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HomeMy WebLinkAbout202.008b - Mass Decontamination Guidelines STANDARD OPERATING PROCEDURES MANUAL TACTICAL OPERATIONS 202.008b MASS DECONTAMINATION GUIDELINE EFFECTIVE: SEPTEMBER 2013 Current Revision Date: 09/01/21 Next Revision Date: 09/01/23 Author’s Name/Rank: Joshua Sellers, Engineer Review Level: 2 Administrative Support: Evelyn Yin-Zepeda, Management Analyst II ADA PURPOSE Incidents that involve mass patient decontamination will likely present challenges with resource constraints. The purpose of this policy is to establish operational guidelines, and to provide instructions for decontaminating patients and first responders during incidents involving hazardous materials and weapons of mass destruction (WMD). APPLICATION Mass Decontamination is a tactical operation that may be performed at hazardous material incidents. This policy and guideline should be applied by all Fresno Fire Department (FFD or Department) personnel performing mass decontamination. This policy should not be used to manage Hazmat incidents. OPERATIONAL POLICY Hazardous material incidents shall be managed in compliance with Department policies and Federal regulations established by Occupational Safety and Health Administration (OSHA), CFR1910.120 – Hazardous Waste Operations and Emergency Response. Personnel operating within the risk reduction zone and/or exclusion zone must be properly trained and have appropriate personal protective equipment (PPE). Support personnel, including EMS, shall not enter the scene beyond the support zone, refer to FIRESCOPE Field Operations Guide ICS 420-1, Hazardous Materials, Control Zone Layout. In compliance with policies established by Central California EMS Authority (CCEMSA), incidents involving six (6) or more victims shall be treated as a Multi- Casualty Incident (MCI), refer to Central California Emergency Medical Services (CCEMSA), Policy 620, Multi Casualty Incident (MCI) Management – Prehospital Operations Section 202.008b Page 1 of 9 OPERATIONAL GUIDELINE Mass decontamination has traditionally been accomplished using fire apparatus and copious amounts of water to create a shower like system, allowing contaminants to be washed from victims. While this tactic remains an effective method, other strategies that achieve similar results may be better suited for non-life-threatening situations. Research shows that water-based decontamination conducted outdoors is not without risk and can cause injury to victims. Injuries may include hypothermia in cool weather, chemical reaction to water-reactive materials and psychological trauma. The potential for slips, trips and falls are greatly increased. At-risk groups including infants, children, the elderly and those with disabilities or impairments may be more susceptible to injuries. Decontamination efforts may be initiated by the first arriving unit or assigned to incoming resources. Because operations of this nature may be complex and dynamic, a Mass Decontamination Group or Branch can be established, refer to FIRESCOPE Field Operations Guide ICS 420-1, Mass Decontamination, for organizational charts. Response measures should be selected based on the hazards of the incident and the severity of the patient’s exposure/contamination. For this reason, an objective based approach is best suitable for preventing the spread of contamination while reducing the risk of injury. These objectives can be accomplished sequentially or concurrently. Objectives include: 1. Evacuation/ Isolation/ Rescue. Reduce the amount of time victims are exposed to a hazardous environment. 2. Decontamination Triage. The task of sorting victims, identifying if decontamination is required and selecting which method is most appropriate. 3. Decontamination Process. Different methods of decontamination include: Self-care: These are actions patient/s can perform themselves, including removing clothing and wiping visible contamination from skin in order to immediately reduce contamination. This may be conducted while waiting for other methods of decontamination to be set up. In some scenarios, self-care may be sufficient, Section 202.008b Page 2 of 9 requiring no additional decontamination. Emergency Gross Decontamination: The process of hastily washing contaminants from victims in life threatening situations. This typically involves using copious amounts of water and has more of an emphasis on speed. In some cases, further decontamination may be required. Technical Decontamination: The process of removing a contaminant in an organized and methodical manner based on its specific properties. This is performed with an emphasis on thorough removal/ neutralization over speed. 4. Evaluation of Decontamination Effectiveness. Are the selected decontamination methods providing sufficient results? Are additional methods required? PROCESS Upon arrival to a Hazardous Material/ WMD incident, the first arriving units should follow the steps outlined in FFD policy Standard Operating Procedures Manual, Section 202.008a, Hazardous Materials Technical Response Actions. First responders without appropriate PPE and training should refrain from entering the exclusion zone. PPE selection should be based on the unique circumstances of the incident. Turnouts and SCBAs provide limited protection against liquid and vapor contaminants. Evacuate/ Isolate/ Rescue Ambulatory casualties should be directed upwind / uphill from the hazard to a safe refuge area located within the risk reduction zone. This may be accomplished using: Verbal commands. Apparatus PA system. Hand gestures. Section 202.008b Page 3 of 9 Non-ambulatory victims may require assistance or rescue. They should be considered contaminated and may require emergency gross decontamination or technical decontamination if it has been established. Depending on the hazard given, responders without appropriate