Foundation Objectives The Haz Mat Response Process

1. S I N P C P C I A D D D Foundation ObjectivesThe Haz Mat Response Process -Operations Level -Protective Equipment -Containment / Control -Command -Protective Actions -Identification -Action Plans -Decon -Disposal -Documentation

2. Response Actions • Conduct decon • Ensure clean-up and proper disposal • Keep documentation D.D.D

3. Decontamination • Removing or neutralizing contaminants • Personnel • Equipment

4. Types of Decon • Responder • Done at the scene (hazmat team) • Precautionary/Medical • Done prior to admittance to the Hospital itself • Emergency • Normally done by first responders or First Receivers

5. Who, What, When & Why • Why: Prevent escalation of problem • Exposure: it might be on you • Contamination: it is on you

6. Who, What, When & Why • Who usually does decon: • FRO’s (properly trained & equipped) • Tech’s and Specialists via Decon Team • How to decon: No absolute methods • Only general guides

7. Degree of Contamination • Amount of material on you • Length of time it’s on you • Concentration of material • Physical state of material • Ambient temperatures

8. Who, What, When & Why • Who/What: People & equipment • Victims • Responders • Equipment • Structures

9. Warning! • Many hazmats are odorless, colorless and tasteless • Acute effects may not show up immediately • You may not be able to confirm exposure/contamination

10. Performing Decon • Physical removal • Chemical removal • Emergency decon

11. Performing Decon • Procedures follow logical order • Go from “dirty” to “clean” • Check your plan Dirty Clean Filthy

12. Consequences of No Decon • Acute/Chronic health effects • Problem gets bigger • Death! oooo-aaaaah!

13. Decon • Use copious amount of water • Copious = more than you have used • Remove all clothing from victim • Including undergarments

14. Emergency Decon • Precautions • Avoid contact w/clothing • Ensure privacy of victim(s) • Barriers/temp garments • Segregate by gender

15. Decon • Anytime you suspect contamination • Use common sense • Life risk • Level of exposure

16. Emergency Decon • Guidelines • In least environmentally sensitive area • Clothes off • Water on

17. Emergency Decon • Medical considerations • Decon prior to admittance • Protect equipment from contamination • Segregate contaminated material

18. Decon • Water - tepid. • Too cold - hypothermia and people will not stay in a cold shower. • Too hot - opens pores and provides pathway for chemical to get into the body. • Mild surfactant (Dawn, baby shampoo) • At least a minute, preferably 3-5 minutes

19. Extreme Environments • Very Hot and Very Cold • Challenges to the safety of victims and responders

20. Cold-Hot Weather Mass Decon • Responders should use whatever resources are available. • Select the fastest method available. • Decontamination is most effective when performed immediately. • The key to successful decontamination is • fastest approach • causing the least harm • the most good for the majority of the people. Information from Guidelines for Cold Weather Mass Decontamination During a Terrorist Chemical Agent Incident U.S. Army Soldier and Biological Chemical Command (SBCCOM) thanks to Jeff Rylee

21. Hypo/Hyperthermia • Regardless of the ambient temperature, people who have been exposed to a known, life-threatening level of chemical contamination should: • Disrobe • Undergo decontamination • with copious amounts of high-volume, low-pressure water • or an alternative decontamination method. • Be sheltered as soon as possible.

22. Hypothermia • A misconception among responders is that the risk of hypothermia as a result of cold weather mass decontamination is minimal. • Risk of cold shock – less well recognized than heat. • Special populations, such as the elderly and the very young, should be given priority for limited resources such as blankets and indoor shelter because of limited or impaired ability to maintain body temperature.

23. Extreme Heat • As indicated in the PPE module, heat stress is possibly the greatest hazard to responders/receivers due primarily to the impervious suit’s compromising of the evaporation of sweat. • Victims in high heat environments must have a means of staying cool to avoid exacerbating medical conditions and effects of chemical exposure.

24. Extreme Heat • One of the best ways to cool victims is to • Get ‘em wet! • Non air conditioned decon areas can get dangerously hot during extreme temperatures. • Consider portable or piped air conditioning.

25. Who is a First Receiver? First Receiver Job Titles: Physician Nurse Administration Security Officer Phlebotomist Respiratory Tech Resident X-ray Tech Others Healthcare workers at a hospital receiving contaminated victims for treatment. Koenig K. 2003. Strip and shower: the duck and cover for the 21st Century. Annals of Emergency Medicine. 42(3):391-394. September.

