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Decontamination Revisited: Big Questions

Big Questions

There has been an upswing in interest on the topic of emergency mass decontamination driven by the number of "drills" being planned for the summer months. So, for the responders and hospital staff that have called/written in, we've put together Decontamination Revisited; a three-part series that will encourage thinking and provide a unique perspective on healthcare preparedness. Contamination Differences will discuss a few basics on the types of contamination that my be encountered, Big Questions will tackle the question of who should actually "do" decon, and in part three we'll provide a simple wrap-up on the topic. 

The big question is; who should do decon? At an emergency scene the issue is clear that the jurisdiction having authority in a chem/bio/rad event (most often the fire department) should provide or cause to provide decontamination. The use of low pressure, high volume water streams and improvised shelters may be used in emergency mass decontamination, while specially trained hazardous materials teams may provide a more refined and specific decontamination. The problems begin to arise when victims begin to self-refer to emergency departments or clinics... that is they leave the scene prior to the arrival of traditional responders. This poses a major issue as these victims will likely arrive a health care sites with no warning and no clue as to what they may have been exposed to or contaminated with. When this occurs and goes unrecognized, the health care facility, civilians, and health care providers are at risk. Immediate action will be needed to stave off secondary contamination and serious impact.

The bigger question is; who should do decontamination at a health care facility? This argument has been going on for years and opinions are highly polarized. One opinion often held by health care organizations is that the local responders will not be able to provide decon services at a hospital during such a large event. This camp believes that hospitals must be able to provide decontamination on their own for a period of time. Still others believe that traditional responders will be able to provide protective services to health care sites by way of mutual-aid from surrounding departments. Both points have concerns.

How do we expect health care providers, security staff, environmental staff, or others to provide decontamination at a health care site? 

This is often the pool of personnel that is called upon to take training and carry out the functions if needed. The concerns however, loom large. Who will carry out the duties of those assigned to decon? Will the people mentioned above be able to retain the training information and function in protective clothing, including self-contained breathing apparatus? These issues are just the tip of the iceberg.

While many hospitals in the nation have added some type of decontamination shelter or system to meet requirements most (if not all) walk-in care, urgent care and retail health care centers lack this level of preparedness. 

As more and more people turn to these clinics rather than emergency departments for routine care, we must realize that the same level of preparedness must exist for these locations. In the non-hospital clinic setting the need for trained traditional responders doing decon operations is even more vital.

Next: The logistical reality...wrap-up.

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