Remove, Remove, Remove:

Following research and review of responder initial actions in a CBRN event, the Remove, Remove, Remove guidance was updated to help deal with the initial contamination of casualties.

The first element of Remove looks at advising the casualty to remove themselves from the immediate area of contamination to avoid further exposure and get to ‘fresh air’.

The second Remove looks at outer clothing removal if contaminated. Try to advise the casualty not to pull clothing overhead if possible, as to stop further contamination to the face and airway. Instead try unbuttoning, unzipping, or cutting off clothing. Do not pull off clothing which is stuck/melted to skin.

The third Remove looks at removing substances from skin using a dry absorbent material to either soak it up or brush it off. If the skin is itchy or painful then rinse it continually with water while awaiting further specialist responders.

Using these initial simple actions can help limit patient exposure to CBRN substances and may benefit their overall outcome moving forward.

Steps 123+:

Initially identifying if there are potential risks/hazards to the environment can be difficult when there are no obvious factors, but using ‘Steps 123+’ can help. Steps 123+ helps responders identify if there are potential substances or risks within the area that may be causing casualties. The tool can be used as follows;

• Step 1 – 1 person incapacitated with no obvious reason – Approach using standard protocols
• Step 2 – 2 people incapacitated with no obvious reason – Approach with caution using standard protocols
• Step 3 – 3 or more people in close proximity, incapacitated with no obvious reason – Use caution and follow the ‘plus’ steps.
• Plus steps –
  • Evacuate people away from the scene of contamination
  • Communicate and advise anyone effected with medical advice and reassurance
  • Advise the removal of contaminated clothing
  • Advise dry decontamination through use of paper towels