Jones & Bartlett Learning Chapter 11 - Decontamination by Jones & Bartlett Learning

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CHAPTER © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION

1 1 1 1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 1 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Skills Objectives 1 After reading this chapter, you will be able to: 1 Demonstrate the ability to set up and implement the following 1 types of decontamination operations (NFPA 472-7.4.5): 1 Knowledge Objectives Technical decontamination operations in support of entry 1 411–415) After reading this chapter, you will be able to: © Jones & Bartlett Learning, LLC © Jones & operations. Bartlett(p.Learning, LLC 2 TechnicalOR decontamination operations involving ambulaDescribe following items and their significance in decon NOT FOR SALE NOT FOR SALE ORtheDISTRIBUTION DISTRIBUTION 2 tory and nonambulatory victims. (p. 413–415) and site safety operations: 2 Mass decontamination operations involving ambulatory Contaminant and nonambulatory victims. (p. 415–420) 2 Contamination and exposure 2 Surface contamination and permeation contamination Direct contamination and cross contamination 2 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Decontamination 2 NOT FOR SALE OR DISTRIBUTION 2 NOT FOR SALE OR DISTRIBUTION Disinfection and sterilization Given the plan of action, select the appropriate decon procedure, 2 determine the equipment required to implement that procedure, 2 Knowledge Objectives and evaluate the effectiveness of the decontamination 3 procedure (NFPA 472-7.3.4, NFPA 472-7.5.2, p. 404–406). After reading this chapter, you will be able to: 3 Identify sources of information for determining the applicable © Jones & Bartlett Learning, LLC © the Jones Learning, LLC Describe phases & andBartlett types of decontamination decontamination procedure and identify how to access those 3 operations andFOR their application and implementation at a resources in a hazardous incident (NFPA NOT FOR SALE materials/WMD OR DISTRIBUTION NOT SALE OR DISTRIBUTION 3 Hazardous Materials / WMD incident (p. 397, 398): 472-7.3.4.2, p. 409–411) 3 Gross decon phase Describe the phases and types of decontamination Secondary decon phase 3 operations and their application and implementation at a Hazardous Materials/WMD incident (p. 397, 398): Emergency decon 3 Gross decon phase Technical decon 3 © Jones & Bartlett Learning, © Jones & Mass Bartlett Secondary decon phaseLLC decon Learning, LLC 3 decon an incident action plan, including site safety and NOT FOR SALEEmergency OR DISTRIBUTION NOT FORDevelop SALE OR DISTRIBUTION 3 control plan, consistent with the emergency response plan or Technical decon 4 standard operating procedures and within the capability of the Mass decon 4 available personnel, personal protective equipment, and Describe the advantages and limitations of each of the followcontrol equipment (NFPA 472-8.3.4, p. 407–409). 4 ing decontamination methods (NFPA 472-7.3.4.1, p. 404–406): Identify the advantages and limitations of each of the follow4 Absorption © Jones & Bartlett Learning, LLC ing decontamination methods © Jones & an Bartlett and describe example Learning, LLC 4 Adsorption where each decontamination method wouldSALE be used (NFPA NOT FOR OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 4 Chemical degradation 472-8.3.4.5.4, p. 404–406): 4 Dilution Absorption Disinfecting 4 Adsorption Evaporation 4 Chemical degradation Isolation and disposal 4 Dilution © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Neutralization Disinfecting 5 NOT FOR NOT FOR SALE OR DISTRIBUTION Solidifi cationSALE OR DISTRIBUTION Evaporation 5 Sterilization Isolation and disposal 5 Vacuuming 5 Neutralization Washing 5 Solidification Identify the types of fixed or engineered safety systems that 5 Sterilization may be used to assist in conducting © Jones & Bartlett Learning, LLC decon operations within © Jones & Bartlett Learning, LLC 5 hazardous materials facilities. (p. 421) Vacuuming NOT FOR SALE DISTRIBUTION OR DISTRIBUTION S5 DefineOR the term clean-up and its coordination with decon- NOT FOR SALE Washing tamination operations. (p. 424, 425) R5

NFPA 472 Competencies for Hazardous Materials Technician

NFPA 472 Competencies for the Hazardous Materials Incident Commander

Describe the general clean-up concerns when decontaminating equipment. (p. 424, 425)

Skills Objectives

There are no Incident Commander skills objectives in this chapter.

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ou are the Hazardous Materials Group supervisor at the scene of a hazmat incident involving an ammonia release at an ice cream plant. The plant maintenance supervisor©advises you a repairLearning, LLC © Jones & Bartlett Learning, LLC Jones &that Bartlett being made to the refrigeration line and a valve was supNOT FORthat SALE OR DISTRIBUTION NOT FOR SALE ORwas DISTRIBUTION posed to be locked closed was actually left open and is now releasing ammonia vapors inside the plant. Although a mechanic was able to partially close the valve before escaping to safety, there is concern that ammonia © Jones & Bartlett Learning, LLC © the Jones Bartlett Learning, vapors will drift downwind and go beyond plant& property, likely impactingLLC a NOT FOR SALE ORnearby DISTRIBUTION NOT FOR SALE OR DISTRIBUTION nursing home and medical facility. A two-person entry team wearing chemical vapor protective clothing (EPA Level A) is sent inside the building to complete the closing of the ammonia valve. © Jones & Bartlett Learning, LLCBoth hazardous materials © Jones & Bartlett technicians and the Learning, backup crewLLC have an internal suit NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION radio communication capability that you are monitoring. The entry team locates the correct valve but needs a crowsfoot wrench to get the leverage required to close the valve. Not having the proper wrench and run© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ning low on air, the Assistant Safety Officer–Hazardous Materials orders them NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION out of the area. As the entry team approaches the decontamination area, one member indicates by radio that she is experiencing a tingling sensation in her fingers and toes. Her voice is tense and she is clearly excited and breathing heavily. HerLLC partner is not experiencing©any difficulties. © Jones & Bartlett Learning, Jones & Bartlett Learning, LLC

NOT FOR SALE OR DISTRIBUTION

1. Does this situation justify an emergency decontamination? 2. How would you handle the decontamination operation when the entry team arrives at the decon station? If you conducted an emergency decon, what risks would there be to the entry team? What risks would there be to the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC decon team?

NOT FOR SALE OR DISTRIBUTION

Introduction

the decon process was © Jones & Bartlett Learning,long LLCtime to bring to closure because © Jones & Bartlett Learning, LLC too slow. Fortunately, we have learned a great deal about what NOT FOR SALE The ORlesDISTRIBUTION NOT FOR SALE OR DISTRIBUTION This chapter will describe the seventh step in the Eight Step works and what doesn’t work under field conditions. Process©, Decontamination or Decon. Proper decon is essential to ensure the safety of emergency responders and the general public. You cannot conduct safe entry operations if you have no way to perform decontamination afterwards. Decon meth© Jones & Bartlett Learning, LLC ods and procedures must be considered early in the incident as FOR SALEand ORrisk DISTRIBUTION part of theNOT “hazard assessment evaluation” process as described in the chapter by that name elsewhere in the text. Twenty-five years ago, when we wrote the first edition of this text, there were many unknowns about the process of decontamination. As a result, emergency responders tended to © Jones & Bartlett Learning, LLC use a lot of overkill when approaching decon problems in the NOT FOR OR DISTRIBUTION field. SALE This overcautious approach usually got the job done safely, but the down side was that hazmat operations took a

sons learned from operations during the 2001 anthrax attacks and the research conducted by government agencies since that time have helped to improve current decon methods. For the purpose of this text, we have adopted the decontami© Jones & Bartlett Learning, LLC nation terminology referenced in NFPA 472 and 473. Where stanFOR SALE ORexist DISTRIBUTION dard terms orNOT technical guidance did not in these standards, we have adopted terms and methods commonly used in the hazmat response community. A list of these additional terms and reference materials can be found in this chapter. Despite the many improvements to the decon process, © Jones & Bartlett Learning, LLC the basic principles of decontamination are simple and have NOT FOR SALE ORover DISTRIBUTION not changed much time. In fact, the simplicity of decontamination has been compared to changing an infant’s

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Proper decontamination is especially important in those

speeds up the process of patient care. Most hospitals will not willingly accept nondecontaminated patients and many hospitals are not equipped to perform proper decon.

1 1 1 1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC At every incident involving hazardous materials, there is a 1 NOT FOR SALE OR DISTRIBUTION NOT SALE OR DISTRIBUTION possibility that FOR personnel, equipment, and members of the 1 general public will become contaminated. The contaminant 1 poses a threat not only to the persons contaminated, but to 1 other personnel who may subsequently have contact with the 1 contaminated individuals or their equipment. The entire pro1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC cess of decontamination should be directed toward confine2 Figure 11-1 needs to be adaptive and flexible. NOT FOR SALE ORDecon DISTRIBUTION NOT FOR OR DISTRIBUTION mentSALE of the contaminant within the Hot Zone and removing it 2 2 within the decon corridor to maintain the safety and health of 2 response personnel and the general public. 2 The fi rst rule of decontamination is to avoid contamination. diaper: (1) remove it from others; (2) keep it off yourself; and 2 If you don’t get the stuff on you, you don’t get hurt. Methods to (3) don’t spread it around! In other&words, don’tLearning, spread the LLC © Jones Bartlett © Jones & Bartlett Learning, LLC 2 minimize contamination and to ensure safe work practices contamination and you won’t have a decontamination probNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2 should be part of the standard safe operating procedures at any lem. The basic principle is that the safety and health hazards incident involving potentially hazardous substances. 2 of the actual contaminants at the incident define how com2 plex decon operations will be. 3 Decon needs to be an adaptive and flexible process that Terminology and Definitions 3 respects the hazards behaviorLearning, of the contaminants, To understand the information in this chapter, let’sLLC first review © Jones &and Bartlett LLC as well as © Jones & Bartlett Learning, 3 Figure 11-1 human behavior in stressful and changing events some of NOT the basic terminology pertaining to contamination, NOT FOR SALE OR DISTRIBUTION . The FOR SALE OR DISTRIBUTION 3 hazards and risks presented by the incident will define the scope, decontamination, and the establishment of decon operations. 3 nature, and complexity of decon operations. For example, a Some of these terms should be familiar to you from your First 3 minimal hazard, such as petroleum oil on turnout boots, can be Responder–Operations-level training. 3 decontaminated by simply wiping the oil from the boot and then ALARA—Performing decontamination to a level As 3 rinsing it with soap and water. In some cases rinsing with water is Low as Reasonably Achievable. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 3 adequate; nothing more elaborate is needed. In contrast, a major Contaminant—A hazardous material that physically NOT FORhazard SALEsuch ORasDISTRIBUTION NOT FOR SALE OR DISTRIBUTION 3 a highly poisonous material will require remains on or in people, animals, the environment, or 4 implementing a detailed procedure that includes several equipment, thereby creating a continuing risk of direct 4 intermediate cleaning steps. Exactly how many steps and where injury or a risk of exposure outside of the Hot Zone. 4 they are performed is best determined locally, based on response Contamination—The process of transferring a hazard4 requirements. ous material from its© source to people, animals, the envi© Jones & Bartlett Learning, LLC Jones & Bartlett Learning, LLC 4 which may act as aOR carrier. NOT FOR SALE DISTRIBUTION 4 NOT FOR SALE OR DISTRIBUTION ronment, or equipment, Exposure—The process by which people, animals, the 4 environment, and equipment are subjected to or come 4 The process of decontamination basically involves the physical in contact with a hazardous material. People may be 4 removal of contaminants from personnel and equipment. This exposed to a hazardous material through any route of 4 procedure is vital&toBartlett lessen the Learning, potential of transferring conentry (e.g., & inhalation, absorption,LLC ingestion, © Jones LLC © Jones Bartlettskin Learning, 5 taminants beyond the hazard area. direct injection). NOT FOR SALE OR DISTRIBUTION NOTcontact, FOR or SALE OR DISTRIBUTION 5 Decontamination Officer—A position within the 5 hazmat branch which has responsibility for identifying 5 the location of the decon corridor, assigning stations, 5 managing all decontamination procedures, and indenProper field decontamination is an essential safety proce5 tifying theLearning, types of decontamination necessary. © Jones & Bartlett Learning, LLC LLC dure to ensure removal of contaminants from personnel and© Jones & Bartlett 5 Decontamination (a.k.a. decon or contamination equipment to prevent contaminants from leaving theNOT FOR SALE NOT FOR SALE ORand DISTRIBUTION OR DISTRIBUTION S5 reduction)—The physical and/or chemical process of hazard area. R5 reducing and preventing the spread of contamination Good decontamination of victims in the field ultimately speeds up hospital patient care.

Basic Principles of Decontamination

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Hazardous Materials: Managing the Incident from persons and equipment used at a hazardous

Mass decontamination—The process of decontami-

© Jones nating & Bartlett Learning, LLC © Jones & m Bartlett Learning, aterials incident. OSHA LLC 1910.120 defines decontamlarge numbers of people in the fastest possible NOT FOR SALE OR DISTRIBUTION NOT FOR SALE ination OR as theDISTRIBUTION removal of hazardous substances from time to reduce surface contamination to a safe level. It employees and their equipment to the extent necessary is typically a gross decon process utilizing simply water to preclude foreseeable health effects. Note: Some or soap and water solutions to reduce the level of effects may manifest themselves as one or more disease contamination. processes many years after exposure and, by definition, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC may not be foreseeable at the time of the incident. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Degradation—(a) A chemical action involving the molecular breakdown of protective clothing material or Before responders can understand the basics of decontaminaequipment due to contact with a chemical. (b) The tion, it is first necessary to establish a foundation by learning molecular breakdown of the spilled or released matesome important concepts about how contamination occurs. In rial to render it less hazardous. © Jones & Bartlett Learning, LLC Jones Bartlett Learning, simple terms,©the level of&decon will always be basedLLC on the Disinfection—The process used to destroy the majorlevel of contamination. FourSALE basic concepts of contamination NOT FOR SALE OR DISTRIBUTION NOT FOR OR DISTRIBUTION ity of recognized pathogenic microorganisms. that will be discussed are: Sterilization—The process of destroying all microor 1. How to prevent contamination ganisms in or on an object. 2. Surface versus permeation contamination Safe refuge area—A temporary holding area for contam 3. Direct versus cross-contamination inated people until a decontamination corridor is set up. © Jones & Bartlett Learning, LLC © Jones & of Bartlett Learning, LLC 4. Types contaminants Decontamination team—The Decon Team is managed NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION by the Decon Leader and is responsible for determining, Preventing Contamination implementing, and evaluating the decon procedure. Emergency responders sometimes get the terms “contaminaDecontamination corridor—A distinct area within tion” and “exposure” confused. They actually have very difthe Warm Zone that functions as a protective buffer help a great and bridge between the Hot Zone and the Cold Zone, © Jones & Bartlett Learning, ferent LLC meanings. Knowing these © differences Jones &can Bartlett Learning, LLC deal in understanding the importance of preventing contamiwhere decontamination stations and personnel are NOTwith FOR SALEradiation, OR DISTRIBUTION FOR SALE OR DISTRIBUTION nation. For instance, when dealing ionizing located to conduct NOT decontamination procedures. An radioactive alpha particles sticking to the outside of your PPE incident may have multiple decon corridors, depending would be an example of contamination of the garment. upon the scope and nature of the incident. Gamma rays passing through the PPE and impacting your Basic terminology pertaining to the phases and methods of body would be an example of an exposure. Poor decontamidecon includes the following: © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC nation practices can ultimately result in a contamination Gross decontamination—The initial phase of the NOT FOR SALE DISTRIBUTION NOT aFOR SALE OR DISTRIBUTION problem becoming life-threatening exposure problem. decontamination process OR during which the amount of Contamination is any form of hazardous material (solid, surface contaminant is significantly reduced. liquid, or gas) that physically remains on people, animals, or Secondary decontamination—The second phase of objects. In the emergency response business, contamination the decontamination process designed to physically or generally means any contaminant on the outside of PPE or chemically remove surface contaminants to a safe and © Jones & Bartlett Learning, LLC & Bartlett Learning, equipment while it is still being wornLLC or after it has been taken acceptable level. Depending on the scope and nature of © Jones NOT FOR SALE OR DISTRIBUTION SALE OR DISTRIBUTION off.FOR In simple terms, it means that something is “dirty.” the incident, multiple secondary decon steps may be NOT Exposure means that a person has been subjected to a implemented. toxic substance or harmful physical agent through any route of Emergency decontamination—The physical process entry into the body (e.g., inhalation, ingestion, injection, or by of immediately reducing contamination of individuals direct contact [skin absorption]). In other words, they have the in potentially life-threatening situations with or with© Jonesof& aBartlett Learning,contaminant LLC Jones Bartlett Learning, LLC (“the Bad Stuff”) on©the outside & or on the inside of out the formal establishment decontamination NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION their bodies. corridor. A responder who has been “contaminated” when wearing Technical decontamination—The planned and sysPPE has not necessarily been “exposed.” For example, an entry tematic process of reducing contamination to a level As team can be contaminated with pesticide dust on the outside of Low As Reasonably Achievable (ALARA). Technical their PPE without having their respiratory system or skin decon operations are normally conducted in support of © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC exposed to the contaminant. In order for exposure to occur, emergency responder recon and entry operations at a NOT FOR SALE OR DISTRIBUTION NOT FOR DISTRIBUTION the contaminant must comeSALE in directOR contact with the person, hazardous materials incident, as well for contaminated such as through a breach in the protective clothing or respiravictims requiring medical treatment. Within this tory protection Figure 11-2 . chapter injured and ill people are referred to as “victims” Even if the contaminant makes direct contact with the until they have undergone decontamination in the responder inside the PPE, it still does not necessarily mean that field. Once decontaminated they are referred to as © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC the person will be harmed by the contaminant, however, they “patients” who can then be safely transported to a NOT FOR SALE OR DISTRIBUTION NOT FOR OR would be SALE “exposed” andDISTRIBUTION need to take further decon precaution medical facility for treatment. (Hospitals want to receive and evaluate the risk of their exposure. Remember the basic decontaminated patients, not contaminated victims.)

Understanding the Basics of Contamination

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Decon is sometimes viewed by responders as a “necessary evil.” Treat your fellow responders with care and respect. Make sure the decon process is complete and thorough.

