Aftermath Process & Procedures

Aftermath Process & ProceduresNext Generation Process & Procedure Training

Agenda• BBP (Bloodborne Pathogen)

• Mask maintenance and cleaning training

• PPE training

• Hierarchy of controls

• Determine the control zone

• Asbestos awareness training

• Lead based paint

• WBGT training

• Job setup phase (P&P)

• Biological debris removal phase (P&P)– Section One: Principle process– Section Two: Chemical, Mechanical, and Combination– Section Three: Cleaning agents– Section Four: Structural removal vs. cleaning– Section Five: Debris zone & Debris net

• ATP training

• Bio Wash phase (P&P)

• Path of extraction phase (P&P)

• Final site inspection and breakdown phase (P&P)

• Off-site demob phase (P&P)

• Paperwork overview– Estimate pages– Service agreement– Customer info sheet– Final Inspection form– Final number review– SCRR– Job Report

• Off-site and departure checklist

• Job management

BBP (BLOODBORNE PATHOGENS)

Aftermath Services, LLCSpecialists in Biohazard

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Why Are We Here?

• OSHA BB Pathogen standard– anyone whose job duties exposes or potentially exposes

them to BB pathogens is required to complete training

• The more you know, the safer you will be and the better you will perform in real situations!

DefinitionsBlood: Human blood, components of human blood and products made from human blood.Bloodborne: Pathogens (BBP): Micro-organisms that are carried in the blood that can cause disease in humans

O.P.I.MOther Potentially Infectious Materials

The fluids of the heart, lungs, joints, spine, and abdominal lining

Amniotic fluid Saliva in dental procedures Semen Vaginal secretions Any body fluid with visible blood in it Any body fluid when you cannot

differentiate body fluids Any unfixed tissue or organ Tissue known to contain BBP

Like blood, these OPIM have enough concentration of BBP to cause transmission of disease.

Human Immunodeficiency Virus (HIV)

Hepatitis B(HBV)

Hepatitis C(HCV)

Common BB Pathogen Diseases

Human Immunodeficiency Virus (HIV)• HIV is the virus that leads to AIDS• HIV depletes the immune system• No threat on contracting HIV

through casual contact• HIV can survive outside the body from

hours to even days if the right temps, pH balance, ,light exposure, and humidity s achieved

• HIV can survive in dried blood at room temps for up to six days

• Transmission– HIV is found in semen, blood, vaginal fluids,

and breast milk– Route of entry: puncture through skin,

absorption through mucous membranes

May lead to chronic liver disease, liver cancer, and death

Vaccination available since 1982 HBV can survive for at least one week Symptoms can occur 1-9 months after exposure 1—1.25 million Americans are chronically infected Symptoms include: jaundice, fatigue, abdominal

pain, loss of appetite, intermittent nausea , vomiting

Transmitted when blood, semen, or other body fluids of an infected person enter the body through sex, childbirth, IV drug user, absorption through mucous membranes, or through an open or break in the skin

Hepatitis B (HBV)

Hepatitis C is the most common chronic blood-borne infection in the United StatesSymptoms include: jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea, vomitingMay lead to chronic liver disease and deathCan live outside the body for up to 4 daysIs transmitted the same as HBVHCV VS. HBV

Hepatitis C (HCV)

Mold

Bacteria

Vomit/Feces/Urine

O.I.M(Other Infectious Material)

Mold helps breakdown organic material (Tissue)

Health hazards causing allergic reaction and respiratory problems

Control zone needs to be disinfected to kill mold and mold spores

Mold

Health Concerns Respiratory Skin Contact PPE neglect

Pathogenic Bacteria Typhoid Pneumonia Sepsis

Vomit/Feces contain enough OIM to transfer

Bacteria

Putrefaction 2-3 days: Staining begins on the abdomen. The body begins to swell owing to gas formation.

3-4 days: The staining spreads and veins become discolored.

5-6 days: The abdomen swells with gas (produced by the bacteria to decompose the body),

and the skin blisters.

2 weeks : The abdomen becomes very tight and swollen.

3 weeks : Tissues begin to soften. Organs and cavities are bursting. The nails fall off.

4 weeks : Soft tissues begin to liquefy, and the face becomes unrecognizable.

The exact rate of putrefaction is, of course, dependent upon many factors, such as weather, health, exposure, and location

Additional Health Risks

MRSA Encephalitis Meningitis Clostridium Difficile (Cdiff)

MRSA Encephalitis

Meningitis CJD

Occurs in Healthy People

Type of Staph

Antibiotic Resistant

Very Contagious and us transmitted from person to person through sin to skin contact

Can live on surfaces for days to several weeks

M.R.S.A(Methici l l in-Resistant Staphylococcus Aureus)

Encephalitis Symptoms include:

• Clumsiness, unsteady gait • Confusion, disorientation • Drowsiness • Fever • Headache • Irritability or poor temper control • Light-sensitivity • Stiff neck and back (occasionally) • Vomiting

Transmission• Mosquitoes• Viral: Rabies virus, poliovirus, and measles virus• Bacterial: Bacterial meningitis and Lyme disease• Bodily fluids from mucous membranes • Spread through air via coughing and sneezing

Sudden inflammation (swelling) and irritation of the brain, usually due to infections.

