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NDLS-DECON “REFRESHER”

NDLS-DECON “REFRESHER”. CME Faculty Disclosure. In order to assure the highest quality of CME programming, the AMA requires that faculty disclose any information relating to a conflict of interest or potential conflict of interest prior to the start of an educational activity.

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NDLS-DECON “REFRESHER”

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  1. NDLS-DECON“REFRESHER” Decon-Ref v.1.0

  2. CME Faculty Disclosure • In order to assure the highest quality of CME programming, the AMA requires that faculty disclose any information relating to a conflict of interest or potential conflict of interest prior to the start of an educational activity. • The teaching faculty for the NDLS course offered today have no relationships / affiliations relating to a possible conflict of interest to disclose. Any discussion of off label usage during this course will be noted. Decon-Ref v.1.0

  3. Course Objectives • List 3 categories of hazardous substances that might necessitate medical decontamination (decon) • Describe potential adverse outcomes on the healthcare system associated with a hazardous substance incident • Identify means of detection of hazardous substances incidents • Describe differences between decon at the incident scene & medical decon at receiving healthcare facilities • Recognize the role of victim triage & medical decon within the Incident Command System • Identify the components of Level C PPE Decon-Ref v.1.0

  4. Course Objectives - 2 • Demonstrate proper donning & doffing procedures for Level C PPE • Perform the component steps of “MASS” Triage during a simulated mass casualty incident • Apply the “ID-ME” color-coded categories to victims of a simulated mass casualty incident • Describe the roles of medical decon team members • Identify selection criteria for a medical decon site • Demonstrate basic dry & wet medical decon procedures • List 4 methods of communication that might be employed in a chaotic medical decon environment Decon-Ref v.1.0

  5. Introduction Chapter 1 Decon-Ref v.1.0

  6. Ch. 1: Objectives • List 3 categories of hazardous substances that might necessitate medical decontamination (decon) • Describe potential adverse outcomes on the healthcare system associated with a hazardous substance incident • Identify means of detection of hazardous substances incidents • Describe differences between decon at the incident scene & medical decon at receiving healthcare facilities • Recognize the role of victim triage & medical decon within the Incident Command System • Identify the components of Level C PPE Decon-Ref v.1.0

  7. Texas Motor SpeedwayExercise, November 2004 Three critical gaps identified: • Casualty / Patient Triage • Medical Decontamination (Med Decon) • Personal Protective Equipment (PPE) Decon-Ref v.1.0

  8. NDLS-Decon • 2 day, 16-contact hours • Meets OSHA awareness and operational training levels • CDLS course, 4 hours • NDLS-Decon, 12 hours • Includes 8 hours of interactive-skills sessions Decon-Ref v.1.0

  9. NDLS-DeconRefresher • 1 day, 8 contact hours • Persons who have taken NDLS-Decon • Review course content • Focus on hands-on skills practice • Level C PPE • Medical Decontamination • Mass Casualty Triage • Communications • No formal CE credit or certification (07-07) Decon-Ref v.1.0

  10. NDLS Family of Courses • A comprehensive, nationally-standardized family of all-hazards training programs developed by the NDLS consortium of academic, state, and federal centers. Decon-Ref v.1.0

  11. The Concern • Worldwide arsenal of weapons of mass destruction (WMD) noted for years: • CHEMICAL • BIOLOGICAL • RADIOLOGICAL • EXPLOSIVE • NUCLEAR • Security, Political, Socioeconomic changes • Threat to intentionally harm large civilian populations has never been greater! Are We Prepared? Decon-Ref v.1.0

  12. Consequences of Non-preparedness • Patients: Morbidity/mortality • Healthcare facilities: closures • Healthcare Providers: Morbidity/mortality Decon-Ref v.1.0

  13. Definitions & DISASTER Paradigm Review Decon-Ref v.1.0

  14. “Disaster” Definition • A disaster is present when need exceeds resources • In other words: the response need exceeds the resources available Disaster = Need > Resources Decon-Ref v.1.0

  15. “MCI” Definition • “Multiple/Mass/Major Casualty Incident” • An MCI is present when healthcareneed exceeds available healthcare resources! MCI = Healthcare Need > Resources Decon-Ref v.1.0

  16. MCI Management Goal: Do the greatest good for the greatest number of potential survivors! This is an important concept! Decon-Ref v.1.0

  17. All-Hazards Definitions • All-Hazards: • Man-made or natural events with the destructive capability of causing multiple casualties • All-Hazards Preparedness: • Comprehensive preparedness required to manage the casualties resulting from All-Hazards Decon-Ref v.1.0

