Guidelines For Mass Casualty

Decontamination

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

Objectives

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 (cytotxin – slower acting

Choking agents Blister Agents Blood Agents Nerve Agents Riot Control

Agents Mustard Agents Psychotomimetic

Agents Toxins

Types of Chemical agents

• S- Salvation• L- Lacrimation• D- Defecation• G- Gastrointestinal• U- Urination• E- Emesis

• M- Miosis

Signs and symptoms of Chemical AgentsS.L.U.D.G.E. M.

Chemical release in Bhopal, India

Radioactive material release in Goiania, Brazil

Sarin Gas release in Tokyo, Japan

Three Historical Events that

Demonstrate the Need for Mass

Decontamination

Bhopal, India

Bhopal is located in the northcentral region of India

Population of 0.9 million in 1984

Juncture of several major rail lines

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

Union Carbide India

Occurred at night on December 23, 198440 tons of hydrogen cyanide and methyliso-cyanide were released into the airCovered a 40 sq km area and hung closeto the ground for 4 hours500,000 people were exposed6,000 people died the first week, about ¾ of those in the first few hoursFew people received medical attention

The Disaster

Union Carbide’s Bhopal Plant

Goiania, Brazil

Located 210 KM west of Brasilia

Population of about 1 million

Modern city

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

Cancer Therapy Clinic

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

The Disaster

Teletherapy unitmuch like the oneinvolved in theGoiania, Brazil

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

Luckily, Exposure was Limited

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

Widespread Panic Gripped the City

Tokyo, Japan

Capital of Japan Population 8.1

million Largest subway

system in the world

Shinjuku Station handles some 4,000,000 commuters daily

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

Aum Shinrikyo

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

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

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

St. Luke’s International

Hospital

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

Drawbacks of SmallDecontamination Facilities

1. Time is critical 2. Provide effective mass casualty

decontamination3. Conduct decontamination

triage prior to showering4. When contamination involves

chemical vapors, biological, or radiological material have patients use gentle friction with hands to remove contaminants

5. Do the most good for the most people

The Principles of Mass Casualty

Decontamination

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.

Definition of Decontamination

Triage

1. Victims are evacuated from the Hazard area

2. 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

3. Victims with likely exposure are sent to the water shower deluge and undergo mass casualty decontamination

Mass Decontamination Stations

4. Following decontamination victims without additional visible symptoms are sent to a safe/refuge observation area for monitoring

5. Symptomatic and ambulatory victims undergo additional medical triage, treatment and are transported to a medical facility if requires for further medical treatment

6. Victims are released from the safe/refuge observation area or medical facility as directed

Mass Decontamination

Stations

Water Shower Deluge

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 decon

Mass Decontamination

Corridor

Use of tarps can add a level of privacy

Notice overheadshower is a 1.75”nozzle attachedto a ladder thatstraddles thedecontaminationcorridor

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

Mass Decon continued

Example Mass Decon

Please direct all questions, comments, or concerns to your department’s Training Officer or HazMat techs.

Train Hard! - Do Work!

The End