Every day in the United States large quantities of hazardous chemicals are made, transported, stored, and used in homes, offices or industrial settings. Even taking every safety precaution, there still is a risk that the chemicals could be released into the environment either by accident or intentionally to cause harm.
Many toxic chemicals are readily absorbed into the body and cause injury and illness quickly. Decontaminating patients can prevent or limit absorption of the chemical and minimize adverse health effects. Decontamination also can prevent the spread of contamination to other people (including responders and receivers) and to health care equipment and facilities. In fact, since it can protect health, patient decontamination is considered a medical countermeasure.
The U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response and the U.S. Department of Homeland Security’s Office of Health Affairs led this effort to provide evidence-based guidance drawing on expertise in emergency response, emergency medicine, toxicology, risk communication, behavioral health, and other relevant fields from academic and non-government organizations and federal, state, and local agencies. The guidance also incorporates public comment.
The new final guidance covers mass casualties, chemical release, external contamination, and decontamination of people (not animals, not inanimate objects, not facilities).
To shape and substantiate the recommendations, a working group of experts sought out and used all of the evidence available. In this extensive process, the working group found that more research is needed to answer many of the essential questions. So the guidance will be updated periodically as new evidence becomes available.
Then in crafting the guidance, the working group relied on a basic set of principles. The first is that the primary goal of patient decontamination should be improved health outcomes. Second, as a medical countermeasure, patient decontamination needs to be coordinated with other medical aspects of the emergency response. The third basic principle is that patient decontamination is a whole community issue.
The guidance recognizes that a risk and crisis communication strategy should be in place pre-incident to reach all community members, and that system-wide coordination is essential, especially between on-scene responders and hospital-based receivers. The working group recommended a tiered, risk-based approach which matches the nature and extent of decontamination to the characteristics of the incident.
For ease-of-use, the guidance organizes recommendations by functional components of a response.
- Determining the need for decontamination of an individual patient. Responders and receivers should make risk-based decisions on whether and how to decontaminate a patient, using their estimations of the type and extent of contamination, the risk posed by the contaminated patient to responders and receivers, and potential adverse effects to the patient from the decontamination process itself.
- Choosing patient decontamination methods. Each incident creates a unique set of demands. A flexible response plan allows the most appropriate patient decontamination methods to be applied to meet those demands. Some specific recommendations:
- Clothing removal can significantly reduce contamination and can be performed without responder assistance.
- If wet decontamination is deemed necessary, water is the preferred decontaminant.
- Determining the effectiveness of decontamination. Clinical signs and symptoms, other observable indicators, and the execution of reliable protocols are the most important and accessible tools to aid decisions on when a patient has been decontaminated sufficiently.
- Prioritizing patients for decontamination in a mass exposure incident. Patients should be prioritized according to relative risk, with patients at greatest risk of severe health effects decontaminated soonest. If resources allow, life-saving medical care should not be delayed for decontamination.
- Coordinating the entire system-wide response. Communication among all response organizations prior to and during an incident is essential in order for all affected individuals to receive appropriate and consistent care.
- Communicating crisis and emergency risk messages to the community. A strategic communications plan can support the effective utilization of patient decontamination as a medical countermeasure. Pre-incident planning should include the identification of message topics and their audiences, drafting of pre-scripted messages, and assignment of appropriate spokespeople to deliver each message.