Personal Protective Equipment

1. Personal Protective Equipment

2. Level A PPE Level A – provides the greatest level of skin, respiratory, and eye protection is required • Self Contained Breathing Apparatus - SCBA • (NIOSH-certified) • Respiratory protection for gases, vapors, aerosols, O2-deficient environment • Vapor-protective fully encapsulated suit

3. Level B PPE Level B – used when the highest level of respiratory is needed, but a lesser level of skin protection is adequate. • SCBA or SAR (Supplied Air Respirator) • Respiratory protection for gases, vapors, aerosols, O2-deficient environment • Splash-protective chemical resistant suit

4. Level C PPE Level C - The concentration(s) and type(s) of airborne substance(s) is known and the criteria for using air purifying respirators are met. • Air-purifying respirator (APR) or Hooded Powered air-purifying respirator (PAPR) , NIOSH-certified • NATO 40mm First Responder Cartridge (NOT HEPA filter) • Level C chemically resistant suit • Double gloves • Chemically resistant boots or disposable, removable outer boot/ shoe covers

5. Level D PPE Level D - A work uniform affording minimal protection: used for nuisance contamination only. • Universal precautions • No protection against chemicals

6. Respiratory Protection Assumptions • Correctly selected, fitted, used, and maintained respiratory PPE significantly reduces the hospital first receiver’s exposure level. • Every facility must have a respiratory protection program compliant with OSHA 1910.134

7. Powered Air-Purifying Respirator (PAPR) • Battery operated • Does not require fit-testing • Can be worn by multiple users • Does NOT provide oxygen, and are not permitted for use in oxygen deficient atmospheres • Provides Level C Respiratory Protection

8. PAPR Filters • High efficiency filter to remove solid and liquid aerosols • Contains activated and impregnated carbon to adsorb or react with gases and liquid vapors

9. Why Decontaminate? • To remove known or suspected hazardous substance from victim – lower the health risk • To decrease the amount of contact the victim has with the hazardous substance • To prevent contamination of staff, other patients or visitors • To prevent contamination of the facility

10. Decontamination • To Avoid Secondary Contamination • Decontamination is required by OSHA at all hazardous materials incidents • Decontamination MUST occur at hospitals receiving contaminated patients during hazmat emergencies “The removal of hazardous substances from employees and their equipment to the extent necessary to preclude the occurrence of foreseeable adverse health effects” (Occupational Safety and Health Administration [OSHA], 2008).

11. Team membership should include staff from all work shifts, including weekends and holidays. The Decontamination Team HICS Hospital Decontamination Team Functions: • Hazardous Materials Branch Director: organizes and directs decontamination incident response activities and coordinates with hospital incident command for overall victim support • Decontamination Safety Unit: monitors the decontamination area and assures the overall safety of the team. • Decontamination Set Up/Support: set up and provide supplies to the decontamination area and coordinate clean-up activities.

12. HICS Hospital Decontamination Team Functions (cont’d): Decontamination Triage: prioritizing victims for decontamination Victim Decontamination: facilitate and/or perform decontamination and clear victim for post-decontamination triage. Employee Health & Well Being: responsible for rehabilitation of decon team members Facility/ Equipment Decontamination: decontaminates equipment and hospital The Decontamination Team

13. The Solution to Pollution is Dilution • Copious amounts of water is needed • Hi volume, low pressure Don’t trade human life and safety for the environment

14. Types of Decontamination: GROSS Gross Decontamination • May be performed at incident site or decon area • Significantly reduces surface contaminant • Must be performed as quickly as possible • Uses low-pressure, high-volume water

15. Deluge System • Trident Deluge System

16. Types of Decontamination: SECONDARY Secondary Decontamination • Used after gross decontamination • More thorough • Focuses on removing all remaining contaminant • Nooks and crannies

17. Hospital Decontamination Response Steps

18. Step 1: Identification & Activation

19. Initial Actions When first encountering the patient: • DO NOT make physical contact with the patient without PPE • Instruct victims from a distance • Bull horn, megaphone, PA system, loud voice • Signage • DO NOT delay deluge while waiting for help if the contaminate is a threat to health • Have the patient disrobe (respect privacy) • Consider weather and safety concerns • When additional support arrives, establish the appropriate decontamination set-up Note: The Emergency Operations Plan should determine the level of activation

20. Clothing Removal • Removal will reduce exposure up 70% • Should be done as quickly as possible • Clothing provides some level of protection depending on the material Guidelines for Mass Casualty Decontamination (US Army Research)

21. Hospital Decontamination Control Zone Contamination Site Decontamination Area Command/ Clean Area

22. Your Hospital Decon Operation

23. Scene Safety • Weather • Ice, lightening, wind, etc • Slips, Trips and Falls • General • Equipment, heater, electricity, people Everyone is a safety officer!!

