Skin decontamination physical removal

A solution that releases chlorine, such as household bleach (5% sodium hypochlorite) or a solution that is sufficiently alkaline to neutralize the agent, such as dilute hydroxide, can also be used for physical removal and chemical neutralization of a chemical agent. Because of the potential for skin damage from 5% hypochlorite, the current military procedure is to use 0.5% hypochlorite for skin decontamination. Dilute hydroxide and the contents of the M258A1 kit are damaging to the skin, however, and should be thoroughly rinsed off. 

Decontamination studies have been conducted using common household products. The goal of these studies was identification of decontaminants for civilians as well as field expedients for the soldier. Timely use of water, soap and water, or flour followed by wet tissue wipes produced results equal, nearly equal, or in some instances better than those produced by the use of fuller s earth, Dutch Powder, and other compounds.4 (Fuller s earth [diatomaceous earth] and Dutch Powder [Dutch variation of fuller s earth] are decontamination agents currently fielded by some European countries.) Because no topical decontaminant has ever shown efficacy with chemical agent that has penetrated into the skin, and because chemical agents may begin penetrating the skin before complete reactive decontamination (detoxification) takes place, early physical removal is most important. 

When animal skin contaminated with the nerve agent GB was flushed with water at 2 minutes (a method in which physical removal predominates over hydrolysis of the agent), 10.6 times more GB was required to produce the same mortality rate as when no decontamination occurred.7 In another study, the use of water alone produced better results than high concentrations of hypochlorite (ie, 5% or greater, which is not recommended for skin).8 Timely copious flushing with water physically removes the chemical agent and will produce good results. 

Decontamination itself can be improved, inclnding the polyvalence and the safety of water as well as the physical removal at the skin surface. Optimization of the physical properties of water washing can be based on other properties such as ... 

Decontamination is defined as the reduction or removal of chemical (or biological) agents so they are no longer hazards. Agents may be removed by physical means or be neutralized chemically (detoxification). Decontamination of skin is the primary concern, but decontamination of eyes and wounds must also be done when necessary. Decontamination can be further defined ... 

There are currently no standardized guidelines of casualty management or dmgs available to prevent HD effects on skin and mucous membranes (Sidell et al., 1997 Graham et al., 2005). The mainstay of treatment is prompt decontamination, blister aspiration or deroofing (epidermal removal), physical debridement, irrigation. 

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