1 Contaminants can present problems in any physical state 1 (i.e., solid, liquid, or gas). There are two general types of 1 contamination—surface and permeation. 1 1. Surface contaminants are found on the outerLLC surface of a © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, 1 material butFOR have not been absorbed into the material. SurNOT FOR SALE OR DISTRIBUTION NOT SALE OR DISTRIBUTION 1 Figure 11-2 Secondary contamination may result from poor deconface contaminants are normally easy to detect and remove to 1 tamination and improper doffing techniques. a reasonably achievable and safe level using standard field 1 decon methods. Examples include dusts, powders, fibers, 1 and so on Figure 11-3A . 1 are generally viewed as being © Jones & Bartlett Learning, LLC © Jones2.&Permeation Bartlett contaminants Learning, LLC principles discussed in the section on “health and safety”— 2 material at the molecular level but they may NOT FORharm SALE ORon DISTRIBUTION NOT FOR absorbed SALE into ORaDISTRIBUTION depends the dose, the route of exposure, and the haz2 also permeate into the microscopic physical spaces between 2 ards and properties of the contaminant. fibers and fabrics. Permeated contaminants are often diffi2 The most common cause of responder and response cult or impossible to detect and remove. If the contaminants 2 equipment contamination comes from poor organization and are not removed, they may continue to permeate through 2 discipline exercised during decontamination and clean-up protective cloth© Jones & Bartlett Learning, LLC the material. Permeation©through Joneschemical & Bartlett Learning, LLC 2 operations. Decon is a critical safety benchmark, and this is the Figure 11-3B . ing can cause an “exposure” the suit OR NOTinside FORof SALE DISTRIBUTION 2 NOT FOR SALE DISTRIBUTION reason why so much emphasis is placed on OR developing and If the material is a tool or piece of equipment, it could lead 2 implementing a well-planned, structured, and disciplined to the failure of the item (e.g., an airline hose on a supplied air 2 approach to decon operations. respirator). Remember that permeation can occur with any If you are good at decon, you will probably be good at 3 porous material, not just PPE. preventing exposures. If contact with the contaminant can be 3 Factors that influence permeation include theLLC following: © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, controlled, the risk of exposure is reduced, and the need for 3 Contact time—The longer a contaminant is in contact SALEConsider OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION deconNOT can beFOR minimized. the following basic princi3 with an object, the greater the probability and extent of ples to prevent contamination: 3 permeation. Stress work practices that minimize contact with hazard3 Concentration—Molecules of the contaminant will ous substances. Stay out of areas that potentially contain 3 flow from areas of high concentration to areas of low hazardous substances. Don’t walk through areas of obvi3 concentration. All thingsLLC being equal, the greater the © Jones & Bartlett Learning,Special LLC care must be taken to avoid © Jones & Bartlett Learning, ous contamination. 3 concentration of the contaminant, the greater the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION slips, trips, and falls into the contaminants. Remember, if 3 potential for permeation to occur. you don’t get the “Bad Stuff” on you, you won’t get hurt! 4 Temperature—Increased temperatures generally increase If contact is made with a contaminant, move contami4 the rate of permeation. Conversely, lower temperatures nated personnel to a safe refuge area within the Hot 4 will generally slow down the rate of permeation. Zone until they can be decontaminated. Remove the 4 Physical state—As ©a Jones rule, gases, vapors, and low© Jones & Bartlett Learning, LLC & Bartlett Learning, LLC contaminant as soon as possible. 4 viscosity liquids tend to permeate more readily than NOT FOR SALE OR DISTRIBUTION 4 NOT protection FOR SALE OR as DISTRIBUTION Keep your respiratory on as long possible high-viscosity liquids or solids. Contact with high presduring the decon process. 4 sure releases can affect the level of contamination. Once you have unzipped your chemical protective 4 A single contaminant can present both a surface and perclothing, be aware of where your hands go and what 4 meation threat. This is especially the case when corrosive they touch. Don’t touch the outside surfaces of your 4 liquids are © PPE, Jones & Bartlett Learning, LLC © involved. Jones & Bartlett Learning, LLC and keep your hands away from your face and 5 NOT FOR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION mouth untilSALE you haveOR washed your hands. 5 Direct vs Cross-Contamination Use of limited-use/disposable protective clothing or 5 Direct contamination occurs when a person comes in direct overgarments can significantly “lighten” your decon 5 physical contact with a contaminant or when a person comes requirements. 5 into contact with any object that has the contaminant on it Use a systematic approach to decon. 5 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC (e.g., contaminated clothing or equipment). Direct contaminaWhen performing decontamination duties, “Do unto 5 NOT FOR SALE ORasDISTRIBUTION FOR SALEoccurs OR DISTRIBUTION tion usually while working in the Hot Zone performing others you would like them to do unto you.” NOT Be S5 leak and spill control tasks but can also occur during the decon methodical and don’t skip any steps for expediency. R5 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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Figure 11-3A Surface contamination—contaminant remains on the surface of the fabric.

Figure 11-4 Secondary contamination can occur when responders NOT SALE OR DISTRIBUTION come into contact withFOR contaminated victims.

categories based on their primary hazards. These include the © Jones & Bartlett Learning, LLC following: NOT 1.FOR OR DISTRIBUTION High SALE acute toxicity contaminants

2. Moderate to highly chronic toxicity contaminants 3. Embryotoxic contaminants 4. Allergenic contaminants 5. Flammable contaminants © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 6. Highly reactive or explosive contaminants NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 7. Water reactive contaminants 8. Etiologic contaminants 9. Radioactive contaminants In the following sections, we will examine each of these nine categories individually; however, as discussed in the chapter © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC called “hazard assessment and risk evaluation” found elsewhere NOT FOR SALE OR DISTRIBUTION NOT FOR SALE in the text, a material may have moreOR than DISTRIBUTION one hazardous property (e.g., a flammable liquid may also be poisonous). Beware of contaminants that have multiple hazardous properties. 1. High acute toxicity contaminants— Can cause damage to the human body as a result of a single or short-duration expo© Jones & Bartlett Learning, LLC © Jones &These Bartlett LLC sure. can beLearning, found in solid, liquid, or gas forms and NOT FOR SALE OR DISTRIBUTION NOT FOR SALErisks OR will present to DISTRIBUTION responders from any route of exposure. Figure 11-3B Permeation contamination—the contaminant has Examples include red fuming nitric acid, sulfur trioxide, permeated the fabric. nitrogen tetroxide, dimethyl hydrazine, chlorine, potassium cyanide, and nerve agents. Note: Some acute toxicity contaminants can have delayed system onset (e.g., some nerve and © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC blister agents, as well as many toxic industrial chemicals). process. Gloves and boots are the most common get NOT FOR SALE ORover DISTRIBUTION NOT FOR SALEareas ORthat DISTRIBUTION 2. Chronic toxicity contaminants—Repeated exposure contaminated Figure 11-4 . time (even decades) to these substances can cause damage Secondary contamination occurs when a person who is to target internal organs or the onset of serious debilitating already contaminated makes contact with a person or object injuries. These contaminants include, but are not limited to, that was not previously contaminated. Secondary contaminacertain heavy metals, their derivatives, and potent carcinogens. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC tion is typically the result of poor site management and conThey can be found in solid, liquid, or gas forms and will prestrol, inadequate site safety procedures, or failure to NOT decon FOR and SALE OR DISTRIBUTION NOT FORfrom SALE OR ofDISTRIBUTION ent risks to responders any route exposure. Examples follow safety procedures. Secondary contamination is a greater include mercury, ethylene dibromide (EDB), and benzene. problem when dealing with liquids and solids. 3. Embryotoxic/Teratogenic contaminants—These are substances that can act during pregnancy to cause adverse Types of Contaminants effects on the fetus, including death, malformation, retarded © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC The more you know about the contaminant, the faster and growth, and postnatal functional deficits. These substances NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION more focused your decontamination operation can be. The may also be called teratogens. The teratogenic period of types of contaminants can be divided into nine different greatest susceptibility to embryotoxins is the first eight to © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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Chapter 11 Decontamination twelve weeks of pregnancy. This includes a period when

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contamination can lead to explosive decomposition.

© Jones &Obviously, Bartlettresponders Learning, LLC © Jones & Bartlett should avoid friction, grinding, a woman Learning, may not knowLLC she is pregnant; therefore, speNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION and other forms of impact. cial precautions must be taken at all times. However, as

7. Water reactive contaminants—These contaminants react an additional precaution, pregnant members of hazardous on contact with water or moisture and therefore water materials teams should avoid working in contaminated should not be used for decon. Examples include perchloric areas involving known embryotoxins. Examples include acid in powder form, fumigants such as aluminum phoslead compounds, ethylene oxide, and formamide. © Jones & Bartlett Learning, LLC phide and magnesium phosphide, © Jonesand & most Bartlett Learning, LLC 4. Allergenic contaminants—Allergens are substances that metal hydrides. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION produce skin and respiratory hypersensitivity. Responders 8. Etiologic contaminants—Etiologic or biological contamiare at risk from allergens from both inhalation and direct nants are microorganisms such as viruses, fungi, and bacte1 skin contact. Two people exposed to the same allergen at ria or their toxins that can cause illness, disease, or death. 1 the same level of exposure may react differently. A sudEtiological contaminates can enter the body by ingestion, 1 den outbreak of a mystery rash from one individual, while direct contact, or through the respiratory system. They are 1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC no other group members show effects, is not cause to disnot always labeled or clearly identifiable, and field detec1 NOT SALE OR DISTRIBUTION FORandSALE OR may DISTRIBUTION miss theFOR individual’ s signs or symptoms. Examples include tion NOT techniques equipment be limited. Without 1 diazomethane, chromium, dichromates, formaldehyde, and proper identification labels and packaging it is difficult for 1 isocyanates. responders to determine whether etiologic contaminants are 1 5. Flammable contaminants—These are substances that present. Specific examples of these materials include bacil1 readily ignite and burn in air and are persistent (they hang lus anthracis (anthrax), clostridium botulinum (botulism), 1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC around and can stick to PPE). Although most are liquids, and hepatitis A, B, C, D, and E. 2 NOT FOR SALE DISTRIBUTION NOT FOR The SALE ORan DISTRIBUTION some OR flammable solids and gases may also present probfact that area is contaminated with an etiological 2 contaminant does not necessarily mean that a person has been 2 lems, especially when indoors. While flammable and comexposed or is susceptible to the effects of an exposure. Basic 2 bustible contaminants demand respect because of their 2 obvious fire hazard, they also include a wide range of secinfectious disease control precautions can often significantly 2 ondary and tertiary hazards. For example, responders conreduce the risk to responders. Good pre-entry planning using © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 2 taminated with toluene may experience respiratory distress safe work practices can reduce risk even further. For example, if NOT SALE OR DISTRIBUTION FOR SALE OR DISTRIBUTION 2 if they remove theirNOT SCBA face piece before adequate deconan etiologic has been spilled in a FOR laboratory setting, there will tamination. Exposure to toluene vapors can potentially lead 2 likely be an aerosol hazard. Waiting 30 to 60 minutes for the to pulmonary edema and eventually pneumonia. Always 2 aerosol to settle before entry can significantly reduce the risk of expect flammables and combustibles to present more than 3 exposure. A release inside a vented lab hood will pose even one contamination problem. Examples include gasoline, 3 lower risks for responders. Four factors influence an etiologic or © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC acetone, benzene, and ethanol (liquids). 3 biological material’s ability to invade and alter the human body: NOT FOR SALE OR DISTRIBUTION NOT FOR SALE ORtheDISTRIBUTION 6. Highly reactive or explosive contaminants—These 3 Virulence—The ability of biological material to contaminants include ethers; olefins (compounds with 3 cause disease. It is important to realize that there are a one double bond) with hydrogen, chlorine, and flourine 3 wide variety of etiologic organisms. Their ability to suratoms attached; dienes and vinyl acetylenes; and vinyl 3 vive, reproduce, and cause harm will depend on the monomers. Some highly reactive or explosive c ontaminants type of organism. If the organism is not strong enough 3 © Jones & Bartlett Learning, © Jones & Bartlett LLClong enough to enter the can react with the oxygenLLC present in the atmosphere. Others to survive Learning, in its environment 3 NOT FOR SALE DISTRIBUTION NOT FOR SALE factorsOR include heat, shock, and friction. Among the humanOR body,DISTRIBUTION or if it is too weak or lacking in its ability 3 more dangerous are the peroxide-forming compounds— to cause illness, then the potential harm to an exposed 4 chemicals that are members of some specific classes of individual is significantly reduced. Some etiologics 4 hazardous m aterials that are well known to form peroxcannot cause disease unless the body’s defense system 4 ides due to age, exposure to heat, or outside contaminants. has been compromised. For example, if a person’s skin 4 © Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC These classes include the aldehydes (some), ethers LLC is intact and the respiratory system has not been com4 NOT FOR OR SALE OR DISTRIBUTION (some), the alkenesNOT (most),FOR and vinyl and vinyldiene compromised, many organisms cannotSALE penetrate theDISTRIBUTION body. 4 pounds. Specific examples of highly reactive or explosive However, cuts, abraded or chapped skin, or exposed 4 contaminants include cyclohexane, diethyl ether, diisopromucous membranes increase the opportunity for the 4 pyl ether, and tetrahydrofuran (THF). organism to enter the body. 4 The concentration of these contaminants plays an imporDose—Refers to the number of organisms that have been 4 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC tant role in determining the risk involved in decontamination. ingested, absorbed, or inhaled during an exposure 5 NOT FORhydrogen SALE peroxide OR DISTRIBUTION NOT The FOR OR DISTRIBUTION For example, below 30% concentration period. size,SALE composition, and population of an eti5 presents no serious fire or explosion hazard. However, ological agent will determine its ability to affect an 5 hydrogen peroxide hazards increase at concentrations above exposed person. If an organism is not compatible with 5 52%. It is also important to recognize that the evaporation the host, or if there are not enough of the organisms to 5 and distillation processes of these materials can create alter the natural balance within the human body, then 5 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC high-risk response scenarios. the etiologic agent cannot survive, regardless of the dose. 5 NOT FOR SALE ORtools, DISTRIBUTION FOR SALE DISTRIBUTION Metal such as spatulas and shovels, should notNOT be PhysicalOR environment—The physical environment can S5 used to clean up peroxide contaminants because metal also determine the ability of the etiologic to enter the R5 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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Hazardous Materials: Managing the Incident body. Factors such as heat, cold, skin, and membrane

If the contaminant is a gamma emitter, there is an additional

& Bartlett Learning, LLC © Jones & acidity Bartlett LLCthe invading organism’s © Jones and Learning, alkalinity can affect hazard of gamma rays coming off tiny bits of radioactive materials NOT FOR SALE DISTRIBUTION NOT FOR SALE DISTRIBUTION potentialOR to survive and cause harm. that may be spread OR all around the area. Of course, the possibility Personal health status—If the exposed person is in good exists that all three types of radioactive emitters may be present. health, with a fully functioning immune system, then The single most important factor in eliminating radioacthe etiologic will have more difficulty surviving. All tive material contamination problems is to avoid contact with things being equal, the very young and the very old are the material. It is very easy to spread radioactive contaminants © Jones & Bartlett Learning, over LLCa wide area by cross-contamination. © Jones &If Bartlett Learning, LLC most susceptible to etiologic exposures. the radioactive NOT FOR SALE OR NOT FOR SALE OR DISTRIBUTION Fortunately, most etiologic contaminants are relatively contaminant has a short half-life, it is sometimes simpler DISTRIBUTION to easy to kill using a wide variety of commercially available isolate contaminated equipment until the radioactivity has decontamination solutions. These are divided into disindeclined by the natural process of passing through its half-life. fectants and antiseptics and are discussed in more detail For example, if a reading of 100 milliroentgens (mR) were later in this chapter. taken from a gamma emitter with a 24-hour half-life, in © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 9. Radioactive Contaminants—Include some isotopes and 24 hours the reading would be down to 50 mR; in 48 hours it NOT FOR SALE OR DISTRIBUTION NOT FOR SALE DISTRIBUTION radioactive nuclides in the form of a very fine dust or powwould be down to 25 mR, and in 72OR hours it would be down der or as a gas. These contaminants can emit alpha or beta to 12.5 mR. Waiting several days to clean equipment signifiparticles or gamma rays. Examples include cesium 137, cantly reduces the risk to responders. cobalt 60, radon 222, uranium hexafluoride, and plutoA good rule of thumb for making an on-scene decision nium. If alpha-emitting contaminants are airborne (e.g., to clean contaminated equipment now or wait out the half© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC carried in dust or smoke), they can become surface conlife is the fact that the passage of 7 half-lives will bring a NOT FORtaminants SALE OR DISTRIBUTION FOR SALE ORtoDISTRIBUTION on protective clothing or tools carried into the NOT radiation level down 1% of what it is at the time you take Hot Zone. These solid contaminants can enter the body the first reading. In 10 half-lives, the level will be down to through inhalation or ingestion. 0.1% Figure 11-5 . Remember the basic principles of emergency response to Beta emitters present both the possibility of becoming radioactive materials—time, distance, and shielding between airborne and creating high radiation levels near the surface of © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC you and the radioactive material will lower the risk to respondthe contaminated area. As is the case of alpha emitters, beta NOT FOR DISTRIBUTION FOR SALE OR ers. The goal is to reduce contaminants to a SALE level As OR Low As contaminants may enter theNOT body through any route of DISTRIBUTION expoReasonably Achievable (ALARA). sure, especially through the respiratory system.

DECAY OF A RADIOACTIVE MATERIAL WITH A 24 HR. HALF-LIFE 200 mR/h

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IN 7 HALF-LIFE PERIODS THE RADIOACTIVITY OF THE MATERIAL HAS DECAYED TO LESS THAN 1%

25 mR/h 12.5 mR/h

ONE

HALF© Jones & Bartlett Learning, LLC LIFE NOT FOR SALE OR DISTRIBUTION

24 HR.

© Jones & Bartlett Bartlett Learning, LLC 7 DAYS 2 LLC 4© Jones & 5 3 6 1 Learning, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Figure 11-5 Radioactive materials have half-life periods that have last seconds, hours—to years. FIGURE 11.4 Radioactive materials half-lifeminutes, periods that last seconds, minutes, hours, to years. © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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Decontamination

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to a cumulative dose of about 21 millisieverts a year (2.1 millrem/yr), surpassing the 20-millisieverts-a-year standard the Japanese government used to designate expanded evacuation zones after the crisis erupted at the Fukushima No. 1 nuclear power plant. & Bartlett Learning, LLC © Jones

LLC NOT FOR SALE OR DISTRIBUTION

1 Sv = 100 rem 1 microsievert = 0.1 millirem 1 rem = 10 mSv

1 1 Damage to the reactor buildings at the Daiichi nuclear plant. 1 1 The ©Disaster Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Decontamination Challenges 1 OnNOT MarchFOR 11, 2011 a magnitude 9 earthquake struck Japan, SALE OR DISTRIBUTION NOT FOR OR DISTRIBUTION 1 Decontamination is a SALE prerequisite for people to safely causing a series of tsunamis that devastated the east coast of 1 return to their homelands in Fukushima Prefecture. There Japan. The highest wave was 127 feet high (38.9 meters) at 1 are many challenges ahead in the years to come to restore Aneyoshi, Miyako. The earthquake and tsunami waves caused 1 the region for healthy occupation. Among the most sigwidespread devastation, taking the lives of an estimated 1 nifi cant challenges are: © Jones & Bartlett Learning, LLC 15,800 people, injuring 6,000, with 3,200 people missing. © Jones & Bartlett Learning, LLC 2 andDISTRIBUTION disposing an estimated 37 million cubic NOT FOR SALE OR DISTRIBUTION NOT FOR Removing SALE OR Tokyo Electric Power Co.’s Fukushima Daiichi atomic plant 2 yards (29 million cubic meters) of soil from a sprawling was damaged by the earthquake and resulting tsunami and 2 area in Fukushima, which is located 150 miles (240 km) began leaking radiation when disabled cooling systems led 2 northeast of Tokyo, and four nearby prefectures. This to the meltdown of uranium fuel rods in three reactors. 2 daunting task will cost more than $13 billion dollars. Cracks in the containment vessels for the melted fuel 2 © Jones & Bartlett Learning, LLC Lack of available disposal © Jones Bartlettwaste. Learning, LLC sites for&radioactive caused radiation leaks that spread radiation downwind and 2 SALE of OR DISTRIBUTION 2 FOR ORthe DISTRIBUTION Establishing realisticNOT goals FOR and adoption deconforced 80,000 peopleNOT to leave theirSALE homes after governtamination methods easy to implement. ment banned entry within a 12-mile radius (20 km) of the 2 plant. The Japanese government estimates that some areas 2 70 percent of Fukushima Prefecture is mountainous; may be uninhabitable for two decades or more. 3 recontamination may occur over time affecting a 3 broad area. Every rainfall brings new radioactive subRadiation Contamination © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 3 stances (like contaminated leaves and soil) washing AnNOT estimated squareOR miles (2,400 square km) of land FOR960 SALE DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 3 down from the hills. Areas in and around mountains will have to be decontaminated to achieve an annual 3 must be repeatedly decontaminated. Guidelines warn radiation exposure limit of 5 millisieverts (0.5 rem). A 3 that conifer (pine tree) needles also accumulate radioradiation level of 4 microsieverts per hour (0.5 millirem/ 3 active cesium over time and can normally be expected hr) exceeds the Japanese government benchmark for 3 to fall after 3 to 4 years. This will require a constant designatedLearning, evacuation zones © Jones & Bartlett LLCset following the disaster. © Jones &and Bartlett Learning, LLC 3 long-term effort to keep clearing fallen needles. As an example of the difficulty in identifying contaminaNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 3 tion—what is safe for humans and determining what needs Taking the Long View 4 to be decontaminated—consider the following example: Whether the mountains and forests will be completely 4 One radiation reading taken in October 2011 recorded at decontaminated remains to be seen. Decontamination 4 Higashi-Fuchie Primary School under the drainpipe of leaf soil (soil made up of decaying leaves) within 246 4 & Bartlett Learning, Jones & Learning, LLC attached to a gutter© of Jones a machinery room found radiation LLC feet (75 meters) of local© properties hasBartlett been planned 4 NOT FORThe SALE OR DISTRIBUTION 4 NOT FOR SALE OR DISTRIBUTION levels of 3.99 microsieverts per hour (0.399 millirem/hr). pending the consent of landowners. decontaminaAt the same location just 2 inches (5 cm) above the ground tion process will continue for a long time. Decontamina4 the reading was 0.41 microsieverts per hour (0.041 millition of all the forest in the contaminated region will 4 rem/hr) At a height of 20 inches (50 cm) the reading was likely continue over the next 20 years, but villages need 4 0.24 microsieverts per hour (0.24 millirem/hr). the forests to guarantee their source of fresh water. 4 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 5 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Sources: 5 “Fukushima Daiichi—A Disaster in the Wings?” by Dorit Zimerman, HazMat Responder World, Autumn 2011. 5 Fukushima Clean-Up Attracts Bids for $14 Billion in Projects by Tsuyoshi Inajima and Yuji Okada. Bloomberg, October 13, 2011. 5 “High Radiation Detected at Tokyo School,” The Yomiuri Shimbun, October 19, 2011. 5 “IAEA Urges Japan to Set Realistic Decontamination Goals,” Wall Street Journal, Dow Jones, October 14, 2011. 5 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC “Japan to Spend at Least $13 billion for Decontamination,” Reuters, October 20, 2011. 5 NOT FOR SALE OR DISTRIBUTION FORJournal, SALEDow ORJones, DISTRIBUTION “Nuclear Agency Urges Japan to Fix Cleanup Plan,” TheNOT Wall Street October 15, 2011. S5 “Residents Near Fukushima Mountains Face Nuclear Recontamination Every Rainfall,” The Mainichi Daily News, October 21, 2011. R5 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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MethodsLLC © Jones & Bartlett Learning, LLC © JonesDecontamination & Bartlett Learning, corrosive materials). Examples of chemical methods include: NOT FOR SALEdegradation OR DISTRIBUTION NOT FOR OR DISTRIBUTION There SALE is no universal decon method that will work for every Chemical

