[PDF] First Receiver Awareness/Operations and Decontamination for Healthcare

1 First Receiver Awareness/Operations and Decontamination for Healthcare 2013 California Office of Emergency Services Ca...

First Receiver Awareness/Operations and Decontamination for Healthcare

2013 California Office of Emergency Services California Specialized Training Institute

Acknowledgments First Receiver Awareness/Operations and Decontamination for Healthcare, is intended to support “handson” training from qualified instructors who are experienced in Hazardous Materials response and Hospital Operations. This course would not be possible without the knowledge and expertise of several dedicated instructors who, over the last 20 years, have taught hundreds of hazardous materials response courses from the awareness level to the specialist level. Chief among those instructors are: 1. Paul Henlin, Emergency Management Coordinator/Instructor II (CSTI Retired); 2. Matt Krimsky, Emergency Management Coordinator II, current Course Manager for First Receiver Awareness/Operations and Decontamination for a Healthcare; 3. Jack Fry, Captain II, Los Angeles City Fire Department (Joint Regional Information Center); 4. Eric Angle, RN, MICN, Sutter Hospital, Roseville, CA., 5. Bill Wennhold, of Mark Twain Medical Center, San Andreas, CA., one of CSTIs most prolific and motivational Instructors. These Instructors, and the others who have been such ardent supporters of CSTI and its goals, have been the true backbone for the outreach programs offered throughout California and elsewhere. Their efforts are greatly appreciated. Subject matter experts worked hand-in-hand with Paul Penn, of Enmagine Inc. Paul’s support and extensive use of HazMat for Healthcare curricula was invaluable in the production of the 2013 revision.

Hazardous Materials First Receiver Awareness/Operations and Decontamination for Healthcare Table of Contents

Acknowledgements Chapter 1

Welcome and Overview

Chapter 2

Recognition and Safety

Chapter 3

Safety, Isolation and Notifications/Directed Self Decontamination

Chapter 4

Command and HICS

Chapter 5

Identification, Hazard Assessment and Action Plans

Chapter 6

Personal Protective Equipment

Chapter 7

Contain and Control Measures

Chapter 8

Decontamination, Disposal and Documentation

Appendix

OSHA Interpretations, OSHA Best Practices, Miscellaneous Information

First Receiver Awareness/Operations and Decontamination for Healthcare: Participant Guide May be used for training, not for commercial use. Citation of the California Specialized Training Institute (CSTI) as the source of these materials is appreciated. California Specialized Training Institute, 2013 CSTI

CALIFORNIA SPECIALIZED TRAINING INSTITUTE

First Receiver Operations and Decontamination for Healthcare

Draft Schedule

Day/Time Subject Day One 0800-0830 Administration and Overview 0830-1030 First Responder Awareness, Recognition and Safety 1030-1200 Safety, Isolation and Notifications/Directed Self Decontamination 1200-1300 LUNCH 1300-1400 Overview of Incident Command 1400-1500 Identification and Hazard Assessment/Incident Action Plans 1500-1700 Personal Protective Equipment/Donning and Doffing Exercise Day Two 0800-0830 Review and Questions 0830-1000 Hazmat Countermeasures 1000-1200 Decontamination, Disposal and Documentation 1200-1300 LUNCH 1300-1530 Field Exercise 1530-1600 Equipment Restoration 1600-1630 Outreach Instructor Information 1630-1700 Exam, Comments, Questions, Wrap up

Course Description Course Overview

The over arching goal of this course is to provide hazardous materials First Receivers with the knowledge and skills to become competent in hazardous materials in a healthcare environment, who have a high regard for safety. The intended outcomes for this course are to ensure that participants will be able to identify, inventory and analyze the hazards and risks involved in an incident and take appropriate action, either through direct intervention or by contacting the responsible supervisor with recommendations for minimizing risk; assist in the preparation and development of components for event-specific and site specific plans that involve personnel safety; implement the elements of personnel monitoring to protect hazardous materials responders’ health and safety; develop appropriate forms of written and oral safety communication for incident planning and to ensure that onscene personnel receive critical information about the specific hazards and risks involved in hazardous materials incidents; assess on-scene decontamination procedures in order to protect responder health and safety; and plan a safe hazardous materials response that is consistent with the emergency response plan and the organization at a Healthcare Facility. The content for this course describes some of the tools and procedures a First Receiver must be familiar with to carry out the responsibilities of possible positions; explains how laws, regulations, plans, policies, and standard operating procedures play an important role in ensuring safety during responses to hazardous materials incidents. In addition to addressing the outcomes and content described above, this course incorporates many opportunities for asking questions and discussing various safety topics. Small-group and independent exercises are structured to reinforce key points. In particular, the class is divided into groups of participants

Scope

This course in hazardous materials response for the Assistant Safety Officer complies with requirements for the state of California’s Hazardous Substances Incident Response Training and Education Program (Government Code Section 8574). This code requires the California Emergency Management Agency to present to field responders approved training classes, taught by trained instructors, in hazardous substance response. These training classes are to be provided through outreach programs and are to certify participants who have completed these training classes. This training is also mandated by the Occupational Safety and Health Act, Title 29, Code of Federal Regulations 1910.120(q) and the California Code of Regulations Title 8–Section 5192(q). The regulations covering the requirements and course contents are contained in the California Code of Regulations Title 19– Section 2520.

Target Audience

The target audiences for this course are Healthcare workers to include, registered nurses, environmental service, security, fire service, law enforcement, emergency management, emergency medical services, hazardous materials, or any other individuals who, in the course of carrying out their job, may be assigned to the incident at a healthcare facility.

Prerequisites

This is an entry level course for Awareness and Operations, no prerequisites are required.

Duration/Course Length

This course has been developed as a 16-hour, instructor-led training delivered over two days.

Course Description Required Materials/Facilities

• Seating and work stations for up to 30 participants • Laptop computer, projector, and screen • Instructor Manual and CD with Power Point presentation (1 for instructor) • Participant Guide (1 for each participant) • Flip charts and markers for safety briefings • ICS forms (201: Incident Briefing, 202: Incident Objectives, 206: Medical Plan, 208: Site Safety and Control Plan, and 214: Unit Log) • Personal Protective Equipment used in a Healthcare Environment.

Testing and Certification

Course completion is based on the final exam with a minimum score of 70 percent and participation in class exercises. Once participants have successfully taken this course, California Specialized Training Institute (CSTI) issues a Certificate of Completion.

Reference List This section provides the source material upon which this course is based. Dashiell, Thomas R., Patrick, William C., Sidell, Federick R.. 2003. Jane’s Chem/Bio Handbook. Jane’s Information Group. Henry, Timothy V. 1999. Decontamination for Hazardous Materials Emergencies, Delmar Publishing http://www.amazon.com/Decontamination-Hazardous-Materials-Emergencies-Timothy/dp/0766806936 National Fire Protection Agency (NFPA). NFPA Form 704 Hazard Identification System. National Institute for Occupational Safety and Health (NIOSH). 2005-149. Pocket Guide to Chemical Hazards, U.S. Department of Health and Human Services. Occupational Safety and Health Administration. November 1983. Code of Federal Regulations, Title 29, Part 1910.120; Hazardous waste operations and emergency response http://www.gpoaccess.gov/CFR State of California Office of Emergency Services. 2007. Firefighting Resources of California Organized for Potential Emergencies (FIRESCOPE). http://www.firescope.org/ U.S. Air Force. 2000. Air Force Instruction 90-901: Operational Risk Management. http://www.mitre.org/work/ sepo/toolkits/risk/policies/files/afi90-901.pdf U.S. Army. January 2000. Soldier and Biological Chemical Command (SBCCOM). Guidelines for Mass Casualty Decontamination during a Terrorist Chemical Agent Incident. http://www.chem-bio.com/resource/2000/cwirp_ guidelines_mass.pdf U.S. Coast Guard. 1999. Commandant Instructions 3500.3: Operational Risk Management. http://www.uscg.mil/ directives/ci/3000-3999/CI_3500_3.pdf

Course Description Reference List Continued U.S. Department of Homeland Security. May 23, 2005. Universal Task List, Version 2.1. http://www.ojp.usdoj.gov/ odp/docs/UTL2_1.pdf http://www.fema.gov/pdf/emergency/nims/im-job-titles.pdf U.S. Department of Transportation (DOT), Transport Canada (TC), Secretariat of Transport and Communications of Mexico (SCT), and collaboration with CIQUIME (Centro de Informacion Quimica para Emergencias) of Argentina. 2008 Emergency Response Guidebook.

Additional References OSHA Best Practices for Hospital Based First Receiver Victims (OSHA 2005) Patient Decontamination for Hospitals (Excerpts) (OSHA 2005) 2012 Hospital Join Commission Standards 02.02.05(5) & 02.02.07(7)

Evaluation Strategy

This course uses a Level 1 evaluation strategy in the form of a questionnaire to determine learners’ reactions to the course and a Level 2 evaluation strategy in the form of a multiple-choice pre/post test to assess learners’ proficiency in the knowledge and skills presented.

Note to Instructors

It’s YOUR course! You may substitute videos, case studies, photos, graphics, etc. (That do NOT change the content or meaning of this program) to suit your needs and specifically address your audience. This program is presented as a generic basis of what must be covered in your classes.

First Receiver Awareness/Operations and Decontamination for Healthcare

Participants Manual: Chapter 1 First Receiver Operations and Decontamination for Healthcare Scope This chapter provides and overview of the course and introduces the First Receiver as a critical link in the medical care of victims, discusses Hazmat emergencies and discusses regulations that cover First Responders and Receivers.

Time

Instructor/Participant Ratio

.5 hours

1/30

Method of Instruction Facilitated Seminar

Terminal Objective At the end of instruction for Chapter 1, participants will be able to determine the magnitude of the Hazardous Materials problem that may develop at a hospital or medical facility.

Enabling Objectives This chapters enabling (performance) objectives are to ensure participants will be able to: 1. Understand who needs to be trained at the awareness and operations level. 2. Describe some of the risks a First Receiver may face. 3. Describe the need for safety for the First Receiver. 4. Recognize the wide range of dangers from hazardous materials

1.1

First Receiver Awareness/Operations and Decontamination for Healthcare

Linkages to Universal Task List The information, objectives, and activities in this chapter promote the acquisition of knowledge and skills in support of the target capabilities identified in the Universal Task List: ResA1a 1.1

Establish procedures for assessing an immediate incident scene

ResB1a 2.1

Develop and implement training program for on-site incident management

Materials and Preparation • Seating and work stations for up to 30 participants • Instructor Manual and CD with PowerPoint presentation (1 for instructor) • Participant Guide (1 for each participant)

Supporting Materials • OSHA Best Practices for Hospitals • Hazmat Tactical Operations and Priorities

Activities • Easel Charts for Brainstorming

1.2

First Receiver Awareness/Operations and Decontamination for Healthcare

Introductions & Welcome

Slide 1.1 Introductions of instructors, Housekeeping (Logistics) issues. Course contents: handouts, power point presentation, evaluations, post tests. Introductions of participants: a. Ask job classifications b. What do they expect to get out of the class?

IV. Show ER segment (Warner Bros, Exodus): “call from dispatch” Slide 1.2 Video: Hospital alerted of fire and explosion by phone

Slide 1.3 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.”

The words in quotes comes from the HAZWOPER standard definition for the First Responder Awareness level ((q)(6)(i) Ask who within the hospital may have potential contact with a Haz Mat incident?

1.3

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 1.4 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.”

Hospital implication: those who will have responsibilities to take defensive actions with hazardous materials from a defensive standpoint. Such as performing decontamination.

Goal is to have enough people trained at the Operations Level to have a minimum of 4-6 people on duty all the time to make up a Decon Resource Team. Will need to train a percentage of Environmental Services / Housekeeping, Plant Operations / Engineering / Facilities, Security, and ED to have enough people trained. Training only ED personnel will result in a clean patient and an empty ED. Design program for 2 AM and work your way back.

Course Requirements • First Receiver Awareness Level 4 Hours • First Receiver Operations Level 16 Hours

Slide 1.5 These are the requirements for certification in both the Awareness and Operations level courses.

• 100% Class Attendance • Complete Certified Exam with 70% or better score

1.4

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 1.6

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.

It is mainly the OSHA regulations that prompt us to provide training and personal protective equipment for our employees. The HAZWOPER regulations state the levels of training, what must be included, minimum hours (exception- no minimum hours for Awareness training- ours is 4 hours), and who should be trained.

The primary standard applicable to this program is called Hazardous Waste Operations and Emergency Response (HAZWOPER).

Slide 1.7 Regulations

(cont.)

Training categories in the Emergency Response section of the HAZWOPER Standard are:

    

First Responder-Awareness Responder-Awareness First First Responder-Operations Responder-Operations First Hazardous Materials Technician/Specialist Hazardous Materials On-Scene Commander Hazardous Materials Skilled Support Personnel

Awareness Objectives

•Define Hazardous Material •Identify risks and problems that can occur in a Hazardous Materials Incident •Recognize a Hazardous Materials Incident

There are other OSHA standards that are applicable too, such as the Respiratory Protection Program. This is primarily a worker safety (staff) training program but also helps to protect patients visitors, the community, and the environment.

Slide 1.8 These are the objectives for the Awareness Level of training.

1.5

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 1.9

Awareness Objectives

Awareness objectives continued •Identify Characteristics of a Chemical •Describe a Safe and Effective Response •Understand how to make Proper Notifications •Describe how to Isolate the Scene and Deny Entry •Describe how to Coduct “Directed Self Decontamination

Awareness & Operations Objectives

Understand the role of Awareness Level personnel in the overall response

Slide 1.10 It is important you know what your role is in a hazardous materials incident that occurs at your facility. This may be internal or external.

COMMAND TECHNICIAN

AWARENESS

OPERATIONS

Slide 1.11 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)

There are many different definitions of a Hazardous Material. OSHA’s Hazard Communication Standard is as listed above. Department of Transportation (DOT) has another one. Bottom line is what OSHA says: “results or may result in adverse affects on the health or safety of employees.” or “anything that can get out of its container and bite you on the bottom.”

1.6

First Receiver Awareness/Operations and Decontamination for Healthcare

OSHA Hazwoper Regulation • Provides Training Requirements • General Response Requirements It’s the foundation of this course • Title 8 California Code of Regulations Section 5192 – California Regulation – Almost Identical to Federal Regulation – Applies to both public and private sector employess

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: •

[A] Any substance defined under section 101(14) of CERCLA;

•

[B] 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.

•

[C] Any substance listed by the U.S. Department of Transportation as hazardous materials under 49 CFR 172.101 and appendices; and

•

[D] Hazardous waste as herein defined.

What does the Regulation State?

Slide 1.12 This course is set up for the Awareness and Operations Level. This level of training provides defensive actions. Higher levels of training such as Haz Mat Technician are offensive in posture. They can go into the middle of a haz mat situation and plug holes or make repairs. In California we follow Title 8 California Code of Regulations section 5192. Slide 1.13 Note section B which can include infectious materials, blood borne pathogens, and bioterrorism. This section was ignored by many responders but has special meaning for healthcare.

Slide 1.14

Superfund is the name given to the environmental program established to address abandoned hazardous waste sites. It is also the name of the fund established by the Comprehensive Any Substance Posing an Adverse Effect on Health Any substance listed by the U.S. Department of Environmental Response, Compensation and Any CERCLA-Defined Substance Transportation as hazardous materials under 49 CFR 172.101 Anyand Biological or Disease Causing Agent appendices; and Any DOT-Defined Haz Mat Substance Liability Act of 1980, as amended (CERCLA Hazardous waste as herein Any Other Substance Defined in 29defined. CFR 1910.1200 statute, CERCLA overview). This law was enacted in the wake of the discovery of toxic waste dumps such as Love Canal and Times Beach in the 1970s. It allows the EPA to clean up such sites and to compel responsible parties to perform cleanups or reimburse the government for EPA-lead cleanups. Hazwoper covers requirements for both emergency and non– emergency hazmat response. "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 ofAny 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 mutation, physiological malfunctions (including malfunctions in reproduction) or physical deformations in such persons or their offspring.

1.7

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 1.15

Hazwoper Requires Employers To • Plan for response and cleanup • Train employees • Follow basic response requirements

Classifications of Hazardous Materials

(OSHA Hazardous Waste Operations and Emergency Response Standard 29 CFR 1910.120 [Title 8 §5192 CCR])

These are lay terms ! • Chemicals that cause cancer • Biohazards or infectious materials • Chemicals that can burn the skin or eyes on

Here are some basic requirements for employers as it relates to hazardous materials.

Slide 1.16 Hazardous materials are classified according to properties they have. We will cover the this more in Chapter 2 Here are the types of hazards in lay person’s terms.

contact

Slide 1.17 • Radioactive materials

Classifications continued

• Chemicals that can cause violent chemical reactions • Poisons • Unknown chemicals • Chemicals that can catch fire or explode

1.8

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 1.18 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.)

In hospitals, we may have to deal with Internal and External incidents. An Internal incident would be a Haz Mat spill that originates in the facility. An External incident is a Hat Mat spill that occurs outside the hospital but affects it due to contaminated victims coming into the hospital or there is a toxic plume that blow over the hospital. Slide 1.19

What are the Impacts of Hazardous Materials Incidents On…

•

You

•

Your Community

•

The Hospital

•

The Emergency

•

Pre-Hospital Providers

Department

Set up video and have students address impacts to the following —You —Community —Hospital —Emergency Room —EMS Slide 1.20 Discuss ER episode thus far in relationship to You, Community, Hospital, ED, EMS

1.9

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 1.21 Gloria Ramirez incident Riverside, California Or local example specific to class

Slide 1.22

Basis For Success

The C’s • • • •

Communication Coordination/Consideration Control Common Sense

These concepts for a successful emergency outcome should have come from the discussion in the previous exercise. Review them as the results that should be expected.

1.10

First Receiver Awareness/Operations and Decontamination for Healthcare

Supporting Material Welcome and Course Overview Main Points

• • • • •

Introductions and Welcome Course Overview Key Administrative Announcements Need for First Receiver Training Class Groups and Teams

1.11

First Receiver Awareness/Operations and Decontamination for Healthcare

Supporting Material First Receiver Awareness. 29 CFR 1910.120(q)(6)(i), Title 8 CCR 5192(q)(6)(A) General:

“(6) Training. Training shall be based on the duties and function to be performed by each receiver in an emergency response organization. The skill and knowledge levels required for all new receivers, those hired after the effective date of this standard, shall be conveyed to them through training before they are permitted to take part in actual emergency operations on an incident. Employees who participate, or are expected to participate, in emergency response shall be given training in accordance with the following paragraphs”:

FRA:

“(i) First Receiver Awareness level.…individuals 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 authorities of the release. First receivers at the awareness level shall have sufficient training or have had sufficient experience to objectively demonstrate competency in the following areas”:

Competencies:

“(A) An understanding of what hazardous substances are, and the risks associated with them in an incident. (B) An understanding of the potential outcomes associated with an emergency created when hazardous substances are present. (C) The ability to recognize the presence of hazardous substances… (D) The ability to identify the hazardous substances, if possible. (E) An understanding of the role of the first receiver awareness individual in the employer’s emergency response plan including site security and control and the [ERG]. (F) The ability to realize the need for additional resources, and to make appropriate notifications to the communication center.”

Minimum Hours: None © State of California- CalOES/CSTI 10/12013

1.12

First Receiver Awareness/Operations and Decontamination for Healthcare

First Receiver Operations. 29 CFR 1910.120(q)(6)(ii), Title 8 CCR 5192(q)(6)(B) FRO:

“(ii) First Receiver Operations level.…individuals who respond to releases or potential releases of hazardous substances as part of the initial response to the site for the purpose of protecting nearby persons, property, or the environment from the effects of the release. They are trained to respond in a defensive fashion without actually trying to stop the release. Their function is to contain the release from a safe distance, keep it from spreading, and prevent exposures. First receivers at the operational level shall have received at least eight hours of training or have had sufficient experience to objectively demonstrate competency in the following areas in addition to those listed for the awareness level and the employer shall so certify:”

Competencies:

“(A) Knowledge of the basic hazard and risk assessment techniques. (B) Know how to select and use proper personal protective equipment provided to the first receiver operational level. (C) An understanding of basic hazardous materials terms. (D) Know how to perform basic control, containment and/or confinement operations within the capabilities of the resources and personal protective equipment available with their unit. (E) Know how to implement basic decontamination procedures. (F) An understanding of the relevant standard operating procedures and termination procedures.”

Minimum Hours: FRA training plus 8 hours

1.13

First Receiver Awareness/Operations and Decontamination for Healthcare

1. Need for First Receiver Training a. Primary need: Overall safe and competent response, within the “Operations” level (S.I.N.C.I.A.P.C.P.D.D.D).

b. To give healthcare workers the ability to: 1) Recognize potential or actual Haz Mat incidents, 2) Conduct basic initial identification and assessment, 3) Safely isolate and deny entry, 4) Initiate notifications, 5) Conduct patient decontamination, 6) Contribute to effective and efficient response.

Note “SAFE” Acronym Theme

Safety first, last and always. Analyze all information per your needs Focus on First Receiver Awareness safety and competence. Enthusiastic involvement by all.

1.14

First Receiver Awareness/Operations and Decontamination for Healthcare

The First Receiver’s Role.

a. b.

The first people there (i.e. First Responders/Receivers) are the first line of defense to protect life, environment & property. Primary First Receiver role is to safely and competently respond within appropriate level, resources and capabilities.

c. First Receiver at the “Awareness” Level: 1) Definition: One likely to witness/discover a Haz Mat release and can initiate notifying authorities and take no further actions. [29 CFR 1910.120(q)(6)(i) & 8 CCR 5192(q)(6)(A)] d. First Receiver at the “Operations” Level: 1) Definition: One who responds to a Haz Mat release to protect nearby persons, environment or property (trained to act in a defensive fashion without trying to actually stop the release as could a “Technician”). [29 CFR 1910.120(q)(6)(ii) & 8 CCR 5192(q)(6)(B)]

First Receivers at Both Levels have Limits: Other Responders with Proper Training: (ICs; Technicians; Specialists; “Skilled Support Personnel;” etc.)

1.15

First Receiver Awareness/Operations and Decontamination for Healthcare

First Receiver’s key role: Safely and competently respond within (OSHA training) level, (receiving) resources and (equipment) capabilities!

Goals of the receiver:

Save lives and limit casualties; Protect the environment; Limit damage to property; Restore area to normal as soon as possible.

1.16

First Receiver Awareness/Operations and Decontamination for Healthcare

Participant Manual: Chapter 2 Recognition & Safety First Receiver Operations and Decontamination for Healthcare Scope This chapter explains how early recognition of a hazardous materials events and warning signs can play an important part in creating a safe and effective response to hazardous materials incidents.

Time

Instructor/Participant Ratio

1.5 hours

1/30

Method of Instruction Facilitated Seminar

Terminal Objective At the end of this chapter participants will be able to describe the warning signs, placards and safety data sheets. HARM Worksheets and other clues that can help identify and develop a safety attitude in a Hazardous Materials Incident Response.

Enabling Objectives 1. 2. 3. 4.

Describe the Department of Transportation hazard classes Describe the Hazmat Problem in the First Receiver environment Explain the First Receiver’s role in a hazmat incident Describe the Hazmat definitions, terms and acronyms

2.1

First Receiver Awareness/Operations and Decontamination for Healthcare

Develop information regarding incident

ResB1b 1.1.1

Develop procedures to identify and assess hazards

ResB1b 6.1.1

Ensure that all responders have minimum training required to perform roles during an incident

ResB1b 1.1.1

Develop procedures to identify and assess hazards

Supporting Materials • Department of Transportation Emergency Response Guidebook • HARM Worksheet • Dose Makes the Poison

2.2

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 2.1

Hazardous Materials/ WMD Recognition and Safety in the Healthcare Environment

This section will focus on recognizing a hazardous materials incident and thinking Safety.

Slide 2.2

Nomenclature and Accuracy TLA’s

Three Letter Acronyms

WMD

Need to be familiar with Haz Mat nomenclature and terminology. There is a list of acronyms and a glossary in the Supplemental Material at the end of this chapter.

WMD

It is very important to use proper terminology. Glossary Some chemicals sound alike. You may need to IC spell out things, don’t rush through information. When looking up the hazards and risks - a small difference in the name of a chemical can make a big impact. For example the difference between carbonic acid (soda carbonation) and carbolic acid (phenol) can cause chemical burns. EOC

2.3

First Receiver Awareness/Operations and Decontamination for Healthcare

Explosives (Class 1) Internal • Powder Actuated Cartridges

External • • • •

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)

Slide 2.3 Internal - are hazards that are present in our hospitals. External - hazards that are present in the community. Even if your facility does not have any chemicals that are “technically” classified as EXPLOSIVE, there may be situations that cause an EXPLOSIVE atmosphere. Two chemicals may not be classified as an explosive, but the combination of the two can create an explosive atmosphere.

Slide 2.4

Compressed Gases (Class 2) Internal • Acetylene • Propane • Oxygen • Nitrogen • Nitrous Oxide • Carbon Dioxide • Anesthetic Gases • Medical Air • Argon

External • Hydrogen Sulfide • Phosgene • Methyl Bromide • Ammonia

With compressed gases: a BLEVE (blev-ee) can occur - BLEVE (Boiling Liquid Expanding Vapor Explosion). This occurs when the container holding the gas ruptures, releasing the liquefied gas. The liquefied gas quickly expands resulting in a fireball. Compressed gases by their nature (being under pressure) are hazardous. A rapid release can cause significant damage. Some compressed gas cylinders have up to 6000 pounds of pressure per square inch.

