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Hospital Patient Decontamination
Topic Collection
June 27, 2022

Topic Collection: Hospital Patient Decontamination

The release of hazardous materials—whether accidental or intentional—has the potential to significantly harm the health of community members and first responders. No matter the cause, patients will require emergent medical care delivered by a team of healthcare providers. Because of the significant draw on human and material resources associated with these incidents, it is critical for emergency medical professionals to develop hospital patient decontamination plans that can help them provide the best medical care possible to patients while ensuring that caregivers are protected. The following resources highlight lessons learned, guidelines, plans, tools, and templates, and promising practices that can help emergency medical practitioners accomplish this goal.

This Topic Collection was refreshed in 2022. Each resource in this Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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Must Reads

Centers for Disease Control and Prevention. (2013). Radiological Terrorism - Just in Time Training for Hospital Clinicians.
This brief video presents just-in-time training on recognition and management of radiation contaminated patients. It uses patient care scenarios to demonstrate key procedures.
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Chilcott, R.P., Larner, J., and Matar, H. (2019). UK’s Initial Operational Response and Specialist Operational Response to CBRN and Hazmat Incidents: A Primer on Decontamination Protocols for Healthcare Professionals. Emergency Medicine Journal. 36(2):117-123.
The authors describe decontamination protocols for healthcare professionals in the event of chemical, biological, radiological, nuclear, and hazardous material incidents. This information is based primarily on the United Kingdom’s evidence-based update to mass casualty and decontamination procedures.
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Chilcott, R.P., Larner, J., and Matar, H. (Eds.). (2019). Primary Response Incident Scene Management: PRISM Guidance, Second Edition. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Biomedical Advanced Research and Development Authority.
The Primary Response Incident Scene Management (PRISM) series is comprised of three volumes that can help ensure that patients exposed to potentially hazardous chemicals receive the most effective treatment possible during the initial stages of an incident (after prompt decontamination). Updated in 2019, PRISM incorporates new scientific evidence on emergency self-decontamination, hair decontamination, the interactions of chemicals with hair, and the effects of a combined decontamination strategy referred to as the “triple protocol.” The clinical research showed that these three steps, taken together, remove 99.9 percent of chemical contamination.
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Cibulsky, S., Kirk, M., Ignacio, J., et al. (2014). Patient Decontamination in a Mass Chemical Exposure Incident: National Planning Guidance for Communities. U.S. Department of Homeland Security and U.S. Department of Health and Human Services.
This guidance can help emergency planners prepare for mass patient decontamination from initial assessment to evaluation of process effectiveness. The authors emphasize the importance of communication and coordination between on-scene and health care facility-based staff.
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Harvard School of Public Health. (2014). Hospital Decontamination Self-Assessment Tool. Commonwealth of Massachusetts Department of Public Health -Office of Emergency Preparedness and Emergency Management.
This tool can help hospitals assess their preparedness for a decontamination event. The authors include chapters on preparedness, response, and recovery, and provide planning and team matrices in the appendices.
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Occupational Safety and Health Administration. (2005). Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances. U.S. Department of Labor.
The Occupational Safety and Health Administration shares best practices document for hospitals to enhance employee protection and training as part of emergency planning for mass casualty incidents involving hazardous substances.
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U.S. Department of Health and Human Services, Chemical Hazards Emergency Medical Management. (2005). Decontamination of Children.
This scenario-based video shares specific considerations for caring for pediatric patients who require decontamination.
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Books Available for Purchase

Blumen, I. (2002). Radiation Emergencies. Pediatric Emergency Medicine: A Comprehensive Study Guide, Chapter 117. American College of Emergency Physicians.
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Burgess, J. (2004). Hazardous Materials Incidents. In Dart, R. Medical Toxicology, 3rd Edition, Chapter 259.
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Christenson, D., Becker, S., Whitcomb, R., et al. (2010). Emergency Management of Radiation Injury and Illness. International Disaster Nursing, Chapter 13.
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Colwell, C. (2014). Radiation Injuries. Rosen's Emergency Medicine Concepts and Clinical Practice 8th Edition, Chapter 146.
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Fong, F., Jr. (2007). Medical Management of Radiation Accidents. Disaster Medicine, Second Edition.
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Hakozaki, Y. (2010). Chemical Preparedness and Response. International Disaster Nursing, Chapter 11.
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Levitin, H. and Siegelson, H. (2007). Hazardous Materials. Disaster Medical Planning and Response. Disaster Medicine, Second Edition.
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Nadig, R. (2014). Hazardous Materials Release and Decontamination. Goldfrank's Toxicologic Emergencies, 10th Edition, Chapter 92.
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Powers, R. (2010). Decontamination. International Disaster Nursing, Chapter 15. Cambridge University Press.
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Sorenson, B. and Sorenson, J. (2006). Chemical Decontamination. Disaster Medicine.
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Chemical Decontamination