introduce other hazards into the process (e.g., neutralization of

hazmat incident. Although there is no “silver bullet” that works Neutralization on everything, there is a wide range of options in the decon Solidification arsenal from which to choose. Most of the techniques d escribed Disinfection in this chapter have been revised and improved through trial Sterilization © Jones & Bartlett Learning, The LLC © Jones & Bartlett Learning, LLC and error over the years. following sections briefly review these various types of NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Decon and cleaning of equipment and fixed facilities can physical and chemical decon methods. be conducted to a point where only trace contaminants at ppb levels are detectable. In contrast, field-based decon in support Physical Methods of Decontamination of emergency response operations are geared toward reduction Absorption is the process of “soaking up” a liquid hazardous of contaminant levels to an acceptable level so that responders material to prevent enlargement of the contaminated It is © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,area. LLC are safe from the short- and long-term health effects of the conprimarily used in decon for wiping down equipment and property. NOTbelow FORtheSALE ORorDISTRIBUTION NOT FOR SALE OR DISTRIBUTION taminant (e.g., TLV/TWA PEL). Beyond wiping off protective clothing and equipment with towels Respect the hazmat—the more you understand the hazor rags, it has limited application for decontaminating personnel. ards and behavior of the hazmats involved, the easier it is to Contaminants in absorbents remain chemically select the right combination of decon methods. For example, a unchanged. In other words, a gallon of oil has the same propchemical plant that manufactures hydrofluoric (HF) acid has erties once it has been Learning, soaked up intoLLC absorbent spill pads. © Jones & Bartlett Learning, LLC © Jones & Bartlett probably perfected their HF decon techniques; years of good With some exceptions, use of absorbents is limited to flat NOT FOR SALE OR DISTRIBUTION and bad experience handling the product have taught them NOT FOR SALE OR DISTRIBUTION surfaces (e.g., soaking up liquids on the ground or contamiwhat gets results and what doesn’t. This is one reason why nants floating on water). The most readily available absorbents product specialists are often the best source of decontaminaare soil, diatomaceous earth, and vermiculite. Other acceptable tion information for public safety organizations. materials include anhydrous fillers, sand, and commercially materials © Jones & Bartlett Learning, available LLC products (e.g., pads, ©pillows). JonesAbsorbent & Bartlett Learning, LLC should be inert (i.e., have no active properties). NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Adsorption is the process of a contaminant adhering to the surface of another material. The adhesion takes place in an Respect the hazmat—the more you understand the hazards extremely thin layer of molecules between the contaminant and behavior of the hazmats involved, the easier it is to and the adsorbent. It is primarily used for the clean-up of select the right combination of decon methods. equipment or©a Jones specific area. Examples Learning, of adsorption LLC include © Jones & Bartlett Learning, LLC & Bartlett activated charcoal, silica, and fuller’ s clay. Commercial spill NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION pads that adsorb petroleum spills while excluding water are Unlike fixed industrial facilities, emergency responders another example. In some instances, the adsorption process must be prepared to handle a wide range of hazmat decon can produce heat and can cause spontaneous combustion. problems. The following discussion has been written with the An easy way to remember the difference between these special challenges of these emergency responders in mind. two methods is that ABsorbtion works like a sponge by “soak© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Decontamination methods can be divided into two basic ing up” the contaminant while an ADsorbant adds itself or NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION categories: physical and chemical. Physical methods generally “sticks to” the contaminant like the way Velcro™ works. involve physically removing the contaminant from the contamiBrushing or scraping basically involves using “elbow nated person or object. While these methods are often easier to grease” to remove the contaminant. It can be used for the perform and may dilute the contaminant’s concentration decon of personnel, PPE, and equipment in both dry decon or it generally remains chemi(i.e., reducing its harmful effects), decon operations using liquid decon solutions. The object © Jones & Bartlett Learning,wet LLC © Jones & Bartlett Learning, LLC cally unchanged. Examples of physical methods include: is to remove as much of the “big chunks” as possible before NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Absorption progressing on in the decon process. For example, contamiAdsorption nated dirt and mud on boots and gloves should be scraped off Brushing and scraping or washed off before stepping into decon showers. Dilution Dilution / washing is the use of water or soap and water Heating and freezing solutions to © flush the hazmat from protective clothing and © Jones & Bartlett Learning, LLC Jones & Bartlett Learning, LLC Isolation and disposal (i.e., “dry decon”) equipment. The use of detergent or soap takes advantage of the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Pressurized air surfactant properties and works well on oils, greases, polar solVacuuming vents, dirt, grime, and powders. Dilution and washing using Washing detergents are the most commonly used methods for deconEvaporation taminating personnel, since large amounts of water are almost Chemical methods generally involve removing the contaminant always available. Common water sources © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLCinclude safety showthrough some type of chemical process. In other words, the ers and fire hydrants. Engine company or tanker water might NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION contaminant is undergoing some type of chemical change that be suitable if the water does not include tank saver additives facilitates its removal. Some chemical methods of decon may that might create contamination/reactions. © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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For example, following the 2001 anthrax attacks, pressurized

© Jones & Bartlett Learning, LLC © Jones i& Bartlett Learning, LLC nclude the following: air hoses were initially used to clean conveyors and mail hanNOT FOR ORat DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Some studies indicate that the dilution of the contamidling SALE equipment the Brentwood, Maryland Post Office. This

nant is not as important as the physical removal due to was responsible for the spread of anthrax spores throughout the water pressure. building. Dilution is especially effective for use on water-soluble Vacuuming involves the use of electric or pneumatic vacumaterials, such as anhydrous ammonia. ums to collect a contaminant. This method is primarily used to © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC The application of water only reduces the contaminant’s decon structures and equipment, and it can be used on a wide NOT FOR SALE DISTRIBUTION NOT FOR SALE OR DISTRIBUTION concentration; it does not change the chemical structure. range of contaminants, including flammable and OR combustible While dilution may be an effective method for removliquids, mercury, lead, asbestos, and other hazardous dusts and 1 ing non-water-soluble dusts and fibers, care must be fine powders. The vacuum must be rated for its service and 1 used to prevent the spread of these contaminants to application (e.g., explosion proof and dust ignition proof). 1 larger areas (e.g., asbestos fibers suspended in water). High Efficiency Particulate Air (HEPA) vacuums are 1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC used when the contaminant is a hazardous dust, powder, or 1 Before using water, consideration should be given to NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION fiber. HEPA filters physically capture the contaminant by 1 whether the contaminant will react with water, be sola llowing air to pass through the filter while capturing the larger 1 uble in water, or whether water will spread the conparticulates floating in the air, and can capture particles as 1 taminants to a larger area. small as 0.1 microns. To be effective, filters must be replaced 1 Dilution and washing usually integrate brushing and frequently. 1 scrubbing within the LLC decon process. © Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC Evaporation is simply allowing a contaminant to 2 TheOR more water consumed in decon operations, NOT the NOT FOR SALE DISTRIBUTION FOR SALE OR DISTRIBUTION e vaporate or “off-gas,” particularly if its vapors do not present 2 greater the cost and potential disposal problems. 2 a hazard. It can be used to decon equipment and vehicles and Always consult with environmental officials before dis2 structures when the contaminant is a high-vapor-pressure posing of any contaminated runoff. 2 l iquid or gas. Its effectiveness can be limited when dealing with Freezing has limited use in the field by emergency 2 porous surfaces and large quantities of materials. responders, but this method has been used by clean-up con- LLC © Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC 2 tractors to solidify runny and sticky into a solid so that NOT FOR SALE OR DISTRIBUTION 2 NOT FORliquids SALE OR DISTRIBUTION Chemical Methods of Decontamination they can be chipped, scraped, or flaked off and handled for a 2 limited time in a solid state. Freezing can be accomplished by Chemical degradation is the process of altering the chemical 2 using ice, dry ice, carbon dioxide, or, if the outside ambient air structure of the contaminant through the use of a second 3 temperature is below the hazmat’s freezing point, allowing it to chemical or material. Commonly used degradation agents 3 cool off solidify the ground (e.g., hot wax or tar). include © calcium hypochlorite bleach, sodium hypochlorite © and Jones & on Bartlett Learning, LLC Jones & Bartlett Learning, LLC 3 Heating usuallySALE involvesOR the use of high-temperature steam bleach, sodium hydroxide as a OR saturated solution (household NOT FOR DISTRIBUTION NOT FOR SALE DISTRIBUTION 3 in conjunction with high-pressure water jets to heat up and blast drain cleaner), sodium carbonate slurry (washing soda), 3 away the contaminant. It is primarily used for the decon of calcium oxide slurry (lime), liquid household detergents, and 3 vehicles, structures, and equipment. When detergent or solvents isopropyl alcohol. Chemical degradation may be used to decon 3 are added, this technique can be very effective on petroleumoutside surfaces on buildings, walking surfaces, roads, motor 3 based materials, such as usedLLC motor oil or high-viscosity, watervehicles, and heavy equipment. It should not be used to decon © Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC 3 materials. Heating may also be used to simply evaporate chemical protective clothing, people, or animals. Degradation NOT FORsoluble SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 3 the contaminant. Heating techniques should not be used to chemicals should never be applied directly to the skin! 4 decontaminate chemical protective clothing or people. Technical advice for chemical degradation procedures 4 Isolation is a two-step process that does not involve the use should be obtained from product specialists to ensure the solu4 of any water or liquid decon solutions. First, contaminated artition used is not reactive with the contaminant. When preparing 4 cles are removed and isolated in a designated area. When enough LLC solutions for decontamination follow the directions to avoid © Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC 4 contaminated items are NOT collected (e.g., SALE disposable clothing), the damage to protective clothing and equipment from OR degradation NOT FOR SALE DISTRIBUTION 4 FOR OR DISTRIBUTION materials are bagged and tagged. The final step involves packagchemicals. (Beware of the Firefighter’s Rule: If 0.5% is good, 4 ing the contaminated material in a container suitable for transthen 25% will be even better! More is not necessarily better.) 4 portation to an approved hazardous waste facility, where they The physical and chemical compatibility of the decon 4 may be incinerated or buried in an approved landfill. solutions must be determined before they are used. Any decon 4 One limitation dry decon is the increased method © that permeates, degrades,Learning, damages, or otherwise © Jones & with Bartlett Learning, LLC potential Jones & Bartlett LLC 5 for secondary contamination of the decon crew engaged in the impairs NOT the safeFOR function of PPE not be used unless NOT FOR SALE OR DISTRIBUTION SALE ORshould DISTRIBUTION 5 isolation process. there are plans to ultimately isolate and dispose of the equip5 Pressurized air may be used to blow dusts and liquids out ment. Note: The use of sodium hypochlorite or bleach solu5 of hard-to-get places (e.g., cracks and crevices) from equipment tions can have adverse effects on any firefighting protective 5 and structures. However, it should never be used for personnel clothing or equipment using Kevlar® or Kevlar® blends. 5 decon becauseLearning, pressurized airLLC on human skin may result in fatal Research by protective clothing manufacturers has shown that © Jones & Bartlett © Jones & Bartlett Learning, LLC 5 OneDISTRIBUTION complication of using pressurized air is NOT the the level of degradation will be dependent upon the duration NOT FORembolisms. SALE OR FOR SALE OR DISTRIBUTION S5 aerosolization of the contaminant into the surrounding atmoof the exposure and temperature, but any degradation processes R5 sphere, where it can create secondary contamination problems. will shorten the life of the garment or material. © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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Neutralization is the process used on corrosives to bring

The terms disinfection and sterilization are sometimes

& Bartlett Learning, LLC © Jones & Bartlett LLC within the range of © Jones used interchangeably. It is important to recognize that the pH of the final Learning, solution to somewhere NOT FOR SALE ORsame DISTRIBUTION NOT FOR SALE sterilization is not the as disinfection. A decontamination pH 5 to pH 9.OR The DISTRIBUTION neutralization process uses an acid sub-

recommendation from an etiologic specialist to sterilize a piece stance to neutralize alkaline or an alkali substance to neutralize of equipment must not be misunderstood to mean disinfect it. an acid. Preferably, the less harmful byproduct produced is a Sterilization is the process of destroying all microorganneutral or biodegradable salt. isms in or on an object. The most common method of sterilAccording to the U.S. EPA, the ideal substances to use for © Jones & Bartlett Learning, ization LLC is by using steam, concentrated © Joneschemical & Bartlett Learning, LLC agents, or the neutralization of alkaline corrosives in emergencies are citNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ultraviolet light radiation. Because of the size of the equipment ric acid (a powder in 25-pound bags) and sodium sesqucarinvolved in the sterilization process, it has limited field applibonate (a powder in 50-pound bags) when neutralizing acids. cation and cannot be used to decontaminate personnel, but it Either one forms neutral salts, and depending on the substance does play an important role in decontaminating medical being neutralized, sometimes forms a biodegradable salt. Neuequipment. Contaminated medical equipment is sometimes tralization is primarily used to decon equipment, vehicles, and © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC initially disinfected at the site, then transported as contamistructures contaminated with a corrosive material. The objecNOT FOR SALE OR DISTRIBUTION NOT DISTRIBUTION nated equipment to aFOR specialSALE facility, OR where it is then sterilized tive of neutralization is to bring the spilled material’s pH or discarded. Contaminated emergency response equipment towards a pH of 7. may be sterilized through autoclaving, but the ability for the Solidification is a process by which a contaminant physiitem to withstand this process has to be confirmed by the cally or chemically bonds to another object or is encapsulated manufacturer. by it. This method is primarily used to decon equipment and © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC vehicles. Commercially available solidification products can be NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION used for the clean-up of spills. In some situations, large pieces of contaminated equipment have been covered with a cement-like material so that the contaminant is permanently bonded to the object. The contaminated object can then be buried in a hazardous © Jones & Bartlett Learning, Decon LLC methods vary in their effectiveness © Jonesfor &removing BartlettdifferLearning, LLC ent substances. The effectiveness of any decon method should waste landfill. After the Chernobyl disaster, large contamiFOR SALEand ORperiDISTRIBUTION NOT FOR SALE DISTRIBUTION be assessed at the beginning of NOT the decon operation nated objects were covered with cement and OR entombed odically throughout the operation. If contaminated materials in-place. are not being removed or are permeating through protective Disinfection is becoming increasingly important due to clothing, the decon operation must be revised. the threats posed by biological warfare agents. Disinfection is Five simple criteria can be used for evaluating decon the process used to inactivate (kill) recognized pathogenic © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC effectiveness: microorganisms. Proper disinfection results in a reduction in NOT FORorganisms SALE OR DISTRIBUTION NOT are FOR SALE OR DISTRIBUTION 1. No personnel exposed to concentrations above the the number of viable to some acceptable level. It TLV/TWA. does not cause complete destruction of the microorganism you are trying to remove. Consequently, it is important that 2. Personnel are not exposed to skin contact with materials emergency responders obtain technical advice about presenting a skin hazard. disinfection techniques prior to their use. Likewise, some 3. Contamination levels are reduced as personnel move © Jones & Bartlett LLC etiologics than others. © Jones & Bartlett LLC disinfectants workLearning, better on certain through the deconLearning, corridor. NOT FOR SALEdisinfectants OR DISTRIBUTION FOR SALE OR DISTRIBUTION Commercial usually include detailed informa- NOT 4. Contamination is confined to the hot zone and decon corridor. tion outlining the capabilities and limitations of the product. 5. Contamination is reduced to a level of ALARA. If you have research labs, hospitals, and universities in your Methods for assessing the effectiveness of decontaminaresponse area, you should perform a hazard assessment and tion include the following: familiarize yourself with the specific types of biological Visual observation—Stains, discolorations, corrosive © Jones & Bartlett LLC effects, and so on. © Jones & Bartlett Learning, LLC hazards present and the best disinfectant(s) for the Learning, type of NOT such FORasSALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION hazard you may encounter. Monitoring devices—Devices photoionization There are two major categories of disinfectants: detectors (PIDs), detector tubes, radiation detection instruChemical disinfectants are the most practical for field ments, and survey meters can show that contamination levuse. The most common types of chemical disinfectants els are at least below the device’s detection limit. For are commercially available, including phenolic comexample, placing CPC in a closed bag after decon will allow © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC pounds, quaternary ammonium compounds, chlorine any residual organic vapors to accumulate; monitoring NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION compounds, iodine, alcohols, glutataldehydes, and devices can then be used later to detect any vapors present. iodophors. Wipe sampling—Wipe sampling can be used to assess Antiseptic disinfectants are designed primarily for decon effectiveness on CPC, equipment, and skin, as direct application to the skin. These include alcohol, well as vehicles and structures. The sample provides iodine, hexachlorophene, and quaternary ammonium after-the-fact information on the effectiveness of the © Jones & Bartlett Learning, LLC © Jones d&econ. Bartlett Learning, LLC compounds. Some of these compounds are also classiIn some cases, wipes can be taken with pH NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION fied as disinfectants, but alterations in concentration paper or other types of indicator papers based on the allow them to be classified as antiseptics. identified product. Some wipe sampling papers for

Evaluating the Effectiveness of Decon Operations

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The Decon Leader performs the following activities:

© Jones & Bartlett Learning, LLC © Jones & Bartlett LLC the type of chemical agent detectorLearning, paper can indicate Determine the appropriate level of decontamination to NOT FOR SALE OR NOT FOR SALE ORfield DISTRIBUTION in the by color changes. It should be noted that be provided.DISTRIBUTION there is currently no practical way to determine the effectiveness of decontamination in the field for most etiologic hazards by wipe sampling. However, many new bio sampling products are coming on the market © Jones & Bartlett Learning, LLC every year, getting responders closer to legitimate onscene sampling NOT results.FOR SALE OR DISTRIBUTION

Ensure proper decon procedures are used by the Decon Team, including decon area set-up, decon methods and procedures, staffing, and protective clothing requirements. © Jones & Bartlett Learning, LLC Coordinate decon operations with the Entry Leader and NOTtheFOR SALE ORThis DISTRIBUTION other personnel within Hazmat Group. will ensure that decon is set up before entry operations begin. Coordinate the transfer of decontaminated patients requiring medical treatment and transportation with the Hazmat Medical Unit. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC The success of decontamination is directly related to how well Ensure the Decon Area is established before any entry the Incident Commander and DISTRIBUTION the Decon Leader control NOT FOR SALE OR NOT FOR SALEto OR personnel are allowed enterDISTRIBUTION the Hot Zone, whenever on-scene personnel and their operations. Before initiating possible. decontamination, the Hazmat Group Supervisor and the Monitor the effectiveness of decon operations. Adjust Decon Leader must decide (1) how much and what decon procedures and operations as necessary. method is required; and (2) to what extent decon will be Appoint or act as an accountability officer to limit access to © Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC accomplished in the field. LLC personnel entering and operating within the decon area. These OR decisions should be based on the answers to the folNOT FOR SALE DISTRIBUTION NOT FOR The SALE OR DISTRIBUTION Decon Leader should use a formal checklist to ensure lowing questions: that important items are not overlooked. Can decon be conducted safely? Dilution may be impractical due to cold weather or because it presents Decon Site Selection an unacceptable risk to emergency personnel. When a hazmat incident ©occurs outdoors, the decon site © Jones & Bartlett Learning, LLC Jones & Bartlett Learning, LLC Are existing resources immediately available to decon should be accessible from a hard-surfaced road. Water supply, personnel and equipment? not, where they be NOT FOR SALE OR DISTRIBUTION NOT FORIf SALE ORcan DISTRIBUTION access to safety showers, runoff potential, and proximity to any obtained, and how long will it take to get them? environmentally sensitive areas, such as streams or ponds, Can the equipment used be decontaminated? The toxshould be considered Figure 11-6 . icity of some materials may render certain equipment The ideal outdoor decon site is upwind and uphill from the unsafe for further use. In these cases, disposal may be incident and remote from drains, manholes, and waterways, © the Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC but only safe alternative. close enough to the scene to limit the spread of contaminants. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Unfortunately, it is often not possible to actually choose such an The Decontamination Team ideal site. Shifting winds and dispersing vapors can further comAt a working hazmat incident, a decontamination team should plicate this selection process. Such real-life problems may force be established to manage and coordinate all decon operations. the movement of the decon area once it has been in operation if The decon team’s functions include research and development initial planningLearning, has been hasty. © Jones & Bartlett Learning, LLC © Jones & site Bartlett LLC of the decon plan and set-up and operation of an effective If decon will be conducted indoors, consideration NOT FORdecontamination SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION area capable of handling all potential exposhould be given to quick access such as hallways, type and sures, including entry personnel, contaminated victims, and slope of floor, floor drains, and ventilation airflows in the equipment. If necessary, the decon team will also coordinate area. the establishment of a safe refuge area. Complete decon may be impractical to achieve at a single location, so a combination of and&off-site contingencies © Jones & Bartlett Learning, LLC © on-site Jones Bartlett Learning, LLC may be necessary. Any time decon is conducted offsite, the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION entire operation will become more complicated due to the logistics of moving people offsite. If you intend to use an offHaving an operational decon area is a prerequisite to Hot site location for decon, special preparations will need to be Zone entry. You must have a decon capability before making made to prevent the spread of contaminants. entry.

