Volume 3 — APPENDIX F EMPLOYMENT OF CHEMICAL AND BIOLOGICAL COLLECTIVE PROTECTION SHELTER SYSTEMS BY MEDICAL UNITS

APPENDIX F EMPLOYMENT OF CHEMICAL AND BIOLOGICAL COLLECTIVE PROTECTION SHELTER SYSTEMS BY MEDICAL UNITS

Section I. INTRODUCTION

F-1. General

To continue the HSS mission under CB conditions, MTFs must search out contamination free areas or employ CPS systems. Levels I and II MTFs may be able to locate contamination free areas; however, due to the mobility limitations of hospitals, they must always be prepared to operate under CB conditions if the area is under attack. Systems that can be employed as an MTF (Levels I, II, III, and IV) are described in this appendix.

F-2. Types of Collective Protection Shelter Systems

a. The CBPS system is employed at the BAS, DCS, and FST. The CBPS is attached to the hard-walled box on the rear of a high mobility multi-purpose wheeled vehicle (HMMWV). The BAS will have one CBPS system per treatment team; the DCS will have four CBPS systems; the FST will have three CBPS systems. Also, systems will be issued to other selected medical treatment teams. When employed at the DCS, the patient holding team will also require GP tents to hold their required number of patients (see Chapter 4). Patients held inside the CBPS will be those that have been decontaminated and admitted into the system for treatment and are recovering from the treatment procedures and are awaiting evacuation. Any patients held in the GP tent must remain in MOPP Level 4 (the GP tent will not have collective protection); these patients are those that are expected to RTD within 72 hours.

NOTES

1. Normally, patients will not be held at the DCS under NBC conditions unless evacuation cannot be accomplished. They should be RTD or evacuated to a clean MTF, as soon as the mission permits.

2. The CBPS can also be employed as the DCS in the conventional mode. Employment in either mode still requires GP tentage for patient holding to meet total patient holding requirements.

b. The DEPMEDS-equipped patient care areas of the US Army Force XXI hospital and the hospital unit base (HUB) of the Medical Force 2000 (MF2K) will employ the CP DEPMEDS. It will not protect personnel or patients from the thermal, blast, and initial radiation effects of nuclear weapons; however, it will provide some protection against fallout effects. Areas of the hospital that are not included in the chemically protected (CP) DEPMEDS are MF2K general hospital unit medical (HUM), MF2K field hospital unit holding (HUH), MF2K combat support and general hospital unit surgical (HUS), minimum care wards, administrative areas, food service, supply (including Class VIII), and staff quarters. The system includes—

Chemically/biologically protected liners for tent, expandable, modular, personnel (TEMPER) and passageways.

CB-filtered and conditioned (heated or cooled) air (field deployable environmental control unit [FDECU] or H80 Army Standard Heater).

Chemically/biologically protected ambulatory, litter, and supply air locks.

Chemically/biologically protected latrines.

Chemically/biologically protected seals for ISO shelters.

Chemically/biologically protected water supply system.

c. The M20 simplified collective protection system is another system that is available. It consists of a chemically protected room liner, a CB filter blower, and an ambulatory air lock. However, it does not have a litter air lock making it unsuitable for litter patient care. The M20 may be used to protect medical staffs at the DCS, FST, and hospitals, patients held in the GP tents at the DCS and in the minimum care wards and staff quarters of the hospitals. Thus providing additional CB protection for staffs and patients.

Section II. EMPLOYMENT OF THE CHEMICALLY BIOLOGICALLY PROTECTED SHELTER SYSTEM

F-3. Establish a Battalion Aid Station in a Chemically Biologically Protected Shelter

