Method and associated apparatus, system and use for the manipulation and decontamination of a casualty

Abstract

A method of manipulating and decontaminating a casualty exposed to a hazardous agent comprising the steps of: providing an apparatus defining a conveyor pathyway (1) with a first, dirty region (2) and a second, clean region (3) separated by a gap (4) enabling disposal of garments, providing a team comprising at least one individual manipulating the casualty’s head, at least one individual placing the casualty head-first onto the first region, and at least one individual providing a lateral force on the casualty and / or conveyor such that the casualty is transferred along the first region, across the gap and along the second region, wherein the garments are removed and disposed via the gap and the casualty can receive downstream medical support. Also included is an apparatus (1) comprising (a) a conveyor pathway having a first, dirty region (2) and a second, clean region (3) separated by a gap (4) enabling disposal of garments and (b) a support element (101 – Figure 5) comprising a connecting element (103 and 104 – Figure 5) enabling lateral movement of the support element and a surface (102 – Figure 5) supporting the casualty’s head during transfer, and a system comprising the apparatus and an associated housing.

Description

Technical Field of the Invention The invention relates to a method for the manipulation and decontamination of a casualty exposed to, and potentially contaminated by, a hazardous agent. The invention also relates to an associated apparatus, system and use. Background to the Invention Safe extraction of a casualty from a hazardous Chemical, Biological, Radiological and Nuclear (CBRN) environment, wherein a hazardous agent(s) of a chemical, biological, radiological and / or nuclear nature may be present that poses the potential to cause harm to humans, other organisms or the surroundings, is an extremely challenging and resource-heavy task. It generally requires high numbers of personnel to complete the extraction as safely and quickly as possible. Indeed, extraction may not be carried out in a safe or timely manner in case of multiple casualties or with fewer available personnel. Retrieving a casualty back to a ‘clean’ environment (i.e. the surroundings being free from a hazardous agent) enables the provision of medical support. While such extraction ensures that the casualty is adequately removed away from the ‘dirty’ environment (i.e. the surroundings associated with the presence of a hazardous agent), the transfer must be completed such that the casualty is freed from contaminated clothing or Personal Protective Equipment (PPE). In addition, removed clothing, PPE and / or decontaminating materials can present a trip or contamination hazard if simply discarded to facilitate quick removal of a casualty. In certain situations, such as during a CBRN trial or exercise, where the provision of decontamination and treatment facilities are a pre-requisite for the trials to take place, the usually-required numbers of personnel may not be available. WO 2004 / 075206 A2 discloses a system and associated method for decontaminating casualties using multiple conveyors, built in stretchers or holder units and a driving mechanism to transport patients through multiple areas, which may include gathering areas, powdering / washing areas, treatment areas and evacuation areas. WO 03046314 A1 discloses decontamination equipment that can be deployed onsite with first responders and set up on a clean line, ready to process personnel as they move from a contaminated area. WO 03046314 A1 also describes a litter (stretcher-bound) patient processing line including stations for decontaminating, washing, rinsing, and drying patients. US 2004 / 238007 A1 discloses a decontamination system for victims of chemical, biological, radiological, or other harmful exposure via an isolation apparatus, a washing chamber, an output enclosure, a method of passing a non-ambulatory patient through the system and a waste collection system. The waste collection system comprises a gravity-fed trough and a hose for liquid waste, while solid waste is deposited into a container through a sealed hatch reachable in the isolation chamber. There remains a need for methods and apparatus that can be rapidly deployed in the event of a hazardous CBRN event, that allow for the timely removal and disposal of contaminated clothing, PPE and decontaminating materials so that a casualty can be swiftly and safely moved from a dirty environment to a clean environment for the provision of medical support. Summary of the Invention According to a first aspect, the invention provides a method for the manipulation and decontamination of a casualty exposed to, and potentially contaminated by, a hazardous agent, the method involving the steps of: a) providing an apparatus defining a conveyor pathway, the conveyor pathway comprising a first region representing a dirty environment, and a second region representing a clean environment, the first region and second region separated by a gap enabling the disposal of a garment(s) and / or other element(s) worn by, or associated with, the casualty; b) providing a team, represented by a plurality of individuals, for the manipulation and decontamination of the casualty, the team comprising a first individual responsible for at least the manipulation of the casualty’s head; c) at least one individual from the team placing the casualty directly or indirectly onto the first region at a first end, the casualty arranged in a head-first