Decon Site Selection and Management

The Decon Team is managed by the Decon Leader, who Once a decon site has been selected, a decontamination reports to the Hazmat Group Supervisor. The Decon Leader corridor should be marked. The decon corridor is simply a and the Decon Team should be trained to the Hazardous Matepathway from the Hot Zone into the decon area, with the exit rials Technician (as described in NFPA 472) level (or equivapoint near the Warm Zone/Cold Zone interface. The decon © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC lent). Personnel providing support to the Decon Team and not corridor and the boundaries of the decon area should be NOT FORinvolved SALEinOR DISTRIBUTION NOT FOR SALE OR Methods DISTRIBUTION direct decon operations should be trained to at clearly identified. for identification include using least the First Responder Operations level. fence post stakes and colored fire line tape, traffic cones, and © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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Hazardous Materials: Managing the Incident

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Figure 11-6 Decontamination operations may need to be conducted in congested areas. This photo shows NOT FOR SALE OR DISTRIBUTION FOR SALE ORtheDISTRIBUTION multiple task force operations close to the HotNOT Zone, due to necessity following 9-11 attack on the Pentagon. so on. Signs may also be used to indicate the entry and exit Response scenarios in which the decon area is physically points to the decon area. Pre-sized tarps (minimum of 20 ft separated from the “problem” by a large distance can also pose © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC by 40 ft) with various stations marked on them can also help additional challenges for responders. These scenarios will often NOTfrom FOR SALE scene OR DISTRIBUTION NOT FOR SALEcontainment OR DISTRIBUTION organize the decon area and provide secondary require some form of transportation the incident to for decon runoff Figure 11-7 . the entry control point, such as small all-terrain utility vehicles or pick-up trucks. Regardless of the type of vehicle, it must Some scenarios will require multiple decon corridors. For have the capability of carrying multiple personnel, PPE, and example, a mass casualty scenario involving hazardous materiany required control equipment. Continuous air monitoring als or weapons of mass destruction (WMD) could have a decon © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC may be required when dealing with flammable substances to corridor for both mass decon operations and a technical decon NOT SALE OR DISTRIBUTION NOTtransport FOR SALE ensure that these vehiclesOR do DISTRIBUTION not enter an unsafe operations. The FOR mass decon corridor would likely be estabatmosphere. PPE must also be provided for the vehicle operalished by first-due fire units. Upon the arrival of a hazmat tor, including SCBA, which can be accomplished by placing team, a separate decon corridor for technical decon operations the SCBA beside the driver on the seat. Also, placing a plastic would then be established. Similarly, an incident covering a tarp in the vehicle bed can help minimize the spread of conlarge area (e.g., the World Trade Center or the Pentagon) will © Jones Bartlett Learning, LLC because of the size and © Jones & Bartlett Learning, LLC taminants. (Nobody said this was going to be easy!) have&multiple decon corridors, simply NOT FOR SALE ORincident DISTRIBUTION NOT FOR SALE OR DISTRIBUTION complexity of the site.

Staffing and Personal Protection of the Decon Team When setting up the decon area, consideration must be given

© Jones & Bartlett Learning,toLLC © Jones Bartlett LLC the staffing of the decon operation and&the safety of Learning, the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Decon Team. Decon is a labor-intensive operation. Although

there are tools and equipment that can expedite the decon process, it still requires time and personnel to set up and operate the decon corridor. The Decon Leader should be trained to the Hazardous © Jones Learning, LLC is Materials Technician level& (orBartlett equivalent). The Decon Leader NOT FOR SALE OR DISTRIBUTION a supervisor and should not be involved in the actual decon process. However, they may still be “dressed out” in the event of an emergency along the decon corridor that requires additional personnel. At a minimum, each staffed decon station should have one decon member assigned. Those stations that © Jones & Bartlett LLC require entry personnelLearning, to be scrubbed or to remove their PPE NOT FOR SALE OR DISTRIBUTION should be staffed with two decon members, if possible. The level of skin and respiratory protection required by Decon Team members will be dependent upon (1) the type of

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contaminants involved, (2) the level of contamination encoun-

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improving your own system. While there are a variety of differ-

© Jones & Bartlett Learning, LLC © Jones tered & Bartlett by entry Learning, personnel, andLLC (3) where individuals are workent approaches to decon, the better standard operating proceNOT FOR DISTRIBUTION NOT FORingSALE ORdecon DISTRIBUTION along the line. duresSALE are builtOR around several basic principles:

Tactical and safety considerations will include the following: Contaminated people and equipment generally flow The Decon Team should be dressed in chemical protecfrom the dirty end (area of highest contamination) to tive clothing and equipment based on the hazards and the clean end (area of least contamination). The best risks of the contaminants they will be decontaminating. analogy we have come across to explain this concept is © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Experience in the field over the last 20 years indicates an automated car wash. You drive your dirty car in one NOT OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION that the Decon Team can usually operate safely using end and it comes out cleanFOR at the SALE other end. chemical protective clothing (i.e., skin protection) one 1 Just like the car wash, decontamination requires a mullevel down from the PPE being used by the Entry Team. 1 tiple-step process to reduce contaminants to an acceptExample: If the Entry Team is using chemical vapor 1 able level. There are two main reasons for adopting a protective clothing (Level A), then the Decon Team 1 multistep cleaning process: ©may Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC use chemical splash protection (Level B). This is 1 1. Conducting all of the cleaning process at one station NOT SALE OR NOT FOR SALE OR DISTRIBUTION just aFOR guideline, there willDISTRIBUTION always be exceptions, but 1 concentrates all of the contamination in one area. exceptions should be based on a hazard and risk assess1 The more things you clean in the same spot, the ment and made in conjunction with the Incident Safety 1 greater the contamination level becomes. Would you Officer and the Assistant Safety Officer–Hazardous Ma1 really want to step out of your protective clothing terials. The risk of heat exhaustion should be factored 1 into a highly contaminated © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLCpuddle of water? into decision making when selecting the right PPE 2 2. Multiple decontamination stations make you cleaner. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION for decon. 2 The further along the decon line you progress, the 2 The most common level of protection for the Decon cleaner you should become. (Think about it: Does a 2 Team is chemical splash protective clothing (i.e., Level dirty shirt get cleaner the more times you launder it?) 2 B) and self-contained breathing apparatus (SCBA). Multistep decon operations can be broken into two broad 2 Most field-based decon operations involve wet decon phases: gross decon and secondary decon. Gross decon is the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 2 methods with a splash hazard. In addition, Level B disinitial rinse and secondary NOT decon is the follow-up process that FOR SALE OR DISTRIBUTION NOT FOR SALE OR are DISTRIBUTION 2 posable or limited-use garments and SCBA readily removes the contaminants to a safe and acceptable level. These 2 available in most response organizations. phases can be defined as follows: 2 Extended entry operations will require that the Decon Gross decontamination—The initial phase of the 3 Team be provided with an uninterrupted air supply. decontamination process during which the amount of 3 The use of airline hose units (see the section on “selectsurface contaminant is significantly reduced. In simple © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 3 ing personal protective clothing and equipment”) can terms, is designed to remove most of the “big chunks.” NOT FOR SALE OR DISTRIBUTION NOTit FOR SALE OR DISTRIBUTION 3 provide an extended air supply but can also decrease At minor incidents, gross decon may be the only field 3 Decon Team mobility. decon performed. At incidents where greater hazards or higher 3 Respiratory protection for Decon Team members may be levels of contamination are suspected, gross decon is the initial 3 downgraded to PAPRs or APRs providing that air monitorstation in the decon process. Gross decon may be provided ing is continually conducted and filter cartridges are com3 through a variety Learning, of means, including © Jones & Bartlett LLC of contaminants present.© Jones & Bartlett LLC fixed or portable showpatible Learning, with the concentration 3 ers, tent units, hoselines, or wands. Emergency decon and NOT FOR SALE DISTRIBUTION NOT FOR SALE OR DISTRIBUTION All OR Decon Team personnel must be decontaminated 3 mass decon are typically only gross decon operations. before leaving the decon area. The extent of this decon 4 Secondary decontamination—The second phase of the process will be determined by the types of contaminants 4 decontamination process is designed to physically or involved and an individual’s work station along the decon 4 chemically remove surface contaminants to a safe and corridor. The use of disposable or limited-use garments 4 acceptable level. Depending on the scope and nature of © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC by the Decon Team can simplify this decon process. 4 secondary decon steps be NOT FOR SALE ORmay DISTRIBUTION NOT FOR SALE OR DISTRIBUTION the incident, multiple 4 implemented. Technical decon incorporates both gross 4 and secondary phases. 4 Once responders who perform decontamination have 4 incorporated these basic concepts into their procedures, it This section will review the different types of decontamination 4 doesn’t matter whether&there are two Learning, or eight different decon sta© Jones & Bartlett Learning, © Jones Bartlett LLC that may be implemented as part of hazmat LLC response opera5 tions or what are called (e.g.,OR stations, steps, phases, etc.). FOR SALE OR DISTRIBUTION NOTthey FOR SALE DISTRIBUTION tions.NOT Let’s first review some basic concepts and operational 5 procedures that are “horizontal” in nature and influence all 5 Decon Information Sources decon operations. 5 The decision to implement all or part of a decon procedure Decontamination can be carried out safely and smoothly if 5 should be based on a field characterization of the hazards and responders follow a standard operating procedure that is prac5 © Jones & Bartlett Learning, © Jones &involved. Bartlett Learning, LLC the appropriate decon risks Sources for determining tical and suitable for use in LLC the field. As is the case with any 5 NOT FORemergency SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION methods and related information can include the following: response procedure, successful implementation S5 requires regular training and practice. Many good “model” proProduct specialists representing the chemical manuR5 cedures are available to serve as a basis for developing and facturer.

Types of Field Decontamination: Basic Concepts

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LLC NOT FOR SALE OR DISTRIBUTION

see and hear may be compromised by the type of Serving as a member of the Decon Team is much like workPPE being worn, exhaustion and stress, as well as ing in a service industry. The customers are those individubackground noise and conditions within the decon als who must go through the decon corridor. Your job is to corridor. make sure your customers are decontaminated in a safe, Jones & manner. Bartlett Learning, LLC © Jones Except for those& at Bartlett the doffingLearning, station, thereLLC is nortimely,© and effective mally no need for you to physically contact your cusHere are FOR a few pointers keep in mind: NOT SALE to OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION tomer. Utilize decon equipment that will allow you Regardless of your level of protective clothing and to physically clean, wash, and rinse without coming equipment, keep the “Bad Stuff ” off of you! in contact with potentially contaminated personnel At night and in low light conditions, provide suffior equipment. cient lighting so that those going through the decon © Jones & Bartlett LLCIt is not uncommon for© Jones &During Bartlett Learning, night-time incidents,LLC the location of the decon corridorLearning, can see clearly. NOT FOR SALE DISTRIBUTION SALEentrance OR DISTRIBUTION in the Hot Zone can be marked with frostOR to form on the inside of a SCBA face piece orNOT FOR corridor a colored light, to help entry team members with rotective clothing during extremely chemical vapor p fogged-up face pieces or visors find where they need cold weather conditions. This frost will make vision to be heading. This is especially useful where terextremely difficult in artificial light. rain, berms, or other obstacles obscure the actual Provide clear verbal directions and instructions to Jones &their Bartlett Learning, LLC decon area. © Jones & Bartlett Learning, your customers.© Remember, ability to clearly

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Decontamination

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symptoms of a chemical exposure. The victim(s) may be either

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, understanding of theLLC behavior and hazards of the emergency responders or civilians. This problem is normally NOT FOR SALE DISTRIBUTION NOT FOR SALE OR DISTRIBUTION contaminants. associated withOR routine events, when hazardous materials are not

Technical information centers, including CHEMTREC™, suspected or anticipated. It may also be required if a responder’s CANUTEC, SETIQ, Centers for Disease Control, and PPE is breached and there is immediate skin contact with the regional poison control centers. contaminant. The urgency of the situation does not allow for the Safety data sheets (SDSs). Decon information is usually formal establishment of a technical decon operation Figure 11-8 . © Jones & Bartlett Learning, LLC Remember, this is not © Jones & Bartlett Learning, LLC found in the first-aid section and is often vague and a controlled situation. Typically, litNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION nonspecific. tle or no chemical protective clothing is being used, and there Emergency response references. These will generally is usually no specialized equipment or expertise on scene to provide information on the physical and chemical assist. Here are some key points to remember: properties of the hazmat you’re dealing with, which Establish an area of refuge as soon as possible. Miniwill be important in assessing the risks and decon mize the potential for cross-contamination. ©requirements. Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC However, they rarely provide specific Establish a gross decon area using some form of water. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION guidance on how to decon personnel or equipment. Hoselines are best, but a garden hose or a bucket of soap Some online computer and electronic databases now and water can work. Depending on the scenario and incorporate decon information. location, emergency decon may also be provided The bottom line: There is no one single best resource for through safety showers, pump sprayers, or even a buildacquiring field decontamination information. Although teching sprinkler system. The key to limiting harm is to © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC nical data and advice from product specialists may be diffiremove the contaminant as rapidly as possible. NOT FORcult SALE OR DISTRIBUTION NOT FOR SALE OR to obtain early in the incident, make every effort to get it Remove anyDISTRIBUTION contaminated clothing. Studies by the U.S. Table 11-1 . Army Soldier and Biological Chemical Command (SBCCOM) of nerve agents using harmless simulants to track contaminants have shown that approximately 80% of contaminants can be removed by simply © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC undressing. NOT FOR SALE OR DISTRIBUTION NOT FORmay SALE OR DISTRIBUTION Different types of decontamination be required based on the nature of the problem, the urgency of the situation, the number of people contaminated, the scope of the contamination, and the hazards and risks of the contaminants. This section will provide an overview of the types of decontamination, Jones &and Bartlett Learning, © Jones & Bartlett Learning, LLC their © application, implementation. TheseLLC types include NOTdecon, FOR technical SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION emergency decon, and mass decon.

1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 Emergency Decontamination 3 Emergency decontamination is the physical process of immedi3 ately reducing Learning, contaminationLLC of individuals in potentially life© Jones & Bartlett © Jones & Bartlett Learning, LLC 3 situations with or without the formal establishmentNOT of NOT FORthreatening SALE OR DISTRIBUTION FOR SALE OR DISTRIBUTION 3 a decontamination corridor. It is used when emergency responders 4 Figure 11-8 Emergency decon may be required for civilians, resencounter a life-threatening situation that requires some type of 4 ponders, or the injured before a formal decon corridor is established. immediate decontamination; e.g. they are exhibiting signs and 4 4 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 4 NOT FOR SALE OR DISTRIBUTION 4 NOT FOR SALE OR DISTRIBUTION Table 11-1 Types of Decontamination 4 TYPES OF DECONTAMINATION 4 EMERGENCY DECON TECHNICAL DECON MASS DECON 4 Field Response Field Response Medical Facility Fog Lines Corridor Tent Corridor 4 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Gross 5 1 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE ORXDISTRIBUTION Decontamination X1 X X X1 5 5 Phase 5 Secondary 5 Decontamination X X 5 Phase © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 5 NOT FOR SALE OR FORbefore SALE OR DISTRIBUTION X1—Any patie nts DISTRIBUTION who will require medical treatment must receive secondary NOT decontamination being treated. S5 R5

Types of Field Decontamination

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Hazardous Materials: Managing the Incident If time allows, construct a basin to collect runoff, or use

evidence and weapons. A weapons safety officer should be

& Bartlett Learning, LLC © Jones & aBartlett LLC such as a depression in © Jones place that Learning, will hold the runoff, established, as appropriate. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION the ground. Don’t delay life-saving decon to collect 2. Overglove/overboot drop—Overgloves and overboots are

runoff. used to minimize the amount of contamination on PPE. The Emergency decon operations are graded on speed, not majority of personal contamination occurs to the hands and neatness. The sooner you decontaminate, the better. feet. Efficient removal of the overgloves and overboots can Provide emergency medical care for the victims within minimize the potential for secondary contamination. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC the scope of your medical training and the available 3. Gross decon—The initial decon step in which the entry FOR SALE DISTRIBUTION NOT FOR SALE OR DISTRIBUTION resources on hand. crew is rinsed off. Special NOT attention is given to theOR hands Emergency decon can be innovative, but the most imporand feet. A soap and water wash may also be used, followed tant concept is to clean the contaminated person as soon as by a rinse. possible. Remember the basics: FLUSH—STRIP—FLUSH. 4. Secondary decon—Additional washing and rinsing steps Soap and water is a universal solution and should be applied in designed to further reduce the level of contamination. Spe© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC large quantities. When acids or bases have contacted bare skin, cial attention is given to the hands and feet. Based on the NOT FOR SALE OR DISTRIBUTION NOT FORand SALE OR DISTRIBUTION the minimum amount of time for a water flush is at least level of contamination the hazards of the contaminant, 20 minutes. this phase may not be necessary. In summary, emergency decon is a gross decon operation. It should include the removal of any contaminated clothing as soon as possible and as thorough a washing as possible. Victims © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC requiring follow-up medical treatment or evaluation should still NOT FOR SALE OR DISTRIBUTION undergo secondary decon either on scene or at a medical facility. NOT FOR SALE OR DISTRIBUTION

