You can transform your HazMat policy
You can transform your HazMat policy
Here are things to consider when transforming your hazardous materials (HazMat) policy into a protocol for weapons of mass destruction, particularly nuclear and chemical agents, according to experts interviewed by ED Management:
o Be ready to decontaminate large numbers of people.
Have a plan for decontaminating hundreds or perhaps thousands of people. For many hospitals, state-of-the-art decontamination means showers adjacent to the ED, says Robert Suter, DO, MHA, FACEP, regional medical director for the North Texas region at Questcare Emergency Services in Plano. "But when it comes to preparation for a terrorist attack, that’s completely inadequate," he maintains. "It’s the same principle but a difference of scale." (See sample protocol, enclosed in this issue.)
Be prepared to take your decontamination efforts into the parking lot, Suter advises. "Everybody has space limitations, but you need a large area almost the size of a football field where you can do outdoor decontamination."
o Use reference tables.
Reference tables can serve as a guide for ED managers preparing for weapons of mass destruction. Such tables list antidotes and decontamination supplies to have on hand. "So when you are planning out the logistics of your policy, it can serve as a shopping list to refer to," Suter explains.
Tables also can serve as a quick reference for staff. There is no substitute for formal education, and all ED clinicians should be familiar with the forms of chemical or biological agent exposure, Suter says. "Staff first need to know what to look for. But once you think you might have a chemical incident, you can go to that table to figure out which one it is and how it’s treated." (See table, p. 125.)
o Direct minimally injured people to a holding area.
A special category is needed for people who are minimally injured. "You need to instruct them to go to a holding area and wait for treatment so your staff can concentrate on the other people," says Suter. "Often, people who are not seriously exposed go rushing to the hospital and overwhelm the EDs." (See story on first and second waves of patients, p. 126.)
The biggest concern is security, he says. "These people may be very upset and agitated and demand somebody take care of them," Suter says. "This could distract you from people who really have physical effects from the attack."
There can be up to 10 people with psychological casualties for every one with serious effects, he says. "But it’s still very difficult to deal with those people. You don’t want 200 people threatening the staff, so you have to triage them into a holding pattern of the worried well.’"
Do check them to see if they are developing symptoms, he advises, but also have security there to keep them from becoming out of control.
o Don’t factor in assistance from others.
Many ED managers expect that all of the triage and decontamination of chemical patients is going to be done by emergency medical services (EMS) or another group before patients get to the hospital, says Suter. That’s an incorrect assumption, he stresses. "The reality is that almost 80% of patients in these incidents go straight to the ED without seeing any EMS or fire department personnel whatsoever. Your disaster plan cannot be call 911,’ because they will be busy and not able to come to help you."
o Don’t assume you can direct patients.
No matter how well you plan, you won’t be able to direct patients to the hospitals in your community. "Most of the time, patients will just show up," Suter says. "If you’re the closest place, you’ll get an overwhelming load and won’t be able to disperse them throughout the community."
When the World Trade Center bombing occurred in 1993, all patients came straight to the nearest hospital. That day, Suter happened to be at Bellevue Hospital, a 1,000-bed comprehensive facility. "We were only 40 blocks away, but not a single patient came to us in the first hour or so," he recalls. "Instead, all the people walked to a relatively small community hospital across the street."
o Protect staff from exposure.
For most agents, only simple respiratory precautions are necessary, notes Richards. "The space suits are great for TV but, for the most part, unnecessary," he says. "However, staff safety is a real problem, so stockpiling gowns and masks should be considered."
You might be surprised to find that a very limited number of supplies are actually on hand, Richards notes. "Even hospitals have adapted to the "just-in-time" business model for inventory. Gowns and masks used for standard precautions would likely run out in a matter of days but could likely be stockpiled since they do not expire."
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