Symptoms

Is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. When the virus/bacteria enters the bloodstream, it may cause inflammation of brain tissue and surrounding membranes. White blood cells invade the brain tissue as they try to fight off the infection. The brain tissue swells (cerebral edema), which may destroy nerve cells, cause bleeding in the brain (intracerebral hemorrhage), and brain damage.

Causes

Encephalitis is most often caused by a viral infection. Many types of viruses may cause it. Exposure to viruses can occur through: Breathing in respiratory droplets from an infected person Contaminated food or drink Insect bites Skin contact

Transmission

Direct contact with saliva, nasal mucus, or feces Doesn’t live outside the body for very long People can be carriers and not have symptoms and can unknowingly transmit the bacteria to others

Types

Bacterial : Extremely dangerous and is the greatest potential of death

Viral: Not as deadly or debilitating. Most patients recover fully over time

Meningitis

Clostridium Difficile (Cdiff) Spore-forming bacteria which can cause symptoms

ranging from diarrhea to life-threatening inflammation of the colon.

Bacterium has 3 transmission routes:•Person-to-Person Contact•Droplet (Contact of body secretions from carrier)• Airborne spores can survive for a very long

time in the environment and can be transported on the hands of people who can have direct contact with infected patients or infected surfaces.

Always wear PPE and follow all safety and best practices. Properly dispose of all materials and waste from the control zone that cannot be cleaned and disinfected that come in contact with blood, bodily fluids, OPIM, or infectious material

All tools and equipment used on a job site must be cleaned and disinfected

Never take chances

Follow Aftermath process & procedures, best practices, and all safety policies and guidelines

Infection Control/Universal Precautions

Contact with another person’s blood or bodily fluid that may contain blood

Routes of Entry; Mucous membranes: eyes, ears, mouth, and nose

Non-intact skin

Contaminated sharps/needles

Transmission Potential

Hand WashingWash hands immediately

after removing PPE Use a soft antibacterial soap A hand sanitizer can be used

but wash with soap and water as soon as possible.

Exposure Incident

A specific incident of contact with potentially infectious bodily

fluid

If there are no infiltrations of mucous membranes or open

skin surfaces, it is not considered an occupational exposure

Report all accidents involving blood or bodily fluids

Post-exposure medical evaluations are offered

Post-Exposure Evaluation Confidential medical

evaluation Document route of

exposure Identify source individual Test source individuals

blood (with individuals consent)

Provide results to exposed employee

Hepatitis B Vaccination Strongly endorsed by

medical communitiesOffered to all

potentially exposed employees

Provided at no cost to employees

Declination form

RecordkeepingMedical records include:Hepatitis B vaccination statusPost-exposure evaluation and follow-up resultsTraining records include:Training datesContents of the trainingSignature of trainer and trainee

MASK MAINTENANCE AND CLEANING


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Photo 1- Station setup

Photo 2- Align the cartridge

Photo 3- Attach cartridge

Photo 4- Place chin in chin cup and pull straps over head

Photo 5- Tighten straps

Photo 6- Negative pressure test

Photo 7- Positive pressure test

Photo 8- Remove head straps Photo 9- Nose cup assembly

Photo 10- Center adapter assembly

Photo 11- Center adapter cover

Photo 12- Exhalation valve Photo 13- Center adapter base

Photo 14- Center adapter gasket

Photo 15- Inhalation gasket Photo 16- Clean the inside of mask

Photo 17- Remember to clean nose cup assembly

Photo 18- Clean the outside of the mask including the center adapter assembly

Photo 19- Fully seated inhalation gasket

Photo 20- re-assembled center adapter assembly

Photo 21- re-assembled nose cup assembly

Photo 22- re-connect the head straps

Photo 23- Never stack masks on top of each other

Photo 24- Don’t hang masks in the truck

Photo 25- never place respirators on the floor in truck or buffer zone

Photo 26- Change out dirty gloves after cleaning mask prior to re-assembly

Photo 27- Always store mask in plastic bag

Agenda• BBP (Bloodborne Pathogen)


• PPE training





• WBGT training



• ATP training







• Job management

PPE


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BBB/PPE Hands-on training

Photo 1- Training station

Photo 2- Engineering controls: HEPA air scrubber, control zone barrier, sharps container

Photo 3- Full PPE with puncture proof gloves

Photo 4- Full PPE with leather gloves

Photo 5- 1st Pair of latex gloves

Photo 6- Encapsulated suit

Photo 7- Thumb loop holes

Photo 8- Full face respirator with hood pulled over

Photo 9- 2nd pair of latex gloves

Photo 10- Puncture proof gloves Photo 11- Leather gloves

Photo 12- Face shield Photo 13- Knee pads

Photo 14- Remove knee pads Photo 15- Remove puncture proof gloves

Photo 16- Remove hood Photo 17- Unzip encapsulated suit

Photo 18- Grasp glove cuff Photo 19- Pull glove off exposing thumb

Photo 20- Pull thumb out of loop Photo 21- Reinsert thumb back into outer pair of gloves- be careful not to touch inner pair

Photo 22- Pull glove back on Photo 23- Grasp suit at chest

Photo 24- Pull one shoulder out at a time- rolling the sleeve inside out

Photo 25- Pull out second shoulder-rolling the sleeve inside out

Photo 26- Pull arms out of sleeves turning suit inside out

Photo 27- Roll suit down continuing to turn suit inside out

Photo 28- Roll suit all the way down to the ground and step out

Photo 29- Pinch cuff

Photo 30- Roll glove partially off exposing inside

Photo 31- Pinch opposite glove and remove

Photo 32- Remove both gloves inside out

Agenda• BBP (Bloodborne pathogens


• PPE training





• WBGT training



• ATP training







• Job management

HIERARCHY OF CONTROLS


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Purpose for training

• OSHA requires that the employer take measures to make an employee’s work environment safe

• Hierarchy of Controls will be utilized in your daily process and procedure to ensure your safety as a technician with Aftermath Services LLC

• Once hazards have been identified how do we utilize controls to protect technicians in the workplace

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What is a Hazard?

