Haz Mat for Healthcare: An Operations Level Course Decontamination, Disposal, Documentation Module IV 1.4 Haz Mat for Healthcare: Module IV

Objectives Explain decontamination procedures for victims, personnel, and equipment. Discuss application of relevant Standard Operating Procedures. Describe proper disposal and documentation procedures during a Haz Mat response. 1.4 Haz Mat for Healthcare: Module IV

Foundation Objectives continued The Hazmat Response Process -Operations Level -Command -Identification -Protective Equipment -Action Plans -Containment / Control -Protective Actions -Decon -Disposal -Documentation C I A P C I. Remember in the Awareness class we introduced this pneumonic 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 pneumonic. In this class (module II), we will cover: C I A (P) C P We’re skipping the 1st ‘P’ for now 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 1.4 Haz Mat for Healthcare: Module IV

Decontamination Removing or neutralizing contaminants Personnel Equipment

Types of Decon Primary Secondary Emergency Done at the scene Done post incident Emergency Normally done by first responders

Who, What, When & Why Why: Prevent escalation of problem Exposure: it might be on you Contamination: it is on you 1.4 Haz Mat for Healthcare: Module IV

Degree of Contamination Amount of material on you Length of time it’s on you Concentration of material Physical state of material Ambient temperatures

Who, What, When & Why When: Anytime you suspect contamination Material is visible Victim complains of pain, odor, etc. Victim was near release

Who, What, When & Why Who/What: People & equipment Victims Responders Structures

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 1.4 Haz Mat for Healthcare: Module IV

Performing Decon Physical removal Chemical removal Emergency decon

Performing Decon Dirty Procedures follow logical order Go from “dirty” to “clean” Check your plan Dirty Clean Filthy

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). 1.4 Haz Mat for Healthcare: Module IV

Consequences of No Decon Acute/Chronic health effects Problem gets bigger Death! oooo-aaaaah! 1.4 Haz Mat for Healthcare: Module IV

Emergency Decon Anytime you suspect contamination Use common sense Life risk Level of exposure

Emergency Decon Use copious amount of water Copious=more than you have used Remove all clothing from victim Including undergarments

Emergency Decon Precautions Avoid contact w/clothing Ensure privacy of victim(s) Barriers/temp garments Segregate by gender

Emergency Decon Medical considerations Decon prior to transport Protect equipment from contamination Segregate contaminated material

Patients arrive Activate Plan EVENT Patients arrive with or without notification Activate Disaster Plan and prepare staff to receive patient(s)

Triage Triage Patient(s) Decontamination Required?

No decontamination required Collect personal belongings/ evidence** NO Patient(s) to Treatment Area Redress Patient(s) with clean covering Reassessment and Treatment Disposition

Decontamination required Yes Activate hospital decontamination protocols Secondary Triage Collect personal belongings/ evidence** Undress Patient(s)

Able to perform Self-decon Assistance or Medical Treatment required? Patient(s) directed to Self-decontamination NO Assess for adequacy of decontamination**

within hospital capability Need assistance Assistance or Medical Treatment required? YES Provide assistance and/or treatment within hospital capability Decontaminate patient(s) Assess for adequacy of decontamination**

Evaluate decontamination Assess for adequacy of decontamination** Adequate? YES NO Re-decontaminate and/or provide technical decontamination**

Treatment / Disposition Adequate? YES Redress Patient(s) with clean covering Reassessment and Treatment Disposition

Management of the Contaminated Patient 1.4 Haz Mat for Healthcare: Module IV

Contamination Reduction Corridor Patients entering from Hot (Exclusion) Zone Safe Refuge Area Decon Resource Team 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 Warm Decon Resource Team Zone washer/ rinser Less Contaminated Patients Cleaner Contamination Reduction Corridor Shower two / tub two Warm Decon Resource Team Zone washer/ rinser Cleaner Less Contaminated Patients Decon Resource Team dryer, dresser, gatekeeper, admittance checklist Clean Un Contaminated Patients Safe Haven Area Patients exit to Cold (Support) Zone 1.4 Haz Mat for Healthcare: Module IV

ICS Haz Mat Organization Hazardous Materials Group Positions Haz Mat Group Supervisor Technical Reference Site Access Control Decon Leader Entry Leader Assistant Safety Officer* *Reports to Safety Officer 1.4 Haz Mat for Healthcare: Module IV

