Table of Contents
APPENDIX L
PLANNING GUIDELINES
FOR RESPONSE PHASE DECONTAMINATION
FOR THE
CHEMICAL STOCKPILE EMERGENCY PREPAREDNESS PROGRAM
APPENDIX L
PLANNING GUIDELINES
FOR RESPONSE PHASE DECONTAMINATION
Preface
The purpose of this appendix is to provide guidance on how to plan for decontamination in the event of a significant chemical agent release. As such, it addresses priorities and procedures for decontamination planning. However, these planning guidelines provide neither policy on provision of resources, nor specific identification of the sites or areas that may require decontamination capability. These policies and guidelines will be determined by the results of ongoing studies regarding liquid agent deposition.
PHASES OF A CHEMICAL RESPONSE
The phases of a chemical event are not distinct. There is no single point in time when all response phase actions terminate and recovery phase actions begin. These actions overlap through much of the event. The following definitions are provided to all planners to assign responsibilities and eliminate duplication in their plans.
Response Phase
The response phase of a chemical agent event covers the initial action in response to an actual or potential chemical agent release. It covers the actions taken to eliminate the source of the release, lifesaving measures for affected personnel, safety measures for potentially affected personnel, and initial security measures taken to preclude the exposure of additional personnel.
The response phase covers the period from the initial recognition of an actual or possible chemical agent event until all of the following actions have been accomplished:
a. The source of the chemical agent event is no longer discharging new
chemical agent into the environment. Residual contamination may exist,
and the residual contamination may still be a hazard.
b. All personnel requiring medical attention beyond first aid have entered
into the medical care system.
c. There is no additional (new) risk to the public ; there exists a stable and
maintainable situation in which no additional public casualties or damages are
expected. This can be due to reduction of the hazard, evacuation of the hazard area,
or both actions.
d. Security measures are in place to ensure the personnel will not inadvertently enter the hazard area.
Recovery Phase
The recovery phase is the period from the end of the response phase until
a. The affected area can be reoccupied without protective equipment,
and there is not present a short- or long-term health risk to humans.
b. Other typical operations, (e.g., agriculture, grazing livestock) can be
conducted without any restrictions stemming from the chemical event.
Additional, detailed guidance for recovery phase activities can be found in Appendix M ("Planning Guidelines for Recovery Phase Activities").
OBJECTIVES
Response Phase Objectives
Lifesaving and minimization of injury to personnel.
Preventing the spread of contamination to key response elements and facilities (e.g., shelters, ambulances and hospitals).
Recovery Phase Objectives
Reduction of hazard to the level where unrestricted use of facilities, lands, and waters are possible without risk to human health.
DECONTAMINATION PRINCIPLES
Decontaminate as soon as possible. This minimizes the effect on personnel and allows for normal operation of equipment/facilities as soon as possible.
Decontaminate only what is necessary. Decontamination requires a significant amount of time and decontamination material. It is essential that limited decontamination assets be focused on high priority operations.
Decontaminate as close to the contaminated area as possible. This will limit the spread of contamination.
DECONTAMINATION PRIORITIES
First priority - People
Second priority - Essential equipment (e.g., ambulances)
Third priority - Less critical assets such as livestock, private property (e.g., personal automobile) and croplands. Decontamination of these resources will be accomplished during the recovery phase (see Appendix M for more detailed treatment).
The remainder of these guidelines will focus on decontamination during the response phase. Decontamination during the recovery phase will be addressed in reentry/restoration guidelines (Appendix M).
DEFINITION AND SCOPE OF DECONTAMINATION
The recommended guidelines in this appendix address two concerns regarding the decontamination of people:
1. Individuals must be decontaminated as soon as possible. Available studies (Sidell 1990 and 1995, Leffingwell 1990; Watson and Munro 1990; Munro et al. 1990; U.S. Dept. of the Army 1989, Morgan 1989) stress that immediate action to remove or neutralize the agent is necessary to minimize adverse health impacts of exposure. The decontamination of exposed people must begin within seconds to a very few minutes after exposure if severe injury or death is to be avoided. The proposed guidelines respond to this requirement by recommending that all people in areas at risk of exposure to agent be provided with information that would enable them to decontaminate themselves and the people around them immediately after an exposure to chemical agent (i.e., self- and buddy-aid).
