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Decontamination effectiveness and the necessity of innovation in a large-scale disaster simulation

Esli Osmanlliu, MDCM, FRCPC, Ilana Bank, MDCM, FRCPC, FAAP, Elene Khalil, MDCM, FRCPC, FAAP, Peter Nugus, PhD, Margaret Ruddy, RN, BSc Nursing, MMgmt, Meredith Young, PhD

Abstract


Background: Chemical, biological, radiologic, nuclear, and explosive (CBRNE) events threaten the health and integrity of human populations across the globe. Effective decontamination is a central component of CBRNE disaster response.

Objective: This paper provides an objective determination of wet decontamination effectiveness through the use of a liquid-based contaminant proxy and describes the mobilization and adaptation of easily available materials for the needs of decontamination in pediatric victims.

Methods: In this in-situ disaster simulation conducted at a pediatric hospital, decontamination effectiveness was determined through a liquid-based contaminant proxy, and standard burn charts to systematically estimate affected total body surface area (TBSA) in 39 adult simulated patients. Two independent raters evaluated TBSA covered by the contaminant before and after decontamination.

Results: On average, simulated patients had 59 percent (95 percent CI [53, 65]) of their TBSA covered by the simulated contaminant prior to decontamination. Following a wet decontamination protocol, the average reduction in TBSA contamination was 81 percent (95 percent CI [74, 88]). There was high inter-rater reliability for TBSA assessment (intraclass correlation coefficient = 0.83, 95 percent CI [0.68, 0.92]. A modified infant bath was tested during the simulated decontamination of infant mannequins and thereafter integrated to the local protocol.

Conclusion: Wet decontamination can remove more than 80 percent of the initial contaminant found on adult simulated patients. The use of a liquid-based visual tool as a contaminant proxy enables the inexpensive evaluation of decontamination performance in a simulated setting. This paper also describes an innovative, low-cost adaptation of a local decontamination protocol to better meet pediatric needs.


Keywords


decontamination, disaster, code orange, simulation, pediatric

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References


Wax PM: Toxicologic misfortunes and catastrophes in history. In: Hoffman RS, Howland MA, Lewin NA, et al. (eds.): Goldfrank’s Toxicologic Emergencies. 10 ed. New York, NY: McGraw-Hill Education; 2015.

Eckert WG: Mass deaths by gas or chemical poisoning: A historical perspective. Am J Forensic Med Pathol. 1991; 12(2): 119-1125.

Olivieri C, Ingrassia PL, Della Corte F, et al.: Hospital preparedness and response in CBRN emergencies: TIER assessment tool. Eur J Emergency Med. 2017; 24(5): 366-370.

Macintyre AG, Barbera JA, Brewster P: Health care emergency management: Establishing the science of managing mass casualty and mass effect incidents. Disaster Med Public Health Preparedness. 2009; 3(2): 52-58.

Kotora JG: An assessment of Chemical, Biological, Radiologic, Nuclear, and Explosive preparedness among emergency department healthcare providers in an inner city emergency department. Am J Disaster Med. 2015; 10(3): 189-204.

Lyle KC, Milton J, Fagbuyi D, et al.: Pediatric disaster preparedness and response and the nation’s children’s hospitals. Am J Disaster Med. 2015; 10(2): 83-91.

Mortelmans LJ, Van Boxstael S, De Cauwer HG, et al.: Preparedness of Belgian civil hospitals for chemical, biological, radiation, and nuclear incidents: Are we there yet? Eur J Emergency Med. 2014; 21(4): 296-300.

Thompson T, Lyle K, Mullins SH, et al.: A state survey of emergency department preparedness for the care of children in a mass casualty event. Am J Disaster Med. 2009; 4(4): 227-232.

Mortelmans LJM, Gaakeer MI, Dieltiens G, et al.: Are Dutch hospitals prepared for chemical, biological, or radionuclear incidents? A survey study. Prehospital Disaster Med. 2017; 32(5): 483-491.

Heon D, Foltin GL: Principles of pediatric decontamination. YCPEM Clin Pediatr Emergency Med. 2009; 10(3): 186-194.

Michael WS, Julia AM, Committee on Environmental H, Committee on Infectious D: Chemical-biological terrorism and its impact on children. Pediatrics. 2006; 118(3): 1267-1278.

Institute of Medicine: Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. 2007. DOI: 10.17226/11655.

Alix-Seguin L, Lode N, Chamorro E, et al.: Et si cÈtait des enfants†? Adaptation de la prise en charge mÈdicale en cas d’attentats terroristes avec de nombreux enfants victimes. Arch Pediatr. 2017; 24(3): 280-287.

Kaufman BJ: Hazardous materials incident response. In: Hoffman RS, Howland MA, Lewin NA, et al. (eds.): Goldfrank’s Toxicologic Emergencies. 10 ed. New York, NY: McGraw-Hill Education; 2015.

Cox RD: Decontamination and management of hazardous materials exposure victims in the emergency department. Ann Emergency Med. 1994; 23(4): 761-770.

Cibulsky SM, Sokolowski D, Lafontaine M, et al.: Mass casualty decontamination in a chemical or radiological/nuclear incident with external contamination: Guiding principles and research needs. PLoS currents. 2015; 7.

Guidelines for mass casualty decontamination during an Hazmat/weapon of mass destruction incident - volumes I and II. Maryland: United States Army Research, Development, and Engineering Command; 2013.

Leary AD, Schwartz MD, Kirk MA, et al.: Evidence-based patient decontamination: An integral component of mass exposure chemical incident planning and response. Disaster Med Public Health Preparedness. 2014; 8(3): 260-266.

Koenig KL: Strip and shower: The duck and cover for the 21st century. Ann Emergency Med. 2003; 42(3): 391-394.

Chilcott RP: Managing mass casualties and decontamination. Environ Int. 2014; 72: 37-45.

Bodurtha P, Gudgin Dickson EF: Decontamination science and Personal Protective Equipment (PPE) selection for Chemical Biological-Radiological-Nuclear (CBRN) events. 2016:89. Centre for Security Science, Canadian Safety and Security Program, CBRN Research and Technology Initiative, Project. CSSP-2013-TI-1036 2016. Available at http://cradpdf.drdc-rddc.gc.ca/PDFS/unc263/p805114_A1b.pdf. Accessed April 19, 2017.

Zhao X, Dughly O, Simpson J: Decontamination of the pediatric patient. Curr Opin Pediatr. 2016; 28(3): 305-309.

Gamble A, Bearman M, Nestel D: A systematic review: Children and adolescents as simulated patients in health professional education. Adv Simul. 2016; 1(1): 1-16.

Services USDoHH: Decontamination procedures. National Library of Medicine. Available at https://chemm.nlm.nih.gov/decontamination.htm. Updated April 17, 2020. Accessed May 10, 2020.

Leary AD, Schwartz MD, Kirk MA, et al.: Evidence-based patient decontamination: An integral component of mass exposure chemical incident planning and response. Disaster Med Public Health Preparedness. 2014; 8(3): 260-266.

van Doremalen N, Bushmaker T, Morris DH, et al.: Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. New England J Med. 2020; 382(16): 1564-1567.

Feldman O, Meir M, Shavit D, et al.: Exposure to a surrogate measure of contamination from simulated patients by emergency department personnel wearing personal protective equipment. JAMA. 2020; 323(20): 2091-2093.




DOI: https://doi.org/10.5055/ajdm.2021.0388

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