Emergency Response to Terrorism:
Tactical Considerations: Hazardous Materials
Student Manual
Unit 7:
Decontamination
Terminal Objective

The students will be able to identify the components of a
decontamination plan for victims, response personnel,
and equipment that have become contaminated during a
terrorist incident.
Enabling Objectives
The students will:

Identify gross decon methods for personnel, equipment,
and victims.

Identify emergency decon methods, including gross
decon.

Identify decon plans for Biological, Nuclear, Incendiary,
Chemical, and Explosive (B-NICE) incidents involving
agents.

Identify the components of the four-stage
decontamination method.
EMERGENCY RESPONSE TO TERRORISM: TACTICAL CONSIDERATIONS: HAZARDOUS
MATERIALS
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UNIT 7: DECONTAMINATION
INTRODUCTION
As hazardous material technicians, we all know two things about every
decon we have been involved in:
1.
2.
It is very time consuming.
It is personnel intensive and equipment demanding.
In a normal haz mat response with six or eight responders requiring decon,
this part of the system seems to be the bottleneck. But in a B-NICE event
the responder may be faced with tens, hundreds, or even thousands of
people at one site.
The amount of resources needed and the additional personnel required to
deal with this incident will tax most communities. The need for tight
scene controls, well-established zones, rapid decontamination methods,
control of runoff, large number of personnel to work the decon lines--all
this without flushing away any evidence--makes this a very critical phase
of the response.
WHAT IS DECONTAMINATION?
Decontamination is the process of removing or neutralizing contaminants
that have accumulated on personnel, equipment, and the environment.
Decontamination:

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protects workers from agents that may contaminate and eventually
permeate the protective clothing, respiratory equipment, tools,
vehicles, and other equipment used on site;
protects all site personnel by minimizing the transfer of harmful
materials to clean areas;
helps prevent mixing of incompatible chemicals; and
protects the community by preventing uncontrolled transportation
of contaminants from the site.
This unit describes the types of contamination that workers may encounter
at a terrorist incident, the factors that influence the extent of
contamination, and methods for preventing or reducing contamination. In
addition, this unit provides general guidelines for designing and selecting
decontamination procedures at a site and presents a decision aid for
evaluating the health and safety aspects of decontamination methods.
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DECONTAMINATION PLAN FOR B-NICE INCIDENTS
A separate decontamination plan should be developed and set up before
any personnel or equipment may enter areas where the potential for
exposure to B-NICE agents exists. The decontamination plan should

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account for the possibility of large numbers of victims needing
decontamination;
determine the number and layout of decontamination stations;
determine the amount of decontamination equipment needed;
determine appropriate decontamination methods;
establish procedures to prevent contamination of clean areas;
establish methods and procedures to minimize worker contact with
contaminants during removal of personal protective clothing and
equipment;
establish methods of disposing of clothing and equipment that are
not completely decontaminated; and
consider evidence preservation.
The plan should be revised whenever the type of personal protective
clothing or equipment changes, the site conditions change, or the site
hazards are reassessed based on new information.
TYPES OF CONTAMINATION
Contaminants can be located on a person, equipment, and the surface of
personal protective equipment or can permeate the chemical-protective
clothing (CPC) material. Surface contaminants may be easy to detect and
remove; however, contaminants that have permeated a material are
difficult or impossible to detect and remove. If contaminants that have
permeated a material are not removed by decontamination, they may
continue to permeate to either surface of the material where they can cause
an unexpected exposure.
Five major factors affect the extent of permeation:
SM 7-4
1.
Contact time--The longer an agent is in contact with an object, the
greater the probability and extent of permeation. For this reason,
minimizing contact time is one of the most important objectives of
a decontamination program.
2.
Concentration--Molecules flow from areas of high concentration to
areas of low concentration. As concentrations of waste increase,
the potential for permeation of personal protective clothing
increases.
UNIT 7: DECONTAMINATION
3.
Temperature--An increase in temperature generally increases the
permeation rate of contaminants.
4.
Size of contaminant molecules and pore space--Permeation
increases as the contaminant molecule becomes smaller and as the
pore space of the material to be permeated increases.
5.
Physical state of the agents--As a rule gases, vapors, and lowviscosity liquids tend to permeate more readily than high-viscosity
liquids or solids.
All personnel, clothing, equipment, and samples leaving the contaminated
area of a site (generally referred to as the exclusion zone) must be
decontaminated to remove any harmful agents or infectious organisms that
may have adhered to them. Decontamination methods do one of the
following:
1.
Physically remove contaminants.
2.
Inactivate contaminants by chemical detoxification or disinfection/
sterilization.
3.
Remove contaminants by a combination of both physical and
chemical means.
Prevention of Contamination
The first step in decontamination is to establish Standard Operating
Procedures (SOP's) that minimize contact with the agents and thus the
potential for contamination. For example:

