All persons, as well as any companion, service, and assistance animals, must be decontaminated prior to evacuating a contaminated area or entering any mass care facility to prevent the spread of contamination. Unfortunately, decontamination of all affected populations at the primary event location may not be possible. Decontamination facilities may not be readily available during the early stages of self-directed population evacuations, and it may not be possible to prevent unprotected people from leaving the contaminated zone. In fact, many individuals not debilitated by exposure likely will be gone before responders arrive. Moreover, depending on the size of the event, local decontamination resources may not be adequate to decontaminate all affected populations, their animals, and other belongings within the warm zone. See KPF 4, Control the Spread of Contamination for further discussion of decontamination.
Thus, unaware contaminated persons may seek entry to mass care facilities. Facilities may require additional detection, monitoring, screening, and decontamination capabilities to identify and accommodate those who were not decontaminated at the primary event location or another location prior to transport to the mass care site. Otherwise, facilities may become contaminated, adversely affecting resident health, long-term usability of the facility, and general public trust; adverse effects on public and/or environmental health and on timelines to achieving recovery outcomes also may ensue. Facility contamination can be mitigated by widespread awareness of the need for screening and decontamination among mass care response workers; such awareness can be facilitated by the inclusion of HazMat or chemical SME support in staffing plans. Depending on the nature of the event, this facility and survivor screening, monitoring, and decontamination may require specialized equipment and additional expertise, as well as PPE for shelter reception/registration officials. However, if these resources are not available, alternative methods such as questionnaires can identify the typical signs of possible contamination and recommend individuals and their belongings for decontamination.
A coordinated approach to “appropriate” decontamination procedures is essential. Conflicting approaches to decontamination at different locations must be addressed as they can result in increased anxiety in survivors and potentially additional people seeking medical care. Competing approaches may also strain available resources and complicate public messaging. A coordinated approach determined by incident command, poison centers, and medical toxicologists should be communicated to the public and to all mass care centers. In a chemical incident, the poison control center should play a key role in developing recommended actions for those leaving an incident site with potential exposure, those sheltering in place, and those displaced. Such recommendations can include procedures to self-decontaminate and contain potentially contaminated clothing or personal items for those at a facility that does not have decontamination capabilities, or for those with modesty concerns at public decontamination sites. Further communications could identify symptoms that should prompt seeking medical care and other relevant risk information.