Something with the potential to cause harm, an injury or illness

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Hazards and complicating factors categories

CHEMICAL & DUST HAZARDS

(cleaning products, pesticides, asbestos, etc.)

BIOLOGICAL HAZARDS

(blood/biological fluids, mold, insects/pests,

communicable diseases, etc.)

ERGONOMIC HAZARDS

(repetition, lifting, awkward postures, etc.)

Psychological or Societal Hazards

Things that cause STRESS!

SAFETY HAZARDS(slips, trips and falls,

faulty equipment, etc.)

PHYSICAL HAZARDS

(noise, temperature extremes, etc.)

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• These are hazards that can cause health or physical hazards to as a result of an exposure

• Examples of the most common are:– Our cleaning agents– Asbestos– Lead paint dust– Flammable, toxic, or corrosive

chemicals that we will encounter on job sites that are present prior to us arriving

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Chemical and dust hazards

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• These hazards are strains and stresses on the body caused by workplace motions and body positions

• Examples of the most common are:– Working in awkward positions– Repeated motions– Lifting materials– Poorly designed work areas or work stations

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Ergonomic hazards

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Safe and correct way to lift an object

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Never lift heavy items above you head

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• Physical hazard is a type of occupational hazard that involves environmental hazards that can cause harm with or without contact

• Examples of the most common are:– Heat-related injuries– Cold-related injuries– Vibration hazards– Noise hazards

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Physical hazards

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• These are common hazards that cause immediate injuries and illnesses, and may lead to death

• Examples of the most common are:– Spills on floors or tripping

hazards– Working from heights– Unguarded machinery and

moving machinery parts– Electrical hazards– Confined spaces– Machinery-related hazards

(LOTO)

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Safety hazards

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• These are hazards associated with blood, biological fluids, and communicable diseases that can cause injury or illness

• Examples of the most common are:– Viruses– Parasites – Bacteria– Mold/Fungi– Blood– OPIM (Other potentially

infectious materials)– Animal and human feces– Bites or stings

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Biological hazards

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• These hazards are caused by interacting with people and social conditions at the workplace

• Examples are:– Workplace violence– Work-related stress– Sexual harassment– Depression– Alcohol and drug addiction– Traumatic events

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Psychological or Societal Hazards

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Factors that compound the hazards

• Constantly changing job environment and conditions

• Various levels of knowledge and experience

• Diversity of work activities occurring simultaneously

• Issues with adapting and conforming to safety policies and process & procedures

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What can we conduct that will help us identify hazards and create a safer work environment?

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How to create a safer work environment• Identifying hazards: First step in making workplace

safe is to identify hazards-the things that have potential to cause harm

• Assessing hazards: Once you have identified hazards, you should assess them to determine which hazards you should control and when. You may have to control some hazards before you control other hazards

• Controlling hazards: To control a hazard means to do something to remove its potential to cause harm, to reduce the potential to do harm, and/or to provide the worker with equipment that provides protection from the hazard

Identify Hazards

Assess Hazards

Control Hazards

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What are the 5 Hazard Controls?

• Controls remove or reduce the hazard’s potential to cause harm

• Elimination

• Substitution

• Engineering controls

• Administrative/warning controls– Safe work practices

• PPE (Personal protective equipment)

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Elimination

• Elimination is easily defined as getting rid of the hazard

• Examples are:– Repair any damaged equipment/tools or disposing of the

damaged equipment/tools– Move an item we have to clean/disinfect to ground level vs.

performing the work where it iso Ex. cleaning a sign affixed to a building

– Move or shutdown a noisy machineo Many times this will need to be done if we perform work in a factory

or commercial building

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Substitution

• Replacing a hazardous substance or work practice with a less hazardous or safer alternative

• Examples are:– The best example of substitution is when Aftermath developed its own

chemical line. Bleach was a staple in the industry but bleach is an unstable chemical and if it is mixed with an acid or other household chemicals may produce very dangerous fumes that could cause serious injury or even death.

– Discontinued using a gas powered fogger and went with an electric fogger

– Using an absorbent agent (Bio Zorb) to absorb blood/biological fluids reduces the chance of splash and spattering vs. towels

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Engineering Controls • Engineering controls design solutions to make hazards safer at its source to

isolate a hazard from employees

• Examples are:– Establishing zones to prevent cross-contamination– Utilizing a HEPA air scrubber to remove airborne particulates– Placing sharps in a sharps container preventing the chance of a sharp creating a

puncture exposure

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Administrative controls & Safe work practices • Safe work practices are companies general workplace rules and other

operation-specific rules. While safe work practices can be considered forms of administrative controls, OSHA uses the term administrative controls to mean other measures aimed at reducing employee exposure to hazards and includes the provision of specific training and supervision

• Examples are:– Job rotation and work/rest intervals– Hazard communication program– Respiratory protection– LOTO– Written safety policies/rules– Training and education– Process & procedures and learned best practices

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PPE (Personal Protective Equipment)

• PPE is defined as protective clothing, hardhats, respirators, latex gloves, or other garments or equipment designed to protect the technician’s body from injury or infection

• PPE is the LAST resort and line of defense– All other controls must be implemented first and PPE should never be

the only control used to control risks and hazards

• Examples are:– Wearing ear plugs in noisy areas– Use of full face respirators– Use of suits and gloves to protect against infection– Face shield

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Which controls should you try first?

