07-2007 Decon-Ref v.1.0 1 NDLS-DECON “REFRESHER”
Jan 11, 2016
Decon-Ref v.1.0 107-2007
NDLS-DECON“REFRESHER”
Decon-Ref v.1.0 207-2007
CME Faculty Disclosure In order to assure the highest quality of CME
programming, the AMA requires that faculty disclose any information relating to a conflict of interest or potential conflict of interest prior to the start of an educational activity.
The teaching faculty for the NDLS course offered today have no relationships / affiliations relating to a possible conflict of interest to disclose. Any discussion of off label usage during this course will be noted.
Decon-Ref v.1.0 307-2007
Course Objectives List 3 categories of hazardous substances that might
necessitate medical decontamination (decon) Describe potential adverse outcomes on the
healthcare system associated with a hazardous substance incident
Identify means of detection of hazardous substances incidents
Describe differences between decon at the incident scene & medical decon at receiving healthcare facilities
Recognize the role of victim triage & medical decon within the Incident Command System
Identify the components of Level C PPE
Decon-Ref v.1.0 407-2007
Course Objectives - 2 Demonstrate proper donning & doffing procedures
for Level C PPE Perform the component steps of “MASS” Triage
during a simulated mass casualty incident Apply the “ID-ME” color-coded categories to victims
of a simulated mass casualty incident Describe the roles of medical decon team members Identify selection criteria for a medical decon site Demonstrate basic dry & wet medical decon
procedures List 4 methods of communication that might be
employed in a chaotic medical decon environment
Decon-Ref v.1.0 507-2007
IntroductionChapter 1
Decon-Ref v.1.0 607-2007
Ch. 1: Objectives List 3 categories of hazardous substances that might
necessitate medical decontamination (decon) Describe potential adverse outcomes on the
healthcare system associated with a hazardous substance incident
Identify means of detection of hazardous substances incidents
Describe differences between decon at the incident scene & medical decon at receiving healthcare facilities
Recognize the role of victim triage & medical decon within the Incident Command System
Identify the components of Level C PPE
Decon-Ref v.1.0 807-2007
Texas Motor SpeedwayExercise, November 2004
Three critical gaps identified: Casualty / Patient TriageMedical Decontamination (Med Decon)Personal Protective Equipment (PPE)
Decon-Ref v.1.0 907-2007
NDLS-Decon
2 day, 16-contact hoursMeets OSHA awareness and
operational training levelsCDLS course, 4 hoursNDLS-Decon, 12 hours
► Includes 8 hours ofinteractive-skills sessions
Decon-Ref v.1.0 1007-2007
NDLS-DeconRefresher
1 day, 8 contact hoursPersons who have taken NDLS-DeconReview course contentFocus on hands-on skills practice►Level C PPE►Medical Decontamination►Mass Casualty Triage►Communications
No formal CE credit or certification (07-07)
Decon-Ref v.1.0 1107-2007
NDLS Family of Courses
A comprehensive, nationally-standardized family of all-hazards training programs developed by the NDLS consortium of academic, state, and federal centers.
Decon-Ref v.1.0 1207-2007
The ConcernWorldwide arsenal of weapons of mass
destruction (WMD) noted for years:►CHEMICAL►BIOLOGICAL►RADIOLOGICAL►EXPLOSIVE►NUCLEAR
Security, Political, Socioeconomic changesThreat to intentionally harm large civilian
populations has never been greater!Are We Prepared?
Decon-Ref v.1.0 1307-2007
Consequences of Non-preparedness
Patients: Morbidity/mortality
Healthcare facilities: closures
Healthcare Providers: Morbidity/mortality
Decon-Ref v.1.0 1407-2007
Definitions & DISASTER Paradigm Review
Decon-Ref v.1.0 1507-2007
A disaster is present when need exceeds resources
In other words: the response need exceeds the resources available
“Disaster” Definition
Disaster = Need > Resources
Decon-Ref v.1.0 1607-2007
“Multiple/Mass/Major Casualty Incident”
An MCI is present when healthcare need exceeds available healthcare resources!
“MCI” Definition
MCI = Healthcare Need > Resources
Decon-Ref v.1.0 1707-2007
MCI ManagementGoal:
Do the greatest good for the greatest number of potential survivors!
This is an importa
nt concept!
