There has been an upswing in interest on the topic of emergency mass decontamination driven by the number of "drills" being planned for the summer months. So, for the responders and hospital staff that have called/written in, we've put together Decontamination Revisited; a three-part series that will encourage thinking and provide a unique perspective on healthcare preparedness. Contamination Differences will discuss a few basics on the types of contamination that my be encountered, Big Questions will tackle the question of who should actually "do" decon, and in part three we'll provide a simple wrap-up on the topic.
There have been several instances over the last many years that highlight the need for emergency decontamination at health care facilities. People contaminated with a hazardous material showing up at random to emergency departments or other health care locations poses untold risks to the health care provider, the facility, other patients, and the community. Events at walk-in/urgent care clinics and increasing Consumer-Level Hazardous Materials incidents have underscored these risks. With the number of walk-in care, urgent care and retail health clinics growing, the issue of emergency decontamination needs to be revisited. Let's face it; even routine events have the potential for turning into a contaminated situation for responders and patients. We've seen local situations involving the intentional use of chemicals in violent civilian attacks. Chemical assisted suicide and homemade chemical bombs increase the threat level to responders, healthcare facilities, and civilians.
Lets start with the understanding that there is a difference between chemical, biological, and radiological contamination.
Chemicals and radiological material is perhaps the most concerning as the longer the material remains in contact with the person, the greater the exposure and subsequent effects will be. Also, if externally contaminated the person may be able to "off gas" or spread the contamination. With chemical materials off-gassing can cause serious inhalation and mucous membrane irritation and secondary contamination in other people. The facility can likewise become contaminated.
The spread of radiological contamination has a higher risk of secondary contamination...although the onset of effects will most likely be delayed...and the possibility for occult contamination and extended cleanup measures will be needed. For more on radiological contamination visit the Radiation Emergency Medical Management site, the Radiation Treatment Network or Biological Effects of Radiation Part#1, Part#2, Part#3 and summary (contains references used) in Mitigation Journal.
Biological contamination can take the form of a person ill with a disease (flu) or the presence of disease containing solid material...like anthrax in a powder. We should point out here that a difference exists between exposure, contamination and reasonable risk. Exposure simply means you've come in contact with something and may or may not suffer from it.
When we talk about exposure we usually are not overly concerned with decontamination unless visible product remains on the person or clothing. Contamination commonly indicates that a residue or material remains on the victim and that material is able to be spread. Contamination comes in two forms...external - able to be spread and internal - not able to be spread. A person who ingests a radiological source most likely would not be capable of spreading that contamination nor would a victim exposed to vapor or gases unless the vapors permiated the clothing.
The point is that once a material is inside the body the risk of secondary contamination is much less as is the need for decontamination. Reasonable risk exists when a person has been in an area and, with or without symptoms, is anticipated to have been exposed or contaminated...prophylactic decontamination is warranted.
Next: Decontamination Revisited: Big Questions.