Objectives Explain decontamination procedures for victims, personnel, and equipment. Discuss application of relevant Standard Operating Guidelines. Describe.

Objectives Explain decontamination procedures for victims, personnel, and equipment. Discuss application of relevant Standard Operating Guidelines. Describe proper disposal and documentation procedures during a Haz Mat response. © EnMagine, Inc All Rights Reserved

Foundation Objectives The Haz Mat Response Process
-Operations Level -Protective Equipment -Containment / Control -Command -Protective Actions -Identification -Action Plans -Decon -Disposal -Documentation P C C I A I. Remember in the Awareness class we introduced this mnemonic to remember how to address a Haz Mat incident in an organized and thorough manner. II. S - Safety I - Isolate and Deny Entry N - Notifications III. In the Operations Level course we will cover the rest of the mnemonic. In this class (module II), we will cover: C I A (P) C P We’re addressing DDD in this module. C - Command / Management I - Identification and Hazard Assessment A - Action Planning P - Protective Equipment C - Containment and Control P - Protective Actions D - Decontamination and Cleanup D - Disposal D - Documentation D © EnMagine, Inc All Rights Reserved

Before we get to decon…. A brief discussion
Hey, what is a presentation on patient decon without the most famous shower scene in filmdom; and the best scream (other than Fay Wray RIP)? © EnMagine, Inc All Rights Reserved

Decontamination Removing or neutralizing contaminants Personnel
Equipment Our main concerns within healthcare are to provide for the safety of patients, visitors, staff, the community, and environment. We primarily decon personnel and our response equipment. Other decontamination activities are generally left to others (e.g., clean up contractors) © EnMagine, Inc All Rights Reserved

There are a number of different descriptions of types of decon
There are a number of different descriptions of types of decon. This is the most current from FIRESCOPE and CSTI.

Types of Decon Emergency Primary/Technical Secondary (Precautionary)
Normally done by first responders Primary/Technical Done at the scene Secondary (Precautionary) Done post incident Primary – Decon of response team and equipment Secondary- A thorough decon of personnel prior to receiving definitive medical care. This is what hospitals conduct. Emergency- Generally a deluge to get the contaminants off people Note: There are many different names for different types of decon. Others may call it something else. Query the class. © EnMagine, Inc All Rights Reserved

Who, What, When & Why Why: Prevent escalation of problem
Exposure: it might be on you Contamination: it is on you Explain the difference between being exposed and being contaminated. Exposure means that there has been contact with a chemical but there is not necessarily a residual that would cause additional harm or should delay receiving treatment. Contamination means that there is material on the victim that must be removed to prevent additional impact from the chemical, to protect staff that will have contact with the victim, and to prevent the chemicals from spreading. Although crude a good analogy is the dog poop analogy. If you smell it you have been exposed, If you step in it you have been contaminated. © EnMagine, Inc All Rights Reserved

Degree of Contamination
Amount of material on you Length of time it’s on you Concentration of material Physical state of material Ambient temperatures These are the things one must consider regarding the potential impacts of contamination. A number of the same issues we have addressed earlier in the class reappear. It is important for students to be able to understand and process the key issues related to decontamination. Each event will be different. © EnMagine, Inc All Rights Reserved

Who, What, When & Why When: Anytime you suspect contamination
Material is visible Victim complains of pain, odor, etc. Victim was near release While it is better to be safe than sorry, it is important to apply common sense to decon. Are the victims covered in the stuff or is it just on their shoes? How “near” is “near?” © EnMagine, Inc All Rights Reserved

Who, What, When & Why Who/What: People & equipment Victims Responders
Structures The focus of this class is on decontaminating people and preventing internal spills from becoming a greater hazard. Equipment and structures can be addressed at a more leisurely pace and conducted by clean up contractors. This goes back to the focus of the course which is managing an “uncontrolled release” (emergency response) versus “uncontrolled waste site” (the other parts of HAZWOPER). © EnMagine, Inc All Rights Reserved

Who, What, When & Why Who usually does decon:
FRO’s (properly trained & equipped) Tech’s and Specialists via Decon Team How to decon: No absolute methods Only general guides OSHA says that anyone conducting decon in a healthcare setting must be trained to the First Responder Operations level. Only guidelines (Kinda like the Pirate’s Code.) But certain key concepts apply. Protect yourself. Get the bad stuff off of the people. Getting their clothes off will get the majority of the contaminants off. Clothes off is a good start but a thorough wash is necessary. Minimize spreading the pollution but do not delay decon because of the runoff. © EnMagine, Inc All Rights Reserved

