DECONTAMINATION
Episode 6
Special considerations
Learning Objectives
Upon completion of this module you should be able to
Objective 3
Objective 1
Objective 2
Describe the care of pediatric patients during the decontamination process
Describe care of special equipment during the decontamination process
Describe the care of adult populations with special needs during the decontamination process
equipment
True or false.... Assistive devices
Patients who use ambulatory assistive devices should be allowed to keep them
True! However, the assistive device must be decontaminated before entering into the COLD ZONE
Patient can wear their hearing aids while underoging decontamination
False! Hearing aids cannot get wet. Instead, they should be removed and placed in the patient belongs bag.
Contextualize your topic
True! However, they can be returned once they are very carefully decontaminated. if they cannot be decontaminated, or the patient can see without them, then they should be placed in the patient belongs bag. Contact lenses should be removed.
If a patient's glasses are contaminated they must be removed
Depends! If there no oral cavity contamination then they do not need to be removed! If there is oral cavity contamination, then they should be removed and placed in the patient belongings bag. (Patient can use an oral rinse to decontaminate their mouth)
Dentures can be worn through the decontamination process
True or false.... Medical devices
Stoma bags or NGTs should always be removed prior to decontmaination
Generally, they can be decontaminated with the patient. However, if they can be easily replaced like a two part ilostomy bag then they should removed in the hot zone and replaced in the cold zone.
Tracheostomy tubes should be removed prior to decontamination
Contextualize your topic
False! These can be decontaminated along with the patient. However, special care will need to be taken when showering these patients.
Dressing for perminant vascular access devices should be changed prior to decontamination
True! Just as with any VAD dressing change, it must be done under sterile conditions. You can wipe down the parts of the vascular access device that are not under the dressing.
Prosethic limbs should be removed and placed with the patient's belongings
False! Prostethic limbs can be decontamined with the patient.
True or false.... Treatments for injuries
Patients who have bandaged wounds should keep their bandages in place during decontamination
False! Wounds need decontamination too. Bandages can absorb contaminated water. Wounds should be cleaned, then covered with occulsive dressing.
Casts or splints should be removed prior to decontamination
Contextualize your topic
True! They can deform when wet.
IV saline locks must be removed
False! The dressing should be changed then the IV site should be covered with a shower safe dressing.
False! The tournqiuet should be left in place during decontamination. After the patient is decontaminated, apply a clean tourniquet. Remove the old tournqiuet and decontaminate the area where the old tournqiuet was applied.
Tourniquets must be removed prior to decontamination
special populations of adults
True or False...Persons with service animals
We might need to decontaminate a service animal
True! Ideally, the patient and the animal will be decontaminated together at the same time
We should not contain the animal at all
False! A muzzle should be used to prevent the animal from drinking contaminated water or biting staff. Additionally, baby gates should be used to prevent the animal doing its natural tendency to shake
Contextualize your topic
Special care should be taken to clean the animals paws
True! The paws are likely to be very contaminated due to the deep pockets around the paw pads
Just water should be used for decontamination of service animals
False! Moist towelettes should be considered for areas that are hard to wash with just water- think around the eyes, nose, mouth, and inside of their ears.
True or False...Non-compliant patients
False! We cannot force people to undergo decontamination against their will. Ideally, try to assertain their name and address to share that information with public health officials who can follow up with the patient
If there is viable contamination, we can force patients to be decomtaminated
We should carefully explain the decontamination process
Contextualize your topic
True! Lack of understanding can lead to fear, distrust, or confusion. These emotions can increase non-compliance.
We should give simple instructions like "come with me" or "stand here"
True! Decontamination is a confusing time for patients. Simple insructions are easy to follow.
Patient privacy is not a concern
False! Patient privacy will not infulence the effectivenss of decontamination, however, our failure to consider our patients' desire for privacy will undercut any trust they have put in us.
True or False... The "worried well"
False! They were likely near or at the site of a hazmat release and are reacting under stress with limited guidance. They’re simply trying to keep themselves safe
The worried well just want attention
False! During the Tokyo Sarin attacks, many victims labeled as ‘worried well’ were actually contaminated at low levels. Because they were denied decontamination, their exposure lasted longer, and many were left with lifelong nervous system disorders
There is no chance that the worried well are actually contaminated
Contextualize your topic
The worried well should be observed for evolving symptoms
True! Some hazmat can have delayed effects especially if the patient was exposed to a low dose
There is nothing we can do for the worried well
False! At a minimum we can provide psychological first aid. If our hospital has the capacity, we should consider providing decontmaintion to these patients as well.
True or False... Non-English speaking patients
We must provide education and guidence to all of our patients
True! All of our patients deserve to the best care that we can provide. Communication is an important part of care.
