Persons suspected of being contaminated are usually separated by sex, and led into a decon tent, a decon trailer, or a decon pod, where they shed their potentially contamined clothes in a stripdown room. Then they enter a washdown room where they are showered. Finally they enter a drying and re-robing room to be issued clean clothing, or a white Tyvek jumpsuit, or the like. Some more structured facilities, as shown in the drawing, include six rooms (stripdown room, washdown room, examination room, for each of men's and women's side). Some facilities, such as Modec's, and many others, are remotely operable, and function like "human carwashes". In describing the plans for Los Angeles authorities, by The ACI World Aviation Security Standing Committee:
"The disinfection/decontamination process is akin to putting humans through a car wash after first destroying their garments". Los Angeles World Airports have put in place a contingency plan to disinfect up to 10,000 persons who might have been exposed to biological or chemical substances."
Mass decontamination is the decontaminating large numbers of people. Hospitals are often prepared for handling a large influx of patients from a terrorist attack:
University of Pittsburgh and Carnegie Mellon University have developed anti-terror software that tracks patients who show up at hospitals with symptoms such as diarrhea, skin rash and respiratory illness. The software, known as the Real-time Outbreak Disease Surveillance system, is used by about 27 hospitals in the Commonwealth of Pennsylvania, as well as in eight states. RODS was the nation's first automated bioterrorism warning system when it was first deployed in 1999. The RODS software has been made available free, as an open-source application, to any local, or state health department, by the University of Pittsburgh.
Exercises are of three types:
* Tabletop- An exercise held with responsible personnel in which a facilitator relays information about a scenario to the group. The group then discusses the actions they each would take in the given situation. There is no "live response" or use of assets. The table top is a low impact, low stress method to review emergency plans.
* Functional-A functional exercise involves the agencies involved in an Emergency Operations Center, a scenario is presented and the players go through the actions they would if it were a real incident. The exercise tests the technical resources and plans of the Emergency Operations Center. There is no "live response" outside of the Emergency Operations Center.
* Full Scale-A full scale exercise is the most involved type of exercise and the most difficult to plan and execute. Full scale exercises can vary in size from one agency or municipality to multinational exercises such as the US Government lead annual TOPOFF exercise. In a full scale exercise a scenario is created and acted out in a real world manner. Responders are expected to act in accordance with established plans and as they would in a real incident. At times certain parts of the exercise have to be simulated due to equipment, financial, or safety reasons, sometimes making the scenario confusing. Full scale exercises are often used as a chance to test and rate an agencies true level of preparedness.
Collaboration among various levels of authority, and among various countries, is required to address bioterror threats, because contamination knows no boundaries. Disease and contamination do not stop at the border from one country to another. Thus organizations such as NATO, bring together member countries to practice how to contain an outbreak, setup quarantine facilities, and care for displaced persons.
The collection of personal belongings for evidence
Dofficers (Decontamination officers in the "doffing" or disrobing area) are often police or military personnel, ready to handle potentially unruly persons who refuse to cooperate with first responders.
For example, the U.S. ARMY SOLDIER AND BIOLOGICAL CHEMICAL COMMAND suggests that:
"The entire incident is a crime scene requiring the collection of criminal evidence and suspicious victim belongings. The preservation of a proper chain of custody must be maintained for all evidence. ... patients could be suspects and their belongings may be evidence. ... Direct patients through a detailed decontamination process and deal with potentially unruly patients. ... Enforce order when persons become uncooperative when asked to remove clothing and relinquish personal items.".
Paul Rega, M.D., FACEP, and Kelly Burkholder-Allen also note, in "The ABCs of Bioterrorism" an additional advantage in decontaminating everyone found at the scene of an incident, because this will help the authorities in searching through everyone's clothes to find suspicious items:
"Removal of clothing in the decon procedure has the additional advantage of detecting weapons or a secondary device on a victim or"pseudo-victim.""
Chris Seiple, in "ANOTHER PERPSECTIVE ON THE DOMESTIC ROLE OF THE MILITARY IN CONSEQUENCE MANAGEMENT" suggests that the evidence gathering process of identifying contaminated people and their belongings should also include the process of video surveillance:
The identification of contaminated victims and their personal effects... Victims are also videotaped as they proceed through the decontamination line.
Video Surveillance... Videotaped documentation could later be used in the evidence processes;
Although there are the obvious privacy concerns in surveillance, one can also argue that due to the high risk nature of terrorism, such surveillance is warranted, as it is in other high risk areas like bathing complexes where surveillance is often used because of the risk of drowning. In these cases the importance of safety may often be thought to outweigh privacy concerns.
Handling uncooperative victims
One of the elements that separates a drill from a real-life situation is dealing with panicked or uncooperative victims.
In a real attack, the perpetrators may be among the victims, or some of the victims may be in possession of contraband, or of evidence that might help law enforcement in solving the crime.
Another consideration is that some of the perpetrator victims might refuse to go through decon because this would result in discovery of the contraband they may be hiding.
For example, a person with explosives strapped to his or her body, under their clothing, would likely not be so willing to take it off. Such a victim might try to escape, and need to be restrained for decon.
Separate male and female dofficers (decon officers) deal with potentially unruly patients, by restraining the hands using flex cuffs, and cutting off the shirt, then removing shoes and pants normally. This usually requires a couple of officers.
The Belfast Telegraph of Sept 22, 2004 describes such a situation:
"...holds back hundreds of extras playing traumatised bomb victims. Coated in ash and wrapped up in bandages, these people are staggering around, dazed and confused, like so many shell-shocked World War I soldiers. While troops in riot gear charge forward to reinforce the cordon and use their shields and batons to beat back ... desperately appeal for calm. They ask people to file in an orderly fashion towards the decontamination units being rapidly assembled by fire fighters in inflated orange Chemical Biological Radiation Nuclear (CBRN) suits."
BATTALION CHIEF MICHAEL FARRI:
They bring a law enforcement agency group with them and they have no problem if somebody needs to be restrained with handcuffs or flex cuffs or whatever to keep them from going from the hot zone to a cool zone; whereas the fire department, we are not geared to do that.... KWAME HOLMAN: Colonel Hammes says his Marines are trained to handle uncooperative people. ... If they're really hysterical, there's some simple techniques from this program called Marine Martial Arts, that teaches various martial arts skills; there are common techniques that police also use to provide pain compliance-- no permanent damage, just enough to get your attention, and allows us to control you. If you still won't, then we can control in flex cuffs, and then we'll flex cuff decontaminate you. And if you're calm at that point, we turn you loose. If you're still not calm, then the police will be asked to give us a hand.