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London Ambulance Service’s involvement in ‘Spring Clean’ emergency planning exercise

To be attributed to Ambulance Operations Manager Steve Colhoun:

“Over 35 London Ambulance Service staff took part in today’s emergency planning exercise with specific responsibility for the clinical decontamination process.

“This included staff from the Service’s chemical, biological, radioactive or nuclear (CBRN decontamination) team and the Hazardous Area Response Team (HART), which has been commissioned by the Department of Health to provide life-saving medical care at major incidents where there are a large number of casualties involved.

“Today has been a valuable learning opportunity for our staff. Working in partnership with our emergency service colleagues, we have been able to test our equipment, systems and procedures for coping with a real life chemical incident.

“In total, we triaged and clinically decontaminated nine patients who were assessed as being in a serious condition, requiring transportation to Homerton hospital for further treatment. A further 31 patients with minor injuries were also taken to Homerton hospital for further assessment. ”

– Ends –

Notes to editors:

Background on clinical decontamination process:

London Ambulance Service staff helped treat civilian volunteers following the process described below:

  • Casualties will be brought by members of the HART team and fire-fighters in chemical protection suits. Some will be walking, others that are injured (i.e. possibly collapsed, have fallen etc) will be on stretchers.
  • All casualties then go through triage where ambulance personnel assess the seriousness of their condition and determine their clinical needs.
  • Patients’ medical needs are prioritised by assessment of their clinical condition, and each is given a corresponding wristband.
  • The priority groups, for the purpose of the exercise, are as follows:
    Priority 1 Immediate Red
    Priority 2 Urgent Yellow
  • Casualties that are contaminated but not injured are then directed to the fire service’s mass decontamination structure, where fire-fighters supported by Service staff will oversee the management of patients that are able to walk.
  • Those that are injured will be directed to the Service’s decontamination unit.
  • Injured casualties will be transferred from the stretchers on which they have been transported to boards.
  • As they go through the decontamination process, patients are told what will be happening to them.
  • They will be taken one-by-one into the first part of the unit (the de-robing section) on a board which is placed on a ‘conveyor system’.
  • Their clothing will often be cut off because patients cannot be moved easily or they are unable to remove it themselves.
  • The clothing will be bagged up and passed out to staff who will hand over the bags to police officers who are responsible for the holding area where personal effects are secured prior to being examined as evidence.
  • The patient will then be moved along into the main part of the unit, where they will be decontaminated by ambulance personnel (*for the purposes of this exercise, this will not involve full ‘wet’ decontamination as outlined below).
  • The decontamination cycle which lasts about 12 to 16 minutes involves rinsing the patient with warm water, wiping the body surface with soap and water, and finally rinsing with water again.*
  • The patient is then moved through into the last section of the unit where they will be covered in blankets and then taken to a casualty clearing area where a further clinical assessment is made (i.e. to ensure their condition has not changed).
  • Patients requiring further treatment will be transferred to the most appropriate emergency room whilst those who remain unaffected will be transferred to the humanitarian assistance centre (HAC) provided by the local authority who will take responsibility for dealing with casualties.
  • In total the process (i.e. from entering the tent to leaving it) takes up to 20 minutes. The clinical decontamination process will always take longer than the mass decontamination process. This is because patients—many of whom may not be able to walk —are treated one at a time by ambulance personnel who also take into consideration the cultural and personal needs of the casualties.

Role of Hazardous Area Response Team (HART):

  • The Hazardous Area Response Team (HART) Project will on completion see teams of highly trained emergency medical technicians and paramedics located across England provide a better response to major incidents.
  • The crews are trained and equipped to work in high risk environments providing advanced life support, triage and treatment to those affected by a major incident, including chemical, biological, radioactive or nuclear events.
  • However, typical incidents to which HART crews are dispatched to are building collapses, serious road-traffic collisions, fires, suspect vehicles and packages, as well as tube trains stuck between stations underground in which there can potentially be thousands of dehydrated patients.
  • The Department of Health commissioned a study into the ability of ambulances to respond not just to major incidents, but to deliver medical care right in the centre of an incident, for instance in a deep Tube station. The London team is being evaluated ahead of a national roll-out programme, and lessons learned from the London pilot scheme will be used to further improve the HART Project.
  • The HART team is sent to a range of incidents at which, it is predicted, there could be large number of casualties. It is not exclusively a chemical, biological, radioactive or nuclear response but a general one that has the capacity to manage incidents on scene so that many of the ambulances that would have been sent can continue to deal with ‘core’ 999 work. The deployment of HART to incidents therefore frees up ambulances to treat ‘regular’ 999 patients (i.e. those not involved in the mass-casualty incident) who may be in a serious or immediately life-threatening condition.
  • HART is based at a south London ambulance station but operates all across Greater London. There are three large vehicles—a command & control vehicle, a reconnaissance & light equipment vehicle, and an equipment-only vehicle. Two other smaller vehicles are rapid-response cars which, when not being used to support incidents to which HART is deployed, are sent to normal Category A 999 calls.

For further information about London Ambulance Service please contact the communications department on 020 7921 5113 or 07770 646595 for out-of-working-hours enquiries.