decon team requirements/ site considerations
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DESCRIPTIONDECON TEAM REQUIREMENTS/ SITE CONSIDERATIONS. Objectives. Who should be on the Decon team? Discuss OSHA First Receivers standard. Roles of various team members. Discuss decontamination site selection. Hospital Decontamination Teams. Core Trained Group Originally only ER staff - PowerPoint PPT Presentation
Decon v2.0 Decon Team Req
Decon v2.01DECON TEAM REQUIREMENTS/SITE CONSIDERATIONS
1Decon v2.0Decontamination Team2ObjectivesWho should be on the Decon team?Discuss OSHA First Receivers standard.Roles of various team members. Discuss decontamination site selection.
2Decon v2.0Decontamination Team3Hospital Decontamination TeamsCore Trained GroupOriginally only ER staffNow core includes many more than ER staffMembers available 24/7PagerStipend for responding and trainingAccountability for equipment and access3For hospital decontamination you must have a core trained group that is available 24 hours a day. It is vital that this capability be available within minutes of patient arrival or initial notification to assure the best outcome for patients and to protect staff. Team members need to be able to access necessary equipment and utilities. Team leader needs to be able to initiate operations without a lot of red tape.
Decon v2.0Decontamination Team4Who will do Decon?Who should not do DECON?AdministratorsED CliniciansFirefighters/EMS HousekeepingFacilitiesMilitaryTechs and non-medical supportSecurity
4Some of the groups listed have other duties that will not let them participate in decontamination. Maintenance/engineering, environmental services and clinical support personnel (nurse aids & care techs) are the likely groups. Some clinicians will participate but we cant take all of the doctors & nurses out of the ED. Every hospital operates differently and will likely use slightly different mixes of personnel in their team.Decon v2.0Decontamination Team5OSHA First Receivers GuidelinesCreated in January 2005It is an extension of the standards for personnel involved in responding to hazardous chemical spillsSpecifically addresses hospital providers
Available at www.osha.org
5 First receivers are are considered to be hospital personnel. These guidelines are a supplement to hazardous waster operations regulations (29 CFR 1910) designed to address the needs of first receivers of a chemical/terrorist event.Takes into account that victims presenting to hospitals after events are less of a risk that a victim at the release site (Hot Zone). Generally, these victims are minimally exposed and have limited contamination.Everyone is encouraced to review this document.Decon v2.0Decontamination Team6Security TeamControl all access to hospital entrance/exits.May have to recruit non-security staff.PPE requirements risk/benefit analysis.Might be the first person to greet a contaminated patient. 6Some hospitals weve seen have lock down procedures in which the entire facilitate can be locked down with the push of a button.
All personnel who are in the dirty zone must have the same level of PPE (level C)
Crowd control issues must be addressed. A community awareness program prior to the incident is a very proactive approach.
Decon v2.0Decontamination Team7Patient transport entry and exit (does not enter tent)To the tent (guide/non-ambulatory)Cut clothes if non-ambulatoryTriage - pre and/or post decontamination (does not normally enter tent)Decontamination personnel Ambulatory (1 per side post DECON)Non-ambulatory (minimum of 4 (?) per patient)Agent specific monitoring for success (another person?)Decontamination Team 7Decon v2.0Decontamination Team8Decontamination Clinical TeamDecides if immediate treatment is needed prior to decontamination MARK 1 kitsAmyl nitrateDecide what type of decontamination is neededDeceased/expectant patients assessment
8A doctor or nurse (or other clinically trained person) will need to evaluate the severity of injury and degree of contamination to decides who gets decontamination first. Another lecture will go in this further. General rule for decon decisionsNon Ambulatory = WetAmbulatory & symptomatic =WetAmbulatory & non symptomatic = Dry
Remember that deceased victims must not go in front of live ones but will be decontaminated prior to be turned over to morgue. For terrorist event runoff and clothesmay need to be kept as evidence.
Decon v2.0Decontamination Team9Perfect WorldDecon zone personnel = 9 peopleSafety Monitor - 1Security - 1Clinical/Triage - 1Litter bearers/escorts 2Decontaminators 4Decon zone personnel = 30 peopleSafety Monitor - 1Security 1 to 4Clinicians 2 to 5 Litter bearers/escorts 14Decontaminators 8
9Decon v2.0Decontamination Team10Decontamination SiteLarge outdoor area Fixed lines vs. deployable sheltersControl run off (EPA)Non-permeable surface if possibleUtilities & Water Hot & cold No tears soapDown wind of the facilityControlled access to the DECON site and the healthcare facility!!!!!!!!! 10The ideal decontamination site would have the following (this may not always be possible due to constraints at your facility).-The ideal location is outside to prevent contamination inside of your facility. This may not be practical in some winter climates without the use of heated shelters.-The surface should be reasonably flat and paved if possible to prevent contamination into the ground. You should have a plan for managing runoff.-It should also be able to be illuminated at night and have hot and cold running water. -The decontamination area should be downwind of the hospital to prevent dangerous vapors from blowing in. -The ingress and egress routes should also be controlled and coordinated with public safety, EMS and others. Decon v2.0Decontamination Team11DecontaminationEquipmentOwnershipAccessibleMobile as site may changeMaintained and Inspected regularly
11Necessary equipment such at PPE, decontamination shelters, hoses, backboards, brushes, etc. should be kept in a location that allows rapid deployment. Decon Team personnel need to be able to be familiar how items are stored and have 24/7 access to keys if storage is locked. They should also inspect the contents at least quarterly.Two common and effective options are closets near the planned site or a trailers. If kept in a closet storing it on roller carts is a good idea in case it is necessary to use an alternate site.
Decon v2.0Decontamination Team12
HospitalSecure EntryControl PointSecondary Facility ?Wet DeconDry DeconLitterDeconTriageStationImmediateTreatment ?DecontaminationSite12Controlling access to the Decon Site is very important. Security personnel in PPE will be needed at the entry point for MCIs. Other security jobs will include controlling of vehicle and crowd movement.
The triage officer will send victims one of the decontamination areas depending on the severity of exposure and ability to walk.
Some facilities may or may not be able to staff immediate treatment areas with providers in PPE. The decision to have an immediate treatment areas is made at the facility level on a case by case basis.
After decontamination patients will then enter the hospital or possibly be transported to a secondary facility if minimally injured. The decision to use a secondary facility will depend on the number of casualties arriving and your facilities resources.
Decon v2.0Decontamination Team13
WetDeconLitterDeconDryDecon13Here is an example of what a hospital based decontamination site may look like. It has a Wet ( ambulatory - self wash) decon station, Litter (non-ambulatory) decon station and dry decon station.
Notice how all 3 stations enter the hospital and provide covering for protection from the elements and offer some privacy. Also there are collection barrels for clothing. Also notice that the ground is covered to control runoff (also called grey water) and risers are there to keep the team and victims from standing in the runoff.
Decon v2.0Decontamination Team14SummaryPersonnel need to Understand the decontamination planUnderstand the difference in requirements between the RELEASE SITE (HAZMAT) and HOSPITAL ENTRY DECON zones Be trained and medically cleared for their specific rolesEquipped with Level C PPE if working in the decon zone Scale response to the size of the eventEstablish a decontamination site
14Decon v2.015Thank you!Questions?15