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U.S. Department of Health and Human Services


Evidence-Based Planning Guidance for Patient Decontamination

Author: Susan M. Cibulsky, PhD, Medical Countermeasure Strategy and Requirements Division, ASPR Office of Policy and Planning
Published Date: 12/19/2014 8:20:00 AM
Category: Public Health Preparedness;

Responding effectively to a catastrophic incident involving the release of hazardous chemicals could be a daunting challenge. In the United States approximately 25 million people live near chemical facilities. In a catastrophic incident, up to 10,000 of those living nearest to those facilities could be at risk of chemical exposure. The potential for chemical terrorism or warfare, like the sarin gas attack in Syria in 2013, poses similar challenges.

To protect health and save lives in such catastrophic incidents, first responders, medical providers, and public health officials will want to make decisions about how to decontaminate patients based on scientific evidence. Now the nation’s first evidence-based guidance  is available to help our communities plan to do just that. The new guidance is flexible and scalable so it can be applied to various types and sizes of incidents, including those that affect a small number of people.

That’s important because while most people only think about chemical spills or attacks when the catastrophes hit the news, large quantities of hazardous chemicals are made, transported, stored, and used in homes, offices or industrial settings every day in the United States. 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. In fact, an estimated 15,000 chemical incidents occurred in the U.S. in 2012, according to the Agency for Toxic Substances Disease Registry.

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.

ASPR and the U.S. Department of Homeland Security’s Office of Health Affairs led the effort to develop this first-ever evidence-based guidance. Joining us were experts 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 covers mass casualties, chemical release, external contamination, and decontamination of people (not animals, not inanimate objects, not facilities). To shape and substantiate the recommendations, this working group of experts sought out and used all of the evidence available. The new guidance also incorporates public comments received last spring.

In crafting the guidance, the team recognized that the primary goal of patient decontamination should be improved health outcomes. The team also acknowledged that as a medical countermeasure, patient decontamination needs to be coordinated with other medical aspects of the emergency response and that patient decontamination is a whole community issue.

The final guidance encourages communities to have a risk and crisis communication strategy in place pre-incident to reach all community members. System-wide coordination and responder communication is essential, too, especially between on-scene responders and hospital-based receivers. So the working group recommended a tiered, risk-based approach which matches the nature and extent of decontamination to the characteristics of the incident.

To be sure the guidance is easy to use recommendations are organized by functional components of a response. In the extensive process to develop this guidance, the team 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.

Responders and public health officials: if you’ve experienced a chemical spill in your community, you can share your experience and your thoughts on the new guidance by commenting on this blog. 





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