University of Hertfordshire


  • 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 languageEnglish
Pages (from-to)671-684
Number of pages14
JournalAnnals of Emergency Medicine
Early online date23 Aug 2018
Publication statusPublished - 1 Jun 2019


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.

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