hospital first8. define directed self decon 9. explain the process of directed self decon 10....
TRANSCRIPT
Instructor‟s Manual
HOSPITAL FIRST
RECEIVER‟S TRAINING
DECONTAMINATION
Table of Contents Instructor Manual
1. Class Planning “To Do” list and OHSA Respiratory Questionnaire template
2. Class Agenda, Certificate, Sign-In and Evaluation, Course
Objectives 3. Slides and Lecture Text 4. Class Handouts a. Pretest b. Skills Station Check Lists i. PPE ii. Patient Decon iii. Decon Equipment 5. Information submitted to STRAC
1
Hospital First Receiver Training Guide
4 Weeks Prior: 1. Confirm class date with site coordinator and STRAC 2. Coordinate with correct number of faculty and adjunct faculty
needed to have 4:1 ratio for skills station 3. Ensure CEUs through STRAC 2 Weeks Prior: 1. Coordinate with STRAC and site coordinator equipment for
skill stations (i.e., PPE and shower) 2. Send out reminder notice 1 Week Prior: 1. Make copies of class handouts 2. Confirm additional faculty and adjunct faculty assistance 3. Offer assistance to site coordinator for Respiratory
Questionnaire process Follow-up: 1. Submit evaluations to STRAC 2. Give copies of roster, tests and skill checklist for site
coordinator, keep one set for files 3. Submit expenses to STRAC
Hospital First Receiver Training Agenda Date: __________________ Facility:________________
Welcome, Introductions and Expectations 8:00 a.m. – 8:30 a.m. Lecture 8:30 a.m. – 9:45 a.m. • Purpose of Training • Hazardous Agents • Response • Patient Decontamination • Decon / Disaster Response Team Roles and Responsibilities • Personal Protective Equipment
BREAK 9:45 a.m. – 10:00 a.m. Lecture (continued) 10:00 a.m. – 11:00 a.m. LUNCH 11:00 a.m. – 12:00 p.m. Decon Response Skills Training • Decon Operations Setup (15 min rotations) 12:00 p.m. – 1:00 p.m.
• Connecting the water supply • Connecting the electric supply • Setting up the tent • Using the Ludlum rate meter
• Donning and Doffing PPE w/ Respirator Use • Full Face-Masks with CBRNE cartridges 1:00 p.m. – 1:45 p.m. • Powered Air Purifying Respirators (PAPRs) 1:45 p.m. – 2:15 p.m.
BREAK 2:15 p.m. – 2:30 p.m. Skills Station Cont. 2:30 p.m. – 4:30 p.m. Closing and Evaluation 4:30 p.m. – 5:00 p.m.
Presenter Name and Title
Certificate of Completion to
______________ for
Successfully completing the Hospital First Receiver’s Training for Decontamination
Date
Name Department 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
Hospital First Receiver Training Sign-In Sheet Date: _________________ Facility:______________
Hospital First Receiver Training Evaluation Date: _________________ Facility:______________
We hope that your class was fun, yet, informative. However, we continually strive to provide you with quality information that benefits you as a healthcare professional
Please rate the following, on a 1-5 scale (1 being the worst, 5 being the best) Class format 1 2 3 4 5 Organization of information 1 2 3 4 5 Class content meets expectations 1 2 3 4 5 Class content was helpful 1 2 3 4 5 Educator’s preparation level 1 2 3 4 5 Instructor’s communication skills 1 2 3 4 5 Instructor’s knowledge level 1 2 3 4 5 What did you like best about this class? What did you like least about this class? Do you have any suggestions for improving the class? Additional comments:
Hospital First Receiver Course Objectives
Purpose of Decontamination Response Teams 1. Describe the risks and problems for healthcare systems that can occur with
hazardous materials incidents 2. Explain exposure 3. Explain contamination 4. Define decontamination 5. Explain the purpose of a hospital/healthcare facility decontamination Need for Decontamination Response Teams 6. Identify hazardous materials 7. Define the process for maintaining personal safety during a hazardous
materials incident Decontamination Response 8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response Team 12. Differentiate between the need for directed self decon and decontamination
response team initiation 13. Define the roles and responsibilities of members of a Decontamination
Response Team 14. Explain the process for decontaminating a patient 15. Identify the role of a greeter 16. Demonstrate the role of a greeter 17. Identify the role of a stripper/bagger 18. Demonstrate the role of a stripper/bagger 19. Explain the process for proper collection of patient belongings 20. Explain the process for proper disposal of patient belongings 21. Demonstrate the process for proper collection and disposal of patient
belonging 22. Identify the role of a washer/rinse
Hospital First Receiver Course Objectives
Decontamination Response 23. Demonstrate the wash-rinse process for an ambulatory patient 24. Demonstrate the wash-rinse process for a non-ambulatory patient 25. Identify the role of a dryer/dresser 26. Demonstrate the role of a dryer/dresser 27 Identify the role of a hospital gatekeeper 28. Demonstrate the role of a hospital gatekeeper 29. Explain the purpose of performing self-decon once decontamination
activities have ceased. Personal Protective Equipment 30. Identify proper personal protective equipment for decontamination
response 31. Verbalize the limitations of personal protective equipment 32. Explain the importance of correctly using personal protective equipment 33. Explain the dangers associated with using personal protective equipment 34. Demonstrate how to don personal protective equipment 35. Demonstrate proper self-decon 36. Demonstrate how to doff personal protective equipment 37. Demonstrate the hand signal used to say „I need help/assistance with this
patient.‟ 38. Demonstrate the hand signal used to say „I‟m having trouble breathing.‟ 39. Demonstrate the hand signal used to say „I‟m O.K.‟ 40. Explain the process for addressing Decontamination Response Team
members in distress
2
2014
1
Hos
pita
l D
econ
tam
inat
ion
Res
pons
e Te
ams
2014
2
Pre
sent
ed b
y…
Y
our F
acili
ty In
form
atio
n
2014
3
Wel
com
e an
d In
trodu
ctio
ns
•C
lass
Sch
edul
e •
Bre
aks
•R
efre
shm
ent a
vaila
bilit
y •
Res
troom
s •
And
…pl
ease
turn
you
r cel
l pho
nes
and
page
rs o
ff or
to s
ilent
2014
4
Sec
tion
I
Intro
duct
ion
2014
5
Cou
rse
Obj
ectiv
es
•D
evel
op a
n un
ders
tand
ing
of h
azar
dous
su
bsta
nces
in a
n em
erge
ncy
•D
evel
op a
n un
ders
tand
ing
of th
e ro
le o
f the
Firs
t R
ecei
ver
•D
evel
op a
n un
ders
tand
ing
of th
e se
lect
ion
on
use
of P
erso
nal P
rote
ctiv
e Eq
uipm
ent (
PP
E)
•D
evel
op a
n un
ders
tand
ing
of d
etec
tion
devi
ces
and
deco
ntam
inat
ion
equi
pmen
t •
Dev
elop
an
unde
rsta
ndin
g of
bas
ic
deco
ntam
inat
ion
proc
edur
es
2014
6
Why
are
we
here
?
•P
eopl
e w
ho h
ave
been
con
tam
inat
ed b
y ha
zard
ous
agen
ts m
ay a
rriv
e at
the
hosp
ital f
or
med
ical
trea
tmen
t •
An
estim
ated
33%
of p
erso
ns fr
om a
haz
mat
in
cide
nt w
ill b
ypas
s E
MS
and
sel
f pre
sent
at
hosp
ital.
•
We
do n
ot w
ant t
o co
mpr
omis
e th
e sa
fety
of o
ur
staf
f or o
ur fa
cilit
y by
exp
osin
g th
em to
ha
zard
ous
agen
ts
2014
7
If a
cont
amin
ated
pe
rson
is a
llow
ed
insi
de o
ur fa
cilit
y…
•W
hat a
re th
e im
pact
s:
–To
you
? –
To th
e em
erge
ncy
depa
rtmen
t?
–To
the
hosp
ital?
–
To th
e co
mm
unity
?
2014
8
Em
ploy
ee e
xpos
ure
and
hosp
ital c
losu
re is
w
hat w
e w
ant t
o av
oid!
2014
9
Exp
osur
e vs
. C
onta
min
atio
n
•E
xpos
ure:
A p
erso
n ha
s be
en in
the
area
of a
co
ntam
inat
e (g
ener
ally
a v
apor
) •
Con
tam
inat
ed:
A
per
son
has
com
e in
con
tact
with
a
cont
amin
ate
(gen
eral
ly a
liqu
id o
r sol
id)
2014
10
How
doe
s a
pers
on
beco
me
expo
sed?
•E
xpos
ure
rout
es in
clud
e:
–In
hala
tion
–In
gest
ion
–A
bsor
ptio
n –
Inje
ctio
n •
Pre
caut
ions
, dec
onta
min
atio
n, a
nd tr
eatm
ent
optio
ns m
ay v
ary
base
d on
exp
osur
e.
2014
11
How
doe
s a
pers
on
beco
me
cont
amin
ated
? •
Hom
e C
hem
ical
Exp
osur
es
•A
gric
ultu
ral E
xpos
ures
•
Tran
spor
tatio
n S
pills
•
Indu
stria
l Spi
lls
•W
eapo
ns o
f Mas
s D
estru
ctio
n
2014
12
Wha
t is
deco
ntam
inat
ion?
•W
hile
it h
as m
any
defin
ition
s, it
is a
met
hod
for c
lean
ing
off
cont
amin
ated
pat
ient
s •
Dec
onta
min
atio
n re
duce
s an
d pr
even
ts th
e sp
read
of
haza
rdou
s ag
ents
to
empl
oyee
s an
d w
ithin
the
faci
lity
2014
13
Sec
tion
II
Haz
ardo
us A
gent
s
2014
14
Haz
ardo
us A
gent
s
Acc
ordi
ng to
OS
HA
: Any
sub
stan
ce to
whi
ch
expo
sure
“res
ults
or m
ay re
sult
in a
dver
se
affe
cts
on th
e he
alth
or s
afet
y of
em
ploy
ees”
or “
any
chem
ical
whi
ch is
a
phys
ical
haz
ard
or a
hea
lth h
azar
d.”
OS
HA
29
CFR
191
0.12
0 (a
)
2014
15
Haz
ardo
us A
gent
s •
Cla
ss 1
– E
xplo
sive
s •
Cla
ss 2
– C
ompr
esse
d G
ases
•
Cla
ss 3
– F
lam
mab
le L
iqui
ds
•C
lass
4 –
Fla
mm
able
Sol
ids
•C
lass
5 –
Oxi
dize
rs a
nd O
rgan
ic P
erox
ide
•C
lass
6 –
Poi
sons
or I
nfec
tious
Mat
eria
ls
•C
lass
7 –
Rad
ioac
tive
Mat
eria
ls
•C
lass
8 –
Cor
rosi
ve M
ater
ials
•
Cla
ss 9
– M
isce
llane
ous
2014
16
How
do
you
know
if a
pa
tient
has
bee
n ex
pose
d?