orientation relative to a direction of travel along the conveyor pathway; and d) at least one individual from the team initiating or providing a lateral force on the casualty and / or conveyor pathway such that casualty is transferred: i) along the first region; ii) across the gap; and iii) along the second region; wherein the garment(s) and / or other element(s) worn by, or associated with, the casualty is / are removed, and disposed via the gap, during the casualty being transferred from the first region to the second region, such that the casualty can received downstream medical support following transfer onto the second region. With respect to the casualty, it is to be understood that the term ‘manipulation’ includes, but is not limited to, the lifting, turning, support, immobilisation or any other movement of the full body of the casualty, as well as the lifting, turning, support or any other movement of one or more body parts of the casualty. It is to be understood that the term ‘conveyor pathway’ includes, but is not limited to, any stabilised means that provides for movement of the casualty from the first region to the second region. Such means could include, but are not limited to, at least one powered mechanism, such as a conveyor belt, that enables the automated transport of the casualty, and / or at least one unpowered mechanism, such as a roller bed, that enables the manual sliding of the casualty by at least one member of the team. Furthermore, it is to be understood that the gap in the conveyor pathway, defined by an interruption in the conveyor pathway located between, and thus helping to define, the first region and the second region, may be provided by the separation of two or more entirely independent apparatus pieces representing the first and second region. However, alternative arrangements are envisaged e.g. the first region and second region may form a co-associated part of a single apparatus in a manner that still provides an interruption in the conveyor pathway. The method of the invention has several key advantages when compared to current methods. The inclusion of a physical gap as part of the method allows for a simple and effective single movement that simultaneously allows for the transfer of a casualty from a dirty environment to a clean environment, as well as the controlled disposal of potentially contaminated garnets and / or other element(s) worn by, or associated with, the casualty. The use of a conveyor pathway in the method, as well as the method of transferring the casualty across the gap, reduces the number of individuals needed in either or both of the first and second regions, when compared to a simple manual lifting method, as well as reducing the risk of further complications to the casualty resulting from constant manual lifting. Equally, the method can be used in many environments with very little required setup time and effort when compared to some methods in the prior art that require more apparatus, housing and personnel. The method of the invention provides for the decontamination of a casualty who, on account of injury and / or impairment, potentially due to contamination with a hazardous agent, is unable to walk and / or remove potentially contaminated garments and / or other element(s) worn by, or associated with, the casualty. In the method of the invention, a casualty may be placed directly onto the first end of the first region of the conveyor pathway by being carried by one or more individuals in a team. However, the casualty may be placed indirectly onto the first end of the first region i.e. upon a stretcher or other kind of man-portable casualty transportation. The head first orientation of the casualty, relative to the direction of travel, enables the support and manipulation of the casualty’s head, as well as potentially their neck and / or shoulders, upon the casualty being placed onto the first region of the conveyor pathway. Upon placement on the first end of the first region, the casualty is moved along the conveyor pathway such that the head of the casualty is subsequently situated at the second end of the first region next to the gap. The garment(s) (which include, but are not limited to, potentially contaminated PPE and external clothing) and other element(s) (including, but not limited to, jewellery and carried equipment), associated with the casualty, are cut away or otherwise excised from the casualty. In addition, the first region provides a setting wherein a decontaminating material, for example Fuller’s Earth, can be applied to a casualty thought to have been exposed to a hazardous agent. The method of the invention requires a separation between the first region (i.e. dirty environment) and the second region (i.e. clean environment) via a gap. This feature provides the advantage of allowing for the removed garment(s) or element(s), associated with the casualty, to easily fall away from the casualty upon transfer from the first region to the second region. It is envisaged that a waste bin could be arranged in the gap to facilitate the easy collection and disposal of items that fall into the gap. The easy disposal of the items associated with the patient, enabled by the gap, means that the casualty can be considered free from, or having a reduced level of, contamination upon transfer across the gap. This feature of the method means that individuals in the team in the second region do not necessarily need to wear the same bulky PPE as individuals in the team at the first region, affording the former greater freedom in the manipulation of the casualty, including during the