Comparative Analysis of Showering Protocols for Mass-Casualty Decontamination

Abstract

A well-established provision for mass-casualty decontamination that incorporates the use of mobile showering units has been developed in the UK. The effectiveness of such decontamination procedures will be critical in minimizing or preventing the contamination of emergency responders and hospital infrastructure. The purpose of this study was to evaluate three empirical strategies designed to optimize existing decontamination procedures: (1) instructions in the form of a pictorial aid prior to decontamination; (2) provision of a washcloth within the showering facility; and (3) an extended showering period. The study was a three-factor, between-participants (or “independent”) design with 90 volunteers. The three factors each had two levels: use of washcloths (washcloth/no washcloth), washing instructions (instructions/no instructions), and shower cycle duration (three minutes/six minutes). The effectiveness of these strategies was quantified by whole-body fluorescence imaging following application of a red fluorophore to multiple, discrete areas of the skin. All five showering procedures were relatively effective in removing the fluorophore “contaminant”, but the use of a cloth (in the absence of instructions) led to a significant (∼20%) improvement in the effectiveness of decontamination over the standard protocol (p <0.05). Current mass-casualty decontamination effectiveness, especially in children, can be optimized by the provision of a washcloth. This simple but effective approach indicates the value of performing controlled volunteer trials for optimizing existing decontamination procedures.

Mass Casualty Decontamination in the United States: An Online Survey of Current Practice

“…Half of respondents reported that shower duration would be between 30 and 60 seconds, below the recommended shower duration of 60 to 90 seconds identified in controlled studies of emergency decontamination. 13,14 Only a quarter of respondents reported that they would provide instructions to casualties about how to progress through the decontamination process. Where details of specific instructions were given, these included asking participants to walk slowly through the decontamination corridor, turn occasionally, and extend arms; these instructions were therefore broadly in line with current guidance, based on perceived best practice.…”

“…12 However, POWER ET AL research into the effectiveness of showering in mass decontamination units suggests that active washing will be important. 14 …”

“…Findings show that in mass decontamination units, the optimal duration for shower-based decontamination is between 60 and 90 seconds, and the recommended water temperature for decontamination is 35°C (95°F). 13,14 The use of detergent removes about 40% more contamination than water alone 7,15 and is recommended to optimize shower-based decontamination. 3,7,12,[16][17][18][19] However, while research has examined the effectiveness of different showering characteristics using mass decontamination units, methods of gross decontamination have not undergone formal testing.…”

Optimization of Nonambulant Mass Casualty Decontamination Protocols as Part of an Initial or Specialist Operational Response to Chemical Incidents

“…While the MDU showering protocol for ambulant casualties has been well defined and evaluated (4,(7)(8)(9), the nonambulant equivalent ("clinical decontamination") has not been subjected to rigorous testing. Consequently, there is currently no evidence-based guidance for clinical decontamination.…”

Percutaneous Toxicity and Decontamination of Soman, Vx, and Paraoxon in Rats Using Detergents

“…Many different decontamination methods have been developed (4)(5)(6). The most common one for mass casualties is wet type decontamination using detergents (7,8).…”