2. Individuals must be completely decontaminated. Thorough decontamination of every potentially contaminated person is necessary both to minimize adverse health effects to that person and to avoid secondary, or cross- contamination. To assist in ensuring thorough decontamination of all potentially contaminated people, the guidelines call for the establishment of official decontamination stations staffed by trained personnel with ready access to all equipment and materials needed to decontaminate, monitor, and care for exposed individuals. (See also Appendix I for additional decontamination information relevant to medical preparedness.)
For users of these guidelines, "decontamination" is defined in Sect. 10 of this Planning Guidance and in Chemical Accident or Incident Response and Assistance (CAIRA) Operations (Dept. of the Army 1991) as "the process of decreasing the amount of chemical agent on any person, object, or area by absorbing, neutralizing, destroying, ventilating, or removing chemical agents" to a safe level. The following guidelines employ this definition to address decontamination for which the primary purpose is to eliminate an immediate threat to human life.
With the exception of decontamination of people, extensive decontamination efforts would not be required for most chemical agent release scenarios. Only liquid forms (including droplet and heavy aerosol forms) of chemical agent pose the risk of significant contamination; vapor is generally not considered a significant source of contamination that poses an immediate threat to human health. Hazardous contamination from a vapor release would likely be limited to materials, such as clothing, which are in contact or very close proximity to the human body and should be best dealt with during personal decontamination. Because agent in liquid form (droplet and aerosol) settles out of the atmosphere relatively quickly, significant contamination would generally be confined to a relatively short distance from the point of release. Off-post contamination presenting a significant risk to the public would most likely occur only in the event of a very large liquid release in the atmosphere—a type of event that is not evident in the planning base.
INTEGRATION OF DECONTAMINATION INTO EMERGENCY PLANNING
Decontamination is closely linked to other aspects of the emergency preparedness program. In particular, a jurisdiction's plans for decontamination must be carefully coordinated with all its other emergency preparedness procedures and especially with the procedures it develops for reentry, monitoring, and medical services. Plans for reentry will prescribe maximum residual agent concentrations that may remain when unrestricted public use of areas and objects can be permitted. The interaction between decontamination and the provision of medical services is particularly important. Medical attention, including decontamination, must be provided to all people who need it; however, procedures must be in place to prevent the spread of contamination to health care providers and facilities (e.g., ambulances and hospitals).
In addition to its interrelationships with other aspects of the CSEPP program, decontamination must respect and integrate the requirements of numerous federal and state laws. These laws could, for example, limit the kinds and quantities of decontamination solutions that could be used in a particular area or require containment and treatment of the decontaminant runoff.
The decontamination guidelines presented in this appendix are derived from a variety of sources, including both policy documents and technical studies. Planners involved in CSEPP are encouraged to review some or all of the source documents listed in the references.
Because of the technical nature of some aspects of decontamination planning, a glossary is provided at the end of this appendix. This glossary supplements that found in Sect. 10 of the Planning Guidance.
GUIDELINES
L.1 Each jurisdiction should incorporate a decontamination plan into the hazard-specific appendix of its EOP. The plan should describe the agencies to be responsible, resources to be available, and procedures to be followed to deal with agent-contaminated people and animals that provide critical support to humans. The decontamination plan may be developed separately by the jurisdiction or jointly with the Army installation and other state and local jurisdictions in the IRZ and PAZ.
L.2 The decontamination plan should include a list of priorities for the decontamination or other treatment of people to guide the allocation of resources. The organization(s) responsible for decontamination of each category of people should be identified. The responsible organizations may include departments of the jurisdiction's government, agencies of other levels of government (e.g., the Army or the state government), private contractors, or volunteers. The following list of priorities (in descending order of urgency of decontamination, treatment, or disposal) is offered as a candidate (see Watson, et al. 1992 for detailed guidelines on prioritizing symptomatic people):
a. people who are known or suspected of being contaminated and who require prompt medical attention due to agent exposure or other severe injury,
b. people who are exhibiting signs/symptoms of agent exposure,
c. people who are known to be contaminated but are not exhibiting signs/symptoms and don't urgently require medical attention,
d. people who are suspected of being contaminated but show no signs of agent toxicity,
e. animals that are known or suspected to be contaminated and that provide critical support to humans (e.g., Seeing Eye dogs).