To establish a BAS in a CBPS, use one CBPS per treatment team for conventional operations in a split-team mode. When operating in a squad configuration and in the conventional mode, the two CBPS systems may be complexed to provide more workspace. However, keep in mind that the treatment squad is not staffed to operate the two systems in the CB mode. Therefore, when the two systems are complexed and the treatment squad must convert and operate in the CB mode, they may want to close the complexing door and only use one system. When initially setting up the CBPS for operations in the CB mode, only one CBPS is setup; see Note 2 below. Set up the system as described in TM 10-5410-228-10. To be operational as a BAS, set up medical supplies and equipment as required or as designated in the TSOP. A PDS consisting of a contaminated ambulance point, contaminated triage point, a patient decontamination area, and a contaminated treatment area is established on the downwind (prevailing wind) side of the CBPS. An overhead cover of plastic sheeting (approximately 20 feet wide by 50 feet long) is set up over the PDS, the hot line, and the clean treatment/waiting area; the cover overlaps the air locks. The clean treatment/waiting area should have an area at least 20 feet wide by 15 feet long to allow space for placing patients into the litter air lock without crossing the hot line. A second area covered with 20 × 25 feet of plastic sheeting (the evacuation holding area) is set up beside the shelter on the opposite side from the generator. The clean treatment area is separated from the decontamination area by a hot line with a shuffle pit. Only clean (decontaminated) patients or personnel are allowed to cross the hot line into the clean treatment area, or are admitted into the CBPS. Figure F-1 presents one layout of a BAS using the CBPS. See TM 10-5410-228-10 for complete details on setting up, operating, and maintaining the CBPS. Each CBPS provides 300 square feet of work area.

NOTES

1. The overhead cover is not needed when the wind speed exceeds 10 knots per hour. The plastic will not stay in place.

2. Although each treatment team of the BAS has a CBPS; only one system is set up when operating in the CB mode. This is due to the lack of authorized personnel to operate all systems at one time in the CB mode. Eight medical personnel are required to operate the BAS (employing one CBPS) in the CB mode. At least eight nonmedical personnel are required to perform patient decontamination under medical supervision. Also, only setting up one system in the CB mode provides the BAS the ability to retain its flexibility in order to maintain its support mission of being where it is needed and when it is needed. The CBPS can be used as the treatment shelter in the conventional mode as well. When the treatment squad is operating in the split-team mode, each team will have a CBPS for use as its treatment shelter. When operating one system in the CB mode, the other system provides a replacement in the event the one in use in the CB mode is damaged beyond repair. This ensures continued HSS to the command.

Figure F-1. Battalion aid station using the chemically biologically protected shelter.

F-4. Division Clearing Station in a Chemically Biologically Protected Shelter

To establish a DCS using the CBPS, set up four shelters as described in the TM. To be operational, medical supplies and equipment are set up as outlined in the unit TSOP. The four shelters are complexed as shown in Figure F-2. With four CBPS systems set up and operational, a total of 1,200 square feet of work area is available. The contaminated triage, decontamination, and contaminated treatment areas are separated from the clean treatment/waiting area by a hot line with a shuffle pit. Overhead covering is provided as described for the BAS. Patients are admitted through the EMT litter or ambulatory air lock. Patients are released through the patient holding air locks. This aids in controlling entry and exits; thus preventing the introduction of contamination into the systems. At least eight nonmedical personnel from supported units are required to perform patient decontamination under medical supervision at the DCS.

NOTE

In the event that the overpressure system fails on a system that is in use with entry/exit air locks, move to the available shelter with an entry/exit air lock in the same direction for use as the entry/exit until the failed system can be restored. Example 1: At the DCS the EMT system fails, move to the ATM shelter to receive patients until the EMT system has been restored. Example 2: At the DCS the patient hold system fails, move exits to the dental/lab/x-ray shelter until the patient hold system can be restored. Example 3: At the FST the postoperative system fails, use the preoperative shelter until the postoperative system can be restored. These options will allow patient care operations to continue until the failed systems can be restored.

Figure F-2. Chemically biologically protected shelter configuration as a division clearing station.

