1. In Place Patient Decontamination
UNCLASSIFIED
In Place Patient Decontamination
Executive Brief
Play the Lackland AFB set-up video on CD: Mission Capable in 4 minutes and 12 seconds. As the video plays, comment to the students about how the team works together in spite of the 100o weather with a 107o heat index. Explain how the IPPD equipment is all integrated and interdependent upon each piece. Explain the scenario the Lackland students are working (nerve agent at the BX), and why they handle the patients the way they do.
After the video say something catchy to gain student’s attention, like “Welcome to the exciting world of Medical Decontamination”.
As you shut down the video and boot up lesson 1, go around the room asking students to introduce themselves. Ask for their name, job, and decon experience. This will help you determine the experience level in the room, and where your level of instruction should begin.
Lastly, introduce yourself.
Mike Anastasio
(254)
Kileen, TX
Brent Fenton
(850)
Shalimar, FL
Tom Bocek
(228)
Biloxi, MS
Eddie McGee
(202)
Oklahoma City, OK
Presented by Battelle

2. Welcome :-) Thanks to MTF staff: IPPD Team Leader:
Participants (Cadre)
Medical Logistics:
Medical Readiness:
Medical Facilities:
-Thank the team leader(s), OIC and NCOIC, for all the preparation put into readying this course (arrange classroom, projector, students, IPPD equipment, hydrant access, etc).
-Thank the participants for taking the time out of the demanding patient load to learn Medical Decontamination, explain the course will award 16 USAF NREMT CEUs. IAW USAF IPPD CONOPS, when trained, these students will become the Cadre to train others in the IPPD concept of operations and equipment handling within the medical facility.
-Thank Medical Logistics for all the work involved in ordering Allowance Standard 886A. It’s not as easy as other AS’s to procure.
-Thank Medical Readiness for their support in arranging training, and the upcoming Medical Disaster Team Chief Round Table Meeting. Also thank Medical Readiness in advance for their role in support and sustainment training for the IPPD.
-Thank Facilities for a place to train and a place to store the equipment. Also for access to the fire hydrant and exterior electric.
Note: This may be a good time to discuss the possibilities for sustainment training.
Some bases have a training afternoon each month. There are roughly 12 major teams in the MCRP, and 12 moths to train, therefore each team can train with the IPPD learning set-up and CONOPS. Training should consist of 4 hours didactic (using these lessons) and 4 hours hands on.
Some bases have incorporated Suiting up and setting up into their annual Medical Readiness Training (MRT).
Some bases train 25% of their entire staff quarterly (it is recommended to exercise NLT quarterly with the equipment to maintain it’s “operational” status).

3. Overview Mission Patient Decontamination Defined
Why a new CONOPS for terrorist use of WMD
How does the IPPD fit in?
Requires MTF Team Approach
IPPD Layout
This is the obligatory “Overview Slide” required by any USAF lesson. It tells students what we will cover in this lesson.

4. Mission Train a Cadre of personnel to operate IPPD
Leave Air Base with capability
The overall Mission of this course is two fold:
-to prepare students (cadre) to operate IPPD equipment efficiently, and to understand it well enough to train others on the equipment.
-to Leave the air base with a Cadre that understands the USAF IPPD CONOPS and how the IPPD fits into a base WMD response.

5. USAF IPPD Training Schedule
Wed (Classroom, 8 hours didactic and hands-on training)
· : Familiarization with IPPD Concept of Operations (Hazardous materials emergencies, potential outcomes)
· : Understanding Hazardous Substances, Recognition, Types/Terms
· : Understanding Hazardous Substances, Risks, Decontaminants
· : Understanding Hazardous Substances, Identification/Detection
· : Decontamination Equipment familiarization
· : The Decontamination Process “How To”
· : Selection and use of PPE (3MÒ and DTAPSÒ)
Thu (IPPD Set-up Site, 4 hours hands-on training – PT Gear)
· : Assemble IPPD package without PPE, then tear down
· : Assemble IPPD package wearing PPE & Processing contaminated victims
· : HAZWOPER (timed event)
12:00: Graduation 
: Tear-down, dry-off, clean-up, re-charge, re-stow
Afterward students will be hot, tired, and probably not in condition for return to duty
This slide exceeds the standard 7 line limit per slide, so only cover the big rocks.
The first day is mostly didactic learning. The USAF IPPD CONOPS requires Cadre to be trained to the HAZWOPER First Responder Operations Level with emphasis on the use of PPE and decontamination procedures [refer to 29 CFR (q)(6)]. The IPPD Team Leader documents personnel are trained to safely perform their job duties and responsibilities. This includes “a minimum of 8 hours of training OR demonstrated competencies and annual refresher training”. The 8 hours covered during the first day of training can be used as “demonstrated competencies” IAW training requirements in page 19 and 34 of IPPD CONOPS. Students will learn basics of HAZWOPER, however the HAZWOPER course is designed more for contaminant identification, and containment. Although many of the HAZWOPER principals apply to medical decontamination, there are some distinct differences. There is very little in HAZWOPER about medical decontamination or initial treatment/triage of contaminated casualties. This course teaches the basics of HAZWOPER First Responder Operation Level training, and focuses on the medical skills required for an MTF decontamination line.
The second day of training is mainly hands-on equipment training, and hands-on processing of victims.
The VIP Show and Tell scheduled in the afternoon of the second day, provides the MTF an opportunity to become the “ambassador of good will” in community relations. It starts with the equipment all set up, then the Cadre decons a couple of victims for the VIPs. The purpose of the VIP demo is three fold:
1st, it provides an opportunity to the IPPD cadre to demonstrate your new capability to your base medical personnel; keep in mind the very next thing on the schedule is the 1500hrs Team Chief round table. So, the 1330 VIP demo is an excellent opportunity for team chiefs to preview the decon capability before the round table and spark excellent questions/discussions on how to integrate this new capability into your next MCRP rewrite.
2nd, it provides an opportunity to invite your base fire department, disaster preparedness, security forces, services (mortuary affairs), and other first responders. These are the personnel that your medics need to meet face to face when planning your base disaster response plan 10-1 (formerly 32-1). It’s important that these individuals become team players that understand your IPPDs capabilities and limitations. This helps your base plans remain realistic in expectations.
3rd, it provides an opportunity to invite your local Initial Response Force (Local Fire, Hospital, EMS, National Guard). So far, we’ve left a wake of success in IRF community partnering for integrated Homeland Defense Response at every location we’ve trained. There is no better way to bolster your communities IRF Homeland Defense efforts than to meet, greet, and get to know one another. The VIP demo provides the perfect place, and reason, for your IRF to meet. Too many times in my travels, I find community plans cris-crossed…that is, the base clinic plans read “patients with life threatening injuries or significant contamination are not transported to the clinic, they are routed directly to Hospital “X-downtown”. And Hospital “X-downtown’s” plans read, “we are a civilian hospital unfamiliar with Military Grade Weapons of Mass Destruction, therefore we send all significantly contaminated casualties to the Air Base”. But neither facility knows what the other’s plan reads? During this VIP demo I tactfully inform the local community that IPPD handles only 100 victims in the initial hours of a WMD response. Sustained operations will require local, and possibly state/federal support. This helps your community response plans remain realistic in expectations.
-Many times IPPD VIP demos ends up in the base paper, the local paper, and local TV. We’ve had up to 3 TV stations at one time filming the VIP demo at some bases. Homeland Defense is big news right now. It’s your IPPD Cadre’s opportunity to be local hero’s (if you wish). I have no problem with local media, I will direct them to your cadre for interviews, they need to be the stars…I’ll be gone before the 6pm news even comes on. If you do invite local media, don’t forget to inform your base Public Affairs office.
Lastly this training provides an MTF Team Chief Round Table Meeting. The purpose of the “Round Table” is to bring all CRT Chiefs together and discuss how the IPPD will fit into the MTF MCRP and the Base Disaster Response Plan (currently 32-1, changing to 10-1). The discussion explains the purpose of the IPPD, how it will integrate with other CRT teams, other Base Level First responders, and how it will fit into a full-spectrum WMD response.