2.4

First Receiver Awareness/Operations and Decontamination for Healthcare

Flammable/Combustible Liquids (Class 3) Internal • Diesel • Alcohols • Xylene • Methyl Methacrylate • Methyl Ethyl Ketone

External • Gasoline • Hydrazine • Methanol • Diesel • Acetone

Slide 2.5 Flammable Liquids: Have a flash point below 100 degrees F. The vapors of flammable liquids are generally heavier than air and will not dissipate rapidly. Gasoline is one of the most common products involved in HazMat incidents. Combustible Liquids: Combustible liquids differ from flammable liquids in that they are not easily ignited at ambient temperatures.

Combustible liquids will be much easier to ignite in hot environments. (Ask class how much diesel fuel is on site. Generally there will be thousands of gallons for backup generators.) Oxygen enriched atmospheres (23.5% oxygen) will cause combustible/flammable liquids to ignite more easily and burn more intensely. Some flammables are used for their solvent characteristics rather then their ability to burn (e.g., isopropyl alcohol, xylene used in the pathology labs). Wastes with an alcohol concentration over 25% are considered ignitable wastes. These products generally have over 60% alcohol with documented burn injuries (“napalm in a bottle”) Some flammables are used for their solvent characteristics rather than their ability to burn.

Flammable Solids (Class 4)

Slide 2.6 Flammable solids:

Internal • Barium

External • Aluminum phosphide • Naphthalene • Sodium • Carbon • Magnesium

Flammable solids burn vigorously and persistently once ignited. Small fires involving combustible metals require the use of special Class D extinguishing agents. Burning metals produce hazardous gases that may be toxic, corrosive or asphyxiating.

2.5

First Receiver Awareness/Operations and Decontamination for Healthcare

Oxidizers & Organic Peroxides (Class 5) Internal • Oxygen (actually a compressed gas or cryogenic liquid) • Peroxyacetic Acid

External • Red Fuming Nitric Acid (a corrosive)

• Nitrogen Tetroxide • Ammonium Nitrate • Methyl Ethyl Ketone Peroxide • Fluorine, Chlorine (also

Slide 2.7 Oxidizers: Oxidizers are materials that may cause or enhance the combustion of other products, generally by yielding oxygen or other oxidizing agents.

Organic peroxides: Organic peroxides may be flammable and unstable and possess fuel (organic compounds), oxygen (an oxidizer component) and heat (through unstable bonds). Their explosive and unstable nature is often a more serious hazard than their characteristics as oxidizers. poison, compressed gas, corrosive)

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

External • • • • • •

Pesticides WMD (Sarin, VX) Solvents Bioterrorism Tear Gas Vesicants (mustard, Lewisite)

Slide 2.8 Poisons and Infectious materials: Avoid contact with any poisonous or infectious substance. Sometimes it is best to allow fires involving these materials to burn. Fire can destroy the toxic properties of some poisons. Pesticide container labels must include additional signal words: DANGER (highly toxic), WARNING (moderately toxic), or CAUTION (relatively low toxicity).

Note that this broad category contains many of the weapons of mass destruction (addressed later in this module) and the infectious materials and blood borne pathogens of concern in a healthcare setting. The characteristics of pesticides and some of the nerve agents are similar (several nerve agents are very potent organophosphates). The treatment of these are also similar (atropine, diazepam, 2-PAM). This is part of the demystification of terrorism highlighted in this course. What are some of these WMD agents but “pesticides where you are the pest.” Also note that some of the products used in chemotherapy are vesicants as are mustard sulphur and Lewisite.

2.6

First Receiver Awareness/Operations and Decontamination for Healthcare

Radioactive Materials (Class 7) Internal • Nuclear Medicine

External • • • •

Terrorist use Military Facilities Nuclear Reactors Commercial/Researc h facilities • Industrial x-ray material

Slide 2.9 Radioactive materials: Radiation can only be detected with special instruments. That is both good and bad. It cannot be seen or smelled. Protect yourself as much as possible using time, distance and shielding. Radiation exposures should be maintained as low as is reasonably achievable.

Ensure that radiological monitoring devices are available 24/7 and not just when nuclear medicine is open. Corrosive Materials (Class 8) Internal

External

• Lab acids (e.g., Hydrochloric Acid) • Boiler treatment caustics

• • • • • •

• Floor stripper

Pool chemicals Sulfuric acid Nitric acid Muriatic acid Sodium Hydroxide Chlorine, Fluorine

Slide 2.10 Corrosives: The strength of a corrosive is measured by pH. The pH scale goes from 0 to 14, with 7 being neutral. 0-6 on the pH scale are acidic (acids). 8-14 are alkaline (bases). Corrosives are also measured in terms of their concentration, which refers to the percentage of acid or base in water.

Strong Acids and Bases are not compatible with each other and may react violently. Miscellaneous. Hazardous Materials (Class 9) Internal • Hazardous waste • Asbestos • Anesthetics

External • Pepper spray/mace • Molten Sulphur

Slide 2.11 If it doesn’t fit somewhere else, it goes into the miscellaneous category.

2.7

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 2.12 Definition of Spill Types Incidental Spill

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.)

When is a spill a problem? Discussion of “Incidental release” versus “Emergency” from definition section of :

HAZWOPER 1910.120(a)(3) “Emergency response or responding to emergencies Requires Haz Mat Response if risk of overexposure to employees. (Tech) means a response effort by employees from outside the immediate release area or by other designated responders (i.e., mutual aid groups, local fire departments, etc.) to an occurrence which results, or is likely to result, in an uncontrolled release of a hazardous substance. Responses to incidental releases of hazardous substances where the substance can be absorbed, neutralized, or otherwise controlled at the time of release by employees in the immediate release area, or by maintenance personnel are not considered to be emergency responses within the scope of this standard. Responses to releases of hazardous substances where there is no potential safety or health hazard (i.e., fire, explosion, or chemical exposure) are not considered to be emergency responses.” Individuals that work in or near chemicals should be trained to the Awareness level, at a minimum. Emergency Response Spill

Slide 2.13 Unknown Chemicals Internal •

Most of these are known

External

We want to spend a few minutes talking about Internal Spills.

Limitless

2.8

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 2.14 What kinds of hazardous materials incidents can you realistically expect in the hospital?

Most Common Type of Release is the Hazardous Materials

What are the most common types of spills in your hospital? Common—Xylene, Formalin,

Spill

Slide 2.15 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 sisters….

Formaldehyde and

There are a number of toxic chemicals used inside the hospital environment We will briefly discuss the Aldehyde’s

Glutaraldehyde Thanks to Kaiser Permanente Western Environmental Health & Safety Service Hub for permission to modify their aldehyde presentation.

Introduction • Aldehydes are used throughout hospitals and pose unique hazards. The most common aldehydes, formaldehyde and glutaraldehyde, can be bad actors. Responding to spills of these chemicals requires preplanning and an effective understanding of the hazards.

Slide 2.16 We want to spend a few minutes talking about Internal Spills. Aldehydes are a big risk in hospitals.

2.9

First Receiver Awareness/Operations and Decontamination for Healthcare

HCHO

• Formaldehyde – Aliphatic (straight-chain) monoaldehyde – Vapor density of 1.01 (similar to air) – Moderate vapor pressure – Exhibits a pungent odor at a threshold of between 0.05 - 1.0 ppm.

Slide 2.17 Obviously the stronger the concentration, the more harm it may cause. “ppm”= parts per million This is a good place to begin to associate the concept of “the dose makes the poison.”

• Full-Strength formalin:

37% HCHO, 10-15% methanol, 48-53% water • 10% formalin:

4% HCHO + methanol + buffer

Also, different people react differently to different concentrations. Healthcare has within its walls society’s most vulnerable members (young, old, frail, ill, compromised) and these patients may have a significant response at low concentrations. Slide 2.18

Formaldehyde Potential Adverse Health Effects Dermal: Skin Irritant (dermatitis, cracking, scaling) & Sensitizer.

Here are some of the health effects from encountering a formaldehyde spill.

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.

Healthcare Uses of Formaldehyde •

Tissue Fixation and Preservation

•

Dialysis equipment disinfection

•

Stool specimen preservation

•

Reticulum staining

•

Biological Safety Cabinet decontamination

•

Pharmacy compounding 

Formaldehyde Use Areas

     

Pathology / Morgue Operating Room Labor and Delivery Hemodialysis Emergency Room Waste Storage Shipping & Receiving

Slide 2.19 Formaldehyde and products made from it are common in the hospital setting. Here are some of the areas where you might encounter this product in one or more formulations.

2.10

First Receiver Awareness/Operations and Decontamination for Healthcare

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.

Healthcare Glutaraldehyde Uses •Cold sterilizing and disinfecting solution •As a component of X-ray film processing chemicals •Histology & Pathology Fixative ingredient   

Glutaraldehyde Use Areas

    

Slide 2.20 There are multiple ways for hazardous materials to enter or harm the body.

Slide 2.21 Glutaraldehyde is used primarily for endoscopes & other delicate instruments that may be damaged by steam, heat or hypochlorite solutions.

Gastroenterology (GI) Operating Room or Ambulatory Surgery Respiratory Therapy Urology Sterile Processing Obstetrics/Gynecology Ultrasound/Radiology Histology/Pathology

Glutaraldehyde Health Effects • Eyes: Clear dose-response relationship for

conjuctival and corneal injury. Lowest concentration producing minor corneal injury is 1%; 0.2% for conjunctival 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 doseresponse for toxicity and moderately severe irritation effects.

Slide 2.22 This is a toxic chemical and precautions should be taken when this product is spilled in the facility. Do you have spill kits? Have you been trained to use them?

2.11

First Receiver Awareness/Operations and Decontamination for Healthcare

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.)

Spill Clean-up Options

• Let it evaporate if operational downtime not a problem and no recirculating exhaust to adjoining departments. (FRA) • Departmental staff to apply spill control product and work fast to minimize exposure. (FRA?) • Internal or external spill clean-up team (will be haz mat after first 10-15 minutes if no spill control product applied). (Tech) • Implement permanent engineering controls that will reduce exposure risk - could be floor exhaust, increased over-all exhaust, emergency exhaust fan.

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.

Slide 2.23 In other words, these spills need to be taken care of with caution, and the proper training and personal protection.

Slide 2.24 - 2.25 These factors can affect our response: Time - If it has just occurred, maybe the liquid has emitted many vapors (avoid the use of the word “fume”) yet > you may be able to intervene before the breathable concentration of the vapors reaches a dangerous level. Or if it has been awhile, maybe the vapors have dissipated some. Volume - there is more danger from something being spread out over a large surface as opposed to something in a container, even if it is the same volume. Concentration - affects the hazard (e.g., 4% formaldehyde in formalin vs. 37% formaldehyde that may be found in pharmacy compounding.

Ventilation - Is the area ventilated, so some of the vapors may be gone. Or are the vapors trapped in an area. Another aspect is where is the ventilation going to, is it spreading vapors though out the facility through the air handling units or is it going outside. Spill Control products (Neutralizers)- do you have any? Personnel location - or patient location. Is the spill in an isolated area? Or is it next to a bunch of offices, or next to patients. © State of California- CalOES/CSTI 10/1/2013

2.12

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 2.26 Multiple Hazards & Health Effects • • • •

Regulations are performance standards More than one hazard class Markings don’t show all hazards Think of multiple hazards always!

Chemicals may have more than one hazard class and multiple health effects. Markings don’t always show all the hazards.

Slide 2.27

External Events

External events may be accidental or intentional.

Most external events, both small and large, are accidents …. but some are not. Lets talk about…

Types of Weapons of Mass Destruction (WMD)

C - Chemical

Slide 2.28 These are the same types of chemicals we may encounter in accidental or intentional spills.

B - Biological R - Radiological

N – Nuclear E - Explosive

2.13

First Receiver Awareness/Operations and Decontamination for Healthcare

Introduction to Haz Mat & WMD

• • • •

• Types of Weapons of Mass Destruction (cont’d.) Others Incendiary (arsonist) Explosive (bomber) Firearm (assassin)

Slide 2.29 Other typicals

• Common Hazards • Typical Hazardous Materials - You May Encounter • Potential Weapons of Mass Destruction - You Will be Directed To

Chemical Terrorism Is a Haz Mat Event Types of Agents • Nerve • Blister (vesicants) • Blood • Choking • Irritating -

Sarin

Mustard

Lewisite

Cyanide Chlorine

Phosgene

Tear Gas

Pepper spray

Biologic Terrorism Is an Infectious Disease Event Types of Agents

• Bacteria Anthrax

Plague

Tularemia

• Viruses Smallpox Hemorrhagic Fevers (Ebola) Venezuelan equine encephalitis (VEE)

Slide 2.30 Here are some common types of chemical agents considered candidates for use by terrorists. Many of these types of chemicals are found in industry as well

Slide 2.31 These are the most likely bacterial agents that might be used by a terrorist. Some of these can exist in the hospital environment through infected patients.

• Toxins Botulism Ricin

2.14

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 2.32

Scene Clues • • • • • • •

Recognition clues from the scene.

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

Note: “One person convulsing on the ground might be epilepsy. Two people convulsing on the ground is not epilepsy.”

Slide 2.33 Information Resources • • • • •

Container Labels SDS’s Poison Control ERG ATSDR – Agency for Toxic Substance & Disease Registry

• Computer programs • People

Do not rely on only one source of information. Be skeptical!!

When you know the name of the chemical involved, how can you find out more information about it? How dangerous is it? 2008

What kind of protection do you need? Container Label may give you some information.

Safety Data Sheets will give you good starting info. Poison Control - great resource. Can also give you treatment information. Can Fax you info. ERG (Emergency Response Guidebook, Orange book) ATSDR (Agency for Toxic Substance & Disease Registry) - Good resource. Can now download Medical Management Guidelines off the web. Other computer programs that provide information are available, such as CAMEO. Should use a minimum of 3 sources of information. One source may not tell you every thing about the substance. © State of California- CalOES/CSTI 10/1/2013

2.15

First Receiver Awareness/Operations and Decontamination for Healthcare

Importance of Recognition • Any responder can encounter WMD or hazmats • Any responder can get hurt

Slide 2.34 Notice that medical personnel make up a large percentage of people injured in a hazardous materials incident.

Cops Fire Medical Others

Slide 2.35

Senses • Last resort! • Highest danger!

Be careful about using your senses to determine anyting about a chemical spill. Many are odorless and colorless. Often toxic chemicals can knock out our ability to smell them in a very short time. “No Nasal Appraisal”

“Clues” are “Clues”! • They are a, – Warning – Note of caution – Indication of things to come – But not always all the answers!

Slide 2.36 Don’t get blinders on just because you believe a clue and come to final conclusions based on them. There may be other things you need to consider. Keep your eyes and mind open.

2.16

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 2.37 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

Safety Data Sheets SDS Diforsuranol Make out your will. It’s all over.Death imminent. No hope for you pal! Bad stuff!

• Should be available for each Hazmat in the workplace – Required by OSHA Hazard Communication Regs

• Provides valuable information

Clues and questions the Triage Nurse should be asking. Especially if the patient has something on them powder, clothes wet and it is not raining outside. Always be cautious! Initial reports may not indicate the presence of hazardous materials. Slide 2.38 SDS’s give you the following information: Chemical Name Chemical/physical properties, etc. Hazard identification Often SDS are incomplete, inaccurate, misleading, difficult to read. Use multiple sources.

Touch this and you die. Call 911 now!

A more complete listing of

Know Your… • • • •

Level of Training Role Responsibility Limits

Slide 2.39 It is important the you remain aware of your level of training, role in your facility, and what your limits are based on training, manpower, and resources. In the next section will be talking about the role of the receiver at the awareness level.

2.17

First Receiver Awareness/Operations and Decontamination for Healthcare

Supplemental Material Introduction/Haz Mat Recognition and Safety Main Points •

The Haz Mat Problem

•

DOT Haz Mat Classes and Examples.

•

Multiple Hazards and Health Effects of Each Class

•

Haz Mat “Commons” and “Typicals”

•

The First Receiver’s Role

•

Haz Mat Tactical Operations/Priorities Acronym

•

Pertinent Authorities and Regulations

• Haz Mat Definitions, Terms and Acronyms •

Importance of Recognizing Haz Mat Incidents

•

Haz Mat Events Not Reported as Haz Mat Incidents

•

Haz Mat Recognition Clues

•

Haz Mat Outward Warning Signs

•

Special Markings

•

D.O.T. Haz Mat Placards and Labels

•

Shipping Papers and SDSs

•

First Operational Thought is Safety

•

Death & Injury Due to Lack of Safety

2.18

First Receiver Awareness/Operations and Decontamination for Healthcare

The Haz Mat Problem.

Common use and misuse of Haz Mats create “Events.” 1) Standard of living requires Haz Mat use and transport. 2) Over 16 million chemicals in existence, up to 70,000 potentially classified as “hazardous.”

Two major elements of the Haz Mat problem include: 1) Volume of hazardous materials, and 2) The human factor.

c. Because of these elements, “Events” (accidents, emergencies and incidents) will happen. d. Haz Mat “Events” can pose at least 3 primary risks (fire, health and reactivity risks) and can have 3 negative outcomes on Life/Health, Environment, and Property — In that order! e.

Government or industry cannot eliminate events, but can: 1) Mitigate events, 2) Prepare for events, 3) More effectively and efficiently respond to events.

Haz Mat events are different from other emergencies: 1) Must respond or receive patients safely, slowly and methodically.

2.19

First Receiver Awareness/Operations and Decontamination for Healthcare

Hazardous Materials Events

People + Hazardous Materials

Haz Mat Events!

Fundamental difference in a Haz Mat resposne: We must receive: •Safely •Slowly •Methodically

Haz Mat events cannot be eliminated—interaction of Haz Mats and human beings will create Haz Mat events!

2.20

First Receiver Awareness/Operations and Decontamination for Healthcare

What are hazardous materials? Definitions:

There is no one definition! Here are a few...

OSHA:

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)

EPA:

Hazardous Substance: “Any substance designated pursuant to Section 311(b)(2)(A) of the CWA[Clean Water Act]; any element, compound, mixture, solution or substance designated pursuant to Section 102 of CERCLA; any hazardous waste having the characteristics identified under or listed pursuant to Section 301 of the Solid Waste Disposal Act... any toxic pollutant listed under Section 307(a) of the CWA; any hazardous air pollutant listed under Section 112 of the Clean Air Act; and any imminently hazardous chemical substance or mixture with respect to which the EPA Administrator has taken action pursuant to Section 7 of the Toxic Substances Control Act.” 40 CFR 300.5

DOT: Hazardous Material: “...substance or material, which has been determined by the Secretary of Transportation to be capable of posing an unreasonable risk to health, safety, and property when transported in commerce… The term includes hazardous substances, hazardous wastes, marine pollutants, and elevated temperature materials as defined in this section...” 49 CFR 171.8

2.21

First Receiver Awareness/Operations and Decontamination for Healthcare

Multiple Hazards and Health Effects of Each Class. a.

DOT regulations are performance standards—it’s possible for a substance to meet the definition of more than one hazard class.

Substances that meet the definition of more than one hazard class are classified according to the highest applicable hazard class (49 CFR 173.2a) and are placarded accordingly.

Shipping papers and placards may not indicate all subsidiary or multiple hazards.

Receivers should always think of multiple hazards regardless of how a substance is placarded or labeled!

Haz Mat “Commons” and “Typicals.” a.

Commons: 1) 2) 3)

Common release: Petroleum products (diesel or gasoline). Common release locations: Fixed facilities (in over 25% of the incidents, the surrounding area was residential). Common release factor: Abandonment/intentional act.

b. Typicals: 1) 2) 3)

Typical receiver exposure: Inhalation; Typical number of response agencies: Four; Typical receiver problem: Poor response management!

2.22

First Receiver Awareness/Operations and Decontamination for Healthcare

Multiple Hazards 49 CFR 171.8

A material may meet the defining criteria for more than one hazard class but is assigned to only one hazard class.

49 CFR 172.505 Hazardous materials that possess secondary hazards may exhibit subsidiary placards. Examples Material Acrolein Ammonia, anhydrous Chlorine Denatured Alcohol Hydrazine, anhydrous Hydrofluoric Acid Methanol Nitric Acid, red fuming Phosphorus, white Sulfur Dioxide Uranium Hexafluoride

Primary Hazard Poisonous Poisonous Poisonous Flammable Corrosive Corrosive Flammable Corrosive Spontaneously Combustible Poisonous Radioactive

Subsidiary Hazard(s) Flammable Corrosive Corrosive Poisonous Flammable, Poisonous Poisonous Poisonous Oxidizer, Poisonous Poisonous Corrosive Corrosive

Commons and Typicals The most commonly released hazardous substance in my location is: The most commonly shipped or manufactured substance in my location is: The most common release location where I live/work is:

2.23

First Receiver Awareness/Operations and Decontamination for Healthcare

Be part of the solution, not the problem,

and know your limits!!

Haz Mat Tactical Operations Acronym. a.

S.I.N.C.I.A.P.C.P.D.D.D. - See attachment, then develop your own acronym/checklist/memory jogger!

Pertinent Authorities and Regulations. a. b. c.

29 CFR 1910.120(q) and Title 8 CCR 5192(q): Safety, Planning, Response and Training. CVC 2454: IC for incidents on highway/road. CVC 2453, CH and SC 6.95, SARA Title III 304: Notifications.

2.24

First Receiver Awareness/Operations and Decontamination for Healthcare

Haz Mat Tactical Operations/Priorities Acronym

S Safety I Isolation & Deny Entry N Notifications C Command/Management I Identification & Hazard Assessment A Action Planning P Protective Equipment C Containment & Control P Protective Actions D Decontamination & Cleanup D Disposal D Documentation

2.25

First Receiver Awareness/Operations and Decontamination for Healthcare

Haz Mat Definitions, Terms and Acronyms. a.

Hazardous Materials — No one definition (Substance outside normal safe containment in sufficient concentration to pose serious immediate threat to life, environment and property?).

IDHA — Identification and Hazard Assessment.

IC — Incident Commander.

Know basic Haz Mat terms and acronyms (See Annex).

2.26

First Receiver Awareness/Operations and Decontamination for Healthcare

DOT Classifications of Hazardous Materials. Class # 1 1 1 1 1 1 2 2 2 3 4 4 4 5 5 6 6 7 8 9 None

Division # 1.1 1.2 1.3 1.4 1.5 1.6 2.1 2.2 2.3 4.1 4.2 4.3 5.1 5.2 6.1 6.2

Name of Class or Division Explosives (with mass explosion hazard) Explosives (with projection hazard) Explosives (with predominately a fire hazard) Explosives (with no significant blast hazard) Very insensitive explosives; blasting agents Extremely insensitive detonating substances Flammable gas Nonflammable compressed gas Poisonous gas Flammable and combustible liquid Flammable solid Spontaneously combustible material Dangerous when wet material Oxidizer Organic peroxide Poisonous materials Infectious substance (Etiologic agent) Radioactive material Corrosive material Miscellaneous hazardous material Other regulated material: ORM-D

49 CFR § 173.50 173.50 173.50 173.50 173.50 173.50 173.115 173.115 173.115 173.120 173.124 173.124 173.124 173.128 173.128 173.132 173.134 173.403 173.136 173.140 173.144

2.27

First Receiver Awareness/Operations and Decontamination for Healthcare

Definitions of DOT Hazard Classes. Class 1 Class 2

Class 3 Class 4

Class 5 Class 6 Class 7 Class 8 Class 9

Any substance, article or device designed to function by explosion (extremely rapid release of gas and heat). Flammable gas: Ignitable at low concentrations (41 psia. Poisonous gas: Toxic to humans or hazardous to health (or LC50 of not more than 5000 ml/m3 for laboratory animals). (i.e. Toxic in low concentrations.) Flammable Liquid: Flash point 141°F. (100°-200°F for domestic shipments.) Explosives shipped with sufficient wetting agent to suppress explosive properties. Substance that can ignite if in contact with air 0.002 microcuries per gram. Substance that causes visible destruction or irreversible alterations in human skin tissue or a liquid that has a severe corrosion rate on steel or aluminum. Material with anesthetic, noxious or similar property that could cause extreme annoyance or discomfort to flight crew and prevent performance of assigned duties. Does not meet the definition of any other class.

2.28

First Receiver Awareness/Operations and Decontamination for Healthcare

Block Outline 1.

Importance of Recognizing Haz Mat Incidents. a.

Any receiver can encounter hazardous materials. According to an ongoing federal government study (ATSDR 1997), of the injuries to responders/receivers in Haz Mat incidents: 1) 18% are law enforcement personnel 2) 30% are firefighters (career and volunteer) 3) 17% are medical personnel (EMS and hospital) 4) 35% are other responders (includes in-house response teams)

If you don’t know it’s there, you can’t protect yourself. 1) Recognition leads to safety, 2) Safety leads to lives preserved!

2. Many Haz Mat Incidents Not Always Clearly Reported as Haz Mat Incidents. a.

Traffic accident,

Medical aid,

c. Fire,

Person down.

Sick walk-in patient

Or, ____________________________________

Initial report may not indicate presence of hazardous materials!

2.29

First Receiver Awareness/Operations and Decontamination for Healthcare

Haz Mat Recognition Clues. a.

Occupancy/Location (e.g. plating shop or highway). 1) Haz Mats manufactured/stored/used/transported anywhere but be aware of common locations.

Container Shapes (e.g. 55-gallon drum or ribbed tanker). 1) Shape may be clue to its contents (they are shaped the way they are for a reason—know common silhouettes). a) DOT specifications. b) Compressed gas containers. c) Common above-ground storage tanks. 2) Potential stresses on Haz Mat containers: thermal, mechanical, chemical and radiation.

Markings & Colors (e.g. package/label markings or colors).

Placards & Labels (e.g. orange placard = Explosive).

