Decontamination Principles and Patient Management

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Decontamination Principlesand Patient
Management
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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

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

• Emergency responders should ONLY decon to
• Control gross contamination
• Facilitate police measures
• Provide medical care
• Including psychological support

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Decontamination

• Three methods
• Mechanical, chemical, physical
• Types of Decontamination
• Patient decontamination
• Personnel decontamination
• Personal decontamination
• Equipment decontamination

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Decontamination

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

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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, 1910.120)

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Levels of Protection
Bunker Gear ?
Greater Hazard
Level A
Level B
Level C
Level D
Higher Burden
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Isolation Zones
COMMAND POST
ACCESS CORRIDOR
INCIDENT SITE
DECONTAMINATION CORRIDOR
HOT

SAFE REFUGE AREA
WARM
COLD
WIND DIRECTION
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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

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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)?

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Personnel

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

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Decontamination Site Selection

• Outside!
• Level impermeable surfaced area
• Up wind
• Water supply/collection
• Illuminated
• Ingress and Egress routes

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

• Purpose
• Initial reception for potentially contaminated
  patients
• Patient checked for contamination
• Location
• Close to triage area
• Staffing
• Personnel in Level C?

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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

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Dry Decontamination

• Vapor or no exposure
• Removal of clothing
• Modesty concerns
• Tracking of Valuables
• Requires large amounts of disposable clothing
• Clothing disposition

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Address Psychological Effects

• Consider the following to
• address public fears after
• decon
• Explain risks (provide information sheet)
• Offer careful but rapidmedical assistance
• Avoid unnecessaryisolation or quarantine
• Treat anxiety inunexposed personswho are
  experiencing somatic symptoms

• Responses following an event may include
• Horror
• Anger
• Panic
• Paranoia
• Fear of contagion
• Demoralization
• Social isolation
• Unrealistic concernsabout infection

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CISM Must have a plan for Critical Incident
Stress Management

• Employees
• Volunteers
• Patients
• Worried well

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One contaminated patient may close your Emergency
Department and/or Hospital
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Decontamination Planning Process
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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

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Decon Planning Required by

• JACHO
• AOHA
• OSHA
• State OSHA
• DEQ

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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

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Planning Issues

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

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Planning Issues

• Cost effective
• Mass Casualty
• Rapid set-up
• Patient privacy
• Protection of property
• Training

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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)

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Personnel Training Requirements

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

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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