Decontamination sulfur mustard

Blister/vesicant exposure is treated primarily as a thermal burn. Sulfur mustard decontamination is limited to immediate washing of exposed skin with water or soap and water, and flushing the eyes with copious amounts of water. Avoid 0.5% sodium hypochlorite solution or vigorous scrubbing as they may cause deeper tissue penetration. Typical burn therapy is accomplished with antibiotic ointment, sterile dressing, and other supportive... 

Shih, M.L., Korte, W.D., Smith, J.R., Szafraniec, L.L. (1999a). Analysis and stability of the candidate sulfur mustard decontaminant S-330. J. Appl. Toxicol. 19 S89-95. 

Sulfur mustard reacts rapidly with chlorine or with bleach, and this reaction is a suitable means of decontamination. Nitrogen mustards, however, chlorinate extremely slowly thus chlorination is not suitable for their decontamination. The formation of water-soluble salts, such as by neutralization with sodium bisulfate, is the usual method for nitrogen mustard removal from contaminated surfaces. The mustard salts are much less vesicant than the corresponding free bases. 

Field First Aid Decontaminate At Once for All Exposed Victims Although sulfur mustards cause cellular changes within minutes of contact, the onset of pain and other clinical effects are delayed for one to twenty-four hours. Sulfur mustards are alkylating agents that may cause bone marrow suppression and neurologic and gastrointestinal toxicity. However, the biochemical mechanisms of action are not clearly understood by anyone. The death rate from exposure to sulfur mustard during World War I was 2-3 percent,... 

Outside of military conflicts, exposure to sulfur mustard has occurred or may occur in work environments associated with chemical weapon materiel (e.g. storage depots, demilitarization facilities, research laboratories), during emergency response operations or remediation and decontamination activities, or during treaty verification activities in support of the Chemical Weapons Convention. Chemical weapons such as the vesicants are stiU considered potential military threats and terrorist targets. The most likely route of exposure to sulfur mustard is via aerosol/vapor exposure of the skin, eyes, and respiratory tract. 

Medical management of nitrogen mustard exposure is similar to that for sulfur mustard and involves prevention of exposure and, where exposure has occurred, decontamination and support therapy. The use of antioxidants in the treatment of nitrogen mustard toxicity is currently under investigation (Hardej and Billack, 2006). 

The USA has disposed of stockpiles of sulfur mustard at sea. Fisherman or boaters who come across discarded canisters, leaky from sitting in salt water, unknowingly have become exposed. In treating these exposures, if the vesicant is pervasive, it is important to decontaminate in a prehospital setting, and have health care providers wear appropriate personal care protection. Latex gloves are not sufficient - butyl rubber is needed. Health care workers do not need to fear the patient s blisters, since these do not contain the vesicating agent. 

Gold, M.B., Bongiovanni, R., Scharf, B.A. (1993). Hypochlorite solution as a decontaminant in sulfur mustard contaminated skin defects in the euthymic hairless guinea pig. Proceedings of the U.S. Army Medical Defense Bioscience Review, Baltimore, MD, pp. 369-78. 

Popiel, S., Witkiewicz, Z., Nalepa, T. (2005). The reactions of sulfur mustard with the active components of organic decontaminants. J. Hazard. Mater. 123 269-80. 

Hobson, D., Blank, J., Menton, R. (1985). Comparison of effectiveness of 39 experimental decontamination systems and evaluation of the effect of three pretreatment materials against percutaneous application of soman, thickened soman, VX, and sulfur mustard to the rabbit. Aberdeen Proving Ground, MD. MREF Task 85-12. 

Skin decontamination deals primarily with liquid exposure. However, agent vapor from offgassing of clothing or materials can be a concern, particularly with sulfur mustard. Warfighters first... 

Though an ideal decontaminant may be difficult to attain, many alternatives exist that are readily available and meet many basic requirements, van Hooidonk et al. (1983) evaluated a variety of household products as decontaminants for VX, soman, and sulfur mustard. His paper provides an excellent comparison of these readily available decontaminants to include flour, soapy water, talcum powder, and tissue paper. We have selected several other candidate decontaminants that are under investigation, in advanced development, or currently fielded. These include the currently fielded U.S. Department of Defense skin decontaminants (M291 Skin Decontamination Kit [SDK], 0.5% hypochlorite, and 1% soapy water). Reactive Skin Decontaminant Lotion (RSDL), Diphoterine, Sandia Laboratory s Decontamination Foam, and the Decontamination Sponge. 

In another study, clipped rabbits were exposed to sulfur mustard, lewisite (L), thickened soman, and VX and were decontaminated between 30 s and 5 min postexposure. Eor the vesicants (sulfur mustard and L), lesion areas were compared. Decontaminating for 1 min resulted in the lesion areas being reduced 21-fold for sulfur mustard and 22-fold for L, relative to no decontamination. For the nerve agents (soman and VX), the inhibition of blood acetylcholinesterase (AChE) was used as a marker. Using a 2 min decontamination time, the dose of nerve agent required to produce 50% inhibition of AChE was increased 1.8-fold for thickened soman and 18-fold for VX (Hobson et al., 1993). 

L, VX, and thickened sulfur mustard. However, it ranked last in decontaminating sulfur mustard... 

Gerasimo et al. (2000) compared the abihty of soapy water, physiological saline, and Diphoterine to decontaminate sulfur mustard. They exposed human skin obtained from elective abdominoplasty to C14 labeled sulfur mustard in vitro for 5 min. They added the lavage to the test tube and removed the skin after 3 min, 10 min, or 3 successive 10 min washes. In each case, Diphoterine significantly removed more sulfur mustard than the other two treatments. For the 3 successive washes, Diphoterine removed 50% of the applied agent compared to 37% for soapy water and 32% for physiological saline. 

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