wrapping the contaminated area until it can be cleaned Because it is much easier to detect radioactive contamination than chemical or biologic hazards, cleanup following a radiation accident will be much more effective External contamination is rarely a significant medical problem, but decontamination requires preplanning Externally contaminated patients should be admitted through a separate entrance of the ED If this is not possible, then patients should be placed on a clean stretcher outside the ED and wrapped in a cloth (not plastic) sheet and then transported to the desired area of the hospital Access to the treatment area should be controlled TABLE 90.17 DECONTAMINATION Remove clothes Wash with a damp cloth Pay special attention to skin folds and fingernails Cover clean wounds to prevent contamination Prevent external and tepid water contamination from becoming internal Do not abrade the skin Removal of the patient’s clothing will eliminate up to 90% of the external contamination ( Table 90.17 ) Contaminated articles should be placed in labeled plastic bags Residual contamination is likely to be on the hands, face, hair, and wounds These should be washed with lukewarm water and soap Cleaning the skin with damp washcloths is better than cleaning with running water The radioactive dirt on the damp washcloth can be contained by placing the cloth in a plastic bag Radioactive dirt in wash water is much more difficult to control Shaving should not be performed because this may make small cuts and increase absorption through the skin Excessive rubbing of the skin may also increase transdermal uptake Open uncontaminated wounds should be covered to prevent them from becoming contaminated Contaminated wounds should be cleaned like any other dirty wound All samples from the patient should be saved and labeled if there is any question about the identity of the radionuclides A Geiger counter should be used to monitor and document the progress of the decontamination efforts If contamination persists, the source may be fixed to the skin or may be internal Radiation experts should be consulted before performing