Decontamination may be required if a casualty has been a victim of a CBRN (Chemical, Biological, Radiological, Nuclear) incident. This is most likely to be the result of a transport accident, but this procedure will be effective for any type of CBRN incident and has been in place in Wiltshire for some time and proven to be effective.

The decontamination process is undertaken through a collaboration of the Health Service and the Fire Service.

The Health Service have the responsibility for ensuring the health of the population - which includes the health workers and emergency services as well as the victim - therefore decontaminating patients is ultimately the responsibility of the Health Service. The Fire service have the appropriate Personal Protective Equipment (PPE) to achieve the task, so by working together they make an effective team. The Ambulance service do have some intermediate equipment that allows them to assist in elements.

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The system of decontamination used in Wiltshire from the Wiltshire Hazardous Material Incidents (HAZMAT) manual that has been adopted by the Department of Health as best practice. It is based on a system of Hot, Warm and Safe zones.

Hazmat diagram1The HOT zone on the right is the contaminated area that you would only be able to survive in with the correct PPE. This is why only Fire Service personnel enter as they have positive pressure Breathing Apparatus that will protect them.

The WARM zone is the area where the contaminant is removed. This is carried out by Ambulance and Fire Brigade personnel using the Rinse-Wipe-Rinse method. Any injury comes second to the removal of the contaminant no matter how serious. Water is used to decontaminate, if the patient is immobile then a stretcher system can be used.

The SAFE zone is signified by a Red and White ribbon. No-one is allowed to pass from the warm to safe zones unless they have been decontaminated and pose no further risk. A known contaminated patient is NEVER knowing put into an ambulance as they may contaminate the hospital causing it to be closed.

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When the patient has been transferred to the safe zone, they can then be triaged as per a patient that had not required decontamination and the process continues normally.

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