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Guidelines For Mass Casualty
Decontamination
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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
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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
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Choking agents Blister Agents Blood Agents Nerve Agents Riot Control
Agents Mustard Agents Psychotomimetic
Agents Toxins
Types of Chemical agents
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• 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.
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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
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Bhopal, India
Bhopal is located in the northcentral region of India
Population of 0.9 million in 1984
Juncture of several major rail lines
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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
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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
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Union Carbide’s Bhopal Plant
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Goiania, Brazil
Located 210 KM west of Brasilia
Population of about 1 million
Modern city
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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
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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
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Teletherapy unitmuch like the oneinvolved in theGoiania, Brazil
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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
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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
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Tokyo, Japan
Capital of Japan Population 8.1
million Largest subway
system in the world
Shinjuku Station handles some 4,000,000 commuters daily
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Water Shower Deluge
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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
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Use of tarps can add a level of privacy
Notice overheadshower is a 1.75”nozzle attachedto a ladder thatstraddles thedecontaminationcorridor
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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
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Example Mass Decon
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Please direct all questions, comments, or concerns to your department’s Training Officer or HazMat techs.
Train Hard! - Do Work!
The End