Stress work practices that minimize contact with the agents (e.g.,
Do not walk through areas of obvious contamination. Do not
directly touch potentially dangerous substances.).

Protect monitoring and sampling instruments by bagging. Make
openings in the bags for sample ports and sensors that must contact
site materials.

Wear disposable outer garments and use disposable equipment
where appropriate.

Cover equipment and tools with a strippable coating that can be
removed during decontamination.
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EMERGENCY RESPONSE TO TERRORISM: TACTICAL CONSIDERATIONS: HAZARDOUS
MATERIALS
In addition, establish SOP's/SOG's that maximize worker protection. For
example, proper procedures for dressing prior to entering the exclusion
zone will minimize the potential for contaminants to bypass the protective
clothing and escape decontamination.
In general, all fasteners should be used (i.e., zippers fully closed, all
buttons used, all snaps closed, etc.). Gloves and boots should be tucked
under the sleeves and legs of outer clothing, and hoods (if not attached)
should be worn outside the collar. Another pair of tough outer gloves is
often worn over the sleeves. All junctures should be taped to prevent
contaminants from running inside the gloves, boots, and jackets (or suits,
if one-piece construction).
Prior to each use, the personal protective equipment (PPE) should be
checked to ensure that it contains no cuts or punctures that could expose
workers to contamination. Similarly, any injuries to the skin surface, such
as cuts and scratches, may enhance the potential for chemicals or
infectious agents that directly contact the worker’s skin to penetrate into
the body. Particular care should be taken to protect these areas. Workers
with large areas of damaged skin should be kept from working on the site
until the skin heals.
All personnel should be trained in the SOP's for minimizing contact and
maximizing worker protection, and these procedures should be enforced
throughout site operations.
METHODS OF DECONTAMINATION
After an agent has been identified, technical information about its physical
properties must be obtained. In the case of warfare agents, it is
recommended that one ascertain whether or not the agent involved is
persistent or nonpersistent. Some nonpersistent agents are designed to
dissipate or degrade fairly readily after coming into contact with wind,
water, sunshine, and other natural elements. The U.S. military has specific
decontamination solutions for use in the decon of various types of agents.
These will be discussed later in this unit.
When dealing with known or unknown contaminants in the field, one or
more of the following methods of decontamination will generally be used:

SM 7-6
Dilution--a method of reducing the concentration of the
contaminant to a level at which it is no longer harmful. The most
common type of decontamination consists of dilution of the
product with water.
UNIT 7: DECONTAMINATION

Absorption--the process of picking up the hazardous material with
an absorbent material. It is important to remember that
decontamination also involves equipment and the environment.
This type of decon has little or no use for people but can be used
on equipment and the environment to limit the spread of the
product.

Degradation--a method of altering the chemical structure of the
hazardous material by mixing it with another chemical. The goal
of this process is to render the hazardous material less harmful.
When using this type of decontamination it is imperative that you
seek technical assistance. Selecting the wrong decontamination
can make matters worse and could cause severe injuries.
Degradation of the substance with soap, liquid detergents,
firefighting foams, or household laundry detergents used in
conjunction with water is usually the safest decontamination
alternative. When used immediately and repeated a second time,
this method will be very successful. A special word of caution-chemicals to degrade a hazardous material are never intended to be
used or applied directly to the skin.

