Victim Evacuation, Extraction, and Transport

EPRC / Version 1
5/29/2009

SECTION I. ADMINISTRATIVE DATA

All Courses Course Number Version Course Title

Including Emergency Preparedness Readiness
This Lesson Course (Clinician)

Task(s) Task Number Task Title

Taught(*) or Victim Evacuation, Extraction, and Transport
Supported

Reinforced Task Number Task Title

Task(s)

Academic The academic hours required to teach this lesson are as follows:
Hours
Resident
Hours/Methods
0.5 mins / Conference / Discussion
0.0 mins / Conference/Demonstration
0.0 mins / Conference/Demonstration
0.0 hrs / Practical Exercise (Performance)
Test 0.0 hrs
Test Review 0.0 hrs
Total Hours: 0.5 hrs

Test Lesson Hours Lesson No.

Number
Testing
(to include test review) N/A

Prerequisite Lesson Number Lesson Title

Lesson(s)

Clearance
Security Level: Unclassified
Access
Requirements: There are no clearance or access requirements for the
lesson.

Foreign
FD5. This product/publication has been reviewed by the product developers
Disclosure
in coordination with the USAMEDDC&S foreign disclosure authority. This
Restrictions
product is releasable to students from all requesting foreign countries without
restrictions.

1
References Number Title Date Additional
Information
FM 3-11 MULTISERVICE 10 Mar 2003
TACTICS,
TECHNIQUES, AND
PROCEDURES FOR
NUCLEAR,
BIOLOGICAL, AND
CHEMICAL DEFENSE
OPERATIONS
FM 3-11.9 POTENTIAL MILITARY 10 Jan 2005
CHEMICAL/BIOLOGICAL
AGENTS AND
COMPOUNDS
FM 3-11.5 MULTISERVICE 04 Apr 2006
TACTICS,
TECHNIQUES, AND
PROCEDURES FOR
CHEMICAL,
BIOLOGICAL,
RADIOLOGICAL, AND
NUCLEAR
DECONTAMINATION
FM 4-25.11 FIRST AID (INCL 23 Dec 2002
CHANGE 1)
FM 4-02.285 MULTISERVICE 18 Sep 2007
TACTICS,
TECHNIQUES AND
PROCEDURES FOR
TREATMENT OF
CHEMICAL AGENT
CASUALTIES AND
CONVENTIONAL
MILITARY CHEMICAL
INJURIES
FM 8-9 NATO HANDBOOK ON 01 Feb 1996
THE MEDICAL
ASPECTS OF NBC
DEFENSE
OPERATIONS AMEDP-
6(B)
STP 21-1-SMCT SOLDIER'S MANUAL 14 Dec 2007
OF COMMON TASKS,
WARRIOR SKILLS,
LEVEL 1
STP 21-24-SMCT SOLDIER'S MANUAL 09 Sep 2008
OF COMMON TASKS,
WARRIOR LEADER,
SKILL LEVELS 2, 3,
AND 4
Student
Study
Assignments

2
Instructor
One instructor, Civilian (CBRNE/NBC), 74D2/30, 74A- ITC qualified
Requirements

Additional Name Stu Qty Man Hours

Support Ratio
Personnel None
Requirements
Equipment Id Stu Instr Spt Qty Exp
Required Name Ratio Ratio
COMPUTER-INSTRUCTOR No 1 No
COMPUTER (CPU) WITH KEYBOARD,
INSTRUCTOR USE ONLY
MONITOR-INSTRUCTOR No 1 No
COMPUTER MONITOR
PROJECTOR-INSTRUCTOR No 1 No
OVERHEAD PROJECTOR WITH
COMPUTER INTERFACE
SCREEN-INSTRUCTOR No 1 No
SCREEN PROJECTOR, INSTRUCTOR
USE
* Before Id indicates a TADSS

Materials Instructor Materials:

Required PowerPoint presentation and lesson plan.

Student Materials:
Duty uniform, student handouts, pen/pencil, paper

Classroom,
Training Area, LEVEL ONE, GENERAL PURPOSE CLASSROOM, 60 PN
and Range
Requirements

Ammunition Exp Stu Instr Spt

Requirements Id Name Ratio Ratio Qty
None
Instructional Before presenting this lesson, instructors must thoroughly prepare by
Guidance studying this lesson and identified reference material.
Ensure the classroom is open, computer, PowerPoint presentation, and
projector work at least 15 minutes prior to the class.