Shipping Papers and SDSs (e.g. consist for railroad incident).

Senses (e.g. sight, hearing and smell - last resort).

Other Clues (e.g. responsible party, witness, business plan, etc.).

“Clues” are clues, not absolutes! They are… 1) A warning, 2) A note of caution, 3) An indication of things to come, 4) But not always all the answers you need.

2.30

First Receiver Awareness/Operations and Decontamination for Healthcare

Recognition—Standard Haz Mat Recognition Clues: Occupancy/Location

Container Shapes

Markings & Colors

Placards & Labels

Shopping Papers & SDS

Senses

2.31

First Receiver Awareness/Operations and Decontamination for Healthcare

Haz Mat Outward Warning Signs. a.

Many signs 1) People running from, or collapsed in the area, 2) Evidence of leak (fire, smoke, vapors, unusual colors/odors), 3) Loud roar or increased pitch of an operating relief valve, etc.

Remember: Assume Haz Mat and look for clues or warning signs until you confirm the absence of hazardous materials!

Special Markings. a.

NFPA 704,

Biohazard markings,

Military markings,

Pipeline markers,

Hazard communication markings (e.g. HMIS®),

f. Railcars, g. Others.

2.32

First Receiver Awareness/Operations and Decontamination for Healthcare

Special Markings.

NFPA 704

Biohazard Markings

Military Markings

Pipeline Markers

Hazcom Markers

2.33

First Receiver Awareness/Operations and Decontamination for Healthcare

D.O.T. Haz Mat Placards and Labels. a.

Know Haz Mat classes (with colors/symbols) and examples: 1) Explosives (Orange/Bursting Ball) — Trinitrotoluene. 2) Gases (Green/Cylinder) — Ammonia. 3) Flammable Liquids (Red/Flame) — Gasoline. 4) Flammable Solids (Red & White Stripes/Flame) — Fusee. 5) Oxidizers (Yellow/Flaming “O”) — Hydrogen Peroxide. 6) Poisons (White/Skull & Crossbones) — Methyl Parathion. 7) Radioactives (Yellow over White/Trefoil) — Thorium. 8) Corrosives (White over Black/Test Tube) — Sulfuric Acid. 9) Misc. Hazardous Materials (White w/Black Vertical Stripes).

Know placard limits. 1) 2) 3)

Multiple and subsidiary hazards. “Dangerous” placard meaning (Table 1 & 2 commodities). Compliance and enforcement.

2.34

First Receiver Awareness/Operations and Decontamination for Healthcare

Safety Data Sheet (SDS) General Info:

The Occupational Safety and Health Act, Hazard Communication Standard, and the regulations issued under that Act, require employers that use or produce hazardous substances to prepare written documentation describing the hazards the substance may present. OSHA regulations require 10 types of information. The American National Standard Institute (ANSI) has developed a standard (ANSI Z400.1) for SDSs that expands on the OSHA requirements and requires an SDS to have the following sections:

Requirements:

• Chemical product and company identification. (OSHA reg) • Composition/information on ingredients. (OSHA reg) • Hazard identification (including an emergency overview subsection to describe the material’s appearance and the most significant concerns). (OSHA reg) • First aid measures. (OSHA reg) • Firefighting measures. (OSHA reg) • Accidental release measures. (OSHA reg) • Handling and storage. (OSHA reg) • Exposure controls/personal protection. (OSHA reg) • Physical and chemical properties. (OSHA reg) • Stability and reactivity. (OSHA reg) • Toxicological information (including background toxicological information). • Ecological information (including information on the material’s effect on plants, animals and the environment). • Disposal considerations. • Transport information (including basic shipping classification information). • Regulatory information (with additional regulatory information affecting the material). • Other information.

2.35

First Receiver Awareness/Operations and Decontamination for Healthcare

Bloodborne Pathogens — Warnings. (CCR 5193) Labels:

Warning labels required on:

Containers of regulated waste. Refrigerators and freezers containing blood or other potentially infectious material. Other containers used to store, transport or ship blood or other potentially infectious materials. May substitute red bag or red container for label under certain conditions. (Regulated waste must also have a label.) Signs:

Work areas containing infectious materials must have a biohazard sign posted on every entrance. Must also have the name of the infectious agent, informtion on special requirements for entering the area and the name and phone number of the responsible person.

Symbol:

Lettering:

The symbol must have the words “BIOHAZARD” or “BIOHAZARDOUS WASTE” under the symbol.

2.36

First Receiver Awareness/Operations and Decontamination for Healthcare

Haz Mat Recognition – Case Histories An emergency medical perspective… “Our engine company (3 man fire engine) arrived on scene at the local high school for an apparent poisoning. The male student ingested Lannate pesticide (quarter pound mixed in water). The student was unconscious with vital signs dropping rapidly. The powder was airborne and floating freely with movement of the patient and wind. The captain started to cough and nearly vomited. I was a firefighter at the time… and rode into the hospital with the private ambulance (paramedic trained). Epi cardio converted the patient and all were excited about a great save.

However, lessons learned:

Safety - recognize danger of spread of pesticide (it’s designed to kill). Isolate and deny entry - keep students away, call for police to secure area. Notifications - notify ambulance of impending danger; environmental health, allied agencies… We now have a full Haz Mat Team in place as well as shift Haz Mat Team members on duty; first responder operations Haz Mat training for all firefighters…”

Scott Coffman Fire Captain

2.37

First Receiver Awareness/Operations and Decontamination for Healthcare

Haz Mat Recognition – Case Histories (cont.) A hospital and emergency medical perspective… “I treated a 28 year old for trouble breathing after she was trying to clean her house. She was using a “flea” powder to help control fleas in her home from the family dog. Most often these powders are placed on the carpet and swept up, however, she decided to place it on the wood floor as well and use a broom to agitate it causing a “dust” in the air which she inhaled. This was her first experience with this powder and we approached it as a possible allergic reaction. Consultation with Poison Control did not lead us to a pesticide poisoning since her symptomology was not consistent with organophosphate OD. We were also at a disadvantage because she was intercepted on the way to the hospital so we did not have access to the actual product. In the [hospital] emergency department, she started getting worse and other patients and nurses began complaining of various things, mostly nausea. I talked to poison control again who explored the issue some more and determined that it might be a pesticide (industrial) and she should be deconned. She was taken into the Haz Mat area where her clothes were removed and redbagged, [she was] showered and put into a gown. All the affected ED personnel were required to go to the locker room, shower and change clothes. The patient’s condition cleared in about 20 minutes. As it turned out, her husband got an industrial strength pesticide which is used on a house (you know when they put that big tarp over your house for a few days).”

Robert M. Sklar, NREMT-P University of Maryland Department of Emergency Health Services Howard County, Fire and Rescue

2.38

First Receiver Awareness/Operations and Decontamination for Healthcare

Haz Mat Recognition – Case Histories (cont.) A “multi-disciplinary” perspective… In August 1996, Los Angeles County Sheriff ’s deputies and paramedics entered a motel room in Carson, CA in response to a report of an unknown number of persons suffering from a possible drug overdose. They found three bodies in the room, one on a bed, one on the floor behind the door and one in the bathroom lying on the floor. None of the bodies showed any signs of injury. The deputies found a collection of typical drug lab chemicals and apparatus, including a 2 liter flask in the bathroom. They also noticed a “heavy chemical odor.” Although the air conditioner was on and the bathroom window was slightly open, there were bed sheets surrounding the edge of the door as if the occupants had attempted to keep any vapors or gases from escaping. The responders exited the location and notified the Bureau of Narcotics Enforcement (BNE) Clandestine Laboratory Task Force. Members of that Task Force and the Los Angeles County Health Hazardous Materials unit assessed the scene and detected the presence of phosphine gas. The coroner later found that the three victims died of pulmonary edema caused by inhalation of phosphine gas. Phosphine is a colorless gas that may have a fishy or garlic-like odor. It has been widely used as a grain fumigant and is also used in the manufacture of semiconductors. Certain processes used in clandestine drug labs can generate phosphine gas. It can be toxic at levels as low as 400 parts-per-million.

2.39

First Receiver Awareness/Operations and Decontamination for Healthcare

Participant Worksheet

In your own words, describe the fundamental difference in receiving patients in a Haz Mat incident vs. a “Normal” day-to-day emergency response:

_______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 2. Identify your jurisdiction’s primary Haz Mat problem, including three potential negative outcomes of the problem: _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 3. Describe the difference in roles between First Receivers at the “Awareness” and “Operations” levels: _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 4. Identify the First Receiver’s Primary Role (regardless of level), and cite at least three tactical operations common to Haz Mat incidents: _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________

2.40

First Receiver Awareness/Operations and Decontamination for Healthcare

HAZMAT FOR HEALTHCARE

HARM / Risk Assessment Worksheet Product Name:

UN# (4 digits)

DOT Hazard Class:

Physical State:

EX-FG-FL-FS-OX-PO-RA-CO-OT 1

ERG Guide #

(at 68 degrees F)

NFPA: H

Poison Control Information = (800) 222-1222

Hazard

Physical Description

Toxicity Lower #’s and/or Narrow Range = higher hazard

Flammability

ppm or mg/m3

TWA

8 Hrs

LEL / UEL:

Lower # = higher hazard

Flashpoint:

Lower # = higher hazard

I.T. =______

Solubility

STEL

Short

Ceiling

Danger

50%

100%

0 F

Flammable?

100 F

200 F

Soluble?

Not, Somewhat, Very (W) Not, Somewhat, Very (O)

Liquid?

Float / Sink / Neither

Vapor?

Air = 1 (less rises, more sinks) V.D. =_____

Float / Sink / Neither

Vapor Production?

Water @ 17.5 mmHg (0.33 psi) = Low 1 PPM = 4.34 Mg/M3

_______mmHg

Low, Medium, High

B.P. =_____

Lower B.P. = more vapor

Corrosivity

Closer to 0 or 14 = more corrosive

Acid 0-6

pH Value

Carcinogen

Non, Somewhat, Very

A.I.T. =______ (paper = 451o F) Soluble (swims) in:

S.G. =_____

Higher = more vapor Lower = less vapor

(0-4)

Little, Somewhat, Very

IDLH

Water (W) Oil (O) Water = 1 (less floats, more sinks)

Vapor Pressure

Hazard Summary

Specific Gravity Vapor Density

Toxicity?

Lower # = higher hazard Wider Range = higher hazard

Solid/Liquid/Gas

0 2

Yes

Base 8-14

Corrosive? Not, Somewhat, Very Cancer risk to staff? Yes / No

Secondary Contamination Risk: Yes / No (Transferable from victim or scene to others?) PPE: Can your team handle a victim decontamination incident with provided PPE? Yes / No Can your team handle an internal incidental spill incident without special PPE? Yes / No

Other Info of Interest:

What challenges are there to you handling this? © HAZMAT FOR HEALTHCARE HARM-Risk Assessment Worksheet v4.6.2

III A 119 © State of California- CalOES/CSTI 10/1/2013

2.41

First Receiver Awareness/Operations and Decontamination for Healthcare

HAZ MAT FOR HEALTHCARE GLOSSARY The express purpose of this glossary of standardized terms is to provide common and readily understandable definitions for both hazardous materials emergency response and terrorism in order to facilitate communications and operations among emergency responders when dealing with hazardous materials incidents. This document is not intended to be a legal or scientific reference. Modified from California Hazardous Materials Incident Contingency Plan. Abatement

The actions taken to reduce the amount, degree of the hazard, or intensity of the release or threatened release of a hazardous material.

Absorption

1) The process of absorbing or “picking up” a liquid hazardous material to prevent enlargement of the contaminated area; 2) Movement of a toxicantinto the circulatory system by oral, dermal, or inhalation exposure.

Acceptable Risk

A risk judged to be outweighed by corresponding benefits or one that is of such a degree that it is considered to pose minimal potential for adverse effects.

Access Control Point The point of entry and exit which regulates traffic to and from control zones. Adjuvant A substance used in pesticide formulation to aid its action. (Also used in the manufacture of drugs.) Adsorption

Process of adhering to a surface.

Aerosols

Liquid droplets, or solid particles dispersed in air, that are of fine enough particle size (0.01 to 100 microns) to remain dispersed for a period of time.

Airborne Pollutants

Contaminants that are carried/released into the atmosphere or air.

Air Purifying

Personal Protective Equipment; a breathing mask with specific chemical cartridges designed to

Air Purifying Respirator- powered

An APR with a portable motor to force air through the filtering/purifying cartridges for use only in atmospheres where the chemical hazards and concentrations are known.

Respirators (APR)

either filter particulates or absorb contaminants before they enter the worker’s breathing zone. They are intended to be used only in atmospheres where the chemical hazards and concentrations are known.

Air Quality Management District Area Plan A document established to facilitate emergency response to a release or threatened release of a hazardous material within a city or county. (California Health and Safety Code, Section 25503, Chapter 6.95) Asphyxiant

A vapor or gas that can cause unconsciousness or death by suffocation (lack of oxygen).

Base (Chemical)

A hydroxide containing (-OH) corrosive material that when in a water solution is bitter, more or less irritating, or caustic to the skin.

2.42

First Receiver Awareness/Operations and Decontamination for Healthcare

Base (ICS)

Location at which additional equipment, apparatus, and personnel are assembled for primary support of activities at the incident scene. The command post may be located at the "base". (NIIMS)

Biohazard

Infectious agents presenting a risk or potential risk to living organisms, either directly through infection or indirectly through disruption of the environment.

Biological Agents

Biological materials that are capable of causing acute or long term damage to living organisms. (NFPA 1990, 1-3)

Boiling Liquid A container failure with a release of energy, often rapidly and violently, which is Expanding Vapor accompanied by a release of gas to the atmosphere and propulsion of the container Explosion (BLEVE) or container pieces due to an overpressurec rupture. Boom A floating physical barrier serving as a continuous obstruction to the spread of a contaminant. Bootie

A sock like over-boot protector worn to minimize contamination.

Breakthrough Time The elapsed time between initial contact of the hazardous chemical with the outside surface of a barrier, such as protective clothing material, and the time at which the chemical can be detected at the inside surface of the material. Buddy System

A system of organizing employees into work groups in such a manner that each employee of the work group is designated to be observed by at least one other employee in the work group. [8 CCR 5192 (a)(3)]

Buffer Zone The area of land that surrounds a hazardous waste facility on which certain usages and activities are restricted to protect the public health and safety, and the environment from existing or potential hazards caused by the migration of hazardous waste. California Department of Fish and Game (DFG)

The State department which enforces provisions of the State Fish and Game Code that prohibits pollution of habitats, waters and ocean waters; and acts as the State Liaison Officer at major off highway hazardous materials incidents.

California Department of Health Services (DHS)

The State department containing the Radiological Health Branch, Office of Drinking Water and Office of Risk Assessment in addition to medical and health services.

California Department of Transportation (Caltrans)

The State department responsible for planning, designing, constructing, operating, and maintaining the State’s highway system. It will ensure, in cooperation with other public and private agencies, the identification and containment of hazardous materials and restoration of orderly traffic flow.

2.43

First Receiver Awareness/Operations and Decontamination for Healthcare

California Division of Occupational Safety and Health (Cal/OSHA)

The State division responsible for enforcement of worker safety laws.

Environmental The State agency consisting of the Departments of Toxic Substances Control Protection Agency and Pesticide Regulation, the Office of Environmental Health Hazard (Cal/EPA) Assessment, the Department of Water Resources and Regional Water Quality Control Boards, the Air Resources Board and the Integrated Waste Management Board. Cal/EPA sets the policy and direction that the member organizations pursue. California Hazardous Materials Incident Reporting System (CHMIRS)

A mandatory post-incident reporting system to collect statistical data on hazardous material incidents in California. This data includes a description of the disaster, the location, the time and date, the state and local agencies responding, the actions taken by the agencies, and the agency which had primary authority for responding to the disaster. (Chapter 6.95 of the Health and Safety Code, Title 19 CCR, and Government Code Section 8574.8 (d))

California Highway Patrol (CHP)

The State agency with primary responsibility for traffic supervision and control on all State highways constructed as freeways, all State-owned vehicular crossings, and on most State and county highways and roadways in unincorporated areas of the State. The department enforces hazardousmaterials transportation laws and acts as Incident Commander, the State Liaison Officer, and the Statewide information, assistance, and notification coordinator for all hazardous materials incidents within its jurisdiction.

California Office of Emergency Services (OES)

The State agency responsible for administration of Health and Safety Code Chapter 6.95 and Title 19 CCR, and development of Statewide disaster response plans, and coordination of Statewide mutual aid.

California Specialized The organization within the State Office of Emergency Services with the Training Institute (CSTI) responsibility to standardize curriculum and certify instructors, students, and classes in the area of hazardous materials emergency response for the public and private sectors. Carboy A container, usually encased in a protective basket or crate, used to ship hazardous materials, particularly corrosives. Carcinogen

An agent that produces or is suspected of producing cancer. (FEMA HMCP)

Cease and Desist Order

Legal direction to stop any and all activities.

Celsius (Centigrade) C

The internationally used scale for measuring temperature, in which 100o is the boiling point of water at sea level (1 atmosphere), and 0o is the freezing point.

Center for Disease The federally funded research organization tasked with disease control and Control (CDC) research.

2.44

First Receiver Awareness/Operations and Decontamination for Healthcare

Chemical Protective Any material or combination of materials used in an item of clothing for the Clothing Material purpose of isolating parts of the wearer’s body from contact with a hazardous chemical. (NFPA 1991,1-3) Chemical Protective Suit

Single or multi-piece garment constructed of chemical protective clothing materials designed and configured to protect the wearer’s torso, head, arms, legs, hands, and feet. (NFPA 1991, 1-3)

Chemical Resistance

The ability to resist chemical attack. The attack is dependent on the method of test and its severity is measured by determining the changes in physical properties. Time, temperature, stress, and reagent may all be factors that affect the chemical resistance of a material.

Chemical Resistant Materials that are specifically designed to inhibit or resist the passage of Materials chemicals into and through the material by the processes of penetration, permeation or degradation. Chemical The Chemical Transportation Center, operated by the Chemical Transportation Manufacturers Association (CMA), can provide information and technical Emergency Center assistance to emergency responders. (Phone number- 1-800-424-9300) (CHEMTREC) Chronic Effect

Delayed or slowly developing harm resulting from a chemical exposure which is often hard to recognize.

Cleanup Incident scene activities directed toward removing hazardous materials, contamination, debris, damaged containers, tools, dirt, water, and road surfaces in accordance with proper and legal standards, and returning the site to as near a normal state as existed prior to the incident. (Sacramento Fire Department HMRT) Cleanup Company A commercial business entity available for hire to specifically remove, (Hazardous Waste) transport, and/or dispose of hazardous wastes; and when appropriate, must meet California Highway Patrol and Department of Toxic Substances Control requirements. Cleanup Operation

An operation where hazardous substances are removed, contained, incinerated, neutralized, stabilized, cleared up, or in any other manner processed or handled with the ultimate goal of making the site safer for people or the environment. (8 CCR 5192(a)(3))

Clean Water Act (CWA)

Federal legislation to protect the nation’s water and set State water quality standards for interstate navigable waters as the basis for pollution control and enforcement. The main objective is to restore and maintain the chemical, physical and biological integrity of the Nation’s waters.

Cold Zone

The area outside of the warm zone. Equipment and personnel are not expected to become contaminated in this area. This is the area where resources are assembled to support the hazardous materials operation.

Combustible Liquid

Liquids with a flashpoint above 100o F. (49 CFR 173.120 (b)(2).)

2.45

First Receiver Awareness/Operations and Decontamination for Healthcare

Command

The act of directing, ordering, and/or controlling resources by virtue of explicit legal, agency, or delegated authority. (NIIMS)

Command Post

The location from which the primary command functions are executed, usually co- located with the incident base.

Community Right- Legislation requiring business establishments to provide chemical inventory to-Know information to local agencies or the public. Compatibility

The matching of protective chemical clothing to the hazardous material involved to provide the best protection for the worker.

Compatibility Charts

ermeation and penetration data supplied by manufacturers of chemical protective clothing to indicate chemical resistance and breakthrough time of various garment materials as tested against a battery of chemicals. This test data should be in accordance with ASTM and NFPA standards.

Compressed Gas

Any material or mixture having an absolute pressure exceeding 40 p.s.i. in the container at 70o F or, regardless of the pressure at 70o F, having an absolute pressure exceeding 104 p.s.i. at 130o F; or any liquid flammablematerial having a vapor pressure exceeding 40 p.s.i. absolute at 100o F as determined by testing. Also includes cryogenic or “refrigerated liquids” (DOT) with boiling points lower than -130o F at 1 atmosphere.

Confinement

Procedures taken to keep a material in a defined or localized area.

Contact

Being exposed to an undesirable or unknown substance that may pose a threat to health and safety. (Sacramento Fire Department HMRT)

Container Any device, in which a hazardous material is stored, transported, disposed of, or otherwise handled. Containment

All activities necessary to bring the incident to a point of stabilization and to establish a degree of safety for emergency personnel greater than existed upon arrival.

Contamination

An uncontained substance or process that poses a threat to life, health, or the environment. (NFPA 472, sections 1-3)

Contamination Control Line

The established line around the contamination reduction zone that separates it from the support zone. Term used by the Coast Guard to identify the area of moderate hazard where threat of contamination spread to the immediate surrounding area is low. It is the area immediately outside of the inner hot zone. (See Warm Zone.)

Contingency Plan

A pre-planned document presenting an organized and coordinated plan of action to limit potential pollution in case of fire, explosion, or discharge of hazardous materials; defines specific responsibilities and tasks.

Control

The procedures, techniques, and methods used in the mitigation of a hazardous materials incident, including containment, extinguishment, and confinement.

2.46

First Receiver Awareness/Operations and Decontamination for Healthcare

Control Zones

The designation of areas at a hazardous materials incident based upon safety and the degree of hazard. (NFPA 472, sections 1-3) (See Support Zone, Warm Zone, Hot Zone, and Decontamination Corridor.)

Corrosive The ability to cause destruction of living tissue or many solid materials surfaces by chemical action. Cryogenic

Gases, usually liquefied, that induce freezing temperatures of -150o F and below (liquid oxygen, liquid helium, liquid natural gas, liquid hydrogen, etc.).

Damming A procedure consisting of constructing a dike or embankment to totally immobilize a flowing waterway contaminated with a liquid or solid hazardous substance. (EPA, 600/2-77-277) Dangerous When Wet

A label required for water reactive materials (solid) being shipped under U.S. DOT, ICAO, and IMO regulations. A labeled material that is in contact with water or moisture may produce flammable gases. In some cases, these gases are capable of spontaneous combustion. (49 CFR 171.8)

Decontamination (Decon)

The physical and/or chemical process of reducing and preventing the spread of contamination from persons and equipment used at a hazardous materials incident. (Also referred to as “contamination reduction”.) (NFPA 472, 1-3)

Decontamination Corridor

A distinct area within the warm zone that functions as a protective buffer and bridge between the hot zone and the cold zone, where decontamination stations and personnel are located to conduct decontamination procedures.

Decontamination Officer

A position within the FIRESCOPE ICS HM-120 that has responsibility for identifying the decontamination corridor location & types of decontamination, assigning stations, and managing all decontamination procedures.

Decontamination A group of personnel and resources operating within a decontamination Team corridor. Degradation

The loss in physical properties of an item of protective clothing due to exposure to chemicals, use, or ambient conditions.

Delayed Toxic Exposure Effect

The condition in which symptoms of an exposure are not present immediately after the exposure, but are delayed for a relatively short period of time (such as pulmonary edema a few hours after an inhalation exposure).

Department of Defense (DOD)

The Federal entity that provides the military forces needed to deter war and protect Department of Justice

2.47

First Receiver Awareness/Operations and Decontamination for Healthcare

Department of Justice (DOJ)

The Federal department which serves as counsel for the citizens of the Nation; represents them in enforcing the law in the public interest; through its thousands of lawyers, investigators, and agents it plays a key role in protection against criminals and subversion, in insuring healthy competition of business in our free enterprise system, in safeguarding the consumer, and in enforcing drug, immigration, and naturalization laws; plays a significant role in protecting citizens through its efforts for effective law enforcement, crime prevention, crime detection, and prosecution and rehabilitation of offenders; conducts all suits in the Supreme Court in which the United States is concerned; and represents the Federal Government in legal matters.

Department of Transportation (DOT)

This agency assures the coordinated, effective administration of the transportation programs of the Federal government and develops national transportation policies and programs conducive to the provision of fast, safe, efficient and convenient transportation at the lowest possible cost.

DHS

See California Department of Health Services.

Dike

An embankment or ridge, natural or man made, used to control the movement of liquids, sludges, solids, or other materials.

Dispersion

To spread, scatter, or diffuse through air, soil, surface or ground water.

Diversion

The intentional, controlled movement of a hazardous material to relocate it into an area where it will pose less harm to the community and the environment.

Division

That organizational level within the ICS having responsibility for operations within a defined geographic area. The “Division” Officer directs approximately 5 Companies, and answers to the “Operations” Officer.

Dose The amount of substance ingested, absorbed, and/or inhaled per exposure period. Double gloving

A set of gloves worn over those already in place for enhanced protection.

Downwind

In the direction in which the wind blows.

Ecosystem A habitat formed by the interaction of a community of organisms with their environment. Edema

The swelling of body tissues resulting from fluid retention.

Emergency Medical Services (EMS)

Functions as required to provide emergency medical care for ill or injured persons by trained providers. The State agency responsible for developing general guidelines for triage and handling of contaminated/exposed patients; develops and promotes hazardous materials training for emergency medical responders in the field and hospital emergency rooms; identifies and coordinates the procurement of medical assistance, supplies, and hospital beds when local and/or regional resources are depleted; and coordinates the evaluation of casualties to other areas of the State.

