Guidelines For Mass Casualty Decontamination

1. Guidelines For Mass Casualty Decontamination

2. Objectives • Provide operations personnel with an understanding of the effects of chemical and biological agents • Provide an understanding and demonstrate the need for mass decontamination • Provide operations personnel with a systematic approach to rescue actions at chemical incidents

3. Biological Living – Bacteria and Viruses • Living organisms that reproduce • May or may not be contagious • Plague, Small Pox & ANTHRAX Non-living – Toxins • Poisonous byproducts of microorganisms. • Not living or contagious • Venom, Botulinum (neurotoxin –fast acting) • Ricin (cytotoxin– slower acting

4. Types of Chemical agents Choking agents Blister Agents Blood Agents Nerve Agents Riot Control Agents Mustard Agents Psychotomimetic Agents Toxins

5. Signs and symptoms of Chemical AgentsS.L.U.D.G.E. M. • S- Salvation • L- Lacrimation • U- Urination • D- Defecation • G- Gastrointestinal • E- Emesis • M- Miosis

6. Three Historical Events that Demonstrate the Need for Mass Decontamination • Chemical release in Bhopal, India • Radioactive material release in Goiania, Brazil • Sarin Gas release in Tokyo, Japan

7. Bhopal, India • Bhopal is located in the northcentral region of India • Population of 0.9 million in 1984 • Juncture of several major rail lines

8. Union Carbide India • Built and operated the pesticide plant • Ownership – 50.9% owned by Union Carbide – 26% owned by the government of India – 23.1% owned by citizens of India • Operating since 1969 • In 1979, began to produce its own methyl iso-cyanide, instead of importing it

9. The Disaster Occurred at night on December 23, 1984 40 tons of hydrogen cyanide and methyl iso-cyanide were released into the air Covered a 40 sq. km area and hung close to the ground for 4 hours 500,000 people were exposed 6,000 people died the first week, about ¾ of those in the first few hours Few people received medical attention

10. Union Carbide’s Bhopal Plant

11. Goiania, Brazil • Located 210 KM west of Brasilia • Population of about 1 million • Modern city

12. Cancer Therapy Clinic • During the 1950’s the clinic had imported a teletherapy unit for cancer treatments that used cesium 137 as its source • In the 1960’s cobalt therapy units were imported and became the standard, replacing the cesium unit • The old clinic was abandoned and eventually slated for demolition

13. The Disaster • During the demolition of the clinic in 1984, two scavengers found the cesium source • They took it home and for four nights tried to open the lead container • Finally they broke the iridium window and the source emitted a brilliant blue glow • Eventually they broke the source open • The cesium chloride was spread by a number of unknowingly contaminated people

14. Teletherapy unit much like the one involved in the Goiania, Brazil

15. Luckily, Exposure was Limited • Only 250 people were exposed to the cesium • 28 people showed signs of radiation sickness • 104 had internal contamination • 4 fatalities (2 men, a woman and a child) • A number of people that handled the source received burns to the hands and chest

16. Widespread Panic Gripped the City • Citizens wanted to be checked to make sure they were not contaminated with the cesium (This was coined as the worried well!) • People were told to gather at a soccer stadium to be evaluated • 112,800 people came to the soccer stadium • 120 had contamination

17. Tokyo, Japan • Capital of Japan • Population 8.1 million • Largest subway system in the world • Shinjuku Station handles some 4,000,000 commuters daily

18. AumShinrikyo • Japanese terrorist group based initially on religious fanaticism, but developed into a political group • Had struck several times with violence, including a sarin gas attack in 1994, seven people died and hundreds were injured. • In 1994, their compound had a serious gas leak and they evacuated for several days

19. AumShinrikyo • 10 Members of the cult released sarin gas on subway trains and in stations at a predetermined time • They used lunch boxes, thermoses and beverage containers to get the material into the subway

20. The Emergency Response • 131 Ambulance responded • 1,364 medical personnel were dispatched • 641 victims were transported to the hospital • Over 4,000 went on there own • 110 hospital staff and 135 EMS personnel suffered from secondary contamination

21. St. Luke’s International Hospital • Received 688 victims of the sarin gas attack • If they had a decon facility… – That had four showers, and – Provided 5 minutes per victim for decon – Could sustain this operation indefinitely, • They could decontaminate 48 victims an hour and complete all 688 victims in 15 hours

22. Drawbacks of SmallDecontamination Facilities • People with continued exposure for 15 hours are going to suffer ill effects • Hospital and emergency responders in protective suits does nothing to calm the situation • The potential for unrest and unruly victims increases • People are not going to wait 15 hours for decontamination

23. The Principles of Mass Casualty Decontamination • Time is critical • Provide effective mass casualty decontamination • Conduct decontamination triage prior to showering • When contamination involves chemical vapors, biological, or radiological material have patients use gentle friction with hands to remove contaminants • Do the most good for the most people

24. Definition of Decontamination Triage Triage is the process of determining the priority of a victim’s treatment based on the severity of their condition. In this context, “Decontamination Triage” is a prioritization mechanism used by first responders to determine whether victims emerging from HAZMAT/WMD incident scenes should be directed to area(s) of safe refuge/observation or to a mass casualty decontamination station.

26. Mass Decontamination Stations • Victims are evacuated from the Hazard area • First responder performs decontamination triage. Victims with no apparent exposure to the hazard are sent directly to a safe/refuge observation area to monitor for delayed symptoms and signs of contamination • Victims with likely exposure are sent to the water shower deluge and undergo mass casualty decontamination

27. Mass Decontamination Stations • Following decontamination victims without additional visible symptoms are sent to a safe/refuge observation area for monitoring • Symptomatic and ambulatory victims undergo additional medical triage, treatment and are transported to a medical facility if requires for further medical treatment • Victims are released from the safe/refuge observation area or medical facility as directed

28. Water Shower Deluge

29. Mass Decontamination Corridor • Nozzle Pressure should be maintained at 60 psi…low pressure, high volume • Requires three pump operators, two nozzle men and three firefighters to direct victims: – One instructing to disrobe – One guiding people into corridor – One guiding people to safe area after decontamination

30. Use of tarps can add a level of privacy Notice overhead shower is a 1.75” nozzle attached to a ladder that straddles the decontamination corridor

31. Mass Decon continued • Have victims remain in shower for between 30 sec. to 3 min. • When possible separate males and females • Use tarps to protect modesty • Quickly dry and dress after decontamination • Communicate with patients • Continue monitoring victims for signs and symptoms

32. Example Mass Decon

33. The End Please direct all questions, comments, or concerns to your department’s Training Officer or Haz-Mat techs. THANK YOU FOR YOUR TIME. Train Hard! - Do Work!