L.3 The decontamination plan should describe the jurisdiction's plans for educating the public on personal self-decontamination procedures and decontamination of others (i.e., self- and buddy-decontamination). These plans should apply to all people in areas at risk of exposure to agent. Elements of the program may include
a. a public education program may include (1) instructions on self- and buddy- decontamination, (2) a list of necessary supplies, and (3) guidance on other means of expedient personal decontamination (see guideline L.4).
b. public information releases at the time of the emergency should clearly identify the population segments that should perform self- and buddy-decontamination. These measures should be recommended for all people who are or have been within the chemical agent plume or have come in contact with people, animals, or objects (e.g., vehicles) that have been in the plume.
L.4 Self- and buddy-decontamination procedures include
a. removal of eyeglasses and contact lenses. Hands should be decontaminated before removing contacts. Contact lens removers could be used to minimize the risk of cross-contamination. If the wearer cannot evacuate safely without the use of eyeglasses, eyeglasses may be expediently decontaminated by soaking in undiluted household bleach for 5 minutes and rinsing thoroughly with plain water. Eyeglasses suspected of being contaminated and not required for safe evacuation should be placed in a plastic bag and carried to the decontamination station. All contact lenses suspected of being contaminated should be placed in a plastic bag and carried to the decontamination station,
b. removal of all external extraneous items from contact with the body. Such items include hearing aids, artificial limbs, jewelry, watches, toupees, and wigs,
c. flushing the eyes with large amounts of lukewarm water,
d. gently washing the face and hair with soap and lukewarm water, followed by a thorough rinse with lukewarm water,
e. decontaminating other body surfaces likely to have been contaminated using one of the following measures:
(1) the most desirable decontamination would use undiluted household bleach followed by a clear-water rinse. Procedures include blotting (not swabbing or wiping) with a cloth wetted in undiluted household bleach followed by washing with lukewarm soapy water and rinsing with clear lukewarm water,
(2) in the absence of bleach, a good expedient method would be washing with copious amounts of lukewarm soapy water and rinsing with clear lukewarm water,
f. changing into uncontaminated clothing. Contaminated clothing that would normally be removed over the head (e.g., undershirts) should be cut off.
g. instructions to proceed to the nearest decontamination station.
L.5 The decontamination plan should provide for a personnel decontamination station to be established at each reception center and at each host hospital identified in the evacuation plan and at other locations as needed. Personnel at the decontamination station should impound and secure potentially contaminated vehicles brought by evacuees and thoroughly decontaminate potentially contaminated evacuees and injured persons. Each decontamination station should
a. be located where adequate supplies of water and electricity are available or can be made available;
b. be staffed by personnel who are trained, equipped, and clothed to decontaminate potentially contaminated people while incurring minimal risk of self-contamination. Protective clothing and equipment should be approved for use with unitary chemical warfare agent (see Appendix H);
c. be staffed and equipped to decontaminate the maximum number of contaminated individuals expected to arrive at the decontamination station;
d. be capable of being staffed quickly after the public has been alerted and notified of the emergency. The initial staff should, at a minimum, be sufficient to detain and provide expedient decontamination to potentially contaminated individuals until the decontamination station can achieve full operability;
e. have evaluation procedures for deciding which individuals require decontamination as well as procedures for immediately decontaminating people (including infants and individuals who are injured, handicapped, or elderly) likely to have been contaminated by chemical agent. Persons who should be decontaminated at the station include, in order of priority,
(1) all people who exhibit any signs or symptoms of exposure to mustard or nerve agent,
(2) all people who may have been exposed to mustard or nerve agent, regardless of whether they exhibit signs or symptoms of exposure. People designated as possibly exposed will be identified through a brief interview by decontamination station personnel and will include all people who
• evacuated from an area within the plume,
• traveled through any portion of the plume area while evacuating, or
• have come in contact with any people, animals, or objects that had been located in or traveled through the plume and had not been decontaminated;
(3) all people whose contamination status cannot be clearly determined by interview or other available means.
