DESCONTAMINACIÓN MASIVA 2da. PARTE.

Presentación del tema: "DESCONTAMINACIÓN MASIVA 2da. PARTE."— Transcripción de la presentación:

1 DESCONTAMINACIÓN MASIVA 2da. PARTE

2 TOKIO el 20 de marzo de 1995 7:46 – 8:01 a.m. 8:09 a.m. 8:16 a.m.
Los miembros del culto liberan sarín en 5 líneas de metro 8:09 a.m. Primera llamada al departamento de Bomberos de Tokio 8:16 a.m. El hospital de St. Luke fue llamado por el Departamento de Bomberos de Tokio 8:28 a.m. Las víctimas llegan caminado al Hospital St. Luke’s 8:40 a.m. Las ambulancias llegan al Hospital St. Luke’s

3 ACCIDENTE de TOKIO Total de víctimas 5,510 Lesionados (estado crítico)
17 Lesionados (estado severo) 37 Lesionados (estado moderado) 984 Ventilación Mecánica requerida 54

4 Las Lecciones del Incidente en Tokio
Descontaminación de víctimas no se alcanzó. Comunicación llegó a ser imposible por teléfono o localizador (beeper). (El ataque de las torres gemelas también sobrecargó las líneas de teléfono). Datos preliminares pueden ser equivocados: explosión de gas, gas lacrimógeno, etc.(Espere accidentes secundarios) Apoyo farmaceútico inadecuado en volumen. Ningún plan para el traslado de víctimas y la falta de control de tráfico.

5 Lecciones del Incidente de las Torres Gemelas
Cada jurisdicción trabajó con su propio personal en las primeras horas del incidente. En las primeras horas, la ciudad de Nueva York fue dividida en zonas de seguridad. Problemas con la Comunicación/Aspecto Legal/Administración de Riesgo limitó el uso de voluntarios.

6 Los Objetivos Planear y ejecutar descontaminación masiva.
Entender el aspecto técnico del equipo de descontaminación. OBJECTIVES The purpose of this module is to ensure responders can transition from standard HAZMAT decontamination procedures to decontamination of NBC agents. This specifically includes the safe mixing, handling, and use of various decontaminants. a. Plan and execute emergency mass casualty decontamination. One of the most difficult tasks facing responders in a CB incident, particularly a chemical incident, will be the decontamination of dozens, hundreds, or even thousands of victims. b. Understand the NBC delta for technical and equipment decontamination. Although the process of technical and equipment decontamination of NBC hazards is the same as for conventional HAZMAT hazards, there are some important concerns and issues that need to be addressed. c. Identify decontaminant capabilities and risks. Decontaminants have different capabilities and uses for various agents. Decontaminants also are subject to limitations because of hazards related to the decontaminants themselves. In certain cases, decontaminants are incompatible with other decontaminants or agents, presenting additional hazards.

7 ¡ Piensa y Pregunta ! ¿Quién es responsable de la descontaminación en su fabrica/en su jurisdicción? ¿Qué procedimientos hay establecidos para la contaminación de sustancias químicas, radiológicas o biológicas? ¿Qué equipo tiene usted a la mano ahora mismo? ¿Si ocurriera lo de Tokio hoy en su ciudad, estaría usted preparado?

8 Nivel de toxicidad es más alta
¿Qué hace la Descontaminación de Armas de Destrucción Masiva Diferente? Nivel de toxicidad es más alta El tiempo es crítico Gran número de víctimas Control de escena Recursos son mayores DECONTAMINATION DELTAS There are several differences, or deltas, between decontamination procedures for everyday HAZMAT incidents and NBC incidents. a. Time is critical. Because of the speed at which some of the chemical agents work against the body, establishment of emergency decontamination lanes must be swift in order to minimize casualties. You won’t be able to wait for technical decontamination to be set up. b. Higher toxicity. Increased risk to the responders, victims, and onlookers may require increasing zone distances and frequent monitoring for symptoms. c. Large number of victims. You may be required to control, triage, decontaminate, and track hundreds or thousands of people at the site. d. Scene control. An NBC incident may involve a larger area, a mass casualty situation with numerous responders who all want to help, and a huge media response seeking information on the incident. e. Resource intensive. More personnel and material will be required than are normally available. This drives you to do more contingency planning before you are faced with the situation. f. Crime scene evidence protection. An everyday HAZMAT incident site is generally not a federal crime scene. In addition to decontaminating the area, evidence must be preserved for eventual use in apprehending and prosecuting the perpetrators. Escena del crimen - conservar la evidencia

