When citizens come in contact with hazardous materials, the decontamination process needs to be initiated immediately to minimize the detrimental effects of the substance. But decon is a rare process that's infrequently practiced by first responders, and often it's more difficult than many responders would believe. When a hazmat incident occurs, the actual decontamination procedure is often responders' first practical experience. These personnel need not only qualified training but also periodic refresher practical exercises to become and remain proficient.

Hazmat preplans

Through grant programs, many jurisdictions are equipped and relatively prepared for a small-scale decontamination of 10 people or fewer. But how do other jurisdictions effectively manage an emergency mass-decontamination event?

One of the first steps in ensuring victims are properly decontaminated is assigning personnel to a decontamination reconnaissance group to identify symptomatic victims.

Responders then should have those contaminated remove their garments. This will eliminate 80% of the potential contamination. Then responders should conduct a simple decontamination process that can be accomplished primarily by applying large amounts of water through a fire hose at a low pressure. This process, although archaic, is adequate when the weather is warm. Applying cold water when the ambient temperatures are frigid is a much more difficult task. Victims won't respond favorably to being doused with cold water in the middle of the street.

In lieu of using water, paper towels or tissue paper (although not 100% effective) could be used to dab off any liquid on any contaminated exposed skin area. Portable fans also should be used to minimize the effect of harmful vapors collecting.

Alternative methods also should be examined and possibly developed as part of a jurisdiction's comprehensive decontamination plan, particularly for decon in cold temperatures. For more than 50 years, fire departments have gone to great lengths to preplan buildings in their coverage area. A similar approach may pay large dividends in mass-decontamination plans.

For example, there are many structures and commercial occupancies that are already equipped to assist in a mass-decontamination event. These facilities aren't useful if they aren't previously identified and designated as potential decontamination resources. Some of the facilities that should be considered for use during a decontamination event are:

• Middle schools and high schools with shower facilities;
• Commercial workout facilities and spas;
• Structures with indoor pools;
• Office buildings that have fountains or other decorative water displays; and
• Large hotels.

To designate a facility as a decontamination resource, the fire department should coordinate meetings with the police department, emergency managers and the owner of the occupancy to discuss the potential decontamination needs for the community. A memorandum of understanding also could be written to ensure that any chosen facility will be available for use when mass decontamination is required. The MOU must clearly state the fire department's intentions regarding the use of the facility.

First responders and facility staff must have a full understanding of what is expected for the plan to be effective. Moreover, this plan should be exercised annually.

When performing decontamination in these facilities, victims' shoes and socks must be taken off before entry and should be collected and identified. Clear instructions should be provided for the victims through sign, a television with looping VHS tape or DVD, and/or electric signboards. If available, towels and garments should be made accessible to redress affected individuals. Plans for gaining access into a structure should be discussed, particularly for an emergency after business hours; a key box system is a reliable after-hours entry plan.

Circumstances also may require the affected victims to be transported by buses to selected facilities. Once again, arrangements for mass transportation must be identified and made part of the plan prior to an event.

Dry decon

Any incident where the ambient temperature is below 65° is problematic, as the adverse effects of cold water must be considered.

There are two cold-weather possibilities that must be considered: cold shock and hypothermia. Cold shock occurs when individuals with pre-existing medical conditions are immersed in cold water, which causes their blood pressure to dramatically increase. The effects of cold shock can be as severe as unconsciousness followed by cardiac arrest.

It's widely believed by the emergency response community that hypothermia will occur in victims who are doused by cold water in a cold environment. Hypothermia is a condition that is caused by an extended exposure to either cold weather or cold water. (The colder the water, the less time it will take for hypothermia to occur.) Although victims will start to shiver in reaction to the body attempting to produce warmth, shivering is not an indication of hypothermia. Victims should be dried off as quickly as possible then moved to a warm location, re-dressed and triaged for potential medical intervention.

Although it is widely agreed that use of soap and water is normally the most effective in mass decontamination, significant cold-weather circumstances may not allow for such a process to take place. There are two forms of dry decontamination that should be considered:

1. Reactive skin decontamination lotion, developed by the Canadian military, has been approved by the U.S. Food and Drug Administration, but unfortunately it's quite expensive. The lotion works primarily by neutralizing the effects of the chemical that has been disbursed. Immediate availability is crucial to treat the contaminated victims for the lotion's effects to be beneficial.

2. The M291 Kit first was produced during World War I. This resin kit is most effective for cleaning contaminated skin areas.

With either treatment, the victim still should be showered as soon as possible to ensure the complete removal of the contaminant.

Ready-made

During the early stages of a large-scale decon, designating a group of personnel to perform decon while considering all the other competing elements such as rescue, firefighting and evacuation, will make decon a lower priority until more resources are requested and arrive at the scene. Decontamination is most effective when performed immediately (within two minutes) after a victim is contaminated or exposed to a toxic material.

The more time it takes to establish the decon corridors, the less effective the decontamination process will be for the affected victims. It's imperative that this process be initiated as soon as possible to minimize or eliminate the potential for cross-contamination to the first responders who may be performing rescues and the paramedics and hospital personnel who will be coming in contact with these potentially contaminated individuals when performing medical intervention.

Written standard operating guidelines for managing mass decontamination must be developed and exercised. The plan should include decon for both ambulatory and non-ambulatory patients. Part of that plan also should address decontamination of other emergency responders and self-decontamination. During a terrorist attack, the personnel assigned to the decontamination group will be performing decontamination on their own for an unpredictable period of time before other trained personnel will be there to relieve them.

Once the decontamination process is developed and practiced, most first responders will agree that emergency mass decontamination is in reality not a simple process, but is quite labor-intensive.

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Robert D. Stephan is a battalion chief with the Montgomery County (Md.) Department of Fire Rescue Services. He has been an emergency responder in Montgomery County for 34 years a nationally registered EMT-P for 25 years. Stephan is a charter member of Montgomery County's Hazardous Incident Response Team, and is the team leader of a 90-member team. He also is a member of the National Medical Response Team.