f. have the capability to perform decontamination concurrently with life-saving first aid for people suffering from agent exposure or other injury;
g. be capable of screening people who have been decontaminated as well as other evacuees for symptoms of chemical agent toxicity;
h. have operating procedures for handling the personal property of potentially contaminated persons. Potentially contaminated personal property will be identified as to ownership and impounded (for later disposition) at a secure location separate from uncontaminated property;
i. be designed to contain and collect all used decontamination solutions and rinse water for later disposition.
L.6 Each decontamination station should be designed, equipped, and staffed to provide a sequence of decontamination functions for all potentially contaminated individuals. Most people should be able to proceed through the decontamination sequence on their own with minimal assistance (other than oral instructions) from attendants. However, those who are impaired by agent exposure, injury, poor health, or other handicap may require the assistance of an attendant or special equipment (e.g., mesh stretcher for the injured, boatswain's chair for wheelchair users). One or more mobile decontamination units may be incorporated into the decontamination station for the purpose of decontaminating people, provided that the mobile units have been shown to be functionally equivalent to fixed facilities in performing the required decontamination actions within the available time. The decontamination station should provide the following sequence of functions:
a. if sufficient resources are available, potentially contaminated individuals should be separated by gender. Males and females should enter separate decontamination facilities that provide visual screening but do not restrict the flow of fresh air (although young children should be permitted to accompany a parent of either sex). If available resources are not adequate to provide separate facilities for each gender, decontamination should be performed according to the priorities stated in guideline L.5.e., without regard to gender;
b. each individual should relinquish personal property (e.g., billfold and external extraneous items) and remove all clothing. Any clothing (e.g., undershirts) that would normally be removed over the head should be cut off. Attendants wearing suitable chemical protective clothing should remove the personal property, place it in an agent-impermeable bag, seal the bag, and label it with the individual's name and any other pertinent identification (e.g., social security number), and place the bag in a secure storage location for later disposition;
c. potentially contaminated eyeglasses and contact lenses should be removed. To reduce unnecessary disposal of corrective lenses that have not been contaminated, the wearer should be interviewed or otherwise evaluated to determine if he/she has been in an agent-contaminated area. Eyeglasses and contact lenses that are determined to be potentially contaminated should be removed and handled according to the following procedures:
(1) hands should be decontaminated by blotting with undiluted household bleach then thoroughly rinsed with water before removing contact lenses. Contact lens removers could be used to minimize the risk of cross-contamination.
(2) contact lenses should be collected for later disposal in an environmentally sound manner (no attempt should be made to decontaminate contact lenses),
(3) eyeglasses in metal frames may be decontaminated by soaking for 5 minutes in undiluted household bleach followed by thorough rinsing, and
(4) eyeglasses in plastic or composite frames should be placed in an agent-impermeable bag labeled with the individual's name and an identification number for later disposition when and if resources can be made available without impeding the decontamination of people. (Suggested disposition: Some eyeglass wearers would be significantly impaired without corrective lenses. Thus, we recommend special treatment for eyeglasses in porous frames such as plastic or plastic composite. We suggest that, if time and resources permit, the lenses be removed from such frames, decontaminated by soaking for 5 minutes in undiluted household bleach and rinsing with plain water, remounted in uncontaminated frames, and returned to their owners);
d. the individual should then blot skin areas (excluding the face) that may have been contaminated with decontamination solution (e.g., undiluted household bleach);
e. the individual should then step under a shower (lukewarm water recommended) and, following the instructions of an attendant, first flush the face and eyes with copious amounts of water, then wash the face and remainder of the body with soapy water and rinse;
f. following the shower, attendants should check the individual for any signs or symptoms of agent exposure and follow medical screening guidelines for treatment. Additional decontamination may be necessary. A special effort should be made to decontaminate suspected mustard victims because of the extended latent period between exposure and the appearance of effects. State and local decontamination plans should incorporate personnel monitoring guidelines;
g. following confirmation of successful decontamination, the individual should proceed to an area designated for first aid and re-dress. Attendants should monitor or treat any injuries and provide replacement clothing (e.g., disposable paper garments and booties or clean used clothing obtained from Goodwill, Salvation Army, etc.);
h. the individual should then be directed to a holding area for observation of any agent exposure symptoms. Decontaminated individuals should generally be kept separate from uncontaminated individuals; however, in some cases it may be prudent to allow uncontaminated individuals to join decontaminated dependents;
i. each individual to have undergone decontamination at the station should be marked (e.g., by a casualty tag, hospital bracelet, or by writing directly on the chest or forehead with an indelible marker) with an indication of the specific treatment that was applied to the individual and the time at which decontamination was completed;
j. each individual processed through the station should be provided with a certificate indicating
(1) a description of the decontamination actions taken,
(2) the time decontamination was completed,
(3) the time the individual was released from the observation area, and
(4) a description of any medical treatment administered in conjunction with decontamination.
