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Self-care Decontamination within a Chemical Exposure Mass-casualty Incident

Published online by Cambridge University Press:  27 April 2015

Raymond G. Monteith*
Affiliation:
Centre for Resilient Communities, Office of Applied Research, The Justice Institute of British Columbia, New Westminster, British Columbia, Canada
Laurie D. R. Pearce
Affiliation:
Centre for Resilient Communities, Office of Applied Research, The Justice Institute of British Columbia, New Westminster, British Columbia, Canada
*
Correspondence: Ray Monteith, MA Centre for Resilient Communities Office of Applied Research The Justice Institute of British Columbia New Westminster, British Columbia, Canada. Email: [email protected]

Abstract

Growing awareness and concern for the increasing frequency of incidents involving hazardous materials (HazMat) across a broad spectrum of contaminants from chemical, biological, radiological, and nuclear (CBRN) sources indicates a clear need to refine the capability to respond successfully to mass-casualty contamination incidents. Best results for decontamination from a chemical agent will be achieved if done within minutes following exposure, and delays in decontamination will increase the length of time a casualty is in contact with the contaminate. The findings presented in this report indicate that casualties involved in a HazMat/CBRN mass-casualty incident (MCI) in a typical community would not receive sufficient on-scene care because of operational delays that are integral to a standard HazMat/CBRN first response. This delay in response will mean that casualty care will shift away from the incident scene into already over-tasked health care facilities as casualties seek aid on their own. The self-care decontamination protocols recommended here present a viable option to ensure decontamination is completed in the field, at the incident scene, and that casualties are cared for more quickly and less traumatically than they would be otherwise. Introducing self-care decontamination procedures as a standard first response within the response community will improve the level of care significantly and provide essential, self-care decontamination to casualties. The process involves three distinct stages which should not be delayed; these are summarized by the acronym MADE: Move/Assist, Disrobe/Decontaminate, Evaluate/Evacuate.

Monteith RG, Pearce LDR. Self-care Decontamination within a Chemical Exposure Mass-casualty Incident. Prehosp Disaster Med. 2015;30(3):1–9.

Type
Special Report
Copyright
© World Association for Disaster and Emergency Medicine 2015 

