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Decontamination Procedures
- Introduction
- Set Up Considerations
- Decontamination Corridor
- Protecting Responding Personnel
- Individual Decontamination
- Mass Decontamination
Introduction
- The purpose of decontamination is to make an individual and/or their equipment safe by physically removing toxic substances quickly and effectively.
- Care should be taken during decontamination, because absorbed agent can be released from clothing and skin as a gas.
- Your Incident Commander will provide you with decontaminants specific for the agent released or the agent believed to have been released.
Set Up Considerations
- Use pictorial and written posted instructions for victims to self decon when able, use locale-appropriate multilingual signage.
- Double bag contaminated clothing etc. (place hearing aids, valuables in small bag). Place bag in container by showers.
- Victims who are able may assist with their own decontamination.
- Children and the elderly are at increased risk for hypothermia - provide warm showers, blankets.
- Privacy must be considered, if possible.
- The decontamination system should be designed for use in children of all ages, by parentless children, the non-ambulatory child, the child with special needs, and also allow families to stay together.
- Use step-by-step, child-friendly instructions that explain to the children and parents what they need to do, why they are doing it, and what to expect.
- Take into consideration that infants when wet are slippery and will need a way to get them through the decontamination process - i.e. plastic buckets, car seats, stretchers...
- Designate a holding area and provide staff to support and supervise the children.
- Recommended age-appropriate staffing ratios for untended children:
- 1 adult to 4 infants
- 1 adult to 10 preschool children
- 1 adult to 20 school-age children
Decontamination Corridor
The following are recommendations to protect the first responders from the release area:
- Position the decontamination corridor upwind and uphill of the hot zone.
- The warm zone should include two decontamination corridors. One decontamination corridor is used to enter the warm zone and the other for exiting the warm zone into the cold zone. The decontamination zone for exiting should be upwind and uphill from the zone used to enter.
- Decontamination area workers should wear appropriate PPE.
- A solution of detergent and water (which should have a pH value of at least 8 but should not exceed a pH value of 10.5) should be available for use in decontamination procedures. Soft brushes should be available to remove contamination from the PPE.
- Labeled, durable 6-mil polyethylene bags should be available for disposal of contaminated PPE.
Protecting Responding Personnel
- Use appropriate Personal Protective Equipment (PPE) when evaluating and treating patients/victims known or suspected to be contaminated with radioactive material
- Pregnant healthcare providers should not be permitted to work in
- Pre-decontamination areas
- Decontamination areas
Individual Decontamination
The following methods can be used to decontaminate an individual:
- Decontamination of First Responder:
- Begin washing PPE of the first responder using soap and water solution and a soft brush. Always move in a downward motion (from head to toe). Make sure to get into all areas, especially folds in the clothing. Wash and rinse (using cold or warm water) until the contaminant is thoroughly removed.
- Remove PPE by rolling downward (from head to toe) and avoid pulling PPE off over the head. Remove the SCBA after other PPE has been removed.
- Place all PPE in labeled durable 6-mil polyethylene bags.
- Decontamination of Patient/Victim:
- Remove the patient/victim from the contaminated area and into the decontamination corridor.
- Remove all clothing (at least down to their undergarments) and place the clothing in a labeled durable 6-mil polyethylene bag.
- Thoroughly wash and rinse (using cold or warm water) the contaminated skin of the patient/victim using a soap and water solution. Be careful not to break the patient/victim's skin during the decontamination process, and cover all open wounds.
- Cover the patient/victim to prevent shock and loss of body heat.
- Move the patient/victim to an area where emergency medical treatment can be provided.
- Decontamination of Children/Infants:
Video: Decontamination of Infants and Children (HHS/AHRQ, Children's Hospital Boston)
(Watch video
)
- Decontamination of Children (HHS/AHRQ) provides a step-by-step decontamination demonstration in real time, and trains clinicians about the nuances of treating infants and children, who require special attention during decontamination.
- For example, children may be frightened not only by the emergency situation itself, but also by the decontamination process as well.
- Decontamination of children also takes longer than decontamination of adults.
- Video, available for free, is produced by Children's Hospital of Boston with funding from HHS/AHRQ.
- Decontamination of Children (HHS/AHRQ) provides a step-by-step decontamination demonstration in real time, and trains clinicians about the nuances of treating infants and children, who require special attention during decontamination.
Mass Decontamination
Decontamination must be conducted as soon as possible to save lives. Responders should use resources that are immediately available and start decontamination as soon as possible. The most expedient approach is to use currently available equipment to provide an emergency low-pressure deluge.
The following forms of water-based decontamination were considered:
- Water alone. Flushing or showering uses shear force and dilution to physically remove chemical agent from skin. Water alone is an excellent decontamination solution.
- Soap and water. By adding soap, a marginal improvement in results can be achieved by ionic degradation of the chemical agent. Soap aids in dissolving oily substances like mustard or blister agent. Liquid soaps are quicker to use than solids, and reduce the need for mechanical scrubbing; however, when scrubbing, potential victims should not abrade the skin. A disadvantage of soap is the need to have an adequate supply on hand. Additionally, extra time may be spent employing it, and using soap may hydrate the skin, possibly increasing damage by blister agents.
- Bleach and water. Bleach and water solutions (utilize 0.5% sodium hypochlorite) remove, hydrolyze, and neutralize most chemical agents. However, this approach is not recommended in a mass decontamination situation where speed is of primary concern.
Sodium hypochlorite is not recommended for use in infants and young children.