casualty’s transfer to downstream medical support. Preferably, the gap has a distance of approximately 20-60 centimetres. This range of gap distance advantageously provides a sufficient gap to allow for removed PPE and other potentially contaminated material to fall away from the casualty during the lateral movement from the first region to the second region. Additionally, this range of gap distance also advantageously minimises the distance of free travel over which the casualty’s head, as well as potentially their neck and / or shoulders, needs to be supported during transfer. In addition, this relatively small gap allows for much faster casualty transfer from the first region to the second region when compared to where the first and seconds regions could be separated by greater distances of e.g. more than one metre. The inventors have found that one possible approach is to vary the gap depending upon casualty height, ensuring that the legs of the casualty do not bend at the knee and drop into the gap during the transfer from the first region to the second region. More preferably, the gap has a distance of approximately 36 centimetres. In practice, those individuals representing the most common casualties, in the scenarios experienced by the inventors, do not vary significantly in height, and a gap distance of approximately 36 centimetres is generally used. Preferably, a support element is provided to support at least the casualty’s head as the casualty is transferred across the gap, the support element capable of lateral movement relative to the second region. It is to be understood that the support element may support any part of a casualty’s head. The support element may additionally support any part of a casualty’s neck and / or shoulders. The provision of the support element provides the advantage of reducing the risk of further injury to the casualty during manipulation, especially to those with suspected head, neck, spine or other associated injuries, by helping to ensure that the casualty’s head is kept in line with their neck. The support element provides additional protection to the patient when compared to only the provision of an individual(s) responsible for the manipulation of the casualty’s head. The lateral movement of the support element, relative to the second region, advantageously allows for the projection of the support element over the gap between the first and second region. This prevents potentially dangerous bending of the casualty’s neck by ensuring that their head does not fall downwards and backwards into the gap whilst the patient is being transferred across the gap. The lateral movement of the support element, relative to at least the second region, further ensures that the head support is maintained at all times in the second region and means that the head support does not need to be removed or become an obstacle for the movement of the casualty along the second region. Preferably, a layer of protective material is provided on the first region, the layer of protective material being disposed through the gap during the casualty being transferred from the first region to the second region. The layer of protective material provides the advantage of protecting the apparatus and surrounding environment of the first region from potential contamination, as the patient is placed on the protective material rather than directly on the first region itself. The protective material can be of any type of suitable material as understood by the skilled person. Preferably, the layer of protective material comprises Chemical Agent Resistant Material (CARM) fabric, routinely used in CBRN training &operations. In use, (potentially) contaminated CARM fabric can be deposited into a waste bin in the gap, or the gap itself, alongside the PPE, during casualty transfer to the second region. This returns the first region to a ‘free from contamination’ status, ready for the next casualty(ies) if applicable. According to a second aspect, the invention provides an apparatus for implementing the method of the first aspect, wherein the apparatus in use comprises: a conveyor pathway, the conveyor pathway comprising a first region representing a dirty environment, and a second region representing a clean environment, the first region and second region separated by a gap enabling the disposal of a garment(s) and / or other element(s) worn by, or associated with, the casualty; and a support element comprising: i) a connecting element associated with, and enabling lateral movement of the support element relative to, the second region, and ii) a surface providing support to at least the casualty’s head as the casualty is transferred across the gap. It is to be understood that the apparatus comprising the support element could be constructed from any rigid and durable material. Another useful attribute for the support element is low-weight, to reduce the weight of the overall system and facilitate lateral movement. While it is envisaged that the surface providing support to the casualty’s head (i.e. at least a part of the casualty’s head) is a substantially planar surface, other arrangements can be provided e.g. a moulded surface to accommodate the shape of a casualty’s head. The support element may additionally support any part of a casualty’s neck and / or shoulders. The conveyor pathway provided for the second region may drive the size and shape of the connecting element. The size of the surface providing support to at least the casualty’s head may be driven at the lower extreme by the length and width necessary to have space to support at least