F-5. Forward Surgical Team in a Chemically Biologically Protected Shelter

To establish a FST using the CBPSs, follow the procedures for the DCS except set up three CBPSs. All equipment is set up inside the CBPS as required by your unit TSOP. With three CBPSs set up and operational, a total of 900 square feet of work area is available (Figure F-3). When the FST is forward in support of a medical company and operating in the CB mode, the FST systems are connected to the DCS of the supported medical company. Figure F-4 shows the FST and DCS connected. When operating in the CB mode with the medical company, all patients are received through the EMT air lock of the DCS. The patients are triaged in the DCS and, based upon their injuries, they are routed to the DCS treatment area or to the FST for surgical care. Patients released from the FST for evacuation are placed in a PPW and processed through the litter air lock in the FST recovery section. Patient decontamination is performed at the PDS operated by the DCS. The FST cannot operate in a CB environment without being complexed with the DCS. They do not have any patient decontamination capabilities.

Figure F-3. Forward surgical team configuration for operations in conventional mode.

Figure F-4. Forward surgical team and division clearing station configuration for operations in a nuclear, biological, chemical environment.

Section III. EMPLOYMENT OF THE CHEMICALLY PROTECTED DEPLOYABLE MEDICAL SYSTEMS AND SIMPLIFIED COLLECTIVE PROTECTION SYSTEMS

F-6. Collective Protection in a Deployable Medical System-Equipped Hospital

a. When the threat of NBC action is anticipated in the AO, the CP DEPMEDS components must be set up as the hospital is being established. The system cannot be set up in a hospital that has already been established; to do so requires the hospital to be closed, all TEMPERs be struck, and erected with the M28 liners installed during the erection process. To establish CPS in a DEPMEDS-equipped hospital, follow the procedures as described in TM 10-5410-283-14&P. Training Circular 8-13 provides instructions on establishing a US Army DEPMEDS-equipped hospital (without CPS). Figure F-5 presents one layout of the DEPMEDS-equipped patient care area of a MF2K CSH HUB employing the CP DEPMEDS with an internal water supply system. Figure F-6 presents a layout of the patient care area of the DEPMEDS-equipped portion of an 84-bed MRI hospital. Figure F-7 presents a layout of the patient care area of the DEPMEDS-equipped portion of a 164-bed MRI hospital.

b. When employing CP DEPMEDS, provisions for waste disposal and protected water and food supplies within the system are established. Additionally, Class VIII supplies must be protected from contamination. Supplies not in use or needed in the protected operational areas are stored in medical chests, shipping containers, or wrapped in layers of plastic that are inside covered areas, such as closed MILVANs or tents. When contamination is present, only open these storage areas for operational area emergency resupply. Use plastic sheeting or other leak-proof material to provide an additional barrier between the supplies and the contamination. Wrap supplies in plastic or other barrier material for movement from the storage area to the resupply air lock of the CP DEPMEDS.

A water supply system with distribution hoses is established inside the CP DEPMEDS areas (Figure F-5). Pumps continuously circulate the water from the storage tank through the hose system back to the storage tank. The continuous circulation ensures that the chlorine residual is maintained in the water supply. Personnel in areas that are not included in the continuous flow system must draw water from the system and carry it to their work areas in 5-gallon water cans or other containers. Water resupply is accomplished by passing a hose through the utility port at the end of the TEMPER and M28 liner for a connection to the water transport vehicle. The ends of both hoses must be decontaminated with a 5 percent chlorine solution before connecting them together. The vehicle must have a tank or water supply container that is NBC protected to ensure that the water supplied is free of NBC contamination.

Rations, as determined by the hospital commander, should be available within the protected area for personnel and patients. Under emergency conditions the commander can authorize feeding patients MRE rations for limited periods of time (up to 72 hours), if they are able to chew and swallow. However, attempts must be made to ensure the required types of rations for patient feeding are available in the CPS. The rations can be stored in any available space; however, the rations must be protected from exposure to possible contaminants, especially liquids. Ration control measures are established to ensure that the rations are only consumed as provided for in the hospital TSOP.

Two CB protected latrine systems are included in the CP DEPMEDS. The latrines contain bedpan wash areas. The waste from the latrines is collected in an outside receiving container. The waste is removed from the container and disposed of as outlined in the unit TSOP.