•O
bvio
us p
hysi
cal s
igns
and
sym
ptom
s of
ha
zard
ous
agen
t exp
osur
e:
–Li
quid
s or
pow
ders
on
the
patie
nt
–O
dors
em
anat
ing
from
the
patie
nt
–D
iffic
ulty
bre
athi
ng
–B
urns
, blis
ters
–
Foam
ing
at th
e m
outh
or t
earin
g –
Em
esis
, def
ecat
ion,
urin
atio
n
2014
17
Bio
agen
ts -
wha
t to
look
for i
n tri
age…
•P
atie
nts
who
: –
Hav
e tra
vele
d ou
t of t
he c
ount
ry
–E
xhib
it un
usua
l sig
ns a
nd s
ympt
oms
–A
re v
ery
sick
•
Sev
eral
pat
ient
s w
ho p
rese
nt w
ith s
imila
r sy
mpt
oms
•P
atie
nts
who
pre
sent
from
the
sam
e ev
ent
or lo
catio
n
2014
18
Don
‟t be
dec
eive
d!
•In
itial
repo
rts fr
om th
e pa
tient
or E
MS
may
no
t ind
icat
e ex
posu
re
•A
sk q
uest
ions
– c
ompl
ete
a th
orou
gh a
nd
accu
rate
ass
essm
ent
•P
atie
nt m
ay n
ot u
nder
stan
d th
at th
ey h
ave
been
exp
osed
–
Mix
ed c
hem
ical
s at
hom
e or
wor
k
2014
19
Met
hods
of d
etec
tion:
C
HE
MIC
AL
•S
mar
t Stri
ps -
Cha
nges
col
ors
whe
n ex
pose
d to
chl
orin
e, p
H,
fluor
ide,
ner
ve a
gent
s,
oxid
izer
s, a
rsen
ic, s
ulfid
es a
nd
cyan
ide
in li
quid
or a
eros
ol
form
at m
inut
e le
vels
. To
use,
pe
el-a
nd-s
tick
adhe
sive
stri
p or
a c
lip to
dec
on s
uit.
Onc
e th
e pr
otec
tive
film
is p
eele
d of
f, th
e ca
rds
are
oper
atio
nal f
or
12 h
ours
, or u
ntil
they
are
ex
pose
d to
one
of t
he e
ight
su
bsta
nces
.
2014
20
Met
hods
of d
etec
tion:
R
AD
IOLO
GIC
AL
Por
tals
- P
orta
ble
and
E
xpan
dabl
e!
Per
sona
l Poc
ket D
osim
eter
Det
ects
Bet
a an
d
Gam
ma
Rad
iatio
n
P
anca
ke P
robe
(L
udlu
m) d
etec
ts
Alp
ha, B
eta
and
Gam
ma
radi
atio
n
2014
21
Wea
pons
of M
ass
Des
truct
ion
(WM
D)
CB
RN
E:
C =
Che
mic
al
B =
Bio
logi
cal
R =
Rad
iolo
gica
l N
= N
ucle
ar
E =
Exp
losi
ves
2014
22
Bio
logi
cal A
gent
s
•A
nthr
ax
•B
otul
ism
•
Pla
gue
•S
mal
lpox
•
Tula
rem
ia
•V
iral H
emor
rhag
ic F
ever
(VH
F)
•In
fect
ious
Res
pira
tory
Dis
ease
(SA
RS
or A
vian
Fl
u)
2014
23
Sig
ns a
nd S
ympt
oms
of e
xpos
ure
to
biol
ogic
al a
gent
s
•Fe
ver
•H
eada
che
•R
ash
•N
eck
stiff
ness
•
Res
pira
tory
sym
ptom
s
2014
24
Whe
re c
an R
adia
tion
be F
ound
?
•Fo
und
in:
–S
unlig
ht a
nd n
atur
al e
lem
ents
–
X-ra
ys
–N
ucle
ar m
edic
ine
proc
edur
es
–C
ance
r-re
late
d ra
diat
ion
treat
men
ts
–In
dust
ry
2014
25
Rad
iolo
gica
l
•A
lpha
par
ticle
s (c
omm
on) -
mos
t har
mfu
l if
inha
led
or in
gest
ed. T
hese
can
be
stop
ped
by a
sh
eet o
f pap
er.
•B
eta
parti
cles
- sm
alle
r tha
n al
pha
and
stop
ped
by re
gula
r PPE
. •
Gam
ma/
X-ra
y –
not a
par
ticle
and
can
pen
etra
te
skin
and
tiss
ue. W
ill p
enet
rate
mos
t PPE
. •
Neu
trons
– fo
und
in n
ucle
ar re
actio
ns, c
an
pene
trate
ski
n an
d tis
sue,
can
not b
e st
oppe
d by
PP
E.
2014
26
Rad
iatio
n E
xpos
ure
2014
27
Rad
iolo
gica
l C
onta
min
atio
n
•In
tern
al c
onta
min
atio
n m
ay re
sult
whe
n pa
rticl
es a
re in
gest
ed o
r inh
aled
. –
Acu
te ra
diat
ion
sick
ness
•
Ext
erna
l con
tam
inat
ion
occu
rs w
hen
parti
cles
com
e in
con
tact
with
the
skin
•
Min
imal
exp
osur
e ris
k to
car
e gi
ver.
Trea
t ac
ute
inju
ry fi
rst!
2014
28
Rad
iatio
n P
rote
ctio
n
•Ti
me
– Li
mit
expo
sure
tim
e •
Dis
tanc
e –
Incr
ease
dis
tanc
e fro
m s
ourc
e •
Shi
eldi
ng –
Shi
eld
self
from
the
haza
rd
•P
PE
– U
se S
tand
ard
Pre
caut
ions
•
Res
pira
tory
•
Con
tact
2014
29
Che
mic
al A
gent
s
Ner
ve A
gent
s B
liste
r Age
nts
Blo
od A
gent
s C
hoki
ng A
gent
s Irr
itant
Age
nts
2014
30
Ner
ve A
gent
s
Ner
ve a
gent
s (p
estic
ides
/milit
ary
agen
ts)
–A
ffect
the
body
‟s n
ervo
us s
yste
m
–S
igns
and
sym
ptom
s:
•S
– S
aliv
atio
n (d
rool
ing)
•
L –
Lacr
imat
ion
(tear
ing)
•
U –
Urin
atio
n (lo
ss o
f bla
dder
con
trol)
•D
– D
efec
atio
n (lo
ss o
f bow
el c
ontro
l) •
G –
Gas
troin
test
inal
(abd
omin
al p
ain)
•
E –
Em
esis
(vom
iting
) •
M –
Mio
sis
(pin
poin
t pup
ils)
2014
31
Che
mic
al A
gent
s
Blis
ter A
gent
s:
–C
ause
bur
ns a
nd b
liste
rs
–E
xam
ples
incl
ude
mus
tard
gas
and
Lew
isite
B
lood
Age
nts:
–
Affe
ct th
e bo
dy‟s
abi
lity
to tr
ansp
ort a
nd u
se
oxyg
en
–E
xam
ples
incl
ude
cyan
ide
2014
32
Che
mic
al A
gent
s
Cho
king
Age
nts:
–
Dam
age
lung
tiss
ue a
nd m
ucou
s m
embr
anes
–
Exa
mpl
es in
clud
e ph
osge
ne a
nd c
hlor
ine
Irrita
nts:
–
Cau
se a
per
son
to b
ecom
e in
capa
cita
ted
–E
xam
ples
incl
ude
tear
gas
, mac
e, a
nd p
eppe
r sp
ray
2014
33
Sec
tion
III
Res
pons
e
2014
34
If a
cont
amin
ated
per
son
pres
ents
to th
e ho
spita
l, w
hat d
o yo
u do
?
S-I-
N
S =
Shi
eld
I =
Isol
ate
N
= N
otify
2014
35
SH
IELD
Don
‟t be
com
e pa
rt of
the
prob
lem
…
–P
rote
ct y
ours
elf b
y us
ing
stan
dard
pr
ecau
tions
–
Do
not t
ouch
the
patie
nt o
r allo
w a
nyon
e el
se
to h
ave
patie
nt c
onta
ct w
ithou
t at l
east
an
N-
95 m
ask
and
glov
es
2014
36
ISO
LATE
•G
et th
e co
ntam
inat
ed p
atie
nt o
ut o
f the
fa
cilit
y to
a p
re-d
esig
nate
d lo
catio
n •
If so
meo
ne h
as s
omet
hing
on
them
, don
‟t le
t the
m g
o aw
ay
•Is
olat
e th
e ex
pose
d sc
ene
and
deny
ent
ry
until
haz
ard
asse
ssm
ent i
s co
mpl
eted
and
ar
ea is
cle
aned
, if n
eede
d
2014
37
NO
TIFY
•N
otify
you
r Sup
ervi
sor t
hat a
con
tam
inat
ed
patie
nt h
as a
rriv
ed a
t the
faci
lity
•If
need
ed, c
all S
ecur
ity to
sec
ure
the
area
–
Sec
urity
sho
uld
wea
r app
ropr
iate
PPE
whi
le
secu
ring
the
area
. •
Wor
k w
ith y
our S
uper
viso
r to
dete
rmin
e yo
ur fa
cilit
y‟s
need
to a
ctiv
ate
the
Dec
onta
min
atio
n R
espo
nse
Team
(DR
T)
or in
itiat
e di
sast
er re
spon
se p
roce
dure
s
2014
38
Act
ivat
ion
of th
e D
econ
tam
inat
ion
Res
pons
e Te
am
•A
con
tam
inat
ed n
on-a
mbu
lato
ry p
atie
nt
pres
ents
to th
e fa
cilit
y •
Mor
e co
ntam
inat
ed p
atie
nts
pres
ent t
o th
e fa
cilit
y th
an c
an b
e m
anag
ed b
y st
aff o
n-si
te
•A
Mas
s C
asua
lty In
cide
nt (M
CI)
has
been
de
clar
ed in
you
r com
mun
ity
2014
39
Wha
t is
a D
econ
tam
inat
ion
Res
pons
e Te
am?
