Decontamination is an important step in protecting emergency personnel and the public during a hazardous materials or terrorist incident. Decon provides protection for victims, including emergency responders, who have become contaminated without the benefit of proper protective clothing. It also protects responders who have entered an incident scene with proper protective clothing by removing any harmful materials they may have contacted during operations. The longer harmful materials contact the body, the more damage that is done. Therefore, the quicker decon can be performed, the quicker the damage can be limited or stopped.
Typically, decon has been a part of hazmat response team operations. According to National Fire Protection Association (NFPA) Standard 472, a "Hazardous Materials Response Team is an organized group of trained personnel operating under an emergency response plan and appropriate standard operating procedures who handle and control actual or potential leaks or spills of hazardous materials requiring possible close approach to the material. The team members respond to releases or potential releases of hazardous materials for the purpose of control or stabilization of the incident."
Emergency Situations
Decontamination generally involves the use of a "corridor" (sometimes referred to as a "contamination reduction corridor") with a gross contaminant reduction section followed by a series of wash-and-rinse stations, an undressing area and a rehabilitation area. This type of decontamination is referred to as "technical decon." However, technical decon operations take time to set up. If a community must wait for a hazmat team to respond from a remote location, the setup is delayed even longer. While the response and setup of technical decon is taking place, chemicals are continuing to harm victims.
This is where the concept of "emergency decontamination" comes into play. NFPA 472 defines emergency decontamination as "the physical process of immediately reducing contamination of individuals in potentially life-threatening situations without the formal establishment of a contamination corridor." Emergency decon is performed by first-responding personnel using ordinary firefighting equipment and water to flush contaminants from victims of hazmat incidents or acts of terrorism.
Terrorism involving the use of chemical and biological weapons is a major concern for emergency responders. Once again, the primary protective measure for victims is decontamination to remove harmful materials from the body. Emergency decon is a standard procedure for use with victims of exposure to terrorist incidents in which chemical agents, radioactive materials, riot control agents or biological agents have been deployed.
While the concept of emergency decon for terrorism is well established, I am not sure all first responders realize that the same tactics can be used for other hazardous materials. Many training programs for first responders do not even mention emergency decon as an option. In fact, I think many times we instill so much fear into first responders that they do not want to do anything with victims. It makes no sense to force people who has been splashed with an acid or other harmful chemical to wait for a hazmat team to set up technical decon before the materials can be removed from their bodies.
Response protocols for hazmat incidents have identified the duties of first responders as isolation, notification, protection, and identification. Protection includes personnel protective clothing for responders and evacuation or sheltering in place for the public. Protection should also include emergency decon for contaminated victims.
Emergency decon can be accomplished without the purchase of any additional equipment for first responders. Equipment used for emergency decon is already available on most fire apparatus. Typical fire apparatus carry rope, tarps, and various types of nozzles and hoselines as standard equipment. Some additional inexpensive supplies to carry include soap, chlorine bleach solutions and some type of garment for victims once emergency decon takes place.
Water for emergency decon can be obtained from the booster tank of fire apparatus or through a supply line connected to a hydrant or other water source. Hand hoselines or master-stream devices on wide-angle fog can be used to provide water for emergency decontamination.
The Center for Domestic Preparedness at Fort McClellan, AL, uses the "good, better, best" concept for decontamination solutions. Water is good, soap and water is better and chlorine bleach solutions are best when dealing with chemical or biological agents.
Chlorine bleach is widely accepted in military and civilian sectors for decontamination of chemical and biological agents, although it is not without dangers when used on people. Chlorine can cause damage to the skin and blindness, if splashed in the eyes. An article that appeared in the January 2000 issue of the Journal of the American Medical Association questions whether the use of chlorine bleach solutions on victims is the best procedure.
While the jury is still out on the use of chlorine bleach, water is still good, and soap and water is better for emergency decon. If there is a question about the use of chlorine bleach solutions on victims, it should be coordinated with local medical personnel, local and state health departments, or the federal Centers for Disease Control (CDC) in Atlanta.
Defensive Operation
Emergency decon should be conducted as a defensive operation. Personnel conducting emergency decon, regardless of the circumstances, should be wearing full firefighter turnouts and self-contained breathing apparatus (SCBA). Personnel should avoid contact with the persons contaminated and runoff from the decon operation.
Emergency decon involves several steps:
- Wash down the victim with water while outer cloths are still on.
- Remove the victim's outer clothing, leaving underwear in place. Clothing may contain the most contaminant and keeping it on will prolong the contact of the harmful materials with the body.
- Wash down the victim again. With the second washdown, soap and water can be applied if soap is available. Liquid soap should be used because it dissolves better in cold water and dry soap can be abrasive.
