Haz Mat for WV Hospitals:
An Awareness Level Course
Module I
This course was developed by EnMagine,
who we wish to gratefully acknowledge. The
material has been modified by WV DHHR in
cooperation with the West Virginia Hospital
Association’s Disaster Preparedness Task
Force in the teaching of Hospital Decon. We
especially wish to thank Kevin Davis of
Weirton Medical Center for his work in
modifying this material.
Abbreviations
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HazMat: hazardous materials
Decon: decontamination
FRA: first responder awareness
FRO: first responder operations
WMD: weapons of mass destruction
MSDS: materials safety data sheet
Who needs to take the
Awareness Level Course?
• Hospital personnel “who are likely
to be exposed to patients that have
been contaminated due to a
hazardous substance
release/incident or a bioterrorism
incident coming to the hospital.”
Who needs to take the
Operations Level Course?
• Hospital personnel “who are part of
a Hospital HazMat Decon Team
that is part of the initial response in
a defensive action.”
Regulations
• The Occupational Safety and Health
Administration has a mandate to ensure
that employers provide a safe and
healthful workplace.
• OSHA has recommended a minimum of
8 hours of training for Healthcare
Workers who may come in contact with
hazardous or bioterrorism materials.
HazMat for Healthcare
at the Awareness Level
Objectives
• What are:
– Hazardous/Bioterrorism Material?
– The risks and problems that can occur?
Awareness Objectives
(continued)
• How can we:
– Recognize a contaminated patient
– Identify characteristics of a
chemical/bioterrorism incident
– Implementing the Hospital HazMat Response
Process
– Respond safely and effectively
– Make proper notifications
– Isolate the patient/patients and deny entry
– Conduct Directed Self-Decon
Definition - SIN
• S = Safety
• I = Isolation
• N = Notifications
Contaminated
Patients
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)
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.
Examples of Hazardous Materials
(OSHA Hazardous Waste Operations and Emergency
Response Standard 29 CFR 1910.120 [Title 8 §5192 CCR])
• Chemicals that cause cancer
• Biohazards or infectious materials
• Chemicals that can burn the skin or eyes on
contact
• Radioactive materials
Examples of Hazardous Materials
(Continued)
• Chemicals that can catch fire or explode
• Chemicals that can cause violent chemical
reactions
• Poisons
• Unknown chemicals
What is the impact of a
Hazardous Materials incident:
• To YOU
• To the EMERGENCY DEPARTMENT
• To the HOSPITAL
• To your COMMUNITY
Watch Closely
Nomenclature and Accuracy
• TLA’s - Three Letter Acronyms
• Glossary
WMD
Hazard Classes
and things that act like them
Explosives (Class 1)
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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)
Compressed Gases (Class 2)
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Acetylene
Propane
Oxygen
Nitrogen
Nitrous Oxide
Carbon Dioxide
Anesthetic Gases
Medical Air
Argon
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Hydrogen Sulfide
Phosgene
Methyl Bromide
Ammonia
Flammable/Combustible
Liquids (Class 3)
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Diesel
Alcohols
Xylene
Gasoline
Acetone
Methanol
Flammable Solids (Class 4)
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Naphthalene
Sodium
Carbon
Barium
Oxidizers & Organic Peroxides
(Class 5)
• Oxygen (actually a
compressed gas or
cryogenic liquid)
• Peroxyacetic Acid
• Red Fuming Nitric Acid
(a corrosive)
• Nitrogen Tetroxide
• Ammonium Nitrate
• Methyl Ethyl Ketone
Peroxide
• Fluorine, Chlorine (also
poison, compressed gas,
corrosive)
Boston Harbor
Poisonous & Infectious
Materials (Class 6)
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Phenol (Carbolic Acid)
Chemotherapy drugs
Biohazardous Waste
Blood Borne Pathogens
Solvents
Sewage
Vesicants (blistering agent,
Doxorubicine, Vincristine)
• Mercury
• ETO (ethylene oxide)
• Glutaraldehyde &
Formaldehyde
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Pesticides
WMD (Sarin, VX)
Solvents
Bioterrorism
Tear Gas
Vesicants (mustard,
Lewisite)
Radioactive Materials (Class 7)
• Nuclear Medicine
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Terrorist use
Military Facilities
Nuclear Reactors
Commercial/Research
facilities
• Industrial x-ray
material
Corrosive Materials (Class 8)
• Lab acids (e.g.,
Hydrochloric Acid)
• Boiler treatment
caustics
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Pool chemicals
Sulfuric acid
Nitric acid
Muriatic acid
Sodium Hydroxide
Chlorine, Fluorine
Miscellaneous. Hazardous
Materials (Class 9)
• Hazardous waste
• Asbestos
• Anesthetics
• Pepper spray/mace
• Molten Sulfur
Unknown chemicals
• Limitless
Definition of Spill Types
• Incidental Spill - Spill that can be
cleaned up in first 10-15 minutes
without risk of overexposure to
employees under normal conditions.