•A
trai
ned
grou
p of
per
sonn
el w
ith re
sour
ces
to o
pera
te
in a
con
tam
inat
ed a
rea
and
perfo
rm th
e fo
llow
ing
func
tions
: –
Mai
ntai
n S
afe
Env
ironm
ent –
Saf
ety
Offi
cer a
nd R
SO
–
Dec
on S
et U
p / S
uppo
rt –
Team
Lea
der
–S
ite A
cces
s C
ontro
l - S
ecur
ity
–Tr
iage
– N
urse
or P
hysi
cian
–
Stri
pper
/ B
agge
r –
Was
her /
Rin
ser
–D
ryer
/ D
ress
er
–H
ospi
tal G
atek
eepe
r
2014
40
Dut
ies
of D
RT
Mem
bers
in
the
Hos
pita
l D
econ
tam
inat
ion
Zone
•E
nsur
e th
e sa
fety
of t
he fa
cilit
y an
d pe
rson
nel
•S
etup
of d
econ
ope
ratio
ns
•Tr
iage
, rea
ssur
e an
d di
rect
con
tam
inat
ed p
atie
nts
thro
ugh
the
proc
ess
•P
erfo
rm d
econ
tam
inat
ion
proc
edur
es
•R
ecov
ery
oper
atio
ns:
–E
quip
men
t cle
anin
g –
Man
agem
ent o
f was
tew
ater
–
Team
deb
riefin
g
2014
41
Hos
pita
l Dec
onta
min
atio
n Zo
ne
2014
42
•C
onta
min
ated
Are
a H
OT
–A
rea
of is
olat
ion
–M
US
T us
e ap
prop
riate
haz
ardo
us
agen
t PP
E
•H
ospi
tal D
econ
tam
inat
ion
Zone
W
AR
M
–A
rea
whe
re d
econ
tam
inat
ion
activ
ities
ta
ke p
lace
–
MU
ST
use
appr
opria
te h
azar
dous
ag
ent P
PE
•H
ospi
tal P
ost-D
econ
tam
inat
ion
Zone
C
OLD
–
Saf
e ar
ea
–U
se S
tand
ard
Pre
caut
ions
CO
LD
Hos
pita
l Gat
ekee
per
HO
T S
ite A
cces
s C
ontro
l S
TAR
T Tr
iage
Stri
pper
/ Ba
gger
WAR
M
Was
her /
Rin
ser
Dry
er /
Dre
sser
Con
trol
Zon
es –
C
onta
min
atio
n R
educ
tion
Cor
ridor
2014
43
Hos
pita
l D
econ
tam
inat
ion
Zone
•To
ens
ure
that
the
agen
t doe
s no
t co
ntam
inat
e th
e „c
lean
‟ are
a, s
et-u
p de
cont
amin
atio
n ac
tiviti
es s
o th
at th
ey a
re:
–U
p H
ill
–U
p W
ind
–U
p S
tream
2014
44
Ens
ure
the
Saf
ety
of th
e Fa
cilit
y an
d P
erso
nnel
•S
ecur
e th
e ar
ea
•E
stab
lish
a pe
rimet
er
•E
stab
lish
cont
rol z
ones
•
Initi
ate
crow
d co
ntro
l mea
sure
s •
Ens
ure
prop
er P
PE
is w
orn
and
safe
ty
proc
edur
es a
re fo
llow
ed
2014
45
Set
up o
f Dec
on
Ope
ratio
ns
•E
stab
lish
Dec
onta
min
atio
n Zo
ne
•A
cces
s de
cont
amin
atio
n su
pplie
s •
Ass
embl
e th
e de
cont
amin
atio
n sh
elte
r and
ad
junc
t equ
ipm
ent
•E
nsur
e ac
cess
to c
onta
min
ated
was
te fo
r ea
se o
f rem
oval
dur
ing
deco
n op
erat
ions
•
EP
A re
quire
s ru
n-of
f be
cont
aine
d if
at a
ll po
ssib
le fo
r pro
per d
ispo
sal
2014
46
Our
Hos
pita
l‟s D
econ
S
et-U
p
Arr
ival
P
oint
Tr
iage
St
atio
n
Am
bula
tory
D
econ
tam
inat
ion
Non
-Am
bula
tory
D
econ
tam
inat
ion
Cle
an
Tria
ge
Are
a
HO
T ZO
NE
WA
RM
ZO
NE
CO
LD Z
ON
E
2014
47
Tria
ge, R
eass
ure
and
Inst
ruct
Con
tam
inat
ed
Pat
ient
s
•U
tiliz
e ST
AR
T (S
impl
e Tr
iage
and
Rap
id
Trea
tmen
t) •
Exp
lain
the
deco
ntam
inat
ion
proc
ess
•C
olle
ct c
onta
min
ated
bel
ongi
ngs
2014
48
Tria
ge d
urin
g a
Mas
s C
asua
lty
Inci
dent
•Fo
cus
on d
oing
the
mos
t for
the
mos
t •
Util
ize
STA
RT
Tria
ge
met
hod
2014
49
Col
lect
ion
of
cont
amin
ated
be
long
ings
•
Sep
arat
e cl
othi
ng a
nd
valu
able
s •
Pla
ce in
tran
spar
ent a
nd
seal
able
col
lect
ion
bags
•
Labe
l clo
thin
g an
d va
luab
les
for t
rack
ing,
re
triev
al a
nd in
vest
igat
ion
purp
oses
2014
50
Dire
cted
Dec
on
•A
ppro
pria
te fo
r con
scio
us a
nd a
mbu
lato
ry
patie
nts
•D
irect
ed d
econ
can
be
used
for s
mal
l nu
mbe
rs o
f con
tam
inat
ed p
atie
nts
•
Pro
tect
you
rsel
f firs
t: –
Use
Sta
ndar
d P
reca
utio
ns
–M
ay re
quire
use
of h
azar
dous
age
nt P
PE
•
Con
side
r pat
ient
mod
esty
2014
51
Pro
cess
for P
erfo
rmin
g
D
irect
ed D
econ
–H
ave
patie
nt re
mov
e al
l val
uabl
es a
nd c
loth
ing
–P
lace
con
tam
inat
ed v
alua
bles
and
clo
thin
g in
a
seal
able
bag
–
Sta
rting
from
the
head
dow
n, h
ave
patie
nt:
•W
ash
body
with
soa
p an
d w
arm
wat
er fo
r 5 m
inut
es
•R
inse
bod
y w
ith w
arm
wat
er fo
r 5 m
inut
es
–H
ave
patie
nt d
ry th
eir b
ody
–P
rovi
de p
atie
nt w
ith a
cle
an c
over
ing
–R
e-ev
alua
te p
atie
nt
2014
52
Dec
onta
min
atio
n of
Non
-A
mbu
lato
ry P
atie
nts
“Ass
iste
d D
econ
”
Spe
cial
Pop
ulat
ions
•C
hild
ren
•In
fant
s •
Dis
able
d •
Ser
vice
Ani
mal
s •
Law
Enf
orce
men
t •
Dec
ease
d In
divi
dual
s •
Oth
er S
peci
al N
eeds
2014
53
Spe
cial
Pop
ulat
ion:
C
hild
ren
•P
aren
ts
•E
ase
fear
s •
Dec
on p
aren
t and
ch
ild
•E
xten
d ru
le o
f thu
mb
time
•A
dditi
onal
ass
ista
nce
for p
aren
t
2014
54
Spe
cial
Pop
ulat
ion:
In
fant
s •
Take
pre
caut
ions
aga
inst
dr
oppi
ng in
fant
•
Ent
er th
roug
h no
n-am
bula
tory
si
de
•Pr
ecau
tions
aga
inst
hyp
othe
rmia
•
Par
enta
l acc
omm
odat
ions
•
Eas
e fe
ars
•D
econ
par
ent a
nd c
hild
•
Ext
end
rule
of t
hum
b tim
e •
Add
ition
al a
ssis
tanc
e fo
r par
ent
2014
55
Spe
cial
Pop
ulat
ion:
D
isab
led
•C
onsi
der t
ype
of d
isab
ility
and
as
soci
ated
equ
ipm
ent
•W
heel
chai
r, w
alke
r, et
c., i
s tre
ated
as
pers
onal
pro
perty
•
Cas
ts (t
empo
rary
or f
ixed
) will
re
quire
rem
oval
for d
econ
•
Con
side
ratio
ns fo
r dea
f and
or
blin
d po
pula
tion
2014
56
Spe
cial
Pop
ulat
ion:
S
ervi
ce A
nim
als
•M
uzzl
e‟s
for a
ll an
imal
s sh
ould
be
requ
irem
ent
•H
andl
er s
houl
d be
kep
t with
the
serv
ice
anim
al w
hen
poss
ible
•
Anim
al: w
ash
for 1
0, ri
nse
for 1
0 •
Con
side
r vin
yl c
olla
r or m
uzzl
e to
en
sure
all
area
s rin
sed
•Le
athe
r app
arat
us w
ill b
e di
spos
ed o
f
2014
57
Spe
cial
Pop
ulat
ion:
La
w E
nfor
cem
ent
•W
eapo
ns m
ust b
e re
nder
ed s
afe
prio
r to
deco
n •
Inve
ntor
y &
sec
ure
wea
pon
•W
eapo
ns m
ay b
e go
vern
men
t pro
perty
no
t per
sona
l
2014
58
Spe
cial
Pop
ulat
ion:
D
eced
ent
•D
eced
ent h
andl
ed la
st
•M
ove
dece
dent
thro
ugh
non-
ambu
lato
ry li
ne
•Tr
eat d
eced
ent w
ith re
vere
nce
•E
nsur
e de
cede
nt is
pro
perly
co
vere
d •
Secu
re p
erso
nal e
ffect
s
2014
59
Spe
cial
Pop
ulat
ion:
O
ther
Nee
ds
•La
ngua
ge c
onsi
dera
tions
: fed
eral
re
quire
men
t to
prov
ide
trans
latio
n se
rvic
es
•C
ultu
ral c
onsi
dera
tions
: nat
iona
lity,
relig
ion,
et
c.
2014
60
2014
61
Dut
ies
of D
RT
Mem
bers
in
the
Hos
pita
l Pos
t-Dec
on
Zone
•
Eva
luat
e de
cont
amin
atio
n ef
forts
•
Re-
triag
e •
Beg
in p
atie
nt
track
ing
•Tr
ansp
ort t
o pa
tient
car
e ar
eas
2014
62
SE
CTI
ON
IV
PE
RS
ON
AL
PR
OTE
CTI
VE
EQ
UIP
ME
NT
2014
63
How
are
you
at r
isk?
