1. Guidelines For Mass Casualty Decontamination

2. Objectives
Provide operations personnel with an understanding of the effects of chemical and biological agents
Provide an understanding and demonstrate the need for mass decontamination
Provide operations personnel with a systematic approach to rescue actions at chemical incidents

3. Biological Living – Bacteria and Viruses
Living organisms that reproduce
May or may not be contagious
Plague, Small Pox & ANTHRAX
Non-living – Toxins
Poisonous byproducts of microorganisms.
Not living or contagious
Venom, Botulinum (neurotoxin –fast acting)
Ricin (cytotxin – slower acting

4. Types of Chemical agents
Choking agents
Blister Agents
Blood Agents
Nerve Agents
Riot Control Agents
Mustard Agents
Psychotomimetic Agents
Toxins

5. Signs and symptoms of Chemical Agents S.L.U.D.G.E. M.
S- Salvation
L- Lacrimation
D- Defecation
G- Gastrointestinal
U- Urination
E- Emesis
M- Miosis

6. Three Historical Events that Demonstrate the Need for Mass Decontamination
Chemical release in Bhopal, India
Radioactive material release in Goiania, Brazil
Sarin Gas release in Tokyo, Japan

7. Bhopal, India Bhopal is located in the northcentral region of India
Population of 0.9 million in 1984
Juncture of several major rail lines

8. Union Carbide India Built and operated the pesticide plant Ownership
– 50.9% owned by Union Carbide
– 26% owned by the government of India
– 23.1% owned by citizens of India
Operating since 1969
In 1979, began to produce its own methyl iso-cyanide, instead of importing it

9. The Disaster
Occurred at night on December 23, tons of hydrogen cyanide and methyl iso-cyanide were released into the air Covered a 40 sq km area and hung close to the ground for 4 hours 500,000 people were exposed 6,000 people died the first week, about ¾ of those in the first few hours Few people received medical attention

10. Union Carbide’s Bhopal Plant

11. Goiania, Brazil Located 210 KM west of Brasilia
Population of about 1 million
Modern city

12. Cancer Therapy Clinic
During the 1950’s the clinic had imported a teletherapy unit for cancer treatments that used cesium 137 as its source
In the 1960’s cobalt therapy units were imported and became the standard, replacing the cesium unit
The old clinic was abandoned and eventually slated for demolition

13. The Disaster
During the demolition of the clinic in 1984, two scavengers found the cesium source
They took it home and for four nights tried to open the lead container
Finally they broke the iridium window and the source emitted a brilliant blue glow
Eventually they broke the source open
The cesium chloride was spread by a number of unknowingly contaminated people

14. Teletherapy unit
much like the one
involved in the
Goiania, Brazil

15. Luckily, Exposure was Limited
Only 250 people were exposed to the cesium
28 people showed signs of radiation sickness
104 had internal contamination
4 fatalities (2 men, a woman and a child)
A number of people that handled the source received burns to the hands and chest

16. Widespread Panic Gripped the City
Citizens wanted to be checked to make sure they were not contaminated with the cesium (This was coined as the worried well!)
People were told to gather at a soccer stadium to be evaluated
112,800 people came to the soccer stadium
120 had contamination

17. Tokyo, Japan Capital of Japan Population 8.1 million
Largest subway system in the world
Shinjuku Station handles some 4,000,000 commuters daily

18. Aum Shinrikyo
Japanese terrorist group based initially on religious fanaticism, but developed into a political group
Had struck several times with violence, including a sarin gas attack in 1994, seven people died and hundreds were injured.
In 1994, their compound had a serious gas leak and they evacuated for several days

19. 10 Members of the cult released sarin gas on subway trains and in stations at a predetermined time
They used lunch boxes, thermoses and beverage containers to get the material into the subway

20. The Emergency Response
131 Ambulance responded
1,364 medical personnel were dispatched
641 victims were transported to the hospital
Over 4,000 went on there own
110 hospital staff and 135 EMS personnel suffered from secondary contamination

21. St. Luke’s International Hospital
Received 688 victims of the sarin gas attack
If they had a decon facility…
– That had four showers, and
– Provided 5 minutes per victim for decon
– Could sustain this operation indefinitely,
They could decontaminate 48 victims an hour and complete all 688 victims in 15 hours

22. Drawbacks of Small Decontamination Facilities
People with continued exposure for 15 hours are going to suffer ill effects
Hospital and emergency responders in protective suits does nothing to calm the situation
The potential for unrest and unruly victims increases
People are not going to wait 15 hours for decontamination

23. The Principles of Mass Casualty Decontamination
Time is critical
Provide effective mass casualty decontamination
Conduct decontamination triage prior to showering
When contamination involves chemical vapors, biological, or radiological material have patients use gentle friction with hands to remove contaminants
Do the most good for the most people

24. Definition of Decontamination Triage
Triage is the process of determining the priority of a victim’s treatment based on the severity of their condition. In this context, “Decontamination Triage” is a prioritization mechanism used by first responders to determine whether victims emerging from HAZMAT/WMD incident scenes should be directed to area(s) of safe refuge/observation or to a mass casualty decontamination station.

26. Mass Decontamination Stations
Victims are evacuated from the Hazard area
First responder performs decontamination triage. Victims with no apparent exposure to the hazard are sent directly to a safe/refuge observation area to monitor for delayed symptoms and signs of contamination
Victims with likely exposure are sent to the water shower deluge and undergo mass casualty decontamination

27. Mass Decontamination Stations
Following decontamination victims without additional visible symptoms are sent to a safe/refuge observation area for monitoring
Symptomatic and ambulatory victims undergo additional medical triage, treatment and are transported to a medical facility if requires for further medical treatment
Victims are released from the safe/refuge observation area or medical facility as directed

28. Water Shower Deluge

29. Mass Decontamination Corridor
Nozzle Pressure should be maintained at 60 psi…low pressure, high volume
Requires three pump operators, two nozzle men and three firefighters to direct victims:
– One instructing to disrobe
– One guiding people into corridor
– One guiding people to safe area after decon

30. Use of tarps can add a level of privacy
Notice overhead shower is a 1.75” nozzle attached to a ladder that straddles the decontamination corridor

31. Mass Decon continued
Have victims remain in shower for between 30 sec. to 3 min.
When possible separate males and females
Use tarps to protect modesty
Quickly dry and dress after decontamination
Communicate with patients
Continue monitoring victims for signs and symptoms

32. Example Mass Decon

33. The End
Please direct all questions, comments, or concerns to your department’s Training Officer or HazMat techs. Train Hard! - Do Work!