• Emergency Response Spill - Requires
Haz Mat Response if risk of
overexposure to employees. (On
Scene Decon)
Key Factors In Assessing a
Patient/Patients
• Any one of these factors can affect the
type of Decon:
– Product
– Time - Vapor levels rise above regulatory
levels that they were exposed to
– Volume of Spill – Body surface area
covered
– Concentration
– Ventilation - Type and location
– Personnel Location - closer = worse
Intentional Events
So now, let’s talk about Terrorism
WMD
and
Terrorism
We all know what terrorism is, but the
official definition is:
“The unlawful use of force against persons
or property to intimidate or coerce a
government, the civilian population, or any
segment there of, in the furtherance of
political or social objectives.”
Types of Weapons of Mass
Destruction (WMD)
B - Biological
N - Nuclear
I - Incendiary
C - Chemical
E - Explosive
Terrorism is a “menace, with malice.”
A biological terrorism event (the “B” of BNICE) is an “Infectious Disease
Outbreak”.
A chemical terrorism event (the “N&C” of
B-NICE) is a “Hazardous Materials
Incident”.
A fire or explosion terrorism event (the
“I&E” of B-NICE) is a “Burn and/or Mass
Casualty-Trauma Incident”.
Biologic Terrorism
Is an Infectious Disease Event
Types of Agents
• Bacteria
Anthrax
Plague
Tularemia
• Viruses
Smallpox
Hemorrhagic Fevers (Ebola)
Venezuelan equine encephalitis (VEE)
• Toxins
Botulism
Ricin
Chemical Terrorism
Is a HazMat Event
Types of Agents
• Nerve Sarin
VX
• Blister (vesicants) - Mustard Lewisite
• Blood Cyanide
• Choking Chlorine Phosgene
• Irritating Tear Gas Pepper Spray
Potential Probability vs. Impact
NUCLEAR
WEAPON
BIOLOGICAL
AGENT
IMPROVISED
NUCLEAR
DEVICE
POTENTIAL
IMPACT
RADIOACTIVE
MATERIAL
PROBABILITY / LIKELIHOOD
CHEMICAL AGENT
OR TOXIC
INDUSTRIAL
CHEMICAL
Hazardous Materials
Recognition & Safety
• Recognition leads to safety
• Safety leads to lives preserved
Not Always Reported as
HazMats
• Traffic accident
• Medical aid
• Fire, person down,
etc.
Initial report may not indicate
presence of hazardous materials!
HazMat Recognition Clues
Markings and Colors
Placards and Labels
HazMat Recognition Clues
Material Safety Data Sheets
(MSDS)
MSDS
Diforsuranol
Make out your will.
It’s all over.Death
imminent. No hope for
you pal!
Bad stuff!
Touch this and you
die.
Call 911 now!
• Should be available for each
HazMat in the workplace
– Required by OSHA Hazard
Communication regulations
• Provides valuable information
Clues from the Patient
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Patient has an unusual odor
Patient has a strange liquid/powder on them
Patient was involved in a chemical fire
Patient talks about being in a strange vapor
Patients skin is an unusual color
“Clues” are “Clues”!
• They are:
– Warnings
– Notes of caution
– Indications of things to come
– But not always all the answers!
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 and save your ED !
Information Resources
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Container Labels
MSDS
Poison Control
Emergency Response
Guide (ERG)
• Computer programs
• People
• ChemTrek
Do not rely on only one source of information.
Be skeptical!!
SAFETY (First, last, and always)
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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.)
Perimeters & Control Zones
• Purpose of Perimeters & Control Zones
– Ensure safety and isolation
– Control the scene (ED and Decon Area)
– Limit spread of contamination
– Allow for safe working area
Control Zones
Yellow Zone
Hot Zone
Green Zone
NOTIFY
• Follow Your Hospital’s Plan!
• Call your Supervisor
• Activate your HazMat response team??
