Emergency Medicine

MAJOR INCIDENT

Administrative and Legal Issues 459

Specialized responses

A chemical, biological and radiological (CBR) incident requires a specialized
response, necessitating staff to wear specific personal protective equipment (PPE)
and patients to be decontaminated.

1 Personal protective equipment
Get advice as to what constitutes appropriate PPE for the incident, as it is
essential for the safety of staff that appropriate PPE is worn.
(i) PPE may at one extreme require self-contained breathing
apparatus with a full face mask and a protective suit with boots
and gloves for a hazard which presents a significant vapour and
contact threat, or
(ii) A simple face mask, eye protection, gloves, cap, gown and shoe
covers for a relatively minor contact hazard.
(iii) Staff must be constantly aware of the threat of hyperthermia
while using such equipment and any staff member experiencing
symptoms suggestive of heat stress should immediately self-
decontaminate, remove their PPE in a safe area and rehydrate.
(iv) Practice in both donning and removing PPE is essential, as well
as in the process of patient decontamination, for instance during
a mass casualty disaster exercise.

2 Decontamination
(i) Decontamination is the reduction or removal of substances such
that they are no longer a hazard.
(ii) The fire service is responsible for the decontamination of patients
at the scene of a CBR incident.
(iii) As patients may self-present to hospital, staff must have the
equipment, facilities, and training to decontaminate a patient
locally
(a) set up a designated decontamination area in a discrete,
outdoor, well-ventilated space
(b) create a ‘Clean-Dirty line’ between the decontamination area
and the ED
(c) only allow staff wearing appropriate PPE to cross this line
into the decontamination area
(d) conversely, no staff, patients or equipment may cross back
from the decontamination area across this line, unless they
have been decontaminated

• patients from the incident are only allowed to enter the ED
  once they have been decontaminated
  (e) ambulant patients should be capable of self-decontamination,
  having received instruction
  (f) non-ambulant patients are decontaminated by staff.
  (iv) The decontamination process is best determined by the process:
  ‘wet, strip, wash, redress’