• Ann Emerg Med · Jun 2019

    Evaluation of US Federal Guidelines (Primary Response Incident Scene Management [PRISM]) for Mass Decontamination of Casualties During the Initial Operational Response to a Chemical Incident.

    • Robert P Chilcott, Joanne Larner, Adam Durrant, Philip Hughes, Devanya Mahalingam, Samantha Rivers, Elliot Thomas, Nevine Amer, Mark Barrett, Hazem Matar, Andreia Pinhal, Toni Jackson, Kate McCarthy-Barnett, and Joseph Reppucci.
    • Research Centre for Topical Drug Delivery and Toxicology, University of Hertfordshire, Hertfordshire, UK. Electronic address: tox.publications@herts.ac.uk.
    • Ann Emerg Med. 2019 Jun 1; 73 (6): 671-684.

    Study ObjectiveThe aim of this study was to evaluate the clinical and operational effectiveness of US federal government guidance (Primary Response Incident Scene Management [PRISM]) for the initial response phase to chemical incidents.MethodsThe study was performed as a large-scale exercise (Operation DOWNPOUR). Volunteers were dosed with a chemical warfare agent simulant to quantify the efficacy of different iterations of dry, ladder pipe system, or technical decontamination.ResultsThe most effective process was a triple combination of dry, ladder pipe system, and technical decontamination, which attained an average decontamination efficiency of approximately 100% on exposed hair and skin sites. Both wet decontamination processes (ladder pipe system and technical decontamination, alone or in combination with dry decontamination) were also effective (decontamination efficiency >96%). In compliant individuals, dry decontamination was effective (decontamination efficiency approximately 99%), but noncompliance (tentatively attributed to suboptimal communication) resulted in significantly reduced efficacy (decontamination efficiency approximately 70%). At-risk volunteers (because of chronic illness, disability, or language barrier) were 3 to 8 times slower than ambulatory casualties in undergoing dry and ladder pipe system decontamination, a consequence of which may be a reduction in the overall rate at which casualties can be processed.ConclusionThe PRISM incident response protocols are fit for purpose for ambulatory casualties. However, a more effective communication strategy is required for first responders (particularly when guiding dry decontamination). There is a clear need to develop more appropriate decontamination procedures for at-risk casualties.Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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