If you are wearing a shroud and PAPR there is no way to communicate with a non-English speaking person
False! Consider using writen information such as those available at: https://www.healthinfotranslations.org/all-translated-health-topics?q=decontamination
Contextualize your topic
Cultral sensativity does not matter during decontamination
False! We should still consider the differences in social, cultural, and religious values.
Care of deceased patients
Deceased patients still need to be decontaminted prior to going to the morgue
Ideally, deceased patients should be decontamination outside away from public view
Our goal is to the most good for the most patients as possible. We can influence the outcomes for living patients so we should focus our efforts there.
Deceased patients should be treated after all of the living patients
Contextualize your topic
All activities of healthcare personnel should be well documented. The deceased should be identified, if possible. The deceased's belongings, including their clothing, should be placed in a chemical safe bag and labled.
Law enforcement may rquire evidence collection
They are people who lived special lives and should be honored as such. While they wait to be decontaminated they should be covered and placed in an area where they will not be disturbed. There must be a person who is within line of site of them at all times.
Treat deceased with reverance and respect
pediatric considerations
Pedatric patients are at greater risk during a hazmat event
They breath more quickly
They are exposed to a greater amount of gaseous or vapor hazmat
They have more perminable skin
Contextualize your topic
They are exposed to a greater amount of hazmat when it is on their skin or clothes.
They have less fluid reserves
Vomiting or dirrhea from hazmat is more likely to lead to shock
They are less able to maintain their tempearture
They are more likely to become hypothermic during decontamination procedures.
Special considerations for pediatric decontamination
True or False... Infants
False! They were likely near or at the site of a hazmat release and are reacting under stress with limited guidance. They’re simply trying to keep themselves safe
The worried well just want attention
False! During the Tokyo Sarin attacks, many victims labeled as ‘worried well’ were actually contaminated at low levels. Because they were denied decontamination, their exposure lasted longer, and many were left with lifelong nervous system disorders
There is no chance that the worried well are actually contaminated
Contextualize your topic
The worried well should be observed for evolving symptoms
True! Some hazmat can have delayed effects especially if the patient was exposed to a low dose
There is nothing we can do for the worried well
False! At a minimum we can provide psychological first aid. If our hospital has the capacity, we should consider providing decontmaintion to these patients as well.
Thank youso much!
Coming up next:
What to do when patients' needs overwhelm your facility's reources
References
Agency for Toxic Substances and Disease Registry. (2025). Specific toxicological information. https://www.atsdr.cdc.gov/pha-guidance/conducting_scientific_evaluations/indepth_toxicological_analysis/reviewContaminantToxInfo.htmlAlertMedia. (2025). A Modern Approach to Tabletop Exercises [Video]. YouTube. https://www.youtube.com/watch?v=0hCEZxzo5lYBBC News. (2018, March 29). Russian spy: Yulia Skripal “conscious and talking.” https://www.bbc.com/news/uk-43588450Best Practices for Hospital-Based First Receivers of victims from mass casualty incidents involving the release of hazardous substances. (2005). In Occupational Safety and Health Administration. https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/flrtc/documents/OSHA-3249-08N-2005-Best-Practices-for-Hospital-Based-First-Receivers.pdfBrenner, B. (2025). What is the difference between hazardous and biohazardous waste? MedPro Disposal. https://www.medprodisposal.com/difference-between-hazardous-biohazardous-wasteBronson, B. (2024, August 21). Really? 37% of Americans don’t wash these body parts in the shower. 