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References

1. Horton, DK, Berkowitz, Z, Kaye, WE. Surveillance of hazardous materials events in 17 states, 1993-2001: a report from the Hazardous Substances Emergency Events Surveillance (HSEES) system. Am J Ind Med. 2004;45(6):539-548.Google Scholar
2. Cox, RD. Decontamination and management of hazardous materials exposure victims in the emergency department. Ann Emerg Med. 1994;23(4):761-770.Google Scholar
3. Government of Canada. Chemical, Biological, Radiological, Nuclear, and Explosives Resilience Strategy for Canada (PS4-19/2011). Ottawa, Canada: Queen’s Printer; 2011.Google Scholar
4. Queen’s University. The Control of Major Accident Hazards in Canada 2009. http://www.chemistry.ca/index.php?ci_id=3211&la_id=1. Published 2009. Accessed September 26, 2012.Google Scholar
5. Kirk, MA, Deaton, ML. Bringing order out of chaos: effective strategies for medical response to mass chemical exposure. Emerg Med Clin North Am. 2007;25(2):527-548.Google Scholar
6. Transport Canada. Transportation in Canada: Summary Report (TP14816) 2012. https://www.tc.gc.ca/media/documents/policy/Transportation_in_Canada_2012_eng_ACCESS.pdf. Accessed March 24, 2014.Google Scholar
7. Ready, SJ, Schwartz, MD, Morgan, BW. Suicide fads: frequency and characteristics of hydrogen sulfide suicides in the United States. West J Emerg Med. 2011;12(3):300-304.Google Scholar
8. Wiesheit, R. Making methamphetamine. J Rural Soc Sci. 2008;23(2):78-107.Google Scholar
9. Spicer, O, Almirall, JR. Extraction of capsaicin in aerosol defense sprays from fabrics. Talanta. 2006;67(2):377-382.Google Scholar
10. Edgewood Chemical Biological Center, US Army Research, Development, and Engineering Command. Guidelines for Mass Casualty Decontamination during a HAZMAT/Weapon of Mass Destruction Incident (ECBC-SP-036, Volume 1 & 2) 2013. http://www.nfpa.org/~/media/Files/Research/Resource%20links/First%20responders/Decontamination/ecbc_Guide_MassCasualtyDecontam_0813.pdf. Published 2013. Accessed October 3, 2013.Google Scholar
11. National Fire Protection Association. NFPA 472: Standard for Competence of Responders to Hazardous Materials/Weapons of Mass Destruction Incidents, 2013 ed. Quincy, Massachusetts USA: NFPA; 2013.Google Scholar
12. Vogt, BM, Sorensen, JH. How clean is safe? Improving the effectiveness of decontamination of structures and people following chemical and biological incidents. Oak Ridge National Laboratory. http://www.ornl.gov/~webworks/cppr/y2001/rpt/114807.pdf. ORNL/TM-2002/178. Published 2002. Accessed April 12, 2012.Google Scholar
13. Freyberg, CW, Arquilla, B, Fertel, BS, et al. Disaster preparedness: hospital decontamination and the pediatric patient – guidelines for hospitals and emergency planners. Prehosp Disaster Med. 2008;23(2):166-173.CrossRefGoogle ScholarPubMed
14. Manley, WG, Furbee, PM, Coben, JH, et al. Realities of disaster preparedness in rural hospitals. Disaster Manag Response. 2006;4(3):80-87.Google Scholar
15. Ghilarducci, DP, Pirrallo, RG, Hegmann, KT. Hazardous materials readiness of United States Level 1 trauma centers. Int J Occup Environ Med. 2000;42(7):683-692.Google Scholar
16. US Department of Homeland Security. Patient Decontamination in a Mass Chemical Exposure Incident: National Planning Guidance for Communities (Pre-decisional draft) 2012. http://www.enmagine.com/items/PatientDeconinMassChemExposureIncident_Sept2012DraftforReview.pdf. Published 2012. Accessed November 7, 2012.Google Scholar
17. Powers, R. Organization of a hospital-based victim decontamination plan using the incident command structure. Disaster Manag Response. 2007;5(4):119-123.Google Scholar
18. Chan, J. Management of hazmat incidents in hospitals. Hospital Engineering & Facilities Management. 2005.Google Scholar
19. US Department of Defense. Multiservice Tactics, Techniques, and Procedures for Chemical, Biological, Radiological, and Nuclear Consequence Management Operations (FM3-11.21/MCRP 3-37.2C/NTTP 3-11.24/AFTTP(I) 3-2.37). http://www.fas.org/irp/DODdir/army/fm3-11-21.pdf. Published 2008. Accessed April 12, 2012.Google Scholar
20. British Columbia Ministry of Health Services Emergency Management Unit. BC Guidelines for Decontamination of Patients in Health Facilities. Victoria, British Columbia, Canada: Queen’s Printer; 2009.Google Scholar
21. Heon, D, Foltin, GL. Principles of pediatric decontamination. Clin Pediatr Emerg Med. 2009;10(3):186-194.Google Scholar
22. International Safety Research Inc. Canadian Safety and Security Program First Responder Decon Workshop Summary (ISR Report 13017-01). Published 2012.Google Scholar
