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AMBULANCE
SE RV I C E
The way the NHS respondsto HAZMAT/CBRN events
is changing
The Initial Operational Response (IOR) programme has beenintroduced following extensive research and an NHS-wide reviewof clinical decontamination processes. It is being rolled out acrossall NHS ambulance trusts and all NHS hospital trusts.
Why is IOR important to you?
You will be a key healthcare team member when it comes to initiatingearly life saving interventions that could improve patient outcomessignificantly. Positive action by first responders and staff in receivinghospitals will reduce the impact on the wider NHS.
What do I need to know?
Casualties should be directed to:
Evacuate to a place of safety (away from the source, ideallyuphill / upwind).
Disrobe – by removing their outer clothing casualties will remove80% of contaminating substances.
Self decontaminate using absorbent materials such as papertowels, thus protecting healthcare staff.
Remember
Communicating clearly with patients and the public, and providingpositive reassurance, are essential for a successful response toHAZMAT/CBRN incidents.
What happens next?
The new protocols are being introduced across the NHS in stages,with training packages soon available in the form of JESIP IORguidance, a multi-agency e-learning package, a DVD outlining the keyelements of IOR and an aide memoire for staff.
For further informationvisit www.naru.org.ukandwww.orchidsproject.euor speak to yourTrust’s EmergencyPlanning Department.
EVACUATION DISROBING DECONTAMINATION
© NARU October 2013
The new focus is on early evacuation and disrobing within15 minutes of exposure to the contamination, followed by
immediate decontamination.
Yes
Yes
No
No
Benefitsoutweigh
risks
HA
ZARD
ASSESSM
ENT
RISK ASSESSM
ENT
COM
MU
NICATE W
ITH PU
BLIC AN
D M
ULTI-A
GEN
CY RESPON
DERS
Risksoutweighbenefits
Report arrival andlocation to ControlIdentify Hazards
Provide Situation Report
Are there 3 or morecasualties in closeproximity, with noobvious reason?
Are there casualtiesunable to walk requiringrescue from hazard area?
Undertake AgencySpecific DynamicRisk Assessment
UndertakeRescue (FRS)
Minimum personnel in mostappropriate level of PPE / RPE
informed by JDHA
EvacuateCommunicate and advise
DisrobeDecontamination
Direct walkingcasualties to place of
relative safety(warm zone)
Jointly Agree Hazards (JDHA)Work together with other
agenciesControl the scene
Identify safe arrival routes, RVPand additional resources required
Follow STEP1 OR 2
ControlMeasures
Apply STEP 123 Plus
AMBULANCE
SE RV I C E
The way the NHS respondsto HAZMAT/CBRN events
is changingSTEP 1-2-3 PLUS
One personincapacitated withno obvious reason
Approach usingstandard protocols
PLUS means follow the CBRN First Responder FlowChart to consider what actions can be undertakento save life, using the following principles:
Evacuate – Get people away from the sceneof contamination.
Communicate and Advise – Give immediatemedical advice and reassurance that helpis on its way.
Disrobe – Remove clothing.
Decontamination – Dry decontamination should be thedefault process.
These new protocols should be implemented upon clear directionfrom your Trust.
So what happens next?The new protocols are being introduced across the NHS in stages,with training packages soon available in the form of JESIP IORguidance, a multi-agency e-learning package, a DVD outlining the keyelements of IOR and an aide memoire for staff.
The Initial Operational Response (IOR) programme has been introduced following extensive research and an NHS-wide review ofclinical decontamination processes. It is being rolled out across allNHS ambulance trusts and all NHS hospital trusts.
For further informationvisit www.naru.org.ukandwww.orchidsproject.euor speak to yourTrust’s EmergencyPlanning Department.
Two peopleincapacitated withno obvious reason
Approach withcaution usingstandard protocols
Three or more peoplein close proximity,incapacitated with noobvious reason
Use caution andfollow
STEP 1
PLUS
STEP 2 STEP 3
PLUS
© NARU October 2013
AMBULANCE
SE RV I C E
The way the NHS respondsto HAZMAT/CBRN events
is changing
Please remember: These new protocols should be implementedupon clear direction from your Trust.
The Initial Operational Response (IOR) programme has been introduced following extensive research and an NHS-wide review ofclinical decontamination processes. It is being rolled out across allNHS ambulance trusts and all NHS hospital trusts.
For further informationvisit www.naru.org.ukandwww.orchidsproject.euor speak to yourTrust’s EmergencyPlanning Department.
Yes
Yes
No
No
Benefitsoutweigh
risks
HA
ZARD
ASSESSM
ENT
RISK A
SSESSMEN
T
COM
MU
NICATE W
ITH PU
BLIC AN
D M
ULTI-A
GEN
CY RESPON
DERS
Risksoutweighbenefits
Report arrival andlocation to ControlIdentify Hazards
Provide Situation Report
Are there 3 or morecasualties in closeproximity, with noobvious reason?
Are there casualtiesunable to walk requiringrescue from hazard area?
Undertake AgencySpecific DynamicRisk Assessment
UndertakeRescue (FRS)
Minimum personnel in mostappropriate level of PPE / RPE
informed by JDHA
EvacuateCommunicate and advise
DisrobeDecontamination
Direct walkingcasualties to place of
relative safety(warm zone)
Jointly Agree Hazards (JDHA)Work together with other
agenciesControl the scene
Identify safe arrival routes, RVPand additional resources required
Follow STEP1 OR 2
ControlMeasures
Apply STEP 123 Plus
CBRN FIRST RESPONDER FLOWCHART
© NARU October 2013