1. Decontamination Principles and Patient Management

2. 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

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

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

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

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

7. 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, )

8. Levels of Protection Bunker Gear ? Greater Hazard Higher Burden Level

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

10. 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

11. 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)”?

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

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

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

15. 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?

16. 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

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

18. 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

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

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

21. Decontamination Planning Process

22. 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

23. Decon Planning Required by:
JACHO
AOHA
OSHA
State OSHA
DEQ

24. 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

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

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

27. 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)

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

29. 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