Rinsing only with water or washing with soap and water are common methods of skin decontamination for skin contaminated during a chemical hazard release. The null hypothesis was that a 15-minute water irrigation (decontamination method 1) would not be superior to decontamination using a microfiber towel, followed by a wet wipe (Signature Select Softly Flushable Tissue Better Living Brands LLC, Pleasanton, CA), followed by using another microfiber towel (decontamination method 2).

A simulated contaminant (Magic Fluorescent Glow Paint for Face and Body, iLC Shenzhen Fulimei Technology Co. LTD, Shenzhen, the People’s Republic of China) was applied to the dorsal skin of each subject’s forearms. Then, photographs of these subject’s skin were taken before and after decontamination of the simulated contaminant by using either decontamination method 1 or 2. Each of the subjects underwent both decontamination methods in separate trials, with each subject using one forearm for decontamination method 1 and their other forearm for decontamination method 2. Discrete points of contamination were quantified on the photographs that were taken with the skin illuminated by ambient visible light or ultraviolet light (395nm, Roceei ultraviolet flashlight, China).

Under visible light, no residual contamination was seen by inspecting photographs taken after decontaminating with either method. Under ultraviolet light, less visible contamination was seen by inspecting photographs taken after decontaminating with method 1 than after decontaminating with method 2.

In this study, skin decontamination with water irrigation was superior to skin decontamination without water irrigation.

The importance of companion animals in the daily lives of people, and the increasing incidence and severity of natural disasters impacting people and their animals, is very well documented. However, despite the advancement of companion animal response capabilities, decontamination remains an inconsistently implemented component of disaster response. The challenge for local authorities is their need for planning factors and protocols specific to companion animal decontamination which are generally lacking. Data is provided on the average time requirements, water use and containment resources necessary, and the personnel required to decontaminate (decon) a large number of companion dogs.

Sixty-three lightly contaminated, medium weight, short to medium coat, highly tractable dogs (Labradors and Hounds) from a State facility colony were used to determine the water requirements, soap effectiveness, and time required to complete decon (washing/bathing). Data were collected over a 6-mo period using 2 personnel that were randomly assigned to wash the dogs. Difference in weight, bathing time, and water use between groups was evaluated using a 2-tailed 2-sample t-test for independent data.

The time and water requirements were significantly different between medium coated dogs and short coated dogs. On average, for a short coated dog, the amount of time to complete decon was 7 min, and the amount of water was 8-10 gal. For medium coated dogs, the time increased to 10-12 min to complete the process and 12-15 gal water.

The results of this study provide important insights emergency management planners, animal response team members, and community personnel tasked with implementation of mass decontamination of companion dogs following a natural or man-made disaster.

The objectives of this study were to: validate current capacity estimates for radiological emergency response by collecting time motion observations from stations that would be used for screening and decontaminating populations, and use collected times to evaluate potential impact on current throughput calculations.

Time observations were collected at 11 functional radiation exercises across the country and aggregated for analysis for population monitoring activities, including contamination screening, decontamination, and registration. Collected times were compared to published estimates in current planning guidance, and evaluated to determine the suitability of using exercise observations to estimate throughput capacity.

2532-time observations were collected from 11 functional exercises. Of those, 2380 were validated and used for analysis. Contamination screening times varied greatly from current guidance, ranging from 19% below to 267% above existing estimates. Measurements indicate that capacity to perform contamination screening is significantly overestimated when using current estimates of service times and calculations when compared to observed aggregate service times.i

Aggregate service time data presented in this study can be used to yield a more realistic estimate of capacity to respond to a radiation event.

This study examined the characteristics of severe patients after the Great East Japan Earthquake in 2011.

Cases in the Futaba area were extracted using the dispatch database of the doctor helicopter and flight-nurse records from March 11, 2008, till March 10, 2014. The period before March 11, 2011, was defined as ‘pre-earthquake’ and the period after March 11, 2011, as ‘post-earthquake’ to compare the recorded data.

Of the 128 total recorded cases, 78 were dispatched during the pre-earthquake period and 50 during the post-earthquake period. The number of patients with physical trauma following the earthquake included 4 patients (33.3%) in 2011, 7 patients (43.7%) in 2012, and 13 patients (59.1%) in 2013. However, the increase in number of requests was not statistically significant (P = 0.33). All 4 incidents of physical trauma in 2011, and 3 out of 7 incidents in 2012, occurred at the power plants. A total of 4 incidents occurred at decontamination worksites in 2013.

It is of primary importance for hospitals to anticipate physical trauma cases during the reconstruction phase following a disaster, and develop a system for patients with physical trauma in the short- and long-term.

