Open Access Open Access  Restricted Access Subscription or Fee Access

Managing CBRN mass casualty incidents at hospitals—Find a simple solution for a complex problem: A pilot study

Maximilian Kippnich, MD, Nora Schorscher, MD, Helmut Sattler, Uwe Kippnich, Patrick Meybohm, MD, Thomas Wurmb, MD

Abstract


Objective: Chemical, biological, radiological, and nuclear (CBRN) incidents are a major challenge for emergency medical services and the involved hospitals, especially if decontamination needs to be performed nearby or even within the hospital campus. The University Hospital Wuerzburg has developed a comprehensive and alternative CBRN response plan. The focus of this study was to proof the practicability of the concept, the duration of the decontamination process, and the temperature management.

Methods: The entire decontamination area can be deployed 24/7 by the hospitals technical staff. Fire and rescue services are responsible for the decontamination process itself. This study was designed as full-scale exercise with 30 participants.

Results: The decontamination area was ready for operation within 30 minutes. The decontamination of the four simulated patients took 5.5 ± 0.6 minutes (mean ± SD). At the end of the decontamination process, the temperature of the undressed upper body of the training patients was 27.25 ± 1°C (81.05 ± 2°F) (mean ± SD) and the water in the shower was about 35°C (95°F).

Conclusion: The presented concept is comprehensive and simple for a best possible care during CBRN incidents at hospitals. It ensures wet decontamination by Special Forces, while the technical requirements are created by the hospital.


Keywords


mass casualty incident, terrorism, decontamination, emergency preparedness

Full Text:

PDF

References


Titus E, Lemmer G, Slagley J, et al.: A review of CBRN topics related to military and civilian patient exposure and decontamination. Am J Disaster Med. 2019; 14(2): 137-149.

Baker D: Civilian exposure to toxic agents: Emergency medical response. Prehosp Disaster Med. 2004; 19(2): 174-178.

Aydin B: Global characteristics of chemical, biological, and radiological poison use in terrorist attacks. Prehosp Disaster Med. 2020; 35(3): 260-266.

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 Prep. 2014; 8(3): 260-266.

Power S, Symons C, Carter H, et al.: Mass casualty decontamination in the United States: An online survey of current practice. Health Secur. 2016; 14(4): 226-236.

Chilcott RP, Mitchell H, Matar H: Optimization of nonambulant mass casualty decontamination protocols as part of an initial or specialist operational response to chemical incidents. Prehosp Emerg Care. 2019; 23(1): 32-43.

Chilcott RP, Larner J, Matar H: UK’s initial operational response and specialist operational response to CBRN and HazMat incidents: A primer on decontamination protocols for healthcare professionals. Emerg Med J. 2019; 36(2): 515.2-515.23.

Amlôt R, Carter H, Riddle L, et al.: Volunteer trials of a novel improvised dry decontamination protocol for use during mass casualty incidents as part of the UK’S initial operational response (IOR). PLoS One. 2017; 12(6): e0179309.

Razak S, Hignett S, Barnes J: Emergency department response to chemical, biological, radiological, nuclear, and explosive events: A systematic review. Prehosp Disaster Med. 2018; 33(5): 543-549.

Koenig KL, Boatright CJ, Hancock JA, et al.: Health care facility-based decontamination of victims exposed to chemical, biological, and radiological materials. Am J Emerg Med. 2008; 26(1): 71-80.

Kako M, Hammad K, Mitani S, et al.: Existing approaches to chemical, biological, radiological, and nuclear (CBRN) education and training for health professionals: Findings from an integrative literature review. Prehosp Disaster Med. 2018; 33(2): 182-190.

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

Brizio A, Hubert J-C, Hennequin B, et al.: Swift and low-cost surge in chemical threat response: Is it possible? The experience of a French hospital. Disaster Med Public Health Prep. 2018; 12(5): 649-656.

Markel G, Krivoy A, Rotman E, et al.: Medical management of toxicological mass casualty events. Isr Med Assoc J. 2008; 10(11): 761-766.

Ahmadi Marzaleh M, Rezaee R, Rezaianzadeh A, et al.: Developing a model for hospitals’ emergency department preparedness in radiation and nuclear incidents and nuclear terrorism in Iran. Bull Emerg Trauma. 2019; 7(3): 300-306.

Larner J, Jones DR, Price SC, et al.: Modified static diffusion cells for decontamination modelling. Toxicology. 2010; 278(3): 351-352.

Amlôt R, Larner J, Matar H, et al.: Comparative analysis of showering protocols for mass-casualty decontamination. Prehosp Disaster Med. 2010; 25(5): 435-439.

Chilcott RP, Larner J, Durrant A, et al.: Evaluation of US federal guidelines (primary response incident scene management [PRISM]) for mass decontamination of casualties during the initial operational response to a chemical incident. Ann Emerg Med. 2019; 73(6): 671-684.




DOI: https://doi.org/10.5055/jem.0650

Refbacks

  • There are currently no refbacks.


Copyright (c) 2022 Journal of Emergency Management