105.7 WROR. https://wror.com/2024/08/21/americans-dont-wash-these-body-parts-in-the-showerBruck, A. [Dr. Bruck VU Chemistry]. (2020, April 22). What is an oxidizer? [Video]. YouTube. https://www.youtube.com/watch?v=ReXceyZvXIQBurlington, VT. (n.d.). Data USA. https://datausa.io/profile/geo/burlington-vtCatlin, M. [markdcatlin]. (2009, February 10). Hospital First Receiver: Decontamination of non ambulatory Patients [Video]. YouTube. https://www.youtube.com/watch?v=VuJtxiCEpc4Caneva, D., Hick, J., & Cibulsky, S. (2020). Healthcare challenges in chemical incidents [Webinar]. In Assistant Secretary of Preparedness and Response. https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/flrtc/documents/aspr-tracie-healthcare-challenges-in-chemical-incidents-webinar-ppt-final.pdfCenter for Disease Control and Prevention. (n.d.). Classic Toxidromes Toxidrome Signs and Symptoms Potential Toxic Agent. Retrieved November 25, 2025, from https://www.cdc.gov/nceh/hsb/elearning/toi/Mod6/Toxidromes_Chart-508.pdfChildren's Health Queensland Emergency Department. (2021). Decontamination of Paediatric Patients Guideline. In Queensland’s Health and Hospital Service. https://www.childrens.health.qld.gov.au/__data/assets/pdf_file/0019/180208/gdl-00766.pdfClifton, L., & Cathey, J. (2016). Leading Practices in Decontamination and Triage. California Hospital Association. https://calhospital.org/wp-content/uploads/2016/08/deconsalttriage_web.pdf Clorox Company. (2015). Safety Data Sheet. In Clorox® Regular-Bleach. https://www.thecloroxcompany.com/wp-content/uploads/cloroxregular-bleach12015-06-12.pdfCommonwealth of Australia. (2021, March 29). Dangerous goods classes and hazard labels. Civil Aviation Safety Authority. https://www.casa.gov.au/operations-safety-and-travel/safety-advice/dangerous-goods-and-air-freight/dangerous-goods-classes-and-hazard-labels#HandlinglabelsDERMAL Resources of Preparedness Phase. (n.d.). https://chemm.hhs.gov/dermal/preparedness.htmlDo you wash your legs? Jenna and Savannah talk grooming habits. (2019, May 15). [Video]. TODAY.com. https://www.today.com/health/do-you-wash-your-legs-shower-internet-divided-t154176DQE Inc. (2020a). Contamination Identification [Video]. YouTube. https://www.youtube.com/watch?v=vVKnrlmC3bkDQE Inc. (2020b). Intro to Hazardous Materials [Video]. YouTube. https://www.youtube.com/watch?v=WQ9jITtekOMDQE Inc. (2020c). Patient decontamination process [Video]. YouTube. https://www.youtube.com/watch?v=pC-bmA2NCFsDQE Inc. (2021). Initial contact [Video]. YouTube. https://www.youtube.com/watch?v=RlvLf1nJczAEndocrine Science Matters. (2016). Sensitive Windows of Exposure and Vulnerable Populations. https://endocrinesciencematters.org/sensitive-populations-and-exposure-windows-2/sensitive-populations-and-exposure-timeEverbridge. (2017). 15 Minutes til 50 Patients, Preparing for an MCI [Video]. YouTube. https://www.youtube.com/watch?v=NOpUkc7xXvIFederal Emergency Management Agency. (2003). An Orientation to Hazardous Materials for Medical Personnel: A Self-Study Guide. In Emergency Management Institute. https://training.fema.gov/emiweb/is/is346/entire%20course.pdfFraga, B. (2014, June 12). Two Fall River DPW workers hospitalized after being exposed to pesticide at landfill. Fall River Herald News. https://www.heraldnews.com/story/news/disaster/2014/06/12/two-fall-river-dpw-workers/37036273007/Galloway, R. (n.d.). Red Pepper Extract Aerosol Products (Bear Repellent Spray) (No. 99-03). https://www.doi.gov/sites/default/files/migrated/aviation/safety/upload/PB_1999-03.pdfGreater Miami Valley EMS Council. (2016, July 19). GMVEMSC SALT Triage Training [Video]. YouTube. https://www.youtube.com/watch?v=8JCVeo15n4EGuzman, J. (2025). Do I need 8, 24, or 40-Hour HAZWOPER Certification? Hazmat Student. https://www.hazmatstudent.com/8-24-40-hour-hazwoper-certificationHarvard School of Public Health. (2014). Hospital Decontamination Self-Assessment Tool. https://www.hsph.harvard.edu/wp-content/uploads/sites/2345/2020/03/Hospital-Decontamination-Resources-Section-2.pdfHaslam, J. D., Russell, P., Hill, S., Emmett, S. R., & Blain, P. G. (2021). Chemical, biological, radiological, and nuclear mass casualty medicine: a review of lessons from the Salisbury and Amesbury Novichok nerve agent incidents. British Journal of Anaesthesia, 128(2). https://doi.org/10.1016/j.bja.2021.10.008Hospital Decontamination Self-Assessment Tool. (2013). https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/flrtc/documents/Hospital-Decontamination-Self-Assessment-Tool-2013_1.pdfInformation for the Hospital Providers. (n.d.). CHEMM. https://chemm.hhs.gov/hospitalproviders.htmJones, A. (n.d.). DSC00426.jpg. Flickr. https://www.flickr.com/photos/bigyahu/1063216915Korn, D., & Eberhardt, A. (2025, August 20). Sanitation worker critically injured by sulfuric acid. FOX21 News Colorado. https://www.fox21news.com/news/sanitation-worker-critically-injured-by-sulphuric-acid/Medical Countermeasures. (n.d.). Primary Response Incident Scene Management. https://www.medicalcountermeasures.gov/barda/cbrn/prismMidwest Consortium for Hazardous Waste Worker Training. (2024). Hospital-Based Decontamination Facilitator Guide. https://mwc.umn.edu/wp-content/uploads/2023/08/HOS-Facilitator-Guide.pdfMilken Institute School of Public Health. (2016). Potentially harmful chemicals widespread in household