Make decontamination part of all-hazards plan
Recent disasters force providers to revamp plans
In the wake of hurricanes Katrina and Rita, health care professionals across the country are revisiting their disaster preparedness plans. And in light of a recent survey by the Centers for Disease Control and Prevention (CDC), it couldn’t be soon enough — particularly in the areas of decontamination preparedness and participation in community planning, which are especially important to ED managers.
The survey, Bioterrorism and Mass Casualty Preparedness in Hospitals: United States, 2003, was conducted by the CDC’s National Center for Health Statistics, and it had responses from roughly 500 hospitals regarding their preparedness for treating patients. Among the findings:
• While 97.3% of hospital responding addressed natural disasters in their plans, only 85.5% addressed chemical terrorism, 84.8% addressed biological terrorism, and 77.2% addressed nuclear or radiological terrorism.
• While almost all hospitals (95.4%) had provisions in their plans to contact outside entities, only 76.4% defined their role in communitywide planning with other health care facilities.
Don’t limit your vision
In revising your disaster response plan, it’s critical for ED managers to think creatively when it comes to these key issues, experts say.
"What we want to get across is that you should have an all-hazards plan — whether it’s a manmade disaster with political intent, an industrial accident, or a natural event," says Eric Weinstein, MD, FACEP, an attending physician at Colleton Medical Center in Walterboro, SC, and immediate past chair of the disaster medicine section for the American College of Emergency Physicians. If you have too many plans, you’re not going to have the right plan, Weinstein says. "If you are good in your daily operations concerning what could possibly happen in a risk analysis of your community, you could pretty much change to adapt to the situation," he says.
And it’s in that risk analysis that you’ve got to think outside the box, advises
Kathy J. Rinnert, MD, MPH, assistant professor at the division of emergency medicine at the University of Texas Southwestern Medical Center in Dallas. "You need an all-hazards response regardless," says she, noting that any event might contain a decontamination element.
A bomb blast, for example, might appear at first to involve only blast injuries, but what if the bomb contained biological material? Or, you might have a laboratory blow up, Rinnert says. "You don’t only need to know about potential injuries. Responders don’t want to get certain chemicals on them."
In doing your risk analysis, creating "wild scenarios" is essential, she says. "A wild scenario on decontamination might be an event that required a certain number of your area hospitals close to new patients and be designated as decon and triage facilities — that’s all they do — and the rest of the area’s patients are sent on to other hospitals that are clean,’" she suggests. "But can you name a hospital that wants to be known as a triage/decon hospital? And you have to have closed hospitals willing to accept inpatients from those facilities."
Sometimes thinking "small" is actually the more creative way to address decontamination considerations, Weinstein adds. "Most of the time, all you really need is a fire truck with an inch and a half spray, and you will pretty much get what you need off [the patients]."
You could work out an agreement with your local fire department to send a truck, or you could go to a local store and purchase polyvinyl chloride (PVC) pipe and some nozzles to use outside your ED, Weinstein says. "People who have stuff on their skin that’s stinging them and whose eyes are burning are not going to want to go calmly through a nice, orderly decontamination line," he says.
It’s equally important to remember you are not alone, Rinnert says. You must start with a written plan and well-trained staff, but what happens if you haven’t worked with other hospitals and agencies, she asks.
"If you don’t develop contingency plans, what happens when all your planning assumptions prove inadequate — when your plan is out the door and doesn’t apply any more?" Rinnert says.
That’s why it’s imperative you develop those important relationships before disaster strikes, she says. For example, she says, what if your municipal fire department can’t get to your hospital because they are occupied elsewhere? "How about getting a volunteer fire department to come and set up decon?" she suggests. "That depends on you having a memorandum of understanding written ahead of time." That’s exactly what Rinnert has done with the volunteer fire department in a small, nearby town. "You can’t call a stranger out of the blue and say you need them to come out and spray people," she says. "They have to already be a good friend of yours."
Resource
For a free copy of "Bioterrorism and Mass Casualty Preparedness in Hospitals: United States, 2003," go to www.cdc.gov/nchs/data/ad/ad364.pdf.
In the wake of hurricanes Katrina and Rita, health care professionals across the country are revisiting their disaster preparedness plans.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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