Follow the hierarchy of controls pyramid

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Hierarchy of Controls

Hierarchy of hazard control is a system used in the industry to eliminate or minimize exposure to hazards. It is a widely accepted system promoted by numerous safety organizations. The Hierarchy of Controls is the preferred method of controlling and preventing hazards.

When deciding on the best way to control a risk, start at the top of the hierarchy of controls.

First investigate if the risk can be eliminated/substituted (by using an engineering control to take the worker out of the equation for the hazard)

Then start to factor the worker back into the equation○ Change the way they work○ How long they will work○ How they can protect themselves from the hazard

Elimination and substitution are sometimes considered engineering controls It is often necessary to use several different types of controls for one hazard

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Hierarchy of ControlsThis hierarchy is intended to provide a systematic approach to control hazards. They are ranked by effectiveness. The controls are less effective as they progress to the bottom of this page. It is common to combine controls. The hazard type,consequence severity, and the risk to workers must be considered when identifying which control(s) should be used. As the risk increases so should the control method.

Elimination

Substitution

Engineering

Warnings

Administrative

PPE

Most Effective

Least Effective

Eliminates or Reduces the Hazard

Reduces Exposure to the Hazard

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Risk Control Flow ChartList identified hazards and risks relating to a particular job or task

Does the job or task need to be completed?

Eliminate job or task all together

Can you reduce the risk by substitution

or isolation?

Can you reduce the risk by using engineering

controls?

Can you reduce the risk by other means? (E.g. Administrative

controls)

List possible ‘control options’ and ‘time

frames’

Prioritize “control options” and develop an “action plan”

No

Yes

No No

No

Yes

Yes

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Conclusion

• Safety is everyone’s responsibility

• Pay attention to your surroundings

• Remember to always perform a hazard inspection and assess the scene so you implement the necessary controls to make the workplace safer

• Always start at the top of the hierarchy of controls and work down the pyramid

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Any Questions?

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Agenda• BBP (Bloodborne pathogens)


• PPE training


• Determine the control zone and building scope of work



• WBGT training



• ATP training







• Job management

AFTERMATH SERVICES LLCSPEACLISTS IN CRIME SCENE & TRAUMA CLEANUP

Determining the Control Zone & Building Scope of Work

CONFIDENTIAL AFTERMATH SERVICES, LLC DO NOT DISTRIBUTE 68

Agenda

• What is a control zone

• What is a restricted control zone

• Types of control zones o Primary control zoneo Secondary affected area

• What is the purpose of a control zone


• What can you do to assist in defining control zoneo What is a site assessmento Purpose of the site assessmento Preparing for site assessmento Identifying hazards and complicating factors

• Job Aid o Explain the situationo Visual inspectiono Doorways & entrywayso Structure assessmento Closer inspectiono Common situations

• Common situationso Large open areaso Open house plano Knife of sharp objecto Gravitational biological fluid droplets

• Scope of worko What is a scope of worko How to build a scope of worko procedures

• Review


What is a control zone

• Area where biological fluids and/or OPIM is or may be present

• The area that presents the highest risk or exposure to blood-borne pathogens, OPIM, or infectious diseases

• It isn’t defined by 4 walls

• Isn't defined by red

• If you focus only on red you will miss the clear fluids and a spot cleaning is performed

• Every job site will have a control zone


What is a restricted control zone

• When our recommended control zone is reduced to a smaller area by the customer

• Restricted control examples:

• Customer only wants a small area cleaned

• Customer elects to not have flooring, walls, ceilings, cleaned/disinfected or removed

• Many times in these situations biological fluids will be left behind and a Declination Page will have to be filled out

What makes how we setup the restricted control zone unique? Think about what is our recommended control zone

Does a restricted control zone change how we clean and disinfect the structure?


Control Zone Types Primary control zone

• “Primary control zone” is used to define the area where the situation happened or epicenter of the situation

• This is what everyone will call the ‘control zone”• Some scenes will require multiple primary control zones

• Examples• Fluids travel through the floor and into an area below• Fluids travel through a wall and into an adjacent area• Individual injures themselves and walks around

• Build a containment • Must be only one egress/ingress to the control zone• Again the control zone doesn’t have to be defined as 4

walls, but may have to construct a barrier using plastic sheeting to prevent cross-contamination

• Full containment is established with plastic sheeting or a wall

• Primary control zone doesn’t include a transfer of biological fluids from 1st responders or just odors

• Presence of biological fluids are due directly to the incident

Secondary affected area • “Secondary affected area” is an area or room outside the

primary control zone which is affected with odors or biological fluid transfer from 1st responders• Biological fluids

• This is usually bloody footprints, bloody hand prints, blood droplets from the gurney, etc.

