taem core lecture nov 2009

1. Emergency Response in Chemical Casualties:
System Approach to Effective Hospital
Preparedness

2. Objectives
• Lessons Learned & Event Characteristics• Antidote and chemical stockpile
• Incident Response Requirements • Chemical protective clothing
• Scene Safety • Hazmat traing trends
• Medical Management of Hazmat Victims • Summary
– Primary Survey & Resuscitation
– Decontamination
– Hazmat Patient Assessment
– Poisoning Treatment Paradigm

3. Lessons Learned From
Coaminated Casualties Incidents

4. Emergency Management Consequence Timelines
EMERGENCY INCIDENT TIMELINES
INCIDENTS POTENTIAL CASUALTIES RESPONSES
Super Terrorism Warfare Type Ops
- Chemical - Evacuation
- Biological - Containment
- Nuclear - Biological - Decontamination
- Radiological - Quarantine
- Vaccination
Tens of (contagious) - Antidotes
Millions - Detoxification
Natural Disasters State-Fed Escalation
Millions - Nuclear - Radio-
- Flood logical - Search & Rescue
- Earthquake - Sustainment
- Hurricane Thousands - Medical Triage
- Chemical - Temp Morgue
- Tornado
-Earthquake
Criminal Terrorism
(non- Escalation
Hundreds -Hurricane contagious)
- Explosives -Tornado - Bomb Squad
Tens
-Explosives
- Flood
Everyday Life First Response
Seconds Days Weeks - First Aid
- Accidents Minutes - Rescue
Months
Hours - Fire
<991130v30> - Police

5. Bhopal Disaster
3 Dec.1984
8,000 died
300,000 injured

6. Tokyo March 20, 1995
• 5,500 People Exposed
• 3,227 Went to Hospital
• 550 Transported Via
EMS
• Essentially no
Decontamination of
Patients

7. SARIN Clip

8. What kind of gas was released? …
•50 Chechen rebels, storm Moscow’s
House of Culture Theatre during a
performance of Nord-Ost, taking 700
hostages. The rebels demand Russian
withdrawal from Chechnya, and threaten
to kill the hostages if demands are not met.
•After three days of fruitless negotiations
an unknown gas, meant to incapacitate the
rebels, is released in the theatre. Most of
the rebels and 116 hostages die.
October 26, 2002

9. Event Characteristics
• Most Victims are Exposed to Vapor
• No warning
• Victims Will Not Wait In Line to Decon.
• Most Decontamination Needs to be Done
at the Hospital Not the Scene
• Mass Disaster Response Occurs With
Local Resources

10. Event Characteristics
• Agent will likely be unknown
• Dry Decontamination Suitable for Most
• Only 10%-15% of Patients Via EMS
• Emergency Department Resources Limited

11. Most Common Fatal Injuries
– Trauma (65%)
– Thermal burns (16%)
– Respiratory irritation with airway obstruction
&/or respiratory failure (10%)
– Chemical burns (6%)
– Other causes (3%)
Hazardous Substances Emergency Events Surveillance (HSEES)

12. What is wrong with the patient
• Physical Trauma
• Exposure to Chemical HAZMAT
– Inhalation
• Most common
– Skin & mucous membranes
• Common
– Ingestion & Injection
• Unlikely
• Toxicity
– Local
– Systemic

13. The World Of Chemical Agents
• The vast majority of HazMat incidents
resulting in the contamination of people
involve common industrial chemical agents.
• The study of all potential sources of
contamination are best supported by looking
at these chemicals in a categorical system.

14. Agents Categories
1. Industrial Chemicals.
2. Chemical Warfare Agents.
3. Biological Warfare Agents.
4. Radiological Materials.

15. Incident Response Requirements
• Protect patients, staff, and facility
• Rapid decon
• Expert informations
• Surge capacity
• Some specialized expertise

16. Hospital Preparedness
•Medicare
•Manage care

17. Reasonable ≠ Adequate
“Best possible care for victims
while not compromising the safety
hospital staff and current patients”

18. Hospital Plan
• Cost effective
• Simple as possible
• Minimized manpower
• Immediate availability
• Rapid patient processing

19. Scene Safety
Hot, Warm and Cold zones
You will be here. Public
Health does not usually
decontaminate or function
in the hot zone
Hot Zone Warm Zone Cold Zone
Contaminated area Contamination Normal function
Need PPE reduction

