Decontamination

1. Decontamination Our lives depends on it!

2. Decontamination • Decontamination – the process preformed or steps taken to rid personnel, equipment, or the environment of contamination caused by hazardous materials.

3. Why Decontaminate? • To be certain no further harm can result from the hazardous material. • To return people, equipment, and the environment to a safe level that existed prior to the incident. • TO PROTECT YOU AND YOUR FAMILY!!

4. Why Decontaminate? • You should establish a NO EXCEPTIONS policy. • Why? • Acute and chronic health effects. • Environmental damage.

5. Why Decontaminate? • Acute Health Effects: • Start from the time you come in contact with hazardous material. • Can be temporary, become a chronic illness, or be fatal! • A small amount of some hazardous materials can be fatal immediately.

6. Why Decontaminate? • Chronic Effects: • These health issues are permanent. • Some can be controlled with limited disability while others are career ending disabilities. • Can develop days, weeks, months, years later. • Can be caused by being exposed to a certain hazardous materials over a prolonged period (several incidents). • Can be caused from contact with equipment that was not decontaminated or not properly decontaminated.

7. Why Decontaminate? • Environmental Effects: • If an area is not decontaminated anyone or anything that would come in contact with the hazardous material could be contaminated and then spread the contamination even further. • It can get into natural resources such as ground water and contaminate them.

8. How Contamination Occurs • Primary contamination occurs by direct contact with the hazardous material. • Secondary contamination can occur by: • contact with a contaminated person, equipment, or environment. • Contact with contaminated by products of the hazardous material. Such as: runoff, fumes, airborne products.

9. How Contamination Occurs • Secondary contamination can also occur away from the scene. • Examples: • Contaminated fire fighter • Contaminated equipment

10. How Contamination OccursContaminated Fire Fighter

11. How Contamination OccursContaminated Equipment

12. How to Prevent Secondary Contamination • Have a large enough and secured perimeter around the incident. • Evacuate public and non essential personnel from the secured perimeter (only needed personnel should be in the hot or warm zones). • Decontaminate personnel, equipment, and apparatus PRIOR to leaving the warm zone and entering the “safe” (cold) zone.

13. How the Human Body is Exposed • The body can be exposed to hazardous materials by four (4) methods. • Inhalation • Absorption • Ingestion • Injection

14. How the Human Body is Exposed • Inhalation • This is the most common form of exposure. • It is also the most damaging. • When vapors are inhaled they can be directly absorbed into the blood stream. • Inhalation injuries can cause respiratory and/or organ damage.

15. How the Human Body is Exposed • Absorption • Hazardous materials can be absorbed either through the skin or the eyes. • By being absorbed through the skin it can get into the blood stream. • Being absorbed through the eyes is a direct connection to the CNS. • Eyes are very vulnerable because the eye tissue has an increased absorbency rate. • Cuts and moisture enhance absorbency.

16. How the Human Body is Exposed • Ingestion • This is usually through a secondary means: • Eating food/drink without properly washing your hands and face. Not eating in a clean environment or from a clean surface. You shouldn’t eat or drink in the Hot or Warm zones. • Smoking • Chewing on pens, pencils, eye glasses, etc.

17. How the Human Body is Exposed • Injection • Not as common but obvious possible in our profession. • Can be done by kneeling down on something sharp and puncturing through PPE and skin. • Getting caught on something and tearing PPE and puncturing skin. • From projectiles from an explosion or falling debris.

18. How the Human Body is Exposed • Good To Know Sh…(Stuff) • Don’t forget about radiation exposures. They can fall under all four (4) categories of exposure as well. • Some hazardous chemical vapors are so toxic that they can be absorbed into or permeate through the rubber on your SCBA face mask.

19. How Equipment Becomes Exposed • The primary way equipment is exposed in being used in direct contact with the hazardous materials during the operations to contain/confine the spill/leak. • The secondary way equipment can become exposed is by contaminated personnel touching the equipment or being exposed to runoff, vapors or fumes. • Some equipment can become impregnated with the hazardous materials such as brooms, fire hoses, turnout gear, wooden handles on tools or wooden tools, etc. • Some of these tools may not be able to be decontaminated and will have to be disposed of.