• If the biological fluid droplets are present due to the injured or deceased individual, that area would be part of the primary control zone

• Odor• In decompositions or biological odors where it is affecting additional

rooms outside the control zone or entire property the entrance to the property will have control zone barrier established for the safety of our technicians and customer alerting them to potential dangers

• Entrance to the Secondary affected area is setup with a egress/ingress just like the primary control zone. This is due to the dangers of inhaling harmful bacteria causing illness symptoms for ex. flu-like symptoms, sore/dry throat, headaches, nausea, vomiting


What is the purpose of a control zone

• Protection of our employees and customers• Alerts our employees and customers that the area is potentially contaminated and requires

PPE to enter• Prevent cross-contamination

• Identifying the correct area as the control zone reduces/eliminates the chance that biological fluids will be transferred to a clean area

• OSHA Requirement• OSHA requires employers to protect its employees when dealing with biological fluids. One

requirement is to section off areas known to have the presence of biological material


How do you determine the control zone?

What do you need to know to determine where the control zone is?

Let’s discuss your answers.


How to determine the control zone

What are the 3 things we need to determine the control zone

• Need to understand the situation

• Need to visually inspect the property, structures, and personal property

• Need to determine if there a decomposition or blood odor and where is it present


Define the control zone- Understand the situation

• Understanding what happened (why we were called- suicide, unattended death, homicide, etc.) the type of weapon that was used or how long the body laid unattended due to death by natural causes (how did it happen) assists the super and the CM at determining the control zone

• Shotgun increases the potential for there to be a larger spatter area while a knife has typically a smaller spatter pattern• Small caliber handgun will produce a small spatter area but many times this generates a large amount of bleeding which increases the

chance that biological fluids traveled further into the structure • Understanding where it happened allows the super and the CM to determine how large the control zone should be

• If a shotgun was used in a large open area in a basement or an open house plan then the potential for there to be biological spatter throughout is much greater then if a knife was used or there was a door and it was closed

• The decedent is unattended in a bath tub for several days with the water running• This situation creates potentially a very large primary control zone due to the running water mixing with the biological fluids and significantly

increasing how far the fluids would have traveled and penetrated into structure• How long ago it happened will also affect how you will determine the control zone

• Scenes that are not released right away and we weren’t called for several days to assist the customer• How long a deceased laid unattended is important to know due to how the odor will affect the rest of the property• Biological fluid absorption increases the longer it is exposed to the structure • Unattended odor can be produced from a homicide, suicide, accident, etc. if the biological fluids are at the property long enough for the

fluids to began to breakdown


Visual inspection

• Visually inspect and identify any hazards, potential hazards, or complicating factors • Visually inspect the structure starting from the outside and work your way in

o Once inside pay attention to: The ceilings The walls The floors

• Inspect the area for the best egress/ingress to the scene• Also pay attention to the POE (path of extraction)

o The path in which first responders used to remove the body from the propertyo Look over the railings, light switches, door knobs, and the corners of the wallso Any high touch area

• Look around and see if you notice anything moved, PPE on the ground or in trash cans, and any medical equipment that may have been used by the EMT’s

• Look around and see if you notice any damage to any structure• Visually inspect personal property

o Do you see any valuables Wallet Jewelry Money

o Any property affected by biological fluids or odor


Hazard Assessment and complicating factors

• Identify hazards and safety concerns for crew and family

• Identify any complicating factors

• Document how hazards and complicating factors will be addressed and controlled


How might hazards and complicating factors impact how you determine the control zone?

Is there an odor

• There is a direct correlation between the # of days unattended and strength of odor, typically the longer the unattended the stronger the odor• This is important when determining the secondary affected area. Is it the immediate room? The first floor? The entire

property?• An area affected by odor only wouldn’t be included in the primary control zone but would be included in the secondary

affected area• What can slow down or speed up the breakdown of tissue and biological fluids

• Weather• Insects• Health of deceased• Pets/animals in the property

• Secondary affected area• Odor remediation (treatment) recommended

• 3 –step Bio wash of structure • Explain what structures and where at

• Containment is required to prevent cross-contamination and alert technicians and customer of dangers


Share your thoughts

So what can you perform to assist in determining the control zone?

Lets discuss your answers.


And the answer is?

Perform a Site Assessment

So how can a site assessment assist you at determining the control

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What is a Site Assessment?

Definition 1

• A Site Assessment or investigation can be defined as the process of identifying the presence or likely presence of any hazardous materials on a property, where conditions indicate a release or threatened release of hazardous material into structures on the property.

Definition 2

• An assessment to confirm the presence of hazardous substances and to determine the relative risk the site poses to human health and the environment.


Purpose of Site Assessment

• Identify areas that contain biological fluid, OPIM, or odor– To determine the Control Zone

• Establish zones – To prevent cross contamination

• Identify hazards and complicating factors– To keep us safe – To identify potential hazards

• Identify affected personal property and valuables– To help the family determine best course of action

• Create an accurate scope of work

Performing Site

Assessment

creates Scope of Work

leads toEstimate

Helps to understand and identify hazards

Defines control zone


Identifying hazards and complicating factors

While performing an assessment to determine the control zone you will need to identify any hazards/complicating factors or potential hazards/complicating factors that will need to be addressed when the scope of work is being built

• What is my best route for entering and exiting the property-what’s going to be most efficient and safe?

• Do I see anything that is obstructing my ability to gain access or perform my assessment or job?

• Do I have to go up and down the stairs?

