hospital emergency response training
Post on 23-Feb-2016
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Making a Case for Hospital Decontamination
-A Community Issue-
Hospital Emergency Response Training
Presented by:
Jan Glarum
Discuss cases of hospital employee exposure to hazardous materials
Discuss common factors of exposures
◦ New Trends◦ Probability
Discuss mitigation strategies
Objectives
What to Prepare For? Playing The Odds
About 9000 releases of hazardous substances occur annually, with 75% occurring at chemical facilities and 25% occurring during transportation.
What to Prepare For? Playing The Odds
In 15 Study States:◦Fact: Most incidents occur at fixed
sites- Application: Your hospital HVA should drive preparedness.
◦Fact: One quarter of the exposures occur during transit –
◦Application: Trauma centers need to have a plan to care for trauma patients who are contaminated
What to Prepare For? Playing The Odds
> 2000 victims of hazardous materials releases each year.
Approximately 50% of these are transported to hospitals.
> 7500 people required decontamination during HAZMAT events. ◦ Of these, 2643 were
decontaminated at medical facilities.
(data from 15 study states)
New Trend The Southampton Hospital Emergency Department entrance was shut down after a man attempted to commit suicide by mixing chemicals in his car, which was parked at the ER entrance.
Data indicates there were 75 chemical suicides during 1999-2010 with increasing numbers each year.
The toxic gases most commonly formed by combining the chemicals in household cleaners are hydrogen sulfide and hydrogen cyanide.
New Trend - Chemical Suicide
New Trend - Chemical Suicide Hydrogen sulfide , odor is often described as that of rotten eggs, but even a short exposure can cause olfactory fatigue. At low doses, exposure to hydrogen sulfide can cause eye and respiratory irritation, headache, dizziness, loss of appetite, and upset stomach. Brief exposures to high concentrations can cause loss of consciousness and death.
Hydrogen cyanide is a bluish-white liquid or a colorless gas with a faint odor of bitter almonds and a bitter, burning taste. Hydrogen cyanide can cause changes in respiration depth, confusion, and asphyxia.
New Trend - Chemical Suicide
Best option is to train ED staff to: Suspect Recognize Decon and Treat
Be prepared for chemical suicide events.
Case Study
Courtesy FEMA
Suicide attempt by ingestion of 14 Oz of Malathion (organophosphate) and ETOH.
Symptoms - HR, respiratory depression, vomiting, diarrhea and diaphoresis.
ED Treatment included airway control (ET) and Atropine.
Background – Specific Case
Courtesy FEMA
Good news – patient transported to ED with bottle of ingested poison.
Not So Good News – ◦No decontamination in spite of emesis
◦EMS not wearing appropriate PPE for hazard
◦EMS did not notify ED staff of the product ingested
EMS Actions
Courtesy FEMA
Strong chemical odor from patient – hospital staff exhibited signs/symptoms of poisoning
HAZMAT, Poison Control and County Health Contacted
ED evacuated and shut down
Consequences
Courtesy FEMA
Staff Impacted- Met Case Definition For Pesticide Poisoning
Courtesy FEMA
Employee 1 Employee 2 Employee 3 Employee 4 Employee 5Nausea, Eye Irritation, Dyspnea, Blurred Vision, Headache, Confusion, Restlessness, Agitation, Weakness, Asphyxia, Syncope and Slurred Speech
Nausea, Vomiting, Dizziness, Headache, Dry Throat
Nausea, Eye Irritation, Dizziness, Sore Throat, Dry Throat, Skin Irritation
Nausea, Eye Irritation, Headache, Dry Throat, Skin Irritation
Eye Irritation, lightheadedness, Skin Irritation
Nurse Housekeeper Respiratory Therapist
Respiratory Therapist
Respiratory Technician
Symptom Onset 15-30 minutes
Symptom Onset within 2 hours
Symptom Onset Immediate
Symptom Onset within 1/2-2 hours
Symptom Onset Unknown
Gloves Double Gloves, Mask, Hair Covering, Shoe Covering
Mask and Gloves Gloves, later a half mask respirator
Unknown
Hazmat Training Hazmat Training Hazmat Training Hazmat Training Unknown
Field notification of chemical poisoning and potential for secondary contamination and share with staff
Take Aways
Courtesy FEMA
Verification of decontamination of patient
Take Aways
Courtesy FEMA
Patient decontamination and treatment in well-ventilated area
Take Aways
Courtesy FEMA
Employees have access to immediate washing after direct exposure to body secretions or vomitus
Take Aways
Courtesy FEMA
Ensure training and exercises are adequate and appropriate PPE, supplies and antidotes are available as needed.
Take Aways
Courtesy FEMA
Initial priorities as taught in ICS are:◦ 1. Life safety◦ 2. Incident Stabilization
Take Aways
Courtesy FEMA
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