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Victims of a chemical exposure or attack require decontamination, ideally on site as rapidly as possible by specially equipped and trained Emergency Medical Services (EMS)/fire personnel or hospital-based health care professionals. Decontamination includes isolation of the victim, preferably outdoors or in a sealed, specially ventilated room; removal of all of the victim's clothing and jewelry; protection of any part of the victim's body that has not been exposed to toxins; repeated irrigation and flushing of exposed skin with water (a dilute wound-cleansing solution, such as Dakin’s solution, may be used on skin but not on the eyes or within penetrating wounds); additional irrigation of wounded skin with sterile solution (typically for about 10 min longer than the irrigation of intact skin); irrigation of the eyes with saline solution (about 15 min); cleansing beneath the surface of exposed fingernails or toenails; and collection and disposal of effluent and contaminated clothing. To avoid secondary injuries and exposures, trained personnel who carry out decontamination must wear chemical masks with a filtered respirator, self-contained underwater breathing apparatus (SCUBA), and splash-resistant protective clothing that covers all skin and body surfaces and is impervious to all chemicals. Following decontamination, victims require triage and treatment.
Treatments for chemical exposures include both supportive care (such as the administration of oxygen, intravenous fluids, analgesics, topical remedies, and psychosocial support) and the administration of antidotes or chemical antagonists such as physostigmine. Details of the treatment for most specific exposures may be found in references such as the National Library of Medicine’s website: www.sis.nlm.nih.gov/Tox/ChemWar.html. See: biological warfare.