Proponent Name Rank Position Date

Lesson Plan
CBRNE SCI BR, PN
Approvals

3
SECTION II. INTRODUCTION

Method of Instruction:
Conference/Demonstration
Instructor to Student Ratio is:
Time of Instruction:
Media:

Motivator
With knowledge of an impending event, evacuation is the best protective
action during an all-hazards incident. However, forewarning of a terrorist
attack may not provide sufficient time to safely evacuate the entire
population that may be affected, especially if the number of people affected
is large. Being familiar with the basic principles relating to victim
evacuation, extraction and transport can dramatically expedient medical
care and increase the probability of survival of victims while protecting
responders from becoming casualties.

Terminal
NOTE: Inform the students of the following Terminal Learning Objective
Learning
requirements. At the completion of this lesson, you [the student] will:
Objective

Action:
Identify procedures for the safe patient evacuation,
extraction, transport and scene safety and control of CBRNE
contamination during an all-hazards incident
Conditions:
Given a CBRNE incident scenario involving casualties
(terrorism, or on the battlefield)
Standards:
Identified procedures for the safe patient evacuation,
extraction, transport and scene safety and control of CBRNE
contamination during an all-hazards incident IAW FM 3-11,
FM 3-11.9, FM 3-11.5, FM 4-25.11, FM 4-02.285, FM 8-9,
STP 21-1-SMCT and STP 21-24-SMCT.

Safety
None
Requirements

Risk
Low
Assessment
Level

Environmental
Considerations
NOTE: It is the responsibility of all Soldiers and DA civilians to protect the
environment from damage.

4
Evaluation
Students will be evaluated using a written exam. Students must score at
least a 70% to receive a GO.

Instructional
A critical aspect of providing timely and appropriate medical care of a
Lead-In
CBRNE agent victims in an all hazard incident is understanding and
applying the principles of safe patient evacuation, extraction and
transportation, Contamination containment of victims, responders and the
incident scene and evacuation routes is essential for optimal treatment,
restorative care and survivability of all personnel. The earlier definitive
medical care can be given the greater probability for survival and the
sooner soldiers can returned to the mission. Avoiding or controlling
contamination of an area allows for safer extraction, evacuation, and
transport of victims and maintains the integrity of the scene. In the event of
a CBRNE incident criminal investigation maybe necessary and good
investigational and crime scene integrity will be crucial in apprehending and
convicting perpetrators.

SECTION III. PRESENTATION

NOTE: Inform the students of the Enabling Learning Objective requirements.

1. Learning Step / Activity 1. Establish scene safety and control zones

Method of Instruction:
Conference/ Demonstration
Instructor to Student Ratio is:
Time of Instruction:
Media:

NOTE: See Slide 3-4

a. Scene Safety
(1) Establishing scene safety is part of the initial evaluation of an incident site and is
fundamental to successful operations. Involves consideration of, but not limited
to, the following areas:
(a) Environmental conditions (e.g., location, population density)
(b) Weather (i.e., temperature, wind, precipitation)
(c) Weakened structures, downed power lines, collapsed roadways, etc.

NOTE: Bear in mind the potential for worsening scene safety, for example possible sources of
primary or secondary developments could include chemical or biological agents, existence of
improvised explosive devices (IEDs), presence of harmful levels of radiation

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 (2) Establish Scene Control Zones
(a) Isolation Zone or Hot Zone is established to secure the site and remove
victims of the incident from the site. Only (essential) authorized personnel
may enter the isolation zone once it is established.

NOTE: Multiple means of securing the isolation zone may be employed by the use of alarm
devices to indicate a disaster, use of physical barriers, rerouting of traffic away from the scene,
physical presence of personnel to notify intruders that access to the site is denied, use of public
address systems to warn people to stay away, or notification of the hazardous area via media
broadcasts.

(3) Protective Action Zone is downwind of the isolation zone. This is where decisions
are made to evacuate, protect-in-place, or do a combination of both.

NOTE: Conduct a check on learning and summarize the learning activity.