The survivability of mass casualties exposed to a chemical attack is dependent on clinical knowledge, evidence-based practice, as well as protection and decontamination capabilities. The aim of this systematic review was to identify the knowledge gaps that relate to an efficient extraction and care of mass casualties caused by exposure to chemicals.

This systematic review was conducted from November 2018 through September 2020 in compliance with Cochrane guidelines. Five databases were used (MEDLINE, Web of Science Core Collection, Embase, Cochrane, and CINAHL) to retrieve studies describing interventions performed to treat victims of chemical attacks (protection, decontamination, and treatment). The outcomes were patient’s health condition leading to his/her stabilization (primary) and death (secondary) due to interventions applied (medical, protection, and decontamination).

Of the 2,301 papers found through the search strategy, only four publications met the eligibility criteria. According to these studies, the confirmed chemical poisoning cases in acute settings resulting from the attacks in Matsumoto (1994), Tokyo (1995), and Damascus (2014) accounted for 1,333 casualties including 11 deaths. No study reported comprehensive prehospital clinical data in acute settings. No mention was made of the integration of specialized capabilities in medical interventions such as personal protective equipment (PPE) and decontamination to prevent a secondary exposure. Unfortunately, it was not possible to perform the planned meta-analysis.

This study demonstrated gaps in clinical knowledge application regarding the medical extraction of casualties exposed during a chemical attack. Further research is required to optimize clinical practice integrating mixed capabilities (protection and decontamination) for the patient and medical staff.

Hazardous material (HAZMAT) protocols require health care providers to wear personal protective equipment (PPE) when caring for contaminated patients. Multiple levels of PPE exist (level D - level A), providing progressively more protection. Emergent endotracheal intubation (ETI) of victims can become complicated by the cumbersome nature of PPE.

The null hypothesis was tested that there would be no difference in time to successful ETI between providers in different types of PPE.

This randomized controlled trial assessed time to ETI with differing levels of PPE. Participants included 18 senior US Emergency Medicine (EM) residents and attendings, and nine US senior Anesthesiology residents. Each individual performed ETI on a mannequin (Laerdal SimMan Essential; Stavanger, Sweden) wearing the following levels of PPE: universal precautions (UP) controls (nitrile gloves and facemask with shield); partial level C (PC; rubber gloves and a passive air-purifying respirator [APR]); and complete level C (CC; passive APR with an anti-chemical suit). Primary outcome measures were the time in seconds (s) to successful intubation: Time 1 (T1) = inflation of the endotracheal tube (ETT) balloon; Time 2 (T2) = first ventilation. Data were reported as medians with Interquartile Ranges (IQR, 25%-75%) or percentages with 95% Confidence Intervals (95%, CI). Group comparisons were analyzed by Fisher’s Exact Test or Kruskal-Wallis, as appropriate (alpha = 0.017 [three groups], two-tails). Sample size analysis was based upon the power of 80% to detect a difference of 10 seconds between groups at a P = .017; 27 subjects per group would be needed.

All 27 participants completed the study. At T1, there was no statistically significant difference (P = .27) among UP 18.0s (11.5s-19.0s), PC 21.0s (14.0s-23.5s), or CC 17.0s (13.5s-27.5s). For T2, there was also no significant (P = .25) differences among UP 24.0s (17.5s-27.0s), PC 26.0s (21.0s-32.0s), or CC 24.0s (19.5s-33.5s).

There were no statistically significant differences in time to balloon inflation or ventilation. Higher levels of PPE do not appear to increase time to ETI.

Having experienced the Tokyo subway sarin attack in 1995, Japan has established extremely strict rules on handling injured victims before they are sent to a hospital. As a result, it takes a long time before rescue actions are taken. This report aims to propose a reform to change the system that focuses on saving lives.

First, the issues in firefighting on sites that currently present problems in Japan were identified. Then, Japanese guidelines were compared with those that were considered in other countries. Based on this, an ideal way of running rescue operations was examined, and a proposal to save many lives was made. This research was conducted with funding from the Ministry of Health, Labour, and Welfare of Japan (MHLW; Chiyoda, Tokyo, Japan).

In addition to preventing secondary injuries, the temporal aspect of rescuing people early with the clear goal of saving many lives was emphasized. Priority was given to measures against nerve agents to prevent secondary injuries, which put the rescuers’ lives at risk. Possible decontamination methods were pursued before choosing the one that was most appropriate. A linear algorithm was used to determine which decontamination method could be started immediately, and then the gradual use of equipment was recommended. Even if Level A personal protective equipment (PPE) and other dedicated equipment and materials cannot be procured, the possibility of starting rescue activities under certain condition using regular equipment was pointed out. The need for a system for possible victims who would require support, such as foreigners, the handicapped, and elderly people, was also identified. Japan limits the scope of activities that can be undertaken by emergency medical technicians (EMTs) on-site. The way in which on-site medical care can be provided with future legal revisions in mind was also discussed.