20. How Equipment Becomes Exposed • GTKS • Contaminated apparatus and tools must be decontaminated with the proper decontamination solution at the scene. The equipment or tools should be confined until it can be checked by a specialist to verify there is no hidden contamination. • Contaminated or potentially contaminated equipment or tools should not be taken back to the fire station to be decontaminated. It should be done on the scene. • Don’t assume that by isolating the equipment or tools for a while that it will take care of the contamination. Some hazardous materials can take years to degrade to a point that they would be safe to handle, if ever.

21. Decontamination Methods • The four (4) methods of decontamination: • Dilution • Absorption • Chemical Degradation • Isolation and Disposal

22. Decontamination Methods • DILUTION: • Most commonly used form of decontamination. • Flushing the chemical, normally with water, to dilute and remove it from people and equipment. • Quick and economical because of its availability. LIMITATIONS: • Water reactive chemicals. • Runoff must be contained and disposed of properly. • Reduces the concentration, but not the chemical make-up, of the chemical.

23. Decontamination Methods • Absorption: • Used for equipment and environment. • Can use soil, sand, ash, commercial products (absorbent pads and pigs, etc.) LIMITATIONS: • Absorbent must be inert so it doesn’t react to the chemical. • Not practical for use on people (most of the time). • It can become a hazardous waste problem.

24. Decontamination Methods • Chemical Degradation: • Chemically alters the chemical to make it inert or less hazardous. • Can use products such as bleach, drain cleaner, washing soda, lime, detergent, isopropyl alcohol. • Can be easier to dispose of. LIMITATIONS: • It can take a long time to confirm the recommended product to use. • May not be able to find a ready supply of the product. • NEVER appropriate for decontamination of people. There can be significant heat generated by the product and chemical reacting.

25. Decontamination Methods • Isolation and Disposal: • Requires it to be disposed of properly. • Can include equipment, clothes, soil, runoff that can not be adequately decontaminated. • Little additional hazardous waste is produced. LIMITATION: • Must wait on a hazardous materials clean-up contractor to arrive. • Can be very expensive. Both for the clean-up itself, as well as, equipment replacement or environmental repair (replacing soil, plants, etc.)

26. Decontamination • There are some questions that need to be answered before decontamination can be set-up. • What is the chemical? • What are the circumstances? • What resources will be needed?

27. Decontamination • What is the chemical? • Need to identify the product and the concentration of the chemical. • How will it react under the current circumstances (need to know its physical and chemical properties). • How will it effect people and the environment.

28. Decontamination • What are the circumstances? • Weather conditions (current and expected) • Exposures • Evacuations will effect how and where you decontaminate. • Where to locate the decontamination site: • Site needs to be close enough to prevent spread of contaminates, but far enough away to be in a safe area. • The best site is uphill and upwind away from any manholes, drains, or water ways. • Decon is set up in the warm zone. It starts as you exit the “hot zone” and works it way to the “cold zone”. • It needs to be clearly marked so responders with limited visibility can see it. • Weather can determine if remote decon will be necessary.

29. Decontamination • What resources will be needed? • Equipment: • Water • Showers / wands • Hoses • Transportation • Supplies: • Liquid surgical soap or body soap • Decon solutions (what is recommended by manufacturer – make sure safe to be used on responders or just equipment) • Shampoo • Nail brushes • Towels / sheets / blankets • Clean clothes • Personnel • Number of personnel will depend on the decon set-up that will be needed.

30. Decontamination Steps • The nine (9) step decontamination process: • Establish an Entry Point • Clearly mark it. • Provide an area for tool drop (on contaminated side). • Primary Decontamination • Removes as much gross contaminate as possible. • Rinse, scrub, rinse. • Use low pressure water streams to avoid splashing and overspray. • Contain as much runoff as possible. • Decon personnel should be in the same level or one step lower protection as the entry personnel. • Start at head of responder and work down.

31. Decontamination Steps • SCBA Removal / Replacement** • For re-entry personnel: • If highly contaminated the entire SCBA should be replaced. • If low risk incident, just the bottle can be changed. • SCBA is passed from the clean side of the decon line to the contaminated. • If unable to decontaminate on site the contaminated SCBA is placed in a bag and tagged for offsite cleaning and placed on the contaminated side of the decon line. • If bottles are being filled on the incident site…the bottles must be decontaminated prior to leaving the decon area. • Decon personnel DO NOT assist in filling bottles or taking them to the fill station. A separate crew will be needed to do this task. • For personnel that will not be re-entering: • SCBA is removed BUT THE FACEPIECE REMAINS ON AND THEY CONTINUE TO “BREATH AIR” UNTIL PPE IS COMPLETELY REMOVED IN STEP FOUR (4). Decon personnel will be needed to hold the SCBA until it is removed.

