Memo to Pacific Support Division, Field Command Defense Nuclear Agency, Subject: Support Requirements for Enewetak Clinic and Lojwa Medical Aid Station (Att: Sketches of Plans, Requirements)

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HEADQUARTERS PACIFIC AIR FORCES APO SAN FRAN C!SCO 96553 SL(F3! C:- Supporti Requirements for Enewetak Clinic and Lojwa Medical “ Pacific Support Division Defense Nuclear Agency Hickam AFB HI 96553 1. FCDNA CONPLAN 1-76, revised 15 Sep 76, tasks PACAF to provide medical services in support of a DNA task force to clean up debris and radioactivity on Enewetak Atoll. To provide this support, a clinic will be established in the 2,000 sq ft space offered in Building 603 on Enewetak Island and a medical aid station on Lojwa Island. The USAF Clinic has been tasked with administration of this project. 2. The following civil engineering, communication, and materiel support is requested to provide adequate medical facilities on Enewetak Atoll. It is our understanding the cost of providing this support will not be billed to the USAF Medical Service. a. Floor Plan for the Enewetak Clinic and Lojwa Medical Aid Station. Partition the 2,000 sq ft area of Building 603 on Enewetak allotted for clinic use into patient care areas as indicated in the attached sketch. (See Atch 1). A building will have to be provided for the Lojwa medical aid station. This building should be partitioned and outfitted in accordance with the floor plan as shown in Atch 2. b. Floor. Existing asphalt tile floor in Building 603 — is adequate except that broken and chipped tile should be replaced. Our concern is that the floor can be kept clean, is free of cracks or chipped areas which will trap dirt, and that it can be washed frequently with a disinfectant without becoming damaged. For the Lojwa medical aid station, an asphalt tile floor over a wood sub-floor is acceptable. A drain line will have to be installed beneath the floor in the Enewetak Clinic dental treatment room.

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c. Partitions, Walls and Ceilings. Dry wall partitions are recommended. Finish on walls should be washable. Liqht pastel colors are acceptable except that light yellow sho~ld be avoided in the doctor’s and technician’s office, the emergency room and the ward. White is recommended for the emergency room. Specifications for lead lining the x-ray area is included in Atch 4. The sterilizer partition should be insulated to keep heat generated by sterilizer from moving into the emergency room. d. Plumbing and Sinks. Install and plumb sinks in areas indicated on the attached sketches of the clinic and aid station floor plan. Sinks in the emergency rooms should be equipped with knee operated faucets and plaster traps. Faucets with threads for a hose connection should be provided on the exterior wall near the emergency room entrance at both the clinic and aid station. e. Doors. Double entry doors are not required but are satisfactory if existing. A 3’ 10” single door at entry penetrations is adequate. A minimum door width of 40” is . required to move x-ray room equipment in and out of the building. The door to the sterilizer room should be vented. f. Electrical Power Requirements. (1) Electrical requirements for the x-ray, dental operating unit and sterilizer are shown in the attachment describing these items. (See Atch 4). (2) Wall outlet receptacles should be 115V AC, 60Hz, 15Amp single-phase duplex outlets-- no more than two on any branch circuit. Locations for electrical outlets are shown on the floor plan for the Lojwa medical aid station and in the detailed sketches of the separate rooms in the Enewetak Clinic. (See Atchs 2, 4 & 5). Location of electrical outlets in the administrative and waiting areas of the Enewetak Clinic are shown in Atch 1. 9“ Emergency Electrical Power. The clinic should be wired to permit hook-up of an alternative source of electrical power. A stand-by generator of sufficient size to operate the x-ray and emergency equipment and light exit signs must be made available in the event the primary electrical power h. Lighting. Lighting is required in accordance with standards as listed in AFR 88-50. Requirements for the various patient care and service areas have been extracted from the regulation and are included as Atch 3. Include sufficient lighting in the rooms to meet these standards.

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Storage battery powered emergency lights should be provided in the patient care and service areas to augment emergency lighting and for continuity during the interim of switching from normal to emergency electrical power. Electrical outlets must be appropriately placed to provide power for charging these battery powered lights. . Air Conditioning and Exhaust Fans. An external air-conditioner of sufficient size to cool the 2,000 sq ft clinic area is required for the Enewetak Clinic. We estimate a maximum of 28 people will be in the clinic at any one time. Exhaust fans should be included on the outside walls in the laboratory, sterilizer, x-ray dark room and toilet areas to vent the excess heat and odors. The exhaust fan to the dark room must be light tight. Cool air should be ducted into each of the rooms through ceiling duct work. At the Lojwa medical aid station, window air-conditioners will be adequate if a central unit is not available. ]W Decontamination. Decontamination of injured personnel would be accomplished at the established decontamination sites. Operating procedures will have to be developed at Enewetak which prescribe handling and movement procedures for patients who cannot be completely decontaminated. Depending on the procedures developed, an additional facility may be required to hold and treat. these patients. k. Veterinary Services Work Space. A work area to include a desk, chair and adequate llghtmg should be provided for the veterinary technician in the commissary cold storage area. (1) Enewetak - two lines are required. Line one for administrative use on camp, preferably with capability of contact with USAF Clinic Hickam, Hickam AFB, Hawaii. Line two should be designated for “emergencies” with an instrument in the administrative area. Line one with seven instruments should be keyed with an intercom to the dental office, pharmacy, laboratory, doctor’s office, emergency room, holding area, and administrative area. (2) Lojwa - one line with contact capability to Enewetak Clinic. Two instruments, one in office and one near radio in emergency room with headset and 20 feet

