1 decontamination principles and patient management decontamination principles and patient...
TRANSCRIPT
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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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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