6. Patient Decontamination (defined)
Remove contamination from patients...
...without further contaminating/injuring the patient.
...to reduce contamination of medical personnel/assets.
(if it works, it’s right)
If I were to pass a slip of paper to each individual in this room, and ask them to write 15 words to describe patient decontamination, we’d probably have 15 different definitions. In the world of WMD (CBRNE) we hear terms like Gross Decon, Hasty Decon, and Complete Decon. But there is no “true definition” of any of these terms.
Back in 1995, when I was building the USAF Medical Decontamination Course, a Col called me from Aeromedical Evacuation. As a part of the decon course, he wanted me to have decon personnel sign a certificate stating that after decon, victims were clean enough to place on an aircraft, seal the doors, and fly away. As the Col continued, I recalled lessons we learned in 1985 from UK flight crews that tried to transfer Iranian Soldiers contaminated with Mustard agent by Iraqis’. Three Iranian soldiers were selected for aeromedical evacuation back to the UK for medical care. Due to religious believes, the soldiers refused to remove their undergarments. Initially everything seemed to go well, the soldiers were decontaminated, then loaded on the aircraft. About 30 minutes into flight the UK Aeromedical Nurses, tending the Iranian soldiers, began to complain of itchy eyes. Mustard agent off-gassing was suspected. In a drastic move, the crew descended below 10,000’, reduced speed and opened the rear cargo door. Unfortunately it was too late, the off gassing had already caused it’s damage, and as the mustard agent took it’s course the crew did experience mild to moderate eye irritation, skin reddening, and some blistering. Although it wasn’t what he wanted to hear, I had to inform the Col that no member educated on decon would ever sign such a certificate.
I believe it’s important that each of us understand the true meaning of what decon is. Do you think medical decon leaves patients perfectly clean? That is a loaded question, because it truly depends upon the type of contaminant and the manpower/equipment/time you have for decon. If the contaminant were a non-persistent agent like cyanide, or chlorine gas; then decon would be relatively easy and we probably could get victims perfectly clean. If the contaminant were a highly penetration GD Soman, or HD thickened Mustard, then chances are the highly penetrating persistent agent will cause us great difficulty in removing it. IPPD provides the best equipment available to perform decontamination as well as technology can today. But it may be important to keep in mind that decon removes contamination form the outside of victims, if the breathed a contaminant inside their lungs, there could be a possibility of the exhaling/off-gassing contaminant even after decon.
The definition above was put together by a group of experts at USAFSAM in I believe it captures the true purpose of decon. Get the contaminant off the victim without further injury, and keep your medical assets operational.

7. Patient Decontamination
Wartime vs. Terrorist Response
What’s the difference?
In the past, when I’d put up this slide, I’d hear arguments from leadership… “if we have a wartime decon team, why would we need a peacetime decon team”? I believe the last conflict we had answered that question, as most of our wartime teams deployed, leaving our CONUS base MTF empty handed for Homeland Defense.
One of the obvious differences between wartime and peacetime decon is the protection factors victims present themselves in. That is, in wartime troops are expecting attack, carrying MOPP gear. At most stateside air bases, in peacetimes, no one has MOPP gear ready. Unless you are preparing to deploy, typically your mask and suit are maintained by your Supply Sq in a warehouse. So, in a terrorist attack during peace-time, your victims would most likely present wearing uniform of the day or street clothes (not in MOPP level IV). For those of you with wartime decon experience, we are going to shatter one of your paradigms… in peacetime decon we try to rip and strip clothing off as fast as possible. Some of you have been taught to remove MOPP gear very carefully and slowly by rolling the cut clothing away from your victim. That’s because a victim in MOPP gear can (theoretically) be alive inside the suit with a lethal dose of contamination on the outside of the suit.

