There Are Different Types of Emergency Decontamination:

1. Technical Decontamination: Hazmat Response Team / Fire Department Personnel Using PPE (Requires Containment of Run-Off)
2. Non-Ambulatory Decontamination (Requires Containment of Run-Off)
3. Ambulatory Self-Decontamination
4. Gross Decontamination Using an Elevated Masterstream (pictured above) 

Note: With both ambulatory and gross decontamination, you direct, control and contain run-off away from both responders and victims dependent upon the specific product(s) / chemical agent(s) involved.

Note: Contained run-off from either Technical Decon or Non-Ambulatory Decon enables response team personnel to hazcat the water run-off to test for the presence of chemical agents or hazardous materials.

Gross Decontamination / Elevated Master Stream Considerations:

1. For large numbers of contaminated victims use hose lines and master streams such as deck guns. One of the more popular methods to use in the event your department does not have acces to an elevated master stream is using engine companies 
2. One of the most effect methods for providing Gross Decontamination is the use of Elevated Master Streams using fog nozzles with LOW pressure to rain the water down on the victims like a giant shower.
3. Truck Company personnel should routinely flush and maintain Fog Nozzles due to foreign materials (rocks, debris) from blocking the interior of the nozzle, creating an uneven spray pattern which creates a more forceful flow verses a fine shower mist.

Decontamination Solutions of Choice:

• The premise remains the same (blot, strip, flush and cover), but the availability of various decontamination solutions can enhance the effectiveness of the decontamination process.
• Personnel can be flushed of agent using just water, or soap and water as the soap will help lift the contaminant. Remember that any covering can trap contamination, so washing must be complete.

Note: Not to be too graphic, but an example of this was an acid leak that contaminated several office workers. One of the victims was a young lady who was forced to remove all of her clothes as a result of the exposure and the resulting burning sensation on her skin. Firefighters, respecting her modesty allowed the lady to keep on her panties. However, the victim had an absorbment pad in place and ended up suffering 3rd degree burns to her genital area because the pad had been soaked in both water and product.

• If available, a 1:10 solution of household bleach is most effective in removing and neutralizing contamination (one quart per 2.5 gallons of water, or 5 gallons to a 55 gallon drum). 
• Wounds that are more than superficial should NOT be decontaminated using bleach.
• Radioactive contamination does not require the use of a hypochlorite solution.
• Soap and water is the next best decontamination solution over water with a solution of household bleach (0.5%) being the preferred decon solution.
• WARNING: Think about having someone spray a bleach solution into your eyes, onto mucous membranes or on your skin. The potential exists where you can actually cause more harm than good. Be careful!
• DO NOT WAIT for soap or bleach to become available.
• USE COPIOUS AMOUNTS OF WATER IMMEDIATELY!

Performing Emergency Decontamination: 

1. COMMUNICATE DIRECTIONS: You must communicate the need for assistance and what these people must do.
2. ARMS OUT / LEGS APART: Ambulatory responders or victims must place their Arms Out and Legs Apart.
3. TOP DOWN WASH: Wash from the top down.
4. IF BIOLOGICAL OR RADIOLOGICAL, RINSE WHILE REMOVING CLOTHES: If you have a suspected biological or radiological agent, start rinsing the people off first as they remove their clothes.

• This will entrain the agent on the clothes and reduce the tendency for the agent to stick to their bodies due to static charge.
• This will reduce the chances for particles becoming airborne.

Provide Cover for Victims / Patients:

1. Use whatever is available from your local area.
2. Obtain blankets, large towels, sheets from local stores, hospitals, hotels and motels or even table clothes from restaurants.
3. Plan Ahead! Contact local hospitals for used operating room / hospital green scrubs (pants and shirt), disposable coveralls, booties, towels and blankets. You can also create emergency disposable clothing when dealing with large incidents by cutting holes out of large black trash bags for both the head and arms.

Establish TTT: Triage, Treatment and Transport Area

1. Establish a clean zone (Cold Zone) large enough to accommodate all casualties and with appropriate security precautions to maintain control of the area.
2. Ensure that all responders are aware of the signs and symptoms of hazardous materials, biological or radiological exposure.
3. Maintain ABC's, minimizing exposure to casualties.

