medical resources available, the resource requirements of providing such treatment, and the need to perform decontamination. 54 A casualty’s MCD Principles for Treatment Vs. Decon DHS UTL Tasks • ResB2b 6.1 and 6.2 • ResC1a 5.1, 6.1, 6.2, 6.2.1, 6.2.2, 6.2.3, and 6.3 USACBRNS Tasks • 03-2-5124 Step 19 • 03-2-6593 Step 2a chance of survival increases exponentially if he/she reaches medical care within the first 60 minutes after the injury, sometimes referred to as the “golden hour.” 42 Original
Guidelines for Military Mass Casualty Decontamination Operations During a Domestic HAZMAT/Weapon of Mass Destruction Incident The medical treatment of those who have been exposed to a radioactive material, in the absence of any other contamination, should take priority over all other activities, including decontamination. 55 Life safety of the responder is the most important aspect of MCD. Any emergency medical service (EMS) personnel operating in such situations should be trained under NFPA 473 and meet PPE requirements under NFPA 472 and 29 CFR 1910.120. 45,47,54 Casualties with open wounds may need special attention because bandages could trap the contaminant against the wound. Only properly trained medical personnel should remove contaminated bandages and splints. If the casualty arrives for decontamination with a bandage, remove the bandage and decontaminate the wound. Examine the wound and remove any visible foreign objects, if they can be removed without aggravating the wound. If bleeding persists, place a fresh bandage over the cleaned wound. 15 The priorities for treatment compared to decontamination in a situation in which other significant injuries exist should be based on the information listed in Table 8: 54 Table 8: Medical Care Versus Decontamination Priorities. Contamination Level Priority Based on Condition Critical (A) Unstable (B) Stable (C) Heavily contaminated with highly toxic substance II III III Heavily contaminated with low-toxicity substance I II II Low-level contamination with highly toxic substance II III III Low-level contamination with low-toxicity substance I I II Chemical in eyes: decontaminate eyes immediately and thoroughly A casualty’s condition can be determined by the following criteria: 54 (A) – Critical condition. Airway compromised, serious signs or symptoms of shock, life-threatening trauma, or burns. (B) – Unstable condition. Shortness of breath, unstable vital signs, altered level of consciousness, significant trauma, or burns. (C) – Stable condition. Stable vital signs, no altered level of consciousness, and no significant trauma or burns. A casualty’s priority can be determined by the following criteria: 54 Priority I – Medical Care First. For these casualties, medical care is more important than thorough decontamination. They should be processed through emergency decontamination before treatment and/or transport. If serious or critical medical conditions are present, start life-saving measures while gross decontamination is being performed. Original 43 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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