Results of an in-hospital CBRN decontamination and stabilization exercise

Research output: Unpublished contribution to conferencePoster

Abstract

Recent reports of organophosphate intoxications indicate the need of hospital preparedness for CBRNe events. Lessons learned from the 1995 Tokyo Sarin attack underline the need for adequate triage, respiratory support, antidotes, decontamination and protection of healthcare personnel. This stabilization and decontamination process requires expensive materials, specialized knowledge and frequent training. To our knowledge, there are only published studies on certain subsections of this stabilization process. All-inclusive real-life data is unavailable in the literature.


In Belgium, the Armed Forces operate a specialized prehospital CBRNe Mobile Medical Team (CBRNe MMT) consisting of 3 paramedics, a doctor and a nurse. This team is trained in prehospital stabilization of contaminated victims while wearing personal protective environment (PPE) clothing. The purpose of this MMT is forward medical stabilisation in a potentially vapour contaminated area, before patients undergo decontamination. They can either be deployed at the disaster site or at a local hospital receiving contaminated victims.


In order to estimate the capacity of this approach, a real-life decontamination exercise was designed modeling a fictitious VX attack. The exercise consists of the arrival of 3 waves of 2 victims in a contaminated ambulance driven by paramedics in PPE. All three waves have similar parameters and treatment requirements. The victims were triaged at the disaster site and consisted of 1 Immediate (red) victim and 1 Minimal (green) victim. Victims are unloaded straight in a forward medical post operated by the CBRNe MMT, stabilized and then guided to a disrobing area and a wet decontamination unit, spanning a distance of 30 meters.


The immediate victim was modelled using a mannequin and needs stabilization by the CBRNe MMT. It requires intubation, oxygen therapy, intramuscular antidote application and intra-osseous access (including local powdered decontamination). The goal of this treatment is stabilization, so the victim can survive decontamination and receive further in-hospital care without risks to hospital personnel. The ambulant victim receives the same antidotes by intramuscular auto-injector and is guided through the disrobing and showering process by doctors and nurses in PPE.
Total duration (and 95% CI in brackets) was for T1 victims on average 15m12s (+/- 6m48s). The average duration was 39s (+- 13s) for unloading, 7m12s (+- 3m8s) for stabilization, 2m3s (+- 1m42s) for disrobing and 5m19s (+- 1m45s) for wet decontamination. Total duration (and 95% CI in brackets) was for the T3 victims on average 5m50s (+/- 2m39s). Included in this are unloading 17s (+- 7s), 1m41 s (+-5s) for stabilization, 56s (+- 21s) for disrobing and 2m45s (+- 2m6s) for decontamination.


This exercise, to our knowledge, is the first to attempt to fully simulate the reception of a contaminated victim stream. Limitations include the limited number of victims, the usage of healthy volunteers and a scenario with a known agent. We believe however that these results are applicable for other hospitals given the short distance between the decontamination unit and ambulance terminal.
Further research should include stress testing of the reception of wild evacuees and including visual and respiratory impairment of ambulant victims in the decontamination process.
Original languageEnglish
Publication statusPublished - 12 Oct 2019
EventEUSEM 2019: 13th European congress on Emergency Medicine - Prague, Czech Republic, Prague, Czech Republic
Duration: 12 Oct 201916 Oct 2019

Conference

ConferenceEUSEM 2019
CountryCzech Republic
CityPrague
Period12/10/1916/10/19

Keywords

  • VX
  • Nerve Agent
  • Decontamination
  • Hospital Reception
  • simulation exercises
  • CBRNe

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