Prehospital and Disaster Medicine http://pdm.medicine.wisc.edu Vol.18, No. 3 SPECIAL REPORT PPE = personal protective equip- ment SBCCOM = US Army Soldier and Biological Chemical Command US = United States of America Web publication: 15 March 2004 Introduction A tanker truck carrying 10,000 gallons of fuming sulfuric acid ruptures in a motor vehicle collision while traveling through the downtown area on a cool April afternoon. A cloud of chemical v apor bellows out from the wreckage and travels downwind towards a nearby lake and shopping center. Bystanders hear the impact and begin running toward the scene, but quickly turn and run when they start feeling the ill effects of the chemical vapor. Fire and law Abstract The events of 11 September 2001 became the catalyst for many to shift their disaster preparedness efforts towards mass-casualty incidents. Emergency responders, healthcare workers, emergency managers, and public health offi- cials worldwide are being tasked to improve their readiness by acquiring equipment, providing training and implementing policy, especially in the area of mass-casualty decontamination. Accomplishing each of these tasks requires good information, which is lacking. Management of the incident scene and the approach to victim care varies throughout the world and is based more on dogma than scientific data. In order to plan effectively for and to manage a chemical, mass-casualty event, we must critically assess the criteria upon which we base our response. This paper reviews current standards surrounding the response to a release of hazardous materials that results in massive numbers of exposed human survivors. In addition, a significant effort is made to prepare an inter- national perspective on this response. Preparations for the 24-hour threat of exposure of a community to haz- ardous material are a community responsibility for first-responders and the hospital. Preparations for a mass-casualty event related to a terrorist attack are a governmental responsibility. Reshaping response protocols and decon- tamination needs on the differences between vapor and liquid chemical threats can enable local responders to effectively manage a chemical attack resulting in mass casualties. Ensuring that hospitals have adequate resources and training to mount an effective decontamination response in a rapid manner is essential. Levitin H, Siegelson HJ, D ickinson S, Halpern P, Haraguchi Y, Nocera A, Turineck D : D econtamination of mass casualties — Re-evaluating existing dogma. Prehosp D isast M ed 2003;18(3):200–207. 1. Clinical Assistant Professor of Medicine, Indiana University School of Medicine and Emergency Physician, St. Francis H ospital and Health Centers, Indianapolis, Indiana USA 2. Clinical Assistant Professor of Emergency Medicine, Emory University, Emergency Physician, Apollo MD, WellStar H ospital System, Atlanta, Georgia USA 3. H azardous Materials Specialist, Indianapolis, Indiana USA 4. Chair, Department of Emergency Medicine, Tel Aviv Medical Center, Tel Aviv, Israel 5. H ead of Division of Pathophysiology Clinical Research Institute, National H ospital, Tokyo Disaster Medical Center, Tokyo, Japan 6. Emergency Physician, Mt. Louisa, Australia 7. Chair, Department of Emergency Medicine, Greater Niagara General H ospital, Niagara H ealth System, Ontario, Canada Correspondence: H oward W. Levitin, MD 5732 West 71st Street Indianapolis, Indiana 46278 USA E-mail: hwlevi@hazmatdqe.com Keywords: decontamination; deconta- mination methods; exposure; hazardous materials; mass-casualty decontamina- tion; mass-casualty incidents; vapor exposure Abbreviations: AIWW = Ambulatory Injured and Ambulatory Worried Well Non- Injured ATSDR = [US]Agency for Toxic Substances Disease Registry EMS = Emergency Medical Services GB = sarin H azMat = hazardous materials H RSA = [US]H ealth Resources and Services Administration ICU = intensive care unit MCI = Mass-Casualty Incident Decontamination of Mass Casualties — Re-evaluating Existing Dogma Howard W. Levitin, MD, FACEP; 1 Henry J. Siegelson, MD, FACEP; 2 Stanley Dickinson, EMT; 3 Pinchas Halpern, MD; 4 Yoshikura Haraguchi, MD, PhD ; 5 Anthony Nocera, MD, FACEM; 6 D avid Turineck, HBSc, MB, BCh, BAO, LRCS(P)I, FACEP 7