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NDLS-DECON“REFRESHER”

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CME Faculty Disclosure In order to assure the highest quality of CME

programming, the AMA requires that faculty disclose any information relating to a conflict of interest or potential conflict of interest prior to the start of an educational activity.

The teaching faculty for the NDLS course offered today have no relationships / affiliations relating to a possible conflict of interest to disclose. Any discussion of off label usage during this course will be noted.

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Course Objectives List 3 categories of hazardous substances that might

necessitate medical decontamination (decon) Describe potential adverse outcomes on the

healthcare system associated with a hazardous substance incident

Identify means of detection of hazardous substances incidents

Describe differences between decon at the incident scene & medical decon at receiving healthcare facilities

Recognize the role of victim triage & medical decon within the Incident Command System

Identify the components of Level C PPE

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Course Objectives - 2 Demonstrate proper donning & doffing procedures

for Level C PPE Perform the component steps of “MASS” Triage

during a simulated mass casualty incident Apply the “ID-ME” color-coded categories to victims

of a simulated mass casualty incident Describe the roles of medical decon team members Identify selection criteria for a medical decon site Demonstrate basic dry & wet medical decon

procedures List 4 methods of communication that might be

employed in a chaotic medical decon environment

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IntroductionChapter 1

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Ch. 1: Objectives List 3 categories of hazardous substances that might

necessitate medical decontamination (decon) Describe potential adverse outcomes on the

healthcare system associated with a hazardous substance incident

Identify means of detection of hazardous substances incidents

Describe differences between decon at the incident scene & medical decon at receiving healthcare facilities

Recognize the role of victim triage & medical decon within the Incident Command System

Identify the components of Level C PPE

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Texas Motor SpeedwayExercise, November 2004

Three critical gaps identified: Casualty / Patient TriageMedical Decontamination (Med Decon)Personal Protective Equipment (PPE)

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NDLS-Decon

2 day, 16-contact hoursMeets OSHA awareness and

operational training levelsCDLS course, 4 hoursNDLS-Decon, 12 hours

► Includes 8 hours ofinteractive-skills sessions

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NDLS-DeconRefresher

1 day, 8 contact hoursPersons who have taken NDLS-DeconReview course contentFocus on hands-on skills practice►Level C PPE►Medical Decontamination►Mass Casualty Triage►Communications

No formal CE credit or certification (07-07)

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NDLS Family of Courses

A comprehensive, nationally-standardized family of all-hazards training programs developed by the NDLS consortium of academic, state, and federal centers.

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The ConcernWorldwide arsenal of weapons of mass

destruction (WMD) noted for years:►CHEMICAL►BIOLOGICAL►RADIOLOGICAL►EXPLOSIVE►NUCLEAR

Security, Political, Socioeconomic changesThreat to intentionally harm large civilian

populations has never been greater!Are We Prepared?

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Consequences of Non-preparedness

Patients: Morbidity/mortality

Healthcare facilities: closures

Healthcare Providers: Morbidity/mortality

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Definitions & DISASTER Paradigm Review

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A disaster is present when need exceeds resources

In other words: the response need exceeds the resources available

“Disaster” Definition

Disaster = Need > Resources

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“Multiple/Mass/Major Casualty Incident”

An MCI is present when healthcare need exceeds available healthcare resources!

“MCI” Definition

MCI = Healthcare Need > Resources

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MCI ManagementGoal:

Do the greatest good for the greatest number of potential survivors!

This is an importa

nt concept!

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All-Hazards DefinitionsAll-Hazards:►Man-made or natural events with the

destructive capability of causing multiple casualties

All-Hazards Preparedness:►Comprehensive preparedness required to

manage the casualties resulting from All-Hazards

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“All-Hazards”Man-madeFiresExplosive devicesFirearmsStructural

collapseTransportation

event►Air, Rail, Roadway,

WaterIndustrial HAZMATWMD – NBC

eventsEtc…

NaturalEarthquakeLandslidesAvalancheVolcanoTornadoHurricanes, floodsFiresMeteorsEtc…

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“WMD / WME”Weapons or devices that injure or kill large

numbersCause widespread destruction and/or panicChemical, Biological, Radiological, Nuclear,

Explosive (CBRNE)

“Weapons of Mass Destruction / Effect” Definition

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Man-made poisons spread as gases, liquids, or aerosols

Cause illness or death in humans, animals, plants

May be inhaled, ingested or absorbedVariety of disseminating devices

Chemical Weapons

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Chemical Weapons

“Nerve agents”: GA, GB, GD, VX“Blood agents”: Cyanide“Blister agents”: Mustard, Lewisite“Choking agents”: Phosgene, Chlorine“Incapacitating agents”: BZ

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Devices to disperse radioactive substancesConventional explosive device (“dirty bomb”) Intentional radiation release: water, food, terrainLess energy & radiation release than a nuclear

weaponDelayed detection: no “scene”“Worried well” & civilian panic

Radiological Weapons

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Catastrophic explosionsMassive nuclear energy release through atom

splittingTraumatic injuries, burns, fallout, delayed effects

Nuclear Weapons

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Disseminate disease-causing microorganisms or biologically-produced toxins (poisons)

Cause illness or death in humans, animals, or plants

Numerous agents could be used

Biological Weapons

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Anthrax as WME

• “Asymmetric” warfare:• “Small event”• Widespread effect

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Biological Weapons

Smallpox Plague

Anthrax

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Biological Events

Influenza 1918-1919

Influenza 2007?

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EpidemicsSevere Acute Respiratory

Syndrome 2003

SARS (Corona virus)

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Natural Disasters

The Concern:Numerous & widespreadMillions of fatalities worldwideCountless millions more injured$ Billions per eventCommon in the U.S. There WILL be a natural

disaster in the U.S. this year

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Transportation Incidents More than 6 million per year in U.S. More than 40,000 traffic fatalities Secondary hazards

Fire, explosion, chemical, radioactive All modes: Highway Air Rail Marine

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Industrial HazmatMostly minor “spills”, occasionally severe!Massive explosionsHazardous materials release

►Toxic fumes, radiation, biological agents►Secondary disasters

Multiple casualtiesProlonged community impact

►Loss of homes & jobs►Emotional impact

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DISASTER ParadigmA standardized method to recognize and

manage the scene and care for victimsReinforced throughout all NDLS courses:

A training tool…Practical approach on scene!

An organizational tool…Utilize resources, assess needs

A series of questions…

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DISASTER Paradigm

Detection Incident CommandSafety & SecurityAssess HazardsSupportTriage & TreatmentEvacuationRecovery

• Natural & Accidental• Trauma & Explosive• Nuclear & Radiological• Biological Agents• Chemical Agents

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Medical Decon & the DISASTER Paradigm

Medical Decontamination needs to be integrated into the pre-planning & support for All-Hazards incidents►Includes mass casualty triage

Goals: ►Allow contaminated victims access to the

medical care they need ►Prevent further victim M/M►Prevent healthcare provider M?M

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Questions?

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SummaryAt least 3 categories of All-Hazards incidents

might necessitate medical decontamination►Chemical►Radiological►Biological►Explosive►Nuclear

Lack of preparedness for such incidents:► Increased suffering for victims►Reduced access to medical care for victims &

others Facility closures Loss of healthcare providers

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Contact Information

Ronna G. Miller, MDAssistant ProfessorEMS, Disaster Medicine & Homeland Security SectionDivision of Emergency MedicineDepartment of SurgeryUT Southwestern Medical Center at Dallas5323 Harry Hines Blvd.Dallas, Texas 75390-8890

Email: Ronna.Miller@UTSouthwestern.edu

Voicemail: (214) 648-6881