  18. Man-made Fires Explosive devices Firearms Structural collapse Transportation event Air, Rail, Roadway, Water Industrial HAZMAT WMD – NBC events Etc… Natural Earthquake Landslides Avalanche Volcano Tornado Hurricanes, floods Fires Meteors Etc… “All-Hazards” Decon-Ref v.1.0

  19. “Weapons of Mass Destruction / Effect” Definition • “WMD / WME” • Weapons or devices that injure or kill large numbers • Cause widespread destruction and/or panic • Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) Decon-Ref v.1.0

  20. Chemical Weapons • Man-made poisons spread as gases, liquids, or aerosols • Cause illness or death in humans, animals, plants • May be inhaled, ingested or absorbed • Variety of disseminating devices Decon-Ref v.1.0

  21. Chemical Weapons • “Nerve agents”: GA, GB, GD, VX • “Blood agents”: Cyanide • “Blister agents”: Mustard, Lewisite • “Choking agents”: Phosgene, Chlorine • “Incapacitating agents”: BZ Decon-Ref v.1.0

  22. Radiological Weapons • Devices to disperse radioactive substances • Conventional explosive device (“dirty bomb”) • Intentional radiation release: water, food, terrain • Less energy & radiation release than a nuclear weapon • Delayed detection: no “scene” • “Worried well” & civilian panic Decon-Ref v.1.0

  23. Nuclear Weapons • Catastrophic explosions • Massive nuclear energy release through atom splitting • Traumatic injuries, burns, fallout, delayed effects Decon-Ref v.1.0

  24. Biological Weapons • Disseminate disease-causing microorganisms or biologically-produced toxins (poisons) • Cause illness or death in humans, animals, or plants • Numerous agents could be used Decon-Ref v.1.0

  25. Anthrax as WME • “Asymmetric” warfare: • “Small event” • Widespread effect Decon-Ref v.1.0

  26. Biological Weapons Smallpox Plague Anthrax Decon-Ref v.1.0

  27. Biological Events Influenza 1918-1919 Influenza 2007? Decon-Ref v.1.0

  28. EpidemicsSevere Acute Respiratory Syndrome 2003 SARS (Corona virus) Decon-Ref v.1.0

  29. Natural Disasters The Concern: • Numerous & widespread • Millions of fatalities worldwide • Countless millions more injured • $ Billions per event • Common in the U.S. • There WILL be a natural disaster in the U.S. this year Decon-Ref v.1.0

  30. Transportation Incidents • More than 6 million per year in U.S. • More than 40,000 traffic fatalities • Secondary hazards • Fire, explosion, chemical, radioactive • All modes: • Highway • Air • Rail • Marine Decon-Ref v.1.0

  31. Industrial Hazmat • Mostly minor “spills”, occasionally severe! • Massive explosions • Hazardous materials release • Toxic fumes, radiation, biological agents • Secondary disasters • Multiple casualties • Prolonged community impact • Loss of homes & jobs • Emotional impact Decon-Ref v.1.0

  32. DISASTER Paradigm • A standardized method to recognize and manage the scene and care for victims • Reinforced throughout all NDLS courses: • A training tool… Practical approach on scene! • An organizational tool… Utilize resources, assess needs • A series of questions… Decon-Ref v.1.0

  33. DISASTER Paradigm • Detection • Incident Command • Safety & Security • Assess Hazards • Support • Triage & Treatment • Evacuation • Recovery • Natural & Accidental • Trauma & Explosive • Nuclear & Radiological • Biological Agents • Chemical Agents Decon-Ref v.1.0

  34. Medical Decon & the DISASTER Paradigm • Medical Decontamination needs to be integrated into the pre-planning & support for All-Hazards incidents • Includes mass casualty triage • Goals: • Allow contaminated victims access to the medical care they need • Prevent further victim M/M • Prevent healthcare provider M?M Decon-Ref v.1.0

  35. Questions? Decon-Ref v.1.0

  36. Summary • At least 3 categories of All-Hazards incidents might necessitate medical decontamination • Chemical • Radiological • Biological • Explosive • Nuclear • Lack of preparedness for such incidents: • Increased suffering for victims • Reduced access to medical care for victims & others • Facility closures • Loss of healthcare providers Decon-Ref v.1.0

  37. Contact Information Ronna G. Miller, MD Assistant Professor EMS, Disaster Medicine & Homeland Security Section Division of Emergency Medicine Department of Surgery UT Southwestern Medical Center at Dallas 5323 Harry Hines Blvd. Dallas, Texas 75390-8890 Email: Ronna.Miller@UTSouthwestern.edu Voicemail: (214) 648-6881 Decon-Ref v.1.0

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