Decontamination will be a major challenge at the scene of a terrorist attack involving the release of a chemical agent. The type, quantity, persistency and the method of dispersal of the chemical agent, its location of release (i.e., inside or outside a structure), number of people involved, and weather conditions are factors that influence the decontamination effort.
First responders should do the best they can with the available resources to have the most positive impact on decontamination of large numbers of casualties. Thinking through the decontamination process for small and large numbers of casualties, developing and adequately exercising the decontamination plan, will help to promote safe, efficient and effective on scene operations.
The points listed below are simply considerations. They are provided to serve as check points and also to stimulate thinking among first responders. This random list is not complete. I plan to provide additional considerations in a future column.
1. Know the basic properties of the four categories of chemical agents (nerve, blister, blood and choking).
2. Establish system to identify and track people going through the decontamination process. Validate the process through practical exercises. Don't assume that what is on paper will necessarily work on the scene.
3. Maintain a supply of disposable towels for use by casualties who are decontaminated. Carry the towels on a response vehicle or package them for quick deployment to the scene.
4. Prepare and practice decontamination procedures to gain proficiency and to determine the approximate number of people that can be processed per hour for each method.
5. Locate the decontamination area upwind in the warm zone.
6. Wear turnout clothing and use self-contained breathing apparatus (SCBA) (or other appropriate protective clothing, respiratory protection, or both).
7. Take a realistic approach to decontamination. Don't plan for more than you are able to deliver.
8. Separate casualties into two groups: ambulatory and non-ambulatory. Use a portable megaphone (or vehicle-installed speaker system) to direct ambulatory casualties to a pre-decontamination area (PDA) in the warm zone, but away from the decontamination area(s).
9. Ask the ambulatory casualties to check each other for signs of liquid contamination on their clothes or skin. Tell them to raise their hands if liquid contamination is suspected.
10. Remove people suspected of liquid contamination to a nearby location and quickly decontaminate them. Use other first responders to verify that the people remaining in the PDA do not have any liquid contamination or need medical attention.
11. Set up area to decontaminate non-ambulatory casualties. Determine ahead of time how to decontaminate casualties who use walkers, wheelchairs, or require other special assitance.
12. Consider measures to minimize environmental impact of contaminated water runoff.
13. Be sure that emergency vehicles near the decontamination site are shut down or relocated to avoid possible exposure to deadly carbon monoxide (CO).
14. Use hose lines to quickly wet casualties while a "high, casualty processing" decontamination system is being set up.
15. Establish and practice procedures for decontaminating casualties when weather conditions prevent outside use of hose streams. Removing the outer layer of a casualty's winter clothing may be help in the decontamination process.
16. Use high volume with low water pressure when using hose lines and master stream devices such as ladder pipes. Be careful not to direct the stream in the face or other sensitive areas.
17. Develop procedures to address people who are mentally or physically challenged, elderly, or have difficulty understanding the English language.
18. Do not add sodium hypochlorite (NaOCl) or other caustic material to shower water.
19. Consider the benefit of using swimming pools or automatic fire sprinkler systems as means of decontamination.
20. Be sure to ask any potential casualties, where practical, where they were when the event occurred. This may help to determine their decontamination priority.
21. Use common sense when deciding whether or not to decontaminate a person before providing emergency medical care. Life-threatening injuries should take precedence over decontamination.
22. Avoid transporting contaminated casualties to hospitals or other medical care facilities.
23. Remember, it is likely that most of the people who are decontaminated were not actually contaminated. Yet, in the interest of caution and also the psychological well being of the casualties, it is the right thing to do.
24. Have a contingency plan for providing decontamination assistance to hospitals.
25. Remember that medical-type gloves do not provide adequate protection against contact with nerve or blister agent.
26. Use chemical agent detection instruments to monitors casualties and the decontamination site(s).
27. Set up a separate decontamination area for emergency response personnel.
28. Provide enclosed areas to protect the modesty of casualties when time, priority level and circumstances dictate.
29. Have a contingency plan for relocating the decontamination site(s) due to unfavorable shift in wind or other dangerous condition.
30. Have a procedure for effectively cleaning turnout clothing and equipment after use.
31. Remember having contaminated casualties remove their clothing at least to their underwear may remove about 50-80 percent of the contamination. However, don't assume that people will remove their clothes simply because first responders requested that they do so. It's not going to be that simple! With large numbers of people, first responders may have to wet them with their clothes on. This may not be the most desirable method, but it may be the most practical one under the circumstances.
32. Read the Guidelines for Mass Casualty Decontamination During a Terrorist Chemical Agent Incident, prepared by the U.S. Army Soldier and Biological Command (SBCCOM).
33. Share the decontamination plan with nearby fire departments and rescue squads.
If you should have other suggestions or considerations, please let me know. I will consider them for the follow up column.
Related:
About the Author - Ted Jarboe, M.S., C.E.M.
Ted Jarboe is a Deputy Chief with the Montgomery County (MD) Fire and Rescue
Service. He is the County’s Fire Marshal and also heads the Bureau of Life
Safety Services.
Jarboe has been a member of many local, state and federal programs involved
with studying and training for weapons weapons of mass destruction (WMD)
incidents. He has tested and trained with a wide range of equipment used in
such incidents.
In January 2000, he designed and created a website titled WMD First
Responders www.wmdfirstresponders.com.
Ted Jarboe has 38 years of career service.
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