CBRNE Training Academy An Introduction to Decontamination and Personal Protective Equipment (PPE)

Lecture Goals Describe decontamination Discuss how decontamination works Detail what techniques are available Describe personal protective equipment Describe complications of PPE Describe decontamination Discuss how decontamination works Detail what techniques are available Describe personal protective equipment Describe complications of PPE

What is decontamination? An attempt to alter absorption Prevent secondary contamination The removal of hazardous substances from employees and their equipment to the extent necessary to preclude the occurrence of foreseeable adverse health effects OSHA 29CFR An attempt to alter absorption Prevent secondary contamination The removal of hazardous substances from employees and their equipment to the extent necessary to preclude the occurrence of foreseeable adverse health effects OSHA 29CFR

Who needs decontamination? Powder, liquid or vapor exposure Decontaminate exposed* areas Situation in which you are unsure Everyone Powder, liquid or vapor exposure Decontaminate exposed* areas Situation in which you are unsure Everyone

Basic assumptions The hospital is not the scene EMS/Fire decontaminate patients, but… 60-80% of people self present The hospital is not the scene EMS/Fire decontaminate patients, but… 60-80% of people self present

Self presentation 90% contamintaion on clothing and hair So, if someone is exposed and he self-presents and he is not sick... He is likely only mildly contaminated and can self-decontaminate and poses little risk. 90% contamintaion on clothing and hair So, if someone is exposed and he self-presents and he is not sick... He is likely only mildly contaminated and can self-decontaminate and poses little risk.

Decontamination triage Contaminated, sick –Assisted decontamination and therapy Contaminated, not sick –Self-directed decontamination Decontaminated (at scene) –Medical evaluation and treatment Contaminated, sick –Assisted decontamination and therapy Contaminated, not sick –Self-directed decontamination Decontaminated (at scene) –Medical evaluation and treatment

Decontamination is simple… Get Naked Get Wet Get Naked Get Wet

A note about soap... Copious water is most important Mild detergent is all you need, if at all Bleach is not necessary –Irritant in wrong concentration Copious water is most important Mild detergent is all you need, if at all Bleach is not necessary –Irritant in wrong concentration

Types of decontamination Mass Decontamination Ambulatory Decontamination –Directed Self-decontamination –“Trash Bag” Decontamination Non-ambulatory Decontamination Mass Decontamination Ambulatory Decontamination –Directed Self-decontamination –“Trash Bag” Decontamination Non-ambulatory Decontamination

Mass decontamination Dilution is the solution to pollution Many people, little finesse Fire department / HazMat team Dilution is the solution to pollution Many people, little finesse Fire department / HazMat team

Ambulatory decontamination What is wrong with this picture? Get naked, get wet What is wrong with this picture? Get naked, get wet

Non-ambulatory decontamination Help those who can’t help themselves

Directed self-decontamination Do-it-yourself decontamination –Instructions posted or broadcast –Something to do besides wait... Gives time for team to assemble –Appropriately don PPE –Focus on those who can’t help themselves Simple –Disrobe, collect valuables –Wash Do-it-yourself decontamination –Instructions posted or broadcast –Something to do besides wait... Gives time for team to assemble –Appropriately don PPE –Focus on those who can’t help themselves Simple –Disrobe, collect valuables –Wash

“Trash bag” Decontamination Do-it-yourself kit –Large, opaque plastic bag –Large clear plastic bag –Small clear plastic bag –Pre-numbered tags/labels Opaque bag is portable dressing room Clear bags for clothes, valuables Labels to assist in tracking Do-it-yourself kit –Large, opaque plastic bag –Large clear plastic bag –Small clear plastic bag –Pre-numbered tags/labels Opaque bag is portable dressing room Clear bags for clothes, valuables Labels to assist in tracking

Decontamination issues Safety –Establishing security, zones Environment –Waste water, temperature, ground cover Property –Valuables, tracking Modesty –Cultural, religious and personal values Special –Language, adults & kids, special needs Safety –Establishing security, zones Environment –Waste water, temperature, ground cover Property –Valuables, tracking Modesty –Cultural, religious and personal values Special –Language, adults & kids, special needs

A brief note on therapy... Decontamination is a priority Pre-decontamination therapies are basic –Bag-valve-mask with oxygen –Spine board and cervical collar –Compression dressing / bandage –Mark I auto-injectors Do not delay for more than this! Decontamination is a priority Pre-decontamination therapies are basic –Bag-valve-mask with oxygen –Spine board and cervical collar –Compression dressing / bandage –Mark I auto-injectors Do not delay for more than this!

