Shands Mass Decontamination Unit Procedures
October 1, 2002 7 minutes read
Jacksonville
Policy Number: A-03-047
Review Responsibility: Disaster Coordinator
Revised Date: December 2001
Reviewed Date: April 2002
Approval Date: November 2001
Approved by: Karen Ketchie, RN, Disaster Coordinator
Mass Decontamination Unit Procedures
PURPOSE:
To provide a plan for Shands Jacksonville Medical Center in the event of an incident that requires decontamination procedures for mass casualties. The Mass Decontamination Unit (MDU) will be utilized for patient volumes that exceed our capabilities to properly decontaminate patients in the shower located adjacent to the Trauma Center.
POLICY:
All personnel who are identified as being part of the decontamination team, and those who interact with the team, are required to be familiar with this policy and review annually.
PROCEDURE:
The procedure is as outlined:
All personnel who enter the MDU hot zone must:
- Have prior Shands Jacksonville Decontamination Unit and Personal Protective Equipment (PPE) training.
- Have a pre-entry medical screening that includes a set of vital signs including weight, temperature, blood pressure, and pulse. This evaluation will occur again upon exiting the MDU.
- Understand the importance of oral fluid hydration prior to donning the PPE and upon the rest phase after the doffing of PPE.
- Know the "distress" signal for all personnel in the MDU. The distress signal is both arms raised high over the head.
- Have their name taped in large bold letters on the back of their suit.
- Have their suit inspected prior to doffing; if there is a breach in its integrity, they will submit to decontamination procedures.
- Follow the commands of the Safety Officer and Medical Control Officer.
- Have an identified "buddy" within the same visual zone.
A staging area will be established adjacent to the entry of the MDU. It is here that:
- Initial briefing for the MDU team is provided.
- Buddy teams (two persons) identified.
- PPE is selected, evaluated, tested, and donned.
- Team member role identification is established.
- A water cooler is provided.
Before patient arrival:
- Remove rolling carts containing PPE from the storage area and take to the Staging Area (cold team assistants).
- Bring two water coolers (filled with cold water) and drinking cups to the MDU area. One is to be placed in the Staging Area and one in the Team Recovery area.
- Transportation personnel will bring six stretchers and six wheelchairs to be placed at the perimeter of the MDU entrance: half near the entrance of the MDU and half at the exit (COLD ZONE) of the MDU.
I. UNIT OVERVIEW AND TERMINOLOGY
The Decontamination Unit is set up to accommodate three distinct zones and includes an adjacent "Green" area to which patients needing only minor care can be treated. The zones are as follows:
Hot Zone: This is the area from the entrance into the garage to the exit of the showers. In this area, contaminated clothing is removed and the patient enters the shower. This is a restricted area for specified decontamination team members only. Only staff members trained in the use of PPE are permitted in the Hot Zone. At the discretion of the Medical Control Officer, patient treatment supplies may be brought into the hot zone.
Cold Zone: Upon exiting the shower, the patients are now considered "cold." The patients are dried, re-clothed, and secondary triage begins. At the discretion of the Medical Control Officer, patient treatment supplies may be brought into the cold zone.
Staging Area: Area identified where MDU members meet to discuss plan, don equipment, identify buddies, and await their rotation into the MDU. See above "A Staging Area" for further detail.
II. UNIT SETUP (See Mass Decontamination Unit setup photos)
The MDU is located on the ground floor in the Employee North garage. Setup of the Decon Unit will primarily be the responsibility of the Facilities Department. There will be three corridors created: Corridor one, located closest to the Flight Crew Quarters, is for female patients. Corridor two, the middle corridor, is for nonambulatory patients or for overflow of the other two corridors. Corridor three is for male patients.
A. Hanging tarps and ground covering: The divisions between the three corridors are created by tarps that are permanently suspended from the ceiling in the ground floor entrance of the garage. To create the corridors, release the tarps and they will drop down. The flooring of the corridors also is covered with tarps. Place the shower bases (yellow) onto the pre-painted site near the elevators.
B. Erect shower frame. The tips of the PVC pieces are color-coded for easy identification and assembly.
C. Attach water hoses to manifold and shower frame.
D. Place shower curtain onto shower frame.
E. Provide bucket of solution (as approved by toxicologist on call, ext. 4480). Provide scrub brush.
F. Biohazardous materials barrel and personal effects bags are placed inside each corridor.
III. UNIT PERSONNEL
In addition to the below mentioned personnel there will be:
1. Team Member Monitor: This person will be in the HOT ZONE to monitor personnel for signs of stress and required assistance by team members. This person is not to decontaminate patients but to observe and monitor.
