Operational Level Lesson 6 Presentation

1. Operational Level Lesson 6 Presentation Hazardous Materials for First Responders, 3rd Ed.

2. Contamination Terms • Contamination — The process of transferring a hazardous material from its source to people, animals, the environment, or equipment • Decontamination • The process of removing hazardous materials to prevent the spread of contaminants beyond a specific area and reduce the level of contamination to levels that are no longer harmful • Is performed when a victim, responder, animal, or equipment leaves the hot zone (1 of 2) Operational Level

3. Contamination Terms • Secondary contamination — The contamination of people, equipment, or the environment outside of the hot zone • Exposure — The process by which people, animals, the environment, and equipment are subjected to or actually come in contact with a hazardous material • Hazard — The harm that can be done by a material (2 of 2) Operational Level

4. Types of Contamination • Primary • The direct transfer of a hazardous material to persons, equipment, and the environment • Occurs in the hot zone because of direct contact with a hazardous material (1 of 3) Operational Level

5. Types of Contamination • Secondary • The contamination of people, of equipment, or the environment outside the hot zone • The contaminant is carried from the hot zone by personnel’s clothing or tools, air currents, and runoff water. • If personnel are not decontaminated before leaving the hot zone, they can contaminate whomever and whatever they touch thereafter. (2 of 3) Operational Level

6. Types of Contamination • Surface • The contamination of the surface of a material • Does not penetrate, permeate, or soak into materials • Permeation • The penetration of a contaminant below the surface of a material (3 of 3) Operational Level

7. Categories of Decontamination • Gross decontamination • Quickly removing the worst surface contamination, usually by rinsing with water from handheld hoselines, emergency showers, or other water sources • Performed on the following people in the following situations: • Entry team personnel before technical decontamination • Victims during emergency decontamination • Persons requiring mass decontamination (1 of 4) Operational Level

8. Categories of Decontamination • Emergency decontamination • Removing contamination on individuals in potentially life-threatening situations with or without the formal establishment of a decontamination corridor • A type of gross decontamination • Technical (formal) decontamination • Using chemical or physical methods to thoroughly remove contaminants from responders (primarily entry team personnel) and their equipment • Conducted within a formal decontamination line or corridor following a gross decontamination (2 of 4) Operational Level

9. Categories of Decontamination • Mass decontamination — Conducting gross decontamination of multiple people at one time • Secondary decontamination — Taking a shower after having completed a technical decontamination • Definitive decontamination — Decontaminating further after technical decontamination (3 of 4) Operational Level

10. Categories of Decontamination • Patient decontamination — Decontaminating injured patients or victims • Buddy decontamination — Performing decontamination between entry team personnel (or others), making it easier to rinse difficult-to-reach areas such as the back and backs of legs and knees • Self decontamination — Conducting emergency decontamination on oneself, usually by rinsing with water or using a blotting/ absorption method (4 of 4) Operational Level

11. Importance ofScene Control Procedures • First responders must direct victims to a safe location to await decontamination and prevent victims from leaving the scene. • Decontamination prevents secondary contamination to others. • All first responders must be sure to also know the department’s plan for evacuation of uncontaminated persons from the hazard area. Operational Level

12. Decontamination Methods • Wet • Washing the contaminated surface with solutions or flushing with a hose stream or safety shower • Usually necessitates the collection of runoff water in wading pools or other liquid-retaining devices • Dry • Scraping, brushing, and absorption • May be as simple as removing contaminated clothing and putting into a 55-gallon (208 L) storage bag • Does not create large amounts of contaminated runoff (1 of 2) Operational Level

13. Decontamination Methods • Physical • Removes the contaminant from a contaminated person without changing the material chemically • The contaminant is contained for disposal • Chemical • To make the contaminant less harmful by changing it through some kind of chemical process (2 of 2) Operational Level

14. Gross Decontamination • Flushing with water from a hose stream, safety shower, or other water source Operational Level

15. Emergency Decontamination • When it is needed: • Failure of protective clothing • Accidental contamination of first responders • Heat illness or other injury suffered by emergency workers in the hot zone • Immediate medical attention required for other victims (1 of 2) Operational Level

16. Emergency Decontamination • Advantages • Requires minimal equipment • Reduces contamination quickly • Does not require a formal contamination reduction corridor or decontamination process • Limitations • Does not always totally decontaminate the victim • Creates contaminated runoff that can harm the environment and other exposures (2 of 2) Operational Level

17. Steps in Emergency Decontamination • Remove the victim from the contaminated area. • Wash immediately any exposed body parts with flooding quantities of water. • Remove victim’s clothing and/or PPE rapidly – if possible, cutting from the top down in a matter that minimizes the spread of contaminants. (1 of 2) Operational Level

