Decontamination Principles and Procedures
Decontamination removes or neutralizes contamination so that it can no longer harm the patient, the responder, or the receiving facility. It is a process, not a single step, and the first step does most of the work.
Sequence
Undressing removes the large majority of liquid and particulate contamination and is the highest-yield action. Follow with gross removal (blotting, absorbing, cutting away), then washing with copious water and mild soap, then drying. Work head to toe so runoff does not travel over already-clean skin, and manage runoff so the decon area does not become a secondary hazard. Ambulatory casualties can self-decon in a walking corridor; non-ambulatory casualties need a litter line with trained staff. Immediate decon on scene is followed by technical decon at a fixed site.
Agent-specific points
Chemical agents generally need soap, water, and speed. Reactive metals and some industrial chemicals are exceptions where water is contraindicated. Radiological contamination is removed mechanically with soap and water without abrading skin; cover open wounds before washing so contamination is not driven into them. Biological contamination is addressed by disinfection of surfaces and equipment, typically with diluted hypochlorite, but never in wounds or eyes.
Traps
Do not scrub. Do not use bleach on skin, wounds, or eyes. Do not delay life-saving care such as airway control or hemorrhage control for decon. Do not overlook hypothermia in cold weather or in children, and do not forget that the patient's clothing, belongings, and stretcher are also contaminated.
Rule of thumb
Remove, blot, wash, dry, and contain. If you remember only one thing, remember that clothing removal is the single most effective decon step.