According to Max Hill, the UK’s new independent reviewer of terrorism laws, Britain faces a level of terror threat it has not seen since the IRA bombings of the 1970s and this would likely include some form of chemical, biological, radiological or nuclear (CBRN) incident. However, the nation’s first responders, the police, and the fire and ambulance services are aware of these growing threats and have been reviewing their responses to chemical incidents and updating their current plans and practices.
In the year 2014, there were 448 CBRN incidents reported to Public Health England (PHE). Of these, 216 were ‘white powder’ incidents, 115 chemical releases, 61 were chemical suicides and 38 were identified as drug incidents relating to home drug laboratories. There were also 778 Hazardous Material (HAZMAT) events that included chemical and microbiological incidents and exposure to radiation.
The UK Home Office has introduced an Initial Operational Response (IOR) programme across all blue light emergency services and to key first responders including the National Health Service (NHS), to improve patient outcomes following HAZMAT contamination or a CBRN incident. Principles of the IOR are applicable to NHS emergency departments, walk-in and urgent care centres or general practices. It is now being rolled out across the NHS in England.
UK Health Boards are also ensuring that all relevant staff are aware of the changes in the decontamination process and are aware of their roles and responsibilities in the event of a chemical contamination incident. This will require regular training for all staff that may be involved in managing chemically contaminated people including reception staff, who are most likely to come into first contact with a patient requiring decontamination, as well triage and assessment staff. All staff should be aware of the need for early identification of chemical contamination, early disrobing, local protocols for containment, isolation and lockdown, alerting and escalating mechanisms etc.
Each Health Board should have a lead officer identified to deliver the training and have an established documented training programme for ensuring staff receive appropriate initial and refresher training. It is important that the decontamination process is consistent with that undertaken by the Emergency Services and that joint training is undertaken by the Hazardous Area Response Team (HART) and Special Operations Response Team (SORT) teams.
Changes to existing chemical decontamination procedures follow the findings of the European Union (EU) Optimisation Research Chemical Incident Decontamination Systems (ORCHIDS) programme which is aimed to strengthen the preparedness of European countries to react to incidents involving the deliberate release of potentially hazardous substances. The intention is to enhance response capabilities by identifying ways of optimising current decontamination processes for emergencies involving large numbers of casualties.
The ORCHIDS programme started in 2008 and comprised the ORCHIDS 1 project to evaluate existing mass casualty decontamination procedures to identify rational means of optimising efficiency. The ORCHIDS 2 project was designed to specifically address the time-dependencies of disrobing and decontamination and to assess existing and novel personal decontamination products as a potential form of interim decontamination.
While mainly limited to wound decontamination, a number of studies were performed during the project that had direct relevance to ‘wet’ and ‘dry’ personal decontamination. Wet decontamination using water should only be used for decontamination where the chemical is confirmed as being caustic or corrosive or if the patient is displaying signs and symptoms consistent with exposure to caustic or corrosive substances. Caustic chemicals tend to refer to alkaline/basic compounds and corrosives, to acids and oxidisers. Wet decontamination also remains the default decontamination process for biological or radiological contaminants.
Cloth and clean refers to the two principal aims of developing a product to arrest uncontrolled haemorrhage and neutralise the effects of chemical warfare (CW) agents from penetrating wounds. The key features are the provision of a washcloth and decreased shower duration. The ORCHIDS mass decontamination showering protocol is being introduced as the standard UK means of performing mass casualty decontamination.
Dry decontamination uses powders or fabric materials to absorb and remove contaminants from the skin surface. For hospitals without emergency departments and other primary care facilities, plans should cover arrangements for dealing with self-presenters through initial disrobing and dry decontamination, including, if necessary, wet decontamination of hair.
The Health Boards’ response should include an assessment of the risk of secondary contamination especially where the patient has ingested the chemical. In such cases, Emergency Services CBRN Personal Protective Equipment (PPE) may be required to reduce the risks from off-gassing from the patient and/or contaminated vomit. Off-gassing can be difficult to manage unless a side ward with independent ventilation is available. It is the responsibility of the Health Board to ensure that appropriate PPE is available and that staffs are suitably trained in its use.
While specialist training of first responders is vital, the speed of their deployment of paramount importance in order to counter any potential terror threat to the UK.