•M
any
haza
rdou
s ag
ents
are
odo
rless
, col
orle
ss
and
tast
eles
s; y
ou m
ay b
e ex
pose
d be
fore
you
kn
ow it
! •
Rec
ent s
tudi
es h
ave
show
n th
at o
nly
a sm
all
num
ber o
f hea
lth c
are
wor
kers
hav
e ha
d ad
vers
e ef
fect
s fo
llow
ing
expo
sure
to
cont
amin
ated
pat
ient
s –
Thes
e co
uld
have
bee
n pr
even
ted
with
the
use
of
appr
opria
te s
afet
y m
easu
res
and
pers
onal
pr
otec
tive
equi
pmen
t
2014
64
Per
sona
l Pro
tect
ive
Equ
ipm
ent (
PP
E)
•U
nfor
tuna
tely
, no
one
type
of P
PE
will
pro
tect
ag
ains
t all
haza
rdou
s ag
ents
! •
App
ropr
iate
PPE
is d
eter
min
ed b
y th
e ch
arac
teris
tics
and
amou
nt o
f the
haz
ardo
us
agen
t pre
sent
. •
PPE
mus
t be
used
cor
rect
ly in
ord
er to
redu
ce
expo
sure
. •
Whe
n th
e ag
ent i
s un
know
n –
use
the
high
est
leve
l of P
PE
avai
labl
e pr
ior t
o st
artin
g an
y de
con
proc
edur
e.
2014
65
Sta
ndar
d P
reca
utio
ns
•H
azar
dous
age
nts
may
requ
ire, a
t a m
inim
um,
spec
ific
type
s of
Sta
ndar
d P
reca
utio
ns to
pr
even
t exp
osur
e •
Exa
mpl
es in
clud
e:
–Fa
ce s
hiel
d –
Mas
k –
Gow
n –
Glo
ves
–B
ootie
s
–B
onne
t
2014
66
Haz
ardo
us A
gent
PP
E
•Fo
ur le
vels
: –
Leve
l A P
PE
–
Leve
l B P
PE
–
Leve
l C P
PE
–Le
vel D
PP
E
•E
ach
leve
l pro
vide
s fo
r a c
erta
in a
mou
nt o
f sk
in a
nd re
spira
tory
pro
tect
ion
agai
nst
biol
ogic
al a
nd c
hem
ical
age
nts
2014
67
Leve
l A P
PE
•P
rovi
des
the
high
est l
evel
of s
kin
and
resp
irato
ry
prot
ectio
n:
–V
apor
pro
tect
ive
suit
(fully
enc
apsu
latin
g)
–S
elf c
onta
ined
bre
athi
ng a
ppar
atus
(SC
BA)
–
Che
mic
al re
sist
ant g
love
s an
d bo
ots
•
Wea
knes
s: b
ulky
, hea
vy, a
nd i
ncre
ased
po
tent
ial f
or h
eat s
tress
and
slip
, trip
or f
all
inju
ries,
requ
ires
a gr
eat d
eal o
f edu
catio
n fo
r sa
fety
2014
68
Leve
l A P
rote
ctio
n
2014
69
Leve
l B P
PE
•P
rovi
des
a lo
wer
leve
l of s
kin
prot
ectio
n w
ith th
e hi
ghes
t lev
el o
f res
pira
tory
pro
tect
ion:
–
Liqu
id s
plas
h pr
otec
tion
suit
(che
mic
al re
sist
ant)
–S
elf c
onta
ined
bre
athi
ng a
ppar
atus
(SC
BA)
–
Che
mic
al re
sist
ant g
love
s an
d bo
ots
•
Wea
knes
s: b
ulky
, hea
vy, i
ncre
ased
pot
entia
l for
he
at s
tress
and
slip
, trip
or f
all i
njur
ies
and
may
no
t red
uce
expo
sure
to a
ll ag
ents
, req
uire
s a
grea
t dea
l of e
duca
tion
2014
70
Leve
l B P
rote
ctio
n
2014
71
Leve
l C P
PE
•P
rovi
des
a lo
wer
leve
l of s
kin
and
resp
irato
ry
prot
ectio
n:
–Li
quid
spl
ash
prot
ectio
n su
it w
ith o
r with
out a
hoo
d (c
hem
ical
resi
stan
t)
–Ai
r-P
urify
ing
Res
pira
tor (
filte
rs v
ary)
–
Che
mic
al re
sist
ant g
love
s an
d bo
ots
•W
eakn
ess:
bul
ky, h
eavy
, inc
reas
ed p
oten
tial f
or
heat
stre
ss a
nd s
lip, t
rip o
r fal
l inj
urie
s an
d m
ay
not r
educ
e ex
posu
re to
all
agen
ts, c
anno
t be
used
in a
n ox
ygen
-dep
rived
are
a.
2014
72
Leve
l C P
rote
ctio
n
2014
73
Leve
l D P
PE
•P
rovi
des
the
low
est l
evel
of s
kin
and
resp
irato
ry p
rote
ctio
n:
–C
loth
es (u
nifo
rm, s
crub
s, s
treet
clo
thes
) –
Sta
ndar
d P
reca
utio
ns
•
Wea
knes
s: p
rovi
des
no c
hem
ical
pr
otec
tion
and
limite
d re
spira
tory
pr
otec
tion
2014
74
Leve
l D P
rote
ctio
n
•Y
our e
very
day
wor
k cl
othe
s!
2014
75
Rad
iatio
n P
PE
•“T
raum
a Te
am” g
ear:
–Fa
ce s
hiel
d –
Mas
k –
Gow
n –
Glo
ves
–B
ootie
s
–B
onne
t
2014
76
Ris
ks o
f Haz
ardo
us
Age
nt P
PE
•In
corr
ect u
se o
r im
prop
er s
elec
tion
•P
enet
ratio
n in
to th
e P
PE
(hol
es/ri
ps)
•S
lips,
trip
s an
d fa
lls
•Lo
ss o
f dex
terit
y, li
mite
d vi
sion
, im
paire
d co
mm
unic
atio
n •
Hea
t-rel
ated
illn
ess
–
Hea
t Exh
aust
ion
–H
eat S
troke
2014
77
Hea
t Cra
mps
•S
igns
and
sym
ptom
s:
–M
uscl
e sp
asm
s –
Dry
ski
n –
Fatig
ue
–D
izzi
ness
–
Dry
mou
th
–In
crea
sed
hear
t rat
e an
d br
eath
ing
2014
78
Hea
t Exh
aust
ion
•S
igns
and
sym
ptom
s:
–H
eada
che
–H
eavy
sw
eatin
g. In
tens
e th
irst
–Li
ght-h
eade
dnes
s –
Feel
ing
fain
t/wea
knes
s –
Pal
e an
d co
ol, m
oist
ski
n –
Incr
ease
d pu
lse
(120
-200
)
2014
79
Hea
t Stro
ke
•S
igns
and
sym
ptom
s:
–H
igh
body
tem
pera
ture
( >1
03 d
egre
es)
–A
bsen
ce o
f sw
eatin
g –
Ski
n is
hot
and
red
–R
apid
pul
se; d
iffic
ulty
bre
athi
ng; c
onst
ricte
d pu
pils
–
Sev
ere
sym
ptom
s of
Hea
t Exh
aust
ion
–A
dvan
ced
sym
ptom
s m
ay in
clud
e se
izur
e,
loss
of c
onsc
ious
ness
or d
eath
2014
80
Be
care
ful…
•If
you
reco
gniz
e an
y of
thes
e si
gns
and
sym
ptom
s in
you
rsel
f or a
noth
er te
am
mem
ber,
NO
TIFY
the
DR
T Le
ader
•
Imm
edia
tely
rem
ove
the
DR
T m
embe
r fro
m th
eir p
ost
•D
off t
he D
RT
mem
ber
•P
erfo
rm d
econ
tam
inat
ion
proc
edur
es
•Tr
eat a
ccor
ding
ly
2014
81
Med
ical
Scr
een
Pre
- and
P
ost-D
econ
•
DR
T m
embe
rs m
ust r
ecei
ve a
pre
- and
pos
t-dec
on
med
ical
scr
een:
–
Blo
od P
ress
ure
–P
ulse
–
Res
pira
tions
–
Tem
pera
ture
–
Wei
ght
–R
ecen
t med
ical
his
tory
for d
iarr
hea,
vom
iting
, etc
…
•O
rally
hyd
rate
dur
ing
this
tim
e •
Team
lead
er n
eeds
to b
e aw
are
of e
nviro
nmen
tal f
acto
rs
that
may
lim
it tim
e in
sui
ts.
Max
imum
tim
e in
sui
ts is
45
min
utes
(inc
ludi
ng s
elf-d
econ
)
2014
82
Wha
t are
we
goin
g to
be
usi
ng?
•Ty
chem
sui
ts w
ith d
uct t
ape
to s
eal
–C
oolin
g V
est o
ptio
nal
•A
ir P
urify
ing
Res
pira
tors
(AP
Rs)
–
Sco
tt O
-Vis
ta F
ull F
ace
Mas
k •
Pow
ered
Air
Pur
ifyin
g R
espi
rato
rs (P
APR
s)
–3-
M B
reat
h E
asy
•C
hem
ical
resi
stan
t boo
ties
or ru
bber
boo
ts
•C
hem
ical
-res
ista
nt a
nd n
itrile
glo
ves
2014
83
AP
Rs
•R
equi
res
fit-te
stin
g an
d ap
prop
riate
filte
r fo
r use
2014
84
PA
PR
s
•D
oes
not r
equi
re fi
t-tes
ting
•R
equi
res
batte
ries
and
appr
opria
te fi
lters
2014
85
Res
pira
tory
Pro
tect
ion
Pro
gram
•M
edic
al s
urve
illanc
e of
DR
T m
embe
r •
Sta
ff m
ust b
e fit
test
ed fo
r AP
R
–N
o fit
test
ing
need
ed fo
r PA
PR
•E
quip
men
t mus
t be
prop
erly
mai
ntai
ned
and
chec
ked
befo
re a
nd a
fter e
ach
use
2014
86
Don
ning
P
PE
W
ork
with
a B
uddy
! •
Put
on:
–
Inne
r Glo
ves
–Ty
chem
Sui
t –
PVC
Boo
t Cov
ers
or c
hem
ical
re
sist
ant r
ubbe
r boo
ts
–O
uter
Glo
ves
–D
uct T
ape
arou
nd g
love
and
boo
t op
enin
gs a
nd s
uit z
ippe
r –
Res
pira
tor –
if u
sing
APR
, duc
t tap
e se
al
–W
rite
iden
tifie
r and
don
tim
e on
duc
t ta
pe o
n ba
ck o
f sui
t
2014
87
Com
mun
icat
ing
whi
le
usin
g P
PE
•It‟
s im
porta
nt to
be
able
to c
omm
unic
ate
with
the
othe
r mem
bers
of t
he D
econ
R
espo
nse
Team
whi
le w
earin
g P
PE
•S
ome
faci
litie
s ha
ve c
omm
unic
atio
n eq
uipm
ent t
hat f
its u
nder
PP
E. I
f you
do
not h
ave
acce
ss to
that
equ
ipm
ent o
r it
fails
…
2014
88
“I ne
ed h
elp
with
this
pa
tient
”
2014
89
“I‟m
hav
ing
troub
le
brea
thin
g”
2014
90
“I‟m
OK
”
2014
91
The
last
pat
ient
has
be
en d
econ
tam
inat
ed -
now
wha
t?