23. Capital Region Metropolitan Medical Response System. Rapid Access Mass Decontamination Protocol 2003. http://www.au.af.mil/au/awc/awcgate/mmrs/mass_decon.pdf. Published 2003. Accessed April 13, 2012.Google Scholar
24. Heptonstall, J, Gent, N. CBRN Incidents: Clinical Management & Health Protection. London, United Kingdom: Health Protection Agency; 2006.Google Scholar
25. US Department of Labor Occupational Safety and Health Administration. Best Practices for Hospital-based First Receivers of Victims from Mass-casualty Incidents Involving the Release of Hazardous Substances (OSHA 3249-08N). http://www.osha.gov/Publications/osha3249.pdf. Published 2005. Accessed April 11, 2012.Google Scholar
26. US Department of Labor Occupational Safety and Health Administration. Best Practices for Hospital-based First Receivers of Victims from Mass-casualty Incidents Involving the Release of Hazardous Substances (OSHA 3370-11). https://www.osha.gov/Publications/OSHA3370-protecting-EMS-respondersSM.pdf. Published 2009. Accessed April 11, 2012.Google Scholar
27. US Army. Soldier Biological Chemical Command. Guidelines for Cold Weather Mass Decontamination during a Terrorist Chemical Agent Incident. http://www.au.af.mil/au/awc/awcgate/army/sbccom_cold_wx_decon.pdf. Published 2003. Accessed January 12, 2013.Google Scholar
28. International Fire Service Training Association. Hazardous Materials for First Responders, 4th ed. Oklahoma State University, Oklahoma USA: Fire Protection Publications; 2010.Google Scholar
29. Garcia, AF, Rand, D, Rinard, JH. IHS Jane’s CBRN Response Handbook, 4th ed. Bracknell, United Kingdom: IHS Global Ltd; 2011.Google Scholar
30. National Fire Protection Association. NFPA 472 Standard for Competence of Responders to Hazardous Materials/Weapons of Mass Destruction Incidents, 2008 ed. Quincy, Massachusetts USA: NFPA; 2007.Google Scholar
31. US Army Edgewood Chemical Biological Center. Guidelines for Mass Casualty Decontamination during a HAZMAT/Weapon of Mass Destruction Incident (ECBC-SP-024, Volume 1 & 2). http://www.nfpa.org/~/media/Files/Research/Resource%20links/First%20responders/Decontamination/ecbc_Guide_MassCasualtyDecontam_0813.pdf. Published 2009. Accessed October 18, 2012.Google Scholar
32. Levitin, H, Siegelson, HJ, Dickinson, S, et al. Decontamination of mass casualties: re-evaluating existing dogma. Prehosp Disaster Med. 2003;18(3):200-207.Google Scholar
33. Edwards, NA, Caldicott, DGE, Eliseo, T, Pearce, A. Truth hurts: hard lessons from Australia's largest mass-casualty exercise with contaminated patients. Emerg Med Australas. 2006;18(2):185-195.Google Scholar
34. Wenck, MA, Van Sickle, D, Drociuk, D, et al. Rapid assessment of exposure to chlorine released from train derailment. Public Health Rep. 2007;122(6):784-792.Google Scholar
35. Carter, H, Drury, J, Rubin, GJ, Williams, R, Amlôt, R. Public experiences of mass casualty decontamination. Biosecur Bioterror. 2012;10(3):280-289.Google Scholar
36. Carter, H, Drury, J, Amlôt, R, Rubin, GJ, Williams, R. Effective responder communication improves efficiency and psychological outcomes in a mass casualty decontamination field exercise: implications for public behavior in the event of a chemical incident. PLoS ONE. 2014;9(3):e89846.Google Scholar
37. Auf der Heide, E. “Common misconceptions in disasters: Panic, the ‘disaster syndrome,’ and looting”. In: O’Leary M, (ed). The First 72 Hours: A Community Approach to Disaster Preparedness. Wilford Connecticut USA: Universe; 2004: 340-380.Google Scholar
38. Drury, J, Cocking, C, Reicher, S. The nature of collective resilience: survivor reactions to the 2005 London bombings. Int J Mass Emerg Disasters. 2009;27(1):66-95.Google Scholar
39. Siegelson, HJ. Preparing for a terrorist attack: mass-casualty management. Disaster Planning International. 2002.Google Scholar
40. Comité aviseur antiterrorism de Montréal [CAAM] [Montreal Anti-Terrorism Advisory Committee]. PowerPoint presented to Service de police de la Ville de Montréal: Montréal, Quebec, Canada; 2010.Google Scholar
41. Joint Emergency Services Interoperability Program. Initial Operational Response to a CBRN Incident. United Kingdom: CBRNE Unit, DSCT, Home Office; 2013.Google Scholar
42. Edkins, V, Carter, H, Riddle, L, Harrison, C, Amlôt, R. ORCHIDS Work Package 9: systematic review of the needs of vulnerable and minority groups in emergency decontamination. Salisbury, Wiltshire, United Kingdom: Health Protection Agency; 2010.Google Scholar