Rethinking Terrorism Response Decontamination Issues

Decontamination (decon) issues have also been at the forefront of preparation efforts. While many of these efforts have been well thought out and conducted with good intentions there are some that argue that the response community needs to rethink what...

What is needed are systems designed to be fast and quickly employed. At large venues like stadiums, arenas, and music festivals, response agencies should work with facilities to employ fixed decon equipment such as showers. Then, if a terrorist event occurs affected people can be directed toward that area through loud speakers or written message signs (both in English and Spanish). The focus should be to quickly flush contaminants off of as many people as possible, as fast as possible, without worrying about their clothing. Depending on the number of people that may be present at each venue decon rates should exceed the capability of 2,000 people per minute. To achieve this goal, locations such as a large stadium may need numerous decon areas within the building or close to the stands. All ambulatory people should be able to self-deliver to the decon area and first responders can focus on getting non-ambulatory people to be deconned. Mass transit buses can be summoned to the site to transport deconned people away from the facility.

What this is all about is called "emergency decontamination" and by definition is a process that is fast, not very thorough, and not very elaborate. In a recent article (2), Robert Burke stated, "Emergency decon has become a major response objective of first responders to terrorism incidents." Burke goes on to say that every department should be able to conduct effective emergency decon. Emergency decon should be readily employed anywhere, at any time.

What is also needed is the training and equipment for every fire department to employ fast emergency decon. While many departments do have the capability many more do not. This has to be a priority! We need to take care of the first responders first by seeing that this capability is in place across the entire country. In doing so, affected people at terrorism attacks will also be taken care of in the most expedient manner. Nozzles and master streams set on low pressure and wide fog with decon rates greater than 500 people per minute should be the goal of each engine company. Operational time from start to water flow should be less than 1 minute.

Technical decon, by contrast to emergency decon, is more elaborate, more thorough, and slower. This is the type of decon that will be conducted at hospital emergency rooms, by hazardous materials response teams (usually for their own personnel), and in portable decon facilities such as specially designed decon tents or trailers. At large scale terrorism attacks, technical decon should not be the major priority. It may, however, be needed to decon non-ambulatory people and/or responders. By nature, technical decon takes time to set-up and activate and requires numerous responders, in proper personal protective equipment, to staff the effort.

In short, emergency decon is similar to fireground primary searches; it must be completed first and fast! Technical decon is similar to secondary searches; it must be completed second and very thoroughly. These basic concepts are also echoed in a 2003 document from the Soldier and Biological Chemical Command (SBCCOM)-U.S. Department of Defense that is concerned with mass decontamination. In "Guidelines for Cold Weather Mass Decontamination During a Terrorist Chemical Agent Incident" (3) it states "Responders should select the fastest method available because decontamination is most effective when performed immediately. The key to successful decontamination is to use the fastest approach that will cause the least harm and do the most good for the majority of the people." The SBCCOM document aptly summarizes all efforts as "Least harm, Most benefit, Most people".

As Scanlon warns, terrorist attacks will most likely produce expanding sites and contamination will spread as victims leave the area. Indeed, in the sarin attacks in Tokyo of March, 1995, it is estimated that between 5,000 and 6,000 people were exposed to the nerve agent. It is reported that 3,227 presented to 41 hospitals over the first several hours. Many of them were delivered by taxis and buses. Fortunately, the death toll was low in comparison to the potential with nine dead at several sites, one dead upon arrival at a hospital, and two dying a few weeks later from complications. Also, 135 emergency medical personnel suffered symptoms from cross contamination and 33 of them were hospitalized. If those people who were exposed to the sarin were deconned before leaving the area, cross contamination issues may have been minimized. Emergency decon is the key.

Technical decon may also be best employed at the sites where people may flee to. Since it may be impossible to capture all exposed victims and send them through emergency decon, these victims may be deconned at hospitals or medical clinics before they enter and expose staff. Since technical decon efforts take longer to set-up, the time afforded before victims begin to arrive will enable responders to activate their decon tents or trailers. Victims that arrive in the mean time can probably be handled by the emergency room staff in their fixed site decon rooms.