8. Why a New Concept for Terrorist/Peacetime Decon?
Peacetime In-Place Decon
Locally Maintained
Accommodates 100: (60 ambulatory, 40 litter)
Articulating Shelter
CONOPS requirement is “ready” in 20 minutes after team assembly
12 People to operate and PPE for 24 members (AS 886A)
Wartime Med Decon
WRM
Deployable, Palletized
Accommodates 500
Alaska Shelters
Takes many hours to days to assemble for readiness
UTC FFGLA = Equipment (AS 902A)
UTC FFGLB = 19 People to operate, and PPE for 38 members
This slide is broken into two halves. Not to slight the wartime capability, it certainly serves it’s purpose when intelligence determines/suspects the enemy has WMD, and there is time set up and MOPP level “0” is at hand. However, the USAF recognized that Terrorists will strike without warning when equipment is not already assembled. Therefore a lighter faster equipment package had to be developed that would provide capability for the initial hours of a peacetime CBRNE incident.
The right half of the slide discusses the current wartime decon capability. The equipment is maintained as War Reserve Material (WRM) assets. That is, they are normally maintained in a warehouse, cargo netted to aircraft pallets 96” x 108”. The equipment theoretically will decontaminate 500 victims from warfare agents. I’ve personally set this equipment up several times, and it is my opinion and the opinion of many others that if you can have this system operational in less than a day, you are doing very well. Even for a well trained team, TEMPER tents take a while to set-up. The UTC is FFGLA and the Allowance Standard number is 902A. It takes 19 personnel (UTC FFGLB) to operate the system, and normally there two FFGLB’s deployed for every one FFGLA. The FFGLA (902A) will soon be updated by the SSPDS (Small Shelter Patient Decontamination System) developed by AFMESA. The SSPDS uses Alaska Shelters with Reeves interior components that look very similar to the IPPD equipment.
The left half of the slide discusses the new IPPD. It should be locally maintained, that is…stored no further than 100’ from the selected set-up site. It accommodates 100 patients (60 ambulatory and 40 litter). Some people ask why does it only accommodate 100, where did that number come from”? In 1999 USAF Force Protection Experts got together from all MAJCOMS and basically determined that “if the average terrorist struck the average Air Base, with the average contaminant…then there would be 200 patients”. That’s the numbers the BEDAL list was built from. The medics applied the math from Tokyo Sarin Subway incident and determined that ~ half (100) patients would flee the scene and self present at the MTF door. IPPD equipment quickly and easily erected…if you take more than a minute to erect the TVI/DRASH shelter…you’re doing something wrong. The USAF IPPD CONOPS requires teams to be mission capable within 20 minutes of team assembly. Most bases are mission capable (with 4 personnel in suits) in 5-7 minutes. 4 personnel can easily erects the system and begin operations, however IPPD uses 12 personnel for maximum patient output. There are 24 suits in the package to allow for a rotation of personnel. It is estimated that personnel will last ~3 hours in a suit (dependent upon environmental conditions and physical conditioning). So IPPD gives you 6 hours of initial capability.
The use of CBRNE in CONUS will be a sentinel event. The FBI classifies the use of CBRNE as a federal crime. Crafters of the USAF IPPD CONOPS estimated that within 6 hours of CBRNE CONUS event, many outside organizations (local/state/federal) will be available for assistance. For example the Marine Corps Chemical Biological Initial Response Force (CBIRF) out of Indian Head plans to be anywhere in CONUS providing decontamination within 5 hours of notification. Therefore IPPD was only designed to provide the “initial hours of capability” to an Air Base. Response in CONUS is unlike that of deployment overseas, in that overseas your re-supply or back-up logistics may be over 20 hours away; in contrast, CONUS re-supply and back-up is seldom more than an hour or two away.

9. How does the IPPD fit in? Capability and Speed “Inverse Proportions”
Unfortunate but true fact:
Capability of Decontamination Team
Speed of Decontamination Team
The USAF needs to take a moment to pat themselves on the back. As a Battelle Military Trainer we get to see how the Army, Navy, Air Force, Marines, Coast Guard, and VA are progressing in CBRNE preparedness. Clearly the USAF is leading the way by fielding similar equipment at every base. The integration and interoperability alone is invaluable.
Without question, the USAF has selected an equipment package hat provides lifesaving speed and capability in one package. An true, yet confounding fact is that typically speed and capability run at inverse proportions. That is, the bigger you build your equipment package, the slower it is to set-up. The USAF has selected a package that truly provides rapid assembly and mass casualty capability. Most bases have the package up in 5-7 minutes…Currently Hurlburt AFB Clinic holds the record of having the equipment up and operational with 4 personnel standing inside wearing IPPD PPE in just 3:37.
We must find the fastest way to provide a real capability for terrorist use of WMD