• Are there trip hazards or any structural issues

• Potential ACM (asbestos containing material)

• Potential lead-based paint (Follow RRP-rule)

• What hazards do I have as I’m walking in and out of the house, what is the weather outside (icy, snow, etc.)?

• Did the coroner or police move anything

• Did the coroner, police, pet, or family create a cross-contamination?

• Is there electricity?

• Is there running water?

• Is there sufficient lighting?

• Is the property safe?

• Is there any structural damage that may pose a threat to the team’s safety?

• Does anything look out of the ordinary?


Questions?

How can complicating factors or hazards cause an issue when trying to define the control zone?

What is a challenging complicating factor or hazard you had to deal with recently, and how did you

address it?



What can we use to help us process through the Site Assessment?



Site Assessment Job Aid!!!!!!!!Purpose:

• Increase employee and customer safety by helping identifying hazards and how we will address and control them

• Identify areas that contain biological fluids/OPIM to determine and establish control zone

• Identify complicating factors

• To deliver an accurate Scope of Work and Estimate for the family

• Site assessment job aid must be used on every job!!


Preparing for the Site Assessment

CONFIDENTIAL AFTERMATH SERVICES, LLC DO NOT DISTRIBUTE

• Customer introduction• Set expectations with

family• Ask family if there are

any valuables in the affected area

• Deliver Info Sheet

Supervisor

• Collect supplies for Site Assessment• Camera• Laser measurer• Pen• Lighting (if necessary)• WBGT• Bio Bag• PPE(Mask, suit, gloves,

booties)• Site Assessment Job Aid

Backup

• Gather all supplies needed for zone set-up including Initial Clean Zone Supply List

• Prepare supplies for set-up

• Prepare technology for Supervisor

Technician

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Site Assessment Job Aid• Site Assessment is broken down into 3 major steps

• Step (1): Explain the situation

• Step (2): Inspection of property

• Step (3): Determine zones

• Additional required information to help us understand

• Required Photos

• Photos assist CM and super to identify structures, hazards, complicating factors, and determining the control zone

• Room Diagram

• Assists CM by helping them visualize the scene

• Personal property

• Identifies personal content that are affected


Importance of good clear pictures

Supervisor responsibilities

• Take required pictures and check off appropriate boxes

• Ensure pictures are clear

CM responsibilities

• Review all pictures to ensure nothing has been missed

Required Photos


Initial Site Inspection (Visual inspection)

• Visual inspection begins upon entering property • Is there an odor?• Is there anything out of the ordinary

• Furniture moved or missing?• Any emergency first aid supplies visible?• Latex gloves or any PPE left from LE or first responders

• Do you see visible biological fluids?• Inspect walls• Inspect light switches• Inspect floors• Inspect Door knobs

• Inspecting around and outside the area/room where you were told incident took place allows you to see if there are additional areas affected or if the incident started elsewhere

• Also need to make sure first responders didn’t cross-contaminate another area or room by moving bedding, clothes, or furniture from the immediate area


Sometimes the 1st responders transfer biological fluids while removing the

body, collecting evidence, or administering first aid

91

Initial Site Inspection (doorways & entryways)

Door Closed

• Biological fluids would only be on the inside part of the door

• Might also be some biological fluids present around the doorjamb

• Biological fluids are not visible on the floor, walls, or ceilings beyond the entryway/doorway

• Control zone would not have to be extended outside the doorway & entryways

Door Open

• Biological fluids maybe visible on both sides of the door

• Biological fluids may still be present in the doorjambs

• Biological fluids may be visible on the floor, walls, or ceilings outside the area/room

• In this instance the control zone will have to be extended outside of the room– Control zone would be extended 4’ beyond where the

visible biological fluids end o This will ensure that the control zone includes the invisible

threats like clear fluids


Explain the situation

1A: What happened?

1B: How it happened?

1C: Where it happened?

ID: How long ago did it happen?

IE: Is there an odor?

1F: Does the scene require Lock-out-Tag-out?

IF: Does anything look out of the ordinary?

1: Explain the Situation

How does this information help you determine your control zone and

build your scope of work??


Thinking through!!!!

What if you cant tell if the door was open or closed…… What do we do now??

Lets discuss


Inspecting the ceiling for biological fluids and OPIM

2A: Identify the ceiling type

2B: Is the ceiling affected with Bio / OPIM?

Notes & Recommendations

Notes and Recommendations? Why is this important?

2A-B: Identify Ceiling Type

Enter Hazard Assessment info here.


Site Assessment (Structural assessment)

• Start by inspecting the ceiling• When working through the structural inspection keep in mind what you found out through “Explain the situation”

• Determine the ceiling type• Is the ceiling affected with biological fluids/OPIM

• Can it be clean and disinfected? • Due to the incident what is the potential for the ceiling to be affected by biological fluids (visible vs. invisible) or OPIM??

• Is there any damage• If yes, was it caused by the incident (ex. bullet hole, skull/bone fragments)

• What type of lighting? Is there a ceiling fan? Is it vaulted? Is there register/vents on ceiling? • Is there an open ceiling?

• Ex. does the room/area have an open ceiling like in a great room where it leads to another level of the home like a loft? If yes, then an assessment of that area must be completed as well


2C: Identify the wall type

2D: Are the walls affected with Bio / OPIM? Outlets Registers/vents Damage

2E: Identify the window you will use to vent HEPA machine.


2C-E: Identify Wall Type



Notes and Recommendations? Again, why is this important?



