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Guidelines for Military Mass Casualty Decontamination Operations During a Domestic HAZMAT/Weapon of Mass Destruction Incident HAZMAT, whether chemical, biological, or radiological, are present in all aspects of everyday life. HAZMAT incidents, either accidental or intentional, have increased in recent years. The following examples show the increasingly effective use of HAZMAT/WMDs by terrorists, both on American and foreign soil: • 1984 Salmonella release in a salad bar in Oregon (0 killed, 715 sickened) 3 • 1995 sarin attack in the Tokyo subway (12 killed, 3800 injured), which was preceded by a test run in 1994 (7 killed, 500 injured) 4 • 2001 anthrax-laden letters in the U.S. mail (5 killed, 17 sickened) 5 • 2006 assassination of Alexander Litvinenko by polonium-210-induced acute radiation syndrome • Regularly occurring use of chlorine-laden bombs in Iraq 6 Incidents in England, France, and Germany, and countless attacks contributed to Al Qaeda show that this problem does not just affect American soil. HAZMAT is available and transported in large quantities, which makes them easier to access by terrorists. Hundreds of casualties may be produced a large-scale HAZMAT or WMD incident, whether accidental or intentional. MCD is one of the key elements in consequence management planning, response operations, and recovery. MCD can take many forms and use many different techniques. Each technique can be just as effective as another in removing contamination from casualties. These Guidelines present baseline and alternate MCD operations that are based on military and civilian guidance and doctrine. However, actual MCD operations are based on available equipment, hazard, time, number of casualties, environmental conditions, and resources at the scene. MCD operations must be adaptable, innovative, and, when necessary, improvisational. 7 This document describes MCD operations that imply a combination of a large number of casualties and incident conditions that challenges or exceeds a jurisdiction’s ability to provide basic life saving services. 2.0 Objective and Scope This document is designed to provide military personnel with a supplemental tool to plan and train mass decontamination operations. Specifically, these Guidelines address the decontamination of an overwhelming number of people resulting from a HAZMAT/WMD incident in a populated area. Mass casualty decontamination is NOT an exact science. The diversity of chemical, biological, and radiological agents that have the capability to produce casualties that need decontamination prior to medical care is overwhelming. The lack of empirical evidence from large-scale MCD incidents requires that planning involve an appropriate MCD process that causes the least harm and does the most good for the majority of casualties. Military and civilian responders conduct MCD operations after a HAZMAT/WMD incident to save lives, minimize suffering, and prepare casualties for follow-on medical care. These Guidelines explain the theory behind suggested baseline operational techniques, but the listed and implied steps are not definitive. The actual incident and associated conditions itself dictates what specific 2 Original
Guidelines for Military Mass Casualty Decontamination Operations During a Domestic HAZMAT/Weapon of Mass Destruction Incident and modified techniques are necessary to effectively conduct MCD operations. The foundation of these Guidelines includes best practices and lessons learned from responders around the nation as well as military doctrine and training standards. To assist in bridging the gap between military and civilian personnel, these Guidelines directly compare MCD principles, decontamination equipment, and language used by both personnel. The differences and similarities in MCD principles are highlighted by text boxes that identify common military and civilian techniques and procedures. Civilians follow the guidance mandated by DHS and FEMA, which includes the National Response Framework (NRF), National Incident Management System (NIMS), and the Target Capabilities List (TCL). 8-11 The TCL describes capabilities that civilian responders need to have to prevent, protect, respond to, and recover from incidents, including MCD operations. 11 The TCL also provides a performance standard that is based on the Universal Task List (UTL), 12 against which emergency preparedness activities can be evaluated and assessed. Throughout these Guidelines, critical MCD tasks identified in the UTL are compared to the MCD tasks presented in the USACBRNS Mass Casualty Decontamination Collective Tasks. 2 An equipment cross-reference guide compares military decontamination equipment to that commonly used by civilian responders. The guide in Appendix D gives military personnel an idea of the types of equipment they might encounter when assisting civilians during a mass casualty incident. While language is not the focus of these Guidelines, it is important to know differences between military and civilian decontamination terminology. These Guidelines are consistent with NIMS, which is a core set of doctrines, concepts, principles, terminology, and organizational processes related to emergency management. NIMS guidance enables effective, efficient, and collaborative incident management. The scope of this best practices document does not include a definitive or universally agreed upon metric for determining that “safe” decontamination has been performed. Currently, how clean-is-clean is not operationally defined for the full spectrum of chemical and biological hazards. For the purposes of this document, clean is defined as undetectable or as low as reasonably achievable (ALARA) on the casualty’s body by field chemical, biological, and radiological detection equipment as determined by the Incident Commander. In addition, it is not meant to include infectious outbreaks for which casualty decontamination is not necessary. 13,14 Postdecontamination levels for radioactive hazards should be determined by the Incident Commander, but they are typically less than twice natural background levels. 15,16 Original 3 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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