Table 6. Decontamination and Treatment
Agent Type
Decontamination
First Aid
Other Patient
Considerations
Assess ABCs
Nerve
 - Remove clothing immediately
- Gently wash skin with soap and water
- Do not abrade skin
- For eyes, flush with plenty of water or normal saline		 - Atropine before other measures
- Pralidoxime (2-PAM) chloride		 - Onset of symptoms from dermal contact with liquid forms may be delayed
- Repeated antidote administration may be necessary
Asphyxiant/Blood
 - Remove clothing immediately if no frostbite*
- Gently wash skin with soap and water
- Do not abrade skin
- For eyes, flush with plenty of water or normal saline		 - Rapid treatment with oxygen
- For cyanide, use antidotes (sodium nitrite and then sodium thiosulfate)
- Arsine and cyanogen chloride may cause delayed pulmonary edema
Choking/
Pulmonary-damaging

- Remove clothing immediately if no frostbite*
- Gently wash skin with soap and water
- Do not abrade skin
- For eyes, flush with plenty of water or normal saline

 - Fresh air, forced rest
- Semi-upright position
- If signs of respiratory distress are present, oxygen with or without positive airway pressure may be needed		 - Other supportive therapy, as needed
- May cause delayed pulmonary edema, even following a symptom
-free period that varies in duration with the amount inhaled
Blistering/Vesicant
 - Immediate decontamination is essential to minimize damage
- Remove clothing immediately
- Gently wash skin with soap and water
- Do not abrade skin
- For eyes, flush with plenty of water or normal saline		 - Immediately decontaminate skin
- Flush eyes with water or normal saline for 10-15 minutes
- If breathing difficulty, give oxygen
- Supportive care
- Possible pulmonary edema
- Mustard has an asymptomatic latent period
- There is no antidote or treatment for mustard
- Lewisite has immediate burning pain, blisters later
- Specific antidote British Anti-Lewisite (BAL) may decrease systemic effects of Lewisite
- Phosgene oxime causes immediate pain

Incapacitating/
Behavior-altering
 - Remove clothing immediately
- Gently wash skin with water or soap and water
- Do not abrade skin		 - Remove heavy clothing
- Evaluate mental status
- Use restraints as needed
- Monitor core temperature carefully
- Supportive care		 - Hyperthermia and self
-injury are largest risks
- Hard to detect because it is an odorless and non
-irritating substance
- Possible serious arrhythmias
- Specific antidote (physostigmine) may be available
*For frostbite areas, do NOT remove any adhering clothing. Wash area with plenty of warm water to release clothing.