* DeAtley, C. (2012). Hospital Preparedness for “Chemical/Detergent” Suicides. Domestic Preparedness. 8(3): 13-14.
The author explains the trend in chemicals being ingested by suicidal patients, how these chemicals may make the scene and patients' bodies dangerous to caregivers, and strategies for protecting medical staff from these hazards.
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* Freyburg, C., Arquilla, B., Fertel, B., et al. (2008). Disaster Preparedness: Hospital Decontamination and the Pediatric Patient. (Free registration required to access abstract and algorithm.) Prehospital Disaster Medicine. 23 (2)166-172.
The authors discuss the medical and psychological planning needs associated with children and chemical decontamination. They developed an algorithm that includes steps for ambulatory and non-ambulatory patients.
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Johnston, G.M. and Wills, B.K. (2022). Chemical Decontamination. StatPearls.
This free book excerpt addresses chemical decontamination before and after patient arrival at a healthcare facility. The authors explain how dosage and time before treatment affect injury severity.
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* Koenig, K., Boatwright, C., Hancock, J., et al. (2008). Healthcare Facility-Based Decontamination of Victims Exposed to Chemical, Biological, and Radiological Materials. (Abstract only.) American Journal of Emergency Medicine. 26(1):71-80.
This authors review the basics of health care facility-based decontamination (e.g., regulatory concerns, types of contaminants, and comprehensive decontamination procedures).
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Occupational Safety and Health Administration. (n.d.). Decontamination. (Accessed 5/19/2022). United States Department of Labor.
This webpage discusses decontamination required due to materials workers may encounter at hazardous waste sites. It lays out decontamination planning, contamination prevention, and decontamination methods. Though geared toward site response, this resource includes valuable information for hospitals to consider.
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Wanner, G.K., Atti, S., Jasper, E. (2019). Chemical Disaster Preparedness for Hospitals and Emergency Departments. Jefferson Digital Commons, Thomas Jefferson University, Department of Emergency Medicine Faculty Papers. 95.
This document provides an overview of the requirements and guidelines needed to respond to a chemical disaster incident from a healthcare perspective. It includes resources for training, evaluation of chemically contaminated patients, and pre-hospital and hospital-based decontamination procedures of ambulatory and non-ambulatory at-risk patients
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Education and Training

