Transcript Classic Template - Blue

Role of the Health Care
Facility in Emergencies
Mike Yarnell
Compliance Assistance Specialist
HCFMSNJ – Union, NJ
What is an Emergency?
• Unplanned event – accidental, natural or
deliberate
• Can cause death or significant injury
• Can also cause physical or environmental
damage
• Can affect anyone
• Can disrupt, shut down or destroy the normal
way of life
Typical and Atypical Emergencies
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Power outage
Communication failure
Winter storm
Flood
Hurricane / tornado
Mud slide
HAZMAT incident
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Fire or explosion
Earthquake
Civil disturbance
Pandemic flu
Bombing
Terrorist attack
Radiological incident
Terrorist Act
• Targets
– Economic assets, symbolic structures, high density
population / occupancies, critical infrastructure,
historic / cultural sites, transportation services,
emergency services, other high visibility targets
– Select certain dates, special events, shock value
• Goals
– Casualties / fatalities, destruction of critical
infrastructure, economic disruption
Terrorist Act
• Types
– Bombing, WMD attack, assassination, cyber
• WMD agents - BNICE
– Biological (bacteria, virus, toxin), nuclear
(weapon, suitcase, dirty bomb), incendiary,
chemical (lung, nerve, blister, blood, choking,
incapacitation, riot agents), explosive
The National Response Framework
• National Contingency Plan requires
communities to prepare local emergency
response plans
• NRF uses NIMS as a template
• Focuses on response and short-term recovery
• Uses the “All Hazards” approach
The National Response Framework
• Incorporates government, community, nongovernment and private sector assistance
• Integrates these resources for an incident
requiring a “Coordinated Federal Response”
• Outlines special circumstances in catastrophic
incidents where significant support is needed
• Requires compliance with the Incident
Command System
The Incident Command System
INCIDENT COMMANDER
OPERATIONS
SECTION
LOGISTICS
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PLANNING
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FINANCE/ADMINISTRATION
SECTION
Emergency Response Plans
• A health care facility may be designated by the LEPC
to serve as an active partner in preparedness and
response organizations
• Considered to be part of the infrastructure, as a
response resource to conduct decontamination and
treatment of affected individuals
• Must develop an ERP that addresses roles of
personnel, decontamination, PPE and training
• Facilities that have not been designated may still have
a role in response
What is Incident Management?
• Operational risk management which considers
– Preparing for
– Responding to
– Mitigating
and
– Recovering from
AN EMERGENCY
to minimize the loss!
Overview
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Basic Concepts
Work with the LEPC / OEM
Develop a plan
Role of health care personnel
Assumptions to anticipate exposures
Personal protective equipment
Training
Putting it all together
Basic Concepts
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Never accept an unnecessary risk
Risk a lot to save a lot
Risk little to save little
Risk nothing to save that which is already lost
Work With the LEPC / OEM
• The health care facility should establish
contact with the local emergency planning
committee / office of emergency management
• Describe facility capabilities and limitations
• Learn what assistance may be expected
• Meet and know the players
• Ensure transported victims are decontaminated
(if possible) prior to arrival
Work With the LEPC / OEM
• Key treatment center – within a large urban
area
• Potential risk center - <50 miles from a large
urban area or situated near a potential target
• Primarily mass casualty incidents
• Inventory of all toxic chemicals within the
community
• “All Hazards” approach makes decision logic
more flexible
Why Develop a Plan?
• Fulfills responsibility to protect employees, the
community and the environment
• Decision making tool, puts the response
mechanism in place
• Enhances the ability to recover
• Reduces liability, risk, injury and illness
Develop a Plan
• Complete a hazard vulnerability analysis
• Assign roles for communication, directing the
response and training
• Designate teams to address decontamination,
treatment and support
• Implement preparations – training, equipment
selection and maintenance, respirator program
• Determine methods of communication with
response organizations
Develop a Plan
• Determine routes of exposure, degree of contact and
specific tasks for each team member
• Consider how to obtain information on toxic
materials
• Manage supply of PPE
• Prevent cross-contamination through ventilation
systems and handling contaminated materials
• Develop an emergency evacuation plan
• Returning to normal following the emergency
• Pre-emergency drills and practice sessions with
LEPC using the ICS
Develop a Plan
• Anticipate number of victims
• Methods of handling ambulatory and nonambulatory victims
• Victim decontamination equipment,
procedures and designated areas
• Managing treatment of non-contaminated
patient
• Joint Commission requirements
Decontamination Considerations
• Precautions to prevent spread of contamination
• Minimize exposure to unprotected staff,
patients, visitors or equipment
• Outdoors preferable with easily
decontaminated or disposable equipment
• Indoors with ventilation isolation
Role of Health Care Personnel
• Viewed as “First Receivers”, not HAZMAT
“First Responders”
• Nearly always remote from the site of the
emergency or point of release
• Primary exposure is from victim’s skin, hair
