1. 1 Module 6 Decontamination

2. 2 Decontamination Reduction or removal of agents by physical means or by chemical neutralization Physical means: flushing, scraping, and powders Neutralization: soap, bleach, and special solutions

3. 3 Purposes of Decontamination Prevent further damage from chemical exposure Prevent secondary or cross contamination

4. 4 Module Organization Overview of decontamination concepts Current practices 3 case studies Special considerations

5. 5 Basic Concepts Must be done immediately Must be done effectively Clothes must be removed to eliminate possible contamination

6. 6 Three Decontamination Types Personal –self –buddy Casualty –non-ambulatory Personnel –non-exposed –ambulatory

7. 7 Liquid versus Vapor Decontamination is needed for both liquid and vapor exposure Vapor is absorbed by clothing and hair Rigorous decontamination is needed for liquid exposure Less rigorous decontamination is needed for vapor exposure

8. 8 Decontamination Solution Soap and water is the preferred solution –as effective as diluted bleach solution –less caustic –takes less time than diluted bleach solution Don’t delay decontamination if only water is readily available

9. 9 Secondary Contamination Case Study: Tokyo Sarin release Case Study: New York HAZMAT Case Study: Louisiana Mustard Exposure Lessons learned –need appropriate PPE and training –need to isolate persons exposed –need to follow standardized protocols and procedures

10. 10 Tokyo Subway Sarin Incident March 20, 1995 3 subway lines attacked in morning rush hour Estimated 5,500 persons exposed No on-scene decontamination Decontamination initiated at medical facilities 3 hours after exposure Secondary contamination at hospitals was a major problem

11. 11 Tokyo Subway Sarin Incident Decontamination initiated at medical facilities 3 hours after exposure Hospitals lacked space and equipment to handle large number of victims Secondary contamination at hospitals was a major problem

12. 12 NY State HAZMAT Event Dimethoate (systemic insecticide) overheated and released fumes Quickly resulted in respiratory problems Eleven workers self-reported to hospital ED ED staff become ill; HAZMAT called Evacuated ED and decontaminated victims and ER staff (1 hour)

13. 13 NY State HAZMAT Event ER washed down by hospital staff and reopened 2 hours later No testing conducted or reentry criteria used

14. 14 NY State HAZMAT Event No screening No training of ER staff in signs and symptoms Lack of communication and info on chemicals No containment area for victims Separate facilities unavailable No testing conducted or reentry criteria used

15. 15 Mustard Exposure in Vinyl Chloride Plant Inadvertently produce nitrogen and sulfur mustard in Louisiana chemical facility Over 150 workers exposed during hydro- blasting operation, 3 seriously Latent symptoms emc.ornl.gov/CSEPPweb/.../m6_decon_2007.ppt

16. 16 Mustard Exposure in Vinyl Chloride Plant 150 people report symptoms 2 days later OSHA involved after 3rd hospitalization Over a week to determine mustard involved Considerable secondary contamination from worker’s clothing to spouses

17. 17 Mustard Exposure in Vinyl Chloride Plant Findings: Personnel decontamination not performed No control of contaminated personnel or clothing Secondary contamination at unknown levels Local physicians do not know how to treat victims Agents were not initially identified Commercial laboratory analysis inadequate PPE not used or used improperly

18. 18 Mustard Exposure in Vinyl Chloride Plant Follow-up 6 years later

19. 19 Current Practices Self- and buddy-decontamination Decontamination station Ambulatory decontamination Non-ambulatory decontamination Mass decontamination Animal decontamination

20. 20 Self- and Buddy-Decontamination Insufficient time to set up decontamination station Need to instruct public to do it themselves Self: Do it on your own Buddy: Help others to do it Followed by technical decontamination

21. 21 Self- and Buddy-Decontamination Anticipate that not all people will follow instructions

22. 22 Field and Hospital Decontamination Siting the facility –upwind, uphill, and upstream –allow for security to control scene Establish reception area for initial screening Establish triage area for rapid medical evaluation and classification Simple Triage and Rapid Treatment (START)

23. 23 Decontamination Station 2 lines

24. 24 Decontamination Station 3 lines

25. 25 Important Considerations Deployment –portable for field use –permanent facilities at HCFs At least two lines, ideally 3 –ambulatory (mixed or male only) –non-ambulatory –female ambulatory Warm water supply Privacy Run-off control

26. 26 Decontamination Priorities People who are known or suspected of being contaminated and who require prompt medical attention due to agent exposure or other severe injury People who are exhibiting signs/symptoms of agent exposure People who are known to be contaminated but are not exhibiting signs/symptoms and don't urgently require medical attention People who are suspected of being contaminated but show no signs of agent toxicity Animals that provide critical support to humans (e.g., seeing eye dogs) that are known or suspected to be contaminated

27. 27 Ambulatory Decontamination Receive, triage and tag Treat wounds (optional) Remove and bag all effects Thoroughly shower with soap and water

28. 28 Ambulatory Decontamination Rinse and dry Don clean clothes and tag Remove to clean zone

29. 29 Non-Ambulatory Decontamination Receive, triage, and tag Send through line on backboard Clothing cut away and bagged

30. 30 Non-ambulatory cont. Flushed with soap solution, scrubbed, rinsed with clean water and dried Tagged and covered Transferred to clean zone for treatment

31. 31 Mass Decontamination Used to process large number of people Water only is recommended Several options: Ladder and TruckOver-head Shower

32. 32 Mass Decontamination Run-off water and EPA

33. 33 Animal Decontamination PETS Act (2006) Pets, livestock, and service animals can be contaminated in a variety of disasters Need plan to set up decontamination facility for animals Scrub with liquid soap and water and dry

34. 34 Animal Decontami nation Need plan to set up decontamination facility for animals Scrub with liquid soap and water and dry

35. 35 Animal Decontamination Animals evaluated for treatment Handling issues of owner/animal separation http://emc.ornl.gov/CSEPPweb/animals/a nimals_emergencies_owner.htm http://emc.ornl.gov/CSEPPweb/animals/A nimals_Emergencies_Planners.htm

36. 36 Special Considerations Infants, children and elderly People with disabilities

37. 37 Special Considerations Cold weather Psychological effects

38. 38 Special Considerations Considerations for biological contamination

39. 39 Special Considerations Considerations for radiological contamination