the head of a casualty, as well as the thickness necessary to support the weight of at least the casualty’s head. There is no foreseen upper limit to the size of the surface apart from one of a practical need to reasonably match the width of the conveyor pathway of the second region. A rectangular shape has been used for the surface by the inventor, but there is nothing precluding the use of other shapes. Preferably, the connecting element forms a band or sleeve that can be arranged around the second region of the conveyor pathway. The use of a connecting element forming a band or sleeve advantageously allows for the choice of whether or not to use the support element on a casualty-by-casualty basis, whilst also allowing for quick installation and removal of the support element as a whole. The band or sleeve can be constructed from wood, PTFE, metal or another rigid, light and durable material. As understood by the skilled person, other material may be provided, e.g. on an inner surface of the band or sleeve, to reduce fiction between the connecting element and the second region of the conveyor pathway during lateral movement of the support element relative to the conveyor pathway. The size and shape of the band or sleeve may depend up the choice of conveyor pathway apparatus in the second region. Alternatively, the connecting element comprises at least one wheel, the apparatus further comprising at least one runner capable of engaging with the at least one wheel, to guide the direction of travel of the support element. The wheel and runner arrangement advantageously allows for smooth sliding during lateral movement of the support element, preventing jolting of e.g. the casualty’s head, neck and / or shoulders. If combined with a roller bed apparatus in the second (and potentially also the first) region, a casualty’s entire body can be moved easily, whilst at least head support is simultaneously provided, from the point of transfer from the first region onwards. The wheel and / or runner could be made from any rigid and durable material; for example wood, PTFE or metal. The preferred material for the runner is generally metal, but alternative materials with rigid and durable characteristics are envisaged. Preferably, the apparatus further comprises a means for deploying the protective material, the means located at the first end of the first region. Provision of the means for deployment of protective material speeds up the process of the patient being placed onto the first region, and further ensures that the protection to the first region’s equipment and surroundings is provided faster than would be possible without said means. There are many potential ways of achieving the deployment of the protective material, but one approach would be the use of a feed roller, such that when a casualty is placed on, and deployed from, the first end of the first region, the protective material is simultaneously pulled from the roller, underneath the casualty, stretcher or other means of casualty transportation. Preferably, the apparatus further comprises at least one barrier capable of extending from the conveyor pathway to demarcate the first region and second region. The provision of the barrier provides clarity to the individuals regarding the demarcation between the dirty environment and clean environment. This demarcation helps to prevent contamination of the second region, ultimately protecting team members at the clean environment. The demarcation also provides cues as to which individual or individuals are responsible for the casualty, depending on the position of the casualty compared to the barrier. There are many options for providing at least one barrier capable from extending from the conveyor pathway, including a barrier capable of deployment via a telescopic extension and / or horizontal or vertical hinging. Depending on the precise definition of a “hotline” between the first region and the second region, the barrier(s) could be placed at the second end of the first region, and / or the first end of the second region, and / or at any point aligned with the gap between the regions. Depending on the space available, there may be barrier(s) on one side of the conveyor pathway, or at least one barrier provided on both sides of the conveyor pathway. According to a third aspect, the invention provides a system comprising: i) the apparatus according to the second aspect; and ii) an associated housing. Providing the invention in the form of a system comprising a housing offers the advantage of a repeatable setup for casualty handling and treatment. The associated housing could be a fixed or relocatable housing, providing further benefits that include: a shelter from the weather and / or elements; a stable base on which the method can be conducted / apparatus can be situated; a means of system and equipment storage; and / or a means of system and equipment transportation. In particular, shelter from the weather and / or elements may be important to prevent exposure to both the casualty and the team, as well as allowing the safe and convenient operation of the apparatus. Providing a stable surface to the apparatus has the benefit of allowing for the safe and convenient operation of the apparatus. In particular, it prevents undesired movement of the potentially vulnerable casualty during both manipulation and item removal. A fully integrated system, containing storage for all necessary apparatus and equipment / materials, provides the user with confidence that these items will be readily available when needed and removing the need for delivery of these