• Assume victims may still have some contamination on them.
• Wear PPE and use the appropriate level of respiratory protection, dependent upon the hazards present.
• If available, use auto-inject pharmaceuticals which are required for stabilizing casualties exposed to chemical agents.
• Use mass transit to assist in transporting casualties.

Perform Self-Decon

1. If you are exposed after emergency decontamination and Technical Decontamination is not available you will need to perform a Self-Decon.
2. Consider yourself contaminated...
3. Take appropriate pre-cautions and go through the decontamination process yourself.

Considerations for Non-Ambulatory Decontamination

1. Minimize exposure to emergency responders.
2. Structural firefighting clothing and positive pressure SCBA's (Self Contained Breathing Apparatus).
3. Rubber / Latex Gloves
4. Limit the number of responders in contact with the victim(s).
5. Keep clothing away from victim's face during removal (to keep casualties from breathing in the agent(s).)
6. Remove / cut clothing from head to toe, front to back, keeping the clothing away from the victims face.

Considerations for Ambulatory Decontamination:

1. Isolate any refusals from the individuals (citizens) contaminated to prevent further contamination.
2. Collect personal items and place in large clear polybags, identifying the outside of the bags using a permanent ink marker.
3. Bagged clothing should be placed into drums

Guidelines For Run-Off Produced From Emergency Decontamination: 

1. If run-off is not contained, notify agency responsible for handling storm water quality.
2. For some chemical agents, it is expected that the agents will be hydrolyzed to some extent and diluted by the large amounts of water and not present a major downstream hazard.
3. For radiation, expect water to spread the contamination downstream.
4. For biological agents, downstream contamination will vary, depending on the type of agent and how it survives in that environment.
5. If run-off goes into the storm drainage system, it may be necessary to notify entities downstream as a precaution.
6. If run-off goes into the sanitary system, notify the water utility providers.

Establish segregated lanes for: 

1. Symptomatic from Asymptomatic
2. Male from Female
3. Ambulatory from Non-Ambulatory

Note: Take into consideration families, small children, the elderly, handicapped persons (blind, persons in wheelchairs, speech impaired, etc.) language issues.

Take into account modesty covers for patient / victims and the public eye (news media).

1. Modesty covers can be easily constructed using large black plastic trash bags. Simply cut a hole (actually a half circle) along the 'bottom' of the bag to enable an individuals head to stick out once the bag has been inverted. Place a strip of duct tape along both 'shoulders' to reinforce the bags seam. An ambulatory patient / victim can remove contaminated clothing while ensuring that modesty considerations are provided. 
2. Modesty covers can be quickly established using aerial ladders with salvage covers hung from the bed ladder extended horizontal to the ground.
3. Modesty covers can be quickly established using pike poles, ground ladders, or ropes between apparatus and covered with salvage covers.
4. Don't forget news helicopters. ( "Eye in the Sky")

If you want to pre-package emergency victim modesty cover/ belongings kits, include the following:

• 35-Gallon .04 ml thick Polybag
• Large ziplock baggie for personal effects.
• Disposable Tyvek suits for temporary clothing.
• Information Card indicating what was collected from the patient / victim.

Assessing levels of Contamination:

1. An inexpensive way to determine whether turnouts, PPE or a civilians clothes have been contaminated is to use large .04 ml thickness polybags to contain the clothing or equipment. Twirl the bag to trap and seal air, using duct tape to hold the bag closed. Double and bend the bunched bag top and re-apply more duct tape. Sit the bag out in the sun, allowing heat to expand the polybag, You know it's ready when you see water droplets forming on the inside of the bag.
2. If your dealing with an organophosphate incident for example, have a small piece of duct tape ready and puncture the bag with a draeger colormetric indicator tube. Pump the draeger as indicated and you will get a visual confirmation for the presence of hazardous materials.
3. Using clear polybags enables you to see what's inside verses having to open the bag.
4. Using polybags with a thickness of at least .04 ml ensures a strong bag that will handle movement and transportation.
5. Don't forget to keep permanent markers for labelling bags with name, incident name, date and time.

Consider Weather Conditions:

1. May need to move decon indoors (e.g, school gym and showers, car wash, etc.)
2. Emergency Shelters