Understand the decontamination options at a HAZMAT/CBRN incident
Course Content
1 Introduction
Hazardous Materials (HAZMAT) and Chemical, Biological, Radiological and Nuclear (CBRN) incidents are many times an obstacle that rescue teams and disaster management groups need to tackle. Specifically, these can occur in various civil emergency situations.
A civil emergency is Defined as:
-An event or situation which threatens serious damage to human welfare in a place
-An event or situation which threatens serious damage to the environment of a place
-War or terrorism which threatens serious damage to the security
Major role in civil emergency situations is being played by Contamination. Contamination is the transfer of hazardous materials from their sources by humans, animals, equipment or environment that can become infected with the corresponding contamination. Can be divided in Primary and Secondary Contamination.
-Primary contamination is a direct transportation of hazardous substances on humans, animals, equipment and environment. First responders can be contaminated when passing through the liquid spills of hazardous substances, clouds of vapor, liquid spray / aerosol /smoke from burning substances, particulate matter and particles of contaminated equipment and environment.
-Secondary contamination occurs from the hot zone through the clothing of personnel, equipment, air currents and outgoing water. If the staff is not decontaminated before leaving the hot zone they can contaminate everything and everyone with which or whom they are in contact.
Decontamination is the rapid and effective removal or neutralization / disposal / of the contaminant to reduce the spread of pollution and its reduction to a lowest possible level. The procedure for the implementation of decontamination varies, depending on the pollutant.
In more precise words Decontamination (sometimes abbreviated as decon, dcon, or decontam) is the process of removing contaminants on an object or area, including chemicals, micro-organisms or radioactive substances. This may be achieved by chemical reaction, disinfection or physical removal. It refers to specific action taken to reduce the hazard posed by such contaminants, as opposed to general cleaning.
Methods for Decontamination include Wet and Dry methods, Physical and Chemical methods. Wet methods generally include cleaning of soiled surfaces with liquids by washing, rinsing, or washing in the shower, whilst dry methods employ Dusting / powder/ inlet using technology and other methods for cleaning pollution.
On the other hand, physical methods employ Decontamination of contaminated persons and materials, without using chemicals, specifically using: absorption, adsorption, brushing and scraping, dilution, condensation / evaporation/, isolation, washing and vacuum cleaning. Chemical methods reduce pollution by using different chemical processes: neutralization and solidification, chemical decomposition / degradation / disinfection and others.
In this context here, decontamination general procedures, techniques, patterns and actions are presented and discussed. At first, general considerations are being discussed and afterwards specific topics such as emergency decontamination, public mass decontamination, responders’ decontamination. Following these, more specific topics are presented, namely equipment, techniques, area setup weather conditions, victim types and implications, management of contaminated property, clothes, water, forensic retrieval and more.
Finally, a set of sample questions were chosen and given in the form of an assessment, for the reader / trainee to test obtained knowledge. Closing this collection, a set of valuable references were gathered and referenced here, where more data might be acquired from.
2 Decontamination
PROCEDURES
The primary purpose of decontamination procedures is to remove enough material to safely extricate the entry team member safely from their protective equipment. Decontamination procedures should be tailored to the specific hazards of the site, and may vary in complexity and number of steps, depending on the level of hazard and the responder’s exposure to the hazard. Decontamination procedures and personal protective equipment decontamination methods will vary according to the specific substance, since one procedure or method may not work for all substances. The decision to implement all or part of the decontamination procedure is based on the field analysis of the hazards and risks involved.
Decontamination Team leaders need to have a complete understanding of the procedures used and the requirements of all personnel. Communication with the Entry Team Leader and other personnel assigned to the Haz-Mat Group are essential. We will discuss a typical decontamination scene and cover wet and dry decontamination procedures.
WET decontamination should only be used if the casualties are presenting with symptoms of exposure, such as redness, itching and burning of the eyes or skin, and then only once the contaminant has been identified and wet decontamination agreed as the appropriate route for that contaminant. Wet decontamination is also the recommended procedure for people contaminated by radiation of biological sources.
DRY decontamination is the recommended default method for CHEMICAL EXPOSURE following disrobing of the casualty.
Process of Decontamination includes:
-Reception and Triage. In an incident involving multiple casualties requiring decontamination, the decontamination nurse in the decontamination room will use standard triage methodology (triage sieve) to prioritise patients for decontamination. The triage and treatment priorities for contaminated children who arrive with parents are as for adults. However, note that for an equivalent level of exposure in general, children are more likely to exhibit greater toxic effects than adults, thus this should be considered within the triage sieve.
-Removal of Clothing. Research shows that the removal of clothing from a patient can remove up to 80% of any contaminant. The following steps should be taken when the decontamination team are assisting with the removal of clothing to commence decontamination.
1.Clothed patients awaiting triage or decontamination should stand if possible.
2.Minimise patient contact by only touching the patient to perform a specific task.