32. Decontamination Steps • Removal and Isolation of Protective Clothing** • Remove protective clothing from top to bottom (turn the protective clothing inside out as you take it off). • The contaminated clothing is to be bagged and placed into salvage drum for disposal. • If structural gear (turn-out’s) are used and can be decontaminated…they are to be placed in a bag, tagged, and set aside for offsite cleaning. • Finish removing the SCBA. Place in bag, tag, and set aside for offsite cleaning if needed. ** NOTE – steps three (3) and four (4) may need to be switched if personnel are in Level A protection.

33. Decontamination Steps • Removal of Personal Clothing • The decision to do this onsite or offsite is based on weather conditions and whether transportation is available. • Clothing should be placed in a bagged and placed in a salvage drum for disposal. • Personal items (watches, rings, wallets, etc.) should be placed in a separate bag and tagged for possible offsite decontamination. • RESPONDERS SHOULD REMOVE PERSONAL ITEMS BEFORE “SUITING UP” AND ENTERING THE HOT ZONE.

34. Decontamination Steps • Body Decontamination • This is usually done offsite. • Wash entire body with soap, ESPECIALLY the head, ears, nails, and groin. • The runoff should be contained. • All items used for cleaning (soap, wash cloths, brushes, bottles, etc.) are used only once and should be bagged and placed in a salvage drum for disposal. • Drying Off and Providing Clean Clothing • Use towels or sheets for drying. • Use only once and bag and tag them and place in a salvage drum for disposal. • Put on clean clothes or disposable clothing such as coveralls or hospital gowns, slippers or rubber thongs.

35. Decontamination Steps • Medical Evaluation • ALL decontaminated personnel should be evaluated by trained medical personnel (usually EMS) • Anyone needing treatment for chemical exposure or injuries or other medical problems will be triaged at this step. • Transportation and Documentation • If all nine (9) steps are used due to the high risk of the incident, this final step is used for observation, rest, recovery, and treatment. If needed, transport for continued monitoring. • Record (document) as much information as possible on the personnel that are decontaminated (i.e.: chemical exposed too, how they where exposed, what their job was, before and after medical evaluation results, etc.).

36. Decontaminating the Victim • Handling contaminated victims: • If a contaminated victim is treated the same as “regular” victims…a serious secondary emergency can be created. • The victim can have greater effects of the chemical they have been exposed too. • Unexposed rescuers become exposed. • The transport vehicle and the hospital can become contaminated.

37. Decontaminating the Victim • Basic Decontamination, packaging, and transport procedures: • Remove victim to a safe but remote site. • Avoid being contaminated. WHERE APPROPRIATE PPE. Wear neoprene, viton, butyl rubber gloves over your latex gloves. They provide greater chemical protection. • Remove victim’s clothing. • Place clothing in a bag and tag it and set aside for disposal. • Place personal items in a separate bag and tag it for offsite cleaning or disposal.

38. Decontaminating the Victim • Remove as much contaminate as possible using appropriate decon solutions. i.e.: water, soap, etc.. • Dry the victim and placed used towels / sheets in a bag and tag and set aside for disposal. • Place victim on a clean sheet and wrap them in it. • Place the victim on a plastic sheet and wrap them the same way (can also use a body bag).

39. Decontaminating the Victim • Place plastic down with sheet on top. Then place the victim on the sheet and fold in order 1-6 Sheet 5 2 3 6 Plastic 1 4

40. Decontaminating the Victim • Protect the transport vehicle if necessary. • Separate the cab from the patient compartment (close door or place plastic over it) • Use plastic to cover all equipment and cabinets in patient compartment and tape the seams. • Wear PPE during transport if necessary. (shouldn’t be needed other than proper gloves.) • Alert the receiving facility of the victim, what has been done to decontaminate the victim, what they were exposed to / contaminated with, any S/S and treatment that has been done. • Provide the hospital with as much information on the chemical as possible. i.e.: MSDS, labels, etc.