2.48

First Receiver Awareness/Operations and Decontamination for Healthcare

Emergency Operations The secured site where government officials exercise centralized Center (EOC) coordination in an emergency. The EOC serves as a resource center and coordination point for additional field assistance. It also provides executive directives to and liaison for State and federal government representatives, and considers and mandates protective actions. Emergency Operations A document that identifies the available personnel, equipment, facilities, Plan supplies, and other resources in the jurisdiction, and states the method or scheme for coordinated actions to be taken by individuals and government services in the event of natural, man-made, and attack related disasters. Emergency Response Personnel assigned to organizations that have the responsibility for Personnel responding to different types of emergency situations. (NFPA 1991, 1-3) Endothermic A process or chemical reaction which is accompanied by absorption of heat. Entry Point

A specified and controlled location where access into the hot zone occurs at a hazardous materials incident.

Entry Team Leader

The entry leader is responsible for the overall entry operations of assigned personnel within the hot zone. (FIRESCOPE ICS-HM)

Environmental Protection Agency (EPA)

The purpose of the Environmental Protection Agency (EPA) is to protect and enhance our environment today and for future generations to the fullest extent possible under the laws enacted by Congress. The Agency’s mission is to control and abate pollution in the areas of water, air, solid waste, pesticides, noise, and radiation. EPA’s mandate is to mount an integrated, coordinated attack on environmental pollution in cooperation with State and local governments.

Etiological Agent A viable microorganism or its toxin, which causes or may cause human disease. Evacuation The removal of potentially endangered, but not yet exposed, persons from an area threatened by a hazardous materials incident. (FIRESCOPE ICSHM) Explosive Any chemical compound, mixture, or device, of which the primary or common purpose is to function by explosion, i.e., with substantial instantaneous Exposure

The subjection of a person to a toxic substance or harmful physical agent through any route of entry.

Fahrenheit The scale of temperature in which 212o is the boiling point of water at 760 mm Hg and 32o is the freezing point. First Responder The first trained person(s) to arrive at the scene of a hazardous materials incident. May be from the public or private sector of emergency services. © State of California- CalOES/CSTI 10/1/2013

2.49

First Receiver Awareness/Operations and Decontamination for Healthcare

First Responder, Awareness Level FRA

Individuals who are likely to witness or discover a hazardous substance release who have been trained to initiate an emergency response sequence by notifying the proper authorities of the release. They would take no further action beyond notifying the authorities of the release. (8 CCR 5192(q)(6))

First Responder, Individuals who respond to releases or potential releases of hazardous Operations Level FRO substances as part of the initial response to the site for the purpose of protecting nearby persons, property, or the environment from the effects of the release. They are trained to respond in a defensive fashion without actually trying to stop the release. Their function is to contain the release from a safe distance, keep it from spreading, and prevent exposures. (8 CCR 5192(q)(6)) Flammable Liquid

Any liquid having a flash point below 100o F (37.8o C). (49 CFR 173.115(a))

Flashpoint

The minimum temperature of a liquid at which it gives off vapors sufficiently fast to form an ignitable mixture with air and will flash when subjected to an external ignition source, but will not continue to burn.

Food and Drug Administration (FDA)

Performs, directs, and coordinates detection and control activities which protect consumers against adulterated, misbranded, or falsely advertised foods, drugs, medical devices, and hazardous products.

Fully Encapsulating Chemical protective suits that are designed to offer full body protection, Suits including Self Contained Breathing Apparatus (SCBA), are gas tight, and meet the design criteria as outlined in NFPA Standard 1991. Fume

Airborne dispersion consisting of minute solid particles arising from the heating of a solid material such as lead, in distinction to a gas or vapor. This physical change is often accompanied by a chemical reaction, such as oxidation. Fumes flocculate and sometimes coalesce. Odorous gases and vapors should not be called fumes.

Gas A state of matter in which the material has very low density and viscosity; can expand and contract greatly in response to changes in temperature and pressure; easily diffuses into other gases; readily and uniformly distributes itself throughout any container. A gas can be changed to a liquid or solid state by the combined effect of increased pressure and/or decreased temperature. Group

Groups are established to divide the incident into functional areas of operation.

Habitat

The native environment of an animal or plant; the natural place for life and growth of an animal or plant.

Hazard Any situation that has the potential for causing damage to life, property, and/or the environment. Hazardous Chemical

A term used by the United States Occupational Safety and Health Administration HealthAdministration (OSHA) to denote any chemical that would be a risk to employees if exposed in the workplace. The list of hazardous chemicals is found in 29 CFR.

2.50

First Receiver Awareness/Operations and Decontamination for Healthcare

Hazardous Material (Hazardous materials)

A substance or combination of substances which, because of quantity, concentration, physical, chemical or infectious characteristics may cause, or significantly contribute to an increase in deaths or serious illness; and/or pose a substantial present or potential hazard to humans or the environment.

Hazardous Substance Hazardous Substance, as used by the California Department of Toxic Substances Control, encompasses every chemical regulated by both the Department of Transportation (hazardous materials) and the Environmental Protection Agency (hazardous waste), including emergency response (8 CCR 5192). Hazardous Waste Any location used for the treatment, transfer, disposal or storage of Facility hazardous waste as permitted and regulated by the California Department of Toxic Substances Control. Herbicide An agricultural chemical intended for killing plants or interrupting their normal growth. (See Pesticides.) High Performance A procedure used in organics analysis to separate chemical mixtures based Liquid Chromatography on differential ionic absorption to various substrates. Hot Zone. An (HPLC) area immediately surrounding a hazardous materials incident, which extends far enough to prevent adverse effects from hazardous materials releases to personnel outside the zone. This zone is also referred to as the “exclusion zone”, the “red zone”, and the “restricted zone” in other documents. (NFPA 472, 1-3) Immediately Dangerous to Life or Health (IDLH)

An atmospheric concentration of any toxic, corrosive or asphyxiant substance that poses an immediate threat to life or would cause irreversible or delayed adverse health effects or would interfere with an individual’s ability to escape from a dangerous atmosphere. (8 CCR 5192(a)3) Information Officer (IO) The individual assigned to act as the liaison between the Incident Commander and the news media, as well as other groups.

Incident An event involving a hazardous materials or a release or potential release of a hazardous material. Incident Action Plan A plan developed at the field response level which contains objectives (IAP) reflecting the overall incident strategy and specific tactical actions and supporting information for the next operational period. The plan may be oral or written. Incident Command

A disciplined method of management established for the specific purpose of control and direction of resources and personnel.

Incident Commander The individual responsible for overall management of the incident at the (IC) field level. Incident Command System (ICS) © State of California- CalOES/CSTI 10/1/2013

2.51

First Receiver Awareness/Operations and Decontamination for Healthcare

Ingestion The process of taking substances such as food, drink, and medicine into the body through the mouth. Irritant

A material that has an anesthetic, irritating, noxious, toxic, or other similar property that can cause extreme annoyance or discomfort. (49 CFR)

Isolating the Scene Preventing persons and equipment from becoming exposed to a release or threatened release of a hazardous material by the establishment of site control zones. LC50 (lethal The amount of a toxicant in air which is deadly to 50% of the exposed lab animal concentration, 50%) population within a specified time. LD50 (lethal dose, 50%)

The amount of a toxicant administered by other than inhalation which is deadly to 50% of the exposed lab animal population within a specified time.

Leak

The uncontrolled release of a hazardous material which could pose a threat to health, safety, and/or the environment.

Level of Protection

In addition to appropriate respiratory protection, designations of types of personal protective equipment to be worn based on NFPA standards. • Level A - Vapor protective suit for hazardous chemical emergencies. • Level B - Liquid splash protective suit for hazardous chemical emergencies. • Level C - Limited use protective suit for hazardous chemical emergencies.

Level One Incident

Hazardous materials incidents which can be correctly contained, extinguished, and/or abated utilizing equipment, supplies, and resources immediately available to first responders having jurisdiction, and whose qualifications are limited to and do not exceed the scope of training as explained in 8 CCR 5192, or California Government Code (CGC), Chapter 1503, with reference to “First Responder, Operational Level”.

Level Two Incident

Hazardous materials incidents which can only be identified, tested, sampled, contained, extinguished, and/or abated utilizing the resources of a Hazardous Materials Response Team, which requires the use of specialized chemical protective clothing, and whose qualifications are explained in 8 CCR 5192, or California Government Code (CGC), Chapter 1503, with reference to “Hazardous Materials Technician Level”.

Level Three Incident A hazardous materials incident which is beyond the controlling capabilities of a Hazardous Materials Response Team (Technician or Specialist Level) whose qualifications are explained in 8 CCR 5192, or California Government Code, Chapter 1503; and/or requires the use of two or more Hazardous Materials Response Teams; and/or must be additionally assisted by qualified specialty teams or individuals. Local Disaster Plan A plan developed and used by local government for extraordinary events. Local Emergency A committee appointed by a State emergency response commission, as required by Planning SARA Title III, to formulate a comprehensive emergency plan for its corresponding Committee(LEPC) Office of Emergency Services mutual aid region.

2.52

First Receiver Awareness/Operations and Decontamination for Healthcare

Lower Explosive Limit The lowest concentration of the material in air that can be detonated by (LEL) spark, shock, or fire, etc. Mutual Aid

An agreement to supply, if available, specifically agreed upon aid or support in an emergency situation between two or more agencies, jurisdictions, or political sub-divisions without the expectation of reimbursem*nt.

Narcosis

Stupor or unconsciousness produced by chemical substances.

National Fire Protection Association (NFPA)

An international voluntary membership organization to promote improved fire protection and prevention, establish safeguards against loss of life and property by fire, and writes and publishes the American National Standards.

National Institute for Occupational Safety and Health (NIOSH)

A Federal agency which, among other activities, tests and certifies respiratory protective devices, air sampling detector tubes, and recommends occupational exposure limits for various substances.

National Response Center (NRC)

A communications center operated by the United States Coast Guard headquarters located in Washington, DC. They provide information on suggested technical emergency actions, and must be notified by the spiller within 24 hours of any spill of a reportable quantity of a hazardous substance.

Necrosis

Death in a particular part of a living tissue.

Nephrotoxic

A substance that negatively affects the kidneys.

Neurotoxic

A substance that negatively affects the nervous system.

Occupational Safety and Health Administration (OSHA)

Component of the United States Department of Labor; an agency with safety and health regulatory and enforcement authorities for most United States industries, businesses and States.

On-Scene Coordinator As explained in the National Contingency Plan, it is the pre-designated (OSC) Federal official who coordinates Federal activities at a hazardous material incident, and monitors the incident for compliance with Federal pollution laws. Operations The coordinated tactical response of all field operations in accordance with the Incident Action Plan.

A concentration of oxygen insufficient to support life.

Oxygen Deficient Atmosphere

An atmosphere which contains an oxygen content less than 19.5 % by volume at sea level.

2.53

First Receiver Awareness/Operations and Decontamination for Healthcare

Pallets A low portable platform constructed of wood, metal, plastic, or fiberboard, built to specified dimensions, on which supplies are loaded, transported, or stored in units. Parts Per Million (ppm)

A unit for measuring the concentration of a particular substance equal to one (1) unit combined with 999,999 other units.

Pathogen

Any disease producing organism, including viruses.

Penetration The movement of liquid molecules through a chemical protective clothing, suit, garment or material. Permeation The movement of vapor or gas molecules through a chemical protective garment material. Permissible Exposure Limit (PEL)

The employees’ permitted exposure limit to any material listed in Table Z-1, Z-2, or Z-3 of OSHA regulations, section 1910.1000, Air Contaminants.

Personal Protective Equipment provided to shield or isolate a person from the chemical, physical, Equipment (PPE) and thermal hazards that may be encountered at a hazardous materials incident. Adequate personal protective equipment should protect the respiratory system, skin, eyes, face, hands, feet, head, body, and hearing. Personal protective equipment includes- personal protective clothing, self contained positive pressure breathing apparatus, and air purifying respirators. (NFPA 472, 1-3) Pesticides

A chemical or mixture of chemicals used to destroy, prevent, or control any living organism considered to be a pest. pH A numerical designation of the negative logarithm of hydrogen ion concentration. A pH of 7.0 is neutrality; higher values indicate alkalinity and lower values indicate acidity.

Plume A vapor, liquid, dust or gaseous cloud formation which has shape and buoyancy. Poison Control Centers California is served by four certified and designated regional poison control centers. Each PCC is available 24 hours a day and can provide immediate health effects, scene management, victim decontamination, and other emergency medical treatment advice for hazardous materials emergencies. A physician specializing in medical toxicology is available for back-up consultation. Radioactive The spontaneous disintegration of unstable nuclei accompanied by emission of nuclear radiation. Radioactive Material Any material, or combination of materials, that spontaneously emits ionizing (RAM) radiation and has a specific activity greater than 0.002 microcuries per gram. (49 CFR 173.389) Rescue

The removal of victims from an area determined to be contaminated or otherwise hazardous by appropriately trained and equipped personnel.

2.54

First Receiver Awareness/Operations and Decontamination for Healthcare

Residue

A material remaining in a package after its contents have been emptied and before the packaging is refilled, or cleaned and purged of vapor to remove any potential hazard.

Response

That portion of incident management where personnel are involved in controlling a hazardous material incident. (NFPA 472, 1-3)

Safety Data A document which contains information regarding the specific identity of hazardous Sheet (SDS) chemicals, including information on health effects, first aid, chemical and physical properties, and emergency phone numbers. Mitigation Any action employed to contain, reduce, or eliminate the harmful effects of a spill or release of a hazardous material. Safety Officer

Selected by the Incident Commander, a person at an emergency incident responsible for assuring that all overall operations performed at the incident by all agencies present are done so with respect to the highest levels of safety and health. The Safety Officer shall report directly to the Incident Commander.

Scenario

An outline of a natural or expected course of events.

Scene

The location impacted or potentially impacted by a hazard.

Self Contained Breathing Apparatus(SCBA)

A positive pressure, self-contained breathing apparatus (SCBA) or combination SCBA/supplied air breathing apparatus certified by the National Institute for Occupational Safety and Health (NIOSH) and the Mine Safety and Health Administration (MSHA), or the appropriate approval agency for use in atmospheres that are immediately dangerous to life or health (IDLH). (NFPA 1991, 1-3)

Sheltering In Place/ To direct people to quickly go inside a building and remain inside until the danger InPlace Protection passes. Short Term Exposure See Threshold Limit Value –Short Term Exposure Limit (TLV-STEL). Limit (STEL) Site

Any facility or location within the scope of 8 CCR 5192(a)(3).

Sludge

Accumulated solids, semisolids, or liquid waste generated from wastewaters, drilling operations, or other fluids.

Solubility

The ability or tendency of one substance to blend uniformly with another.

Staging Area

The area established for temporary location of available resources closer to the incident site to reduce response time.

State Warning Center (OES Warning Center)

The Governor’s Office of Emergency Services Warning Center facilitates emergency communications with government agencies at all levels. The could cause a disaster and is the central reporting office for any release or threatened release of a hazardous material. The Warning Center is the initial point in the state where coordination begins to mobilize federal, state and local agencies during a disaster.

Synergistic Effect The combined effect of two chemicals which is greater than the sum of the effect of each agent alone. Systemic

Pertaining to the internal organs and structures of the body.

2.55

First Receiver Awareness/Operations and Decontamination for Healthcare

Team Leader

See Entry Team Leader.

Person assigned to document activities of the Hazardous Material Team and gather information relevant to the chemicals involved and their hazards.

Termination

That portion of incident management where personnel are involved in documenting safety procedures, site operations, hazards faced, and lessons learned from the incident. Termination is divided into three phases- Debriefing, Post-Incident analysis, and Critique. (NFPA 472, 1-3) (See Post-Incident Analysis.)

Threshold Limit Value(TLV)

The value for an airborne toxic material that is to be used as a guide in the control of health hazards and represents the concentration to which nearly all workers may be exposed 8 hours per day over extended periods of time without adverse effects.

Toxic

Poisonous; relating to or caused by a toxin; able to cause injury by contact or systemic action to plants, animals or people.

Traffic Control/ CrowdControl

Action(s) by law enforcement to secure and/or minimize exposure of the public to unsafe conditions resulting from emergency incidents, impediments and congestion.

Treatment

Any method, technique, or process which changes the physical, chemical, or biological character or composition of any hazardous waste, or removes or reduces its harmful properties or characteristics for any purpose.

United Nations (UN) When UN precedes a four-digit number, it indicates that this identification number is Identification used internationally to identify a hazardous material. Number Upper Explosive Limit(UEL)

The highest concentration of the material in air that can be detonated.

Vapor

An air dispersion of molecules of a substance that is normally a liquid or solid at standard temperature and pressure.

Vulnerability

The susceptibility of life, the environment, and/or property, to damage by a hazard.

Warm Zone The area where personnel and equipment decontamination and hot zone support takes place. It includes control points for the access corridor and thus assists in reducing the spread of contamination. This is also referred to as the “decontamination”, “contamination reduction”, “yellow zone”, or “limited access zone” in other documents. (NFPA 472, 1-3)

2.56

First Receiver Awareness/Operations and Decontamination for Healthcare

Participants Manual: Chapter 3 Safety, Isolation, Notifications First Receiver Operations and Decontamination for Healthcare Scope This chapter introduces the Awareness Level Actions of Safety, Isolation and Notification and discusses the procedures for Directed Self Decontamination.

Time

Instructor/Participant Ratio

2 hours

1/30

Method of Instruction Facilitated Seminar

Terminal Objective At the end of this chapter participants will be able to initiate the Awareness Level Actions of Safety, Isolation and making proper Notifications in a hazardous materials incident.

Enabling Objectives 1. 2. 3. 4.

Describe the First Operational Thought Understand the limits of the Awareness Level Describe the Frst Operational Action Describe the proper procedures of making notifications in a hazmat incident 5. Understand the concept and procedure for directed selfdecontamination. © State of California-CalOES/CSTI 10/12013

3.1

First Receiver Awareness/Operations and Decontamination for Healthcare

Develop proceduers to identify and assess hazards Develop plans, policies, procedures and systems for public information, alert/warnings and notifications

ResB2b 5.2.1

Identify hazardous materials and extent/scope of incident

Res B2b 8.1

Identify assest required for decontamination activities

Supporting Materials • Course Outline • Participant Manual

Activities • Easel Charts for Brainstorming

3.2

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 3.1

S I N

AFETY

SOLATION

Now let’s talk about what you do at the Awareness Level when you encounter a Hazardous Materials situation. You SIN!

OTIFICATION

SIN: The Correct Awareness Level Response to Internal Spills and Contaminated Patients

SAFETY (First, last, and always) Don’t be a Dead Hero!

• • • • •

Get the big picture. Can you handle it? What are the risks? What do you know? What don’t you know?

ISOLATE • Isolate the scene and deny entry.

– (if someone has something on them don’t let them go away. If others haven’t been exposed don’t let them have contact with the chemicals.)

Slide 3.2 Safety is the MOST important thing. Your Safety comes first. It is the First Operational Thought. It doesn’t help for you to take unprotected or uninformed actions if it incapacitates or kills you.

Slide 3.3 Discuss how this would be done in an: Internal event: shutting doors, barricades, posting personnel to isolate area. External event: barricade, caution tape, establishing a perimeter, posting “guards”.

3.3

First Receiver Awareness/Operations and Decontamination for Healthcare

NOTIFY • Call the hospital operator to announce a Code Orange (or site specific name) • Call your Supervisor • Call your Hazmat Coordinator • Have the operator call 911

Definitions - FRA

Slide 3.4

Hazmat incidents both internal and external require that notifications be made. What is your facility code for a Hazmat incident? At a minimum you should notify the operator and your supervisor. Procedures should be in place for the operator to notify 911.

Slide 3.5 This slide defines the role of the First Receiver at the Awareness Level.

• First Receiver “Awareness” – Likely to witness/discover a release – Notify proper authorities – Take no further action

First Operational Thought • First operational thought is safety – Safety starts with first receiver on-scene – All must have positive safety attitude

Slide 3.6 Safety is an operational thought, not an action.

3.4

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 3.7

Conduct Safe Assessment

Evaluate the situation. Don’t get to close if you suspect a hazmat. SLOW DOWN. Do not become part of the problem.

• Conduct size-up! • Don’t get close enough for positive ID • Slow down, shut-off A/C, observe area • Don’t touch suspected contaminated patients

Slide 3.8

Isolation First Operational Priority • FROs — usually isolate and deny entry by establishing a “Perimeter” ERG

Isolation is the first Operational Action. Keep yourself and others from becoming contaminated.

• How do you set up perimeters in the Hospital ? – Use ERG recommendations

Isolation First Operational Priority • Dilemma – Safe distance vs. control of Perimeter

Slide 3.9 Be realistic about how much area you can isolate until enough resources are available.

– If too large will require more resources.

3.5

First Receiver Awareness/Operations and Decontamination for Healthcare

Perimeters & Control Zones • Purpose of Perimeters & Control Zones – Ensure safety and isolation – Control the scene – Limit spread of contamination – Allow for safe working area

Slide 3.10 Establishing the Perimeter is essential. To ensure safety and isolation, limit contamination spread, control scene & allow for activities such as decontamination. Main operational difference between Perimeter & Zones —FRO’s usually set Perimeters and Tech’s/Specialists set Zones.

Control Access to Perimeter • • • • •

Deny entry to all Stage receivers not assigned Establish emergency exit procedures Establish control zones If outside watch for wind shifts

Slide 3.11 Control Zones will be covered more in the FRO course. Exclusion/Hot Zone: Area of isolation (only responders with proper level of protection, as determined by Haz Mat Group and enforced by Safety Officer are allowed in this Zone). Contamination Reduction/Warm Zone: Used to control areas such as Decontamination (reduced levels of protection might be used).

Support/Cold Zone — Safe area for Command Post, Media, etc. (No protective clothing or respiratory protection required).

3.6

First Receiver Awareness/Operations and Decontamination for Healthcare

Field Control Zones

Exclusion Zone

Slide 3.12 This diagram shows how the zones may lay out at an incident. This will look different at a hospital.

Contamination Reduction Zone

Support Zone

Hospital Zones • Hospital Decontamination Zone

Slide 3.13 Identification of zones. Hospitals use a modified version of the zones.

• Post Decontamination Zone

Slide 3.14 Pre-Decon Zone (Exclusion / Hot / Red)

We often use color codes in association with the zones.

Decon Zone (Contamination Reduction / Warm / Yellow) Post-Decon Zone (Support / Cold / Green)

Pre-decontamination zone (HOT)= Red Hospital Decon Zone (WARM) = Yellow Post-Decon (Support) = Green

3.7

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 3.15 Decontamination Control Zones

Here is what happens in each zone.

Pre-Decon = Staging of “dirty” People Decon = Removing Contamination Post-Decon = Medical Care

Slide 3.16 Video on decontamination

Types of Notifications • Mandatory notifications • Resource requests

Slide 3.17 Notifications: who do you need to contact? Activate your facility protocols. Code Orange, etc.

Every facility should have someone designated as the Haz Mat Coordinator. Depending on the size of the facility, this person may or may not have much hazmat experience. But they are responsible. If the situation is bad, or people need rescue, 911 should be initiated. Get someone there with higher levels of protection. • Report of conditions

Note: If you need help, ask for it. Generally the local resources are contacted first (e.g., fire, law, environmental management). Know your local capabilities. © State of California- CalOES/CSTI 10/1/2013

3.8

First Receiver Awareness/Operations and Decontamination for Healthcare

Notification Requirements • Mandatory Notifications – Local 911 (Local Dispatch) – CUPA/Administering Agency – State Warning Center (800-852-7550) – National Response Center (800-424-8802)

Notification Requirements • Receivers — make same notifications as back-up • RP must make “mandatory” notifications – Possible civil/criminal penalties for non–notification!

Slide 3.18 External- In the event outside resources are required notify 911. They will usually make the other notifications.

Slide 3.19 Other notifications

Slide 3.20

Internal notifications need to be made. Notify the operator, supervisor, and hazmat coordinator. Ensure 911 has been notified.

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

3.9

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 3.21 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?

What are the concerns when there is a contaminated patient? (in the context of Awareness Level training). 1st - Is the patient contaminated? How dangerous is the contamination? Is there a danger of secondary contamination?

2nd - It must be a priority to prevent or reduce contamination of the Emergency Department. This includes contamination of staff and other patients. 3rd - Actions need to be taken as promptly as possible (without sacrificing safety). Does the patient need medical care, need to decon so the patient can receive medical treatment. Slide 3.22 Directed Self Decontamination (continued)

What are your first ACTIONS?

S I N

Here are your initial actions before initiating “Directed Self Decontamination”

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.

Slide 3.23 [show video, “Fresno Fire, Self Assessment, Decontamination”, segment with patient presenting to the Triage nurse] I. Discuss the clues that were seen.

3.10

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 3.24

Trash Bag Decon

[handout - Trash Bag Decon kit” contents]

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

Your facility may not have Decon showers, so what can you do. Maintaining modesty screening is important. So this is the lowest tech method you can use if you don’t have showers or capabilities for modesty screening.

Even if you do have showers, using these “Trash Bag Decon kits” can be helpful in managing valuables and clothes. IE: The bags are pre-numbered with matching arm bands. [Demonstrate contents and use of contents. Patient would need to be directed to put valuables in smaller bag (leave glasses on), put black trash bag on over head, take all clothes off underneath, place clothes in larger bag, double bag into big bag all the contents came in. Wash with large amount of water, can put hose right under bag. Can dry off and put on gown or coveralls under bag, then take the bag off. I. Remember you must SIN. Slide 3.25

How Soap Works.