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(1) Enewetak - locate base station between center pillars (see overall sketch) with two portables. (2] Lojwa - locate base station in emergency room next to hall with two portables. (3) Antennas should be suitably installed. n. Dental Air Compressor. To be Air Force furnished and installed outside of clinic area near DTR (Dental Treatment Room) . A cement platform and cover should be provided to protect the compressor from the elements. As an alternative, the compressor could be placed in enclosed, un-air conditioned area adjacent to the dental treatment room. Electrical requirements for the compressor are: 115v, 60Hz, single phase, 1840 watts, 1 H.P. motor. See attachment 4 for dimensions and skid pallet size. o. Dental Treatment Room, Radioloqy Area Equipment andSterilizer Installation Instructions. Atch 4 details the dimensions, electrical requirements and installation diagrams for equipment located in this area. P“ Electrical Outlets, Work Counters, Shelving, Sinks and Cabinetry Detail. Enewetak Clinic electrical outlet, work counter, shelvinq placement~ and sink locations for emergency room, laboratory, 4-bed holding area, toilet and storage area are included in Atch 5. Sink locations are also shown in smaller detail in Atchs 1 and 2. Electrical outlet, sink, counter and shelving requirements for the Lojwa medical aid station are shown in Atch 2. q“ Furniture and Adrninistrative Equipment. Following furniture is requested. If available at site, USAF Clinic Hickam should be advised. (1} Desks, standard size, 2 1 (2) Desks, small, approximately 4 1

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Chairs, rotary without arms 1 0 Chairs, straight (side chair) 9 2 Waiting room furniture 10 4 Director, Medical Admin Services 1. Sketch of Enewetak Office of the Command Surgeon Clinic Floor Plan 2. Sketch of Lojwa Aid Dental & Radiology Dept Drs & Tech Office, Pharmacy, Lab, ER, Toilets, 4-Bed

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TUBE 4 FEET FROM EACH END FOR LIGHTING. oj LIGHT SMITCH A FULL SIZE UNIT TEVPL, IS A~AILABLE FROV USAF InlCLUPEQ IN THIS PACKA IN CAS: THE PREFERRED METHO[ CANNOT BE DONE.

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~“or proper operation of this x-ray ,mlt at Its full rated capac:ty of 100 ma at 100 kvp, the power JUpp]y .nust be w:thln the rated voltage and frequency range and must bc of ~ufficicntly good regulation ths( the /oltagc”drop under load does not exceed specified limits. T~cVa,rious factors which must be considered in the selection of power supply are discussed in paragraphs following: Voltage and Frcquenc y:- rhis ?quipment IS designed to operate from power Iinca which will deliver: l-o pcrrnit operation of the unit at full rated output, this power supply must meet the requirements of the ,nl lowing paragraph. If it does not, the maximum output demand should be reduced. ‘:henevcr a load )s thrown on a power supply, a voltage drop takes place, the magnitude of which is a Lnct]on of the regulat~on of the power supply, It IS convenient to measure the ability of the power supply I properly supply the full !oad demand of the x-ray machine by measuring the voltage drop which takes lace when the unit is operated at 50 ma, 80 kvp. At this load, the permissible exposure time is suffi - :~ntly long to pcrmlt accurate’ reading of the control voltmeter. I) detcrmlnc the adequacy of a given power SUpply, the x-ray unit must b? installed and tested as cov . , cd In paragraphs 7 through 10 of the Installation section and in paragraphs 7 and 8 of the Testing and powcr supply is to bc Installed to meet the requirements of the x-ray unit, the following is recommend- . Such power supply will provide for opcratlon of this x-ray unit under Line 1 and Line Z conditions. Power Transformer 10 kva Line Safety Switch, double pole 250-v, 60-amp Line Safety Fuses 250-v, 60 amp TO LINE SWITCH r Line Voltage of 190 to 250: AWG Inches Millimeters