Isolation--simply moving the contaminated item to a safe haven
until an appropriate decontamination method is found. The use of
a professional decontamination contractor or the assistance of a
technical expert may help.

Disposal--accepting the fact that certain equipment and protective
garments cannot be decontaminated and must be disposed of
properly.

Neutralization--the adding of acids to bases or bases to acids to
render the product less harmful. The use of a material safety data
sheet (MSDS) or technical assistance from the company that
produced the product will provide you with direction in this
process. This method is similar to degradation.

Solidification--the process of adding a material to a product to
create a solid. This method is commonly used at hazardous waste
site facilities.
Note: When faced with a more persistent agent, the decon procedure is
likely to be more difficult, as these chemicals often have an oily base and
are designed to remain in place and prevent personnel from accessing the
area where they are to be used. Decontamination may require the use of
alcohol, acetone, or other solvents.
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EMERGENCY RESPONSE TO TERRORISM: TACTICAL CONSIDERATIONS: HAZARDOUS
MATERIALS
Physical Removal
In many cases gross contamination can be removed by physical means
involving dislodging/displacement, rinsing, wiping off, and evaporation.
Physical methods involving high pressure and/or heat should be used only
as necessary and with caution since they can spread contamination and
cause burns. Contamination that can be removed by physical means can
be categorized as follows:

Loose contaminants--Dust and vapors that cling to equipment and
workers or become trapped in small openings, such as the weave of
the clothing fabrics, can be removed with water or liquid rinse.
Removal of electrostatically attached materials can be enhanced
with antistatic solutions. These are available commercially as
wash additives or antistatic sprays.

Adhering contaminants--Some contaminants adhere by forces
other than electrostatic attraction. Adhesive qualities vary greatly
with the specific contaminants and the temperature.

Physical removal methods for gross contaminants include scraping,
brushing, and wiping. Removal of adhesive contaminants can be
enhanced through certain methods such as solidifying, freezing
(e.g., using dry ice or ice water), adsorption, or absorption (e.g.,
with powdered lime or kitty litter).

Volatile liquids--Volatile liquid contaminants can be removed
from protective clothing or equipment by evaporation followed by
a water rinse. Using steam jets can enhance evaporation of volatile
liquids. With any evaporation or vaporization process, care must
be taken to prevent worker inhalation of the vaporized chemicals.
EMERGENCY DECONTAMINATION
SM 7-8

All personnel who come in contact with, or have the potential to
come in contact with, exposed casualties must wear protective
clothing and respiratory protection.

Self-contained breathing apparatus (SCBA), some type of
impervious gloves and boots, and structural firefighting gear must
be worn.

Minimize contact with the casualties and stay out of the product
and/or the vapors.
UNIT 7: DECONTAMINATION
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Ensure all responders are aware of the signs and symptoms of
agent exposure.

Consider responders contaminated following exposure to victims.

Decontaminate very soon after the incident (minutes) in order to
save lives. Some recent studies indicate that the critical factor in
saving lives is the speed at which decon can be performed rather
than the type of decon used.