9 Niveles de Descontaminación
Descontaminación Masiva Salvar vidas al remover el agente quimico/biológico/radiológico y remover la ropa contaminada. Decontaminación adicional en instalaciones médicas. Decontaminación difinitiva. Equipo Técnico y Equipo de Descontaminación Decontaminación completa No estar con el tiempo limitado DECONTAMINATION LEVELS There are two levels of decontamination involved: emergency and technical. These combine to cover the rapid decontamination of victims and the deliberate decontamination of the responders and equipment at the scene. a. Emergency decontamination. Emergency decontamination is primarily employed to save the lives of potential victims by first removing contaminated clothing, then removing the agent hazard from the skin by washing off or neutralizing the agent. Additional emergency decontamination setups may be required at supporting medical facilities away from the incident scene to take care of self-referrals who left the incident before responders gained control. A follow-on decontamination procedure may also be performed at the medical facility on casualties who have already been through an emergency decon corridor. This secondary decontamination, known as definitive decon, assures all body surfaces are free of any residual contamination. b. Technical decontamination. Technical decontamination is performed to remove or neutralize all contamination from personnel, their equipment, and contaminated facilities in a deliberate fashion. Technician Level responders focus on both emergency mass casualty decontamination of victims and technical decontamination of personnel. Although HAZMAT technicians may execute decontamination, it is more likely that they will supervise the Operations Level responders as they execute mass decontamination.

10 Consideraciones de la Descontaminación Masiva
Seguridad de los equipos de respuesta Principios de descontaminación Proceso de descontaminación Evaluación de la situación Aíslar las victimas Triage de descontaminación EMERGENCY MASS CASUALTY DECONTAMINATION CONSIDERATIONS We will first turn our attention to emergency mass casualty decontamination, taking into consideration how the deltas of an NBC incident will affect the decontamination process. In the next several slides, we will discuss in greater detail each of the points listed here, then look at some procedures which have been shown to be successful.

11 La Seguridad de los Equipos de Respuesta
Equipo de Protección Personal (EPP) Equipo de respiración autónoma (SCBA) con equipo de bombero o trajes de Nivel B Guantes de hule, de preferencia (no de latex)) Contacto mínimo Monitorear sus síntomas y las de su compañero Considérese contaminado USE SU SENTIDO COMUN! SAFETY OF RESPONDERS Responder safety is paramount. a. PPE. All personnel who come in contact, or have the potential to come in contact, with the exposed casualties must wear protective clothing and respiratory protection. (1) Structural firefighting clothing and self-contained breathing apparatus or OSHA Level B chemical protective clothing can provide adequate protection for responders operating the decontamination stations in the Warm Zone. (2) If available, wear (butyl) rubber gloves, but not latex. b. Minimize contact. Minimize direct contact with the casualties and avoid any liquid contamination. c. Monitor self and buddy. Ensure all responders are aware of the signs and symptoms of exposure. Monitor yourself and your buddy for these both during and after decontamination. d. Consider yourself contaminated. From the moment you enter the decontamination area or contact a casualty, consider yourself contaminated.

12 Proteger al Personal Médico
Víctimas de la experiencia de Tokio: 10% de los técnicos de atención médica, bomberos y policías llegaron a ser los afectados – ninguno de gravedad; 110 personas del personal del hospital fueron afectadas, 1 persona fue hospitalizada.