(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.

OIL

Molecules

SOAP

WATER

Molecules

There may be a question of what to use to Decon someone. Soap and Water is the best. Use a mild, liquid soap. (Small bottles of surgical soap or baby shampoo work well.) Can have buckets of water with soap in it. Provide soft long handled brushes, wash clothes or sponges. Do not use bars of soap - people have a tendency to scrub too hard.

3.11

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 3.26

Step A • Open this package and find the clear bag.

These are the steps in Directed Self Decontamination using the Trash Bag Technique.

• Remove your over garments, and shoes. • Place these items in the clear bag.

Thanks to Anna Valdez, RN for use of these slides

Slide 3.27

Step B •

The kit should have a bag for personal items.

Remove your personal items such as your watch, jewelry, and valuables and place them in the small Ziploc bag.

Slide 3.28

Step C

It is important to identify personal belongings.

• With the pen, write your name on the label on the clear bag. • Attach the label to the large clear bag.

3.12

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 3.29

Step D • Find the black plastic bag and place it on you over your clothing like a poncho.

Here a large opaque trash bag is used to protect the modesty of the victim. Modesty protection is very important. Screens and shelters may also be used.

There are holes for your head and arms.

Slide 3.30

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.

When no other modesty protection is available the victim my disrobe while covered with the trash bag.

Slide 3.31

Step F • Use the sponge and soap that is inside of this bag to wash any residue from your body. • Await further decontamination instructions.

The bag may be left in place as the victim washes and rinses.

3.13

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 3.32 Demonstrate Directed Self Decon for the class. This may be an outside activity.

Review • Questions • Post Assessment – must have name on top

• Module Evaluation – name optional

3.14

First Receiver Awareness/Operations and Decontamination for Healthcare

Supplemental Material Safety, Isolation and Notifications: (S.I.N.) Main Points •

Definition of “First Receiver” & “SIN”

•

The First Operational Thought—Safety

•

The First Operational Priority—Isolation

•

The First Operational Alert—Notifications

3.15

First Receiver Awareness/Operations and Decontamination for Healthcare

Block Outline 1.

Definition of First Receiver and “SIN.” a.

Definition of First Receiver Awareness and Operations levels: 1) First Receiver “Awareness”: One likely to witness or discover a Haz Mat release and can initiate a response by notifying authorities, taking no further actions (SIN only). 29 CFR 1910.120(q)(6)(i), Title 8 CCR 5192(q)(6)(A). 2) First Receiver “Operations”: One who responds to Haz Mat releases for purpose of protecting nearby persons, environment or property — trained in a defensive fashion without trying to stop the release. (SINCIAPCPDDD). 29 CFR 1910.120(q)(6)(ii), Title 8 CCR 5192(q)(6)(B).

Definition of “SIN:” 1) Safety, 2) Isolation, 3) Notifications.

c. All Haz Mat receivers should “SIN” at the basic initial on–scene actions at all Haz Mat incidents.

3.16

First Receiver Awareness/Operations and Decontamination for Healthcare

Response/Receiving Levels. First Receiver “Awareness” vs. “Operations” Awareness

Likely to witness or discover a release. Initiate an emergency response. Notify the authorities of the release.

Operations

Likely to witness or discover a release. Initiate an emergency response. Notify the authorities of the release. Respond to release in defensive fashion. Protect persons, property & environment. Contain the release from a safe distance.

First Receiver vs. Technician/Specialist Awareness/Operations

Part of initial response. Respond to release in defensive fashion. Contain the release from a safe distance.

Tech-Spec

Implement emergency response plan. Assume a more aggresive role. Control or stop the release.

3.17

First Receiver Awareness/Operations and Decontamination for Healthcare

The First Operational Thought — SAFETY. a.

The first operational thought for everyone = Safety! 1) Safety starts with the first contact with the patient in the hospital! 2) Receivers must have a “Positive Safety Attitude.”

Three techniques to ensure safety and a positive safety attitude: 1) Safe Approach, 2) Safe Assessment, 3) Key Safety Guides for all receivers to follow.

c. Approach Haz Mats from a safe direction (Upwind, Upgrade & Upstream), and a safe distance (per ERG). d.

Conduct a safe assessment/size-up: 1) Do not get close enough for positive identification. 2) Slow vehicle down, shut off air/ventilation and observe area. 3) Use binoculars to identify/assess incident.

Desired First Receiver initial actions: 1) Safe approach at a safe distance, 2) Isolate and deny entry, 3) Make initial Notifications, 4) Establish temporary command.

3.18

First Receiver Awareness/Operations and Decontamination for Healthcare

S.I.N.

First Operational Thought: Safety

First Operational Priority: Isolate and Deny Entry

First Operational Alert: Notifications Not all notifications are mandatory but the following are: •Local Dispatch Local 911 •Administering Agency/CUPA ???-???? •State OES/Warning Center 800-852-7550 •National Response Center 800-424-8802

Note: Specific incidents may require other notifications!

3.19

First Receiver Awareness/Operations and Decontamination for Healthcare

The First Operational Thought — SAFETY (cont.) f.

Ten key safety guides for hospitals: 1) Be cautious; treat materials as hazardous until proven otherwise. 2) Approach upwind, upgrade and upstream. 3) Keep safe distance until IDHA complete and risk is confirmed. 4) Isolate and deny entry (limit number of receivers). 5) Do not rush to victims without doing a risk assessment (Risk vs. Gain) and wearing proper protective equipment. 6) Do not touch, taste or breathe unknown released material (do not assume vapor is harmless due to lack of smell). 7) Do not eat, drink or smoke in incident area. 8) Eliminate all ignition sources near incident area. 9) Establish and observe safety perimeters and control zones. 10) Do not worry about looking foolish (your health and the health of others is at stake), think safety!

g. OSHA regulations, 29 CFR 1910.120(q) and Title 8 CCR 5192(q), require IC to designate a Safety Official/Officer. 1) Safety Officer ensures safety on scene by conducting safety related activities—can suspend any unsafe act. 2) Checklist of safety “Rules” vs. “Guides” may provide better tool for “Safety Official” to enforce safe response on scene.

3.20

First Receiver Awareness/Operations and Decontamination for Healthcare

Safety Official 29 CFR 1910.120(q)(3), Title 8 CCR 5192(q)(3) “(vii) The individual in charge of the ICS shall designate a safety official, who is knowledgeable in the operations being implemented at the emergency response site, with specific responsibility to identify and evaluate hazards and to provide direction with respect to the safety of the operations for the emergency at hand. (viii) When activities are judged by the safety official to be an IDLH and/or to involve an imminent danger condition, the safety officer shall have the authority to alter, suspend, or terminate those activities. The safety official shall immediately inform the individual in charge of the ICS of any actions needed to be taken to correct these hazards at the emergency scene.”

3.21

First Receiver Awareness/Operations and Decontamination for Healthcare

HICS Hazardous Materials Group Organizational Chart Hospital Incident Command System Incident Management Team Structure August 2006 Incident Commander

Safety Officer

Public Information Officer

Liaison Officer

Planning Section Chief

Operations Section Chief

Staging Manager

Personnel Staging Team Vehicle Staging Team Equipment/Supply Staging Team Medication Staging Team

Medical Care Branch Director

Inpatient Unit Outpatient Unit Casualty Care Unit Mental Health Unit Clinical Support Services Unit Patient Registration Unit

Infrastructure Branch Director

Power/Lighting Unit Water/Sewer Unit HVAC Unit Building/Grounds Damage Unit Medical Gases Unit Medical Devices Unit Environmental Services Unit Food Services Unit

HazMat Branch Director

Detection and Monitoring Unit Spill Response Unit Victim Decontamination Unit Facility/Equipment Decontamination Unit

Security Branch Director

Access Control Unit Crowd Control Unit Traffic Control Unit Search Unit Law Enforcement Interface Unit

Business Continuity Branch Director

Information Technology Unit Service Continuity Unit Records Preservation Unit Business Function Relocation Unit

Medical/Technical Specialist

Biological/Infectious Disease Chemical Radiological Clinic Administration Hospital Administration Legal Affairs Risk Management Medical Staff Pediatric Care Medical Ethicist

Finance/ Administration Section Chief

Logistics Section Chief

Resources Unit Leader

Personnel Tracking Materiel Tracking

Service Branch Director

Communications Unit IT/IS Unit Staff Food & Water Unit

Time Unit Leader

Situation Unit Leader

Patient Tracking Bed Tracking

Support Branch Director

Employee Health & Well-Being Unit Family Care Unit Supply Unit Facilities Unit Transportation Unit Labor Pool & Credentialing Unit

Procurement Unit Leader

Documentation Unit Leader

Demobilization Unit Leader

Compensation/ Claims Unit Leader

Cost Unit Leader

3.22

First Receiver Awareness/Operations and Decontamination for Healthcare

The First Operational Priority — ISOLATION a.

The first operational priority = Isolate and deny entry! 1) Receivers can safely attempt to isolate and deny entry by establishing Perimeters & Control Zones via ERG. 2) The dilemma of distance in safety vs. isolation (distance is safety’s #1 ally, while it is isolation’s #1 enemy).

Perimeter and Zones 1) Purpose: ensure safety and isolation, control the scene, limit contamination spread and allow for safe working areas. 2) Main difference: FRAs and FROs usually set up Perimeters, while Technicians/Specialists set up Control Zones. c.

Perimeter and Control Zone terminology: 1) Perimeter - Outside security line around all Control Zones. 2) Exclusion/Hot Zone - Area of isolation (only responders/ receivers with a specific task & proper level of protective clothing in this Zone). 3) Contamination Reduction/Warm Zone - Used to control areas like Safe Refuge and Decontamination (may use a reduced protective clothing level in this Zone). 4) Support/Cold Zone - Safe area for Command Post, media, medical aid, etc. (No protective clothing or SCBA required). Exclusion Zone, Contamination Reduction Zone and Support Zone are all within the Perimeter. Remember in a hospital and/or emergency room setting, the PATIENT may BE the Hot Zone!

3.23

First Receiver Awareness/Operations and Decontamination for Healthcare

Perimeters and Zones

First Operational Thought — Safety First Operational Priority — Isolate & Deny Entry... Via Perimeter and Zones

Perimeter:

Security line surrounding control zones to isolate and deny entry to any unnecessary people, usually established by law enforcement.

Zone: Zones to ensure safety, limit spread of the hazard, control hazard area, conduct decon and support emergency operations as established by Haz Mat Group/Team. Examples: Exclusion Zone: Also called Hot Zone, Red Zone, Inner Perimeter. Contamination Reduction Zone: Also called Warm Zone, Yellow Zone, Secondary Perimeter. This is where Decontamination occurs! Support Zone: Also called Cold Zone, Green Zone, Outer Perimeter. Control Zone terms from Occupational Safety and Health Guidance Manual for Hazardous Waste Site Activities, NIOSH Publication 85-115, October 1985.

3.24

First Receiver Awareness/Operations and Decontamination for Healthcare

The First Operational Priority — ISOLATION (cont.) d.

Perimeter Control Objectives: 1) Control “Entry Points” (secure doors, stairways, gates, etc.). 2) Control “Perimeter” between all Entry Points. 3) Control “Access” inside Perimeter (incl. responders/ receivers).

Perimeter Control Tactics: 1) Determine size and extent of perimeter (per ERG, downwind perimeter will usually be longer), 2) Identify all entry points, 3) Control all entry points, 4) Identify and establish boundaries for perimeter, a) Unstaffed barricades usually ineffective, b) Use existing barriers. 5) Control access to the perimeter, a) Deny entry to all unauthorized personnel (including unnecessary hospital personnel), b) Stage all workers without an immediate mission, c) Establish emergency exit procedures for all workers.

f. The IC is ultimately responsible for Perimeters and Control Zones (may need tactical plans and prearranged logistics to manage this).

3.25

First Receiver Awareness/Operations and Decontamination for Healthcare

Isolation and Deny Entry Objectives Entry Points: Control Entry Points •Visually determine isolation distance for Perimeter. •Identify closest entry/control points for Perimeter. (e.g. doorways, gates, etc.) Others: ___________________________ •Start with most obvious and most commonly used Perimeter entry point. (FEMA studies have shown people will evacuate through exits they are accustomed to using.) •Make early request for sufficient units to secure entry points. (Use Hospital Security, Law Enforcement or Auxiliary/Reserve Units. Give incident location and safe routes for ingress.) •Use all available methods of restricting access (e.g. barricades, cones, etc.) Others: ____________________________ •Identify staging areas for receivers. Hazard:

Control Area Around Hazard •Secure the area around the hazard area. •Use tape, natural barriers, patrols, etc. •Remember, it’s easier to make a perimeter smaller than bigger after you establish it. Don’t be afraid to start big.

Perimeter:

Control Access Inside Perimeters •Keep public and nonessential receivers out. •Maintain patrol of perimeter area. •Provide security for Support Zone work areas. •Provide traffic control as necessary. •Maintain communication with security group at all times! •Have an emergency escape route!!

3.26

First Receiver Awareness/Operations and Decontamination for Healthcare

The First Operational Alert — NOTIFICATIONS a.

Three types of “Notifications” to alert others of a Haz Mat event: 1) “Mandatory” Notifications, 2) “Resource” requests, 3) “Report of Conditions.”

b. Responsible Party must notify authorities of a Haz Mat release or potential release. Criminal penalties are possible for non-notification. 1) Receivers should make the same notifications as back-up. 2) Mandatory notifications: a) Local dispatch (Local 911), b) CUPA/Local Administering Agency (#:_____________), c) State Warning Center (800-852-7550), d) National Response Center (800-424-8802). 3) Other notifications per specific incident: a) Pesticide spill - County Agriculture, b) Spill in state waters - OES (who must notify RWQCB, OSPR & State Lands Commission), c) Spill on state highway/freeway (incl. county roads) – CHP d) Radiological release - DHS (Radiological Branch), e) Release impacting state wildlife – DFG, f) Acutely hazardous material within 1/2 mile of school - School District Superintendent, Prop 65 Haz Mats Board of Supervisors & Health Officer. Note: Receivers must make notifications for f)

3.27

First Receiver Awareness/Operations and Decontamination for Healthcare

Legal Requirements for Notifications Required Notifications

NRC

OES

FOSC

State Agenci es

Admi ni steri ng Agency/CUPA

Local Response Agenci es*

* Usual l y contact through 911

NRC:

“Notice of an oil discharge or release of a hazardous substance in an amount equal to or greater than the reportable quantity must be made immediately…to the NRC duty…” 40 CFR 300.125(c).

CUPA/AA:

“(a) … provide an immediate, verbal report of any release or threatened release of a hazardous material to the Administering Agency and the [OES]…(d) The [AA] may designate a call to the 911 … as meeting the requirement to call the [AA].” Title 19 CCR 2703.

CalEMA:

“… immediately report any release or threatened release of a hazardous material to the administering agency and the [California Emergency Management Agency].” §25507, California Health & Safety Code.

Transportation:

“…each carrier who transports hazardous materials (including hazardous wastes) shall give notice in accordance with paragraph (b) of this section after each incident…” 49 CFR 171.15 (federal regulation) Title 13 CCR 1166 (equivalent California regulation).

Schools: “Emergency rescue personnel…shall immediately advise the superintendent…where the location of the release or threatened release is within one-half mile of a school.” §25507.10 California Health & Safety Code. Oil: “Any local or state agency responding to a spill of oil shall notify the Office of Emergency Services, if notification…has not occurred.” §8670.26 California Government Code.

3.28

First Receiver Awareness/Operations and Decontamination for Healthcare

The First Operational Alert — NOTIFICATIONS (cont.) 4)

General information needed for mandatory notifications: a) Name/Agency of person reporting, b) Location of Haz Mat release, c) Haz Mat involved, d) Nature of problem, e) Quantity released, f) Potential hazards, etc. 5) Key point of notification for state agencies is State Warning Center. a) CalEMA will provide IC with control number. 6) Notification checklist may help c.

Resource Request Notification 1) Types of resources: a) Agencies/Personnel (Law, Fire, EMS, Health, etc.), b) Materials/Equipment (Haz Mat Team), c) Facilities (ICP, EOC, evacuee shelters, etc.), d) Other (Information sources, Haz Mat Teams, etc.). 2) Criteria when additional resources needed: a) Size, type and nature of incident vs. your resources, b) Availability and training of personnel, c) Availability and sophistication of apparatus and equipment, d) Amount, type and access of supplies and expertise. 3) Possible off-site resources (CHEMTREC, CHLOREP, USA and Poison Control Centers). Other: ___________________________ 4) Non-Governmental Organizations. a) American Red Cross, Salvation Army, etc.

3.29

First Receiver Awareness/Operations and Decontamination for Healthcare

When Do You Need Help?

You don’t have enough stuff.

You don’t have enough people. You don’t have the right stuff. You just need “more”!

3.30

First Receiver Awareness/Operations and Decontamination for Healthcare

The First Operational Alert — NOTIFICATIONS (cont.) 5)

Know your local resources for Haz Mat and request early. a) Request all Haz Mat response agencies early. b) Know Mutual Aid for area Haz Mat Teams, local industry, State & Federal Haz Mat resources that can help. c) Stage incoming resources until needed and give arriving resources a safe route of access. 6) Accessing resources implies pre-awareness and contact lists. a) Develop points of contact and notification lists. b) Need “user-friendly” Haz Mat resource list. 7) You are not alone (many Haz Mat resources are available), but you must contact, coordinate and manage resources properly! d.

Report of Conditions Notification. 1) Report of Conditions includes: a) What you see in and around hazard area, b) What you want, c) What you are doing. 2) Report of Conditions helps IC assess basic actions, identify needed resources, and begin the IDHA process.

3.31

First Receiver Awareness/Operations and Decontamination for Healthcare

Haz Mat Notification Guide Agency/Organization Phone # Time Person Notified Local First Resp/Rec (Fire, PD, etc.)* ______ _____ _____________ Administering Agency* ______ _____ _____________ County OES ______ _____ _____________ County Agriculture Dept. ______ _____ _____________ County Health ______ _____ _____________ Local Haz Mat Team ______ _____ _____________ Animal Control ______ _____ _____________ Other ______ _____ _____________ State OES Warning Center* ______ _____ _____________ Highway Patrol ______ _____ _____________ Fish and Game ______ _____ _____________ Dept. of Toxic Substances Control ______ _____ _____________ Other ______ _____ _____________ Federal National Response Center* ______ _____ _____________ Coast Guard ______ _____ _____________ EPA Region IX ______ _____ _____________ Other ______ _____ _____________ Private CHEMTREC ______ _____ _____________ Local Cleanup Company ______ _____ _____________ Underground Services Alert ______ _____ _____________ Regional Poison Control Center ______ _____ _____________ Hospitals ______ _____ _____________ Other ______ _____ _____________ Special Districts Air Quality Mgt. District ______ _____ _____________ Regional Water Quality Cntl. Brd. ______ _____ _____________ Flood Control Districts ______ _____ _____________ School Districts ______ _____ _____________ Sewer Districts ______ _____ _____________ Other ______ _____ _____________ *Mandatory Notifications © State of California- CalOES/CSTI 10/1/2013

3.32

First Receiver Awareness/Operations and Decontamination for Healthcare

Do This! DO DO DO DO DO DO DO DO DO DO DO DO DO DO DO DO DO DO DO

think safety and consider it a big deal!!! report your location. stay upwind, uphill and upgrade. isolate and deny entry. establish perimeters and observe zones. notify and request assistance early. establish command & practice unity of command. complete identification and assessment. have alternative plans and consider no action. recognize your limits. forecast your intervention and expect change. weigh risk against gain (benefits). wear protective clothing. maintain control of the incident. evacuate and warn public early. decontaminate & document before demobilization. communicate & coordinate with other agencies. ensure the safety of all on-scene personnel! (Fill in your recommendation)

3.33

First Receiver Awareness/Operations and Decontamination for Healthcare

Don’t Do This! DON’T DON’T DON’T DON’T DON’T DON’T DON’T DON’T DON’T DON’T DON’T DON’T DON’T DON’T DON’T DON’T DON’T DON’T DON’T

be overly aggressive. have a negative safety attitude. get coaxed into a bad situation. touch, breathe or swallow it. act without a plan. lose sight of your mission. act on emotion. confuse rescue with evacuation. believe everything you’re told. intervene unless sure of positive outcome. drive through spills or clouds. pick up or move containers needlessly. key in on only one hazard. take victims to the incident. let small amounts fool you. use flares. be lulled into a false sense of security. fail to competently respond to the event! (Fill in your recommendation)

3.34

First Receiver Awareness/Operations and Decontamination for Healthcare

Participant Worksheet

In your own words, identify three objectives for setting the “Perimeter”:

3.35

First Receiver Awareness/Operations and Decontamination for Healthcare

TRASH BAG DECON CONTENTS: •

Armband for patient (pre-numbered) – tape to the outside of the bags or near the inside top.

•

Zip-lock bag gallon sized, (pre-numbered) for valuables (i.e. watch, keys. Jewelry, wallet) – Have the patient keep glasses on, may need to keep hearing aid also.

•

Large zip-lock bag (at least 24” X 24”, pre-numbered) for clothing.

•

Another zip-lock bag (24” X 30”, pre-numbered) to place all these items in This will be used to double-bag the clothes and valuables.

•

Black lawn type trash bag (at least 60 gallon, larger the better, 2.0 mil thick) Cut a hole in the top big enough for a head and armholes in the sides. This will be used for patients to use as a covering if no other shelter is available. They can disrobe under the bag and rinse under it.

• • •

Each kit should be pre-numbered with the same number, for tracking purposes. Optional: Can include a Tyvek type covering to change into, or a patient gown

3.36

First Receiver Awareness/Operations and Decontamination for Healthcare

IV A 1

3.37

First Receiver Awareness/Operations and Decontamination for Healthcare Job Action Sheet

Victim Decon Unit Leader DIRECTED SELF-DECON GUIDE

DIRECTED SELF-DECON GUIDE Mission:

Direct ambulatory patients in the process of their self-decontamination.

Date: _______ Start: _______ End: _______ Position Assigned to: ______________ Initial: _______ Position Reports to: Victim Decon Unit Leader Signature: _______________________________________ Hospital Command Center (HCC) Location: _____________________ Telephone: ___________________ Fax: __________________ Other Contact Info: ________________ Radio Title: ___________________

Immediate (Operational Period 0-2 Hours) [Operational Periods are arbitrary and may vary by incident.] Tasks are not in order of execution.

Time

Initial

Recognize the need for decontamination of a presenting patient. Be aware of possible hazardous materials exposure to yourself or others. Isolate the patient from other patients and staff. Make appropriate notifications to ensure others know of the situation. Do not touch patient. Identify the substance on the patient if possible. Ensure you are protected by the use of full Standard Precautions and maintain a sufficient distance between you and the victim. Ensure the patient can understand and follow directions. (No visual, hearing, or language challenges) [If challenged – activate the Decontamination Team and await their arrival and set-up maintaining isolation of the patient and the immediate area] Lead the patient to a predesignated self-decontamination area. Use the shortest path possible to reach the area – retrace the patient’s path to you if possible. Instruct the patient to stand in the designated area. Take a position near the patient but without the possibility of being touched by the patient or any water spray. Maintain security of the area by excluding all other personnel. Maintain the privacy of the patient with the use of visual barriers or the use of a Trash Bag style decon kit. Make use of chair device to assist patient in disrobing. Instruct the patient to remove all personal items, including jewelry, and place them in a sealable bag that can be identified as the patient’s. Instruct the patient to remove clothing without pulling anything over their head. Instruct patient to place clothing in larger sealable bag that can be identified as patient’s. Ensure patient is completely disrobed and all personal items are removed. Respect gender differences and remain conscious of inappropriate remarks or actions.

3.38

First Receiver Awareness/Operations and Decontamination for Healthcare Job Action Sheet

Victim Decon Unit Leader DIRECTED SELF-DECON GUIDE

Immediate (Operational Period 0-2 Hours) [Operational Periods are arbitrary and may vary by incident.] Tasks are not in order of execution.

Time

Initial

Time

Initial

Time

Initial

Verbally guide patient to begin the process of washing thoroughly with tepid water and soap. Observe patient for any signs of stress or physical conditions that may interfere with complete decontamination. If you must physically assist patient - communicate this to your supervisor and ensure Decon Team is activated and responds. (Directed Self-Decon is suspended) Ensure patient is completely cleaned of any contaminant and is dried and redressed. Escort patient to medical triage area.

Intermediate (Operational Period 1-2 Hours) Ensure your own medical monitoring is conducted, if necessary, and coordinate with the Employee Health & Well-Being Unit Leader. Advise Victim Decon Unit Leader of any operational issue you are not able to correct or resolve.

Demobilization/System Recovery Ensure decontamination equipment that you used is cleaned, repaired, and replaced as warranted. Ensure disposable materials and wastes that you used or created are properly managed. Debrief with staff on lessons learned and procedural/equipment changes needed. Upon deactivation of your position, ensure you contribute to all documentation and Operational Logs (HICS Form 214) with the Victim Decon Unit Leader as appropriate. • • • •

Submit comments to the Victim Decon Unit Leader for discussion and possible inclusion in the after-action report; topics may include: Review of pertinent position descriptions and operational checklists Recommendations for procedure changes Section accomplishments and issues

Participate in stress management and after-action debriefings. Participate in other briefings and meetings as required.

Documents/Tools • • • • •

Incident Action Plan - reviewed Hospital patient decontamination plan - reviewed (e.g., decontamination area drawings, procedures, and documentation logs) Sufficient Self-Decontamination kits for one for each patient anticipated Universal Precautions for yourself Communication device if available

3.39

First Receiver Awareness/Operations and Decontamination for Healthcare

Decontamination Process I.

