First receivers can rely on protection from PAPRs
CT incident highlights risks of chemical terrorism
In New London, CT, terrorists set off a car bomb on a crowded pier. The explosion at first belies the greater threat: Mustard gas disperses throughout the crowd attending a festival.
As the first patients trickled into the hospital, it was not immediately apparent what caused their symptoms. “No one knew it was a blister agent,” says David Ippolito, director of Occupational Safety and Health Administration’s (OSHA) Office of Science and Technology Assessment. “Because of the very low levels of the material needed to cause blistering of the skin and the sickness that followed, it would not be readily evident that decontamination was necessary.”
OSHA offers best practices guidance to hospitals dealing with unknown hazardous material incidents or chemical terrorism in its “first receivers” document, available at www.osha.gov/dts/osta/bestpractices/html/hospital_firstreceivers.html#table1.
In this case, the agency actually lowered the level of respiratory protection required by distinguishing “first receivers” from first responders who arrive at the scene.
According to the first receivers document, hospitals first must have policies, equipment, and procedures in place to minimize employee exposure. For example, in the zone where newly arrived patients are decontaminated, the victims’ clothing must be removed promptly and contained in a way that will not cause further exposure to employees. The hospital must have a hazard vulnerability analysis and emergency management plan. If the release of a hazardous substance occurs near the hospital, so that it takes 10 minutes or less for the victims to arrive, the first receivers’ designation doesn’t apply because the gas or vapors may not have had time to dissipate.1
If criteria are met, first receivers may use the following personal protective equipment (PPE): a powered air-purifying respirator (PAPR) with an assigned protection factor of 1,000, a chemical-resistant protective garment, head covering if it is not already included in the respirator, a double layer of protective gloves, and chemical-protective boots. “As part of OSHA’s required hazard assessment process, each hospital also must consider the specific hazards first receivers might reasonably be expected to encounter. The hospital must then augment OSHA’s PPE selection when necessary to provide adequate protection against those specific identified hazards,” the document states.
After patients have been decontaminated, health care workers may wear normal PPE for infection control purposes. (That assumes the emergency department has not become contaminated, OSHA states.) The first-receivers document also outlines training requirements.
By contrast, first responders on the scene of a hazardous incident must wear self-contained breathing apparatus for unknown hazards.
“The amount of material brought to the hospital is limited to the amount of material that can exist on a living patient after a period of time after the exposure and transportation,” Ippolito explains.
The first receivers approach worked well in Connecticut, he notes. He also lauds improvements in emergency preparedness.
“I’m heartened by the fact that I believe that hospitals are becoming more aware of their responsibilities to be prepared,” Ippolito says. “I believe the best practices document helps give them a start in that direction. As a general rule, they’re much better prepared than they were three or four years ago.”
Reference
1. Occupational Safety and Health Administration. OSHA Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances. Washington, DC; January 2005. Web site: www.osha.gov/dts/osta/bestpractices/html/hospital_firstreceivers.html#table1.
In New London, CT, terrorists set off a car bomb on a crowded pier. The explosion at first belies the greater threat: Mustard gas disperses throughout the crowd attending a festival.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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