With help from researchers from the University of Hertfordshire in the United Kingdom, The US Department of Health and Human Services (HHS) has updated guidance on how best to decontaminate after mass chemical exposure. This second edition of Primary Response Incident Scene Management (PRISM) incorporates new scientific evidence on emergency self-decontamination, hair decontamination, and the interactions of chemicals with hair.
The goal of working with the University of Hertfordshire was to help emergency managers and first responders make “fundamental and fast decisions on how to save the greatest number of lives in chemical emergencies,” says Rick Bright, PhD, director of the Biomedical Advanced Research and Development Authority (BARDA).
The study included a large-scale exercise in which > 80 volunteers were dosed with a chemical warfare agent simulant to quantify the efficacy of different forms of decontamination.
Notably, the research demonstrates that immediate “dry” decontamination—wiping down the victim with any absorbent material (eg, toilet paper, paper towels, wound dressings) can be highly effective on its own and can be done by affected individuals themselves under the instruction of first responders. The dry decontamination step removes up to 99% of contamination and minimizes the accumulation of hazardous material in the subsequent steps.
The new guidance also expands on the effects of the “triple protocol,” a combined decontamination strategy. The 3 steps of that protocol—dry decontamination, wet decontamination using water deluges from fire trucks, and technical decontamination—have been shown to remove 99.9% of chemical contamination. Moreover, the latest clinical evidence indicates that the 3-step approach is faster and more effective than traditional methods for treating chemically contaminated patients.
The guideline also addresses how communities can prepare for chemical emergencies and what to do after the event, such as providing washcloths, towels, blankets, and temporary clothing.
Federal experts and the researchers devised the Algorithm Suggesting Proportionate Incident Response Engagement (ASPIRE), a decision-support tool to help emergency management planners and responders decide which decontamination approach suits a given situation. Using the algorithm, they can tailor plans and responses based on the chemical and type of exposure, how quickly the chemical evaporates, and the amount of time passed since exposure.
ASPIRE and the guidance are integrated into the Chemical Hazards Emergency Medical Management (CHEMM), a web-based resource and suite of preparedness and emergency response tools. The developers also plan to incorporate them into a mobile app.
PRISM is available at www.medicalcountermeasures.gov.