European survey on decontamination in mass casualty incidents

Objective: The goal of this study is to assess the European status in the case of mass casualties regarding legislation, responsibilities of ministries and organizations, education and training, material and equipment, and bottlenecks.Design: A questionnaire answered by 22 of 27 European Union member states and Croatia, Norway, and Switzerland. Results and recommendations of a European expert’s workshop on decontamination of victims of mass casualties.Setting: Ministries and responsible organizations of 22 European Union member states Croatia, Norway, and Switzerland.Subjects: Hazardous chemical agents are a global realistic risk. Therefore it is an important obligation to direct education, service activities and research towards priority concerns of prevention and response in case of an accidental or criminal liberation of toxic chemicals. The most effective procedures to save the life and health of contaminated persons are: (1) The decontamination of chemically contaminated casualties as soon as possible reduces both morbidity and mortality. (2) The removal of clothing as the first stage of the decontamination process reduces the amount of contamination by 75-85 percent. The decontamination in case of a mass casualty incident needs a high number of personnel, personal protection equipment (PPE), a decontamination unit, education and permanent training, and a management of command, communication, and coordination; all these in the shortest time of preparedness, reaction, and cross border nationally and internationally.1Interventions: During the German EU Council Presidency in the first 6 months of 2007 the Federal Ministry of the Interior held a 3 days seminar (Ahrweiler, February 22-24, 2007) on the “Decontamination of Casualties Involved in Incidents with Hazardous Chemical Materials—European Inventory and Perspectives.” The aim was to arrange an exchange of information and experience on the various systems in place in Europe which would be beneficial to all parties concerned. The seminar was organized by the Federal Office of Civil Protection and Disaster Assistance.Main outcome measure: (1) Results of a nine question enquiry, (2) results of four workgroups with the focus on medicine, organization, equipment, and education.Results: In most countries, the medical sector is the weakest part of the integrated approach. Decontamination has two goals: to decontaminate the casualties and to avoid secondary contamination of personnel, equipment, and institutions (hospitals). The most effective method for decontamination is to undress patients as soon as possible. The procedures for undressing, triage, basic life support, etc have to be evidence based by research. Cooperation between MS should be developed including transborder cooperation, designing modules in the framework of the EU Mechanism, and considering reinforcement between MS as precautionary measures, for example, for major international events. Interoperability of equipment is recommended and achievable. Need for European inventory of decontamination units. Need for national stockpiles of antidotes and drugs as well as logistics.Conclusions: The following recommendations were given to the EU Commission: Organize focused experts meetings on the above mentioned subjects. Promote common exercises. Collect and promote best practices by supporting research for evidence-based results. Promote crossborder cooperation and possibly preplanned reinforcements.