HOSPITAL BIOTERRORISM PREPAREDNESS

1
HOSPITAL BIOTERRORISM PREPAREDNESS

• COUNTY OF LOS ANGELES
• EMERGENCY MEDICAL SERVICES AGENCY

2
Overview of the HRSA Grant

• Authorized by the Public Health and Social
  Services Emergency Fund
• Section 319 of the Public Health Services Act, 42
  U.S.C.247d
• 125 million funded for hospitals through the
  Health Resources and Services Administration
• Los Angeles County receiving 3.6 million
• State of California receiving 9,962,905

3
Overview of the HRSA Grant

• Awarded to State and 4 Jurisdictional Public
  Health Departments
• The Emergency Medical Services Agency will
  administer and implement the plan in Los Angeles
  County

4
Purpose of the HRSA Grant

• Develop and implement regional plans to improve
  the response to bioterrorism (or other outbreaks
  of infectious disease) incidents.

5
Purpose of the HRSA Grant

• Focus on
• Hospitals
• Emergency Departments
• Outpatient centers
• EMS systems
• Other collaborating health care entities

6
HRSA Grant Requirements

• Critical Benchmarks
• First Priority Planning Areas
• Second Priority Planning Areas

7
Critical Benchmarks

• Program Leadership
• Coordinator
• Medical Director
• Support Staff
• Hospital Bioterrorism Preparedness Planning
  Committee
• Regional Planning

8
Hospital Bioterrorism Preparedness Planning
Committee

• MISSION
• The Los Angeles County DHS/HASC Hospital
• Bioterrorism Preparedness Planning Committee
• (HBPPC) will provide guidance, direction and
• oversight to the Department of Health Services
• and its EMS Agency to ensure coordination,
• communication, and education of hospitals in
• planning for the Countys healthcare bioterrorism
• response.

9
First Priority Planning Areas

• Medications and vaccines
• Recommended Hospital Pharmaceutical Stock
• Personal Protective Equipment (PPE),
  Decontamination, Quarantine
• Communications
• Biologic Disaster Drills

10
Second Priority Planning Areas

• Personnel
• Mobilization of staff to impacted area(s)
• Training
• Recognition of biological diseases
• Use of PPE/decon equipment/quarantine
• Assessment, stabilization, transport
• Patient Transfer
• Special needs populations
• Designated facilities

11
Coordination and Collaboration

• Coordination of funding streams
• HRSA grant
• CDC grant
• MMRS grant
• Collaboration with the State of California HRSA
  and CDC grant planning and response

12
Needs Assessment

• October 2001 Los Angeles County surveyed all
  eighty-one 9-1-1 receiving facilities to
  determine the level of preparedness to respond to
  a terrorist incident
• Based on these findings Los Angeles County
  developed their plan for the HRSA grant

13
Los Angeles County Plan

• Governing Principles
• 80 of the victims will flee the scene and seek
  medical care at the hospital that is familiar to
  them. Therefore all hospitals need to be
  prepared to deal with converging victims.
• ALL HAZARDS approach used.
• Current funding being directed to 9-1-1 receiving
  facilities. All eighty-one will be offered
  participation.
• Current funding inadequate for addressing major
  hospital infrastructure needs such as isolation
  capabilities.
• By participating, hospitals are committing to be
  a part of a system wide response to potential
  acts of terrorism.

14
Los Angeles County Plan

• Personal Protective Equipment
• Decontamination Capabilities
• Pharmaceuticals and Disaster Staging
• Communications

15
Hospital Participation

• WHAT DO I GET?
• WHAT DO I HAVE TO DO TO GET IT?

16
Hospital Receivables

• Basic Level
• Personal Protective Equipment (PPE)
• Training of Decontamination Team

17
Hospital Receivables

• Expanded Level
• Personal Protective Equipment
• Training of Decontamination Team
• Funding for Mass Casualty Decontamination
  Capability

18
Personal Protective Equipment

• PPE worth 10,000
• Group purchased by Los Angeles County and given
  to the hospitals
• Standardization
• Purchasing power reducing cost

19
Personal Protective Equipment

• Level C
• Reasonable level of protection for hospital
  personnel to be equipped with and trained to use.
• Powered Air Purifying Respirator Hood

20
Personal Protective Equipment

• Level C
• Splash Suit
• Nitrile gloves
• Boots
• Patient Privacy Kit

21
Decontamination Team Training

• Operations level course on hospital
  decontamination for contaminated victims
• County Disaster Training Unit will provide
  training at no cost
• Course is 20 hours of instruction
• No cost offset for staff attendance and/or
  replacement staff costs