dust. https://publichealth.gwu.edu/potentially-harmful-chemicals-widespread-household-dustOkumura, S., Okumura, T., Ishimatsu, S., Miura, K., Maekawa, H., & Naito, T. (2005). Clinical review: Tokyo - protecting the health care worker during a chemical mass casualty event: an important issue of continuing relevance. Critical care (London, England), 9(4), 397–400. https://doi.org/10.1186/cc3062Parkinson, C. (2024, November 8). How to wash your body according to statistics. Plumbworld. https://www.plumbworld.co.uk/blog/how-to-wash-your-bodyPaschall, J. [Jeremy Paschall]. (2021, March 25). Hazmat Ops Lesson 7 [Video]. YouTube. https://www.youtube.com/watch?v=SPuTbtAJZ4kThe Radiation Emergency Medical Management [REMMWebSite]. (2014, November 18). Decontamination of children [Video]. YouTube. https://www.youtube.com/watch?v=-50bBNTRcrkRicharz, A. (2019). A Terrorist Attack Led Japan to Remove All Its Trash Cans. Now They’re Making a Comeback. Pacific Standard. https://psmag.com/environment/trash-cans-are-coming-back-to-japanSafety Data Sheets. (n.d.). FRONTIERSMAN Bear Attack Deterrent. Retrieved November 25, 2025, from https://images.thdstatic.com/catalog/pdfImages/c9/c9f9d66e-0e8a-4bb0-a3ec-725e43e83f30.pdfSaid-Moorhouse, L., & Quashie-Idun, S. (2019). Salisbury declared Novichok-free nearly a year after nerve agent attack. CNN. https://www.cnn.com/2019/03/01/uk/salisbury-novichok-cleanup-gbr-intlSalisbury’s Novichok story. (n.d.). Salisbury Blog. https://www.experiencesalisbury.co.uk/salisbury-blog/2021/june/salisburys-novichok-storySaunders, M. N., Iyer, N., Lucas-Roberts, C., & He, K. (2018). A simplified mass casualty incident training for medical students. In Journal of Medical Education (Vols. 17–2, pp. 61–85). https://brieflands.com/articles/jme-105610.pdfTourism South East Research Services. (2004). Salisbury Destination Benchmarking Visitor Survey. In Wiltshire Council. https://www.wiltshire.gov.uk/media/10314/Salisbury-Destination-Benchmarking-Visitor-Survey-2004/pdf/Salisbury_Destination_Benchmarking_Visitor_Survey_2004.pdfToxic Syndromes/Toxidromes. (n.d.). CHEMM. https://chemm.hhs.gov/toxicsyndromes.htmU.S. Department of Labor Occupational Safety and Health Administration. (2008). Hospitals and community emergency response: What you need to know. https://www.osha.gov/sites/default/files/publications/3152-hospitals.pdfUS Environmental Protection Agency. (2025, February 14). Fact Sheet for Communities: Safer Communities by Chemical Accident Prevention. Risk Management Program. https://www.epa.gov/rmp/fact-sheet-communities-safer-communities-chemical-accident-prevention-risk-management-programVermont Agency of Natural Resources. (2025). Spills. Vermont Environmental Research Tool. https://anrweb.vt.gov/dec/ert/Spills.aspxWalker, K., & Kahlon, M. (2021). Common toxidromes. Emergency Care BC. https://emergencycarebc.ca/clinical_resource/clinical-summary/common-toxidromes-diagnosis-treatmentWetter, D., & Stone, R. (2014). Strategies for first receiver decontamination. In Office of Emergency and Preparedness Management. https://www.massgeneral.org/assets/mgh/pdf/emergency-medicine/strategies-for-first-receiver-decontamination.pdfWRAP-EM. (2023, October 4). Decontamination [Video]. YouTube. https://www.youtube.com/watch?v=reU6gN0aY0w地下鉄サリン事件】除染活動に向かう自衛隊員. (n.d.). Wikimedia Commons. https://commons.wikimedia.org/wiki/File:%E3%80%90%E5%9C%B0%E4%B8%8B%E9%89%84%E3%82%B5%E3%83%AA%E3%83%B3%E4%BA%8B%E4%BB%B6%E3%80%91%E9%99%A4%E6%9F%93%E6%B4%BB%E5%8B%95%E3%81%AB%E5%90%91%E3%81%8B%E3%81%86%E8%87%AA%E8%A1%9B%E9%9A%8A%E5%93%A1.jpg Name
Episode 6
brit swett
Created on October 16, 2025
Start designing with a free template
Discover more than 1500 professional designs like these:
View
Interactive Onboarding Guide
View
Corporate Christmas Presentation
View
Business Results Presentation
View
Meeting Plan Presentation
View
Customer Service Manual
View
Business vision deck
View
Economic Presentation
Explore all templates
Transcript
DECONTAMINATION
Episode 6
Special considerations
Learning Objectives
Upon completion of this module you should be able to
Objective 3
Objective 1
Objective 2
Describe the care of pediatric patients during the decontamination process
Describe care of special equipment during the decontamination process
Describe the care of adult populations with special needs during the decontamination process
equipment
True or false.... Assistive devices
Patients who use ambulatory assistive devices should be allowed to keep them
True! However, the assistive device must be decontaminated before entering into the COLD ZONE
Patient can wear their hearing aids while underoging decontamination
False! Hearing aids cannot get wet. Instead, they should be removed and placed in the patient belongs bag.
