Haz Mat for Healthcare Haz Mat for Healthcare

Haz Mat for Healthcare Haz. Mat for Healthcare An Awareness Level Course Brought to you by Paul@En. Magine. com (530) 622 -5964 © En. Magine 2009 All rights Rightsreserved Reserved Awareness Level

Haz Mat for Healthcare Haz Mat Awareness Level for Healthcare An Awareness Level Course An Awareness Program for Managing Hazardous Materials Emergencies Within Healthcare Brought to you by Paul@En. Magine. com (530) 622 -5964 © En. Magine 2009 All rights Rightsreserved Reserved

Haz Mat for Healthcare © En. Magine 2009 All Rights Reserved Awareness Level

Haz Mat for Healthcare Awareness Level Who needs to take the Awareness Level Course? Hospital personnel “who are likely to witness or discover a hazardous substance release and who have been trained to initiate an emergency response sequence by notifying the proper authorities of the release. ” © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Who needs to take the Operations Level Course? Hospital personnel “who respond to a Haz Mat release as part of the initial response in a defensive action and contain the release from a safe distance. ” © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Regulations The Occupational Safety and Health Administration (or it’s state equivalent) has a mandate to ensure that employers provide a safe and healthful workplace. The primary standard applicable to this program is called Hazardous Waste Operations and Emergency Response (HAZWOPER). © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Regulations (cont. ) Training categories in the Emergency Response section of the HAZWOPER Standard are: § § § First Responder-Awareness First Responder-Operations Hazardous Materials Technician/Specialist Hazardous Materials On-Scene Commander Hazardous Materials Skilled Support Personnel © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Awareness Objectives Define Hazardous Materials Identify the risks and problems that can occur in Hazardous Materials Incidents. © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Awareness Objectives Recognize a Hazardous Materials Incident Identify Characteristics of a Chemical © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Awareness Objectives Describe Safe and Effective Response Understand How to Make Proper Notifications © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Awareness Objectives Describe How to Isolate the Scene and Deny Entry Describe How to Conduct Directed Self-Decon © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Awareness Objectives Understand the role of Awareness Level personnel in the overall response COMMAND TECHNICIAN AWARENESS © En. Magine 2009 All Rights Reserved OPERATIONS

