Medical Aspects of Chemical Warfare (2008) - The Black Vault

Medical Aspects of Chemical WarfareINTRODUCTIONDecontamination is the process of removing orneutralizing hazardous substances from people, equipment,structures, and the environment. 1,2 This chapterfocuses on the safe decontamination of medical casualtiesexposed to chemical agents; however, the patientdecontamination process discussed here also is appropriatefor those exposed to biological and radiologicalhazards (although procedures, operator protectiveensemble, and detectors may vary slightly).Decontamination performed within the first fewminutes after exposure is the most effective for protectingthe patient, although later skin decontamination,which can benefit the patient by reducing the agentdose, should not be ignored. Early skin decontaminationcan often mean the difference between patientsurvival (or minimal injury) and death (or severeinjury). Patient decontamination serves two primarypurposes: (1) protecting the casualty by removingharmful agents from the skin, thus reducing the doseand severity of the agent’s hazardous effects, and (2)protecting emergency responders, transport personnel,medical personnel, and other patients from secondaryexposure. Cross contamination from dry or liquidagent on the patient’s clothing or skin can sicken othersor make equipment temporarily unusable. Cloth fiberscan hold agent liquid and vapors. The off-gassing ofliquid contaminants, or vapor trapped in clothing andhair, can cause those who work near the casualty to becomesymptomatic if they are not wearing respiratoryprotection. Often removing clothing and brushing thehair greatly reduces the level of contaminant carriedon the patient; in some instances, these actions are theonly necessary decontamination.Contaminated persons who present for decontaminationmay additionally have conventional wounds,psychological stress reactions, physiological reactionsto heat or cold, or any combination of these. Personswearing individual protective ensemble (IPE) areparticularly prone to heat injuries caused by extendedtime in this gear.MILITARY AND CIVILIAN DECONTAMINATION PROCEDURESThe decontamination of chemical casualties is achallenging task that may require large numbers ofpersonnel, water and equipment resources, and time.Casualty decontamination takes place at all levels ofpatient care, from the exposure site to the door of themedical treatment facility (MTF). In the military, thereare three levels of patient decontamination (these sameprocesses may differ in the civilian sector) 3 :1. Immediate decontamination is conducted by theindividual exposed to the agent, or anotherindividual (a buddy), who comes to assistthe victim, as soon as possible after exposure.Ideally it is performed within minutes afterexposure. The individual decontaminatesexposed skin and garments using a militarydecontamination kit. If a kit is not available,any material, dry or wet, that can be appliedor used to physically remove agent from theskin is beneficial. This process is very effectivein reducing the hazard posed by agent onthe skin, particularly if IPE is already beingworn.2. Patient operational decontamination is carriedout by members of the individual’s unit toprepare the individual for transport. At thislevel the casualty is kept in IPE, from whichany large concentration of agent is removed.The casualty is placed on a litter coveredwith plastic and loaded into a transport vehiclededicated to evacuating contaminatedpatients. Evacuation vehicles are kept wellventilated, and crew members wear protectiveensemble. Operational decontaminationhelps to reduce the level of contaminationon the patient, thereby reducing the level ofcross contamination to the transport vehicle.This level of decontamination allows forlarge numbers of contaminated casualties tobe quickly evacuated to patient decontaminationfacilities that are prepared to handlethem.3. Patient thorough decontamination is performedoutside the MTF that receives the contaminatedpatients. At the decontamination stationthe patients’ clothing is removed and theirskin and hair are thoroughly decontaminated.It is critical that patients are prevented fromentering a medical facility until patient thoroughdecontamination has been conducted.In civilian industry, workers are usually trained inself-decontamination methods pertinent to the hazardsfor that setting. In a civilian or homeland defensescenario, however, immediate decontamination bythe victims themselves may not be possible becausethey may not have access to decontaminants or knowwhat to do. Immediate decontamination in a civilian528