items from other areas when needed. This is particularly beneficial if the system is capable of transportation by land, sea and / or air to allow for its rapid deployment elsewhere from its usual base. Preferably, the housing is an International Organisation for Standardisation (ISO) container. An ISO container, being a generally-standardised and well understood transportation and housing method, provides a convenient, consistent (due to its standardisation) and controllable operating environment. The choice of an ISO container as the housing allows for convenient transportation by land, sea and air. The standardised environment provided by the ISO container also advantageously allows for repeatable approaches to storage solutions, floor markings and / or power and lighting provision. The doors on a typical ISO container advantageously provide the option to operate the system with the doors closed (once the casualty is in place) to provide a more discreet workspace and a level of containment should a chemical vapour or gross liquid hazard be present. However, in use, it is envisaged that the doors are generally left open to provide the benefit of good ventilation and permit easy information exchange, for example from an individual(s) to downstream medical support personnel. Preferably, the system further comprises a vehicle and an associated trailer for transporting a casualty to the apparatus. The use of a vehicle and associated trailer provides a means for the timely and effective transportation of a casualty from the point of injury to the system. The term ‘vehicle’ includes, but is not limited to, a Quad Bike, with this form of transport having the advantage of being usable on rough terrain to reach areas that other vehicles or individuals are unable to reach quickly or safely. Another example of a vehicle is a snowmobile, which can be selected in accordance with the operating environment. The provision of a suitable trailer for the transportation of the casualty would generally allow the casualty to be supported in a safer and / or more comfortable position that would be possible if carried inside or upon a vehicle. Depending on trailer size, individuals effecting the rescue of the casualty can travel alongside a casualty in the trailer, providing comfort, reassurance and / or treatment to the casualty. According to a fourth aspect, the invention provides use of an apparatus according to the second aspect or a system according to a third aspect. In particular, it is envisaged that one potential use of the described apparatus or system would be in support of live trials or experiments involving the use of hazardous CBRN materials, where the provision of an effective casualty evacuation process is a prerequisite for trial safety planning signoff. However, the apparatus and system of the invention are suitable for deployment in a real-life CBRN event. Any feature in one aspect of the invention may be applied to any other aspects of the invention, in any appropriate combination. In particular, method aspects may be applied to apparatus, system and / or use aspects and vice versa. The invention extends to a method, apparatus, system or use substantially as herein described, with reference to the accompanying Figures. In all aspects, the invention may comprise, consist essentially of, or consist of any feature or combination of features. Description of the Figures The present invention will now be described, purely by way of non-limiting example, with reference to the accompanying Figures, in which: Figure 1 shows a schematic representation from a plan view of the conveyor pathway in use according to one preferred embodiment of the invention; Figure 2 shows a schematic representation from an isometric view of a region of the conveyor pathway according to Figure 1; Figure 3 shows a schematic representation from an isometric view of the conveyor pathway according to Figure 1; Figure 4 shows a schematic representation from a side view of the conveyor pathway in use according to Figure 1; Figure 5 shows a schematic representation from a side view of the apparatus according to one preferred embodiment of the invention; Figure 6 shows a schematic representation from a side view of the apparatus according to another preferred embodiment of the invention; Figure 7 shows a schematic representation from an isometric view of a region of the conveyor pathway according to the embodiment of Figure 5; and Figure 8 shows a schematic representation from an isometric view of a region of the conveyor pathway according to the embodiment of Figure 6. The drawings are for illustrative purposes only and are not to scale. Detailed Description Figure 1 shows a conveyor pathway (1) formed from a first conveyor region (2) and a second conveyor region (3), each provided by an industrial conveyor roller bed. The first conveyor region (2) and the second conveyor region (3) are separated by a gap (4). The conveyor pathway (1) is formed from a plurality of rollers (5) and provides a platform on which a casualty (6) can be placed and subsequently transported along. At one end of the first conveyor region (2) is a feed roller (7) from which can be dispensed CARM fabric (8). In use, conveyor pathway (1) is located in an operational site wherein the first conveyor region (2) is situated in an area defined as a dirty environment and the second conveyor region (3) is situated in an area defined as a clean environment. A casualty (6) is initially introduced on the conveyor pathway (1) via the first conveyor region (2). The first conveyor region (2) is covered with a CARM fabric (8) on which the casualty (6) is placed, wherein the CARM fabric (8) is dispensed along the whole of the first conveyor region (2) from feed roller (7) prior to the placement of the casualty (6) on the first conveyor region (2), and / or the CARM fabric (8) is dispensed from the feed roller (7) as the casualty (6) is transported along the first conveyor region (2). The casualty (6) is handled and decontaminated in the first conveyor region (2) by a team consisting of a plurality of individuals (9), (10) and (11), with individual (9) being responsible for the support and manipulation of the casualty’s (6) head. Upon completion of the decontamination process, the casualty (6) is transferred across the gap (4), with the CARM fabric (8) and other elements (not shown), such as clothing associated with the casualty (6) falling into the gap (4) without passing (and therefore without contaminating regions the other side of a designated ‘hotline’ (12) between the dirty environment and the clean environment. Upon completion of the transfer of the casualty (6) onto the second conveyor region (3), a team consisting of a plurality of individuals (13), (14) and (15) take charge of the casualty (6) and their transfer to downstream medical treatment. Figure 2 shows the first conveyor region (2) comprising a plurality of rollers (5) that provide a low-rolling-resistance surface that eases the transfer of a casualty (6) (not shown) along the first conveyor region (2) (and by extension along the whole of the conveyor pathway (1) (not shown). The rollers (5) are housed within a robust housing frame (16), held at an appropriate height by support legs (17) with sturdy stretchers (18), providing a stable and safe platform for a casualty (6) (not shown). Figure 3 shows conveyor pathway (1) formed from the first conveyor region (2) and the second conveyor region (3), each provided by an industrial conveyor roller bed. Separating the two conveyor pathways is a gap (4) filled with a waste disposal bin (19), allowing for disposal of the CARM fabric (8) and elements (not shown) associated with the casualty during transfer between the first conveyor region (2) and the second conveyor region (3). Figure 4 shows the conveyor pathway (1) in use, wherein the casualty (6), having been decontaminated, is being transferred across the gap (4) between the first conveyor region (2) and the second conveyor region (3). The CARM fabric (8) and excised PPE (20) associated with the casualty (6) are disposed into the waste disposal bin (19) during transfer across the gap (4). Figure 5 shows apparatus (100) in use with a support element (101) that provides support to the casualty’s (6) head and shoulders during transfer across the gap (4) between the first conveyor region (2) and the second conveyor region (3). The support element (101) comprises a planar support surface (102) extending over the gap (4) in order to support the head and shoulders of the casualty (6). Attached to the planar support surface (102) at each side are, via connectors (103a, 103b; shown on one side of support surface (102)), two wheels (104a, 104b; also shown on one side of support surface (102)). The wheels (104a, 104b) are housed in a runner (105) on both sides of the second conveyor region (3) (shown on one side of second conveyor region (3)), which retains the association of the support element (101) with the second conveyor region (3) as well as allowing lateral movement of the support element (101) relative to the second conveyor region (3). Figure 6 shows apparatus (200) in use with a support element (201) that provides support to the casualty’s (6) head and shoulders during transfer across the gap (4) between the first conveyor region (2) and the second conveyor region (3). The support element (201) comprises a planar support surface (202) connected to the second conveyor region (3) via sleeve (203) that encircles the second conveyor region (3), allowing the support element (201) to slide laterally relative to the second conveyor region (3). Figure 7 shows the second conveyor region (3) associated with the support element (101), in particular demonstrating how the support element (101), can be moved laterally (as indicated by the arrow) relative to the second conveyor region (3) along a runner (105) housing two wheels (104a, 104b) connected to the planar support surface (102) by connectors (103a, 103b). Figure 8 shows the second conveyor region (3) associated with the support element (201). The support element (201) can be moved laterally (as indicated by the arrow) relative to the second conveyor region (3) by a sliding motion, enabled by sleeve (203) that encircles the second conveyor region (3) and connects to the planar support surface (202). It will be understood that the present invention has been described above purely by way of example, and modification of detail can be made within the scope of the invention. Each feature disclosed in the description, and (where appropriate) the claims and figures may be provided independently or in any appropriate combination. Moreover, the invention has been described with specific reference to manipulation and decontamination of a casualty exposed to, and potentially contaminated by, a hazardous agent. It will be understood that this is not intended to be limiting and the invention may be used more generally. For example, the invention may be used in 5 endeavours relating to casualty rescue, disaster response and so on. Other examples of use include incidents relating to fire and rescue. Additional applications of the invention will occur to the skilled person.

