CBRN and Hazmat Incidents at Major Public Events: Planning and Response

CHAPTER 13

Initial Assessment and Response

The purpose of this chapter is to discuss the initial assessment and response to an incident. Regardless of whether it was a deliberate terrorist action or a random accident, the incident has now occurred and the emergency services need to deal with it. I will first discuss the initial assessment, provide some thoughts on overall incident-management schemes, and use a specific incident-management framework to begin responding to the problem. I will then discuss major response tactics, many of which I would categorize as “best practices.”

THE GOLDEN HOUR

Emergency medicine has long operated under the concept of the “golden hour.” This phrase was coined by Dr. R. Adams Cowley,¹ the father of the trauma-center concept. The principle of the golden hour is that serious trauma patients have about an hour to get from injury to the operating table under care of a trauma surgeon if they are going to have a good chance of survival. I strongly believe that a similar concept is operative in major CBRN/HAZMAT situations in that the actions and responses taken in the first hour will dictate a successful outcome versus a poor one. The golden-hour concept is most apposite in acute chemical scenarios with prompt symptoms, such as toxic inhalational agents, where there will be victims who need acute care in order to keep them alive. However, the concept applies to most CBRN/HAZMAT scenarios in a more general sense. Scene control, product control, and decontamination ...