Haz Mat for Healthcare Awareness Level Definition of a Hazardous Material There is NO one definition. OSHA definition: Hazardous Chemical: Any substance to which exposure “results or may result in adverse affects on the health or safety of employees: ” or “any chemical which is a physical hazard or a health hazard. ” 29 CFR 1910. 1200 (c) © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level What does the Regulation State? "Hazardous substance" means any substance designated or listed under (A) through (D) of this definition, exposure to which results or may result in adverse effects on the health or safety of employees: © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level What does the Regulation State? "Hazardous substance" means any substance designated or listed under (A) through (D) of this definition, exposure to which results or may result in adverse effects on the health or safety of employees: Any substance defined under section 101(14) of CERCLA; © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level What does the Regulation State? "Hazardous substance" means any substance designated or listed under (A) through (D) of this Any substance defined under section definition, exposure to which results or may result in 101(14)ofofemployees: CERCLA; adverse effects on the health or safety Any biologic agent and other disease causing agent which after release into the environment and upon exposure, ingestion, inhalation, or assimilation into any person, either directly from the environment or indirectly by ingestion through food chains, will or may reasonably be anticipated to cause death, disease, behavioral abnormalities, cancer, genetic mutation, physiological malfunctions (including malfunctions in reproduction) or physical deformations in such persons or their offspring. © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level What does the Regulation State? "Hazardous substance" means any substance designated or listed under (A) through (D) of this definition, exposure to which results or may result in Anyeffects substance section 101(14) of adverse on the defined health or under safety of employees: CERCLA; Any biologic agent and other disease causing agent which after release into the environment and upon exposure, ingestion, inhalation, or assimilation into any person, either directly from the environment or indirectly by ingestion through food chains, will or may reasonably be anticipated to cause death, disease, behavioral abnormalities, cancer, genetic mutation, physiological malfunctions (including malfunctions in reproduction) or physical deformations in such persons or their offspring. Any substance listed by the U. S. Department of Transportation as hazardous materials under 49 CFR 172. 101 and appendices; and © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level What does the Regulation State? "Hazardous substance" means any substance designated or listed under (A) through (D) of this definition, exposure to which results or may result in adverse. Any effects on the health or safety of employees: substance defined under section 101(14) of CERCLA; Any biologic agent and other disease causing agent which after release into the environment and upon exposure, ingestion, inhalation, or assimilation into any person, either directly from the environment or indirectly by ingestion through food chains, will or may reasonably be anticipated to cause death, disease, behavioral abnormalities, cancer, genetic malfunctions Any substance listedmutation, by thephysiological U. S. Department of (including malfunctions in reproduction) or physical deformations such 49 CFR Transportation as hazardous materials inunder persons or their offspring. 172. 101 and appendices; and Hazardous waste as herein defined. © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level What does the Regulation State? "Hazardous substance" means any substance designated or listed under (A) through (D) of this definition, exposure to which results or may result in adverse. Any effects on the health or safety of employees: substance defined under section 101(14) of CERCLA; Any biologic agent and other disease causing agent which after release into the environment and upon exposure, ingestion, inhalation, or assimilation into any person, either directly from the environment or indirectly by ingestion through food chains, will or may reasonably be anticipated to cause death, disease, behavioral abnormalities, cancer, genetic malfunctions Any substance listedmutation, by thephysiological U. S. Department of (including malfunctions in reproduction) or physical deformations such 49 CFR Transportation as hazardous materials inunder persons or their offspring. Any Substance Posing an Adverse Effect on Health Any CERCLA-Defined Substance 172. 101 and appendices; and Any Biological or Disease Causing Hazardous waste. Agent as herein Any DOT-Defined Haz Mat Substance defined. Any Other Substance Defined in 29 CFR 1910. 1200 © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Examples of Hazardous Materials (OSHA Hazardous Waste Operations and Emergency Response Standard 29 CFR 1910. 120 [Title 8 § 5192 CCR]) Chemicals That Cause Cancer Chemicals That Burn the Skin or Eyes on Contact Biohazards or Infectious Materials Radioactive Materials © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Examples of Hazardous Materials (OSHA Hazardous Waste Operations and Emergency Response Standard 29 CFR 1910. 120 [Title 8 § 5192 CCR]) Chemicals That Catch Fire or Explode Chemicals That Can Cause Violent Chemical Reactions © En. Magine 2009 All Rights Reserved Poisons Unknown Chemicals

Haz Mat for Healthcare Awareness Level Hazardous Materials in Hospitals Internal incidents where the spill originates onsite and is limited to the facility. External incidents that occur offsite and are brought to the hospital (either through a plume of hazardous material or by contaminated patients accessing the facility for treatment. ) © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level • Your Community What are the Impacts of Hazardous Materials Incidents On… © En. Magine 2009 All Rights Reserved • The Hospital • The Emergency Department • Pre-Hospital Providers

Haz Mat for Healthcare Awareness Level Basis For Success The C’s • • Communication Coordination/Consideration Control Common Sense © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare © En. Magine 2009 All Rights Reserved Awareness Level

Haz Mat for Healthcare © En. Magine 2009 All Rights Reserved Awareness Level

Haz Mat for Healthcare Awareness Level Nomenclature and Accuracy TLA’s Three Letter Acronyms Pa ge Glossary 53 © En. Magine 2009 All Rights Reserved WMD PPE CIA O H ICS A HHS S NRRT WMD P I C SPPE A CIEOC O H ICS WMS A D TPPE R OSC N IC

Haz Mat for Healthcare Awareness Level Nomenclature and Accuracy CARBO NIC ACID © En. Magine 2009 All Rights Reserved CARBO L IC ACID