20. Zone rules
Very limited treatment Isolate
cadavers
before decontamination Control access to zones
Temporary
Morgue
Decontamination direction No back flow!!
Hot Zone Warm Zone Cold Zone
Contaminated area Contamination Normal function
Need PPE reduction

21. Medical Management of Hazmat Victims
• Primary Survey & Resuscitation
• Decontamination
• Hazmat Patient Assessment
• Poisoning Treatment Paradigm

22. Primary Survey & Resuscitation: The Basics
• Airway with cervical spine control
• Breathing
• Circulation
• Disability (nervous system)
• Exposure with environmental control

23. Decontamination
“The process of removing or neutralizing surface contaminants that
have accumulated on personnel and equipment.”

24. Chemical Victim Triage
High Priority for Decontamination:
• Victims closest to point of release and reporting exposure.
• Victims showing some evidence of contamination on clothing or skin.
• Victims demonstrating serious symptoms.
Medium Priority for Decontamination:
• Victims not as close to point of release, and who have minimal
evidence of contamination on clothing or skin.
• Victims who are mildly symptomatic.
Low Priority for Decontamination:
• Victims who are far away from point of release.
• Victims who have no verified contamination.
• Victims who are asymptomatic.

25. Urgency for
Medical Care
Low risk for High risk for
secondary secondary
contamination contamination
Critically ill Critically ill
Focus on Simultaneous
Treatment decontamination and
treatment
Low risk for High risk for
secondary secondary
contamination contamination
Mild or no illness Mild or no illness
Decontamination Decontamination
not needed before treatment
Triage Urgency for
decontamination

26. General Principles
• Decontaminate victims as soon as possible.
• Disrobing is decontamination; head to toe, more
removal is better.
• Water flushing generally is the best mass
decontamination method.
• After a known exposure to a liquid chemical
agent, emergency responders should be
decontaminated as soon as possible to avoid
serious effects.

27. Decontamination Site Selection
• Outside!
• Level impermeable surfaced area
• Up wind
• Water supply/collection
• Illuminated
• Ingress and Egress routes

28. Layout of Hospital
Decontamination Zone

29. Decontamination Station 2 lines

30. Decontamination Station 3 lines

31. Suggested Cut-Out Procedures
(Non-ambulatory Patient’s Clothing)

32. Ideal Decontaminants
• Neutralize all Agents
• Safe
• Easy to use
• Available
• Rapid acting
• No toxic end products
• Affordable
• No irritability

33. Dry Decontamination
• Remove clothing/personal effects –
85% decon performed by this step
• Vapor or no exposure
• Removal of clothing
• Modesty concerns
• Requires large amounts of
disposable clothing
• Clothing disposition

34. Wet Ambulatory Decontamination
Requires only one or two personnel to perform,
primarily supervisory role
At least one person should be medically trained
May be quicker than non-ambulatory process,
should utilize about the same amount of solution
Focus on non-clothed/exposed areas
Decon wounds and bandage before entering
shower (occlusive dressing)

35. Wound Decontamination

36. Wet Ambulatory Decontamination
• Remove clothing/personal effects
• Decontaminate from head down
– Lean head back to avoid runoff in
eyes
• Encourage careful scrubbing of warm,
moist regions – axilla, groin, etc.
• Rinse thoroughly, copious water

37. Wet Ambulatory Decontamination
• Once decontaminated, patient
moves to cold zone staging area
• Re-clothed
• Status monitored until
transport available

39. Do not need to decon if it
can be confirmed that patient:
• Never in contaminated area
• Without signs and symptoms of exposure

40. Litter Wet Decontamination
• Requires minimum of 2-4 persons per patient
• 10 to 20 minutes per patient
• Average resources per patient: 35 – 50 gallons
• Decontamination solutions:
– Water and Detergent
– Hypochlorite 0.5% and 5% (do not use in eye,
open head or abd wounds, must be made daily)
• Scrape off visible contamination

41. Litter Wet Decontamination
• Decontaminate with copious decontaminating fluid
• Transfer to clean stretcher
• Monitor patient and move to clean area

42. Litter Wet Decontamination
• Non-ambulatory patients displaying serious
signs and symptoms
• Rapid decontamination
• 5-10 minutes per patient

43. Skin Decon: Special Areas
• Commonly ignored during decon
• Including
– Scalp
– Body hair
– Genitalia
– Skin creases & folds
– Hands
– Feet
– Nails

44. CORRIDOR
DECONTAMINATION
• The simplest solution
• The nozzles are set at low pressure and high
volume so as not to inflict damage but which
maximize the amount of water each victim is
exposed to.