There is an urgent need to build a framework in which rescue activities can take place so that the number of deaths would not rise, even if sarin and other poisons are scattered.

A Chemical, Biological, Radiological, Nuclear, and explosive (CBRNe) event is an emergency which can result in injury, illness, or loss of life. The emergency department (ED) as a health system is at the forefront of the CBRNe response with staff acting as first receivers. Emergency departments are under-prepared to respond to CBRNe events - recognizing key factors which underlie the ED CBRNe response is crucial to provide evidence-based knowledge to inform policies and, most importantly, clinical practice.

Challenges in detection, decontamination, and diagnosis are associated with the ED CBRNe response when faced with self-presenting patients.

A systematic review was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An in-depth search strategy was devised to identify studies which focused on the ED and CBRNe events. The inclusion criteria were stringent in terms of the environment (ED), participants (first receivers), situation (CBRNe response), and actions (detection, decontamination, and diagnosis). Fifteen databases and topic-specific journals were searched. Studies were critically appraised using the Mixed Methods Appraisal Tool (MMAT). Papers were thematically coded and synthesized using NVivo 10 (QSR International Ltd, Melbourne, Australia).

Sixty-seven full-text papers were critically appraised using the MMAT; 70% were included (n = 60) as medium- or high-quality studies. Data were grouped into four themes: preparedness, response, decontamination, and personal protective equipment (PPE) problems.

This study has recognized the ED as a system which depends on four key factors - preparedness, response, decontamination, and PPE problems - which highlight challenges, uncertainties, inconsistencies, and obstacles associated with the ED CBRNe response. This review suggests that response planning and preparation should be considered at three levels: organizational (policies and procedures); technological (decontamination, communication, security, clinical care, and treatment); and individual (willingness to respond, PPE, knowledge, and competence). Finally, this study highlighted that there was a void specific to detection and diagnosis of CBRNe exposure on self-presenting patients in the ED.

The review identified concerns for both knowledge and behaviors which suggests that a systems approach would help understand the ED response to CBRNe events more effectively. The four themes provide an evidence-based summary for the state of science in ED CBRNe response, which can be used to inform future policies and clinical procedures.

RazakS, HignettS, BarnesJ. Emergency Department Response to Chemical, Biological, Radiological, Nuclear, and Explosive Events: A Systematic Review. Prehosp Disaster Med. 2018;33(5):543–549.

The present study aimed to provide a comprehensive assessment of Swiss hospital disaster preparedness in 2016 compared with the 2006 data.

A questionnaire was addressed in 2016 to all heads responsible for Swiss emergency departments (EDs).

Of the 107 hospitals included, 83 (78%) returned the survey. Overall, 76 (92%) hospitals had a plan in case of a mass casualty incident, and 76 (93%) in case of an accident within the hospital itself. There was a lack in preparedness for specific situations: less than a third of hospitals had a specific plan for nuclear/radiological, biological, chemical, and burns (NRBC+B) patients: nuclear/radiological (14; 18%), biological (25; 31%), chemical (27; 34%), and burns (15; 49%), and 48 (61%) of EDs had a decontamination area. Less than a quarter of hospitals had specific plans for the most vulnerable populations during disasters, such as seniors (12; 15%) and children (19; 24%).

The rate of hospitals with a disaster plan has increased since 2006, reaching a level of 92%. The Swiss health care system remains vulnerable to specific threats like NRBC. The lack of national legislation and funds aimed at fostering hospitals’ preparedness to disasters may be the root cause to explain the vulnerability of Swiss hospitals regarding disaster medicine. (Disaster Med Public Health Preparedness. 2019;13:433-439)

Great demands have been placed on disaster medicine educators. There is a need to develop innovative methods to educate Emergency Physicians in the ever-expanding body of disaster medicine knowledge. The authors sought to demonstrate that video-based learning (VBL) could be a promising alternative to traditional learning methods for teaching disaster medicine core competencies.

The objective was to compare VBL to traditional lecture (TL) for instructing Emergency Medicine residents in the American College of Emergency Physicians (ACEP; Irving, Texas USA) disaster medicine core competencies of patient triage and decontamination.

A randomized, controlled pilot study compared two methods of instruction for mass triage, decontamination, and personal protective equipment (PPE). Emergency Medicine resident learning was measured with a knowledge quiz, a Likert scale measuring comfort, and a practical exercise. An independent samples t-test compared the scoring of the VBL with the TL group.

