Let’s get to the OP
Marking is performed by ripping the tag in the appropriate places (see photo on pp.26). The plastic tag lets hospital staff know exactly what medical treatment has been administered, and is decontaminated along with the casualty at the hospital entrance. Evacuation starts at the periphery of
the scene then works towards the centre. For rescue members in level C suits, the ‘no entry’ line at scene, especially for outdoor events, is defined as the point from which bodies are encountered. This is a precaution to prevent rescue teams from being exposed to high levels of toxicity that may penetrate level C PPE. Evacuation consists of short cycles
out of the contaminated area. Mildly injured casualties will be guided out of the isolation area on foot, while moderate to severely injured casualties, who are by definition non-ambulatory, will be carried out on stretchers or in other ways, including ambulances if available. EMTs wearing PPE will undress casualties outside the isolation area and inside the evacuation vehicle on the way to the hospital to prevent further delays. At the same time, due to an anticipated lack of evacuation platforms, several medical field stations will be established at the margins of the isolation area for more definitive on-site treatment. This doctrine leads to contamination
of many ambulances, which is a significant drawback with this approach, especially in case of persistent agents. Bringing victims to a definitive treatment site and saving as many lives as possible are regarded on a nationwide level as top priorities, however. The introduction of new evacuation platforms is required soon after an event has ended in order to maintain daily routine.
Immediate psychological care We assume that following a TMCE, hospitals will overflow with citizens experiencing stress-related symptoms. The spectrum of these disorders will primarily include acute stress reaction, anxiety with or without somatisation, and concern for relatives. The number of these casualties may exceed the numbers physically injured by a remarkable factor
of up to 500. This would impair or even paralyse the capability of hospitals to provide sufficient medical treatment as well as increase the risk of post- traumatic stress disorder among both physically injured and stress casualties. It is therefore essential that, concomitant to field rescue teams, mental health professionals arrive at hospitals and initiate treatment as quickly as possible. Attention should be given also to any stress-related symptoms among first responders.
Summary The availability of various dangerous chemical agents makes a TMCE, including chemical terrorism, among the major threats to homeland security. The complexity of a TMCE results from the combination of mass casualties, potential further spread of the contaminant leading to secondary injuries and severe psychological impact to rescue forces and citizens alike. This poses a considerable logistical and medical challenge to local and national authorities, and highlights the need for a central medical command that can orchestrate patient transfers between relevant medical facilities. In the past two decades, the Israeli
authorities have made considerable collaborative efforts developing a strategic theoretical analysis of chemical terrorism as well as practical management of such events. These collaborative efforts have yielded a
practical doctrine fully implemented throughout Israel and tested in numerous national drills as well as in small scale industrial chemical accidents. Emphasis is placed on rapid identification of the event as a chemical event, notification to central headquarters, and appropriate self-protection. Medically, it is most important to
determine whether an OP is involved, as this dictates a different approach and treatment. In order to allow efficient work under stressful conditions, Israeli authorities have developed a procedure to serve as a simple and practical agenda for first responders on scene. Moreover, as the determination of a TMCE entails serious consequences for the entire population, we have defined criteria to increase the specificity of the evaluation. Casualties receive optimal treatment
in medical centres and not in the field. We recommend performing only life saving procedures (eg, antidotal treatment) on site and a scoop and run approach following a pre-organised evacuation plan. This approach takes advantage of the short evacuation distances in Israel. Finally, continuous preparedness of the health system, exemplified by periodic CBRN medical training, provision of antidotal autoinjectors in all ambulances, and CBRN emergency kits in the emergency department, will considerably improve the response to a TMCE.
The no entry line is defined at the point at which bodies are encountered ©Eisenkraft
CBRNe Convergence, Indianapolis Motor Speedway, Indiana, USA, 6 - 8 Nov 2017
www.cbrneworld.com/convergence2017 28 CBRNe WORLD June 2017
www.cbrneworld.com
CBRNeWORLD
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