Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter VII: Mass Causalties in Thermonuclear Warfare

Skin Decontamination

United States Department of Defense

Skin contamination with radionuclides is almost never immediately life threatening. As in every other aspect or radiation accident management, the serious medical problems have priority over decontamination. The primary objectives of skin decontamination should be to remove as much radionuclicle as possible to reduce the surface dose rate and minimize entry into the body. Decontamination also increases the accuracy of determining incorporated radionuclide burdens by whole-body counting. Zealous decontamination to decrease the percutaneous absorption is to be discouraged. Simple removal of the victim's clothing can remove as much as 70-80% of the contamination. No human exposure to date has represented a significant risk to the personnel giving assistance. Additionally, the principles of time, distance, and shielding can reduce any potential radiation exposure to the attending personnel. Personnel participating in decontamination should wear protective clothing, including surgical gowns, gloves, shoe and head covers, and aprons. Health physics monitoring may suggest the need for additional protective gear. Clothing, personal effects, and biological samples from swabs of the nares, aural canal, and mouth should be placed in plastic bags and glass-stopped tubes with proper identification for later analysis.

The first priority of surface decontamination should be open wounds Since these areas may allow the rapid incorporation of radionuclides, they should be copiously irrigated with physiological saline for several minutes. If contamination persists, gentle surgical debridement may be necessary. Experiments with plutonium oxides have shown translocation to regional lymph nodes within a few minutes to several hours. After one month, the concentration absorbed is 60% of the implanted dose. For this reason contaminated wounds must receive first decontamination priority. If the radionuclide is plutonium or other alpha emitters for which DTPA is an effective chelating agent, treatment should begin immediately. An effective irrigating solution for americium or plutonium contamination is 1 gram calcium DTPA and 10 ml of 2% lidocaine in 100 cc of normal saline. If an extremity is so severely contaminated that it is not possible to decontaminate it adequately, a decision may be required of whether or not to amputate. Amputation should be seriously contemplated only when the extremity injury is so severe that it precludes functional recovery or when the contamination burden is so great that severe radionecrosis will occur. The best conservative advice is still "decontaminate, but do not mutilate"

After contaminated wounds have been treated, other areas can be decontaminated. The eyes, ears, nose, mouth, areas adjacent to uncontaminated wounds, and remaining skin surface should be decontaminated. Gentle, frequent irrigation and suction of the eyes and ears should be sufficient to decontaminate them. Decontamination of the mouth is important because of possible incorporation. The mouth should be irrigated. A nasogastric tube should be inserted and aspirated for analysis. If radionuclides have been ingested, lavage and decorporation therapy should be begun. Decontamination of the skin usually requires only soap and warm water with gentle scrubbing The use of hot water is contraindicated because of the subsequent vasodilation. If more aggressive decontamination is necessary, a mixture of half cornmeal and Tide (detergent) has been shown to be very effective. Hair can usually be decontaminated with soap and water. If this is inadequate, the scalp should be clipped rather than shaved, to avoid disruption of the skin barrier.

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Operational Medicine 2001

Health Care in Military Settings

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