Biomedical Engineering Reference
In-Depth Information
7 Decontamination and Personal
Protection
JOSEPH H. M
C
ISAAC, III
Decontamination is the most fundamental and
potentially the most difficult step in the manage-
ment of mass casualties. Successful decontamina-
tion limits the extent of toxic exposure and converts
the contaminated casualty from a hazard to a more
manageable patient. Large scale implementation
demands considerable resources. This enormous
task requires both large numbers of personnel and
large amounts of time.[1]
Three levels of decontamination are recognized:
personal, casualty, and personnel. Personal refers
to self-removal of the offending agent. This is
most effective if performed within 1-2 minutes
of exposure. The advantage of self-decon methods
is the non-specificity, effective equally on agents
regardless of chemical structure or knowledge of
specific agent, and the timeliness of the procedure
[1]. It can make the difference between minimal
or no injury and severe toxicity or death. Casu-
alty decontamination refers to the treatment of
contaminated patients, whether ambulatory or non-
ambulatory. Personnel decontamination refers to
those who are considered non-casualties—usually
those who are wearing Personal Protective Equip-
ment (PPE).
Decontamination is defined as the reduction,
neutralization, or removal of external radiological,
chemical, or biological agents to the extent that
they are no longer a hazard to the patient or the
caregiver [1]. This process consists of either phys-
ical removal through mechanical abrasion, solva-
tion and dilution (i.e., washing
7.1 Removal of Clothing
The greatest reduction in agent burden is accom-
plished by removal of clothing. Complete disrobe-
ment is ideal, but in civilian situations, there may
be considerable resistance by those who are ques-
tionably exposed. A reasonable accommodation for
ambulatory patients when expected contamination
is minimal and privacy is lacking would be removal
of all outer clothing; retaining undergarments into
and through the shower should provide a reason-
able level of modesty preservation without greatly
inhibiting reduction in contamination (Figure 7.1).
7.2 Skin Contamination
The primary concern should be elimination of
skin contamination, taking care to include the
eyes, ears, hair, and any wounds. Any means
possible to mechanically remove the substance,
such as scraping or adsorption is acceptable for
liquids and solids on skin. “Adsorption refers to
the formation and maintenance of a condensed
layer of a substance, such as a chemical agent,
on the surface of a decontaminant” [1]. Sand,
oatmeal, “kitty litter,” diatomaceous earth, or other
porous/particulate matter will serve as a field
Clothing Removal
Washing Skin with Soap and Water
Skin Detoxification (optional depending on agent)
detergent action),
and chemical neutralization (detoxification).
±
Figure 7.1
Critical Decontamination Steps.
89
