Patient decontamination

It is also important to consider the issue of patient decontamination. Many hospitals rely on local fire or HAZMAT resources to decontaminate patients prior to arrival at the emergency department. This model is almost always effective as the typical HAZMAT or chemical exposure is an isolated event in which a limited access/egress quarantine can be established, and in which patients can be controlled and decontaminated. However, as was demonstrated during the sarin gas attack in Tokyo, in a disaster, there is no control over the scene or scenes. Patients will self-refer to emergency departments without being decontaminated (Auf der Heide, 2006 Okumura, Suzuki, Fukuda, 1998 Okumura, Takasu, Ishimatsu, 1996). 

Disaster events may create a sudden influx of patients who have been exposed to a chemical, radiation, or other hazard that requires decontamination. Protecting nurses and other health care workers who respond to chemical or hazardous materials (HAZMAT) mass casualty incidents is critical. Patient decontamination is an organized method of removing residual contaminants from the victim s skin and clothing and should be performed whenever known or suspected contamination has occurred with a hazardous substance through contact with either aerosols, solids, or liquids. The degree of decontamination performed will... 

Nonambulatory Patient Decontamination Prioritization and Relation to START Triage System... 

Change clothes and shower at the end of the shift or when leaving patient decontamination or treatment areas. 

Assist with patient decontamination when practicable. 

At least two lanes should be used for patient decontamination—an ambulatory decontamination... 

The past few years have seen an increase in research into procedures and protocols for patient decontamination and the development of a range of equipment to facilitate that process at the scene and in hospitals. A detailed account of recent developments in this field is provided below. Depending on the type of agent released, speedy decontamination can be a critical part of preventing or limiting harm and controlling the spread of contamination. 

Figure 3-9. Layout for a patient decontamination station and a dean treatment area without Collective Protection Shelter (CPS).

Patient decontamination, 3-62 Prediction. See Chemical hazard prediction. Protection, biological, 5-0 Protection, troop, 3-4—3-5... 

See Appendix C of FM 8-10-7 for guidance on patient decontamination. Information about decontamination of specific agents is found in the scientific chapters and in the equipment chapter. 

Patient Decontamination Procedures. These procedures are written for chemical warfare, but are useful for all NBC. Medical personnel performing the decontamination should wear mask, gloves, and protective overgarments. 

E. Patient Decontamination and Triage. The management and treatment of contaminated casualties will vary with the tactical situation and the nature of the contaminant. Each medical unit must have a plan that can be put into effect immediately. Decentralization is necessary - casualties must not be forced to wait at a central point for decontamination. All medical units should have comparable sets of medical items and decontamination equipment for treatment of contaminated patients originating in their area. Decontamination of patients serves two purposes it prevents the patients from absorbing additional contaminants, and it protects medical personnel treating the patient and other patients from contamination. 

UA (0258), LIN (M25865), 6545-01-176-4612. The Medical Equipment Set (MES) Chemical Agent Patient Decontamination contains supplies and equipment required to decontaminate sixty contaminated casualties with nerve, blood, and/or blister agents. The basis of issue is one per battalion aid station/treatment squad, one per treatment team, and three per Combat Support Hospital. The weight is 1046.27 lbs and cube is 90.642 cubic feet. There is no power... 

The Office of Emergency Preparedness provides other emergency response teams, such as Disaster Mortuary Teams. Additionally, it has established special National Medical Response Teams to provide treatment, decontamination, and special pharmacenticals to treat np to 1,000 patients. The Metropolitan Medical Strike Teams, also established nnder this office, ensnre the continned viabihty of a jurisdiction s existing health system given the added bnrden of a WMD incident. The Metropolitan Medical Response System consists of parts of existing local systems that can be called in to provide triage, treatment, and patient decontamination. This system transports patients who have been decontaminated at the scene to other facilities as appropriate for continned care. The System also assists medical facilities in developing procednres that ensnre patients are decontaminated before they enter a facility. ... 

The accomplishment of these objectives plus patient decontamination will require augmentation of the BAS and Forward Support Medical Company (FSMC) by 10 to 20 personnel from the supported unit. 

Medical facilities treating chemical casualties must divide their operations into two categories contaminated (dirty) and uncontaminated (clean). Contaminated operations include triage, emergency treatment, and patient decontamination. Uncontaminated operations include treatment and final disposition. All activities conducted in the Casualty Decontamination Center (CDC) and not inside a collective protection shelter must be conducted at MOPP 4. Operational flexibility is essential. Therefore, the number and arrangement of functional areas will be adapted to both medical and tactical situations. 

A clearing company or a clearing company team will set up ambulance exchange points, which have a treatment squad to perform first aid and the capability to perform patient decontamination before further evacuation. As a rule, contaminated ambulances operate from the FLOT, transporting contaminated casualties back to the exchange point, while clean vehicles transport decontaminated casualties to Echelon III medical treatment facilities. 

The process of patient decontamination must be a factor in the judgment of the triage officer during... 

Prepare in advance a hose with 85°F water, soap, and an old gurney for rapid decontamination outside the emergency department entrance. Have a child s inflatable pool or another container ready to collect water mnoff, if possible. However, do not delay patient decontamination if water runoff cannot be contained easily. 

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