Transcript Hospital Considerations Part 1

Special Hospital Considerations
Part I
Protection, Detection,
and Decontamination
DPT 8.0
Special Hospital Considerations in
NBC Mass Casualty Incidents
DPT 8.0
Special Considerations
Terminal Objectives
• Describe the unique principles of triage,
agent detection and decontamination in an
NBC mass casualty incident (MCI)
• List factors to be considered in planning
emergency response to a terrorist attack
involving weapons of mass destruction
DPT 8.0
Medical Disaster
• A medical disaster occurs when the destructive effects
of natural or manmade forces overwhelm a
community’s ability to properly allocate existing
resources
• Terrorism’s impact on the medical infrastructure
– World Trade Center Bombing - 6 dead; 1000 injured
– Oklahoma City Bombing - 168 dead; 759 injured
– Tokyo Subway Attack - 12 dead; 5500 injured
– World Trade Center and Pentagon/Sept 11 - 3000 dead;
hundreds injured
DPT 8.0
MCI - Disaster Planning Lessons Learned
• Hospitals provide most of the initial care
• High risk of secondary contamination
• Personal protective equipment is required
• Disaster planning must address NBC
• Maximize use of existing resources
DPT 8.0
Special Considerations - Overview
• Preparedness for an
MCI
• Training
• Command, control,
communication
• PPE
• Decontamination
• Detection
• Triage
• Staff preparedness
• Logistics / supplies
• Hospital space utilization
• Evidence preservation
• Exercising “ the plan”
DPT 8.0
NBC “Delta” Planning Considerations
• Planning similar to other disasters
• Unique characteristics of an NBC terrorist attack
must be considered
• Pro-active and integrated planning, coordination, and
training is essential
• Must be familiar with local incident management
system
• “All hazards approach” to disaster planning
DPT 8.0
Current Preparedness
• Must improve state of readiness
• Training and equipment lacking
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Agent recognition
Patient management
Patient decontamination
Patient transport
• Supplies and equipment
– Antidote
– PPE
– Decontamination
DPT 8.0
NBC “Delta” Planning
Readiness Phase
• Take a genuine inventory of
current capabilities and rectify
any deficiencies
• Instruct personnel about the
disaster plan using realistic
scenarios
• Ensure plan addresses triage,
decontamination, and treatment
DPT 8.0
NBC “Delta” Planning
Planning Phase
• Develop strategies to overcome resistance to
preparedness
– Incorporate responsible people in the planning process
– Keep the plan cost effective
– Plan for problems that may occur
• Communication and sharing of information
• Security, traffic control, hospital access
• Staff identification, triage, decontamination,
information management
DPT 8.0
NBC “Delta” Planning
Planning Phase
• Participate in joint planning
– Work together with EMS, law
enforcement, fire, LEPC
– Integrate plan into communitywide disaster plan
• Develop mutual aid
agreements
• Develop policies and
procedures
DPT 8.0
NBC “Delta” Planning
Planning Phase
• Acquire necessary
equipment
– Purchase PPE and
decontamination
equipment and provide
training
• Stockpile antidotes &
other medications
• Make sure facility
remains open and viable
DPT 8.0
NBC “Delta” Planning
Recovery Phase
• Focus shifts from acute injury and illness to the
everyday needs of the population
• May have increased need for medications, shelter,
food, water, clothing, and emotional support
• Hospital staff emotional needs and fatigue
DPT 8.0
Training
• Hospitals must first prepare to treat the everyday HAZMAT
contaminated patient
• Once established, HAZMAT training should be supplemented
to include NBC
• Training must be facility-wide and tailored to the needs of the
hospital staff
• Train using realistic scenarios
• Equipment training available from commercial sources
• Public education should also be considered
DPT 8.0
Command, Control & Communications
• Community orchestrated and
coordinated response based on
the incident command model
– At the incident scene
– At the healthcare facility
DPT 8.0
Command, Control & Communications
• Accurate, timely notifications
– Disaster scene to hospital
– Hospital to disaster scene
• Communications
– Community to disaster scene
– Disaster scene to hospital
– Hospital to disaster scene
– Within the hospital
DPT 8.0
Command, Control & Communications
• Media Coordination
– Accurate communications
• At the disaster scene
• At the hospital
– Provide the media
• Dedicated space
• Timely and accurate updates
• Public relations
DPT 8.0
Personal Protective Equipment (PPE)
• Equipment and training
mandated
– OSHA (29 CFR 1910.120
and 1910.134)
– NIOSH
– EPA
– JCAHO
• Equipment and training mandated for all personnel who
have substantial risk of exposure to hazardous materials
DPT 8.0
Levels of PPE
• Level A - IDLH
environments, fully
encapsulated, requires
SCBA
• Level B - Chemicals or
substances with inhalation
hazard, requires SCBA or
SAR
• Level C - Known
contaminants, requires airpurifying respirator
DPT 8.0
PPE
• PPE for decontamination
personnel
• PPE for healthcare
providers
• Limitations of PPE
• Staff rotation
DPT 8.0
PPE - Biological Self-Protection
• Treat every patient with respiratory complaints and
open wounds as an “infectious source”
• Normal standard universal precautions for most BW
agents
• HEPA filter mask upgrade for pneumonic
plague / smallpox / VHF
• Special protective garments usually not necessary
• Precaution upgrades in areas of the hospital where
aerosols could be generated: lab centrifuges,
autopsy facilities, etc.
DPT 8.0
PPE - Radiological Self-Protection
• Respiratory - Particulate mask (level C minimum)
• Shielding
• Dosimeter
DPT 8.0
Decontamination
• Decontamination removes harmful substances
• Hospital preparedness for decontamination
• Decon of casualties
arriving at the
healthcare facility
• Vapor exposure
– Liquid exposure
– Mass casualty incident
DPT 8.0
Decontamination
• Vapor verses liquid exposure
• Mass casualty incidents
– Ambulatory vs. non-ambulatory
– Decon methods
– Water vs. bleach
– Location of decon area
DPT 8.0
Decontamination
• Decon of casualties arriving at the hospital
– Already decontaminated
– Not decontaminated
• Decon of healthcare providers
– Decon Team Members
– Treating personnel
DPT 8.0
NBC Agent Detection
• Recognition
– Signs and symptoms
– Detectors/monitors
• Purposes of detection
equipment
– Hazard assessment
– Levels of PPE
– Need for decontamination
• Detector limitation
– Sensitivity
– Environmental conditions
DPT 8.0
Biological Agent Detection
• Many biological agents can be
identified by standard hospital
laboratory techniques
• Standard laboratory procedures
may require 12 to 48 hours to
yield results
• Treatment should be based on
index of suspicion; should not
await test results
DPT 8.0
Radiation Detection
• Instrumentation
– G.M. Survey Meter
– Dose Rate Meter - Ionization
– Alpha Meter
– Neutron Meter
Chamber
• Personal Dosimeters
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Film Badge
Thermoluminescent Dosimeter
Quartz Fiber Dosimeter
Electronic Instantaneous Read Out Dosimeter
DPT 8.0