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Instructor‟s Manual HOSPITAL FIRST RECEIVER‟S TRAINING DECONTAMINATION

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Page 1: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

Instructor‟s Manual

HOSPITAL FIRST

RECEIVER‟S TRAINING

DECONTAMINATION

Page 2: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 3: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

1

Page 4: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 5: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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.

Page 6: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

Presenter Name and Title

Certificate of Completion to

______________ for

Successfully completing the Hospital First Receiver’s Training for Decontamination

Date

Page 7: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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:______________

Page 8: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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:

Page 9: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 10: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 11: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2

Page 12: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

1

Hos

pita

l D

econ

tam

inat

ion

Res

pons

e Te

ams

Page 13: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

2

Pre

sent

ed b

y…

Y

our F

acili

ty In

form

atio

n

Page 14: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 15: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

4

Sec

tion

I

Intro

duct

ion

Page 16: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 17: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 18: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

?

Page 19: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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!

Page 20: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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)

Page 21: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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.

Page 22: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 23: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 24: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

13

Sec

tion

II

Haz

ardo

us A

gent

s

Page 25: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

)

Page 26: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 27: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 28: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 29: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 30: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

.

Page 31: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 32: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 33: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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)

Page 34: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 35: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 36: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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.

Page 37: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

26

Rad

iatio

n E

xpos

ure

Page 38: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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!

Page 39: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 40: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 41: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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)

Page 42: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 43: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 44: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

33

Sec

tion

III

Res

pons

e

Page 45: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 46: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 47: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 48: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 49: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 50: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 51: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 52: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

41

Hos

pita

l Dec

onta

min

atio

n Zo

ne

Page 53: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 54: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 55: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 56: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 57: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 58: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 59: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 60: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 61: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 62: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 63: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

52

Dec

onta

min

atio

n of

Non

-A

mbu

lato

ry P

atie

nts

“Ass

iste

d D

econ

Page 64: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 65: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 66: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 67: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 68: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 69: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 70: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 71: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 72: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 73: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

62

SE

CTI

ON

IV

PE

RS

ON

AL

PR

OTE

CTI

VE

EQ

UIP

ME

NT

Page 74: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 75: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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.

Page 76: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 77: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 78: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 79: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

68

Leve

l A P

rote

ctio

n

Page 80: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 81: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

70

Leve

l B P

rote

ctio

n

Page 82: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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.

Page 83: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

72

Leve

l C P

rote

ctio

n

Page 84: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 85: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

74

Leve

l D P

rote

ctio

n

•Y

our e

very

day

wor

k cl

othe

s!

Page 86: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 87: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 88: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 89: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

)

Page 90: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 91: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 92: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

)

Page 93: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 94: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

83

AP

Rs

•R

equi

res

fit-te

stin

g an

d ap

prop

riate

filte

r fo

r use

Page 95: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 96: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 97: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 98: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 99: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

88

“I ne

ed h

elp

with

this

pa

tient

Page 100: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

89

“I‟m

hav

ing

troub

le

brea

thin

g”

Page 101: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

90

“I‟m

OK

Page 102: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 103: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 104: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

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

Page 105: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

94

Que

stio

ns a

nd

Ans

wer

s

Page 106: HOSPITAL FIRST8. Define Directed Self Decon 9. Explain the process of Directed Self Decon 10. Demonstrate the procedure for Directed Self Decon 11. Define Decontamination Response

2014

95

Pra

ctic

e A

ctiv

ities

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# 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

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# 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

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# 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

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# 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.

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# 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.

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# 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.

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# 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)

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# 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

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# 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

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# 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

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# 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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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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Regional Decontamination Response Team (DRT) Curriculum

Updated: 02-2008

Page 16

# 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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Regional Decontamination Response Team (DRT) Curriculum

Updated: 02-2008

Page 17

# 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!

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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

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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

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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):

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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

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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]

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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: _________________

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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: _________________

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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: _________________