DelValle Institute of Emergency Preparedness

Contents

Roles and Responsibilities for Assistant Practical Instructors

1. Prior to class, assist in setting up personal protective gear, decontamination equipment, and any other equipment required for the particular class.

2. Check out first aid bag, green bag, and SAED.

3. Prepare BP cuffs for medical monitoring.

4. Perform medical monitoring as needed and record results. Bring to the attention of the lead instructor any student that may require close observation.

5. At all times act as a Safety Officer.

6. Attend to any illness or injury that may arise. Summon EMS as needed.   

7. Using SOP’s, assist in demonstrations.

8. Using SOP’s, assist students during group exercises.  

9. Assist in the cleaning and stowage of equipment.

10. In the case of off-sight training, assist in the loading and unloading of equipment at the venue sight.

11. Identify faulty equipment and that in need of upgrade or repair.

12. Make suggestions for equipment and procedures in future classes. 

Hazardous Materials Course Regimen

Practical Sessions

Hazardous Material Protection for Health Care Providers:

Protection Level B

Audience: EMTs, Nurses, MDs, Health Hygienists, Radiological Technicians, Clerks, Public Health, and other allied health care employees.

Day 1. Respirator Demonstration

• The class will assemble SCBA units as a group.
• Students will don and doff masks and SCBA units.
• There will be a dress out demonstration in which one volunteer will be dressed in a Level B suit and one volunteer will be dressed in a Level A suit.

Day 2. Instructor Supervised Class Setup of Non-Ambulatory and Ambulatory Decontamination Lines

• The class will conduct a dry walkthrough of the non-ambulatory and ambulatory decontamination process.
• Half of the class will dress in Level B gear and the other half will assist them.

·          Students will perform the decontamination of a non-ambulatory patient (manikin) under the direction of the instructors.

·          Students will man the ambulatory decontamination line and perform decontamination on the remainder of the dressed students.

Day 3. Class Setup and Walkthrough of Ambulatory Decontamination Line

·          Students will be given the task of decontaminating 4-5 fellow contamination simulated students dressed in Level B gear. The roles, including limited ICS positions, will have been assigned in the classroom.          

Hazardous Material Protection for Law Enforcement:

Protection Level C

Audience: Police officers, Security officers, Corrections officers, Code Enforcement and Inspectional Services.

Day 1. Respirator Demonstration

• Students will have a demonstration of donning, doffing, cleaning and storing respirator masks.

·          There will be a dress out demonstration with one volunteer dressed in a Level C suit and one volunteer dressed in a Level C suit with tactical gear.

Day 2. Instructor Supervised Class Setup of Non-Ambulatory and Ambulatory Decontamination Lines

• The class will conduct a dry walkthrough of the non-ambulatory and ambulatory decontamination process.
• Half of the class will dress in Level C gear and the other half will assist them.

·          Students will perform the clothing removal and decontamination of a non-ambulatory patient (manikin) under the direction of the instructors.

·          Students will man the ambulatory decontamination line and perform decontamination on the remainder of the dressed students.

Day 3. Class Setup and Walkthrough of Ambulatory Decontamination Line

·          Students will be given the task of decontaminating 4-5 fellow students dressed in Level C gear. The roles, including limited ICS positions, will have been assigned in the classroom.

Advanced Hazardous Material Protection for Technicians:

Protection Level B

Audience: Multi-disciplinary. Many executive level and command personnel.

         Day 1. Respirator Demonstration

• The class will assemble SCBA units as a group.

• Students will don and doff masks and SCBA units.
• There will be a dress out demonstration in which one volunteer will be dressed in a Level B suit and one volunteer will be dressed in a Level A suit.

Day 2. Instructor Supervised Class Setup of Non-Ambulatory and Ambulatory Decontamination Lines

• The class will conduct a dry walkthrough of the non-ambulatory and ambulatory decontamination process.
• Half of the class will dress in Level B gear and the other half will assist them.

·          Students will perform the clothing removal and decontamination of a non-ambulatory patient (manikin) under the direction of the instructors.

·          Students will man the ambulatory decontamination line and perform decontamination on the remainder of the dressed students.

Day 3. Class Setup of Ambulatory Decontamination Line

·          Students will be given the task of decontaminating 4-5 fellow students dressed in Level B gear. The roles will have been assigned in the classroom.

Day 4. Skills Station Setups

·          Three to four skill stations will be set up. The stations will be determined based on the student make up, but may include:

§         Radiation detection.

§         Chemical detection.

§         Caisson assembly and patient transport.

§         Airway station.