Claims

1. A method for the manipulation and decontamination of a casualty exposed to, and potentially contaminated by, a hazardous agent, the method involving the steps of:a. Providing an apparatus defining a conveyor pathway, the conveyor pathway comprising a first region representing a dirty environment, and a second region representing a clean environment, the first region and second region separated by a gap enabling the disposal of a garment(s) and / or other element(s) worn by, or associated with, the casualty;b. Providing a team, represented by a plurality of individuals, for the manipulation and decontamination of the casualty, the team comprising a first individual responsible for at least the manipulation of the casualty’s head;c. At least one individual from the team placing the casualty directly or indirectly onto the first region at a first end, the casualty arranged in a head-first orientation relative to a direction of travel along the conveyor pathway; andd. At least one individual from the team initiating or providing a lateral force on the casualty and / or conveyor pathway such that casualty is transferred:i. along the first region;ii. across the gap; andiii. along the second region;wherein the garment(s) and / or other element(s) worn by, or associated with, the casualty is / are removed, and disposed via the gap, during the casualty being transferred from the first region to the second region, such that the casualty can received downstream medical support following transfer onto the second region.

2. A method according to Claim 1, wherein the gap has a distance of approximately 20-60 centimetres.

3. A method according to any preceding claim, wherein a support element is provided to support at least the casualty’s head as the casualty is transferred across the gap, the support element capable of lateral movement relative to the second region.

4. A method according to any preceding claim, wherein a layer of protective material is provided on the first region, the layer of protective material being disposed through the gap during the casualty being transferred from the first region to the second region.

5. An apparatus for implementing the method of Claim 3, wherein the apparatus in use comprises:a. a conveyor pathway, the conveyor pathway comprising a first region representing a dirty environment, and a second region representing a clean environment, the first region and second region separated by a gap enabling the disposal of a garment(s) and / or other element(s) worn by, or associated with, the casualty; andb. a support element comprising:i. a connecting element associated with, and enabling lateral movement of the support element relative to, the second region, andii. a surface providing support to at least the casualty’s head as the casualty is transferred across the gap.

6. An apparatus according to Claim 5, wherein the connecting element forms a band or sleeve that can be arranged around the second region of the conveyor pathway.

7. An apparatus according to Claim 5, wherein the connecting element comprises at least one wheel, the apparatus further comprising at least one runner capable of engaging with the at least one wheel, to guide the direction of travel of the support element.

8. An apparatus according to Claim 5 to Claim 7 for implementing the method of Claim 4, wherein the apparatus further comprises a means for deploying the protective material, the means located at the first end of the first region.

9. An apparatus according to Claim 5 to Claim 8, wherein the apparatus further comprises at least one barrier capable of extending from the conveyor pathway to demarcate the first region and second region.

10. A system comprising:i. The apparatus according to Claim 5 to Claim 9; andii. An associated housing.11 .A system according to Claim 10, wherein the housing is an ISO container.

12. A system according to Claim 10 to Claim 11, wherein the system further comprises a vehicle and an associated trailer for transporting a casualty to the apparatus.

13. Use of an apparatus according to Claim 5 to Claim 9 or a system according to Claim 10 to Claim 12.

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