In the case of managing casualties in a known radiation hot zone: there is no documented case of medical personnel receiving a clinically significant dose while performing lifesaving interventions on a contaminated casualty. Medical personnel are extremely unlikely to receive a medically significant acute radiation dose when providing patient care to casualties with radioactive debris in wounds from an RDD (radiologic dispersal device).4,11 That being said, providers should shield themselves and wear appropriate PPE.

The physical state of the radioisotope will determine the best method of decontamination. If the patient has only been exposed to ionizing radiation, DECON IS NOT REQUIRED.

Personal Protective Equipment (PPE) should be selected such that eyes, nose, mouth, hair, and all exposed skin is covered. Respiratory protection should consist of a N95 or P100 mask. Double gloves and disposable apron or overgarment with long sleeves are sufficient skin coverage for personnel performing decontamination.5,12 While operating in a tactical or field setting, Mission-Oriented Protective Posture (MOPP) level 4 may be downgraded to mask and gloves in order to provide respiratory and dermal protection (See Appendix A for descriptions of levels of PPE). While full PPE changes may not be feasible when moving from casualty to casualty, frequent glove changes are recommended. During decontamination, the casualty should wear an N95 or P100 mask (or remain in their tactical respirator) to minimize inhalation of any aerosolized radioactive particles. Open wounds should be considered contaminated and irrigated using clean or sterile water and subsequently covered to prevent recontamination. If surgical debridement of radioactive shrapnel is required, consider utilizing x-ray (lead) aprons as PPE for the surgical team, or drape over the patient, when not actively operating. This will reduce any dose received by the providers.

Dry decontamination consists of removing all clothing, equipment, and personal effects from the casualty, and this step alone removes about 90% of external contamination from exposure to radioactive solids or liquids. Further dry decontamination involves brushing the skin to remove loose epithelial cells and/or using lint rollers or masking tape to remove contamination.6,13 Use of non-ethanol containing baby or wet wipes would be adequate to remove contaminants on skin and should be used in a motion that wipes away from the face and open wounds.

Wet decontamination consists of water and mild soap to remove contamination on the patient’s skin. Self-showering for ambulatory patients can be employed for large numbers of casualties. Avoid irritating the skin with aggressive abrasions and avoid contaminated fluid from entering the mouth/nose or wounds. If available, use indoor facilities for wet decontamination in temperatures below 65°F/18°C. If these facilities are unavailable, use of dry decontamination materials is recommended to prevent hypothermia.

Decontamination should be confirmed with appropriate radiological monitoring equipment utilized by personnel familiar with their use (See Appendix B). The goal for decontamination is to reduce external contamination to a level less than two times the background level, however, levels can be over two times without significant health risk to others.

Radiation detectors and dosimeters produce outputs with various different units. When decontaminating a patient, the detector should display in units of counts per minute (cpm) or counts per second (cps). This provides information on the amount of radioactive material present but does not provide information on the energy being deposited in tissue. The recorded cpm before and after decontamination indicate the effectiveness of the method and whether another iteration of decontamination is necessary.