CBRNE Training Academy

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

2. Lecture Goals • Describe decontamination • Discuss how decontamination works • Detail what techniques are available • Describe personal protective equipment • Describe complications of PPE

3. 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

4. Who needs decontamination? • Powder, liquid or vapor exposure • Decontaminate exposed* areas • Situation in which you are unsure Everyone

5. Basic assumptions • The hospital is not the scene • EMS/Fire decontaminate patients, but… • 60-80% of people self present

6. 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.

7. Decontamination triage • Contaminated, sick • Assisted decontamination and therapy • Contaminated, not sick • Self-directed decontamination • Decontaminated (at scene) • Medical evaluation and treatment

8. Decontamination is simple… Get Naked Get Wet

9. 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

10. Types of decontamination • Mass Decontamination • Ambulatory Decontamination • Directed Self-decontamination • “Trash Bag” Decontamination • Non-ambulatory Decontamination

11. Mass decontamination • Dilution is the solution to pollution • Many people, little finesse • Fire department / HazMat team

12. Ambulatory decontamination • What is wrong with this picture? • Get naked, get wet

13. Non-ambulatory decontamination • Help those who can’t help themselves

14. 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

15. “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

16. 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

17. 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!

18. Remember Warm is where decontamination occurs Cold is where treatment occurs

19. Personal Protective Equipment An Introduction

20. 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

21. How are we exposed? • Determines decontamination • Determines what PPE we wear

22. 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

23. The Basics

24. Standard precautions • Hand washing • Clothes (uniforms, gowns, etc.) • Gloves, glasses • Masks and splash shields • Limited respiratory & splash protection

25. Hospital PPE • Add liquid splash protection • Fluid resistant suit • Add higher respiratory protection • Air purifying respirator

26. Industrial PPE • Same skin protection • Highest level of respiratory protection • Atmosphere supplying respirator • Don’t need oxygen atmosphere

27. Hot zone PPE • Highest level of skin and respiratory protection • Atmosphere supplying respiratory • Vapor protective suit • A body bag with a window

28. 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

29. 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

30. 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.)

31. 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

32. 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”

33. 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

34. Questions ?