Haz Mat for Healthcare:An Operations Level CourseDecontamination, Disposal,

Documentation

Module IV

Objectives

• Explain decontamination procedures for victims, personnel, and equipment.

• Discuss application of relevant Standard Operating Procedures.

• Describe proper disposal and documentation procedures during a Haz Mat response.

Foundation Objectives continuedThe Hazmat Response Process

-Operations Level

-Command

-Identification -Protective Equipment

-Action Plans -Containment / Control

-Protective Actions

-Decon

-Disposal

-Documentation

SIN

CIA

PCP

DDD

Decontamination

• Removing or neutralizing contaminants– Personnel– Equipment

Types of Decon

• Primary– Done at the scene

• Secondary– Done post incident

• Emergency– Normally done by first responders

Who, What, When & Why

• Why: Prevent escalation of problem– Exposure: it might be on you– Contamination: it is on you

Degree of Contamination

• Amount of material on you

• Length of time it’s on you

• Concentration of material

• Physical state of material

• Ambient temperatures

Who, What, When & Why

• When: Anytime you suspect contamination– Material is visible– Victim complains of pain,

odor, etc.– Victim was near release

Who, What, When & Why

• Who/What: People & equipment– Victims– Responders– Equipment– Structures

Who, What, When & Why

• Who usually does decon:– FRO’s (properly trained & equipped)– Tech’s and Specialists via Decon Team

• How to decon: No absolute methods – Only general guides

Performing Decon

• Physical removal

• Chemical removal

• Emergency decon

Performing Decon

• Procedures follow logical order

• Go from “dirty” to “clean”

• Check your plan

Summary

• Purpose: Prevent spread of contamination

• Decon procedures are guides only

Consequences of No Decon

• Acute/Chronic health effects• Problem gets bigger• Death!

Emergency Decon

• Anytime you suspect contamination

• Use common sense– Life risk– Level of exposure

Emergency Decon

• Use copious amount of water– Copious=more than you have used

• Remove all clothing from victim– Including undergarments

Emergency Decon

• Precautions– Avoid contact w/clothing– Ensure privacy of victim(s)

• Barriers/temp garments

• Segregate by gender

Emergency Decon

• Medical considerations– Decon prior to transport– Protect equipment from contamination– Segregate contaminated material

E V E N T

T ria g e P a tie n t(s )

D e c o n ta m in a tio nR e q u ire d ?

P a tie n t(s ) toT re a tm e n t A re a

C o lle c t p e rs o n a lb e lo n g in g s /e v id e n c e **

N OY e s

A s s is ta n c e o rM e d ic a l T re a tm e n t

R e q u ire d ?Y e s

P ro v id e A s s is ta n c ea n d /o r tre a tm e n t

w ith in h o s p ita lc a p a b ility

N O

Y e sN O

R e -d e c o n ta m in a tea n d /o r p ro v id e

te c h n ic a ld e c o n ta m in a tio n **

R e d re s s P a tie n t(s )w ith c le a nc o v e rin g

R e a s s e s s m e n ta n d T re a tm e n t

D is p o s it io n

C a lifo rn ia E m e rg e n c y M e d ic a l S e rv ic e s A u th o r ityJ u ly , 2 0 0 1

D is a s te r In te re s t G ro u p

D e c o n ta m in a teP a tie n t(s )

C o lle c t p e rs o n a lb e lo n g in g s /e v id e n c e **

D ire c te d p a tie n t(s )s e lf-

d e c o n ta m in a tio n

A s s e s s fo r a d e q u a c yo f d e c o n ta m in a tio n **

A d e q u a te ?

P a tie n ts a rr iv e w itho r w ith o u t

n o tif ic a t io n

A c t iv a te D is a s te rP la n a n d P re p a reS ta ff to re c e iv e

p a tie n t(s )

A c t iv a te h o s p ita ld e c o n ta m in a tio n

p ro to c o ls

S e c o n d a ryT ria g e

N o te : ** in d ic a te s ad o c u m e n t w ill b e

a v a ila b le fo r re fe re n c e

U n d re s s P a tie n t(s )

P a tie n t D e c o n ta m in a tio n in th e H o s p ita l S e ttin gF in a l D ra ft

Patients arriveActivate Plan

EVENTPatients arrive with or without

notification

Activate DisasterPlan and preparestaff to receive

patient(s)

Triage

Triage Patient(s)

DecontaminationRequired?

No decontamination required

NO Patient(s) toTreatment Area

Collect personal belongings/evidence**

Redress Patient(s)with clean covering

Reassessmentand Treatment

Disposition

Decontamination required

Yes

Activate hospitaldecontamination

protocols

Collect personal belongings/evidence**

SecondaryTriage

Undress Patient(s)

Able to perform Self-decon

Assistance orMedical Treatment

required?NO Patient(s) directed to

Self-decontamination

Assess for adequacyof decontamination**

Need assistance

Assistance orMedical Treatment

required?

