Page 107

research on biological decontamination by eight different "electro-technologies." These include electron beams, X-rays, pulsed electric fields, microwaves, and UV light. Of these, only UV light is likely to be feasible for patient decontamination, and then only with low-power UV in conjunction with a photosensitizer like hydrogen peroxide. Contaminated terrain often needs no decontamination other than natural drying and solar UV radiation, but exceptionally persistent organisms like anthrax need to be decontaminated using a spray mixture of chlorine-calcium, formalin, or lye solutions. In some locations seawater may serve as an expedient and less hazardous substitute (Manchee and Stewart, 1988).

Psychological Impact of Undergoing Decontamination

The psychological impact of being exposed to a poison is not well studied. Whether crowds will listen to instructions or panic, what they need to be told and how that message should be given, whether they will take off their clothes in the absence of an obvious immediate danger, whether they will shower with persons they have never met before, and how best to control or avoid hysteria are among the issues that need to be addressed.

Mass-Casualty Triage Procedures

The three primary objectives of a disaster response are: (1) do the greatest good for the greatest number of victims; (2) effectively utilize personnel, equipment, and health facilities; and (3) do not relocate the disaster from one location to another by poor command, control, or communication practices.

The triage process is the initial step taken to meet the primary objectives of a disaster response. The purpose of triage is to sort the injured by priority and determine the best use of available resources (e.g., personnel, equipment, medications, ambulances, and hospital beds). Many EMS agencies have in place a triage plan to implement in the event of an airplane crash, train derailment, or school bus accident. Traditional triage centers around the use of diagnosis-based criteria or involves the evaluation of each patient's respiration, perfusion, and mental status findings in order to determine whether they should be classified as urgent, delayed, or deceased. Both triage approaches require the examiner to see the patient and obtain certain clinical data by verbal communication and tactile examination. In a chemical terrorist incident the victim(s) may suffer from the effects of poison, trauma, or both. In a more conventional disaster, unless they are in danger, the patients can usually remain in place until directed to relocate. Their evacuation and treatment priority is indicated