• Utilize your Hospital Emergency Incident
Command System (HEICS)
Ask Yourself
• What are your first concerns?
– Is this patient contaminated with a
hazardous material? Review the clues!
– 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?
Actions
What are your first actions?
Safety
• Do not touch the patient or allow anyone
else to have patient contact.
Isolation
• Get them out of the ED to a predesignated location!!!!
Notify
• Activate your facility’s protocol for a
hazardous material incident.
Strip and Shower!
• Removal of clothing
eliminates 80% of the
contamination!
Directed Self Decontamination
One to Five (1 to 5) Persons enter the Emergency Department
(Ambulatory)
-Directed Self DeconOperational Information
Known Substance:
Assumption: Sure of what agent is. Or
container is present.
Action: Have patient Self Decon.
Be prepared to assist if required.
Team Needed
Decon Triage Personnel to:
Triage
Manage Airway,
Breathing, Circulation
(ABC’s)
Directed Self Decon
Unknown Substance:
Same as if Known since Self Decon will
be performed.
Site Access Personnel to:
Establish & maintain
perimeter
See Post Decon Procedures
Set Up / Support Personnel
to:
Set up & tear down
equipment.
Contain, manage, &
dispose of waste
See Decon Job Action
Sheets
ALL of the above need to be
FRA (First Responder
Awareness) trained
PPE Needed
Assumption: NO direct
patient contact will be
made
Universal Precautions /
Splash Protection
Face Shield
Gown
Gloves
Booties
Setting: Well ventilated
(not a regular room)
Preferred - outdoors
Equipment Needed
Water (tepid preferred)
Shower (decon)
Hose
Sealable plastic bags
Soap
Labels/ Sharpie pen
Gowns
Blankets
Modesty Screen
or rope & blankets
“Trash Bag Decon”
Laminated instructions in
the shower area (in
multiple languages)
Directed Self Decontamination
One to Five (1 to 5) Persons enter at any other entrance
(Ambulatory)
-Directed Self DeconOperational Information
 As soon as discovered – have the person
exit the same way they came, or though
the closest exit if appropriate (to reduce
spread of contamination).
 Escort to the designated decon. area (not
though the hospital).
 Close down the contaminated area until
someone can deem it safe. Haz Mat
Coordinator will determine the steps to
take. (See Termination Procedures)
 Call Security to secure area.
 Identify alternative entrance if needed.
 Observe for and isolate anyone who may
have received secondary contamination.
 Lockdown all manners of ingress.
Known Substance:
Assumption: Sure of what agent is. Or
container is present.
Action: Have patient Self Decon
Unknown Substance:
Same as if Known since Self Decon will
be performed.
See Post Decon Procedures
Team Needed
Decon Triage Personnel to:
Triage
Manage Airway,
Breathing, Circulation
(ABC’s)
Directed Self Decon
Site Access Personnel to:
Establish & maintain
perimeter
Set Up / Support Personnel
to:
Set up & tear down
equipment.
Contain, manage, &
dispose of waste
See Decon Job Action
Sheets
ALL of the above need to be
FRA (First Responder
Awareness) trained
PPE Needed
Assumption: NO direct
patient contact will be
made
Universal Precautions /
Splash Protection
Face Shield
Gown
Gloves
Booties
Setting: Well ventilated
(not a regular room)
Preferred - outdoors
Equipment Needed
Water (tepid preferred)
Shower (decon)
Hose
Sealable plastic bags
Soap
Labels/ Sharpie pen
Gowns
Blankets
Modesty Screen
or rope & blankets
“Trash Bag Decon”
Laminated instructions in
the shower area (in
multiple languages).
How soap (surfactants) works
• Soap molecules are composed of a head
(that likes water, hydrophilic) and a tail (that
likes oils, hydrophobic/oleophilic)
• Soap :
– breaks the surface tension of the water and make
the “water wetter.”
– also attracts the water soluble and oil soluble
contaminants and sends them away.
Watch Closely
Self Decon Issues
• Improvise using a large opaque plastic
bag
• Place potentially contaminated clothing
in double clear plastic bags
• Place valuables in a separate sealable
clear plastic bag
• Track patients
• Clothing a decontaminated patient
Awareness Module Summary
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Recognize the contaminated patient
Safety. Protect yourself, others.
Isolate. Deny entry.
Notify. Activate hospitals emergency plan.
Consider directed self decon
Questions?
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Haz Mat for Healthcare: An Awareness Level Course