18. Steps in Emergency Decontamination • Perform a quick cycle of head-to-toe rinse, wash, and rinse. • Transfer the victim to treatment personnel for assessment, first aid, and medical treatment. • Ensure that ambulance and hospital personnel are told about the contaminant involved. (2 of 2) Operational Level

19. Technical (Formal) Decontamination • Absorption • Picking up liquid contaminants with absorbents • Advantage — Absorbents are inexpensive and readily available • Limitations • Absorbents do not alter the hazardous material • Absorbents have limited use on protective clothing and vertical surfaces • Absorbent disposal may be a problem (1 of 9) Operational Level

20. Technical (Formal)Decontamination • Adsorption • Process in which a hazardous liquid interacts with (or is bound to) the surface of a sorbent material • Brushing or scraping • Removing large particles of contaminant or contaminated materials such as mud from boots or other PPE • Is not sufficient decontamination • Is used before other types of decontamination (2 of 9) Operational Level

21. Technical (Formal)Decontamination • Chemical degradation • Using another material to change the chemical structure of a hazardous material • Commonly used materials • Household bleach • Isopropyl alcohol • Hydrated lime • Household drain cleaner • Baking soda • Liquid detergents (3 of 9) Operational Level

22. Technical (Formal)Decontamination • Chemical degradation • Advantage — Can reduce cleanup costs and the risk posed to the first responder • Limitations • Takes time to determine the right chemical to use and set up the process • Can be harmful to first responders if the process creates heat and toxic vapors (4 of 9) Operational Level

23. Technical (Formal)Decontamination • Dilution • Using water to flush contaminants from contaminated victims or objects and diluting water-soluble hazardous materials to safe levels • Advantage — The accessibility, speed, and economy of using water • Limitations • Water may cause a reaction and create even more serious problems. • Runoff water from the process is still contaminated and must be confined and then disposed of properly. (5 of 9) Operational Level

24. Technical (Formal)Decontamination • Neutralization • Changing the pH of a corrosive, raising, or lowering, it towards 7 (neutral) on the pH scale • Sanitization, disinfection, or sterilization • Sanitization — Reduces the number of microorganisms to a safe level (such as by washing hands with soap and water) • Disinfection — Kills most of the organisms present • Sterilization — Kills all microorganisms present, with chemicals, steam, heat, or radiation (6 of 9) Operational Level

25. Technical (Formal)Decontamination • Solidification — Process that treats a hazardous liquid chemically so that it turns into a solid • Vacuuming — Process using high efficiency particulate air (HEPA) filter vacuum cleaners to vacuum solid materials such as fibers, dusts, powders, and particulates from surfaces (7 of 9) Operational Level

26. Technical (Formal)Decontamination • Washing • Process similar to dilution, but also involves using prepared solutions such as solvents, soap, and/or detergents mixed with water in order to make the contaminant more water-soluble before rinsing with plain water • Evaporation • Can be accomplished by simply waiting long enough for hazardous materials to evaporate (8 of 9) Operational Level

27. Technical (Formal)Decontamination • Isolation and disposal • Isolating the contaminated items by collecting them in some fashion and then disposing of them in accordance with applicable regulations and laws (9 of 9) Operational Level

28. Mass Decontamination • The process of conducting gross decontamination of multiple people at one time in emergency situations • Is initiated where the number of victims and time constraints do not allow the establishment of an in-depth decontamination process • Uses large volumes of low-pressure water to reduce the level of contamination • Check with LERP or SOPs for exact procedures Operational Level

29. Patient Decontamination • Is necessary whenever victims have been contaminated yet need medical attention • Uses the same techniques as other types of decontamination, but gives special consideration to the injuries and medical conditions of the victims (1 of 2) Operational Level

30. Patient Decontamination • Ambulatory patients • Victims who are able to understand directions, talk, and walk unassisted • Most are triaged as minimal • Factors for determining priority • Casualties closest to the point of release • Casualties reporting exposure to the hazardous material • Casualties with evidence of contamination on their clothing or skin • Casualties with serious medical symptoms • Casualties with conventional injuries (2 of 2) Operational Level

31. Decontamination Steps for Ambulatory Patients • Direct patients by voice, PA system amplification, and/or hand signals to the gross decontamination area inside the hot zone but away from the high-risk areas. • Direct patients to remove their clothing down to their underwear. • Place the patient's clothing in trash barrels whenever possible, separating valuable personal effects into clear plastic bags, and placing the patient’s name or a unique identifying number on the bags whenever possible. (1 of 2) Operational Level