Assess for adequacyof decontamination**

YES

Provide assistance and/or treatment

within hospital capability

Decontaminatepatient(s)

Evaluate decontamination

Assess for adequacyof decontamination**

Adequate? YESNO

Re-decontaminateand/or provide

technicaldecontamination**

Treatment / Disposition

Adequate? YES

Redress Patient(s)with clean covering

Reassessmentand Treatment

Disposition

Management of the Contaminated Patient

Patients entering from Hot (Exclusion) Zone

Decon Resource TeamDecon Initial Contact Unit Leader

Decon Triage Unit Leader(Stay upwind & keep distant from patients)

stripper, bagger

Highly Contaminated Patients

Shower one / tub one

WarmZone

Decon Resource Teamwasher/ rinser

Less Contaminated Patients

Shower two / tub twoWarm

ZoneDecon Resource Team

washer/ rinser

Less Contaminated Patients

Patients exit to Cold (Support) Zone

Decon Resource Teamdryer, dresser, gatekeeper, admittance

checklist

Un Contaminated Patients

Dirty

Cleaner

Cleaner

Clean

Safe Refuge Area

Safe Haven Area

ICS Haz Mat Organization

• Hazardous Materials Group Positions– Haz Mat Group Supervisor

– Technical Reference

– Site Access Control

– Decon Leader

– Entry Leader

– Assistant Safety Officer*• *Reports to Safety Officer

Haz Mat Decon Resource Team

Public Inform ation Officer Safety & Security Officer

Liaison O fficer

Logistics Chief P lanning Chief F inance Chief

M edical CareD irector

Ancillary ServicesD irector

Human ServicesD irector

Entry

S ite Access Control

Safe Refuge Area

Init ial Contact Decon Triage Decon SiteAccess Control

Decon Set Up/Support

Decon G roup Supervisor

Decontamination

Technical Specialists

Hazardous Mater ials G roup

O perations Chief

IncidentCommander

Decontamination Procedures

Mass Decon

Fire Department / Haz Mat Team

Mass Decon

Hospital Based

VICTIM DECONTAMINATION

FACILITY

VANDERBILT UNIVERSITY MEDICAL

CENTER

Entrance to Emergency Department

Site of Decon UnitSite of Decon Unit

Site of Decon UnitSite of Decon Unit

Circular Drive at Front of Med Ctr

Routinely used as break area.

During emergency, site of decon unit.

Deploying the shower curtains

Curtain separates male/female ambulatory decon lines

Drop down sprayers help with final rinse of ambulatory and decon of non-ambulatory victims.

Off/on box and mixing unit for shower

Deluge shower head – five on each line

Fully deployed shower

Entrance for Entrance for ambulatory victimsambulatory victims

Shower lines for Shower lines for ambulatory victimsambulatory victims

Disrobing area for Disrobing area for ambulatory victimsambulatory victims

Looking down the ambulatory men’s shower line

Assisting an ambulatory victim (drill)

Decon’ing a non-ambulatory victim

Practice Exercise

What do you do/ if one of the Decon Resource Team goes

down?

Disposal Requirements• Strict legal requirements• Track from cradle to grave• You must know them and

follow them– Regs apply to government

agencies also!

Documentation & Reporting

• Need: get better handle on HazMat problem– Role of FRO in documentation

• Capture key initial info

– Use ICS-214

Reasons for Documentation

• Cost recovery

• Exposure records

• Training records

• Future lawsuits & investigations, etc.

Components of Documentation

• Date, time and location

• Names of all response personnel– And exposure times!

• Incident conditions, observations and statements

• Chemical names, weather conditions, release factors

Components of Documentation

• Actions taken, resources used, costs incurred

• Casualties, sample data, etc.

• Statements & Observations of witnesses

• Diagrams, photos, video, samples

Chemical Exposure Records

• Keep exposure records!– Employer must keep for 30 years

• All responders: keep own copies

Mike Zolotoff

Salazar, Robert

Chemical Exposure Records

• Date, time and location of incident

• Chemical name

• Type, concentration and duration of exposure

• Decon or medical aid given

Post Event Monitoring

• Environmental concerns (Work with state/local/federal agencies)

– Air/Water/Soil/Ground Monitoring

• Personnel (Work w/Employee Health Services)

– Respiratory Monitoring

– Chronic and Acute exposure and affects

– Chemical Exposure Records for files

To summarize what we have learned in the FRO course

Role of the FRO

• Safely and competently respond

• Within appropriate –– Level– Resources and – Capabilities

The Acronym Process

• There are 12 essential Tactical Operations in a safe and competent hazardous materials response.

SN

IC I

A S.I.N.

•Safety

•Isolate and Deny Entry

•Notifications

S.I.N.

• When clues indicate possible Haz Mat– Be cautious

• Approach upwind, upgrade & upstream– At a safe distance!

• Use natural barriers, avoid vapors/liquids

S.I.N.

• Do safe size-up

• Identify primary safety concern

• Position vehicles headed away from event

• Deny entry via safe entry point

S.I.N.

• Establish a secure perimeter

• Make mandatory notifications & request aid

• Keep unnecessary people away

C.I.A. • Command

• Identification and Hazard Assessment

• Action Planning

SN

IC I

A

C.I.A.

• First responder: assume temporary IC

• Maintain initial CP in safe area

• Begin IDHA with NA ERG– Verify with 3 sources

• Brief IC at Incident Post & aid in IDHA

C.I.A.

• Follow Incident Action Plan

• Have back-up plans

• Observe Perimeter & Control Zones

• Stay in Staging Area if no mission & not released

P. C. P•Personal Protective Equipment

•Containment/Control

•Protective Actions

P.C.P.

• Use appropriate protective equipment

• Monitor for flammable/explosive vapors

• Use agreed upon emergency signals

P.C.P.

• Use buddy system & back-ups

• Take defensive actions

• Take appropriate protective actions

D.D.D

• Decontamination

• Disposal

• Documentation

D.D.D.

• Ensure decon is conducted

• Do proper disposal

D.D.D.

• Keep good documentation & exposure records

• Keep essential communications

• Consider teamwork essential

• Coordinate with all responders

Review

• Questions

• Vague and evasive answers

• Post Test