Contextualize your topic
True! However, they can be returned once they are very carefully decontaminated. if they cannot be decontaminated, or the patient can see without them, then they should be placed in the patient belongs bag. Contact lenses should be removed.
If a patient's glasses are contaminated they must be removed
Depends! If there no oral cavity contamination then they do not need to be removed! If there is oral cavity contamination, then they should be removed and placed in the patient belongings bag. (Patient can use an oral rinse to decontaminate their mouth)
Dentures can be worn through the decontamination process
True or false.... Medical devices
Stoma bags or NGTs should always be removed prior to decontmaination
Generally, they can be decontaminated with the patient. However, if they can be easily replaced like a two part ilostomy bag then they should removed in the hot zone and replaced in the cold zone.
Tracheostomy tubes should be removed prior to decontamination
Contextualize your topic
False! These can be decontaminated along with the patient. However, special care will need to be taken when showering these patients.
Dressing for perminant vascular access devices should be changed prior to decontamination
True! Just as with any VAD dressing change, it must be done under sterile conditions. You can wipe down the parts of the vascular access device that are not under the dressing.
Prosethic limbs should be removed and placed with the patient's belongings
False! Prostethic limbs can be decontamined with the patient.
True or false.... Treatments for injuries
Patients who have bandaged wounds should keep their bandages in place during decontamination
False! Wounds need decontamination too. Bandages can absorb contaminated water. Wounds should be cleaned, then covered with occulsive dressing.
Casts or splints should be removed prior to decontamination
Contextualize your topic
True! They can deform when wet.
IV saline locks must be removed
False! The dressing should be changed then the IV site should be covered with a shower safe dressing.
False! The tournqiuet should be left in place during decontamination. After the patient is decontaminated, apply a clean tourniquet. Remove the old tournqiuet and decontaminate the area where the old tournqiuet was applied.
Tourniquets must be removed prior to decontamination
special populations of adults
True or False...Persons with service animals
We might need to decontaminate a service animal
True! Ideally, the patient and the animal will be decontaminated together at the same time
We should not contain the animal at all
False! A muzzle should be used to prevent the animal from drinking contaminated water or biting staff. Additionally, baby gates should be used to prevent the animal doing its natural tendency to shake
Contextualize your topic
Special care should be taken to clean the animals paws
True! The paws are likely to be very contaminated due to the deep pockets around the paw pads
Just water should be used for decontamination of service animals
False! Moist towelettes should be considered for areas that are hard to wash with just water- think around the eyes, nose, mouth, and inside of their ears.
True or False...Non-compliant patients
False! We cannot force people to undergo decontamination against their will. Ideally, try to assertain their name and address to share that information with public health officials who can follow up with the patient
If there is viable contamination, we can force patients to be decomtaminated
We should carefully explain the decontamination process
Contextualize your topic
True! Lack of understanding can lead to fear, distrust, or confusion. These emotions can increase non-compliance.
We should give simple instructions like "come with me" or "stand here"
True! Decontamination is a confusing time for patients. Simple insructions are easy to follow.
Patient privacy is not a concern
False! Patient privacy will not infulence the effectivenss of decontamination, however, our failure to consider our patients' desire for privacy will undercut any trust they have put in us.
True or False... The "worried well"
False! They were likely near or at the site of a hazmat release and are reacting under stress with limited guidance. They’re simply trying to keep themselves safe
The worried well just want attention
False! During the Tokyo Sarin attacks, many victims labeled as ‘worried well’ were actually contaminated at low levels. Because they were denied decontamination, their exposure lasted longer, and many were left with lifelong nervous system disorders
There is no chance that the worried well are actually contaminated
Contextualize your topic
The worried well should be observed for evolving symptoms
True! Some hazmat can have delayed effects especially if the patient was exposed to a low dose
There is nothing we can do for the worried well
False! At a minimum we can provide psychological first aid. If our hospital has the capacity, we should consider providing decontmaintion to these patients as well.
