Handreiking voor grootschalige chemische decontaminatie, van de US Departments of Homeland Security en Health and Human ServicesNB: “Patient” is defined here as:Any individual who was at or near the location of a hazardous materials release and who was potentially exposed and therefore potentially contaminated and may require some form of care (e.g., decontamination, lifesaving interventions, antidotal therapy, supportive medical care, communication, or reassurance).IntroductionThe potential for a large-scale chemical release resulting in the need to decontaminate an overwhelming number of people has garnered wide interest among policy makers and emergency planners. Guidance and best practice documents have been published and specialized equipment has been purchased. However, decontamination practices have evolved based on sparse evidence. Limited research has been conducted on decontaminating civilians. Patient decontamination, like other aspects of disaster response, medicine, and public health, could benefit from an assessment of the body of evidence, enhanced incorporation of the evidence into planning and practice, and additional study to generate needed evidence. Furthermore, many current guidance and best practice documents do not address the full spectrum of issues that a community may face when large-scale patient decontamination is necessary in a mass chemical exposure incident.Audience, scope, intentThe intended audience includes senior leaders, planners, incident commanders, emergency management personnel, and trainers of local response organizations and health care facilities. Though the guidance was developed with this specific audience in mind, it may be of value to other audiences, including first responders and first receivers, community leaders, scientific researchers, as well as others from the response and emergency management fields. A basic assumption of this document is that mass patient decontamination takes place at the level of the local affected community. The subject matter considered here is limited to external contamination of living people (henceforth defined as “patients”) with toxic industrial chemicals (TICs), toxic industrial materials (TIMs), or chemical warfare agents (CWAs) in a mass casualty incident resulting from an accidental or intentional release. This guidance attempts to address the full spectrum of the decontamination response operation, from initial assessment and decision making through evaluation of decontamination effectiveness. Further, the entire affected community is considered, with emphasis on coordination between on-scene and health care facility-based response activities and communication on multiple levels.Patient decontamination principles are set forth here from a strategic perspective, rather than a tactical one. The principles are meant to guide, but not specify, operational practices. The guidance is evidence-based to the extent possible and the supporting evidence is documented and briefly discussed.