CBRNE Training Academy

CBRNE Training Academy

An Introduction to An Introduction to Decontamination and Decontamination and Personal Protective Personal Protective Equipment (PPE)Equipment (PPE)

An Introduction to An Introduction to Decontamination and Decontamination and Personal Protective Personal Protective Equipment (PPE)Equipment (PPE)

Lecture GoalsLecture Goals

• Describe decontamination• Discuss how decontamination

works• Detail what techniques are

available• Describe personal protective

equipment• Describe complications of PPE

• Describe decontamination• Discuss how decontamination

works• Detail what techniques are

available• Describe personal protective

equipment• Describe complications of PPE

What is decontamination?What is decontamination?

• An attempt to alter absorption• Prevent secondary contamination

• The removal of hazardous substances from employees and their equipment to the extent necessary to preclude the occurrence of foreseeable adverse health effects

• OSHA 29CFR1910.120

• An attempt to alter absorption• Prevent secondary contamination

• The removal of hazardous substances from employees and their equipment to the extent necessary to preclude the occurrence of foreseeable adverse health effects

• OSHA 29CFR1910.120

Who needs decontamination?

Who needs decontamination?

• Powder, liquid or vapor exposure• Decontaminate exposed* areas• Situation in which you are unsure

Everyone

• Powder, liquid or vapor exposure• Decontaminate exposed* areas• Situation in which you are unsure

Everyone

Basic assumptionsBasic assumptions

• The hospital is not the scene• EMS/Fire decontaminate patients,

but…• 60-80% of people self present

• The hospital is not the scene• EMS/Fire decontaminate patients,

but…• 60-80% of people self present

Self presentationSelf presentation

• 90% contamintaion on clothing and hair

So, if someone is exposed . . .. . . and he self-presents . . .

. . . and he is not sick . . .He is likely only mildly contaminated .

. . . . . and can self-decontaminate . . .

. . . and poses little risk.

• 90% contamintaion on clothing and hair

So, if someone is exposed . . .. . . and he self-presents . . .

. . . and he is not sick . . .He is likely only mildly contaminated .

. . . . . and can self-decontaminate . . .

. . . and poses little risk.

Decontamination triageDecontamination triage

• Contaminated, sick– Assisted decontamination and

therapy

• Contaminated, not sick– Self-directed decontamination

• Decontaminated (at scene)– Medical evaluation and treatment

• Contaminated, sick– Assisted decontamination and

therapy

• Contaminated, not sick– Self-directed decontamination

• Decontaminated (at scene)– Medical evaluation and treatment

Decontamination is simple…

Decontamination is simple…

Get NakedGet Wet

Get NakedGet Wet

A note about soap . . .A note about soap . . .

• Copious water is most important

• Mild detergent is all you need, if at all

• Bleach is not necessary– Irritant in wrong

concentration

• Copious water is most important

• Mild detergent is all you need, if at all

• Bleach is not necessary– Irritant in wrong

concentration

Types of decontaminationTypes of decontamination

• Mass Decontamination• Ambulatory Decontamination

– Directed Self-decontamination– “Trash Bag” Decontamination

• Non-ambulatory Decontamination

• Mass Decontamination• Ambulatory Decontamination

– Directed Self-decontamination– “Trash Bag” Decontamination

• Non-ambulatory Decontamination

Mass decontaminationMass decontamination

• Dilution is the solution to pollution• Many people, little finesse• Fire department / HazMat team

• Dilution is the solution to pollution• Many people, little finesse• Fire department / HazMat team

Ambulatory decontamination

Ambulatory decontamination

• What is wrong with this picture?• Get naked, get wet

• What is wrong with this picture?• Get naked, get wet

Non-ambulatory decontaminationNon-ambulatory decontamination

• Help those who can’t help themselves

• Help those who can’t help themselves

Directed self-decontamination

Directed self-decontamination

• Do-it-yourself decontamination– Instructions posted or broadcast– Something to do besides wait . . .

• Gives time for team to assemble– Appropriately don PPE– Focus on those who can’t help

themselves

• Simple– Disrobe, collect valuables– Wash

• Do-it-yourself decontamination– Instructions posted or broadcast– Something to do besides wait . . .

• Gives time for team to assemble– Appropriately don PPE– Focus on those who can’t help

themselves

• Simple– Disrobe, collect valuables– Wash

“Trash bag” Decontamination

“Trash bag” Decontamination

• Do-it-yourself kit– Large, opaque plastic bag– Large clear plastic bag– Small clear plastic bag– Pre-numbered tags/labels

• Opaque bag is portable dressing room

• Clear bags for clothes, valuables• Labels to assist in tracking

• Do-it-yourself kit– Large, opaque plastic bag– Large clear plastic bag– Small clear plastic bag– Pre-numbered tags/labels

• Opaque bag is portable dressing room

• Clear bags for clothes, valuables• Labels to assist in tracking

Decontamination issuesDecontamination issues

• Safety– Establishing security, zones

• Environment– Waste water, temperature, ground

cover• Property

– Valuables, tracking• Modesty

– Cultural, religious and personal values• Special

– Language, adults & kids, special needs

• Safety– Establishing security, zones

• Environment– Waste water, temperature, ground

cover• Property

– Valuables, tracking• Modesty

– Cultural, religious and personal values• Special

– Language, adults & kids, special needs

A brief note on therapy. . .A brief note on therapy. . .