Technical Decontamination Technical decontamination is the planned and systematic pro© Jones Learning, LLC © Jones & Bartlett Learning, LLC cess of reducing contamination to a level&ofBartlett ALARA. Technical decon operations are normally conducted in support of DISTRIBUTION emerNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR gency responder recon and entry operations at a hazardous materials incident and by medical facilities handling contaminated patients. The key variable with technical decon operations is the time and resources required to become operational. © Jones Learning, LLC © Jones & Bartlett Learning, LLC Technical decon is&a Bartlett multistep process in which contaminated individuals are cleansed assistance of trained NOT FOR SALEwith OR the DISTRIBUTION NOT FOR SALE OR DISTRIBUTION personnel. While the process has changed over the years, it still follows some basic operational concepts. Technical decon is similar to a car wash: 1. There is an entry point and an exit point (i.e., the decon corridor). © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 2. In between the entry point (i.e., Hot Zone) and the exit point NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION (i.e., Warm Zone/Cold Zone interface), several progressive cleaning steps takes place to remove the dirt (same as the contaminants). 3. Most of the dirt is removed in the initial stage of the car wash (i.e., gross decon),©and the car& becomes cleaner as it Jones Bartlett Learning, LLC © Jones & Bartlett Learning, LLC moves through the various cleaning (i.e.,OR secondary NOT FOR SALE OR DISTRIBUTION NOT FORstages SALE DISTRIBUTION decon). Now, replace the words car wash with decon corridor and you have a technical decon operation. While the car wash facility is permanent, our technical decon process and decon corridor must©typically up in the Learning, field Figure 11-9 . Jonesbe&setBartlett LLC © Jones & Bartlett Learning, LLC

NOTDecon FORProcess SALE OR DISTRIBUTION The Technical There are nine basic steps in technical decon: 1. Tool and equipment drop—Tools that may be reused at the job site are placed here. When the job is completed, they will receive further cleaning. © Jones & Bartlett Learning, LLCMonitoring instruments should be separated from other equipment to protect them NOT FORfrom SALE ORIf DISTRIBUTION damage. the incident involves law enforcement officers, it may also be necessary to incorporate a drop area for

NOT FOR SALE OR DISTRIBUTION

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Jones & Bartlett Learning, LLC Decontamination of ©Injured Personnel

NOT FOR SALE OR DISTRIBUTION

Contaminated nonambulatory victims pose unique chalmembranes than through intact skin. Therefore, these lenges for emergency responders. At incidents where there areas should be decontaminated first. n Begin to rinse the victim around the face and head are both ambulatory (walking) and nonambulatory (nonarea; ensure that all fluids flow away from the eyes walking) contaminated individuals, separate decon corri© Jones & Bartlett Learning, © Jones & Bartlett LLC and respiratory system. ThenLearning, move to any open dors should be established to facilitate victim LLC flow. wounds, followed a head-to-toe rinse in a systemDecon injured and/or individuals NOTofFOR SALE ORcontaminated DISTRIBUTION NOT FOR by SALE OR DISTRIBUTION atic fashion. Pay close attention to skin folds, armpits, should be accomplished in the field before transport to a genital areas, fingernails, and the feet. These areas of medical facility—failure to decon these people before the body are important for chemicals that like moistransport will only lead to bad outcomes, including crossture to hydrolyze (e.g., blister agents). contamination to EMS personnel, ambulances, and emer© Jonesgency & Bartlett Learning, LLC © Jonesn & Bartlett Learning, LLCHowever, if the adher Water is the universal decon agent. room facilities. NOT FOR SALE OR DISTRIBUTION SALE OR DISTRIBUTION solids or liquids are not water soluble, a mild liquid In some instances, hospitals and medical facilitiesNOT FORent detergent can be used to facilitate skin washing. Do not may encounter “surprise packages” where contaminated use hot water, as this will cause pores in the skin to open. victims simply show up at the front door. Approximately It is better to use slightly cooler than body temperature 80% of those who sought medical treatment after the 1995 water, ideally 30°C (86°F). Tokyo subway incident involving sarin sought treatment © medical Jonessystem & Bartlett Learning, LLCn If the eyes are symptomatic, © Jones & Bartlett Learning, LLC irrigate the eyes conoutside of the emergency by self-evacuatNOT FOR SALE OR DISTRIBUTION NOT FOR OR DISTRIBUTION tinuously. ing to the nearest hospital and SALE overwhelming the n Attempt to isolate contaminated areas on the victim resources. if the whole victim is not contaminated. For example, Regardless of whether emergency, technical, or mass cover uncontaminated areas on the victim with a waterdecon is being provided, there are some basic principles proof material and avoid washing a contaminated area that need to be recognized when dealing with the injured. Jones Bartlett Learning, LLC © open Jones & Bartlett Learning, LLC into an wound. This may require placing goggles, These © include the & following: n NOT Remove FOR SALE jewelry, OR DISTRIBUTION NOTorFOR SALE DISTRIBUTION earplugs, an oxygen maskOR on the victim. all clothing, and shoes as soon as n Provide initial medical treatment based on the signs possible. If possible, remove clothing from head to and symptoms of the suspected material. Remember foot to limit the risk of inhalation. n Protect the victim’s airway. Blot away any obvious liqthe basic ABCs! n Bag and tag all clothing and possessions. Depending uids using a soft sponge or washcloth, and/or brush © Jones & Bartlett © Jones & Learning, LLCto be disposed of as onBartlett the scenario, these may need away anyLearning, obvious solidLLC or dust materials. n Hazardous materials will tend to enter the body hazardous waste or they may be treated as evidence if NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION a criminal event is suspected. more readily through wounds, the eyes, or mucous

1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 4 NOT FOR SALE OR DISTRIBUTION 4 NOT FOR SALE OR DISTRIBUTION 4 4 5. PPE removal—PPE should be removed in a manner that 7. Clothing removal—If necessary, change out of the under4 minimizes the potential for the Decon Crew to contact those garments. In this case, it will also be necessary to provide 4 © Jones & Bartlett LLC © Jones & Bartlett LLC being decontaminated. LargeLearning, trash bags make handling and an additional change of clothingLearning, for personnel. 5 NOT FOR OR DISTRIBUTION NOThygiene—Normal FOR SALE OR DISTRIBUTION disposal easier. SALE If the materials will require an administrative 8. Personal hygiene procedures are usu5 chain of custody (e.g., samples, weapons, evidence), clear ally adequate following removal of protective clothing. 5 plastic bags should be used. There is seldom a situation where it is necessary for someone 5 6. Respiratory protection removal—Should always be the to totally undress and shower on scene. If a whole body wash 5 last item removed. If individuals being deconned are wearis required immediately it should be done inside a tempo5 © Jones & Bartlett Learning, LLC should be given so that © Jones &rary Bartlett Learning, LLCmodesty and comfort are ing coveralls, special attention portable decon shelter where 5 NOT FOR SALE OR DISTRIBUTION FOR respected. SALE OR DISTRIBUTION the user will continue to wear the face piece until PPENOT is If a breach in a suit has occurred and the contamiS5 removed. nants are believed to be inside the suit, dangerous, and an R5 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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exposure has occurred, then the whole body wash, or at least

If the responder is wearing outer gloves, they can be

© Jones & Bartlett Learning, LLC © Jones the & Bartlett potentiallyLearning, contaminated LLC area, might be justified. This removed now; inner gloves will be removed later. The NOT FOR DISTRIBUTION NOT FORactivity SALE DISTRIBUTION mayOR be done on-site using temporary inflatable shelresponderSALE then OR proceeds through the decontamination ters or off-site at a locker room facility. If a full body shower corridor to an area where helmets, respiratory protection, is required, it should always be done prior to going home. and any other ancillary equipment are removed. Deposit 9. Medical evaluation—Responders should always be respiratory protection in a plastic bag or on a tarp. Highly medically evaluated after an entry. Vital signs are taken contaminated respiratory protective equipment should be © Jones & Bartlett Learning, removed LLC and isolated until©itJones & Bartlett Learning, LLC 10–15 minutes after rest and oral rehydration to ensure can undergo complete NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION adequate recovery from the stress of entry. Responders who decontamination. are not recovering appropriately should go to rehabilitaRemove inner gloves, and sort them into individual contion (Rehab) for further evaluation, hydration, and further tainers for clean-up or disposal. Plastic bags can be used for treatment. For guidance on Rehab, consult NFPA 1584— this purpose because they provide sufficient temporary protecStandard on the Rehabilitation Process for Members During tion from most materials. They should be sealed with tape and © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Emergency Operations and Training Exercises. transported elsewhere for disposal. Place the bags in a properly NOT FOR SALE OR DISTRIBUTION NOT FOR SALE ORofDISTRIBUTION Portable tents, rapidly inflatable temporary structures, marked recovery drum when disposing them. and specially designed vehicles or trailers may also be inteMost chemical-protective equipment in use today is considgrated into the decon corridor and the technical decon proered to be disposable. In most cases, the d econtamination process. In addition, some hospitals and high-hazard facilities cess is done to safely remove the person from the garment; the have constructed specialized rooms or areas where technical garment is then discarded. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC decon can be completed. There is not necessarily a right way or Decontaminated personnel can now don clean clothes. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE DISTRIBUTION a wrong way—there are many different options. Use what Disposable cotton OR coveralls, hospital gowns, hospital booties, works for you. slippers, and flip-flops are inexpensive and easy-to-use options for this purpose. They can be prepackaged according to size and stored for easy access. After personnel are thorPerforming Technical Decontamination oughly decontaminated and have showered and donned To begin the technical decontamination process, anyone leav© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC clean clothes, they should proceed to a medical station for ing the hot zone should place any belongings, oversuits, or NOT FORbeSALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION should left in place evaluation. Respiratory protection as tools in a drop area near the entrance of the decontamination long as possible to protect the lungs and eyes from potential corridor (these items can be cleaned later, after the contamiinjury. nated responders are taken care of). This drop area can consist Technical decontamination can be performed in a numof a c ontainer, a recovery drum, a special tarp or other collecber of ways, and your AHJ may have established a specific tion device. another&trip into the hot zone is required, © IfJones Bartlett Learning, LLC sub© Jones & Bartlett Learning, LLC procedure for it. Check your policies and procedures for sequent teams may use the same tools. NOT FOR SALE OR DISTRIBUTION SALE instructions NOT on theFOR preferred wayOR to DISTRIBUTION carry out technical The responder, still wearing full PPE, proceeds or is moved decontamination. into the decontamination corridor for gross decontamination To perform technical decontamination on a responder, (if required). The gross decontamination step is optional, follow the steps in Skill Drill 11-1 ▼ : depending on the amount and nature of the contaminant. A 1. Drop any tools and equipment into a tool drum or onto a portable shower using a low-pressure, © Jones & Bartlett Learning, LLChigh-volume water flow © Jones & Bartlett Learning, LLC designated tarp. (photo 1) may complete this step (the shower contains the water). TechNOT FOR SALE OR DISTRIBUTION NOT FOR SALE DISTRIBUTION 2. Perform gross OR decontamination, if necessary. (photo 2) nical decontamination typically involves one to three wash 3. Perform technical decontamination. Wash and rinse the and-rinse stations, again depending on the nature of the responder one to three times. (photo 3) expected contamination. Only one contaminated responder is 4. Remove outer hazardous materials–protective clothing. allowed in a wash and rinse station at a time. The technical (photo 4) decontamination team is responsible for containing © Jonesnot&only Bartlett Learning, LLC 5. Remove personal clothing. © Jones & Bartlett Learning, LLC the water used, but also for scrubbing the PPE wornOR by personNOT SALEmonitorOR DISTRIBUTION NOT FOR SALE DISTRIBUTION 6. Proceed to the rehabilitation areaFOR for medical nel. The decontamination team member who is scrubbing ing, rehydration, and personal decontamination shower. should pay special attention to the gloves, crevices in the PPE, (photo 5) and boot bottoms, as these are areas in which hazardous materials are likely to collect. After©the chemical-protective thoroughly Jones & Bartlett equipment Learning,is LLC scrubbed NOT and rinsed, it can be safely removed from the FOR SALE OR DISTRIBUTION responder. The SCBA face piece, air-purifying respirators, or fan powered air-purifying respirators, should remain in place. The members of the decontamination team who are responsible for assisting responders with doffing the PPE should fold or roll the PPE back soLearning, that the contaminated © Jones & Bartlett LLC side of the garment contacts only itself. If the procedure is done properly, the conNOT FOR SALE OR DISTRIBUTION taminated side of the garment will not touch the interior of the suit or the person wearing it.

© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION The concept of removing PPE should follow the same principle as applies when extricating a victim pinned inside an automobile: Remove the car from the p erson; don’t take the © Jones & from Bartlett person the car.Learning, When it comesLLC to decontamination and PPE removal, PPE from the person; don’t take the NOT FOR SALEremove OR the DISTRIBUTION person out of the PPE.

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11-1

Decontamination

415

Performing© Jones Technical Decontamination & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION

1 1 1 1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 1 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1 1 1 1 1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 2 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2 2 2 Perform gross decontaminaPerform technical deconDrop any tools and equipment 2 2 1 3 tion, if necessary. tamination. Wash and rinse into a tool drum or onto a des2 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC the responder one to three ignated tarp. 2 times. SALE OR DISTRIBUTION NOT FOR NOT FOR SALE OR DISTRIBUTION 2 2 2 3 3 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 3 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 3 3 3 3 Remove personal clothing. 3 Remove outer hazardous 4 5 © Jones & Bartlett Learning, LLC Proceed toLearning, the rehabilitationLLC materials–protective clothing. © Jones & Bartlett 3 area for medical monitoring, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 3 rehydration, and personal 4 decontamination shower. 4 4 4 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 4 NOT FOR SALE OR DISTRIBUTION 4 NOT FOR SALE OR DISTRIBUTION including ambulatory and nonambulatory, children, the Mass Decontamination 4 elderly, and people with disabilities. 4 Mass decontamination is established when large numbers of Mass decon is a gross decontamination process that relies 4 people (i.e., civilians or responders) need to be decontamion the use of water or soap and water solutions to flush the 4 nated at the scene of a hazmat emergency. The general goal is © Jones & Bartlett Learning, LLC & Bartlett majority ©ofJones the contaminant fromLearning, individuals. LLC Mass decon 5 to provide the greatest good to the greatest number of people FOR SALE OR DISTRIBUTION NOT FORonSALE OR DISTRIBUTION operations are based the following basic principles: 5 in theNOT shortest amount of time. 1. Removing clothing is a form of decon that can remove the 5 What is considered a “large” number of people is really majority of the contaminants. SBCCOM tests with simulated 5 based on your local resources. From a training and exercise chemical agents show that this can account for the removal 5 perspective, begin mass decon practice evolutions with a 5 of up to 80% of the contaminant. If victims are unwilling school bus-sized group (approximately 20 to 40 people) and © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 5 to remove their clothing, they should be showered while then develop expanded capabilities from there. A major NOT FORdifference SALE between OR DISTRIBUTION NOT FOR clothed. SALE Responders OR DISTRIBUTION S5 should not spend any significant technical and mass decon is the wide range R5 of victims likely to be involved in a mass decon scenario, amount of time trying to convince people to disrobe since © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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this impedes the goal of rapidly decontaminating as many

for their own peace of mind as well as for their health

© Jones care & Bartlett Learning, LLC © Jones people & Bartlett Learning, LLC as possible. providers. The “worried well” may also complain of NOT FOR SALE OR NOT FOR SALE ORhas DISTRIBUTION 2. Once clothing been removed, flushing a victim with symptoms similarDISTRIBUTION to that of truly contaminated individa low pressure/high-volume shower of water will remove uals but which cannot be differentiated in the short time additional amounts of the contaminant. Tests conducted that responders have to decide who warrants emergency by SBCCOM and the Virginia Department of Emergency decon and treatment. Services have shown that high volume, low-pressure quick air © Jones & Bartlett Learning, LLC When dealing with large©numbers Jonesof&victims, Bartlett Learning, LLC streams are most effective. Optimal operating pressures for monitoring and detection is crucial. Early identification NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION both automatic and standard fire department nozzles are of the presence of contaminants followed by risk charapproximately 30 to 50 psi, with average flows of 150 gpm acterization is critical to survival. per nozzle. 3. Water flushing can be delivered in a variety of methods, The Mass Decon Process including the following: The following©tasks and factors should Learning, be incorporated into © Jones & Bartlett Learning, LLC Jones & Bartlett LLC Establishment of mass decon corridors using either the mass decon procedure: NOT FOR SALE DISTRIBUTION NOT FOR SALE OR DISTRIBUTION handlines or master fog OR streams from fire engines or 1. Protective clothing—Responders should use either strucaerial devices. Note: Caution should be used if tank tural firefighting clothing or Level B chemical splash protecsaver additives are mixed with fresh water. As more tive clothing with self-contained breathing apparatus. Butyl units arrive on scene, they can be added into the gloves should be used for hand protection. process. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 2. Decon prioritization—Whether you call it triage or decon Use of portable shower set-ups (commercial and availprioritization process, responders must have a system for NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION able systems). initially sorting and prioritizing those individuals who are Use of indoor or outdoor swimming pools (victims potentially contaminated or injured. Decon prioritization wade into the water). works in a similar way. In the initial response window, most The use of sprinkler heads in a building with a fire proresponders will have a limited amount of personnel and tection sprinkler system. © Jones & Bartlett Learning, LLC ©ofJones & Bartlett LLC equipment. The general goal mass decon is to ensureLearning, the Multiple bathroom showers, such as in a school or survival of the greatest number of people. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION health club locker room. When people show symptoms and it is evident that There are many options and methods to provide mass they have been contaminated, they will generally willingly decon. It is our intent to focus on the key concepts, operational submit to some form of decontamination. Don’t slow issues, and lessons learned that should be incorporated into down the overall process to argue with the victims. Studyour mass decon procedure. Again—use the method that © Jones & Bartlett Learning, LLC © Jones & warfare Bartlett Learning, ies involving chemical agents show that LLC victims works for you. should beNOT washed for atSALE least 3 minutes but no longer than NOT FOR SALE OR DISTRIBUTION FOR OR DISTRIBUTION 5 minutes. It’s All about People People who may have been exposed to the problem The greatest challenge in a mass decon operation will be the but who were not physically contaminated (e.g., most gas management and control of people. Among the lessons learned and vapor exposures) do not need decon, although they from research and exercises are the following: may&beBartlett “psychologically decontaminated” at a later time. © Jones & Bartlett Learning, LLC to create a more favor- © Jones Learning, LLC Timing is everything! In order People who have material on them or able outcome, mass decon must be established by the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION are severely symptomatic must be decontaminated in a timely manner. first-arriving responders in a rapid and efficient manOthers who were just in the building or in the area in most ner. Speedy operations are critical to success. cases do not need to be decontaminated. Law enforcement will play a key role in assisting with 3. Ambulatory versus nonambulatory victims—Injured vicmass decon. Depending on the scenario, their training © Jones and & Bartlett LLC © Jonesand & nonambulatory Bartlett Learning, LLC tims should be sorted into ambulatory and expertise in controlling containingLearning, large groups. Medical triage procedures S.T.A.R.T.—Simple groups of people willNOT be a major in aOR successful NOT(e.g., FOR SALE OR DISTRIBUTION FORfactor SALE DISTRIBUTION Triage and Rapid Treatment Process) can facilitate this prooperation. More than a few people will want to leave cess. However, responders should recognize that most triage the scene and seek medical treatment on their own, protocols, including S.T.A.R.T., were designed to be used which defeats the goal of rapid decon. for victims of acute traumatic injuries. These protocols may The ability to establish a safe refuge area and maintain © Jones & Bartlettand Learning, © Jones Bartlett not accurately identify&and classify illLearning, patients from aLLC hazmat effective site management control willLLC be critical or WMDNOT scenario or predict which will clinically NOT SALE OR isDISTRIBUTION FOR SALE ORpatients DISTRIBUTION until the FOR mass decon corridor established. deteriorate. Psychology will play a major factor in a mass decon sceAmbulatory—Victims are able to understand direcnario; a majority of the victims may not be contaminated tions, talk, and walk unassisted. Classified as Priority 3 and are “worried well.” For example, approximately or minor (walking wounded). 80% of the 5,510 people who sought medical attention © Jones & Bartlett Learning, LLC & Bartlett Learning, LLC who are unconscious, as a result of the 1995 Tokyo subway sarin attack were © Jones Nonambulatory—Victims NOT FOR SALE OR DISTRIBUTION SALE ORorDISTRIBUTION unresponsive, unable to move unassisted. Classified not exposed to any significant amount of the chemical NOT FOR as Priority 1—immediate (life threatening injury) or agent. These individuals needed to be decontaminated © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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2—delayed

