Chemical Decontamination

Excerpt

Contending with a mass casualty incident involving a chemical exposure seems daunting; fortunately, these are rare events. Acute care clinicians may encounter single patients or possibly several individuals presenting for care following hazardous chemical exposure. Emergency medical services (EMS) have protocols and employ providers who are well versed in responding to hazardous chemical exposures, but these specialized response teams take time to mobilize. It is likely that injured patients, including those exposed to a dangerous chemical, will arrive at a healthcare facility before undergoing decontamination.

Chemical exposure and subsequent tissue injury or organ-system dysfunction are both dose and time-dependent. Some hazardous materials will produce toxicity even after removing an individual from the “hot zone” or source of exposure. Chemical exposures, in general, will cause injury more rapidly than radiological or biological agents. Given the relationship between exposure time and degree of injury, immediate decontamination is essential to limit further absorption as well as reduce potential hazardous exposures to treating healthcare providers. In the case of noxious or highly toxic substances, contamination can render a healthcare treatment site inoperable; thus, decontamination initiation outside the patient treatment area is essential. Decontamination is best initiated before arrival at the medical treatment facility, but this not always feasible. This review will focus on decontamination at the site of a medical treatment facility. Most medical treatment facilities do not possess extensive equipment and expertise compared to highly trained hazardous materials emergency medical services (HAZMAT) teams; however, review of personal protective equipment (PPE) options, even if unavailable to the provider, is relevant.