1. Name two control zones that must be established for scene safety.
a. Isolation Zone or Hot Zone
b. Protective Action Zones
2. The presence of ____________ may be a potential source of worsening scene
safety.
a. Chemical or biological agents
b. Improvised explosive devices (IEDs) or
c. Harmful levels of radiation

2. Learning Step / Activity 2. Extraction, Evacuation, or Protect-in-Place

Method of Instruction:
Conference/ Demonstration
Instructor to Student Ratio is:
Time of Instruction:
Media:

NOTE: See Slides 5-10

a. Standard victim extraction protocol includes:

(1) Perform initial scene assessment
(2) Designate a site and plan for quarantining in case the attack involves use of a
biological agent
(3) Position equipment and teams for hot zone entry
(4) Enter hot zone, identify easily rescued victims, and perform critical emergency 1staid,
‘Kick Triage’ set as required prior to victim being extracted, and only as necessary to
sustain life

NOTE: In many organizations, rescuers wearing PPE have been trained to use noxious
stimulus to determine the victim's responsiveness and thus estimate the victim's potential for
survival

6
 (5) Rescue victims and deliver them to the contamination reduction corridor for
emergency medical personnel and decontamination
(6) Search voids and dead spaces for entrapped victims
(7) Free live, entrapped victims and deliver them to the contamination reduction corridor
for medical treatment and decontamination

b. Temporary Protection-in-Place
(1) For example: Vehicles afford temporary protection-in-place and may be used to
simultaneously protect-in-place and evacuate

c. Evacuation vs. Protect-in-Place. Multiple factors must be weighed by the Incident

Commander when making the decision to evacuate, protect-in-place, or perhaps, both.
(1) Agent considerations
(a) Toxicity
(b) Amount
(c) Rate of release
(d) Direction of spread
(e) Ability to contain
(2) Population
(a) Number of victims
(b) Location of victims (dense/sparse settlement)
(c) Available means of transportation
(3) Environmental conditions
(a) Wind direction and speed
(b) Temperature and humidity
(c) Weather conditions
(d) Topography
(e) Interaction of environmental conditions
(f) Availability of filtered air (sufficient to produce overpressure)

d. Evacuation
(1) The following factors regarding evacuation are critical:
(a) How quickly people can prepare to evacuate - where people are and what they
are doing affects how quickly they can react to a terrorist attack. For example,
office workers can evacuate more efficiently than personnel and patients in a
hospital.
(b) Size of area threatened and density of population - getting to all possible victims
in a sparsely populated area may be as difficult as moving individuals out of a
densely populated area. The number of lives saved will depend on efficient
evacuation appropriate to the situation.
(c) Configuration of area threatened - density of buildings, type of area (e.g.,
business district, proximity to airports, rivers, mountains, etc.), access and egress
routes, and similar issues affect the ability to evacuate people quickly
(d) Number of responders available to oversee evacuation - a definite plan for
evacuation and sufficient individuals to oversee execution of that plan is
particularly important when large numbers of people are involved.
(e) Resources available for evacuation - if massive numbers of people need to be
evacuated, adequate physical means of transportation and adequate roadways
on which to travel are necessary.
(f) Weather conditions – for example, if life threatening low temperatures or storm
conditions.

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NOTE: First responders should begin evacuating people upwind or crosswind of the expected
incident at a distance specified in the Emergency Response Guidebook. Evacuees should be
sent to a designated site upwind of the threatened area.

e. Evacuation of Downwind Hazard Areas. The hazard from a CBRNE event is not
confined to the area directly affected. The resulting vapor or aerosol travels with the wind
and can cover a large area downwind of the attack area. To prevent casualties, you
must quickly identify the possible hazard and warn personnel within the hazard area.
Downwind hazard area depends on:
(a) Horizontal hazard area:
i Type of agent material
ii Means of delivery
iii Meteorological conditions
iv Defined hazard (size of affected area)
(b) Vertical hazard area:
i Extends at least up to 150 meters above the surface
ii Warn air crews flying low level

f. Evacuation is the preferred response to a CBRNE incident; however, the Incident

Commander may opt for protection-in-place.
(a) Evacuation may be the only option if the following conditions exist:
i Vapors/gas are explosive
ii Toxic agent will be present for an extended time
iii Victims are inside a structure that cannot be effectively sealed
(b) The Incident Commander may opt for protect-in-place if the following conditions
exist:
i Toxic agent is spreading too rapidly
ii Toxic agent is too deadly to risk exposure that might result during evacuation
iii Toxic agent is heavier than air and population affected is in a high-rise
structure

NOTE: Conduct a check on learning and summarize the learning activity.