13 Principios de Descontaminación Masiva
Zona Tibia, cerca de la Zona Caliente Viento arriba, y estar preparado si hay cambios En gran volumen, agua de baja presión EMERGENCY MASS CASUALTY DECONTAMINATION PRINCIPLES Consider the following principles when performing emergency decontamination of mass casualties: a. Setup. Set up the decontamination lanes in the Warm Zone near the Hot Zone, orienting the exit point to extend away from the Hot Zone. This will limit the traffic of victims into the hazard area and reduce their potential for additional exposure. b. Upwind and upgrade. Establish the shower point upwind and upgrade of the Hot Zone. The water runoff and any vapors from contamination will tend to flow back into the Hot Zone. c Water. Use copious amounts of water. Physical removal is the primary method of decontamination, the more water the better. d. Runoff. Remember the direction of the runoff to prevent cross contamination between lanes. (1) Saving lives through rapid decontamination is the priority. Control the runoff to the extent feasible; know where it is going and that it will not flow into clean areas or cause additional casualties. (2) If possible, and time and resources allow, confine the runoff to an isolated area. This is more critical for radiological materials, which are not neutralized by decontaminants.

14 Principios de Descontaminación Masiva
Considerar el escurrimiento del agua, puede ser causa de contaminación adicional Contención del agua Ubicación de vías de agua cercanas Considerar víctimas Temperatura exterior Si es posible, divida corredores en secciones para hombres y mujeres, por razones de intimidad, sin embargo, no demore los procedimientos por esta razón

15 Principios de Descontaminación Masiva
Para impedir una contaminación adicional, es imperativo el control de las multitudes. Víctimas deberán ser contenidas y no permitir el ingreso de personas no autorizadas Mantenga protocolos para los perímetros internos y externos Mantenga despejadas las rutas de ingreso y egreso para los vehículos de emergencia (plan de tráfico en el sitio) La mayor parte de las víctimas abandonarán la escena para ir a hospitales antes de que llegue el personal de respuesta. Esto hace necesario establecer controles similares en los hospitales.

16 Procesos de descontaminación del personal
Remoción de Agentes Biológico, Nuclear Químico Blot Mojar Quitar Ropa Enjuagar EMERGENCY MASS CASUALTY DECONTAMINATION PROCESS Emergency decontamination of NBC agents is a 4-step process. a. Blot or wet. (1) For chemical contamination, carefully blot the agent off of exposed skin immediately. Do not rub; this will only increase the potential spread and penetration of the agent. Clothes may be used to blot contamination from the skin, once they have been carefully checked for contamination. (2) For contamination by biological agents or radioactive materials, wetting down the exposed surfaces first will help prevent the contaminant from re-suspending in the air. b. Strip. Strip off all clothing down to the briefs. This will remove approximately 80% of the contamination. Nylons or pantyhose should be removed since they can hold a large amount of liquid or vapor close to the skin and they cover a significant amount of skin. c. Flush. Flush the affected area with large amounts of water. d. Cover. Provide cover for decontaminated victims to prevent hypothermia and for modesty. (1) Get blankets, towels, sheets, or tablecloths from local stores, hotels, hospitals, or other nearby facilities. Carry disposable ponchos, coveralls, or cut up salvage covers. Procesos de descontaminacion del personal Cubrir

17 Evaluación de la Escena
Zona Caliente Se puede ampliar o reducir los límites si cambian las condiciones ambientales, o Si se llega a conocer el agente y se justifica un tamaño de sitio diferente Ayuda adicional para la descontaminación Primer equipo en escena puede estar contaminado Hospitales, ambulancias, equipo medico

18 Contener a las Víctimas
Comunicar instrucciones Trate de mantenerlas tranquilas Clasificación de víctimas (menores, mayores y críticas) Reúna artículos personales Ropa contaminada puede ser parte de la evidencia ISOLATE THE CASUALTIES Isolate the victims and other potentially exposed people. a. Communicate directions. Communicate the need for assistance and what these people must do. (1) Loudspeaker or other voice amplification system. (2) Communicate authority with concern. (3) Signs in the decontamination corridors and areas. (4) Responder communications, particularly between members of different organizations in the same area or task. b. Away from hazard. Keep casualties away from the hazard, but still controllable. c. Segregate. Segregate ambulatory from non-ambulatory, symptomatic from asymptomatic, male from female. (1) Consider families, small children, handicapped, and elderly people. (2) Isolate people refusing to cooperate from the rest. d. Collect personal items. Collect clothing and personal items. (1) Use plastic bags, tags, or other means of identification. (2) Pack contaminated items into drums later. e. Evidence. Some of these items may contain evidence, such as agent samples which can be collected from contaminated clothing or personal items.