10. for terrorist use of WMD?
Why a Separate CONOPS
for terrorist use of WMD?
1995, Tokyo subway sarin incident:
57% of victims will flee the scene
Will self present to Medical Facilities
1999, HQ USAFE envelope
This slide addresses historical events that brought us to where we are today.
In the past, our USAF would write plans that stated “all victims will be decontaminated at the scene by the Fire Department, no contaminated victims will be brought to the medical treatment facility”. However, one critical piece was missing from this plan…what about those individuals that flee the scene. Each year when you go to CBRNE Training through CEX and MRT; you learn to don your mask and run upwind. No one stays in the gas cloud waiting for the initial response force. Would all of us agree that Tokyo is a fairly modern city with a rapid Initial Response Force? During Monday morning rush hour traffic, 20 Mar 1995, the Japanese cult Aum Shinrikyo placed Sarin nerve gas in the Tokyo subway people died, over 5500 personnel were injured…many of which were medical workers from cross-contamination. Medical workers physically grabbed hold of victims presenting to the front door and escorted them in without decontamination. Once a Medical Facility interior is contaminated by dirty patients, continued operations are seriously jeopardized if not destroyed.
Here’s a rhetorical question…what other medical team can perform their medical mission in a WMD incident without decon? The answer is “none” (except the BEE response team).
In 1999, a perfect example of how “unprepared we were” occurred in HQ USAFE, Ramstein AFB. In April of 1999, General Jumper’s secretary opened an envelope, and a “white powder” spilled onto her desk. Back in 1999, we were not yet a “powder sensitive culture”, so she didn’t think much of the powder and swiped it off her desk with her arm into her trash can. Soon after her nose began to sniffle, eyes begin to water, head began to ache, and stomach became nauseous. An OSI agent walked by the secretaries office and asked her “are you feeling alright Ma’am”? She described her symptoms and the powder, and the OSI agent used his radio to announce “I’m in General Jumper’s office, and I believe we have a chem/bio incident, this is not an exercise”. Instantly the world came alive…OSI agents ran to all 4 Generals’ offices in bldg 201 to find an exact envelope with the same return address was delivered to each General. To set the scene a little more, in April 1999 we were in THREATCON “C” (now called FORCEPROTECTION-CON “C”) because we were at war with Serbia, dropping bombs on behalf of the Albanian Refugees in Kosovo. Furthermore, Osama Bin-Laden had just published an article in the German news-papers offering the equivalent of $10,000 for any American head, dead or alive. So we were in alert status already.
In spite of the fact that the Ramstein Clinic expended great efforts to educate their enrolled population to utilize the Landstuhl Regional Medical center only 6 miles away if they were seriously injured. Two OSI agents brought the secretary directly to the doors of the Ramstein Clinic. In a WMD event, people will not always think clearly, and react out of habit “this was where they were used to going for care”. Fortunately a young Airman had heard something on the radio about a WMD event, recognized the lady was in crisis, and guarded/blocked the primary care doors as the Agents/Secretary approached. He was protecting the ~25 people sitting in the waiting room around him, as the victims were pressing their faces against the glass begging help.
Back at bldg 201 the Bio-Environmental Engineers (BEEs) arrived wearing level B suits (with SCBA). They brought out their air sampling devices, and began to try detecting the agent. An unfortunate but true fact is that, if you take a person like one of your Battelle Instructors, who’ve studied WMD for years…we know a huge spectrum of ways to contaminate and possibly shut down a base…Unfortunately, as good as technology is today, detection can only find a narrow bandwidth of that spectrum. Certainly the BEEs are getting better equipment (like the HAZMAT I.D. or the HAPSITE gas chromatograph) and training every month, but I served as a MAJCOM WMD Consultant for almost 7 years. During those years, I probably received close to 100 calls on possible contamination events. In almost every case, people were down, powder was found, or contamination was suspected. Out of all those cases, only one actually knew the contaminant they were dealing with, the rest could not detect what it was. It’s likely that many events will begin as an “unknown contaminant”. So as you’ve probably already guessed, the BEEs could not detect what the agent was?
As fire department personnel arrived at the scene in their turn out gear (level A), they brought with them a “biological containment unit”. Basically a Styrofoam container with 3 zip-lock baggies inside. Envelopes and the powder were placed in the bags.
As more and more personnel arrived at the scene in protective gear, the inevitable became obvious…HQ USAFE would have to be evacuated even though a war was going on. Approximately 140 personnel were escorted by security police to the parking lot. It was about 28o outside and spitting sleet. As the evacuees talked, they compared notes about what happened and many of them started complaining of runny noses, itchy eyes, headaches and upset stomachs. The fire department set up the decontamination capability they had. IAW NFPA regulations, they had a decon ability for personnel exiting the scene in suits, the purpose of the decon was to clean the protective suits before they were removed. The equipment consisted of basically a kiddies pool with a PVC shower plumbed over it. As the decon systems 34o water began to flow, the fire department asked anyone with symptoms to strip and walk through the shower. A medical miracle happened that day, as all victims symptoms instantly cleared up?
Back at the Ramstein Clinic, a brave Airman (4N) put on a TB respirator, and a gown (that was all the protection available at the time) and went out the clinic doors to lead the Secretary and her OSI agents to the Public Health building. There they were briskly showered off with no run-off control.
Back at the Secretaries office, a brave BEE technician carried the a "biological containment unit” to his shop truck, placed it in the back, detached his SCBA tank and slid in in the seat beside him. As he breathed through his respirator, he drove off Ramstein AB, through Landstuhl village, to the CHIPPMEUR laboratory located just North of the Landstuhl Regional Medical Center. As he carried the containment unit to the laboratory, he met locked doors. About that time his “out of air” alarm began to sound. Fortunately he had a radio, and after some high ranking involvement the laboratory doors opened. He placed the unit under a lab-hood, and the technicians went to work with their M-40 masks on.
In the next two days, the Ramstein Clinic filled with people who were near Bldg Finally, about 48 hours after the event, the lab determined to the best of their ability that the contaminant was nothing more than silica packing dust. All this was a false alarm, and thank goodness it was because it certainly showed how “under-prepared” we really were for WMD events. Gen Jumper allocated $500,000 to the medics shortly after, and the SWEDE decontamination trailer was fielded at every Major Medical Treatment Facility.
Everyone can remember what they were doing when the second airplane hit the twin towers. I was in weapons training that day, preparing for another deployment. We were on break, and I heard a commotion with my buddies in the SF break room, so I stepped in to see what was happening. They said “look Tom, the world trade center is on fire…they think a plane hit it?”. And then the second plane hit…I turned to Chief Harper standing next to me and I said…”Ranger, that’s no accident; we are at war”. Ranger Harper agreed and weapons training was discontinued. We slapped all the weapons together as fast as we could and every SF and Ready Augmentee was called to secure the gates in FPCON Charlie. I went back to my office to find out I was now assigned as the 1st Sergeant of 105 Medics in the 81EMEDS. Our mission was to fly to “Ground Zero” and set up a 25 bed Medical overnight. Boss said go get your gear and meet at the Aeromedical Staging Area. I immediately jumped in my truck and tried to drive off base to get my mobility bags at home. Unfortunately, I was stopped in traffic almost 1.5 miles from the gate. I got out and ran to the gate and explained “I was the 1st Sgt for Medics going to NY to save lives”. The response was “get back in your vehicle and wait”. Almost 3 hours later I managed to get off base, I grabbed my bags, kissed my family, and returned to find a 4 hour wait to get back on base. When I managed to make it to the Staging Facility, I was one of the first 10 to arrive. It took almost 10 hours to get our 105 medics gathered.
We left Keesler on a military bus with police escort, and when we tried to get into the Gulfport Reserve Airport, we again hit a long delay waiting to get through security. We flew to McGuire AFB and set the EMEDS up overnight, but of course…you know the story, survivors were few and NY medical centers were not overwhelmed.
That afternoon Gen Carlton came to congratulate us for responding/setting up so quickly. He asked if we had anyone that could run air samplers. I was part of a Preventive Aerospace Medicine Team bussed to the Pentagon to sample air and determine where we could put War-planners back to work in the building after the 767 crashed. When we arrived the building was still smoldering and small fires would still erupt. We were billeted at Anders and supported by Bolling…all of which has a minimum of a 1 hour wait to get on base. The lesson here is, I saw 7 different places in 48 hours post 9/11 and all had long waits to get in the gate…even with the important missions we had. In the USAF we used to write plans that would say “in a WMD event, the decon team will be recalled on base and set up”. I ask you, if the base is attacked and “locked down” in FPCON C, will they even get on base within the golden hour? Or will medics “locked down” on base (in housing, dorm, or just caught on base) be the only medical care available in initial hours?
As we established earlier, no medical team can perform their function in a WMD event without decon. So if you find yourself waiting for the decon team to set-up, while you’re inside the Medical Facility with doors locked, while patients are dying at the door…you’re doing it wrong. The USAF is the last service to recognize that decon should be a corps skill for all medics. Army and Navy medics had to learn medical decon and their promotions tests have included questions on WMD for many years. It is time for all USAF medics to understand the basics of decon…how to put on a protective suite…how to stand up the shelter and light the water heater. The days of “it’s not my job” are over. If you are the first medic to arrive, suit up and set up what you can to decon and save lives. There is no more decon team, there is a Cadre that will train all medics on decon.
In Oct 2001 we experienced anthrax “scares” in the mail. Some of those postal facilities are still closed today due to possible residual anthrax contamination. I’ve read USAF plans that actually stated “if the Medical Facility gets contaminated, it will be decontaminated”. That’s a mouthful to say, in order to “decon” a room it may require ripping out walls, ceilings, and floors; then fumigating with formaldehyde, and final certification by the EPA and other federal organizations before it’s considered “decontaminated”. The best way to keep the Medical Facility operational is to keep the contaminated out… decon them outside the point of entry. Many Medical Facilities are investing in a push button security system that blocks all doors from the outside, yet allows personnel inside to exit (thus complying with fire code).
Before the Anthrax “scares” in the last part of 2001, many personnel thought of Force Protection as something we did overseas. Now, after 9/11 and watching Washington DC be attacked by anthrax through the mail, it’s become evident that Homeland Defense and Force Protection are clearly intertwined.