No Chemical Reactions on People!
Performing Decon Physical removal Chemical removal Emergency decon We do physical removal. No chemical reactions on people. Get rid of the sodium hypochlorite (bleach) for skin. (A lot of old decon techniques call for a .5% bleach solution. NO!) Bleach is OK for equipment but needs contact time and is only effective in certain circumstances. Soap and water-yes! No Chemical Reactions on People! © EnMagine, Inc All Rights Reserved

Performing Decon Dirty Procedures follow logical order
Go from “dirty” to “clean” Check your plan Dirty Clean Filthy Each facility should have a designated area for conducting decon. The location should be close to, but not immediately by, the ED. The area should be accessible at all times (e.g., not have to move cars), able to contain runoff, able to be secured, provide privacy from passersby and CNN, have lights, tepid water, heat/air conditioning. © EnMagine, Inc All Rights Reserved

Summary Purpose: Prevent spread of contamination
Decon procedures are guides only Purpose: To prevent spread of contamination — keep event from getting any bigger. When: Anytime contamination is suspected. What: People (victims and responders), equipment, etc. How: Only general guides based on factors of event. Not absolute standards (may vary from event to event, but should follow logical order). Why guidelines and not hard and fast protocols. Each event will be different. Chemicals have different characteristics (e.g., persistent [sticky and sticks around] versus non-persistent, water/ non-water soluble) Amount of contamination Number of victims Weather conditions Resources available It all comes down to getting the contaminants off of the victims so that any deleterious effects of the chemicals can be stopped and the patient can receive definitive medical care while not being a danger to themselves and others. © EnMagine, Inc All Rights Reserved

Consequences of No Decon
Acute/Chronic health effects Problem gets bigger Death! oooo-aaaaah! Again, reiterate that getting the bad stuff off of the victim is key to everything else. © EnMagine, Inc All Rights Reserved

Decon Anytime you suspect contamination Use common sense Life risk
Level of exposure We want an efficient means of getting the contaminants off of the victims. Using common sense in weighing the hazards and the appropriate actions goes back to the Identification and Hazard Assessment (IDHA) covered in the Foundation module. © EnMagine, Inc All Rights Reserved

Decon Use copious amount of water Remove all clothing from victim
Copious = more than you have used Remove all clothing from victim Including undergarments Lots of water means lots of runoff. As a fixed facility the hospital has a responsibility to not be a polluter, including runoff water. That being said do not delay conducting decon because of runoff issues. Again let us apply common sense in a healthcare setting. For example, most hospital laboratories have a deluge shower. Often that shower does not have a drain. Is it better to use that closest deluge shower in the event of a spill on a worker in the lab or strip the victim down and walk them outside to the decon site where the water can be collected and thus avoid having many gallons of contaminated water spread throughout the facility? There is no right answer and the decision must be based on the criteria we have covered thus far. By all of the clothes we mean all of the clothes. There is a story- we are unsure whether it is anecdotal or not, of a woman who was contaminated and was menstruating. She was wearing a pad and was understandably embarrassed to remove her undergarments; and received chemical burns in her groin since the pad was working as it should by absorbing liquids. Unfortunately the liquids can be chemicals also. Let us continue to apply common sense. If the only contamination is that the victim stepped into the chemical, removing their footwear may be sufficient. An IDHA is key to taking the proper actions. And you wondered why we spent so much time on that material in the Foundation module. © EnMagine, Inc All Rights Reserved

Decon Precautions Avoid contact w/clothing Ensure privacy of victim(s)
Barriers/temp garments Segregate by gender Recognize that privacy issues have become significant areas of concern. A number of organizations have regretted not providing privacy or not behaving in a professional manner. Allowing people to maintain their modesty will make a big difference in their willingness to cooperate with you when the event is occurring and minimize the headaches afterward. When possible separate people by gender but be realistic. If parents do not want to be separated from their children do not force them to do so. Don’t forget helicopters. You do not want to have video footage from above of bare buttocks from your hospital on the evening news. © EnMagine, Inc All Rights Reserved

