1. HazMat for WV Hospitals: Decontamination, Disposal, Documentation Module IV

2. This course was developed by EnMagine, who we wish to gratefully acknowledge. The material has been modified by WV DHHR in cooperation with the West Virginia Hospital Association’s Disaster Preparedness Task Force in the teaching of Hospital Decontamination.

3. Objectives Explain decontamination procedures for victims, personnel, and equipment. Discuss application of relevant Standard Operating Procedures. Describe proper disposal and documentation procedures during a Decon response.

4. Decontamination Removing or neutralizing contaminants –Personnel –Equipment

5. Types of Decon Primary/Technical –Done at the scene, usually by Emergency Services Secondary – Done at hospital for patients who received decon at the scene (detailed decon) Emergency –Done at hospital for patients who have bypassed on-scene decon

6. Who, What, When & Why Who/What: People & equipment –Patients –Responders –Equipment

7. Who, What, When & Why Who should do Decon : –properly trained & equipped personnel What/How to Decon: –Decon individuals who have not received primary decon and those who need secondary decon –No absolute method of decon –Only general guides for decon

8. Who, What, When & Why When: Anytime you suspect contamination –Material is visible –Patient complains of pain, odor, etc. –Patient was in the release

9. Who, What, When & Why: Degree of Contamination Amount of material on the patient Length of time it’s on the patient Concentration of material Physical state of material Ambient temperatures

10. Who, What, When & Why Why: Prevent escalation of problem –Exposure: patient is exposed to release or product –Contamination: it is on patient –Exposure of others; contamination of facility, etc.

11. Who, What, When & Why Consequences of No Decon Acute/Chronic health effects Problem gets bigger Death!

12. Performing Decon Physical removal Chemical removal Emergency Decon

13. Performing Decon Procedures follow logical order Go from “dirty” to “clean” Check your plan

14. Decon Procedures Anytime you suspect contamination Use common sense –Life risk –Level of exposure

15. Decon Procedures Remove all clothing from victim –Including undergarments Use copious amounts of water –Copious=more than you have used Large amounts: high volume

16. Decon Procedures Precautions –Avoid contact w/clothing (use PPE) –Ensure privacy of victim(s) Barriers/garments Segregate by gender

17. Decon Procedures Hospital Considerations –Did individuals receive decon prior to transport? –Protect staff/facility/equipment –Secure contaminated clothing

18. Patients arrive Activate Plan? EVENT Patients arrive with or without notification Follow your hospital’s plan

19. Triage Triage Patient(s) Decontamination Required? NO Yes

20. No decon required NO Patient(s) to Treatment Area Assess and Treat Disposition

21. Decon required Yes Activate hospital Decon protocols Collect personal belongings/ evidence** Emergency Treatment required? Secondary Triage

22. Able to perform Self-decon? YES Patient(s) directed to Self-decon Assess for adequacy of decon**

23. Need assistance? Assistance or Medical Treatment required? Assess for adequacy of decontamination** YES Safely provide assistance and/or treatment within hospital capability Decon patient

24. Evaluate decon Assess for adequacy of decon** Adequate? YESNO Re-decontaminate and/or provide technical decon**

25. Treatment / Disposition Adequate? YES Redress Patient with clean covering Reassess and Treat Disposition

26. Medical Management of Contaminated Patients Is patient in severe distress? –Airway compromise? –Severe wheezing or respiratory distress? –Persistent nausea/vomiting? –Having a seizure? May need emergency medical treatment –Chemical antidotes (atropine, 2PAM, etc.) –Intubation

27. Patients entering from Hot Zone Decon Resource Team Decon Initial Contact Unit Leader Decon Triage Unit Leader (Stay upwind & keep distant from patients) Stripper,,bagger Highly Contaminated Patients Shower / Center of Shelter Warm Zone Decon Resource Team washer/rinser Less Contaminated Patients Patients exit to Cold (Support) Zone Decon Resource Team dryer, dresser, gatekeeper, admittance Un Contaminated Patients Dirty Cleaner Clean Safe Refuge Area Safe Haven Area

28. Decon Organization Decon Group Positions –Decon Group Supervisor –Technical Reference –Site Access Control –Decon Leader –Entry Leader –Assistant Safety Officer* *Reports to Safety Officer

29. Decon Resource Team

30. Decontamination Procedures

31. Mass Decon Hospital Based

32. Photos courtesy of Andrew Fulton, CREM

35. What do you do/ if one of the Decon Resource Team goes down?

36. Reasons for Documentation of Decon Activities Cost recovery Exposure records

37. Disposal of Contaminated Items All contaminated items are to be bagged and in a secure location until they can properly removed and de- contaminated /disposed of by a licensed firm or government agency.

38. Components of Documentation Date, time and location Names of all response personnel –What jobs were they assigned? Incident conditions, observations and statements Material name/s, weather conditions

39. Components of Documentation Actions taken, resources used, costs incurred Statements & Observations of witnesses Diagrams, photos, and video

40. Decon Exposure Records Keep exposure records! –Employer must keep for 30 years All responders: keep own copies Mike Zolotoff Salazar, Robert

41. Decon Exposure Records Date, time and location of incident Chemical name Decon or medical aid given

42. Post Event Monitoring Personnel (Work w/Employee Health Services) –Respiratory Monitoring –Chronic and Acute exposure and affects –Chemical Exposure Records for files

43. Role of the FRO Safely and competently respond Within appropriate – –Level –Resources and –Capabilities

44. Summary of Module IV - Decon Decon of victims –Who, What, When, Why –How to decon –Directed, self decon vs. Mass decon –Documentation –Disposal Some may need medical management

45. Questions?