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1 Decontamination Principles and Patient Management Decontamination Principles and Patient Management.

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Presentation on theme: "1 Decontamination Principles and Patient Management Decontamination Principles and Patient Management."— Presentation transcript:

1 1 Decontamination Principles and Patient Management Decontamination Principles and Patient Management

2 2 Module Objectives  Define decontamination  Describe the differences between non- ambulatory and ambulatory decontamination  Discuss procedures for the wet and dry decontamination  Discuss the decontamination planning process / patient management  Identify regulatory compliance issues

3 3 The process of removing or neutralizing surface contaminants that have accumulated on personnel and equipment. What is Decontamination?

4 4 Why Decontaminate?  Emergency responders should ONLY decon to:  Control gross contamination  Facilitate police measures  Provide medical care  Including psychological support

5 5 Decontamination Three methods: –Mechanical, chemical, physical Types of Decontamination: –Patient decontamination –Personnel decontamination –Personal decontamination –Equipment decontamination

6 6 Decontamination  Level of Protection - Respiratory - Respiratory - Protective clothing - Protective clothing  Isolation Zones  Hospital Decontamination  Decontamination Planning Process

7 7 Selection of Appropriate PPE  Personal protective equipment (PPE) selection shall be based on an evaluation of the performance characteristics of the PPE relative to the requirements and limitations of the site, the task-specific conditions and duration, and the hazards and potential hazards identified at the site (CFR 29, )

8 8 Levels of Protection Greater Hazard Higher Burden Level A Level B Level C Level D Bunker Gear ?

9 9 Isolation Zones WARM INCIDENT SITE HOT **SAFE REFUGE AREA DECONTAMINATIONCORRIDOR ACCESS CORRIDOR COLD COMMAND POST WIND DIRECTION **

10 10 Hospital Decontamination  Patient population  Selection of appropriate PPE  Decontamination process  Medical care at the incident site and decontamination areas  EPA will waive requirements for run off collection in an emergency situation

11 11 Patient Population  Self-selected population  Ambulatory minimally symptomatic or worried well  Sick patients brought in via EMS  Survived without PPE  Can be considered not “immediately dangerous to life and health (IDLH)”?

12 12 Personnel  Who gets trained? - Awareness - Awareness - Operations - Operations  Availability  Operational Control  Emergency Department Staff  Other Identified Hospital Staff

13 13 Decontamination Site Selection  Outside!  Level impermeable surfaced area  Up wind  Water supply/collection  Illuminated  Ingress and Egress routes

14 14 Hospital Decontamination Immediate Treatment Triage Arrival Point Hospital & Secondary Treatment Facility Dry Decon Wet Non-Ambulatory Wet Ambulatory

15 15 Arrival Point  Purpose  Initial reception for potentially contaminated patients  Patient checked for contamination  Location  Close to triage area  Staffing  Personnel in Level C?

16 16 Decontamination Areas  Personnel  Self vs Buddy Assisted  Hasty vs. Thorough  Standard vs. Field-Expedient  Casualty  Ambulatory vs. Non-Ambulatory  Spot vs. Whole-body  Wound  Mechanical vs. Chemical

17 17 Dry Decontamination  Vapor or no exposure  Removal of clothing  Modesty concerns  Tracking of Valuables  Requires large amounts of disposable clothing  Clothing disposition

18 18 Address Psychological Effects Responses following an event may include:  Horror  Anger  Panic  Paranoia  Fear of contagion  Demoralization  Social isolation  Unrealistic concerns about infection Consider the following to address public fears after decon:  Explain risks (provide information sheet)  Offer careful but rapid medical assistance  Avoid unnecessary isolation or quarantine  Treat anxiety in unexposed persons who are experiencing somatic symptoms

19 19 CISM: Must have a plan for Critical Incident Stress Management  Employees  Volunteers  Patients  Worried well

20 20 One contaminated patient may close your Emergency Department and/or Hospital

21 21 Decontamination Planning Process

22 22 Decontamination Planning  Integral part of planning for emergency response  Will reduce potential for injury and save lives during emergency response phase following significant agent release  Decon of people must begin immediately, with implementation of protective actions  Addresses priorities and procedures for decon planning

23 23 Decon Planning Required by:  JACHO  AOHA  OSHA  State OSHA  DEQ

24 24 Decon Plan Required  Describe agencies to be responsible  Describe resources to be available  Describe procedures to be followed to deal with agent-contaminated people and animals that provide critical support to humans  Plan should emphasize self and buddy decontamination

25 25 Planning Issues  Site location, layout, preparation  Security and Communications  Logistical support  Equipment (unit level)  Evacuation assets  Personnel issues  Training  Manpower

26 26 Planning Issues  Cost – effective  Mass Casualty  Rapid set-up  Patient privacy  Protection of property  Training

27 27 Where do we go from here?  Reassess our approach to the Mass Casualty Incident  Hospitals Develop Internal Plans for Decontamination  Reassess the regulations concerning PPE  Regional Planning  Pre-Planning  Advance Training Programs (ADLS)

28 28 Personnel Training Requirements  Patient transport  Decontamination  Non-Ambulatory, Ambulatory, Personnel  Detection and monitoring  Hazard avoidance (for all personnel)  Personal protection  Work / rest cycles  Rehydration

29 29 Summary  Physical removal is BEST decon  Must plan for patient decon at all aspects of care  Decon process is resource intensive and must be planned and practiced in advanced  Identify and train personnel early  Learn benefits of coordination with medical assets in your hospital and region Prior Planning Prevents Poor Performance


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