11. Why a Separate Decontamination Plan for terrorist use of WMD
2001, 9/11 attacks:
Base gates close, traffic stops
Medical Facility must function with whoever is available
2001, Anthrax scares:
2004, Dover AFB:
This slide addresses historical events that brought us to where we are today.
In the past, our USAF would write plans that stated “all victims will be decontaminated at the scene by the Fire Department, no contaminated victims will be brought to the medical treatment facility”. However, one critical piece was missing from this plan…what about those individuals that flee the scene. Each year when you go to Disaster Preparedness training (could be at MRT); you learn to don your mask and run upwind. No one stays in the gas cloud waiting for the initial response force. Would all of us agree that Tokyo is a fairly modern city with a rapid Initial Response Force? During Monday morning rush hour traffic, 20 Mar 1995, the Japanese cult Aum Shinrikyo placed Sarin nerve gas in the Tokyo subway people died, over 5500 personnel were injured…many of which were medical workers from cross-contamination. Medical workers physically grabbed hold of victims presenting to the front door and escorted them in without decontamination. Once a Medical Facilities interior is contaminated, continued operations are seriously jeopardized if not destroyed.
Here’s a rhetorical question…what other medical team can perform their medical mission in a WMD incident without decon? The answer is “none” (except the BEE response team).
In 1999, a perfect example of how “unprepared we were” occurred in HQ USAFE, Ramstein AFB. In April of 1999, General Jumper’s secretary opened an envelope, and a “white powder” spilled onto her desk. Back in 1999, we were not yet a “powder sensitive culture”, so she didn’t think much of the powder and swiped it off her desk with her arm into her trash can. Soon after her nose began to sniffle, eyes begin to water, head began to ache, and stomach became nauseous. An OSI agent walked by the secretaries office and asked her “are you feeling alright Ma’am”? She described her symptoms and the powder, and the OSI agent used his radio to announce “I’m in General Jumper’s office, and I believe we have a chem/bio incident, this is not an exercise”. Instantly the world came alive…OSI agents ran to all 4 Generals’ offices in bldg 201 to find an exact envelope with the same return address was delivered to each General. To set the scene a little more, in April 1999 we were in THREATCON “C” (now called FORCEPROTCION-CON “C”) because we were at war with Serbia, dropping bombs on behalf of the Albanian Refugees in Kosovo. Furthermore, Osama Bin-Laden had just published an article in the German news-papers offering the equivalent of $10,000 for any American head, dead or alive. So we were in alert status already.
In spite of the fact that the Ramstein Clinic expended great efforts to educate their enrolled population to utilize the Landstuhl Regional Medical center only 6 miles away if they were seriously injured. Two OSI agents brought the secretary directly to the doors of the Ramstein Clinic. In a WMD event, people will not always think clearly, and react out of habit “this was where they were used to going for care”. Fortunately a young Airman had heard something on the radio about a WMD event, recognized the lady was in crisis, and guarded/blocked the primary care doors as the Agents/Secretary approached. He was protecting the ~25 people sitting in the waiting room around him, as the victims were pressing their faces against the glass begging help.
Back at bldg 201 the Bio-Environmental Engineers (BEEs) arrived wearing level B suits (with SCBA). They brought out their air sampling devices, and began to try detecting the agent. An unfortunate but true fact is that, if you take a person like one of your Battelle Instructors, who’ve studied WMD for years…we know a huge spectrum of ways to contaminate and possibly shut down a base…Unfortunately, as good as technology is today, detection can only find a narrow bandwidth of that spectrum. Certainly the BEEs are getting better equipment (like the HAZMAT I.D. or the HAPSITE gas chromatograph) and training every month, but I served as a MAJCOM WMD Consultant for almost 7 years. During those years, I probably received close to 100 calls on possible contamination events. In almost every case, people were down, powder was found, or contamination was suspected. Out of all those cases, only one actually knew the contaminant they were dealing with, the rest could not detect what it was. It’s likely that many events will begin as an “unknown contaminant”. So as you’ve probably already guessed, the BEEs could not detect what the agent was?
As fire department personnel arrived at the scene in their turn out gear (level A), they brought with them a “biological containment unit”. Basically a Styrofoam container with 3 zip-lock baggies inside. Envelopes and the powder were placed in the bags.
As more and more personnel arrived at the scene in protective gear, the inevitable became obvious…HQ USAFE would have to be evacuated even though a war was going on. Approximately 140 personnel were escorted by security police to the parking lot. It was about 28o outside and spitting sleet. As the evacuees talked, they compared notes about what happened and many of them started complaining of runny noses, itchy eyes, headaches and upset stomachs. The fire department set up the decontamination capability they had. IAW NFPA regulations, they had a decon ability for personnel exiting the scene in suits, the purpose of the decon was to clean the protective suits before they were removed. The equipment consisted of basically a kiddies pool with a PVC shower plumbed over it. As the decon systems 34o water began to flow, the fire department asked anyone with symptoms to strip and walk through the shower. A medical miracle happened that day, as all victims symptoms instantly cleared up?
Back at the Ramstein Clinic, a brave Airman (4N) put on a TB respirator, and a gown (that was all the protection available at the time) and went out the clinic doors to lead the Secretary and her OSI agents to the Public Health building. There they were briskly showered off with no run-off control.
Back at the Secretaries office, a brave BEE technician carried the a "biological containment unit” to his shop truck, placed it in the back, detached his SCBA tank and slid in in the seat beside him. As he breathed through his respirator, he drove off Ramstein AB, through Landstuhl village, to the CHIPPMEUR laboratory located just North of the Landstuhl Regional Medical Center. As he carried the containment unit to the laboratory, he met locked doors. About that time his “out of air” alarm began to sound. Fortunately he had a radio, and after some high ranking involvement the laboratory doors opened. He placed the unit under a lab-hood, and the technicians went to work with their M-40 masks on.
In the next two days, the Ramstein Clinic filled with people who were near Bldg Finally, about 48 hours after the event, the lab determined to the best of their ability that the contaminant was nothing more than silica packing dust. All this was a false alarm, and thank goodness it was because it certainly showed how “under-prepared” we really were for WMD events. Gen Jumper allocated $500,000 to the medics shortly after, and the SWEDE decontamination trailer was fielded at every Major Medical Treatment Facility.
Everyone can remember what they were doing when the second airplane hit the twin towers. I was in weapons training that day, preparing for another deployment. We were on break, and I heard a commotion with my buddies in the SF break room, so I stepped in to see what was happening. They said “look Tom, the world trade center is on fire…they think a plane hit it?”. And then the second plane hit…I turned to Chief Harper standing next to me and I said…”Ranger, that’s no accident; we are at war”. Ranger Harper agreed and weapons training was discontinued. We slapped all the weapons together as fast as we could and every SF and Ready Augmentee was called to secure the gates in FPCON Charlie. I went back to my office to find out I was now assigned as the 1st Sergeant of 105 Medics in the 81EMEDS. Our mission was to fly to “Ground Zero” and set up a 25 bed Medical overnight. Boss said go get your gear and meet at the Aeromedical Staging Area. I immediately jumped in my truck and tried to drive off base to get my mobility bags at home. Unfortunately, I was stopped in traffic almost 1.5 miles from the gate. I got out and ran to the gate and explained “I was the 1st Sgt for Medics going to NY to save lives”. The response was “get back in your vehicle and wait”. Almost 3 hours later I managed to get off base, I grabbed my bags, kissed my family, and returned to find a 4 hour wait to get back on base. When I managed to make it to the Staging Facility, I was one of the first 10 to arrive. It took almost 10 hours to get our 105 medics gathered.
We left Keesler on a military bus with police escort, and when we tried to get into the Gulfport Reserve Airport, we again hit a long delay waiting to get through security. We flew to McGuire AFB and set the EMEDS up overnight, but of course…you know the story, survivors were few and NY medical centers were not overwhelmed.
That afternoon Gen Carlton came to congratulate us for responding/setting up so quickly. He asked if we had anyone that could run air samplers. I was part of a Preventive Aerospace Medicine Team bussed to the Pentagon to sample air and determine where we could put War-planners back to work in the building after the 767 crashed. When we arrived the building was still smoldering and small fires would still erupt. We were billeted at Anders and supported by Bolling…all of which has a minimum of a 1 hour wait to get on base. The lesson here is, I saw 7 different places in 48 hours post 9/11 and all had long waits to get in the gate…even with the important missions we had. In the USAF we used to write plans that would say “in a WMD event, the decon team will be recalled on base and set up”. I ask you, if the base is attacked and “locked down” in FPCON C, will they even get on base within the golden hour? Or will medics “locked down” on base (in housing, dorm, or just caught on base) be the only medical care available in initial hours?
As we established earlier, no medical team can perform their function in a WMD event without decon. So if you find yourself waiting for the decon team to set-up, while you’re inside the Medical Facility with doors locked, while patients are dying at the door…you’re doing it wrong. The USAF is the last service to recognize that decon should be a corps skill for all medics. Army and Navy medics had to learn medical decon and their promotions tests have included questions on WMD for many years. It is time for all USAF medics to understand the basics of decon…how to put on a protective suite…how to stand up the shelter and light the water heater. The days of “it’s not my job” are over. If you are the first medic to arrive, suit up and set up what you can to decon and save lives. There is no more decon team, there is a Cadre that will train all medics on decon.
In Oct 2001 we experienced anthrax “scares” in the mail. Some of those postal facilities are still closed today due to possible residual anthrax contamination. I’ve read USAF plans that actually stated “if the Medical Facility gets contaminated, it will be decontaminated”. That’s a mouthful to say, in order to “decon” a room it may require ripping out walls, ceilings, and floors; then fumigating with formaldehyde, and final certification by the EPA and other federal organizations before it’s considered “decontaminated”. The best way to keep the Medical Facility operational is to keep the contaminated out… decon them outside the point of entry. Many Medical Facilities are investing in a push button security system that blocks all doors from the outside, yet allows personnel inside to exit (thus complying with fire code).
Before the Anthrax “scares” in the last part of 2001, many personnel thought of Force Protection as something we did overseas. Now, after 9/11 and watching Washington DC be attacked by anthrax through the mail, it’s become evident that Homeland Defense and Force Protection are clearly intertwined.

