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

Chilcott, Robert P.; Larner, Joanne; Matar, Hazem

doi:10.1136/emermed-2018-207562

Cited by 25 publications

(22 citation statements)

References 19 publications

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“…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).…”

Section: Discussionmentioning

confidence: 99%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Larner

Durrant

Hughes

et al. 2019

Prehospital Emergency Care

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Prompt disrobing and minimization of time to casualty decontamination are key to the effective treatment of individuals exposed to toxic chemicals. Established procedures for mass casualty decontamination that involve the deployment of equipment for showering with water (such as the ladder pipe system [LPS] and technical decontamination) necessarily introduce a short, but critical delay. The purpose of this study was to investigate the effectiveness of dry and wet decontamination approaches (individually and in combination) for removing a chemical warfare agent simulant from the hair and skin of human volunteers. A secondary aim was to quantify potential hazards arising from the decontamination processes. Volunteers were exposed to the simulant (mixture of methyl salicylate, fluorophore [curcumin] and mineral oil) as an aerosol within a custom-built dosing chamber. Three decontamination protocols (dry, LPS and technical decontamination) were applied in various sequences. The efficacy of the protocols was evaluated by whole-body fluorescent imaging and measurement of residual simulant recovered from the hair, skin, decontamination materials and air samples using liquid chromatography and thermal desorption gas chromatography. Dry decontamination before LPS or technical decontamination produced significant reductions in methyl salicylate skin contamination. The greatest reductions were seen with the Triple Protocol (dry, then LPS, then technical decontamination). Secondary sources of contamination (e.g. off-gassing of vapor and residue on wash cloths/towels) decreased following dry decontamination. The introduction of dry decontamination prior to wet forms of decontamination offers a simple strategy to initiate treatment at a much earlier opportunity, with a corresponding improvement in clinical outcomes. Our results confirm the value of a "Triple Protocol" response strategy based on the integration of dry and wet decontamination procedures. 3 Importantly, we highlight how these combined protocols may reduce toxicological risks downstream in the operational process.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Larner

Durrant

Hughes

et al. 2019

Prehospital Emergency Care

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“…The intricacies of this response vary across the United States (Power et al , 2016). However, the overall response to mass casualty chemical incidents has been revised to incorporate disrobing (the removal of clothing), an improvised form of dry decontamination (DD) and specialist methods of decontamination (technical decontamination [TD]), similar to the principles being adopted in the United Kingdom (Chilcott et al , 2019a; UK Home Office, 2015).…”

mentioning

confidence: 99%

Decontamination and Management of Contaminated Hair following a CBRN or HazMat Incident

Matar

Pinhal

Amer

et al. 2019

Toxicological Sciences

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This in vitro study evaluated the “triple protocol” of dry decontamination, the ladder pipe system (a method for gross decontamination), and technical decontamination for the decontamination of hair following chemical contamination. First, we assessed the efficacy of the 3 protocols, alone or in combination, on excised porcine skin and human hair contaminated with either methyl salicylate (MS), phorate (PHR), sodium fluoroacetate (SFA), or potassium cyanide (KCN). A second experiment investigated the residual hair contamination following decontamination with the triple protocol at different intervals postexposure. In a third experiment, hair decontaminated after exposure to MS or PHR was evaluated for off-gassing. Though skin decontamination was highly effective, a substantial proportion (20%–40%) of the lipophilic compounds (MS and PHR) remained within the hair. The more water-soluble contaminants (SFA and KCN) tended to form much smaller reservoirs within the hair. Interestingly, substantial off-gassing of MS, a medium volatility chemical, was detectable from triple-decontaminated hair up to 5 days postexposure. Overall, the decontamination strategies investigated were effective for the decontamination of skin, but less so for hair. These findings highlight the importance of contaminated hair serving as a source of potential secondary contamination by contact or inhalation. Therefore, consideration should be given to the removal of contaminated hair following exposure to toxic chemicals.

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“…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 .…”

mentioning

confidence: 99%

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

Collins

James

Southworth

et al. 2020

Sci Rep

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The decontamination of exposed persons is a priority following the release of toxic chemicals. Efficacious decontamination reduces the risk of harm to those directly affected and prevents the uncontrolled spread of contamination. Human studies examining the effectiveness of emergency decontamination procedures have primarily focused on decontaminating skin, with few examining the decontamination of hair and scalp. We report the outcome of two studies designed to evaluate the efficacy of current United Kingdom (UK) improvised, interim and specialist mass casualty decontamination protocols when conducted in sequence. Decontamination efficacy was evaluated using two chemical simulants, methyl salicylate (MeS) and benzyl salicylate (BeS) applied to and recovered from the hair of volunteers. Twenty-four-hour urinary MeS and BeS were measured as a surrogate for systemic bioavailability. Current UK decontamination methods performed in sequence were partially effective at removing MeS and BeS from hair and underlying scalp. BeS and MeS levels in urine indicated that decontamination had no significant effect on systemic exposure raising important considerations with respect to the speed of decontamination. The decontamination of hair may therefore be challenging for first responders, requiring careful management of exposed persons following decontamination. Further work to extend these studies is required with a broader range of chemical simulants, a larger group of volunteers and at different intervention times.

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

Cited by 25 publications

References 19 publications

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

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

Decontamination and Management of Contaminated Hair following a CBRN or HazMat Incident

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

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