Water is now recommended for decontaminating warfare agents.
In some cases bleach and water will cause more harm to the
victim. Mustard agent is an example; bleach and water causes
further tissue damage.
Victim Considerations
1.
In a biological attack a response to the agent may come hours or
days later. This response may be at a patient’s home, place of
business, or any other location. All patients should be assessed to
determine whether they are decontaminated or still contaminated,
and whether they are infectious. All patients should be considered
infectious, and proper isolation practices should be enforced.
2.
Evacuate victims upwind, upgrade, and upstream of the hazard.
3.
Isolate and establish control of victims.
4.
Segregate the symptomatic victims from the asymptomatic victims,
and male from female. Take into consideration families, small
children, the elderly, handicapped persons (the blind, persons in
wheelchairs, the speech impaired, etc.).
5.
Isolate those who refuse to comply with directions to prevent
further contamination of victims.
6.
Collect personal items.
7.
Use plastic bags and a method of identification; voucher personal
articles.
8.
Have victims strip to their undergarments.
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EMERGENCY RESPONSE TO TERRORISM: TACTICAL CONSIDERATIONS: HAZARDOUS
MATERIALS
9.
Approximately 80 percent of the contamination will be removed
with the clothing. In a decontamination process, modesty should
take a back seat.
10.
Use bags (large trash bags, biohazard bags or other bags of suitable
size and strength) to collect the individual clothing. Bagged
clothing should be placed into drums at a later time.
11.
Wet people down before stripping them if the hazard is biological
or radiological. This will prevent re-aerosolization of the agent.
Setting up the Emergency Decon Corridor
SM 7-10
1.
Remember that time will be critical. This corridor should not be
complex nor should it take any more than a few minutes to
establish.
2.
An adequate area is required upwind of the hot zone to handle
decontamination of large numbers of people, victims, responder
personnel, and equipment. A dual corridor might be considered.
Establish segregated lanes for symptomatic and asymptomatic
victims and, as time permits, male and female.
3.
If practical, control water runoff and manage the hazardous waste
that will be generated. If runoff is not confined, notify the proper
authorities downstream. If runoff goes into the storm drainage
system, notify locations downstream as a precaution. If runoff
goes into the sanitary sewer system, notify the receiving
wastewater treatment facility as a precaution. There will be
uncontrolled runoff in spite of most efforts. Notify agencies that
treat or routinely have access to runoff areas. Track and monitor
the runoff as the agent source strength may not degrade over time.
Contact the municipal environmental management agency for
assistance with runoff control and proper disposal of contaminated
runoff.
4.
Decontamination of casualties is a top-level priority, especially
with chemical agents.
5.
Confinement may be critical if radiological materials are involved.
6.
Consider weather conditions and the possible requirement to
perform decontamination indoors (e.g., school gym with showers,
car wash, etc.).
UNIT 7: DECONTAMINATION
7.
Fog nozzles may be used with low pressure to rain the water down
on the victims.
8.
When capabilities and resources allow, employ soap and water as
the best decontaminant of choice.
Decontaminate
1.
Communicate what victims should do.
2.
Have victims spread arms and legs out and rotate so all body parts
can be washed thoroughly. Concentrate on the hands and feet as
the victim may have touched or walked through an agent.
3.
Wash victims from top down.
4.
If liquid mustard agent (a persistent agent) is believed present on a
victim, blot the agent off (using a pinching motion) first to remove
the liquid.
5.
If the presence of a biological or radiological agent is suspected,
start rinsing the victims as they begin removing their clothes to
entrain the agent on the clothing of the victims and reduce the
potential for the agent to adhere to the bodies of the victims.
6.
Establish a Triage, Treatment, and Transport (T3) Area in a clean,
secure location large enough to hold all the casualties. Ensure all
responders are aware of the signs and symptoms of exposure, and
maintain ABC's while minimizing exposure to the casualties. As
victims may have some contamination on them, responders should
wear PPE. Use of mechanical ventilation and pharmaceuticals
may be required to stabilize casualties exposed to chemical agents.
Use mass transit to assist in transporting casualties.
7.
Execute self-decontamination if exposed. If emergency/technical
decontamination is not available, responders should take
appropriate precautions and decontaminate themselves.
8.
Arrange for nonambulatory (litter) emergency decon.
9.
Minimize responder exposure. Employ proper protective clothing
and positive-pressure SCBA as minimum PPE. Limit the number
of responders that contact victims.
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EMERGENCY RESPONSE TO TERRORISM: TACTICAL CONSIDERATIONS: HAZARDOUS
MATERIALS
Baltimore County Fire
Department Hazardous
Materials Team
Engine 14
FF w/hoseline
Use rear, side
discharges, deck guns,
and ladder pipe
FF w/hoseline
Basic mass decon
Victims
Pump pressure
less than 30 psi
Baltimore County Fire
Department Hazardous
Materials Team
Engine 63
Engine 14
Truck 673
FF w/hoseline
Advanced mass decon
Symptomatic
victims
Engine 3
Contaminated
victims
E-3 not staffed,
discharges open, all
lines at less than 30
psi. Victims herded
separately to a
Staging Area for
further triage.
FF w/hoseline
Engine 63
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UNIT 7: DECONTAMINATION
Baltimore County Fire
Department Hazardous
Materials Team
Engine 14
Herding diagram
Holding
area
Contaminated
victims
Clothes
holding
area
FF/PM herding
patients
Contaminated
area
Nonsymptomatic
noncontaminated
victims held for
evaluation
Engine 3
Symptomatic
victims
Holding
area
Engine 63
Mass Casualty Decontamination