41. Mass Decontamination • This type of decontamination is only used for victims. • This type of decontamination is usually used on incidents involving W.M.D.’s • The methods used can go from simple to more complex depending on the personnel and equipment available by initial arriving units. • The most difficult hurdle to cross is keeping victims on scene and in a separate area from non victims. • Convincing victims of the necessity of the need to be decontaminated may also present some difficulties.

42. Mass Decontamination • Not all persons at the scene need decontamination. • Do they have product on them? • Were they in the immediate vicinity of the hazardous chemical that was released? • Were they in a confined area when a hazardous material was released? • Are they showing signs and symptoms of exposure to a hazardous material? • Just because they were in the building or in the area doesn’t necessarily mean they need to be decontaminated.

43. Mass Decontamination • The steps used for mass decontamination are similar to the steps used in “standard” decontamination but the process used if different. • This process is only used for victims not exhibiting signs and symptoms of exposure. • Establish an Entry Point • Mark as clearly as possible • Have someone there to explain to the victims what they will need to do and direct them to proper line (if using separate lines – male/female).

44. Mass Decontamination • Gross Decontamination • This station is used to remove the majority of the contamination. • Biological agent – Flush with water or lightly wet down to prevent it from becoming airborne. • Chemical agent – Wipe visible agent off (no water) • Clothing Removal • Have victims remove as much clothing as they are comfortable with – preferably down to their underwear. • If possible each victims clothing should be bagged separately and tagged to identify the victim (triage tags are good for this). 4. Wash Station • This station is for the victims to clean personal items such as eye glasses, jewelry, wallets – what ever they want to keep with them. • Use a bleach & water mixture (spray bottle or tub) – allow items to soak 2-5 minutes and rinse with water. • **easiest way is to have them thoroughly spray them down and place in a ziplock bag and take it with them through the rest of the decon process.

45. Mass Decontamination 5. Primary Decontamination • Use copious amounts of water • If possible provide soap for the victims to use • Drying Off and Clean Clothes • Use towels or sheets for drying and then place in salvage drum for disposal. • We will probably have to provide disposable clothing such as coveralls or hospital gowns, slippers or rubber thongs. 7. Medical Evaluation / Transport • Most victims that went through this decontamination process shouldn’t need this station. • Any victims needing evaluation or treatment will be triaged at this station. Victim will then be sent to the designated area for his/her triage level for further treatment and transport.

46. Mass Decontamination • Victims showing signs and symptoms are decontaminated and packaged the same as our personnel would be, BUT NOT USING THE RESPONDING PERSONNELS DECONTAMINATION AREA. • Run off used from the mass decontamination area, both standard and emergency, doesn’t have to be contained but we should make every effort to try too. Once the incident “slows down” you need to make sure you would contain the runoff from any further victims that would use the decontamination area.

47. Mass Decontamination • BE SURE TO DO YOUR BEST TO PROTECT THE MODESTY OF THE VICTIMS BEING DECONTAMINATED!!! • If possible use separate lines for male and female victims. If unable too, send victims through in groups by gender. • If needed have airspace around the incident closed. Why? News media camera’s taking photos. • You can (and should) use apparatus, sheets, blankets, plastic to help protect their modesty. • Don’t forget - Today’s world is sue happy!!! • Remember the following: • Biological Agents – Flush, Strip, Flush, Cover • Chemical Agents – Wipe, Strip, Flush, Cover

48. LCHMT Decontamination Set-up’s • The LCHMT Decontaminations Set-ups: • Minor Incident Decon • Basic Decon (5 step) • Full Decon (9 step) • Mass Decon • Mass Decon Set-Up #1 (1 Engine Set-up) • Mass Decon Set-Up #2 (2 Engine Set-up) • Mass Decon Set-Up #3 (2 Engine Set-Up) • Mass Decon Set-Up #4 (2 Engine and Ariel Ladder Set-up) • Mass Decon Tent

49. LCHMT Decontamination Set-up • Personnel numbers listed on all decon set-ups are the minimum number of personnel needed to operate the decontamination process not the number to set it up, personnel for running equipment/supplies back and forth or EMS.

50. Minor Incident Decontamination • Requires a minimum of 4 personnel but preferably 8 personnel. It consist of: • Entry Point with tool drop off area • Primary Decontamination • SCBA Removal/Replacement • PPE Removal and Isolation • Medical Evaluation • Emergency Decontamination Area