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AWG Lnches Millimeters TO LINE SWITCH For Line Voltage of 95 to 125: Deviation from the Recommended Power Supply:- The objective of the recommended power supply is to deliver at the line terminals of the x-ray machine sufficient power for proper operation. The maximum rated demand of the un]t is 10 KVA at 90% power factor. .4ny combination of generating lquipment, power supply lnd feed lines which will deliver this power with a voltage change between load and no load of not more than 9% or preferably 6%, may be IMP OR TAN T-- Effect of frequency change While this equipment is designed to operate at either 50-cycles or 60-cycles, the x-ray timer IS driven by a synchronous motor the speed of which is proportional to the frequency. The tlmcr dial calibration is correct only At 60-cycles, At 50-cycles the timer runs at 5/6 the speed of 60-cycle opcratao~, hence actual timing is 6/5 or 1, 2 times that shown on the dial. Proper recognition must be g;vcn this condition when s’ctting up technics and utilizing x-ray tube ratings. Disregard of the correction factor may result in over exposed films or an overloaded tube. See Operation Section for detads.

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SUPU+ATION OF WORK REQUIRED FOR ENIEWTOK l’~NTAL,X-RAY, A DARKROOM 1. Permanent walls and partions for Dental Clinic 2. Installation of Dental Unit Template base with appropriate services 3. Installation of electrical, water, waste, and lighting for Dental Clinic 4. Installation of permanent walls and partions for X-Ray and Darkroom 5. Wall and protective barriers will have to be leadl ined with 1/16 inch equivalent to the at least the 7 foor height. Protective barriers will have to hae leadlined glass observations windows. Glass is available from USAF Clinic-Hickam/SG 6. Darkroom will have to have a cold water line, drain line of 2’+1’& a 115VAC; 60Hz;15AMP;lfl outlet 5 feet above floor. 7. Darkroom will have to have the room air exhausted to atmosphere in order to keep the fumes from the chemicals from building up and also for air circulation. a. Wall between darkroom and x-ray will require a pass box with a light tight seal 9. Darkroom will require a 40watt red light at each corner into dental & x-ray that ties in with the 100 watt light in the darkroom so that when one is turned off the other one comes on i.e.; red on white off, white on red off. This shows the dark room is occupied and do not enter. 10. X-RAY will require an electrical disconnect box rated for 220VAC;60HZ;60AMPS; 10 with at least 5*Lregulation. See attched list for specific wire size and also 11.X-Ray for portable use will require a 22OVAC;6OHZ;4OAMP;1O receptacle as indicated on print to match this plug: 12. X-Ray will require ceiling mounted fluorescent lights as indicated on print 13. X-Ray will require several 115VAC;6OHZ;15AMP;1O duplex outlets as indicated for equipment and testequipment use 14. All doors will have to be at least 30” wide to allow for passege of equipment. (except dazk room which will have to be 34”). 15. X-Ray will require a double door, leadlined, each panel at least 24’’wide. 16. X-Ray will need an exposed film storage bin to store permanent x-rays for file This can be a plywood construction against the wall with 4 compartments, each comp-

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lr~ol The installation does not require the services of a refrigeration service man. Only plumbing connections are required. A I1O-II5 V, 60 cycle AC single phase receptacle is required for electric current. Provide for 15 amp service. !.3.2 To take off front access panel remove 7 screws on front. 1.3.3 Connectcity water tO connection “A” with a shut off valve and a 100 mesh strainer between this shut off valve and connection “A”. This is a ~“ female pipe connection; no smaller than ~“ pipe should 1,3.4 Connect 1+” drain pipe to connection “B” which is the main overflow and drain assembly and carries all waste from the tank and refrigerating system; no smaller than l+” pipe should be used. 1.3.5 Plug in line cord to 115V 60 cycle AC 15 amp service. 1.3.6 All other connections are made and tested at the factory. 1.3.7’ See Owg. T- 17.1 for location of connections.

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1. Although not actual dimensions have bevu gfve fw---t~~s”piece of equipmnt, al’ftha.~ is needed Is for a shelf capa~<supportlng 60 pounds be built and supported on the wall as 1 cated, approximately q’j’ above structions and drawings provided. ‘ q height--were--thestill is to mount is of prime self is approximately -3%-@et long so allow for cei?- STERILIZER INSTRUCTION PLANN 1. .Srrall blue print information is provided for a steam st~rilizer which c:~n be used for installation of the electric. All one has to do is substitute an incomrning tempered (hot) water line in place of the incoming steam line shown, then provide a stardard clothes dryer connection (female) for the sterilizer. 22OVAC;6OHZ;6OAMP;1O. 2. The other power required is a 115VAC;60HZ ;15AMP; I0 power to run the timer and automatic cycle control this plug must be 6’ above floor level. 3. Pl,~nned location for this sterilizer is …