45. SPRINKLER HEAD
DECONTAMINATION
• water delivered at 500 gallons a minute
• If the victim remains in the shower for 3
seconds on average, and assuming the
person is exposed to 50% of the water
• 500 gals./minute = 8 gals/second
• 8 gals./second × 3 seconds = 24 gals.
• 24 gals. × 50% = 12 gals.

49. Other Field-Expedient Water
Decontamination Methods
• should not overlook existing facilities when
identifying means for rapid decontamination
methods.
• although water damage to a facility might occur,
the necessity of saving lives would justify the
activation of overhead fire sprinklers for use as
showers.

50. Other Field-Expedient Water
Decontamination Methods
• wade and wash in water sources such as public
fountains, chlorinated swimming pools, swimming
areas, etc., provides an effective, high-volume decon
technique.
• Car washes with hand-held wands should also be
considered. Water used for decontamination in
lifesaving operations should be properly handled
and disposed of in compliance with environmental
and health regulations, whenever possible.

52. Hazmat & Children

53. Children: Not “Small Adults”
• Anatomical/ physiological differences
• Vital signs vary with age
• Smaller, shorter stature
– lower “breathing zones”
• Higher minute volume
• Less intravascular volume reserve

54. Uniquely Vulnerable
• Greater body surface area to weight ratio
• Increased skin permeability
• More pliable skeleton
• Weight is critical in determination of:
– drug dosages
– fluid requirements
– equipment sizes

55. Example:Decontamination of Children
• Must be done with high-volume, low-pressure,
heated water systems
• Must be designed for decontamination of all
ages and types of children
• All protocols and guidance must address:
– Water temperature and pressure
– Nonambulatory children
– Children with special health care needs
– Clothing for after decontamination

56. Decon Shower- Infants
& nonambulatory kids
Pediatric Disaster Toolkit: Hospital Guidelines for Pediatrics in Disasters
http://www.nyc.gov/html/doh/html/bhpp/bhpp-focus-ped-toolkit.shtml

57. Decon Shower- Child
Pediatric Disaster Toolkit: Hospital Guidelines for Pediatrics in Disasters
http://www.nyc.gov/html/doh/html/bhpp/bhpp-focus-ped-toolkit.shtml

58. From a Child’s Perspective?

60. Operations Set-up
• Arrival Point
– Staffed by Animal Control Staff and one
veterinary tech in appropriate PPE
– Personnel arriving for decontamination with pets will
be relieved of the animal
– Animals will be evaluated for injuries and extent of
contamination
– Animal will be tranquilized (if necessary) for handling
and decontamination, or will be euthanized if injuries
are too severe
– Disposable leash will be placed on animal and moved
to the gross decontamination area

61. Operations Set-up
• Gross Decontamination Area
– Staffed by Animal Control personnel in appropriate
PPE
– All collars and tags removed and discarded
– Animal washed with soap and water solution and rinsed
– Leash is again removed after the gross decon and
discarded
– Animal wrapped in large blanket or towel to prevent
environmental exposure
– Clean leash will be placed on animal prior to transfer to
second decontamination area

62. Operations Set-up
• Second Decontamination Area
– Staffed with two Animal Control staff
– Leash and blanket or towel removed, discarded
– Animal sprayed with soap and water solution
– Clean leash and blanket placed on animal for transport to
third decontamination area

63. Operations Set-up
• Third Decontamination Area
– Staffed with two Animal Control staff
– Leash and blanket removed, discarded
– Animal rinsed with clean water, wrapped in new blanket
– New leash will be placed on the animal

64. Operations Set-up
• Clean Area
– Decontamination identification tags placed on animal
– Animal evaluated by veterinarian and Animal Control staff
– Wounds will be treated or animal will be transported to veterinary
clinic for further treatment
– Animals reunited with owners if possible
– Unclaimed animals transported to Animal Shelter or other
shelter facilities
• Photo of animal displayed at scene
– Contaminated deceased animals will be placed in appropriate
container at site
• Container will be left in hot zone for mitigation contractor

