Inclusive emergency management after CBRN incidents: adapting decontamination for individuals with disabilities and assistive devices

Background: Emergency decontamination procedures overlook people with disabilities, particularly those dependent on assistive devices. This study examines how decontamination protocols can be adapted to enhance inclusivity and effectiveness during accidental or intentional release of chemical or biological agents referred to as CBRN incidents.

Methods: A qualitative study was conducted through 28 semi-structured interviews with patient representatives and professionals working with individuals with disabilities. Participants discussed physical and psychological needs before, during, and after decontamination. Data was analysed using Rapid Assessment Procedure (RAP) sheets to identify key themes.

Results: Participants highlighted that disabilities are heterogenous and complex, often involving multiple impairments. Limited first responders (FRs) experience with disabilities may lead to exclusion from care and inappropriate responses. Physical needs include safe handling, tracking and preservation of assistive devices, particularly those with electronic or customised equipment. Devices should remain with or return them to their owners whenever possible. Alternative methods, such as sitting decontamination using plastic wheelchairs, were suggested to improve autonomy. Psychological considerations included emotional attachment to assistive devices, clear communication, involvement of trusted caregivers, and minimising distress. The physical environment (e.g., noise, lighting) influences stress levels and must be adapted. Participants emphasised the importance of fair triage, informed consent, and integrating inclusive protocols.

Conclusion: Standard decontamination protocols should incorporate accessible communication strategies, electronic-friendly procedures, and environmental adaptations to better accommodate individuals with disabilities. The next phase of this project will focus on developing European guidelines for decontaminating assistive devices sensitive to conventional water-based methods, enhancing inclusivity and effectiveness in CBRN emergency response.