Читать книгу Health Service Support in a Nuclear, Biological, and Chemical Environment - United States. Department of the Army - Страница 30

a. The HSS mission must continue in a nuclear environment; protected shelters are essential to continue the support role. Well-constructed shelters with overhead cover and expedient shelters (reinforced concrete structures, basements, railroad tunnels, or trenches) provide good protection from nuclear attacks (see Appendix H). Armored vehicles provide some protection against both the blast and radiation effects of nuclear weapons. Patients generated in a nuclear attack will likely suffer multiple injuries (combination of blast, thermal, and radiation injuries) that will complicate medical care. Nuclear radiation patients fall into three categories:

 The irradiated patient is one who has been exposed to ionizing radiation, but is not contaminated. They are not radioactive and pose no radiation threat to medical care providers. Patients who have suffered exposure to initial nuclear radiation will fit into this category.

 The externally contaminated patient has radioactive dust and debris on his clothing, skin, or hair. This radioactive debris can cause burns if not removed quickly. This usually presents a "housekeeping" problem to the MTF, similar to the lice-infested patient arriving at a peacetime MTF. However, an accumulation of radioactive debris, from several patients admitted to the MTF, may present a threat to other personnel. The externally contaminated patient is decontaminated at the earliest time consistent with required medical care. Lifesaving care is always rendered, when necessary, before decontamination.

 The internally contaminated patient is one that has ingested or inhaled radioactive material, or radioactive material has entered the body through an open wound. The radioactive material continues to irradiate the patient internally until radioactive decay and/or biological elimination removes the radioactive isotope. Attending medical personnel are shielded, to some degree, by the patient's body. Inhalation, ingestion, or injection of quantities of radioactive material sufficient to present a threat to health care providers is highly unlikely.

b. Medical units operating in a radiation fallout environment will face three problems:

 The MTF may be immersed in fallout, requiring decontamination and relocation efforts.

 Patients may continue to be produced from continued radiation exposure.

 The contaminated environment hinders MEDEVAC.

c. Decontamination of most radiological contaminated patients and equipment can be accomplished with soap and water. Soap and water will not neutralize radioactive material. However, it will remove the material from the skin, hair or material surface. See Appendix G for specific patient decontamination procedures. The waste can become a concentrated point of radiation and must be managed and monitored.

d. Commanders and leaders must consider the radiation exposure levels for themselves, their staffs, and patients when operating in or determining if the unit will enter a radiologically contaminated area. The commander and leader must establish an operational exposure guide for their unit and personnel. The operational exposure guide (OEG) is established for either battlefield exposures as shown in Table 3–1 or for exposures in stability operations and support operations as shown in Table 3–2. The tables present radiation exposure status (RES) categories; however, they can be used to establish OEGs based on the same exposure criteria.

Table 3–1. Radiation Exposure Status Categories for Tactical Operations

RES-O	THE UNIT HAS HAD NO RADIATION EXPOSURE.
RES-1	THE UNIT HAS BEEN EXPOSED TO GREATER THAN 0 cGy BUT LESS THAN OR EQUAL TO 75 cGy.
RES-2	THE UNIT HAS BEEN EXPOSED TO GREATER THAN 75 cGy BUT LESS THAN OR EQUAL TO 125 cGy.
RES-3	THE UNIT HAS BEEN EXPOSED TO GREATER THAN 125 cGy.

Table 3–2. Radiation Exposure Status Categories During Stability Operations and Support Operations

	RES-O	<0.05 cGy
	RES-1A	0.05 TO 0.5 cGy
	RES-1B	0.5 TO 5 cGy
	RES-1C	5 TO 10 cGy
	RES-1D	10 TO 25 cGy
	RES-1E	25 TO 75 cGy