Decon Medical considerations Decon prior to transport
Protect equipment from contamination Segregate contaminated material If the public safety agencies at the scene communicate that decon has been conducted at the site of release do you just bring those victims into your ED? The answer is “no.” Nor does everyone automatically get deconned again. At the scene decon is often quick and intended to remove the gross contamination. At the hospital, decon has to be effective enough so that the victim can enter the ED and no longer be a danger to themselves or others. Each victim that is transported to your facility should be evaluated for the thoroughness and effectiveness of the decon. Is their hair wet or dry? Is there an obvious odor? Do they still have their clothes on? Based on what you determine will drive the next actions. If the decon is not adequate- do it again! Wherever possible, minimize the extent of contamination at your location. Clothing and valuables should be kept separated from everything else and each other. Some organizations let the victims carry their valuables in a sealed bag with them during decon, others do not. If possible and circumstances allow, try to return the victims valuables. You and they will appreciate it. Think about it. If the decon is completed and the victims can leave the facility but their keys and credit cards are not being returned- you have a problem.

Decon Water - tepid. Too cold - hypothermia and people will not stay in a cold shower. Too hot - opens pores and provides pathway for chemical to get into the body. Mild surfactant (Dawn, baby shampoo) At least a minute, preferably 3-5 minutes

Extreme Environments Very Hot and Very Cold
Challenges to the safety of victims and responders

Cold-Hot Weather Mass Decon
Responders should use whatever resources are available. Select the fastest method available. Decontamination is most effective when performed immediately. The key to successful decontamination is fastest approach causing the least harm the most good for the majority of the people. Information from Guidelines for Cold Weather Mass Decontamination During a Terrorist Chemical Agent Incident U.S. Army Soldier and Biological Chemical Command (SBCCOM) thanks to Jeff Rylee

Hypo/Hyperthermia Regardless of the ambient temperature, people who have been exposed to a known, life-threatening level of chemical contamination should: Disrobe Undergo decontamination with copious amounts of high-volume, low-pressure water or an alternative decontamination method. Be sheltered as soon as possible.

Hypothermia A misconception among responders is that the risk of hypothermia as a result of cold weather mass decontamination is minimal. Risk of cold shock – less well recognized than heat. Special populations, such as the elderly and the very young, should be given priority for limited resources such as blankets and indoor shelter because of limited or impaired ability to maintain body temperature.

Cold Weather Consideration – Hypothermia
Not a significant risk for most people undergoing mass decon in cold weather. Takes longer to develop. Shivering is a sign that the body is trying to warm itself. IF AN INDIVIDUAL IS COLD AND WET AND IS NOT SHIVERING, PROMPT MEDICAL ATTENTION SHOULD BE SOUGHT. Hypothermia, although a genuine threat to inadequately protected individuals in some outdoor exposure situations, is not a significant risk for most people undergoing mass decontamination in cold weather. Hypothermia is a condition of deep body cooling that usually takes longer to develop than one would normally encounter in a mass decontamination situation. Most individuals can tolerate 55°F water, and although they would shiver severely and experience great discomfort, they would not be in an immediate life-threatening situation due to hypothermia. For a wet individual in a cold environment, shivering is a sign that the body is trying to warm itself and is not in and of itself a sign for alarm. If an individual is cold and wet and is NOT shivering, prompt medical attention should be sought since some people are not able to shiver and are at greater risk of developing hypothermia. Firefighters can decontaminate the general population using the baseline method (Method 1), when the ambient temperature is at or above 65°F, with minimal risk of precipitating a serious cold-related injury, provided the decontaminated victims are not required to stand outside unprotected from the environment for an extended length of time. This report provides alternative decontamination methods (Methods 2 through 4) so that unprotected outside exposure of victims can be minimized.

Extreme Heat As indicated in the PPE module, heat stress is possibly the greatest hazard to responders/receivers due primarily to the impervious suit’s compromising of the evaporation of sweat. Victims in high heat environments must have a means of staying cool to avoid exacerbating medical conditions and effects of chemical exposure.

Extreme Heat One of the best ways to cool victims is to
Get ‘em wet! Non air conditioned decon areas can get dangerously hot during extreme temperatures. Consider portable or piped air conditioning.

More excerpts from a presentation by:
Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances Craig D. Thorne, M.D., MPH, FACP, FACOEM Medical Director, Employee Health and Safety, University of Maryland Medical Center. David Ippolito Director – Office of Science and Technology Assessment USDOL/OSHA More excerpts from a presentation by:

Who is a First Receiver? First Receiver Job Titles: Physician Nurse Administration Security Officer Phlebotomist Respiratory Tech Resident X-ray Tech Healthcare workers at a hospital receiving contaminated victims for treatment. Koenig K Strip and shower: the duck and cover for the 21st Century. Annals of Emergency Medicine. 42(3): September.

