Pediatric emergency medicine trisk 4563 4563
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an outdoor facility must provide adequate water, temperature control, and curtains
separating shower lines for males and females. An alternative might be the use of
a facility that is enclosed, and adjacent to, but separate structurally from, the main
ED, with a separate and high-volume ventilation system vented directly outdoors
( Fig. 132.4 ). Optimally, the surface of the decontamination facility would allow
drainage, minimizing risk of patients slipping and falling and risk of further
exposure to contaminated rinse water. Young children requiring assistance may be
accompanied by parents if they are contaminated, as well. Older ambulatory
patients can be instructed in self-decontamination.
Decontamination efforts should stress physical and mechanical removal over
chemical decontamination. For vapor-exposed patients, decontamination is
effected primarily by clothing removal and hair washing with soap and water. In
contrast, those patients with liquid dermal exposure require disrobing and
thorough skin decontamination. Agent on their skin or in their clothing poses a
serious threat to ED personnel. Clothing must be carefully removed and double
bagged. Patients with ocular exposure require copious eye irrigation with saline
or water. Skin and hair should be washed thoroughly with soap and tepid water.
Previously, some authorities have recommended 0.5% sodium hypochlorite
(dilute bleach) for skin decontamination of nerve agents and vesicants. However,
even dilute bleach may be a skin irritant, thus increasing permeability to agent,
and application is time-consuming and not proven superior to copious soap and
water washing. A decontaminant that is now the standard for U.S. military field
use is reactive skin decontamination lotion (RSDL), which is packaged as a
lotion-impregnated sponge and acts by both physical removal and also
neutralization of chemical agents. RSDL is orders of magnitude superior to
standard decontamination methods and is particularly useful for immediate (local,
or “spot”) skin decontamination; the FDA has not yet approved it for whole-body
decontamination or use in eyes or wounds.
