Specification and Selection of Chemical Personal Protective Equipment (CPPE) for Health Service First Responders — The United Kingdom Approach

Abstract

Background: Early decontamination (DECON) on site, triage, second DECON at hospitals and emergency treatment are required for dealing with chemically contaminated mass casualties. Purpose: To introduce the activities planned for dealing with chemically contaminated, massive numbers of casualties at the hospital and on-site of the exposure. Methods: The planning, training, and exercises to treat massive numbers of chemically contaminated casualties that were developed and conducted after the 11 September 2001 attacks were reviewed. Results: a. DECON showers and outlets of compressed air were set at the bottom of the parking building. Casualties doff their dress at this area. Wet DECON for massive numbers of casualties was conducted using showers and fire engines in the parking area, DECON shelters, and a DECON room inside of the hospital. The type of Wet DECON administered was determined according to severity. Exercises were performed according to the plan using trained, medical procedures wearing level "C" Personnel Protective Equipment (PPE). b. An exercise was conducted with the Tokyo Fire Department in order to coordinate with the HAZMAT teams and EMT/Paramedics on-site. Triage and emergency treatment were conducted at the warm zone and temporary care tents in cold zone. Conclusions: At the hospital, preparing DECON shelters was time consuming. For the treatment of massive numbers of casualties, multiple DECON facilities should be prepared including rapid undressing and wet DECON using fixed showers. It is important to play a role in spite of the lack of PPEs, equipment, and a communication system, since Japanese paramedics are not able to provide a full complement of medical care.

Essential Lessons in a Potential Sarin Attack Disaster Plan for a Resource-Constrained Environment

“…2,14,16 Whereas level A protection is recommended when decontaminating patients exposed to sarin, this level of protective equipment is often not available within a resourceconstrained environment. 13,18,24 Isolation of victims of high-level exposure, limiting contact between exposed victims and health care providers, triaging more aggressively, and withholding medical care from victims whose exposure risk outweighs the potential treatment efficacy or available resources, may be the only realistic approach for health care providers in austere environments without level A protection. 18,[36][37][38] In extreme cases, where the patient exposure level increases the risk to health care providers beyond the potential treatment efficacy or available resources, a facility may need to "quarantine" itself and not allow patients to access it.…”

“…13,18,24 Isolation of victims of high-level exposure, limiting contact between exposed victims and health care providers, triaging more aggressively, and withholding medical care from victims whose exposure risk outweighs the potential treatment efficacy or available resources, may be the only realistic approach for health care providers in austere environments without level A protection. 18,[36][37][38] In extreme cases, where the patient exposure level increases the risk to health care providers beyond the potential treatment efficacy or available resources, a facility may need to "quarantine" itself and not allow patients to access it. 3,24,[36][37][38] For most patients requiring sarin decontamination, the greatest risk for health care providers and first responders is direct contact with sarin on skin and clothing surfaces.…”

“…The identification of the release point and hazard areas is difficult to predict in the initial hours as a result of intermingling and movement of exposed victims. 2,3,6,7,18,24,26 Due to its volatility, sarin rapidly disperses as well as degrades, quickly removing any trace of its presence within 36 hours of delivery. 9,24,54,55 Accurate testing of sarin levels in the field remains the domain of bulky gas chromatograph military equipment, which is not currently commercially available.…”

“…The identification of the release point and hazard areas is difficult to predict in the initial hours as a result of intermingling and movement of exposed victims 2 3 , 6 , 7 , 18 , 24 , 26 …”

“…3,9,[13][14][15][16] CLINICAL RELEVANCE OF TOXICITY By convention, toxic agents have 4 distinct properties relevant in the clinical setting: toxicity, latency, persistency, and transmissibility. 2,12,17,18 These properties provide important information regarding the immediate and long-term risks associated with exposure to that particular substance. The spectrum of toxicity is broad, ranging from minor irritation to almost instant death and is graded on the degree to which biological processes are impaired.…”