Identification of Event a. Recognition of Contaminated Patient b. Identify Contaminated areas c. Establish Control Zones

II.

Activation of Response Plan a. Facility Notification b. Job Assignments c. External notifications

III.

Determine need for Decontamination a. Who

IV.

Action Plan development a. Within Facilities Capabilities? b. Decon site c. Flow d. Procedure e. Selection of PPE f. Pre-entry monitoring of Decon Resource Team g. Equipment set up h. Safety considerations

General Decontamination process a. Patient remove valuables b. Remove clothing c. Rinse 1. Start at head and move down d. Soap wash 1. Gentle washing 2. Best to use sponges or soft brushes 3. Start at head and move down, remember nooks and crannies 4. Move to next step if possible (next kiddie pool) 5. Wash bottom of foot, step into next area without putting foot in “dirty water”. Repeat with other foot. e. Rinse 1. Lots of water 2. Start at head and move down 3. Rinse bottom of foot, step into next area without putting foot in “dirty water”. Repeat with other foot. f. Dry g. Clean Covering

VI.

Decontamination Re-evaluation a. Need for further triage?

VII.

Medical Triage

3.40

First Receiver Awareness/Operations and Decontamination for Healthcare

VIII.

Termination Process a. Decon the Decon Resource Team 1. Start with most potentially contaminated. 2. Same decon process as patients, except doing with suit on. b. Post monitoring of Decon Resource Team c. Containment of PPE d. Containment of expendable equipment e. Containment of collected runoff f. Containment of durable equipment that will need decontaminated g. Maintain security on all items until properly disposed of. h. Debrief/evaluation of process i. Complete documentation

3.41

First Receiver Awareness/Operations and Decontamination for Healthcare

Participant Manual: Chapter 4 Command and Scene Management First Receiver Operations and Decontamination for Healthcare Scope This chapter covers Command and Scene Management with emphasis on the Hospital Incident Command System (HICS). It covers basic principles, organization, implementation and information flow.

Time

Instructor/Participant Ratio

1 hour

1/30

Method of Instruction Facilitated Seminar

Terminal Objective Participants will be able to identify the purpose and need to safely initiate command and explain the purpose, need and benefits of scene management.

Enabling Objectives 1. Demonstrate proper information flow from first receivers to the Incident Commander. 2. Describe basic implementation of HICS to manage a Hazmat Event, both internal and external. 3. Describe healthcare worker roles under HICS

4.1

First Receiver Awareness/Operations and Decontamination for Healthcare

Develop plans, policies, procedures and systems for on-site incident management Implement command staff functions

ResB1a 5.1.2

Establish the command and general positions needed to manage the incident and meet incident objectives

ResB1a 5.1.3

Establish branches, groups and divisions needed to manage the incident and meet incident objectives, strategies and tactics

Supporting Materials • Participant Manual

Activities • Easel charts for brainstorming

4.2

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 4.1

An Operations Level Program for Managing Hazardous Materials Emergencies Within Healthcare

Command, Introduction to Scene Management

These next chapters make up the remainder of the First Receiver Operations Training.

Slide 4.2 I. Remember in the Awareness class we introduced this mnemonic device to remember how to address a Haz Mat incident in an organized and thorough manner. II.

S - Safety I - Isolate and Deny Entry N - Notifications

III. In the Operations Level course we will cover the rest of the mnemonic. In this class we will cover: C I A P C P D D D C - Command / Management I - Identification and Hazard Assessment A - Action Planning P - Protective Equipment C - Containment, Control and Cleanup P - Protective Actions D - Decontamination D - Disposal D - Documentation © State of California- CalOES/CSTI 6/30/2013

4.3

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 4.3

Main Points • Scene Management System

Scene management main points.

• Common Scene Management Systems • ICS’s General Premise & Basic Principles • Hazmat and “Who’s In Charge”

Slide 4.4

Need Good Scene Mgt System

Why we need to have good scene management.

• Purpose of Scene Management – Provide workable system in hospital setting – Efficiently/effectively use resources – Minimize impacts of incident on rest of facility

Incident Command System • The required command system – CCR 5192: use “the ICS” – CGC 8607: must use ICS in the field

Slide 4.5 Managing an event effectively from the beginning of the evolution is key to the safety of all involved.

4.4

First Receiver Awareness/Operations and Decontamination for Healthcare

Benefits of ICS • • • •

Hospitals use a modified system called HICS More efficient use of resources More effective management Safer response

Slide 4.6 Fire and Law also use the Incident Command System. At hospitals we have the Hospital Incident Command System (HICS) HICS is used for all emergency events, not just HazMat. Hospitals that have not adopted HICS as their organizational structure for managing emergencies are encouraged to do so.

Haz Mat & “Who’s In Charge” • Haz Mat requires establishing Command early, but… • Common Haz Mat deficiency is poor management (i.e. Command)! – Early assumption of Command reduces chaos and aids in management

Slide 4.7 Some one has to be in charge. With HazMat situations, someone who is familiar with HazMat emergencies needs to be in charge of the response. Activating the emergency protocols early will increase the potential for a safe and effective response.

Recognizing that an event may be beyond the capabilities of the normal activities of a department/facility is often contrary to human nature wanting to be able to handle the situation. Recognizing that a hazardous materials incident is an extraordinary event and responding appropriately is not a sign of weakness. In a healthcare setting, someone from the hospital should be within the Unified Command if outside responders are participating in the event (e.g., fire).

4.5

First Receiver Awareness/Operations and Decontamination for Healthcare

Need a good Scene Management System Goal: Protect – Life – Environment – Property

Need one system for all responders

HICS Organization • Command/IC (overall management) – Planning/Intel (does incident action planning) – Operations (manages tactical operations) – Logistics (procures incident resource needs)

Slide 4.8 The priority of protection - is to protect Life first, then Environment, and lastly Property. Need one system so everyone is talking the same language. Inside and outside the hospital. An incident command system is a requirement of JCAHO Emergency Management standard 1.4, the HAZWOPER Standard, and Homeland Security Presidential Directive #5 mandates that all Federal agencies use ICS and encourage other organizations to do so also. Slide 4.9 Using HICS really does make response easier. This is especially true since a hazmat incident will bring many players from many organizations and disciplines. Without a common system and nomenclature (language) the incident can become a Tower of Babel or more illustrative expressions.

– Finance/Admin (manages financial aspects)

Review of HICS 5 main components: Command is in charge and makes the final decisions Planning figures out what is going on and makes suggestions on what to do Operations gets the job done Logistics provides the tools to get the job done Finance pays for everything (we hope)

4.6

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 4.10

Hospital Incident Command Org Chart Hospital Incident Command System Incident Management Team Structure August 2006 Incident Commander

Public Information Officer

Safety Officer

Medical/Technical Specialist

Liaison Officer

Planning Section Chief

Operations Section Chief

Staging Manager

Personnel Staging Team Vehicle Staging Team Equipment/Supply Staging Team Medication Staging Team

Medical Care Branch Director

Inpatient Unit Outpatient Unit Casualty Care Unit Mental Health Unit Clinical Support Services Unit Patient Registration Unit

Infrastructure Branch Director

Power/Lighting Unit Water/Sewer Unit HVAC Unit Building/Grounds Damage Unit Medical Gases Unit Medical Devices Unit Environmental Services Unit Food Services Unit

Biological/Infectious Disease Chemical Radiological Clinic Administration Hospital Administration Legal Affairs Risk Management Medical Staff Pediatric Care Medical Ethicist

Finance/ Administration Section Chief

Logistics Section Chief

Resources Unit Leader

Personnel Tracking Materiel Tracking

Service Branch Director

Communications Unit IT/IS Unit Staff Food & Water Unit

Situation Unit Leader

Patient Tracking Bed Tracking

Support Branch Director

Employee Health & Well-Being Unit Family Care Unit Supply Unit Facilities Unit Transportation Unit Labor Pool & Credentialing Unit

Detection and Monitoring Unit Spill Response Unit Victim Decontamination Unit Facility/Equipment Decontamination Unit

Security Branch Director

Access Control Unit Crowd Control Unit Traffic Control Unit Search Unit Law Enforcement Interface Unit

Business Continuity Branch Director

Information Technology Unit Service Continuity Unit Records Preservation Unit Business Function Relocation Unit

Procurement Unit Leader

Compensation/ Claims Unit Leader

Documentation Unit Leader

HazMat Branch Director

Time Unit Leader

Demobilization Unit Leader

Cost Unit Leader

This is the HICS org chart. There are some subtle differences between HICS and Firescope ICS. Note that HAZMAT falls under Operations and is now considered a Branch rather than a Group Technical Specialists are now part of command staff.

See Chart on Page 4.18 Slide 4.11

Operations Section Operations Section Operations Section Chief

Staging Manager

Vehicle Staging Team Leader

Personnel Staging Team Leader

Equipment/Supply Staging Team Leader

Medical Care Branch Director

Infrastructure Branch Director

HazMat Branch Director

Medication Staging Team Leader

Security Branch Director

Business Continuity Branch Director

Inpatient Unit Leader

Power/Lighting Unit Leader

Detection and Monitoring Unit Leader

Access Control Unit Leader

Information Technology Unit Leader

Outpatient Unit Leader

Water/Sewer Unit Leader

Spill Response Unit Leader

Crowd Control Unit Leader

Service Continuity Unit Leader

Casualty Care Unit Leader

HVAC Unit Leader

Victim Decontamination Unit Leader

Traffic Control Unit Leader

Records Preservation Unit Leader

Mental Health Unit Leader

Building/Grounds Damage Unit Leader

Facility/Equipment Decontamination Unit Leader

Search Unit Leader

Business Function Relocation Unit Leader

Clinical Support Services Unit Leader

Medical Gases Unit Leader

Patient Registration Unit Leader

Medical Devices Unit Leader

Under HICS the HAZMAT Branch is further subdivided into Units. For the most part this course focuses on the Victim Decontamination Unit and to a lesser degree the Spill Response Unit, since at the FRO level spill response is “defensive.”

Law Enforcement Interface Unit Leader

Groups are established to divide the incident management structure into functional areas of operation. They are composed of resources that have been assembled to perform a special function not necessarily within a single geographic division. A Supervisor leads a Group. Environmental Services Unit Leader

Food Services Unit Leader

Units are organizational elements that have functional responsibility for a specific incident planning, operations, logistics, or finance/administration activity (e.g., Inpatient Unit, Situation Unit, Supply Unit).

4.7

First Receiver Awareness/Operations and Decontamination for Healthcare

Haz Mat Victim Decon Team Branch Director

Technical Specialist

Preparation Unit Leader

Victim Decon Group Supervisor

Forward Unit Leader

Assistant Safety Officer

Services Unit Leader

Rapid Intervention Unit Leader

Site Logistics

Site Access

Stripper/ Bagger

Rapid Intervention Team Leader

Site Set Up

Initial Contact

Washer/ Rinser

Team Rehab Area

PPE Donning

Decon Triage

Dryer/ Dresser

Site Support

Refuge Area

Non-Ambulatory

PPE Doffing

Safe Haven

ICS Haz Mat Organization

Slide 4.12 - 4.13 Hospitals often only perform the Decon component. This response may be a standalone activity (decontaminating staff, patients, contaminated victims from external to the hospital) or as part of an integrated response with an internal hazardous materials team, fire department (or other public safety organization), or clean-up contractor. Thus the Victim Decon Team. (Note: a HAZMAT team is considered one of the groups that requires being enrolled in a medical surveillance program. A Decon Resource team is not technically a HAZMAT team.)

• Hazardous Materials Branch Positions – Haz Mat Spill Response Unit Leader • • • • •

Technical Reference Site Access Control Decon Team Leader Entry Team Leader Assistant Safety Officer* – *Reports to Safety Officer

Discuss roles of these sections: - Victim Decon Team Leader - Safety Officer - Site Access Control - Set Up / Support - Initial Contact - Triage - Stripper / Bagger - Washer / Rinser - Dryer / Dresser

4.8

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 4.14 - 4.15

Job Action Sheets • Guidance for each position with: – Basic information – Mission – Tasks (immediate, intermediate, long-term)

Review Job Action Sheets

The positions and Job Action Sheets for the Decon Resource Team were developed by HAZMAT for Healthcare and are not currently an official part of HICS, FIRESCOPE, or NIIMS. These Job Action Sheets are HICS-compatible. Have the students turn to the Job Action Sheets for the Decon Group Director/ Supervisor in their notebook and show them the format as demonstrated on the next slide. On the following slide which is a repeat of the org chart slide you should briefly review the positions with Job Action Sheets and Task Specific sheets.

Slide 4.16 This is an example of the Task List form that is used for specific decontamination team assignments.

4.9

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 4.17

Chaos

Set up video of contaminated patients coming into emergency room.

Video

Slide 4.18 Video of Chaos occurring in a hospital emergency room Discuss the vignette and how the presence or lack of an incident command system impacted the response.

Know Your Own Hospital Mgt System • Who is ultimately “In Charge”? • What is your initial role? • Where will you eventually fit in?

Slide 4.19 Summary of chapter. Know your hospital plan, who’s in charge and you role in the hospital system. Liken the IC (Incident Commander) to a “Code Team Leader.” It is the IC’s job to “Successfully resuscitate” the situation.

4.10

First Receiver Awareness/Operations and Decontamination for Healthcare

Supporting Material Command and Introduction to Scene Management: (C.) Main Points •

Scene Management System

•

Common Scene Management Systems

•

ICS’s General Premise and Basic Principles

•

Haz Mat and “Who’s In Charge”

•

ICS Organization

•

HICS/Hospital Emergency Incident Command System

•

Implementing and Expanding ICS

•

Information Flow & the Incident Command Post

•

Know the Incident Command System!!

4.11

First Receiver Awareness/Operations and Decontamination for Healthcare

Block Outline 1.

Haz Mat Requires a Good Scene Management System. a. Purpose of scene management: provide one workable “System” for all receivers to use, to make the most efficient and effective use of all resources, to minimize impacts of the incident. b. Goal: Intervene and better protect life, environment and prop erty. c. Need organization/management system for all receivers working together as one system to support common goal. d. In Haz Mat, the Incident Command System (ICS) is the required scene management system to use. 1) ICS is an organized system of roles, responsibilities and S.O.P.s used to manage and direct emergency operations. 2) CCR 5192(q)(3) requires the use of “the” ICS as the com mand system for Haz Mat events. (Note: 29 CFR 1910.120 requires the use of “a site-specific Incident Command Sys tem.”) 3) CGC 8607, also known as the “Standardized Emergency Management System” (SEMS), mandates the use of ICS in any field emergency involving two or more agencies.

4.12

First Receiver Awareness/Operations and Decontamination for Healthcare

Requirements for using ICS California Government Code Section 8607 SEMS “By December 1, 1993, the Office of Emergency Services…shall jointly establish by regulation a standardized emergency management system for use by all emergency response agencies… This system shall be applicable, but not limited to, those emergencies or disasters referenced in the state emergency plan. …state agencies shall use the standardized emergency management system…to coordinate multiple- jurisdiction or multiple-agency emergency and disaster operations. …each local agency…shall use the standardized emergency management system…to coordinate multiple-jurisdiction or multiple- agency operations.” 29 CFR 1910.120(q)(3)(i) Fed OSHA

“The senior emergency response official responding to an emergency shall become the individual in charge of a site-specific Incident Command System (ICS). All emergency responders/receivers and their communications shall be coordinated and controlled through the individual in charge of the ICS, assisted by the senior official present for each employer.”

Title 8 CCR Section 5192(q)(3)(A)

State OSHA “The senior emergency response official who has ultimate site control responsibility shall confirm that the Incident Command System (ICS) is in place and the position of Incident Commander (IC) instituted. All emergency responders/ receivers and their communications shall be coordinated and controlled through the ICS.”

4.13

First Receiver Awareness/Operations and Decontamination for Healthcare

Common Scene Management Systems a. Many systems used (e.g. ICS, IMS, agency models, etc.). b. For this class, we will use the Hospital Emergency Incident Command System (HEICS): 1) Organized system to manage and direct emergency operations. 2) Purpose: Provide predetermined and standard organization. c. Benefits: Many, but primarily for an efficient and effective scene management “System” for multi-agency incidents like a hazmat. d. “System” defined: Interacting, interrelated or interdependent elements forming a collective entity—with a common goal.

ICS’s General Premise and Basic Principles. a. Customized organization and management tool to help — If us ers understand and agree to “Incident Operating Procedures,” “Common Terminology” & “Structural Organization.” b. Review of “ICS Operational Systems Descriptions” (ICS 120-1). c. ICS is a scene management “tool chest.”

4.14

First Receiver Awareness/Operations and Decontamination for Healthcare

Principles of ICS Definitions

Definitions of a System:

• A group of interacting, interrelated or interdependent elements forming, or regarded as forming, a collective entity. • A functionally related group of elements, as: the human body regarded as a functional physiological unit. • A social, economic or political organizational form. • The state or condition of harmonious, orderly interaction.

Requirements

The following are basic system design operating requirements:

Provides for the following kinds of operations: single jurisdiction/single party, single jurisdiction with multi-party involvement and multi jurisdiction/multi-party involvement. Organizational structure must be able to adapt to any incident. Applicable and acceptable to all users. Readily adaptable to new technology. Able to expand in a logical manner from an initial emergency into a major incident. Have basic common elements in organization, terminology and procedures. Implementation should have the least possible disruption to existing systems. Effective in fulfilling all of the above requirements and simple enough to ensure low operational costs.

4.15

First Receiver Awareness/Operations and Decontamination for Healthcare

Haz Mat and “Who’s In Charge.” a.

Haz Mat events require establishing Command early, but a common deficiency is poor management (i.e. Command)! 1) Assume Command early to reduce chaos and aid management.

29 CFR 1910.120 and Title 8 CCR 5192 mandate an “IC.”

CVC 2454 designates “Incident Command Authority” for “OnHighway/Road” Haz Mat events to be the law enforcement agency with primary traffic investigative authority where the spill occurs (state highway or county road: CHP, city street: Police Department).

Use concept of IC in “Single” or “Unified” Command: 1) Can use Single Command IC with many deputies in hazmat, or Unified Command when multi-jurisdictional or when multi-agencies have vested interests in event management.

The first arriving FRO can help “command” by doing this: 1) Assume “Temporary Command” formally. 2) Set up a “Temporary Command Post” where you are. 3) Manage event until the designated IC arrives for briefing.

4.16

First Receiver Awareness/Operations and Decontamination for Healthcare

ICS Organization a.

Critical components of a good organization: 1) One unified organization, 2) Clear functional elements (division of labor), 3) Flexibility and expandability, 4) Unity of command (with good supporting chain of command), 5) Manageable span of control, 6) Effective communications and coordination. 7) Other: __________________________________________

Major ICS Sections (and functions): 1) Command/IC (overall management), 2) Operations Section (manages tactical operations), 3) Planning/Intel Section (does incident action planning), 4) Logistics Section (procures incident resource needs), 5) Finance/Admin Section (manages incident financial aspects).

Know role of Command and General Staff positions.

Typical functional “Groups” within Operations. 1) Haz Mat Group. 2) Security Group. 3) Medical Group. 4) Protective Action Group. 5) Containment Group.

Know where the FRO may best fit into the organization (any position that he/she can function in and is trained to—usually, in a defensive role, within Operations.)

4.17

First Receiver Awareness/Operations and Decontamination for Healthcare

HICS General Staff

Incident Commander

Operations

Plans /Intel

Logi stics

Finance /Admin

4.18

First Receiver Awareness/Operations and Decontamination for Healthcare

HICS General Staff

Hospital Incident Command Org Chart

Hospital Incident Command System Incident Management Team Structure August 2006 Incident Commander

Public Information Officer

Safety Officer

Liaison Officer

Medical/Technical Specialist

Planning Section Chief

Operations Section Chief

Staging Manager

Personnel Staging Team Vehicle Staging Team Equipment/Supply Staging Team Medication Staging Team

Medical Care Branch Director

Inpatient Unit Outpatient Unit Casualty Care Unit Mental Health Unit Clinical Support Services Unit Patient Registration Unit

Infrastructure Branch Director

Power/Lighting Unit Water/Sewer Unit HVAC Unit Building/Grounds Damage Unit Medical Gases Unit Medical Devices Unit Environmental Services Unit Food Services Unit

HazMat Branch Director

Detection and Monitoring Unit Spill Response Unit Victim Decontamination Unit Facility/Equipment Decontamination Unit

Security Branch Director

Access Control Unit Crowd Control Unit Traffic Control Unit Search Unit Law Enforcement Interface Unit

Business Continuity Branch Director

Information Technology Unit Service Continuity Unit Records Preservation Unit Business Function Relocation Unit

Biological/Infectious Disease Chemical Radiological Clinic Administration Hospital Administration Legal Affairs Risk Management Medical Staff Pediatric Care Medical Ethicist

Finance/ Administration Section Chief

Logistics Section Chief

Resources Unit Leader

Personnel Tracking Materiel Tracking

Service Branch Director

Communications Unit IT/IS Unit Staff Food & Water Unit

Time Unit Leader

Situation Unit Leader

Patient Tracking Bed Tracking

Support Branch Director

Employee Health & Well-Being Unit Family Care Unit Supply Unit Facilities Unit Transportation Unit Labor Pool & Credentialing Unit

Procurement Unit Leader

Compensation/ Claims Unit Leader

Documentation Unit Leader

Demobilization Unit Leader

Cost Unit Leader

4.19

First Receiver Awareness/Operations and Decontamination for Healthcare

Know the Incident Command System!!! a.

Who is ultimately “In Charge” of the System?

What is your initial role in the System regarding Command?

Where will you eventually fit into the overall System?

Who do you report to and communicate with in the System?

Do you have a basic understanding of the System so that you can function in a safe and competent manner at Haz Mat events?

4.20

First Receiver Awareness/Operations and Decontamination for Healthcare

HospitalHazardousMaterialsSiteSafetyandControlPlan‐Annex (TobeusedwithandattachedtoIAPandHazardousMaterialsSiteSafetyandControlPlanandHARMWorksheet)

1. IncidentName:

2. DatePrepared:

3. OperationalPeriod: Time:

Decon 4. SiteAccessIssues?(includingweather)

SpillResponse

Both

5. DeconOrganization(Includenamesandmedicalmonitoringinfo)

HospitalHazMat DeconIncident CommandChart

Branch Director

Technical Specialists

Assistant Safety Officer

Technical Specialists

Victim Decon Group Sup.

Facilities Unit Leader

Forward Unit Leader

Services Unit Leader

Site Logistics

Site Access Control

Stripper/Bagger

Rapid Intervention Team

Team Re-Hab Area

Site Set Up

Initial Contact

Washer/Rinser

PPE Donning

Decon Triage

Dryer/Dresser

Site Support

Safe Refuge

PPE Doffing

Rapid Intervention Unit Leader

Non-Ambulatory

Safe Haven

4.21

First Receiver Awareness/Operations and Decontamination for Healthcare

6. SpillResponseOrganization(Includenamesandmedicalmonitoringinfo)

HospitalHazMat SpillResponseIncident CommandChart

Branch Director

Technical Specialists

Assistant Safety Officer

Technical Specialists

Spill Response Group Sup.

Entry Team Unit Leader

Forward Unit Leader

Services Unit Leader

Rapid Intervention Unit Leader

Entry Team

Site Access Control

Rapid Intervention Team

Site Set Up

Safe Refuge

Team Re-Hab Area

PPE Donning

Site Support

PPE Doffing

7. IncidentCommander 9. SafetyOfficer

8. OperationsChief 10.

11. HazardMonitoring(typeandreadings) Oxygen Flammability(LEL) Radiological Other

Toxicity Other

4.22

First Receiver Awareness/Operations and Decontamination for Healthcare

12. Communications Tactical Decon Frequency o HandSignalsReviewed LoudHailer(bullhorn)

SpillResponse

CommandFrequency Whiteboard Other

13. DecontaminationObjectives 14. SpillResponseObjectives 15. Typeof Decon 16. TypeofSpill Response

o o

Precautionary/Secondary/ Patient Offensive(Tech/Spec)

Emergency

Contain/ Control(Ops)

Technical

SIN (Awarene ss) 17. VictimDeconGuidelinesandWorkPracticesandSpecial/SafetyInstructions(include maximumtimeinsuitbasedonheatstressguidelines,chemicalspecifichazardsandwarning signs,deconsolutionsifotherthansoapandtepidwater) 18. ResponseGuidelinesandWorkPracticesandSpecial/SafetyInstructions(includemaximum timeinsuitbasedonheatstressguidelines,chemicalspecifichazardsandwarningsigns,tools needed,ResponderDeconGuidelinesifdifferentthanabove) 19. PersonalProtectiveEquipment(PAPRw/MulltigasCartridge,LiquidSplashSuit,Doublegloves, Boots)Noteifdifferent Respiratory None APR PAPR SAR SCBA Protection InitialContact/DeconTriage/SafeRefuge Dryer‐Dresser/SafeHaven(maybeStandard Precautions) Stripper‐Bagger/Washer‐Rinser/Non‐Ambulatory SiteAccess RapidIntervention EntryTeam © State of California- CalOES/CSTI 6/30/2013 III A 77

4.23

First Receiver Awareness/Operations and Decontamination for Healthcare

20. EmergencyProcedures Injury/IllnessinZones

VictimDecon

SpillResponse

Fire/Explosion

PPEFailure

EmergencyEvacuationRoute andCongregationArea

21. VictimDeconSiteMap

22. SpillResponseSiteMap

23. SafetyBriefingCompleted:Time

24. ByWhom:

4.24

First Receiver Awareness/Operations and Decontamination for Healthcare

UNIT LOG 4. UNIT NAME/DESIGNATORS

1. INCIDENT NAME

5. UNIT LEADER (NAME AND POSITION)

2. DATE PREPARED

3. TIME PREPARED

6. OPERATIONAL PERIOD

PERSONNEL ROSTER ASSIGNED NAME

ICS POSITION

HOME BASE

ACTIVITY LOG (CONTINUE ON REVERSE) TIME

MAJOR EVENTS

NFES 1337

4.25

First Receiver Awareness/Operations and Decontamination for Healthcare TIME

MAJOR EVENTS

4.26

First Receiver Awareness/Operations and Decontamination for Healthcare

Participant Manual: Chapter 5 Identification and Hazard Assessment, Action Plans First Receiver Operations and Decontamination for Healthcare Scope

This chapter describes identification and hazards assessment techniques, and demonstrates the use of a variety of Technical Reference sources including the Department of Transportation “Emergency Response Guidebook”.

