Could you decontaminate hundreds of patients?
If a chemical attack occurs, you might need to decontaminate hundreds or perhaps thousands of people, says Robert Suter, DO, MHA, FACEP, medical director for the North Texas region at Questcare Emergency Services in Plano. Suter also serves on the faculty of the department of military and emergency medicine at the Uniform Services University of Health Sciences in Bethesda, MD.
Most EDs are not prepared for this scenario, he warns. "For many hospitals, state-of-the-art decontamination means showers adjacent to the ED. But when it comes to preparation for a terrorist attack, that’s completely inadequate," says Suter. "It’s the same principle, but a difference of scale."
You might need the parking lot
Here are ways to prepare for large-scale decontamination:
• Identify a large area for decontamination.
HazMat showers built into your ED are ideal for taking care of low numbers of patients, says Suter. "But you need to be prepared to take it out into the parking lot," he adds. "Everybody has space limitations, but you need a large area the size of a football field where you can do outdoor decontamination."
• Don’t rely on the fire department.
Most ED staff mistakenly believe that the fire department will be able to decontaminate large numbers of patients if a chemical attack occurs, warns Suter. "You may be counting on the local fire department to perform this function for you, but that is not going to be an effective strategy in the event of a large-scale incident that is caused intentionally. You need to prepare for this."
Use your fire department as consultants in developing a plan, Suter recommends. "Have them come and evaluate your decontamination team setup, but don’t rely on them as providers," he says. "Don’t develop your plan expecting them to do everything for you, because that is not realistic."
Likewise, don’t assume patients will be decontaminated before they arrive at your ED. "Although patients who are transported from the scene of the event may be decontaminated on the scene prior to transport, those arriving by car or other means of transportation will require decontamination," says Jeffrey Doucette, RN, MS, CEN, director of emergency services at Medical Center of Arlington (TX).
• Protect yourself.
Always take a safety-first approach, warns Suter. "If you are unprepared or untrained to decontaminate patients, then your duty is to either wait for instructions or for someone else to do it," he says. "Don’t give in to the urge to jump in and do something." Your first responsibility is to protect yourself so you can care for patients, he adds.
• Develop plans with local organizations.
EDs should work closely with local and state HazMat agencies, such as the fire department, to develop plans for mass decontamination efforts, says Doucette.
• Know which patients need decontamination.
Understand who does and doesn’t need to be de contaminated, says Ali S. Khan, MD, MPH, deputy director for the Bioterrorism Preparedness and Response Program for the Atlanta-based Centers for Disease Control and Prevention. "Remember that this is generally an issue only for chemical exposures and not biological casualties."
• Consider training other hospital staff to perform decontamination.
You might want to train other hospital personnel to decontaminate in the event of a bioterrorism incident, suggests Suter.
"There is no law that patient care personnel can’t do the decontamination," he says. "In fact, you can make the argument that you are better off using administrative personnel to decontaminate, so the ED caregivers receive patients at the point when they are capable of being treated."
Care that occurs prior to decontamination is very limited, explains Suter. "So the actual work of decontaminating patients may be best assigned to people with no patient care duties whatsoever," he says.
That plan might be difficult to sell politically, but it actually makes a lot of sense, Suter maintains. "People don’t need to be performing billing during a disaster," he says.
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