Welcome to Athens-Limestone Hospital

Procedures

A. Emergency Department Preparation
1. Intermediate Treatment Unit Leader will activate this plan upon notification from the ALH Incident Command Center, Emergency Management Agency or EMS
2. Intermediate Treatment Unit Leader will delegate assignments to the decontamination team
3. all personnel assigned to these positions will have vital signs taken and recorded prior to entering the decontamination area
4. all personnel assigned to these positions will don required protective clothing per procedure in Appendix B
5. Intermediate Treatment Unit Leader will brief the staff on the number and types of expected patients, CBRN hazard and other available information
6. Incident Command Center will assign personnel from the manpower pool to set up the decontamination area for patient intake
7. Security will assist in establishing control points for patient intake and redirecting traffic flow of both patients and vehicles as required
8. Emergency Department Physician will assist with contamination control and advise on the CBRN hazard

B. Patient Arrival - Clean Team Transfer
1. take hospital stretcher with decontamination unit in place out to the designated transfer point (place stretcher up to yellow polyurethane tarp, but not on it)
2. EMS personnel brief the Intermediate Treatment Unit Leader and Emergency Department Physician on
a.medical conditions
b. CBRN agents and hazards
c. decontamination performed in the field
3. transfer patient from EMS stretcher to decontamination stretcher
4. transport to decontamination area
5. secure entrance to decontamination area for contamination control
6. make sure EMS personnel roll-up yellow transfer sheet and place in disposal container

C. Triage - Treatment
1. basic and advance life support procedures should be instituted without delay whenever possible, based on the patient's medical condition, CBRN hazard and extent to which the patient was decontaminated on-site
2. decontamination is secondary to medical intervention – patients' medical signs and symptoms should be addressed whether they are trauma induced or CBRN agent induced
3. Intermediate Treatment Unit Leader will contact Poison Control or other resource agencies for appropriate treatment guidelines, see Appendix A

D. BIOASSAY Sample Assessment
1. all samples must be considered potential evidence of a crime and handled as such to the extent permitted by the incident
2. document medical/physical assessment
3. document CBRN agent identification, if known
4. document percentage of body contaminated (Rule of Nines)
5. sampling procedure
a. apply label to tube (i.e. wound, right nostril, etc.)
b. remove swab from tube and moisten with saline
c. swab selected site and return sample to tube
d. return swab to tube and put sample back into sample kit
6. tissue sample from wounds
a. fill a 2 ounce sample jar half way with saline
b. place tissue sample into jar
c. apply proper label and put sample into sample kit
7. label all samples with patient name, time of sample and location
8. secure all contaminated waste and patient clothing – clothing must be handled as evidence of a crime
9. samples and sample kit remain in the decontamination area until released to testing agency for analysis

Note: TBA will analyze sample upon request. Phone: TBA

E. Patient Decontamination
1. Emergency Department Physician and Decontamination Area Nurse will direct the decontamination process
2. open wounds and facial contamination should be the primary concern
3. the decontamination solution should be one that is recommended by the resource agency for the CBRN agent, see Appendix A, the Emergency Department Physician will select the solution
4. after addressing open wounds and facial contamination, decontamination should start at the head and proceed toward lower extremities systematically decontaminating the patient from head to toe, as necessary
5. document all decontaminated efforts – see Appendix D
a. area being decontaminated
b. skin condition in the area of decontaminated (open vs. intact)
c. time of decontamination
d. solution used
e. method of decontamination
1. decontaminate the area a minimum of three (3) times, or until the patient is completely decontaminated

F. Patient Exit
1. Buffer Zone Nurse will roll in a clean floor covering from the buffer zone into decontamination, parallel to the patient stretcher
2. Buffer Zone Nurse and assistant will bring a clean stretcher into decontamination, being sure to stay on the clean pathway
3. transfer the patient from the decontamination table onto the clean stretcher
4. transport the patient out of decontamination and into the buffer zone area
5. after the patient has left decontamination, the pathway should be pulled into decontamination and disposed of

Note: Decontamination personnel should not walk on clean pathway during patient transfer.

G. Staff Exit From Decontamination
1. place 32 gallon waste container at exit point from decontamination area
2.Decontamination Area Nurse will designate sequence of staff exit - exit one person at a time
3.Buffer Zone Nurse will control the exit protocol and assist verbally with the proper clothing removal sequence
4.doff all protective clothing before departing decontamination following the procedure in Appendix C

H. Decontamination Area Clean-up
1. Intermediate Treatment Unit Leader will decide, in consultation with the ALH Incident Command Center, when to take down and clean up the decontamination area
2. appropriate protective equipment must be worn during clean up
3. a contractor will normally be used for clean up
4. Director of Environmental Services will contact the clean up contractor and oversee the clean up
5. disposable supplies that have entered the decontamination area are considered contaminated and disposed of as hazardous waste
6. medical equipment will be decontaminated prior to being returned to service or disposed of if unsalvageable
7. ground coverings, collected water, and medical waste will be placed in appropriate containers
8. patient clothing and belongings are considered evidence of a crime and will be processed as directed by the law enforcement agency responsible for the incident investigation
9. all areas shall then be cleaned utilizing traditional methods of house keeping
10. Security will maintain the area until all material and waste are removed
11. Incident Commander will inspect the area before Security is released and the area is reopened
12. If the processing contractor has not picked up the BIOASSAYS, the Intermediate Treatment Unit Leader will transfer the samples to the Incident Commander for safekeeping. The chain of custody must be maintained.

Contact Agency: TBA
24 hour Phone: TBA

I. Decontamination Plan Termination
1. Intermediate Treatment Unit Leader, in consultation with the ALH Incident Command center, will terminate this plan
2. support personnel will return to the Manpower Pool for reassignment
3. Nursing Unit Leader will reassign nurses
4. Incident Commander will terminate Code 10 when permitted by the situation

US Patent Numbers 7,720,998 B2, 7,836,207