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

2. 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

3. 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

4. Decontamination Removing or neutralizing contaminants Personnel
Equipment

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

6. 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

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

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

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

10. 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

11. Performing Decon
Physical removal
Chemical removal
Emergency decon

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

13. 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

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

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

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

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

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

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

21. Triage
Triage Patient(s)
Decontamination
Required?

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

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

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

25. 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**

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

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

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

29. 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

30. 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

31. 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

32. Decontamination Procedures
1.4 Haz Mat for Healthcare: Module IV

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

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

40. 1.4 Haz Mat for Healthcare: Module IV

41. 1.4 Haz Mat for Healthcare: Module IV

42. 1.4 Haz Mat for Healthcare: Module IV

43. 1.4 Haz Mat for Healthcare: Module IV

44. 1.4 Haz Mat for Healthcare: Module IV

45. 1.4 Haz Mat for Healthcare: Module IV

46. VICTIM DECONTAMINATION FACILITY
VANDERBILT UNIVERSITY MEDICAL CENTER

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

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

49. Routinely used as break area. During emergency, site of decon unit.

50. Deploying the shower curtains

51. Curtain separates male/female ambulatory decon lines

52. Drop down sprayers help with final rinse of ambulatory and decon of non-ambulatory victims.

54. Off/on box and mixing unit for shower

55. Deluge shower head – five on each line

56. Fully deployed shower Entrance for ambulatory victims
Disrobing area for ambulatory victims
Shower lines for ambulatory victims
Fully deployed shower

58. Looking down the ambulatory men’s shower line

59. Assisting an ambulatory victim (drill)

60. Decon’ing a non-ambulatory victim

61. Practice Exercise
1.4 Haz Mat for Healthcare: Module IV

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

63. 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

64. 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

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

66. 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

67. 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

68. 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

69. 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

70. 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

71. To summarize what we have learned in the FRO course

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

73. 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

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

75. 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

76. 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

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

78. C.I.A. Command Identification and Hazard Assessment Action Planning C

79. 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

80. 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

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

82. 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

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

84. D.D.D
Decontamination
Disposal
Documentation

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

86. 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

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