Haz Mat Decon Resource Team 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 - Safety Officer - Site Access Control - Set Up / Support - Initial Contact - Triage - Stripper / Bagger - Washer / Rinser - Dryer / Dresser 1.4 Haz Mat for Healthcare: Module IV

Decontamination Procedures 1.4 Haz Mat for Healthcare: Module IV

Fire Department / Haz Mat Team Mass Decon Fire Department / Haz Mat Team 1.4 Haz Mat for Healthcare: Module IV

Mass Decon Hospital Based 1.4 Haz Mat for Healthcare: Module IV

1.4 Haz Mat for Healthcare: Module IV

1.4 Haz Mat for Healthcare: Module IV

1.4 Haz Mat for Healthcare: Module IV

1.4 Haz Mat for Healthcare: Module IV

1.4 Haz Mat for Healthcare: Module IV

1.4 Haz Mat for Healthcare: Module IV

VICTIM DECONTAMINATION FACILITY VANDERBILT UNIVERSITY MEDICAL CENTER

Entrance to Emergency Department Site of Decon Unit Entrance to Emergency Department

Circular Drive at Front of Med Ctr Site of Decon Unit Circular Drive at Front of Med Ctr

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

Looking down the ambulatory men’s shower line

Assisting an ambulatory victim (drill)

Decon’ing a non-ambulatory victim

Practice Exercise 1.4 Haz Mat for Healthcare: Module IV

What do you do/ if one of the Decon Resource Team goes down? 1.4 Haz Mat for Healthcare: Module IV

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 1.4 Haz Mat for Healthcare: Module IV

Documentation & Reporting Need: get better handle on HazMat problem Role of FRO in documentation Capture key initial info Use ICS-214 1.4 Haz Mat for Healthcare: Module IV

Reasons for Documentation Cost recovery Exposure records Training records Future lawsuits & investigations, etc. 1.4 Haz Mat for Healthcare: Module IV

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 1.4 Haz Mat for Healthcare: Module IV

Components of Documentation Actions taken, resources used, costs incurred Casualties, sample data, etc. Statements & Observations of witnesses Diagrams, photos, video, samples 1.4 Haz Mat for Healthcare: Module IV

Chemical Exposure Records Mike Zolotoff Salazar, Robert Keep exposure records! Employer must keep for 30 years All responders: keep own copies 1.4 Haz Mat for Healthcare: Module IV

Chemical Exposure Records Date, time and location of incident Chemical name Type, concentration and duration of exposure Decon or medical aid given 1.4 Haz Mat for Healthcare: Module IV

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. 1.4 Haz Mat for Healthcare: Module IV

To summarize what we have learned in the FRO course

Role of the FRO Safely and competently respond Within appropriate – Level Resources and Capabilities 1.4 Haz Mat for Healthcare: Module IV

XII The Acronym Process There are 12 essential Tactical Operations in a safe and competent hazardous materials response. XII 1.4 Haz Mat for Healthcare: Module IV

S.I.N. Safety Isolate and Deny Entry Notifications C N A I S 1.4 Haz Mat for Healthcare: Module IV

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 1.4 Haz Mat for Healthcare: Module IV

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; 1.4 Haz Mat for Healthcare: Module IV

S.I.N. Establish a secure perimeter Make mandatory notifications & request aid Keep unnecessary people away 1.4 Haz Mat for Healthcare: Module IV

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; 1.4 Haz Mat for Healthcare: Module IV

C.I.A. Follow Incident Action Plan Have back-up plans Observe Perimeter & Control Zones Stay in Staging Area if no mission & not released 1.4 Haz Mat for Healthcare: Module IV

P. C. P Personal Protective Equipment Containment/Control Protective Actions 1.4 Haz Mat for Healthcare: Module IV

P.C.P. Use appropriate protective equipment Monitor for flammable/explosive vapors Use agreed upon emergency signals 1.4 Haz Mat for Healthcare: Module IV

P.C.P. Use buddy system & back-ups Take defensive actions Take appropriate protective actions 1.4 Haz Mat for Healthcare: Module IV

D.D.D Decontamination Disposal Documentation

D.D.D. Ensure decon is conducted Do proper disposal 1.4 Haz Mat for Healthcare: Module IV

D.D.D. Keep good documentation & exposure records Keep essential communications Consider teamwork essential Coordinate with all responders 1.4 Haz Mat for Healthcare: Module IV

Review Questions Vague and evasive answers Post Test 1.4 Haz Mat for Healthcare: Module IV