32. Decontamination Steps forAmbulatory Patients • Vacuum, brush, or wipe all particulate matter off the contaminated patients. • Have patients close their mouth and eyes. • Using handheld sprayers containing tepid water and/or diluted bleach solution, rinse the patient from head to toe for 1 minute. • Direct patients to proceed to the cold zone. (2 of 2) Operational Level

33. Patient Decontamination • Nonambulatory patients • Victims who are unconscious, unresponsive, or unable to move unassisted Operational Level

34. Decontamination Steps for Nonambulatory Patients • Remove the person from the high-risk area in the quickest way possible and carry the patient to the edge of the hot zone bordering the warm zone. • Remove the patient’s clothing, cutting it off as necessary, down to the underwear. • Place the patient’s clothes in a trash barrel, separating personal effects into clear plastic bags, and placing the patient’s name or a unique identifying number on the bags whenever possible. (1 of 4) Operational Level

35. Decontamination Steps forNonambulatory Patients • Vacuum, brush, or wipe off all particulate matter from the patient. • Close the patient’s mouth and pinch the nose shut if the patient cannot do so. • Using the handheld sprayer or hoseline, rinse the patient with tepid water for 1 minute, beginning with the face and airway and proceeding to open wounds. • Ensure that the armpits, genitalia, and the back are rinsed. (2 of 4) Operational Level

36. Decontamination Steps forNonambulatory Patients • Rinse the backboard before transferring the patient to the cold zone, unless switching to clean basin. • Apply a C-collar as soon as possible if a C-spine injury is suspected and a collar is available. (3 of 4) Operational Level

37. Decontamination Steps forNonambulatory Patients • Determine whether secondary decontamination will be done. If not, carry the patient into a decontamination alley to be quickly dried, covered, wrapped in an enclosing blanket, and then carried to the cold zone on a backboard. • Scan the patient with detection equipment and report the results to the treatment team if a radiological agent is involved. • Transfer the patient to properly protected cold-zone personnel who will perform indicated patient care. (4 of 4) Operational Level

38. Factors to Consider when Choosing a Decontamination Site • Accessibility • Must be away from hazards, but adjacent to the hot zone • Crucial time periods to consider • Travel time in the hot zone • Time allotted to work in the hot zone • Travel time back to the decontamination site • Decontamination time (1 of 4) Operational Level

39. Factors to Consider when Choosing a Decontamination Site • Terrain and surface material • The decontamination site ideally slopes toward the hot zone. • Diking around the site prevents accidental contamination escaping. • It is best if the site has a hard, nonporous surface to prevent ground contamination. • When a hard-surface driveway, parking lot, or street is not accessible, some type of impervious covering may be used to cover the ground. • Use covers or sheeting to form the decontamination corridor regardless of whether the surface is porous. (2 of 4) Operational Level

40. Factors to Consider when Choosing a Decontamination Site • Lighting (and electrical supply) • A site illuminated by streetlights, floodlights, or other type of permanent lighting reduces the need for portable lighting • Drains and waterways • Avoid locating a site near storm or sewer drains, ponds, ditches, and other waterways. • Water supply • Water (and sometimes detergent) must be available. (3 of 4) Operational Level

41. Factors to Consider when Choosing a Decontamination Site • Weather • Set up the site upwind in order to prevent the spread of contaminants into clean areas. • Make every attempt to shield victims from cold winds while they are removing protective clothing. (4 of 4) Operational Level

42. Setting up aDecontamination Corridor • Ensure privacy. • Provide a private, restricted area in which to conduct decontamination. • Use female responders to assist whenever possible when decontaminating women. (1 of 2) Operational Level

43. Setting up aDecontamination Corridor • Bag and tag contaminated clothing/effects carefully. • Label bags whenever possible. • Separate personal effects into clear plastic bags clearly marked with the person’s name. • Mark all personal effects so that they can be returned to their proper ownders after the incident without confusion. • Make the corridor visually recognizable – with barrier tape, safety cones, etc. (2 of 2) Operational Level

44. Decontamination Corridor Operational Level

45. Collecting Evidenceat Crime Scenes • Minimize disturbance to possible crime-scene evidence, while still making life safety the top priority. • Take notes or pictures documenting where victims were located and how the scene looked upon arrival. • Dead victims at crime scenes must go through a decontamination process before transport to the medical examiner. Operational Level

46. Terminating an Incident • Hold a debriefing for those involved in the incident as soon as possible. • Provide exposed persons with as much information as possible about the delayed health effects of the materials involved in the incident. • Schedule follow-up examinations with medical personnel if necessary. Operational Level

47. Operational Level Lesson 6 Presentation Hazardous Materials for First Responders, 3rd Ed.