Is a contaminated area or area with greatest potential for exposure.
All personnel entering this area must wear appropriate level of PPE for degree and types of hazards.
Outer boundary, or hotline, separates area of contamination from contamination reduction zone, either with a physical barrier (such as fence, rope, hazard tape) or with signs. Along periphery of this zone, access control points may be established to control personnel and equipment entering and leaving contaminated area.
In some cases this zone may be subdivided further, depending upon contaminant and other factors. Some of these subdivisions may include ambulatory patient assembly areas, and triage and secondary triage areas (for both ambulatory and nonambulatory victims).
Is a decontamination area.
All personnel entering this area must wear PPE no more than one level below PPE worn in exclusion zone.
Contamination control line separates this zone from exclusion and support zones. Access control points for this zone are to ensure that personnel are wearing proper PPE to enter exclusion zone and that personnel exiting contamination reduction zone to support zone remove or decontaminate all potentially contaminated PPE.
Personnel, ambulatory and nonambulatory patients and equipment are decontaminated in designated areas within this zone in an area referred to as contamination-reduction corridor.
Is an uncontaminated area.
No PPE is required in this area, since personnel are unlikely to become contaminated in this zone. Any potentially contaminated clothing, equipment, and samples (outer containers) should not be permitted in this zone.
Command post supervisor as well as administrative, medical, and support personnel (to help keep other zones running) set up work areas in this zone. These may include an entry PPE layout area, a clean patient treatment area, a rapid treatment area, and access to transportation to healthcare facilities and/or shelters.
HOSPITAL SETTING WORK ZONES
In the event of a chemical or hazardous material release, hospitals and other healthcare facilities also need to establish work zones (Table 11-2). These are generally referred to as follows:
• Hot
• Warm (dirty)
• Cold (clean)
| ZONE | LOCATION | DESCRIPTION |
|---|---|---|
| Hot | Contamination site (prehospital) | Is a contaminated area where release occurred. See discussion of on-scene decontamination (see Table 11-1). |
| Warm/dirty | Adjacent to hospital, usually near emergency department (remote to release site) | Is a hospital decontamination area. This area needs a source of water (cold climates require a warm water source) for decontamination and barriers to control entrance and exit from area, which must be tightly controlled. Personnel working in this area (first receivers) have potential to be exposed to contaminant(s), and therefore must wear appropriate level of PPE (level C minimum). At entrance to the warm zone is the initial triage station. All ambulance and walk-in cases must enter facility after going through this triage station. Victims who are clearly not contaminated skip the warm zone and enter the cold (clean) zone directly. All others proceed into the warm zone for decontamination. |
| Cold/clean | Hospital treatment area, often emergency department | Is an uncontaminated hospital treatment area (postdecontamination). Since no agent exposure is expected in this area, in most cases only standard (universal) precautions are needed for healthcare workers. This area needs to be tightly controlled so that only patients that have been triaged and decontaminated are allowed entry. Any potentially contaminated victims, clothing, PPE, and/or equipment should not be permitted to enter this zone. Another more thorough triage is performed in cold (clean) zone before treatment is begun based on nature and acuity of signs and symptoms. |
TECHNICAL DECONTAMINATION
For both on-scene and hospital setting decontamination, there may also be a technical decontamination zone (for decontaminating PPE and equipment).
DECONTAMINATION PRIORITIZATION
In the hot zone, when resources are limited and the number of victims is high, responders may have to prioritize patients for receiving decontamination, treatment, and medical evaluation while providing the greatest benefit for the greatest number with the least amount of harm.
Determining where to treat and whether to treat or decontaminate a nonambulatory patient who is symptomatic is a particularly difficult part of this prioritization/triage. There should be protocols established by your local emergency response agencies based on the nature of the release, the amount of antidote or post-exposure vaccine available, and the number of workers available to transport and treat large numbers of victims.
After sorting victims into ambulatory and nonambulatory, the general guidelines in Table 11-3 may be useful for ambulatory patients.
| DECONTAMINATION PRIORITY | AMBULATORY PATIENT CRITERIA |
|---|---|
First priority: Direct to warm zone for immediate decontamination | • Closest to point of release • Report exposure to an aerosol/mist or have known liquid agent contamination serious signs/symptoms (e.g., dyspnea, chest tightness, etc.) |
| Second priority | • Not as close to point of release • May or may not have known liquid agent contamination, but patients are clinically symptomatic (moderate to minimal signs/symptoms) |
| Third priority | • Suffering from conventional injuries (e.g., open wounds) |
Lowest priority: Direct to ambulatory assembly area in warm zone for further review | • Far from point of release • No known/suspected exposure to liquid, aerosol, or vapor • Minimal or no signs/symptoms |
Nonambulatory patients (unconscious, unresponsive, unable to move unassisted) remain in place while further prioritization for decontamination occurs. Recommended guidelines, which follow the prioritization (color-coding system) used in the medical triage system called START (simple triage and rapid treatment system), are outlined in Table 11-4.
| START CATEGORY | DECON PRIORITY | START MEDICAL CRITERIA | CONTAMINATION CRITERIA |
|---|---|---|---|
| RED (Critical) | 1 | Respiration present only after repositioning airway RPM: Respiration: respiratory rate >30/min Perfusion: capillary refill >2 sec Mental status: unable to obey commands | Closest to point of release Serious signs and symptoms and/or known liquid agent contamination or severe exposure |
| YELLOW (Urgent) | 2 | Injuries treatable or controllable on-scene for limited time RPM: Respiration: respiratory rate <30/min Perfusion: capillary refill <2 sec Mental status: able to obey commands
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