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Guidelines for Military Mass Casualty Decontamination Operations During a Domestic HAZMAT/Weapon of Mass Destruction Incident Table 6: Principals of Mass Casualty Decontamination. Identify and understand the hazard(s) and operating conditions of the incident. Conduct and coordinate both decontamination and medical triage. Disrobing may be a critical step and can remove the majority of physical contamination (depends on casualty state of dress). Use high-volume, low pressure lukewarm water showers, with liquid soap if available, for up to 5 minutes or as indicated by post-decontamination monitoring. Monitor decontamination effectiveness; use random sampling of casualties before transportation to medical treatment facility. Principals of Mass Casualty Decontamination Knowing what agent that contaminated the casualties can 1) change the level of IPE/PPE to be worn by responders during response operations, 2) determine MCD decontamination processes to be used, and 3) modify the MCD processes as appropriate as the incident response progresses. Knowing hazards such as slip, trip, falls, overhead hazards, and heat/cold hazards ensures that responding personnel and casualties are safe. Safety is a large concern. (Sections 8.1.2 and 8.1.5) Triage is a prioritization system to allow responders to provide the necessary care to as many people as possible. Decontamination triage should not be confused with medical triage. Decontamination triage is performed to determine who should be washed off first, while medical triage is performed to determine who should receive medical treatment first. (Section 8.1.9) Disrobing is a fast and easy decontamination process that can remove most of the external contaminant, during most times of the year. Summer months in warmer climates will result in a lower removal percentage by disrobing, due to a greater percentage of exposed skin. (Section 7.3.1) High volume and low pressure water aids in the removal of any contamination. High volume ensures there is enough water to completely douse the casualty. Low pressure flow minimizes potential damage to the skin that could allow the contaminant to penetrate the skin faster. Water should be lukewarm so that the skin’s pores are less likely to open. Soap or other decontamination solutions can be added into a decontamination process to ensure more thorough removal of the contaminant. (Sections 8.2.1 – 8.2.5) Verify casualties have been decontaminated with appropriate detectors to verify that contaminants were successfully removed. If an appropriate detector is not available, visually observe the casualty for indicators that contamination removal was unsuccessful or wait for appropriate detector. (Section 8.1.11) During decontamination operations, also consider the containment, environmental run-off and monitoring, contamination and recontamination avoidance, and site cross-contamination prevention. However, the key MCD principles described in Table 6 apply regardless of the size and complexity of the incident. 7.3 Methods of Decontamination Mass casualty decontamination can be accomplished predominately by physical removal and neutralization. 15,23 Preventive methods, such as the use of disposable protective clothing and equipment, reduce the risk of cross-contamination. 23 Consider the agent’s solubility and reactivity with water when selecting the best method to decontaminate casualties. 23 Decontamination methods are described in detail in Field Manuals 3-11.5 and 4-02.7. 13,15 28 Original
Guidelines for Military Mass Casualty Decontamination Operations During a Domestic HAZMAT/Weapon of Mass Destruction Incident 7.3.1. Physical Removal of Contaminants Physical removal is the preferred technique when decontaminating mass casualties, particularly for the gross/immediate/emergency decontamination process. Disrobing, absorption, adsorption, flushing, brushing and scraping, isolation and disposal, vacuuming, and washing are common techniques to physically remove contaminants. Using water showers is the most practical method for performing gross decontamination. Disrobing, followed by flushing, is a fast and easy process that can remove most of the external contaminant, during most times of the year. 1 In warmer climates, summer months will result in a lower removal percentage by disrobing, due to a greater percentage of exposed skin. When water is limited or not available, dry materials, such as dirt, flour, baking powder, Fuller’s earth, activated charcoal, leaves, and/or sawdust, may be used to remove contaminants. 13 However, it is important that the dry material is not abrasive, like sand is to skin. Abrasiveness causes the skin’s pores to open, which could allow greater absorption of the contaminant through the skin. 13 Another consideration is the temperature of the water used to flush contaminants from the skin. The warmer the water is, the more the pores of the skin are opened. As such, it is recommended that lukewarm water is used in the decontamination process. 13 Physical methods simply reduce the amount of contaminant on the casualty. Physical removal of the contaminant could be sufficient on its own to decontaminate casualties, depending on the nature of the contaminant. This method does not change or reduce the toxicity of the agent. Therefore, subsequent neutralization of the contaminant on casualties may be required during the mass/thorough/operational/detailed/definitive decontamination process. 7.3.2. Cleansing and Neutralization of Contaminants Adding a cleansing or neutralizing compound to the water spray during the mass decontamination process makes decontaminating casualties more efficient and thorough. Cleansing compounds do not change or reduce the toxicity of the agent. The chemical nature of the cleansing compounds aid in disrupting the bond between the skin and the contaminant, so that the contaminant can be washed away by water. Neutralization is a reaction of the contaminating agent with other chemicals to render the agent less toxic, but its use on skin is discouraged because of possible irritation. Table 7 describes decontamination solutions. Table 7: Common Decontamination Solutions. Decontamination Description Solution Soap Is a cleansing compound. A fat-based soap can be added into a decontamination process to ensure more thorough removal of the contaminant. Soap removes chemical, biological, and radiological contaminants, but it does not kill biological agents or neutralize radiological agents. 13 Soap removes oily contaminants that stick to skin, such as VX and mustard. Do not delay decontamination to incorporate the soap, but introduce it as soon as practical. An effective solution can be made by mixing 16 ounces of baby shampoo with 5 gallons of water. 48 Original 29 Table of Contents Introduction MCD Equipment Comparison Decontamination Overview MCD Operations Summary Appendix A References Appendix B Acronym List Appendix C Glossary Appendix D MCD Cross- Reference Guide Appendix E CBR Guide Appendix F MCD Decision Trees Appendix G ARNORTH Guidance
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