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DECONTAMINATION RESPONSE PLAN

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PURPOSE

Emergency Department team members and hospital guests (patients) will be protected from any external contaminative materials of a guest by isolating the contamination and decontaminating the guest by appropriate procedures.
   
POLICY
 
This plan has been developed to take effect when the safety and welfare of guests and team members is threatened as a result of a chemical agent that must be removed from skin and clothing to prevent exposure to others.   It directs the use of the decontamination shower and the use of the portable decontamination tent in providing accessibility for exposed guests prior to receiving emergency care at Dupont Hospital. 

This plan has been devised to provide a concise yet thorough presentation of information required to assure the fulfilling of Dupont Hospitals role in conjunction with the Allen County Emergency Preparedness Director in any reasonable conceivable potential or actual disaster situation that precipitates problems resulting from sharp departure from normal routine. 

Definition of Decontamination

Decontamination is the process of cleansing to remove contamination, or the possibility (or fear) of contamination.  The most important and most effective decontamination of any chemical exposure is that decontamination done within the first minute or two after exposure.  Decontamination at a medical facility is directed toward maintaining an uncontaminated treatment facility.

Dupont Hospital is part of a community wide disaster plan and can expect to receive approximately 50 victims based on available beds and guest acuity.

AUTHORITY AND RESPONSIBILITY

Upon notification of disastrous event or situation with need for decontamination, the Emergency Department personnel will notify ED physician on duty and administration.    Until Incident Command is fully functional with administrative leadership, the ED physician will act as Incident Commander and direct the initiation and preparation for decontamination.  Security will be notified to set outside parameters and the ED team will prepare for decontamination.

PROCEDURE FOR TEAM MEMBERS 

During an event that requires decontamination, Dupont Hospitals role includes, but is not limited to:  

1. Continued protection and care of its guests and team members.
2. Decontamination of all victims presenting to the hospital for care.
3. The Emergency Department team and Security will work together to facilitate  safe entry into the hospital following decontamination.

Procedure for initiating decon of victims:

1. Once the ED is notified of possibility of disaster victims, it is the ED physicians responsibility to alert Security to announce overhead that we are in a D1 situation.

2. Once it is established from the scene that an exposure has occurred that will require decontamination, the ED team will access the Disaster Preparedness trailer for PPE.

3. Security will establish the outside parameter.

4. The ED will prepare at least four individuals for entering the decontamination shower with victims.

5. Two team members will be designated as the decon team and two will be designated as suit support.  Once the first team enters the shower for decon of guests, another two will then become suit support for the previous two-suit support that now become the two waiting to take over for the two in the shower.

6. The ED physician will make the determination of how long each victim will shower and what soap will be used.

7. Once Incident Command is functional, the ED physician will relinquish IC to the Command Center.

8. Upon notification of impending arrival of victims, the ED physician will advise Security to announce D2 overhead.

9. Triage of victims will take place following decontamination and the guest will enter the ED through the ambulance bay doors.

Note:  No victim will enter the ED prior to decontamination.

Decontamination Shower

The portable decontamination shower will be deployed when:

1. There are both critical and ambulatory victims presenting to the hospital.   The critical guests will be decontaminated in the regular shower and the ambulatory guests will go through the portable shower.

2. The number of victims that are presenting are overwhelming the area and becoming unruly.

3. The victims that are presenting are the walking wounded and can shower themselves.

4. The hospital has exhausted its team members that can be in PPE suits and can no longer support the shower.

5. Incident Command and the ED physician determine the need and can support the deployment with manpower.

Decontamination showers will have necessary equipment of:

1. Plastic buckets.
2. Powdered laundry detergent.
3. Soft brushes.
4. Hazmat disposable bags for discarded clothing, tags to marks bags. 
5. Assorted clean linens for victims following shower.

Personal Protective Equipment

PPE will consist of:

1. Level B Tyvex suits.  These suits are in canvas bags marked L, XL, and XXL, stored in the Emergency Preparedness trailer.  

2. Bootsalso in canvas bags with suits.  Size marked on outside.

3. Gloves-- also in canvas bags with suits.  Size marked on outside.

6. Air purifier HEPA filters PAPRs.-in canvas bags.

7. Suits will be taped where sleeves meet gloves and where pant legs meet boots.

8. Suit support will assist team members in dressing and taping.

9. The ED physician when advised of the specific chemical agent, will determine the need for PPE.

Upon notification of guest arrival:

1. Obtain information of product or chemical involved.
2. The number of victims.
3. Route of exposure.
4. Field treatment.
5. Expected time of arrival.

