title: Mass Casualty Decontamination in a Chemical or Radiological/Nuclear Incident with External Contamination: Guiding Principles and Research Needs.
abstract: Hazardous chemical, radiological, and nuclear materials threaten public health in scenarios of accidental or intentional release which can lead to external contamination of people.  Without intervention, the contamination could cause severe adverse health effects, through systemic absorption by the contaminated casualties as well as spread of contamination to other people, medical equipment, and facilities.  Timely decontamination can prevent or interrupt absorption into the body and minimize opportunities for spread of the contamination, thereby mitigating the health impact of the incident.  Although the specific physicochemical characteristics of the hazardous material(s) will determine the nature of an incident and its risks, some decontamination and medical challenges and recommended response strategies are common among chemical and radioactive material incidents.  Furthermore, the identity of the hazardous material released may not be known early in an incident.  Therefore, it may be beneficial to compare the evidence and harmonize approaches between chemical and radioactive contamination incidents.  Experts from the Global Health Security Initiative's Chemical and Radiological/Nuclear Working Groups present here a succinct summary of guiding principles for planning and response based on current best practices, as well as research needs, to address the challenges of managing contaminated casualties in a chemical or radiological/nuclear incident.
authors.affiliation: Office of the Assistant Secretary for Preparedness and Response.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Cibulsky
authors.affiliation: Chemical Events Working Group of the Global Health Security Initiative; Chemical Emergency Preparedness and Response Unit, Health Canada, Ottawa, Canada.
authors.forename: Danny
authors.initials: D
authors.lastname: Sokolowski
authors.affiliation: Chemical Events Working Group of the Global Health Security Initiative; Chemical Emergency Preparedness and Response Unit, Health Canada, Ottawa, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Lafontaine
authors.affiliation: Chemical Events Working Group of the Global Health Security Initiative; Chemical Emergency Preparedness and Response Unit, Health Canada, Ottawa, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Gagnon
authors.affiliation: Chemical Events Working Group of the Global Health Security Initiative; 4Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Medical Toxicology Centre, Newcastle University, Newcastle-upon-Tyne, U.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Blain
authors.affiliation: Chemical Events Working Group of the Global Health Security Initiative; WHO-Collaborating Centre for Chemical Incidents, Public Health England, Cardiff Metropolitan University, Cardiff, Wales, UK.
authors.forename: David
authors.initials: D
authors.lastname: Russell
authors.affiliation: Chemical Events Working Group of the Global Health Security Initiative; Bundeswehr Medical Service Academy, Division of Medical NBC-Protection, German Armed Forces, Munich, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Kreppel
authors.affiliation: Chemical Events Working Group of the Global Health Security Initiative; Strengthening Global Biosecurity, Robert Koch-Institut, Berlin, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Biederbick
authors.affiliation: Chemical Events Working Group of the Global Health Security Initiative; Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimazu
authors.affiliation: Chemical Events Working Group of the Global Health Security Initiative; National Hospital Organization Disaster Medical Center, Tachikawa, Japan.
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Kondo
authors.affiliation: Chemical Events Working Group of the Global Health Security Initiative; Department of Health Crisis Management, National Institute of Public Health, Saitama, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Saito
authors.affiliation: Radiological/Nuclear Threats Working Group of the Global Health Security Initiative; Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France.
authors.forename: Jean-René
authors.initials: JR
authors.lastname: Jourdain
authors.affiliation: Radiological/Nuclear Threats Working Group of the Global Health Security Initiative; Institute for Radiological Protection and Nuclear Safety, Saint-Paul lés Durance, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Paquet
authors.affiliation: Radiological/Nuclear Threats Working Group of the Global Health Security Initiative; Radiation Protection Bureau, Health Canada, Ottawa, Canada.
authors.forename: Chunsheng
authors.initials: C
authors.lastname: Li
authors.affiliation: Radiological/Nuclear Threats Working Group of the Global Health Security Initiative; National Institution of Radiological Sciences, Chiba, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Akashi
authors.affiliation: Radiological/Nuclear Threats Working Group of the Global Health Security Initiative; National Institution of Radiological Sciences, Chiba, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Tatsuzaki
authors.affiliation: Radiological/Nuclear Threats Working Group of the Global Health Security Initiative; Centre for Radiation, Chemical, and Environmental Hazards, Public Health England, Chilton, UK.
authors.forename: Lesley
authors.initials: L
authors.lastname: Prosser