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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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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
Purposes of Decontamination
  • Prevent further damage from chemical exposure
  • Prevent secondary or cross contamination
module organization
Module Organization

• Overview of decontamination concepts

  • Current practices
  • 3 case studies
  • Special considerations
basic concepts
Basic Concepts
  • Must be done immediately
  • Must be done effectively
  • Clothes must be removed to eliminate possible contamination
three decontamination types
Three Decontamination Types
  • Personal
    • self
    • buddy
  • Casualty
    • non-ambulatory
  • Personnel
    • non-exposed
    • ambulatory
liquid versus vapor
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
decontamination solution
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
secondary contamination
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
tokyo subway sarin incident
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
tokyo subway sarin incident11
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
ny state hazmat event
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)
ny state hazmat event13
NY State HAZMAT Event
  • ED washed down by hospital staff and reopened 2 hours later
  • No testing conducted or reentry criteria used
ny state hazmat event14
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
mustard exposure in vinyl chloride plant
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
mustard exposure in vinyl chloride plant16
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
mustard exposure in vinyl chloride plant17
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
current practices
Current Practices
  • Self- and buddy-decontamination
  • Decontamination station
  • Ambulatory decontamination
  • Non-ambulatory decontamination
  • Mass decontamination
  • Animal decontamination
self and buddy decontamination
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
self and buddy decontamination21
Self- and Buddy-Decontamination
  • Anticipate that not all people will follow instructions
field and hospital decontamination
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)
important considerations
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
decontamination priorities
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
ambulatory decontamination
Ambulatory Decontamination
  • Receive, triage and tag
  • Treat wounds (optional)
  • Remove and bag all effects
  • Thoroughly shower with soap and water
ambulatory decontamination28
Ambulatory Decontamination
  • Rinse and dry
  • Don clean clothes and tag
  • Remove to clean zone
non ambulatory decontamination
Non-Ambulatory Decontamination
  • Receive, triage and tag
  • Send through line on backboard
  • Clothing cut away and bagged
non ambulatory cont
Non-ambulatory cont.
  • Flushed with soap solution, scrubbed, rinsed with clean water and dried
  • Tagged and covered
  • Transferred to clean zone for treatment
mass decontamination
Mass Decontamination
  • Used to process large number of people
  • Water only is recommended
  • Several options:

Ladder and Truck

Over-head Shower

mass decontamination32
Mass Decontamination
  • Run-off water and EPA
animal decontamination
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
animal decontamination34
Animal Decontamination
  • Need plan to set up decontamination facility for animals
  • Scrub with liquid soap and water and dry
animal decontamination35
Animal Decontamination
  • Animals evaluated for treatment
  • Handling issues of owner/animal separation
special considerations
Special Considerations
  • Infants, children and elderly
  • People with disabilities
special considerations37
Special Considerations
  • Cold weather
  • Psychological effects
special considerations38
Special Considerations
  • Considerations for biological contamination
special considerations39
Special Considerations
  • Considerations for radiological contamination