First Receiver Job Functions
Triage Assist in Decontamination Post Decontamination Inspection Provide clinical testing, treatment and transport Provide direct clinical assessments and care Gather personal information Close Patient Contact

Important Considerations
Traditional Response Site divided into 3 functional zones – based on exposure potential. OSHA used hospital-specific terminology – Limited to only 2 zones Decontamination Post-Decontamination In most situations, hospitals will not know what is contaminating the victims Victims will arrive with little or no warning – Self Referrals – up to 80% Exposure Potential – dictated by roles and functions From these roles and functions one can estimate the anticipated worst case exposure In the case of a traditional first responder, they are confronted with a HOT or EXCLUSION ZONE where large quantities of contaminant can exist or continue to leak. Not true of a First Receiver. As I mentioned previously exposure potential is limited.. Limited to……. Best to prepare for the worst reasonably anticipated situation including chemical WMD where you won’t know what your facing and probably have more than you planned for.

Self Referred victims will go to the nearest hospital Many self referred victims will not have actually been exposed Some, or many victims will arrive needing decontamination Victims don’t care which hospital is designated or which hospital is best prepared. You plans need to anticipate the need to separate the worried well from the actual victims AND to have a decontamination team and the infrastructure, training and administrative tools to support the teams.

Victims will use all hospital entrances Non Ambulatory victims will take at least 2-4 times more personnel to decontaminate Being part of the Community Based Response Plan reduces risk to first receivers and presents problem solutions This reality impacts your planning for the safety of security personnel A function of the extent of their injuries Increases the chance that your hospital will get crucial information in real time from the incident scene such as the contaminant in question

Functional Zones Post Decontamination Decontamination Zone Zone
The Hospital Decontamination Zone includes any areas where the type and quantity of hazardous substance is unknown and where contaminated victims, contaminated equipment, or contaminated waste may be present. It is reasonably anticipated that employees in this zone might have exposure to contaminated victims, their belongings, equipment, or waste. This zone includes, but is not limited to, places where initial triage and/or medical stabilization of possibly contaminated victims occur, pre-decontamination waiting (staging) areas for victims, the actual decontamination area, and the post- decontamination victim inspection area. This area will typically end at the ED door. In other documents this zone is sometimes called the “Warm Zone.” The Hospital Post-decontamination Zone is an area considered uncontaminated. Equipment and personnel are not expected to become contaminated in this area. At a hospital receiving contaminated victims, the Hospital Post-decontamination Zone includes the ED (unless contaminated). In other documents this zone is sometimes called the “Cold Zone.”

Hot Zone = Uncontrolled
S I N SOLATION Hazard Control Zones Cold Zone = Incident Control Warm Zone = Entry Team Preparation For a hazmat spill this is what the scene layout may look like. Hot Zone = Uncontrolled Product

Decontamination Zones OSHA First Receivers
SOLATION Decontamination Zones OSHA First Receivers Pre-Decontamination Zone Decontamination Zone Post-Decontamination Zone OSHA doesn’t use a “Pre-decontamination Zone” designation, but we do. Treat the area where the most contaminated people are being held (the Safe Refuge Area) as if it were the Hot Zone and thus where the greatest hazards exist and where the greatest precautions are taken.

Decontamination Control Zones
SOLATION Decontamination Control Zones Pre-Decon = Staging of “dirty” People Decon = Removing Contamination This is what they may look like. We will cover this more later. Post-Decon = Medical Care

ICS Haz Mat Organization
Hazardous Materials Group Positions Haz Mat Group Director Technical Reference Assistant Safety Officer* *Reports to Incident Safety Officer Spill Response Group Supervisor Victim Decon Group Supervisor Developed by the FIRESCOPE Hazardous Materials Specialist Working Group. Intended for HAZMAT teams. We went over this in the Foundation module.

