DECONTAMINATION AND MANAGEMENT OF CONTAMINATATED CASUALTIES

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DECONTAMINATION AND MANAGEMENT OF CONTAMINATATED
CASUALTIES
csepp multi-hazard medical curriculum
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Objective

• List the three zones of a decontamination
  casualty receiving station
• State the appropriate instructions to perform
  unassisted ambulatory decontamination
• State one rationale for animal decontamination

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Decontamination
IMAGES CO CSEPP
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Purposes

• Minimize injuries
• Protect support personnel
• Control the spread of contamination
• Secondary contamination can occur any time after
  initial contamination
• Example cases studies in lecture materials

IMAGES NASA, DOS
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Planning Factors

• Manpower/training
• Equipment/logistics
• Site location and layout
• Environmental conditions
• - Environmental conditions are important factors
  that will dictate the number of personnel
  required for continuous operations A hot humid
  environment will require more frequent rotation
  of personnel
• Personnel decontamination
• Evacuation

IMAGE FEMA
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Layout Of A TypicalCasualty Receiving Station
WIND DIRECTION
HOT ZONE
WARM ZONE
COLD ZONE
AMBULATORY DECON DELAYED PATIENTS
DELAYED (YELLOW) PATIENTS CARE
I N C S I I D T E E N T
WARM TRIAGE
COLD TRIAGE
IMMEDIATE (RED) PATIENTS CARE
LITTER DECON IMMEDIATE PATIENTS
LITTER DECON DELAYED PATIENTS
MINIMAL (GREEN) PATIENTS CARE
Entry/Exit control points located at each line
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Decontamination Algorithm

• Closely follows START
• Can be performed in warm/hot
  zone by protected medical
  providers
• Based on patient injuries and proximity to
  release point
• Walking wounded are tagged as minimal, can be
  directed to self - decon area with supervision

IMAGE U.S. Army
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Decontamination Algorithm
Position Airway/ Respiratory effort?
NO
Expectant, Lowest Decontamination Priority
YES
Respirations Compromised?
YES
IMMEDIATE Decon and Interventions
NO
Circulatory System Intact?
NO
YES
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Decontamination Algorithm
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Decontamination Algorithm
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Non-Ambulatory Patient Decontamination

• Requires at least two personnel to perform, four
  to carry patient safely
• One person should be medically trained
• Red tags - rapid processing
• Yellow tags - normal processing
• Average resources per patient 35 - 50 gallons,
  10 - 20 minutes

IMAGE SAIC
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Non-ambulatory Patient Decontamination

• Requires at least two personnel to perform, four
  to carry patient safely
• One person should be medically trained
• Red tags - rapid processing unless confirmed
  liquid exposure
• Yellow tags - normal processing regardless of
  exposure
• Average resources per patient 35 - 50 gallons,
  10 - 20 minutes

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Non-Ambulatory Patient Decontamination (contd)

• Remove clothing/personal effects - approximately
  85 decon performed by this step
• Decontaminate from head down
• Wipe from center of body to lateral areas
• Limit contamination spread by utilizing copious
  amounts of water and frequent rinsing of sponge
• Rinse thoroughly

IMAGE SAIC
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Non-Ambulatory Patient Decontamination (contd)

• Decontaminate suspicious areas
• Soap water for skin
• Spot decontaminate
• Determine necessity of removing bandages
• Flush open wounds with sterile water or normal
  saline if available
• Move to a clean litter/backboard
• Transfer across hotline to clean area

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Non-Ambulatory Patient Decontamination (contd)
IMAGE USAF
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Ambulatory Patient Decontamination

• Requires only one or two personnel to perform,
  primarily supervisory role
• At least one person should be medically trained
• May be quicker than non-ambulatory process,
  should utilize about the same amount of soap and
  water
• Focus on non-clothed/exposed areas
• Decontaminate wounds and bandage before entering
  shower (occlusive dressing)

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Ambulatory Patient Decontamination (contd)

• Remove clothing/personal effects
• Decontaminate from head down
• Lean head back to avoid runoff in eyes
• Encourage careful scrubbing of warm, moist
  regions - axilla, groin, etc.
• Rinse thoroughly with copious amounts of water

IMAGE SAIC
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Ambulatory Patient Decontamination (contd)

• Once decontaminated, patient moves to cold zone
  staging area
• Re - clothed
• Status monitored until transport available

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Ambulatory Decontamination (contd)
IMAGE SAIC
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Patient Decontamination

