decontamination daniel kollek, md, frcpc public health cbrn course
Post on 20-Dec-2015
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Outline of sessionOutline of session
Erroneous assumptions Decontamination concepts
– Biological vs Chemo/Radiation– People vs. Places & Objects– Hot/Warm/Cold zones– Decontamination methods– Streaming by acuity
PPE levels
Common erroneous assumptionsCommon erroneous assumptions
All contaminated victims will be decontaminated at the scene
Patients will only go to designated hospitals
Victims will arrive via the EMS system Victims at a non designated hospital can
be safely transported to the appropriate site
“Hazardous Materials” Levitin& Siegelson, Emerg. Med. Clin. Of N.Am. Vol 14 No2, May 1996, 327-348
Reasons for DecontaminationReasons for Decontamination
Prevent the spread of chemicals or biological agents from the area of initial release
Remove chemicals or radionucleides from the patient to terminate their exposure
Reduce the need for PPE among those providing care
Prevent accidental exposure to responder/receiver while removing PPE ensembles
Key concept # 1 - BiohazardsKey concept # 1 - BiohazardsStaff treating biological (infected)
patients need appropriate PPE only (as determined by routine practice & additional precautions)
Need for isolation of patients depends on pathogen and or syndrome
Infected patients do not need formal decontamination
Key concept # 2 Key concept # 2 Contaminated objects or sitesContaminated objects or sites
Need to decide if area should be closedNeed to decide if people should be
isolated or decontaminated
Suspicious object
Opened Unopened
Spilled substance or
airborne substance
No Spill andnot airborne
Leaking oily or granular substance
No leak
Evacuate areaShut ventilation
Office can be closed off
“Open concept”office
No closureNo environmental decontamination
Close work stationuntil decon or-ve test result
Close office onlyuntil decon or-ve test result
Close flooruntil decon or-ve test result
Close the site?
Suspicious object with threat
Opened Unopened
Staff exposed Staff not exposedLeaking oily or
granular substanceNo leak
Hands only;Wash hands
Shower at homeWash Hands
Wash handsShower at home
Wash Hands
Hands & clothes;Remove clothes
and shower
Gross contamination:Remove clothes
and shower
Launder clothesat home with
bleach if possible
Decontaminate the people?
Leave clothes
on site if possible
Key concept # 3Key concept # 3Methods of decontaminationMethods of decontamination
MechanicalDilutionAbsorptionDegradation
Mechanical: Clothing RemovalMechanical: Clothing Removal First step in patient decontamination Removes majority of contaminant Only form of decon necessary in vapor/aerosol exposure Should be performed outside
of treatment areas Privacy/personal space essential Clothing may need containment
Dilution: Soap & Water ShowerDilution: Soap & Water Shower
Necessary for liquid or solid contamination
Dilutes the offending agent Washes away the toxin Decreases the rate of chemical
reaction Restores normal skin pH Can usually be self-administered Consider run-off containment
Key concept # 4Key concept # 4Hot, Warm and Cold zonesHot, Warm and Cold zones
Hot ZoneContaminated area
Need PPE
Warm ZoneContamination
reduction
Cold ZoneNormal function
Key concept # 4Key concept # 4Hot, Warm and Cold zonesHot, Warm and Cold zones
Hot ZoneContaminated area
Need PPE
Warm ZoneContamination
reduction
Cold ZoneNormal function
You will be here. Public Health does not usually
decontaminate or function in the hot zone
Zone rulesZone rules
Hot ZoneContaminated area
Need PPE
Warm ZoneContamination
reduction
Cold ZoneNormal function
Control access to zones
TemporaryMorgue
Very limited treatment before decontamination
Isolate cadavers
Decontamination direction No back flow!!
Key concept # 5Key concept # 5Minor incident vs. MCIMinor incident vs. MCINot everyone needs formal
decontaminationDecontamination should be
streamed by acuity or ambulatory ability
Decontamination TriageDecontamination Triage Serious medical/chemical signs and
symptoms get urgent decontamination Moderate signs or symptoms, or confirmed
liquid exposure- delayed decontamination Minimal signs and symptoms, or vapor
exposure will follow the delayed patients No signs and symptoms, or potential for
exposure, but remain significantly concerned re contamination will be processed last- “psychological decontamination”
Key decon. conceptsKey decon. concepts
Protect yourself and your staff– Containment of people & contaminants– Appropriate PPE (& know how to use it!)
Define the Hot and Cold zones– Triage in or before Hot zone– Secure the perimeter– Very limited care (if at all) in Hot zone
Stream patients by acuity– Integrate the decontamination plan into the
general disaster plan Not everyone needs a shower
PPE levelsPPE levels
When response activities are conducted where atmospheric contamination is known or suspected to exist, personal protective equipment (PPE) must be worn.
Personal protective equipment is designed to prevent/reduce skin and mucous membrane contact as well as inhalation or ingestion of the chemical substance.
Protective equipment to protect the body against contact with known or anticipated chemical hazards has been divided into four categories, levels A-D.
PPE level APPE level A
This is the level you are most likely to see in the Hot Zone of a significant event.
It is entirely self contained with SCBA and fully encapsulated.
PPE level BPPE level B
This is the level you are most likely to see in the Hot Zone of a less hazardous event or in the warm zone.
It is still fully encapsulated and maybe self contained or not.
PPE level CPPE level C
This is the level you are most likely to see in the cold zone, in transit and the hospital.
Full-face or half-mask or air-purifying respirator
Chemical resistant clothing Gloves Not self contained.
PPE level DPPE level D
Used for nuisance contamination only.
It requires only coveralls or equivalent and safety shoes/boots or equivalent.
PPE levelsPPE levels
Reasons to upgrade – Known or suspected presence of dermal hazards – Occurrence or likely occurrence of gas or vapor emission – Change in work task that will increase contact or potential
contact with hazardous materials – Request of the individual performing the task
Reasons to downgrade:– New information indicating that the situation is less
hazardous than was originally thought – Change in site conditions that decreases the hazard– Change in work task that will reduce contact with hazardous
materials
SummarySummary Receiving facilities all need some form of
decontamination plan, assume everyone arrives dirty
Biological, Chemical and Radioactive contamination have different decontamination and isolation requirements
People, Places & Objects have decontamination and isolation protocols
Divide the decontamination area and the impact site into Hot/Warm/Cold zones and stream patients by acuity
PPE levels vary by the agent