CBRN decontamination protocols establish that the decontamination of people has as a priority:
- Save the life of the affected person, eliminating contaminating agents from their body surface.
- Prevent the contaminated person from contaminating other people.
The Decontaminating Agents used in the decontamination of people, whether they are valid or assisted (injured or disabled), must provide a double function:
- Ensure that effective decontamination of contaminating agents is obtained.
- Do not damage sensitive parts of the body: skin, eyes, nose, etc.
Manufacturers of CBRN Decontamination solutions must develop Decontamination Agents with formulas based on dermogels and neutralizing components; as a means to ensure this double challenge: to ensure an effective decontamination of the affected person, but without damaging the most sensitive parts of his body: skin, eyes, mucous membranes, etc.
Another important factor that CBRN decontamination protocols take into account is the type of contaminating agent: Chemical Agents, Biological Agents and Radiological Agents. Depending on the type of agent that caused the contamination, appropriate decontamination must be applied to it.
The scientific literature usually establishes 5 major categories within Chemical Warfare Agents (CWAs):
- Disabling agents: they are divided between Neutralizing agents (they cause temporary irritations) and Calming agents (they cause long-lasting irritations).
- Nervous or Neurotoxic Agents: they are usually divided between Nervous Agents Series G (Tabún, Sarín, etc) and Nervous Agents Series V (agent VX, ...)
- Blood Agents: they are absorbed and transported by the blood, having a systemic effect, interfering in the oxygen-CO2 exchange of the hemoglobin in the blood.
- Vesicant agents: can occur in solid, liquid or gaseous form, and in contact with the skin produce irritation and blisters. They can cause from a slight irritation of the skin until the ulceration and destruction of the tissues.
- Nemo toxic agents: substances that cause physical damage to the lungs, their exposure is through inhalation or contact.
In any case, the Process of Decontamination of people requires a quick and thorough washing of both the skin and the eyes and mucous membranes with a neutral dermogel solution (pH 7), which is precisely the basis for the formulation of specific decontaminating agents for their use on people.
In addition, the decontaminating agent must have components in its formulation that neutralize the chemical agents, degrading them into compounds that are harmless to the human body. This process is known as Detoxification.
An important consideration about decontamination and detoxification processes that must be taken into account is that these processes refer to the decontamination of the agents that are on the skin of the affected person. For chemical agents that are already found inside the human body (due to being inhaled or absorbed through the skin or mucous membranes), a specific medical treatment is necessary.
The scientific literature usually establishes 3 major categories within biological agents:
- Toxins (Botulinum, Ricine, Palytoxine, etc)
- Bacteria (Yarsinia Pestis, Cholera, Bacillus Anthracis, etc)
- Virus (Nipah, Dengue, Zika, etc).
One of the main characteristics of biological agents is their broad spectrum of "Effect Time". The Effect Time measures both the period elapsed from exposure to the biological agent until the affected person suffers the first symptoms of contamination as the maximum time in which the affected person must be decontaminated before suffering irreversible damage to their health and / or life
One of the great challenges in CBRN or Hazmat incidents management with biological agents is precisely that the great dispersion in the Effect Times (between a few minutes in the case of Toxins up to several hours or even weeks in the case of Bacteria and Viruses) causes a great difficulty in identifying contaminated people and being able to decontaminate and isolate them to avoid contaminating other people.
In this context, the scientific literature establishes the following ranges of "Effect Time" depending on the category of Biological Agent:
For Toxins: between 0 minutes and 1 hour and a half
For Bacteria: from 8 hours to 15 days
For Virus: from 8 hours to 15 days.
In all cases, the process of decontamination of people requires a quick and thorough washing of both the skin and the eyes and mucous membranes with a neutral dermogel solution (pH 7), which is precisely the basis for the formulation of specific decontaminating agents for their use on people.
In addition, the decontaminating agent must have biocidal components in its formulation that provide sterilizing properties, eliminating any pathogenic agent of biological origin from the skin of the affected person. This process is known as Detoxification.
As with chemical agents, an important consideration on the processes of decontamination and detoxification of biological agents that must be taken into account is that these processes refer to the decontamination of the agents that are on the skin of the affected person. For chemical agents that are already found inside the human body (due to being inhaled or absorbed through the skin or mucous membranes), a specific medical treatment is necessary.
Hazmat incidents caused by radiological agents refer to any incident caused by a radioactive agent or contamination of an area with radiological sources.
Normally, incidents with radiological agents are usually caused by: civil accidents (nuclear power plants, medical centers, research centers, etc.), dirty bombs (with non-nuclear radiological agents), poisoning with radiological agents, etc.
The emission of radiation by some chemical elements is the result of the nuclear decomposition of these elements, and usually has a life of hundreds or thousands of years, so the decontamination process is not focused on the elimination of radiation, but in the removal of radioactive particles that are on the surface of the contaminated person.
The process of decontamination of people requires a quick and thorough washing of both the skin and the eyes and mucous membranes with a neutral dermogel solution (pH 7), which is precisely the basis for the formulation of specific decontaminating agents for use on people.
In addition, the decontaminating agent must have chelating compounds in its formulation that facilitate the dragging effect of the radioactive particles present in the body of the contaminated person.
It is important to note that, as well as in the decontamination of biological and chemical agents, the Detoxification process allows the neutralization / elimination of the contaminating agent. Due to the nature of radiological agents, this process is not feasible, and the sole objective of decontamination is the total removal of the radiological agent from the surface of the body of the affected person
Finally, CBRN decontamination protocols pay special attention to the place where the decontamination of the people affected in an Hazmat incident must be carried out, as well as the time in which it must be carried out.
In this context, one of the most universally accepted guides by Organizations and Agencies within the Hazmat or CBRN incident management is STANAG 2228 AJP 4.10B (Allied Joint Medical Support Doctrine) published by NATO, and which establishes 5 fundamental premises for the management of casualties in CBRN environments:
1. CBRN incidents will likely result in a large number of injuries
2. The types of injuries in a CBRN incident are not those normally handled in a military medical support system
3. CBRN casualties may be contaminated or contagious, and may constitute a significant danger to medical personnel and facilities responsible for their care.
4. Medical Treatment Facilities (MTF) may have to operate in areas that are contaminated, or with restrictions that limit the movement of personnel and material inside and outside MTF
5. Medical assistance will continue to be required for the conventionally casualties while at the same time CBRN casualties
This same STANAG 2228 AJP 4.10B, in the specific section referring to Patient Decontamination, establishes 4 basic principles:
1. Reduce the risk of contamination of medical personnel and other patients
2. Should be performed as soon as patient stabilization allows
3. It must be decentralized to avoid creating delays in a centralized point
4. Each Medical Treatment Facility (MTF) should be able to establish its own Decontamination Area, either a Decontamination Shower or a Decontamination Tent (Mass Decontamination Station)