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Comparative Analysis of Showering Protocols for Mass-Casualty Decontamination

  • Richard Amlôt (a1), Joanne Larner (a2) (a3), Hazem Matar (a2) (a3), David. R. Jones (a2) (a3), Holly Carter (a1), Elizabeth A. Turner (a4), Shirley C. Price (a3) and Robert P. Chilcott (a2)...

A well-established provision for mass-casualty decontamination that incorporates the use of mobile showering units has been developed in the UK. The effectiveness of such decontamination procedures will be critical in minimizing or preventing the contamination of emergency responders and hospital infrastructure. The purpose of this study was to evaluate three empirical strategies designed to optimize existing decontamination procedures: (1) instructions in the form of a pictorial aid prior to decontamination; (2) provision of a washcloth within the showering facility; and (3) an extended showering period. The study was a three-factor, between-participants (or “independent”) design with 90 volunteers. The three factors each had two levels: use of washcloths (washcloth/no washcloth), washing instructions (instructions/no instructions), and shower cycle duration (three minutes/six minutes). The effectiveness of these strategies was quantified by whole-body fluorescence imaging following application of a red fluorophore to multiple, discrete areas of the skin. All five showering procedures were relatively effective in removing the fluorophore “contaminant”, but the use of a cloth (in the absence of instructions) led to a significant (∼20%) improvement in the effectiveness of decontamination over the standard protocol (p <0.05). Current mass-casualty decontamination effectiveness, especially in children, can be optimized by the provision of a washcloth. This simple but effective approach indicates the value of performing controlled volunteer trials for optimizing existing decontamination procedures.

Corresponding author
CBRN & Chemical Toxicology Group, Chemical Hazards and Poisons Division, Health Protection Agency, Porton Down, Salisbury, Wiltshire, SP4 0JG UK, E-mail:
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1.Levitin, HW, Siegelson, HJ, Dickinson, S, Halpern, P, Haraguchi, Y, Nocera, A, et al: Decontamination of mass casualties—Re-evaluating existing dogma. Prehosp Disaster Med 2003;18(3):200207.
2.Houston, M, Hendrickson, RG: Decontamination. Crit Care Clin 2005;21(4):653672, v.
3.Chilcott, RP: CBRN Contamination. In: Ayres, J, Harrison, R, Nichols, G, Maynard, RL, (eds.): Textbook of Environmental Medicine. London: Hodder Arnold, pp 475486.
4.Chilcott, RP: An overview of the Health Protection Agency's Research and Development Programme on Decontamination. Chemical Hazards and Poisons Report 2009;15:2628.
5.Moody, RP, Maibach, HI: Skin decontamination: Importance of the wash-in effect. Food Chem Toxicol 2006;44(11):17831788.
6.Sharp, RB: The Detection of Spray Deposits Using Fluorescent Tracers: The British Society for Research in Agricultural Engineering, 1955.
7.Fenske, RA, Leffingwell, JT, Spear, RC. A video imaging technique for assessing dermal exposure. I. Instrument design and testing. Am Ind Hyg Assoc J 1986;47(12):764770.
8.Fenske, RA, Wong, SM, Leffingwell, JT, Spear, RC: A video imaging technique for assessing dermal exposure. II. Fluorescent tracer testing. Am Ind Hyg Assoc J 1986;47(12):771775.
9.Vo-Dinh, T, Gammage, RB: The lightpipe luminoscope for monitoring occupational skin contamination. Am Ind Hyg Assoc J 1981;42(2):112120.
10.Frobin, W, Hierholzer, E: Rasterstereography: A photogrammetric method for measurement of body surfaces. J Biol Photogr 1983;51(1):1117.
11.Roff, MW: A novel lighting system for the measurement of dermal exposure using a fluorescent dye and an image processor. Ann Occup Hyg 1994;38(6):903919.
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Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
  • URL: /core/journals/prehospital-and-disaster-medicine
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