• Next inspect the walls• Again keep in mind what you found out through “Explain the situation”

• Determine the wall type• Are the walls affected with biological fluids/OPIM

• Can it be clean and disinfected? • Due to the incident what is the potential for the walls to be affected by biological fluids (visible vs. invisible) or OPIM??

• Are any outlets or register/vents affected?• Is there any damage

• If yes, was it caused by the incident (ex. bullet hole, skull/bone fragments) • Identify the window you will use to vent HEPA machine

• Is it operable


Lets discuss

98


2F: Identify the floor type

2G: Are the floors affected with Bio / OPIM?

2H: Are any baseboards and/or registers affected on the floor and/or walls?


2F-H: Identify Floor Type

Again so why is Notes and Recommendations important?



Site Assessment (Structural assessment)• Now inspect the floors

• Again, keep in mind what you found out through “Explain the situation”• Determine the floor type• Are the floors affected with biological fluids or OPIM?

• Can it be clean and disinfected? • Due to the incident what is the potential for the floors to be affected by biological fluids (visible vs. invisible) or OPIM??

• Is there any damage• If yes, was it caused by the incident (ex. bullet hole)

• If pooling present on the floor • Are baseboards and/or registers affected on the floor?• Must inspect the room/area below to see if fluids traveled • If fluids traveled to the area below or adjacent how large does the control zone have to be extended?

• Extend the control zone containment 4’ beyond where the visible biological fluids end this will ensure that the control zone includes the invisible threats like clear fluids

• If biological fluids traveled through the floor registers/vents• If yes, must include in the control zone• Requires an inspection below to see if fluids breached through the duct work and affected any structure

• Will need to remove HVAC duct work• May require ceiling removal and/or wall removal


Site Assessment (Closer inspection)

• Complete Structural Inspection• Follow the Site Assessment to assist in inspecting the scene correctly• Must inspect the entire room/area

• See red/clean red is the wrong thinking• Most people target what stands out

• Move furniture around and personal property to see if anything traveled behind• If bed or couch is involved see if anything looks out of the ordinary

• Look for missing bedding (pillows, sheets, comforter, throw pillows) • Inspect connecting rooms (i.e. closets and bathrooms)

• Doors open or closed? Sliding doors with vertical or horizontal vents• Inspect the vents for biological fluids • Inspect inside the closet to see if biological fluids affected any personal property (look through clothing and move

around articles to complete a full inspection of the closet) or structure inside• If any evidence of biological fluids found then must include as part of the control zone


Common Situations • Defining the control zone in a large open area

• Large common areas (management companies, businesses, factories, storage areas, etc.)• An area with no walls or structure to separate space

• How do we determine the control zone in large open areas?• Completely inspect the area • Extend the control zone an additional 10’ beyond where biological fluids are visible to take into account clear fluids

» Exception: Gravitational biological fluids where spraying, splashing, spattering doesn’t come into play then only 4’ beyond where the visible biological fluids end

• 20’+ ceiling • Inspect rafters if possible

• Depending on height • If is infected

• Clean and disinfect if possible• If not infected, discuss with customer and CM

• Containment must always be established• If vertical containment isn’t possible then bio tape outlining control zone is required


What are some hazards and complicating factors when dealing with cleanups at businesses and factories?

Common Situations

• Determine the control zone in an open house plan• Open house plan: Large areas or multiple rooms connecting with no structures or minimal structures (walls, ceilings)

to separate rooms/space (ex. dinning room/living, great room, basement)• An assessment and complete inspection of the area is required to determine the control zone • Many times the space or all the connecting rooms are not affected

• Follow the rule of 4’ beyond visible biological fluids • This will ensure that clear fluids are addressed

• Containment is required to prevent cross-contamination• Entire room/area vs. partial room/area

• If under 50%, then partial• If over 50%, entire room• If large area, following the “large open area” rule is best option• Must use the thought process, what is the potential the entire area is affected. Inspect the entire area thoroughly


Common Situations

• Defining the control zone when a knife or sharp object was used• Biological fluids 6’

• Must always perform a full inspection of area • In many of these situation a control zone of the entire room isn’t required and following the 4” rule is best option

• It is very possible to determine the control zone to be a 5’X6’ area in the corner where the lounge chair is and 6’ high• In this situation a full containment is required including vertical containment

• Full inspections of the room/space is very important due to the back splash• This is when the knife or sharp object is being pulled in/out and biological fluids spatter is visible on the ceiling and/or walls

• After full inspection and there is limited biological fluids discovered:• Following the 4’ rule is required for the containment

• Incident may involve multiple rooms/areas• Complete inspection in every room/area is required • Don’t assume anything

What makes these types of situations unique?


Lets discuss your answers

Common Situations • Determine the control zone when gravitational biological fluid droplets are involved

• What is gravitational biological fluid droplets• This is where the biological droplets are straight down and there isn’t any projection of biological fluids where it is being

sprayed onto the walls and/or ceilings like arterial bleeding• This is a situation where there is zero chance that there is biological fluids on the walls and/or ceiling• Usually this is where the individual exited from where the incident started and proceeded to walk around the house or around

the room/area• In cases like these there can be a single room/area or multiple rooms/areas that are affected and the control zone can

vary • Situations may require a complete bio wash in a room/area then the area where the individual walked around would be an

additional primary control zone where only the floor is addressed • Complete inspection is necessary to rule out and determine where all the biological fluids are present

• Situations where individual just walked through the room the control zone will be just 2’ wide on each side of where the visible biological fluids ends

• A containment will have to be established• Floor, unless carpet, will have to be cleaned and disinfected • If flooring has to be removed (grout, wood floors) you will have to setup a debris zone to prevent the particulates from settling and increasing

the safety hazards as well as potentially cross-contaminating

What makes these types of situations unique?