- Provide victims with replacement clothing or coverings. This can be as simple as large plastic trash bags with holes cut in them, disposable sheets or blankets, hospital gowns or scrubs, used clothing from Goodwill or the Salvation Army, or commercially available paper clothing.
When outer clothing is removed, actions should be taken to protect the privacy of victims. Tarps used for salvage and ropes used in rescue operations can be employed to provide privacy curtains for decon. Ropes can be strung between the hosebeds of apparatus placed back to back with spacing for the protected decon corridors. Tarps can then be placed over the ropes to provide privacy corridors for victims and can be used to segregate sexes. Nozzles can be placed on discharge ports of two engines side by side to provide a wide-angle fog for decontamination. The area between the engines can be used as a privacy protected corridor.
Personnel conducting emergency decon should avoid contact with victims, product and runoff. While there are important environmental concerns for the runoff from any type of decontamination, life safety of victims should be the first priority when conducting emergency decon. Runoff may contain contaminants that could harm the environment and every effort should be made to control it; however, the life safety of victims and responders takes precedence. First responders should not take time to worry about runoff at the expense of the victims well being.
The U.S. Environmental Protection Agency (EPA) has issued guidance for emergency decontamination of victims of terrorist agents, which reflect the priority of victims and then protect the environment as soon as possible after life safety has been addressed. This same guidance may be applied to hazmat incidents. Once again, tarps and salvage covers could be used to aid in runoff control, if time permits. Dirt and other materials found at an incident site can also be used to help control runoff.
Decon Teams
The process of decontamination is not overly technical, nor does it require the purchase of lots of expensive equipment or training personnel to the technician level. While traditionally technician-level personnel from hazmat teams have conducted decon, many fire departments train and equip specialized decon teams with personnel who have operations-level hazmat training and provide them with training for decontamination. This is an acceptable procedure under U.S. Occupational Safety and Health Administration (OSHA) regulations.
OSHA's basic regulatory philosophy is to train and equip employees to do the job they are asked to do. A decon team should have a response plan and standard operating procedures (SOPs) to establish protocols for decon operations, including emergency decon. Jurisdictions which choose to operate with first-responder emergency decon should also have written procedures in place guiding the operations.
Many jurisdictions do not have their own hazmat teams. They require the use of mutual aid or private contractors for hazmat responses. Mutual aid teams and private contractors generally do not respond with large numbers of people, but a simple entry into a hazmat "hot zone" and resulting decon easily can require 20 to 30 personnel. So, the idea of a local designated decon team can provide additional personnel to assist the mutual aid hazmat team.
This concept can also work well in departments that have hazmat teams because in both cases decon teams will free technician-level personnel on the hazmat team to concentrate on entry operations. A local decon team can provide ambulatory victim decontamination while waiting for the hazmat team to arrive. A local decon team can then provide technical decontamination for hazmat team members, thus freeing technicians for entry tactics and rescue of non-ambulatory victims.
Many of the supplies needed to do decontamination can be purchased locally at hardware and discount stores. Fire departments usually have access to SCBA for respiratory protection. OSHA regulations permit decon teams to wear one level of protective clothing less than the entry team is wearing. Hazmat teams generally use Level A (total encapsulation) for vapor atmospheres or Level B (splash protection) for non-vapor atmospheres. As a result, the decontamination team will almost always be in Level B protection. Disposable Level B suits can be purchased for less than $100 per suit.
Decon teams also must be trained. Training has a monetary value in terms of the cost of the training and in the cost of the time spent on the training. Decon training would require 16-24 hours, including theory and hands-on. Training should include elementary toxicology, decontamination solutions, decontamination setup, protective equipment and decontamination procedures. Toxicology is covered because the primary reason for decontamination is to remove toxic materials from victims and personnel.
Being flexible and creative in establishing decontamination procedures can streamline operations, make better use of personnel, and provide better protection for responders and the public.
Robert Burke, a Firehouse® contributing editor, is the fire marshal for the University of Maryland. He is a certified Hazardous Materials Specialist, and has served on state and county hazmat response teams. Burke is a veteran of over 18 years in the fire service, in career and volunteer fire departments, having attained the ranks of lieutenant and assistant chief, and served as deputy state fire marshal. He has an associate's degree in fire protection technology and a bachelor's degree in fire science, and is pursuing a master's degree in public administration. Burke is an adjunct instructor at the National Fire Academy. He is the author of the books Hazardous Materials Chemistry For Emergency Responders, published in 1997, and Counter-Terrorism For Emergency Responders, published in 1999. Burke can be reached on the Internet at [email protected].
