Further studies of the efficacy of military, commercial and novel skin decontaminants against the chemical warfare agents sulphur mustard, soman and VX

Background/Aims: Following an incident involving toxic chemicals, deployment of countermeasures before the arrival of specialised services at the scene may provide a “therapeutic” window in which to mitigate skin absorption. Methods: Five potential candidates (itaconic acid, N,N′-methylenebisacrylamide, 2-trifluoromethylacrylic acid, fuller's earth and Fast-Act®) previously found effective against a simulant (methyl salicylate) were evaluated against a 10 μL droplet of 14C-sulphur mustard (HD), soman (GD) or VX applied to the surface of porcine skin mounted on static skin diffusion cells. Results: All the decontaminants applied to the skin 5 min post exposure achieved a marked reduction in the amount of 14C contaminant remaining within the skin at 24 h. Itaconic acid significantly (p <.05) reduced the amount of 14C-HD, GD and VX remaining in the skin at 24 h. Additionally, 2-trifluoromethylacrylic acid significantly reduced the amount of 14C-HD, whilst fuller's earth significantly reduced the amounts of 14C-HD and VX recovered within the skin at 24 h. Conclusion: All of the products evaluated in this study performed well in reducing the dermal absorption of all the chemical warfare agents tested.Peer reviewe

Optimization of Nonambulant Mass Casualty Decontamination Protocols as Part of an Initial or Specialist Operational Response to Chemical Incidents

© 2018 The Author(s). Published with license by Taylor & Francis.© 2018 Robert P. Chilcott, Hannah Mitchell, Hazem Matar. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-ncnd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.Objective: The UK's Initial Operational Response (IOR) is a new process for improving the survival of multiple casualties following a chemical, biological, radiological or nuclear incident. Whilst the introduction of IOR represents a patient-focused response for ambulant casualties, there is currently no provision for disrobe and dry decontamination of nonambulant casualties. Moreover, the current specialist operational response (SOR) protocol for nonambulant casualty decontamination (also referred to as “clinical decontamination”) has not been subject to rigorous evaluation or development. Therefore, the aim of this study was to confirm the effectiveness of putatively optimized dry (IOR) and wet (SOR) protocols for nonambulant decontamination in human volunteers. Methods: Dry and wet decontamination protocols were objectively evaluated using human volunteers. Decontamination effectiveness was quantified by liquid chromatography–mass spectrometry analysis of the recovery of a chemical warfare agent simulant (methylsalicylate) from skin and hair of volunteers, with whole-body fluorescence imaging to quantify the skin distribution of residual simulant. Results: Both the dry and wet decontamination processes were rapid (3 and 4 min, respectively) and were effective in removing simulant from the hair and skin of volunteers, with no observable adverse effects related to skin surface spreading of contaminant. Conclusions: Further studies are required to assess the combined effectiveness of dry and wet decontamination under more realistic conditions and to develop appropriate operational procedures that ensure the safety of first responders.Peer reviewe

Decontamination and Management of Contaminated Hair following a CBRN or HazMat Incident

© The Author(s) 2019. Published by Oxford University Press on behalf of the Society of Toxicology.This in vitro study evaluated the “triple protocol” of dry decontamination, the ladder pipe system (a method for gross decontamination), and technical decontamination for the decontamination of hair following chemical contamination. First, we assessed the efficacy of the 3 protocols, alone or in combination, on excised porcine skin and human hair contaminated with either methyl salicylate (MS), phorate (PHR), sodium fluoroacetate (SFA), or potassium cyanide (KCN). A second experiment investigated the residual hair contamination following decontamination with the triple protocol at different intervals postexposure. In a third experiment, hair decontaminated after exposure to MS or PHR was evaluated for off-gassing. Though skin decontamination was highly effective, a substantial proportion (20%–40%) of the lipophilic compounds (MS and PHR) remained within the hair. The more water-soluble contaminants (SFA and KCN) tended to form much smaller reservoirs within the hair. Interestingly, substantial off-gassing of MS, a medium volatility chemical, was detectable from triple-decontaminated hair up to 5 days postexposure. Overall, the decontamination strategies investigated were effective for the decontamination of skin, but less so for hair. These findings highlight the importance of contaminated hair serving as a source of potential secondary contamination by contact or inhalation. Therefore, consideration should be given to the removal of contaminated hair following exposure to toxic chemicals.Peer reviewe

Preliminary evaluation of military, commercial and novel skin decontamination products against a chemical warfare agent simulant (methyl salicylate)

This is an Accepted Manuscript of an article published by Taylor & Francis in Cutaneous and Ocular Toxicology on 13 August 2015, available online: http://www.tandfonline.com/doi/full/10.3109/15569527.2015.1072544.Rapid decontamination is vital to alleviate adverse health effects following dermal exposure to hazardous materials. There is an abundance of materials and products which can be utilised to remove hazardous materials from the skin. In this study, a total of 15 products were evaluated, 10 of which were commercial or military products and 5 were novel (molecular imprinted) polymers. The efficacies of these products were evaluated against a 10µL droplet of 14C-methyl salicylate applied to the surface of porcine skin mounted on static diffusion cells. The current UK military decontaminant (Fuller’s earth) performed well, retaining 83% of the dose over 24 hours and served as a benchmark to compare with the other test products. The five most effective test products were Fuller’s earth (the current UK military decontaminant), Fast-Act® and three novel polymers (based on itaconic acid, 2-trifluoromethylacrylic acid and N,N-methylene bis acrylamide). Five products (medical moist free wipes, 5% FloraFree™ solution, normal baby wipes, baby wipes for sensitive skin and Diphotérine™) enhanced the dermal absorption of 14C-methyl salicylate. Further work is required to establish the performance of the most effective products identified in this study against chemical warfare agents.Peer reviewedFinal Accepted Versio