Time

Instructor/Participant Ratio

1.5 hours

1/30

Method of Instruction Facilitated Seminar

Terminal Objective At the end of this chapter participants will describe the use of several technical resources and develop action plans to aid in the response to internal and external incidents in a healthcare environment.

Enabling Objectives This chapters enabling (performance) objectives are to ensure participants will be able to: 1. Describe identification and hazard assessment techniques 2. Demonstrate use of the DOT Emergency Response Guidebook to initiate basic action planning. 3. Demonstrate the use of the Hazard and Risk Management (HARM ) Worksheet 4. Demonstrate the use of the Site Safety Plan © State of California- CalOES/CSTI 10/12013

5.1

First Receiver Awareness/Operations and Decontamination for Healthcare

Identify extent and potential nature of incident Develop information regarding incident Develop plans, policies, procedures and systems for on-site incident management Develop procedures to identify and assess hazards

Supporting Materials • Emergency Response Guidebook • Participant Guide (1 for each participant)

Activities • Emergency Response Guidebook Worksheet

5.2

First Receiver Awareness/Operations and Decontamination for Healthcare

Identification and Hazard Assessment (IDHA) and Incident Action Plans: (I.A.P.)

Slide 5.1 Liken an Incident Action Plan (IAP) to a “Patient Car Plan” IDHA = Identification and Hazard Assessment You need to know what you are working with and the hazards involved.

Must have an Action Plan. Shouldn’t just be jumping in.

Note: Most organizations do not develop Incident Action Plans or develop them poorly. Spill Management vs. Decontamination • Spill Management Internal Stop/Clean up the spill (if within capabilities) • Decontamination Internal or External Clean up the people

Slide 5.2 Are you dealing with an Internal Spill? Decontamination of people? Or both? If the spill is not within your capabilities and resources, you shouldn’t be dealing with it. Request outside resources. Decon may be of people contaminated by an Internal Spill or of people contaminated by an External event outside the hospital. Slide 5.3

How bad is this? • • • •

What do I know? What don’t I know? Quantity and Concentration Characteristics of Hazardous Waste – – – –

Toxicity Reactivity Ignitable / Flammable Corrosive

These are some of the criteria to determine a “gono go” situation and helps to determine the type and level of response. A revisit to material in the Awareness section.

5.3

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 5.4

How bad is this? • Spill Area (surface area) • Ventilation • Population at risk to exposure • Environment at risk

Spill Area- Discuss how the spread of a liquid increases surface area and subsequently increase airborne vapor concentration of contaminant. Ventilation- Discuss air exchanges, shutting down or increasing HVAC. Population at Risk- Patients (ambulatory, non ambulatory), staff, Community surrounding hospital

Environment at Risk- Plume direction, waterways For example, a spill in a Medical Office Building at 5 PM on a Friday afternoon is of less concern than a release in the substerile area of a busy operating room complex.

Info Sources to Aid Identification and Hazard Assessment (IDHA) • • • •

Markings and Colors Placards and labels S.D.S. ERG (Emergency Response Guidebook) • Reference guides • Technical information centers • People

Slide 5.5 Markings - UN #’s Placards - as we discussed in the FRA class SDS’s - as discussed in the FRA class ERG - see slides Reference guides - such as the NIOSH pocket guide and the ATSDR- Agency for Toxic Substances & Disease Registry

Technical information - such as Chemtrec, reiterate the benefits of Poison Control Centers People - see next slide

5.4

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 5.6

Info Sources to Aid IDHA • People

Often eye witnesses are not the most reliable resource. Use them as appropriate.

– Facility manager/employee – Victim – Witnesses

Slide 5.7 Info Sources

Emergency Response Guidebook (ERG) • ERG purpose: – Basic safety tool – Basic identification – Initial actions

The DOT Emergency Response Guidebook is one of the basic tools in hazardous materials response. Although designed for highway spills, it’s ease of use and quick reference guides may be of value in any hazmat incident

5.5

First Receiver Awareness/Operations and Decontamination for Healthcare

Info Sources

ERG Organization • • • • •

White — Basic info & instructions Yellow — UN #, guide # & material name Blue — Material name, guide # & UN # Orange — Chemical information Green —Isolation & Protective Actions

Slide 5.8 General information on placards and shapes of transportation tanks in front Sections, White pages - basic info Yellow pages - Placard ID #, the guide number, and the material name Blue - lists the index information in alphabetical order

Orange - gives the information about the chemicals. (Greatest hazards listed first.) Fire and Health hazards First Aid PPE needed Green - give isolation, evacuation and protective actions information for items highlighted in the blue and yellow sections.

Slide 5.9 These pages are used to identify the guide page that describes xylene, either numeric (yellow) or alphabetically (blue). Each sends the reader to guide 130.

5.6

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 5.10 The guide pages identify the category of the product (flammable liquid). The potential hazards lists the greatest hazard first- in this case fire or explosion).

Info Sources

ERG—Good But Limited • Classification of hazard • Guides — “most essential guidance” • Isolation/evacuation distances — guides • Use table of placards only if no ID • Intended use

Info Sources to Aid IDHA • NFPA 704 System – Blue = Health – Red = Flammability – Yellow = Reactivity – No color = special hazards # in diamond 0 = No Hazard to 4 = Worst Hazard

Slide 5.11 The intended use of the ERG is for initial actions to a transportation hazardous materials emergency. Not the best resource for hospitals, but still useful (and required to be included in the curricula under HAZWOPER).

Slide 5.12 National Fire Protection Association system. Used at fixed facilities Ratings from 0 to 4 (4 the worst) Special hazards may include acid, trefoil (radioactive symbol), W with slash (use no water), pol (potential for polymerization)

5.7

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 5.13 Introducing The HARM form

• H - Hazard • A - and

One of the forms hospitals may decide to use is the Hazard and Risk Management Worksheet. This is a tool that may be helpful in both internal and external incidents.

• R - Risk • M - Management

Slide 5.14 This form should be used by persons trained to the First Receiver Operations level and familiar with various technical reference sources.

Slide 5.15 What does the HARM do? The HARM form allows responders to make informed decisions about future actions.

Using this worksheet will assist in developing an Action Plan.

Can we, with given resources, decon the victims? Can we handle a small spill? Do we say YES or NO? What are our limits?

5.8

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 5.16 What HARM means to you

Toxicity Flammability Solubility Specific Gravity Vapor Density Vapor Pressure Corrosivity Carcinogenic

– – – – – – – –

How long can I be exposed? How easily does it catch fire? What does it mix with? Will it sink or float in water? Will it settle, stay or float away? How easily does it get into the air? Will it eat away at my suit? Could it cause cancer in me?

When & Who • When do we fill out the HARM form?

As soon as the substance is identified, when possible.

• Who fills this out?

Trained FRO’s or other persons familiar with SDS, NIOSH, etc. and the information needed for the form.

This worksheet can provide vital information on how the substance may act and it’s threats to personnel and patients.

Slide 5.17 Identification of the substance will lead to many answers on how the actions of the facility personnel will be impacted

Slide 5.18 Chemicals may be identified by name, a four digit UN number, SDS, labels or a variety of other means.

5.9

First Receiver Awareness/Operations and Decontamination for Healthcare

Other Reference Guides

Reference Sources • NIOSH Guide

Slide 5.19 There are a number other resources used in hazardous materials. These included printed material and databases.

Slide 5.20 Here are some common reference sources used in the hospital setting.

• ATSDR Medical Management Guidelines • ATSDR Volume ll Managing Hospital Incidents

Safety Data Sheet 8. Exposure Controls/Personal Protection Airborne Exposure Limits: -OSHA Permissible Exposure Limit (PEL): 100 ppm (TWA) xylene 100 ppm (TWA) ethylbenzene -ACGIH Threshold Limit Value (TLV): xylene: 100 ppm (TWA) 150 ppm (STEL), A4 - Not classifiable as a human carcinogen. ethyl benzene: 100 ppm (TWA) 125 ppm (STEL), A3 - Confirmed Animal Carcinogen with Unknown Relevance to Humans. Ventilation System: A system of local and/or general exhaust is recommended to keep employee exposures below the Airborne Exposure Limits. Local exhaust ventilation is generally preferred because it can control the emissions of the contaminant at its source, preventing dispersion of it into the general work area. Please refer to the ACGIH document, Industrial Ventilation, A Manual of Recommended Practices, most recent edition, for details. Use explosion-proof equipment. Personal Respirators (NIOSH Approved): If the exposure limit is exceeded and engineering contro2l0s7 are not feasible, a half-face organic vapor respirator

Slide 5.21 As we go through these different reference sources we will be using the Chemical Xylene. This chemical if found in most healthcare facilities. At left is a portion of the Safety Data Sheets that gives information on exposure control.

5.10

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 5.22 The adjacent slide show Xylene information from the NIOSH pocket guide. NIOSH stands for the National Institute for Occupational Safety and Health.

ATSDR Medical Management Guidelines (MMG)

Standards and Guidelines OSHA PEL (permissible exposure limit) = 100 ppm (averaged over an 8hour work shift) NIOSH IDLH (immediately dangerous to life or health) = 900 ppm

Slide 5.23 Medical Management Guidelines are available in the 3 volumes of the Agency of Toxic Substances and Disease Registry, (ATSDR). Volume III contains medical management guidelines for acute chemical exposures.

5.11

First Receiver Awareness/Operations and Decontamination for Healthcare

IDHA - Acronyms and Terms • LD/LC 50 – Lethal Dose 50% – Lethal Concentration 50%

• PPM/MgM3 – Parts Per Million • measured as volume of contaminant to volume of liquid or air collected in sample

– Milligrams Per Cubic Meter • measured as weight of contaminant to volume of air collected in sample

Slide 5.24 LD/LC 50 - lethal dose/ lethal concentration (used in animal experiments to determine when half of the test populations die and then extrapolated to a human population) PPM/MgM3 - the amount of product in water or air. With all of these exposure values - the lower the number the more toxic the material.

IDHA - Acronyms and Terms • TLV™ - Time Weighted Average (TLV-TWA) – Average concentration that a worker can be exposed to during a 40 hour week/8 hour day without adverse effects. • TLV-STEL - Short Term Exposure Limit – Fifteen minute time-weighted average exposure • TLV-Ceiling (TLV-C) – Instantaneous levels which should not be exceeded

Slide 5.25 When using Technical References Sources there are many Acronyms used.

TLV™ — Threshold Limit Value (guides) – Time Weighted Average. Exposure limit recommended by the American Conference of Governmental Industrial Hygienists (ACGIH). Level to which nearly all workers may be repeatedly exposed without adverse effect. Time weighted average. 8 hour workday. 40 hour workweek. Derived for the protection of healthy adult male workers. All workers should be able to withstand up to four exposures per day at this concentration with no ill effects (if TLV®-TWA not exceeded). Applied to supplement the TLV®-TWA when there are recognized acute effects from a substance whose toxic effects are primarily of a chronic nature. Time weighted average for 15 minutes. Look up the exposure values for xylene TWA 100 ppm, STEL (ST) 150 ppm, no Ceiling value. These can be found in the ATSDR MMG, NIOSH Pocket Guide, and SDS. Have the students find the values in each location. Same for IDLH on the next slide. STEL — Short Term Exposure Limit. (An excursion limit.) The concentration that should not be exceeded during any part of the working exposure. These are acronyms used in workplace chemical exposure limits. © State of California- CalOES/CSTI 10/1/2013

5.12

First Receiver Awareness/Operations and Decontamination for Healthcare

IDHA - Acronyms and Terms

Slide 5.26

IDLH — Immediately Dangerous to Life & Health Defined as conditions that pose immediate danger to life or health, or conditions • PEL - Permissible Exposure Limit that pose a threat of severe exposure. IDLH limits – OSHA standards - therefore are legal limits were created mainly to assist in making decisions – Based on TLV’s and many are identical regarding respirator use: above the IDLH, only – Include 8 hour PEL, 15 minute STEL, and Ceiling Limit supplied air respirators should be used, below the IDLH, air purifying respirators may be used, if appropriate. Two factors were considered when establishing the IDLH limits: Until the last revision in 1994, an exposure duration of 30 minutes was associated with the IDLH. This is no longer the case. The current definition has no exposure duration associated with it. Workers should not be in an IDLH environment for any length of time unless they are equipped and protected to be in that environment. IDLH values were determined based on animal and human data. They may be found in the NIOSH Pocket Guide to Chemical Hazards, and in other references. http://response.restoration.noaa.gov/cameo/locs/worklims. html • IDLH -Immediately Dangerous to Life & Health

– Maximum level from which a worker could escape without any escape impairing symptom or irreversible health effect

IDLH for xylene 900 ppm.

IDHA - Acronyms and Terms • LEL and UEL – Lower Explosive/ Upper Explosive Limit

• FR and FL – Flammable Range/Flammable Limit

Slide 5.27 These have to do with fire and explosion. Flash point is covered on the next slide. Use reference material to compare UEL/UFL, LEL/LFL (flammable range) or benzene, ammonia, hydrogen sulfide, hydrazine. (Use a NIOSH Pocket Guide.)

5.13

First Receiver Awareness/Operations and Decontamination for Healthcare

IDHA - Acronyms and Terms • FP - Flash Point

– The temperature at which the liquid phase gives off enough vapor to flash when exposed to an external ignition source. [Gasoline = minus 40o F]

• IT - Ignition Temperature/Fire Point

– The temperature at which a liquid is capable of sustained fire with an external ignition source. [Gasoline = minus 35o F]

• AIT – Auto-Ignition Temperature

– The temperature at which a mixture of flammable vapor and air would ignite without a spark or flame. (It is always a higher temperature than the Ignition Temperature) [Gasoline = 536o F and Paper = 451o F]

IDHA - Acronyms and Terms • BP • SG • Sol

Boiling Point Specific Gravity Solubility

Slide 5.28 Flash Point then Ignition Temperature/Ignition Point/Fire Point then Auto-ignition temperature (Think book title Fahrenheit 451)

Slide 5.29 Boiling Point - temperature when it goes from a liquid to a vapor. Specific Gravity - does it float or sink in water. < 1 - it floats > 1 - it sinks For xylene the Specific Gravity is less than 1 and thus it floats.

Slide 5.30

IDHA - Acronyms and Terms • VD • VP • pH

Vapor Density Vapor Pressure Acidity/Alkalinity

Vapor Density - like specific gravity but for vapors. < 1 - it floats to the top of the air > 1 - it sinks below the air Vapor Pressure - how much the substance wants to get out of it’s container. The higher the vapor pressure the greater the evaporation rate. Expressed in atmospheres or mm/Hg.

5.14

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 5.31 Toxicity Relationships

Acrolein

Dangerous

H 2S Chlorine

Chart at left shows the toxicity relationship between some well know chemicals.

VX Dangerous

Ammonia

Dangerous

Methanol

Dangerous

25000

Unsafe

Safe 1200

200

Methanol

Safe

Carbon Monoxide

Unsafe

300

25 Safe

Ammonia

100 10

Un. Safe

H2S HCL

Un.

0.5

Chlorine

5 0.0001 0.00001

0.1

Acrolein

Remember! • Many hazmats are odorless, colorless and tasteless! • You may be exposed before you know it! • Wear PPE • Approach safely - UUU Internal Above / Upgrade Different Ventilation Out of flow

External Up Hill Up Wind Up Stream

Limits of Toxicology • Most exposure levels based on animal tests

Slide 5.32 Because many chemicals are odorless, colorless and tasteless it is important to approach from uphill, upwind and upstream. Also proper PPE can protect you until the hazard is determined. UUU = Up hill, Up wind, Up stream

Slide 5.33 Most of these numbers are based on animal tests and are estimates of what a human dose would be.

• Test results with animals are often different than results with humans

5.15

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 5.34

Routes of Entry and Preventing Exposure • Inhalation - you breath it – Isolate and deny entry – Wear SCBA – Just stay away!

Routes of Entry and Preventing Exposure • Ingestion - you eat it – Isolate and deny entry – Don’t eat, smoke, drink – Natural reactions

Routes of Entry and Preventing Exposure • Absorption - soaks through skin – Isolate and deny entry – Wear proper PPE – Decon any exposure

The greatest route of entry hazard to an unprotected responder is inhalation! The oft quoted statistic is that the air sacs (alveoli) if laid out would have the surface area of a tennis court.

Slide 5.35 Wearing respiratory protection will help keep you from ingesting hazardous materials. Don’t eat, drink or smoke in hazard areas.

Slide 5.36 The second greatest concern and why we wear liquid splash protection usually. The skin is usually a good barrier against many chemicals but a significant number of hazardous materials can pass through the skin. (Many solvents and corrosives are examples.)

5.16

First Receiver Awareness/Operations and Decontamination for Healthcare

Routes of Entry and Preventing Exposure • Injection - puncture wound – Isolate and deny entry – Wear proper PPE – How can this happen?

Variables & Modifying Conditions

• Location

– Proximity to patients – Ability to isolate

Slide 5.37 This is not shooting up in an alleyway. Injection means anything that breaks the integrity of the skin and can send the contaminant into the bloodstream. Puncture wounds (that is why we like steel toed and shanked boots) slips, trips and falls that rip the suit and the skin are concerns.

Slide 5.38 When developing information on an incident many factors come into play.

Slide 5.39

Predicted Behavior • Before intervention • Try to predict behavior of release – What will it do? – Where will it go? – What will it hurt?

One of the things we try to do is predict the behavior of the release. If internal to the hospital may require a completely different response than an external incident.

5.17

First Receiver Awareness/Operations and Decontamination for Healthcare

Baseline Question • Before intervention – Outcome of natural stabilization? – Favorable impact intervention will make?

Result • IDHA is “Intelligence” • Now ready to Action Plan!

Action Planning • Components of action plans

Slide 5.40 Most incidents will self stabilize over time. We need to consider how our intervention will impact the incident in a positive way.

Slide 5.41 Now that we have obtained intelligence on the hazards and risks we are ready to develop an Action Plan!

Slide 5.42 This is what most organizations do poorly or not at all.

– ID the problem – ID resources available – Use available resources to solve problem

5.18

First Receiver Awareness/Operations and Decontamination for Healthcare

Start With a HICS 201/202 Form

Slide 5.43 HICS uses several forms that are helpful in developing an Action Plan. Here is a sample. The forms can be found in the supplemental material section of this chapter.

Slide 5.44

Site Safety Plan • Required and necessary for a safe and effective response • Much of the information can be planned before there is an incident

Note examples of Site Safety Plans in the HICS forms and another in handouts. These Plans should be filled out for each incident and the information conveyed to all responders. If the decon area or other aspects are consistent, those components of the plan can be pre-filled.

Review Safety Plan Document

Slide 5.45

Pg III A 75

This is a simplified IAP along with a Site Safety Plan annex. Organizations are encouraged to plan ahead of time for likely scenarios and develop Incident Action Plans beforehand. For example, if they have a specific area for decon, a site map and directions can be developed and then incident specific information added at the time of the event.

5.19

First Receiver Awareness/Operations and Decontamination for Healthcare

Slide 5.46 This is a simplified IAP along with a Site Safety Plan annex.

Action Planning

Slide 5.47

Capabilities & Resources

Personnel- Who do you have? (Day/night staffing) What is their training? Are the trained people • Personnel • Equipment internal or external. Protection of personnel must • Policies/Procedures/Guidelines be the top priority. • Facilities Equipment- Decon, Spill cleanup HVAC Do the policies/procedures exist for the type of Water containment incident? Will the P&Ps suffice as the basis of an Incident Action Plan? Facilities- HVAC (Heating, Ventilation, Air Conditioning) - where does the intake come from and where does the exhaust go (outside, another dept. Can the facility shut down the outside air entirely in the event of the need for in-place protection? Water Containment- Can runoff be contained. If not what where does it go (storm sewer, waterway, sanitary sewer )? While the facility is responsible for any contamination caused by runoff water, the priorities will always be life, environment, and property. Do not refrain from conducting decontamination due to inability to contain decon runoff.

5.20

First Receiver Awareness/Operations and Decontamination for Healthcare

Supporting Material IDHA and Action Plans: (I.A.) Main Points •

The IDHA Process

•

Emergency Response Guidebook

•

Hazard and Risk Management Worksheet

•

Safety Data Sheets

•

SDS as an IDHA Tool

•

Importance of Toxicology

•

Routes of Entry and Preventing Exposure

•

SDS Toxicology Acronyms and Terms

•

Dose-Response Relationship

•

Other Reference Guides

•

Key Physical and Chemical Terms

•

Variables/Modifying Conditions on IDHA

•

Predicted Behavior and the Baseline Question

•

Action Planning

5.21

First Receiver Awareness/Operations and Decontamination for Healthcare

Block Outline 1.

The IDHA Process a. One of the most critical aspects (the heart) of a hazardous materials response is “Identification and Hazard Assessment” (IDHA). 1) It can be a long, complex process. 2) OSHA regs require the IC to do IDHA (“identify... all hazardous substances or conditions present...”) 3) Can’t manage if you can’t identify and assess the problem. b.

Must link Identification with Hazard Assessment, which requires: 1) Identifying chemical names(s) and 2) Assessing the specific hazards of the chemical name(s).

The basic five step IDHA process: 1) Identify chemical name, 2) Assess all hazards, 3) Assess physical, chemical and toxicological properities, 4) Assess variables/modifying conditions and 5) Predict behavior/outcome.

5.22

First Receiver Awareness/Operations and Decontamination for Healthcare

Block Outline

The IDHA Process (continued) d.

Information sources to aid in IDHA: 1) 2) 3) 4) 5) 6)

SDS (Safety Data Sheets) Placards and labels (e.g. colors and symbols) Shipping papers (e.g. Bill of Lading, Way Bill, etc.) Reference guides (e.g. NA Emergency Response Guidebook) Technical information centers (e.g. CHEMTREC) NFPA 704 warning system: a) b) c) d)

Blue = Health Red = Flammability Yellow = Reactivity No Color = Special Hazard Information

7) Computer databases (CAMEO, TOMES, PEAC, etc.) 8) Consumer product labeling: a) “Danger” - highest hazard b) “Warning” - moderate hazard c) “Caution” - lowest hazard

9) Pipeline markers (product, owner & emergency number )

e. Three information sources preferred minimum for IDHA

5.23

First Receiver Awareness/Operations and Decontamination for Healthcare

Signal Words 16 CFR 1500 Background:

“(a)(1) Background and scope. Section 2(p)(1) of the Federal Hazardous Substances Act (FHSA) or ‘the Act’’), 15 U.S.C. 1261(p)(1), requires that hazardous substances bear certain cautionary statements on their labels. These statements include: signal words; affirmative statements of the principal hazard(s) associated with a hazardous substance; the common or usual name, or chemical name of the hazardous substance; the name and place of business of the manufacturer…statements of precautionary measures to follow; instructions, when appropriate, for special handling and storage; the statement ‘Keep Out of the Reach of Children’ or its practical equivalent; and, when appropriate, first-aid instructions. Section 2(p)(2) of the Act specifies that all such statements shall be located prominently on the label of such a substance and shall appear in conspicuous and legible type in contrast by typography, layout, or color with other printed matter on the label.”

15 USC §1261(p)(1)

“DANGER”

On substances which are extremely flammable, corrosive, or highly toxic.

“WARNING” “CAUTION”

On all other hazardous substances.

“POISON”

Any hazardous substance which is defined as “highly toxic.”

5.24

First Receiver Awareness/Operations and Decontamination for Healthcare

DOT Emergency Response Guidebook (ERG)

ERG purpose: Basic safety tool for basic identification, basic assessment and initial response (recognized good practice/ standard for FROs to follow).

1) Use the current version of ERG for transportation-related Haz Mat incidents! 2) Use current SDS if available for other incidents.

ERG page border colors and basic organization:

1) White - Basic information and instructions (+ Placard Table), 2) Yellow – ID number index (materials listed by ID number), 3) Blue - Material name index (materials listed alphabetically), 4) Orange – Numbered guide pages, 5) Green - Table of Initial Isolation and Protective Actions. c. ERG is a good “User-Friendly” basic guide but is limited: 1) Classifies by major hazard class or general chemical only. 2) Guides are only the most elemental guidance (cross-verify). a) “P” – polymerization hazard. 3) Isolation and evacuation distances in back of book are guides. a) List of dangerous water–reactive materials. 4) Use table of placards only if materials cannot be identified. a) Guide 111. 5) Intended for use in transportation-related incidents. 6) Intended only for use in “initial response phase.” d. Receivers should have ready access to an ERG and other guides, and must know how to efficiently and effectively use them.