26. Triage • Assist in Decontamination • Post Decontamination Inspection • Provide clinical testing, treatment and transport • Provide direct clinical assessments and care • Gather personal information First Receiver Job Functions Close Patient Contact

27. Important Considerations • TraditionalResponse Site divided into 3 functional zones – based on exposure potential. • OSHA used hospital-specific terminology – • Limited to only 2 zones • Decontamination • Post-Decontamination • In most situations, hospitals will not know what is contaminating the victims • Victims will arrive with little or no warning – Self Referrals – up to 80%

28. Important Considerations • Victims will use all hospital entrances • Non Ambulatory victims will take at least 2-4 times more personnel to decontaminate • Being part of the Community Based Response Plan reduces risk to first receivers and presents problem solutions

29. Functional Zones Post Decontamination Zone Decontamination Zone

30. Decontamination Control Zones Pre-Decon = Staging of “dirty” People Decon = Removing Contamination Post-Decon = Medical Care

31. Decontamination Zones OSHA First Receivers Pre-Decontamination Zone Decontamination Zone Post-Decontamination Zone

33. ICS Haz Mat Organization • Hazardous Materials Group Positions • Haz Mat Group Supervisor • Technical Reference • Assistant Safety Officer* • *Reports to Incident Safety Officer

34. Haz Mat Decon Resource Team Incident Commander Public Info Officer Safety Officer Liaison Officer Logistics Chief Planning Chief Finance Chief Operations Chief Medical Care Director Ancillary Services Director Human Resources Director HazMat Branch Director Victim Decon Group Sup. Hospital-Based Command and Control Preparation Unit Leader Forward Unit Leader Services Unit Leader Rapid Intervention Leader Site Logistics Site Access Control Stripper / Bagger Rapid Intervention Site Set Up Washer / Rinser Team Re-Hab Area Initial Contact PPE Donning Decon Triage Dryer / Dresser Refuge Area Site Support Non-Ambulatory PPE Doffing Safe Haven

36. Haz Mat Branch Director Assistant Safety Officer Technical Specialists Spill Response Group Supervisor Victim Decon Group Supervisor Preparation Unit Leader Forward Unit Leader Services Unit Leader Rapid Intervention Leader Site Access Control Site Logistics Stripper / Bagger Rapid Intervention Site Set Up Initial Contact Washer / Rinser Team Re-Hab Area PPE Donning Decon Triage Dryer / Dresser Site Support Refuge Area Non-Ambulatory PPE Doffing Safe Haven

37. Management of the Contaminated Patient

39. Patients entering from Hot (Exclusion) Zone Decon Resource Team Refuge Area Decon Initial Contact Unit Leader Dirty Decon Triage Unit Leader (Stay upwind & keep distant from patients) stripper, bagger Highly Contaminated Patients Shower one / tub one Decon Resource Team Warm washer Zone Less Contaminated Patients Cleaner Contamination Reduction Corridor Shower two / tub two Decon Resource Team Warm rinser Zone Cleaner Less Contaminated Patients Clean Un Contaminated Patients Decon Resource Team dryer, dresser Un Contaminated Patients Clean Safe Haven Area Patients exit to Cold (Support) Zone Gatekeeper - admittance checklist

40. Tools for Stability in Decon

41. What about Children? • Design decontamination systems so that they can be used for decontamination of children: • of all ages (including infants), • of the parentless child, of the non-ambulatory child, • and of the child with special health care needs. • Address the following pediatric considerations in all protocols and guidance for decontamination: • 1) water temperature and pressure (high-volume, low- pressure, heated water systems), • 2) non-ambulatory children, • 3) children with special health care needs, and • 4) clothing after decontamination.

42. What about Children? • Children without parents will require additional personnel to assist in decontamination and emotional support; • Keep kids warm; • Ensure appropriately sized clothing, including diapers; • Develop systems to identify, tag and track unaccompanied children.

43. What About Other Special Populations?

44. What About Your Team? • Team members must be clean before they leave the decontamination zone • Stripper/Bagger = the most dirty • Dryer/Dresser = the least dirty • Washer/Rinser = the most physically at-risk • The team must clean each other in their full PPE in the washing-rinsing area • Start with all members gathering at the Stripper/Bagger area • Decon Triage assumes command of process • Examine each team member for physical problems • Determine which member should be decon’d first

45. Goal of Team Decon • Team members PPE has been exposed to contamination • No team member must leave the washing-rinsing area until thoroughly cleaned • Safety of the team member(s) is the most important goal • This includes the other members who will be assisting in doffing of the PPE

46. Decontamination Procedures

47. Mass Decon Fire Department / Haz Mat Team Examples