Decontamination

1. Public Health CBRN course Decontamination Daniel Kollek, MD, FRCPC

2. Goals of session To provide an overview of Decontamination and PPE

3. Outline of session • Erroneous assumptions • Decontamination concepts • Biological vs Chemo/Radiation • People vs. Places & Objects • Hot/Warm/Cold zones • Decontamination methods • Streaming by acuity • PPE levels

4. Common erroneous assumptions • All contaminated victims will be decontaminated at the scene • Patients will only go to designated hospitals • Victims will arrive via the EMS system • Victims at a non designated hospital can be safely transported to the appropriate site “Hazardous Materials” Levitin& Siegelson, Emerg. Med. Clin. Of N.Am. Vol 14 No2, May 1996, 327-348

5. Reasons for Decontamination • Prevent the spread of chemicals or biological agents from the area of initial release • Remove chemicals or radionucleides from the patient to terminate their exposure • Reduce the need for PPE among those providing care • Prevent accidental exposure to responder/receiver while removing PPE ensembles

6. Key concept # 1 - Biohazards • Staff treating biological (infected) patients need appropriate PPE only (as determined by routine practice & additional precautions) • Need for isolation of patients depends on pathogen and or syndrome • Infected patients do not need formal decontamination

7. Key concept # 2 Contaminated objects or sites • Need to decide if area should be closed • Need to decide if people should be isolated or decontaminated

8. Close the site?

9. Decontaminate the people? Leave clothes on site if possible

10. Mechanical Dilution Absorption Degradation Key concept # 3Methods of decontamination

11. Mechanical: Clothing Removal • First step in patient decontamination • Removes majority of contaminant • Only form of decon necessary in vapor/aerosol exposure • Should be performed outside of treatment areas • Privacy/personal space essential • Clothing may need containment

12. Dilution: Soap & Water Shower • Necessary for liquid or solid contamination • Dilutes the offending agent • Washes away the toxin • Decreases the rate of chemical reaction • Restores normal skin pH • Can usually be self-administered • Consider run-off containment

13. Key concept # 4Hot, Warm and Cold zones Hot Zone Contaminated area Need PPE Warm Zone Contamination reduction Cold Zone Normal function

14. Key concept # 4Hot, Warm and Cold zones You will be here. Public Health does not usually decontaminate or function in the hot zone Hot Zone Contaminated area Need PPE Warm Zone Contamination reduction Cold Zone Normal function

15. Zone rules Isolate cadavers Very limited treatment before decontamination Control access to zones Temporary Morgue Decontamination direction No back flow!! Hot Zone Contaminated area Need PPE Warm Zone Contamination reduction Cold Zone Normal function

17. Key concept # 5Minor incident vs. MCI • Not everyone needs formal decontamination • Decontamination should be streamed by acuity or ambulatory ability

18. Decontamination Triage • Serious medical/chemical signs and symptoms get urgent decontamination • Moderate signs or symptoms, or confirmed liquid exposure- delayed decontamination • Minimal signs and symptoms, or vapor exposure will follow the delayed patients • No signs and symptoms, or potential for exposure, but remain significantly concerned re contamination will be processed last- “psychological decontamination”

19. Chemical MCI - Ambulatory

20. Chemical MCI – Non-ambulatory

21. Key decon. concepts • Protect yourself and your staff • Containment of people & contaminants • Appropriate PPE (& know how to use it!) • Define the Hot and Cold zones • Triage in or before Hot zone • Secure the perimeter • Very limited care (if at all) in Hot zone • Stream patients by acuity • Integrate the decontamination plan into the general disaster plan • Not everyone needs a shower

22. PPE levels • When response activities are conducted where atmospheric contamination is known or suspected to exist, personal protective equipment (PPE) must be worn.Personal protective equipment is designed to prevent/reduce skin and mucous membrane contact as well as inhalation or ingestion of the chemical substance.Protective equipment to protect the body against contact with known or anticipated chemical hazards has been divided into four categories, levels A-D.

23. PPE level A This is the level you are most likely to see in the Hot Zone of a significant event. It is entirely self contained with SCBA and fully encapsulated.

24. PPE level B This is the level you are most likely to see in the Hot Zone of a less hazardous event or in the warm zone. It is still fully encapsulated and maybe self contained or not.

25. PPE level C This is the level you are most likely to see in the cold zone, in transit and the hospital. • Full-face or half-mask or air-purifying respirator • Chemical resistant clothing • Gloves • Not self contained.

26. PPE level D Used for nuisance contamination only. It requires only coveralls or equivalent and safety shoes/boots or equivalent.

27. PPE levels • Reasons to upgrade • Known or suspected presence of dermal hazards • Occurrence or likely occurrence of gas or vapor emission • Change in work task that will increase contact or potential contact with hazardous materials • Request of the individual performing the task • Reasons to downgrade: • New information indicating that the situation is less hazardous than was originally thought • Change in site conditions that decreases the hazard • Change in work task that will reduce contact with hazardous materials

28. Summary • Receiving facilities all need some form of decontamination plan, assume everyone arrives dirty • Biological, Chemical and Radioactive contamination have different decontamination and isolation requirements • People, Places & Objects have decontamination and isolation protocols • Divide the decontamination area and the impact site into Hot/Warm/Cold zones and stream patients by acuity • PPE levels vary by the agent