•D
econ
Res
pons
e Te
am m
ust n
ow
deco
n th
emse
lves
in
thei
r PPE
and
then
th
e eq
uipm
ent
•O
nce
in th
e P
ost-
Dec
onta
min
atio
n Zo
ne, D
RT
mem
bers
ca
n do
ff P
PE
2014
92
Dof
fing
PP
E
•W
ork
with
a B
uddy
! •
For s
peed
, cut
with
sci
ssor
s an
d pe
el o
ff or
•
Take
off:
–
Duc
t tap
e at
sui
t and
glo
ve s
eals
–
Out
er g
love
s –
Res
pira
tor
–P
eel s
uit a
way
from
bod
y –
PVC
boo
t cov
ers
–In
ner g
love
s
2014
93
W
hat d
o yo
u do
if o
ne o
f th
e D
RT
Mem
bers
goe
s do
wn?
•If
one
of th
e te
am b
ecom
es a
pat
ient
: –
Rem
ove
them
from
thei
r pos
t –
Rem
ove
thei
r PPE
sui
t and
clo
thes
–
Per
form
ass
iste
d de
con
–Tr
eat
2014
94
Que
stio
ns a
nd
Ans
wer
s
2014
95
Pra
ctic
e A
ctiv
ities
•D
onni
ng a
nd D
offin
g P
PE
–
Use
of A
PR
s –
Use
of P
APR
s •
Set
up o
f Dec
on E
quip
men
t –
Con
nect
ing
the
Wat
er S
uppl
y –
Con
nect
ing
the
Elec
trica
l Sup
ply
–S
ettin
g up
the
Sho
wer
Sys
tem
•
Pat
ient
Dec
onta
min
atio
n
–D
irect
ed D
econ
–
Am
bula
tory
Pat
ient
Dec
on
–N
on-A
mbu
lato
ry P
atie
nt D
econ
2014
96
Med
ical
Sur
veill
ance
Que
stio
nnai
re
2014
97
Cla
ss E
valu
atio
n
2014
98
Than
k yo
u fo
r you
r tim
e an
d yo
ur in
tere
st in
be
ing
a m
embe
r of y
our f
acilit
y‟s
Dec
on
Res
pons
e Te
am.
We
hope
that
you
foun
d th
is in
form
ativ
e an
d fu
n!
3
Regional Decontamination Response Team (DRT) Curriculum
Updated: 02-2008
Page 1
# Slide Title Slide Text 1. Hospital Decontamination
Teams Welcome to the Regional Decontamination Response Team Course sponsored by the EMS-Hospital Disaster Group or EHDG. This curriculum was developed by the health care providers within Trauma Service Area-P as a way to provide specific training on healthcare facility decontamination response. This training course is based on the HazMat for Healthcare curriculum and was developed on a regional level to ensure a consistent and coordinated response to any incident that results in contaminated patients, as well as, to reduce facility-training costs.
2. Presented By… Introduction of Instructors Name Place of Employment/Department Background Related Training
3. Welcome & Introductions Introduction of Class Participants Name Place of Employment/Department Background Related Training Explain the Class Logistics Class length and break times Cell phone/pager use Location of restrooms and phones Location of vending machines Food/drink restrictions (if any) Lunch arrangements Questions regarding class set-up / agenda
4. Section I: Introduction:
5. Course Objectives Develop an understanding of hazardous substances in an emergency Develop an understanding of the role of the First Receiver Develop an understanding of the selection on use of Personal Protective Equipment (PPE) Develop an understanding of detection devices and decontamination equipment Develop an understanding of basic decontamination procedures
6. Why are we Here? Since 9/11, hospitals have become increasingly aware of their vulnerability to manmade and natural incidents. Our focus today will be on contaminate related events, whether from an
Regional Decontamination Response Team (DRT) Curriculum
Updated: 02-2008
Page 2
# Slide Title Slide Text accidental internal or external event. Persons exposed to hazardous materials may present to hospitals for treatment and possible decontamination. Prior to their treatment for medically related issues, contaminated patients must be decontaminated so as not to place the facility or its personnel at risk for becoming contaminated with biological, chemical, or radiological agents. A healthcare facility‟s number one priority is to protect their employees, their environment, and their property. You are being trained to become a member of your healthcare facility‟s Decontamination Response Team. This team will most likely be activated AFTER emergency management personnel know an incident has occurred. As part of a healthcare facility‟s Decon Response Team, you are tasked with ensuring the safety of personnel and the facility. This is accomplished by performing complete and thorough decontamination of contaminated or exposed patients.
7. If a contaminated person is allowed inside our facility…
What if a contaminated patient were able to enter a facility for treatment prior to decontamination, what are the possible consequences for that facility? Facilitate discussion among participants. Answers may include: Close the department/hospital Damaged public image Contamination of staff, patients Cost of facility decontamination Employee health effects Loss of work Loss of revenue
8. Employee exposures & hospital exposure is what we want to avoid!
As you‟ve heard, the potential consequences of a contaminated person entering your facility for treatment can have severe and lasting effects.
9. Exposure vs. Contamination Patients that have been exposed to biological, chemical, or radiological agents may be contaminated…so, what‟s the difference between exposed and contaminated? Exposure is when a person has been in the area of an agent and there is a potential for absorption or surface contamination. Contamination means there is an agent on the person that MUST be removed or washed away to prevent additional harm. Anyone that is in the area of exposure to a hazardous agent
Regional Decontamination Response Team (DRT) Curriculum
Updated: 02-2008
Page 3
# Slide Title Slide Text should be decontaminated because it may not be possible to see the agent on the person. Err on the side of caution.
10. How does a person become exposed?
People can be exposed to biological, chemical, and radiological toxins through internal and external accidental spills, as well as through terrorist attacks. Any one of these agents will adversely affect a hospital if a contaminated person is allowed inside prior to decon. Exposure routes include: Inhalation – breathing in air with hazardous particles Ingestion – eating or drinking food with particles on them Absorption – through the skin, especially if clothes are allowed to remain on Injection – through needles and other invasive devices *Based on exposure, precautions, decontamination, and treatment options may vary.
11. How does a person become contaminated?
Contamination can occur any day through average means. One could be exposed from the chemicals under their kitchen sink, working in the fields, or driving down the highway.
12. What is decontamination? It is the process of reducing and preventing the spread of contamination by having a person wash their body – a shower and a shampoo. You are here to learn critical skills to protect yourself when working with a small number of patients and/or to use these skills in a team approach for mass casualty events.
13. Section II: Hazardous Agents:
14. Hazardous Agents There is no one definition; however, hazardous agents, according to OSHA are „any substance to which exposure results or may result in adverse affects on the health or safety of employees‟. They are also „any chemical, which is a physical hazard or a health hazard‟.
15. Hazardous Agents Hazardous agents include materials that can cause cancer, chemicals that burn the skin or eyes on contact, infectious materials, blood borne pathogens, radiological agents and bioterrorism agents. Hazardous agents are classified according to the properties they have. Any of these could be used by terrorists to cause mayhem and harm.
16. How do you know if a patient has been exposed?
How do you know if a patient that has presented has been exposed to a hazardous agent? Be highly suspicious of
Regional Decontamination Response Team (DRT) Curriculum
Updated: 02-2008
Page 4
# Slide Title Slide Text patients who present with: Liquids or powders on them Odors emanating from them Difficulty breathing Burns, blisters Foaming at the mouth or tearing Emesis, defecation, urination Prior to providing treatment, rule out exposure to hazardous agents.
17. Bio agents: What to look for in triage…
Biological events will unfold over a period of hours, days, or weeks. Biological events can occur across the globe but are only one plane trip from your hospital.
18, Don‟t be deceived! However, the initial reports from most patients are not likely to indicate exposure to a hazardous agent. Therefore, it is important to complete a thorough and accurate assessment of each patient. They may not even KNOW they have been exposed to a hazardous material!
19. Methods of detection: Chemical Smart strips have been provided to you to help you determine if a chemical agent has been involved. Just peel and stick it to your suit, a change in color would indicate a specific chemical was involved.
20. Methods of detection: Radiological
You‟ve also been provided several devices to check for radiological exposure. Portals can identify radiation on an individual or an 18-wheeler. Pocket dosimeters detect beta and x-ray with a pager-like device. The Ludlum detects alpha, bet and gamma. If any of these devices register radiation, always ask if the person has had a nuclear medication study and verify that information. If no study has been done, have the person remove their clothing and use the Ludlum to determine if the clothes or the patient is radioactive. Notify security and your RSO.
21. Weapons of Mass Destruction (WMD)
Any of the above agents may be made into a weapon. These weapons can be designed to kill, but can also cause fear and panic, injury or incapacitation, or disruption of services.
22. Biological Agents Biological agents include bacteria, viruses, and toxins. Persons contaminated with biological agents should be treated as though they have been exposed to an infectious disease. Generally, these people will not require decontamination – only the use of proper protective equipment to include the use of negative pressure rooms.
Regional Decontamination Response Team (DRT) Curriculum
Updated: 02-2008
Page 5
# Slide Title Slide Text
23. Signs & Symptoms of Exposure to Biological Agents
Persons exposed to biological agents may present with unusual signs and symptoms. Watch for: Fever Headache Rash Neck stiffness Respiratory symptoms Treatment of these may include medications, vaccines, and/or supportive care
24. Where can radiation be found? Radiological agents are used in X-rays, nuclear medicine procedures, cancer-related radiation treatments, research and industry. Proper use of personal protective equipment minimizes healthcare worker exposure. A facility‟s Radiation Safety Officer or Radiology Department can be a good resource for questions or concerns on radiological agents.
25. Radiological Alpha particles (common) - most harmful if inhaled or ingested. These can be stopped by a sheet of paper. Beta particles - smaller than alpha and stopped by regular PPE. Gamma/X-ray – not a particle and can penetrate skin and tissue. Stopped by inches to feet of concrete or less than an inch of lead. Neutrons – found in nuclear reactions, can penetrate skin and tissue, cannot be stopped by PPE. Exposure can lead to contamination. A radiological event can result from the detonation of a dirty bomb or the sabotage of a radiation source. This type of device will produce more blast and trauma injuries to people than radiation contamination, which is likely to be minimal and not hazardous to the health care worker. A nuclear device is a several ton radioactive device such as an atom bomb that would produce wide spread devastation and contamination. Explosive events include any device that can blow up a structure, cause shrapnel dispersal and possibly cause fire. Exposure to Neutrons can cause an internal reaction.
