Decontamination

“ Once a vehicle or aircraft has entered a contaminated area, it is highly unlikely that it can be spared long enough to undergo thorough decontamination. However, operational decontamination should be performed to the greatest extent possible. This will depend upon the contaminant, the tempo of the battle, and the resources available to the MEDEVAC unit. Normally, contaminated vehicles (air and ground) will be confined to dirty environments. See FM 3-5 for details on decontamination procedures. ”

“ Decontamination is an individual and first responder responsibility. However, some individuals that self evacuated or were evacuated due to the mass casualty situation arrive at the MTF that have not been decontaminated. These individuals must be decontaminated at the MTF before they are admitted to prevent contamination of the MTF and exposure of unprotected medical personnel and other patients to the TIM. See FM 8-500 for detailed information on decontamination procedures for TIM contaminated casualties. ”

“ Active decontamination is attempted only when weathering will not decontaminate the packaging material in sufficient time. Decontamination procedures can be enhanced by using heat to vaporize the chemical agent ”

“ Decontamination of most BW contaminated patients and equipment can be accomplished with soap and water. Soap and water will not kill all biological agents; however, it will remove the agent from the skin or equipment surface. See Appendix G for specific patient decontamination procedures.
e. Treatment of BW agent patients may require observing and evaluating the individual to determine necessary medications, isolation, or management. See FM 8-284 for specific treatment procedures for BW agent patients. ”

“ Table J-8 lists the decontamination procedures for unpackaged food contaminated with a chemical agent.
(9) Decontaminating cattle, poultry, and other livestock is only attempted when other sources of food are not available. Heavily contaminated animals should be destroyed. Livestock contaminated lightly by phosgene, nerve agents, mustards, and arsenicals (such as vapor or liquid) may be slaughtered in the early stages of poisoning before the full effects of exposure are shown. ”

“ The patient decontamination station should be established in a contamination-free area of the battlefield. However, it may be necessary to establish a patient decontamination station that is collocated with an MTF that is employing a CBPS, in a chemical vapor hazard area in order to decontaminate patients and clear the battlefield before moving the MTF to a clean area. When CPS systems are not available, the clean treatment area is located upwind 30 to 50 meters of the contaminated work area. When personnel in the clean working area are away from the hot line, they may reduce their MOPP level. ”

“ Aging may not be possible when there is a short food supply. In some instances, such as with induced radioactivity, it may be the only way to decontaminate. Removing nuclear contamination from areas, personnel, food, or moving equipment to another location eliminates the immediate hazard. To determine which decontamination method is required, food supplies are divided into groups. See Table J-1 for additional information on food items and decontamination. ”

“ Contamination of foodstuffs by a chemical agent may occur at any point on the battlefield. This contact may render the food unpalatable also. In many cases, decontamination is difficult, thus, emphasis must be placed on protection. Keep food supplies covered at all times. Take special precautions to protect food that is not packed in protective packages. Unprotected food, forage, and grain supplies may be so contaminated that their consumption will produce gastrointestinal irritation, or systemic poisoning. Nerve agents, vesicants, and arsenicals are the most dangerous. ”

“ Each US Army hospital is issued five chemical agent patient treatment MES and three chemical agent patient decontamination MES, Chemical Agents Patient Decontamination, for use in decontaminating patients. Each hospital must decontaminate and treat its own personnel who become casualties ”

“ Patient decontamination presents special problems for units and HSS personnel. Nuclear, biological, and chemical contaminated patients create increased hazards to rescuers and HSS personnel; thus, causing delays in providing essential first aid and medical treatment for injuries from sources other than the exposure to NBC weapons/agents. Casualty decontamination procedures are performed by each individual, as buddy aid, or at a unit decontamination station prior to the arrival of medical personnel. See FM 3-5 for procedures on individual, buddy aid, and unit decontamination. ”

“ Without CPS and with persistent agent contamination that absorbs into the tentage and presents a continuing vapor hazard, the hospital stops receiving patients and evacuates all patients as quickly as possible. When large portions of the hospital are contaminated, personnel decontaminate all equipment possible and relocate to a new site, leaving the contaminated equipment to age or to be decontaminated by a specialized unit. When small portions of the hospital are contaminated, the contaminated portions are removed to another location for decontamination ”

“ Food supplies in storage are not likely to be seriously contaminated if reasonable protection precautions are taken. For this reason, large supplies of food are not to be condemned as a whole simply because they have been exposed to possible chemical contamination. A prompt and careful survey of the supplies may reveal that only a few items have been contaminated to a level that decontamination is required. Prompt segregation of the heavily contaminated portions will prevent, or minimize, contamination of the remainder. Foods without protective packages constitute the major difficulty. ”

“ No one save the doctor or nurse should enter the room of the person quarantined. After the disease has run its course, the clothing, bedding, etc., in the sick room is fumigated. This is usually done by the board of health. Formaldehyde in the form of candles for burning or in a liquid form is a good disinfectant. In disinfecting the room should be tightly closed to prevent the escape of the gas used, as the object of the disinfection is to kill all the disease germs left in the room. ”

“ The advocates of the contagion theory have no weakness for sewage, especially in an olfactory point of view. They say, also, that it places disease under the most favorable conditions for the consummation of its evil mission. But they assert, in opposition to former theories of the Board of Health—that has an unlimited command of print and pay—that sewage, in itself, does not breed fever and infection, unless it is charged with specific ingredients of contamination. Infectious diseases are only communicated by the virus of specific poison. ”