Remember Warm is where decontamination occurs Cold is where treatment occurs Warm is where decontamination occurs Cold is where treatment occurs

Personal Protective Equipment An Introduction

Nothing special about it Used everyday, often overlooked Three layers of protection –Basic protective and safety gear Skin and work clothes Oven mitt, apron, glasses Earplugs, back belts, work boots, hard hat –Standard infectious precautions Gowns, gloves, booties, masks –Advanced Personal Protective Equipment PAPR, SCBA Used everyday, often overlooked Three layers of protection –Basic protective and safety gear Skin and work clothes Oven mitt, apron, glasses Earplugs, back belts, work boots, hard hat –Standard infectious precautions Gowns, gloves, booties, masks –Advanced Personal Protective Equipment PAPR, SCBA

How are we exposed? Determines decontamination Determines what PPE we wear Determines decontamination Determines what PPE we wear

The last line of defense... Ideally, we aren’t exposed Healthcare has chemical and biological protective gear We don’t have protection against... –Fire –Explosions –High energy radiation No gear protects against everything Ideally, we aren’t exposed Healthcare has chemical and biological protective gear We don’t have protection against... –Fire –Explosions –High energy radiation No gear protects against everything

The Basics

Standard precautions Hand washing Clothes (uniforms, gowns, etc.) Gloves, glasses Masks and splash shields Limited respiratory & splash protection Hand washing Clothes (uniforms, gowns, etc.) Gloves, glasses Masks and splash shields Limited respiratory & splash protection

Hospital PPE Add liquid splash protection –Fluid resistant suit Add higher respiratory protection –Air purifying respirator Add liquid splash protection –Fluid resistant suit Add higher respiratory protection –Air purifying respirator

Industrial PPE Same skin protection Highest level of respiratory protection –Atmosphere supplying respirator –Don’t need oxygen atmosphere Same skin protection Highest level of respiratory protection –Atmosphere supplying respirator –Don’t need oxygen atmosphere

Hot zone PPE Highest level of skin and respiratory protection –Atmosphere supplying respiratory –Vapor protective suit A body bag with a window Highest level of skin and respiratory protection –Atmosphere supplying respiratory –Vapor protective suit A body bag with a window

The Hierarchy In healthcare, we work in the cold zone –Standard precautions, hand washing –Use this everyday In an event, we add a warm zone –Level C PPE –You may be asked to use this We NEVER work in the hot zone –Level A and B –You will NEVER be asked to do this In healthcare, we work in the cold zone –Standard precautions, hand washing –Use this everyday In an event, we add a warm zone –Level C PPE –You may be asked to use this We NEVER work in the hot zone –Level A and B –You will NEVER be asked to do this

When should we use PPE? ALWAYS At a minimum, standard precautions If you are unsure of the exposure, use the highest level available to you As directed by HEICS ALWAYS At a minimum, standard precautions If you are unsure of the exposure, use the highest level available to you As directed by HEICS

Important Be aware Remember potential exists –Situation can and may change Follow HEICS Need more protection than you have? –If so, get out (S-I-N) –Call for help (911, HazMat, etc.) Be aware Remember potential exists –Situation can and may change Follow HEICS Need more protection than you have? –If so, get out (S-I-N) –Call for help (911, HazMat, etc.)

Advanced PPE = Bag You are living in a bag –Can’t eat, drink, go to the bathroom You are working in a bag –You can’t hear or talk –Slips, trips and falls –Claustrophobic You are exercising in a bag –Dehydration –Heat exhaustion, stress and stroke You are living in a bag –Can’t eat, drink, go to the bathroom You are working in a bag –You can’t hear or talk –Slips, trips and falls –Claustrophobic You are exercising in a bag –Dehydration –Heat exhaustion, stress and stroke

Health and monitoring Hydrate –Before and after –At least 8 oz. of water Brief assessment –Before and after –Pulse, blood pressure Be aware of how you feel 20 to 30 minutes per “shift” Hydrate –Before and after –At least 8 oz. of water Brief assessment –Before and after –Pulse, blood pressure Be aware of how you feel 20 to 30 minutes per “shift”

Summary Decontamination removes secondary contamination Get naked, get wet Maintain the zones PPE is the last line of defense It is not perfect It is difficult and hot Decontamination removes secondary contamination Get naked, get wet Maintain the zones PPE is the last line of defense It is not perfect It is difficult and hot

Questions ?