An extensive discussion of decontamination is outside the scope of this CPG; however, recognize decontamination is considered a critical medical treatment for the casualty and limits exposure risk to medical providers. Basic decontamination principles are outlined below:

1. Medical personnel apply appropriate PPE before treating others

2. Remove all clothing and equipment from the casualty (removal of clothing can eliminate 90-95% of contamination). 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 the skin barrier becomes erythematous or broken.

a. For additional details reference CBRN CPG 3

4. Decontamination solutions

a. Soap and water

- Use in copious amounts for the physical removal and dilution of agents
- Does not destroy biological agents or neutralize radioactive particles. Does not destroy all chemical agents.

b. 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/abdominal cavity, open brain/spinal cord wounds, or in the eyes

c. Reactive Skin Decontamination Lotion (RSDL)

- Deactivates mustard (HD) and nerve agent
- Currently FDA-approved only for intact skin, not for wounds or eyes
- Packaged sponge contains reactive agent that penetrates skin
- Indicated for chemical agents and T-2 mycotoxin
- Best results occur when RSDL is applied immediately after exposure, the sponge is vigorously rubbed in circles on skin for a minimum of two minutes, RSDL is removed, and then reapplied (RSDL may be left on skin for up to 24 hours).
- RSDL is not effective for decontamination of hair

d. Surgical irrigation solutions for open chest and abdominal cavity wounds

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

f. Decontamination of hair following chemical exposure should not be forgotten. Consideration should be given to cutting (not shaving due to potential spread of contamination) longer hair vs spending time to decontaminate. Level of contamination will determine effectiveness of the decontaminant used.

g. Additional detail on decontamination by chemical agent is discussed in CBRN Injury Response Part 2

5. Due to potential time delays in presentation after exposure, casualties presenting with syndromes due to infectious agents may not require decontamination. Note that the casualties may be infectious, and warrant the use of empiric transmission-based precautions.

a. However, if there was an incident with a weaponized biothreat delivered via aerosol or powder, decontamination is warranted.

b. Removing clothing and washing exposed skin and hair with soap and water, followed by drying the skin and hair is generally considered adequate decontamination for most biothreats.

c. Additional detail on decontamination of biological casualties is discussed in CBRN Injury Response Part 4.

6. Internal decontamination for radiologic agents will be discussed in detail in the medical management of radiologic exposure and nuclear events (CBRN Injury Response Part 3).