06 The Hospital Decontamination Station (Submission) PDF

Hospital Decontamination Station
(HDS)
Disaster Preparedness (Disaster Medical Management) Leaders and Specialists Training Programme Makassar, Indonesia
Scope
• What is HDS ?
• Types of HDS
• Why HDS ?
• Where to site HDS ?
• Deployment of HDS ?
• Decontamination Procedure
What is HDS?
• Hospital Decontamination Station is usually
situated adjacent/close to the Emergency
Department.
• A place to decontaminate a contaminated casualty
(a victim with symtoms/signs of exposure)
• It should have the capacity and the capability to
decontaminate multiple/mass casualties ASA
(feasibly)P.
What Types of HDS?
Why HDS?
Threat of Industrial Hazmat Exposure
Hazmat Medical Life Support Program ‐
Basic Provider Course
Background
Date: 20 March 1995, Monday
Time: 0755 hours (0809 hours)
Place: 15 stations of the Tokyo Subway System
Weapon: Sarin (GB)
Fatalities: 12
Casualties: 5,500
Evacuation
• EMTs transported 688 casualties to hospitals. 452 by
ambulances and 236 by minivans.
• > 4,000 reached hospitals on foot, taxis, private
vehicles
• 3 cardiac arrest casualties arrived in private vehicles..
• Flooding of casualties to the nearest hospital
Patients transported to St Luke’s International Hospital in
Tokyo, Japan after Sarin gas release in the 1st Hour
Mode of Arrival Number of Cases (%)
On foot 174 (34.9%)
Taxi 120 (24.1%)

Car (Good Samaritans) 67 (13.5%)
Car (Tokyo Metro Fire Department – 64 (12.9%)
excluding ambulances)
Ambulance 35 (7.0%)
Police Patrol Car 7 (1.4%)

Others 31
Total 498
OKUMURA T et al. The Tokyo Subway Sarin Attack: Disaster Management, Part 1: Community Emergency
Response. ACAD EM MED 1998; 5:613-617
Impact on Health Care Workers
• 135 (9.9%) of 1,364 EMTs developed acute
symptoms and received treatment at hospitals.
Most developed symptoms during transportation.
• 23% of staff had experienced symptoms and signs
of secondary exposure. (staff wore mainly surgical
gloves and masks)
Are We Prepared to Deal with Hazardous
Material Incidents ? – An SGH Experience
Ponampalam R, Leong M K F, Lim S H
SGH Proceedings 2002. Vol 11 No 4:238‐241
• Gas Canister explosion
• CS agent
• 87 medical and nursing
staff on duty
• 35 (40%) experienced
symptoms from
secondary contamination.
Where to site HDS?
Where do we decontaminate casualties?
Location Plan of DEM in SGH
UGD
HDS
Wind
Warm Zone
Definitive
Care
Cold Zone
Treatment Hospital
Decontamination
P1
Hot Zone
Emergency Dept
Triage Evac
Hospital Triage
P2
Decontamination
P3
Deployment of HDS
Activation Procedures
Head UGD activates:
Plan 50
Plan 100
Plan 260
Head DEM will inform Senior Management
• UGD Nurse in charge will inform the following:
– Call center (in turn activates SGH key personnel)
– Radiation Response Team Chief
– Radiation Isolation Room Rep
– Preparedness and Readiness Department
– Director of Nursing
– Admission Office
– Other adjacent departments e.g Outpatient clinics
– Bed Management Unit
– UGD Pharmacy
– Other hospital UGD
• UGD Nurse in charge to recall DEM personnel based on level of response
Roles & Functions Of HDS
• The Hospital • To receive casualties from Hazmat
Decontamination Station is incident site and provide initial
required to decontaminate treatment when necessary
casualties as part of the • To decontaminate casualties by
mission of the Hospital to trained HDS personnel using the
manage casualties arriving correct decontamination agents
from a hazardous material according to the properties of the
(Hazmat) incident. material to be decontaminated
• To reduce contamination to a • To collect properties from those
level that is no longer a casualties and subsequent handing
threat to the patient, over to law enforcement agency
emergency and hospital • To direct casualties to the
personnel hospital’s DEM Triage Area after
• To reduce contamination of decontamination
equipment, facilities and
other hospital resources
Pre-Decon Phase Actions Decon Phase Actions Post-Decon Actions
Treatment Officer 1 ‐ Impermeable Suit
1. Equipment check
2. Ensure proper set‐up of HDS (including logistics)
3. Assist triage officer in briefing
4. Check casualty's vital signs using Pulse Oximeter
5. Initiate treatment ordered
6. Direct ambulatory casualties to Stripping Area
7. Supervise personnel decontamination
8. Self Decontamination
9. Assist triage officer in debrief
Deployment Of Hospital Decontamination Station
Manpower Structure & Organization
Total 128 (excludes RRT x 2) • Triage
12 from UGD • Stripping Area
• Shower Area
116 from other departments
– Ambulant Casualties
Divided into 4 teams of 32
– Trolley Casualties
members per team • Re‐Clothing & Clean Area
Teams are called A, B, C and D
All HDS / RRT members will be
suited in non permeable suits and
issued with an electronic personal
dosimeter (EPD)
DOC NO/REV NO 68500 – AER – 056
Hospital Decontamination Station Alpha SGH DEM REFERENCE DOCUMENT 3
(Updated 31 July 2013)
W/Chair Row of Chairs