§         Hazardous material sample preservation

§         Hazardous material survey techniques

Day 5. Classroom Exercise

·          Students will be given the task of preparing a decontamination line involving the identification of an unknown substance. In this exercise, students will perform the decontamination of responders as well as possible patients. The roles, including limited ICS positions, will have been assigned in the classroom.

Protective Suit Levels and Respirators

Protective Suits

Level A: Fully Encapsulated Suit with SCBA. Demonstration Only           

Advantages:                                                      Disadvantages:

Highest level of protection.                                Highest risk.

Seamless, fully encapsulated.                             Field of vision and movements restricted.

Good for entry and reconnaissance.                  Not good for tasks such as lifting, repairs.

Level B: Chemical Protective Suit with SCBA. Health Care, EMS, and Advanced Technician Course

Advantages:                                                      Disadvantages:

High respiratory protection.                               Less chemical protection.

More freedom of movement.                             Seams require taping.

Good for tasking.                                              More effort to don suit.

Level C: Chemical Protective Suit with Cartridge Respirator or PAPR. Law Enforcement and Hospital Training

Advantages:                                                      Disadvantages:

Fewer moving parts to respirator.                      Cannot be used in low oxygen environment.

Longer operating times (up to 8 hours). Inefficient for many IDLH substances.  

Respirator Types

SCBA (Self Contained Breathing Apparatus) Highest level of protection. Thirty-minute bottle is the standard and is filled under 1500 lbs. of pressure. Bottles good for 15 years with testing every 3. Can be used on demand or with purge feature.

PAPR (Powered Air Purifying Respirator) Used with 2 cartridges. Blower pulls constant flow of air through cartridges and into mask. Cannot be used in low oxygen environments (less than 19.5% O₂). Does not replace SCBA.

APR (Air Purifying Respirator) Cartridge type that screws into mask or onto PAPR. Can be single use mask and cartridge combination. HEPA filter good for 99.95% particles including Alpha, Beta particles. Good for most chemical warfare agents, but not nerve agents. Cannot be used in low oxygen environments (less than 19.5% O₂).         

N95 Respirator. N designation means it is primarily for particle protection, and is 95% efficient down to 3 microns (hair is around 8-10 microns). Not practical for wet or oily agents.  

Procedure For Donning The Chemical Protective Suit Level C

NOTE: This regimen is strictly for use in exercises.  

Donning Stages

1. Wearer Preparation
2. Equipment Preparation 
3. Dressing to the Waist
4. Dressing to the Neck
5. Donning the Mask
6. Filter Attachment
7. Inspection

When dressing, actions should be taken to ensure all members are dressing in this order and in these stages. This prevents wearers from overheating while waiting for others to complete dressing.  

Wearer Preparation

Obtain pre-entry vital signs from each student to be dressed. If vitals are outside of the normal limits then the person should not dress for this operation. Exclusion limits are…

• Respirations > 24.
• Pulse > 100.
• Systolic BP > 160 mmHg.
• Diastolic BP > 100 mmHg.
• Temperature > 100 F.

Students should:

• Remove all jewelry hearing aids etc. prior to entering the suit.
• Remove shoes and leave sock on.
• Hydrate with non-caffeinated beverages and avoid heavy sweetened soda.

Equipment Preparation

Required Equipment:

q       Respirator mask w/ Adapter

q       Air Purifying Respirator (APR)

q       Chemical Protective Suit

q       Chemical resistant boots

q       Chemical gloves

q       Inner exam gloves

q       Duct tape for training and chemical resistant tape for incidents

Preparation:

·          Inspect mask for defects. Make sure straps are in place and not twisted excessively.

·          Have adapter and accessory cartridge(s) at hand.

·          If a PAPR is to be used, check fit with adapter, the battery strength, and 2 APR’s.

Dressing to the Waist

• Step into the suit, pulling it up to the waist. Do not insert arms at this point.
• Don boots.

NOTE: If the suit has protective gaiters, they should be pulled up and over the boot. If the suit has open feet, they will also be pulled over the boot. If the suit has attached boots, they must be worn inside the over-boot.

·          Using tape, seal where the boot and suit meet, making only two or three passes. Do not encircle so tightly as to create a tourniquet. Tab the ends.

Dressing to the Neck

·          Don both inner and outer gloves.

·          Insert arms into suit and pull the remainder up over the shoulders.

·          Pull cuffs of the suit over the gloves.

·          Tape the seam where the glove and suit meet, again making only two or three passes, and again ensuring not to create a tourniquet. Tab the ends.

·          Attach a 6-8 inch strip of tape, either on the shoulder, the chest, or wherever the IC has designated, and write the wearer’s ID on it.

