Question 1 · Major Incident & Triage · Moderate
You arrive at a call where three people have collapsed in a lobby with no obvious cause. According to STEP 1-2-3 Plus, what should you do?
- AApproach with caution, report on arrival and update control
- BApproach using normal procedures and assess the nearest casualty
- CDo not approach; withdraw, contain, report and seek specialist help
- DPut on gloves and a face mask, enter and give all three oxygen
- ECarry each casualty out to fresh air yourself, then report to control
Show answer
Answer: C
Do not approach; withdraw, contain, report and seek specialist help
STEP 1-2-3 Plus (Safety Triggers for Emergency Personnel) scales the approach to the number of people incapacitated with no obvious reason. One casualty: approach using normal procedures. Two: approach with caution, report on arrival and update control. Three or more in close proximity: treat as a possible chemical, biological, radiological or nuclear (CBRN) incident - do not approach; withdraw, contain and report, isolate yourself if you may have been contaminated, and send for specialist help. The Home Office Initial Operational Response (IOR) guidance (v2.0, 2015) then directs first responders to 'Plus': evacuate, communicate and advise, disrobe and decontaminate, using dry decontamination when a non-caustic agent is suspected and wet decontamination when a caustic agent is suspected. The current National CBRN Centre IOR brochure (v1.1, June 2024) frames the response as Recognise, Assess, React, and the immediate casualty actions as Remove, Remove, Remove; the first 15 minutes are the most critical for life-saving activity, and casualties should be moved upwind and ideally uphill of the incident. Entering to give oxygen, even with gloves and a mask, or carrying casualties out yourself, risks making you the next casualty; approaching with caution is the step 2 response, and normal procedures the step 1 response.
Where this comes from
- Initial Operational Response to a CBRN Incident, Version 2.0, July 2015Home Office CBRNE Unit on behalf of the UK emergency services (hosted by JESIP)·5. First responders: STEP 1-2-3 Plus, step 3“Three or more people in close proximity, incapacitated with no obvious reason”Open PDF at page 11
- Initial Operational Response to a CBRN Incident, Version 2.0, July 2015Home Office CBRNE Unit on behalf of the UK emergency services (hosted by JESIP)·5. First responders: 'Plus' - evacuate, communicate and advise, disrobe, decontaminate“wet decontamination when a caustic agent is suspected”Open PDF at page 11
- Initial Operational Response (IOR) to Incidents Suspected to Involve Hazardous Substances or CBRN Materials, Version 1.1, June 2024National CBRN Centre / JESIP·Initial operational response: the first 15 minutes“the first 15 minutes are the most critical for achieving life-saving activity”Open PDF at page 5
- Initial Operational Response (IOR) to Incidents Suspected to Involve Hazardous Substances or CBRN Materials, Version 1.1, June 2024National CBRN Centre / JESIP·Glossary: RRR“RRR: Immediate decontamination model (Remove, Remove, Remove).”Open PDF at page 4
- Initial Operational Response (IOR) to Incidents Suspected to Involve Hazardous Substances or CBRN Materials, Version 1.1, June 2024National CBRN Centre / JESIP·Recognise, assess, react“ASSESS the incident to inform an appropriate response strategy”Open PDF at page 12
- Initial Operational Response (IOR) to Incidents Suspected to Involve Hazardous Substances or CBRN Materials, Version 1.1, June 2024National CBRN Centre / JESIP·Remove people from the hazard“casualties should be moved to an area upwind and ideally uphill of the incident”Open PDF at page 22
- ABC of Prehospital Emergency Medicine
- Ch. 34 Emergency Preparedness: Chemical, Biological, Radiation and Nuclear Incidents · Figure 34.1 The STEP 1-2-3 approach: step 3 · p. 185“Isolate yourself and SEND for SPECIALIST HELP”
- Ch. 34 Emergency Preparedness: Chemical, Biological, Radiation and Nuclear Incidents · Figure 34.1 The STEP 1-2-3 approach: step 2 · p. 185“Approach with caution, consider all options”
- Oxford Handbook of Pre-Hospital Carep. 617Ch. 11 Chemical, biological, radiological, and nuclear incidents · Mode of presentation: the NATO model of STEP 123“do not approach, withdraw, contain and report the incident”