The Office of the Assistant Secretary for Preparedness and Response (ASPR), in partnership with the Department of Homeland Security (DHS) and other agencies, has developed two resources for managing mass exposure chemical incidents: Patient Decontamination in a Mass Chemical Exposure Incident: National Planning Guidance for Communities and Primary Response Incident Scene Management (PRISM) Guidance.
Patient Decontamination in a Mass Chemical Exposure Incident: National Planning Guidance for Communities
Patient Decontamination in a Mass Chemical Exposure Incident: National Planning Guidance for Communities provides science-based guidance for managing patient decontamination in large-scale chemical exposure incidents. It draws on expertise in emergency response, emergency medicine, toxicology, risk communication, behavioral health, and other relevant fields and covers mass casualties, chemical release, external contamination, and decontamination of people (not animals, inanimate objects, or facilities).
This guidance is intended for senior leaders, planners, incident commanders, emergency management personnel, and trainers of local response organizations and health care facilities. However, first responders and first receivers, community leaders, scientific researchers and others from the response and emergency management fields will find it useful as well.
The guidance provides a broad community perspective of managing patient decontamination and applies a flexible and scalable approach based on the resources and capability limitations of each community. It emphasizes six key principles:
Patient Decontamination in a Mass Chemical Exposure Incident: PRISM Guidance
The Biomedical Advanced Research and Development Authority (BARDA) also supported the development of the Primary Response Incident Scene Management Guidance for Chemical Incidents (PRISM), which helps tackle some of the knowledge gaps identified in the National Planning Guidance. The PRISM guidance is based on scientific evidence gathered under a program of research sponsored BARDA and conducted in the United States and at the University of Hertfordshire in the United Kingdom. The program combined lab studies on the effects of water temperature, flow rate, detergents, and delayed decontamination with verification in human volunteer studies, using safe chemicals to simulate the dangerous contaminants. The guidance was developed with input from US first responders and agencies in 35 municipalities across 21 states. The aim of PRISM is to ensure that all patients exposed to potentially hazardous chemicals receive the most effective treatment possible during the initial stages of an incident. Prompt decontamination is the best way to prevent the serious health consequences of exposure to toxic chemicals.
The PRISM Guidance recommends three steps to reduce exposure and remove 99% of chemical containments: (1) move quickly away from the hazardous area (if feasible); (2) carefully remove all clothes; and (3) wipe skin with a paper towel or dry wipe. The effects of each decontamination step are best depicted by the graphic below:
| Key Messages |
|
Primary Actions |
|
Critical Aspects |
|---|
| |
|
|
|
|
Time Critical, very effective and
prevents transfer of contaminant
from clothing to skin of casualty |
|
Disrobe |
|
- Failure to disrobe is dangerous
- Time Critical
|
| |
|
⮟ |
|
|
Time Official, effective and safest
method for removing non-corrosive
chemicals |
|
Dry
Decontamination |
|
- Effectiveness for hair unknown
- Time Critical
- Well-defined parameters
|
| |
|
⮟ |
|
|
Time Critical, effective and safe
method for removing all chemicals
after dry contamination |
|
Gross (LPS)
Decontamination |
|
- Well-defined parameters
- Failure to disrobe is very dangerous
- Be wary of hypothermia
|
| |
|
⮟ |
|
|
Most important stage
of decontamination - removes the most contamination following showering |
|
Active Drying |
|
- Not drying properly may increase skin absorption of contaminant
- Towels may be heavily contaminanted
|
| |
|
⮟ |
|
|
| "Wash yourself from head to toe." |
|
Technical
Decontamination |
|
- Well-defined parameters
- Ensure casualties effectively dry
- Be wary of hypothermia
|
The PRISM guidance also provides actions indicating critical aspects of decontamination following a chemical event along with key messages for responders to provide to exposed individuals during the incident. The table below summarizes such actions and messaging:
The PRISM series comprises three volumes:
- Volume 1: Strategic Guidance (PDF 2.83MB) – A review of best practices, available evidence, and areas that require further investigation.
- Volume 2: Tactical Guidance (PDF 1.70 MB) – An overview of the processes involved in mass casualty disrobing and decontamination and the rationale underpinning each process.
- Volume 3: Operational Guidance (PDF 1.29 MB) – The salient features of mass casualty disrobing and decontamination.
Future Guidance
Future guidance from ASPR and DHS will focus on creating evidence-based guidance for decontaminating pediatric and pregnant patients in a mass exposure chemical incident. In addition, BARDA, in collaboration with the University of Hertfordshire, is in the process of updating the PRISM guidance based on recent data. The primary objective is to generate appropriate evidence to allow focused revision of existing PRISM guidance to facilitate a fully optimized, generic, and standardized response by first responders to chemical incidents. The revised PRISM guidance will encompass a user-friendly algorithm to allow first responders to rapidly assess the severity of an incident to ensure that any response is both effective and proportionate. The University of Hertfordshire conducted a human volunteer trial to evaluate how the applicability of evidence-based practices may significantly enhance the overall effectiveness of the Ladder Pipe System for chemical decontamination; a similar human volunteer trial (Operation DOWNPOUR) was successfully conducted in Rhode Island in August 2017.