Haz Mat for Healthcare Hazard Classes Awareness Level and things that act like them © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Explosives (Class 1) External Internal • Powder Actuated Cartridges • Commercial Explosives • Fireworks • Ammunition • Fertilizer Bombs (Ammonium nitrate & fuel oil) • Hydrazine (A flammable liquid. Forms explosive mixtures [hypergolic] - a high energy rocket fuel, corrosive and poisonous) © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Compressed Gases (Class 2) Internal • • Acetylene Propane Oxygen Nitrous Oxide Carbon Dioxide Anesthetic Gases • Medical Air • Argon © En. Magine 2009 All Rights Reserved External • Hydrogen Sulfide • Phosgene • Methyl Bromide • Ammonia

Haz Mat for Healthcare Awareness Level Flammable/ Combustible Liquids (Class 3) Internal • • Diesel Alcohols Xylene Methyl Methacrylate • Methyl Ethyl Ketone © En. Magine 2009 All Rights Reserved External • • • Gasoline Hydrazine Methanol Diesel Acetone

Haz Mat for Healthcare Awareness Level Flammable Solids (Class 4) External Internal • Barium • Aluminum Phosphide • Naphthalene • Sodium • Carbon • Magnesium © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Internal • Oxygen (actually a compressed gas or cryogenic liquid) • Peroxyacetic Acid O OO O O O Oxidizers & Organic Peroxides (Class 5) External • Red Fuming Nitric Acid (a corrosive) • Nitrogen Tetroxide • Ammonium Nitrate • Methyl Ethyl Ketone Peroxide • Fluorine, Chlorine (also poison, compressed gas, corrosive) © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Poisonous & Infectious Materials (Class 6) • • Internal Phenol (Carbolic Acid) Chemotherapy Drugs Biohazardous Waste Blood Borne Pathogens • Solvents • Sewage • Vesicants (Blistering Agent, Doxorubicine, Vincristine) • Mercury • ETO (Ethylene Oxide) • Glutaraldehyde & Formaldehyde © En. Magine 2009 All Rights Reserved External • Pesticides • WMD (Sarin, VX) • • Solvents Bioterrorism Tear Gas Vesicants (Mustard, Lewisite)

Haz Mat for Healthcare Awareness Level Radioactive Materials (Class 7) Internal • Nuclear Medicine © En. Magine 2009 All Rights Reserved External • • Terrorist Use Military Facilities Nuclear Reactors Commercial/ Research Facilities • Industrial X-Ray Material

Haz Mat for Healthcare Awareness Level Corrosive Materials Internal • Lab Acids (e. g. , Hydrochloric Acid) • Boiler Treatment Caustics © En. Magine 2009 All Rights Reserved (Class 8) External • Pool chemicals • Sulfuric acid • Nitric acid • Muriatic acid • Sodium Hydroxide • Chlorine, Fluorine

Haz Mat for Healthcare Awareness Level Miscellaneous Hazardous Materials (Class 9) Internal External • Hazardous Waste • Asbestos • Anesthetics • Pepper Spray & Mace • Molten Sulphur © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Unknown Chemicals Internal • Most of these are known © En. Magine 2009 All Rights Reserved External Limitless

Haz Mat for Healthcare Awareness Level What kinds of hazardous materials incidents can you realistically expect in the hospital? Most Common Type of Release is the Hazardous Materials Spill © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Definition of Spill Types Incidental Spill that can be cleaned up in first 10 -15 minutes without risk of overexposure (above Cal/OSHA short-term or Ceiling Limits) to employees under normal conditions. (May be FRA. ) Emergency Response Spill Requires Haz Mat Response if risk of overexposure to employees. (Tech) © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Haz Mat Spills Bottom line is to minimize the risk to employees and to patients. For example, let’s look at a class of chemicals: the Aldehyde Formaldehyde and Glutaraldehyde sisters…. Thanks to Kaiser Permanente Western Environmental Health & Safety Service Hub for permission to modify their aldehyde presentation. © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Healthcare Uses of • Tissue Fixation and Preservation Formaldehyde • Dialysis Equipment • • • Pathology / Morgue Operating Room Labor and Delivery Hemodialysis Emergency Room Waste Storage Shipping & Receiving © En. Magine 2009 All Rights Reserved Disinfection Stool Specimen Preservation Reticulum Staining Biological Safety Cabinet Decontamination Pharmacy Compounding Formaldehyde Use Areas