26. Radiation Exposure Use diagram to reinforce exposure information
27. Radiological Contamination Internal contamination may result when particles are ingested or inhaled and may result in acute radiation sickness. External contamination occurs when particles come in contact with the skin requiring decontamination.
Regional Decontamination Response Team (DRT) Curriculum
Updated: 02-2008
Page 6
# Slide Title Slide Text Minimal exposure risk to care giver. Treat acute injury first! Internal contamination may result when particles are ingested or inhaled or when exposed to gamma rays or x-rays and may result in acute radiation sickness. External contamination occurs when particles come in contact with the skin requiring decontamination. Not contagious!!!!! Treat acute injury first! Tips to reduce particle spread: Swaddle with blanket, double glove, change gloves frequently, put people with the same symptoms in the same area.
28. Radiation Protection The degree of illness is in direct proportion to the time exposed, distance from the source, and the amount of radiation given off by the source. Limiting time exposed and shielding are important when exposure occurs. PPE should include N-95 Mask or better for respiratory protection and full body coverage to protect from particles.
29. Chemical Agents Chemical agents can be inhaled, absorbed through the skin or mucous membranes, or ingested. Proper use of personal protective equipment minimizes healthcare worker exposure. Chemical agents that are used as weapons fall into one of five general categories: All could be used as WMD.
30. Nerve Agents The body‟s nervous system sends messages through chemical reactions; nerve agents interrupt these reactions. Examples of nerve agents include Sarin, Tabun, VX, Soman and many others. Signs and symptoms of exposure to nerve agents can be remembered by using the acronym: SLUDGEM S – Salivation (drooling) L – Lacrimation (tearing) U – Urination (loss of bladder control) D – Defecation (loss of bowel control) G – Gastrointestinal (abdominal pain) E – Emesis (vomiting) M – Miosis (pinpoint pupils)
31. Chemical Agents Blister agents cause burns and blistering of the skin such as mustard gas and Lewisite. Blood agents affect the body‟s ability to transport and use oxygen. Cyanide is an example of a blood agent. Persons exposed to blood agents will have breathing problems.
32. Chemical Agents Choking agents damage lung tissue and mucous membranes.
Regional Decontamination Response Team (DRT) Curriculum
Updated: 02-2008
Page 7
# Slide Title Slide Text These agents cause the person‟s airway to become obstructed from the swelling. Phosgene and chlorine are examples of choking agents. Irritants generally don‟t kill but they cause a person to become unable to perform their duties. Tear gas, mace, and pepper spray are irritants.
33. Section III: Response:
34. If a contaminated person presents at the hospital, what do you do?
Regardless of how you might come in contact with a contaminated person, your safety is the MOST important thing. Anytime you encounter a situation with potential exposure to a biological, chemical or radiological agents, you SIN. How do you protect yourself? SIN!
35. Shield Remember, your safety comes first. It doesn‟t help you, your facility or the patient, if you take unprotected or uninformed actions that incapacitate or kill you. Shield yourself by putting on personal protective equipment at the first sign of danger. No direct patient contact should be made! Protect yourself and use standard precautions/splash protection: N-95 mask Face shield Gown Gloves Booties
36. Isolate Isolate the scene and deny entry. This will limit the spread of contamination. This could be something as simple as closing the door, posting personnel to seal off the area or establishing a perimeter with caution tape or barricades. As soon as it is discovered, escort the person to the designated decon area – not through the hospital. Have the person/persons exit the same way they came or exit through the closest exit. Isolate the contaminated area until it is deemed safe by your facility‟s designated safety personnel. Be sure to identify anything that the contaminated person has contacted ie. Floor, desk, other people, hallways. Identify an alternative entrance, if needed. Observe for and isolate anyone who may have received secondary contamination.
37. Notify Be familiar with your hospital‟s and department‟s emergency response plan and contact the designated personnel for guidance. (Insert facility-specific info here)
Regional Decontamination Response Team (DRT) Curriculum
Updated: 02-2008
Page 8
# Slide Title Slide Text
38. Activation of the Decontamination Response Team
Our hospital's Decontamination Response Team may be activated by: ____________________________________. They should be activated when a non-ambulatory patient arrives or when more help is needed than is currently available or if there has been an MCI event. Be aware that people escorting the non-ambulatory patient may need decontamination, as well.
39. What is a Decontamination Response Team?
A facility‟s Decon Response Team falls under the Operations Section in an Incident Command structure and is a group of personnel and resources operating within a contaminated area. The personnel that make up this team are trained to properly use personal protective equipment, setup the decontamination area and equipment, and perform decontamination activities. The ultimate purpose of every member is to ensure the safety of personnel, patients, and the facility. A Decon Response Team performs the following functions: Safety Officer - Ensuring the Safety of the Facility, Personnel and Patients Decon Response Team Leader and/or Nurse Manager are tasked to ensure the DRT has the appropriate supplies to complete their activities. Additionally, they supervise the clean up of contaminates and equipment; as well as, arrange for proper disposal of contaminated items. Site Access Control Pre-Decon Triage Stripper / Bagger Washer / Rinser Dryer / Dresser Hospital Gatekeeper Minimum response should have at least four members. Plan on these members needing to be replaced in 30 minutes (depending on the weather) and one person can perform multiple functions.
40. Duties of DRT Members in the hospital decontamination zone
Duties of DRT Members in the Hospital Decontamination Zone includes: establish the perimeter crowd control setup of decon operations triage and tag contaminated patients establish care area for expectant patients remove and bag clothing and valuables wash and rinse contaminated patients
Regional Decontamination Response Team (DRT) Curriculum
Updated: 02-2008
Page 9
# Slide Title Slide Text dry and dress contaminated patients
41. Hospital Decontamination Zone Hospital Decontamination Zone
42. Control Zone – Contamination Reduction Zone
The Hospital Contamination Zone is the area where the type and quantify of hazardous substance is unknown. It is also where contaminated victims, equipment, and waste may be present. It is the HOT area The WARM zone is there the decontamination process occurs The COLD zone is when decon has occurred and the patient is clean
43. Hospital Decontamination Zone To ensure that the agent does not contaminate the „clean‟ area, set-up decontamination activities so that they are: Up Hill Up Wind Up Stream
44. Ensure the Safety of the Facility & Personnell
The Decon Team Leader assures the safety of personnel and property during decontamination operations must supervise the Decontamination Zone. This person organizes and enforces employee and facility protection. Their duty is to modify, alter or stop the decontamination process if it has become unsafe and, if necessary, order personnel to leave the dangerous area. This person must be able to communicate the needs and progress of the Decon Response Team with the hospital command center.
45. Setup of Decontamination Operations
DRT members work to setup the decon operation area by establishing the decontamination zone, ensuring access to supplies, and assembling the necessary decontamination equipment. Additionally, DRT members must ensure easy access to contaminated waste during decon operations.
46. Our Hospital‟s Decon Setup Our Hospital‟s Decon Setup
47. Triage, Reassure & Instruct Contaminated Patients
In the Hospital Decontamination Zone, DRT members are responsible for greeting, triaging and escorting contaminated patients to the decon operations area for decontamination. Pre-decontamination triage should focus on assessing the medical status of victims and prioritizing decontamination efforts according to the patient‟s medical instability.
48. Triage During a Mass Casualty Incident (MCI)
In a Mass Casualty Incident (MCI) situation, patient care / treatment is postponed until the patient has been fully
Regional Decontamination Response Team (DRT) Curriculum
Updated: 02-2008
Page 10
# Slide Title Slide Text decontaminated and moved into the Hospital Post-Decontamination Zone. In an MCI situation, the goal of decontamination is to provide „the most for the most‟. Contaminated patients should be sorted according to priority: ability to ambulate and level of contamination. Utilization of START Triage will ensure the greatest number of contaminated victims will be decontaminated and can receive treatment.
49. Collection of Contaminated Belongings
Research has proven that upwards of 85% of the contaminate is removed when the contaminated victim removes his/her clothing. While it is important to ensuring patient privacy, contaminated victims should remove their clothing and valuables as soon as possible. Clothing and valuables should be placed into separate, transparent, sealable bags and labeled. This is important for decontamination, tracking, retrieval, and investigation purposes. In a Mass Casualty Incident, contaminated belongings could be considered evidence; therefore, it is important that all belongings are correctly labeled and tracked.
50. Directed Decon A way to minimize contact with a contaminated person is to have them perform directed decon. If the patient is ambulatory, can understand instructions, and there is no physical contact needed, they can perform the steps of decon themselves
51. Process for Performing Directed Decon
First and foremost – attempt to maintain the patient‟s modesty during the self-decontamination process. The steps for Directed Decon are: Remove all valuables and clothing (to prevent further contamination, should not be removed over the head – may need to use scissors to cut clothing off) Place contaminated valuables and clothing in sealable, labeled containers/bags Rinse with tepid water – start at the head and move down Wash with soap and tepid water for 5 minutes Gentle washing Best to use sponges or soft brushes Start at the head and move down – remember the nooks and crannies Wash bottom of foot, step into „clean‟ area without putting foot back into „dirty‟ water. Repeat with the other foot. Rinse for 5 minutes Use lots of water Start at the head and move down
Regional Decontamination Response Team (DRT) Curriculum
Updated: 02-2008
Page 11
# Slide Title Slide Text Rinse bottom of foot, step into „clean‟ area without putting foot back into „dirty‟ water. Repeat with the other foot. Dry Provide patient with a clean covering There are times when Directed Decon is not appropriate and the facility‟s Decon Response Team must be activated.
52. Decontamination of Non-Ambulatory Patients: “Assisted Decon”
Non-ambulatory patient decontamination follows the same process as ambulatory patient decon; however, since most non-ambulatory patients will be on a stretcher, washing and rinsing are initiated at the part of the body that is located closest to the Hospital Post-Decontamination Zone. This is to ensure that contaminated waste is kept as far away from the facility as possible.
53. Duties of DRT Members in the Hospital Decontamination Zone
Once the patient has been through the decontamination process, it is important to evaluate the success of the decontamination effort. Depending on the type of contaminate, this can be accomplished through the use of agent-specific detection equipment such as M8 Chemical Detection Paper or Radiation Detection equipment. Once the patient has been decontaminated, the patient may enter the facility where patient registration and treatment can begin. Keep in mind that each person on the Decon Response Team performs an essential function – protection of life, environment, and property.