Decon should be immediate.

Symptomatic patients need decon within 10 to 15 minutes of
contamination.

Large amounts of flowing water at low pressure is best.

For victims plain water is best for decontaminating all chemical
and biological agents.

Do not delay the application of water to set up other equipment; as
more resources arrive dedicate them to the setup of tents, showers,
and other equipment.

Victims who are symptomatic or are contaminated should remove
their clothes.

Victims who were in the vicinity of the incident and are not
contaminated can be held for further evaluation at a later time.
This may include persons on other floors of the building, or at
other parts of the building.
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EMERGENCY RESPONSE TO TERRORISM: TACTICAL CONSIDERATIONS: HAZARDOUS
MATERIALS
SM 7-14

As resources arrive detection equipment can be used to determine
who has agent on his/her clothes.

In almost all cases patients who have liquid on their clothes will be
dead, or at a minimum symptomatic. The exception would be for
mustard agent, but most persons can determine if they are
contaminated with a mustard agent due to its chemical properties.

Persons should be encouraged to stay in the water for as long as
possible; this will be driven by the number of victims, and the
resources available. As resources arrive the bank teller or
amusement park line setup should be used to slow the process
down and have the victims wait in the water.

If the process gets delayed, make sure victims wait in water.

When using engine companies, use rear, side, and front discharges,
the deck gun/pipe also should be used to create a water curtain. A
staffed hoseline should be used at the end of the line, after the
victim has gone through the water, to further wash the victims off.
As more resources arrive, a soap and water solution can be used to
lightly scrub the victims.

All persons, whether they are decontaminated are not, are to be
held. They should be herded into separate areas to be further
evaluated.

Victims who have been in fresh air for15 minutes, for the most part
have been decontaminated.

Victims who initially are not symptomatic or contaminated can be
decontaminated at another location if they so desire. The use of a
building that offers privacy, such as a school, is a good location.
They should be transported by emergency responders. In the event
they later become symptomatic they can be run through the
symptomatic line, or taken to a facility for decon.

In many cases psychological decon may need to be performed, and
these types of victims can be transported to a fixed facility for
decon.

Plan your decon setup to help the masses, specifically the victims
that can be saved. Victims who are alive but unable to self-rescue
are at the greatest risk. Victims who have removed themselves
from the area have started the decon process by being in fresh air.
UNIT 7: DECONTAMINATION

Attempts should be made to preserve privacy. Tents can be used,
as well as tarps. Tarps can be run along apparatus to provide some
privacy. Children should stay with one of their parents.

When possible, attempt to capture the runoff. Realistically,
however, when confronted with hundreds of patients, runoff is a
secondary concern. When operating under emergency conditions
runoff is secondary to life preservation. If using one of the setups
shown here, the amount of water is reducing the agent, and in most
cases rendering it harmless. The decon setups shown here are
flowing a considerable amount of water, and would quickly cause
all of the agents to break down. If the runoff entered the storm
drain, there would be little damage, due to the many contaminants
that already exist in that type of system.