“ Danger of direct infection from the patient is slight, but the poison remains in the evacuations from the bowels and is propagated by them. By this means a reservoir or river has been known to infect a whole town. Broken or defective drains, the entrance of sewer gas into houses, wells polluted by cesspool drainage, and milk diluted with infected water, are among the principal means of spreading the disease. It is an absolute rule that all bedding which becomes soiled should be destroyed, and the refuse of the sick room should be instantly disinfected and removed from the dwelling. ”

“ Shall we content ourselves with finding a heap of decomposing vegetable or animal matter, or rest satisfied by discovering an escape of sewer-gas from some untrapped drain into one or more of the houses? Since we—the reader and I—are scientific and reasonable people, we can not adopt the theory that the disease is contagious—an opinion held by some able but rather easy-going physicians—and having once effected a lodgment in the community is capable of infecting all who have systems favorable to the development of the poison. ”

“ The dissemination of biological agents also poses difficult technical challenges. Whereas persistent chemical agents such as sulfur mustard and VX nerve gas are readily absorbed through the intact skin, no bacteria and viruses can enter the body via that route unless the skin has already been broken. Biological agents must either be ingested or inhaled to cause infection. To expose large numbers of people through the gastrointestinal tract, possible means of delivery are contamination of food and drinking water, yet neither of these scenarios would be easy to accomplish. ”

“ My theory is that the toxicity of germs is due to being saturated with poisonous gases. The germs of typhoid fever, for example, are not poisonous until the patient is sufficiently broken down to cause the generation of toxic gases, after which all the fluids and solids of the body take on a septic state, poisoned by the absorbed gas.... Bacteria are not the cause of disease; wrong living, which puts the system into such a condition that the bacteria can readily multiply, is the real cause ”

“ The means of disinfection, and the substances employed, are very numerous, as are the classes and conditions of disease and contagion they are designed to meet. Nature, in the oxidizing influence of freely circulating atmospheric air, in the purifying effect of water, and in the powerful deodorizing properties of common earth, has provided the most potent ever-present and acting disinfecting media. Of the artificial disinfectants employed or available three classes may be recognized:—1st, volatile or vaporizable substances, which attack impurities in the air ”

“ Disinfection is practised by fits and starts. With us it has been mainly a summer practice, when our nostrils encounter the smell off offensive matters. Contagion seizes a house, or a town, and for a time the sanitary inspectors, and the awakened people themselves, distribute even the most noxious disinfectants without system, and with the inevitable result of expending the most money with the least possible good result. ”

“ Those who hold to the doctrine of contagion admit that, to give such contagion efficacy in the production of wide spread results, filth or decaying organic matter is essential; while those who sustain the theory of non-contagion—the production of the poison from sources without the bodies of the sick—contend that it has its entire origin in such filth—in decomposing matter, especially in fermenting sewage, and decaying human excreta. ”

“ A deodoriser is a substance which will absorb or destroy bad smells; an antiseptic is an agent which will prevent or retard putrefaction; and a disinfectant is an agent which will render harmless the virus of smallpox, scarlet fever, measles, diphtheria, influenza, pleuro-pneumonia, cattle plague, glanders, distemper in dogs, and other infectious or contagious diseases.
Now, medical authorities and sanitarians are of opinion that the most potent disinfectant with which we are acquainted is sulphurous acid, a gas which has been used for ages, as a fumigator. ”

“ Large urban reservoirs are usually unguarded, but unless terrorists added massive quantities of biological agent, the dilution effect would be so great that no healthy person drinking the water would receive an infectious dose ( [65] ) . Moreover, modern sanitary techniques such as chlorination and filtration are designed to kill pathogens from natural sources and would probably be equally effective against a deliberately released agent. Bacterial contamination of the food supply is also unlikely to inflict mass casualties. ”

“ During sieges, the hygienic measures of precaution, which are absolutely essential to the maintenance of health in cities, can no longer be carried out. If spring-water is secured outside the city for the inhabitants, the besiegers cut off the source of supply; if the water of rivers is used, then filtration plants have to be erected. But even filtration does not prevent the appearance of those infectious diseases the germs of which are carried in water, since for washing purposes the river-water is used just as it is found. The removal of refuse constitutes an extremely difficult problem ”

“ If water is impure, it must be boiled and then aerated before it is drunk. If the air is the vehicle of the germs of the disease, it will have to be filtered by means of a muslin curtain kept wet with a hygroscopic solution, glycerine for example. Finally, when, after an epidemic, contaminated apartments are to be occupied, the walls and floor and the clothing must be washed with antiseptic solutions whose nature will vary according to circumstances--steam charged with phenic acid, water mixed with a millionth part of sulphuric acid, boric acid, ozone, chlorine, etc. ”

“ If a house in which a consumptive has lived is thoroughly [148] disinfected, all the germs he left there will be killed. Scattering disinfectants about a room does no good. The only proper way to disinfect is to close the house, for if the disinfectant is strong enough to kill the disease germs, no human being can stay in the house while it is being used. Disinfecting should be done by the health officer, because he knows how much disinfectant is needed to kill every germ in the house and how it should be used. ”

“ Disinfection of Premises, etc.—Every local authority is invested with power to enforce the cleansing and disinfection of premises, and the disinfection or destruction of bedding, clothing, or other articles, which have been exposed to infection from any dangerous infectious disorder. ”