1. DECON v2.0 Basic Disaster Life Support1 Detection & Monitoring Chapter 2

2. DECON v 2.0DETECTION & MONITORING2 Objectives List the goals of detection during Decontamination operationsList the goals of detection during Decontamination operations Discuss general detection principlesDiscuss general detection principles Describe detection & monitoring for:Describe detection & monitoring for: –Chemical events –Biological events –Radiological events

3. DECON v 2.0DETECTION & MONITORING3 Detection Goals of detection during an event:Goals of detection during an event: –Determine the possible cause –Determine if decontamination is necessary –Determine risks to workers –Recognizing the need for PPE is vital! Detection is Awareness !

4. DECON v 2.0DETECTION & MONITORING4 PELs Permissible Exposure LimitsPermissible Exposure Limits –Federal standards for chemical exposure –Different chemicals have different limits –Not all chemicals have established PEL 8 hour time weighted average concentration8 hour time weighted average concentration –Higher short term exposure limits (STEL)

5. DECON v 2.0DETECTION & MONITORING5 IDLH Immediately Dangerous to Life and Health – –AKA the “Hot Zone” Simply walking into the area could cause you to collapse and possibly die Unknown releases are IDLH until proven otherwise

6. DECON v 2.0DETECTION & MONITORING6 IDLH Examples Confined space entryConfined space entry Potentially explosive or flammable situationsPotentially explosive or flammable situations Visible vapor cloudsVisible vapor clouds –Dead animals –Collapsed victims Hospitals are not IDLH environmentsHospitals are not IDLH environments

7. DECON v 2.0DETECTION & MONITORING7 Information Sources PlacardingPlacarding –Emergency Response Guide Book Shipping papersShipping papers Material Safety Data Sheet (MSDS )Material Safety Data Sheet (MSDS ) Product labelingProduct labeling –NFPA NIOSH HandbookNIOSH Handbook Poison Control CentersPoison Control Centers

8. DECON v 2.0DETECTION & MONITORING8 Hazardous Matetials 1.Explosives 2.Gases 3.Flammable Liquids 4.Flammable Solids 5.Oxidizing chemicals 6.Toxic or infectious substances 7.Radioactive 8.Corrosives 9.Miscellaneous

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10. DECON v 2.0DETECTION & MONITORING10 ERG Identifies UN number on placardIdentifies UN number on placard Refers to “Guide” with information onRefers to “Guide” with information on –Health and fire hazards –Protective Equipment needed –Containment & Evacuation –First aid & Emergency response

11. DECON v 2.0DETECTION & MONITORING11 Shipping Papers Required for ANY hazardous material being transportedRequired for ANY hazardous material being transported Chemical nameChemical name Amount (weight or volume)Amount (weight or volume) Hazard ClassificationHazard Classification

12. DECON v 2.0DETECTION & MONITORING12 MSDS Chemical NameChemical Name Hazard IdentificationHazard Identification Physical & Chemical PropertiesPhysical & Chemical Properties Information is NOT reviewed but any agency for completenessInformation is NOT reviewed but any agency for completeness

13. DECON v 2.0DETECTION & MONITORING13 NFPA Labels Health HazardHealth Hazard FlammabilityFlammability InstabilityInstability –0 = Good –4 = Very Bad Special HazardsSpecial Hazards –Oxidizer –Water Reactive –Radiation

14. DECON v 2.0DETECTION & MONITORING14 Chemical Names, synonyms, trade names, Description of chemical and physical properties PEL & IDLH values Personal Protection Recommendations Respirator Recommendations Information on Health Hazards

15. DECON v 2.0DETECTION & MONITORING15 Poison Control Centers In depth information about health effectsIn depth information about health effects In depth treatment informationIn depth treatment information Antidote availabilityAntidote availability Toxicologist ConsultationToxicologist Consultation