12. How does the IPPD fit in? Emergency Response to Terrorist WMD Incident…
For discussion purposes…
A terrorist releases VX at … Any AFB’s BX
Disclaimer: Of course different contaminants or different terrorist acts may dictate slightly different responses, however, this scenario will help display our response capabilities:
To understand how the IPPD fits into your base response plan 10-1 (old 32-1), the USAF TTP , the USAF IPPD CONOPS, and your local MCRP I’d like to go through a base response scenario.
If you want an interesting study of human dynamics in a suspected CBRNE incident in the USA…Look at the incident at Club E-2 in Chicago in Feb One individual sprayed mace on the dance-floor and 21 were trampled to death in the ensuing panic. Apply this model to your base. Where are your places of public gathering? What would VX at the BX look like?
For this scenario, I’d like to use a contaminant that causes immediate deadly reaction. Something like VX at the BX. Using an insidious substance like Mustard just wouldn’t have the same reaction. If I were a sick human, and put mustard agent droplets on your armrests this morning before you came in, over the course of the last 20 minutes you would have contacted them on your arms, possibly touched your face, and cross-contaminated everything else you’ve touched. But there wouldn’t be any panic yet; although the mustard agent would have caused catastrophic DNA damage to your skin in the first two minutes…it’s insidious. You wouldn’t feel anything from the mustard until min later when your eyes began to itch, then 6-12 hours later your skin would redden, and finally hours later painful blisters would begin to form. But the problem with a mustard incident is, without detection it may go un-noticed. So I’d like to use VX, it kills quickly and would rapidly become obvious a contaminant was present.

