Читать книгу Health Service Support in a Nuclear, Biological, and Chemical Environment - United States. Department of the Army - Страница 38

a. Protection of hospital assets requires intensive use of intelligence information and careful planning. The limited mobility of hospitals makes their site selection vital to minimize collateral damage from attacks on other units.

  Hospitals must be located as close to the supported units as possible to provide responsive care in support of the tactical commander's plan. However, their limited mobility must be considered when selecting their locations.

 Protective factors (distance from other support units and interposed terrain features) must be balanced against the operational factors (accessibility and time required for patient transport).

 Depending on the weapon systems used, local topography, and meteorological conditions, relatively large portions of the tactical area may remain uncontaminated.

b. Many defensive measures will either impede or preclude performance of the hospital mission. Successful hospital defense against an NBC threat is dependent upon accurate, timely receipt of information via the nuclear, biological, and chemical warning and reporting system (NBCWRS). This information will allow the hospital to operate longer without the limitations and problems associated with the use of the CPS and personnel assuming MOPP Levels 3 and 4. The detailed information (provided in the NBC 5 and 6 reports respectively) on the areas affected and the types of agents used allows the hospital staff to—

 Project the number and types of patients to be expected.

 Establish a patient decontamination area.

 Request patient decontamination assistance.

(1) Protective procedures.

(a) Because most hospital sections operate in sheltered areas (tentage or hard-walled shelter), some protection is provided against vapor, liquid, and particulate (fallout) hazards. Sealing all openings can increase the temporary protection from such hazards; all entries and exits must be curtailed while operating in this mode. Liquid agents will eventually seep through the tent fabric and create a vapor hazard inside the shelter. Locating equipment, such as trucks, under trees or other cover provides similar effects. Setting up hospitals in existing structures (concrete or steel buildings) provides greater protection from hazards and eliminates many decontamination problems. However, without means to seal openings, chemical agent vapors can enter the structure. The addition of CB filtration systems with air locks, that provide overpressure, can provide maximum protection for occupants. Entry and exit procedures must be established to prevent contamination being introduced by personnel and patients entering. See Appendix F for entry/exit procedures when CB filters and air locks are in use.

(b) Concealment and good operations security (OPSEC) will help prevent identification of a unit.

(c) Dispersion is a defensive measure employed by tactical commanders; however, hospital operations limit the value of this technique. One technique that may be used is locating sections of the hospital, such as the motor pool, personnel billets, laundry, and logistical storage, a greater distance from the hospital complex than normal. This will increase dispersion without severely compromising the hospital mission.

(d) The MOPP ensemble does not protect against all radiation effects of nuclear weapons. However, it provides some protection against alpha and beta radiation burns. By covering all body surfaces, especially hairy areas, MOPP greatly expedites the decontamination process.

(2) Nuclear.

(a) Most protective measures for hospitals against nuclear attack require engineer and/or intensive logistic support. This support includes placing sandbag walls around tents; digging trenches for patient occupation; or constructing earthen berms (see Appendix H). Occupying existing structures, depending upon their strength and potential flammability, may be the best protection against the effects of a nuclear strike. The remainder of this section presents factors to consider when selecting the protective posture for the hospital against a nuclear attack. Leaving equipment packed and loaded until actually needed for operations will help protect materiel in an NBC environment. In any event the unit must have established an OEG, implemented radiation monitoring, and have contingency plans if these radiation levels are approached or exceeded.

(b) Personnel and patient protection requirements will depend upon the threat (blast, thermal, immediate radiation, or fallout effects). The MOPP ensemble will not protect against internal radiation, but will provide some protection from external radiological contamination.

 If the threat is nuclear fallout, the hospital structure provides protection; the fallout can be brushed or washed off. This allows protection while permitting patient care to continue virtually uninterrupted. A need to relocate the hospital will depend upon the degree of contamination; the amount of decontamination possible; and the projected stay before a normal move in support of operations.

