1 Decontamination Principles and Patient Management Decontamination Principles and Patient Management.

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Decontamination Decontamination PrinciplesPrinciples

andand Patient Management Patient Management

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Module ObjectivesModule Objectives

Define decontaminationDefine decontamination Describe the differences between non-Describe the differences between non-

ambulatory and ambulatory decontaminationambulatory and ambulatory decontamination Discuss procedures for the wet and dry Discuss procedures for the wet and dry

decontaminationdecontamination Discuss the decontamination planning Discuss the decontamination planning

process / patient managementprocess / patient management Identify regulatory compliance issuesIdentify regulatory compliance issues

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The process of removing or neutralizing surface contaminants that have accumulated

on personnel and equipment.

What is Decontamination?What is Decontamination?

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Why Decontaminate?Why Decontaminate?

Emergency responders should Emergency responders should ONLYONLY decon to:decon to: Control gross contaminationControl gross contamination Facilitate police measuresFacilitate police measures Provide medical careProvide medical care

Including psychological supportIncluding psychological support

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DecontaminationDecontamination

• Three methods:– Mechanical, chemical, physical

• Types of Decontamination:– Patient decontamination– Personnel decontamination– Personal decontamination– Equipment decontamination

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DecontaminationDecontamination

Level of ProtectionLevel of Protection

- Respiratory- Respiratory

- Protective clothing- Protective clothing

Isolation ZonesIsolation Zones Hospital DecontaminationHospital Decontamination Decontamination Planning ProcessDecontamination Planning Process

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Selection of Appropriate Selection of Appropriate PPEPPE Personal protective equipment (PPE) Personal protective equipment (PPE)

selection shall be based on an evaluation selection shall be based on an evaluation of the performance characteristics of the of the performance characteristics of the PPE relative to the requirements and PPE relative to the requirements and limitations of the site, the task-specific limitations of the site, the task-specific conditions and duration, and the hazards conditions and duration, and the hazards and potential hazards identified at the and potential hazards identified at the site (CFR 29, 1910.120)site (CFR 29, 1910.120)

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Levels of ProtectionLevels of Protection

Greater Hazard

Higher Burden

LevelA

LevelB

LevelC

LevelD

Bunker Gear ?

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Isolation ZonesIsolation Zones

WARM

INCIDENTSITE

HOT

**SAFE REFUGE **SAFE REFUGE AREAAREA

DECONTAMINATION DECONTAMINATION CORRIDORCORRIDOR

ACCESS CORRIDORACCESS CORRIDOR

COLD

COMMAND POSTCOMMAND POST

WIND DIRECTIONWIND DIRECTION

**

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Hospital DecontaminationHospital Decontamination

Patient populationPatient population Selection of appropriate PPESelection of appropriate PPE Decontamination processDecontamination process Medical care at the incident site and Medical care at the incident site and

decontamination areasdecontamination areas EPA will waive requirements for run off EPA will waive requirements for run off

collection in an emergency situationcollection in an emergency situation

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Patient PopulationPatient Population

Self-selected populationSelf-selected population Ambulatory minimally symptomatic or Ambulatory minimally symptomatic or

worried wellworried well Sick patients brought in via EMSSick patients brought in via EMS Survived without PPESurvived without PPE Can be considered not “immediately Can be considered not “immediately

dangerous to life and health (IDLH)”?dangerous to life and health (IDLH)”?

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PersonnelPersonnel

Who gets trained?Who gets trained?

- Awareness- Awareness

- Operations- Operations

AvailabilityAvailability Operational ControlOperational Control Emergency Department StaffEmergency Department Staff Other Identified Hospital StaffOther Identified Hospital Staff

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Decontamination Site Decontamination Site SelectionSelection

Outside!Outside! Level impermeable surfaced areaLevel impermeable surfaced area Up windUp wind Water supply/collectionWater supply/collection IlluminatedIlluminated Ingress and Egress routesIngress and Egress routes

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Decontamination AreasDecontamination Areas

PersonnelPersonnel Self vs Buddy AssistedSelf vs Buddy Assisted Hasty vs. ThoroughHasty vs. Thorough Standard vs. Field-ExpedientStandard vs. Field-Expedient

CasualtyCasualty Ambulatory vs. Non-AmbulatoryAmbulatory vs. Non-Ambulatory Spot vs. Whole-bodySpot vs. Whole-body WoundWound

Mechanical vs. ChemicalMechanical vs. Chemical

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Dry DecontaminationDry Decontamination

Vapor or no exposureVapor or no exposure Removal of clothingRemoval of clothing Modesty concernsModesty concerns Tracking of ValuablesTracking of Valuables Requires large amounts of disposable Requires large amounts of disposable

clothingclothing Clothing dispositionClothing disposition

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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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Decon Planning Required Decon Planning Required by:by:

JACHOJACHO AOHAAOHA OSHAOSHA State OSHAState OSHA DEQDEQ

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Decon Plan RequiredDecon Plan Required

Describe agencies to be Describe agencies to be responsible responsible

Describe resources to be availableDescribe resources to be available Describe procedures to be followed Describe procedures to be followed

to deal with agent-contaminated to deal with agent-contaminated people and animals that provide people and animals that provide critical support to humans critical support to humans

Plan should emphasize self and Plan should emphasize self and buddy decontaminationbuddy decontamination

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Planning IssuesPlanning Issues

Site location, layout, preparationSite location, layout, preparation Security and CommunicationsSecurity and Communications Logistical supportLogistical support Equipment (unit level)Equipment (unit level) Evacuation assetsEvacuation assets Personnel issuesPersonnel issues

TrainingTraining ManpowerManpower

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Planning IssuesPlanning Issues

Cost – effectiveCost – effective Mass CasualtyMass Casualty Rapid set-upRapid set-up Patient privacyPatient privacy Protection of propertyProtection of property TrainingTraining

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Where do we go from Where do we go from here?here? Reassess our approach to the Mass Casualty Reassess our approach to the Mass Casualty

IncidentIncident Hospitals Develop Internal Plans for Hospitals Develop Internal Plans for

DecontaminationDecontamination Reassess the regulations concerning PPEReassess the regulations concerning PPE Regional PlanningRegional Planning Pre-PlanningPre-Planning Advance Training Programs (ADLS)Advance Training Programs (ADLS)

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Personnel Training Personnel Training RequirementsRequirements

Patient transportPatient transport DecontaminationDecontamination

Non-Ambulatory, Ambulatory, PersonnelNon-Ambulatory, Ambulatory, Personnel Detection and monitoringDetection and monitoring Hazard avoidance (for all personnel)Hazard avoidance (for all personnel)

Personal protectionPersonal protection Work / rest cyclesWork / rest cycles RehydrationRehydration

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SummarySummary

Physical removal is BEST deconPhysical removal is BEST decon Must plan for patient decon at all aspects of Must plan for patient decon at all aspects of

carecare Decon process is resource intensive and must Decon process is resource intensive and must

be planned and practiced in advancedbe planned and practiced in advanced Identify and train personnel earlyIdentify and train personnel early Learn benefits of coordination with medical Learn benefits of coordination with medical

assets in your hospital and regionassets in your hospital and region

Prior Planning Prevents Poor PerformancePrior Planning Prevents Poor Performance