Planning for Mass-Casualty Incidents With Hazmat Contamination

By Michael Lippincott and Marlene Fischer
Photos by Jack Carr

Is your local hospital prepared to handle patients contaminated with hazardous materials? Has your local hospital identified the fire department as its primary decontamination provider? What will the local hospital do in the event of hazardous materials spill on-site? If you have a hospital in your response area and have not asked these questions, you should. Too often, hospital disaster planners and local fire departments make assumptions about each other’s role in hazardous materials events without consulting each other.

Prior to September 11, 2001, many hospitals never gave much thought to the effects of large numbers of contaminated patients arriving at their facilities. Even the sarin attack in the Tokyo subway in 1995 did not prompt many hospitals to adequately prepare for such a catastrophe. Those hospitals that did write plans for dealing with contaminated patients often wrote that the local fire department or hazmat team would be summoned to the hospital to set up decontamination operations in the parking lot and “protect” the hospital. Unfortunately, many hospitals never checked with their local departments to see if this service could be provided.

After September 11, 2001, many hospitals began to place more emphasis on the subject of emergency preparedness, especially what to do if large numbers of patients (mass casualties) are contaminated with chemical or biological agents. As the 1995 sarin attack in Tokyo showed, allowing contaminated patients into an emergency department can be disastrous: staff becomes ill, and the entire emergency department has to be closed. Hospitals began looking at their plans and communicating with local emergency planners and fire departments. What they found was that most fire departments and hazmat teams could not send sufficient staff to set up decontamination units at hospitals and that these types of scenarios would probably stretch local responders’ abilities to the max. In a worst-case scenario of a mass-casualty incident (MCI) with hazardous contamination, many patients might receive only a gross decon at the scene prior to transportation. In addition to this information, the attack in Tokyo showed that many patients will not wait for first responders and will “self-refer” to hospitals seeking treatment.

With this renewed awareness, many hospitals decided to form their own hazmat or decontamination teams. Post-September 11 homeland security grants were becoming available, and hospitals began to use this funding to train and equip their staff for decontamination operations. One such hospital is South Jersey Healthcare (SJH). SJH operates two acute-care hospitals and employs approximately 3,000 employees. Starting in 2003, SJH began working closely with the Cumberland County 911 Training Center; Cumberland and Salem County Offices of Emergency Management; and the City of Vineland (NJ) Fire Department Hazmat Team. The goal was to make the hospital self-sufficient in an MCI involving contaminated patients and also capable of to handling individual patients contaminated from everyday industrial accidents and the like. The hospital decided to train its entire emergency department staff in basic personal protective equipment (PPE) use and basic decon procedures and establish a separate Hospital Emergency Response Team (HERT) to handle large decontamination operations: the team would be made up of volunteers from all hospital departments and disciplines. Today, this team has 70 members representing the: nursing, maintenance, security, housekeeping, respiratory, dietary, employee health, human resources departments and administration.

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All emergency department and security staff are trained to the hazmat awareness level in accordance with Occupational Safety and Health Administration (OSHA) 1910.120. In addition, all security and emergency department clinical staff receive annual training and competency evaluations on the use of level C PPE and the proper use of powered air-purifying respirators (PAPR).

HERT member receive the above training along with an additional eight-hour hospital operations course that covers identifying hazmats, decontamination procedures, PPE donning/doffing, PAPRs and the operation of fixed decon showers and the hospital’s mobile decon trailer. In addition, the team meets four times a year for three-hour training sessions.

All housekeeping and maintenance employees also receive annual hazmat awareness training along with specific training on the use of spill kits for certain hazards kept on-site. These staff members respond to any Code Orange (hazmat spill) in the hospital and determine if a spill kit can handle it or if the county hazmat team is needed.

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The hospital used grant money to purchase a cache of Tychem® F suits, hazmat boots, gloves, chem tape, and powered air-purifying respirators. In addition to PPE, the grants were used to buy each acute-care hospital a decontamination trailer that accommodates ambulatory and nonambulatory patients. In addition to the trailers, each hospital emergency department maintains a dedicated negative-pressure decon room located next to the ambulance entrance. Grants also were used to purchase portable radios, water heaters, personal effects bags, and other related items. OSHA’s report, “Best Practices for Hospital-Based First Receivers,” is used as a guideline in purchasing equipment.

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SJH complies with the National Incident Management System (NIMS) and has written emergency operations plans and standard operating procedures and trains all its staff in the required incident management system (ICS) levels and uses ICS to manage all incidents,

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SJH’s HERT conducts one major full-scale exercise per year in conjunction with local first responders. Local fire and hazmat send personnel to observe and evaluate team performance and work on ways to share resources whenever possible.

If you have a hospital in your response area, talk to it about its level of preparedness for a hazmat incident. Don’t assume it is ready–ask, find out its capabilities, and begin to work with the hospital on this issue.

Michael Lippincott has been a RN for 20 years and a Firefighter/EMT for 18 years. He is a career fire captain with the Millville (NJ) Fire Department and an emergency preparedness trainer for South Jersey Healthcare, Vineland, New Jersey.

Marlene Fischer, BSN, has been a RN for 15 years and is the emergency preparedness coordinator for South Jersey Healthcare, Vineland, New Jersey.

Subjects: Mass-casualty incidents, terrorism, hazmat, decontamination

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