Your response to a potential terrorist agent should focus on
detection. If the agent is not present, decon is not needed. If a
specific agent is detected, decon can be tailored to that specific
agent. If no agent is found, mass decon does not need to be set up.
Terrorist agents were designed to be more toxic than standard hazardous
materials and, as such, present some unique problems.
1.
The hot and warm zone locations must be reassessed periodically
to ensure liquid contamination is contained within the hot zone,
and that decontamination efforts take place within the warm zone.
Runoff and changes in the wind may require alteration of zones or
relocation of decontamination corridors.
2.
The large number of possible victims can present a control
problem, as many people may panic. An expedient emergency
decontamination capability such as a wide, low-pressure fog
pattern may be necessary.
3.
Methods of quick patient removal must be identified. The use of
decon stretchers is one possibility. They allow for the quick
removal of a victim and permit decon to be accomplished without
removing the patient from the stretcher. There are several types
available, specifically designed for mass casualty incidents.
Standard patient decontamination units such as those sold to work
on stretchers also may be useful for nonambulatory patients, but
may not be efficient for mass numbers. Wire Stokes baskets also
may be useful for quick removals and for decontamination without
removing the patient from the basket.
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EMERGENCY RESPONSE TO TERRORISM: TACTICAL CONSIDERATIONS: HAZARDOUS
MATERIALS
4.
Monitoring the site for agent presence is critical, as even small
amounts of agent can cause many additional casualties. If
contamination is found to have spread, neutralize it.
Transportation to Medical Facilities
1.
Prior to the incident the Emergency Medical Services (EMS) must
be contacted and asked, “What kind of resources could you bring
to the arena?” Some of the questions that may be asked are

Can you provide advanced life support (ALS)?

Can you provide basic life support (BLS)?

Can you provide medical decontamination?

