Transcript Hospital Based Haz Mat Response Module IV

HazMat for WV Hospitals:
Decontamination, Disposal,
Documentation
Module IV
This course was developed by EnMagine,
who we wish to gratefully acknowledge.
The material has been modified by WV
DHHR in cooperation with the West
Virginia Hospital Association’s Disaster
Preparedness Task Force in the teaching
of Hospital Decontamination.
Objectives
• Explain decontamination procedures for
victims, personnel, and equipment.
• Discuss application of relevant Standard
Operating Procedures.
• Describe proper disposal and
documentation procedures during a Decon
response.
Decontamination
• Removing or neutralizing contaminants
– Personnel
– Equipment
Types of Decon
• Primary/Technical
– Done at the scene, usually by Emergency
Services
• Secondary
– Done at hospital for patients who received
decon at the scene (detailed decon)
• Emergency
– Done at hospital for patients who have
bypassed on-scene decon
Who, What, When & Why
• Who/What: People & equipment
– Patients
– Responders
– Equipment
Who, What, When & Why
• Who should do Decon :
– properly trained & equipped personnel
• What/How to Decon:
– Decon individuals who have not
received primary decon and those who
need secondary decon
– No absolute method of decon
– Only general guides for decon
Who, What, When & Why
• When: Anytime you
suspect contamination
– Material is visible
– Patient complains of pain,
odor, etc.
– Patient was in the release
Who, What, When & Why:
Degree of Contamination
•
•
•
•
•
Amount of material on the patient
Length of time it’s on the patient
Concentration of material
Physical state of material
Ambient temperatures
Who, What, When & Why
• Why: Prevent escalation of problem
– Exposure: patient is exposed to release or product
– Contamination: it is on patient
– Exposure of others; contamination of facility, etc.
Who, What, When & Why
Consequences of No Decon
• Acute/Chronic health effects
• Problem gets bigger
• Death!
Performing Decon
• Physical removal
• Chemical removal
• Emergency Decon
Performing Decon
• Procedures follow logical
order
• Go from “dirty” to “clean”
• Check your plan
Decon Procedures
• Anytime you suspect contamination
• Use common sense
– Life risk
– Level of exposure
Decon Procedures
• Remove all clothing from victim
– Including undergarments
• Use copious amounts of water
– Copious=more than you have used
• Large amounts: high volume
Decon Procedures
• Precautions
– Avoid contact w/clothing (use
PPE)
– Ensure privacy of victim(s)
• Barriers/garments
• Segregate by gender
Decon Procedures
• Hospital Considerations
– Did individuals receive decon prior to
transport?
– Protect staff/facility/equipment
– Secure contaminated clothing
Patients arrive
Activate Plan?
EVENT
Patients arrive
with or without
notification
Follow your
hospital’s plan
Triage
Triage Patient(s)
Decontamination
Required?
Yes
NO
No decon required
NO
Patient(s) to
Treatment Area
Assess
and Treat
Disposition
Decon required
Yes
Activate hospital
Decon protocols
Collect personal
belongings/
evidence**
Secondary
Triage
Emergency Treatment required?
Able to perform Self-decon?
YES
Patient(s) directed to
Self-decon
Assess for adequacy
of decon**
Need assistance?
YES
Safely provide assistance
and/or treatment
within hospital capability
Assistance or
Medical Treatment
required?
Decon
patient
Assess for adequacy
of decontamination**
Evaluate decon
Assess for adequacy
of decon**
NO
Re-decontaminate
and/or provide
technical
decon**
Adequate?
YES
Treatment / Disposition
Adequate?
YES
Redress Patient
with clean
covering
Reassess
and Treat
Disposition
Medical Management of
Contaminated Patients
• Is patient in severe distress?
– Airway compromise?
– Severe wheezing or respiratory distress?
– Persistent nausea/vomiting?
– Having a seizure?
• May need emergency medical treatment
– Chemical antidotes (atropine, 2PAM, etc.)
– Intubation
Decon Initial Contact Unit Leader
Decon Triage Unit Leader
Patients entering from
Hot Zone
Decon Resource Team
(Stay upwind & keep distant from patients)
Stripper,,bagger
Highly Contaminated Patients
Dirty
Shower / Center of Shelter
Warm
Zone
Decon Resource Team
washer/ rinser
Less Contaminated Patients
Cleaner
Clean
Patients exit to
Cold (Support) Zone
Safe Haven
Area
Decon Resource Team
dryer, dresser, gatekeeper, admittance
Un Contaminated Patients
Safe
Refuge
Decon Organization
• Decon Group Positions
–
–
–
–
–
–
Decon Group Supervisor
Technical Reference
Site Access Control
Decon Leader
Entry Leader
Assistant Safety Officer*
• *Reports to Safety Officer
Decon Resource Team
Incident
Commander
Public Information Officer
Safety & Security Officer
Liaison Officer
Logistics Chief
Planning Chief
Finance Chief
Medical Care
Director
Operations Chief
Ancillary Services
Director
Human Services
Director
Hazardous Materials Group
Entry
Site Access Control
Safe Refuge Area
Decontamination
Decon Group Supervisor
Initial Contact
Decon Triage
Decon Site
Access Control
Technical Specialists
Decon Set Up/
Support
Decontamination Procedures
Mass Decon
Hospital Based
Photos courtesy of Andrew Fulton, CREM
What do you do/ if one of the
Decon Resource Team goes
down?
Reasons for Documentation of
Decon Activities
• Cost recovery
• Exposure records
Disposal of Contaminated
Items
All contaminated items are to be
bagged and in a secure location until
they can properly removed and decontaminated /disposed of by a licensed
firm or government agency.
Components of Documentation
• Date, time and location
• Names of all response personnel
– What jobs were they assigned?
• Incident conditions, observations and
statements
• Material name/s, weather conditions
Components of Documentation
• Actions taken, resources used, costs
incurred
• Statements & Observations of witnesses
• Diagrams, photos, and video
Decon Exposure Records
Mike Zolotoff
Salazar, Robert
• Keep exposure records!
– Employer must keep for 30 years
• All responders: keep own copies
Decon Exposure Records
• Date, time and location of incident
• Chemical name
• Decon or medical aid given
Post Event Monitoring
• Personnel (Work w/Employee Health Services)
– Respiratory Monitoring
– Chronic and Acute exposure and affects
– Chemical Exposure Records for files
Role of the FRO
• Safely and competently respond
• Within appropriate –
– Level
– Resources and
– Capabilities
Summary of Module IV - Decon
• Decon of victims
– Who, What, When, Why
– How to decon
– Directed, self decon vs. Mass decon
– Documentation
– Disposal
• Some may need medical management
Questions?