Transcript CBRNE Training Academy An Introduction to Decontamination and Personal Protective Equipment (PPE)

CBRNE Training Academy
An Introduction to
Decontamination and Personal
Protective Equipment (PPE)
Lecture Goals
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Describe decontamination
Discuss how decontamination works
Detail what techniques are available
Describe personal protective equipment
Describe complications of PPE
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
Who needs decontamination?
• Powder, liquid or vapor exposure
• Decontaminate exposed* areas
• Situation in which you are unsure
Everyone
Basic assumptions
• The hospital is not the scene
• EMS/Fire decontaminate patients, but…
• 60-80% of people self present
Self 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.
Decontamination triage
• Contaminated, sick
– Assisted decontamination and therapy
• Contaminated, not sick
– Self-directed decontamination
• Decontaminated (at scene)
– Medical evaluation and treatment
Decontamination is simple…
Get Naked
Get Wet
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
Types of decontamination
• Mass Decontamination
• Ambulatory Decontamination
– Directed Self-decontamination
– “Trash Bag” Decontamination
• Non-ambulatory Decontamination
Mass decontamination
• Dilution is the solution to pollution
• Many people, little finesse
• Fire department / HazMat team
Ambulatory decontamination
• What is wrong with this picture?
• Get naked, get wet
Non-ambulatory decontamination
• Help those who can’t help themselves
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
“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
Decontamination 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
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!
Remember
Warm is where decontamination occurs
Cold is where treatment occurs
Personal Protective
Equipment
An Introduction
Nothing 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
How are we exposed?
• Determines decontamination
• Determines what PPE we wear
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
The Basics
Standard precautions
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Hand washing
Clothes (uniforms, gowns, etc.)
Gloves, glasses
Masks and splash shields
Limited respiratory & splash protection
Hospital PPE
• Add liquid splash
protection
– Fluid resistant suit
• Add higher respiratory
protection
– Air purifying respirator
Industrial PPE
• Same skin protection
• Highest level of respiratory protection
– Atmosphere supplying respirator
– Don’t need oxygen atmosphere
Hot zone PPE
• Highest level of skin and respiratory
protection
– Atmosphere supplying respiratory
– Vapor protective suit
• A body bag with a window
The 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
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
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.)
Advanced 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
Health 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”
Summary
• 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 ?