(serious

Decontamination

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non-life-threatening

© Jones & Bartlett Learning, LLC © Jones & Bartlett LLC injury).Learning, Types of injuries may include Figure 11-10 : NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Serious medical symptoms (e.g., shortness of breath, chest tightness) • Evidence of liquid on clothing or skin • Conventional injuries • Casualties reporting exposure to vapor or aerosol © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • Casualties closest to the point of release NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 4. Cold weather operations—Victims can be washed off in cold weather and survive hypothermia if they are then moved to a warm building or vehicle as soon as possible. The rule of thumb is simple: If the victims may die from the contamination, then wash them off, regardless of the theoretical risk of hypothermia. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC You should then move them to a covered environment with NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION an ambient temperature of at least 70°F (preferably higher) as soon as possible. There is no evidence that cold weather decon will cause permanent injury or harm Figure 11-11 . Nothing in these preceding statements should imply that these victims will be happy; they will be extremely © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC cold and may be shivering violently. Hypothermia develops NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION when an individual is continuously exposed to a cold stimulus for a period of time, but it is unlikely that responders will cause a significant core temperature drop by performing emergency decon. A person who has stopped shivering or who does not respond to verbal or physical stimuli may © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC be developing hypothermia. Victims who are young, NOT FOR SALE OR DISTRIBUTION NOThealth FORproblems SALE will ORsuccumb DISTRIBUTION elderly, or have chronic to hypothermia faster. These people should be moved to a warm area as soon as possible since hypothermia in this group may begin in approximately 10 minutes. Figure 11-10 Nonambulatory victims are unconscious, unrespon5. Mass Decon Operations Using Fire Apparatus— sive, or© unable to move&unassisted. © Jones & Bartlett Learning, LLC Jones Bartlett Learning, LLC Numerous options using fire apparatus have been developed NOT FOR SALEthe OR NOT FOR SALE OR DISTRIBUTION and tested throughout fireDISTRIBUTION service. All of these options are typically based upon using the items immediately available to emergency responders—hoselines, water, and the firefighting apparatus itself. SBCCOM’s report entitled Guidelines for Mass Casualty Decontamination During a © Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC Terrorist Chemical AgentLLC Incident is an excellent reference NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION and recommended reading for anyone considering implementation of this mass decon method. Mass decon operations can be implemented using a single engine company, multiple engine companies, a truck company, or multiple engine/truck companies in combination with each © resources Jones & Bartlett © Jones & Bartlett Learning, LLC other. Regardless of the available, all Learning, involve the LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION establishment of a decon corridor using a combination of overhead and/or side water sprays from fire apparatus. The following information is referenced from the Virginia Department of Emergency Services mass decon training program. Figure© 11-11 The risk hypothermiaLearning, must be considered for vic© Engine JonesCompany & Bartlett Learning, LLC Jones &ofBartlett LLC Single Response Procedure tims who are decontaminated. Position theFOR engineSALE to create herding lane (think cattle) NOT ORa DISTRIBUTION NOT FOR SALE OR DISTRIBUTION between the apparatus and a building wall or other structure. The lane should be 12 to 16 feet wide. By positioning the engine Engine company personnel should attach 2 to 3 nozzles to in this manner, victims’ modesty can be somewhat protected. the opposite side of the pump panel and set them for a wide Use the apparatus PA system to direct the victims to the safe © Jones & Bartlett LLC © Jones Bartlett Learning, fog & pattern. The operator shouldLLC engage the pump and mainrefuge area andLearning, the Mass Decontamination Corridor. Instructions tain aSALE pressureOR of between 30–50 psi at the panel if using autobe simple, clear, and authoritative (e.g., where to put clothNOT FORmust SALE OR DISTRIBUTION NOT FOR DISTRIBUTION matic or regular nozzles. ing, what to do in the shower area, where to go after exiting).

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Upon exiting the decon corridor a cover should be pro-

who are unconscious or otherwise unresponsive, requires a

& Bartlett Learning, LLC © Jones LLCdisposable gowns, blan- © Jones vided&toBartlett all victims.Learning, Black trash bags, significant number of emergency response personnel to NOT FOR OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION kets, etc. are acceptable. Tactics to protect personal modesty complete SALE the decontamination process. It is physically more (e.g., tarps and poles) may be required. taxing to carry unresponsive victims, and work times for If emergency tape is available, set up lanes to the entrance and emergency responders will be limited. Some manufacturers from the exit of the decon corridor. At the exit point personnel offer stretchers with wheels or other types of carts or sleds to should be stationed to direct victims to the EMS area to be triaged. carry those victims who cannot walk. Nevertheless, using © Jones & Bartlett Learning, these LLCdevices may not significantly © Jones & Bartlett Learning, LLC If EMS has not yet set up or has not arrived, place victims in a speed up the mass deconNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION secure area (e.g., building lobbies, schools, large warehouses, etc.). tamination process; but it does ease the workload on the The goal is to get victims out of the weather and into a contained responders. area suitable to deliver medical treatment as soon as possible. Many jurisdictions set up two separate areas for mass decontamination: one for nonambulatory victims and one for Multiple Engine Company Response Procedure ambulatory victims. It is up to your AHJ to determine the © Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC If using engine companies with a side-mount pump,LLC the pump specific procedures for handling both types of victims. panels must face FOR to the street curbside. The engine companies NOT SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION From first responders’ perspective, it is important to should be positioned approximately 12 to 16 feet apart. Perchoose a system that fits the responding agency’s needs, sonnel will attach nozzles to all discharges on the side of the based on staffing levels, anticipated numbers of casualties, pumper facing the decon corridor. If there is only a single distopography, and proximity to other mass decontamination charge, another nozzle should be attached to a section of hose units in the region. There is no one perfect setup for all © Jones Learning, LLC or rear of the pumper © Jones & Bartlett Learning, LLC and & tiedBartlett off to either the front bumper occasions. The AHJ must evaluate all operational facets of its (e.g., trash line). corridor will also establish a modesty NOT NOT FOR SALE ORThis DISTRIBUTION FOR SALE and ORchoose DISTRIBUTION own operations a process that best suits the corridor for the victims. Emergency tape and personnel should anticipated need. be positioned to direct victims into the lane (herding). To set up and use a mass decontamination system on ambulatory victims, follow the steps in Skill Drill 11-2 ▼ : Multiple Engine/Ladder Apparatus Response Procedure 1. Ensure you have the appropriate PPE to protect against the If using engine companies with a side-mount pump, theLearning, pump © Jones & Bartlett LLC © Jones & Bartlett Learning, LLC chemical threat. panels must face to the street curbside. The engine companies NOT FOR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2. Stay clear of the product, and do not makeSALE physicalOR contact should be positioned approximately 12 to 16 feet apart. Personwith it. nel will attach nozzles to all discharges on the side of the pumper 3. Direct victims out of the hazard zone and into a suitable facing the decon corridor. If there is only a single discharge, location for decontamination. (photo 1) another nozzle should be attached to a section of hose and tied off 4. Set up the appropriate type of mass decontamination system to either the bumper or rear of the pumper (e.g.,LLC trash line). © front Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC based on the type of apparatus, e quipment, and/or system The truck company should approach from behind the NOT FOR SALE OR DISTRIBUTION available.NOT (photoFOR 2) SALE OR DISTRIBUTION engine company so that the operator will be able to work u pwind 5. Instruct victims to remove their contaminated clothing and and uphill. The aerial apparatus should position the ladder pipe walk through the decontamination corridor. to form a water shower. The water shower should be directed 6. Flush the contaminated victims with water. (A water temjust ahead of the pumpers to give a final rinse to the victims exitperature of 70°F (21°C) is ideal but may not be possible. ing the primary shower set up by LLC the engine companies. © Jones & Bartlett Learning, © Jones Bartlett LLC Try & to avoid using Learning, water that is uncomfortably hot or cold.) NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION (photo 3) Mass Decontamination Methods 7. Direct the contaminated victims to the triage area for medical evaluation, which may include on-scene treatment and/or Over the last several years, a number of mass decontamination transport to an appropriate receiving hospital. (Many agencies methodologies have evolved. In today’s marketplace, there is provide modesty/comfort packages after decontamination that no shortage of prepackaged mass decontamination showers © Jones Bartlett Learning, LLC © Jones Bartlett Learning, LLC include gowns, booties, towels, and other&pertinent items). for ambulatory victims (able to walk)&and nonambulatory NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION (photo 4) victims (unable to walk without assistance). Several versions To set up and use a mass decontamination system on nonof pre-plumbed, rapid-deploy shelters are available that conambulatory victims, follow the steps in Skill Drill 11-3 ▼ : tain intricate showerheads and spray wands, along with segre 1. Set up the appropriate type of mass decontamination system gated areas for gender-specific showering. Self-contained based on the type of apparatus, equipment, and/or system decontamination trailers with pop-out sides and overhead © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC available. (photo 1) tents are also available, as are a wide array of portable showNOT FOR SALE OR DISTRIBUTION NOT SALE OR 2. Ensure you haveFOR the appropriate PPE DISTRIBUTION to protect against the ers. Some of these units come equipped with portable water chemical threat. heaters, space heaters, water collection bladders, and sections 3. Remove the appropriate amount of the victim’s clothing. Do of rollered platforms for sliding nonambulatory victims not leave any clothing underneath the victim; these items (supine, on rigid backboards, or in Stokes baskets) through a wick the contamination to the victim’s back and hold it series of wash–rinse stations. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC there, potentially worsening the exposure. (Medical trauma Decontaminating nonambulatory victims is a much NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION scissors are a helpful and rapid way to accomplish this step.) slower process than performing mass decontamination on (photo 2) ambulatory victims. Handling casualties who cannot walk, or © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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training, it is impossible to remain proficient in this infre-

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ature of 70°F (22°C) is ideal but may not be possible. Try to quently used, but potentially high-impact technique. ContamNOT FOR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION avoid using water that is uncomfortably hot or cold.) Make inatedSALE victimsOR will not wait around for responders to establish sure to rinse well under and around the straps that may a formal decontamination area. Instead, they will hurry to the be holding the victim to a backboard or other extrication hospital by self-transport while still contaminated, which will device. Take care to avoid compromising the victim’s airway ultimately affect the ability of the hospital-based providers to with water during the process. (photo 3) render proper medical care. © Jones & Bartlett Learning, LLC Because water is a good © general-purpose Jones & Bartlett Learning, LLC 5. Move the victims through the decontamination corridor solvent, washing NOT FOR SALE OR NOT FOR SALE OR DISTRIBUTION and into the triage area for medical evaluation, which may off as much of the contaminant as possible with a massiveDISTRIBUTION water include on-scene treatment and/or transport to an approspray is the best and quickest way to decontaminate a large group priate receiving hospital. In most cases, significant medical of people. treatment should be provided after decontamination, in a Regardless of the mass decontamination methodology designated medical treatment area. (photo 4) employed by the responding agency, the theory behind the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Training is a key component in ensuring an effective mass work focuses on one of three ways to reduce or eliminate conNOT FOR SALE OR DISTRIBUTION NOT FORisolation, SALEand ORwashing. DISTRIBUTION decontamination operation. Without regular and frequent tamination: dilution,

1 1 1 1 1 1 1 1 1 1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 2 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2 2 2 2 2 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 2 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2 * This skill drill begins after the victim(s) have been extricated from the contaminated environment and transported 2 in some manner to the mass decontamination corridor. 2 3 3 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 3 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 3 3 3 3 3 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 3 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE2ORSetDISTRIBUTION 1 Ensure that you have the appropri3 up the appropriate type of ate PPE to protect from the chemical mass decontamination system 4 threat. Stay clear of the product and based on the type of apparatus, 4 do not make physical contact with it. equipment, and/or system 4 Make an effort to contain runoff by available. directing victims out of the hazard 4 ©zone Jones Bartlett Learning, LLC © Jones & Bartlett Learning, LLC and into& a suitable location. 4 NOT FOR SALE OR DISTRIBUTION 4 NOT FOR SALE OR DISTRIBUTION 4 4 4 4 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 5 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 5 5 5 5 3 Instruct victims to remove all contaminated clothing and walk 4 Direct the contaminated victims to 5 triage area. LLC © Jones & Bartlett Learning, LLC © Jones & Bartlett the Learning, through the decontamination 5 corridor. Flush the contaminated NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION S5 victims with water. R5 NFPA 472–7.4.5.3

Skill Drill

11-2

Performing Mass Decontamination on Ambulatory Victims

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NFPA 472–7.4.5.3

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Performing Mass Decontamination on Nonambulatory Victims© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION

NOT FOR SALE OR DISTRIBUTION

Set up the appropriate type of mass decontamination system based on the type of equipment available.

© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Ensure that you have the appropriate PPE to protect against the chemical threat. Remove the victim’s clothing. Do not leave any clothing underneath the victim; these LLC © Jones & Bartlett Learning, items may wick the contamination to the NOTvictim’s FORback SALE OR DISTRIBUTION and hold it there, potentially worsening the exposure.

Flush the contaminated victim with water.

Move the victim to a designated triage area

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Operations Inside Special Buildings © Jones & Bartlett Learning, LLC © Jones &Decon Bartlett Learning, LLC fountains or hoses are located throughout most i ndustrial NOT FOR SALE OR DISTRIBUTION NOT FORHigh SALE ORresearch DISTRIBUTION hazard and manufacturing facilities are often and laboratory facilities. Their location should be identiEmergency eyewash fountains—Emergency eyewash

esigned and engineered for specific emergency response sced fied for responders during the pre-entry briefing. narios. An increasing number of hospital emergency departFixed air supply systems—Some facilities may proments are now being designed to provide immediate decon vide air outlets for use with airline hose respirators. capability. For guidance on designing decon capability within a These may be supplied by a bank of air cylinders or © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC health care facility, one should consult NFPA 99—Health Care from a dedicated breathing air compressor. NOT FOR OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Facilities. Many of these facilities have features that can faciliPersonal protective clothing andSALE equipment—Some tate the delivery of timely and effective decon operations. 1 facilities will maintain an inventory of protective clothThe following factors should be considered when evaluat1 ing and equipment to be used for emergency response ing fixed facilities for decon operations: 1 activities. Decon rooms—The size of the room should be based 1 The systems and capabilities outlined above are designed ©upon Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC the number of patients the facility expects to han1 based on the physical, chemical, and toxicological characterisNOT SALE ORwalls, DISTRIBUTION FOR SALE ORorDISTRIBUTION dle. FOR The room’ s floor, and ceiling should be 1 tics of theNOT materials being handled anticipated. Responders coated with an inert material that allows the area to be 1 should consider the use of these specialized systems as a decontaminated. Electrical fixtures should be rated 1 method of reducing the potential contaminants within the Hot based upon the expected hazards. If flammable vapors 1 Zone. Activation of fixed ventilation systems may also signifiare expected, the room or area should meet NFPA 70— 1 cantly reduce the contamination level before entry. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC National Electric Code™ requirements for Class 1, Divi2 Always consult with the facility building engineer and NOT FOR SALE DISTRIBUTION NOT FOR OR DISTRIBUTION sionOR 2, Group D classifications. 2 safetySALE personnel before using fixed ventilation options. ActivaVentilation systems—Most facilities engaged in haz2 tion of a ventilation system not designed and rated for the hazardous materials research or manufacturing have spe2 ards present under emergency conditions could worsen the cially engineered ventilation systems to reduce 2 situation (e.g., cause an explosion or spread the contaminants employee exposure to hazardous materials. Removal of 2 to a larger area). © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC air contaminants at the source is the most effective 2 NOT FOR SALE OR DISTRIBUTION 2 NOT FOR SALE OR DISTRIBUTION method of preventing employee chemical exposure. These systems can be an asset when conducting decon 2 and for determining entry points into a spill area. 2 The exhaust system should be filtered to control the mateAnimal decontamination is not the same as people decontami3 rials encountered in the facility (e.g., infectious materials, nation, although the goals and objectives are the same. Most 3 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC chemicals, radioactives, etc.). Responders must not shut down fire departments, Hazardous Materials Response Teams, and 3 NOTsupply FORthat SALE OR these DISTRIBUTION NOT FOR SALE OR DISTRIBUTION the power maintains special systems. law enforcement agencies are not trained and prepared to deal 3 In some facilities, fixed monitoring and detection systems with contaminated animals. In many areas of North America, 3 (e.g., oxygen, toxicity, flammability, etc.) may also be installed county and state-based Animal Response Teams (ART) have 3 in the ventilation system to provide early warning of a release. been developed to address animal handling and response 3 These fixed systems may be monitored in a process control issues. Specialized training courses on animal response and 3 © Jones & Bartlett LLC © Jones & Bartlett LLCare usually coordinated room, securityLearning, center, or by an off-site alarm company. safety have beenLearning, developed and 3 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE ORagriculture DISTRIBUTION Positive and negative pressure atmospheres—These through the state or emergency management agen3 systems maintain a negative air pressure within the cies. While emergency services may not take the lead role on 4 hazard area and a positive air pressure outside of the this issue, they may be asked to play a support role by the lead 4 hazard area. If an incident occurs, the flow of air is from animal safety and health agencies. 4 the outside toward the inside, thereby minimizing the Animals may become contaminated with hazardous 4 © Jones & vapors, Bartlett © Jones & Bartlett LLC spread of contaminants (dust, and Learning, gases) from LLC materials during an emergency at a fixed facility orLearning, from a 4 NOT FOR SALE OR agents, DISTRIBUTION 4 NOT FOR SALE OR DISTRIBUTION the involved area. transportation accident. This could include biological Safety showers—Safety showers are usually located hazardous chemicals, or radioactive materials. Higher proba4 throughout high risk and medical facilities and they are bility animal contamination scenarios include agricultural 4 restricted for emergency use in the event of accidental pesticide storage building fires, train derailments near farms 4 chemical contamination. If a hazmat incident occurs and ranches, and petroleum spills on a farm. Lower probabil4 © iJones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ndoors, consider using these safety showers for gross ity, but credible scenarios include a radiological release effect5 NOT FOR SALE OR DISTRIBUTION NOT SALE OR DISTRIBUTION decon. Safety showers have special “deluge” heads that ing a large areaFOR or biological attack targeting our animal5 deliver 30 to 50 gallons per minute, far more than a bathrelated food supply Figure 11-12 . 5 room shower head. This large flow is essential in the initial Pets and farm animals can become contaminated due to 5 stage to sweep away, rather than just to dilute, the strong exposure to standing floodwaters caused by severe inland 5 contaminant. Safety showers are a good gross decon flooding, tropical storms, and hurricanes. Contaminants from 5 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC option if they have drains and provisions to confine floodwater exposure can range from a matrix of hazardous 5 NOT FOR SALE OR DISTRIBUTION NOT FOR SALEin OR DISTRIBUTION runoff. substances the water to biological materials, sewage and S5 R5

Decontamination of Pets and Animals

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC n an effort to maintain control of a Hazardous Materials or CBRNE emergency, NOTtheFOR OR©DISTRIBUTION NOT FOR SALEFirst ORResponders DISTRIBUTION must be prepared to continue through EightSALE Step Process

and properly decontaminate their victims, fellow emergency response personnel, equipment, and the environment by the systematic isolation, neutralization, or removal of contamination.

Effective decontamination guidance can be & found by consulting regulations, © Jones & Bartlett Learning, LLC © Jones Bartlett Learning, LLC consensus standards, and best practices. Some examples include 29 CFR NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1910.120, National Fire Protection Association (NFPA) Standard 472, and the OSHA Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances. For generations prefire planning has helped fire fighters to mitigate potential problem areas in their response zones and to make faster, safer, and more efficient responses to a citizen call for help. My personal experience in © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Hazardous Materials planning and response, as well as in Emergency Management for the healthcare industry, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONhas shown that preplanning is equally important to the Hazardous Materials Responder. By taking the time to preplan their community, a response team can perform a hazard vulnerability analysis, determining where their focus on training and response protocols need to lie. In addition, preplanning will help to ensure that appropriate types and quantities of decontamination agents are readily available and their application strategies are understood through appropriate training.