Solid waste (including medical) must be placed in plastic bags. Seal the top of the bags to prevent spillage, odors, or spread of infections/disease. NEVER overfill the bags; always leave enough room in the bag to make a good seal. Place the sealed bags in the supply air lock. Inside personnel close the inner door to the air lock. Outside personnel check to ensure that the inner air lock door is closed before opening the outside door. Remove the bags and take them to the designated waste collection/disposal site. Disposal may be by burial on site or by transport to a designated disposal facility. Transport may be by organic vehicles or contractor support vehicles. The specific technique for disposal will be outlined in the unit TSOP.

All liquid waste produced within the CP DEPMEDS is collected through a piped liquid waste system to a central collection container. The waste container for the latrines may be used to collect the liquid waste from the operational areas of the CP DEPMEDS. The container is emptied and the waste disposed of as outlined in the unit TSOP.

Figure F-5. Sample layout of a medical force 2000 combat support hospital unit base employing chemically protected deployable medical system.

Figure F-6. Sample layout of an 84-bed medical reengineering initiative hospital employing chemically protected deployable medical system.

Figure F-7. Sample layout of a 164-bed medical reengineering hospital employing chemically protected deployable medical system.

F-7. Chemically/Biologically Protecting the International Organization for Standardization Shelter

To chemically/biologically protect the ISO shelters, seal all seams and openings of the ISO to prevent the entry of CB agents. The seals connecting the various sides and floor of the shelter may be a CB protected material; thus providing a seal to the shelter. When the seals are not of a CB protected material, the seams must be taped to provide a CB protected barrier over the soft seals. Any openings not being used for introduction of support power lines, water lines or waste water lines must be sealed to prevent entry of CB agents. All access panels must be securely closed to prevent entry of vapors.

F-8. Chemically/Biologically Protecting the Vestibules

The vestibules connect TEMPERs to TEMPERs, ISOs to ISOs, and ISOs and TEMPERs. To harden the vestibules, install the CB liners inside and fasten the ends to the liners of the TEMPER or to the doors of the ISOs. Vestibule liner connectors are provided for use at the entry of each ISO.

F-9. Chemically/Biologically Protecting Air Handler Equipment

a. The FDECU is chemically/biologically protected. The system can be operated without the CB filters. When required to operate in the CB mode, the fresh air intake on the FDECU is closed and the CB filter blower is turned on drawing fresh air through the filters to support the FDECU and to provide clean air for the CPS. Additionally, recirculation filters are placed within the shelter system to remove any agent that may have entered through any of the entry/exit areas or through breaches in the shelter system.

b. When heaters are required, they must be chemically/biologically protected to prevent entry of contamination. The CB filter units are connected to the fresh air intake side of the heater and the heated air discharge side of the heater is connected to the air supply of the TEMPER/ISO.

F-10. Establish Collective Protection Shelter Using the M20 Simplified Collective Protection System

The M20 is used to establish a CPS within a room of opportunity, or inside a tent; however, the available space will be limited by tent poles and other components of the tent. Currently this system only provides ambient temperature air. See the TM and manufacturer's publication provided with the system and system components for details.

NOTE

The M20 does not have a litter air lock. Only staff or ambulatory patients can enter. See the TM provided with the system for setup procedures.

F-11. Casualty Decontamination

Patients admitted into the MTF must be contamination free. Therefore, a casualty decontamination area must be established near the MTF. The casualty decontamination area should be provided with an overhead cover as described for the CBPS system, except that it does not overlap the entry to the hospital. Also, consideration must be given to the location of other operations at the hospital site when establishing the casualty decontamination area. However, the area must be close enough to the entry/exit of the CPS to protect the patients from the environment and reduce their exposure to recontamination. Keep in mind that under NBC conditions personnel outside of the CPS are at MOPP Level 4 (except decontaminated patients; they have their mask on), thus increasing the stress load and reducing their overall performance capabilities. The entry/exit area must have overhead cover to protect patients awaiting access to the CPS. See Appendix I for setting up a casualty decontamination area and for decontamination procedures.

Section IV. OPERATIONS, ENTRY, AND EXIT GUIDELINES

F-12. Operations

These operations, entry, and exit guidelines may be used to prepare a unit SOP for the operation of CPS systems in your unit.

a. When using these guidelines, the following should be considered:

Location of the shelter (flat, hilly, rocky ground).