Donning the Mask

·          Using the technique advised by the manufacturer, don the mask.

·          Check and inspect all adjuncts such as filters, cartridges, batteries, etc.

·          Zip up the suit, and tape this seam as well, tabbing both ends. Usually only one strip is required for this neck to crotch seam.

·          Pull hood up and tuck in all exposed portions of the mask, paying attention to straps.

·          Have the wearer raise his head slightly, called the “sniffing position.”

·          The void between the suit and mask at the neck should be covered first. Use two or three overlapping layers of tape to create a strip approximately 6-8 inches wide and 14-16 inches long. Tab both ends. Place this over the neck void, taking care not to put pressure on the neck that may impair breathing.  

·          Take a 12-14 inch length of tape and tape the topmost horizontal seam where it meets the mask. Try not to impair field of vision wherever possible. Tab both ends.

·          Tape the vertical seams on the left and right sides where they meet the mask. Make sure communication ports, ventilation ports, or accessory adjuncts are not taped over. Tab all ends.

Filter Attachment

·          Whether an organic vapor cartridge or a PAPR unit is to be employed, do not attach until actually ready to enter operations. This ensures longer life of batteries and filters, and is often more comfortable to the wearer.    

Inspection

·          Perform a head to toe inspection of all seams and assure proper tabs on tape ends.

·          Check mask to see if it is mated properly with suit.

·          Check the status of the wearer with a “Thumbs up.”

Procedure For Donning The Chemical Protective Suit Level B

NOTE: This regimen is strictly for use in exercises.  

Donning Stages

1. Wearer Preparation
2. Equipment Preparation 
3. Dressing to the Waist
4. Dressing to the Neck
5. Donning the Mask
6. Donning the SCBA
7. Inspection

When dressing, actions should be taken to ensure all members are dressing in this order and in these stages. This prevents wearers from overheating while waiting for others to complete dressing.  

Wearer Preparation

Obtain pre-entry vital signs from each student to be dressed. If vitals are outside of the normal limits then the person should not dress for this operation. Exclusion limits are…

• Respirations > 24.
• Pulse > 100.
• Systolic BP > 160 mmHg.
• Diastolic BP > 100 mmHg.
• Temperature > 100 F.

Students should:

• Remove all jewelry hearing aids etc. prior to entering the suit.
• Remove shoes and leave socks on.

• Hydrate with non-caffeinated beverages and avoid heavy sweetened soda.

Equipment Preparation

Required Equipment:

q       Respirator mask

q       SCBA frame and bottle

q       Chemical protective suit

q       Chemical resistant boots

q       Chemical gloves

q       Inner exam gloves

q       Duct tape for training and chemical resistant tape for incidents

Preparation:

·          Inspect mask for defects. Make sure straps are in place and not twisted excessively. 

·          Attach a full bottle to the SCBA frame, and inspect all harness straps and fittings.

·          Make sure harness straps are fully extended and regulator is secure in waist belt cup.

·          Open valve. Check regulator gauge against the bottle gauge. (Should be the same reading).

·          Turn bottle off. Test both audible and vibra-alert alarm. (Check as needle passes (10) mark on gauge.)

Dressing to the Waist

• Step into the suit, pulling it up to the waist. Do not insert arms at this point.
• Don boots.

NOTE: If the suit has protective gaiters, they should be pulled up and over the boot. If the suit has open feet, they will also be pulled over the boot. If the suit has attached boots, they must be worn inside the over-boot.

·          Using tape, seal where the boot and suit meet, making only two or three passes. Do not encircle so tightly as to create a tourniquet. Tab the ends.

Dressing to the Neck

·          Don both inner and outer gloves.

·          Insert arms into suit and pull the remainder up over the shoulders.

·          Pull cuffs of the suit over the gloves.

·          Tape the seam where the glove and suit meet, again making only two or three passes, and again ensuring not to create a tourniquet. Tab the ends.

·          Attach a 6-8 inch strip of tape, either on the shoulder, the chest, or wherever the IC has designated, and write the wearer’s ID on it.

Donning the Mask

·          Using the technique advised by the manufacturer, don the mask.

·          Check and inspect all adjuncts such as filters, cartridges, batteries, etc.

·          Zip up the suit, and tape this seam as well, tabbing both ends. Usually only one strip is required for this neck to crotch seam.

·          Pull hood up and tuck in all exposed portions of mask, paying attention to straps.

·          Have the wearer raise his head slightly, called the “sniffing position.”

