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Decontamination Procedures

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I. RESPONSE & PROCEDURES

A.ONCE NOTIFIED
The DECON Team members will be notified through the hospital issued pager and/or building overhead paging.  The decision to contact the team members will be made by the Incident Commander via the Emergency Operations Plan- Appendix IV: Decontamination Procedures.  

B.RESPONSE
Upon activation, the DECON Team members should report to the Big Shed. If under Secure Operations (Appendix II) and if you are in the hospital, you can make your way to the area through the Hospital.  

The DECON Group Director or Safety Officer will assign individuals their initial roles as they arrive. Some individuals will need to don their equipment and others will need to setup the tents.  Please read your checklist carefully before going into the decon area. 

C.SETUP TEAM
The setup team will consist of the Setup Leader and additional team members.  The location for setup is the Close to the Ambulance Entrance.  If this location is not adequate or available, the secondary location is the in the Parking area by Emergency Entrance. The big shed and DPO office contains all the material and equipment needed for setup. The Setup Leader job action sheet will have the details of setup and responsibilities (Appendix D).  The Decontamination Setup instructions will have details of setup and location and equipment (Appendix E)

D.PARTICIPANTS
Once the DECON Group Director or Safety Officer has assigned the initial roles, the individual will begin donning their equipment.  The Proper Donning instructions are located inside each team member's locker and in Appendix L.  

The other equipment needed for donning is located in the ER or the DPO's office, the following items and their location is: 

1.The following items are needed for proper donning: 

Alcohol wipes
Anti-fog wipes for mask
Chem. tape
Scissors
Radios with accessories

2.   The DPO's office contains the following Personal Protective Equipment (PPE):

1 outer chemical suit 
1 pair of DECON boots
1 pair of butyl (black) gloves

When donning equipment, respirators and radios always use the buddy system.  This will ensure that your equipment is donned properly and everything is cinched in place.  After the team member is ready, they will report to the DECON Staging Area.

E.DECON STAGING AREA
When you respond to the staging area located near the ambulance entrance the job action checklist and/or card that you received will be the role that you will perform unless otherwise changed by the DECON Group Director.  Once you have your role follow the instructions on that checklist. You will also receive a leader at this point who will be your contact during the decontamination procedures.  The leaders are: DECON Support and Setup. 

At any point in your role during decontamination, if you feel overly stressed, fatigued, or claustrophobic while you are working, notify your leader that you need to come out.  You will need to decon yourself before exiting. 

F.SELF-DECONTAMINATION
Once the DECON Leader has determined that your time on the job has expired, you will need to DECON yourself before exiting.  This is how you would DECON yourself:

1.Wash and rinse the outside of your suit before removal
2.Remove/doff your PPE in this order:

Tape at gloves and boots
Outer gloves
Suit (roll down top to bottom inside out)
Boots
Respirator (turn battery off)
Inner gloves

3.Dispose of equipment properly.  

G.DISPOSAL OF EQUIPMENT
Upon completion of self decontamination, all PPE are put into the PPE drum provided.  The respirators will be put into a separate drum for decontamination and re-use.  

II. DECONTAMINATION OF PATIENTS

The Decontamination Team will setup the decontamination staging area and equipment. The contaminated patients will enter the Decontamination site from the hot zone. The DECON Triage will manage airway, breathing and circulation (A,B,C's) and identify the patients. The patients will receive a band for identification. The non-ambulatory patients will be sent into the non-ambulatory corridor and the ambulatory patients will be sent to the appropriate male or female ambulatory corridor.

A. Decontamination Procedures for Ambulatory Patients
These are patients who require no assistance and have few or no symptoms.  Some of these patients may need to shower sitting on a chair and/or require additional supervision.

a. Hot Zone

1.Direct patients to the appropriate decontamination corridor.

2.Triage will access the patient and document on the decon triage identification badge and then placed around the patient's neck.   

3.The ID/Bagger/Stripper will give the patient an instruction sheet explaining the procedures that they are about to perform on the patient. 

4.The patient will remove jewelry and personal belongings while in line and place them in the personal bag. One of the personal bag identification numbers off the triage tag will be place inside the bag and then seal the bag. 

5.The clothing of the patient will need to be removed once inside the decontamination tent.  The ID/Bagger/Stripper will aid the patient in removal. 

6.The clothing will be placed in the clothing bag after removal.  One of the personal bag identification numbers off the triage tag will be place inside the bag and then seal the bag. 

b. Warm Zone

1.The patient will proceed through to the washer/rinse area and have the patient wash the entire body head to toe.  The patient will be provided a soft bristle brush or sponges to wash for three to five minutes then rinse.

2.Pay particular attention to the groin, axilla, folds in the skin and nails. Patient must close their eyes and mouth during the decontamination procedure. 

3.In extreme cases, the hair may be clipped.

c. Cold Zone

1.The patient will then proceed to the dryer/dresser area.

2.The patient will dry off with the towel.

3.The patient will be given a disposable gown and foot covers to dress.

4.The patient will be directed to Emergency Department Triage staff for medical evaluation.

B.  Decontamination Procedures for Non-Ambulatory Patients
These are patients who are unable to sit or stand unattended. They will   be on litters or backboards.  The collapsible roller system will be used to provide an elevated and level surface to work on patients. 

a. Hot Zone

1.Transfer patient to decontamination area on backboard and place on collapsible roller system so patient is not lying in dirty water or spent decontamination solution.