General climate of the AO (high and low temperature variations during operation).

b. Information on setting up, striking, and operating the CPS is contained in the equipment publications. Where applicable, special procedures are provided in these publications for setting up in both clean and CB vapor hazard areas. However, the CP DEPMEDS is NOT set up in a CB vapor hazard area. The commander will determine which procedures to use.

c. During operations, periodic checks are made of the atmosphere within the shelter. These checks are made by using available chemical agent detection equipment and material to determine if chemical agent penetration has occurred. Should chemical agent penetration occur, all personnel must mask; then ensure that patients are protected until the agent has been purged from the shelter.

F-13. Decontamination of Entrance Area

a. Normally, the MTF will not operate in a CB vapor hazard environment. However, if the MTF must remain in an area on a temporary basis and liquid agent contamination is present, the immediate area around the entrance must be decontaminated.

b. To decontaminate the area around the entrance, use one or more of the following methods:

Turn over about 2 inches of soil.

Remove the top 1-inch layer of soil containing the liquid agent. Use the CAM or M8 detector paper to check the area after the topsoil is removed to ensure complete agent removal.

Add several inches of clean soil or sand.

Mix STB into the top 1/2 to 1 inch of soil.

Use DS2 on contaminated hard-surfaced areas or frozen ground.

F-14. Procedures Prior to Entry

All personnel (staff and patients) must be decontaminated before they are permitted entry into the CPS.

Use chemical detection equipment to check for the presence of contamination on individuals and their equipment; also check for presence of contamination on individual weapons if they are allowed in the CPS. Normally, weapons will not be allowed in the patient care areas, but will be stored outside near the entry/exit. Thorough decontamination is critical in preventing contamination transfer into the CPS.

When a chemical agent is detected, follow the procedures in Appendix C for patient decontamination and FM 3-5 for other personnel decontamination before entering the CPS. All contaminated clothing and equipment are placed in the contaminated dump. Weapons should not have been evacuated with patients. However, if weapons are evacuated with the patient, they are decontaminated and held by the MTF (administrative personnel or hospital supply) for disposition instructions.

Decontamination must be thorough; procedures must be strictly followed. Failure to do so can contaminate the interior of the MTF and injure medical treatment personnel; thus reducing their mission support capabilities.

WARNINGS

1. ALWAYS PURGE THE AIR LOCK BEFORE OPENING THE INNER DOOR, IF THE OUTER DOOR HAS BEEN OPENED.

2. WHEN OPERATING IN A TOXIC ENVIRONMENT, NEVER OPEN THE OUTER AND INNER DOORS OF THE AIR LOCKS AT THE SAME TIME.

F-15. Entry/Exit for the Collective Protection Shelter System

a. Ambulatory Personnel.

(1) Entry procedures.

(a) Ambulatory patients and others remove their MOPP (except their mask), BDUs, and boots outside the air lock. This procedure reduces the amount of possible contamination entering the air lock.

(b) A check is made to ensure that the ambulatory air lock is empty and the inner door is closed.

(c) The individual enters the air lock and closes the outer door.

(d) The air lock is purged for 3 minutes. At the end of the purge cycle, the individual checks for contamination. If contaminated, the individual must return to the outside and decontaminate his skin; then return to the air lock and repeat the purge cycle and contamination check. If no contamination is detected, the protective mask is removed and placed in a plastic bag. The plastic bag is sealed and labeled. The individual opens the inner air lock door and enters the CPS; the plastic bag is carried into the shelter with the individual.

(2) Exit procedures.

(a) A check is made to ensure that the ambulatory air lock is empty and the outer door is closed.

(b) The individual enters the air lock and closes the inner door.

(c) The individual puts on his protective mask; then exits through the outer door.

(d) The individual puts on his BDU and boots then assumes the established MOPP level before departing the immediate area of the exit door.

WARNING

DO NOT OPEN THE OUTER DOOR UNTIL THE PROTECTIVE MASK HAS BEEN PUT ON.