19 Descontaminación Masiva - Triage
Servicio Ambulatorio – Clasificación de víctimas 1) Víctimas presentan síntomas, requieren atención inmediata 2) Víctimas presentan evidencia de contaminación 3) Víctimas no presentan contaminación, no se observan efectos EMERGENCY MASS CASUALTY DECONTAMINATION TRIAGE In many instances, decontamination capability will be quickly overwhelmed by the number of persons to decontaminate. In this case, a triage process must be applied to do the most good for the greatest number of people. a. Ambulatory. The first triage criterion is that between ambulatory and non-ambulatory victims. Ambulatory victims can walk through the decontamination corridor. (1) Those exhibiting symptoms should receive decontamination first, then be referred for medical treatment. (2) Victims with no symptoms, but with signs of contamination, should be decontaminated next and placed under medical observation. (3) Victims with no symptoms or signs of contamination can be held and processed last. b. Non-ambulatory. Non-ambulatory victims have to be processed through a litter-based decontamination corridor, assisted by at least two responders per victim. Those who require immediate care should go first; they may need life-saving care during the decontamination process. Multiple decontamination lanes should be established to process the victims as quickly as possible.

20 Descontaminación Masiva - Triage
No-ambulatorio Tratamiento médico es limitado y sólo es suficiente para estabilizar a los pacientes durante el tiempo necesario para que puedan someterse a los precedimientos de descontaminación

21 Procedimientos de Descontaminación Masiva
Primeras unidades Manguera de incendios y una boquilla de rociado Dirigir a las víctimas por los corredores EMERGENCY MASS CASUALTY DECONTAMINATION PROCEDURES a. First units employed. First units on the scene will likely have limited capability and, in fact, may be quickly overwhelmed by the magnitude of the problem. They may have already deployed a pre-connected handline, charged the pump and line, and begun directing people through a makeshift corridor before you arrive. b. Elevated master stream. You may be able to set up a large-scale shower with an elevated master stream, using low-pressure, high-volume water to rain down in a shower for each lane. c. Additional lanes. As more apparatus arrive, direct them where to set up additional lanes or, based on space restrictions, to set up secondary decontamination corridors to support the decontamination effort.

22 Procedimientos de Descontaminacióm Masiva
Descontaminación - Ambulatoria Comunicar instrucciones Extender brazos, piernas separadas, cabeza hacia atras Lavado de arriba hacia abajo EMERGENCY MASS CASUALTY DECONTAMINATION PROCEDURES (continued) d. Ambulatory decontamination. (1) Clearly communicate to the victims what you want them to do. (2) Have them walk through the shower with their arms out, legs apart, and head back. This helps to clean them off more quickly. (3) Wash from the top down. Advise them not to swallow the water and avoid getting anything but the direct spray into their faces (and not to wipe their faces with dirty hands). e. Non-ambulatory (litter) decontamination. (1) Cut off all clothing, including briefs, if they are contaminated. Remove clothing from head to toe, front to back. Keep the clothing away from the victim’s face during removal. Remember to minimize contact with the victim or the contaminated clothing; this could transfer contamination to the next victim as well as to yourself. (2) Keep litters and backboards off the ground with milk crates, sawhorses, or other expedient supports. Avoid getting runoff into the victim’s face.

23 Procedimientos de Descontaminación Masiva
Descontaminación – no ambulatoria Elimine todas las señales de contaminación visible de las víctimas Transfiera el paciente a una camilla Corte la ropa Toda la propiedad deberá ponerse en bolsas, aseguradas e identificadas claramente

24 Corredor de Descontaminación Ambulatoria
Maquinas usando salidas de 2 ½ con chorro de niebla. Chorro elevado maestro EMERGENCY MASS CASUALTY DECONTAMINATION CORRIDOR The following is an example of an emergency mass casualty decontamination corridor setup. a. Decontamination corridor. An effective decontamination corridor can be established by placing pumpers parallel (pump panels facing away from each other) approximately feet apart and incorporating a master stream at the end of the corridor. Depending on water supply pressure, another pumper may be needed at the hydrant to provide minimal pressure. Attach 2-1/2 inch fog nozzles to the side discharges, positioned to provide a fog pattern into the area between the pumpers. b. Personnel. Station firefighters at key locations within or along the corridor. At least two should be at the beginning and two at the end. Firefighters must be in SCBA and should avoid touching the victims. Bombero Victimas En ruta al area de salida

