Hospitals HAZMAT

Hazardous Materials Response Team(s) Establish the HazMat Group, and Provide Technical information/Assistance to Command, EMS Providers, Hospitals, and Law Enforcement. Detect/Monitor to Identify the Agent, Determine Concentrations and Ensure Proper Control Zones. Continually Reassess Control Zones, Enter the Hot Zone (with chemical personal protective clothing) to Perform Rescue, Product Information, and Reconnaissance. Product Control/Mitigation may be implemented in Conjunction with Expert Technical Guidance. Improve Hazardous Environments Ventilation, Control HVAC, Control Utilities. Implement a Technical Decontamination Corridor for Hazardous Materials Response Team (HMRT) Personnel. Coordinate and Assist with Mass Decontamination. Provide Specialized Equipment as Necessary. Assist Law Enforcement Personnel with Evidence Preservation/Collection, Decontamination. 

It is also important to consider the issue of patient decontamination. Many hospitals rely on local fire or HAZMAT resources to decontaminate patients prior to arrival at the emergency department. This model is almost always effective as the typical HAZMAT or chemical exposure is an isolated event in which a limited access/egress quarantine can be established, and in which patients can be controlled and decontaminated. However, as was demonstrated during the sarin gas attack in Tokyo, in a disaster, there is no control over the scene or scenes. Patients will self-refer to emergency departments without being decontaminated (Auf der Heide, 2006 Okumura, Suzuki, Fukuda, 1998 Okumura, Takasu, Ishimatsu, 1996). 

During a disaster, hospitals must expect to perform decontamination themselves and cannot rely on the fire department or HAZMAT team as those assets will be on scene mitigating the consequences of the disaster. 

Describe the differences among daily hospital triage, mass casualty incident triage, disaster triage, tactical-military triage, and special conditions (hazmat) triage. 

Minimally, all hospital personnel (e.g., nurses, physicians, security, and triage) who have a designated role in a HAZMAT response must be trained to the first responder awareness level (Levitin Siegelson, 2002). Staff must be comfortable with knowing how to locate and use personal protective equipment and with the decontamination process (see chapter 26, Mass Casualty Decontamination, for further discussion). 

Every hospital must prepare to treat victims of HAZMAT accidents before an event occurs. The hospital must provide appropriate HAZMAT training, provide personal protective equipment, and develop and disseminate policies and procedures necessary to quickly and efficiently treat contaminated patients (Levitin Siegelson, 1996, 2002 Pfaff, 1998). Guidelines for the initial management of patients with acute toxic exposures have been established by the Centers for Disease Control and Prevention. Initial treatment protocols are agent specific and are provided for review (see Table 25.13 CDC, 2006b). At a minimum, nurses should be aware of the guidelines and how to access them quickly at the point of care (see Table 25.14). 

Describe the levels of training for hazardous materials exposure management. What should hospital personnel involved in HAZMAT response have as a minimal level of training ... 

The Joint Commission, which implements standards that must be met for hospitals to receive accreditation, has also established specific HAZMAT guidelines for hospitals. Locate a copy of these guidelines and identify the primary requirements they con-... 

Once the HazMat response is in place, you can move appropriately protected medical personnel in to assess the patients while decontamination commences. This is also tme at the hospital. There are limited interventions that can be initiated in a contaminated environment. These revolve around Basic Cardiac Life Support, Advanced Cardiac Life Support, Advanced Trauma Life Support, and Advanced HazMat Life Support (BCLS, ACLS, ATLS, and AHLS, respectively, with trademarks) ABCDE s (Establish responsiveness, Airway/C-Spine, Breathing, Circulation/Control Hemorrhage, Dmgs/Defibrillation/Dehnitive Care/Disability (Neurologic)/Decontamination, Exposure/ Environmental/Elimination). The triage process would determine the level of responsiveness, along... 

Victims of chemical contamination need prompt and effective treatment, both at the scene of the incident and in hospital. Ambulance or emergency medical services and hospital emergency rooms provide the front line health response and most will already have tried and tested contingency arrangements for accidental chemical releases - often referred to as HAZMAT or HAZCHEM (hazardous materials and hazardous chemicals) protocols. Whether for an accidental or deliberate chemical release contingency arrangements need to address the following key objectives ... 

