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DECONTAMINATION PLAN

SECTION 1:  PURPOSE

This policy sets forth the minimum standards, which must be met with respect to Mass Casualty Event-Chemical Incident.  This policy is intended to supplement Jefferson Regional Medical Center's overall mass casualty plans, specifically those policies addressing those emergency preparedness situations that involve patients arriving at Jefferson Regional Medical Center who have been contaminated with a hazardous chemical or substance.  This policy provides guidelines for response and treatment of patients upon arrival at the hospital while protecting employees from contamination.  If this chemical incident is also suspected to be a weapons of mass destruction (WMD) event, then the appropriate security measures must also be considered and activated.

SECTION 2:  PROCEDURE

A. Initiation Sequence:

1. In the event of an event involving patients who may potentially be contaminated with hazardous chemicals, at a minimum, the following steps should be initiated:

A. Upon initial notification of the incident involving a potentially hazardous chemical, the hospital will notify key departments and personnel, as outlined in the Emergency Response Plan.

B. If the incident is an MCI, all elements of the hospital's Incident Command Center should be implemented.  This should include initiation of the hospital's command center functions.

C. If the incident is suspected to be a WMD event, or the hospital receives information that the incident is suspected to be a WMD event, then additional security policy SM XXXXXX must be initiated.  The facility must notify and coordinate when appropriate, to the local, state and federal authorities in accordance with their overall mass casualty plan.

D. The level of response will depend on the severity of the chemical incident and number of patients arriving at the hospital location.  For some situations, including WMD situations the hospital On Scene Commander will communicate with the community, county, regional state and federal Incident Commander(s).

E. Decontamination Team Primary Functions

1) To prepare decontamination area
2) To don personal protective equipment (PPE)
3) To receive and decontaminate patient
4) To monitor decontamination area
5) To decontaminate team members
6) To decontaminate equipment

F. Upon the Emergency Department (ED) being notified of the potential for chemical contamination, the following information will be obtained:

1) Identity, affiliation and phone number of person reporting incident  (necessary due to possible prank calls) and obtain pre-arrival information;

2) Type(s) of chemical incident: external exposure, contamination (internal vs. external contamination);

3) Number and condition of victim(s): number which have serious trauma (details), number which have contamination;

4) Name of chemicals involved, form (solid/ liquid/ powder/ gas), length and exposure route(s);

5) Expected time of arrival.

A. Based on the information received, a determination can be made as to the need for decontamination and the level of protective equipment needed by staff, as well as the medical treatment procedures for the patient.  The Nursing Shift Supervisor will initiate the Emergency Response Plan.

2.  General Chemical Decontamination Procedures
(The Decon Team should prepare for decontamination prior to patient arrival as follows:)

A.  Obtain chemical hazard and exposure information related to chemical.

B.  The Decon Team will be notified and if needed the Decon Call List will be implemented.

C. The Decon Team will meet at the Hazmat Room (located by the ER) for assignments.

D. Assigned Decon Team members will set up location (location to be designated by the Decon Team Leader due to wind changes and other variances).  All Decon equipment will be set up prior to patient arrival or entry into the Triage / Hot Zone. (If a negative airflow is required a fan may be placed in the cold zone blowing out the Hot zone.

E. The Decon Team will follow decontamination line process, Triage, Hot Zone, Warm Zone, Cold Zone utilizing brushes and soap/water and/or 5% bleach solution depending on chemical.

F. The Decon Team members that are designated to suit up will don equipment with the assistance of a partner, checking that all equipment being used is in good condition and decon member will be protected.

G. All patients, regardless of severity and acuity of illness must be decontaminated prior to entering the Emergency Department.  Effective decontamination consists of making the patient “as clean as possible”, or to a level that is no longer a threat to patients of staff.  All efforts should be made to ensure a steady flow through the decontamination process.  Children should be allowed to stay with parents.  In the event that children are unescorted by an adult, actions should be initiated to provide additional staff to assist in facilitating the children through the process of decontamination and treatment.

3. Decontamination Line Sequence

a. The decontamination line is made up by a triage area, Hot Zone, Warm Zone and Cold Zone.

b. Triage Area:  The initial triage area is located in the Hot Zone.  Patients will be tagged according to the severity of their injuries and directed to the decon tent area by the triage team.

c. The Hot Zone (hazard is present).  The hot zone encompasses all known or suspected hazardous material contamination, and should be clearly marked with hazard tape, lines, signs, ropes, and/or barriers.

1. Contaminated patient's articles and clothing should be separated, bagged and labeled with a number corresponding to the assigned patient number and placed into a sealable bag.  This area will also be used for contaminated victims to undress.

a. The Warm Zone (Contamination Reduction Zone).

1. Should contain decontamination supplies including decontamination solutions.

2. Patient privacy should be respected as much as possible.

a. The Cold Zone (Clean Zone)

1. Free of all hazardous materials.

2. No contaminated persons may enter cold zone.

3. Patient gowns, coverings will be available for redress.

4.  Personal Protective Equipment

a. While in the initial triage area, Hot Zone and Warm Zone, personal protection must be worn by decon team members, which at a minimum will consist of Level C.

b. Decon Team members will receive instruction and training as to the proper use, fit, care and maintenance of this equipment.

c. Medical evaluations will be completed by the Decon Team member when accepted into the Decon Team.  These evaluations will then go to Employee Health who will forward the completed evaluation to the Occupational Medical Doctor who will then determine if the member is eligible to dress out at level C and return the evaluation to Employee Health for record keeping.

d. Medical Records will be kept on file for 30 years plus the duration of employment through Employee Health.

e. Team members who participated in the decontamination event will be medically evaluated after the event.

5.  Training requirements

a. First Responder Awareness Level personnel within the decon team will be the registered nurses, paramedics and EMT members.

b. Other decon team members as well as first responders will include the following training:

1. Understanding of hazards and associated risks

2. Understanding of potential situation outcomes

3. Ability to recognize and identify hazards in an emergency situation.

4. Understanding of their role as part of the Decontamination Team

5. Knowledge of basic hazards

6. Selection, use, maintenance and limitation of personal protective equipment, including respirators.

7. Understanding of terminology associated with hazardous incidents.

8. Performance of basic control, containment set-up, decontamination procedures.

9. Mandatory for all Decon Team members.

6.  Post-incident Recovery and Review

a. Jefferson Regional Medical Center Incident Command will need to address post-incident issues as follows:

1. Environmental issues including wastewater treatment and disposal.

i. Disposal of contaminated clothing and equipment

ii. Cleanup of contaminated equipment such as the decontamination showers, supplies, protective equipment, stretchers, patient rooms/areas used and medical equipment.

a. Jefferson Regional Medical Center Safety Department will do a follow-up critique of the incident and document as part of the review process.

7.  This core policy will be reviewed annually and updated periodically as determined necessary.

REFERENCES

OSHA Best Practice for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances.  OSHA (2004, December 20)

BJC Chemical Incident Policy as allowed by Debra Mayes, Director of Security and Safety for BJC

US Patent Numbers 7,720,998 B2, 7,836,207