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Caring for the Chemically Contaminated Patient

Part 2:  What a Patient Decontamination Looks Like --

A Comprehensive How-To

 

Author/Presenter:                   

 

Length of Program:            2 hours  

 

Course Description:  This course is a discussion of the issues and techniques related to care for a contaminated patient.  Providing care within the necessary context, decontamination procedures and decontamination for nuclear, chemical and biological agents will be discussed.

 

Content for the program will include the following:  

I.   Introduction and Background

 

II.  Review of Part One Elements  

A.     Pre-emergency planning

B.     Duty to perform decontamination

C.    HAZWOPER required planning elements and procedures

      1.  Pre-emergency planning and coordination with outside parties

2.  Personnel roles, lines of authority, training and communication

      3.  Emergency recognition and prevention

      4.  Safe distances and places of refuge

      5.  Site security and control

      6.  Evacuation routes and procedures

      7.  Decontamination

      8.  Emergency medical treatment procedures

      9.  Emergency alerting and response procedures

     10.  Critiques of responses and follow-up

     11.  PPE and emergency equipment

 

III.        Assumptions-Community and OSHA HAZWOPER Context for Procedures and Operations Level Certification

A.     Decontamination must take place at your facility

B.     Your staff must perform decontamination

C.    Your program is OSHA compliant (although compliance is not the point)

1.     Respiratory protection program

2.     Minimum operations level trained

3.     Use of ICS/IMS

4.     Necessary plans and procedures

D.    Your facility has been adapted for decon operations

 

IV.       Management of the Event

A.     Control and prevention of contamination spread

1.     Is the patient enroute, under the care of emergency personnel or wandering the halls?

2.     Determine who and what may have been exposed or cross-contaminated

3.     Isolate  and detain those individuals, items and areas for proper care and handling and to limit contamination spread

4.     Manage the disposition of wastes (clothing and other personal effects, rinsate, medical items)

5.     Establish command using the Incident Command System

B.     Assess Hazard and Risk

1.     Basis for operational and personal protection decisions

2.     Evaluate degree of contamination (suspected, slight, gross)

3.     Obtain substance identifiers (chemical names and synonyms; industry identifiers such UN 4-digit number, STCC)

4.     Access chemical resources

a.      Databases

b.      References

c.      MSDS

d.      CHEMTREC

e.      Local experts and authorities

f.        ATSDR

5.     Evaluate substance physical and chemical properties

a.      Physical state

b.      Type of hazard (toxic, reactive, flammable, corrosive, radioactive, etc.)

c.      Degree of hazard

i.                    Measures of toxicity (IDLH, TLV, LD/LC50s)

ii.                  Measures of flammability (flash point, ignition temperature, flammable range)

iii.                Reactive to what, consequences, likelihood of contact

iv.                 Radioactivity

v.                   Corrosivity

d.  Other pertinent characteristics (vapor density, water solubility, boiling point, vapor pressure)

                        e.  Vulnerable exposure routes

6.     Evaluate potential for caregiver contact

a.      Degree of contamination

b.      Role of the individual

c.      Vulnerable exposure routes

7.     Determine effective protection for caregivers

a.      Levels of protection

i.                    Level A

ii.                  Level B

iii.                Level C

iv.                 Level D

b.  Don PPE

C.    Decontamination

1.  First address life-threatening issues and then decon and supportive measures

2.     Give priority to the ABC while simultaneously reducing contamination

3.     Remove and contain contaminated clothing and personal effects

4.     Begin at patient’s head and proceed downward

5.     Focus on eyes and open wounds

a.      Clean wounds:  irrigate with copious amounts of normal saline.  Deep debridement and excision only when particles or pieces of material are imbedded in tissues. Cover with waterproof dressing

b.      Flush eyes gently with stream of normal saline directed away from the medial canthus so that material is not forced into lacrimal duct.

c.      Contaminated nares and ear canals should be gently irrigated with frequent suction to prevent forcing of materials into those cavities.

6.     Avoid skin damage or abrasion-increased absorption

7.     Wash with tepid water, gentle action, sponge and possibly mild soap

D.    Waste management

1.     Assume wastes to be hazardous

2.     Decon area and equipment

3.     Evaluate and support regarding lingering contamination in the community (ambulances, emergency responders and their equipment)

4.     Contain rinsate and substances

5.     Handle as hazardous until advised otherwise by appropriate local, state and/or federal environmental and health authorities

6.     Work with these authorities and local resources to ensure proper disposal

 

V.                 Adaptation of the Facility for Patient Decontamination

A.     Engineering

B.     Inexpensive and portable

                           

Target Audience: Hospital emergency room staff, emergency medical responders, healthcare security professionals, emergency managers and responders 

 

At the conclusion of this program, participants will be able to:

 

1.      Understand the process of hazard and risk assessment as a basis for operational and personal protection decisions

2.      Explain the importance of quick actions to control the contamination 

         event

3.      Describe the process for assessing the threat posed by a hazardous

         substance

4.      List the levels of personal protective clothing, their limitations and  

         degree of protection

5.      Explain the process for decontaminating the victim of a hazardous 

         substance event

6.      Understand the principles of proper waste management following 

          patient decontamination  

 

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