Located just 45 miles from Fort Bliss, the White Sands Missile Range (WSMR) Fast Burst Reactor (FBR) is the only remaining fast burst nuclear reactor in the Department of Defense. According to the Defense Technical Information Center, the reactor produces a nuclear environment which stimulates the neutron portion of a nuclear weapon to test weapons systems' response to the environment.

The unique mission of responding to an incident at the FBR falls upon WSMR's sole clinic, McAfee U.S. Army Health Clinic (MUSAHC) as part of Nuclear Accident or Incident Response and Assistance (NAIRA) operations. Because of MUSAHC's relationship with William Beaumont Army Medical Center, which is the closest Military Treatment Facility to WSMR, Soldiers and staff with WBAMC's Department of Emergency Medicine performed a decontamination/ Chemical, Biological, Radioactive, Nuclear and Explosives (CBRNE) exercise to measure WBAMC's capability to respond to a CBRNE incident, Nov. 9.

"(MUSAHC) would respond to the site where the patient may have been exposed to or injured by CBRNE," said Lt. Col. Patrick Marlow, Clinical Nurse Specialist, Dept. of Emergency Medicine, WBAMC. "If the patient was stable and not injured then they would (decontaminate) at MUSAHC but if the patient is unstable or had any kind of medical condition then they would be (evacuated) to WBAMC."

Sixty personnel with WBAMC's ED observed or took part in the simulated CBRNE casualty decontamination process staged outside of WBAMC's ED. Decontamination is the process of removing or neutralizing hazardous substances from individuals who may have been exposed.

"Going through this process we realized early on the decontamination team and treatment team have such different missions that run parallel to each other," said Maj. Melanie Bowman, Clinical Nurse Officer in Charge, Dept. of Emergency Medicine, WBAMC. "Unless we train together, we'll never be 100 percent effective. Neither one can do our job without the other."

According to the Medical Management of Chemical Casualties Handbook published by the U.S. Army Medical Research Institute of Chemical Defense, there are three levels of patient decontamination: Immediate Decontamination performed to protect the individual by removing contamination from Individual Protective Equipment (IPE) and skin, Patient Operational Decontamination performed to prepare a contaminated individual for transport to the next level of care, and Patient Thorough Decontamination performed to protect the medical facility and staff by decontaminating a casualty before entering an MTF. During the exercise staff trained on all three levels.

In preparation for the exercise, personnel trained with CBRNE subject matter experts and collaborated with multiple agencies to obtain equipment necessary for the decontamination process. For the ED team, just preparing for the exercise was effective in training Soldiers for real-world incident response missions.

"Readiness is the key and this (exercise) is multifaceted," said Bowman, a native of Nashville, Tennessee. "There is CBRNE, learning how to don (Personal Protective Equipment) and treating the patient in that gear. We also need to understand how to collaborate with other organizations and facilities to make the mission work."

While staff at WBAMC gained insight on proper decontamination and CBRNE-response procedures, MUSAHC staff were also trained on trauma treatment to enhance medical capability and stabilize casualties for medical evacuation.

"Evacuation times, injuries, stabilization of the patient, all that factors into the decision making process of whether the patient can make it to WBAMC," said Bowman. "We would never want to put someone in the situation where they wouldn't survive the evacuation time."

"All of our medics and active-duty personnel need to be ready to (deploy) at any time," said Marlow, a Milwaukee native. "One of the challenges we have is we don't get enough training in (CBRNE casualty treatment) and we all need to get nurses and medics in the warfighter mindset."

Future training exercises will address challenges at WBAMC concerning CBRNE casualty admissions, operations and evacuation. WBAMC ED staff anticipates future exercises to include multi-level command collaboration to monitor a CBRNE casualty throughout the entire health care treatment process.

"From a leadership standpoint, from a readiness standpoint, from a military standpoint, (the exercise will address) everything that a leader should be able to execute whether it's on the battlefield or (at home)," said Bowman. "Exposing staff to that type of operation pulls them out of the mindset that they're coming in to take care of patients and going home. It really opens up that military door for some who have never been in a combatant command and enables them to see how a military operation is planned and the process to execute it."

Addressing a potential CBRNE casualty during the exercise also exposed staff to military medicine's different levels of care, or medical capabilities available during combat operations with Level I care being immediate first aid delivered at the point of injury usually in a combat zone by a combat medic and Level V care provided by an MTF in the United States.

"(The exercise) is the same concept, opening their eyes to military medicine on the battlefield and putting that in our backdoor speaks volume to what we can do," said Bowman. "We know what military medicine can do on the battlefield. We know these things work, we know they save lives. Now we're going to do them here."