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 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, Joseph Reppucci

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)
100 Downloads (Pure)

Abstract

Study objective The 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. Methods The 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. Results The 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. Conclusion The 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.
Original languageEnglish
Pages (from-to)671-684
Number of pages14
JournalAnnals of Emergency Medicine
Volume73
Issue number6
Early online date23 Aug 2018
DOIs
Publication statusPublished - 1 Jun 2019

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