and personal effects
• In rare instances, personnel may be called to
respond at the scene (must be capable)
Roles of First Receivers
• Decontamination staff
• Clinicians who may triage and / or stabilize
victims prior to decontamination
• Security staff that will control entry
• Setup crew
• Victim tracking clerks
• Other support personnel
Assumptions / Exposures
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Little or no warning, contaminant unknown
Up to 80% self-referred, not decontaminated
Some stretcher-bound (symptomatic)
Clinical issues may include triage, CPR, IV
insertion or life support
• PPE depends on decontamination prior to entry
and duty of personnel
Assumptions / Exposures
• Security or sign on entrance to prevent facility
entry prior to decontamination
• Risk is low, even without PPE
• Primary determinants
– Clothing removal, field decontamination, time
lapse since exposure, extent of exposure, type of
agent, evaporation / dissipation of agent
• Secondary determinants
– Clothing handling and disposal, wash
water disposal
Personal Protective Equipment
• Sufficient for the type and level of exposure
anticipated; goal is to prevent inhalation and
contact with the skin an mucous membranes
• Must consider splashes or patient contact
• There are no clear or absolute answers
– Latitude in judgment
– Independent decision-making
– Decontamination zone vs. treatment zone
PPE at the Site
• Level B protection
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Supplied air respirator including face protection
Full coverage chemical-resistant suit
Chemical resistant gloves
Chemical resistant boots
Taped at seams
Training at the Site
• First responder operations level – 29 CFR
1910.120 (q)(6)(ii) (8 hours)
– Selection and use of PPE, decontamination
procedures, hazard recognition, controlling spread
of contamination, adequacy of equipment
• Respirator training which includes fitting and
medical evaluation
• ICS level 200 as a minimum
PPE for First Receivers
• Level C protection for chemicals
– Respirator of choice is a PAPR - helmet and hood
with an APF of 1,000
– Filter includes HEPA and AG/OV cartridge
– Chemical-resistant coveralls (Tychem F, Kappler
9400), head cover (if not part of the suit), boots
and double layer of gloves (openings taped)
– Outer glove should be chemical-resistant e.g. butyl
over nitrile, or two layers of nitrile for
dexterity
PPE for First Receivers
• Level C protection for biological agents
– N-95 or equivalent respirator – NOTE: a surgical
mask is not a respirator
– Tyvek or other coveralls, surgical gloves, shoe
covers
Training for First Receivers
• First responder operations level – 29 CFR
1910.120 (q)(6)(ii) (8 hours)
– Selection and use of PPE, decontamination
procedures, hazard recognition, controlling spread
of contamination, adequacy of equipment
• Respirator training which includes fitting and
medical evaluation
• ICS level 100 as a minimum
PPE for Triage / Treatment
• Personnel not expected to have contact with a
contaminated victim or their personal effects
and those who may encounter self-referred
victims without prior notification
– Standard healthcare gear including a lab coat and
surgical gloves (infection control)
– May need a respirator for a patient in respiratory
distress or for high hazard procedures
Training for Triage / Treatment
• First responder awareness level suggested
– Risks of hazardous materials, recognition of
presence (hazard communication), knowledge of
roles, notification to others, knowledge of the
response plan
– Important that these personnel avoid physical
contact with a contaminated victim, are aware of
notification procedures and that properly-equipped
personnel decontaminate the victim before
proceeding
Putting it All Together
• Learn number of victims, type or nature of
contaminant, associated symptoms
• Activate decontamination system
• Initial medical monitoring of staff
• Staff dresses out with PPE
• Triage and stabilize victims
• Disrobe victim and remove personal effects
Putting it All Together
• Place clothing and effects in isolated area
• Wash victims with mild liquid soap and tepid
water – step must include copious rinsing
• Dry and gown victim – treatment follows
• Decontaminate equipment
• Staff decontaminates themselves (showering)
• Post response medical monitoring of staff
Important Considerations
• Always consider periodic vital sign monitoring
during extended events
• Limit response time and provide rest breaks
• Consider post response traumatic stress
Disclaimer
• This information has been developed by an OSHA Compliance Assistance
Specialist and is intended to assist employers, workers, and others as they
strive to improve workplace health and safety. While we attempt to
thoroughly address specific topics, it is not possible to include discussion of
everything necessary to ensure a healthy and safe working environment in a
presentation of this nature. Thus, this information must be understood as a
tool for addressing workplace hazards, rather than an exhaustive statement
of an employer’s legal obligations, which are defined by statute,
regulations, and standards. Likewise, to the extent that this information
references practices or procedures that may enhance health or safety, but
which are not required by a statute, regulation, or standard, it cannot, and
does not, create additional legal obligations. Finally, over time, OSHA may
modify rules and interpretations in light of new technology, information, or
circumstances; to keep apprised of such developments, or to review
information on a wide range of occupational safety and health topics, you
can visit OSHA’s website at www.osha.gov.