Center for Domestic Preparedness. (2018). Hospital Emergency Response Training for Mass Casualty Incidents. Federal Emergency Management Agency.
This three-day course prepares healthcare personnel (emergency and hospital-based) to conduct a safe and effective emergency medical response to a mass-casualty incident. Participants will learn how to recognize the procedures for ambulatory and nonambulatory decontamination and select and use appropriate levels of personal protective equipment, among other skills.
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* Centers for Disease Control and Prevention. (2013). Radiological Terrorism - Just in Time Training for Hospital Clinicians.
This brief video presents just-in-time training on recognition and management of radiation contaminated patients. It uses patient care scenarios to demonstrate key procedures.
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Hick, J. (2014). HCMC Hospital HAZMAT Curriculum. Hennepin County Medical Center.
This series of five videos developed by Hennepin County Medical Center is part of the facility’s eight-hour hazardous materials decontamination team training. Hands-on training follows completion of on-line video training.
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* Hick, J., Penn, Pl, and Hanfling, D. (2003). Establishing and Training Healthcare Facility Decontamination Teams. (Abstract only.) Annals of Emergency Medicine. 42(3):381-90.
The authors of this article review Occupational Safety and Health Administration (OSHA) training requirements for healthcare personnel involved with decontamination responses. They discuss team selection and training and highlight relevant sample OSHA operations-level training curricula.
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Kako, M., Hammad, K., and Mitani, S., et al. (2018). Existing Approaches to Chemical, Biological, Radiological, and Nuclear (CBRN) Education and Training for Health Professionals: Findings from an Integrative Literature Review. (Abstract only.) Prehospital and Disaster Medicine. 33(2).
The authors reviewed the literature on education and training for health professionals regarding chemical, biological, radiological, and nuclear incidents. They emphasize the importance of including scenario simulations in this type of training.
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Minnesota Department of Health. (2018). Hazardous Materials Exposure Guide: A Step-by-Step Medical Response Guide.
This quick-reference cardset is intended for use by pre-hospital and hospital personnel and groups the exposure by class rather than agent (corrosives, asphyxiants, cholinergics) for easier initial assessment and treatment. It includes detailed descriptions of patient treatment steps (decontaminate and collect information; treat chemical exposure; collect blood and urine specimens) following hazardous materials exposure.
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Osmanlliu, E., Bank, I., and Khalil, E., et al. (2021). Decontamination Effectiveness and the Necessity of Innovation in a Large-Scale Disaster Simulation. (Abstract only.) American Journal of Disaster Medicine. 16(1):67-73.
This article describes a large-scale simulation of a chemical or biological incident, in which 39 adult simulated patients experienced decontamination with a wet decontamination protocol. The authors found that a wet decontamination protocol significantly reduced the simulated contaminant found on adult participants.
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Ron Blank and Associates (2008). Principles & Design Considerations for Sterile Processes. An American Institute of Architects (AIA) Continuing Education Program.
Training participants can learn more about the importance of a sterile processing department and the concepts of decontamination and sterilization. They will also learn how to identify the type of equipment found in these departments and better understand the related nature of the workflow and design factors.
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* U.S. Department of Health and Human Services, Chemical Hazards Emergency Medical Management. (2005). Decontamination of Children.
This scenario-based video shares specific considerations for caring for pediatric patients who require decontamination.
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Guidance Documents

