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HazMat for Healthcare 2013/2014

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by

Preston Brown

on 2 November 2016

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Transcript of HazMat for Healthcare 2013/2014

HazMat for Healthcare
Administrative Overview
Personal Protective Equipment (PPE)
NER & HERT
National Emergency Response
Hospital Emergency Response Team
HICS
Hospital Incident Command System
Emergency Treatment Area
Hospital Decontamination
Procedures
Triage
Health Effects
of CBRNE Events
Briefing
Restroom
Lunch
Exits/Evacuation
Questions?
Who we are
During a HazMat release first responder & receiver operations (FRO) protect people, environment, and/or property in a
defensive
action without trying to actually stop the release.
What we do.
&
First Receiver Operations (FRO)
Our Goal
Apply fundamental concepts required to establish a Hospital Emergency Response Team (HERT) that can respond operationally to a Mass Casualty Incident (MCI).
Protect This House!
Our Objectives
Why do we need a HERT?
How do we roll out HICS in an MCI?
What is the appropriate level of Personal Protective Equipment (PPE) when receiving contaminated patients?
What is the Emergency Treatment Area (ETA) and where is it located during an MCI?
How do you triage patients during an MCI involving contamination?
...and we'll compare decon methods & procedures.
Scope
Hurdles
to Clear
IMPORTANCE
RESPIRATORY
LIMITATIONS
DONNING & DOFFING
REGULATIONS
17%
of Medical personnel (ems & hospital)
are injured at hazmat emergencies.
#1 Exposure =
LEVELS
APR
PAPR
SCBA
Employee must pass fit test
Medical clearance
Known concentration of hazmat
HEPA
PREVENTION
Drink water
Gradually acclimate to working in PPE
Maintain good physical condition
Take rest breaks from working PPE
Recognize early symptoms
STRESSORS
Impaired communication
Impaired vision
Heat-related issues
Encapsulation
Dexterity issues
Time limitation
100% Humidity
Limited mobility
Elevated temperatures
Limited field of vision
No evaporative cooling
Communication challenges
Salt loss
Water loss
Sweat mechanism failure
PHYSICAL & PSYCHOLOGICAL
SAFETY ISSUES
WITH LEVEL C SUITS
INJURY CAUSES
Heat cramps
Heat exhaustion
Heat stroke
Heat Stress is the primary risk when wearing PPE.
HEAT-RELATED
INJURIES INCLUDE:
HEAT-RELATED
PRACTICAL HANDS-ON
Weaknesses
HSPD-5
National Emergency
Response System (NERS)
National Response
Framework (NRF)
National Incident
Management System (NIMS)
OSHA regulations require responders to know their local/employer (hazardous materials) emergency plan, including the responder's role, responsibilities, and scene management system.
ERG
SDS
chemtrec
infotrac
niosh
pocket guide
National
response
center
Jane's Bio-chemical
handbook
wiser
Physical data
Chemical name
Exposure limits
Health hazard data
Special precautions
is it feasible to evacuate this?
protect this house!
Incident Commander via Security Control Center
NOTIFIES HERT AND INITIATES CALL-OUT
HERT MEMBERS REPORT TO
MC PHYSICIAN'S LOT
SECURITY/PARKING SECURES HOSPITAL
& RESTRICTS ACCESS
EH&S MOBILIZES & DISTRIBUTES
HERT SUPPLIES
Mandatory Notifications
Local Dispatch/9-1-1
Administering Agency/CUPA
State Warning Center
National Response Center
ERG
PRACTICAL EXERCISE
I
dentification
A
ction
& Hazard Assessment
Plan
WHY
?
You Are Here!
IDHA
Who?
What?
When?
Where?
How?
Why?
Incident Action Plan (IAP)
Consists of 5 primary phases
Enables completion of incident objectives in specified time
Provides clear strategic direction
Lists tactical objectives, resources, reserves, & support
Coordinates sequence of events to achieve multiple incident objectives
Putting HICS into Operation
Triage
CUTOUT
Non-Ambulatory Decon
Medical
Treatment
Warm Zone
Contamination Reduction Zone
Cold Zone
Hot Zone
Ambulatory Decon
Technical Decon
Emergency Response Equipment
Mobilizing
EQUIPMENT
First Operational Thought
SAFETY TECHNIQUES
Practical Hands-On
Approach Safely
Conduct Assessment
Follow Standard
Safety Guides
(at a distance)
(Don't touch, taste, smell)
PRIORITIES:
S
afety
I
solation
N
otifications
D
econtamination
D
isposal
D
ocumentation
NAVY DRILL
Safety Briefing:
Hydration
Hazards
Buddy System
Hand Signals
Questions?
INITIAL 2-Day
Team Business
This is a 2-Day Initial Class
Annual 1-Day Refresher Class REQUIRED
Code ORANGE Drills
Team Website
Video Recording, Interviews
Slogan: "Protect This House"
CONGRATULATIONS!
Pre-Test
= Planning
Document
HERT's Primary Responsibility:
Protecting the hospital by decontaminating patients for entry into the facility for medical treatment.
Who designates
the level of PPE worn by the Decon Team?
A: The Incident Commander (IC)
Responsible for tactical execution of
incident goals and objectives.
Always activated in the event of a MCI.
Also, the person on-scene in charge until relieved by pre-determined or more qualified individual.
1
2
3
4
5
Understand
the Situation
CHEMICAL
BIOLOGICAL
RADIOLOGICAL
NEUROLOGICAL
EXPLOSIVE
Symptoms:
Symptoms:
Symptoms:
Symptoms:
Symptoms:
Itchiness
Burning sensation in the eyes
Nausea & vomiting
Coughing
Fever
Chills
Headache
Malaise
Examples:
Tularemia
Examples:
Examples:
Shortness of breath
Hearing difficulty
Soft tissue damage
Why discuss CBRNE Events?
Generally, they cause MCI's and often
require the setup of the ETA.
What conditions must be met for Level C to be used?
A: Known type & concentration of substance & APR criteria
is met.

