Special Operations Forces Medical Handbook

6-54

NOTE: Dimercaprol (BAL) is no longer available for skin or eye application. However it is available for IM
use and will reduce systemic effects of Lewisite exposure.

Evacuation Plan: Evacuate if unstable and after decontamination completed.

CBR: Set Up a Casualty Decontamination Station

18D Skills and Training Manual, Reviewed by LTC Richard Broadhurst, MC, ARNG

What: Establish an area in which to decontaminate and treat a casualty. It consists of a decontamination
area: triage, emergency treatment (may be co-located with triage) and skin decontamination; a treatment
area: clean holding area pending treatment, advanced treatment facility; a clean patient holding area
for those pending evacuation (can be located inside the treatment area); and a hot-line separating the
decontamination and treatment areas.

When: Chemical agents used against your unit, or against personnel you support. Similar procedures can
be used to remove nuclear fallout and biological agents.

What You Need: Required: water source, supertropical bleach (STB), shovels, personnel MOPP4 ensem-
ble for decontamination crews, protective shelter (tents, buildings, tree cover, caves, etc.). Optional: medical
equipment sets (MES) for patient decontamination and patient treatment (contains many of these items),
tentage, plastic sheeting, chemical agent alarms, chemical agent monitors, engineer tape or wire, field radio
or telephone, windsock, camouflage netting, brushes and/or sponges, plastic bags, litters, litter stands, and
contaminated disposal containers.

What To Do:

1. Select primary and alternate sites.
   a. Select primary and alternate sites in advance of operations. If the prevailing winds change direction, use
   of the primary site may no longer be possible.
   b. Site selection factors:
   
   
   1. Direction of the prevailing winds.
   
   
   2. The location of friendly facilities downwind from the chemical hazard released at the decontamination
      station.
   
   
   3. Availability of protective shelters or buildings to house clean treatment facilities.
   
   
   4. Terrain
   
   
   5. Availability of cover and concealment. The protective shelter may have visual, audible and infrared
      signatures that can compromise concealment.
   
   
   6. General tactical situation
   
   
   7. Availability of evacuation routes (contaminated and clean).
   
   
   8. Location of the supported unit’s vehicle decontamination point, personnel decontamination point and
      MOPP exchange point. It is sometimes best to collocate with these unit decontamination sites. The
      arrangement of the operational areas must be kept flexible and adaptable to both the medical and
      tactical situations.
   
   
   
   


2. Set up the decontamination area.
   a. Triage area. Do not decontaminate expectant patients. Personal equipment, including weapons, should
   be returned to the patient’s unit if possible, for decontamination and management. Patient equipment can
   be decontaminated in the decontamination area as an option.
   b. Emergency treatment area. NOTE: Sometimes triage and emergency treatment are conducted in the
   same area.
   c. Skin decontamination area. Mix the STB with water in buckets and apply to garments and skin with
   brushes, sponges or rags. Sequentially decontaminate the chemical agent protective ensemble, remove
   the components as well as any clothing, decontaminate the underlying skin, and pass the clean patient
   to the shuffle pit (see below).