Do you need additional support from the local agencies
and, if so, what type?
2.
Contamination transfer translates into contaminated medical
transport vehicles and crews. Other response vehicles also can
serve to transfer contamination. If a vehicle goes into the hot zone,
it must remain there until it is decontaminated and monitored.
Until proven otherwise, assume that any equipment entering the
hot zone is contaminated. This may reduce resources in the short
term, but contamination transfer will reduce resources over the
long term by spreading the contamination.
3.
Hospital emergency rooms and clinics may require support, as
some victims may have departed the scene for hospital emergency
rooms prior to the first responders’ arrival on site. If victims are
not effectively decontaminated and monitored, they will spread
contamination.
Technical Decon
Stages versus Stations
Many of the procedures we carry out in a hazardous material incident have
been borrowed from industry or the Environmental Protection Agency
(EPA). Some of their procedures have worked very well for us, others not
so well. Today many haz mat responders are using some form of the EPA
decontamination procedures that can include up to 19 stations. Many
times, this is neither practical nor necessary for a terrorist incident
SM 7-16
UNIT 7: DECONTAMINATION
response. To simplify the operation, this system considers stages of
decontamination. Webster’s defines a stage as a step in a process or, for
our use, the concept of what must be accomplished at this point before
moving to the next step. Coming from the hot zone, we could call our
people dirty/dirty; moving through the decontamination corridor, they
become dirty/clean; and eventually exiting the decontamination corridor,
they become clean/clean. Personnel entering decon from the hot zone are
as dirty as they can be. They are returning from an area where
contamination can occur.
THE FOUR-STAGE METHOD
Predecon Activities--First and foremost, contamination avoidance is
crucial; if you don’t get dirty, you don't have an excessive need for
decontamination. Avoid puddles; don’t kneel down or crawl, lie in the
product, or put yourself in a position to be showered with chemicals. As
you approach the actual decon system, remember that the less product on
you, the less the danger.
Stage One--Solo. Stage One of decon consists of a tool drop and a
primary wash to remove the gross contaminants. This will include a full
outer wash and rinse. Because the entry person is the dirtiest he/she can
be at this point, this stage should be solo. This solo wash can be
accomplished by a shower, polyvinyl chloride (PVC) washing stalls, a
portable stall, or a garden hose that the entry person could use him/herself.
Stage Two--Wash, Rinse, Remove Outer Protection--Assisted. Stage
Two will consist of a full outer wash and rinse. This will be an assisted
wash and rinse using decontamination personnel. This stage should
concentrate on the boots and gloves of the individual. Many times they
have received a high level of contamination from walking through or
touching the product. With standard firefighting gear, a second wash and
rinse are performed. In chemical-protective clothing, a wash and rinse
followed by the removal of outer bands, tape, outer gloves or boots will be
performed. Remember that a wash and rinse followed by a wash and rinse
has proved to be very effective.
Stage Three--Wash, Rinse, Remove All Inner Protection--Assisted.
Stage Three will include another wash and rinse followed by removal of
the protective equipment. This will be an assisted wash, rinse, and
removal of equipment using decontamination personnel. It is important to
note that respiratory protection should be the last item removed.
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EMERGENCY RESPONSE TO TERRORISM: TACTICAL CONSIDERATIONS: HAZARDOUS
MATERIALS
Stage Four--The Person. Stage Four consists of a full body wash,
drying, and dressing of the individual. This may be performed on site or
off site. It is incomprehensible that after a chemical emergency we do not
shower our people. Supplies like shampoo, soap, scrub brushes, Q-tips,
gowns, and slippers must be made available to adequately carry out this
stage. Onscene medical examination and rehabilitation should be
performed. An exam will compare vital signs taken before entry to vital
signs taken after decontamination. This may be performed on site or off
site. If the entry involved the use of chemical-protective clothing, heat
stress reduction and hydration of the individual should be a priority.
Postdecon Activities. Recordkeeping and exposure records should be
completed at this time, along with discussion of the future effects of the
chemical. Postexposure discussions should include what to look for if
there is a delayed effect of exposure. Incident stress should be discussed.
Many of these chemicals may be reproductive toxins or carcinogens.
There will be a lot of psychological stress that needs to be diffused.
The fact that decontamination is so equipment and personnel intensive
makes it imperative that it be practical and practiced. Planning,
contingencies, proper equipment, and training will prove to be the
difference between failure and success. The scene of a B-NICE event is
no place to rehearse.
Mass Decontamination Considerations
The window of opportunity for decon to make a medical difference with
victims is 10 to 15 minutes. Without decon some patients may die, or in
many cases may actually recover. In some cases standard triage may not
apply, as your local resources will dictate which patients may be
salvageable. The amount of atropine that your jurisdiction has may play a
factor in the type of patients who are decontaminated first. If large
quantities of atropine are available, this would mean that seriously ill
patients could be saved and should take first priority. If very little atropine
is available, then patients exhibiting minor symptoms should be
decontaminated first as they will probably recover without the atropine.
The patients who are seriously ill need decontamination as well as
atropine, and just decon will probably not be enough to save their lives.
The key to saving lives is quick application of water, in flooding
quantities, at a low pressure. Recent studies have shown that water is the