OUTSIDE THE ETA
Temporary Morgue Section
Victims of MCI Arrive at the ETA...
prior to entering the patient reception area they must be assessed & filtered as...
they have not been decontaminated...
Potentially Contaminated
or
Uncontaminated
IED
Acid
Example:
Vomiting
Fatigue
Skin burn
Bleeding
Dirty bomb
Accident
Examples:
S
alivation
L
acrimation
U
rination
D
efecation
G
astrointestinal
E
mesis
M
iosis
Nerve agent
Types of Decon:
Directed Self Decon
Gross
Tech
Patient/Secondary
Ambulatory
Non-Ambulatory
Spot
JumpSTART
Pediatric patients have key physiological differences not recognized by adult-based triage tools.
Example 1:
A patient who is able to walk when directed is classified as:
Example 2:
An unconscious patient with no visible wounds, spontaneous respiration after opening the airway, and a capillary refill time of > 2 seconds is classified as:
Class
Hand Out
T-SHIRTS
PHOTOGRAPH
INSTRUCTION
Establish incident objectives & strategies
Develop the Plan
Prepare & Disseminate the Plan
Evaluate & Revise
the Plan
FEMA Center for Domestic Preparedness (CDP)
cdp.dhs.gov
Lunch
FEMA Post-Test
Passing Score: 70%
CSTI Post-Test
Passing Score: 70%
Student ID #
T-Shirts - Team Pride!
SID Sign-up
cdp.dhs.gov
Welcome!
1. Sign up for a SID.
2. Write your SID on
a sticky note.
3. Complete Indirect
Training Registration
Form & include SID.

Survey & Monitoring (S&M)
M8 Paper Procedures
Remove 1 sheet
Blot (DO NOT RUB) on liquid
Observe for color change
Compare results
Determine if clean or dirty
Flammable vapors/gases
Toxic materials
Radioactivity
O2 content
LEL % (combustible gases)
CO (carbon monoxide)
H2S (hydrogen sulfide)
Alkaline
Acidic
pH Paper
2-Way Radio
COMMUNICATION
Pancake Ludlum Detector
Monitors Detect:
4 Gas Monitor Alarms
Date: 9/24/14
The Technical Specialist is part of the victim decon team.
Employers must keep exposure
records for
30
years.
Highly toxic material by inhalation and skin absorption requires level A PPE.
We must know oxygen level before donning our PAPR's.
If you don't have PPE for protection, you may only employ defensive containment
First Receiver Awareness
(FRA) is trained only in recognizing
the presence of hazmat.


FRA can
take no action in clean up or
response. Only ID and notification.
OSHA regs require employers to have SDS available for all chemicals in the work place.
SHElter in place is the protective action employed during a hazmat incident.

In addition, initial actions are to deny entry to contaminated patients
Directed self decon first task is to isolate the contaminated patient
Poison Control is also a useful resource
for emergency department staff.
Many nerve agents fall into a class of organophosphates including the warfare agent Sarin.
Their properties mirror that of pesticides.
Specific gravity will tell you
weather a chemical will sink
of float in water.
Treshold limit value (TLV)
refers to long term exposure
to a chemical.
Full transcript