 In a contaminated environment, casualties enter a medical treatment facility through the contaminated casualty receiving area. This occurs at all echelons of medical care that are at risk for receiving contaminated casualties. The purpose of this area is to provide for the removal of all chemical contamination from the casualty before he enters the clean medical treatment facility and as a result to maintain a contamination-free treatment area where maximal medical care can be provided. The components of this receiving area are the arrival point, the triage area, the emergency treatment area, the decontamination areas, and the hotline. The exact function and staffing and other support of each of these areas will depend on the size of the medical facility. At a battalion age station, for example, staffing is limited and the senior medical NCO will usually be both the triage officer and the emergency treatment care provider. The decontamination areas will be staffed by a limited number of augmented personnel and very limited medical care can be provided in the clean treatment area. At a higher echelon of medical care, another type of medical professional will be the triage officer, a second medical professional, the emergency care provider, and if augmented personnel are not plentiful, the decontamination team might be supplemented by non-medical personnel from the hospital staff. The arrival point is the entrance to the casualty receiving area. There should be one clearly marked road for incoming traffic and another clearly marked road for outgoing traffic. Ambulatory casualties will use the same routes. From this area, ambulatory casualties will walk to the triage area and litter bearers will carry litter patients to the triage area. Casualties are transported from the arrival area to the triage area. The word triage is derived from the French term to cool or sort. In this area, the triage officer will quickly evaluate each casualty and place him into one of the triage categories, immediate, minimal, delayed, or expectant. The triage officer might be a senior medic in a battalion age station and a physician or physician's assistant in larger medical units. His ability to evaluate the casualty will be limited because both he and the casualty will be a mop level four. Those casualties needing immediate care will be sent to the emergency treatment station also in the contaminated area. Casualties classified as minimal might also be sent to this area if the care they need can be provided in a contaminated environment. The purpose of this is to return them to duty quickly and to lessen the workload on the decontamination teams. Administration of Mark I's is an example of treatment that can be given without breaking the seal of the protective garment. However, if the casualty is ambulatory, the administration of Mark I's is self or buddy aid. The expectant will be temporarily set aside for later reevaluation. The emergency treatment care provider provides assistance to the immediate casualties and minimal casualties. The care that can be provided in this area is limited because both the casualty and care provider are completely enclosed in protective garments and because the time the single care provider can allocate to a single patient is limited. This emergency treatment area is downwind of the clean area. The only vapor hazard is vapor from liquid that enters the area on the contaminated garments of patients and the amount of vapor arising from this small amount of liquid should be miniscule and it will quickly dissipate in a breeze. Ventilation of a newly apneic patient will be limited more by the lack of personnel to squeeze the amul bag than by the risk of forcing more chemical vapor into the casualty's lungs. Intravenous injections can be given and intravenous fluids can be started after thorough decontamination of the skin site and the care provider's gloves. In some circumstances, an additional task of the medical care provider at this station will be to irrigate or decontaminate a wound and surrounding area or to wash out or decontaminate any remaining agent or to decontaminate exposed areas of skin that seem to be the site of agent exposure. A symptomatic casualty exposed to nerve agent in a wound or unprotected skin might present at a medical facility while still absorbing agent from the wound or skin surface. It's unlikely that there will be active agent in a wound unless a foreign body is present, but it's good practice to flush the site. Immediate decontamination will remove this source of further exposure. Amounts of a decontamination solution suitable for flushing sites of potential contamination should be among the equipment at the emergency treatment station. After treating the casualty, the emergency treatment provider will send the casualty back to duty if there's been no violation of his protective encapsulation to the contaminated disposition area by passing the decontamination procedure in clean treatment facility or to the decontamination area. Casualties who would be sent to the contaminated disposition area for dirty evacuation are those who need treatment or hospitalization later but do not need immediate care and those who need resupply at their unit. These will be evacuated in the contaminated evacuation vehicle. Those who will be sent to the decontamination area are casualties who need immediate treatment in the clean treatment area and can don their own second BDO in the clean area. Before he's sent for decontamination, a casualty must be stabilized so that he can survive for 20 to 30 minutes without further care. There are two decontamination areas, one for litter casualties and one for ambulatory casualties. Decontamination is time and labor intensive. Estimates of the time required to decontaminate a litter patient range from 8 to 20 minutes. Personnel working in the patient decontamination area will be at mop level 4 plus toxological agent protective apron at all times. Personnel performing litter decontamination were beautiful rubber aprons over their protective garments. The ambient temperature and humidity dictate their work rest cycle but even under temperate conditions the work period is short necessitating frequent change of personnel. Two different concentrations of chlorine solution are used in the patient decontamination procedure. A 0.5% chlorine solution is used for all patient washing procedures and for the mask decontamination. The 5% chlorine solution is used to decontaminate the scissors, the tap aprons and the gloves on personnel working in patient decontamination area and the casualties hood. The chlorine solutions are placed in buckets for use in this area. The buckets should be distinctly marked because it's very difficult to tell the difference between the 5% chlorine solution and the 0.5% solutions. At the decontamination stations two people typically work together one on each side of the litter to prepare the casualty for treatment on the clean side of the hotline. The following step by step procedures are used in litter patient decontamination. First decontaminate the mask and hood. Sponge down front, sides and top of hood with 5% calcium hypochlorite solution or wipe off with the M258A1 or the M291 decontamination kit. Secondly, remove the hood. Dip scissors in 5% hypochlorite solution. Then