Transcript Haz Mat for Healthcare: An Operations Level Course Foundation

HazMat for WV Hospitals:
An Operations Level Course
Module II
2.10
This course was developed by EnMagine,
who we wish to gratefully acknowledge.
The material has been modified by WV
DHHR in cooperation with the West
Virginia Hospital Association’s Disaster
Preparedness Task Force in the teaching
of Hospital Decon.
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Objectives
• Describe the purpose and need to implement the
Hospital Emergency Incident Command System.
• Apply basic hazard and risk assessment techniques
to hazardous materials incidents for action planning.
• Demonstrate the use of the Department of
Transportation Emergency Response Guidebook.
• Describe the aspects of control, containment, and
confinement within your resources.
• Describe protective actions and rescue options
available to first responders, within their capabilities
and resources.
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Operations Level Objectives
C
I
A
• Command
• Identification
• Action Plans
P
C
P
• Protective Equipment
• Containment / Control
• Protective Actions
D
D
D
• Decon
• Disposal
• Documentation
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Command (C)
Scene Management System
• Purpose of Scene Management (Decon
area)
– Provide workable system
– Efficiently/effectively use resources
– Minimize impacts of incident
• Hospital Emergency Incident Command
System is required under JCAHO.
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Scene Management System
(Decon Area)
Goal: Protect
– Life
– Environment
– Property
Need one system for all responders
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What is HEICS?
• Hospital Emergency
Incident Command System
• Organized system
– Of roles, responsibilities &
procedures
• To manage & direct
– All emergency operations
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Benefits of HEICS
• More efficient use of resources
• More effective management
• Safer response
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Who’s In Charge?
• HazMat requires establishing Command
early, but…
• Common HazMat deficiency is poor
management (i.e. Command)!
– Early assumption of Command reduces
chaos and aids in management
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HEICS Organization
• Command/IC (overall management)
– Operations (manages tactical operations)
– Planning/Intel (does incident action
planning)
– Logistics (procures incident resource
needs)
– Finance/Admin (manages financial aspects)
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HazMat Group
Incident
Commander
Public Information Officer
Safety & Security Officer
Liaison Officer
Logistics Chief
Planning Chief
Finance Chief
Medical Care
Director
Operations Chief
Ancillary Services
Director
Human Services
Director
Hazardous Materials Group
Entry
Site Access Control
Safe Refuge Area
Decontamination
Technical Specialists
Assistant Safety Officer
(Derives authority from Safety Officer)
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HEICS HazMat Organization
• Hazardous Materials Group
Positions
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–
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Decon Group Supervisor
Technical Reference
Site Access Control
Decon Leader
Entry Leader
Assistant Safety Officer*
• *Reports to Safety Officer
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Job Action Sheets
• Guidance for each position with:
– Basic information
– Mission
– Tasks (immediate, intermediate, long-term)
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How bad is this?
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•
•
•
What do I know?
What don’t I know?
Quantity and Concentration
Characteristics of Hazardous materials
– Toxicity
– Reactivity
– Ignitable/ Flammable
– Corrosive
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How bad is this?
• Population at risk to
exposure--the ED
• Environment at risk—
the entire hospital
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Information Resources
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•
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Container Labels
MSDS
Poison Control
Emergency Response Guide (ERG)
Computer programs
People
ChemTrek
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Info Sources
• NFPA 704 System
– Blue = Health
– Red = Flammability
– Yellow = Reactivity
– No color = special hazards
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Info Sources
DOT Emergency Response
Guidebook (ERG)
• ERG purpose:
– Basic safety tool
– Basic identification
– Initial actions
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Info Sources
ERG Organization
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White —
Yellow —
Blue
—
Orange —
Green —
Basic info & instructions
UN #, guide # & material name
Material name, guide # & UN #
Chemical information
Isolation & Protective Actions
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Info Sources
ERG—Good But Limited
• Classification of hazard
• Guides — “most essential guidance”
• Isolation/evacuation distances —
guides
• Use table of placards only if no ID
• Intended use
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Info Sources
• People
– Patient
– Witnesses
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Acronyms and Terms
• TWA - Time Weighted Average
– Average concentration that a worker can be
exposed to during a 40 hour week/8 hour day
without adverse effects.