Haz Mat Decon Resource Team
Incident Commander Public Info Officer Liaison Officer Safety Officer Logistics Chief Planning Chief Finance Chief Operations Chief Medical Care Director Victim Decon Group Sup. Ancillary Services Human Resources HazMat Branch Forward Unit Leader Services Unit Leader Rapid Intervention Leader Site Access Control Initial Contact Decon Triage Stripper / Bagger Washer / Rinser Dryer / Dresser Non-Ambulatory Rapid Intervention Preparation Unit Leader Site Logistics Site Set Up PPE Donning Team Re-Hab Area Site Support PPE Doffing Refuge Area Safe Haven Hospital-Based Command and Control I. At the hospital we are really only doing the Decon component. Thus the Decon Resource Team. II. [hand out Decon Resource Team Job Action Sheets] Discuss roles of these sections: - Decon Group Supervisor - Assistant Safety Officer - Site Access Control - Set Up / Support - Initial Contact - Triage - Stripper / Bagger - Washer / Rinser - Dryer / Dresser

Haz Mat Branch Director
Assistant Safety Officer Technical Specialists Spill Response Group Supervisor Victim Decon Group Supervisor Preparation Unit Leader Forward Unit Leader Services Unit Leader Rapid Intervention Leader Site Access Control Site Logistics Stripper / Bagger Rapid Intervention Site Set Up Initial Contact Washer / Rinser Refresh the class on the positions. Team Re-Hab Area PPE Donning Decon Triage Dryer / Dresser Site Support Refuge Area Non-Ambulatory PPE Doffing Safe Haven

Preparation Unit Leader Rapid Intervention Unit Leader
Decon Group Supervisor Preparation Unit Leader Assistant Safety Officer Rapid Intervention Unit Leader This excerpt comes from the Disaster Interest Group Recommendations in the notebook. This and the next series of slides is intended to have the students understand the evolution of a decon activities and how each position fits into the operation. Have them look at the overall slide. The following slides deconstruct the diagram into manageable chunks.

Decon Forward Unit Leader
Initial Contact Site Access Decon Triage Site Access Control (generally Security) maintains the integrity of the facility by moving contaminated patients to a location near where decon will take place (Safe Refuge Area). Initial Contact greets the (frightened) victims, explains what is going to happen and why, and prepares them for decon. Decon Triage begins to determine who needs to be deconned first. This is based on acuity of contamination and/or injury, preexisting conditions, and other factors. Meanwhile Set Up and Support in an uncontaminated location is preparing the decon area to be operational. (Set Up and Support should be Awareness trained at a minimum. If they are Operations trained they can transition to decon task specific activities once set up is completed.) Set-Up and Support

Decon Triage determines whether decon is needed and what order victims get decontaminated.

Services Unit Leader Refuge Area Stripper/Bagger Washer/Rinser
For those that need decon the Stripper/Bagger helps the victims to remove the clothing, separate the valuables, and bag the clothes. The Washer/Rinser helps the victims with soap and water repeating as many times as necessary. For non-ambulatory patients these activities will have to be done by the worker not merely assisting or supervising. Non-ambulatory victims are much more labor intensive and take more time than ambulatory patients. The Dryer/Dresser does what the name implies, but before that is accomplished the Gatekeeper must determine the adequacy of the decon. If not thorough, decon again. Dryer/Dresser

Safe Haven Once the victim is no longer a danger to themselves or others they can proceed to receive definitive medical care. Once completed, hospital personnel should not require chemical protective clothing.

Review the big picture once again.

Management of the Contaminated Patient
Refer back to Module I appendix to review Management of the Contaminated Patient for more than 5 people. Take the students through the document and highlight the key points. Video Refer to Mod. I just after Glossary Mod I

Dirty Cleaner Cleaner Clean Clean Refuge Area Safe Haven Area
Patients entering from Hot (Exclusion) Zone Decon Resource Team Refuge Area Decon Initial Contact Unit Leader Dirty Decon Triage Unit Leader (Stay upwind & keep distant from patients) stripper, bagger Highly Contaminated Patients Shower one / tub one Decon Resource Team Warm Zone washer Less Contaminated Patients Cleaner Contamination Reduction Corridor Shower two / tub two Decon Resource Team Warm rinser Zone Cleaner Less Contaminated Patients Clean Un Contaminated Patients Safe Refuge- where to hold patients prior to decon Safe Haven- where to hold patients that have been deconned, prior to entering ED Decon Resource Team dryer, dresser Un Contaminated Patients Clean Safe Haven Area Patients exit to Cold (Support) Zone Gatekeeper - admittance checklist

Tools for Stability in Decon
Here are examples of items that are found in the hospital and can be used to make decontamination more efficient and safer in moving from station to station and for donning and doffing. They are designed to get wet and can be either decontaminated after the event or disposed appropriately.