13. Terrorist WMD Incident Occurs
How does the IPPD fit in?
Terrorist WMD Incident Occurs
-VX released at BX
-Personnel down BX
Wind
direction
So VX is released…whether by a plane flying overhead spraying a mist, a fogging truck, a mortar that goes hiss instead of boom, or by a terrorist with binary agents in a suit case walking into the wind as his deadly toxin is mixed and dispersed down-wind through a small exhaust fan inside.
The victims in peacetime will most likely be unprepared. That is, no mask, no MOPP gear. Most likely they will be in uniform of the day or street clothes. So when a lethal or overwhelming dose is released, those subjected to a lethal or overwhelming dose will die or collapse (as compared to those in MOPP gear who can “theoretically” survive a lethal dose inside their charcoal impregnated suit). Those subjected to less than a lethal dose will …(next slide)…

14. Terrorist WMD Incident Occurs
How does the IPPD fit in?
Terrorist WMD Incident Occurs
-Some people are incapacitated and collapse at the scene
-Others are affected, and flee the scene for medical care
-Thus, two decontamination sites will be necessary (1) at scene, (2) at hospital
Wind
direction BX
Most likely flee the scene. Thus, dictating the necessity of decon at two sites…at the scene, and at whatever medical treatment facility they will “self present”. At this point victims are generally panicked and not thinking rationally. They go wherever they think of first for medical care. Furthermore, if the contamination event happens on base, they are trapped inside the gates…unable to exit the based they will go to your medical facility whether you’re a Simple Sniffle Clinic or a Regional Medical Centre.
Let’s take a look at what happens at the scene…

15. Terrorist WMD Incident Occurs Actions at Site 1, The Scene
How does the IPPD fit in?
Terrorist WMD Incident Occurs
Actions at Site 1, The Scene
-Initial Response Force arrives
-Entry Control Point Selected
Wind
direction BX
At the scene, typically the security forces are first to arrive. If unsuspecting, they could become victims as well as they enter the scene. The firemen are usually next on the scene. National Fire Protection Association (NFPA) regulations require they don protective gear before they enter the scene. The Fire chief consults with the Bio-Environmental Engineers
ECP

16. Terrorist WMD Incident Occurs Actions at Site 1, The Scene
How does the IPPD fit in?
Terrorist WMD Incident Occurs
Actions at Site 1, The Scene
Fire Department sets up decontamination systems for rescuers and patients
Wind
direction BX
FD will likely perform gross decon initially before they set up full decon
The sequence of events would typically look something like this:
-Event 0:00hr
-Victims collapse or flee the scene
-911 call happens
-Fire Dept alarms go off
-Fire Department scrambles and drives trucks to the scene
-Establish entry control point (typically 2000’ upwind from the incident, or they may use the HAZMAT “rule of thumb” at smaller incidents)
-Fire Dept consults with BioEnvironmental Engineers on contaminant detection, plume modelling, wind direction and where to evacuate down- wind.
-Fire Department Suits up
-Fire Department sets-up NFPA required decon for their PPE
-Fire Department may now enter the scene to remove those victims who collapsed from an overwhelming dose…how long ago?
Most experts agree that it may take 30 minutes to well over an hour for anyone to enter the scene and attend to victims that collapse at the scene.
I submit to you for consideration, there may be more of a mortuary affairs mission at the scene and more of a medical mission on it’s way to the front door of …
ECP

17. Terrorist WMD Incident Occurs Actions at Site 2, the Hospital
How does the IPPD fit in?
Terrorist WMD Incident Occurs
Actions at Site 2, the Hospital
-Contaminated People that fled the scene begin to show up at the hospital
-The hospital must control the flow of contaminated casualties through a decon unit
HOSPITAL
EMERGENCY
… your medical facility.
Victims who flee the scene suffer from panic (and if nerve agent is involved some degree of delusion). They are not thinking straight, typically they will go where they are used to going for medical care. Unfortunately that will most likely be your medical facility door, even if you’re just a small clinic. At one base, they crafted a plan to have all contaminated casualties report to a central location (like the aircraft wash rack, or the base car wash, or swim pool) for decon. The problem with this plan was…. when exercised the active duty that understood the plan went to the wash rack…all others (dependents, retirees, and other guests who didn’t know the plan) naturally reported to the MTF. So, the MTF had their decon team down at the wash rack, while the majority of their victims were standing at the MTF door.
An absolute for success: Each medical facility must consider having these first 3 items on their MCRP checklist if they suspect a CBRNE event. If the crash phone rings, and there is suspicion of CBRNE, if there is a possibility of CBRNE, even if you are not sure (it’s always better to be safe than to be sorry) the 3 following items must occur rapidly:
Security Team must lock the door and control MTF access
Launch the IPPD with whatever staff is available
Launch the BEE detection team
Note: this will all most likely occur even before the MCC gets stood up.
Another consideration is, if your base gates get locked down due to attack, where else can victims go for medical care? If the event happens at 1400 Monday afternoon, the victims will be lucky because medical personnel will be at the MTF. But if it happens at 1400 on Saturday…
-if you’re a hospital, you may have minimal medical staff available in your ER, Ward, X-ray, Lab? These few people are going to be “home alone” trying to conduct an almost impossible mission. They will have to secure the facility, initiate a recall, and begin suiting-up and setting up to begin decon. Again, without decon first, no other medical team can function. Your facility may wish to have a listing of personnel that live on base (housing and dorms). If your housing and MTF are located within the same fenced perimeter, these are the only personnel that will be able to respond in the initial hours. Those recalled from off base will likely be caught in gate traffic.
Responses can vary….there is the perfect world, and then there is the imperfect world.
In the perfect world, you’ve been watching the threat rise. National intelligence personnel intercept threat messages with specific targeting information and you are in the target zone. Our Nation goes from Condition Orange to Red, you base in-turn goes from FPCON Bravo to Charlie. At this point you began planning. At Charlie plus, your IPPD team chief decides to set up the IPPD and leave it up because the threat seems to warrant it. The crash phone rings Monday, a CBRNE event is suspected your equipment is set up and your IPPD members have time to suit up before the victims can arrive. You are completely ready when victims show-up. But the world usually isn’t perfect.
In the imperfect world, the crash phone rings, someone hesitates and doesn’t launch the IPPD immediately. The victims arrive before the IPPD is set up. Now the victims are standing at your door pressing their faces on the glass. The IPPD members must don their PPE before they can begin setting up (they can’t go out amongst the contaminated without protection). At this point, we could really have a problem if you stored your PPE in a shed outside the hospital, you begin to realize that was a tactical error. As other recalled medical staff members arrive to assist, there must be a “secret back door clean entry” to get them inside to suit up.
The bottom line is you must plan for, and practice many different scenarios.

