Decontamination

An extensive discussion of decontamination is outside the scope of this CPG, however basic decontamination principles are outlined below. (Figure 1)

1. Prevent further casualties by applying PPE before treating others.

2. Remove all clothing and equipment. Contain and dispose of contaminated material appropriately.

3. If radiologic exposure, cover wounds before further decontamination. Ensure gentle decontamination as radionuclide absorption may be increased if skin becomes erythematous.

4. Decontamination Solutions

a. Soap and water in copious amounts

- Physical removal and dilution of agents
- Does not destroy biological agents or neutralize radioactive particles

b. 0.5% Hypochlorite Solution

- Nine parts water to one part 5% bleach
- Wipe on the skin and rinse with fresh water
- Can be used in open wounds but do not use in chest or abdominal cavity (risk of adhesions), open brain or spinal cord wounds (unknown effects), or in the eyes (risk of corneal opacification)

c. Reactive Skin Decontamination Lotion (RSDL)

- Indicated for chemical agents and T-2 mycotoxin
- Packaged sponge contains reactive agent that penetrates skin
- Deactivates mustard (HD) and nerve agent
- Currently FDA-approved only for intact skin, not for wounds or eyes
- Best results occur when RSDL is applied immediately after exposure, gently scrubbed (agitated) on skin for two minutes, removed, and then reapplied (RSDL may be left on skin for up to 24 hours)

d. Surgical solutions for open chest and abdominal cavity wounds

e. Water, saline, or eye solutions are recommended for the eye

5. Standard infectious disease protective measures should be utilized for biological agents

6. Internal decontamination will be discussed in detail in the medical management of radiologic exposure and nuclear events

Figure 1. Casualty decontamination schematic
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