Bennett, R.L. (2006). Chemical or Biological Terrorist Attacks: An Analysis of the Preparedness of Hospitals for Managing Victims Affected by Chemical or Biological Weapons of Mass Destruction. International Journal of Environmental Research and Public Health. 3(1):67-75.
This article discusses findings from a survey of acute care hospitals in Mississippi to determine their readiness for biological, chemical, radiological, or other types of terrorist attacks . Tables illustrate participating hospitals’ demographics and select preparedness variables (e.g., plans and supplies). Overall, the author found that while efforts had improved, hospitals in this state lacked in “true” preparedness; areas for improvement are identified.
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Centers for Disease Control and Prevention. (2001). Managing Hazardous Materials Incidents (MHMIs), Version 2001. Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry.
This three-volume set of guidance documents and a video provide recommendations for on-scene and hospital medical management for patients exposed to hazardous materials.
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Chilcott, R.P., Larner, J., and Matar, H. (Eds.). (2019). Primary Response Incident Scene Management: PRISM Guidance, Second Edition. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Biomedical Advanced Research and Development Authority.
The Primary Response Incident Scene Management (PRISM) series is comprised of three volumes that can help ensure that patients exposed to potentially hazardous chemicals receive the most effective treatment possible during the initial stages of an incident (after prompt decontamination). Updated in 2019, PRISM incorporates new scientific evidence on emergency self-decontamination, hair decontamination, the interactions of chemicals with hair, and the effects of a combined decontamination strategy referred to as the “triple protocol.” The clinical research showed that these three steps, taken together, remove 99.9 percent of chemical contamination.
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Cibulsky, S., Kirk, M., Ignacio, J., et al. (2014). Patient Decontamination in a Mass Chemical Exposure Incident: National Planning Guidance for Communities. U.S. Department of Homeland Security and U.S. Department of Health and Human Services.
This guidance can help emergency planners prepare for mass patient decontamination from initial assessment to evaluation of process effectiveness. The authors emphasize the importance of communication and coordination between on-scene and health care facility-based staff.
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Commonwealth of Massachusetts Department of Public Health -Office of Emergency Preparedness and Emergency Management (2014). Proposed Minimum Decontamination Capabilities for Hospitals in Massachusetts.
This resource was designed to assist hospitals and their response partners with addressing challenges in hospital-based decontamination during all four phases of the emergency management cycle. While each document can be used individually to facilitate improvement, the resources are most effective when used in combination
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* Department of Health (Victoria, Canada). (2013). Decontamination Guidance for Hospitals. Department of Health and Human Services.
This guide features diagrams, tables, antidote suggestions, and templates that can be tailored by medical facilities when preparing for patient, responder, and facility decontamination.
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Koenig, K.L., Boatright, C.J., and Hancock, J.A., et al. (2008). Health Care Facility-Based Decontamination of Victims Exposed to Chemical, Biological, and Radiological Materials. The American Journal of Emergency Medicine. 26(1):71-80.
The authors discuss hospital-based decontamination for chemical, biological, and radiological mass casualty events and review regulatory considerations, various contaminants, procedures for decontamination, and preparedness planning.
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Magnano, G.C., Rui, F., and Larese Filon, F. (2021). Skin Decontamination Procedures Against Potential Hazards Substances Exposure. (Comprehensive abstract only.) Chemico-Biological Interactions. 344.
This review examines old and new literature on how to decontaminate skin after exposure to hazardous substances, including flushing with soap and water, other liquid decontamination methods, adsorbent powders, and chelation therapy.
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Occupational Safety and Health Administration. (2005). Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances. U.S. Department of Labor.
The Occupational Safety and Health Administration shares best practices document for hospitals to enhance employee protection and training as part of emergency planning for mass casualty incidents involving hazardous substances.
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Ponampalam, R. (2019). A Novel Hospital-Based Mass Casualty Decontamination Facility for Hazardous Material Disasters. Toxicology and Forensic Medicine. 4(1):18-23.
This article discusses hospital preparedness for mass decontamination of chemical casualties. The author focuses on an innovative decontamination facility in Singapore, which can serve as a model for healthcare preparedness in the United States.
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Razak, S., Hignett, S., and Barnes, J. (2018). Emergency Department Response to Chemical, Biological, Radiological, Nuclear, and Explosive Events: A Systematic Review. Prehospital Disaster Medicine. 33(5):543–549.
The authors conducted a literature review to identify challenges associated with Emergency Department (ED) CBRNE response. They concluded that “response planning and preparation should be considered at three levels: organizational (policies and procedures); technological (decontamination, communication, security, clinical care, and treatment); and individual (willingness to respond, PPE, knowledge, and competence),” and that there is a gap “specific to detection and diagnosis of CBRNE exposure on self-presenting patients in the ED.”
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Titus, E., Lemmer, G., and Slagley, J., et al. (2019). A Review of CBRN Topics Related to Military and Civilian Patient Exposure and Decontamination. (Abstract only.) American Journal of Disaster Medicine. 14(2):137-149.
This article discusses chemical, wet, and dry decontamination methods for chemical and biological emergencies, including the drawbacks of each method. It discusses considerations for civilian and military populations.
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U.S. Army Soldier and Biological Chemical Command. (2003). Guidelines for Cold Weather Mass Decontamination During a Terrorist Chemical Agent Incident. U.S. Department of the Army.
Emergency medical professionals can learn about military practice for performing decontamination in cold weather situations. The document includes charts, figures, and photographs of decontamination equipment and techniques.
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U.S. Army Soldier and Biological Chemical Command. (2003). Guidelines for Mass Casualty Decontamination during a Terrorist Chemical Agent Incident. U.S. Department of the Army.
Originally written as guidance for military personnel, the decontamination guidelines in this document can be applied by medical personnel in civilian facilities. The document includes charts, figures, and photographs of decontamination equipment and techniques.
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U.S. Department of Defense, U.S. Department of Health and Human Services, U.S. Department of Transportation, et al. (2019). Fourth Generation Agents: Medical Management Guidelines.
This document was designed to educate and prepare fire, emergency medical services, and hospital staff and guide the medical management of patients exposed or potentially exposed to a fourth generation agent. This is one PDF document that is divided into two sections, one for pre-hospital care and one for in-hospital care.
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Lessons Learned and Research

