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Tuesday
Aug012017

VHF - 1  VHF/PPE/CPC

This is the first in a continuing series covering the new VHF (Viral Hemorrhagic Fever) Training program that meets and exceeds the standards for Emergency Response Operations set forth by the CDC (Center for Disease Control) and the WHO (World Health Organization). If your organization needs additional information feel free to contact me directly at contactus@hazmatmike.com I will be glad to assist your organization with any issues regarding VHF hazardous materials needs.

Since this program presentation was created for varied response group/organizations, there are a variety of presentations that you can implement to meet your personnel’s needs. Therefore, this month we will outline the concept, and options that are available to your group needs.

Whether or not it is presented in a module, (depending on class parameters/time scheduled) one of the first recommendations I make is for the student to view the news film “Outbreak”. This was originally a news documentary created by the PBS.org group “Frontline”. This group is especially good at placing the entire events that occur in “context”. I recommend to all students that they view this film before class begins. It can be viewed for free at pbs.org/Frontline.

As a result of the 2014 West Africa “Outbreak” their became a need for Emergency Responders to acquire a version of the WHO field manual for Ebola Operations in the field that meets the unique training, equipment, personnel, and operational theater outside of the hospital setting. There are many issues that differ between emergency response personnel from hospital workers that we shall discuss in the coming months’.

At the core of this issue is, when faced with a response to a VHF incident/possibility, how should the emergency responder limit exposure, contamination and public spread? For first responders, the initial reaction becomes that of using PPE (Personal Protective Equipment) and CPC (Chemical Protective Clothing) to maximize minimal contact between patient and emergency response personnel. To the emergency responder, this may present an initial hurdle. CPC is generally delegated to hazardous materials responders not necessarily “first responders”. So many response organizations may have to upgrade their first responder Training to include the use of CPC. While PPE in this instance refers primarily to respiratory protection, some emergency response personnel that do not work for a Fire Department may also need additional Training in this equipment. Many Ambulance responders are not required to be familiar with this type of protection. Your own group’s SOP’s (Standard Operating Procedure) will direct you in the proper Training direction. Once these issues have been resolved, we can begin to look at the needed issues to be addressed.

There are six (6) concepts on which the premise of responder, patient, and citizenry protection are based. Each one needs consideration to varying degrees depending on the scope of your organizations function. If you have a large well practiced Team, a slight refresher may only be needed, while a smaller less frequently Trained Team may need a new structure. You can see which best will fit your needs as we progress through the coming months. FYI; this presentation/Technique was created during the incident in 2014 and as yet, its first scheduled presentation is scheduled for September of 2017. Are we ready for the next incident? Probably not, due to the fact that there are over 300 other VHFs which have not yet shown themselves upon the world stage, yikes!

Rule 1];

All contamination stays in the Hot Zone (think restraints & Security Personnel)

Whether you use incident site, Hot Zone, or Exclusion Zone, this site is where the initial infection discovery is made. Additionally, it includes the transportation vehicle to a medical facility or area, and the patient treatment isolation site throughout the infectious site. So we are basically speaking of three (3) separate areas the need treatment or “Decontamination”. Here the goal is total restriction of cross-contamination and destruction of the suspected agent before civilians/emergency responders or hospital worker traffic is allowed to use these areas. Before patients are too sick to move about, they often become scared and will attempt to flee for fear of total isolation. This is where Security forces come into play. As we shall see, they too must be protected and enter into the formula for success in VHF spread of contamination infection.

Rule 2];

DO NOT VIOLATE rule #1

Here is where we get into the dicey realm of forced isolation. There are many social concerns that need debate by the JHA (Jurisdiction Having Authority) that you can imagine and will inevitably have. Whatever decision your group arrives at just remember, violating rule #2 spreads the contamination/disease and increase your response needs which may quickly over-whelm your resources. When this occurs, failure may be imminent for your organization.

 

Rule 3];

VHF is a SPLASH Contamination/Exposure

This means that for complete responder protection and NO cross-contamination a Full Level “B” response is required. Nothing short of this shall do. A complete list of the Level “B” ensemble’ can be found in other archived articles at www.hazmatmike.com please contact me if your needs are greater, I will gladly assist you. SOME tweaking may have to function depending on your particular response and can be done with respiratory protection. But this is a tricky issue and should only be attempted with great care and due diligence by your EM (Emergency Manager). Alterations to SPLASH protective garments and ensemble’ items will result in personnel contamination and infection. Note that in the film “Outbreak” by pbs.org “Frontline”, there were alterations when JOB function was changed. This is important to note as not all responders shall be handling direct patients or contaminated wastes. When considering ensemble’s please consider every individual job function BEFORE making adjustments to the wearer’s ensemble. This is best practices for Hazardous Materials Technicians.

Rule 4];

Decontamination is a way of THINKING, more than a process!

Every movement in the Decontamination process must be precise, carefully completed and thoroughly managed by a decon officer. This person can be someone familiar with “their” process and simply watch the decon movements of the individual performing the process. What the operator can easily miss an independent viewer will not. When this occurs, the process must be stopped and the problem or missed area re-decontaminated at that point. This is a labor intensive procedure, but the only way to be sure that the process has been successful and NO contamination is allowed to leave the decontamination corridor. If a line process is implemented, this will enable better viewing and better decontamination for those units that infrequently practice this art form. DRY Decon should NOT be used in a VHF incident.

Rule 5];

VHF is the perfect Haz-Mat (cannot see, smell, or hear) only requires one (1) exposure

Viral Hemorrhagic Fevers (VHF) are lethal agents that have an incubation/isolation period to determine infection of between 21 to 30 days. Isolation for any worker exposed is mandatory and needs to be planned if one or more of your Team members become exposed. Where will they go? Who will replace them? How will you manage their needs and family concerns? All these elements and more need to be pre-planned BEFORE incidents occur.

Rule 6];

There will always be cross-contamination (line process reduces)

There was cross contamination in West Africa incident in 2014 and the U.S. wound up with three patients shipped back to American facilities. The concern of spread of contamination in our country was high for quite a period of time. Again, the “line-process” of decontamination does assist in the reduction of cross-contamination, but does not eliminate the possibility of viral spread.  

As you will discover in the coming months, the core of this presentation/Training is the decontamination process. The challenge shall be for your organization to pre-plan the adaptations needed for the decontamination “system” to fit your response situation. If like most responders, you do not have portable isolation buildings, this shall be the challenge before your Team.

Join us next month when we look at “Who should wear CPC/PPE?”

                Haz Mat Mike

 

 

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