18. Terrorist WMD Incident Occurs Actions at Site 2, the Hospital
How does the IPPD fit in?
Terrorist WMD Incident Occurs
Actions at Site 2, the Hospital
-The hospital quickly sets up the IPPD to allow only decontaminated casualties enter the MTF (note: containment berm goes down first as shown)
-If contaminated casualties enter the MTF (causing significant contamination) the MTF may have to discontinue operations and move to alternate medical facility.
HOSPITAL
Once the victims have arrived, access must be controlled by the security team. If victims are there, the decon team dons PPE and sets-up.
The bottom line is no contaminated victim should be allowed to enter the MTF. Even the 6’4” 240lb man who’s dragging his 6yo daughter by the arm because she hasn’t breathed in over a minute has to be stopped from rushing past the decon line to save his daughter. In the end, we may save one 6 year old, but the MTF could be rendered useless to all other victims.
EMERGENCY

19. Actions at Site 2, the Hospital
-IPPD sets up tent
-Lane with roller system is for litter casualties on backboards
-Lane/s without roller system is for ambulatory (walking casualties)
HOSPITAL
EMERGENCY
The decon team is very busy inside the shelter/s. They will already be overworked trying to handle the onslaught of victims arriving, there wont be time for them to try and provide security too. The MTF security will have to assist in ensuring all victims “act like adults” and process through decon. Unfortunately, at the writing of this document, the USAF still hasn’t offered PPE on an AS for Security. So many MTFs are moving a few of the 24 sets of PPE from the new AS886C Triage team to the security team.

20. Terrorist WMD Incident Occurs Actions at Site 2, the Hospital
How does the IPPD fit in?
Terrorist WMD Incident Occurs
Actions at Site 2, the Hospital
-IPPD completely set-up, processing 60 ambulatory, and 40 litter patients
HOSPITAL
EMERGENCY
Many of you have practiced your annual Mass Casualty Response Exercise (MARE), every year with a mock plane crash, or bus wreck. This event isn’t much different, it’s still a MARE, only now CBRNE is involved. Each year Patient Admin Team struggles to track multiple victims in the MARE (where they go, and what is their condition)? Can you imagine the challenge Pt Admin team will have tracking victims in this event when all identifying clothing and belongings removed in decon. Fortunately there is an answer to this dilemma; HQ ACC recently added patient effects bags to AS886A. The Pt effects bags have a pictorial on the front that anyone speaking any language can understand instructing them to remove clothing and place it in the bag. The bag has a tamper-proof seal to protect medics. Let Ambulatory victims seal their own bags…that way they can’t accuse your team members of taking anything.
What about the field response team? The go to the scene and the firemen are all wearing PPE, they come back to the MTF entry and the decon team is wearing PPE…shouldn’t they have PPE. Many MTFs are putting two sets of PPE on board their response ambulances (if they have any).
Overall, the decon team is very busy inside the shelter. They will require the support of multiple CR teams in order to have an integrated response capability flowing patients from the scene to inside the MTF.

21. Confounding Factors Limiting Factors we recognize… Not staffed 24 hrs
Response Time (who will get there first)?
Unknown Agents
Securing MTF
The reason the fire department owns the decon mission at the scene is because they have 24 hour staff, and they have mobile equipment in trailers. After hours staffing at MTFs can range from limited in hospitals to non-existent in clinics.
Whoever arrives first will have to secure the MTF, and begin setting up decon. After all, what medical team can perform their mission in a WMD event without decon.
In the past, some units would construct response plans that would say…”if agent “X” is detected, we’ll respond as “Y”. But as we discussed earlier, even with today’s improved technology, detection is still “not a perfect science”. Almost every “real-world” event starts out with an “unknown agent”. Units would serve they response needs better if they plan to deal with “unknown agents”. It forces them to plan for worst case, and can adjust to a simpler (detectable) scenario later if permissible.
Securing the MTF is a critical task. Keeping contaminated victims out, and deconing at the door, will allow the MTF to continue operations. In contrast, if contamination victims are allowed to enter the MTF, mission capability will be significantly degraded if not lost completely. But simply writing the words we will secure the doors can be a loaded statement. If the incident occurs at 1400 on Tuesday afternoon, adequate may be available for a robust response. In contrast, if the WMD event happens on a Sunday afternoon:
Hospital: the only staff that may be available are a few ER staff, possibly ward, Xray, and lab personnel. This may total between personnel depending upon the hospital. It will be extremely difficult for a staff this size to
Secure the doors
Launch the IPPD
Initiate a recall
All at the same instance
Clinic: It is highly likely that no staff will be available at the clinic at this time. However, if the base gates slam shut in FPCON Delta, victims will have nowhere to go for care except your base MTF…so they are coming whether you are prepared or not. Even if your MTF personnel are recalled, it is possible victims will arrive at your MTF before your staff residing on base, and highly probably they will arrive before your personnel that get stuck at the gate attempting to arrive from off base.
In either Hospital or Clinic one more complicating factor will exist. If victims arrive before recalled staff, your staff must have a “clean entrance” that only your staff knows about. This allows staff to enter the MTF and don PPE before going out amongst the contaminated victims.

22. Requires MTF Team Approach!
Patient’s may arrive before recalled personnel arrive to help!
Start with what is available and build capability. There will be no time for debates on who’s job it is!
Enough said about this already…just re-emphasize the point…decon is every medic’s job…there is no more special team.

23. Top-Down View of MTF Warm Zone with 886A and 886C
886C, IMR =
Triage/EMT/Security
886A, IPPD (Decon)
886C, 2nd Triage 02
MTF 02
Patient Flow
Desired Wind Direction

24. Summary Patient Decontamination Defined
Why a new CONOPS for terrorist use of WMD
How does the IPPD fit in?
IPPD Layout
Requires MTF Team Approach
Failure To Prepare Is
Preparing to Fail
Benjamin Franklin