65. Planning for Decontamination Washwater
• Decon washwater is an issue that has gained
prominence in the last couple of years
• Hospital washwater only one possible source

66. In the real world
• Hospitals required to plan for rapid influx of
victims in mass-contamination incident
– Increased numbers, may not be deconned prior
to arrival, contaminant unknown or unusual
• May need to rapidly perform emergency
mass decontamination
– life saving, personnel/facility protection

67. In the real world
• Capacity for mass decon limited in most
hospitals (a few victims)
• Proper on-site washwater management
identified as barrier
– containment ~ 90% of cost
– may not solve problem anyway

68. What is the Problem?
• Is there a problem if decon washwater enters
the sanitary sewer system?
– Yes
– No
– Maybe, not enough information….depends on
contaminant type/amount/concentration,
exposure potential, impacts to wastewater
system or environment, legal concerns

69. Plausible Scenario
• Hospital needs to provide urgent
decontamination for large number victims
• Contaminant(s) uncertain or unknown
• Decon by disrobing and showering or
flushing with copious amounts of water
• Large volume of washwater generated
• Capacity to collect and test washwater on-
site overwhelmed

70. Quantitative Solution
• Attempted calculation based on plausible
“worst-case” scenario
• 2.5 mg VX / victim -- 25% of LD50
• VX selected -- low vapor pressure and
relative persistence
• 90% removal by disrobing
• 10:1 ratio uncontaminated to contaminated
victims

71. Quantitative Solution
• 1000 victims x 10 gal/person = 37854 liters
• 100 contaminated with 2.5 mg VX = 250 mg
• 90% removed with disrobing = 25 mg
• 25 mg/37854 L = 0.00066 ppm = 0.66 ppb
at most concentrated point

72. Quantitative Solution
• is this (0.66 ppb VX) a problem?
• Is this the worst case?
• have we considered all down stream issues?
• could other contaminants be worse?

73. Key Uncertainties
• Scenario Uncertainties –
– how many victims total?
– at what rate?
– how much contamination?
– how much water used?
– amount of dilution in system?
– effects of treatment processes (e.g., retention
time for short-lived radionuclides)

74. Key Uncertainties
• Contaminant(s) unknown
– Amount (total and concentration)
– Behavior/fate
– Exposure potential
– Toxicity
– Treatability
– Impacts on people, system, environment
• May not have opportunity to test waste stream for
hazardous properties and make treatment or
disposal decisions

75. Problem Summary
• Theoretical hazard – nature and magnitude
of downstream risks uncertain
• Hazard-specific assessment not be possible
during incident
• Decisions must be made rapidly based on
limited, if any, information about
contaminants

76. Nopparat capacity
• 12 Non ambuatory victims per hour
• 48 Ambulatory victims per hour
• Ability to CPR 6 Pts. at Red Zone
• Information services (MSDS)
• Chemical (antidote) stockpile in term
of Network ( local, regional )
• Level C and PPE
• Health surveillance for Decon team
and Hazmat team

77. Hazmat Patient Assessment
• Occurs concurrently
• Only once Resuscitated and Stable
• Patient history
• Secondary survey

78. Secondary Survey
• Identify poisoning complications
• Recognize preexistent problems
• Assess for trauma & burns
• Recognize toxic syndromes (toxidromes)

79. Identify Poisoning Complications
• Airway Insufficiency
– Ammonia etc.
• Breathing Insufficiency
– Aspiration pneumonitis, Noncardiogenic pulmonary edema
– Sarin, Phosgene etc.
• Cardiovascular
– Bradydysrythmias, Tachydysrythmias, Hypotension, Hypertension
• Disability (nervous system)
– Confusion, Agitated delirium, Combativeness, Seizures, Coma
– Weakness, Paralysis, Sarin, etc .
• Elimination (liver & kidneys)

80. Preexistent Problems
• Airway • Disability
– Overbite – Epilepsy
– Small jaw • Elimination
– Big tongue
– Renal failure
• Breathing
– Liver failure
– Asthma
– COPD
• Cardiovascular
– Coronary Artery
Disease (CAD)
– Anemia

81. Recognize Toxic Syndromes
• Toxic + syndrome = Toxidrome
• 5 fundamental hazmat toxidromes
– Irritant gas
– Asphyxiant
– Cholinergic
– Corrosive
– Hydrocarbon & halogenated
hydrocarbon

