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Could your hospital safely treat a single victim of a chemical poisoning without endangering emergency department (ED) staff? Could you handle 50 or more victims? If hospitals can cope with hazardous material spills or poisonings, they are on track to develop readiness for chemical or biological terrorist events, preparedness experts say.
That capability must be available 24 hours a day, seven days a week, and must be backed up by updated policies and periodic training, says Henry Siegelson, MD, FACEP, an emergency physician based in Atlanta and an expert on hospital disaster preparedness. "Unless there are policies and procedures in place for the management of a victim exposed to a chemical, then the health care worker can very rapidly become a victim," Siegelson says, who has provided consulting worldwide through Disaster Planning International, based in Indianapolis.
"It’s much more than just training. It’s more than equipment," he says. "It’s also policies and procedures and exercises. I believe that every single hospital that has an emergency department must be able to, without exception, manage at least one or two victims of a hazardous material exposure on a 24-hour basis, anytime day or night. You cannot depend on the fire department. You cannot depend on any other agency to help. This must be an internal capability. This is a community responsibility for the hospital."
Starting with a solid hazardous materials disaster plan is a cost-effective strategy for hospitals, says Susan McLaughlin, MBA, CHSP, MT(ASCP) SC, president of SBM Consulting Ltd., in Barring-ton, IL, and an expert on hospital preparedness. "The one thing that’s important is sustainable planning. If you plan to manage a small hazardous materials incident, like an industrial accident, an agricultural accident, even a hazmat accident in the hospital, when you have a big incident, you will be able to gear up from there," she points out.
That advice may seem basic, but many hospitals lack the training or clear policies to protect health care workers. In one case, three health care workers at a Georgia hospital suffered symptoms that required inpatient treatment after they cared for a patient who had ingested a veterinary insecticide concentrate in a suicide attempt. One staff member required intubation and ventilator support for 24 hours and was hospitalized for nine days. The staff had not followed decontamination procedures before treating the patient and had not used personal protective equipment.
Surveillance in six states showed that from 1987 to 1998 at least 46 health care workers suffered secondary contamination after providing care to pesticide-contaminated patients, according to the National Institute for Occupational Safety and Health.
"It sounds logical that hospitals already would have this capability, but many do not," says Siegelson. "This involves policies, procedures, personal protective equipment, and decontamination equipment that allow the health care worker to deliver care." He recommends taking these steps toward preparedness:
1. chemical preparedness, including proper decontamination and protective equipment and awareness and operations-level training;
2. incident command systems, which enable the hospital to organize resources to respond during disasters;
3. syndromic surveillance, which allows the hospital to recognize patterns of patient complaints that might suggest a biologic attack;
4. reporting to the health department of data collected from syndromic surveillance;
5. exercises and drills in the community;
6. responding to an actual event.
Preparedness doesn’t have to be a budget-buster, Siegelson says. For example, an outdoor decontamination unit costs far less than an internal one that requires new construction or remodeling. If the hospital is flooded with the "worried well" who have minimal, if any, exposure, the hospital can use simple decontamination kits that allow people to remove their clothing even in a public place. The kit, manufactured by Haz/Mat DQE in Indianapolis, leaves the patient draped in a poncho-like garment.