Читать книгу Health Service Support in a Nuclear, Biological, and Chemical Environment - United States. Department of the Army - Страница 37

a. Many factors must be considered when planning for Levels III and IV hospital support on the integrated battlefield. The hospital staff must be able to defend against threats by individuals or small groups (two or three) of infiltrators and survive NBC strikes or TIM incidents while continuing their mission. This threat may include the introduction of NBC or TIM in the hospital area, the water or food supplies; and the destruction of equipment and/or supplies. On the larger scale of surviving NBC strikes and continuing to support the mission, operating in a contaminated environment will present many problems for hospital personnel. The use of NBC weapons or TIM release can compromise both the quality and quantity of health care delivered by medical personnel due to the contamination at the MTF; constrain mobility and evacuation; and contaminate the logistical supply base. While providing hospital support, consider the following assumptions:

(1) Their location, close to other support assets, makes them vulnerable to NBC strikes and release/dispersion of TIMs.

 Command, control, communications, computers, and intelligence (C4I) infrastructure, logistical nodes, and base clusters are high value targets.

 Most NBC weapons are designed for wide-area coverage. Chemical and biological agents may present a hazard some distance downwind from the area of attack; also, residual radiation may extend for hundreds of kilometers (km) from ground zero.

 The large signature (size, heat, infrared) of a hospital makes it easy to find and target (the assumption is that the hospital is very near the intended targets).

 Hospitals located near road networks and airfields for access to evacuation routes increase their exposure to tactical strikes of NBC weapons and exposure to TIM releases.

 There are ever-increasing numbers of countries and individuals with the ability to manufacture and deliver NBC weapons/agents. This activity increases their use potential at all levels of conflict.

NOTE

When using existing civilian hospitals, the materials for an RDD may be at these hospitals. Exploding the material in place is very practical for a small team of terrorists.

(2) Large numbers of casualties are produced in a short period of time. Many of these casualties may have injuries that are unfamiliar to hospital personnel. These injuries may include—

 Radiation casualties.

  Biological casualties.

 Chemical casualties.

 Toxic industrial biological casualties (release of material from biological research facilities).

 Toxic industrial chemical casualties.

 Toxic industrial radiological casualties.

 Chemical agent antidote overdose casualties.

 Combined conventional and NBC injuries.

 Stress casualties mimicking all the above.

(3) In addition to the wounding effects of NBC weapons on troops, their use will have other effects upon the patient care delivery system.

 Follow-on treatment may have to be delayed due to the need for patient and faculty decontamination.

 The arrival of contaminated patients at the hospital will require hospital personnel to perform triage; administer EMT procedures in the patient decontamination area; supervise augmentation personnel performing patient decontamination; and constantly monitor the hospital for contamination. The combat support hospital [CSH] requires at least 20 nonmedical personnel from units within the geographic area/base cluster of the hospital to perform patient decontamination under medical supervision. See Appendix G for patient decontamination procedures.

 Patients may have been triaged and decontaminated at a Level I or Level II MTF. However, all patients must be triaged and checked for contamination as they arrive at the hospital ambulance drop off point. Triage ensures patients receive life- or limb-saving care in a timely manner. If patients are arriving from a suspected NBC contaminated area, they must be decontaminated before admission into the clean treatment area of the hospital. The patient decontamination area is established on the downwind side of the hospital. When the hospital does not have collective protection, the patient decontamination point must be at least 50 yards downwind of the hospital entry point. When the hospital is located inside a base cluster, the patient decontamination area may have to be established some distance from the hospital to prevent contamination of other units in the area. Should this be the case, the patients may have to be transported by ambulance or other vehicle from the clean side (hot line) of the patient decontamination area to the receiving point of the hospital.

 Conditions may mandate the use of nonmedical vehicles to transport casualties to the MTF. The use of these vehicles limits or prohibits en route medical care, but may be the only way to clear the battlefield and ensure timely care of patients at the hospital.

(4) Mission-oriented protective posture reduces the efficiency of all personnel.

(5) Without CPS systems, hospitals may operate for a limited time in a nonpersistent agent environment, but are incapable of operating in a persistent agent environment.

 Chemical/biological filters for fixed site hospital ventilation systems will be a critical item of supply. Controlled entry and exit point with sufficient space to permit placement of litter patients and/or numbers of personnel that permit purge of vapors will have to be established. All windows, doors, and other points that may have air leaks will have to be sealed (use tape and plastic sheeting) to enable the facility to have a positive overpressure to keep CB agents out.

 Liquid chemical agents can penetrate the TEMPER in about 6 hours or general purpose (GP) tentage in a shorter period of time. These agents will penetrate the wrappings on medical supplies and equipment; especially, sterilized equipment and supplies, paper-wrapped cotton sponges, and open or lightly closed medications/solutions. They can also contaminate water/food supplies. Therefore, equipment and supplies must be stored in protected areas or under protective coverings.

 Without a CPS system, treatment procedures involving open wounds or the respiratory tract in the presence of a CB agent hazard is limited. Exposing open wounds and the respiratory tract to the agent increases the effects of these agents on the patient.

 Without hardened protection, the hospital, staff, and patients are susceptible to the effects (blast, thermal, radiation, and missiling) of nuclear weapons.

 Hospital electrical and electronic medical equipment is vulnerable to the effects of the EMP produced by nuclear weapons. The EMP is not harmful to humans, animals, or plants, but is very damaging to electronic equipment.

 Hospital equipment is very difficult to decontaminate. Aging (allowing the agent to off-gas) may be the only means of decontamination.

 Hospitals are not kept in reserve. All personnel and equipment losses due to NBC contamination or radiation will have to be replaced.

b. There are currently two force modernization initiative hospital systems in the force structure. The Medical Force 2000 (MF2K) system consists of the CSH, the field hospital (FH), and the general hospital (GH). The Medical Reengineering Initiative (MRI) consists of only one hospital system—the CSH. The MF2K CSH is a corps asset, whereas, the FH and GH are the echelon above corps hospital systems. The MRI CSH will be located in the corps and at echelons above corps. The MRI CSH will replace the FH and GH at echelons above corps. See FM 4–02.10, FM 8–10-14, and FM 8–10-15 for detailed information on these hospital systems.