Initially, the Tokyo Fire Department s HazMat Team conducted a rapid field test and reported to medical institutions that the causative agent was acetonitrile. However, this was incorrect. Fortunately, given the number of victims with mild to severe symptoms treated at St. Luke s International Hospital, acetonitrile poisoning was ruled out. However, some medical institutions that handled only severe cases, suspected cyanide poisoning and treated patients with antidotes to cyanide. 

One of the operating license criteria for commercial facilities is the preparation and testing of an Emergency Management Plan (EMP). Arrangements must be coordinated with the local hospital. Are department, police department, HAZMAT... 

With the constant threat of accidental releases of hazardous materials and the potential use of chemical weapons by terrorists, local emergency response providers must be prepared to handle victims who may be contaminated with chemical substances. Many local jurisdictions have developed hazardous-materials (HazMat) teams, usually composed of fire and paramedical personnel who are trained to identify hazardous situations quickly and to take the lead in organizing a response. Health care providers, such as ambulance personnel, nurses, physicians, and local hospital officials, should participate in emergency response planning and drills with their local HazMat team before a chemical disaster occurs. 

Ask the local HazMat team to set up a contamination reduction area outside the hospital emergency department entrance. However, keep in mind that all teams may already be committed and not available to assist. 

Hospitals receive not only field-decontaminated patients but also "walk-ins" who may have bypassed field decontamination. Despite Joint Commission on Accreditation of Healthcare Organizations standards calling for hospitals to have hazardous materials (Hazmat) plans and conduct Hazmat training, two recent reviews have suggested that most hospitals in the United States are ill prepared to treat chemically contaminated patients. 

Standard Operating Procedures for communicating chemical detection information from first responders to Hazmat teams, EMS teams, and hospitals. 

The removal of solid or liquid chemical agent from exposed individuals is the first step in preventing severe injury or death. Civilian Hazmat teams generally have basic decontamination plans in place, though proficiency may vary widely. Very few teams are staffed, equipped, or trained for mass decontamination. Hospitals need to be prepared to decontaminate patients, despite plans that call for field decontamination of all patients before transport to hospitals. However, few hospitals have formal decontamination facilities even fewer have dedicated outdoor facilities or an easy way of expanding their decontamination operations in an event involving mass casualties. 

Patient decontamination, which Hazmat teams have to undertake much less often than technical decon, is to be performed when the contaminant poses a further risk to the patient or a secondary risk to response personnel. Fire and EMS publications frequently describe how patient decontamination can be done, but few of the recommendations are based on empirical research. Because little scientific documentation exists for when and how patient decontamination should be performed expeditiously and cost effectively, prehospital and hospital providers are left to doing what they think is right, rather than doing what has been proven to work best. Generally, the process involves three stages gross, secondary, and definitive decontamination. 

As soon as you suspect that you are dealing with a terrorist attack, you should immediately notify dispatch and have them notify all appropriate agencies and local hospitals. Resist the urge to immediately rush into the scene and rescue the victims (Box 2-3). You should immediately withdraw to a safe place and wait for the HazMat team to enter and size up the scene. They will test for chemical and radiological hazards as well as search for bombs and booby traps. 

If you detect or confirm an explosion, have dispatch notify other responders, law enforcement, the bomb squad, the fire service, the on-line medical direction physician, receiving hospitals, and the HazMat team. 

Although is is not quite as good as Level A PPE this level provides protection against liquids and most vapors. Unless there is strong evidence of a severe risk, this level is usually adequate. EMS, hospital, and law enforcement personnel require a level of dexterity to perform their duties that precludes the use of Level A PPE. If HazMat evaluation determines that the scene is too dangerous for Level B PPE then victims will have to be removed from the scene before evaluation by EMS. Level B PPE is a... 

Kent Shea has been a technical services representative for Lab Safety Supply (www.labsafety. com) for 21 years. He has 22 years experience as a lieutenant/ paramedic for the Janesville, Wise., Fire Department has been a hospital EMT-paramedic instructor for 21 years and a hazmat technician and rescue SCUBA diver and business owner teaching CPR and first aid for 20 years. 

Emergency medical personnel managing toxic trauma in hospitals may be involved in the incident itself either as part of the pre-hospital response teams, as is the case in France and other European countries, or because of the need to manage contaminated casualties who arrive at the emergency department without having been processed through a chemical incident management system (HAZMAT). Such contaminated casualties may pose a serious risk to the hospital personnel and their activities. 

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