Haz Mat for Healthcare Awareness Level Formaldehyde Potential Adverse Health Effects Dermal: Skin Irritant (dermatitis, cracking, scaling) & Sensitizer. Inhalation: Direct irritant at 1. 0 ppm. Sneezing, coughing, sore throat. Chronic exposures may cause asthma and increase risk of pneumonia and bronchitis. Can cause olfactory fatigue. Eye Contact: Transient discomfort to severe, corneal clouding/loss of vision. Ingestion: Burning of mouth, pharynx, stomach. 37% causes severe irritation, inflammation, and even death. © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Formaldehyde Health Effect Levels The Dose Makes the Poison Reported Health Effects None Odor Threshold Eye Irritation Tearing of Eyes Upper Airway Irritation Difficulty in Breathing, Burning of Nose and Throat, Coughing Pulmonary Edema, Inflammation, Pneumonia Death © En. Magine 2009 All Rights Reserved Concentration (ppm) 0 to 0. 05 to 1. 0 to 2. 0 3. 0 to 5. 0 0. 10 to 2. 5 10 to 20 50 to 100 More than 100

Haz Mat for Healthcare Uses of Glutaraldehyde • Gastroenterology (GI) • Operating Room or Ambulatory Surgery • Respiratory Therapy • Urology • Sterile Processing • Obstetrics/Gynecology • Ultrasound/Radiology • Histology/Pathology © En. Magine 2009 All Rights Reserved Awareness Level • Cold sterilizing and disinfecting solution • As a component of X-ray film processing chemicals • Histology & Pathology Fixative ingredient Glutaraldehyde Use Areas

Haz Mat for Healthcare Awareness Level Glutaraldehyde Health Effects Eyes: Clear dose-response relationship for conjunctiva and corneal injury. Lowest concentration producing minor corneal injury is 1%; 0. 2% for conjunctiva irritation. Skin: Function of site on body, time of contact, concentration, and condition of skin. Threshold concentrations for primary dermal irritation under occlusive conditions on sensitive skin is about 0. 4% solution. However, concentrations of up to 5% may not induce an irritant effect when applied briefly to bare skin. Respiratory: The threshold for peripheral sensory irritation of the respiratory tract is 0. 3 ppm. Short-term repeated exposure to Glutaraldehyde vapors in concentrations from 0. 2 to 3. 0 ppm shows a steep dose-response for toxicity and moderately severe irritation effects. © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Summary of Health Hazards • In spill situations, both formaldehyde and glutaraldehyde have the potential to pose a significant threat to the respiratory system, skin or eyes. • Proper selection of respiratory protection and protective clothing is key to mitigating risk to personnel during spill clean up. (Covered in FRO) © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Key Factors In Response Any of these factors can affect the type of response… • Time - Vapor levels rise above regulatory levels before response occurs • • Surface Area of Spill Concentration Ventilation - Type and location Spill Control Product - Some work better than others • Personnel Location - Closer = Worse © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Spill Response Options Neutralization/Absorption Products Neutralizers react with the aldehyde and convert it to a non-hazardous product. Inert Absorbents capture the aldehyde but it still possesses Its hazardous qualities. © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level General Spill Clean-up Options • Implement permanent engineering controls that will reduce exposure risk - could be floor exhaust, increased over-all exhaust, emergency exhaust fan. • Departmental staff to apply spill control product (if available and trained) and work fast to minimize exposure. (FRA? ) • Clean up if an Incidental Spill and have been trained. • Isolate and deny entry until qualified personnel arrive to evaluate/clean up. (FRA) • Internal or external spill clean-up team. (Tech) © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level External Events Most external events, both small and large, are accidents…. but some are not. Lets talk about © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level What is terrorism “The unlawful use of force against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in the furtherance of political or social objectives. ” © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Types of Weapons of Mass Destruction (WMD) B - Biological N - Nuclear I - Incendiary C - Chemical E - Explosive © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Terrorism is a “menace, with malice” A Chemical Terrorism event (the “N” & “C” of B-NICE) is a Hazardous Materials incident A Biological Terrorism event (the “B” of B-NICE) is an Infectious Disease outbreak A Fire or Explosion event (the “I” & “E” of B-NICE) is a Burn and/or Mass Casualty-Trauma incident © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Biological Terrorism Is an Infectious Disease Event BACTERIA Anthrax Plague Tularemia VIRUSES Smallpox Hemorrhagic Fevers (Ebola) Venezuelan Equine Encephalitis (VEE) TOXINS Botulism © En. Magine 2009 All Rights Reserved Ricin