Amlôt, R., Carter, H., Riddle, L., et al. (2017). Volunteer Trials of a Novel Improvised Dry Decontamination Protocol for Use during Mass Casualty Incidents as Part of the UK’S Initial Operational Response (IOR). PLoS One. 12(6): e0179309.
In this study, authors reviewed the effectiveness of skin decontamination via dry decontamination using paper towels and incontinence pads. Findings indicated that these methods were even more successful when combined with guidance provided by emergency responders and healthcare workers.
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Collins, S., Williams, N., Southworth, F., et al. (2021). Evaluating the Impact of Decontamination Interventions Performed in Sequence for Mass Casualty Chemical Incidents. Scientific Reports. 11: 14995.
The authors examined to UK decontamination procedures (Initial Operational Response and Specialist Operational Response) alone and in sequence (improvised dry, improvised wet, interim wet, specialist decontamination and a no decontamination control). They found “modest additional benefits” associated with conducting decontamination interventions in sequence.
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Matar, H., Pinhal, A., and Amer, N., et al. (2019). Decontamination and Management of Contaminated Hair following a CBRN or HazMat Incident. Toxicological Sciences. 171(1): 269-279.
The authors conducted an in vitro porcine study on skin and hair to determine the most effective strategies for post-chemical decontamination. They examined dry decontamination, the ladder pipe system, and technical decontamination and determined that while these methods worked well on skin, they were less effective on hair, leading them to recommend removing contaminated hair post exposure.
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Okumura, T., Suzuki, K., Fukuda, A., et al. (1998). The Tokyo Subway Sarin Attack: Disaster Management, Part 2. Hospital Response. Academic Emergency Medicine. 5(6):618-24.
The authors describe the response effort of St. Luke's International Hospital to the Tokyo sarin attack.
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Rispens, J., Jones, S., Clemmons, N., et al. (2020). Anhydrous Ammonia Chemical Release - Lake County, Illinois, April 2019. Morbidity and Mortality Weekly Report. 69(4):109-113.
This article details the 2019 2-ton ammonia spill in Lake County Illinois, where 83 people were evaluated for exposure at local hospitals. There were no fatalities, but 14 (17%) were hospitalized (eight were admitted to the intensive care unit and seven 7 required endotracheal intubation and mechanical ventilation). Healthcare providers experienced symptoms of secondary exposure. None of the patients had been decontaminated in the field, prompting the authors to call for hospitals to review their related policies and procedures.
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Southworth, F., James, T., Davidson, L., et al. (2020). A Controlled Cross-over Study to Evaluate the Efficacy of Improvised Dry and Wet Emergency Decontamination Protocols for Chemical Incidents. PLoS One. 15(11): e0239845.
The authors describe a study using readily available materials to achieve dry decontamination, wet decontamination, and combined dry and wet decontamination after a chemical exposure. While “improvised decontamination” is relatively effective, the authors noted challenges with reaching certain areas of the body.
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Wenck, M., Van Sickle, D., and Drociuk, D., et al. (2007). Rapid Assessment of Exposure to Chlorine Released from a Train Derailment and Resulting Health Impact. Public Health Reports. 122(6): 784–792.
In 2005, in Graniteville, South Carolina, a train carrying three tanker cars of liquid chlorine under pressure derailed and released nearly 60 tons of chlorine until a patch could be applied. The authors describe patient characteristics, how they were transported (and where), symptoms, and components for planners to consider incorporating.
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Pediatric

