Cautionary Notes for Contamination Algorithm
in Mass Casualty Events
- The REMM Contamination Algorithm is appropriate for events small enough to permit individualized evaluation and decontamination of each patient/victim.
- Limited resource availability in mass casualty events (e.g., insufficient water, personnel, equipment, medical facilities, laboratories) may necessitate major modifications of Contamination Algorithm guidelines.
- Large numbers of victims seeking decontamination and reassurance may overwhelm the emergency response infrastructure, at least initially.
- Modifications to both the Contamination Algorithm and Decontamination Procedures Guidelines in a mass casualty event may include
- Instructing large numbers of ambulatory victims to self-decontaminate at home
- Limiting radiation surveys to simplified, one-time screenings of the head, neck, hands, and forearms rather than comprehensive whole body screenings with repeated re-evaluations
- Altering decontamination methods
- Altering target decontamination levels (i.e., accepting decontamination levels in excess of 2 times background)
- Eliminating or curtailing early collection of biological specimens (e.g. radioisotope assays, nasal swabs) if logistical barriers to timely collection, transport, analysis, and reporting results limit their utility
- Initiating isotope decorporation therapy in highly selected, life-threatening circumstances prior to receiving diagnostic test results normally required
- This algorithm and supporting material are guidelines, not mandates.