What about Children? Design decontamination systems so that they can be used for decontamination of children: of all ages (including infants), of the parentless child, of the non-ambulatory child, and of the child with special health care needs. Address the following pediatric considerations in all protocols and guidance for decontamination: 1) water temperature and pressure (high-volume, low- pressure, heated water systems), 2) non-ambulatory children, 3) children with special health care needs, and 4) clothing after decontamination. Recognize the need for addressing special needs patients – children and adults. Query class and ask about other special needs patients. (Frail, hearing/sight impaired, language issues, hysterical) Thanks to Janet Houston, MHA NH EMSC Project © EnMagine, Inc All Rights Reserved

What about Children? Children without parents will require additional personnel to assist in decontamination and emotional support; Keep kids warm; Ensure appropriately sized clothing, including diapers; Develop systems to identify, tag and track unaccompanied children. © EnMagine, Inc All Rights Reserved

What About Other Special Populations?

What About Your Team? Team members must be clean before they leave the decontamination zone Stripper/Bagger = the most dirty Dryer/Dresser = the least dirty Washer/Rinser = the most physically at-risk The team must clean each other in their full PPE in the washing-rinsing area Start with all members gathering at the Stripper/Bagger area Decon Triage assumes command of process Examine each team member for physical problems Determine which member should be decon’d first This procedure is critical for the team to understand and practice well to assure safety when doffing the PAPR. The use of the Decon Triage as Team Leader of this process is driven by the assumption that they are the most qualifed of all decon team members to determine the fitness of all team members.

Deconing the Decon’rs Dryer/Dresser steps into wash-rinse area
Remains in complete PPE Assumes task of cleaning all other team members Cleans Washer/Rinser team member first Work from head to toe Spending sufficient time ensuring a thorough cleaning Once cleaning is complete the Washer/Rinser steps through the drying-dressing area Proceeds to doffing area Dryer/Dresser is cleaning people who, we must assume, have contaminated PPE so the cleaning process must be thorough. The Washer/Rinser should be the most tired and stressed but not necessarily the most contaminated. Each team member’s PPE is considered to be contaminated and cleaned accordingly.

Completion of Team Decon
All team members move through the wash-rinse area one at a time No team member exits to doffing area until thoroughly cleaned Clean members move to doffing area just outside of the drying-dressing area Removal of PPE begins immediately upon arrival at doffing area Last team member washes Dryer/Dresser The last team member that is cleaned becomes the washer of the Dryer/Dresser. Remember that the Dryer/Dresser should not have had any contamination during victim decon and has been in running water with lots of soap while cleaning other team members.

Goal of Team Decon Team members PPE has been exposed to contamination
No team member must leave the washing-rinsing area until thoroughly cleaned Safety of the team member(s) is the most important goal This includes the other members who will be assisting in doffing of the PPE The assistants in the doffing area will be wearing Standard Precautions so will have limited protection from contaminates. If the team decon washing is done well this is not a concern.

Decontamination Procedures
© EnMagine, Inc All Rights Reserved

Fire Department / Haz Mat Team Examples
Mass Decon Fire Department / Haz Mat Team Examples Go through these quickly. © EnMagine, Inc All Rights Reserved

This is a method of using two fire engines for a makeshift decon area.

Note the dishwashing soap on the left
Note the dishwashing soap on the left. Traditionally firefighters use a 30/30/30 technique- 30 gpm, 30 degree fog nozzle, at 30 psi. © EnMagine, Inc All Rights Reserved

The firefighters should be in PPE and the victim should be undressed and not in a head-down position. A Stokes litter is useful since you can get water all the way around the victim. © EnMagine, Inc All Rights Reserved

This is a system using two deck guns (monitors)
This is a system using two deck guns (monitors). These devices can shoot up to 1000 gpm at enough pressure to take your skin off. By directing the water streams into each other above the victims the pressure is dissipated and a very high volume deluge is created. © EnMagine, Inc All Rights Reserved

Decon Shelters Should be considered interim (until remodel?)
Factors to consider: Ease of use (set up) Space Weight Durability Heat/Cold Plumbing Moving parts Repair Size Lanes Stations Price Hospitals are acquiring decon shelters. These are interim measures. If it takes too long (~more than 10 minutes) to set up and take patients; and/or requires a lot of staff to erect- the mission is not being met and victims will seek other means of getting care.

Shelter Types Erector Set Exo/Endo-skeleton Bounce House
Post Office Tote Here we quickly go through the basic types of shelters on the market. Go quickly through this. Skip if not relevant.

Erector Set

Exoskeleton

Bounce House

Post Office Tote

Don’t forget the Accessories
Pallettes Plumbing Heaters Coolers Sump pumps Tarps Guys Bladders, barrels, containment pools

Fixed, Easily Activated, Protected Decon Facilities are the Preferred Option
Some Examples The following are examples of fixed facilities at hospitals and is intended to show different configurations of decon areas. If the training is being held at a hospital with its own decon area, you can skip or move quickly through this section.

