1 in place patient decontamination executive brief in place patient decontamination executive brief...

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In Place Patient DecontaminationIn Place Patient DecontaminationExecutive BriefExecutive Brief

In Place Patient DecontaminationIn Place Patient DecontaminationExecutive BriefExecutive Brief

UNCLASSIFIED

Mike AnastasioMike Anastasio(254) 317-1588(254) 317-1588

Kileen, TXKileen, [email protected]@Battelle.org

Mike AnastasioMike Anastasio(254) 317-1588(254) 317-1588

Kileen, TXKileen, [email protected]@Battelle.org

Brent FentonBrent Fenton(850) 247-9942(850) 247-9942Shalimar, FLShalimar, FL

[email protected]@Battelle.org

Brent FentonBrent Fenton(850) 247-9942(850) 247-9942Shalimar, FLShalimar, FL

[email protected]@Battelle.org

Tom BocekTom Bocek(228) 365-2278(228) 365-2278

Biloxi, MSBiloxi, [email protected]@Battelle.org

Tom BocekTom Bocek(228) 365-2278(228) 365-2278

Biloxi, MSBiloxi, [email protected]@Battelle.org

Eddie McGeeEddie McGee(202) 222-5525(202) 222-5525

Oklahoma City, OKOklahoma City, [email protected]@Battelle.org

Eddie McGeeEddie McGee(202) 222-5525(202) 222-5525

Oklahoma City, OKOklahoma City, [email protected]@Battelle.org

Presented by BattellePresented by Battelle

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Welcome :-)Welcome :-)Welcome :-)Welcome :-)

• Thanks to MTF staff:Thanks to MTF staff:• IPPD Team Leader:IPPD Team Leader:

• Participants (Cadre)Participants (Cadre)

• Medical Logistics:Medical Logistics:

• Medical Readiness: Medical Readiness:

• Medical Facilities: Medical Facilities:

• Thanks to MTF staff:Thanks to MTF staff:• IPPD Team Leader:IPPD Team Leader:

• Participants (Cadre)Participants (Cadre)

• Medical Logistics:Medical Logistics:

• Medical Readiness: Medical Readiness:

• Medical Facilities: Medical Facilities:

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OverviewOverviewOverviewOverview

• MissionMission

• Patient Decontamination DefinedPatient Decontamination Defined

• Why a new CONOPS for terrorist use of WMDWhy a new CONOPS for terrorist use of WMD

• How does the IPPD fit in?How does the IPPD fit in?

• Requires Requires MTF TeamMTF Team Approach Approach

• IPPD LayoutIPPD Layout

• MissionMission






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MissionMissionMissionMission

• Train a Cadre of personnel to operate IPPD Train a Cadre of personnel to operate IPPD

• Leave Air Base with capabilityLeave Air Base with capability

• Train a Cadre of personnel to operate IPPD Train a Cadre of personnel to operate IPPD

• Leave Air Base with capabilityLeave Air Base with capability

USAF IPPD Training ScheduleUSAF IPPD Training Schedule

WedWed (Classroom, 8 hours didactic and hands-on training) (Classroom, 8 hours didactic and hands-on training)0800-0850: Familiarization with IPPD Concept of Operations (Hazardous materials

emergencies, potential outcomes)

0900-0950: Understanding Hazardous Substances, Recognition, Types/Terms

1000-1050: Understanding Hazardous Substances, Risks, Decontaminants

1100-1150: Understanding Hazardous Substances, Identification/Detection

1300-1350: Decontamination Equipment familiarization

1400-1450: The Decontamination Process “How To”

1500-1650: Selection and use of PPE (3Mand DTAPS)

Thu (IPPD Set-up Site, 4 hours hands-on training – PT Gear)

0800-0950: Assemble IPPD package without PPE, then tear down

1000-1120: Assemble IPPD package wearing PPE & Processing contaminated victims

1130-1150: HAZWOPER (timed event) Graduation 1330-1530: Tear-down, dry-off, clean-up, re-charge, re-stow Afterward students will be hot, tired, and probably not in condition for return to duty

USAF IPPD Training ScheduleUSAF IPPD Training Schedule

WedWed (Classroom, 8 hours didactic and hands-on training) (Classroom, 8 hours didactic and hands-on training)0800-0850: Familiarization with IPPD Concept of Operations (Hazardous materials

emergencies, potential outcomes)

0900-0950: Understanding Hazardous Substances, Recognition, Types/Terms

1000-1050: Understanding Hazardous Substances, Risks, Decontaminants

1100-1150: Understanding Hazardous Substances, Identification/Detection

1300-1350: Decontamination Equipment familiarization

1400-1450: The Decontamination Process “How To”

1500-1650: Selection and use of PPE (3Mand DTAPS)

Thu (IPPD Set-up Site, 4 hours hands-on training – PT Gear)

0800-0950: Assemble IPPD package without PPE, then tear down

1000-1120: Assemble IPPD package wearing PPE & Processing contaminated victims

1130-1150: HAZWOPER (timed event) Graduation 1330-1530: Tear-down, dry-off, clean-up, re-charge, re-stow Afterward students will be hot, tired, and probably not in condition for return to duty

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Patient DecontaminationPatient Decontamination(defined)(defined)

Patient DecontaminationPatient Decontamination(defined)(defined)

Remove contamination from patients...Remove contamination from patients...

