Hospital Emergency Response Training

Making a Case for Hospital Decontamination

-A Community Issue-

Hospital Emergency Response Training

Presented by:

Jan Glarum

Discuss cases of hospital employee exposure to hazardous materials

Discuss common factors of exposures

◦ New Trends◦ Probability

Discuss mitigation strategies

Objectives

What to Prepare For? Playing The Odds

About 9000 releases of hazardous substances occur annually, with 75% occurring at chemical facilities and 25% occurring during transportation.

What to Prepare For? Playing The Odds

In 15 Study States:◦Fact: Most incidents occur at fixed

sites- Application: Your hospital HVA should drive preparedness.

◦Fact: One quarter of the exposures occur during transit –

◦Application: Trauma centers need to have a plan to care for trauma patients who are contaminated

What to Prepare For? Playing The Odds

> 2000 victims of hazardous materials releases each year.

Approximately 50% of these are transported to hospitals.

> 7500 people required decontamination during HAZMAT events. ◦ Of these, 2643 were

decontaminated at medical facilities.

(data from 15 study states)

New Trend The Southampton Hospital Emergency Department entrance was shut down after a man attempted to commit suicide by mixing chemicals in his car, which was parked at the ER entrance.

Data indicates there were 75 chemical suicides during 1999-2010 with increasing numbers each year.

The toxic gases most commonly formed by combining the chemicals in household cleaners are hydrogen sulfide and hydrogen cyanide.

New Trend - Chemical Suicide

New Trend - Chemical Suicide Hydrogen sulfide , odor is often described as that of rotten eggs, but even a short exposure can cause olfactory fatigue. At low doses, exposure to hydrogen sulfide can cause eye and respiratory irritation, headache, dizziness, loss of appetite, and upset stomach. Brief exposures to high concentrations can cause loss of consciousness and death.

Hydrogen cyanide is a bluish-white liquid or a colorless gas with a faint odor of bitter almonds and a bitter, burning taste. Hydrogen cyanide can cause changes in respiration depth, confusion, and asphyxia.

New Trend - Chemical Suicide

Best option is to train ED staff to: Suspect Recognize Decon and Treat

Be prepared for chemical suicide events.

Case Study

Courtesy FEMA

Suicide attempt by ingestion of 14 Oz of Malathion (organophosphate) and ETOH.

Symptoms - HR, respiratory depression, vomiting, diarrhea and diaphoresis.

ED Treatment included airway control (ET) and Atropine.

Background – Specific Case

Courtesy FEMA

Good news – patient transported to ED with bottle of ingested poison.

Not So Good News – ◦No decontamination in spite of emesis

◦EMS not wearing appropriate PPE for hazard

◦EMS did not notify ED staff of the product ingested

EMS Actions

Courtesy FEMA

Strong chemical odor from patient – hospital staff exhibited signs/symptoms of poisoning

HAZMAT, Poison Control and County Health Contacted

ED evacuated and shut down

Consequences

Courtesy FEMA

Staff Impacted- Met Case Definition For Pesticide Poisoning

Courtesy FEMA

Employee 1 Employee 2 Employee 3 Employee 4 Employee 5Nausea, Eye Irritation, Dyspnea, Blurred Vision, Headache, Confusion, Restlessness, Agitation, Weakness, Asphyxia, Syncope and Slurred Speech

Nausea, Vomiting, Dizziness, Headache, Dry Throat

Nausea, Eye Irritation, Dizziness, Sore Throat, Dry Throat, Skin Irritation

Nausea, Eye Irritation, Headache, Dry Throat, Skin Irritation

Eye Irritation, lightheadedness, Skin Irritation

Nurse Housekeeper Respiratory Therapist

Respiratory Therapist

Respiratory Technician

Symptom Onset 15-30 minutes

Symptom Onset within 2 hours

Symptom Onset Immediate

Symptom Onset within 1/2-2 hours

Symptom Onset Unknown

Gloves Double Gloves, Mask, Hair Covering, Shoe Covering

Mask and Gloves Gloves, later a half mask respirator

Unknown

Hazmat Training Hazmat Training Hazmat Training Hazmat Training Unknown

Field notification of chemical poisoning and potential for secondary contamination and share with staff

Take Aways

Courtesy FEMA

Verification of decontamination of patient

Take Aways

Courtesy FEMA

Patient decontamination and treatment in well-ventilated area

Take Aways

Courtesy FEMA

Employees have access to immediate washing after direct exposure to body secretions or vomitus

Take Aways

Courtesy FEMA

Ensure training and exercises are adequate and appropriate PPE, supplies and antidotes are available as needed.

Take Aways

Courtesy FEMA

Initial priorities as taught in ICS are:◦ 1. Life safety◦ 2. Incident Stabilization

Take Aways

Courtesy FEMA