Haz Mat for Healthcare Awareness Level Chemical Terrorism Is an Hazardous Materials Event NERVE Sarin VX BLISTER (Vesicants) Mustard Lewisite BLOOD Cyanide CHOKING Chlorine Phosgene IRRITATING Tear Gas © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Hazardous Materials Recognition & Safety Recognition leads to safety © En. Magine 2009 All Rights Reserved Safety leads to lives preserved

Haz Mat for Healthcare Awareness Level Not Always Reported as Haz. Mats INTERNAL • Spilled Liquids EXTERNAL • Traffic Accident • Medical Aid • Fire, Person Down, etc. Initial report may NOT indicate presence of hazardous materials! © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Haz Mat Recognition Clues Markings and Colors Placards and Labels © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Haz Mat Recognition Clues S MSD l o n a r su r o s all ’ f t i I. l D r wil o t you inent. N u o e Mak eath imm ! D over. r you pal fo hope tuff! e. s d a B ou di y d n a h this c u o T now! 1 1 9 Call © En. Magine 2009 All Rights Reserved Material Safety Data Sheets • Should be available for each Haz Mat in the workplace – Required by OSHA Hazard Communication regulations • Provides valuable information

Haz Mat for Healthcare Scene Clues • People running from area • People collapsed in the area • Evidence of a leak • Fire • Vapors • Unusual colors/odors • Loud roar or increased pitch of a valve © En. Magine 2009 All Rights Reserved Awareness Level

Haz Mat for Healthcare Senses • Last resort! • Highest danger! © En. Magine 2009 All Rights Reserved Awareness Level

Haz Mat for Healthcare Awareness Level “Clues” are “Clues”! They are a… – Warning – Note of caution – Indication of things to come – But not always ALL the answers! © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Hospital Triage Clues • Liquids or powders on the patient • Odors • What were they doing when this happened? • Where were they? • How long ago did the accident occur? Need to recognize and act fast © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Information Resources • • • Container Labels MSDS’s Poison Control ERG ATSDR – Agency for Toxic Substance & Disease Registry • Computer programs • People © En. Magine 2009 All Rights Reserved Do not rely on only one source of information. Be skeptical!! 2008

Haz Mat for Healthcare Awareness Level At the Awareness Level, what should be your First Thought when you encounter a hazmat release? ? ? © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level AFETY SOLATION OTIFICATION SIN: The Correct Awareness Level Response to Internal Spills and Contaminated Patients © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare S I N • • • AFETY First, last, and always DON’T BE A HERO !! Get the big picture. Can you handle it? What are the risks? What do you know? What don’t you know? © En. Magine 2009 All Rights Reserved Awareness Level

Haz Mat for Healthcare S SOLATION I N If someone has something on them don’t let them go away. Awareness Level If others haven’t been exposed don’t let them have contact with the chemicals Isolate the scene and deny entry © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare S I N SOLATION Awareness Level Perimeters & Control Zones • Ensure safety and isolation • Control the scene • Limit spread of contamination • Allow for safe working area © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare S I N SOLATION Awareness Level Decontamination Control Zones Pre-Decon Zone (Exclusion / Hot / Red) Decon Zone (Contamination Reduction / Warm / Yellow) Post-Decon Zone (Support / Cold / Green) © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare S I N SOLATION Awareness Level Hazard Control Zones Exclusion / Hot / Red Zone Contamination Reduction / Warm / Yellow Zone Support / Cold / Green Zone © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare S I N SOLATION Hazard Control Zones Hot Zone = Uncontrolled Product Warm Zone = Entry Team Preparation Cold Zone = Incident Control © En. Magine 2009 All Rights Reserved Awareness Level

