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Guidelines for Military Mass Casualty Decontamination Operations During a Domestic HAZMAT/Weapon of Mass Destruction Incident o Cut a hole in the top, big enough for a head, and arm holes on the side. o This bag can be used as covering if no other shelter is available. o A Tyvek-type covering could be used as a gown instead of a trash bag. Bags of personal effects, once identified, closed, and secured, can be placed into large trash cans, large plastic-lined cardboard boxes, 58 or barrels to keep them all together. Some personal effects, such as eyeglasses, hearing aids, walkers, or prosthetic limbs, may be critical for the casualty to be able to function independently. However, such personal effects may be made of porous materials or have numerous crevices that could easily trap contamination. Try to decontaminate the item while the casualty is assisted through the mass decontamination line. Submerse the item into a proper decontaminant if it will not be damaged or destroyed in the process. Have proper monitoring equipment available to verify that the item is thoroughly decontaminated before it is released back to the casualty. The return of such items should be made on a case-by-case basis and done with the approval of a higher authority. Any contact lenses should be removed, discarded, and not reinserted. 8.1.9. Triage INTENT: Sort casualties into groups for decontamination and treatment based on their presenting conditions. Triage is a prioritization system to allow responders to provide the necessary care to as many people as possible. Do not confuse decontamination triage with medical triage. Decontamination triage is performed to determine who should be washed off first. Medical triage is performed to determine who should receive medical treatment first. Triage should be conducted repeatedly throughout the MCD process because a casualty’s status could change. Some response agencies may perform gross decontamination on all casualties as rapidly as possible without performing any triage. However, if decontamination triage is performed, casualties should be separated into these categories: 1. Ambulatory and symptomatic 2. Nonambulatory 3. Ambulatory, non-symptomatic, exposed to contaminant 4. Ambulatory, non-symptomatic, no obvious exposure to contaminant MCD Principles for Triage DHS UTL Tasks • ResB2b 6.1 and 6.2 • ResC1a 5.1, 6.1, 6.2, 6.2.1, 6.2.2, 6.2.3, and 6.3 USACBRNS Tasks • 03-2-5124 Step 3 • 03-2-5126 Step 5 • 03-2-6593 Step 2 The highest priority for decontamination is ambulatory casualties who are symptomatic yet can follow simple directions. They are easiest to decontaminate 40 Original
Guidelines for Military Mass Casualty Decontamination Operations During a Domestic HAZMAT/Weapon of Mass Destruction Incident because they can walk themselves through the decontamination system. The next highest priority is those casualties who are nonambulatory. 1 Remember that some nonambulatory casualties will be extracted once responders can safely access the hot zone wearing appropriate PPE. Based on operational conditions, decontaminating ambulatory casualties may continue in decreasing order of priority until nonambulatory casualties can be physically moved. The next priority is casualties are those that are ambulatory, non-symptomatic, but have been exposed to the contaminant because of their location in relation to the release. The health of these casualties could rapidly deteriorate due to their exposure to the contaminant. Depending upon the degree of exposure, the onset of symptoms could occur at any time during the decontamination process. Decontaminate these casualties as soon as possible after higher priority casualties. The last priority includes those casualties who are ambulatory, non-symptomatic, and who likely were not exposed to the hazard. The Mass Casualty Decontamination Research Team from ECBC states that commanders should, “expect at least a 5:1 ratio of unaffected to affected casualties.” 61 This group of unaffected casualties may also be referred to as “worried well.” Because they are usually the largest group presenting for help, they result in a large logistical hurdle. It is possible that these casualties may not require decontamination. They may instead be sent to another area for observation of delayed onset of symptoms. If the situation and resources allow, the Incident Commander may choose to decontaminate these casualties to provide an additional degree of safety. Casualties who are deemed deceased in the hot zone should be left in place as part of the crime scene as evidence. Place those who die after entering the decontamination process or those who are deemed “expectant” into a morgue away from operations. This gives the decedents appropriate respect while removing visual cues from the remaining casualties as to the severity of the incident. The morgue structure could be a tent or tarps suspended from wires or ropes, or a portable system, such as a trailer. Section 8.5 gives additional Guidelines on mass fatality decontamination operations. Medical triage should be conducted on casualties after gross and mass decontamination to determine the order in which they receive medical care. Many medical triage systems are in routine practice. 62 The most commonly used system in the United States is the Simple Triage and Rapid Treatment (START) system. START was developed in 1983 by Hoag Hospital and the Newport Beach (California) Fire and Marine Department. It is a system by which casualties are triaged as Immediate, Delayed, Minor, or Deceased based on the severity of illness and/or injury. A special medical triage algorithm has been developed for children called JumpSTART. 63 Using the JumpSTART algorithm, all children that did not walk under their own power are evaluated first. Both START and JumpSTART use the same color-coding system, as described below: Original 41 Table of Contents Introduction MCD Equipment Comparison Decontamination Overview MCD Operations Summary Appendix A References Appendix B Acronym List Appendix C Glossary Appendix D MCD Cross- Reference Guide Appendix E CBR Guide Appendix F MCD Decision Trees Appendix G ARNORTH Guidance
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