cut off hood. To remove the hood, first release or cut hood shoulder straps. Secondly, cut or untie the neck cord. Then cut or remove the zipper cord. Next, cut or loosen drawstring under the voice mitter. And then proceed cutting upward close to the inlet valve covers and eye lens outserts. Cut upward to the top of eye lens outsert and then cut across the forehead. Cut from center of forehead over the top of the head. Fold left and right sides of the hood to the side of the patient's head laying sides on the litter. The quicked off hood is loosened and removed. Decontaminate protective mask and face. Use M258A1, M291 or 0.5% hypochlorite. Cover both inlet valve covers with gauze or hands. Wipe external parts of mask. Uncover inlet valve covers. Wipe exposed areas of patient's face, including the chin, neck and back of ears. Remove field medical card. Cut field medical card tie wire. Allow field medical card to fall into a plastic bag. Seal plastic bag and wash with 0.5% hypochlorite. Place plastic bag containing the field medical card under back of mask head straps. Remove all gross contamination from patient's overgarment. Wipe all evident contamination spots with M258A1 decontamination kit, M291 or 0.5% hypochlorite. Wipe external parts of mask with M258A1 decontamination kit or M291. Next, you'll cut and remove the casualties overgarments. Cut clothing around tourniquets, bandages, and splints. Two persons will be cutting clothing at the same time. Dip scissors in 5% hypochlorite solution before doing each complete cut to avoid contaminating inner clothing. Cut overgarment jacket. Unzip protective overgarment. Cut from wrist area of sleeves, up to armpits, and then to neck area. Roll chest sections to respective sides with inner surface facing outward. Tuck clothing between arm and chest. Repeat procedure for other side of jacket. Cut overgarment trousers. Cut from cuff along inseam to waist on left leg. On right overgarment leg, cut from cuff to just below zipper and then go sideways into the first cut. Allow trouser halves to drop to litter with contamination away from patient. Tuck trouser halves to sides of body and roll the camouflage sides under between the casualties legs. Remove outer gloves. This procedure can be done with one aid man on each side of the patient working simultaneously. At this point, do not remove inner gloves. Lift the patient's arms by grasping his gloves. Fold the glove away from the patient over the sides of the litter. Grasp the fingers of the glove. Roll the cuff over the finger, turning the glove inside out. Carefully lower the arms across the chest when the gloves are removed. Do not allow the arms to contact the exterior camouflage side of the overgarment. Dispose of contaminated gloves by either placing in a plastic bag or depositing in a contaminated dump. Dip your own gloves in hypochlorite solution. Remove over boots. Cut the over boot laces. Fold lacing eyelets flat outward. Hold heels with one hand. Pull over boots downwards over the heels with the other hand. Pull the over boots towards you until removed. Place over boots in contaminated disposal bag. The casualties' combat boots will be removed in the same manner as the protective over boots. Remove personal articles from pockets. Place in plastic bags. Seal the bags. Place in contaminated holding area. Remove inner clothing. Unbuckle belt. Cut BDU pants following same procedures as for overgarment trousers. Cut fatigue jacket following same procedures as for overgarment jacket. Remove undergarments following same procedure as for fatigues. If patient is wearing a brassiere, cut between cups. Both shoulder straps are cut where they attach to cups and laid back off shoulders. After the patient's clothing has been cut away, he's transferred to a decontamination litter or a canvas litter with a plastic sheeting cover. Three decontamination team members decontaminate their gloves and apron with the 5% hypochlorite solution. One member places his hands under the small of the patient's legs and thigh. A second member places his arms under the patient's back and buttocks. And the third member places his arms under the patient's shoulders and supports the head and neck. They carefully lift the patient using their knees, not their backs, to minimize back strain. While the patient is elevated, another decontamination team member removes the litter from the litter stands and another member replaces it with a decontamination or clean litter. The patient is carefully lowered onto the clean litter. Two decontamination members carry the litter to the skin decontamination station. The contaminated clothing and overgarments are placed in bags and moved to the decontaminated waste dump. The dirty litter is rinsed with the 5% decontamination solution and placed in a litter storage area. Decontaminated litters are returned by ambulance to the maneuver units. At this point, a casualty wearing only a protective mask is transported to the skin decontamination area. The areas of potential contamination should be spot decontaminated using the M2581 kit, the M291 kit, or the 0.5% hypochlorite. These areas include the neck, wrists, lower face, and skin under tears or holes in the protective ensemble. However, it's not so much what method is used. Rather, it's how and when it's used. Chemical agents should be removed as quickly and completely as possible by the best means available. Certification of decontamination is accomplished by any of the following. Processing through the decontamination facility, M8 paper, M9 tape, M256A1 ticket, or by the chemical agent monitor. If proper procedures followed, the possibility of admitting a contaminated casualty to field medical facility is extremely small. The probability of admitting a dangerously contaminated casualty is minuscule to non-existent. Fear is the worst enemy, not the contaminated soldier. Once a casualty has been certified contamination-free, they're ready to be transferred across the hotline. The hotline is an arbitrarily established line that demarcates the area of liquid agent contamination from an area that is liquid agent-free. Once established, it should be clearly marked using engineered tape. After final monitoring for contamination, the casualties carried on the litter to the shuffle pit and there is moved to a clean litter provided by a team from the clean side of the hotline. The mask is removed further upwind at the entrance to the clean treatment area. We got it! We got it! Decontamination at the medical treatment facility is directed toward eliminating any agent transferred to the patient during removal of protective clothing, decontaminating or containing of contaminated clothing and personal equipment, and maintaining an uncontaminated treatment facility. Decontamination issues have been explored since the beginning of modern chemical warfare. After years of research worldwide, the simple principles covered in this video consistently still apply. The procedures utilized in this video were adapted from FM 8-10-4 and FM 8-10-7. Military personnel may be questioned for guidance by local civilian authorities or may deal with supply shortages in the field. Knowledge of the U.S. doctrinal solutions may not suffice in these situations and awareness of alternative methods of decontamination will prove very beneficial.