Download - ED preparation for mass contamination
ED preparation for mass contamination
Jaco Slabbert18 February 2009
• Introduction• Types of contamination• Preparation• Equipment• Decontamination• Security and Traffic control• Media• Cape Town perspective
Mass casualty events – ER challenges
• High impact, low-probability events• Delayed notification• Self presenting patients• Convergence of medical staff• Convergence of the media• Convergence of family, friends• Lack of supplies• Less than 20% of victims receive decon on scene• High index of suspicion
Types of contamination
• Chemical
• Biological
• Radiological
• Nuclear
Chemical contamination• Peloponnesian war 429 BC – Spartans and
Thebans created a hot fire, and added brimstone and pitch
• Henry III – finely pulverized lime used by English sailors
• 1899 Boer War – picric acid
• WW I – Mustard gas
Tokyo subway sarin attack
• 5510 people seeked medical attention• 640 chemically contaminated patients arrived
at a single hc facility, using private transport• 23% ED staff contaminated• In one instance 11 doctors were affected
treating 2 patients
Preparation
• Planning – ER layout, hospital’s capacity, outdoor decontamination area.
• Table top exercise• Full-scale, live exercise• Virtual live exercise (VLE)
VLE
• University of Alberta Hospital,Edmonton,Ca• 136 simulated patients created,using data
from actual pt. encounters• 15 physicians and 18 nurses• MD-delay / Workup-delay• Results:↓ pt flow, under-triage• Conclusions:inexpensive,discovery of new
approaches,triage accuracy
Equipment
• Protection of staff
• Decontamination of casualties
• Specialist medical supplies
Personal protective equipment
• Levels A – D• A:fully encapsulating chemical-resistant+SCBA• Protect head, face and eyes, the ears, the body,
the hands and feet.• Protect against unknown chemicals• B:splash protection,chemical-resistant,SCBA• C:full-faced,air-purifying respirator• Filter change times monitored• D:standard work uniform,gloves,mask
Decontamination equipment• Scissors• Clean, warm or tepid water• Buckets (10 litre capacity)• Decontaminent/liquid soap : 10 ml added to a 10
litre bucket• Sponges/ soft brushes/ wash cloths• Disposable towels,gowns,slippers. Blankets• Plastic bags and plastic bins• Nsaline and drip sets for eye and wound irrigation
Specialist medical supplies
• Medical equipment may become contaminated(wheelchairs, stretchers)
• Antidotes
Decontamination• ↓absorption and ↓ spread of contamination
• Remove clothing : 80-90% of contamination.
• Rinse affected areas
• Wipe with a sponge or soft brush
• Rinse for a second time
• 3-5 minutes
Limitations to decontamination
• PPE suits require filter change – takes time• Staff needs to be rotated: fatique,heat• PPE suits are cumbersome• Space in decon tents are limited• Decon units can clear 2 ambulatory pts every
10 minutes
Questions about decontamination that await further scientific evaluation
• Will victims remove their clothing?• How long will victims remain at the scene
awaiting decontamination?• What impact does modesty or inclement
weather have on clothing removal?• How long should victims be showered and
what water volume is required?• Can victims be effectively managed and
communicated to by staff in PPE?
Security and Traffic control
• “Lockdown”• Difficulty containing contaminated patients• Family• Media• Ambulances – “clean and dirty”circuits• Nonessential vehicles
Case Report
• Singapore – chlorine gas released from pump room at a local swimming pool
• 54 pts seeking treatment – 36 presented to Singapore General Hospital over 90 minutes
• Hospital Decontamination Station outside of ED
• ED Staff donned Level-C protective gear• Entrances to ED were secured
• Disaster plan activated• ED re-organized to triage, treat and evacuate
victims as well as manage existing patients• HAZMAT incident, not causing severe injuries• Well executed• Valuable lessons learned
Hospital decontamination and the Paediatric patient
• Psychosocial needs• Communication• Chaperones• Removal of clothing• Holding infants• Process of decontamination
Cape Town perspective
• Fire Service• 7 Medical Battallion – Simonstown• Dilution is the solution• Fire hoses at hospitals• TBH Pharmacy – 160 ampules Atropine in
Disaster cupboard in F1, 896 ampules in main pharmacy
Tygerberg Hospital
Groote Schuur Hospital
G.F.Jooste Hospital