Upon guest arrival:

1. Decon team will be fully dressed in Level B PPE including Hooded PAPRs.
2. Water will be running to warm.
3. Appropriate drain will be open (one to sewer or one to tank as designated by ED physician).
4. Soap mixture is prepared.
5. Oxygen equipment is in shower.

Care of team members:

1. Team members will have vital signs taken and recorded prior to entering shower.
2. Team members will be allowed to remain in shower a maximum of thirty minutes.
3. Team members in shower will communicate with team member outside of shower with hand signals used to designate:  I cant breathe or thats enough.
4. Team member will assist victim in disrobing. All clothing articles will be placed in HAZMAT bag and tagged. Bag will not be released to team member until authorized by Hazmat Specialist.
5. Person outside of shower will act as timekeeper.

Care of the guest:

1. It is important to do our best to protect the guests privacy
2. All guests must be decontaminated prior to entering the ED even if they were deconned at the scene.
3. Guests clothing will be placed in hazmat bags, tagged and tied, and not released to guest without authorization of a hazmat specialist.
4. Guests will be wrapped in blankets or sheets following showering and taken into the ED via cart, wheelchair or ambulatory.
5. Postmortem care of any guest that has died as a result of a hazmat exposure will be determined by the ED physician in consultation with the coroner.

Team members will remove suit using the following guidelines:

1. Place hazmat disposable bag onto floor near the inner door of the decontamination room and step into bag.
2. Unzip Tyvex suit and undo PAPR belt.  Place belt and hose in separate bag.
3. Roll up suit with decontamination side inward and down around boots..
4. Step one foot out of boot and suit at a time onto clean (not contaminated) floor.
5. Remove gloves and drop in bag.
6. Remove hood over head by reaching inside and pushing up. Place hood in the separate bag.
7. Remove and place inner gloves in bag.
8. Close and tie bag being careful to only touch non-contaminated part of bag.   
9. Leave bags in area outside of ED.
10. ED team members must recheck vital signs, offer refreshment and break as needed.


STEPS FOR MAINTENANCE, SETUP, AND TEAR DOWN OF IN HOUSE AND PROTABLE DECONTAMINATION SHOWERS AND RELATED EQUIPMENT


Hospital Decontamination Shower Unit

1. There are two shower heads available for use.

2. The Support Services Team minimum manpower consists of two Security Officers and Plant Operations team members 24 hours per day, seven days a week.

3. The decontamination shower control panel is monitored 24 hours per day by Support Services.
4. Preventive maintenance functions and testing are completed by Plant Operations on the following items:
a. Control panel
b. Front end monitoring computer
c. Water Temperature
d. Water Flow Rate
e. Clocks
f. Tank levels
g. Valves and Strainers.

5. Upon notification of the need for decontamination from Incident Command, the following steps will be taken by Support Services to prepare the hospital decontamination shower for use:
a. Based on direction from Incident Command, Support Services will assure the  appropriate drain is open and ready for use.
1) Brass drain cap is city sewer.
2) Black drain cap is decontamination tank.
3) Team member will utilize T-handle to switch plug from one drain to the other.
b. Control panel mode switch will be set to normal when flow is being sent to city sewer.
c. When instructed to set up for containment of decontamination water, team member will move plug to city sewer drain to seal, thereby opening tank drain.
d. When utilizing decontamination tank, set mode switch to Decon.  This allows for measurement of water going into tank.
e. The decontamination tank holds 600 gallons of water.  At 90% or 540 gallons, the full tank alarm will light and sound.  This indicates that there is 12 minutes of shower use time left.
f. Silence alarm by pushing button.
g. After 12 minutes, shower water will shut off.  At this point, tank is at 95% or 580 gallons.  The full alarm will light and sound.  
h. Control panel will stay in decon mode until tank is pumped out. 
i. Once tank has been pumped, use key that is located in Plant Operations to key box to reset alarm.  This will also reset tank readings to zero.
j. Change mode switch back to normal.
k. Check building control system to assure reset has taken place in system.



