Fourth Generation Agents

Decontaminaton

Shower

Decontamination

Patient Decontamination

After FGA exposures, decontaminating patients’ skin and hair is essential. Decontamination is a medical intervention and should be performed as soon as possible to prevent absorption of agent. However, even after a delay of hours or days, decontamination may still reduce harm to the patient and the risk of secondary exposure to other people.

  • Removal of clothing and personal effects is a vital step to reduce ongoing and secondary exposure and can remove significant amounts of chemical contamination. Pay particular attention to how clothing is removed in order to minimize the spread of contamination.
  • Containment of suspected or confirmed contaminated clothing in tightly closed plastic bags, double layered in 6 mil polypropylene bags if possible, is critical. Patient clothing and personal effects should be secured for law enforcement purposes.
  • Blotting skin with a paper towel, dry wipe, or other dry cloth will also contribute to effective decontamination. Primary Response Incident Scene Management (PRISM) guidance recommends 10 seconds of blotting followed by 10 seconds of rubbing the contaminated area of skin. This dry decontamination step can be performed by patients themselves and, along with clothing removal, should be done as early as possible. Disrobing and blotting skin with a paper towel, dry wipe, or other dry cloth can remove significant amounts of chemical contamination.
  • If Reactive Skin Decontamination Lotion (RSDL) is available, it is recommended for spot decontamination.
  • Water should be utilized per established decontamination protocols after disrobing, ideally with a high-volume, low-pressure shower, including soap if available, gentle rubbing with a soft cloth or sponge, and active drying with a clean towel after the shower. Do not delay decontamination awaiting specialized products such as soap or RSDL.
  • Avoid using hand sanitizer or other products containing alcohol, as they may enhance absorption of FGAs.
  • Do not use bleach to decontaminate skin.
  • FGAs are not readily degraded by water; thus, avoid direct contact with runoff.
  • The U.S. Environmental Protection Agency (EPA) issued a statement in 2000 generally allowing responders to prioritize actions to save human lives and protect health. After imminent threats are addressed, responders should immediately take all reasonable steps to contain contamination (including decontamination runoff) and mitigate environmental consequences.

Waste Management

Used PPE, body fluids, and waste generated in the management of patients should be handled with extra caution and segregated from other waste, as they may be contaminated with chemical agent.

Once lifesaving efforts are under control, the incident command should develop a comprehensive waste management plan along with a site-specific health and safety plan. The incident-specific comprehensive waste management plan should address the following:

  • Consideration must be given early on, in an exposure or suspected exposure event, of the need to preserve certain materials and samples as required for investigation and chain of custody purposes. Consultation with the local FBI WMD Coordinator or other law enforcement may be necessary to ensure proper materials (and quantities) are preserved.
  • Materials and samples needed for investigation and chain of custody should be secured and isolated from the waste collection activities. Once designated as “evidence” the materials are no longer treated as “waste.”
  • FGAs can persist for extremely long periods of time on materials and effluent liquids such as water (e.g., from patient and responder decontamination processes). Personnel handling these materials and liquids must be made aware of the potential hazard they present and provided with appropriate PPE.
  • The plan must identify specific collection and decontamination methods and personnel. Personnel must be knowledgeable of the FGA hazards, effective decontamination methods, and have appropriate PPE.
  • Waste must be decontaminated before it is handled by the facility’s regular waste management staff.
  • Incineration may be identified in the Comprehensive Waste Management Plan as the best decontamination method for some of the contaminated materials. Local permit modifications and requirements may vary per state regulation.
  • Consult with experts for disposal recommendations.
Shower

Decontamination

  • Conduct decontamination as soon as possible after a known or suspected exposure to an FGA, with particular emphasis on removing any liquid agent from the skin.
  • Remove potentially contaminated clothing and equipment using proper doffing procedures, place items in a plastic bag, and secure it as evidence at the scene.
  • Avoid using hand sanitizer or other products containing alcohol, as they may enhance absorption of agent and spread it over a larger area of skin. Do not use bleach to decontaminate skin.
  • Use a paper towel or other dry cloth to blot (do not wipe) any visible contamination from the skin.
  • Wash affected area with copious amounts of soap and water. Do not delay decontamination if soap is not available.
  • Avoid contact with decontamination runoff (wash water). FGAs are highly water soluble; however, they are not readily degraded by water.

Please visit Fourth Generation Agents for the FGA Reference Guide and other FGA-related resources.

Shower

Decontamination

  • Cross-contamination can occur between victims and responders. Follow established decontamination procedures.
  • Avoid direct contact with runoff water because FGAs are not readily degraded by water.
  • According to a statement issued by the EPA, responders generally may prioritize actions to save human lives and protect health. After imminent threats are addressed, responders should immediately take all reasonable steps to contain contamination (including decontamination runoff) and mitigate environmental consequences.

Emergency Decontamination of Victims and First Responders

  • Remove clothing and personal effects and place items in a plastic bag. This is a vital step to reduce ongoing and secondary exposure and can remove significant amounts of chemical contamination. Responders should pay particular attention to how clothing and personal effects are removed in order to minimize the spread of contamination.
  • Contain suspected or confirmed contaminated clothing and personal effects, by tightly closing bags and double bagging in 6 mil polypropylene bags, if possible.
  • Do not break the victim’s skin. Cover all open wounds during the decontamination process.
  • Use a paper towel, dry wipe, or other dry cloth to blot (do not wipe) any visible contamination from the skin. This dry decontamination step can be performed by victims themselves and, along with clothing removal, should be done as early as possible. Disrobing and blotting skin with a paper towel, dry wipe, or other dry cloth can remove significant amounts of chemical contamination.
  • Reactive Skin Decontamination Lotion (RSDL), if available, is recommended for spot decontamination. RSDL cannot come into contact with bleach. Combustion may occur upon contact with strong oxidizing chemicals (e.g., dry chlorine products like, HTH [calcium hypochlorite powder], super tropical bleach). Do not discard used RSDL components into strong oxidizing chemicals or their containers.
  • Water should be utilized per established decontamination protocols after disrobing, ideally with a high-volume, low-pressure shower, including soap if available, gentle rubbing with a soft cloth or sponge, and active drying with a clean towel after the shower. Do not delay decontamination awaiting specialized decontamination products such as soap or RSDL. FGAs can remain toxic in the wash water; treat it as contaminated waste.
  • Avoid using hand sanitizer or other products containing alcohol, as they may enhance absorption of the agent and spread it over a larger area of the victim’s skin. Do not use bleach to decontaminate skin.

Caring for Victims after Emergency Decontamination

  • Move the victim to a casualty collection area where ongoing evaluation and emergency medical treatment can be provided.
  • Coordination with the hospital(s) prior to transport is necessary to ensure that the hospital(s) knows the victims have been exposed to an FGA and confirm an isolation/decontamination receiving area and proper PPE are available.
  • If the victim was transported without being decontaminated, the ambulance or other transport vehicle should be considered contaminated. Steps should be taken to prevent further contamination of victims and equipment.
  • See the FGA Medical Management Guidelines (Fourth Generation Agents) for additional information related to decontamination in a hospital setting.

Technical Decontamination of Entry Teams

  • A decontamination line suitable for CWAs/FGAs for responders entering the exclusion zone should be established.
  • Refer to your department or agency’s standard operating procedures for technical decontamination procedures for nerve agents.
  • Double bag all PPE and equipment in labeled, durable 6 mil polyethylene bags.
  • All equipment that has been potentially contaminated by FGAs should be set aside; consult with experts for current decontamination or disposal recommendations.
Find more information on this substance at: Hazardous Substances Data Bank , TOXNET , PubMed