1. The Incident Commander may opt for protect-in-place if a toxic agent is

_______________.
a. spreading too rapidly
b. too deadly to risk exposure that might result during evacuation
c. heavier than air and population affected is in a high-rise structure

2. An environmental condition such as weather conditions is not a factor to be

considered by an incident commander in making a decision to evacuate or protect-
in-place. True or False?
False. Multiple factors must be weighed by the Incident Commander when making
the decision to evacuate, protect-in-place, or a mix of both these options, for
example:
• Agent characteristics/considerations
• Population dynamics
• Environmental conditions

3. Learning Step / Activity 3. Victim Transport

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 Method of Instruction:
Conference/ Demonstration
Instructor to Student Ratio is:
Time of Instruction:
Media:

NOTE: See Slide 11-12

a. Victim Transport procedural precautions

(1) The following precautions should be taken to protect personnel involved in the
transport of victims:
(a) Wrap victim in a commercially available patient wrap, plastic sheeting, or a
double layer of bed linens to prevent contamination spread.
(b) Clad emergency medical services personnel assisting in transport in Level
C PPE with an appropriate respirator.
(c) Vent vehicles at full power to the outside.
(d) Use ground transportation when possible.
(e) Execute hasty decontamination of a vehicle used to transport a potentially
contaminated victim prior to use for other victim.
(f) Decontaminate vehicle used to transport potentially contaminated victims
thoroughly before returning vehicle to full service.
(g) Do not smoke.

b. Victim Transport: Ground vs. Air

(1) Use ground ambulances before aircraft for victim transport:
(a) More plentiful
(b) Easier to decontaminate
(c) Easier to replace
(2) Considerations with air transport include:
(a) Contamination does not preclude the use of aircraft
(b) Be aware of rotor wash
(c) Proximity to decontamination site

NOTE: Conduct a check on learning and summarize the learning activity.

1. A ground ambulance or an aircraft can be used equally well for victim transport from an
all-hazard incident scene where CBRNE agents may have been utilized? True or
False?
False. Use ground ambulances before aircraft for victim transport. Aircraft can
be difficult to fully decontaminate after use in a CBRNE incident.

2. A hasty decontamination of a vehicle should be performed between each use when

transporting potentially contaminated victims from an all-hazard incident scene. True
or False?
True, this assists with cross and continued contamination of both patients and
responders.

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NOTE: See Slide 13 - The slide illustrates varies aspects of the victim extraction, evacuation,
and transport process.
1. Victim wrapped in plastic sheeting (top left)
2. Venting a vehicle (top center)
3. Decontaminating a vehicle (top right)
4. Personnel in PPE (bottom left)
5. Utilizing ground transportation (bottom center)
6. Do not smoke (bottom right)

SECTION IV. SUMMARY

Method of Instruction:
Conference/Demonstration
Instructor to Student Ratio is:
Time of Instruction:
Media: Group Instruction

Review /
A. Review of Main Points:
Summarize
Lesson 1. Establish scene safety and control zones of an-hazard incident
2. Compare extraction, evacuation, or protect-in-place options for situation
3. Fundamentals of safe victim transport from all-hazard incident scene
B. Closing Statement: Evacuation is the best protective action during an all-hazards
incident. However there may not be sufficient time to safely evacuate everyone
affected or there may be factors that make immediate evacuation more
dangerous to victims or responders. Being familiar with the basic principles
relating to victim evacuation, extraction and transport can dramatically expedient
medical care and increase the probability of survival of victims while protecting
responders from becoming casualties.

SECTION V. STUDENT EVALUATION

Testing
NOTE: Students will be evaluated using a written exam. Students must
Requirements
score at least a 70% to receive a GO.
Feedback NOTE: Feedback is essential to effective learning. Schedule and provide
Requirements feedback on the evaluation and any information to help answer students'
questions about the test. Provide remedial training as needed.

10
C-1