Chung, S., Baum, C.R., and Nyquist, A.C. (2020). Chemical-Biological Terrorism and Its Impact on Children. American Academy of Pediatrics. 145(1).
This policy statement addresses the steps that clinicians and policy makers can take to protect children and mitigate the effects of a chemical or biological attack. To access the technical report, copy and paste this link into a new browser: https://pediatrics.aappublications.org/content/early/2020/01/23/peds.2019-3750
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* Freyburg, C., Arquilla, B., Fertel, B., et al. (2008). Disaster Preparedness: Hospital Decontamination and the Pediatric Patient. (Free registration required to access abstract and algorithm.) Prehospital Disaster Medicine. 23 (2)166-172.
The authors discuss the medical and psychological planning needs associated with children and chemical decontamination. They developed an algorithm that includes steps for ambulatory and non-ambulatory patients.
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Meyer, K. (2020). Decontamination. (Abstract only.) Nursing Management of Pediatric Disaster.
This book chapter addresses providing healthcare to children after hazardous materials events, with an emphasis on preventing secondary contamination, ensuring decontamination procedures are developmentally appropriate, and other special considerations (e.g., keeping family members together).
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Rotenberg, J., Burklow, T., and Selaniko, J. (2003). Weapons of Mass Destruction: The Decontamination of Children. (No abstract available.) Pediatric Annals. 32(4):261-7.
The authors share challenges specific to pediatric decontamination planning and issues healthcare providers clinicians will face in the response phase.
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U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (2005). Decontamination of Children.
This video explains how children differ from adults physically and emotionally, and provides recommendations for pediatric decontamination.
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* U.S. Department of Health and Human Services, Chemical Hazards Emergency Medical Management. (2005). Decontamination of Children.
This scenario-based video shares specific considerations for caring for pediatric patients who require decontamination.
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Zhao, X., Dughly, O., and Simpson, J. (2016). Decontamination of the Pediatric Patient: Current Opinion in Pediatrics. (Abstract only.) Emergency and Critical Care Medicine. 28(3):305-309.
This article discusses age-appropriate decontamination procedures for pediatric populations after chemical, biological, and radiological incidents.
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Plans, Tools, and Templates

California Emergency Medical Services Authority. (2005). Patient Decontamination Recommendations for Hospitals. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This document provides recommendations for protecting staff and managing patients during events involving a hazardous material. The document also includes decision trees and algorithms as well as equipment recommendations for specific hazards.
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Chilcott, R.P., Larner, J., and Matar, H. (2019). UK’s Initial Operational Response and Specialist Operational Response to CBRN and Hazmat Incidents: A Primer on Decontamination Protocols for Healthcare Professionals. Emergency Medicine Journal. 36(2):117-123.
The authors describe decontamination protocols for healthcare professionals in the event of chemical, biological, radiological, nuclear, and hazardous material incidents. This information is based primarily on the United Kingdom’s evidence-based update to mass casualty and decontamination procedures.
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* Department of Health (Victoria, Canada). (2013). Decontamination Guidance for Hospitals. Department of Health and Human Services.
This guide features diagrams, tables, antidote suggestions, and templates that can be tailored by medical facilities when preparing for patient, responder, and facility decontamination.
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Harvard School of Public Health. (2014). Hospital Decontamination Self-Assessment Tool. Commonwealth of Massachusetts Department of Public Health -Office of Emergency Preparedness and Emergency Management.
This tool can help hospitals assess their preparedness for a decontamination event. The authors include chapters on preparedness, response, and recovery, and provide planning and team matrices in the appendices.
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New York City Department of Health and Mental Hygiene (Continuum Health Partners Center for Bioterrorism Preparedness and Planning). (2006). Hospital Decontamination of Exposed Casualties Policy and Procedure Draft. Domestic Preparedness.
This hospital decontamination plan template was prepared for the City of New York. It includes considerations for various hazardous materials, decision algorithms, and job action sheets.
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Radiological Decontamination

Alexander, G. (2006). Radiation Decontamination. (Book available for purchase.) Disaster Medicine.
The author of this chapter shares information on radiation emergencies and patient/hospital decontamination principles.
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* Centers for Disease Control and Prevention. (2013). Radiological Terrorism - Just in Time Training for Hospital Clinicians.
This brief video presents just-in-time training on recognition and management of radiation contaminated patients. It uses patient care scenarios to demonstrate key procedures.
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Centers for Disease Control and Prevention. (2014). Radiological Terrorism: Medical Response to Mass Casualties. Centers for Disease Control and Prevention, Emergency Preparedness and Response.
This course provides medical professionals with an overview of key concepts of radiological terrorism. It includes medical response scenarios, and patient triage and treatment recommendations.
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* Koenig, K., Boatwright, C., Hancock, J., et al. (2008). Healthcare Facility-Based Decontamination of Victims Exposed to Chemical, Biological, and Radiological Materials. (Abstract only.) American Journal of Emergency Medicine. 26(1):71-80.
This authors review the basics of health care facility-based decontamination (e.g., regulatory concerns, types of contaminants, and comprehensive decontamination procedures).
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Resource Allocation