...without further contaminating/injuring ...without further contaminating/injuring the patient.the patient.

...to reduce contamination of medical ...to reduce contamination of medical personnel/assets.personnel/assets.

(if it works, it’s right)(if it works, it’s right)

Remove contamination from patients...Remove contamination from patients...

...without further contaminating/injuring ...without further contaminating/injuring the patient.the patient.

...to reduce contamination of medical ...to reduce contamination of medical personnel/assets.personnel/assets.

(if it works, it’s right)(if it works, it’s right)

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Patient DecontaminationPatient DecontaminationPatient DecontaminationPatient Decontamination

Wartime vs. Terrorist ResponseWartime vs. Terrorist Response

What’s the difference?What’s the difference?

Wartime vs. Terrorist ResponseWartime vs. Terrorist Response

What’s the difference?What’s the difference?

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Why a New Concept for Why a New Concept for Terrorist/Peacetime Decon?Terrorist/Peacetime Decon?

Why a New Concept for Why a New Concept for Terrorist/Peacetime Decon?Terrorist/Peacetime Decon?

Wartime Med Decon Wartime Med Decon

WRMWRM

Deployable, PalletizedDeployable, Palletized

Accommodates 500Accommodates 500

Alaska SheltersAlaska Shelters

Takes many hours to days to Takes many hours to days to assemble for readinessassemble for readiness

UTC FFGLA = Equipment (AS UTC FFGLA = Equipment (AS 902A)902A)

UTC FFGLB = 19 People to UTC FFGLB = 19 People to operate, and PPE for 38 operate, and PPE for 38

membersmembers

Wartime Med Decon Wartime Med Decon

WRMWRM

Deployable, PalletizedDeployable, Palletized

Accommodates 500Accommodates 500

Alaska SheltersAlaska Shelters

Takes many hours to days to Takes many hours to days to assemble for readinessassemble for readiness

UTC FFGLA = Equipment (AS UTC FFGLA = Equipment (AS 902A)902A)

UTC FFGLB = 19 People to UTC FFGLB = 19 People to operate, and PPE for 38 operate, and PPE for 38

membersmembers

Peacetime In-Place DeconPeacetime In-Place Decon

Locally MaintainedLocally Maintained

Accommodates 100: Accommodates 100: (60 ambulatory, 40 litter)(60 ambulatory, 40 litter)

Articulating ShelterArticulating Shelter

CONOPS requirement is CONOPS requirement is “ready” in 20 minutes after “ready” in 20 minutes after

team assemblyteam assembly

12 People to operate and PPE 12 People to operate and PPE for 24 members (AS 886A)for 24 members (AS 886A)

Peacetime In-Place DeconPeacetime In-Place Decon

Locally MaintainedLocally Maintained

Accommodates 100: Accommodates 100: (60 ambulatory, 40 litter)(60 ambulatory, 40 litter)

Articulating ShelterArticulating Shelter

CONOPS requirement is CONOPS requirement is “ready” in 20 minutes after “ready” in 20 minutes after

team assemblyteam assembly

12 People to operate and PPE 12 People to operate and PPE for 24 members (AS 886A)for 24 members (AS 886A)

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How does the IPPD fit in? How does the IPPD fit in? Capability and SpeedCapability and Speed “Inverse Proportions”“Inverse Proportions”

How does the IPPD fit in? How does the IPPD fit in? Capability and SpeedCapability and Speed “Inverse Proportions”“Inverse Proportions”

Capability of D

econtamination Team

Speed of Decontamination Team

Unfortunate but true fact:

We must find the fastest way to provide a real capability for terrorist use of WMD

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• 1995, Tokyo subway sarin incident:1995, Tokyo subway sarin incident:• 57% of victims will flee the scene 57% of victims will flee the scene • Will self present to Medical FacilitiesWill self present to Medical Facilities

• 1999, HQ USAFE envelope1999, HQ USAFE envelope

• 1995, Tokyo subway sarin incident:1995, Tokyo subway sarin incident:• 57% of victims will flee the scene 57% of victims will flee the scene • Will self present to Medical FacilitiesWill self present to Medical Facilities

• 1999, HQ USAFE envelope1999, HQ USAFE envelope

Why a Separate CONOPS for terrorist use of WMD?

