• The REMM Contamination Algorithm is appropriate for events small enough to permit individualized evaluation and decontamination of each patient/victim.
• Limited resource availability in mass casualty events (e.g., insufficient water, personnel, equipment, medical facilities, laboratories) may necessitate major modifications of Contamination Algorithm guidelines.
• Large numbers of victims seeking decontamination and reassurance may overwhelm the emergency response infrastructure, at least initially.
• Modifications to both the Contamination Algorithm and Decontamination Procedures Guidelines in a mass casualty event may include
• Instructing large numbers of ambulatory victims to self-decontaminate at home
• Limiting radiation surveys to simplified, one-time screenings of the head, neck, hands, and forearms rather than comprehensive whole body screenings with repeated re-evaluations
• Altering decontamination methods
• Altering target decontamination levels (i.e., accepting decontamination levels in excess of 2 times background)
• Eliminating or curtailing early collection of biological specimens (e.g. radioisotope assays, nasal swabs) if logistical barriers to timely collection, transport, analysis, and reporting results limit their utility
• Initiating isotope decorporation therapy in highly selected, life-threatening circumstances prior to receiving diagnostic test results normally required
• This algorithm and supporting material are guidelines, not mandates.

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