16. DECON v 2.0DETECTION & MONITORING16 Chemicals Wide Variety of Dispersal Mechanisms

17. DECON v 2.0DETECTION & MONITORING17 Chemical Agent Clues Rapid symptom onsetRapid symptom onset Multiple victims and civilian panicMultiple victims and civilian panic Similar signs and symptomsSimilar signs and symptoms Present at same timePresent at same time History of similar site exposureHistory of similar site exposure Absence of traumatic injuriesAbsence of traumatic injuries Emergency responders may be affectedEmergency responders may be affected A disseminating device may be usedA disseminating device may be used Cloud or vapor release or irritating odorCloud or vapor release or irritating odor Animal or insect die-offAnimal or insect die-off Rapid symptom onsetRapid symptom onset Multiple victims and civilian panicMultiple victims and civilian panic Similar signs and symptomsSimilar signs and symptoms Present at same timePresent at same time History of similar site exposureHistory of similar site exposure Absence of traumatic injuriesAbsence of traumatic injuries Emergency responders may be affectedEmergency responders may be affected A disseminating device may be usedA disseminating device may be used Cloud or vapor release or irritating odorCloud or vapor release or irritating odor Animal or insect die-offAnimal or insect die-off

18. DECON v 2.0DETECTION & MONITORING18 Chemical Agents ChokingBlisterBloodNerve Phosgene Chlorine Mustard Lewisite Phosgene Oxime CyanideTabun Sarin Soman VX

19. DECON v 2.0DETECTION & MONITORING19 Choking (Pulmonary) Chemical Agents PHOSGENEPHOSGENE Odor: newly cut hayOdor: newly cut hay Symptoms:Symptoms: Coughing, choking, vomiting CHLORINE Odor: swimming pool Symptoms: Coughing, choking, vomiting

20. DECON v 2.0DETECTION & MONITORING20 Blister (Vesicant) Chemical Agents MustardMustard Odor: garlicOdor: garlic Symptom onset: delayedSymptom onset: delayed Symptoms: tearing, eye itching, running nose, cough, blistersSymptoms: tearing, eye itching, running nose, cough, blisters Lewisite Odor: geraniums Symptom onset: Immediate Symptoms: tearing, eye itching, running nose, cough, painful blisters

21. DECON v 2.0DETECTION & MONITORING21 Blood (Asphyxiant) Chemical Agents Cyanide GasCyanide Gas Odor: Bitter almonds Symptom Onset: Rapid Symptoms: Normal skin color, gasping for air, shock & seizures

22. DECON v 2.0DETECTION & MONITORING22 Nerve Agents (Cholinesterase Inhibitors) OdorProperties Tabun & Sarin:None or Fruity Volatile Soman:None Volatile VX:None / Sulfur Persistent Symptom Onset: Rapid to 48hrs Symptoms: Pinpoint pupils, salivation, runny nose, shortness of breath, chest tightness, nausea, muscle twitching, seizures, coma, death

23. DECON v 2.0DETECTION & MONITORING23 Nerve Agents Signs and Symptoms D- defecation U - urination M – miosis (pinpoint pupils) B – BRONCHORRHEA, BRONCHOSPASM E – emesis (vomiting) L – lacrimation (watery eyes) S - salivation Muscarinic toxidrome

24. DECON v 2.0DETECTION & MONITORING24 Nerve Agent Signs and Symptoms M: Mydriasis (dilated pupils)M: Mydriasis (dilated pupils) T: TachycardiaT: Tachycardia W: WeaknessW: Weakness tH: HypertensiontH: Hypertension F: Fasciculations (muscle twitching)F: Fasciculations (muscle twitching) Nicotinic toxidrome

25. DECON v 2.0DETECTION & MONITORING25 Chemical Detection Devices Identify unknown chemicalsIdentify unknown chemicals Determine if situation is safeDetermine if situation is safe –Is concentration in air IDLH? Monitor patients after decontaminationMonitor patients after decontamination –Significant clinical effects –Extremely dangerous chemicals –Highly contaminated victims

26. DECON v 2.0DETECTION & MONITORING26 Chemical Detection Tools All have limited ranges of substances Chemical Detection PapersChemical Detection Papers –Concentrated vapors or liquids Air Sampling DevicesAir Sampling Devices –Vapors or gasses in low concentration

27. DECON v 2.0DETECTION & MONITORING27 Choosing a Detection Device Agents detected What chemicals can it find? What forms; gas, liquid or vapor? Sensitivity Can it measure lower than levels necessary for injury? Interference Does smoke, moisture, or other chemicals prevent accurate results? Response timeTime to analyze & report Start-up timeTime to deploy the device Alarm capabilityAudible, visual, or both

