Decontamination of Mass Casualties — Re-evaluating Existing Dogma

Abstract

The events of 11 September 2001 became the catalyst for many to shift their disaster preparedness efforts towards mass-casualty incidents. Emergency responders, healthcare workers, emergency managers, and public health officials worldwide are being tasked to improve their readiness by acquiring equipment, providing training and implementing policy, especially in the area of mass-casualty decontamination. Accomplishing each of these tasks requires good information, which is lacking. Management of the incident scene and the approach to victim care varies throughout the world and is based more on dogma than scientific data. In order to plan effectively for and to manage a chemical, mass-casualty event, we must critically assess the criteria upon which we base our response.This paper reviews current standards surrounding the response to a release of hazardous materials that results in massive numbers of exposed human survivors. In addition, a significant effort is made to prepare an international perspective on this response.Preparations for the 24-hour threat of exposure of a community to hazardous material are a community responsibility for first-responders and the hospital. Preparations for a mass-casualty event related to a terrorist attack are a governmental responsibility. Reshaping response protocols and decontamination needs on the differences between vapor and liquid chemical threats can enable local responders to effectively manage a chemical attack resulting in mass casualties. Ensuring that hospitals have adequate resources and training to mount an effective decontamination response in a rapid manner is essential.

Chemical Agent Simulant Release from Clothing Following Vapor Exposure

“…'' 4 Nude showers are currently recommended by authorities as the standard technique for mass decontamination, even in cold weather. 5,6 While full disrobing and showering with water is necessary to remove liquid and solid (dust) contamination, most live victims of a chemical agent attack will have either no contamination or contamination with chemical vapor only.…”

“…By the time showers can be set up, any trapped vapor may have dispersed, making active decontamination unnecessary. 6 To address these issues, this study set out to investigate the degree and duration of trapped chemical vapor released from several different types of clothing. …”

Decontamination

“…Patients exposed to liquids, aerosols, or solids will likely require skin decontamination [14,20]. Exposure to gases or vapor does not require decontamination [1,20,21], as removal of the affected patient from the area is all that is required [1]. However, patients who are exposed to vapor should have their clothing removed in case the vapor has condensed on their clothing [21], and so that they do not expose the workers caring for them [1].…”

“…In that time, the patient has been out of the hot zone and has possibly been partially decontaminated by evaporation of the agent off the skin [18]. The quantity of contaminant that hospital personnel may encounter is therefore dramatically less than the quantity to which the victim was initially exposed [1]. Given this, the hospital decontamination procedure begins with a lower risk of secondary contamination than in the prehospital setting [17,19].…”

“…In these scenarios, it is imperative to separate the victims from the potential causative agent to decrease the risks to the treating health care workers and to the patients themselves. Decontamination is the reduction or removal of harmful substances from the body [1]. The primary goal of decontamination is to eliminate substances from the skin, hair, mucosal surfaces, lungs, and gastrointestinal (GI) tract so that the agent is neither absorbed by the patient nor is transferred to the treating health care workers or rescuers.…”