Transcript EMS The Canadian Experience

Public Health CBRN course
Decontamination
Daniel Kollek, MD, FRCPC
Goals of session
To provide an overview of
Decontamination and PPE
Outline of session
 Erroneous assumptions
 Decontamination concepts
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Biological vs Chemo/Radiation
People vs. Places & Objects
Hot/Warm/Cold zones
Decontamination methods
Streaming by acuity
 PPE levels
Common 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 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 - Biohazards
Staff 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
Contaminated objects or sites
Need to decide if area should be closed
Need to decide if people should be
isolated or decontaminated
Close the site?
Suspicious object
Opened
Spilled substance
or
airborne substance
Unopened
No Spill and
not airborne
Leaking oily or
granular substance
No leak
Evacuate area
Shut ventilation
Close work station
until decon or
-ve test result
No closure
No environmental
decontamination
Office can
be closed off
“Open concept”
office
Close office only
until decon or
-ve test result
Close floor
until decon or
-ve test result
Decontaminate
the people?
Suspicious object
with threat
Opened
Staff exposed
Hands only;
Wash hands
Shower at home
Unopened
Staff not exposed
Leaking oily or
granular substance
No leak
Wash Hands
Wash hands
Shower at home
Wash Hands
Hands & clothes;
Remove clothes
and shower
Gross contamination:
Remove clothes
and shower
Launder clothes
at home with
bleach if possible
Leave clothes
on site if possible
Key concept # 3
Methods of decontamination
Mechanical
Dilution
Absorption
Degradation
Mechanical: 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 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 selfadministered
 Consider run-off containment
Key concept # 4
Hot, Warm and Cold zones
Hot Zone
Contaminated area
Need PPE
Warm Zone
Contamination
reduction
Cold Zone
Normal function
Key concept # 4
Hot, Warm and Cold zonesYou will be here. Public
Health does not usually
decontaminate or function
in the hot zone
Hot Zone
Contaminated area
Need PPE
Warm Zone
Contamination
reduction
Cold Zone
Normal function
Zone rules
Isolate
cadavers
Very limited treatment
before decontamination
Control access to zones
Temporary
Morgue
Decontamination direction No back flow!!
Hot Zone
Contaminated area
Need PPE
Warm Zone
Contamination
reduction
Cold Zone
Normal function
Key concept # 5
Minor incident vs. MCI
Not everyone needs formal
decontamination
Decontamination should be streamed
by acuity or ambulatory ability
Decontamination 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”
Chemical MCI - Ambulatory
Chemical MCI – Non-ambulatory
Key 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 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 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 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 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 airpurifying respirator
 Chemical resistant clothing
 Gloves
 Not self contained.
PPE level D
Used for nuisance
contamination only.
It requires only
coveralls or equivalent
and safety shoes/boots
or equivalent.
PPE 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
Summary
 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