Optimization of Nonambulant Mass Casualty Decontamination Protocols as Part of an Initial or Specialist Operational Response to Chemical Incidents

Abstract

Objective: The UK's Initial Operational Response (IOR) is a new process for improving the survival of multiple casualties following a chemical, biological, radiological or nuclear incident. Whilst the introduction of IOR represents a patient-focused response for ambulant casualties, there is currently no provision for disrobe and dry decontamination of nonambulant casualties. Moreover, the current specialist operational response (SOR) protocol for nonambulant casualty decontamination (also referred to as "clinical decontamination") has not been subject to rigorous evaluation or development. Therefore, the aim of this study was to confirm the effectiveness of putatively optimized dry (IOR) and wet (SOR) protocols for nonambulant decontamination in human volunteers. Methods: Dry and wet decontamination protocols were objectively evaluated using human volunteers. Decontamination effectiveness was quantified by liquid chromatography--mass spectrometry analysis of the recovery of a chemical warfare agent simulant (methylsalicylate) from skin and hair of volunteers, with whole-body fluorescence imaging to quantify the skin distribution of residual simulant. Results: Both the dry and wet decontamination processes were rapid (3 and 4 min, respectively) and were effective in removing simulant from the hair and skin of volunteers, with no observable adverse effects related to skin surface spreading of contaminant. Conclusions: Further studies are required to assess the combined effectiveness of dry and wet decontamination under more realistic conditions and to develop appropriate operational procedures that ensure the safety of first responders.

Human volunteer study of the decontamination of chemically contaminated hair and the consequences for systemic exposure

“…To develop clear and actionable guidance for first responders, acute healthcare receivers and the public, decontamination interventions should be evidence-based. Traditionally this evidence has been generated by evaluating decontamination interventions using in vitro skin diffusion models [2][3][4][5][6][7][8][9][10] or using human volunteers exposed to non-toxic chemical simulants that mimic the properties of chemical agents of concern [10][11][12][13] . To date most studies have evaluated the removal of chemical simulants from the skin only.…”

“…Outputs of these studies have been informative and have led to changes to both UK and US emergency decontamination protocols for chemical incidents 14,15 . However, few studies have examined the effectiveness of current decontamination interventions in removing chemicals from hair 7,[16][17][18][19][20] and even fewer have done so with human volunteers 10,14,21 .…”

Elhunytakkal kapcsolatos teendők COVID–19-gyanús, valószínűsített és megerősített esetekben

“…B. A következőkben a fertőtlenítővel átitatott, egyszer használatos szivaccsal vagy mosdatókesztyűvel le kell mosni a tetem hozzáférhető felszíneit [19].…”

UK’s initial operational response and specialist operational response to CBRN and HazMat incidents: a primer on decontamination protocols for healthcare professionals

“…The new IOR and SOR processes described above have been developed specifically for ambulant casualties, that is, individuals who can both understand instructions and perform self-decontamination with minimal assistance. Work is currently in progress to develop optimised methods for dry and wet decontamination of non-ambulant casualties 31…”