Decontamination station personnel should also retain a copy of the certificate.
L.7 Emergency medical personnel should be trained, equipped, and clothed to safely decontaminate any injured person suspected of being contaminated before placing the person in the ambulance for transport to a care facility. Protective clothing and equipment should be approved for use with chemical warfare agents (see Appendix H). Procedures for dealing with injured individuals who are potentially contaminated should incorporate standard medical procedures for the injury involved and should also include
a. removing the outer clothing of the injured person by cutting the clothing and lifting the person free of the clothing onto a wire stretcher or a stretcher with a non-absorbent surface (e.g., a disposable backboard with drainage holes),
b. removing remaining clothing by cutting it and pulling it from underneath the person,
c. removing any potentially contaminated bandage material, exercising extreme care when removing bandages that are used to control hemorrhage,
d. removing eyeglasses and contact lenses (contact lens removers could be used to minimize the risk of cross-contamination) as well as any other external extraneous items,
e. blotting (not swabbing or wiping) potentially contaminated body surfaces with copious amounts of 5% bleach solution (e.g., undiluted household bleach) or with reagents from the Army's M258A1 or M291 skin decontamination kit and washing the face and eyes with clear water,
f. decontaminating the chemical protective clothing of the care provider, and
g. applying fresh bandages where necessary to control bleeding and placing the injured person in the ambulance.
L.8 Because companion animals accompanying evacuees represent a possible pathway for human exposure to chemical agents, emergency response plans should include provisions for minimizing the cross-contamination hazards presented by companion animals. Planning guidance for decontamination of companion and other valuable animals will be presented in Appendix M. Additional resource material is available in Watson and Munro (1990), American Veterinary Medical Association (1995), Heath (1995), Barrabee and Heath (1995); and American Humane Association (1990).
L.9 The decontamination plan should identify the officials and agencies responsible for establishing and implementing a strict quarantine of all potentially contaminated materials and property that will not be immediately decontaminated. The strict quarantine should prohibit entry by the unprotected public until responsible officials determine through monitoring and sampling that unrestricted reentry and use by the public is safe. Criteria for making this determination and methods to deal with the types of potentially contaminated materials and property listed above are specified in Appendix M.
L.10 The decontamination plan should describe how the jurisdiction will obtain sufficient quantities of non-contaminated water for decontamination activities. Massive amounts of water may be required if the contaminated area or number of contaminated people is sizable. The water may come from any source.
REFERENCES
American Humane Association 1990. Emergency Animal Relief and Disaster Planning: Operational Guide for Animal Care and Control Agencies, Bull A05G500, The American Humane Association, P.O. Box 1266, Denver, CO 80201-1266.
American Veterinary Medical Association 1995. AVMA Emergency Preparedness and Response Guide. American Veterinary Medical Association, 1931 N. Meacham Road, Suite 100, Schaumberg, IL 60173-4360.
Barrabee, D. P. and S. E. Heath 1995. "Veterinary Service and Animal Care Annex," pp V-1 to V-6 of Indiana State Emergency Operations Plan, SEMA, Indiana Government Center South, 302 W. Washington St., Indianapolis, IN 46204-2760.