most effective agent, and the use of bleach can actually make the situation
worse. The use of bleach to decontaminate victims contaminated with
mustard may cause serious, if not fatal, effects by allowing the mustard
agent to get into the body at a faster rate. Bleach is still acceptable for
equipment and the environment. In most cases the bleach solution has to
SM 7-18
UNIT 7: DECONTAMINATION
remain in contact with the contaminant for 10 to 20 minutes if not longer
in some cases.
Haz mat teams must develop plans for handling mass decon for any
number of scenarios. Through planning you should identify the areas of
your jurisdiction that may be host to large numbers of people. Some malls
may have 900 employees, and the day after Thanksgiving may have
20,000 people shopping. Stadiums, arenas, and other areas may have
upwards of 60,000 people. Most haz mat teams are capable of providing
decon for themselves, but have trouble with more than a handful of
victims. For mass casualties the most effective method developed so far
has been the engine and truck company setup. Three methods are shown
in the pages following. By using the engine companies, and the pump
panels facing outward, a high-volume water curtain can be established. If
the victims are going to be held up or delayed in any fashion, they should
wait in the water. Teams should identify methods of herding victims into
several areas depending on signs and symptoms. Patients who are not
contaminated or symptomatic can be held for observation and do not need
decon at that point. If at a later time they start to become symptomatic
(possibly due to psychological reasons) then they can be decontaminated.
In most cases this decon can take place at a school or other shelter. By
being in the fresh air, these types of victims already are being
decontaminated. Victims should be separated according to priority levels
for decon, and contaminated victims should be separated from
noncontaminated symptomatic patients. It cannot be emphasized enough
that the sooner they get wet the better off they will be. All efforts should
focus on immediate removal and decontamination by lots of water.
Some of the concerns with mass decon involve capturing of the runoff. In
the first case life comes before the environment, and the hazardous waste
regulations state that runoff is allowed when lives are involved. Should
attempts be made to contain all runoff? The answer is yes, but,
practically, this is impossible. When confronted with 800 patients, runoff
control goes by the wayside. Given the amount of runoff, and the amount
of agent that could be present if we are decontaminating live people, the
runoff is a comparatively small concern. The amount of water is breaking
down the agent into less harmful byproducts. If you are using city water,
the chlorine in the water is probably causing more environmental damage
than any of the terrorism agents. If the runoff enters a storm sewer
system, the biological and other chemical matter that exist in most cases
will not be harmed by the severely diluted breakdown products.
Remember some of these agents are very toxic, such as Sarin. If people
are contaminated with liquid Sarin they will not need decontamination, as
they will be dead. The victims that are alive upon your arrival have most
likely been exposed to the vapor as a result of the dissemination and need
only fresh air to decontaminate them.
SM 7-19
EMERGENCY RESPONSE TO TERRORISM: TACTICAL CONSIDERATIONS: HAZARDOUS
MATERIALS
Other concerns with mass decon involve the removal of clothes. The
removal of clothes can remove up to 80 percent of the contamination.
Unless the victims are symptomatic, or know they are contaminated with a
liquid or a solid material they will probably not remove their clothes.
Quick identification of the agent (or at least a category) is important so as
to identify if decon is actually required at all. Just because a victim was in
the vicinity of an agent does not mean he/she requires decontamination.
When confronted with someone who won't remove his/her clothes, do not
delay decontaminating others when trying to deal with this person. If
he/she refuses, you have two choices, you can allow him/her to go through
with clothes on, or herd him/her off to the side, and deal with him/her
later. If he/she becomes symptomatic, he/she will agree to remove
clothes. Another option is to use air monitors to determine which victims
are contaminated and which ones are clean. If you do remove clothes,
attempt to protect privacy. One way of tracking the clothes is to issue the
victim a numbered wrist tie which matches the bag his/her clothes are in.
The one weak link in the system is the thought process that all victims will
stay in one place waiting for assistance. In reality victims are going to
rush the first-arriving apparatus, looking for assistance. The people who
rush the apparatus, if victims of a chemical attack, are the ones least
needing assistance. The victims are not going to remain unless they think
there is a benefit. One way to minimize victims leaving the area is to herd
them into specific areas, try and keep them calm, and dedicate some
resources to keep them informed. Plans should be established to protect
the health care system, as it will be overwhelmed. Some communities are
planning to send engine companies and other resources such as mutual-aid
haz mat companies to the hospital to assist with the onslaught of victims.
Mass decon will test the resources of all communities, and basic plans
should be established to provide quick but simple decon in incidents
involving large numbers of victims. Speed is of the essence, and the
quicker water is applied to the victims, the better their chance of survival.
SUMMARY
In many responses the elements are there, but the bodies are not. Looking
at decon from an initial set of building blocks, all decon begins with the
pre- and postconsiderations. Actual decon always begins with a line
drawn--simply put, clean/contaminated (dirty). The amount of decon will
depend on the agent, the level of contamination and the available
personnel. Because decontamination is so equipment and personnel
intensive, it is imperative that it be practical and practiced. Planning,
contingencies, proper equipment, and training will be the difference
between failure and success. The scene of a B-NICE event is no place to
rehearse.
SM 7-20