54. Section IV: Personal Protective Equipment
55. How are you at Risk? Before beginning any decontamination procedure, one must always remember that the „S‟ in SIN stands for SHIELD. Your safety is the number one priority. To ensure your safety, you must use proper personal protective equipment when dealing with any suspected contaminated patient. At a very basic level, DRT members should always use standard/universal precautions because they are being exposed to hazardous agents. It is important to protect yourself. Responders are there to save lives, not risk lives! Without the correct use of personal protective equipment, you place yourself at risk for exposure to the agent you are working with. Decon Response Team members run the greatest risk of inhalation and absorption exposure when working with contaminated persons. Possible routes of entry are inhalation, ingestion, absorption and, even, injection.
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# Slide Title Slide Text
56. Personal Protective Equipment (PPE)
In the Hospital Decontamination Zone, properly selected and worn personal protective equipment is your best defense against exposure! Remember that many agents are odorless, colorless and tasteless. You may be exposed before you know it! No one type of PPE will protect against all biological or chemical agents. However, Personal Protective Equipment (PPE) is your last line of defense against an agent because now you are „in contact‟. If you fail to use PPE, exposure is likely. Take care to properly select and use PPE, otherwise it can fail and place the user at risk. Incorrect use of PPE can lead to exposure due to penetration, degradation, or permeation. Penetration can occur from the passage of chemicals through holes, seams or rips in the PPE. PPE degradation or deterioration can occur from exposure to temperature, abrasion, and sunlight. Permeation can occur from the passage of chemicals through PPE.
57. Standard Precautions No one type of equipment is good against all types of agents. The characteristics and amount of the hazardous material present determine the appropriate personal protective equipment. Some hazardous agents may only require the use of Standard Precautions. However, when the agent is unknown always use hazardous agent personal protective equipment.
58. Hazardous Agent PPE There are four levels of PPE for protection against biological, chemical or radiological agents: Level A, Level B, Level C, and Level D.
59. Level A PPE Level A PPE offers the highest levels of skin and respiratory protection from agents.
60. Level A Protection Notice that the people in the picture are squatting, not kneeling, in order to protect their suits.
61. Level B PPE Level B PPE provides a lower level of skin protection but the highest level of respiratory protection. Level A and Level B type PPE is necessary for individuals working at the release site or in an environment permeated by the contaminate.
62. Level B Protection Notice that the face masks and tanks are not encapsulated in the suits. Suit color is immaterial to level of protection.
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# Slide Title Slide Text
63. Level C PPE Level C PPE provides for liquid splash protection and a lower level of respiratory protection through the use of air-purifying respirators. This is the level of PPE that we use as first receivers. Cannot be used in O2 deprived area.
64. Level C Protection Level C Protection
65. Level D PPE Level D PPE provides for the lowest level of protection against hazardous agents. Level D PPE offers no protection from chemical agents and limited respiratory protection. However, Level D PPE is appropriate for protection against most radiological agents. Level D PPE consists of work uniforms/scrubs and Standard Precautions (N-95 mask, face shield, gown, gloves, and booties).
66. Level D Protection Level D Protection
67. Radiation Protection For protection against radiation use: Face shield Mask Gown Gloves Booties Bonnet
68. Risks of Hazardous Agent PPE As we discuss the types and proper use of hazardous agent PPE, keep in mind the potential for heat stress, slips, trips, falls, and overexertion when using this equipment.
69. Heat Cramps Heat cramps are muscle spasms which usually affect the arms, legs, or stomach. Frequently they don't occur until sometime later after work, at night, or when relaxing. Heat cramps are caused by heavy sweating, especially when fluid is replaced by drinking water, but not salt or potassium. Although heat cramps can be quite painful, they usually don't result in permanent damage. To prevent them, drink electrolyte solutions such as Gatorade during the day and try eating more fruits like bananas.
70. Heat Exhaustion Heat exhaustion is more serious than heat cramps. It occurs when the body's internal air-conditioning system is overworked, but hasn't completely shut down. In heat exhaustion, the surface blood vessels and capillaries which originally enlarged to cool the blood collapse from loss of body
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# Slide Title Slide Text fluids and necessary minerals. This happens when you don't drink enough fluids to replace what you're sweating away. The symptoms of heat exhaustion include: headache, heavy sweating, intense thirst, dizziness, fatigue, loss of coordination, nausea, impaired judgment, loss of appetite, hyperventilation, tingling in hands or feet, anxiety, cool moist skin, weak and rapid pulse (120-200), and low to normal blood pressure. Somebody suffering these symptoms should be moved to a cool location such as a shaded area or air-conditioned building. Have them lie down with their feet slightly elevated. Loosen their clothing, apply cool, wet cloths or fan them. Have them drink water or electrolyte drinks. Try to cool them down, and have them checked by medical personnel. Victims of heat exhaustion should avoid strenuous activity for at least a day, and they should continue to drink water to replace lost body fluids.
71. Heat Stroke Heat stroke is a life threatening illness with a high death rate. It occurs when the body has depleted its supply of water and salt, and the victim's body temperature rises to deadly levels. A heat stroke victim may first suffer heat cramps and/or the heat exhaustion before progressing into the heat stroke stage, but this is not always the case. It should be noted that, on the job, heat stroke is sometimes mistaken for heart attack. It is therefore very important to be able to recognize the signs and symptoms of heat stroke - and to check for them anytime an employee collapses while working in a hot environment. The early symptoms of heat stroke include a high body temperature (103 degrees F); a distinct absence of sweating (usually); hot red or flushed dry skin; rapid pulse; difficulty breathing; constricted pupils; any/all the signs or symptoms of heat exhaustion such as dizziness, headache, nausea, vomiting, or confusion, but more severe; bizarre behavior; and high blood pressure. Advance symptoms may be seizure or convulsions, collapse, loss of consciousness, and a body temperature of over 108° F. It is vital to lower a heat stroke victim's body temperature. Seconds count. Pour water on them, fan them, or apply cold packs.
72. Be Careful… If you recognize any of these signs and symptoms in yourself or another Decontamination Response Team member, you should: Remove the DRT member from their post Doff the DRT member Perform decontamination
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# Slide Title Slide Text Treat accordingly, once inside the Post-Decontamination Zone
73. Medical Screen Pre- and Post-Decon
DRT members should be monitored before and after the decon process to ensure team safety.
74. What are we going to be using? As a First Receiver, OSHA recommends using Level C PPE as it provides adequate liquid splash and respiratory protection. Exposure to First Receivers operating in a Hospital Decontamination Zone is greatest during the pre-decon activities and the wash/rinse step. Liquid splash protection is achieved by using Tychem suits; in conjunction with butyl rubber gloves and PVC boot covers.
75. APRs Respiratory protection will be achieved through the use of an air-purifying respirator (APR) or powered air-purifying respirator (PAPR). An APR is a respirator with an air-purifying filter, cartridge, or canister that removes specific air contaminants by passing ambient air through the air-purifying element. APR‟s have special filters that attach to either a tight or loose fitting face piece. A person is able to breath through an APR through the use of a demand valve or powered supply system. APRs provide a filtered air source; however, they may not protect against all biological or chemical agents. APRs may not fit over glasses and facial hair
76. PAPRs A powered air-purifying respirator (PAPR) is a powered respirator with an air-purifying filter, cartridge, or canister that removes specific air contaminants by passing ambient air through the air-purifying element. For training, NiCad Batteries last 5 hours. During an event, use lithium batteries – 10 hour life. The life of the filter depends on the agent.
77. Respiratory Protection Program Members of a Decon Response Team that use any level of respiratory protection must be enrolled in a Respiratory Protection Program at their facility. Prior to participating on a Decon/Disaster Response Team, members will be fit-tested for use of N-95 facemasks and air-purifying respirators (APRs). Fit-testing of PAPRs is not required. Decon Response Team members must participate in a Respiratory Protection Program that meets the OSHA Respiratory Standard which establishes guidelines for maintenance and care, fit-testing, and medical clearance. At the conclusion of this training, you will be given a respiratory
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# Slide Title Slide Text questionnaire to complete for your Employee Health files. Additionally, DRT members will participate in medical surveillance program. Medical monitoring is key to maintaining the health and safety of DRT members.
78. Donning PPE Donning is the term used to describe the process of putting on personal protective equipment. When properly donning PPE, you must work with a buddy! To appropriately don PPE, put the following on in order: A pair of gloves Tychem suit PVC boot covers Outer butyl rubber gloves Appropriate respiratory protection (either an APR or PAPR) When donning PPE, the last thing that should be done is putting on the respiratory protection. Duct tape should then be used to cover all seals between the suit, gloves, boot covers, and APR/PAPR. Prior to beginning any decontamination operation, every DRT member will be checked to ensure they have correctly protected themselves using PPE. Note identifier (name, identifying number) and don time on duct tape on back of suit
79. Communicating while using PPE
Wearing a respirator can hinder the ability to communicate verbally. Therefore, we have created non-verbal signs to facilitate communication among DRT members. Resist the urge to remove the respirator to communicate with others during decontamination operations.
80. “I need help with this patient.” This is the sign to communicate if you are having trouble with a particular patient.
81. “I‟m having trouble breathing.” This is the sign to communicate if you are having trouble breathing.
82. “I‟m OK.” This is the sign used to communicate if you are „OK‟.
83. The last patient has been decontaminated - now what?
Once the last patient has been through the decontamination process, you must decontaminate your suit before you can remove it. This will ensure that you do not exposure yourself to any contaminants. Decontamination of DRT Members should be performed accordingly: First – members in the Contaminated Zone Second – members in the Decontamination Zone Once DRT members have entered the Post-Decontamination
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# Slide Title Slide Text Zone, they may doff their PPE.
84. Doffing PPE Doffing is the term used to describe the process of taking off personal protective equipment. When doffing PPE, it should be done so that the last thing to be removed is the respiratory protection. To safely doff PPE, you must work with a buddy! To appropriately doff PPE, remove the following in order: Duct tape at the suit and glove seals Outer butyl rubber gloves Respirator Peel the suit away from the body PVC boot covers Remove gloves When doffing PPE, the last thing that should be removed is the respiratory protection!
85. What do you do if one of the DRT members goes down?
There may come a time where a Decon Response Team member has difficulty wearing the personal protective equipment. If that happens, other DRT members should: Remove the DRT member from their post Doff the DRT member Perform decontamination Treat accordingly, once inside the Post-Decontamination Zone
86. Questions & Answers Questions & Answers
87. Practice Activities Practice Activities
88. Medical Surveillance Questionnaire
Practice Activities
89. Class Evaluation Thanks
90. Thank you for your time and your interest in being a member of your facility‟s Decon Response Team. We hope that you found this informative and fun!