Noble Training Center Anniston, AL

VICTIM DECONTAMINATION FACILITY
VANDERBILT UNIVERSITY MEDICAL CENTER © EnMagine, Inc All Rights Reserved

Entrance to Emergency Department
Site of Decon Unit Entrance to Emergency Department © EnMagine, Inc All Rights Reserved

Circular Drive at Front of Med Ctr
Site of Decon Unit Circular Drive at Front of Med Ctr © EnMagine, Inc All Rights Reserved

Routinely used as break area. During emergency, site of decon unit.

Deploying the shower curtains

Curtain separates male/female ambulatory decon lines

Drop down sprayers help with final rinse of ambulatory and decon of non-ambulatory victims

Off/on box and mixing unit for shower

Deluge shower head – five on each line

Fully deployed shower Entrance for ambulatory victims
Disrobing area for ambulatory victims Shower lines for ambulatory victims Fully deployed shower © EnMagine, Inc All Rights Reserved

Looking down the ambulatory men’s shower line

Assisting an ambulatory victim (drill)

Decon’ing a non-ambulatory victim

Hahnemann University Hospital Philadelphia, PA
Patient Decontamination Room

Outside Entrance External SAR Hookups
External Frost Free Shower Heads External SAR Hookups Non Ambulatory Entrance with ramp Ambulatory Entrances

MSA Safesite CWA Detector (SAW Technology)
Inconspicuous and Nonlabeled w/remote annunciation at guard stand inside

Close-up of External SAR Hookups

Waste Collection Tank Pump-Out Port

Post Decon Area Entrance to ED after Decon

VOC / HF / H2S Fixed Gas Detection
VOC’s

Decon Room Hose Lines Coiled SAR Lines Eyewash Station Conveyors

Ambulatory Entrances (separated by wall in middle)

Non Ambulatory Entrance
External Radiation monitor – transported outside for screening of ambulatory victims and does not hinder ingress for non – ambulatory victims during incident

Close–up of VOC/HF/H2S Sensors (Non-Ambulatory Entrance

Dedicated Ventilation – Decon Switch for increased exhaust and negative pressurization
VOC sensor (Ceiling)

Eyewash Station VOC/HF/H2S Sensors at Exit

Laminated Decontamination Procedures
Staff reference and reminders to ensure thorough Decon of patients

Additional Procedures

Drains for AST in Basement

500 Gallon Waste Collection Tank in Basement

Pre Decon Staging Area – Inside ED
PAPR’s SAR’s SCBA’s Other PPE and Equipment Boots

Practice Exercise Activity Pick Your Team & Get Wet!
Now is the time to put it together. There are many ways to run the exercise but the essence is to have the students demonstrate competency. One way is to designate a Victim Decon Group Supervisor and have that person assign the remainder of the positions. Whoever is left over can be victims. (Suggestion: laminate the org chart, Job Action Sheets, donning/doffing instructions, and Schematic. Have clip boards and grease pencils.) Everyone outside Set-up Tent either as a group or with smaller group Don decon team up to not placing PAPR over head Gather entire class at Site Access Control point Place Initial Contact and Decon Triage members exactly where you want them to be during exercise Explain what their jobs are to everyone’s satisfaction Move to Stripper/Bagger position and repeat placement and explanation of duties through Washer/Rinser to Dryer/Dresser. Turn exercise over to Decon Unit Leader and conduct exercise from donning PAPR to all victims being decontaminated. (Hint: Keep it simple in the beginning. Don’t have the scenario too complex and minimize complications.) Go through the process, hopefully running water and getting wet. When done, have the decon positions decon themselves (Decon decons Decon) starting at the Washer/Rinser using the Dryer/Dresser, who should be the least contaminated, as the new Team Decon Washer/Rinser. Ensure they take this activity seriously and actually perform Decon. We act in an emergency as we act in training! Do it again - rotating victims with responders/receivers. Do it again.