©January Jones & Bartlett Jones &ofBartlett Learning, LLC In the early morning hours of 6, 2005, a NorfolkLearning, Southern trainLLC derailed in the small rural South© Carolina town Graniteville, resulting in the release of over 60 tons of liquefied gas into the night air, killing nine people and displacing over SALE 5000 from NOT FOR OR DISTRIBUTION NOT FOR SALEchlorine OR DISTRIBUTION their homes. In all, 554 people were treated at area hospitals, 75 were admitted, and nine would eventually die from the poison. The expected response of local, state and federal agencies ensued and a Unified Command was established to manage the scene. While many lessons were learned and opportunities for improvement presented themselves in the aftermath (as is true for most disasters), one particularly effective practice involved the use and coordination of a variety of decon resources from area agencies, © Jones & Bartlett LLC © alike. Jones Bartlett Learning, which resulted in effective and timelyLearning, decontamination of first responders and victims Local&and state agencies performedLLC © NOT FOR SALE DISTRIBUTION FOR OR resources wereSALE employed in aDISTRIBUTION joint decon various functions throughout theOR incident using the Eight Step Process , and federalNOT effort, which included the use of a heated, two-lane decontamination trailer from the Fort Gordon Fire & Emergency Services organization. Through preplanning of local resources, inter-operative exercises across county and state lines, and use of Unified Command, a tragic situation was kept from becoming even worse. Preplanning of the hazards in the community has also become a critical piece of the Emergency Management puzzle for

© Jones & Bartlett Learning, LLC Jones & standards Bartletta Learning, LLC must be in hospitals and other healthcare organizations. As part of ongoing©accreditation myriad of EM functions NOT FOR NOT spill FOR ORtoDISTRIBUTION place,SALE among OR themDISTRIBUTION the ability to decontaminate victims of a chemical or SALE release prior their entry into the facility for medical treatment. Eliminating the potential for cross-contamination is critical to a healthcare system’s operational capabilities and the continuous availability of a standard of care that the local community expects. During the Tokyo subway sarin attacks in 1995, these principles were not in place. As self-selected ambulatory victims arrived at area hospitals in need of© care—the were still contaminated and there was no plan in place decontaminate them—Learning, LLC Jonesfact & they Bartlett Learning, LLC © toJones & Bartlett cross-contamination became a major concern. In the years since, the international healthcare community has taken to heart an FORa SALE OR DISTRIBUTION FORStateside, SALE OSHA OR DISTRIBUTION invaluable lesson from thisNOT experience. published a best practice document on howNOT to develop decon team at a healthcare facility, and an entire new subset of first response was born in First Receivers. I have personally visited healthcare organizations in upwards of 25 states as well as internationally and have witnessed their evolving adaptation to this new mission. Overall, I have been very impressed with the dedicated professionals I have met who are learning about the industrial dangers in their local communities, as well as investigating the local commodity flow patterns on their highways and railways © Jones Bartlett Learning, LLCin the dangers that exist and © Jones & Bartlett Learning, LLC in an effort to ensure& their decon teams are well versed well prepared to respond when duty calls.

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Decon does not need to be the most difficult of the Eight Steps, but it also should not be disregarded as simple or something that doesn’t require preplanning. Taking the time to research the resources available in your district to assist in a complex event, learning of the specific hazards that may be present during an emergency, and ensuring that the appropriate decon agents are on hand—is truly time well spent.

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1 1 1 1 Figure 11-12 Animal decon is not the same as LLC people decon, © Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC 1 although the goals and objectives are similar. Figure NOT 11-13 AFOR small animal does not DISTRIBUTION mean a lack of danger. A NOT FOR SALE OR DISTRIBUTION SALE OR 1 common house cat attacked her handler’s hand, causing 52 lacera1 tions and puncture wounds in under a minute. Emergency medical treatment required five hours in the emergency room and 3 weeks to 1 recover. 1 1 © Jones & Bartlett LLCpets and farms animals, ani© Jones & Bartlett Learning, LLC manure, mud,Learning, and sludge. Loose 2 contamination, animal euthanizing, and dead animal carNOT FORmal SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2 cass disposal were problematic issues created by Hurricanes 2 method of containment and restraint may be different Katrina (Louisiana) and Ike (Texas). The September 13, 2008 2 from one animal to the next. Like people, some animals hurricane Ike disaster caused widespread coastal flooding on 2 do not always get along together, especially when sharthe Texas Gulf Coast, including the Bolivar Peninsula which 2 Jones & due Bartlett Learning, © Jones ing the same confined space. & Bartlett Learning, LLC lost an estimated 4,000©head of cattle to drowning. Some LLC 2 Working dogs—K-9s assigned to search and OR rescue, arson of these animals washed up FOR along SALE shorelines as DISTRIBUTION dead and NOT FOR SALE DISTRIBUTION NOT OR 2 and bomb, and law enforcement operations may require decaying carcasses, some were washed out to sea and never 2 single animal decon on completion of the mission. When seen again, and a few came ashore alive on Galveston Island 2 these animals are separated from their handler they can and other locations. 3 become unsettled. If possible keep the handler with the The following issues should be anticipated when dealing 3 Jones &animals: Bartlett Learning, LLC © Jones & handler Bartlett Learning, LLCand the K-9 and ask the for advice on restraints with © contaminated 3 best way FOR to manage the animal the decon process. Animal 101—Before you can address the issue of how to NOT FOR SALE OR DISTRIBUTION NOT SALE OR during DISTRIBUTION 3 Outer covering—With worst-case human decontamidecon animals, you must first understand the fundamental 3 nation you are primarily dealing with clothing removal issues of animal movement and handling. This should 3 and a shower. With animals you are dealing with hair, include some hints on how to “read” animal behavior. 3 fur, feathers, or scales. They don’t like it when you try Unlike people, animals can’t help you decontaminate 3 to remove Learning, them! themselves nor tell youLLC where it hurts. To humans, “ouch” © Jones & Bartlett Learning, © Jones & Bartlett LLC 3 Type of animal—If you live and work in the city, your means hurts!” To a human, “moo” simply means, “moo.” NOT FOR SALE OR“itDISTRIBUTION NOT FOR SALE OR DISTRIBUTION 3 experience with animals is probably limited to houseIt probably means something else to fellow cattle, like 4 hold pets and the zoo. The wildlife and farm animal “I can’t believe they want me to raise my left hoof! I weigh 4 population is very diverse. You need to identify what 1,500 pounds and need four legs to stand!” Responders 4 type of animal you are decontaminating and what its should identify veterinarian and large animal specialists, 4 needs are and how it behave around people. such as farmers and agriculture representatives, © Jones &extension Bartlett Learning, LLC ©might Jones & Bartlett Learning, LLC 4 like dairy cattle a who can provideNOT assistance on animal behavior. NOT FOR SALE ORfollow DISTRIBUTION FOR SALE OR DISTRIBUTION Animal routines—Animals 4 daily routine. Daily feeding and milking need to continue Human safety—Animals that have been under stress 4 regardless if their products enter the food supply or not. or are out of their natural environment can present 4 Animal first-aid and euthanasia—If animals have handlers with the potential for being injured by bites, 4 been injured from exposure to hazardous materials a scratches, kicks, and crushes. Consider for example 4 veterinarian be brought to the scene to assist. If an average horseLearning, weighs between © that Jones & Bartlett LLC 900 and © Jonesshould & Bartlett Learning, LLC 5 the animal requires or is unconscious you 1,100 pounds. CattleOR are even heavier. If a horse steps NOT FOR SALE DISTRIBUTION NOT FOR SALEfirst-aid OR DISTRIBUTION 5 should have a restraint plan in place. If an animal’s on your foot, you will remember the experience for the 5 injuries are obviously fatal and needs to put down, the rest of your life. On a smaller scale, a common house 5 animal’s owner (if known) must be consulted as well as cat can do some serious damage when it is stressed out 5 the authority having jurisdiction. The authority to and in the fright and flight mode Figure 11-13 . 5 sedate or euthanize an animal AnimalLearning, safety—Preventing © Jones & Bartlett LLC escape of the animal using © Jones & Bartlett Learning, LLC may fall within various 5 government agencies depending on the type of animal, proper safe restraints to ensure the safety of NOT the NOT FOR SALE OR and DISTRIBUTION FOR SALE OR DISTRIBUTION S5 its condition, and the interest of public safety and animal requires expert knowledge and experience. The R5 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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Hazardous Materials: Managing the Incident health. Knowing the law and having a plan for this sce-

(PERO) under OSHA 1910.120. Make sure your clean-up

© Jones & Bartlett Learning, LLC © Jones & nario Bartlett Learning, will help reduce theLLC animal’s suffering. a ctivities are conducted within regulatory guidelines. NOT FOR SALE DISTRIBUTION NOT FORLarge-scale SALE OR DISTRIBUTION contamination of animals can generate ecoAgencies that OR should be consulted in the development of

nomic, environmental, cultural, and emotional impact within equipment decon plans can include the following: the community. Single and isolated cases involving injured or Water/sewage treatment facilities—Prior arrangecontaminated animals can draw media attention. If you do not ments will be necessary before large quantities of waste deal with contaminated animal scenarios well you can expect water can be flushed into storm/sewer systems via drains © Jones & Bartlett Learning, LLC connected to the street or©from Jones & Bartlett Learning, LLC some negative feedback from a broad section of the commufacilities such as fire staNOT FOR OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION nity you protect. tions, gyms, etc. As a general rule, all SALE waste should be It is important to have an Animal Decontamination Plan in contained until permission is received for disposal. place that has been coordinated with law enforcement, health, Pollution control (State Environmental Quality, U.S. animal control, agricultural, and wildlife agency officials. The Environmental Protection Agency, or U.S. Coast plan should also be coordinated with volunteer organizations Guard)—The Incident Commander’s authority to create a © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC that specialize in animal care and rescue and veterinary spe“runoff” situation during an emergency involving NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR established. DISTRIBUTION cialists. When large-scale decontamination of animals is life-threatening materials is well Creating required it should be conducted using trained teams with a additional runoff from equipment decontamination is written Incident Action Plan. questionable in most cases. Failure to isolate the runoff could result in a citation from regulatory agencies, generate publicity, and increase your potential for civil liability. © Jones & Bartlett Learning, LLC © Jones bad & Bartlett Learning, LLC Product specialists—May be able to provide clean-up NOT FOR SALE OR DISTRIBUTION NOT FORrecommendations SALE OR DISTRIBUTION based on their practical knowledge. What Is Clean-Up? Some chemical manufacturers are trained and experiThe term clean-up means different things to different emerenced in equipment decon and can be invaluable when gency response personnel. For our purposes, clean-up activitheir information is correct, but very damaging when ties consist of any work performed at the emergency scene by should be interviewed to © Jones & Bartlett Learning, LLC wrong. Product specialists © Jones & Bartlett Learning, LLC emergency responders, which is directed toward removing establish credibility, as discussed in the section on “hazard NOT FOR DISTRIBUTION NOT FORtools, SALE DISTRIBUTION contamination from protective clothing, dirt,OR water, and assessment and risk evaluation” found SALE elsewhereOR in the so on. Clean-up may also involve responder decontamination text. They do not have legal authority and cannot assume of some debris, damaged containers, and so on. the responsibility for approving on- or off-site disposal. From a decon perspective, not all work related to restoring the contaminated site to its previous (nonpolluted) state is ©“clean-up.” Jones &The Bartlett LLC © Jones & Bartlett Learning, LLC Equipment Clean-Up General Guidelines considered section onLearning, “implementing response Decon of equipment and apparatus can be difficult and very SALE DISTRIBUTION NOT FOR SALE OR DISTRIBUTION objectives”NOT foundFOR elsewhere in OR the text provides a detailed expensive. Liquids can soak into wood and flow into metal review of the short- and long-term site restoration and recovcracks and seams or under bolts. Consult product specialists ery activities associated with hazmat emergency response. before initiating decon and clean-up operations. A responder with authority should supervise this phase to ensure that proper General Clean-Up Options © Jones & Bartlett Learning, LLC © Jones Bartlett Learning, LLC planning&and coordination between all parties takes place. The Incident Commander has two clean-up options: While decontaminating, avoid direct contact with conNOT FOR SALEa limited-scale OR DISTRIBUTION 1. Conduct clean-up of key emergency response NOT FOR SALE OR DISTRIBUTION taminated equipment. Brooms and sponge mops can be used equipment such as fire apparatus. The objective of this option to apply cleaning agents to equipment. Protective clothing and is to place essential equipment back in service as soon and as respiratory protection must be worn unless proven to be safely as possible. Responders may also get involved in the unnecessary by technical specialists who have conducted an more technical aspects of clean-up by working directly under © Jones & Bartlett Learning,appropriate LLC © Jones & Bartlett Learning, LLC analysis of the contaminants. the supervision of an outside agency or contractor. FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Small and Portable EquipmentNOT Clean-Up 2. Conduct clean-up using a qualified and authorized enviAll small to medium-sized equipment, such as monitoring ronmental contractor. This option is usually exercised when instruments and hand tools, should be decontaminated before large pieces of heavy equipment have been contaminated leaving the site. The following issues and concerns should be and are not part of the emergency response organization’s considered: © Jones & Bartlett Learning, LLC fleet.© Examples of such equipment are bulldozers and end Jones & Bartlett Learning, LLC Hand tools—May be cleaned for reuse or disposed. loaders used by responders, for instance, to construct dikes FOR NOT FORinclude SALEhand ORcleaning DISTRIBUTION Cleaning methods or, more cominsideNOT the Hot Zone.SALE OR DISTRIBUTION monly, pressure washing or steam cleaning. You must Before jumping into clean-up activities, make sure you weigh the cost of the item against the cost of decontamihave a sufficiently detailed and coordinated decon plan that is nation and the probability that it can be completely documented within the overall Site Safety Plan. Once respondWooden and plastic handles ers are decontaminated, the rules of the game shift from one of © Jones & Bartlett Learning, LLC © Jones cleaned. & Bartlett Learning, LLC on tools should be evaluated to determine if they can be completely deconbeing an “Emergency Responder” to “Hazardous Waste GenNOT FOR OR DISTRIBUTION SALE OR DISTRIBUTION taminated. The scientific literature referenced at the end erator.”SALE In addition, there are clear differences between emer- NOT FOR of this chapter provides overwhelming evidence that gency response and post-emergency response operations

Clean-Up Operations

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When a vehicle is exposed to corrosive atmospheres, it

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC handles, cannot be adequately decontaminated. Conshould be inspected by a mechanic for possible motor damage. NOT FOR SALEsprayed OR DISTRIBUTION NOT FOR SALE sultOR withDISTRIBUTION product specialists for the best advice. Equipment with acids should be flushed or washed as Monitoring instruments—Follow the manufacturer’s soon as possible with a neutralizing agent such as baking soda recommendations with respect to decon. If the instruand then flushed again with rinse water. ment becomes damaged or disabled during the emergency, most instrument manufacturers will not accept © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC the device for repair unless it has been properly deconNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION taminated. If instruments were covered with protective Debriefing plastic, remove and discard the plastic covering, and A debriefing should be held for those involved in decontamitape properly. nation and clean-up as soon as practical. Responders and conFire hose—Should be cleaned following the manufactractors involved in the operation should be provided with as turer’s recommendations. For most materials, deter©gents Jones & Bartlett Learning, LLC © Jones Bartlett LLC effects much information as & possible aboutLearning, any delayed health will perform adequately. However, strong deterNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION of the hazmats. gents and cleaning agents may damage the fire hose If necessary, follow-up examinations should be scheduled fibers. The fire hose should be thoroughly rinsed to with medical personnel and exposure records maintained for prevent any fiber weakening. The hose should then be future reference by the individual’s personal physician. marked and pressure tested before being placed back into service. Severe exposure to some chemicals such © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC as chlorine will result in damage that may require takSite Security and Custody NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ing the hose out of service (e.g., when the cleaning In many instances, contaminated materials must remain at the water turns to hydrochloric acid, Cl2 + H2O = HCL). incident scene until they can be removed for off-site cleaning or disposal. In this case, special precautions should be taken: Take appropriate security measures. Potential probMotor Vehicle and Heavy Equipment lems that validate © theJones need for&security include the © Jones & Bartlett Learning, LLC Bartlett Learning, LLC Clean-Up potential for vandalism, curious children who may be NOT FOR SALE OR DISTRIBUTION NOTneed FOR SALE OR DISTRIBUTION If a large number of vehicles to be decontaminated, coninjured, or folks who simply see an opportunity to sider implementing the following recommendations: dump their waste. Always ensure that security is proEstablish a decon pad as a primary wash station. The vided for hazardous waste and that the proper chain pad may be a concrete slab or a pool liner covered with of custody is maintained. Additional lighting may be gravel. Each of these should be bermed or diked with a necessary if the remain overnight. © sump Jones & Bartlett Learning, LLC © Jones & materials Bartlettmust Learning, LLC or some form of water recovery system to collect Make sure appropriate warning signs are posted and NOT FOR SALE ORsome DISTRIBUTION NOT FOR SALE OR DISTRIBUTION the resulting rinse. Get engineering help and do labels are attached to containers. it right the first time. Make sure containers are properly sealed. Completely wash and rinse vehicles several times with an appropriate detergent. Pay particular attention to wheel wells and the chassis. Depending on the nature of the Hazardous Waste Handling and Disposal © Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC contaminant, it may LLC be necessary to collect all runoff Regulatory Compliance water the initial gross rinse, particularly if thereNOT is NOT FOR SALE ORfrom DISTRIBUTION FOR ORfederal DISTRIBUTION Local,SALE state, and regulations require that hazardous contaminated mud and dirt on the underside of the wastes be disposed in a specific manner. All personnel involved chassis. in the disposal of hazardous waste must be trained in the proEngines exposed to toxic dusts or vapors should have visions of the Federal Resource Conservation and Recovery Act their air filters replaced. Mechanics sometimes blow (RCRA) and any related state or local regulations for waste © Jones Bartlett Learning, © Jones & Bartlett Learning, LLC dust out of air filters during& routine maintenance, ex- LLC disposal. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION posing themselves unnecessarily to this hazardous Hazardous Waste Containers dust. Contaminated air filters should be properly All hazardous waste containers should be visibly identified disposed. with the proper markings and labels per DOT 215K (Global If vehicles have been exposed to minimal contaminants Harmonization) and EPA regulations. such as smoke and vapors, they may be decontaminated on © Jones & Bartlett Learning, LLC Joneschemically & Bartlett Learning, LLCof suffiOnly©approved compatible containers site and then driven to an off-site car wash for a second, more NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION cient strength should be used for hazardous waste. The conthorough washing. Car washes may be suitable if the drainage tainers should be kept covered at all times and arranged so that area is fully contained and all runoff drains into a holding tank. easy access exists. Care should be taken during all handling to Car washes are not recommended if they drain into the sanimaintain the integrity of the container. Any container stored tary sewer. Car washes used for decon should be inspected and outdoors must be waterproof. approved in advance.

