Evaluation of US Federal Guidelines (Primary Response Incident Scene Management [PRISM]) for Mass Decontamination of Casualties During the Initial Operational Response to a Chemical Incident

Abstract

The PRISM incident response protocols are fit for purpose for ambulatory casualties. However, a more effective communication strategy is required for first responders (particularly when guiding dry decontamination). There is a clear need to develop more appropriate decontamination procedures for at-risk casualties.

Efficacy of Different Hair and Skin Decontamination Strategies with Identification of Associated Hazards to First Responders

“…This was shown not only directly, by the much smaller quantities of methyl salicylate measured in back swabs, but also indirectly, by the significantly smaller amounts of contaminant recovered from the washcloths and towels used in the technical decontamination phase and the lower vapor concentrations of MS in the decontamination unit when protocols were combined. Moreover, the higher (16-fold) relative recoveries of methyl salicylate from hair in relation to scalp skin of control (untreated) volunteers were in good agreement with previous studies, confirming that hair protects the underlying scalp skin (13,32).…”

“…Dosing was therefore deemed considered reflective of a spray exposure and comparisons could subsequently be made between different decontamination protocols. Dry decontamination, LPS and technical decontamination, following current US emergency personnel guidance (4, 31), were then compared to the proposed improved procedures derived from in vitro hair and skin decontamination studies (10,32) and other human volunteer trials incorporating an initial dry decontamination step (12,13).…”

“…Dry decontamination (cleansing of the skin with dry absorbent materials) offers the opportunity to reduce the delay between casualty exposure and the onset of decontamination: previous in vitro and in vivo studies have demonstrated the value of dry decontamination in removing contaminants prior to the arrival and deployment of more formal decontamination measures (9-11). This has consequently been incorporated in the Initial Operational Response to mass casualty chemical exposure in the UK (12) and its operational and clinical value has been evaluated (13) as part of revised US federal guidance for emergency responders (4).…”

“…In the present study, the clinical efficacy of the above three decontamination methods (dry, ladder pipe and technical decontamination), alone and in various sequences, was analyzed following the controlled exposure of human volunteers to an aerosolized, semivolatile simulant. The simulant, methyl salicylate, was mixed with curcumin, a component of turmeric, for fluorescent traceability and with cosmetic-grade mineral oil to suppress volatility by 50%; this was to ensure consistency with a previously reported large-scale exercise (13). Methyl salicylate is a readily available, semi-volatile chemical that has low toxicity and physicochemical properties similar to those of sulfur mustard.…”

Analysis of Chemical Simulants in Urine: A Useful Tool for Assessing Emergency Decontamination Efficacy in Human Volunteer Studies

“…The efficacy of emergency decontamination interventions for persons exposed to a chemical agent are often assessed in human volunteers using chemical simulants. [1][2][3][4] Simulants are chemicals that have similar physicochemical properties to agents of concern but that are non-toxic at the doses applied to humans. Only a limited number of simulants for human volunteer trials have been identified for use, 5 the most common of which is methyl salicylate (MeS), a colorless, viscous liquid naturally produced by some plants and commonly used as a flavoring in foodstuffs and as a component of topical medications and consumer products.…”