Decon-Ref v.1.0 1807-2007
All-Hazards DefinitionsAll-Hazards:►Man-made or natural events with the
destructive capability of causing multiple casualties
All-Hazards Preparedness:►Comprehensive preparedness required to
manage the casualties resulting from All-Hazards
Decon-Ref v.1.0 1907-2007
“All-Hazards”Man-madeFiresExplosive devicesFirearmsStructural
collapseTransportation
event►Air, Rail, Roadway,
WaterIndustrial HAZMATWMD – NBC
eventsEtc…
NaturalEarthquakeLandslidesAvalancheVolcanoTornadoHurricanes, floodsFiresMeteorsEtc…
Decon-Ref v.1.0 2007-2007
“WMD / WME”Weapons or devices that injure or kill large
numbersCause widespread destruction and/or panicChemical, Biological, Radiological, Nuclear,
Explosive (CBRNE)
“Weapons of Mass Destruction / Effect” Definition
Decon-Ref v.1.0 2107-2007
Man-made poisons spread as gases, liquids, or aerosols
Cause illness or death in humans, animals, plants
May be inhaled, ingested or absorbedVariety of disseminating devices
Chemical Weapons
Decon-Ref v.1.0 2207-2007
Chemical Weapons
“Nerve agents”: GA, GB, GD, VX“Blood agents”: Cyanide“Blister agents”: Mustard, Lewisite“Choking agents”: Phosgene, Chlorine“Incapacitating agents”: BZ
Decon-Ref v.1.0 2307-2007
Devices to disperse radioactive substancesConventional explosive device (“dirty bomb”) Intentional radiation release: water, food, terrainLess energy & radiation release than a nuclear
weaponDelayed detection: no “scene”“Worried well” & civilian panic
Radiological Weapons
Decon-Ref v.1.0 2407-2007
Catastrophic explosionsMassive nuclear energy release through atom
splittingTraumatic injuries, burns, fallout, delayed effects
Nuclear Weapons
Decon-Ref v.1.0 2507-2007
Disseminate disease-causing microorganisms or biologically-produced toxins (poisons)
Cause illness or death in humans, animals, or plants
Numerous agents could be used
Biological Weapons
Decon-Ref v.1.0 2607-2007
Anthrax as WME
• “Asymmetric” warfare:• “Small event”• Widespread effect
Decon-Ref v.1.0 2707-2007
Biological Weapons
Smallpox Plague
Anthrax
Decon-Ref v.1.0 2807-2007
Biological Events
Influenza 1918-1919
Influenza 2007?
Decon-Ref v.1.0 2907-2007
EpidemicsSevere Acute Respiratory
Syndrome 2003
SARS (Corona virus)
Decon-Ref v.1.0 3007-2007
Natural Disasters
The Concern:Numerous & widespreadMillions of fatalities worldwideCountless millions more injured$ Billions per eventCommon in the U.S. There WILL be a natural
disaster in the U.S. this year
Decon-Ref v.1.0 3107-2007
Transportation Incidents More than 6 million per year in U.S. More than 40,000 traffic fatalities Secondary hazards
Fire, explosion, chemical, radioactive All modes: Highway Air Rail Marine
Decon-Ref v.1.0 3207-2007
Industrial HazmatMostly minor “spills”, occasionally severe!Massive explosionsHazardous materials release
►Toxic fumes, radiation, biological agents►Secondary disasters
Multiple casualtiesProlonged community impact
►Loss of homes & jobs►Emotional impact
Decon-Ref v.1.0 3307-2007
DISASTER ParadigmA standardized method to recognize and
manage the scene and care for victimsReinforced throughout all NDLS courses:
A training tool…Practical approach on scene!
An organizational tool…Utilize resources, assess needs
A series of questions…
Decon-Ref v.1.0 3407-2007
DISASTER Paradigm
Detection Incident CommandSafety & SecurityAssess HazardsSupportTriage & TreatmentEvacuationRecovery
• Natural & Accidental• Trauma & Explosive• Nuclear & Radiological• Biological Agents• Chemical Agents
Decon-Ref v.1.0 3507-2007
Medical Decon & the DISASTER Paradigm
Medical Decontamination needs to be integrated into the pre-planning & support for All-Hazards incidents►Includes mass casualty triage
Goals: ►Allow contaminated victims access to the
medical care they need ►Prevent further victim M/M►Prevent healthcare provider M?M
Decon-Ref v.1.0 3607-2007
Questions?
Decon-Ref v.1.0 3707-2007
SummaryAt least 3 categories of All-Hazards incidents
might necessitate medical decontamination►Chemical►Radiological►Biological►Explosive►Nuclear
Lack of preparedness for such incidents:► Increased suffering for victims►Reduced access to medical care for victims &
others Facility closures Loss of healthcare providers
Decon-Ref v.1.0 3807-2007
Contact Information
Ronna G. Miller, MDAssistant ProfessorEMS, Disaster Medicine & Homeland Security SectionDivision of Emergency MedicineDepartment of SurgeryUT Southwestern Medical Center at Dallas5323 Harry Hines Blvd.Dallas, Texas 75390-8890
Email: [email protected]
Voicemail: (214) 648-6881