82. Antidotes
• There is no
for 99% of Chemicals
• There is only supportive treatment for 99%
of Chemicals
• There are standard WHO guidelines for
antidotes in an industrial setting, where
chemicals enter through lungs or skin

83. Only Supportive treatment
No Antidotes for following
• Ammonia
• Chlorine
• Hydrogen sulphide
• Phosgene
• Carbon monoxide
• Nitrogen Oxides
• Formalin
• Acids

89. Chemical Protective Clothing

90. Levels of Protection
Greater Hazard
Level Level Level Level
A B C D
Higher Burden

91. Hazmat PPE
• Levels of PPE
– A: big suit, big tank
– B: little suit, big tank
– C: little suit, little mask
– D: no suit, no mask
• Level A for entry
• Level C for known hazard
• Level B or C for unknown?

93. Selecting the Correct Glove

95. MATERIAL of CPC GOOD FOR POOR FOR

96. MATERIAL GOOD FOR
POOR FOR

97. MATERIAL GOOD FOR
POOR FOR

98. Results of Alternate Protective Clothing
Performance Test
Possible alternate Defense capability Remarks
Classification
material
Method 204 Method 206
(Blister resistance) (Gas resistance)
Military standard (butyl coated texture for 100 min 200 min Defense
ministry
protective clothing) standard
Military use Officer’s raincoat 2 min 2 min
Sapper’s raincoat, poncho 7 min 7 min
Disposable protective suit 14 min 14 min Tyvek
Disposable raincoat 2 min 2 min
Civilian use
Sae-ma-eul raincoat 5 min 5 min
Transparent raincoat 6 min 6 min
Raincoat 11 min 11 min
Gentlemen’s raincoat 10 min 10 min
Sportswear raincoat 17 min 17 min

99. Results of Alternate Protective hood/ Overboots/
Protective gloves Performance Test
Defense capability
Remarks
Classification Possible alternate material Method 204 Method 206
(Blister (Gas
resistance) resistance)
Military Standard
(butyl coated texture for protective 30 min 30 min Military
Standard
clothing)
Protective Black plastic bag 2 min 4 min
hood
Supermarket plastic bag 2 min 5 min
Standard garbage bag 6 min 10min
Military Standard 360 min 450 min
Protective
Gloves Taewha rubber gloves 25 min 50 min
Goeunson rubber gloves 25 min 42 min
Military standard 360 min 450 min
Overboots
Farmer’s boots 100~120 min 210 min
Regular boots 220 min 230 min

100. Results of Covers/ Adhesive Tapes
Performance Test
Defense capability
Possible
Classification alternate Remarks
material Method 204 Method 206
(Blister resistance) (Gas resistance)
Military vehicle
1 min Less than 1 min
cover
Agricultural
Covers
Vinyl 10 min 12 min
plastic cover
Industrial Vinyl
2 min 3 min
plastic cover
Transparent
100 min Over 240 min
Adhesive tape
Tapes
Blue tape 25 min 50 min

101. Effect of Overlapping Vinyl Plastic Covers
Classification One layer Double layers Triple layers
Method 204
10 min 26 min 40 min
(Blister Resistance)
Agricultural Vinyl
plastic cover
(thickness: 0.1 mm)
Method 206 104 min
(Gas Resistance) 12 min 50 min
Method 204
2 min 7 min 14 min
(Blister Resistance)
Industrial Vinyl
plastic cover
(thickness: 0.05 mm)
Method 206 3 min 14min 38 min
(Gas Resistance)

102. Agricultural Vinyl plastic cover (one layer) added
Cover/Raincoats
Double layers
One layer
Triple layers
Classification
Original Vinyl plastic
Original Vinyl Plastic
material cover added
material cover added
Military vehicle
1 min 50 min 1 min 20 min
cover
Officer’s raincoat 2 min 33 min 2 min 50 min
Sapper’s
7 min 55 min 14 min 180 min
raincoat/ poncho
Gentlemen’s 68 min
4 min 45 min 5 min
raincoat

105. Evatox™ NBC hoods for civiliansBaby Safe Pro Infant Protective Wrap

107. โรงพยาบาลนพรัตนราชธานีกับเครือข่ายศูนย์พิษแห่งชาติ

110. โรงพยาบาลลาปาง
โรงพยาบาลขอนแก่น
โรงพยาบาลนพรัตนราชธานี
โรงพยาบาลระยอง
โรงพยาบาลหาดใหญ่
รูปภาพแสดงเครือข่ายศูนย์พิษแห่งชาติ

