Here are two recent disaster drill scenarios used by Shands Jacksonville (FL) Medical Center to practice decontamination procedures:
1. A small institutional drill with 15 casualties using limited decontamination facilities built into the ED/trauma center.
The scenario: 15 individuals contaminated with organophosphates from an explosion at a storage facility. "This caused us to use the smaller decontamination facility integral to the ED/trauma center instead of the parking lot decontamination facility," says David J. Vukich, MD, professor and chairman of the department of emergency medicine at the University of Florida in Jacksonville.
The trauma center was used as the receiving unit, with patients decontaminated in the single decontamination shower built for this purpose. The floors were covered with tarps, areas were taped off, and staff dressed in Level C suits, which are used for known contaminants, are protective for liquid and vapor agents, and require an air-purifying respirator. Patients with simple contamination were combined with contaminated patients with injuries, and staff went through the process of decontamination, triage, and treatment.
According to Karen G. Ketchie, RN, EMT-P, the facility’s disaster preparedness manager, the drill revealed that the one-room, one-shower area is not suitable for a large volume of patients. "Patients must use a single-file approach, and this is very time-consuming, while the patients in the rear may be deteriorating," she says. As a result, the small decontamination room outside the trauma center was replaced with a larger mass decontamination unit (MDU).
Vukich says he learned that crowd control and staff flow are difficult to manage. "Whatever you think it will take to keep people in the right places — security, taped floors, barricades — is not enough," he says. "Even well-trained staff can contaminate themselves in a hurry. It was embarrassing."
While ED staff may be familiar with the need to avoid contaminating the facility and themselves, other departments may not be as well-educated, Vukich adds. "The rest of the hospital is probably clueless and sees little reason to play the game," he says.
2. A larger citywide drill using the MDU in the hospital’s parking garage.
The scenario: A terrorist attack at the airport with explosives and nerve agents with hundreds of casualties. Every hospital in the area received patients. At Shands Jacksonville, staff set up the large decontamination center and prepared for dozens of contaminated patients.
Because the hospital is closest to the airport and is the primary receiving hospital, about 50 patients were received, significantly more than the other facilities, Vukich says. "We followed the same general process as with the smaller drill. But with the larger volumes, traffic, media, and family control were issues as well," he adds.
Ketchie stresses the importance of learning as much information about a mass-casualty incident scene as possible. For example, if only 10 patients are expected, she says there would be a minimal impact on the operations of areas outside the immediate patient care areas. However, if 25 patients may be received, some advanced warning time can allow for other areas to be prepared, including alternate care sites.
As a result of concerns that arose during the critique of the citywide drill, Ketchie says it was agreed to have a hospital liaison at the scene whose job was exclusively to communicate directly to the hospitals and answer their questions.
A communication problem was identified since some personnel received notification of the disaster, while others did not, Ketchie says. This was resolved when the Hospital Emergency Incident Command System (HEICS) was implemented. (For more information about the HEICS system, see "Use this proven system for disaster communications," ED Management, December 2001, p. 136.)
Through the HEICS structure and command chart, the appropriate personnel are notified, says Ketchie. "We also have the HEICS organizational chart set up as a group text page, sending everyone the same message at the same time," she says. "This is a great tool for updates as well."
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