2. Safety Officer: The Safety Officer is to monitor the team and patient movement to prevent a breech in safety of personnel as well as the environment. He/she will observe and enforce zone boundaries in the Decontamination Unit. He/she will observe proper setup of unit and enforce all safety protocols. The Safety Officer has the final authority related to the management of personnel and the environment.
3. Medical Control Officer: The Medical Control Officer decides who is fit to enter the MDU, being sure to take into consideration the team members’ pre-entry medical screening and mental health status. This officer decides medical management of all patients as well as agreement of patient disposition from the MDU (green/walking wounded area, or entrance into the medical facility). The Medical Control Officer has final authority on medical management of patients within the MDU.
Patient arriving at the Decontamination Unit will be met by the following hospital personnel:
A. Primary Triage Officer: located at entrance into the Unit. Evaluates for life-threatening conditions and decides priority of patient decontamination.
B. Patient Flow Personnel: Explains procedures to victims and directs them into the proper corridors.
C. Corridor Attendants: Corridor one and three each will have one attendant, as these victims are able to ambulate and wash themselves with little assistance. Corridor two will have a minimal of two attendants, as these patients present via stretcher or are assistance-dependent. This corridor also can be used as overflow of the other two if there is not a large volume of nonambulatory patients.
D. Secondary Triage Officer and Staff: Evaluate patients as they exit the showers and direct them to the appropriate treatment areas.
E. Assistants: Provide patients towels and gowns. Assist with walking and directing the patients to the proper areas as assigned by the triage staff.
F. Registration Staff: Provide identification bands to all patients before leaving the Decon Unit. Gather pertinent information such as demographics and their initially assigned destination of care. Location: Near elevators after patient exits shower and in the Minor Treatment Area.
G. Transporters: Will be utilized to transport those patients that need assistance. They will bring wheelchairs to the sidewalk that exits the Decon Unit.
H. Minor Treatment (green) Area Staff: This area is located adjacent to the Decon Unit near the Handicapped Parking Area on the ground floor. The patients seen here presented for decontamination purposes only, or have minor care issues such as abrasions. These patients will be evaluated, treated, and discharged from Shands Jacksonville directly from this area. A registration person(s) will be assigned to staff this area.
I. Mental Health Personnel: Personnel from the Stress Response Team will be stationed in the Minor Treatment Area as well as other gathering places of victim and staff.
J. Security Personnel: (Or designee) will ensure a perimeter around the Decontamination Unit. Additional personnel will be utilized to secure the doors closest to the Emergency Departments and Trauma Center, staff entrance, and tower entrance. See Security procedures for further information.
IV. PATIENT FLOW
It is standard operating procedure for Jacksonville Fire-Rescue to decontaminate patients prior to transport. It is the policy of Shands Jacksonville to secondarily decontaminate all patients prior to entrance into the building(s).
Patients arriving to the Decontamination Unit will proceed as follows:
A. Ambulatory Patients:
Present to the Primary Triage Officer and after evaluation, the Patient Flow personnel will direct them to the proper corridor. In the corridor they will be instructed to remove all clothing and all personal affects. These items will be placed separately in a patient clothing bag and a smaller bio zip-lock bag for personal affects. There will be a separate barrel for clothing and personal affects. A corridor attendant will handle this process as well as place patient ID bands on them. The patient will be instructed and/or assisted with the gross decontamination process of scrubbing their body with the solution in the bucket (as determined by toxicologist, for they may simply need to step into the shower and wash with soap and water). After this process and that of a final rinse, the patient then will be handed a towel and provided a patient gown/sheet for privacy.
B. Nonambulatory Patients:
May present via privately owned vehicles as well as rescue units. They will be placed on stretchers at the entrance of the HOT ZONE and proceed as above. They will be wheeled into Corridor Two, where their clothing and effects will be removed. The personnel then will begin gross decontamination, anteriorly and posteriorly. The patient then will be wheeled into the shower for a final rinse of water, anteriorly and posteriorly. The contaminated stretcher will remain in the contaminated area, and the patient will be transferred to a clean stretcher after the final rinse phase. There the patient will be evaluated by the Secondary Triage Officer and transported to the appropriate care area.
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