Decontamination Principles and Patient Management

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

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

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

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

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

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, 1910.120)

Levels of Protection Bunker Gear ? Greater Hazard Higher Burden Level

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

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

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)”?

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

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

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

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

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

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

Address Psychological Effects 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 Responses following an event may include: Horror Anger Panic Paranoia Fear of contagion Demoralization Social isolation Unrealistic concerns about infection

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

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

Decontamination Planning Process

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

Decon Planning Required by: JACHO AOHA OSHA State OSHA DEQ

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

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

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

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)

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

Prior Planning Prevents Poor Performance 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