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• 2001, 9/11 attacks:2001, 9/11 attacks:• Base gates close, traffic stopsBase gates close, traffic stops• Medical Facility must function with Medical Facility must function with

whoever is availablewhoever is available• 2001, Anthrax scares:2001, Anthrax scares:• 2004, Dover AFB:2004, Dover AFB:

• 2001, 9/11 attacks:2001, 9/11 attacks:• Base gates close, traffic stopsBase gates close, traffic stops• Medical Facility must function with Medical Facility must function with

whoever is availablewhoever is available• 2001, Anthrax scares:2001, Anthrax scares:• 2004, Dover AFB:2004, Dover AFB:

Why a Separate Decontamination Plan for terrorist use of WMD

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How does the IPPD fit in? How does the IPPD fit in? Emergency Response to Emergency Response to

Terrorist WMD Incident…Terrorist WMD Incident…

How does the IPPD fit in? How does the IPPD fit in? Emergency Response to Emergency Response to

Terrorist WMD Incident…Terrorist WMD Incident…

• For discussion purposes…For discussion purposes…

• A terrorist releases VX at … Any AFB’s BXA terrorist releases VX at … Any AFB’s BX

• Disclaimer: Of course different contaminants or different terrorist acts may dictate slightly different responses, however, this scenario will help display our response capabilities:Disclaimer: Of course different contaminants or different terrorist acts may dictate slightly different responses, however, this scenario will help display our response capabilities:

• For discussion purposes…For discussion purposes…

• A terrorist releases VX at … Any AFB’s BXA terrorist releases VX at … Any AFB’s BX

• Disclaimer: Of course different contaminants or different terrorist acts may dictate slightly different responses, however, this scenario will help display our response capabilities:Disclaimer: Of course different contaminants or different terrorist acts may dictate slightly different responses, however, this scenario will help display our response capabilities:

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How does the IPPD fit in?How does the IPPD fit in? Terrorist WMD Incident OccursTerrorist WMD Incident Occurs

Winddirection

BX

-VX released at BX

-Personnel down

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Winddirection

BX

-Some people are incapacitated and collapse at the scene

-Others are affected, and flee the scene for medical care

-Thus, two decontamination sites will be necessary (1) at scene, (2) at hospital

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Actions at Site 1, The SceneActions at Site 1, The Scene

WinddirectionBX

-Initial Response Force arrives

-Entry Control Point Selected

ECP

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Actions at Site 1, The SceneActions at Site 1, The Scene

WinddirectionBX

ECP

Fire Department sets up decontamination systems for rescuers and patients

FD will likely perform gross decon initially before they set up full decon

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How does the IPPD fit in?How does the IPPD fit in? Terrorist WMD Incident Terrorist WMD Incident

OccursOccursActions at Site 2, the HospitalActions at Site 2, the Hospital

HOSPITAL

EMERGENCY

-Contaminated People that fled the scene begin to show up at the hospital

-The hospital must control the flow of contaminated casualties through a decon unit

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HOSPITAL

EMERGENCY

-The hospital quickly sets up the IPPD to allow only decontaminated casualties enter the MTF (note: containment berm goes down first as shown)

-If contaminated casualties enter the MTF (causing significant contamination) the MTF may have to discontinue operations and move to alternate medical facility.

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Actions at Site 2, the HospitalActions at Site 2, the Hospital

-IPPD sets up tent

-Lane with roller system is for litter casualties on backboards

-Lane/s without roller system is for ambulatory (walking casualties)

HOSPITAL

EMERGENCY

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HOSPITAL

EMERGENCY

-IPPD completely set-up, processing 60 ambulatory, and 40 litter patients

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Confounding FactorsConfounding Factors

• Limiting Factors we recognize…Limiting Factors we recognize…

• Not staffed 24 hrsNot staffed 24 hrs

• Response Time (who will get there first)?Response Time (who will get there first)?

• Unknown AgentsUnknown Agents

• Securing MTFSecuring MTF

• Limiting Factors we recognize…Limiting Factors we recognize…

• Not staffed 24 hrsNot staffed 24 hrs

• Response Time (who will get there first)?Response Time (who will get there first)?

• Unknown AgentsUnknown Agents

• Securing MTFSecuring MTF

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Requires MTF Team Approach!Requires MTF Team Approach!Requires MTF Team Approach!Requires MTF Team Approach!

• Patient’s may arrive before recalled Patient’s may arrive before recalled personnel arrive to help!personnel arrive to help!

• Start with what is available and build Start with what is available and build capability. There will be no time for capability. There will be no time for debates on who’s job it is!debates on who’s job it is!

• Patient’s may arrive before recalled Patient’s may arrive before recalled personnel arrive to help!personnel arrive to help!

• Start with what is available and build Start with what is available and build capability. There will be no time for capability. There will be no time for debates on who’s job it is!debates on who’s job it is!

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Top-Down View of MTF Warm ZoneTop-Down View of MTF Warm Zone with 886A and 886C with 886A and 886C

Top-Down View of MTF Warm ZoneTop-Down View of MTF Warm Zone with 886A and 886C with 886A and 886C

886C, IMR = Triage/EMT/Security 886A, IPPD (Decon) 886C, 2nd Triage

MTF

Patient Flow Desired Wind Direction

02

02

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SummarySummarySummarySummary











Failure To Prepare

Is

Preparing to FailBenjamin Franklin

1 in place patient decontamination executive brief in place patient decontamination executive brief...

Documents

ippd package

ippd team leader

medical readiness

medical facilities

ippd setup site

mtf staff

cadre of personnel

decontamination process