3.Explain the procedure to the patient.
4.Instruct patient to undress completely, using the disrobing kits in the ED. Clothes are not to be taken over the head, if possible. (This may require the cutting of clothes.)
5.Non-ambulant patients should have clothes cut away. Minimise patients’ contact with the outside of their clothes, peel clothes back in order to avoid this.
6.Remove patients clothing: “STRIP-BAG-SEAL” in individual clear plastic bags Put valuables in separate bag. Put wrist label on patient with corresponding information onto property bag in indelible ink. All bags to remain in the warm zone. Valuables to be stored in the warm zone in double, sealed clear, numbered plastic bags. Change scissors and equipment frequently
7.Improvised Dry Decontamination of Ambulant (Walking) patients. Explain the procedure to the patient. Walking patients should be encouraged to self-decontaminate wherever possible, supervised and assisted by Emergency Department staff. Use any available dry, absorbent material e.g. kitchen towel; paper tissues; towels and clean rags; strips of blankets or sheeting. Other absorbent material such as dry soil or cat litter can be used.
8.Exposed skin surfaces should be blotted and rubbed, starting with the face, head and neck and moving down and away from the body. Sufficient absorbent material should be used to avoid transferring contamination from one part of the body to another. Rubbing and blotting should not be too aggressive or it could drive contamination further into the skin. All absorbent material used in this process may also be contaminated and should not be used on another casualty. Move the casualty from the waste decontamination material as soon as the process is complete. Bag all dry decontamination material and arrange removal as per the contaminated waste process.
9.Wet Decontamination of Ambulant (Walking) Patients (Rinse-Wipe-Rinse method). Explain the procedure to the patient. Walking patients should be encouraged to self-decontaminate wherever possible, supervised and assisted by Emergency Department staff. Issue patients with a bucket of warm water and detergent and cloth (approximately 5ml/litre of warm water). Brush off gross contamination before washing down (Chemicals Only). Use RINSE-WIPE-RINSE procedure - RINSE with shower-head, no detergent, from the highest point, downwards- WIPE the affected areas with sponge and water-detergent mix from bucket- RINSE with shower head, no detergent, During wet decontamination the duration of decontamination has changed to between 45 and 90 seconds and ideally, to use a washing aid such as a cloth . Assist the patient to “backwash” the face and head (including the hair) avoiding further contamination of the airway, eyes and the rest of the body Ensure that the ears and eyes are decontaminated. Eyes: contact lenses should be removed if possible. Proceed to full body shower working downwards to avoid recontamination of cleaned areas. Ensure that the patient washes in the creases of the elbows, under the breasts, behind the knee, under the buttocks and around the genitalia and groins. Endeavour to wash wounds from the centre outwards. Patient to dry in the tent (towels to stay in the warm zone). Patient can then walk out of the tent, dress in modesty clothing, be wrapped in a blanket and be directed into emergency department.
10. Decontamination of Non-ambulant (Stretcher) Patients. The following actions should be undertaken when decontaminating all non-ambulant patients: Keep patient on the ambulance cot before rolling through the decontamination tent (cot is already contaminated) and bending to treat the patient renders the suits ineffective. Wear appropriate PPE i.e. gloves, aprons and surgical masks. Decontaminate patients in the order determined by triage. Explain the procedure to the patient. Decontaminate on a spinal board. Put the patient head first into the tent. Brush off gross contamination before beginning decontamination (Chemical Only). Use the recommended method of decontamination. If wet decontamination is appropriate, backwash the face and head (including hair) avoiding further contamination of the airway, eyes and the rest of the body. Ensure that the ears and eyes are decontaminated. Eyes: contact lenses should be removed if possible. Ensure that the creases of the elbows, under the breasts, behind the knee, under the buttocks and around the genitalia and groins are decontaminated. Wash wounds from the centre outwards. Log-roll the patient and ensure that the backs and sides of all patients are decontaminated. Cover patient with clean gown and blankets. Transfer the patient over the clean/dirty line (assisted by personnel in medium level PPE). Patient may require further drying on the clean side. Transfer patient to into the Emergency Department.
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2.1 Emergency Decontamination
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2.2 Public Mass Decontamination
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2.3 Clinical Decontamination
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2.4 Responder Decontamination
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2.5 Equipment, Techniques and area setup
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2.6 Options and methods dependent on substance/agent
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2.7 Needs for medical treatment
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2.8 Number of Victims
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2.9 Categorization of victims (walking, stretcher)
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2.10 Weather Conditions
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2.11 Victim types and implications (families, children, gender, religious)
3 Understanding additional considerations
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3.1 Collection of contaminated water
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3.2 Management of contaminated clothing and property
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3.3 Forensic Retrieval (evidence gathering)
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3.4 Decontaminate and service operational equipment
TEST
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Assessment test
MODULE MATERIAL
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COURSE BOOK
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PPT
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