Twenty-six residents were randomized to VBL (n=13) or TL (n=13). Knowledge score improvement following video (14.9%) versus lecture (14.1%) did not differ significantly between the groups (P=.74). Comfort score improvement also did not differ (P=.64) between video (18.3%) and lecture groups (15.8%). In the practical skills assessment, the VBL group outperformed the TL group overall (70.4% vs 55.5%; P<.0001), with significantly better performance in donning PPE and decontamination. Although not part of the original study design, a three-month post-hoc analysis was performed. When comparing the pre-intervention and three-month post-hoc performances, there were no significant differences in knowledge increases between VBL versus TL (P=.41) or in comfort (P=.39).

Video modules can be as effective as TL when utilized to train Emergency Medicine residents in the ACEP disaster medicine core competencies of patient triage and decontamination.

Curtis HA , Trang K , Chason KW , Biddinger PD . Video-Based Learning vs Traditional Lecture for Instructing Emergency Medicine Residents in Disaster Medicine Principles of Mass Triage, Decontamination, and Personal Protective Equipment. Prehosp Disaster Med. 2018;33(1):7–12.

To compare the microbiological efficacy, turnaround time, cost, convenience, and patient and user tolerance of Tristel Trio Wipes, PeraSafe solution and Cidex OPA solution for the high-level disinfection of flexible nasendoscopes.

Flexible nasendoscopes were used in routine clinical encounters. They were then disinfected with one of the three disinfectant methods. Surveillance cultures were taken before and after each disinfection process. Data relating to each of the study parameters were recorded.

Positive bacterial cultures were discovered on nasendoscopes disinfected with PeraSafe and Cidex OPA. Tristel Trio Wipes have no capital outlay cost, the lowest running cost, the greatest convenience and the fastest turnaround time. PeraSafe had a faster turnaround time than Cidex OPA, and lower running costs.

Tristel Trio Wipes are equal to PeraSafe and Cidex OPA in terms of microbiological efficacy. Turnaround time and cost are dramatically reduced when using Tristel Trio Wipes compared to the other disinfectant methods.

The preparedness level of Finnish Emergency Medical Services (EMS) for treating chemical emergencies is unknown. The aim of this study was to survey the preparedness level of EMS systems for managing and handling mass-casualty chemical incidents in the prehospital phase in Finland.

The study hypothesis was that university hospital districts would have better clinical capability to treat patients than would central hospital districts in terms of the number of patients treated in the field within one hour after dispatching as well as patients transported to hospital within one hour or two hours after dispatching.

This cross-sectional study was conducted as a Webropol (Wuppertal, Germany) survey. All hospital districts (n=20) in continental Finland were asked about their EMS preparedness level in terms of capability of treating and transporting chemically affected patients in the field. Their capability for decontamination of affected patients in the field was also inquired.

University hospital district-based EMS systems had at least 20% better absolute clinical capacity than central hospital-based EMS systems for treating chemically affected patients concerning all treatments inquired about, except the capacity for non-invasive ventilation (NIV)/continuous positive airway pressure (CPAP) treatment in the field. Overall, there was a good level of preparedness for treating chemical accident patients with supplemental oxygen, bronchodilators, and inhaled corticosteroids. Preparedness for providing antidote therapy in cases of cyanide gas exposure was, in general, low. The variation among the hospital districts was remarkable. Only nine of 15 central hospital district EMS had a mobile decontamination unit available, whereas four of five university hospital districts had one.

Emergency Medical Services capacity in Finland for treating chemically affected patients in the field needs to be improved, especially in terms of antidote therapy. Mobile decontamination units should be available in all hospital districts.

JamaTJ, KuismaMJ. Preparedness of Finnish Emergency Medical Services for Chemical Emergencies. Prehosp Disaster Med. 2016;31(4):392–396.

To analyze acute hazardous substance release surveillance data for events involving secondary contamination of hospital emergency departments (EDs). Secondary contamination of EDs may occur when a patient exposed to a hazardous chemical is not decontaminated before arrival at the ED and when ED staff are not wearing appropriate personal protective equipment. This can result in adverse health outcomes among department personnel, other patients, and visitors. Even events without actual secondary contamination risk can be real in their consequences and require the decontamination of the ED or its occupants, evacuation, or temporary shutdown of the ED.

Events involving secondary contamination were identified by using the Hazardous Substances Emergency Events Surveillance system and the National Toxic Substance Incidents Program from 2007 to 2013.

Five incidents involving the threat of secondary contamination (0.02% of all events reported to the surveillance systems [n=33,001]) were detected and are described. Four incidents involved suspected secondary contamination in which the facility was evacuated or shut down.

These results suggest that although rare, incidents involving secondary contamination continue to present a hazard for emergency departments. Suggested best practices to avoid secondary contamination have been described. Hospitals should be made aware of the risks associated with secondary contamination and the need to proactively train and equip staff to perform decontamination. (Disaster Med Public Health Preparedness. 2016;10:199–202)