EDs receive unexpected 'visitors': chemically contaminated patients
EDs quarantined for 24 hours following incident
It's enough of a challenge when an ED is alerted by its local EMS that victims of chemical contamination are on their way by ambulance. But when these patients arrive by car — unannounced — that brings your response to an entirely different level.
That's exactly what happened on Aug. 31 in several EDs in St. Louis, MO. Several people were sickened by exposure to a dangerous chemical that was spilled at a storage and mixing plant in East St. Louis, IL. They drove themselves to four St. Louis area EDs.
"We got three patients, and I believe we were the first to receive any of them," says Patty Wors, RN, BSN, director of the ED at St. Anthony's Medical Center. "They went to the triage desk, which is right where you walk in the door."
The sickest of them literally was blue, and all of them were covered with a white, powdery chemical, she said. "We did not know what had happened at the time, so we put the sickest one in the first room off triage, and the other two right next door," says Wors.
Alan Martin, MD, the most senior ED physician present at SSM DePaul Health Center that night, says, "We had three individuals who were exposed to the chemical, which we later learned was nitro aniline, and who arrived in a private vehicle as opposed to an ambulance." The driver of the car came in and said he had sick people with him. "The staff went out, realized they were covered in a chemical and started decontamination right off the bat," says Martin.
The ED at Barnes-Jewish Hospital was a little more fortunate, says Keith Outlaw, RN, assistant clinical manager for the ED. They were given advance warning from the local EMS, Outlaw says. "Our patient had come from home after showering a couple of times," he says.
Outlaw says his department already knew about the incident, because a message had come across their computers as part of a citywide incident alert system. "We were aware two other hospitals in the area had gotten patients, but we were not really expecting any," he says. "But then we got a call saying a patient was on the way with a 10-15 minute ETA."
Because of the different nature of the arrivals, the EDs had varied responses. At Barnes Jewish, for example, "We already knew what the chemical was, so we started pulling MSDS sheets [Material Safety Data Sheets] to learn the chemical base and proposed treatment, and we also started setting up for decontamination to make sure he was clean," says Outlaw.
The staff at St. Anthony's didn't learn the whole story until one of the patients identified the chemical. "As soon as we got the story, which was within 15 minutes, we had them in the 'decon' room, had them strip, and washed them down," says Wors.
At SSM DePaul, says Martin, "The staff recognized immediately the potential exposure risk for the department and proceeded to initiate decontamination procedures." The decontamination area is attached to the ED but has a separate entrance from the outside. He says. "The staff kept all three of them in the car until they got the decon room prepared," notes Martin.
St. Anthony's and SSM DePaul were ordered to be quarantined by the local hazardous materials (hazmat) organization.
"While we waited for official word as to whether the entire ED had to be decontaminated, as a precaution, everybody who had been admitted was washed down," Wors says. "Everyone who had been discharged was told to go home, take a shower, and wipe down all non-clothing items."
The hospital already had formed an incident command center once it was known there was a chemical exposure. All three exposed patients were admitted. The ED gave them the recommended antidote, Methylene blue intravenously, in the ED, and then discharged them, says Wors. The incident had started at about 3:30 that afternoon. "We were up and running 100% by that time the next day," Wors says.
The SSM Depaul ED also was closed for about 24 hours, Martin says. "The quarantine was activated shortly after the patients' arrival, in conjunction with our local hazmat," he says.
Anyone who was in the waiting room was decontaminated. As a precautionary measure, several members of the staff who were exposed also were decontaminated and given blood draws. According to their disaster plan, the ED was relocated to the surgical recovery room, where the staff were able to treat any emergent patients. All new stable patients were diverted. "The incident started at about 3 p.m., and by midnight we had the backup ED set up to treat walk-in or ambulance arrivals, and we were able to handle whatever came in," says Martin. (For more on how the EDs responded to this incident, see the story, below.)
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