Haz Mat for Healthcare S I N SOLATION Awareness Level Decontamination Zones OSHA First Receivers Pre-Decontamination Zone Post-Decontamination Zone © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare S I N SOLATION Awareness Level Decontamination Control Zones Pre-Decon = Staging of “dirty” People Decon = Removing Contamination Post-Decon = Medical Care © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare S I N Awareness Level OTIFICATION • Call the hospital operator to announce a Code Orange (or site specific name) • Call your Supervisor • Call your Haz Mat Coordinator • Have the operator call 911, if necessary © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level S I N OTIFICATION Who you gonna call? © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare S I N OTIFICATION Awareness Level External Notifications • 911 - to access the local emergency responders • State Warning Center (or equivalent) to access state resources (and/or meet notification requirements) • National Response Center (to access federal resources and if spill exceeds Reportable Quantities [800 -424 -8802]) © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare S I N OTIFICATION Awareness Level WHO ELSE? (if necessary) • Local Emergency Planning Committee - if 911 does not meet the requirement • FBI - if a suspected terrorism/criminal event and local law enforcement does not contact • POTW (sewage plant) - if discharge to sanitary sewer • State/local natural resources, wildlife, environmental agencies This list is not inclusive. Check local requirements. © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare © En. Magine 2009 All Rights Reserved Awareness Level

Haz Mat for Healthcare Awareness Level Watch Closely © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare © En. Magine 2009 All Rights Reserved Awareness Level

Haz Mat for Healthcare Awareness Level Directed Self Decontamination What are your first concerns? • Is this patient contaminated with a hazardous material? • How can contamination of the ED and its occupants (patients and staff) be minimized? • How can the patient be managed so that he can receive medical care? © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Directed Self Decontamination (continued) What are your first ACTIONS? S I N SAFETY: Do not touch the patient or allow anyone else to have patient contact. ISOLATION: Get the patient out of the ED to a predesignated location!!! NOTIFICATION: Activate your facility’s protocol for a haz mat incident. © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Situation 1 -5 Persons Enter the Emergency Department (Ambulatory) Operational Information If Known Substance Assumption: Sure of what agent is, or container is present Action: Have patient Self Decon. Be prepared to assist if required If Unknown Substance Same as if known since Self Decon will be performed. See Post Decon Procedures Awareness Level Directed Self Decontamination Team Needed Decon Triage Personnel • Do Triage • Manage Airway, Breathing, Circulation (ABC’s) • Directed Self Decon Site Access Personnel • Establish & Maintain Perimeter Set Up/Support Personnel • Set up & tear down equipment • Contain, manage, & dispose of waste See Decon Job Action Sheets All of the above need to be FRA (First Responder Awareness) trained © En. Magine 2009 All Rights Reserved PPE Needed Equipment Needed Assumption: NO direct patient contact will be made • Water (tepid preferred) - Shower (decon) - Hose • Sealable plastic bags • Soap • Labels/Sharpie Pen • Gowns • Modesty Screen or rope & blankets • “Trash Bag Decon” • Laminated instructions in the shower area (in multiple languages) Standard Precautions / Splash Protection • Face Shield • Gown • Gloves • Booties Setting: Well ventilated (not a regular room). Preferred outdoors

