Mass Decon Issues for first responders and hospital personnel
Contaminated Casualty Previous Doctrine
 Hospitals have minimal decontamination Capability
 HazMat teams decontaminate Patients at the incident site
 Decontaminated patients transported to health care facilities for treatment
 No contaminated patients
Current state of preparedness
 Many hospital plans identify the local fire department or hazardous materials team as
their decontamination resource.
 100% of sites not fully prepared for biological incident.
 73% not prepared for chemical incident.
 73% not prepared for nuclear incident.
 73% would set up a “single room” decontamination process.
 13% had no decontamination process.
 3% (1 hospital) had chemical antidote stockpile
 0% had prepared media statements
 25% had “some” training in WMD incidents
Normal victim Decon
 Gross
 Secondary
 Definitive
 Time Consuming
 Personnel Intensive
 Specialised Personnel
 How many victims can we handle this way?
Mass Decon guidelines
 Purpose of mass Decon
 Remove agent.
 Protect emergency response & medical personnel.
 Provide psychological comfort.
Objectives
 Do the greatest good for the greatest number of victims.
 Effectively utilise and protect personnel and equipment.
 Don’t relocate the incident from one location to another.
 Provide for safety of responders.
Focus
 Initiating Mass Decon with equipment carried on first responding units
 Challenges
 Victims
 Severity
 Agent
 Triage
 Time
 Personnel
 Equipment
 Crime Scene
Priorities in healthcare facilities
 Protection of current patients, staff and the facility.
 Provide the best possible medical care for contaminated patients presenting to the facility
for care.
 Environmental protection external to the HCF.
General principles
 Expect at least a 5:1 ratio of unaffected to affected casualties.
 Decontaminate victims ASAP
 Disrobing is decontamination; head to toe, more is better
 Water flushing is the best Mass Decon method. After known exposure to liquid agent,
first responders must self-Decon ASAP to avoid serious effects.
Recommendation
 “Fire-fighters should use resources immediately available and start decontamination as
soon as possible
Mass Decon for first responders
 Overview
 Concerns over mass contamination using chemical, biological, nuclear, other harmful
products
 Turning victims into patients
 Initial tactical decisions
 Dispelling the ideas of the use of hose lines
 This is a way…….Not the only way
What is decontamination?
 Products that when dispersed are deposited on skin, clothing, equipment, or the
environment
 The product then migrates through the victims skin or clothing and attacks organs
 Involves removal and deactivation from victims, equipment and environment
What is secondary decontamination?
 Carried from area of higher concentration to lower
 The move movement of the product from place to place
 Victim to victim
 Victim to rescuer
 Victim to health care provider
How Decon?
 Technical decontamination
 Emergency decontamination
 Mass decontamination
Wet Decon
 Water
 Most readily available to the first responder
 Used to dilution
 Equipment is commonly available
 The primary focus is to familiarise personnel with the various methods of wet
decontamination that can be performed with normal response equipment.
Dry Decon
 Scraping
 Absorbent materials
 Vacuuming
 Pressurised air
Other considerations
 Equipment
 Types of PPE
 Monitoring
 Disposable supplies (covers for victims, etc)
 Cleanup and disposal
Mass Decon
Most expedient and most practical methods for mass causality Decon for first arriving units
are removing of clothes and flushing / showering with water
Wet decontamination for the first arriving companies:
 Single engine
 Multiple engines
 Single truck
 Multiple apparatus
Set-up options
 Type of set-up Ladder Pipe
 Emergency Decon Corridor System
 Commercial Systems
 Other Field-Expedient Methods
 Location
 Personnel
 PPE Respiratory
 Skin
 SCBA
 Turnout
 Level B
 Gloves
Victim Priority
 Law Enforcement
 Legal Concerns
Mass Decontamination for the First
Responder
TRANSPORT
HERDING GUIDE
EMS
A ERIA L
PUMPER
TRIAGE
PUMPER
Contaminated
Victims
Single Engine Company
 1 - Pumper
 2 - 3 - personnel
 2 - 3 - nozzles
 Banner tape
 Patient covers
 Sheets
 Blankets
 Black plastic bags
Exposed
NonSymptom
Multiple company
 Pumpers
 Trucks
 Specialised
 Banner tape
 Patient covers
 Sheets
 Blankets
 Black plastic bags
Runoff
 Responders should closely monitor the direction of runoff to prevent cross contamination
between lanes and between zones.
Other field methods
 Sport facilities
 Sprinklers
 Car was station
 Swimming pool
 Olympic swimming pool: 2000 persons in 10 minutes
Location
 Upwind
 Uphill
 Incident Driven
 Away from:
 Operations Areas
 Command Areas
 Responder Decon
Ambulatory Decon Order
 Symptomatic
 Closest to the point of release
 Contaminated non-symptomatic
 Exposed non-symptomatic
Non ambulatory
 Non-ambulatory victims are those victims that are unconscious and unresponsive.
 These victims are unable to move unassisted.
 Set-up a separate line for non-ambulatory victims.
 Critical to managing the mass Decon of large numbers of victims is gaining crowd control.
How fare to disrobe?
Victims should remove clothing at least down to their undergarments prior to showering
Victims unwilling to disrobe should shower clothed before leaving Decon area
Prioritising
 Who needs Decon
 In what order
 Medical treatment
Ambulatory
 Victims closest to the chemical release.
 Victims reporting exposure to vapours or aerosols.
 Victims with evidence of liquid on their skin or clothes.
 Victims with serious medical symptoms]
Non ambulatory
 Non-ambulatory victims are those victims that are unconscious and unresponsive.
 These victims are unable to move unassisted.
Safety for responders
 PPE
 Structural turnout gear or Level “B” chemical protective clothing
 Wear (butyl) gloves instead of latex
 Upwind and uphill
 Limit contact
 Crime Scene
 Weather
Summary
Use the SEE principle
 Safe
 Effective
 Efficient
Summary of the lecture Gene Carlson USA presented at the CTIF HazMat Meeting in
Valencia May 2003
Ben Janssen and Dick Arentsen, July 2003 The Netherlands