Module 6 Decontamination

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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
  workers 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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Mustard Exposure in Vinyl Chloride Plant

• Follow-up 6 years later

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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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Decontamination Station2 lines
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Decontamination Station 3 lines
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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