Nerve Agents

Basic Decontamination

Shower

Basic Decontamination

Set up Considerations

  • Use pictorial and written posted instructions for victims to self decon when able, use locale-appropriate multilingual signage.
  • Double bag contaminated clothing etc. (place hearing aids, valuables in small bag). Place bag in container by showers.
  • Victims who are able may assist with their own decontamination.
  • Children and the elderly are at increased risk for hypothermia - provide warm showers, blankets.
  • Privacy must be considered, if possible.
  • The decontamination system should be designed for use in children of all ages, by parentless children, the non-ambulatory child, the child with special needs, and also allow families to stay together.
  • Use step-by-step child friendly instructions that explain to the children and parents what they need to do, why they are doing it, and what to expect.
  • Take into consideration that infants when wet are slippery and will need a way to get them through the decontamination process - i.e. plastic buckets, car seats, stretchers...
  • Designate a holding area and provide staff to support and supervise the children.
  • Recommended age appropriate staffing ratios for untended children:
    • 1 adult to 4 infants
    • 1 adult to 10 preschool children
    • 1 adult to 20 school-age children

Washing Instructions

  • If there will be significant delay to decontamination, have the victims rinse off with water exposed skin surfaces and disrobe (disposable clothing kits should be available).
  • Remove all clothing (at least down to their undergarments) and place the clothing in a labeled durable 6-mil polyethylene bag (removal of clothing, at least to the undergarment level will reduce victim's contamination by 85 %).
  • If exposure to liquid agent is suspected, cut and remove all clothing and wash skin immediately with soap and water.
  • If exposure to vapor only is certain, remove outer clothing and wash exposed skin with soap and water.
  • The eyes must be decontaminated within minutes of exposure to liquid nerve agent to limit injury. Flush the eyes immediately with water for about 5 to 10 minutes by tilting the head to the side, pulling eyelids apart with fingers, and pouring water slowly into eyes. There is no need to flush the eyes following exposure to nerve agent vapor. Remove contact lenses if easily removable without additional trauma to the eye.
  • If clothes have been exposed to contamination, then extreme care must be taken when undressing to avoid transferring chemical agents to the skin - i.e. any clothing that has to be pulled over your head should be cut off instead of being pulled over your head.
  • Scraping with a wooden stick, i.e. a tongue depressor or popsicle stick, can remove bulk agent.
  • Cover all open wounds with plastic wrap prior to performing head to toe decontamination (particular attention should be made to open wounds because cyanide is readily absorbed through abraded skin).
  • Flush the exposed skin and hair with plain water for 2 to 3 minutes then wash twice with mild soap. Rinse thoroughly with water. Be careful not to break the patient/victim's skin during the decontamination process.
  • Caution - many people shower as they do it at home rather than conducting a rapid decontamination of their bodies. Too aggressive scrubbing can lead to further damage to skin and open wounds.
  • Irrigate exposed or irritated eyes with plain water or saline for 5 minutes. Continue eye irrigation during other basic care or transport. Remove contact lenses if easily removable without additional trauma to the eye.
  • Utilizing large amounts of water by itself is very effective (limit pressure in infants).
  • If water supplies are limited, and showers are not available an alternative form of decontamination is to use absorbent powders such as flour, talcum powder, or Fuller's earth (0.5% sodium hypochlorite solution is contraindicated).
  • Sodium hypochlorite is not recommended for use in infants and young children.
  • Certification of decontamination is accomplished by any of the following: processing through the decontamination facility; M8, M9 tape; M256A1 ticket; or by the Chemical Agent Monitor (CAM).
  • If still contaminated repeat shower procedure.

In cases of ingestion, do not induce emesis. If the victim is alert, asymptomatic, and has a gag reflex, administer slurry of activated charcoal (administer at 1 gm/kg, usual adult dose 60-90 g, child dose 25-50 g). A soda can and a straw may be of assistance when offering charcoal to a child (consider naso-gastric tube - if possible contact ED prior to use of NG tube in infants and children [risk vs. benefit of inducing emesis with NG tube placement]).

Decontamination of First Responder

  • Begin washing PPE of the first responder using soap and water solution and a soft brush. Always move in a downward motion (from head to toe). Make sure to get into all areas, especially folds in the clothing. Wash and rinse (using cold or warm water) until the contaminant is thoroughly removed.
  • Reactive Skin Decontamination Lotion (RSDL) - designed to be carried by First Responders and warfighters, this lotion was found to be highly effective in removing and or neutralizing groups of chemical warfare agents. RSDL performed significantly better than the predicate device against the agents tested. The foam applicator immediately removes the CW agent off the skin and the CW Agent is chemically changed to a non-toxic form. Once the CW Agent is decontaminated, RSDL leaves a non-toxic residue that can be rinsed off when operational conditions allow.
  • Avoid combining bleach (hypochlorite) with RSDL - the combination is combustible
  • Links - RSDL background information
  • Remove PPE by rolling downward (from head to toe) and avoid pulling PPE off over the head. Remove the SCBA after other PPE has been removed.
  • Place all PPE in labeled durable 6-mil polyethylene bags.

Decontamination of Infants and Children

  • Video: Decontamination of Infants and Children (HHS/AHRQ, Children's Hospital Boston) (Watch video)
    • Decontamination of Children (HHS/AHRQ) provides a step-by-step decontamination demonstration in real time, and trains clinicians about the nuances of treating infants and children, who require special attention during decontamination.

Wound Management

References

  • Medical Management of Chemical Casualties Handbook, 2nd edition, September, 1995
  • Braue EH, Boardman CH. Decontamination of Chemical Casualties
  • Jagminas L. CBRNE - Chemical Decontamination (eMedicine)
Find more information on this substance at: PubChem, PubMed