APPENDIX D: Class VIII

Disclaimer: This document should not be taken as doctrinal and should not supersede any command directed, or SOP directed medical materiel planning documents. Each of the Services have CBRN medical assemblages. Direct all questions regarding Class VIII and assemblage contents to appropriate unit supply personnel.

This is an example medical materiel list for the Joint Trauma System CPG “Chemical, Biological, Radiological, and Nuclear (CBRN) Injury — Part I: Initial Response” (CPG ID: 69). This list reflects a focus on chemical casualties. For biologic and radiation/nuclear lists see CBRN CPGs 3 and 4.

There is additional information contained in the Field Management of Chemical and Biological Casualties Handbook: https://medcoe.army.mil/borden-field-mgt-of-cb-casualities.

A.Personal Protective Equipment (PPE) & clinician protection

- CBRN masks/service respirators (fit-tested combat masks or equivalent)
- Powered Air Purifying Respirators (PAPR) or SCBA
- Nitrile/chemical-resistant gloves (multiple sizes) recommend 3 layers or spares for don/doff
- Chemical & Biological Protective Garment/MOPP ensemble
- Joint Service Lightweight Integrated Suit Technology (JSLIST)
- Eye protection/splash goggles
- Reusable or disposable surgical gowns/aprons for warm/cold zone tasks
- Face shields, vinyl boot covers, and tape/seal kits (6 mm sheeting and tape)
- All-purpose-Personal Protective Ensemble (AP-PPE)
- Lion Extended Response Team (XRT) Suit
- Butyl rubber gloves with cotton liner

B. Respiratory & airway adjuncts

- Emergency Passenger Oxygen System (EPOS) or equivalent field respiratory support devices
- Chemical Resuscitation Device (RDIC) (Bag-valve mask with viral/chemical filter)
- Oxygen tubing & masks
- Suction, intubation kits, airway adjuncts

C. Antidotes, countermeasures, and critical medications (forward-stock)

- ATNAA (Antidote Treatment Nerve Agent Auto-injector) and/or service nerve-agent autoinjectors
- Advanced Anticonvulsant System (AAS) [midazolam autoinjector]
  - AAS is replacing CANA (Convulsant Antidote for Nerve Agent)
- Hydroxocobalamin (Cyanide antidote - Cyanokit)
- Rapid Opioid Countermeasure System (ROCS) [Naloxone 10mg autoinjector]
- Pyridostigmine bromide 30 mg oral tablets (Soman Nerve Agent Pretreatment Pyridostigmine [SNAPP]) taken three times per day OR 105 mg extended release (PB ER) taken daily
- IV/IO supplies for resuscitation per TCCC (catheters, tubing, fluids)
- Nebulizers/inhaled bronchodilators and supplies
- Emergency analgesics and sedation
- If planning for any level of extended care include IV atropine, pralidoxime, midazolam and naloxone vials

D. Decontamination supplies (spot & systematic decon)

- Reactive Skin Decontamination Lotion (RSDL) individual and casualty packs
- M100, M295, sorbent pads, tech wipes (or service-equivalent decon wipes/cloths)
- Eyewash solutions/Morgan lens
- Large-volume wash/decontamination showers or improvised decon setups: supply of water, hoses, shower nozzles, collection berms
- Buckets, basins, large tarps (6mm), plastic sheeting, heavy-duty trash bags
- Disposable gowns, apron-TAP, towels, scrub brushes, disposable razors
- Containment/segregation supplies - labeled bags

E. Triage, documentation & small equipment

- DD Form 1380/TCCC casualty cards, and pens/markers
- Triage tags (color coded), waterproof markers
- Laminated pocket MARCHE2/CRESS quick reference cards
- Signage kits for decon zones and contaminated areas/equipment

F. Waste management, infection control & sanitation

- Sharps containers, biohazard waste bags
- Neutralization/treatment capacity or coordination plan for contaminated waste per environmental/operational SOPs
- Hand hygiene supplies (alcohol-based hand rubs, soap and water)

G. Casualty handling / evacuation equipment

- Stretchers/litters suitable for contaminated casualties (designated “dirty” litters)
- Blankets/hypothermia prevention
- Replacement/sterile tourniquets and indwelling device spares
- Contaminated human remains pouches

H. Clinical supplies for point-of-care & symptomatic treatment

- IV/IO kits, catheter trays, fluids
- Basic wound care & dressings, splints
- Nebulizers, O2 cylinders, bronchodilators, suction
- Portable monitors (pulse oximeter, BP cuff, thermometer)

I. Communications, manpower & ergonomics

- Two-way radios/comms with range to coordinate hot/warm/cold zones and evacuations
- Heat-mitigation aids (cooling vests, shaded shelters)

For additional information including National Stock Number (NSN), please contact dha.ncr.med-log.list.lpr-cps@health.mil