4
DRT Post-Test Questions
1. Which of the following patients are contaminated and will need decon?
A. 27 year old female mixed bleach and ammonia in her toilet. Family brought her gasping to the ER
B. 57 year old male crashed his motorcycle, gas tank ruptured and gasoline soaked his jeans. His friend brought him to the ER without taking jeans off.
C. 18 year old female assisting with putting lime on foot ball field, had container of lime spill onto her legs. She brushed off lime and rinsed off her legs. Presents with redness and pain to both legs.
D. 28 year old male complains of headache after working on auto in closed garage, had engine running while adjusting timing.
2. List the following actions in the proper order.
1. Escort patient to Decon Area by closest route 2. Identify contaminated patient 3. Inform leadership of contaminated patient in hospital 4. Don proper PPE
A. 1, 2, 3, 4 B. 3, 1, 2, 4 C. 2, 4, 1, 3 D. 4, 1, 3, 2
3. Most patients infected with Biological WMDs will present with:
A. Seizure activity B. Death C. Flu like symptoms D. High fever
4. Patients may be contaminated with chemicals from.
A. Transportation spills B. Acts of terrorism/warfare C. Home products D. All the above
5. Two patients arrive at your facility and walk through the door. You determine that they will need
decontamination prior to treatment. The most effective method will be
A. Call decon team to set up decon shower system then have patients deconned. B. Tell patients to go home, shower and change clothes then return for treatment. C. At your designated location have the patients do Directed Decon. D. Tell patients that you are sorry but they need to go to next hospital.
6. EMS brings in a Priority 1 patient that is in severe distress, they called and said the patient was
contaminated with radioactive material at his job site when he was injured. The proper response is to
A. Call Decon team to set up decon shower system and decon patient before treatment. B. Have treatment team don Level D PPE and do life saving treatment. C. Call 911 and have hazmat team respond. D. Tell ambulance crew to divert to a radiation treatment hospital.
7. You receive a call from the ER, charge nurse reports that there has been a major wreck on the highway,
it is estimated that in 15-20 minutes there will be approximately 25 patients arriving by POV and EMS that have been contaminated at the scene. To effectively deal with this you:
A. Alert decon team and set up decon shower system. B. Develop a major migraine headache and go home. C. Try and call the Safety Officer at home and ask what to do. D. Find the nearest TV to watch what is happening at the scene.
8. The decon team has been alerted and will be setting up the decon shower system in a new location due
to damage to primary site. You know they will need all the following for operations except:
A. Water source B. Electricity C. Diesel fuel D. Shaded area to set up in
9. Using the PAPR you know the team members can use the NiCad batteries for a maximum time of:
A. 1 hour before recharging B. 5 hours before recharging C. 1 hour then disposing D. 5 hours then disposing
10. What is not a feature of the Type C PPE that we are using?
A. Splash protection B. Respiratory protection C. Increased heat stress and decreased mobility D. The ability to work in an oxygen deprived environment
Regulations (Standards - 29 CFR) OSHA Respirator Medical Evaluation Questionnaire (Mandatory). - 1910.134 App C
Appendix C to Sec. 1910.134: OSHA Respirator Medical Evaluation Questionnaire (Mandatory)
To the employer: Answers to questions in Section 1, and to question 9 in Section 2 of Part A, do not require a medical examination.
To the employee:
Can you read (circle one): Yes/No
Your employer must allow you to answer this questionnaire during normal working hours, or at a time and place that is convenient to you. To maintain your confidentiality, your supervisor must not look at or review your answers. Your answers will be kept confidential in your employee health file. If you have any questions please contact your Employee Health Nurse. Employee Health will be responsible for reviewing all questioners.
Part A. Section 1. (Mandatory) The following information must be provided by every employee who has been selected to use any type of respirator (please print).
1. Today's date:_______________________________________________________
2. Your name:__________________________________________________________
3. Your age (to nearest year):_________________________________________
4. Sex (circle one): Male/Female SSN:______________________________
5. Your height: __________ ft. __________ in.
6. Your weight: ____________ lbs.
7. Your job title:_____________________________________________________
8. A phone number where you can be reached by the health care professional who reviews this questionnaire (include the Area Code): ____________________
9. The best time to phone you at this number: ________________
10. Has your employer told you how to contact the health care professional who will review this questionnaire (circle one): Yes/No
11. Check the type of respirator you will use (you can check more than one category):
a. ___X___ N95 3M 8170 Particulate Respirator.
b. ______ Other type (for example, half- or full-face piece type, powered-air purifying, supplied-air, self-contained breathing apparatus).
12. Have you worn a respirator (circle one): Yes/No
If "yes," what type(s):______________________________________________ _____________________________________________________________________
Part A. Section 2. (Mandatory) Questions 1 through 9 below must be answered by every employee who has been selected to use any type of respirator (please circle "yes" or "no").
1. Do you currently smoke tobacco, or have you smoked tobacco in the last month: Yes/No
2. Have you ever had any of the following conditions?
a. Seizures (fits): Yes/No b. Diabetes (sugar disease): Yes/No c. Allergic reactions that interfere with your breathing: Yes/No d. Claustrophobia (fear of closed-in places): Yes/No e. Trouble smelling odors: Yes/No
3. Have you ever had any of the following pulmonary or lung problems?
a. Asbestosis: Yes/No b. Asthma: Yes/No c. Chronic bronchitis: Yes/No d. Emphysema: Yes/No e. Pneumonia: Yes/No f. Tuberculosis: Yes/No g. Silicosis: Yes/No h. Pneumothorax (collapsed lung): Yes/No i. Lung cancer: Yes/No j. Broken ribs: Yes/No k. Any chest injuries or surgeries: Yes/No l. Any other lung problem that you've been told about: Yes/No
4. Do you currently have any of the following symptoms of pulmonary or lung illness?
a. Shortness of breath: Yes/No b. Shortness of breath when walking fast on level ground or walking up a slight hill or
incline: Yes/No c. Shortness of breath when walking with other people at an ordinary pace on level
ground: Yes/No d. Have to stop for breath when walking at your own pace on level ground: Yes/No e. Shortness of breath when washing or dressing yourself: Yes/No f. Shortness of breath that interferes with your job: Yes/No g. Coughing that produces phlegm (thick sputum): Yes/No h. Coughing that wakes you early in the morning: Yes/No i. Coughing that occurs mostly when you are lying down: Yes/No
j. Coughing up blood in the last month: Yes/No k. Wheezing: Yes/No l. Wheezing that interferes with your job: Yes/No m. Chest pain when you breathe deeply: Yes/No n. Any other symptoms that you think may be related to lung problems: Yes/No
5. Have you ever had any of the following cardiovascular or heart problems?
a. Heart attack: Yes/No b. Stroke: Yes/No c. Angina: Yes/No d. Heart failure: Yes/No e. Swelling in your legs or feet (not caused by walking): Yes/No f. Heart arrhythmia (heart beating irregularly): Yes/No g. High blood pressure: Yes/No h. Any other heart problem that you've been told about: Yes/No
6. Have you ever had any of the following cardiovascular or heart symptoms?
a. Frequent pain or tightness in your chest: Yes/No b. Pain or tightness in your chest during physical activity: Yes/No c. Pain or tightness in your chest that interferes with your job: Yes/No d. In the past two years, have you noticed your heart skipping or missing a beat: Yes/No e. Heartburn or indigestion that is not related to eating: Yes/ No f. Any other symptoms that you think may be related to heart or circulation problems:
Yes/No
7. Do you currently take medication for any of the following problems?
a. Breathing or lung problems: Yes/No b. Heart trouble: Yes/No c. Blood pressure: Yes/No d. Seizures (fits): Yes/No
8. If you've used a respirator, have you ever had any of the following problems? (If you've never used a respirator, check the following space and go to question 9:) Never worn a respirator ______.
a. Eye irritation: Yes/No b. Skin allergies or rashes: Yes/No c. Anxiety: Yes/No d. General weakness or fatigue: Yes/No e. Any other problem that interferes with your use of a respirator: Yes/No
9. Would you like to talk to the health care professional who will review this questionnaire about your answers to this questionnaire: Yes/No
[63 FR 1152, Jan. 8, 1998; 63 FR 20098, April 23, 1998]
5
Decontamination Response Training For Hospital First Receivers
Decontamination Equipment Skills Checklist
NAME:__________________________________________ DEPT: ____________________________ _ YES OR
NO INSTRUCTOR
INITIALS ATTENDEE
INITIALS
Correctly sets up the decon shower system.
Correctly disassembles the decon shower system.
Correctly identifies and connects to water supply.
Correctly identifies and connects to the electrical supply.
Performs correct setup of ambulatory and non-ambulatory patient decontamination routes.
Verbalizes correct use of chemical agent detection equipment: M8 paper and Chem-Strips.
Correctly uses Ludlum ratemeter.
Correctly explains the use of EPDs.
Verbalizes correct cleaning and maintenance procedures for decontamination and detection equipment.
Attendee’s Signature/Initials: ________________________________________ Date: _________________ Instructor’s Signature/Initials: ________________________________________ Date: _________________
Decontamination Response Training For Hospital First Receivers
Patient Decontamination Skills Checklist
NAME:__________________________________________ DEPT: ____________________________ _ YES OR
NO INSTRUCTOR
INITIALS ATTENDEE
INITIALS
Verbalizes the process for Directed Decon.
Explains the process of performing decontamination on ambulatory patients.
Explains the process of performing decontamination on non-ambulatory patients.
Verbalizes the process for providing decontamination to an escalating number of patients.
Correctly identifies the Cold, Warm and Hot Zones of the Patient Decontamination Area.
Explains the roles of the Decontamination Response Team Members: x Decon Unit Leader / Safety Officer x Greeter x Triage x Stripper / Bagger x Washer / Rinser x Dryer / Dresser x Hospital Gatekeeper
Verbalizes correct disposal process for contaminated belongings, equipment and hazardous waste.
Verbalizes correct cleaning and maintenance procedures for decontamination equipment.
Attendee’s Signature/Initials: ________________________________________ Date: _________________ Instructor’s Signature/Initials: ________________________________________ Date: _________________
Decontamination Response Training For Hospital First Receivers
Personal Protective Equipment Skills Checklist
NAME:__________________________________________ DEPT: ____________________________ _ YES OR
NO INSTRUCTOR
INITIALS ATTENDEE
INITIALS
Correctly dons and doffs Level C personal protective equipment
Demonstrates familiarity with Air Purifying Respirator (APR)
Correctly uses a Powered Air Purifying Respirator (PAPR)
Verbalizes correct disposal process for contaminated personal protective equipment
Verbalizes correct cleaning and maintenance procedure for personal protective equipment
Attendee’s Signature/Initials: ________________________________________ Date: _________________ Instructor’s Signature/Initials: ________________________________________ Date: _________________