True or False... Non-English speaking patients
We must provide education and guidence to all of our patients
True! All of our patients deserve to the best care that we can provide. Communication is an important part of care.
If you are wearing a shroud and PAPR there is no way to communicate with a non-English speaking person
False! Consider using writen information such as those available at: https://www.healthinfotranslations.org/all-translated-health-topics?q=decontamination
Contextualize your topic
Cultral sensativity does not matter during decontamination
False! We should still consider the differences in social, cultural, and religious values.
Care of deceased patients
Deceased patients still need to be decontaminted prior to going to the morgue
Ideally, deceased patients should be decontamination outside away from public view
Our goal is to the most good for the most patients as possible. We can influence the outcomes for living patients so we should focus our efforts there.
Deceased patients should be treated after all of the living patients
Contextualize your topic
All activities of healthcare personnel should be well documented. The deceased should be identified, if possible. The deceased's belongings, including their clothing, should be placed in a chemical safe bag and labled.
Law enforcement may rquire evidence collection
They are people who lived special lives and should be honored as such. While they wait to be decontaminated they should be covered and placed in an area where they will not be disturbed. There must be a person who is within line of site of them at all times.
Treat deceased with reverance and respect
pediatric considerations
Pedatric patients are at greater risk during a hazmat event
They breath more quickly
They are exposed to a greater amount of gaseous or vapor hazmat
They have more perminable skin
Contextualize your topic
They are exposed to a greater amount of hazmat when it is on their skin or clothes.
They have less fluid reserves
Vomiting or dirrhea from hazmat is more likely to lead to shock
They are less able to maintain their tempearture
They are more likely to become hypothermic during decontamination procedures.
Special considerations for pediatric decontamination
True or False... Infants
False! They were likely near or at the site of a hazmat release and are reacting under stress with limited guidance. They’re simply trying to keep themselves safe
The worried well just want attention
False! During the Tokyo Sarin attacks, many victims labeled as ‘worried well’ were actually contaminated at low levels. Because they were denied decontamination, their exposure lasted longer, and many were left with lifelong nervous system disorders
There is no chance that the worried well are actually contaminated
Contextualize your topic
The worried well should be observed for evolving symptoms
True! Some hazmat can have delayed effects especially if the patient was exposed to a low dose
There is nothing we can do for the worried well
False! At a minimum we can provide psychological first aid. If our hospital has the capacity, we should consider providing decontmaintion to these patients as well.
Thank youso much!
Coming up next:
What to do when patients' needs overwhelm your facility's reources
References
Agency for Toxic Substances and Disease Registry. (2025). Specific toxicological information. https://www.atsdr.cdc.gov/pha-guidance/conducting_scientific_evaluations/indepth_toxicological_analysis/reviewContaminantToxInfo.htmlAlertMedia. (2025). A Modern Approach to Tabletop Exercises [Video]. YouTube. https://www.youtube.com/watch?v=0hCEZxzo5lYBBC News. (2018, March 29). Russian spy: Yulia Skripal “conscious and talking.” https://www.bbc.com/news/uk-43588450Best Practices for Hospital-Based First Receivers of victims from mass casualty incidents involving the release of hazardous substances. (2005). In Occupational Safety and Health Administration. https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/flrtc/documents/OSHA-3249-08N-2005-Best-Practices-for-Hospital-Based-First-Receivers.pdfBrenner, B. (2025). What is the difference between hazardous and biohazardous waste? MedPro Disposal. https://www.medprodisposal.com/difference-between-hazardous-biohazardous-wasteBronson, B. (2024, August 21). Really? 37% of Americans don’t wash these body parts in the shower. 