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500, and 5,000 people, what level of medical training is required for the personnel performing decon, and how much medical care should be given in the warm zone as opposed to the cold zone or at the hospital. Delaying or improperly conducting decontamination increases the danger to the patient as well as the health care provider.

No less important is the hospital's ability to process large numbers of victims in a timely fashion. Hospitals need to know how their decon systems should be organized and equipped, whether decon is best done inside or outside of the facility, what PPE emergency department personnel should wear, how the system should accommodate both walk-in and ambulance-delivered patients, and the patient volume that should be manageable in an emergency department that has 10,000, 25,000, or 60,000 visits a year. Another issue is how the cost for being prepared could be recovered by the hospital. Unlike other modernization efforts, a decontamination unit is not going to pay for itself with new patients and fees for the hospital.

Decontamination of Biologic Agents

Biological warfare agents on the skin and clothing of patients pose only minimal risk to medical personnel from aerosolization ("off-gassing") if standard precautions (gown, gloves, eye protection, and careful handling of needles and other "sharps") are observed. Dermal exposure to a suspected agent should nevertheless be treated immediately with soap and water, followed, after a thorough rinse, with a 0.5 percent hypochlorite solution, which will neutralize any remaining microorganisms within 5 to 10 minutes. As noted in the previous section, hypochlorite is contraindicated for decontamination of eyes or in cases of wounds involving brain, spinal cord, or the abdominal or thoracic cavities. Equipment used in caring for potentially contaminated or infected patients should receive special attention in view of the likelihood of its subsequent use with other patients. Normal sterilization with dry heat or autoclaving is ideal, but 30 minutes soaking in a 5.0 percent hypochlorite solution (undiluted household bleach) will serve as a field expedient.

Additional attention will need to be paid to how to decontaminate any facilities contaminated by a release. This may prove to be a bigger undertaking than dealing with the human exposure risks, as there is little experience in the literature on how to most cost effectively accomplish this task. Gases or liquids in aerosol form (e.g., formaldehyde) combined with surface disinfectants are often used to ensure complete decontamination. Gels and foams being pursued by scientists at Sandia National Laboratory (Zelikoff, 1998) can help in carrying and holding disinfectant to walls and ceilings. Curry and Clevenger (1997) recently reviewed promising