·          The void between the suit and mask at the neck should be covered first. Use two or three overlapping layers of tape to create a strip approximately 6-8 inches wide and 14-16 inches long. Tab both ends. Place this over the neck void, taking care not to put pressure on the neck that may impair breathing.  

·          Take a 12-14 inch length of tape and tape the topmost horizontal seam where it meets the mask. Try not to impair field of vision wherever possible. Tab both ends.

·          Tape the vertical seams on the left and right sides where they meet the mask. Make sure communication ports, ventilation ports, or accessory adjuncts are not taped over. Tab all ends.

Donning the SCBA

·          Don the SCBA either parachute style or using the over the head method.

·          Cinch up shoulder straps first and waist straps second. Tuck in all loose straps.

·          Open valve on bottle all the way.

·          Perform one more check of shoulder gauge to assure bottle is open.

·          Attach regulator to mask. Test demand function and the purge valve. Check for positive pressure.

·          Remove regulator from mask until order to go “On air,” is given.  

Inspection

·          Perform a head to toe inspection of all seams.

·          Check mask to see if it is mated properly with suit and sealed with tape.

·          Look for any loose harness straps and either tuck them in place or tape them down.

·          Check that SCBA bottle has adequate air supply (full).

·          Check the status of the wearer with a “Thumbs up.”

Procedure For Setting Up and Operating a Non-Ambulatory Decontamination Line

NOTE: This regimen is strictly for use in exercises.

For use in Law Enforcement, Health Care, and Advanced Technician courses. This is a multiple-station setup for demonstration.

Student Activities and Preparation

• Students will be dressed in Level D uniforms for the demonstration.
• Students will be dressed in Level C (Law Enforcement) or Level B (Healthcare / Technician) for the practical decontamination exercise portion.
• Inform students that each station involves the rolling of a patient and possible heavy lifting (180 pound manikin).
• An evidence preservation and suit removal step will be followed by stations of simulating decontamination procedure.

Equipment Preparation

Required Equipment:

Optional Equipment:

      Simulated bomb belt or weapon to be hidden inside the Tyvek suit of the manikin.

Decontamination Line Set Up

1. Lay out tarp and berm the edges by rolling them under, about six or seven turns.
2. Dress manikin in simulated bomb belt or weapon (if applicable) and Tyvek suit.
3. Lash manikin to board runners up.
4. Open the rolling racks and join end-to-end ensuring that brakes are ON.  Secure the two rolling rack units together with straps to outside handles.
5. Tie trauma shears where accessible, to be used for removing the Tyvek suit from the manikin.
6. Put manikin on the caisson cart and apply the detergent simulant contaminant on the Tyvek suit.
7. Place liquid waste pans under first rolling rack section.
8. Place brush buckets on both sides of the rack and fill with ten inches of water
9. Fill sprayer with one-third baby shampoo and two-thirds water.
10. Place sprayer and hose on opposite sides.

11. Put second board on second rack.
12. Place UV light, GM detector, and chemical sensor adjacent to the caisson cart.

NOTE: Illuminate the simulant prior to decontamination for demonstration purposes. This is ordinarily done at the “Hot Zone” contaminated end of the decontamination line.

Demonstration Procedure

1. After demonstrating the non-ambulatory decontamination procedure, have the students assemble to dress in protective equipment levels to participate in the decontamination exercise.
2. Have students dressed in protective clothing line each side of the racks, distributed equally.
3. Illuminate the simulant using the UV light over the Tyvek suit of the manikin on the caisson cart.
4. Remove straps and cut off clothing with suit edges rolled as far under the victim (manikin) as possible.

NOTE: If a simulated device (bomb) is found, abandon the decontamination line until ordinance disposal takes place. Verbalize this action.  

5. Roll victim to one side and roll clothing toward center upon itself.
6. Bag clothing using evidence preservation technique (ODP) or Mass Decontamination Unit (MDU) contaminated clothing procedures.
7. Apply gross wash-down with water and return patient to supine position.
8. Apply and scrub patient skin surfaces with soap and water.
9. Rinse using water only.
10. Roll victim to side and soap and rinse posterior portions, armpits and groin areas.
11. Remove contaminated board toward Hot Zone.
12. Slide clean board under patient from Cold Zone end of rolling rack and return victim to supine position. 
13. Push victim along second rolling rack where next decontamination operation would take place. Verbalize this action.

Procedure For Setting Up And Operating A Five-Station, Ambulatory Decontamination Line

NOTE: This regimen is strictly for use in exercises.

Student Activities and Preparation

• Casual clothing with socks and shoes should be worn.
• Exam gloves or work gloves helpful.
• Students with restrictions should use caution. This portion of the activity involves lifting and moving equipment around.  