105.7 WROR. https://wror.com/2024/08/21/americans-dont-wash-these-body-parts-in-the-showerBruck, A. [Dr. Bruck VU Chemistry]. (2020, April 22). What is an oxidizer? [Video]. YouTube. https://www.youtube.com/watch?v=ReXceyZvXIQBurlington, VT. (n.d.). Data USA. https://datausa.io/profile/geo/burlington-vtCatlin, M. [markdcatlin]. (2009, February 10). Hospital First Receiver: Decontamination of non ambulatory Patients [Video]. YouTube. https://www.youtube.com/watch?v=VuJtxiCEpc4Caneva, D., Hick, J., & Cibulsky, S. (2020). Healthcare challenges in chemical incidents [Webinar]. In Assistant Secretary of Preparedness and Response. https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/flrtc/documents/aspr-tracie-healthcare-challenges-in-chemical-incidents-webinar-ppt-final.pdfCenter for Disease Control and Prevention. (n.d.). Classic Toxidromes Toxidrome Signs and Symptoms Potential Toxic Agent. Retrieved November 25, 2025, from https://www.cdc.gov/nceh/hsb/elearning/toi/Mod6/Toxidromes_Chart-508.pdfChildren's Health Queensland Emergency Department. (2021). Decontamination of Paediatric Patients Guideline. In Queensland’s Health and Hospital Service. https://www.childrens.health.qld.gov.au/__data/assets/pdf_file/0019/180208/gdl-00766.pdfClifton, L., & Cathey, J. (2016). Leading Practices in Decontamination and Triage. California Hospital Association. https://calhospital.org/wp-content/uploads/2016/08/deconsalttriage_web.pdf Clorox Company. (2015). Safety Data Sheet. In Clorox® Regular-Bleach. https://www.thecloroxcompany.com/wp-content/uploads/cloroxregular-bleach12015-06-12.pdfCommonwealth of Australia. (2021, March 29). Dangerous goods classes and hazard labels. Civil Aviation Safety Authority. https://www.casa.gov.au/operations-safety-and-travel/safety-advice/dangerous-goods-and-air-freight/dangerous-goods-classes-and-hazard-labels#HandlinglabelsDERMAL Resources of Preparedness Phase. (n.d.). https://chemm.hhs.gov/dermal/preparedness.htmlDo you wash your legs? Jenna and Savannah talk grooming habits. (2019, May 15). [Video]. TODAY.com. https://www.today.com/health/do-you-wash-your-legs-shower-internet-divided-t154176DQE Inc. (2020a). Contamination Identification [Video]. YouTube. https://www.youtube.com/watch?v=vVKnrlmC3bkDQE Inc. (2020b). Intro to Hazardous Materials [Video]. YouTube. https://www.youtube.com/watch?v=WQ9jITtekOMDQE Inc. (2020c). Patient decontamination process [Video]. YouTube. https://www.youtube.com/watch?v=pC-bmA2NCFsDQE Inc. (2021). Initial contact [Video]. YouTube. https://www.youtube.com/watch?v=RlvLf1nJczAEndocrine Science Matters. (2016). Sensitive Windows of Exposure and Vulnerable Populations. https://endocrinesciencematters.org/sensitive-populations-and-exposure-windows-2/sensitive-populations-and-exposure-timeEverbridge. (2017). 15 Minutes til 50 Patients, Preparing for an MCI [Video]. YouTube. https://www.youtube.com/watch?v=NOpUkc7xXvIFederal Emergency Management Agency. (2003). An Orientation to Hazardous Materials for Medical Personnel: A Self-Study Guide. In Emergency Management Institute. https://training.fema.gov/emiweb/is/is346/entire%20course.pdfFraga, B. (2014, June 12). Two Fall River DPW workers hospitalized after being exposed to pesticide at landfill. Fall River Herald News. https://www.heraldnews.com/story/news/disaster/2014/06/12/two-fall-river-dpw-workers/37036273007/Galloway, R. (n.d.). Red Pepper Extract Aerosol Products (Bear Repellent Spray) (No. 99-03). https://www.doi.gov/sites/default/files/migrated/aviation/safety/upload/PB_1999-03.pdfGreater Miami Valley EMS Council. (2016, July 19). GMVEMSC SALT Triage Training [Video]. YouTube. https://www.youtube.com/watch?v=8JCVeo15n4EGuzman, J. (2025). Do I need 8, 24, or 40-Hour HAZWOPER Certification? Hazmat Student. https://www.hazmatstudent.com/8-24-40-hour-hazwoper-certificationHarvard School of Public Health. (2014). Hospital Decontamination Self-Assessment Tool. https://www.hsph.harvard.edu/wp-content/uploads/sites/2345/2020/03/Hospital-Decontamination-Resources-Section-2.pdfHaslam, J. D., Russell, P., Hill, S., Emmett, S. R., & Blain, P. G. (2021). Chemical, biological, radiological, and nuclear mass casualty medicine: a review of lessons from the Salisbury and Amesbury Novichok nerve agent incidents. British Journal of Anaesthesia, 128(2). https://doi.org/10.1016/j.bja.2021.10.008Hospital Decontamination Self-Assessment Tool. (2013). https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/flrtc/documents/Hospital-Decontamination-Self-Assessment-Tool-2013_1.pdfInformation