Cahill, J. (2005). Hospital Staffing for Decontamination. Domestic Preparedness.
The author suggests hospital staff prioritize preparing for hazardous materials incidents, specifically maintaining the ability to function in a hazardous materials incident (which includes protecting and caring for staff), and providing related patient care.
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DeAtley, C. (2013). Hospital Decontamination - High Costs & Limited Benefits. Domestic Preparedness.
The author discusses the costs associated with hospital decontamination preparedness.
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Tully, T. (2008). Hospital Decontamination: Many Questions Few Answers. Domestic Preparedness.
In this article, the author presents challenges facing hospitals of all sizes as they prepare to conduct decontamination. Issues include the cost of decontamination equipment, the number of staff needed for a small number of contaminated patients, and mass decontamination incidents.
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Responder Health and Safety

De Groot, R., Van Zoelen, G.A., and Leenders, M., et al. (2021). Is Secondary Chemical Exposure of Hospital Personnel of Clinical Importance? Clinical Toxicology. 59(4):269-278.
This review examined secondary contamination and safety of healthcare personnel due to chemical exposures. The authors found that these risks were low assuming routine use of gloves and water-resistant gowns when caring for chemically contaminated patients.
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* DeAtley, C. (2012). Hospital Preparedness for “Chemical/Detergent” Suicides. Domestic Preparedness. 8(3): 13-14.
The author explains the trend in chemicals being ingested by suicidal patients, how these chemicals may make the scene and patients' bodies dangerous to caregivers, and strategies for protecting medical staff from these hazards.
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Hick, J., Hanfling, D., Burstein, J., et al. (2003). Protective Equipment for Healthcare Facility Decontamination Personnel: Regulations, Risks, and Recommendations. Annals of Emergency Medicine. 42(3):370-80.
The authors provide an overview of the issues related to choosing the appropriate personal protective equipment (PPE) for healthcare facility decontamination personnel.
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* Hick, J., Penn, Pl, and Hanfling, D. (2003). Establishing and Training Healthcare Facility Decontamination Teams. (Abstract only.) Annals of Emergency Medicine. 42(3):381-90.
The authors of this article review Occupational Safety and Health Administration (OSHA) training requirements for healthcare personnel involved with decontamination responses. They discuss team selection and training and highlight relevant sample OSHA operations-level training curricula.
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Horton, D., Berkowitz, Z., and Kaye, W. (2003). Secondary Contamination of ED Personnel from Hazardous Materials Events, 1995-2001. (Abstract only.) American Journal of Emergency Medicine. 21(3):199-204.
The authors examined hazardous materials events from 1995-2001 and found that the main injuries sustained by emergency medical responders were respiratory and eye irritation. They found that victim decontamination procedures, field-to-hospital communication, and appropriate personal protective equipment can help prevent these types of injuries and responder contamination.
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Levitin, H., Siegelson, H., Dickinson, S., et al. (2003). Decontamination of Mass Casualties -Reevaluating Existing Dogma. (Abstract only.) Prehospital Disaster Medicine. 18(3):200-207.
The authors review standards for handling human survivors of a mass hazardous materials exposure.
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Agencies and Organizations

California Hospital Association.
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Oak Ridge Institute for Science and Education. Radiation Emergency Assistance Center/Training Site.
This webpage links to the Radiation Emergency Assistance Center/Training Site (REAC/TS), which offers several resources to prepare medical professionals to respond to radiological emergencies. There are links to books, live training courses, online trainings, and assessment and treatment guidance documents. REAC/TS staff are available for deployment to provide medical consultation during emergencies, upon request.
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Occupational Safety & Health Administration (OSHA).
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Radiation Emergency Medical Management (REMM).
Comprehensive web page rich with information for EMS and Hospital response to a radiation emergency
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U.S. Department of Health and Human Services. Chemical Emergency Medical Management (CHEMM).
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This ASPR TRACIE Topic Collection was refreshed in 2022. It was comprehensively reviewed in June 2015 by Craig DeAtley, PA-C, Director, Institute for Public Health Emergency Readiness, MedStar Washington Hospital Center, and Administrative Director, D.C. Emergency HealthCare Coalition and John Hick, MD, HHS ASPR and Hennepin County Medical Center.

Additional assistance provided by James Paturas, Director, Center for Emergency Preparedness and Disaster Response, Yale New Haven Heath System.
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