5.25

First Receiver Awareness/Operations and Decontamination for Healthcare

Emergency Response Guidebook Exercise

Name

UN#

Guide #

Isolation Distance Small Large Spill Spill

Protective Action Distance Small Large Major Hazard Spill Spill

Bromine Epichlorohydrin Fluorine, Refrig, Liquid Arsine Chloroacetaldeyhde Resinox 2783 2683 2615 1595 1050 1325

5.26

First Receiver Awareness/Operations and Decontamination for Healthcare

3. Safety Data Sheets (SDS). a. Who, What, When and Where of SDSs. 1) Required by OSHA Hazard Communication Regulation. a) 29 CFR 1910.1200 b) Title 8 CCR §5194 2) Required in the “workplace” (not just fixed facilities). 3) Informs employees of “hazardous chemicals” present. 4) Purpose: ensure that the hazards of all chemicals are: a) Evaluated and that, b) Information is transmitted to employees. 5) Methods of transmitting information. a) Comprehensive hazard communication programs, b) Container labeling and other forms of warning, c) Safety data sheets and, d) Employee training. b. Does not apply to: 1) Any food, food additive, color additive, drug, cosmetic, or medical or veterinary device or product, 2) Any distilled spirits (beverage alcohols), wine, or malt beverage intended for non-industrial use, 3) Consumer products, 4) Hazardous waste (including those at waste sites), 5) Tobacco and tobacco products, 6) Wood and wood products, 7) Drugs (legal ones), 8) Radiation, 9) Biological hazards.

5.27

First Receiver Awareness/Operations and Decontamination for Healthcare

SDS as an IDHA Tool

a. b. c. 5.

Importance of Toxicology.

a. b. 6.

What is it? (IDHA) How can I protect myself from it? (IDHA) What will it do to me? (IDHA) 1) SDSs often provide useful toxicological information.

Related to your life and health! Many deaths and injuries are to exposed persons. You and other receivers must consider short- and long-term health effects!

Definition of Toxicology and Poison.

a. Toxicology: The study of adverse systemic effects of chemicals. b. Poison: Chemical that produces illness or death when taken in very small quantities (DOT: LD50 < 50 mg per kg of body weight): 1) “Poison Gas 2” placard: gas (compressed or liquid), 2) “Poison 6.1” placard: liquid or solid, 3) “Poison 6.2” placard: infectious substance or etiological agent. c. Toxicology has limits — Tests usually on animals (rats, guinea pigs, etc.), and there are often wide variations of health effects between animals and humans.

5.28

First Receiver Awareness/Operations and Decontamination for Healthcare

SDSs and IDHA.

Importance:

Without Hazard Assessment, Identification means nothing!

Priorities:

First identify the chemical then use an SDS to assess: • General, Health and Fire Hazards • Physical and Chemical Properties • Variables and Modifying Conditions • Behavior and Outcomes

Impacts: IDHA impacts selection of: • Protective Clothing and Equipment • Containment and Control Methods • Protective Action Options • Medical Aid, Decon and Cleanup SDS can provide pertinent information for all of the above. Intel vs. Info: Intelligence is information that has been: • Verified • Organized • Analyzed • Prioritized • Made useful for valid IDHA. Use SDS to find “information.” Use your head to develop “intelligence”!

5.29

First Receiver Awareness/Operations and Decontamination for Healthcare

Routes of Entry and Preventing Exposure.

a. Inhalation—You breathe vapors, fumes, gases, etc. 1) Isolate and deny entry. 2) Wear SCBAs. 3) Just stay away! b. Ingestion—You eat it. 1) Isolate and deny entry. 2) Don’t eat, smoke or drink near the scene. 3) You have a natural ability to fight off exposures from ingestion (i.e. barfing). c. Absorption—Soaks through your skin. 1) Isolate and deny entry. 2) Wear proper PPE. 3) May absorb hazmats through skin, eyes or wounds. d. Injection/Physical Contact—Puncture wound. 1) Isolate and deny entry. 2) Wear proper PPE (e.g. steel-toed shoes). 3) Ways this can occur: ______________________________ e. Remember: many toxic vapors lack color, odor and taste. 1) You may get exposed before you even know it. a) “If you think it is burning, it already is!” Martin Yan. 2) Exposure occurs from approaching downwind, from wind shifts or not wearing protective clothing and SCBAs, etc.

5.30

First Receiver Awareness/Operations and Decontamination for Healthcare

SDS Toxicology Acronyms and Terms.

a. Tools for determining relative toxicity and selecting appropriate levels of PPE. Many measure occupational (chronic) exposures and may not apply to emergency (acute) response exposures. 1) IDLH — Immediately Dangerous to Life and Health, 2) TLV™ — Threshold Limit Value (guides), a) TLV™-TWA b) TLV™-STEL c) TLV™-C 3) STEL — Short-Term Exposure Limit, 4) PEL — Permissible Exposure Limit (law), 5) MLD — Minimum Lethal Dose, 6) LD/LC50 — Lethal Dose/Lethal Concentration 50%, 7) LDlo — Lethal Dose, low, 8) PPM/MgM3 — Parts-Per-Million/Milligrams Per Cubic Meter, 9) ERPG — Emergency Response Planning Guide. 9.

Dose-Response Relationship.

a. Effect produced by a toxic compound depends on the dose of the compound you receive. b. Typically, as dose increases, severity of toxic response increases. 1) Humans exposed to 100 ppm of tetrachloroethylene, a solvent that is commonly used for dry cleaning fabrics, may experience relatively mild symptoms, such as headache and drowsiness. 2) Exposure to 200 ppm tetrachloroethylene can result in a loss of motor coordination in some individuals. 3) Exposure to 1,500 ppm tetrachloroethylene for 30 minutes may result in a loss of consciousness. c. Severity of toxic effect also depends on duration of exposure.

5.31

First Receiver Awareness/Operations and Decontamination for Healthcare

10. Other Reference Guides. a. CHEMTREC – Chemical Transportation Emergency Center. 1) 24 hour technical information center. 2) One person call 1 (800) 424-9300 (stay on phone). 3) Information CHEMTREC will want: a) Name of caller and call back number, b) Name of product, nature and location of problem, c) Shipper or manufacturer, carrier and consignee name, d) Container type and local conditions. 4) Limited primarily to SDS-type info. Will notify shipper, NRC and other industry Mutual Aid teams (e.g. CHLOREP). b. Other IDHA reference guides. 1) ATSDR – Medical Management Guidelines. 2) ATSDR, Volume II, Managing Hospital Management Incidents 3) NIOSH Pocket Guide to Chemical Hazards. 4) Condensed Chemical Dictionary. 5) CHRIS Manual. 6) Dangerous Properties of Industrial Chemicals. 7) Farm Chemical Handbook. 8) AAR – Emergency Handling of Hazardous Materials. 9) NFPA Fire Protection Guide to Hazardous Materials. 10) Merck Index. 11) Computer databases. 12) Pesticide labels.

5.32

First Receiver Awareness/Operations and Decontamination for Healthcare

Reference Sources. CHEMTREC 24 hour information center. Operated by the Chemical Manufacturers Association. Explosives

Explosives, Rudolf Meyer, Comprehensive reference. Publisher: VCH Publishing. Cost: $250.00

Hawley’s Hawley’s Condensed Chemical Dictionary. Basic info about chemicals and chemistry in a dictionary-type format. Publisher: Sax and Lewis. Cost: $80.00. CHRIS Chemical Hazards Response Information System. Detailed information for over 3500 substances. Publisher: U. S. Gov’t Printing Office. Cost: $50.00. NIOSH Guide National Institute for Occupational Safety and Health Pocket Guide to Chemical Hazards. Toxicological info for over 400 substances. Publisher: U. S. Gov’t Printing Office. Cost: $15.00. Sax Book Dangerous Properties of Industrial Materials. Three volume set with detailed info on over 20,000 substances. Publisher: Sax and Lewis. Cost: $450.00. Meisters

Farm Chemical Handbook. Detailed info on pesticides and other ag chemicals. Publisher: Meister. Cost: $80.00.

AAR Book Emergency Handling of Hazardous Materials in Surface Transportation. ERG-type info for materials listed in 49 CFR 172. Publisher: Assoc. of American Railroads. Cost: $100.00. Merck

The Merck Index. Info on over 10,000 chemicals, drugs and biological substances. Publisher: Merck. Cost: $65.00

NFPA Guide

NFPA Fire Protection Guide to Hazardous Materials. Fire-related info for various hazardous substances. Publisher: NFPA. Cost: $90.00.

5.33

First Receiver Awareness/Operations and Decontamination for Healthcare

11. Variables/Modifying Conditions on IDHA.

a. Many variables will impact the hazard assessment, such as: 1) Location (e.g. urban area vs. rural area). In hospital is the patient population in danger? 2) Time/date (e.g. evening or day, business hours, next to a school), 3) Weather (wind, temperature or rain—actual or forecast), 4) Nature of materials (e.g. household bleach vs. liquid chlorine), 5) Stage of incident (e.g. initial stage of release vs. empty tank), 6) Size of problem (potential amount, release rate, etc.), 7) Type, condition, nature and behavior of container, 8) Amount, type and training of responders/receivers and equipment, 9) Availability, type and amount of control agents. b.

The same material with different variables may significantly change the incident and the way you respond to it.

You may not find these variables in a “book” – use your head!

5.34

First Receiver Awareness/Operations and Decontamination for Healthcare

12. Predicted Behavior and the Baseline Question. a. Before intervention, try to predict the behavior of the release. Think about the potential outcome of “natural stabilization.” 1) What will this stuff do? 2) Where will it go? 3) Who will it hurt? b. Ask the baseline question: 1) First ask “What if I did nothing?” as a baseline question; 2) Then ask “What favorable impact will my intervention make?” c. May need chemist, technical specialist, industrial hygienist or hazmat team for complex incident, multiple hazards, radioactive materials or “Mixed Bag” problem to aid in IDHA, hazard categorization and action planning. 1) “Dangerous” placard, 2) 4-4-4 NFPA 704 symbol. d. End result of IDHA is “Intelligence,” which is based on “Information” that is: 1) Verified, 2) Organized, 3) Analyzed, 4) Prioritized and, 5) Made useful. e. If you have IDHA intelligence, you’re ready for action planning.

5.35

First Receiver Awareness/Operations and Decontamination for Healthcare

Tips for Identification & Hazard Assessment

Sources:

Identification and Assessment Sources

• Safety Data Sheets (SDS) • Shipping Papers • Technical Information Centers • Computer Databases • Hazmat Technicians and Specialists • Placards and Labels • Reference Guides and Books • NFPA 704 System • Responsible Party • Pipeline Markers • Many Others

Important:

Use at least 3 sources for IDHA!

ERG:

Emergency Response Guidebook is a basic tool, however, all First Responders/Receivers and Incident Commanders should keep a copy in their vehicles and use it.

CHEMTREC:

CHEMTREC operates a 24-hour Technical Information Center and can transmit data to First Responders/Receivers via fax. Have one person call them at (800) 424-9300.

5.36

First Receiver Awareness/Operations and Decontamination for Healthcare

Action Planning—What OSHA Says…

Appendix C to 1910.120 - Compliance guidelines

6. Incident Command System.

FRO:

“The first responding senior officer would implement and take command of the ICS. That person would size up the incident and determine if additional personnel and apparatus are necessary; would determine what actions to take to control the leak; and determine the proper level of personal protective equipment.” (In other words, the first responder/ receiver will develop an action plan.)

7. Site Safety and Control Plans.

Plans:

“The safety and security of response personnel and others in the area of an emergency response incident site should be of primary concern to the incident commander. The use of a site safety and control plan could greatly assist those in charge of assuring the safety and health of employees on the site.”

Plan Contents:

“A comprehensive site safety and control plan should include the following: summary analysis of hazards on the site and a risk analysis of those hazards; site map or sketch; site work zones (clean zone, transition or decontamination zone, work or hot zone); use of the buddy system; site communications; command post or command center; standard operating procedures and safe work practices; medical assistance and triage area; hazard monitoring plan (air contaminate monitoring, etc.); decontamination procedures and area; and other relevant areas. This plan should be a part of the employer’s emergency response plan or an extension of it to the specific site.”

5.37

First Receiver Awareness/Operations and Decontamination for Healthcare

Pesticide Label Info Availability: “A copy of the registered labeling that allows the manner in which the pesticide is being used shall be available at each use site.” (Title 3 CCR §6602) Placement: “The label shall appear on the pesticide or the immediate container thereof. If the immediate container is enclosed within a wrapper or outside container through which the label cannot be clearly read by a person with normal vision, the label must also appear on such outside wrapper or container if it is a part of the retail package.” (Title 3 CCR §6237) Statements: “Warning or caution statements…must appear on the label in a place sufficiently prominent to warn the user, and must state clearly and in non-technical language the particular hazard involved in the use of the pesticide, e.g., ingestion, skin absorption, inhalation, flammability or explosion, and the precautions to be taken to avoid accident, injury, or damage.” (a) The label of every pesticide shall bear warnings or cautions which are necessary for the protection of the public, including the statement, “Keep out of reach of children,” and a signal word such as “Danger,” “Warning,” or “Caution” as the director may prescribe, on the front panel or that part of the label displayed… (b) The label of every pesticide which is highly toxic to man shall bear the word “Danger” along with the word “Poison” in red on contrasting background in immediate proximity to the skull and crossbones, and an antidote statement including directions to call a physician immediately on the front panel or that part of the label displayed…”(Title 3 CCR §6242)

5.38

First Receiver Awareness/Operations and Decontamination for Healthcare

Minimizing Exposure in a Response

The Law:

“The individual in charge of the ICS shall limit the number of emergency response/receiving personnel at the emergency site, in those areas of potential or actual exposure to incident or site hazards, to those who are actively performing emergency operations.” 29 CFR 1910.120(q)(3)(v), Title 8 CCR 5192(q)(3)(E)

Inhalation: Approach the scene from upwind. Establish control zones. Require all entry teams to wear SCBAs. Evaluate potential vapor/gas dispersion. Consider the possibility of wind shifts. Decontaminate all exposed personnel and equipment. Absorption:

Require all entry teams to wear proper PPE. Isolate all sources of potential exposure. Decontaminate all exposed personnel and equipment.

Ingestion:

Forbid eating, drinking and smoking until decon is complete. Require all responders/receivers to thoroughly wash hands, face and hair. Decontaminate all exposed personnel and equipment.

Injection:

Require all responders/receivers to wear proper PPE and basic safety equipment (hardhats, steel-toed shoes, gloves, etc.). Evaluate hazards of debris, wreckage, etc.

5.39

First Receiver Awareness/Operations and Decontamination for Healthcare

Participant Worksheet 1.

In your own words, identify the link between “Identification” of the chemical name and “Assessing” the analysis of the chemical hazards:

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 2. List at least three (3) common sources for IDHA: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 3. List the five (5) basic steps of IDHA: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 4. Per attached DOT Emergency Response Guidebook Exercise, (or 6 chemical names + 6 UN ID numbers provided by the instructor) identify the UN ID number/chemical name, Guide Page Number, Primary Hazard, and Initial Isolation and Protective Action Distances as required using a DOT Emergency Response Guidebook. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ © State of California- CalOES/CSTI 10/1/2013

5.40

First Receiver Awareness/Operations and Decontamination for Healthcare

Physical and Chemical Properties BP

Boiling Point. The temperature at which a liquid will evaporate at its fastest rate and become a gas or vapor.

Concern:

At which temperature will this material vaporize and become an airborne hazard? (Hint: Compare the boiling point with the air temperature.) Flash Point. The lowest temperature at which evaporation of a substance produces sufficient vapor to form an ignitable mixture with air.

FP Concern IT Concern: FR/FL

Concern: Sol Concern: SG Concern: VD Concern:

At what temperature will this material flash but not necessarily continue to burn? (Hint: Compare the flash point with the air temperature) Ignition Temperature. The minimum temperature at which the material will ignite without a spark or flame being present. At which temperature will this material burn on its own? (Hint: Compare the ignition temperature with the air temperature) Flammable Range and Flammable Limit (also called UEL and LEL- Upper Explosive and Lower Explosive Limit). The range of concentration (usually expressed as a percentage) of a flammable gas or vapor, in air, at which fire or explosion can occur upon ignition. What is the possibility of this material igniting. (Hint: A wider range indicates a greater hazard) Solubility. The amount, in pounds, of a material that will dissolve in100 pounds of water. Solubility usually increases with temperature. Will this material mix with water? (Hint: What is the temperature of the water this material may end up in?) Specific Gravity. The ratio of the weight of the material to the weight of an equal volume of water. Greater than 1, it sinks. Less than 1, it floats. What will this material do when it enters a body of water? If this material is burning, would water be an effective extinguishing agent? (Hint: Petroleum products usually have a specific gravity less than 1. Pesticides often have a specific gravity greater than 1) Vapor Density. The ratio of weight of a vapor or gas to the weight of an equal volume of dry air at the same temperature and pressure. Will the vapors from the material rise or fall? (Hint: Compare the boiling point with the air temperature. Vapors coming from extremely cold liquids may fall even though their vapor density is less than 1.)

5.41

First Receiver Awareness/Operations and Decontamination for Healthcare

Physical and Chemical Properties VP

Vapor Pressure. The pressure exerted by vapor that is in equilibrium with the liquid at a specified temperature. The pressure a saturated vapor exerts over its own liquid that is confined in a closed container. A measure of a liquid’s tendency to evaporate. Usually expressed in millimeters of mercury (mmHG). Examples: - Mercury - 0.0012 - Water - 17.5 - Benzene- 80.0 - Acetone- 215.0

Concern: PH

Concern:

What is the possiblility of this material evaporating and spreading downwind? (Hint: Pay attention to the time of day of the release and the type of surface material it is on since vapor pressure varies greatly with temperature.) Acidity/Alkalinity. The measure of the degree of acidity or alkalinity of a solution. A pH of less than 7 indicates the presence of an acid. A pH of greater than 7 indicates the presence of an alkaline substance. Will this material react with other materials? (Hint: Get advice from competent sources when responding to incidents involving these materials since their reaction with other materials can vary greatly.

5.42

First Receiver Awareness/Operations and Decontamination for Healthcare

Practical Exercise (H.A.R.M. worksheet) Using the substance Xylene Pages that follow:

1. 2. 3. 4.

H.A.R.M. Worksheet NIOSH Guide excerpt Safety Data Sheet 2012 DOT ERG Pages

5.43

First Receiver Awareness/Operations and Decontamination for Healthcare

HAZMAT FOR HEALTHCARE

HARM / Risk Assessment Worksheet Product Name:

UN# (4 digits)

DOT Hazard Class:

Physical State:

EX-FG-FL-FS-OX-PO-RA-CO-OT 1

ERG Guide #

(at 68 degrees F)

NFPA: H

Poison Control Information = (800) 222-1222

Hazard

Physical Description

Toxicity Lower #’s and/or Narrow Range = higher hazard

Flammability

ppm or mg/m3

TWA

8 Hrs

LEL / UEL:

Lower # = higher hazard

Flashpoint:

Lower # = higher hazard

I.T. =______

Solubility

STEL

Short

IDLH

Ceiling

Danger

50%

100%

0o F

100o F

200o F

Liquid?

Float / Sink / Neither

Vapor?

V.D. =_____

Float / Sink / Neither

Vapor Production?

Water @ 17.5 mmHg (0.33 psi) = Low 1 PPM = 4.34 Mg/M3

_______mmHg

Low, Medium, High

B.P. =_____

Lower B.P. = more vapor

Corrosivity

Acid 0-6

pH Value

Carcinogen

Non, Somewhat, Very

Soluble?

Air = 1 (less rises, more sinks)

Closer to 0 or 14 = more corrosive

Flammable?

Not, Somewhat, Very (W) Not, Somewhat, Very (O)

S.G. =_____

Higher = more vapor Lower = less vapor

(0-4)

Little, Somewhat, Very

A.I.T. =______ (paper = 451o F) Soluble (swims) in: Oil (O) Water (W) Water = 1 (less floats, more sinks)

Vapor Pressure

Hazard Summary

Specific Gravity Vapor Density

Toxicity?

Lower # = higher hazard Wider Range = higher hazard

Solid/Liquid/Gas

0 2

Yes

Base 8-14

Corrosive? Not, Somewhat, Very Cancer risk to staff? Yes / No

Other Info of Interest:

5.44

First Receiver Awareness/Operations and Decontamination for Healthcare

UNIT LOG 4. UNIT NAME/DESIGNATORS

1. INCIDENT NAME

5. UNIT LEADER (NAME AND POSITION)

2. DATE PREPARED

3. TIME PREPARED

6. OPERATIONAL PERIOD

PERSONNEL ROSTER ASSIGNED NAME

ICS POSITION

HOME BASE

ACTIVITY LOG (CONTINUE ON REVERSE) TIME

MAJOR EVENTS

NFES 1337

5.45

NIOSH Pocket Guide to Chemicaland Hazards (2005-151) : o-X... FirstDocument: Receiver Awareness/Operations Decontamination for Healthcare

http://www.cdc.gov/niosh/npg/npgd0668.html

NIOSH Publication No. 2005-151:

September 2005

NIOSH Pocket Guide to Chemical Hazards

CAS 95-47-6

o-Xylene C6H4(CH3)2

RTECS ZE2450000

Synonyms & Trade Names

DOT ID & Guide

1,2-Dimethylbenzene; ortho-Xylene; o-Xylol

Exposure Limits IDLH 900 ppm See: 95476

1307 130

NIOSH REL: TWA 100 ppm (435 mg/m3) ST 150 ppm (655 mg/m3) OSHA PEL†: TWA 100 ppm (435 mg/m3)

Conversion 1 ppm = 4.34 mg/m3

Physical Description

Colorless liquid with an aromatic odor. MW: 106.2

BP: 292°F

VP: 7 mmHg

IP: 8.56 eV

Fl.P: 90°F

UEL: 6.7%

FRZ: -13°F

Sol: 0.02% Sp.Gr: 0.88

LEL: 0.9%

Class IC Flammable Liquid: Fl.P. at or above 73°F and below 100°F.

Incompatibilities & Reactivities Strong oxidizers, strong acids

Measurement Methods

NIOSH 1501, 3800; OSHA 1002 See: NMAM or OSHA Methods

Personal Protection & Sanitation (See protection) Skin: Prevent skin contact Eyes: Prevent eye contact Wash skin: When contaminated Remove: When wet (flammable) Change: No recommendation

First Aid (See procedures) Eye: Irrigate immediately Skin: Soap wash promptly Breathing: Respiratory support Swallow: Medical attention immediately

Respirator Recommendations NIOSH/OSHA

Up to 900 ppm: (APF = 10) Any chemical cartridge respirator with organic vapor cartridge(s)* (APF = 25) Any powered, air-purifying respirator with organic vapor cartridge(s)* (APF = 10) Any supplied-air respirator* (APF = 50) Any self-contained breathing apparatus with a full facepiece Emergency or planned entry into unknown concentrations or IDLH conditions: (APF = 10,000) Any self-contained breathing apparatus that has a full facepiece and is operated in a pressure-demand or other positive-pressure mode (APF = 10,000) Any supplied-air respirator that has a full facepiece and is operated in a pressure-demand or other positive-pressure mode in combination with an auxiliary self-contained positive-pressure breathing apparatus Escape: (APF = 50) Any air-purifying, full-facepiece respirator (gas mask) with a chin-style, front- or back-mounted organic vapor canister/Any appropriate escape-type, self-contained breathing apparatus Important additional information about respirator selection

Exposure Routes inhalation, skin absorption, ingestion, skin and/or eye contact Symptoms Irritation eyes, skin, nose, throat; dizziness, excitement, drowsiness, incoordination, staggering gait; corneal vacuolization; anorexia, nausea, vomiting, abdominal pain; dermatitis III A 101

1 of 2

5.46 11/20/2006 7:08 PM

First Receiver Awareness/Operations and Decontamination for Healthcare

Xylene

Material Safety Data Sheet CITGO Petroleum Corporation 1701 Golf Road, Suite 1-1101 Rolling Meadows, IL 60008-4295

MSDS No.

07306

Revision Date

8/22/2012

IMPORTANT: This MSDS is prepared in accordance with 29 CFR 1910.1200. Read this MSDS before transporting, handling, storing or disposing of this product and forward this information to employees, customers and users of this product.

Emergency Overview Physical State Liquid. Transparent, Color colorless.

Odor

Sweet, pungent aromatic hydrocarbon.

Hazard Rankings HMIS NFPA Health Hazard

Fire Hazard

Reactivity

* = Chronic Health Hazard

WARNING: Flammable liquid; vapor may cause flash fire. Harmful or fatal if swallowed - Can enter lungs and cause damage. Can cause eye, skin or respiratory tract irritation. Overexposure can cause central nervous system (CNS) depression and/or other target organ effects. Breathing high concentrations can cause irregular heartbeats which may be fatal. Harmful to aquatic organisms.

Protective Equipment Minimum Recommended See Section 8 for Details

SECTION 1. PRODUCT IDENTIFICATION Trade Name

Xylene

Technical Contact

Product Number

07306

Medical Emergency

(832) 486-4700

CAS Number

Mixture.

CHEMTREC Emergency (United States Only)

(800) 424-9300

Product Family

Petroleum hydrocarbon solvent

Synonyms

Xylol; Mixed Xylenes; Xylene Isomers and Ethylbenzene; Dimethylbenzenes and Ethylbenzene; C8 Alkylbenzenes; C8 Aromatics; C8 Aromatic Hydrocarbon Solvent; Industrial-grade Xylene (meets ASTM D-364 Specifications); "Ten-degree" Xylene (meets ASTM D-846 Specifications). CITGO ® Material Code: 07306

(847) 734-7699 (8am - 4pm CT M-F)

SECTION 2. COMPOSITION Component Name(s) Xylene, all isomers Ethylbenzene Toluene

CAS Registry No. 1330-20-7 100-41-4 108-88-3

Concentration (%) 60 - 100 10 - 30

[PDF] First Receiver Awareness/Operations and Decontamination for Healthcare - Free Download PDF (2024)

References