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

Decontamination of Chemical Casualtiestory rate is faster than adults (increased minute ventilation),so they will inhale a greater quantity of toxins. 94Children have a reduced fluid reserve, so diarrhea andvomiting can rapidly lead to shock. 95 They will alsoabsorb a greater dose of agent than adults because oftheir thinner skin, reduced weight, and larger bodysurface area related to volume of agent. 94Children have limited vocabulary and may benonverbal or crying, which makes assessing theirneeds difficult and complicates the decontaminationprocess. 95 Young children will also be anxious about theunfamiliar and inhuman appearance of decontaminationoperators dressed in IPE. An additional challengeis identifying children; a patient numbering systemincorporating photographic identification in combinationwith an identification bracelet that is difficult toremove is ideal.If possible, parents and children should be decontaminatedas a family so parents can assist inthe process, although staff will need to direct them.If children are unaccompanied, provisions must bemade for appropriate custodial care through the decontaminationline and for several hours thereafter,and operators need to wash younger children whocannot bathe independently. Ideally, these operatorsshould have some training and be comfortable workingwith children.Soap and water is the safest decontaminant forchildren. Chemical decontaminants may cause skinbreakdown. 94,95 Wet agents with components thatcan transit the skin, such as RSDL, should be usedwith caution with this population until their safety isproven, and any use should be followed by a soap andwater wash. Children have greater difficulty maintainingbody temperature, so warm showers, ample towelsupplies, and other means to warm them before andafter decontamination are critical.Other Special PopulationsIndividuals with physical or mental disabilitiesmay require escorts during decontamination. If thesepatients can walk independently, they should beprocessed through the ambulatory decontaminationline. Ideally, relatives or acquaintances among fellowambulatory patients can help individuals with specialneeds wash themselves; otherwise decontaminationoperators or other staff members must guide these patients.Hands-on assistance will probably be requiredfor those with limited comprehension or movementlimitations that impede their ability to shower independently.Patients in wheelchairs, using walkers, or withlimited mobility are more safely processed throughthe decontamination line as litter patients becausefloor grates, slippery floors, and water collectionberms can pose hazards or barriers. Individuals withlimited vision will need to be escorted through thedecontamination line. Plastic chairs, which can bereadily decontaminated, can be placed in disrobing,showering, and redressing areas as room allows to helpthose with limited mobility undress themselves. Theyshould be washed off between patients. Canes, crutches,and other assistive devices should be thoroughlywashed with soap and water, dried, and returned tothe patients or caregivers after the decontaminationprocess is complete. Eyeglasses can be worn duringdecontamination but must be thoroughly washed.Wheelchairs must be decontaminated with specialattention paid to cracks, crevices, movable joints, andwater-resistant cushions. Contaminated cushions andother items that absorb water should be discarded. Ifa wheelchair cannot be decontaminated at the sametime as its owner, it should be labeled for later decontaminationand returned.Communication challenges may occur with thosewho are deaf, blind, or nonverbal; additional staff willbe required to assist these individuals through thedecontamination line. Professionals with occupationaltherapy, physical therapy, mental health, or nursingbackgrounds are ideal as members of decontaminationteams to assist those with special needs. They shouldbe trained, qualified to wear IPE, and integrated intodecontamination operations.SUMMARYDecontamination is a process in which hazardousmaterials are removed from an individual, usedin some form since World War I. Chemical liquids,dry powders, and vapors pose a significant risk tocontaminated patients and individuals they comein contact with. Early removal prevents or reduces apatient’s injury from a chemical agent. Later removalalso protects the patient, but its primarily purpose isto reduce any contamination in an MTF and reduceinjury to medical staff.Current doctrine specifies the use of soap andwater, the M291 kit, or 0.5% hypochlorite solution todecontaminate skin. RSDL was recently selected toreplace the M291 kit. Fabric and other foreign bodiesthat have entered a wound can present a hazard toboth the patient and medical personnel. These objectsshould be irrigated with fresh water or saline solutionand removed carefully using a no-touch technique.551