Haz Mat for Healthcare Situation 1 -5 Persons Enter at Any Other Entrance (Ambulatory) Awareness Level Operational Information Directed Self Decontamination • As soon as discovered, have the person exit the same way the came, or through the closest exit if appropriate (to reduce spread of contamination) • Escort to the designated decon area (not through hospital) Operational PPE Equipment Team Needed the contaminated area. Needed until someone can deem Information • Close down Needed Decon Triage Personnel safe. Haz Mat • Coordinator will determine the steps to take. Do Triage Assumption: • As soon as discovered, have the • Water (tepid person exit the same way the came, or • Manage Airway, NO direct (See Termination Procedures) through the closest exit if appropriate preferred) Breathing, patient contact (to reduce spread of contamination) - Shower (decon) Call Security to secure(ABC’s) area. • Escort to the designated decon • area Circulation will be made (not through hospital) - Hose • Directedentrance Self Decon if needed. • Close down the contaminated area • Identify alternative • Sealable plastic until someone can deem safe. Haz Mat Standard Site Personnel Coordinator will determine the steps to bags • Observe for Access and isolate anyone who may have received take. (See Termination Procedures) Precautions / • Establish & • Soap • Call Security to secure area. secondary contamination. Splash • Identify alternative entrance if needed. Maintain Perimeter • Labels/Sharpie • Observe for and isolate anyone who Protection Pen may have received secondary • Lockdown all manners of ingress. Set Up/Support Personnel contamination. • Face Shield • Gowns • Lockdown all manners of ingress. • Set up & tear down • Gown If Known Substance • Modesty Screen or equipment • Gloves rope & blankets If Known Substance Assumption: Sure of what agent is, or container is present • Contain, manage, & • Booties • “Trash Bag Assumption: Sure of what dispose of waste agent is, or container is Decon” Action: Have patient Self Decon Setting: present • Laminated Action: Have patient Self Decon See Decon Job Action Sheets Well ventilated instructions in If Unknown Substance (not a regular If Unknown Substance the shower area Same as if known since Self All of the above need to be room). (in multiple Decon will be performed. Same as FRA (First Responder if known since Self Decon. Preferred will be performed. languages) Awareness) trained outdoors See Post Decon Procedures © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare How Soap Works. Awareness Level (Surfactants) Oil and water molecules repel each other, so water by itself cannot be used to cleanse or remove oilbased material because the oil molecules will not be carried by the water. OIL Molecules WATER Molecules © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare How Soap Works. Awareness Level (Surfactants) Soap molecules are composed of a head (that likes water, hydrophilic) and a tail (that likes oils, hydrophobic/ oleophilic) OIL Molecules SOAP WATER Molecules © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare How Soap Works. Awareness Level (Surfactants) Soap breaks the surface tension of the water and makes the “water wetter. ” Soap attracts the water soluble contaminants to one end of the molecule and oil soluble contaminants to the other end and carries them away. © En. Magine 2009 All Rights Reserved OIL Molecules SOAP WATER Molecules

Haz Mat for Healthcare Awareness Level Trash Bag Decon A kit intended to allow for: • directed self-decon without modesty screens using a large(!) opaque plastic bag • placing potentially contaminated clothing in double clear plastic bags • placing valuables in a separate sealable clear plastic bag • tracking of patients • clothing a decontaminated patient © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Step A • Open this package and find the clear bag. • Remove your over garments, and shoes. • Place these items in the clear bag. © En. Magine 2009 All. Valdez, Rights Reserved Thanks to Anna RN for use of these slides

Haz Mat for Healthcare Awareness Level Step B • © En. Magine 2009 All Rights Reserved Remove your personal items such as your watch, jewelry, and valuables and place them in the small Ziploc bag.

Haz Mat for Healthcare Awareness Level Step C • With the pen, write your name on the label on the clear bag. • Attach the label to the large clear bag. © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Step D • Find the black plastic bag and place it on you over your clothing like a poncho. There are holes for your head and arms. © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Step E • Now bring your arms inside of the poncho type plastic bag you are wearing and undress. • Remove all clothing, including underwear and socks. • Place all clothing in the clear bag. © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Step F • Use the sponge and soap that is inside of this bag to wash any residue from your body. • Await further decontamination instructions. © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare © En. Magine 2009 All Rights Reserved Awareness Level

Haz Mat for Healthcare Awareness Level Response Scenarios © En. Magine 2009 All Rights Reserved

Haz Mat for Healthcare Awareness Level Review • Questions • Vague and evasive answers • Post Assessment – must have name on top • Module Evaluation – name optional © En. Magine 2009 All Rights Reserved