Step 2: Warm Zone/Tactical Field Care

In the warm zone, or tactical field care phase, attention is given to decontamination and reassessment of the casualty. This phase occurs at a dirty CCP (hotline) and requires personnel dedicated to triage, decontamination, and patient treatment. At this phase, interventions may have altered the clinical presentation of the casualty (e.g., the patient may have decreased secretions and reduced airway resistance from use of the ATNAA), so it is important to take into account prior interventions and changes in the clinical status of the casualty. However, the goal is to quickly transition the casualty to the cold zone for definitive care, so only life-saving treatments should be done in the warm zone.

Decontamination and treatment can be synchronous processes. Medical personnel will need to clearly communicate with non-medical personnel responsible for decontamination. “Expose to treat” is used by decontamination personnel when the provider deems it in the best interest of the casualty to remove PPE to provide life-saving medical intervention. For example, the mask may be removed and the head, face, and chest quickly decontaminated so that the provider can ventilate the casualty and insert a sternal IO if parenteral antidotes, blood product or fluid resuscitation or countermeasures are immediately indicated. It would also be appropriate to prioritize decontamination of an arm to establish an IV or proximal humerus IO access.

Circulation should be assessed to identify external hemorrhage and shock. The provider can assess the effects of both CBRN agents and antidotes on the patient’s circulatory status. As decontamination ensues, dirty treatments are replaced with clean. Due to cold water and the need to fully expose the casualty in order to conduct thorough decontamination, hypothermia is a significant risk. Ensure rapid transit through the decontamination line with careful attention to hypothermia mitigation in order to prevent iatrogenic injury from the decontamination process. Additionally, personnel working within the warm zone in full protective gear are at risk of heat injury and stressors associated with operating in PPE, which must be recognized and mitigated