What do you do/ What does it mean if one of the Decon Resource Team goes down?
Discuss possibilities: Incompatible PPE Improper use of PPE Heat Stress Physical Injury Illness (e.g., heart) What to do? Get responder, now victim, out of area for medical care and to determine cause. Stop or modify operations until cause is determined. Take appropriate actions. Recognize that when a responder/colleague is injured, the other responders are now concerned, scared, have less resources. © EnMagine, Inc All Rights Reserved

Disposal Requirements
Strict legal requirements Track from cradle to grave You must know them and follow them Regs apply to government agencies also! Baby Neil It may not be your fault, but until determined otherwise, it is your responsibility. There has some discussion over whether organizations are responsible for the wastewater. See FIRST RESPONDERS’ FIRST RESPONDERS’ ENVIRONMENTAL ENVIRONMENTAL LIABILITY DUE TO MASS LIABILITY DUE TO MASS DECONTAMINATION DECONTAMINATION RUNOFF RUNOFF in Handouts. Note hospitals are fixed facilities and may be held responsible for runoff. Further there are state and local enforcement agencies for environmental and other (e.g., fish and game) regulations that may consider the hospitals liable. The best bet is to prepare for what is reasonable for your community based on a hazard and vulnerability assessment. © EnMagine, Inc All Rights Reserved

Reasons for Documentation
Cost recovery Exposure records Training records Future lawsuits & investigations, etc. Remember a real incident may count as part of the annual exercise requirements under the JCAHO standards, as long as other criteria are met. © EnMagine, Inc All Rights Reserved

Components of Documentation
Date, time and location Names of all response personnel And exposure times! Incident conditions, observations and statements Chemical names, weather conditions, release factors © EnMagine, Inc All Rights Reserved

Components of Documentation
Actions taken, resources used, costs incurred Casualties, sample data, etc. Statements & Observations of witnesses Diagrams, photos, video, samples © EnMagine, Inc All Rights Reserved

Chemical Exposure Records
Mike Zolotoff Salazar, Robert Keep exposure records! Employer must keep for 30 years following an employee leaving the company All responders: keep own copies This may be valuable down the road if you develop a medical condition that might be related to your work activity. Records can be lost. Keep your own. © EnMagine, Inc All Rights Reserved

Post Event Monitoring Environmental concerns (Work with state/local/federal agencies) Air/Water/Soil/Ground Monitoring Personnel (Work w/Employee Health Services) Respiratory Monitoring Chronic and Acute exposure and affects Chemical Exposure Records for files During and after the event it is important to work with environmental health/management agencies to determine what impacts of the event may have occurred to the environment. Also work with the ED and Employee Health/Occupational Medicine to ensure that all potentially exposed individuals have the appropriate tests, monitoring, and documentation of their exposure. It must be noted that while we are pretty good at understanding “how clean is clean” for air, soil, and water- we are not very good at being able to determine “how clean is clean” when it comes to people. Understanding signs and symptoms and close observation are key. In some cases (e.g., a person contaminated with a corrosive- dabbing the wet skin with pH paper) there are good tools and indicators but not many. © EnMagine, Inc All Rights Reserved

S.I.N. When clues indicate possible Haz Mat
Be cautious Approach upwind, upgrade & upstream At a safe distance! Use natural barriers, avoid vapors/liquids Your safety is the most important aspect of the response © EnMagine, Inc All Rights Reserved

S.I.N. Do safe size-up Identify primary safety concern
Position vehicles headed away from event Deny entry via safe entry point Stop at visual sighting, use binoculars and do safe size-up; Identify primary safety concern and establish safety guides; Position vehicles headed away from and not too close to event; Don't forget to isolate and deny entry via safe entry point; © EnMagine, Inc All Rights Reserved

C.I.A. Command Identification and Hazard Assessment Action Planning C

C.I.A. First responder: assume temporary IC
Maintain initial CP in safe area Begin IDHA with NA ERG Verify with 3 sources Brief IC at Incident Post & aid in IDHA If you are first response unit on-scene, assume temporary IC; Maintain your position in safe area as initial Command Post; Begin IDHA with DOT ERG; verify with at least 3 sources; Brief IC at Unified/Joint Command Post and aid in IDHA; © EnMagine, Inc All Rights Reserved

D.D.D. Decontamination Disposal Documentation

D.D.D. Ensure decon is conducted Do proper disposal

Objectives Explain decontamination procedures for victims, personnel, and equipment. Discuss application of relevant Standard Operating Guidelines. Describe.

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Objectives Explain decontamination procedures for victims, personnel, and equipment. Discuss application of relevant Standard Operating Guidelines. Describe.

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Presentation on theme: "Objectives Explain decontamination procedures for victims, personnel, and equipment. Discuss application of relevant Standard Operating Guidelines. Describe."— Presentation transcript:

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