an outdoor facility must provide adequate water, temperature control, and curtains separating shower lines for males and females An alternative might be the use of a facility that is enclosed, and adjacent to, but separate structurally from, the main ED, with a separate and high-volume ventilation system vented directly outdoors ( Fig 132.4 ) Optimally, the surface of the decontamination facility would allow drainage, minimizing risk of patients slipping and falling and risk of further exposure to contaminated rinse water Young children requiring assistance may be accompanied by parents if they are contaminated, as well Older ambulatory patients can be instructed in self-decontamination Decontamination efforts should stress physical and mechanical removal over chemical decontamination For vapor-exposed patients, decontamination is effected primarily by clothing removal and hair washing with soap and water In contrast, those patients with liquid dermal exposure require disrobing and thorough skin decontamination Agent on their skin or in their clothing poses a serious threat to ED personnel Clothing must be carefully removed and double bagged Patients with ocular exposure require copious eye irrigation with saline or water Skin and hair should be washed thoroughly with soap and tepid water Previously, some authorities have recommended 0.5% sodium hypochlorite (dilute bleach) for skin decontamination of nerve agents and vesicants However, even dilute bleach may be a skin irritant, thus increasing permeability to agent, and application is time-consuming and not proven superior to copious soap and water washing A decontaminant that is now the standard for U.S military field use is reactive skin decontamination lotion (RSDL), which is packaged as a lotion-impregnated sponge and acts by both physical removal and also neutralization of chemical agents RSDL is orders of magnitude superior to standard decontamination methods and is particularly useful for immediate (local, or “spot”) skin decontamination; the FDA has not yet approved it for whole-body decontamination or use in eyes or wounds