Managing mass casualties and decontamination

Chilcott, Robert P.

doi:10.1016/j.envint.2014.02.006

Cited by 58 publications

(50 citation statements)

References 29 publications

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“…1,9 The act of disrobing has been shown to be a highly effective method for removing hazardous chemical contaminants from casualties and should be implemented at the earliest opportunity during incidents involving chemical agents. 7,10 For incidents involving biological and radiological materials, a ''wet strip flush'' approach may be more effective, but the current survey focuses on response to chemical incidents, for which disrobing prior to showering has been shown to be most effective. 7 It is important that casualties disrobe prior to showering, as failure to do so could facilitate increased transfer of any contaminant to the skin.…”

mentioning

confidence: 99%

“…7,10 For incidents involving biological and radiological materials, a ''wet strip flush'' approach may be more effective, but the current survey focuses on response to chemical incidents, for which disrobing prior to showering has been shown to be most effective. 7 It is important that casualties disrobe prior to showering, as failure to do so could facilitate increased transfer of any contaminant to the skin. 7 Disrobing should then be followed by gross decontamination, which is the use of standard equipment to provide a rapid yet structured decontamination process for large numbers of people.…”

mentioning

confidence: 99%

“…7 It is important that casualties disrobe prior to showering, as failure to do so could facilitate increased transfer of any contaminant to the skin. 7 Disrobing should then be followed by gross decontamination, which is the use of standard equipment to provide a rapid yet structured decontamination process for large numbers of people. One recommended method for conducting gross decontamination is the ''ladder-pipe system'' (LPS).…”

mentioning

confidence: 99%

“…Findings show that in mass decontamination units, the optimal duration for shower-based decontamination is between 60 and 90 seconds, and the recommended water temperature for decontamination is 35°C (95°F). 13,14 The use of detergent removes about 40% more contamination than water alone 7,15 and is recommended to optimize shower-based decontamination. 3,7,12,[16][17][18][19] However, while research has examined the effectiveness of different showering characteristics using mass decontamination units, methods of gross decontamination have not undergone formal testing.…”

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confidence: 99%

“…While decontamination may be used in response to incidents involving biological and radiological materials, it is likely to be of most benefit during incidents involving chemical agents, since this type of exposure may be overt (it is immediately obvious that a release has occurred) and an immediate response is necessary in order to minimize injury and save lives. 7 Mass decontamination is described as ''the emergency removal of contamination quickly from large numbers of victims.'' 8(p172) Although there are gaps in the research literature to date, evidence suggests that rapid physical removal of a hazardous agent is the most important aspect of decontamination.…”

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confidence: 99%

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Mass Casualty Decontamination in the United States: An Online Survey of Current Practice

Power¹,

Symons²,

Carter³

et al. 2016

Health Security

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Mass casualty decontamination is a public health intervention that would be employed by emergency responders following a chemical, biological, or radiological incident. The decontamination of large numbers of casualties is currently most often performed with water to remove contaminants from the skin surface. An online survey was conducted to explore US fire departments' decontamination practices and their preparedness for responding to incidents involving mass casualty decontamination. Survey respondents were asked to provide details of various aspects of their decontamination procedures, including expected response times to reach casualties, disrobing procedures, approaches to decontamination, characteristics of the decontamination showering process, provision for special populations, and any actions taken following decontamination. The aim of the survey was to identify any differences in the way in which decontamination guidance is implemented across US states. Results revealed that, in line with current guidance, many US fire departments routinely use the ''ladder-pipe system'' for conducting rapid, gross decontamination of casualties.The survey revealed significant variability in ladder-pipe construction, such as the position and number of fire hoses used.There was also variability in decontamination characteristics, such as water temperature and water pressure, detergent use, and shower duration. The results presented here provide important insights into the ways in which implementation of decontamination guidance can vary between US states. These inconsistencies are thought to reflect established perceived best practices and local adaptation of response plans to address practical and logistical constraints. These outcomes highlight the need for evidence-based national guidelines for conducting mass casualty decontamination.