BID
Ambulatory Lane
Holding
Table
Shower Head Area
Lead Lined
Bin
Clean Zone 1 HDS Team Leader
Non Ambulatory Lane
1 Triage Officer (Dr.)
Re-clothing Shower Area Stripping Area 2 Treatment Officer
Area (Nurse)
x5
Trolley HDS
Non Ambulatory Lane Triage Area
Stretcher Trolley
Biohazard Bin Ambulance Top of slope
Trolley = Towels/Gowns/Blankets
Trolley = Sponges/Soap/FAD/Cling Wrap Bottom of slope
Top of slope LEGEND

Traffic Flow Stretcher
HDS Staff
To HDS Rest Area (Block 3 Health Screening Centre) Bearer
Supervisor
RRT
DEM CAM Operator
Triage Area Taxi Stand Security Officer
Reception
Entrance / Exit Entrance / Exit
HDS Control Panel & Main Valve / Water Supply Line HDS Store
At back of DEM Entrance Lift 3 DEM
Hospital Decontamination Station (HDS) : Decontamination
Capability
HDS 3 lanes:
1 ambulatory lane with 3 shower pointers
2 non ambulatory lanes with 2 shower pointers each lane
Total of 7 shower points & showering process approximate 10 minutes
per casualty = 42 casualties/hour (24 non ambulatory + 18 ambulatory
casualties)
Ambulatory Lane
Non Ambulatory Lane

Re-clothing Shower Area Stripping Area
Area
Non Ambulatory Lane

Decontamination of Casualties
Scope
• What is decontamination?
• Why decontaminate?
• Where are contaminants?
• Methods of decontamination
• Principles of Mass Decontamination
• Decontamination Procedures (How to)
• Special Considerations
What is decontamination?
The process of removing or neutralizing
surface contaminants that have
accumulated on personnel and
equipment
Why Decontaminate?
• To protect the patient from further
harm from exposure to the
chemical or contaminant.
• To protect responders and the
community from secondary
contamination (i.e. transfer of
hazardous material)
• To protect other HCW,
infrastructure, equipment etc
Where can contaminants be found?
Decontamination Methods
• Physical
– Washing (gentle scrubbing)
• Chemical
– Detoxification
– Disinfection
– sterilization
Removing casualties clothes could remove 80‐90%
of external contamination
Principles of Mass Decontamination
• Triage
– Exposed vs Non exposed?
– Ambulatory vs Non ambulatory?
– Immediate treatment?
• Decontamination
• Post Decontamination
• Triage
– Exposed vs Non exposed?
– Ambulatory vs Non ambulatory?
– Immediate treatment?
• Decontamination
• Expect a 5:1 Ratio of Unaffected:Affected
Casualties
• Decontaminate ASAP
• Disrobing is Decontamination
• Water Flushing Generally is the Best Mass
Decon Method
• After known exposure to liquid agent, first
responders must self‐decontaminate ASAP
• Triage
• Decontamination
– Check for contamination
– Gown
– triage
Casualty Decontamination
Issues and Lessons from Mass
Decontamination
• Special groups
– Children
– Women/pregnancy
– foreigners
• Security
• Managing throughput
• Water supply
• Environmental control
• Legal
– Privacy
– Property

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Hospital Decontamination Station

Mode of Arrival Number of Cases (%)

On foot 174 (34.9%)

Taxi 120 (24.1%)

Police Patrol Car 7 (1.4%)

W/Chair Row of Chairs

Top of slope LEGEND

Non Ambulatory Lane

Non Ambulatory Lane

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