111. ศูนย์พิษวิทยา โรงพยาบาลนพรัตนราชธานี
ข้อมูลข่าวสาร ศูนย์ข้อมูลด้านพิษสาหรับประชาชน
บุคลากรทางการแพทย์
เครือข่าย
การรักษาพยาบาล การให้ความช่วยเหลือในที่เกิดเหตุ
การรับส่งต่อในกรณีทางวิชาการ
เฝ้าระวังและควบคุม จัดทาข้อมูล GIS นาสถิติภัยหรือ
โรคจากสารพิษมาวางแผนงาน

112. ศูนย์พิษวิทยา โรงพยาบาลนพรัตนราชธานี
การซ้อมแผน
การฝึกอบรม
การประชุมวิชาการ
การจัดประชุมเครือข่าย
การประสานเครือข่าย
ระดับภูมิภาค
การจัดประชุมเครือข่าย
ระดับประเทศ
ห้องปฏิบัติการ การประสานเครือข่าย สร้าง
มาตรฐาน ใช้ทรัพยากรร่วมกัน

113. ผลของการจัดประชุมเครือข่ายระดับภูมภาค
ิ
• อยากให้มีการแบ่งระดับศูนย์พิษ
• อยากให้มีนโยบายที่ชัดเจน และ มีการถ่ายทอดให้กบผู้บริหาร
ั
• อยากให้มีการสนับสนุนเรื่องงบประมาณ
• ต้องการให้มีการซ้อมแผน
• ให้ศูนย์พิษขึ้นกับอาชีวก่อนในชั้นแรก
• ผู้ปฏิบัติควรเป็น แพทย์และเจ้าหน้าที่ห้องฉุกเฉิน อาชีวจะให้ข้อมูลด้าน
พิษ

114. ห้องปฏิบัติการ
• มีการประสานเครือข่ายห้องปฏิบัติการ
• มีการจัดทามาตรฐานห้องปฏิบัติการ
• มีระบบส่งต่อตัวอย่างเพื่อการตรวจ
• ห้องปฏิบัติการควรไปเป็นกลุ่มกับระดับของศูนย์พิษแม่ข่ายของตนเอง
เพื่อง่ายต่อการบริหารจัดการ
• ในการประชุมเครือข่ายควรนาเรื่องห้องปฏิบัติการเข้าประชุมด้วย

120. Common pitfalls in Hazmat Drill
In a drill , hospital personnel treated
patients without wearing PPE

121. Common pitfalls in Hazmat Drill
In a drill, contaminated patients would be sent
to a designated hospital, but in reality……

122. Overlook the time
required for actions
Before a drill, responders
wear PPE and waited for
the signal.

123. Man dropped bucket of silver paint that splattered onto areas of
body commonly ignored or forgotten during decon.
Photo credit: Mike Vance, MD

124. Can of mace went off in pants pocket & pants not removed in timely
manner. Photo credit: Mike Vance, MD

125. What can happen if genitals are forgotten during decontamination.
Photo credit: Mike Vance, MD

126. What can happen if skin folds are forgotten during decon.
Photo credit: Mike Vance, MD

127. Close-up of what can happen if skin folds are forgotten during decon.
Photo credit: Mike Vance, MD

128. What can happen if feet are forgotten during decon.
Photo credit: Mike Vance, MD

129. Eye Decon
• Irrigate exposed, symptomatic eyes
immediately & continuously
– Use water or saline
•Water is best
– Readily available in large quantity
– Efficient
• Check for & remove contact lenses

130. Mild corneal chemical burn
 Fluorescein indicates corneal burn site
 Adjacent chemical conjunctivitis
Photo credit: Mike Vance, MD

131. Severe corneal chemical burn
 Opaque cornea
 Blind eye Photo credit: Mike Vance, MD
 Requires cadaver corneal transplant

132. HAZMAT Training Trends

135. Summary
• Physical removal is BEST decon
• Must plan for patient decon at all aspects of care
• Decon process is resource intensive and must be
planned and practiced in advanced
• Identify and train personnel early
• Learn benefits of coordination with medical assets
in your hospital and region
Prior Planning Prevents Poor Performance