28. DECON v 2.0DETECTION & MONITORING28 Portability Consider weight, size & power source Durability Amount of abuse the device withstands Procurement costsCost per device needed Operator skill & training Skill involved in using the device & hours of training MaintenanceCalibration & Replacement parts Choosing a Detection Device

29. DECON v 2.0DETECTION & MONITORING29 Biological Agents Infectious diseases or bacterial toxinsInfectious diseases or bacterial toxins There may not be a “scene”There may not be a “scene” May be hard to detect Long incubation period Symptoms manifest slowly Non-specific symptoms Infectious diseases or bacterial toxinsInfectious diseases or bacterial toxins There may not be a “scene”There may not be a “scene” May be hard to detect Long incubation period Symptoms manifest slowly Non-specific symptoms Beware of multiple “healthy” people with similar complaints! Ebola

30. DECON v 2.0DETECTION & MONITORING30 Biological Agents “SAFETY” S: Skin rash with fever SmallpoxSmallpox A: Acute Pulmonary Syndrome with fever Anthrax and plagueAnthrax and plague F: Flu like syndrome with fever Tularemia and SARSTularemia and SARS E: Excessive Bleeding Viral hemorrhagic feversViral hemorrhagic fevers T: Toxin Effect without fever BotulismBotulism Y: Your personal and community safety Depends on recognitionDepends on recognition

31. DECON v 2.0DETECTION & MONITORING31 Biological Detection Mainly clinical diagnosisMainly clinical diagnosis –Large numbers of victims –Unusually bad cases –Laboratory confirmation be delayed Evidence of a bioterrorism attack:Evidence of a bioterrorism attack: –Witness –Report or threat –Device found

32. DECON v 2.0DETECTION & MONITORING32 Decon for Bio? Decontamination is usually not neededDecontamination is usually not needed –Patients have usually bathed during incubation Exceptions would be known exposuresExceptions would be known exposures –White powder letters –Spraying over crowds –Etc. PPE may still be needed in either casePPE may still be needed in either case

33. DECON v 2.0DETECTION & MONITORING33 Radiological Events Nuclear weapons will be obviousNuclear weapons will be obvious Dirty bombs or simple dispersal devices may not!Dirty bombs or simple dispersal devices may not!

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35. DECON v 2.0DETECTION & MONITORING External Exposure / Irradiation s     Local Partial Body Whole Body 

36. DECON v 2.0DETECTION & MONITORINGContamination InternalExternal

37. DECON v 2.0DETECTION & MONITORING Radiation Injury Chemical Damage Free Radicals 10 -10 Seconds 1. Proteins 2. Membrane 3. DNA Cellular Damage Tissue damage & Loss of organ function Hours to years Organ Damage Seconds to hours

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39. DECON v 2.0DETECTION & MONITORING39 What to look for … Most common presentation is Nausea and Vomiting Onset may be delayed Early symptom onset predicts worse outcome Extreme cases may include hair loss, burns or loss of consciousness

40. DECON v 2.0DETECTION & MONITORING40 Radiological Detection Survey Meters “Geiger Counters” Detect and measure the presence of radiation Dosimeters Measure your personal radiation exposure. Survey meters Dosimeters

41. DECON v 2.0DETECTION & MONITORING41 Rad Victim Monitoring Use a survey meterUse a survey meter –Be careful not to contaminate probes Identify contaminated victims prior to decontaminationIdentify contaminated victims prior to decontamination Unlike chemical post decontamination monitoring is needed for all victimsUnlike chemical post decontamination monitoring is needed for all victims –This will be a very slow process

42. DECON v 2.0DETECTION & MONITORING42 Summary Now you can: Define PEL and IDLHDefine PEL and IDLH Identify resources to aid in hazard identification and monitoringIdentify resources to aid in hazard identification and monitoring Discuss general detection principlesDiscuss general detection principles Describe detection specifics for:Describe detection specifics for: –Chemical events (including “toxidromes”) –Biological events –Radiological events

43. DECON v2.0 Basic Disaster Life Support43 Thank you! Questions?