• Decontamination is a priority• Pre-decontamination therapies are

basic– Bag-valve-mask with oxygen– Spine board and cervical collar– Compression dressing / bandage– Mark I auto-injectors

• Do not delay for more than this!

• Decontamination is a priority• Pre-decontamination therapies are

basic– Bag-valve-mask with oxygen– Spine board and cervical collar– Compression dressing / bandage– Mark I auto-injectors

• Do not delay for more than this!

RememberRemember

Warm is where decontamination occurs

Cold is where treatment occurs

Warm is where decontamination occurs

Cold is where treatment occurs

Personal Protective Equipment

Personal Protective Equipment

An IntroductionAn IntroductionAn IntroductionAn Introduction

Nothing special about itNothing special about it

• Used everyday, often overlooked• Three layers of protection

– Basic protective and safety gear• Skin and work clothes• Oven mitt, apron, glasses• Earplugs, back belts, work boots, hard hat

– Standard infectious precautions• Gowns, gloves, booties, masks

– Advanced Personal Protective Equipment• PAPR, SCBA

• Used everyday, often overlooked• Three layers of protection

– Basic protective and safety gear• Skin and work clothes• Oven mitt, apron, glasses• Earplugs, back belts, work boots, hard hat

– Standard infectious precautions• Gowns, gloves, booties, masks

– Advanced Personal Protective Equipment• PAPR, SCBA

How are we exposed?How are we exposed?

• Determines decontamination• Determines what PPE we wear

• Determines decontamination• Determines what PPE we wear

The last line of defense. . . The last line of defense. . .

• Ideally, we aren’t exposed• Healthcare has chemical and

biological protective gear• We don’t have protection

against . . .– Fire– Explosions– High energy radiation

• No gear protects against everything

• Ideally, we aren’t exposed• Healthcare has chemical and

biological protective gear• We don’t have protection

against . . .– Fire– Explosions– High energy radiation

• No gear protects against everything

The BasicsThe Basics

Standard precautionsStandard precautions

• Hand washing• Clothes (uniforms, gowns, etc.)• Gloves, glasses• Masks and splash shields • Limited respiratory & splash

protection

• Hand washing• Clothes (uniforms, gowns, etc.)• Gloves, glasses• Masks and splash shields • Limited respiratory & splash

protection

Hospital PPEHospital PPE

• Add liquid splash protection– Fluid resistant suit

• Add higher respiratory protection– Air purifying

respirator

• Add liquid splash protection– Fluid resistant suit

• Add higher respiratory protection– Air purifying

respirator

Industrial PPEIndustrial PPE

• Same skin protection• Highest level of respiratory

protection– Atmosphere supplying respirator– Don’t need oxygen atmosphere

• Same skin protection• Highest level of respiratory

protection– Atmosphere supplying respirator– Don’t need oxygen atmosphere

Hot zone PPEHot zone PPE

• Highest level of skin and respiratory protection– Atmosphere supplying respiratory– Vapor protective suit

• A body bag with a window

• Highest level of skin and respiratory protection– Atmosphere supplying respiratory– Vapor protective suit

• A body bag with a window

The HierarchyThe Hierarchy

• In healthcare, we work in the cold zone– Standard precautions, hand washing– Use this everyday

• In an event, we add a warm zone– Level C PPE– You may be asked to use this

• We NEVER work in the hot zone– Level A and B– You will NEVER be asked to do this

• In healthcare, we work in the cold zone– Standard precautions, hand washing– Use this everyday

• In an event, we add a warm zone– Level C PPE– You may be asked to use this

• We NEVER work in the hot zone– Level A and B– You will NEVER be asked to do this

When should we use PPE?When should we use PPE?

ALWAYS

• At a minimum, standard precautions

• If you are unsure of the exposure, use the highest level available to you

• As directed by HEICS

ALWAYS

• At a minimum, standard precautions

• If you are unsure of the exposure, use the highest level available to you

• As directed by HEICS

Important Important

• Be aware• Remember potential exists

– Situation can and may change

• Follow HEICS• Need more protection than you

have?– If so, get out (S-I-N)– Call for help (911, HazMat, etc.)

• Be aware• Remember potential exists

– Situation can and may change

• Follow HEICS• Need more protection than you

have?– If so, get out (S-I-N)– Call for help (911, HazMat, etc.)

Advanced PPE = BagAdvanced PPE = Bag

• You are living in a bag– Can’t eat, drink, go to the bathroom

• You are working in a bag– You can’t hear or talk– Slips, trips and falls– Claustrophobic

• You are exercising in a bag– Dehydration– Heat exhaustion, stress and stroke

• You are living in a bag– Can’t eat, drink, go to the bathroom

• You are working in a bag– You can’t hear or talk– Slips, trips and falls– Claustrophobic

• You are exercising in a bag– Dehydration– Heat exhaustion, stress and stroke

Health and monitoringHealth and monitoring

• Hydrate– Before and after– At least 8 oz. of water

• Brief assessment– Before and after– Pulse, blood pressure

• Be aware of how you feel• 20 to 30 minutes per “shift”

• Hydrate– Before and after– At least 8 oz. of water

• Brief assessment– Before and after– Pulse, blood pressure

• Be aware of how you feel• 20 to 30 minutes per “shift”

SummarySummary

• Decontamination removes secondary contamination

• Get naked, get wet• Maintain the zones• PPE is the last line of defense• It is not perfect• It is difficult and hot

• Decontamination removes secondary contamination

• Get naked, get wet• Maintain the zones• PPE is the last line of defense• It is not perfect• It is difficult and hot

Questions ?Questions ?