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Decontamination


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Caution


  • Your decontamination system should be designed for use in children of all ages, by parentless children, the non-ambulatory child, the child with special needs, and also allow families to stay together.

  • Step by step child friendly instructions that explain to the children and parents what they need to do, why they are doing it and what to expect

Decontamination Acute Care

Types of decon; Nuclear/radiation, Biological, Chemical, Unknown

Zones - fill in definitions

  • Hot
  • Warm
  • Cold

Decision making - When is PPE necessary, PPE types for specific situations, limitation of PPE

  • Predetermine decontamination location
  • Need tepid water supply
  • Need gentle shower spray and eyewash
  • Predetermine water runoff issues
  • Structure must be able to be deconned
  • Provide privacy for victims
  • Prepare decon victims bags beforehand
  • Train staff to ID signs and symptoms
  • Brief decon team on hazard (if known)
  • Perform staff medical assessment?
  • Don PPE
  • Staff in PPE rapid triage victims - provide critical treatment to stabilize only
  • Use pictorial and written posted instructions for victims to self decon when able, use locale appropriate multilingual signage
  • 80% of decon is victim clothing removal
  • Assist victims in clothing removal
  • Add pediatric recommendations here
  • Use age specific directions
  • Double bag contaminated clothing etc (place hearing aids, valuables in small bag)
  • Place bag in container by showers
  • Wet down, soap, wash 5 minutes, rinse for 2 minutes
  • Move to shower exit for warm towels and assessment by staff
  • Clean - (triage station)
  • Contaminated repeat shower procedure
  • Use decon team buddy system
  • Plan for emergencies, personnel safety comes First
  • Decon cleans up decon area
  • Personel perform self decon
  • Assessed prior to exit to ensure clean
  • Doff PPE strictly per protocol
  • Medical assessment and rehydration
  • Decon team assess event response
  • Determine terminal handling of bag
  • Identify lessons
  • Reassess decontamination procedure as needed based on lessons learned
  • Removal of clothing, at least to the undergarments will reduce victim's contamination by 85%. Privacy must be considered if possible.
  • Water - large amounts of water by itself is very effective. Limit pressure in infants
  • Soap and Water - While very effective many people shower as they as they do it at home rather than conducting a rapid decontamination of there bodies. To aggressive scrubbing can lead to further damage to skin and open wounds
  • Avoid Hypochlorite 0.5% if at all possible. This can be toxic to young children.
  • Absorbent materials - detergents, earth and flour - wipe with wet tissue paper
  • Buddy system/elementary school age students
  • Designate a holding area and provide staff to support and supervise the children
  • Recommended age appropriate staffing ratios
  • 1 adult to 4 infants
  • 1 adult to 10 preschool children
  • 1 adult to 20 school-age children
  • If possible "imbed" psy - soc staff
  • Decontamination of infants
    • Take into consideration that infants when wet are slippery and will need a way to get them through the decontamination process - i.e. plastic buckets, car seats, stretchers...
    • Hypothermia must be minimized and treated
    • Decon with trauma/ stretchers/ special needs
    • Hypothermia...
    • Hypochlorite issues with young children? Infants

References

  1. Rotenberg J, Burklow T, Selanikio, J. The Decontamination of Children, Pediatric Annals32:4 April 2003
  2. Sternberg P. The Management of Pediatric Patient Victims During Hazmat Decontamination: Practical Considerations for communication, 3/24/05
  3. Sternberg P: A Manual for Managing Pediatric Victims and Their Families During a Mass Casualty (Including Hazmat ) Event, April 28, 2005

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