Table 2

The EMERGENCY mnemonic for key elements of the Initial Operational Response

E Evacuate: casualties should be instructed to leave the contaminated area if they have not already done so.
M Move the casualties as a group to a safe distance, away from any potential source of contaminant. Ideally, this should be uphill and upwind and preferably in a sheltered (external) area away from strong winds and rain.
E Engage with casualties to explain what is happening and how they can help themselves by following your instructions and advice. Some casualties may not wish to cooperate for cultural, religious or other reasons: focus initial attention on compliant individuals.
R Remove as much clothing as possible. It is important to communicate the benefits of rapid disrobe to the casualties in order to gain their cooperation. The more clothes that are removed the better, but be mindful of modesty concerns. Where possible, do not remove clothing over the head. If available, trauma scissors can be used to cut away clothing.
G Give any available absorbent material to the casualties. Ideal materials include ‘blue roll’ (absorbent paper tissue), wound dressings, incontinence pads, cotton wool, toilet paper and paper towels. Do not get close to casualties when handing out the decontamination material.
E Establish dry decontamination. Using a blot and rub motion, start with the face, then the hands, then any other exposed skin areas and finally the hair. If availability of material permits, ask casualties to use clean swatches of absorbent material for each body area. Above all, ensure that casualties do not reuse material after decontaminating their hair. Encourage casualties to repeat the entire process several times, paying particular attention to the hair, face and hands.
N Note the development of any signs and symptoms. Begin triage to identify priority casualties.
C Communicate constantly with casualties to encourage cooperation and reassurance that disrobe and decontamination will remove the vast proportion of any contamination. Confirm to the casualties that advanced medical assistance is on its way.
Y Yards not inches: maintain a safe distance from casualties at all times, but close enough so that they can hear instructions.