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« Rope, Line, & Practical Confined Space | Main | Phase 2 Exposures »

Phase 3 Decon-Patient Systems

As we saw last month in our field treatment section of exposures, exactly “how” we decontaminate our patients, equipment, and responders makes a huge difference. As in the case of HF (Hydrofluoric Acid), the length of time vs. the application of neutralizer can change the outcome gravely. Decontamination of our three variables may very well change your “system” three separate times within an incident for the best possible results. Therefore, we need to take a closer look at each variable separate from the whole within the concept.

Patients within an operation who have undergone grave contamination of an unknown hazardous material have many issues with the decontamination process. First, they are living people and as such, they cannot undergo a process that will result in greater stress to their already compromised life system. This creates a problem for decontamination processes that are geared for exterior operations involving and designed for the removal of contaminants from non-living CPC (Chemical Protective Clothing). Normal scrub brushes and pressure jets need to be replaced by soft sponges and gentle showers. This means that decontamination lines may need all their equipment at a mass decontamination situation. Changing “over” from CPC responders to unprotected victims can be accomplished, but this will likely involve more responders, additional washing equipment, additional CPC for the responders breaking down the line and re-setting it for a more gentle application, a greater volume of hazardous waste collected, and the need for an additional staging area to secure and control the generated waste from the clean unused equipment awaiting staging. Regardless of which “system” you adopt, some of the items of concern that may assist with this change-over “within” a line system are;

1] Adjustable shower or garden nozzles for your water discharge

2] Disposable sponges

3] A solution change to a less abrasive surfactant

4] Re-usable towels that provide absorbance as well as warmth after the final rinse system

Depending upon whether the patients are ambulatory or non-ambulatory, will challenge the elements of decontamination within your system. Regardless of a self-decontamination or one made by decontamination workers in a line configuration may force your team to quickly adapt. Assuming ample manpower and equipment, two separate lines may be a possible solution. As always, remember that civilians are not trained in the world of decontamination systems. Expecting a panicked contaminated victim to find a mass decontamination trailer while watching others walk through a decon-line will not occur. Multiple pieces of equipment while requiring fewer set-ups by decontamination workers may create more organizational havoc and accountability unless clearly marked and separated by distance. This may also lessen the control of a single decon officer and necessitate the need for “branch” decon officers, a system also seldom used by fire departments and Haz-Mat Teams. This may add more confusion, and ultimately contaminated patients “slipping between the cracks” and cross-contaminating unsuspecting workers, bystanders, or hospital personnel.

Whichever coordinated systems(s) you choose, be sure your personnel have the operation down pat, so when panicked patients throw your system a “curve” your responders are able to “catch” it by adapting as the need arises. Hazardous Materials Teams should explore the thought of offering “stand-alone” decontamination services to outside organizations. This will perfect your decontamination system for a variety of situations.

During a mass decontamination operation, it is helpful to have an isolated area that is relatively compact for the responders. Since responders are well versed in decontamination practices, little supervision should be needed. Often, depending on the hazard, a “dry” decontamination system can be most beneficial. This system should be set-up as a self decontamination and in an isolated area; Haz-Mat responders with protected respiratory systems in place can afford the time to be slow and methodical with their process. This promulgates a high level of efficiency while reducing cross-contamination to the first responders and the Entry Team. As they are likely to be the most contaminated due to a lengthy exclusion zone exposure, great care and exactness must be practiced in their “dry” decontamination system. 

Equipment decontamination also has issues that need addressing. If a “scrub-n-wash” system is adapted for your equipment, what kind of equipment will you decontaminate? If it is mechanical, lubrication must be brought into play after the equipment has been declared “clean”. Do not rely on post examination upon return to service, as tired personnel are likely to miss equipment checks and you can end up with a frozen or inoperable piece of equipment the next time it is needed for an emergency. A good thought if applicable, may be to rotate portable equipment through your departments equipment repair division for an in-depth “seasonal” type evaluation.

If the equipment is powered by a fueled engine, air intakes must be masked off before the wash and rinse cycle begins. Additionally, how long has this equipment been running? If it has reached its full operating temperature, application of wash & rinse water could crack the engines block rendering the equipment useless and in need of expensive replacement. For this type of equipment a prolonged cooling “down-time” after the incident is completed, on-site may be necessary to avoid damaging equipment before decontamination begins.

If the equipment is electrical, is it water-proof? Do water sensitive areas need pre-masking before the decontamination wash and rinse begins? In both cases above, does this equipment need purging with wash, rinse, or fresh water? An important aspect of your decontamination equipment system is in the pre-plan. Discovering these needs “before” an incident of this magnitude occurs affords the responder surety of the most sacred theory of “all contaminant remains on-site”, thus becoming waste to be removed by the environmental contractor to an appropriate TSD (Treatment, Storage, and Disposal) facility.

In all cases, a major concern shall be post-incident response down-time. Additional man-power, any additional waste generated off-site (upon return to base), secondary contamination generated within “your” clean area, and possible cross-contamination of your base facility will all lengthen your “out-of-service” time, thereby reducing the next response capability when it alarms.

                                     Haz-Mat Mike    


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