- 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
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Original language | English |
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Pages (from-to) | 671-684 |
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Number of pages | 14 |
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Journal | Annals of Emergency Medicine |
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Volume | 73 |
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Issue | 6 |
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Early online date | 23 Aug 2018 |
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DOIs | |
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Publication status | Published - 1 Jun 2019 |
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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.
ID: 15214831