24. Decontamination Control • HazMat Branch Director • Victim Decontamination Unit Leader • Safety Officer • No PPE needed • Overall Site Management • Place to report to when assignment complete • Consider bullhorn • Radio • Signage to increase communication

25. Step 2: Decon Triage

26. Decontamination Triage Simple sorting of patients into exposed or contaminated groups Nota medical triage Consider cones, scene tape, and security in this area

27. Decontamination Process

28. Step 3: Don PPE (if necessary)

29. Pre-entry Exclusion Criteria Vital Sign criteria should be determined by facility medical control. Examples: • Diastolic BP > 95, Systolic > 160 • Pulse rate > 70% maximum heart rate, (220 – age) x 0.7 • Irregular heart rhythm undocumented and/or treated • Respiratory rate > 24 • Temperature > 99.5 or < 97

30. Pre-entry Exclusion Criteria • Inability to fit into PPE without stress on seams of suit • Impaired skin • Alteration in mental status • History of nausea, vomiting, diarrhea, or heat related injury in past 24 hrs. • New prescription started in the last 72 hrs. • Pregnancy

31. Medical Monitoring and Rehabilitation Before Entrance After Exit Re-assessment & documentation of vital signs Documentation flow sheet must be started Re-hydration after exit Use weight to estimate fluid losses Medical control & protocol used to determine need for further follow-up of rescuer • Assessment & documentation of vital signs and weight • Normal vital signs should be on file for team members • Remember that rescuer PPE can cause considerable heat stress • Hydration should be offered before entry

32. Safety: Responder Health & Safety Heat stress factors • Prehydration of team • Level of physical fitness • Ambient air temperature • Degree of activity and duration • PPE being used • suits protect but prevent cooling • normal processes to dissipate heat not available

33. Medical Monitoring & Rehabilitation • Medical control & protocols determine need for • Oral fluids • IV fluids • Additional protocols as needed • No re-entry until vitals back to normal • Alert • Non-tachycardic • Normotensive • Body weight within a set percentage of normal

34. Work/ Rest and Dehydration • Work/ Rest Cycle • Team Leader needs to ensure team safety. • Length of rotation determined by team leader • Hydration before and after decon of patients • Frequent checks on staff • Assess for signs of dehydration • Track time in suit • Switching of team mates often. Signs/Symptoms of Dehydration: • Fatigue • Light headedness, headache • Muscle cramps • Thirst • Altered mental status • Vital sign changes • Increased temp., increased pulse, decrease BP, increased respirations

35. Step 4: Decontamination Ambulatory Non-Ambulatory

36. Step 4: Decontamination (Shower) • Secondary decontamination takes place here • May be external or internal • Ambulatory & Non-ambulatory considerations • Signage • Donning and Doffing Patient kits • Barrel to place contaminated clothing and items • Soap, Sponges, Buckets • Medical Shears • Towels and Blankets How do you track, secure and decontaminate patient belongings?

37. Ambulatory Decontamination Ambulatory patients progress as follows: • Clothing removal, including: • Patients’ items bagged and tagged. • Triage tag or other tracking tag placed around patients’ neck or wrist.

38. Personal Belongings • Must have process for managing belongings • Contain contaminated personal items • Document • Track • Secure • Decontaminate • Return (if possible)

39. Ambulatory Decontamination • Remove clothes and personal belongings • Removal will reduce exposure up 70% • Direct patient to remove in such a way to protect the respiratory system • Place items in an appropriate container • Plastic bags with labels for identification • Instruct patient to enter shower and wash entire body head to toe with soap and water

40. Non-Ambulatory Decontamination Move patient to decontamination corridor with • Placement on pad-less gurney or backboard • Four staff members to move patient • Three staff members, minimum, attending

41. Non-Ambulatory Decontamination During this stage • Clothing removed by two members, cutting as needed. • One member maintains patient’s airway

42. Non-Ambulatory Decontamination Patient cutout procedures • Perform medical monitoring from head • First cut: head to waist • Second cut: down the sleeves • Third cut: down the pant legs

43. Decontamination Priorities • Eyes, mucous membranes & severely affected areas of skin • Take care not to contaminate unaffected areas of skin • Thoroughly irrigate areas of affected skin • Avoid abrasive cleansing

44. Decontamination Priorities • Eyes • If one eye is contaminated, turn head to ensure other eye isn’t contaminated • If both eyes are contaminated, lay head back to avoid cross contamination • Full Body • Roll patient and wash both sides • Lift arms and legs and wash • Clean genital areas

45. How do you know when the patient is clean?

46. Decon End Point • Is the patient symptomatic • Has the burning stopped? • Respiratory issues resolved / improved? • Is the product obviously removed? • All the nooks and crannies have been cleaned • DHS time frame to flow water – 3 min? • Eyes may need further flushing post decontamination • Ph paper? • Radiation detector or other meters?

47. Step 5: Patient Care • Hypothermia prevention • Primary Assessment • Signs and Symptoms • Any residual symptoms? • Have symptoms improved? • Secondary Assessment • Follow hospital protocols for treatment

48. Step 6: Termination of Operations • Decontaminate the Decon Team • What is your termination plan? • Who decontaminates your equipment? • What is your run off / containment plan? • Hazardous waste disposal? • Returning equipment to operational status • Re-stock of PPE, equipment & supplies

49. Decon the Decon Team • Team decons each other • Last team member stays in PPE and performs team cut-outs • Last member self decons and proceeds to cut-out • PPE level for last member cut-out? • Level C? • Level D with APR and gloves? • Level D?

50. PPE Decision • Has the product / chemical been identified? • Are / were any of the patients symptomatic? • Are any type of detectors or meters in use? • Is this a radiological event? • How confident are you in your decon procedures?