2.Triage will access the patient and document on the decon triage identification badge and then placed around the patient's neck.

3.Remove patient's jewelry, and personal belongings.  These items should be placed in place them in the personal bag. One of the personal bag identification numbers off the triage tag will be place inside the bag and then seal the bag. 

4.The clothing of the patient will need to be removed once inside the decontamination tent.  

5.When undressing a patient, remember that outside must not touch inside to avoid additional contamination.  The clothing can also be cut off the patient. 

6.The clothing will be placed in the clothing bag after removal.  One of the personal bag identification numbers off the triage tag will be place inside the bag and then seal the bag. 

7.Dirty bandages should be carefully removed to avoid bleeding and should be placed in a biohazard bucket.

b. Warm Zone

1.Use hand held hose and soft bristle brushes or sponges for 3 to 5 minutes over entire body.

2.Pay special attention to groin, axilla, folds in the skin and nails.  Avoid the patient's mouth and eyes during decontamination procedure.

3.Re-evaluate the patient for need of a second shower.  (See similar comments for ambulatory)

4.Remove patient from shower and take to edge of decontamination area adjacent to clean zone. 

c. Cold Zone

1.Personnel from clean zone will dry the patient, dress them in a gown and transfer to a clean backboard.  

2.Take patient to Emergency Department Triage staff for medical evaluation.

C.  RADIOLOGICAL DECONTAMINATION 
Additional members will be needed for the decontamination team when dealing with radiological contamination.  They will usually include Radiation Safety Officer/Nuclear Medicine Technologists.  Their roles will be to:

1.Check all dosimeters & monitoring equipment

2.Prepare for contaminated sample collections/supplies

3.Brief assembled staff on safety procedures to be followed during operational management of the victim

Emergency treatment of radiation accidents victims may have to be given before contact with or arrival of specialists having expertise in evaluation and management of these accidents.  In this case, the management of the victim should take place in the following order:

a. Resuscitation & Stabilization

Since radiation injury is not immediately life-threatening, primary attention should always be directed to maintenance of airway, breathing, and circulation; to traumatic life-threatening injuries; and to management of open wounds, etc.

b. Decontamination

Before accepting contaminated patients into the DECON tent, the monitoring equipment must be checked against background before monitoring the patient.  There will be 2 radiological technologists in the DECON area: one in the hot zone triage area and the other in the cold zone while patient is drying. The following are the procedures for these patients:

1.Survey for radioactivity & note levels of contamination on triage tag.

2.Remove & bag all clothing, shoes, & personal articles.

3.Remove obvious dirt and debris bathe, if necessary, while protecting wounds.

4.Flush all wounds with copious amounts of water.

5.Flush orifices with water.  Do not allow victim to swallow.

6.Contaminated equipment and clothes will be packaged in plastic bags.

D.  Informing the Public
Radiation accidents are a rare and noteworthy event.  Consequently, they will draw considerable public attention.  To avoid unnecessary alarm, misinterpretation, and misunderstanding, it is imperative that correct and concise information be given.  

All requests for information concerning the victim and the accident should be directed to the Public Information Officer.

This information on the radiation accident should be directed to the hospital Public Information Officers as the central source for news dissemination to the media.

The Radiation Safety Officer will provide decontamination instruction and will monitor attending personnel.  The Radiation Safety Officer/Nuclear Medicine Technologists will decontaminate equipment and all facilities and will collect and dispose of non-salvageable items.

As soon as is convenient following cleanup activities, all personnel who were involved in the care or treatment of the victim will attend a post-accident conference convened by the Radiation Safety Officer.  The conference will cover subjects such as the following:

1.Exposures of attending personnel, if any;

2.Recommendations for future handling of radiation casualties.

3.Following the post accident conference, the Radiation Safety Officer will submit a complete report of events to the Safety Committee, to concerned regulatory authorities, and to the Medical and Hospital Director and management of the company in which the accident occurred.

4.The members of the DECON team and Radiology department will be further evaluated by the infection control officer, post-decontamination. 

E.  DECEASED 
These victims will not be decontaminated as per the Medical Examiner's office. The Medical Examiner has the legal authority when moving or disturbing a body. 

F.  CLEAN UP OF DECONTAMINATION SITE
1.This is frequently overlooked and is important to ensure that contamination is not spread.

2.After decontamination, all equipment, patient clothing, personal belongings and PPE should be placed in the center of the decontamination area.  Consult with the Decon Safety Officer to determine appropriate disposal options.

3.The area will remain secured until all clean up procedures are completed. 

4.If there was uncontrolled run off or possible uncontrolled run off, the Incident Commander will notify the appropriate government agencies. 

5.The Decontamination Team will then decontaminate themselves after clean up of site.

6.Each team member will be post evaluated by Infection Control Officer before returning to their regular duties. 

7.Staff may need to defuse after the decontamination procedures. They can receive Critical Incident Stress Briefings (CISD).

8.The Safety Officer, DECON Group Director and Leaders will perform a decontamination debriefing in a timely manner. This debriefing will also be shared in the after actions debriefing of the Emergency Response.

9.All equipment used for decontamination will need to be restocked.  The Safety Officer will discuss equipment usage and restocking to the Finance Chief for allocation of funds.