Portable Decontamination Shower

1. Equipment to construct portable decontamination shower is stored in the emergency trailer at rear of hospital.

2. Upon notification of the need for decontamination from Incident Command, the following steps will be taken by Support Services to prepare  the portable decontamination shower for use:
a. Layout tarp on level area.
b. Unroll tent and place tent with exit to North (Cold Zone) and entrance to South (Warm Zone).
c. Check air intake outlets to assure cap is tightly closed.
d. Plug air pump into power supply; building power or portable generator.
e. Plug air hose into ballast port.
f. Once inflated, lay out floor grid.
g. Attach and power on halogen lights inside tent.
h. Secure tent to ground using straps and stakes.

3. Heater tank set up using building supplied water
a. Connect adapter to inlet port at front bottom of unit.
b. Connect line to adapter and building.
c. Turn on water and open flow valves.

4. Hydrant preparation
a. Using hydrant tool, which is located in emergency trailer, remove hydrant outlet on side.
b. With hydrant tool, open hydrant valve and flush hydrant until water runs clear.  Close the valve.
c. Connect hydrant hose to outlet then to inlet portion of heater tank.
d. Slowly open hydrant and flow valves.

5. Heater tank set up using water from fire hydrant
a. Locate unit on level ground and block wheels.
b. Use diesel fuel to fill fuel tank.
c. Connect water supply at lower right hand inlet.
d. Open supply valve near water inlet.
e. Open purge valve at rear of heater.
f. Make sure electrical switch on front of heater is off.  Plug in electrical cord located at front of heater.
g. Fill decontamination tank with appropriate solution as directed by ED physician.
h. Turn flow meter knob counterclockwise to full open for proper flow.
i. Connect rinse/decon hoses to unit.
j. Slowly turn hydrant water supply.  After a constant flow of water exits purge valve, close purge and supply valves.
k. Check for leaks.
l. Reopen supply valve to establish flow.
m. Adjust thermostat located on right hand side to 120*F.
n. Set mixer valve on right hand side to approximately 11:00 position or open.
1) When the gauge is between 88 and 92*F, turn electrical switch to the on position.
2) If heater fails to ignite after 20-30 seconds, assure mixer valve is set to demand heated water.
3) If necessary, utilize reset button (red) located at rear of heater blower housing.

6. Portable generator
a. Place generator on a level surface in an area clear from air intakes, yet shielded from weather.
b. Unplug battery float charger from electrical source.
c. Check fuel level.
d. Turn fuel valve on.
e. Turn idle control switch off.
f. Do not start or stop engine with devices plugged in or turned on.  
g. Push start switch for a maximum of 15 seconds until unit starts.
1) If engine starts, but then fails to run, make sure on level surface and check oil level.
h. Let engine warm up for 3 minutes.
i. Plug in and turn to desired 120 and/or 240-volt AC single phase, 60 Hz electrical loads.
j. Turn idle control on.  This will moderate engine speed based on called for load capacity.

7. When water level reaches 1 inch in tent basin, connect pump hose to containment vessel.  Place pump in tent and remove contaminated liquid.

8. Tent tear down 
a. Clean with brush, hose and hot water.
b. Shut off water supply at hydrant.
c. Remove hydrant line and reinstall hydrant caps.
d. Unplug lights and allow cooling.
e. Puck up floor grids and restack in trailer.
f. Blow out hose lines with clean water, then air and remove.
g. Blow out tent with blower fans.
h. Un-stake tent straps.
i. Set air pump to reverse flow.
j. Roll up tent.
k. Roll up ground tarp.

9. Water heater shut down
a. Turn off heater power.
b. Allow water to continue to run through heater to cool.
c. Disconnect power cord from source.
d. Shut off water flow and disconnect from water source.
e. Disconnect decon and fresh water supply lines.
f. Open drain at front side of decon tank and flush with clean, clear water.
g. Close purge valve.
h. Blow out water lines from inlet end with air until lines are clear.
i. Open purge valve.
j. Dry heater off prior to storage.

10. Generator Shut Down
a. To stop the engine, turn off and unplug all electrical loads from generator panel receptacles.
b. Move idle control switch to off.
c. Let engine run at no load for several minutes to stabilize temperature.
d. Move fuel valve to off position.
e. Set ignition switch to off position.

11. Portable decontamination shower will be maintained and tested by Support Services team members following a planned event procedure and/or an actual event.