Decontamination following deliberate mass-casualty exposures

November 29, 2017, 6:00 pm

[wikipedia.org]

★★★★☆

Decontamination. Houston M, Hendrickson RG. Crit Care Clin 2005:21:653-672.

Abstract

Looking to finish some Lifelong Learning and Self-Assessment (LLSA) tests before the end of the year so I can re-certify in emergency medicine, I discovered that the subspecialty Medical Toxicology reading list modules can be used to comply with these requirements. At this time there are 3 active toxicology reading lists: 2017, 2015 and 2013. In the coming weeks, I will review selected articles from these lists.

This  review comes from the October 2005 issue of Critical Care Clinics, which covered the general theme of: “Terrorism and Critical Care: Chemical, Biologic, Radiologic, and Nuclear Weapons.” It deals mainly with external decontamination following CBRN mass casualty exposures, This topic is particularly difficult, as I found when I tried to make sense of it while teaching in the Dept. of Defense Domestic Preparedness Program in the late 1990s.

If all staff involved in decontaminating and treating these victims do not grasp some basic principles, developing a coherent response will be impossible. This long article does a very good job of emphasizing some key concepts, including:

  • External decontamination must be accomplished before patients enter the hospital or emergency treatment area
  • Exposure to vapor alone does not require wet decontamination — removal and bagging of patients’ clothing in a well-ventilated area before entry should suffice
  • Wet decontamination is best accomplished by showering with soap and water
  • The goal of external decontamination of patients contaminated with particulate radioactive material is to avoid ingestion or inhalation (internalization) of the particles
  • “Because the risk to health care workers from exposure to a radioisotope-contaminated patient is very low, patients may require medical treatment of traumatic conditions before having any decontamination.”
  • “Unlike chemical decontamination, radiologic decontamination is not an emergency.”

This is the best review of decontamination following a CBRN mass casualty attack I’ve seen. It is must-reading for anyone involved in responding to these incidents, or planning for them.

 

Related post:

Strip and Shower? Or just strip? Decontamination after a chemical attack 

 

 

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