for the Hospital Providers. (n.d.). CHEMM. https://chemm.hhs.gov/hospitalproviders.htmJones, A. (n.d.). DSC00426.jpg. Flickr. https://www.flickr.com/photos/bigyahu/1063216915Korn, D., & Eberhardt, A. (2025, August 20). Sanitation worker critically injured by sulfuric acid. FOX21 News Colorado. https://www.fox21news.com/news/sanitation-worker-critically-injured-by-sulphuric-acid/Medical Countermeasures. (n.d.). Primary Response Incident Scene Management. https://www.medicalcountermeasures.gov/barda/cbrn/prismMidwest Consortium for Hazardous Waste Worker Training. (2024). Hospital-Based Decontamination Facilitator Guide. https://mwc.umn.edu/wp-content/uploads/2023/08/HOS-Facilitator-Guide.pdfMilken Institute School of Public Health. (2016). Potentially harmful chemicals widespread in household dust. https://publichealth.gwu.edu/potentially-harmful-chemicals-widespread-household-dustOkumura, S., Okumura, T., Ishimatsu, S., Miura, K., Maekawa, H., & Naito, T. (2005). Clinical review: Tokyo - protecting the health care worker during a chemical mass casualty event: an important issue of continuing relevance. Critical care (London, England), 9(4), 397–400. https://doi.org/10.1186/cc3062Parkinson, C. (2024, November 8). How to wash your body according to statistics. Plumbworld. https://www.plumbworld.co.uk/blog/how-to-wash-your-bodyPaschall, J. [Jeremy Paschall]. (2021, March 25). Hazmat Ops Lesson 7 [Video]. YouTube. https://www.youtube.com/watch?v=SPuTbtAJZ4kThe Radiation Emergency Medical Management [REMMWebSite]. (2014, November 18). Decontamination of children [Video]. YouTube. https://www.youtube.com/watch?v=-50bBNTRcrkRicharz, A. (2019). A Terrorist Attack Led Japan to Remove All Its Trash Cans. Now They’re Making a Comeback. Pacific Standard. https://psmag.com/environment/trash-cans-are-coming-back-to-japanSafety Data Sheets. (n.d.). FRONTIERSMAN Bear Attack Deterrent. Retrieved November 25, 2025, from https://images.thdstatic.com/catalog/pdfImages/c9/c9f9d66e-0e8a-4bb0-a3ec-725e43e83f30.pdfSaid-Moorhouse, L., & Quashie-Idun, S. (2019). Salisbury declared Novichok-free nearly a year after nerve agent attack. CNN. https://www.cnn.com/2019/03/01/uk/salisbury-novichok-cleanup-gbr-intlSalisbury’s Novichok story. (n.d.). Salisbury Blog. https://www.experiencesalisbury.co.uk/salisbury-blog/2021/june/salisburys-novichok-storySaunders, M. N., Iyer, N., Lucas-Roberts, C., & He, K. (2018). A simplified mass casualty incident training for medical students. In Journal of Medical Education (Vols. 17–2, pp. 61–85). https://brieflands.com/articles/jme-105610.pdfTourism South East Research Services. (2004). Salisbury Destination Benchmarking Visitor Survey. In Wiltshire Council. https://www.wiltshire.gov.uk/media/10314/Salisbury-Destination-Benchmarking-Visitor-Survey-2004/pdf/Salisbury_Destination_Benchmarking_Visitor_Survey_2004.pdfToxic Syndromes/Toxidromes. (n.d.). CHEMM. https://chemm.hhs.gov/toxicsyndromes.htmU.S. Department of Labor Occupational Safety and Health Administration. (2008). Hospitals and community emergency response: What you need to know. https://www.osha.gov/sites/default/files/publications/3152-hospitals.pdfUS Environmental Protection Agency. (2025, February 14). Fact Sheet for Communities: Safer Communities by Chemical Accident Prevention. Risk Management Program. https://www.epa.gov/rmp/fact-sheet-communities-safer-communities-chemical-accident-prevention-risk-management-programVermont Agency of Natural Resources. (2025). Spills. Vermont Environmental Research Tool. https://anrweb.vt.gov/dec/ert/Spills.aspxWalker, K., & Kahlon, M. (2021). Common toxidromes. Emergency Care BC. https://emergencycarebc.ca/clinical_resource/clinical-summary/common-toxidromes-diagnosis-treatmentWetter, D., & Stone, R. (2014). Strategies for first receiver decontamination. In Office of Emergency and Preparedness Management. https://www.massgeneral.org/assets/mgh/pdf/emergency-medicine/strategies-for-first-receiver-decontamination.pdfWRAP-EM. (2023, October 4). Decontamination [Video]. YouTube. https://www.youtube.com/watch?v=reU6gN0aY0w地下鉄サリン事件】除染活動に向かう自衛隊員. (n.d.). Wikimedia Commons. https://commons.wikimedia.org/wiki/File:%E3%80%90%E5%9C%B0%E4%B8%8B%E9%89%84%E3%82%B5%E3%83%AA%E3%83%B3%E4%BA%8B%E4%BB%B6%E3%80%91%E9%99%A4%E6%9F%93%E6%B4%BB%E5%8B%95%E3%81%AB%E5%90%91%E3%81%8B%E3%81%86%E8%87%AA%E8%A1%9B%E9%9A%8A%E5%93%A1.jpg Name