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
Register now for our next scheduled course!
Occupational Health Solutions ensures your employees are trained in
full compliance with OSHA and other applicable regulatory requirements.
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