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Chapter 06 Casualty Decontamination and Hospital Decontamination Station Submission
Chapter 06 Casualty Decontamination and Hospital Decontamination Station Submission
Introduction
The HDS is organised into 4 main sections, namely the dirty area or Hot Zone, decon
area or Warm Zone, buffer zone and clean area or Cold Zone. The dirty area is the first
point of contact for contaminated casualties with the hospital. In this area, HDS staff don
semipermeable protective suits and air purifying respirators providing Level C protection,
while they assess, triage and treat chemical contaminated casualties that are brought in from
the scene of a Hazmat incident. In the decon area, staff don impermeable splash suits and
air purifying respirators, also providing Level C protection and perform systematic
decontamination as described in the subsequent section. At the buffer zone,
decontaminated casualties from the decon area are dried before chemical agent monitors
(CAMs) are applied systematically to screen for residual chemical agents, including nerve
agents and blister agents. HDS staff in this area don the same suits as their colleagues in
the decon area. Casualties with residual contamination identified by the CAMs will be
redirected through the decontamination cycle again, focussing on hot spots or areas of
residual contamination on the body identified by the CAM. Clean casualties with no residual
contamination will be allowed to proceed to the clean area where conventional triage and
treatment will be continued. HDS staff working in this area follow universal precautions -
wearing surgical masks, gowns and gloves while managing casualties (Level D protection).
HDS staff working in different sections are not allowed to cross to other areas in order to
reduce cross contamination. Each designated staff in a particular area has a specific role,
which will be assigned to them upon reporting following activation. All HDS staff are cross-
trained, tested and certified in all the roles so that they are able to take up responsibilities in
any area of the HDS.
Decontamination is the process of removing contaminants from the skin and hair of
individuals exposed to hazardous materials. There are many methods that can be used in
this regard but the method adopted currently involves the use of specially built shower
facilities for washing down contaminated casualties. The following phases describe the
decontamination process:
2. Initial triage and treatment by protected triage teams wearing personal protective
equipment (PPE).
8. Re-triage of casualty at the mass casualty triage point outside the Emergency
Department
9. Recovery phase
This phase involves the reception and co-ordinated transfer of non-ambulant contaminated
casualties from ambulance trolley to specially designed decontamination stretchers and then
to the chemical casualty triage point for further evaluation. All staff involved in management
of the casualties are required to be in Level C protection i.e. wearing respiratory protection
with carbon impregnated canisters and full dermal protective suits. Ambulant contaminated
casualties will be guided to the chemical casualty triage point.
During this phase, casualties will be systematically disrobed and their valuables collected
and tagged for subsequent identification. Ambulatory casualties will be supervised during
disrobing while non-ambulatory casualties will be disrobed by crew members. This important
step is expected to remove 80 to 90% of contamination, depending on the body surface area
covered by clothing items on the particular casualty. Due care is taken by following special
techniques in this process so as to reduce the chances of contamination of the skin from the
contaminated outer garments. In addition, special effort will be made so as not to destroy
crucial evidence during the disrobing process.
A systematic chemical agent screen using military CAMs is done for all casualties following
decontamination. Any casualties with residual contamination detected will be sent back
through the decontamination chain for re-decontamination.
At the mass casualty triage point, reassessment and re-triaging will be carried out and
appropriate further treatment will be continued in the Emergency Department.
Recovery Phase
When the last casualty has been decontaminated and the incident has been declared over,
the recovery phase will start. During this phase, the HDS crew will first proceed to
decontaminate the station and clean up the facility before proceeding to thorough personal
decontamination. The HDS will be reinstalled and logistics replenished so that the HDS will
be ready for the next activation. A debrief session for the crew will be held and lessons learnt
will be noted and procedures updated in order to improve future operations.
The HDS crew are the pillars for the successful operations of the HDS. These staff
may be recruited from various departments within the hospital and include nurses, doctors,
hospital maintenance crew, physiotherapist, healthcare attendants, and administrators. All
selected staff are physically fit and are assessed on their endurance and ability to withstand
rigorous training in less than ideal conditions. They also have to undergo specialised training
which includes the use of PPE such as gas masks and protective suits, operation of
chemical agent detectors, carrying out of decontamination procedures on ambulant and non-
ambulant casualties. They are also specially trained in chemical agent recognition, triage
and specific antidote administration.
This handout is adapted from Decontamination Rationale and Step-By-Step Procedure published in
SGH Proceedings VOL 12, NO 4 ,2003