Chemical Terrorism

By James A. Geiling, MD, FCCP

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Decontamination

Decontamination of personnel and equipment poses great challenges in a chemical agent release. Once contaminated, the condition of victims may continue to deteriorate depending on the persistence of the agent. In addition, health-care workers subjected to agent off-gassing or direct contact may themselves become victims. This potential hazard requires well-planned coordination not only with prehospital emergency personnel, but also with security agencies in order to manage those victims who arrive via their own means to seek care.¹⁰ Lastly, equipment contamination can become a major challenge in the overall scene management, as vehicles, litters, mechanical equipment, etc, that become contaminated pose additional threats to rescue and health-care personnel if they are taken to "clean" areas without proper and thorough decontamination.

Personnel decontamination involves one of three methods: physical removal of the agent, chemical deactivation, or, perhaps in the future, biological deactivation. The equipment required may be individual and portable, or large and power driven. Physical removal most commonly takes place by removing clothing and simply flushing with water, but may also include the use of adsorbent materials such as Fuller's Earth, flour, or other resins. Chemical methods include simple soap and water. Additional benefit may occur through oxidation with chlorine compounds (normally household bleach), such as 0.5% hypochlorite for personnel and 5.0% hypochlorite for equipment.

Other decontamination issues that must be considered in the management of a site include weather factors, principally wind direction and temperature. The water and hypochlorite or bleach source, as well as runoff and waste disposal, must be planned. Decontamination planning must also involve the management of associated injuries, particularly from an explosion. Finally, the need to conduct mass decontamination exposes the notion of the public health consequences of a chemical terrorist event.¹¹

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