When duty calls, one hopes that the training received can respond in kind to the situation at hand.
The Decontamination (decon) drill is part of a course in the Colorado School of Public Health Public Health Emergency & Disaster Responder certificate program. It provides the perfect hands-on experience for those who might find themselves participating in a decon response.
As an Army Public Health Nurse, I have background with frequent training in Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) response. However, I do not have the specific experience or training similar to what I received at the decon drill. This drill was exceptional and provided muscle memory that will allow me to perform this task in the future with minimal additional training.
With a solid foundation from the Public Health Emergency Preparedness 101 course taught by Dr. Debra Kreisberg, encompassing training such as Incident Command System (ICS) and Psychological First Aid (PFA), Clinton Andersen and Bethany Weeks (EM directors at UCH) offered a detailed overview of the decon process at University of Colorado Hospitals (UCH).
My expectations were refuted. I anticipated being lectured through the decon process while observing instructors’ demonstration of the gear. I was instead met with a huge surprise, that we (the students) were to “Don and Doff” the equipment and perform decon on manikins patients ourselves… How exciting!
We arrived on scene at the decon storage area where we received orientation and instructions to obtain our gear. We received guidance on the correct donning and doffing of our decon gear which included a non-porous suit, large rubber over-boots, inner and outer gloves, a powered air-purifying respirator (PAPR) along with a hood and face-shield, and chemical tape to seal the whole outfit at ankles and wrists, and at the zipper lapel.
We paired up and utilized the provided detailed checklist to assist each other with correctly wearing the decon suit. This provided an additional layer of safety as wearing the suit reduces mobility and physical agility. We walked a few feet across the ambulance bay to arrive at the decon area where we received another quick orientation, were given our scenario for the day, set up our teams, and quickly began receiving patients.
We were excited, anxious, and ready to take action. However, the reality of the situation quickly emerged as communication among team members and with simulated patients was much harder than anticipated due to the suits adding to the difficulty of the response.
Although the PAPR provided some air circulation within the hood and the suit, some of us were still sweating; others had glasses or strings of hair that could not be readjusted while suited; others of us could not hear well or could not be heard. As humans, we use both verbal and non-verbal cues when communicating. Wearing the decon suit greatly decreased our ability to rely on our non-verbal communication skills with patients that were potentially anxious, fearful, disoriented, had sensory difficulties, or other disabilities. In some instances, we had to increase our voices to the level of what felt like yelling; however, the focus was to ensure that our patients and team members heard us. As these suits made us look like aliens or what people’s most recent memory attribute to Ebola workers, we had to be mindful of what our patients perceived and use our words and gestures in a non-threatening way.
The facilitators provided a real-life experience like no other. We were receiving simulated patients with different needs which confronted us with having to make decisions requiring immediate action. They further tested our limits by increasing the patient flow. However, we had to concentrate on the goal of proper decon with plenty of water for dilution of contaminant and the safety of patients and staff. We utilized all the equipment in the decon area as if responding to an actual drill: showers, stretchers, soap, sponges, towels, etc. We also performed staff decon representing the end of the decon process. We received excellent guidance throughout the process.
Partnering MPH students with University of Colorado Hospital staff during these exercises is one of the best educational experiences I have had. During the decon drill, we were given tasks that promoted muscle memory and provided guidance for our missteps. The drill setup supported the type of learning experience that will remain with the participants for a long time. As a group, we voiced our utmost satisfaction with this well-planned and well-executed drill. I am sincerely grateful for the opportunity to learn through practice and applied activities which not only provides specific knowledge about core Public Health Preparedness and Response activities, but also pushes students to recognize and utilize their own knowledge and in doing so builds confidence and critical thinking skills. I honestly experienced adult learning at its best.
Written by: Ms. Jasmine Dede, Dual MPH and Doctor of Nursing Practitioner student.