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26 Consideraciones Técnicas y Equipos de Descontaminación
Establecer una manera rápida de realizar operaciones de descontaminación Establecer corredores de descontaminación Contaminación de equipo y vehículos Contaminación de hospitales TECHNICAL AND EQUIPMENT DECON CONSIDERATIONS As the need for a rapid response is critical, HAZMAT teams should be on the scene early to conduct reconnaissance, rescue victims, and identify the agent. For the HAZMAT teams to perform these missions, a technical decontamination capability must exist. a. Rapid setup. Responders who will enter the Hot Zone must have decontamination set up before they can go in. Some of the first responders who were already on scene before the agent was identified and a Hot Zone designated may have gone through emergency decontamination, or be waiting for the technical decontamination. b. Separate corridors. When setting up the technical decontamination corridor, establish it away from the emergency decontamination corridors. (1) Responders are likely to be contaminated and the victims will not have protective clothing. (2) Some victims awaiting emergency decontamination may become unruly or interfere with the process when they observe responders moving to the head of the line or receiving a different decontamination effort than they are. (3) With emergency decontamination, the emphasis is on speed and agent removal, since the victims have no protection from it. Technical decontamination concentrates more on thoroughness and neutralization of the agent.

27 Procedimientos Tecnicos y Equipo de Descontaminación
Incrementa el tiempo de contacto de los descontaminantes Monitorear hasta completar Control del agua de descontaminación Asistencia técnica TECHNICAL AND EQUIPMENT DECON PROCEDURES The majority of current technical decontamination procedures will apply to NBC agents as well. There are some differences which may have significant impact on the site management and on decontamination operations. a. Contact time. Some decontaminants require prolonged contact time in order to ensure the agent is completely neutralized. This may require the equipment to be placed into a holding area for this extended time before it can be rinsed off and checked. b. Monitor. Monitoring for “complete” decontamination is as easy or difficult as detecting the agent. For radioactive materials, monitoring decontaminated equipment can be fairly easy. For biological and some chemical agents, there are limited field detection kits that will give an immediate answer. c. Runoff control. Runoff control is more important during technical decontamination than emergency decontamination. Since the prime effort is not in lifesaving, protection of the environment and minimization of risk to people downstream will dictate strict control measures of all runoff. d. Technical assistance. Given the nature of the agents involved, additional technical guidance or resources may be required. If so, contact the Hotline or, for training and planning, the Help Line cited at the beginning of the course.

28 Remoción de Agentes Agua Agua y Jabón
Un buen ejuaque con abundante agua puede eliminar eficazmente un agente. Agua Las soluciones de agua jabonosa pueden eliminar fisicamente o diluir agentes. Agua y Jabón Las soluciones deben prepararse poco antes de usarlas, pueden causar irritación o daño a la piel. Agua y Cloro DECONTAMINANTS OF CHOICE (PERSONNEL) The premise remains the same (blot, strip, flush with water, cover), but the availability of various surfactants (such as soap) can enhance the effectiveness of the decontamination process. Personnel can be flushed of agent using just water, or soap and water, as the soap will help lift the contaminant off the skin. Remember that any covering can trap contamination. Deconning with a bleach solution has shown benefit in reducing damage caused by some agents, as well as neutralizing chemical and biological agents in runoff. However, the contact time of a bleach solution on casualties is usually not sufficient to neutralize the agent, while increasing the contact time may actually result in chemical burns from the bleach. We do not recommend using bleach solutions for emergency mass casualty decontamination. High volume, low pressure water showers are recommended for emergency mass casualty decon. En situaciones de emergencias, los beneficios de enjuagues o baños de agua son mas efectivos que las soluciones con jabón o cloro.

29 Mensaje: Educar a todo el personal que participa en el area descontaminación. Haga contacto con su oficina local de emergencia Trabaje con la comunidad medica para implementar un plan de acción. Organizar y participar en simulacros de emergencias en todos los turnos en sus empresas.