NOTES

1. Ambulatory patients that enter the CBPS become litter patients and are placed in PPW when released because the MTF does not have replacement MOPP ensembles for patient issue.

2. Exits must be spaced so that at least a 3 minute purge of the air lock is accomplished before the inside door is opened. Only open the doors long enough to permit passage.

b. Litter Patients.

(1) Entry procedures.

(a) An outside aidman notifies an inside aidman that a litter patient is ready for admission.

(b) The inside aidman ensures that the inner litter air lock door is closed. The outside aidmen open the outer air lock door and place the litter on the litter rails; they push the patient into the air lock headfirst; then they close the outer door. After a purge time of 3 minutes, an aidman inside the CPS opens the inner door and checks the patient to ensure that he is contamination free. The patient is checked by placing the CAM nozzle near absorptive surfaces, such as the patient's hair. If no contamination is found, the aidman removes the patient's mask and places it in a plastic bag. The inside aidmen remove the patient from the air lock and position him on treatment litter stands, or move him to the treatment area as directed by supervisory personnel.

(c) Patients received at the treatment facility in the PPW are checked for contamination; if they are contamination free, they may be processed through the litter air lock in the PPW. The inside aidmen ensure that the inner litter air lock door is closed. The outside aidmen open the outer air lock door and place the litter on the litter rails and push the patient into the litter air lock headfirst, then close the outer door. Purge the air lock for 3 minutes. After the purge time, an aidman inside of the CPS opens the inner air lock door and uses the CAM to check the patient to ensure that he is free of contamination. If no contamination is found, the inside aidmen remove the patient from the air lock. (If the patient is wearing a protective mask, the mask is removed and placed in a plastic bag before the patient is moved from the air lock.) As the patient is removed from the air lock, the PPW is opened and rolled inside out so that any desorbing vapors are adsorbed by the charcoal layer. The inside aidmen remove the patient from the air lock and position him on litter stands. The patient is transferred to a clean litter; then moved to the treatment area as directed by supervisory personnel. The receiving litter and PPW is returned to the outside; dispose of the PPW in the contaminated waste dump. Decontaminate the litter and return it to the litter pool.

NOTE

Should contamination be found when monitoring the air lock in (b) or (c) above, repeat the purge cycle, then retest for contamination. All vapor hazards must be eliminated before the patient is moved into the CPS. Repeating the purge cycle may NOT be possible if the patient is in need of immediate lifesaving care. The patient may have to be returned to the outside treatment area for immediate care.

(2) Exit procedures.

(a) The litter patient is placed in a PPW. A battery operated blower unit with a CB filter may be attached to the PPW to provide fresh air to the patient; thus reducing the heat load on the patient and the carbon dioxide buildup inside the PPW.

(b) An inside aidman notifies an outside aidman that the patient is ready to exit the shelter. An outside aidman ensures that the outer air lock door is closed. The patient is placed in the litter air lock feet first. The inner air lock door is closed. The outside aidmen open the outer door and remove the patient.

(c) Hospital staff, visitors, or ambulatory patients exit through the ambulatory air lock. Before entering the air lock, each individual must ensure that the outer air lock door is closed. The individual enters the air lock and closes the inner door; puts on his protective mask and exits through the outer door. The individual puts on his BDU and boots, and then assumes the established MOPP level before departing the immediate area of the exit door.

WARNING

DO NOT OPEN THE OUTER DOOR UNTIL THE INNER DOOR HAS BEEN CLOSED.

NOTE

Exits must be spaced at least 3 minutes apart to allow for a complete purge cycle of the air lock.

F-16. Resupply of Protected Areas

Resupply of protected areas is accomplished by placing contamination-free supplies or equipment on a litter and passing it through the litter air lock, or processing it through the supply air lock. The litter air lock must be purged for 3 minutes. The supplies must be checked for contamination before they are removed and placed within the CPS. The supply air lock must be purged for the stated time as outlined in the supporting technical manual; usually 45 minutes. Again the supplies must be checked for contamination before they are removed and placed within the CPS.