Mass Casualty Decontamination in the United States : An Online Survey of Current Practice

Final publication is available from Mary Ann Liebert, Inc., publishers https://doi.org/10.1089/hs.2016.0047.Mass casualty decontamination is a public health intervention that would be employed by emergency responders following a chemical, biological, or radiological incident. The decontamination of large numbers of casualties is currently most often performed with water to remove contaminants from the skin surface. An online survey was conducted to explore US fire departments' decontamination practices and their preparedness for responding to incidents involving mass casualty decontamination. Survey respondents were asked to provide details of various aspects of their decontamination procedures, including expected response times to reach casualties, disrobing procedures, approaches to decontamination, characteristics of the decontamination showering process, provision for special populations, and any actions taken following decontamination. The aim of the survey was to identify any differences in the way in which decontamination guidance is implemented across US states. Results revealed that, in line with current guidance, many US fire departments routinely use the "ladder-pipe system" for conducting rapid, gross decontamination of casualties. The survey revealed significant variability in ladder-pipe construction, such as the position and number of fire hoses used. There was also variability in decontamination characteristics, such as water temperature and water pressure, detergent use, and shower duration. The results presented here provide important insights into the ways in which implementation of decontamination guidance can vary between US states. These inconsistencies are thought to reflect established perceived best practices and local adaptation of response plans to address practical and logistical constraints. These outcomes highlight the need for evidence-based national guidelines for conducting mass casualty decontamination.Peer reviewedFinal Accepted Versio

Evaluation of US Federal Guidelines (Primary Response Incident Scene Management [PRISM]) for Mass Decontamination of Casualties During the Initial Operational Response to a Chemical Incident

Study objective The aim of this study was to evaluate the clinical and operational effectiveness of US federal government guidance (Primary Response Incident Scene Management [PRISM]) for the initial response phase to chemical incidents. Methods The study was performed as a large-scale exercise (Operation DOWNPOUR). Volunteers were dosed with a chemical warfare agent simulant to quantify the efficacy of different iterations of dry, ladder pipe system, or technical decontamination. Results The most effective process was a triple combination of dry, ladder pipe system, and technical decontamination, which attained an average decontamination efficiency of approximately 100% on exposed hair and skin sites. Both wet decontamination processes (ladder pipe system and technical decontamination, alone or in combination with dry decontamination) were also effective (decontamination efficiency >96%). In compliant individuals, dry decontamination was effective (decontamination efficiency approximately 99%), but noncompliance (tentatively attributed to suboptimal communication) resulted in significantly reduced efficacy (decontamination efficiency approximately 70%). At-risk volunteers (because of chronic illness, disability, or language barrier) were 3 to 8 times slower than ambulatory casualties in undergoing dry and ladder pipe system decontamination, a consequence of which may be a reduction in the overall rate at which casualties can be processed. Conclusion The PRISM incident response protocols are fit for purpose for ambulatory casualties. However, a more effective communication strategy is required for first responders (particularly when guiding dry decontamination). There is a clear need to develop more appropriate decontamination procedures for at-risk casualties.Peer reviewedFinal Published versio

The United Kingdom’s initial operational response and specialist operational response to CBRN and HazMat incidents: a primer on decontamination protocols for healthcare professionals

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.The UK is currently in the process of implementing a modified response to chemical, biological, radiological and nuclear and hazardous material incidents that combines an initial operational response with a revision of the existing specialist operational response for ambulant casualties. The process is based on scientific evidence and focuses on the needs of casualties rather than the availability of specialist resources such as personal protective equipment, detection and monitoring instruments and bespoke showering (mass casualty decontamination) facilities. Two main features of the revised process are: (1) the introduction of an emergency disrobe and dry decontamination step prior to the arrival of specialist resources and (2) a revised protocol for mass casualty (wet) decontamination that has the potential to double the throughput of casualties and improve the removal of contaminants from the skin surface. Optimised methods for performing dry and wet decontamination are presented that may be of relevance to hospitals, as well as first responders at the scene of a chemical incident.Peer reviewe

Temporal effects of disrobing on the skin absorption of chemical warfare agents and CW agent simulants

Procs 2010 Annual Congress of The British Toxicology SocietyPeer reviewe

Protective effects of clothing on the in vitro absorption of chemical warfare agents

Peer reviewe

Identical twins with Pierre Robin syndrome; unusual encounter

New born babies could suffer from multiple craniofacial abnormalities, such as Pierre Robin syndrome, which consists of micrognathia and relative macroglossia with or without cleft palate. Although Pierre Robin syndrome is well described in literature, only a few have mentioned its occurrence in identical twins. This paper presents a rare incident of full-term twin babies born with the sequence of Pierre Robin syndrome, which consists of micrognathia, cleft palate, and glossoptosis. Although it is a rare coincidence, Pierre Robin syndrome still can occur in identical twin babies. The treatment is a step-by-step approach, but all procedures are mainly directed to widening the pharyngeal space