Heath, S. E. 1995. The Development of the Veterinary Service and Animal Care Annex to the Indiana State Emergency Operations Plan. Proceedings of the Indiana Veterinary Medical Association Disaster Preparedness Committee (1993-1995). State Emergency Management Agency, Indiana Government Center South, Indianapolis, IN.
Leffingwell, S. S. 1990. "Health Effects of Incidents," presented at Technical Orientation Workshop (Sept. 5-7, 1990, Park City, Utah), Center for Environmental Health and Injury Control, Centers for Disease Control, 1600 Clifton Road, Atlanta, GA 30333.
Leffingwell, S. S. 1990. "Emergency Room Procedures in Chemical Hazard Emergencies: A Job Aid," Center for Environmental Health and Injury Control, Centers for Disease Control, 1600 Clifton Road, Atlanta, GA 30333.
Morgan, D. P. 1989. Recognition and Management of Pesticide Poisonings, EPA-540/9-88-001, U.S. Environmental Protection Agency.
Munro, N. B., A. P. Watson, K. R. Ambrose, and G. D. Griffin 1990. "Treating Exposure to Chemical Warfare Agents: Implications for Health Care Providers and Community Emergency Planning," Environmental Health Perspectives, 89: 205–215.
Sidell, F. R. 1990. "Clinical Notes on Chemical Casualty Care," Army Training Pamphlet USAMRICD TM 90-1, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD (Aug. 14, 1990).
Sidell, F. R. 1995. Management of Chemical Warfare Agent Casualties: A Handbook for Emergency Medical Services. HB Publishing, Bel Air, MD.
U.S. Dept. of the Army 1989. "Occupational Health Guidelines for the Evaluation and Control of Occupational Exposure to Mustard Agents H, HD, and HT," USAEHA TG No. 173, U.S. Army Environmental Hygiene Agency, Aberdeen Proving Ground, MD.
U.S. Dept. of the Army, Headquarters 1991. Chemical Accident/Incident Response and Assistance (CAIRA) Operations, Dept. of the Army Pamphlet 50-6, Commander, U.S. Army Nuclear and Chemical Agency, Attn: MONA-SU, 7500 Backlick Rd., Bldg. 2073, Springfield, VA 22150-3198.
Watson, A. P. and N. B. Munro 1990. Reentry Planning: The Technical Basis for Offsite Recovery Following Warfare Agent Contamination, ORNL-6628, Oak Ridge National Laboratory, Oak Ridge, TN 37831.
Watson, A. P., F. R. Sidell, S. S. Leffingwell, and N. B. Munro 1992. "General Guidelines for Medically Screening Mixed Population Groups Potentially Exposed to Nerve or Vesicant Agents," ORNL/TM-12034, Oak Ridge National Laboratory, Oak Ridge, TN 37831.
GLOSSARY
contamination—chemical agent (typically in liquid form; including droplets and/or aerosols) deposited on skin, clothing, or any other material that constitutes a source of potential agent exposure until it is neutralized, removed, or degrades naturally. (Compare to Exposure.)
dose—the quantity of agent absorbed by the body. Often expressed in mass units of agent per body weight or surface area exposed (e.g., mg/kg or mg/m2). (Compare to Exposure.)
exposure—contact by a person or animal with chemical agent in either liquid or vapor form through inhalation, contact with eyes or the skin, or ingestion of contaminated food or water. Exposure to agent in liquid form (including droplet and/or aerosol form) can result in contamination. (Compare to Contamination.)
household bleach—off-the-shelf chlorine bleach available for domestic purposes. Contains 5% NaOCl (sodium hypochlorite) in water. A strong oxidant with a high (i.e., alkaline) pH.
liquid agent—any chemical agent in undiluted form; includes droplets and heavy aerosols. Only VX or the vesicant agents are likely to be encountered in liquid form.
reentry—entry of persons to an affected area following a hazardous materials incident. Reentry can be restricted (entry of monitoring crews) or unrestricted (unlimited public access).