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Mass Casualty Decontamination in the United States: An Online Survey of Current Practice

Power¹,

Symons²,

Carter³

et al. 2016

Health Security

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View full text Add to dashboard Cite

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How Should Exposure Risk to Tactical Personnel Be Balanced Against Clinical and Ethical Rescue Demand?

Williams

Ajisafe

2022

AMA Journal of Ethics

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Chemical, biological, radiological, nuclear, and explosive devices can all be used to cause mass disruption and mass casualties. These incidents can occur naturally but are usually associated with terrorism and often require prehospital and hospital care for patients and various precautions for clinicians. It is important to consider for each kind of exposure how clinical and ethical demand for rescue should be balanced against field-based risk of injury, contamination, or death to tactical personnel. Chemical exposures typically require prompt extrication, decontamination, and medical management; biological and radiation exposures generally require donning personal protective equipment; and explosives could contain "dirty bombs" or secondary devices.Hazardous Exposures Chemical, biological, radiological, nuclear, and explosive (CBRNE) devices can all cause mass disruption and lead to massive numbers of casualties. These events, frequently referred to as CBRNE incidents, may be of natural or man-made origin. In the early phases of medical response to these incidents, prehospital personnel (first responders) and in-hospital personnel (first receivers) are the initial contacts for medical care of the victims involved in CBRNE incidents who are triaged at the scene or who self-present to a health care facility. 1 Difficult decisions often need to be made and should be informed by the ethical and clinical implications of possible courses of action that were discussed with highly trained personnel during the planning phases of disaster response. 2,3 The degree and duration of management efforts will often be determined by the type of exposure and the capacity of the health care delivery system. In this article, we discuss the inherent danger posed by such incidents to both prehospital and hospital personnel and the care dilemmas that arise as overburdened health care delivery systems must consider shifting from what some would argue is "crisis standards of care" 4,5 to "altered standard of care" 6 to allow for any contingency or crisis plan to be successfully implemented. 7 Risks to Personnel Chemical exposure. CBRNE incidents involving chemical exposure, though varying widely in their treatment, require immediate identification, decontamination, and prompt

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Comparison of four different fuller's earth formulations in skin decontamination

Roul

Gustin

et al. 2017

J of Applied Toxicology

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Industrial accidents, wars and terrorist threats are potential sources of skin contamination by highly toxic chemical warfare agents and manufacturing compounds. We have compared the time-dependent adsorption capacity and decontamination efficiency of fuller's earth (FE) for four different formulations for the molecular tracer, 4-cyanophenol (4-CP), in vitro and ex vivo using water decontamination as standard. The adsorption capacity of FE was assessed in vitro for 4-CP aqueous solutions whereas decontamination efficiency was investigated ex vivo by tracking porcine skin 4-CP content using attenuated total reflectance Fourier transform infrared spectroscopy. Decontamination was performed on short time, exposed porcine skin to 4-CP by application of FE: (1) as free powder; (2) loaded on adhesive tape; (3) on powdered glove; or (4) in suspension. Removal rate of 4-CP from aqueous solutions correlates with the amount of FE and its contact time. Decontamination efficiency estimated by the percentage of 4-CP recovery from contaminated porcine skin, achieved 54% with water, ranged between ~60 and 70% with dry FE and reached ~90% with FE suspension. Successful decontamination of the FE suspension, enabling a dramatic reduction of skin contamination after a brief exposure scenario, appears to be rapid, reliable and should be formulated in a new device ready to use for self-application.

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Managing mass casualties and decontamination

Cited by 58 publications

References 29 publications

Mass Casualty Decontamination in the United States: An Online Survey of Current Practice

Mass Casualty Decontamination in the United States: An Online Survey of Current Practice

How Should Exposure Risk to Tactical Personnel Be Balanced Against Clinical and Ethical Rescue Demand?

Comparison of four different fuller's earth formulations in skin decontamination

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