Disaster Site Worker Safety

Decontamination

Purpose for Decontamination

the three most important reasons for decontaminating exposed victims are:

to remove the agent from the victim’s skin and clothing.

to protect responders from secondary transfer exposures.

to provide victims with psychological comfort.

Physical Removal of Contaminant

aeration

scraping, sweeping, brushing, or vacuuming

hosing

absorbent material

soap and water

Chemical Removal of Contaminants

0.5% bleach solution (hypochlorite)

Soap and water

Mass Decontamination

Is time constrained

Saves lives by reducing agent from skin of victims

Also known as emergency, gross, hasty, immediate

Technical Decontamination

Not time constrained

Complete decontamination of the residual hazard

Usually for responders, their PPE, equipment, and facilities

Also known as thorough, deliberate, detailed, responder, definitive

Emergency Decontamination

Can occur at any time during a decon procedure

Speed is crucial: Conduct rapid decon followed by response to the emergency

Decontamination Procedures

Self decontamination

Emergency decontamination

Technical decontamination

Patient decontamination

Mass decontamination

Self Decontamination

Use soap and water if available

Be careful to keep rinse from entering eyes or open wounds

Disrobe – remove all clothing

Emergency Decontamination

Use copious amounts of water

Best efforts should be made to capture as much contaminated water as possible (however life safety must come first)

Disrobe

Peel clothing from inside (minimize contact with chemical on clothing)

Technical Decontamination

Use soap and water or dilute bleach solution

Capture run-off in pools or bladder (for removal as hazardous waste)

Technical Decontamination

Technical Decontamination

Decontamination Corridor

Decontaminate Ambulatory Victims

To decontaminate victims:

Communicate directions

Arms out/legs apart

Wash from top down

If mustard – BLOT first

If biological or radiological – WET while removing clothes

Decontaminate Non-Ambulatory Patients

Speed and efficiency are crucial

Minimize exposure

Handling victims during cut-out

Monitor responders for contamination

Technical Decontamination

Set-up away from mass decon

Emphasis on neutralization; not speed

Focus on cross-contamination avoidance

Self-decontamination

Decon Options

Outdoors (wading pools)

Tents

Outside

Inside

RAM Decon

Trailers

Indoors

Multipurpose room

Dedicated room

“Mass” Decon Unit

Basic Requirements

Contain contamination

Control environment

Protect staff

Allow decon

Contain runoff

Allow cleanup or disposal

Patient through-put

Standards?

American Institute of Architects

For rooms

NFPA and ASTM

For some field devices

NIOSH eventually

Really, it’s still caveat emptor

Try before you buy

Staff PPE

Levels of PPE

A:  big suit, big tank

B:  little suit, big tank

C:  little suit, little mask

D:  no suit, no mask

Level A for entry

Level C for known hazard

Level B or C for unknown?

Level C with PAPR

Standard (Universal) Precautions

Gown

Gloves

Mask

N95 HEPA, to upgrade for plague or smallpox

RESPIRATORY PRECAUTIONS

Shoe covers

Level B vs. Level C

Training time

8 hours vs. 40 hours

B training requires escape bottles (OSHA)

Equipment Cost

About $4000 per person for B

About $1000 per person for C

But is C safe???