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Module 6 Decontamination Decontamination Reduction or removal of agents by physical means or by chemical neutralization Physical means: flushing, scraping, and powders Neutralization: soap, bleach, and special solutions Purposes of Decontamination

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Module 6 decontamination l.jpg

Module 6Decontamination


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Decontamination

  • Reduction or removal of agents by physical means or by chemical neutralization

  • Physical means: flushing, scraping, and powders

  • Neutralization: soap, bleach, and special solutions


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Purposes of Decontamination

  • Prevent further damage from chemical exposure

  • Prevent secondary or cross contamination


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Module Organization

• Overview of decontamination concepts

  • Current practices

  • 3 case studies

  • Special considerations


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Basic Concepts

  • Must be done immediately

  • Must be done effectively

  • Clothes must be removed to eliminate possible contamination


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Three Decontamination Types

  • Personal

    • self

    • buddy

  • Casualty

    • non-ambulatory

  • Personnel

    • non-exposed

    • ambulatory


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Liquid versus Vapor

  • Decontamination is needed for both liquid and vapor exposure

  • Vapor is absorbed by clothing and hair

  • Rigorous decontamination is needed for liquid exposure

  • Less rigorous decontamination is needed for vapor exposure


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Decontamination Solution

  • Soap and water is the preferred solution

    • as effective as diluted bleach solution

    • less caustic

    • takes less time than diluted bleach solution

  • Do NOT delay decontamination if only water is readily available


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Secondary Contamination

  • Case Study: Tokyo Sarin

  • Case Study: New York HAZMAT

  • Case Study: Louisiana Mustard Exposure

  • Lessons learned

    • need appropriate PPE and training

    • need to isolate persons exposed

    • need to follow standardized protocols and procedures


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Tokyo Subway Sarin Incident

  • 3 subway lines attacked in morning rush hour

  • Estimated 5,500 persons exposed

  • No on-scene decontamination

  • Decontamination initiated at medical facilities 3 hours after exposure

  • Secondary contamination at hospitals was a major problem


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Tokyo Subway Sarin Incident

  • Decontamination initiated at medical facilities 3 hours after exposure

  • Hospitals lacked space and equipment to handle large number of victims

  • Secondary contamination at hospitals was a major problem


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NY State HAZMAT Event

  • Dimethoate (systemic insecticide) overheated and released fumes

  • Quickly resulted in respiratory problems

  • Eleven workers self-reported to hospital ED

  • ED staff become ill; HAZMAT called

  • Evacuated ED and decontaminated victims and ED staff (1 hour)


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NY State HAZMAT Event

  • ED washed down by hospital staff and reopened 2 hours later

  • No testing conducted or reentry criteria used


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NY State HAZMAT Event

  • No screening

  • No training of ED staff in signs and symptoms

  • Lack of communication and info on chemicals

  • No containment area for victims

  • Separate facilities unavailable

  • No testing conducted or reentry criteria used


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Mustard Exposure in Vinyl Chloride Plant

  • Inadvertently produce nitrogen and sulfur mustard in Louisiana chemical facility

  • Over 150 workers exposed during hydro-blasting operation, 3 seriously

  • Latent symptoms


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Mustard Exposure in Vinyl Chloride Plant

  • 150 people report symptoms 2 days later

  • OSHA involved after 3rd hospitalization

  • Over a week to determine mustard involved

  • Considerable secondary contamination from worker’s clothing to spouses


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Mustard Exposure in Vinyl Chloride Plant

Findings:

• Personnel decontamination not performed

• No control of contaminated personnel or clothing

  • Secondary contamination at unknown levels

  • Local physicians do not know how to treat victims

  • Agents were not initially identified

  • Commercial laboratory analysis inadequate

  • PPE not used or used improperly



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Current Practices

  • Self- and buddy-decontamination

  • Decontamination station

  • Ambulatory decontamination

  • Non-ambulatory decontamination

  • Mass decontamination

  • Animal decontamination


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Self- and Buddy-Decontamination

  • Insufficient time to set up decontamination station

  • Need to instruct public to do it themselves

  • Self: Do it on your own

  • Buddy: Help others to do it

  • Followed by technical decontamination


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Self- and Buddy-Decontamination

  • Anticipate that not all people will follow instructions


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Field and Hospital Decontamination

  • Siting the facility

    • upwind, uphill, and upstream

    • allow for security to control scene

  • Establish reception area for initial screening

  • Establish triage area for rapid medical evaluation and classification

  • Simple Triage and Rapid Treatment (START)




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Important Considerations

  • Deployment

    • portable for field use

    • permanent facilities at HCFs

  • At least two lines, ideally 3

    • ambulatory (mixed or male only)

    • non-ambulatory

    • female ambulatory

  • Warm water supply

  • Privacy

  • Run-off control


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Decontamination Priorities

  • People who are known or suspected of being contaminated and who require prompt medical attention due to agent exposure or other severe injury

  • People who are exhibiting signs/symptoms of agent exposure

  • People who are known to be contaminated but are not exhibiting signs/symptoms and don't urgently require medical attention

  • People who are suspected of being contaminated but show no signs of agent toxicity

  • Animals that provide critical support to humans (e.g., seeing eye dogs) that are known or suspected to be contaminated


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Ambulatory Decontamination

  • Receive, triage and tag

  • Treat wounds (optional)

  • Remove and bag all effects

  • Thoroughly shower with soap and water


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Ambulatory Decontamination

  • Rinse and dry

  • Don clean clothes and tag

  • Remove to clean zone


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Non-Ambulatory Decontamination

  • Receive, triage and tag

  • Send through line on backboard

  • Clothing cut away and bagged


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Non-ambulatory cont.

  • Flushed with soap solution, scrubbed, rinsed with clean water and dried

  • Tagged and covered

  • Transferred to clean zone for treatment


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Mass Decontamination

  • Used to process large number of people

  • Water only is recommended

  • Several options:

Ladder and Truck

Over-head Shower


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Mass Decontamination

  • Run-off water and EPA


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Animal Decontamination

  • PETS Act (2006)

  • Pets, livestock, and service animals can be contaminated in a variety of disasters

  • Need plan to set up decontamination facility for animals

  • Scrub with liquid soap and water and dry


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Animal Decontamination

  • Need plan to set up decontamination facility for animals

  • Scrub with liquid soap and water and dry


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Animal Decontamination

  • Animals evaluated for treatment

  • Handling issues of owner/animal separation


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Special Considerations

  • Infants, children and elderly

  • People with disabilities


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Special Considerations

  • Cold weather

  • Psychological effects


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Special Considerations

  • Considerations for biological contamination


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Special Considerations

  • Considerations for radiological contamination


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