• Always inspect personal property• Look for:

– Is any of it affected?– Is any of it damaged?

o By the incidento When we arrived

• Determine– Utilize personal property inventory note

sheet of SAJA to list out property and determine if our recommendation is:

o Recommend cleaning?o Recommend disposal?

• Identify any valuables – Notify customer what was found

• Need to identify hazards and determine recommendations (controls) how to address

106CONFIDENTIAL AFTERMATH SERVICES, LLC DO NOT DISTRIBUTE

Personal property

• Describe where the control zone is:– Master bedroom, bathroom, 6X10 area in the

northwest corner of the living room, etc.

• Always include measurements• WBGT reading must be included• Describe where the buffer will be

established • Describe where the clean zone will be

established• Describe where the POE will be described• Must identify hazards and complicating

factors for the rest of the property not including what you have already identified for the walls, ceilings, and floors and how they will be addressed (controlled)


• Room diagrams are extremely important by giving the CM a better idea how the supervisor believes the job should be laid out

• Diagram must include– Control zone

o Indicate doors, windows, major furnitureo Location of HEPA and where it will be ventedo Location of biological fluids

– Buffer zoneo Staging areao Traffic area

– Clean zone– POE

• Use additional room diagram to include secondary affected area


Question

Can anyone explain what a scope of work is?



What does the family want?

Our professional recommendation

Our understanding of

the situation

What, Where, Why, and How

Scope of Work

We want to build a Scope of Work ensuring the safety for the families we help and our employees.

● Build a scope of work and provide the family with our professional recommendation

● We want to assist the family, not to push them to do what we want

What is a scope of work

• Is a formal statement (document) that captures and defines:• Work activities (specific tasks)• Deliverables (what our services will produce)• Timeline (deadlines)

• Includes detailed exclusions and constraints• Statement about what the project will not accomplish or produce. This is important if the customer chooses a

different scope of work than our professional recommendation• Be sure to have a signed Declination Page if customer chooses a lessor service level than our recommendation

• Cost to perform the approved scope of work• Address assumptions

• How will we address uncertain conditions (what we call our discovery work, we don’t know the true amount of damage until we remove structure to expose what we cannot see)

• Change order form will be used to document the adjustments to the initial scope of work

Do you think it is important to build a scope work?


Procedures Bio Removal

• Structures• What can be cleaned and disinfected• What must be removed • Any structure damaged (compromised) and recommend

for removal• Personal property

• Cleanable vs. disposal• Cloth, fabric, and paper

• Is a surface we cannot disinfect or remove the odor• Antiques or collectables

• How will it be cleaned• Cleaning agent regiment

Bio wash

• Structure• Where are we bio washing

• Which walls?• Floors?• Ceilings?

• What part of the structure • The entire wall• Entire floor• From the floor up 4’, 6’, etc.• Only the north wall• All the walls and floors but not the ceiling• The entire control zone

• We don’t have to bio wash the entire control zone if it isn’t needed

• Certain job types don’t require the entire 3-step bio wash


Why is it important to discuss personal property that cannot be cleaned/disinfected with the customer?


How do you build a scope of workBuilding a scope of work is easy. Just answer the questions

• Explain the situation?– What happened?– How did it happen?– Where did it happen?– Is there an odor?

• What structural items are affected by biological fluids/OPIM?

• What personal items are affected by biological fluids/OPIM?

• What structural items can be cleaned/disinfected and which ones will have to be removed?

• What personal items do we recommend for disposal of and which ones are we cleaning?

• What is the location of the control zone?

• Is there a secondary affected area?

• Where are you performing the bio wash?

• What is the location of the buffer and clean zone?

• What is the location of the POE and what we will you be doing?

• What structural items may potentially have to be removed?

• What will not be accomplished during the cleanup or produced?– Customer chooses different service level than recommended

• What will we accomplish?

• How long will it take? When do we expect to be finished?

• How much will it cost?


Things to Remember

• A full inspection of the room is always required• Don’t use the see red clean red plan. • As you perform your inspection by processing through the assessment you can at that time start to restrict the

control zone if that is what you find through your inspection of the scene• When conducting your visual assessment and inspection of the room/area look for ricochet. Meaning, where the

biological fluids/debris ricochets off the wall, floor, or ceiling and travels across the room/area. This is very common in high powered weapons like shot-guns, rifles, or high caliber hand-guns

• During the assessment and inspection think through what is the possibility that other areas may be affected with biological fluids but you cannot physically see them. • An important note when performing your assessment is to keep an open mind and try not to let yourself assume

things

• ***Safety*** Although we set the standards for the control zone at 4’ beyond where visible biological fluids end but, safe work environment is most important so extend beyond 4’ if it is necessary• Ex. A control zone entrance cannot be established at the top of stairs. This creates a fall/trip hazard so extending the

control zone to the bottom of the stairs is required

• Remember you must always establish a debris zone if you will be cutting out any flooring (except carpeting), removing walls, or ceiling


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Aftermath Process & Procedures

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