PPE and training should refrain from entering the exclusion zone. Decontamination Triage and Risk Assessment Assess the ambulatory casualties and identify the extent of their contamination. Casualties should be assumed contaminated until determined otherwise. Responders should wear PPE. Decontamination Triage Do victims have signs of visible contamination? o Victim may have been exposed, but not contaminated. Are victims showing signs and symptoms? o SLUDGEM. o Altered Mental Status. o Difficulty breathing. o Burns or Blisters. o Psychosomatic Symptoms. Does the victim have uncontrolled bleeding? o Consider tourniquet application. Decontamination Risk Assessment Special consideration must be given to the following: Necessity: How urgent is decontamination needed? Section 202.008b Page 4 of 9 Location: Try to establish decontamination uphill and upwind of the hazard. If possible, provide modesty for victims. Weather: Consider time of day, current weather, and forecasted conditions. This may affect which method of decontamination is selected. Water Supply: Do you have one? How close is it? Resources: What resources do you have? What do you need? Where will victims go following decontamination? Decontamination Process If Emergency Gross Decontamination is not urgently needed, victims who are contaminated and/or symptomatic can be directed to start self-care to reduce the possibility of ongoing exposures. Triage tags may be distributed to victims performing self-care. Self-Care: Victims should remove outer layers down to undergarments as needed. o Contaminated clothing articles should be bagged with personal property portion of triage tag. This allows for tracking of items should they become evidence and allows items to be returned if possible. o Victims should be allowed to retain non contaminated personal items such as wallets, purses, cell phones, keys, and medications, etc. These items may be placed in a second bag if available. If available, wipes or towels may be disbursed to victims to aid the self-care process. o Contaminated wipes/towels should be collected for disposal. If Self-Care is not sufficient, consider Emergency Gross Decontamination or wait for Technical Decontamination to be set up by the Hazardous Material Response Team (HMRT). Section 202.008b Page 5 of 9 Emergency Gross Decontamination: Emergency Gross Decontamination should be initiated as soon as the need is identified. Victims should be advised to disrobe down to their undergarments prior to water application. However, if a victim refuses or it is not time feasible to disrobe, water application should not be delayed. Decontamination may be accomplished with the use of: Hose lines. Nozzles attached to a discharge. Multiple apparatus creating a corridor. Other water sources available. Special Considerations: Perform in area up-hill, up-wind of hazard. Low pressure (50-60psi). Water supply available. Modesty/privacy. Control of runoff if possible. Technical Decontamination: Technical Decontamination should be established and directed by the HMRT based on the specific hazards and properties of the contaminant. Appropriate PPE selection will be determined by the HMRT. Large scale events may require multiple resources and operational periods. First Responders that are trained in First Responder Operations (FRO) Decontamination may be utilized to assist with decontamination operations. These resources would be assigned under the Decontamination Group Supervisor, refer to FIRESCOPE Field Operations Guide ICS 420-1, Mass Decontamination, for organizational charts. Section 202.008b Page 6 of 9 Evaluate Effectiveness: Decontamination efforts will need to be evaluated to ensure that contamination has been removed or reduced to a safe level. In the event that further decontamination is needed, Emergency Gross Decontamination may be repeated and/or Technical Decontamination can be established by the HMRT. Successful decontamination indicators: Elimination of visible contamination from the skin and/or clothing. Improvement in signs and symptoms. Patient’s perception of improvement. Screening using detection equipment if applicable. Following successful decontamination, victims should be moved to a triage area within the support zone for medical triage and treatment. Section 202.008b Page 7 of 9 DECONTAMINATION ALGORITHM EXCLUSION ZONE Dire ct Amb ula t ory casualt i es away from Hazard t-+-1► I Deco n Tr i age DO NOT ENTER RISK REDUCTION ZONE Pa t ie nt t o Deco ntam in a:i o n A r ea I Ri sk Assessment I ✓ ' Em erge ncy Gro ss Se lf -car e i Victi m Has Life Th r eat en i ng He mor rh agi ng V i cti m Has Physi cal Cont a m in at io n an d/o r Sig ns & Sym pt oms? 1. W ash W i t h Copi o us A mounts o f W ater 1. Pat i e nt Undresses Th em setves I 2. Re move Cl othing 3 . Collect an d Bag Pati ents' Bel o ngings Pl. Wipe & Cl ean A ffected Areas 3 . Collect an d Bag ~-............... Repea t Gross Was Deco n t a m i natio n Adequat e ? ....J CONS IDER TO U RN I QUET AP PU CATION SUPPORT ZONE Pa t ie nt to Treat m en t Area Red r ess Pa t i en t w i t h Clean Med i ca l Triage Treatment Ar ea Tr ansport A rea INFORMATION Section 202.008b Page 8 of 9 CROSS-REFERENCES Standard Operating Procedures Manual Section 202.008a, Hazardous Materials Technical Response Actions Central California Emergency Medical Services, Policy 620, Multi Casualty Incident (MCI) Management – Prehospital Operations Occupational Safety and Health Administration (OSHA) CFR 1910.120 – Hazardous Waste Operations and Emergency Response FIRESCOPE Field Operations Guide ICS 420-1 Hazardous Materials and Mass Decontamination Department of Homeland Security Patient Decontamination in a Mass Chemical Exposure Incident: National Planning Guidance for Communities California Emergency Medical Services Authority Patient Decontamination Recommendations for Hospitals Section 202.008b Page 9 of 9