• Bleach is too toxic to use for patient
  decontamination
• Remove loose foreign bodies
• Decontaminate around wound by wiping outward
  pack wound, occlusive dressing prior to full body
  decontamination
• Once decontamination is complete, the patient
  should be observed for residual signs and
  symptoms
• Replace bandaging and clothing
• Protect modesty

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Wound Decontamination
IMAGE SAIC
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Treatment Transport Areas

• Purpose
• Field medical treatment
• Transport to definitive care facility
• Activities
• Banding/Tagging of patients for treatment, decon,
  and tracking purposes
• Reception and re-triage of patients
• Preparation for transport
• Patient transport
• Re-supply location (clothing)
• Medical records initiated, tracking continued

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Mass Decontamination

• Utilized for large amount of people exposed to
  possible vapor
• Can be set up using fire department aerials or
  deluge guns
• High volume, low pressure
• Set up at exit point of building or access
  control point in open area
• Personnel manning such equipment should be in
  appropriate PPE
• Consider runoff issues (EPA vs. State)

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Mass Decontamination

• Utilized for large amount of people exposed to
  possible vapor
• Can be set up using fire department aerials or
  deluge guns
• High volume, low pressure
• Set up at exit point of building or access
  control point in open area
• Personnel manning such equipment should be in
  appropriate PPE
• Consider runoff issues (EPA vs. State)

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Field Expedient Shower
IMAGES USN, USAF, DOD
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Special Problems

• Nonmedical augmentees
• Assignment, availability, training
• Logistical support
• Replacement clothing and blankets
• Soap and warm water
• Environmental concerns
• Heat stress protection from cold
• Changing winds
• Runoff control
• Mixed casualties (wounds, agent)

IMAGE USAF
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Chemical Agent Detection

• Recognition
• Signs and symptoms
• Detectors/monitors
• Purpose of detection equipment
• Hazard assessment
• Levels of PPE
• Need for decontamination
• No substitute for observation of decontamination
  by trained personnel

IMAGES SAIC
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Fatality Decontamination

• Purpose
• Minimize exposure/injury to responders
• Protect personnel

IMAGE SAIC
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Animal Decontamination
IMAGE EPA
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Medical Protocol

• Upon arrival of the animal in the triage area,
  the animal will be evaluated for any apparent
  injury
• Animal will be tranquilized for further handling
  using approved dosages of sedatives as directed
  by a licensed veterinarian. Several choices of
  sedatives have been provided in the event of a
  shortage of a particular sedative

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Operations Set-Up

• Arrival Point
• Staffed by Animal Control Staff and one
  veterinary tech in appropriate PPE
• Personnel arriving for decontamination with pets
  will be relieved of the animal
• Animals will be evaluated for injuries and extent
  of contamination
• Animal will be tranquilized (if necessary) for
  handling and decontamination, or will be
  euthanized if injuries are too severe
• Disposable leash will be placed on animal and
  moved to the gross decontamination area

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Operations Set-up (contd)

• Gross Decontamination Area
• Staffed by Animal Control personnel in
  appropriate PPE
• All collars and tags removed and discarded
• Animal washed with soap and water solution and
  rinsed (all reptiles can only be washed with
  water)
• Leash is again removed after the gross decon and
  discarded
• Animal wrapped in large blanket or towel to
  prevent environmental exposure
• Clean leash will be placed on animal prior to
  transfer to second decontamination area

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Operations Set-Up (contd)
IMAGE J. Cody
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Operations Set-Up (contd)

• Second Decontamination Area
• Staffed with two Animal Control staff
• Leash and blanket or towel removed, discarded
• Animal sprayed with soap and water solution
• Clean leash and blanket placed on animal for
  transport to third decontamination area

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Operations Set-Up (contd)
IMAGE J. Cody
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Operations Set-Up (contd)

• Third Decontamination Area
• Staffed with two Animal Control staff
• Leash and blanket removed, discarded
• Animal rinsed with clean water, wrapped in new
  blanket
• New leash and ID tags will be placed on the
  animal

IMAGE FEMA
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Operations Set-Up (contd)

• Clean Area
• Decontamination identification tags placed on
  animal
• Animal evaluated by veterinarian and Animal
  Control staff
• Wounds will be treated or animal will be
  transported to veterinary clinic for further
  treatment
• Animals reunited with owners if possible
• Unclaimed animals transported to Animal Shelter
  or other shelter facilities
• Photo of animal displayed at scene
• Contaminated deceased animals will be placed in
  appropriate container at site
• Container will be left in hot zone for mitigation
  contractor

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Summary

• During disaster situations, the need for animal
  care and control is necessary to aid in
  evacuation of people, and to prevent
  contamination by wandering animals

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Questions
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