07-2007 Decon-Ref v.1.0 2 CME Faculty Disclosure In order to assure the highest quality of CME programming, the AMA requires that faculty disclose any information relating to a conflict of interest or potential conflict of interest prior to the start of an educational activity. The teaching faculty for the NDLS course offered today have no relationships / affiliations relating to a possible conflict of interest to disclose. Any discussion of off label usage during this course will be noted.
07-2007 Decon-Ref v.1.0 3 Course Objectives List 3 categories of hazardous substances that might necessitate medical decontamination (decon) Describe potential adverse outcomes on the healthcare system associated with a hazardous substance incident Identify means of detection of hazardous substances incidents Describe differences between decon at the incident scene & medical decon at receiving healthcare facilities Recognize the role of victim triage & medical decon within the Incident Command System Identify the components of Level C PPE
07-2007 Decon-Ref v.1.0 4 Course Objectives - 2 Course Objectives - 2 Demonstrate proper donning & doffing procedures for Level C PPE Perform the component steps of “MASS” Triage during a simulated mass casualty incident Apply the “ID-ME” color-coded categories to victims of a simulated mass casualty incident Describe the roles of medical decon team members Identify selection criteria for a medical decon site Demonstrate basic dry & wet medical decon procedures List 4 methods of communication that might be employed in a chaotic medical decon environment
07-2007 Decon-Ref v.1.0 6 Ch. 1: Objectives Ch. 1: Objectives List 3 categories of hazardous substances that might necessitate medical decontamination (decon) Describe potential adverse outcomes on the healthcare system associated with a hazardous substance incident Identify means of detection of hazardous substances incidents Describe differences between decon at the incident scene & medical decon at receiving healthcare facilities Recognize the role of victim triage & medical decon within the Incident Command System Identify the components of Level C PPE
07-2007 Decon-Ref v.1.0 7 Texas Motor Speedway Exercise Scenario: Aircraft explodes on race day Result: > 10,000 victims Included a dirty bomb Stakeholders & Resources: All area Public Health departments Over 40 State and federal agencies Over 2,300 victim volunteers Over 300 First Responders 30 area hospitals participated
07-2007 Decon-Ref v.1.0 8 Texas Motor Speedway Exercise, November 2004 Three critical gaps identified: Casualty / Patient Triage Medical Decontamination (Med Decon) Personal Protective Equipment (PPE)
07-2007 Decon-Ref v.1.0 9 NDLS-Decon 2 day, 16-contact hours Meets OSHA awareness and operational training levels CDLS course, 4 hours NDLS-Decon, 12 hours ► Includes 8 hours of interactive-skills sessions
07-2007 Decon-Ref v.1.0 10 NDLS-Decon Refresher 1 day, 8 contact hours Persons who have taken NDLS-Decon Review course content Focus on hands-on skills practice ► Level C PPE ► Medical Decontamination ► Mass Casualty Triage ► Communications No formal CE credit or certification (07-07)
07-2007 Decon-Ref v.1.0 11 NDLS Family of Courses A comprehensive, nationally-standardized family of all-hazards training programs developed by the NDLS consortium of academic, state, and federal centers.
07-2007 Decon-Ref v.1.0 12 The Concern Worldwide arsenal of weapons of mass destruction (WMD) noted for years: ► CHEMICAL ► BIOLOGICAL ► RADIOLOGICAL ► EXPLOSIVE ► NUCLEAR Security, Political, Socioeconomic changes Threat to intentionally harm large civilian populations has never been greater! Are We Prepared?
07-2007 Decon-Ref v.1.0 15 A disaster is present when need exceeds resources In other words: the response need exceeds the resources available “Disaster” Definition Disaster = Need > Resources
07-2007 Decon-Ref v.1.0 16 “Multiple/Mass/Major Casualty Incident” An MCI is present when healthcare need exceeds available healthcare resources! “MCI” Definition MCI = Healthcare Need > Resources
07-2007 Decon-Ref v.1.0 17 MCI Management Goal: Do the greatest good for the greatest number of potential survivors! This is an important concept!
07-2007 Decon-Ref v.1.0 18 All-Hazards Definitions All-Hazards: ► ► Man-made or natural events with the destructive capability of causing multiple casualties All-Hazards Preparedness: ► ► Comprehensive preparedness required to manage the casualties resulting from All- Hazards
07-2007 Decon-Ref v.1.0 20 “WMD / WME” Weapons or devices that injure or kill large numbers Cause widespread destruction and/or panic Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) “Weapons of Mass Destruction / Effect” Definition
07-2007 Decon-Ref v.1.0 21 Man-made poisons spread as gases, liquids, or aerosols Cause illness or death in humans, animals, plants May be inhaled, ingested or absorbed Variety of disseminating devices Chemical Weapons
07-2007 Decon-Ref v.1.0 23 Devices to disperse radioactive substances Conventional explosive device (“dirty bomb”) Intentional radiation release: water, food, terrain Less energy & radiation release than a nuclear weapon Delayed detection: no “scene” “Worried well” & civilian panic Radiological Weapons
07-2007 Decon-Ref v.1.0 24 Catastrophic explosions Massive nuclear energy release through atom splitting Traumatic injuries, burns, fallout, delayed effects Nuclear Weapons
07-2007 Decon-Ref v.1.0 25 Disseminate disease-causing microorganisms or biologically-produced toxins (poisons) Cause illness or death in humans, animals, or plants Numerous agents could be used Biological Weapons
07-2007 Decon-Ref v.1.0 30 Natural Disasters The Concern: Numerous & widespread Millions of fatalities worldwide Countless millions more injured $ Billions per event Common in the U.S. There WILL be a natural disaster in the U.S. this year
07-2007 Decon-Ref v.1.0 31 Transportation Incidents More than 6 million per year in U.S. More than 40,000 traffic fatalities Secondary hazards Fire, explosion, chemical, radioactive All modes: Highway Air Rail Marine
07-2007 Decon-Ref v.1.0 32 Industrial Hazmat Mostly minor “spills”, occasionally severe! Massive explosions Hazardous materials release ► Toxic fumes, radiation, biological agents ► Secondary disasters Multiple casualties Prolonged community impact ► Loss of homes & jobs ► Emotional impact
07-2007 Decon-Ref v.1.0 33 DISASTER Paradigm A standardized method to recognize and manage the scene and care for victims Reinforced throughout all NDLS courses: A training tool… Practical approach on scene! An organizational tool… Utilize resources, assess needs A series of questions…
07-2007 Decon-Ref v.1.0 35 Medical Decon & the DISASTER Paradigm Medical Decontamination needs to be integrated into the pre-planning & support for All-Hazards incidents ► Includes mass casualty triage Goals: ► Allow contaminated victims access to the medical care they need ► Prevent further victim M/M ► Prevent healthcare provider M?M
07-2007 Decon-Ref v.1.0 37 Summary At least 3 categories of All-Hazards incidents might necessitate medical decontamination ► Chemical ► Radiological ► Biological ► Explosive ► Nuclear Lack of preparedness for such incidents: ► Increased suffering for victims ► Reduced access to medical care for victims & others Facility closures Facility closures Loss of healthcare providers Loss of healthcare providers
07-2007 Decon-Ref v.1.0 38 Contact Information Ronna G. Miller, MD Assistant Professor EMS, Disaster Medicine & Homeland Security Section Division of Emergency Medicine Department of Surgery UT Southwestern Medical Center at Dallas 5323 Harry Hines Blvd. Dallas, Texas 75390-8890 Email: Ronna.Miller@UTSouthwestern.edu Voicemail: (214) 648-6881