• STEL - Short Term Exposure Limit
– Fifteen minute time-weighted average exposure
• Ceiling
– Instantaneous levels which should not be
exceeded
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Acronyms and Terms
• IDLH -Immediately Dangerous to Life &
Health
– Maximum level from which a worker could escape
without any escape impairing symptom or
irreversible health effect
• PEL - Permissible Exposure Limit
– OSHA standards - therefore are legal limits
– Based on TLV’s and many are identical
– Include 8 hour PEL, 15 minute STEL, and Ceiling
Limit
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Acronyms and Terms
• LD/LC 50
– Lethal Dose 50%
– Lethal Concentration 50%
• PPM/MgM3
– Parts Per Million
• measured as volume of contaminant to volume
of liquid or air collected in sample
– Milligrams Per Cubic Meter
• measured as weight of contaminant to volume
of air collected in sample
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Respiratory
Arrest
Coma
Nausea
Mental Impairment
Euphoria
Concentration
Understanding Toxicity 101
Time of Exposure
Courtesy of Mike Callan <www.mikecallan.com>
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Toxicity Relationships
VX
Dangerous
Dangerous
Dangerous
Dangerous
Dangerous
Dangerous
Dangerous
CO Ammonia H2S Chlorine Acrolein
Methanol
Dangerous
Unsafe
25000
Unsafe
Safe
1200
Unsafe
200
Methanol
Carbon
Monoxide
Safe
Safe
Safe
35
Unsafe
Unsafe
300
25
Ammonia
100
10
Safe
Un.
Safe
H2S
HCL
10
Un.
0.5
S.
Chlorine
5
0.0001
0.00001
0.1
Acrolein
VX
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Acronyms and Terms
• UEL and LEL
– Upper Explosive/Lower Explosive
Limit
• FR and FL
– Flammable Range/Flammable Limit
• FP
– Flash Point
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Routes of Entry into the Body
• Inhalation: Breathing it in!
• Ingestion: Swallowing it by
mouth!
• Absorption: Through the
skin!
• Injection: Puncture!
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Routes of Entry and Preventing
Exposure
• Inhalation: Most common route of entry
– Isolate and deny entry
– Wear air supplied respirator (SCBA or airline
respirator) if unsure of what it is or how much
is there
– Just stay away!
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Preventing Exposure
• Isolate and deny entry
• Don’t eat, drink, smoke around
contaminated areas
• Wear proper PPE
• Engineering controls
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Remember!
• Many hazmats are odorless, colorless
and tasteless!
• You may be exposed before you know it!
• Wear PPE
• Approach safely - UUU
Above/ Upgrade
Up Hill
Different Ventilation Up Wind
Out of flow
Up Stream
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Acute vs. Chronic
• Exposure
– Acute: short-term,limited,one time
– Chronic: long-term, repeated, continuous
• Effects
– Acute: may not show immediately
– Chronic: not detectable for years. May differ
from acute effects
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Action Planning
• Components of action plans
– ID the problem
– ID resources available
– Use available resources to solve problem
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Action Planning
Capabilities & Resources
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Personnel
Equipment
Policies/Procedures
Facilities
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Site Safety Plan
• Required and necessary for a safe and
effective response
– Decon area
– Route of entry
– Adequate vehicle access
• Much of the information should be preplanned
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Containment and Control (C)
Hazmat Counter measures
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Eventual Outcome
• All HazMat Incidents Eventually Stabilize
– Actions by responders should contribute to the
solution, not the problem!
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When Not to Intervene
• Action would be unsafe
• Lack of response resources
• Lack of proper PPE
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Why Non-Intervention?
• Responders are there to
save, not risk lives!
• Any level of responder
can follow this strategy
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Decon
• Dilute it!
• Remove it!
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Can we
handle this
Incident?
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Our Roles
• What can I do as a:
– First Responder Awareness: Understand
hazardous materials
– First Responder Operations:
Conduct decon
– Technician Level: Contain releases, clean up
the hazmat spill
• What can my hospital do:
– Hospital’s role
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Standard Operating Procedures
• Policies and Procedures
• Safety Manual
• Disaster (Emergency Preparedness) Plan
– Example: Management of the Contaminated
Patient
• What happens if you need to deviate from
the plan?
– Be flexible
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Watch Closely
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Module II Ops Summary
• Understand HEICS
• Understand available resources
– ERG
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Terminology: LD50, PPM, FP
Routes of exposure and Preventing Entry
When to intervene
Various roles
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Questions?
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