Post-Incident Decon Concerns

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Chief Concepts

The pathway is from the Hot Zone into the decon area, with the exit point near the Warm Zone/Cold Zone interface. The decontamination corridor should be clearly Decontamination is the process of making people, equipmarked.© Jones & Bartlett Learning, LLC © Jones Bartlett safe Learning, LLC materiment, and the & environment from hazardous alsNOT contaminants. The OR moreDISTRIBUTION you know about how Decon isNOT a labor-intensive operation. When setting up FOR SALE FOR SALE OR DISTRIBUTION contamination occurs and spreads, the more effective the decon area, consideration must be given to the staffdecontamination will be. ing of the decon operation and the safety of the Decon Team. The basic concepts of decontamination are relatively simple. If contact with the contaminant can be controlled Multistep decon operations can be broken into two broad © Jones & Bartlett Learning, & Bartlett Learning, LLC and minimized, the needLLC for decontamination can be© Jones phases: gross decon and secondary decon. Gross decon is reduced. the initial secondary decon is the follow-up NOT FOR SALE OR DISTRIBUTION NOT FOR SALErinse ORand DISTRIBUTION process that removes the contaminants to a safe and Decon needs to be an adaptive and flexible process that acceptable level. respects the hazards and the behavior of the contaminants, as well as human behavior under stress. The hazEmergency decontamination is the physical process of ards and risks presented by the incident will define the immediately reducing contamination of individuals in © Jonesof& Bartlett Learning, LLCpotentially life-threatening©situations Joneswith & Bartlett LLC scope, nature, and complexity decon operations. or withoutLearning, the NOT FOR SALE OR DISTRIBUTION NOT SALEmaterial OR DISTRIBUTION formal establishment of a decontamination corridor. Contamination is any formFOR of hazardous (solid, liquid, or gas) that physically remains on people, aniEmergency decon can be innovative, but the most impormals, or objects. tant concept is to clean the contaminated person as soon as possible. Remember the basics—FLUSH—STRIP— Direct contamination occurs when a person comes in FLUSH. Soap and water is a near-universal solution and direct physical contact with a contaminant or when a © Jones & Bartlett Learning, LLC & Bartlett Learning, LLCor should © be Jones applied in large quantities. When acids person comes into contact with any object that has the NOT FORonSALE ORcontaminated DISTRIBUTION NOT FOR bare SALE DISTRIBUTION bases have contacted skin,OR the minimum amount of contaminant it (e.g., clothing or time for a water flush is at least 20 minutes. equipment). Technical decon is a multistep process in which contamiCross-contamination occurs when a person who is nated individuals are cleansed with the assistance of already contaminated makes contact with a person or trained personnel. object not contaminated. Cross-contamination is typi© Jones & Bartlett Learning, & decontamination Bartlett Learning, LLCwhen large numbers cally the result of poor LLC site management and control,© Jones Mass is established NOT FOR SALE ORdecon DISTRIBUTION SALE DISTRIBUTION inadequate and site safety procedures, or a failureNOT FOR of people (i.e.,OR civilians or responders) need to be deconto follow safety procedures. taminated at the scene of a hazmat emergency. The general goal is to provide the greatest good to the greatest Exposure means that a person has been subjected to a number of people in the shortest amount of time. toxic substance or harmful physical agent through any route of entry into the body (e.g., inhalation, ingestion, A debriefing should be held for those involved in decon© Jones & Bartlett Learning, LLCtamination and clean-up as©soon Jones & Bartlett Learning, LLC injection, or by direct contact [skin absorption]). as practical. Responders NOT FOR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION and contractors involved in the operationSALE should OR be proThe safety and health hazards of the contaminants at vided with as much information as possible about any any incident will define how complex decon operations delayed health effects of the hazmats. will be. The best field decontamination procedures emphasize the to confine contaminants to a limited area. Estab©need Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC lishing a designated decontamination corridor and NOT FOR SALE OR DISTRIBUTION NOT FOR SALE ORtoDISTRIBUTION ALARA Performing decontamination a level As Low As decontamination area are the first steps in limiting the Reasonably Achievable. spread of contaminants. Chemical Degradation The process of altering the chemiThere is no universal decon method that will work for cal structure of a contaminant through the use of a every hazmat incident or release. Regardless of the numchemicalLearning, or material. LLC ber of decontamination steps required, decontamination © Jones & Bartlett Learning, LLC © Jonessecond & Bartlett Contaminant A hazardous material that physically reis most effective when it is carried out by a trained NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION mains on or in people, animals, the environment, or Decontamination Team using multiple cleaning stations.

Hot Terms

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equipment, thereby creating a continuing risk of Direct Contamination Occurs when a person comes in direct injury or a risk of exposure outside of the Hot direct physical contact with a contaminant or when a Zone. person comes into contact with any object that has the contaminant on it (e.g., contaminated clothing or © JonesThe & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Contamination process of transferring a hazardous equipment). material from its source OR to people, animals, the enviNOT FOR SALE DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ronment, or equipment, which may act as a carrier. Emergency Decontamination The physical process of immediately reducing contamination of individuals in Decontamination The physical and/or chemical process potentially life-threatening situations with or without of reducing and preventing the spread of the formal establishment of a decontamination contamination from persons and equipment used at © Jones & Bartlett Learning, LLC OSHA 1910.120 © Jonescorridor. & Bartlett Learning, LLC a hazardous materials incident. definesOR decontamination as the removal of hazardous NOT Exposure The process by which people, animals, the enviNOT FOR SALE DISTRIBUTION FOR SALE OR DISTRIBUTION substances from employees and their equipment to ronment, and equipment are subjected to or come in the extent necessary to preclude foreseeable health contact with a hazardous material. effects. Gross Decontamination The initial phase of the decontamination process during which the amount of surface Decontamination Corridor A distinct area within the © Jones & Bartlett Learning, LLC © Jones contaminant is significantly reduced. & Bartlett Learning, LLC Warm Zone that functions as a protective buffer and SALE OR DISTRIBUTION FOR DISTRIBUTION bridge between theNOT Hot Zone andSALE the ColdOR Zone, Mass Decontamination The NOT processFOR of decontaminating where decontamination stations and personnel are large numbers of people in the fastest possible time to located to conduct decontamination procedures. reduce surface contamination to a safe level. Sterilization The process of destroying all microorganisms Decontamination Officer A position within the hazmat in or on an object. branch which has responsibility for identifying the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC location of the decon corridor, assigning stations, manSafe Refuge Area A temporary holding area for contamiNOTallFOR SALE OR DISTRIBUTION NOT until FORa decontamination SALE OR DISTRIBUTION aging decontamination procedures, and identifying nated people corridor is the types of decontamination necessary. set up. Degradation (a) A chemical action involving the molecular Secondary Decontamination The second phase of the breakdown of a protective clothing material or equipdecontamination process designed to physically or ment due to contact with a chemical. (b) The molecuchemically remove surface contaminants to a safe and © Jones & Bartlett Learning, LLC © Jonesacceptable & Bartlett Learning, LLC lar breakdown of the spilled or released material to level. NOT FOR SALE DISTRIBUTION NOT Technical FOR SALE OR DISTRIBUTION renderOR it less hazardous. Decontamination The planned and systematic process of reducing contamination to a level As Low As Disinfection The process used to destroy the majority of Reasonably Achievable (ALARA). recognized pathogenic microorganisms.

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© Jones & BartlettMedical Learning, LLC you and your Paramedic © Jones LLC As an Emergency Technician, partner& areBartlett in chargeLearning, of NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION the EMS unit that has been dispatched to the Hazardous Materials Incident within your community. This is your first real incident since finishing EMT school. You are preparing a report and are looking for terminology that addresses what you have provided on scene within your Patient Report.

in people or equipment and that thereby creates a are subjected to or come in contact with a hazardous continued risk of direct injury or a risk of exposure material? outside of the hot zone is called: A. Contamination A. Contamination © Jones & Bartlett Learning, LLC B. Contaminant © Jones & Bartlett Learning, LLC B. Contaminant NOT FOR SALE OR DISTRIBUTION C. Disinfection NOT FOR SALE OR DISTRIBUTION C. Disinfection D. Exposure D. Exposure 4. What is the process used to destroy the majority of 2. The process of transferring a hazardous material from recognized pathogenic microorganisms? its to people or equipment, which may © source Jones & Bartlett Learning, LLCcount as © Jones & Bartlett Learning, LLC A. Contamination aNOT carrier.FOR SALE OR DISTRIBUTION B. Contaminant NOT FOR SALE OR DISTRIBUTION A. Contamination C. Disinfection B. Contaminant D. Exposure C. Disinfection D. Exposure

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1 13. Emergency Film Group. Decon Team (DVD), 1 Edgartown, MA: Emergency Film Group, Edgartown, 1 MA: Emergency Film Group (2003). 1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,(DVD), LLC 14. Emergency Film Group, Mass Decontamination 1 1. Air Force Civil Engineer Support Agency (AFCESA) Edgartown, Emergency (2004). NOT FOR SALE OR DISTRIBUTION NOTMA: FOR SALEFilm ORGroup DISTRIBUTION 1 and PowerTrain, Inc., Hazardous Materials Incident 15. Emergency Film Group, Medical Operations at Hazmat 1 Commander Emergency Response Training, Tyndall Air Incidents (DVD), Edgartown, MA: Emergency Film 1 Force Base, FL: Headquarters AFCESA (2010). Group (2000). 1 2. Air Force Civil Engineer Support Agency (AFCESA) 16. Emergency Film Group, Patient Decontamination 1 and PowerTrain, Inc, Hazardous © Jones & Bartlett Learning, LLC Materials Technician © Jones(DVD), & Bartlett Learning, LLC Film Group Edgartown, MA: Emergency 2 Emergency Training CD, Tyndall Air Force NOT FOR SALE OR Response DISTRIBUTION NOT FOR SALE OR DISTRIBUTION (2007). 2 Base, FL: Headquarters AFCESA (2010). Emergency Film Group, Terrorism: Medical Response 2 3. Armed Forces Radiobiology Research Institute— (DVD), Edgartown, MA: Emergency Film Group 2 Military Medical Operations, Medical Management of (2002). 2 Radiogical Casualties Handbook (3rd Edition), Bethesda, 17. Emergency Film Group, The Eight Step Process: Step 2 © Jones & Bartlett Learning, LLC 7—Decontamination (videotape), © Jones & Bartlett Learning, LLC MD: AFRRI (June 2010). Plymouth, MA: 2 4. Amlot, R., et al., Comparative Analysis of Showering NOT FOR SALE OR DISTRIBUTION 2 NOT FOR SALE OR DISTRIBUTION Emergency Film Group (2005). Protocols for Mass-Casualty Decontamination, Prehospital 2 18. Federal Emergency Management Agency, Hazardous and Disaster Medicine, 25(5), 435–439 (2010). Materials Workshop for Hospital Staff, Washington, 2 5. Black, R. H., “Protecting and Cleaning Hands ContamiDC, (July, 1992). 3 nated by Synthetic Fallout Under Field Conditions.” 3 19. Finley, E. L., G. I. Metcalfe, and F. G. McDermott, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Industrial Hygiene Journal (April, 1960), pages 3 “Efficacy of Home Laundering in Removal of DDT, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 162–168. 3 Methyl Parathion and Toxaphene Residues From 6. Bledsoe, Bryan E., D. O., Robert S. Porter, and Richard 3 Contaminated Fabrics.” Bulletin of Environmental Cherry, Essentials of Paramedic Care (2nd Edition), Upper 3 Contamination and Toxicology (1974), Saddle River, NJ: Pearson Prentice Hall, Inc. (2007). 3 pages 268–274. 7. Carroll, Todd, R., “Contamination and Decontamina3 20. Finley, E. L., and R. B. Rogillio, “DDT and Methyl © Jones & Bartlett Learning, LLC & Bartlett Learning, LLC tion of Turnout Clothing,” Washington, DC: Federal © JonesParathion 3 Residues Found in Cotton and CottonNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Emergency Management Agency (April 1993). 3 Polyester Fabrics Worn in Cotton Fields.” Bulletin of 4 8. Cleaning Pesticide Contaminated Clothing: A Special Environmental Contamination and Toxicology (1962), 4 Report on Safety. Pest Control Technology Magazine pages 343–351. 4 (November, 1984) pages 42–44. 21. Friedman, William, J., “Decontamination of Synthetic 4 9. Dawson, Gaynor, W., B. W. & Mercer, Hazardous Intact Human Industrial © and Jones Bartlett Learning, LLCRadioactive Fallout from © Jones & Skin,” Bartlett Learning, LLC 4 Waste Management, New York, NY: John Wiley and Hygiene Journal (February, 1958). NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 4 Sons (1986). 22. Ganelin, Robert, M. D., Gene Allen Mail, and L. Cueto, 4 Jr., “Hazards of Equipment Contaminated with Para10. DOL/HHS Joint Advisory Notice, “Protection Against 4 thion.” Archives of Industrial Health (June, 1961) pages Occupational Exposure to HBV and HIV,” U.S. Depart4 326–328. ment of Labor (DOL) and U.S. Department of Health and 4 Human Services (HHS) Publications (October, 1987). 23. Gold, © Avram, William A. Burgess,Learning, and Edward V. © Jones & Bartlett Learning, LLC Jones & Bartlett LLC 5 Clough, “Exposure Firefighters Toxic Air 11. Easley, M., R.SALE E. Laughlin, K. Schmidt, “DeterNOT J.FOR OR and DISTRIBUTION NOT FORofSALE OR toDISTRIBUTION 5 Contaminants.” American Industrial Hygiene Association gents and Water Temperature as Factors in Methyl 5 Journal (July, 1978). Parathion Removal from Denim Fabrics.” Bulletin of 5 Environmental Contamination and Toxicology (1982), 24. Hawley, Chris, Gregory G. Noll, and Michael S. 5 pages 241–244. Hildebrand, Special Operations for Terrorism and Hazmat 5 Chester,Learning, MD: Red HatLLC Publishing, Inc. (2002). © Jones & Learning, & Bartlett 12.Bartlett Emergency Film Group,LLC AIDS, Hepatitis & the Emer- © JonesCrimes. 5 Hildebrand, Michael, S., “Complete Decontamination gency Responder (DVD), Edgartown, MA: Emergency NOT 25. NOT FOR SALE OR DISTRIBUTION FOR SALE OR DISTRIBUTION S5 Procedures for Hazardous Materials: The Nine Step Film Group (2000). R5

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References and Suggested Readings

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Department of Health and Human Services, Process, Part-1.” Fire Command (January, 1985), Washington, D.C. (September, 1995). pages 18–21. 38. National Fire Protection Association, NFPA 1581—Standard 26. Hildebrand, Michael, S., “Complete Decontamination © Jonesfor&Hazardous BartlettMaterials: Learning, LLCStep © JonesInfection & Bartlett Learning, on Fire Department Control Program, Quincy,LLC MA: Procedures The Nine National Fire Protection Association Process, Part-2.”SALE Fire Command (February, 1985), NOT FOR OR DISTRIBUTION NOT FOR SALE OR(2010). DISTRIBUTION pages 38–41. 39. National Fire Protection Association, NFPA 1851— Standard on Selection, Care, and Maintenance of Protective 27. Hildebrand, Michael, S., Hazmat Response Team Leak Ensembles for Structural Fire Fighting and Proximity Fire and Spill Control Guide, Oklahoma State University, Fighting, Quincy, MA: National Fire Protection AssociaStillwater, OK (1984). © Jones & Learning, LLC & Bartlett (2008). Learning, LLC 28.Bartlett Hughes, Stephen M., David W. Berry, and Edward D. © Jonestion NOT FOR SALE DISTRIBUTION FOR SALE OR DISTRIBUTION National Fire Protection Association, Hazardous MateriHartin,OR “What Does a Car Wash and a Baby Have to DoNOT 40. als Response Handbook (6th edition), Quincy, MA: with Hazardous Materials Decon?” An independent National Fire Protection Association (2013). technical paper prepared by HazMat-TISI, Columbia, MD, (1992). 41. National Fire Protection Association, NFPA 473—Standard for Competencies for EMS Personnel 29. Hsu V. P., et al., “Opening a Bacillus Anthracis-Contain© Jones & Bartlett LLC Responding to Hazardous Materials/Weapons © Jones & Bartlett of Mass Learning, LLC ing Envelope,” Capitol Hill, Washington, D.C.:Learning, The NOT FOR SALE DISTRIBUTION NOTEmerging FOR SALE OR DISTRIBUTION Destruction Incidents, Quincy, MA: National Fire OR ProtecPublic Health Response. Infectious Diseases, tion Association (2013). Volume 8, No. 10., U.S. Centers for Disease Control and Prevention, Atlanta, GA. (October 2002). 42. Olson, Kent R., M. D. and Ilene B. Anderson, Poisoning and Drug Overdose (5th Edition), New York: Lange 30. Kampmier, Craig, “Decon Design,” NFPA Journal Medical Books/McGraw-Hill, (2007). (March/April, 2000), pages 59–61. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 43. OSHA Instruction CPL 2–2.44B, “Enforcement Proce31. LeMaster, Frank, “Why Protective Clothing Must Be NOT FOR SALE OR DISTRIBUTION NOT FOR SALE ORtoDISTRIBUTION dures for Occupational Exposure HBV and HIV,” Cleaned.” The Voice, (August/ September 1993), pages U.S. Department of Labor (DOL) and U.S. Department 19–20. of Health and Human Services (HHS) Publications 32. Lillie, T. H., et al., “Effectiveness of Detergent and (February 27, 1990). Detergent Plus Bleach for Decontaminating Pesticide 44. Perkins, John, J., Principles and Methods of Sterilization Applicator Clothing.” Bulletin of Environmental Contami© Jones & Bartlett Learning, LLC © Jonesin&Health Bartlett Learning, LLC Sciences (2nd Edition), Chicago, IL: Charles nation and Toxicology (1982), pages 89–94. NOT FOR33. SALE OR DISTRIBUTION SALE OR DISTRIBUTION Thomas Publishing Co. (1980). Macintyre, Anthony G., MD, et al., “Weapons of Mass NOT FOR 45. Ronk, Richard, and Mary Kay White, “Hydrogen SulDestruction Events With Contaminated Casualties— fide and the Probabilities of Inhalation Through a TymEffective Planning for Health Care Facilities.” Journal of panic Membrane Defect.” Journal of Occupational the Amercian Medical Association (January 12, 2000), 337–340. pages 242–249. © Jones & Bartlett Learning, LLCMedicine (May, 1985), pages © Jones & Bartlett Learning, LLC 46. Rudner, Glen D, “First Responder Considerations for 34. McGary, Roger, A., “Disinfection of SCBA.” The Voice NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Decontamination at Mass Casualty Incidents,” Student (October, 1993), pages 26–28. handout material developed for Virginia Department of 35. Molino, Louis N., Sr. “The Big One: Proven Methods Emergency Services (January, 2003). for the Management and Mass Decontamination of a 47. Teller, Robert, “Developing Proper Decontamination Crowd.” Homeland First Response (July/August, 2003), Procedures for Emergency Response.” Econ Magazine pages 14–21.& Bartlett Learning, LLC © Jones © Jones & Bartlett Learning, LLC (March 1993), pages 32–33. 36. National Alliance of State Animal and Agricultural EmerNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 48. United Kingdom Home Office, The Decontamination of gency Programs, Animal Decontamination: Current Issues People Exposed to Chemical, Biological, Radiological or and Challenges, Report by the Animal Decontamination Nuclear (CBRN) Substances or Material—Strategic NaBest Practices Working Group (December 2010). tional Guidance (1st Edition), London, England: Home 37. National Institute for Occupational Safety and Health, (February, 2003). “Report toLearning, Congress on Workers’ © Jones & Bartlett LLC Home Contamination© JonesOffi & ce Bartlett Learning, LLC U.S. Army Medical Research Institute of Chemical Study OR Conducted Under The Workers’ Family Protec- NOT 49. NOT FOR SALE DISTRIBUTION FOR SALE OR DISTRIBUTION Defense, Medical Management of Chemical Casualties tion Act (29 U.S.C. 671a).” Publication No. 95-123, © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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(3rd Edition), Aberdeen Proving Ground, MD: US53. U.S. Centers for Disease Control (CDC) Publications, AMIC—Chemical Casualty Care Office (July, 2000). Guideline for Handwashing and Hospital Environmental Control (1985). 50. U.S. Army Medical Research Institute of Infectious Diseases © Jones Medical & Bartlett Learning, © Jones & Bartlett LLC (USAMRID), Management of BiologicalLLC Casualties 54. U.S. Centers for Disease ControlLearning, (CDC) (6th Edition), Detrick, MD:DISTRIBUTION USAMRID (April, 2005). Publications, Guideline for Prevention of HIV and HBV NOT FORFort SALE OR NOT FOR SALE OR DISTRIBUTION Exposure to Health Care and Public Safety Workers 51. U.S. Army Soldier and Biological Chemical Command (February, 1989). (SBCCOM), Guidelines for Mass Casualty Decontamination During a Terrorist Chemical Agent Attack, Aberdeen 55. U.S. Environmental Protection Agency, Guide for InfecProving Ground, MD (January, 2001). tious Waste Management (1986). © Jones & Learning, & Bartlett LLC 52.Bartlett U.S. Centers for DiseaseLLC Control (CDC) Publications, A© Jones 56. Walter, Frank G.,Learning, Raymond Klein and Richard G. NOT FOR SALE OR DISTRIBUTION SALE OR DISTRIBUTION Curriculum Guide for Public Safety Emergency Response NOT FOR Thomas, Advanced Hazmat Life Support (AHLS) Course— Workers: Prevention of Human Immunodeﬁciency Virus Provider Manual (3rd Edition), Tucson, AZ: University of and Hepatitis B Virus (February, 1989). Arizona Emergency Medicine Research Center (2003).

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