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Tuesday, January 17, 2012

Less than lethal can still be deadly

Planning, decontamination, proactive response is needed. 

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Riot control agents are considered “less-than-lethal” but they possess the potential to create multiple patients, decontamination issues, and respiratory hazards to the responders. Although usually not deadly, exposure to riot control agents stress the respiratory and cardiovascular systems. Like many other respiratory irritants they exacerbate a variety of respiratory and cardiovascular medical conditions and cause hypoxia resulting in critical patients.

Exposed persons with liquid product remaining on the skin or clothing is another concern. Certain types of chemical mace and pepper spray can cause skin irritation and burns. Ocular exposure can result in loss of sight.  Persons who remain contaminated with product also threaten secondary contamination by exposing responders to off-gassing. If exposed, contaminated persons are allowed to get into an ambulance or worse, into the hospital, without proper decontamination, the risk of significant secondary contamination and potentially hinder hospital efforts. Along the same theme is the risk of self-referring victims. People who have been exposed to a riot control (or any other irritant liquid or gas) may leave the scene prior to being decontaminated and triaged. Victims self referring to hospitals or urgent care centers pose a significant threat of secondary contamination. This risk is even greater when the local health care institutions are left out of the pubic service information loop. 

When encountering a situation involving riot control gases, I recommend the following:

  • Never assume the obvious threat is the only threat; other potentials should be considered. When someone tells you "its only pepper spray", don't believe them. Consider the potential of other agents such as cyanide, hydrogen sulfide, nitrates, chlorine, and phosgene can cause similar signs and symptoms to riot control agents.
  • Proper personal protective equipment and atmospheric monitoring devices must be used. This should include respiratory protection for responders. Canister masks or self contained breathing apparatus may be the appropriate level of protection. Atmospheric monitoring and non-invasive monitoring of patients should also be considered to help identify the agent. 
  • Anyone with reasonable exposure to the material should be assessed and decontaminated prior to leaving the scene. Little can be done for the internal exposure a gas. Those with exterior contamination, those who have residual agent on the skin or clothing, must undergo emergency mass decontamination prior to transport.
  • Local health care systems, including urgent care centers and walk-in care centers, must be informed of a chemical event occurring in their area. Health care systems must be able trigger their Emergency Operations Plans as soon as possible in order to prepare for the possibility of contaminated self-referring victims.
  • Fire and EMS resources should be deployed to appropriate health care locations in effort to assist with secondary decontamination efforts and management of contaminated self-referrals. 

Priority must be given to pre-planning at areas of critical infrastructure. Schools, hospitals, government buildings, and sporting venues are examples of soft targets that may also be considered critical infrastructure. Collaborative planning and training efforts between traditional and non-traditional responders (ie: EMS/Fire and school officials) will pay big dividends during crisis.

Response plans must be tested, practiced and revised. Tabletop exercises are a great low-cost way of doing this. Plans should be general in scope with annexes for specific threats. Planning for school events must include accounting for weather, media, dispersal of victims prior to arrival and site security. Don’t forget to build in communication with local hospitals.

Concern over too much school security has asserted that school security measures are a result of paranoia and not actual potential for an event. My stance is that schools are facilities of critical infrastructure by virtue of occupancy and potential impact of an attack/event. A natural disaster such as an earthquake or a Columbine-like attack will yield panic and disruption in any community. We cannot simply dismiss an event, any event, involving health care facilities, schools or other areas of critical infrastructure. They are soft targets and should be hardened and protected.

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