Equipment Preparation

Required equipment

Decontamination Line Set Up

Other than first laying the tarps, there is no particular order to the set up of the decontamination line. The hoses, however, should not be charged until the last moment in order to keep the area drier and less tangled with hoses. This helps minimize slip/trip hazards.

• Berm the edges of the tarps by rolling them under about six or seven turns.
• Be sure the valves from the hose manifold are all OFF.
• Attach the main line from the hose reel cart to the house line.
• Open the individual lines just prior to receiving victims.
• Fill sprayers with one-third baby shampoo and the rest with water.
• Fill buckets with about ten inches of water.
• Produce the UV light last, as it is very fragile.

Decontamination Line Procedure

Station 1. Gross Decontamination

1. Hold victims outside of station until ready to begin.
2. Gesture victim into first pan.
3. If victim is wearing an SCBA, the waist belt is opened now.
4. Shower victim from top to bottom, turning them so as to cover four sides: front, side, back, side. Victim should now be facing forward.

5. Apply soap to four sides, paying attention to the hands and other wrinkles and crevices.
6. Work up lather on suit surfaces giving attention to hands and gloved fingers with scrub brushes.
7. Rinse on all four sides by having the patient rotate around.
8. With victim facing forward, have them place their hands on the two cones and raise one foot to the rear.
9. Spray, scrub and rinse the bottom of the boot. When completed, tap the bottom of the boot. They should now, with this clean foot, step onto the rubber step-off pad outside of the pan.
10. Still holding the traffic cones have victim raise second foot and clean bottom of boot in the same manner, only now have the victim step completely out of the pan. Both feet should now be on the rubber step-off pad between stations 1 and 2.

Station 2. Second Wash

1. Gesture victim into pan.
2. As victim is already wet, begin by applying soap to all four sides and scrubbing it in. Again, pay attention to hands.
3. Rotate victim and rinse away soap.
4. Use same procedure from step one for cleaning the bottom of the boots and have victim step onto second rubber stand-off pad.

Station 3. Final Rinse and SCBA or APR Removal

1. Gesture victim into pan.
2. With victim leaning slightly forward, remove the SCBA regulator and then the backpack. If APR is worn, remove only the cartridge. Deposit SCBA/cartridge in tool drop.
3. Rotate victim and give a final rinse, paying attention to the back where the SCBA had been.
4. Rinse boots and have victim step out of pan.

Station 4. Decontamination Check

1. Check efficiency of the decontamination either visually, with a UV light or with some other meter.

NOTE: Send victim back to Station 2 if decontamination is not complete.

2. When decontamination is complete, move victim to the doffing stations.

Station 5. Doffing

1. Remove tape from all surfaces.
2. Sit victim on wet chair, if necessary.
3. Unzip suit.
4. Working from hood down, invert suit so it is removed from the inside out.
5. When suit is off shoulders and down to the waist, remove outer gloves.
6. Once past the waist, sit victim in the dry chairs.
7. Showing nothing but the inside, pull suit down over the boots.
8. Remove boots and suit in one motion and as one package.
9. While sitting forward, have victim remove the mask from top down so they do not spray any others in the area or drip contaminant in their face.
10. Remove inner gloves.

Final Steps

• Hydrate victim and take vital signs.

• Advise them that in actual decontamination, they would take a final shower and shampoo.

Procedure for Doffing the Chemical Protective Suit, Level C or B.

Respirator or SCBA should have been removed in the final rinse station. Doffing crew should be in a minimum of Level C Protection with either cartridge respirator or PAPR.

• With subject standing, remove all tape from mask, suit, gloves, and boots.
• Unzip the suit completely.
• From the rear, place a gloved hand on the back of the subject’s head and invert the hood.
• From the front, reach inside the suit and begin to roll it down over the shoulders. Attempts should be made to remove the suit by turning it entirely inside out.
• Pull arms out and attempt to trap the outer gloves inside the suit. If unable to do so, simply remove the gloves by hand.
• Continue inverting the suit down past the hips.
• Once the knees are clear the subject may sit down.
• Complete the removal by rolling the excess portion of the suit down over the boots. Attempt to pull the boots off using the now inverted suit.  
• Subject removes the mask as follows:

§         Lean forward slightly.

§         Loosen all straps.

§         Hold face piece in place with one hand.

§         With second hand on the rear and bottom of the netting, pull it up and over the face piece. Continue holding the mask in place.

§         Remove the mask from the top first and the chin last.

·          Remove inner gloves.        

NOTE: In an actual decontamination, the subject would then take a non-clothed shower.            

 Lt. Brian Pomodoro
August 2005

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