1. 07-2007 Decon-Ref v.1.0 1 NDLS-DECON “REFRESHER”

2. 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.

3. 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

4. 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

5. 07-2007 Decon-Ref v.1.0 5 Introduction Chapter 1

6. 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

7. 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

8. 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)

9. 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

10. 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)

11. 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.

12. 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?

13. 07-2007 Decon-Ref v.1.0 13 Consequences of Non-preparedness  Patients: Morbidity/mortality  Healthcare facilities: closures  Healthcare Providers: Morbidity/mortality

14. 07-2007 Decon-Ref v.1.0 14 Definitions & DISASTER Paradigm Review

15. 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

16. 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

17. 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!

18. 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

19. 07-2007 Decon-Ref v.1.0 19 “All-Hazards” Man-made  Fires  Explosive devices  Firearms  Structural collapse  Transportation event ► Air, Rail, Roadway, Water  Industrial HAZMAT  WMD – NBC events  Etc… Natural  Earthquake  Landslides  Avalanche  Volcano  Tornado  Hurricanes, floods  Fires  Meteors  Etc…

20. 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

21. 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

22. 07-2007 Decon-Ref v.1.0 22 Chemical Weapons  “Nerve agents”: GA, GB, GD, VX  “Blood agents”: Cyanide  “Blister agents”: Mustard, Lewisite  “Choking agents”: Phosgene, Chlorine  “Incapacitating agents”: BZ

23. 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

24. 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

25. 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

26. 07-2007 Decon-Ref v.1.0 26 Anthrax as WME “Asymmetric” warfare:“Asymmetric” warfare: “Small event”“Small event” Widespread effectWidespread effect

27. 07-2007 Decon-Ref v.1.0 27 Biological Weapons Biological Weapons Smallpox Plague Anthrax

28. 07-2007 Decon-Ref v.1.0 28 Biological Events Influenza 1918-1919 Influenza 2007?

29. 07-2007 Decon-Ref v.1.0 29 Epidemics Severe Acute Respiratory Syndrome 2003 SARS (Corona virus)

30. 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

31. 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

32. 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

33. 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…

34. 07-2007 Decon-Ref v.1.0 34 DISASTER Paradigm  Detection  Incident Command  Safety & Security  Assess Hazards  Support  Triage & Treatment  Evacuation  Recovery Natural & AccidentalNatural & Accidental Trauma & ExplosiveTrauma & Explosive Nuclear & RadiologicalNuclear & Radiological Biological AgentsBiological Agents Chemical AgentsChemical Agents

35. 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

36. 07-2007 Decon-Ref v.1.0 36 Questions?

37. 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

38. 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