 Hospital tentage alone offers little protection against blast and missiling effects. If the patients are to remain in the tents, they are placed on the floor. Place all equipment on the ground or as low as possible and secure all loose objects. In GP tents, sandbags can be piled around the base of the tent poles to add stability. The tent poles and patient beds should keep the canvas off the ground enough (if the tent collapses) to continue minimal patient care and evacuation; however, be aware of possible tent pole breakage.

 Hospital units are very susceptible to the thermal effect of a nuclear detonation. Tents will not provide protection against the thermal pulse. If the thermal effect (fire) is an impending threat, patients and personnel in tentage must move to trenches, bunkers, or other nonflammable areas.

 Protection factors that can reduce the overall radiation exposure rate for hospital personnel and patients are—

 Time. Reducing the exposure time to the radiation reduces the overall exposure proportionally (cut the time of exposure in half and the overall exposure is cut in half). EXAMPLE: An exposure time of 60 minutes to a dose rate of 100 centigray (cGy) is cut in half (30 minutes) to an exposure rate of 50 cGy.

 Distance. Increasing the distance from the radiation source reduces the exposure in an inverse square relationship (double the distance factor by 2 decreases the exposure factor by 4).

  Shielding. Placing material between personnel and patient and the radiation source decreases the dose (the reduction factor is dependent on the type of radiation and the density of the shielding material). Placement of sandbags (two feet wide) around the hospital tents and shelters provides adequate shielding for protection from gamma and x-ray radiation; the thicker the sandbag stacks the greater the protection factor. Tent material is a good shield for alpha particles and adequate shielding from beta particles. See Appendix H for field expedient shielding techniques.

(3) Biological. The most likely use of a biological agent (such as anthrax) is releasing the agent as an aerosol. While such agents may produce large numbers of casualties, initially patients may be seen at the MTF in small numbers, but the number of patients will rapidly increase within a few hours to days. When a trend is identified, the enemy use of a biological agent is suspected. General protective measures are the same as for any infectious disease; specific protective measures are used once the vector or method of transmission has been identified. Designating a single hospital to care for these patients (from a patient care or disease transmission standpoint) may not be necessary. However, if the agent is communicable, consolidating them all at one facility maximizes the use of limited assets and aids in limiting the spread of the disease. Protective measures against biological attack are the same as those for chemical agents when bombs, sprays, or gases are used; see (4) below. The difficulty in rapidly identifying biological agents may force the use of protective measures for longer periods of time. Faced with this situation, a careful evaluation of the mask-only posture is necessary before implementing any level of MOPP. See FM 8–284 for additional information on prevention, protection, and treatment of biological casualties.

(4) Chemical.

(a) Individual protection. When CPS systems are not available, using the correct MOPP level is essential in hospital mission performance. The level of MOPP assumed depends upon the level of threat. An alternative approach for the hospital commander is the use of the mask-only posture. This posture is acceptable when the hazard is from vapor only (except mustard). See FM 3–4 for a description of each MOPP level and mask-only procedures.

 Hospital warning system. The hospital must have a warning system that alerts all personnel of impending or present hazards. This system must include visual and auditory signals; the signals must operate inside and outside the hospital complex. There are numerous problems associated with warning personnel; they include—

 The wide area covered by the hospital operations.

 Some personnel will be asleep at all times of the day or night (two or three shifts).

 The considerable noise from mechanical support equipment; such as the power generation and environmental control equipment.

 Tentage and equipment interrupts line of sight.

  Hospital personnel response. When NBC alarms are activated, all personnel (including off duty personnel) report to their duty stations as soon as they are in the designated MOPP level. This allows for 100 percent personnel accounting and provides additional personnel to secure patients and materiel.

 Unprotected hospital areas. Areas of the hospital without CPS are at their best posture with all openings secured and the ventilation systems turned off. For nonpersistent agents (vapor hazards), personnel and patients stay at the designated MOPP level until the all clear signal is given; then normal operations are resumed.