22
Mass CasualtyDecontamination Capabilities

• Fixed turnkey warm water operation capable of
  decontaminating 50 ambulatory patients/hour
• Minimum of 20,000 toward construction

23
Hospital DeliverablesBasic and Expanded

• Store, secure, maintain, and replace PPE
• Establish a decontamination team
• Identify Decontamination Team Safety Officer
• Establish a Respiratory Protection Program
• Establish Medical Monitoring Program
• Training/Exercise
• Conduct on-going decontamination team training at
  least quarterly
• Conduct decontamination drill annually

24
Hospital DeliverablesBasic and Expanded

• Complete an Information Technology capabilities
  survey conducted by the County of Los Angeles
  Public Health Programs and Services
• Identify hospital contacts
• Bioterrorism incidents (clinician)
• Radiological incidents
• Other terrorism/disaster incidents

25
Hospital Deliverables

• Decontamination Capability
• Basic Level
• Describe hospitals capability
• Expanded Level
• Fixed turnkey warm water structure capable of
  decontaminating 50 ambulatory individuals per
  hour

26
Mass Casualty Decontamination at Hospitals
27
Hospital Mass Casualty Decontamination
The Challenge
Hazardous materials incidents often involve
civilians that have been exposed to potentially
deadly chemicals. Also the possibility of NBC
weapons released on civilian populations are
increasing. Prompt, safe and effective
decontamination procedures are essential to
protect both the victims and hospital/response
members.
28
Hospital Mass Casualty Decontamination
Methods of decontamination

• The National Fire Protection Association standard
• 472 identifies four basic methods.
• Dilution
• Absorption
• Discarding
• Neutralization
• Additional methods include
• chemical and physical degradation, evaporation,
• solidification, vacuuming

29
Hospital Mass Casualty Decontamination
Types of Decontamination

• Emergency
• Respiratory
• Primary
• Secondary
• Equipment
• Mass Casualty -Incident Site
  -Hospital

30
Hospital Mass Casualty Decontamination
Decontamination Process

• Triage
• Remove and bag clothes
• Shower soak/flush
• Detergent soap scrub with sponge
• Shower rinse
• Dry and dress

31
Hospital Mass Casualty Decontamination
Factors That Affect Decontamination Process

• Physical chemical properties of the material
• Amount location of contaminant
• Contact time temperature
• Level of protection work function
• Reason for leaving hazard site

32
Setting up the Contamination Reduction Corridor

• Personnel
• Water
• Decon solutions
• Air supplies
• Protective clothing
• Electricity/utilities
• Miscellaneous tools

33
Setting up the Contamination Reduction Corridor
Exclusion Zone
Safe Refuge Area
Safe Refuge Manager/ Triage
CRC
Contamination Reduction Zone
100 feet
Washer
Down Slope
Decon Leader
Rinser
Wind
Welfare
Staging Treatment Area
Support Zone
Air Cart Manager/ Safety Officer
34
(No Transcript)
35
Setting up the Contamination Reduction Corridor
What is required

• Planning
• Equipment
• Identification
• Coordinating
• Training
• Exercising
• Documentation

Will become part of the employers emergency
plan
36
Setting up the Contamination Reduction Corridor
The key is through pre-event planning that
identifies and documents all aspects for the
decontamination of either ambulatory or
non-ambulatory patients. Any system that fails
to prioritize, manage and control patients
through the decontamination process will fail
without proper planning.
37
Setting up the Contamination Reduction Corridor
Consideration of all safety aspects of the
decon operation area prior to selecting the site
is paramount. Issues such as drainage, trip
hazards, lighting, overhead obstructions and
ability to control access must be addressed.
Secondary decon sites or back-up plans also
must be considered.
38
Setting up the Contamination Reduction Corridor
Determining Effectiveness of Decontamination

• Visual examination
• Meters, instruments, test paper
• Testing by qualified lab
• Analysis of test swatches or samples
• Consulting with appropriate health officials

39
Setting up the Contamination Reduction Corridor
When the decontamination operation is over
You must also have a formal system to terminate
your decontamination operations that will
be part of your operational plan.

• Decontaminate the decon team
• Decontaminate or dispose of equipment
• Clean-up options
• Debriefings
• Record keeping

40
Setting up the Contamination Reduction Corridor
ADDITIONAL CONCERNS

• Site security
• Force protection
• Evidence Collection

Must be coordinated with law enforcement.
41
Draw back of portable equipment

• Number of people needed to set it up
• The time it takes to set it up

42
Draw back of portable equipment
43
Fixed Mass Casualty DeconConex Trailers or
Permanent Tents
44
Fixed Mass Casualty Decon Corridor or Alleyway
45
Fixed Mass Casualty DeconCorridor or Alleyway
46
Fixed Mass Casualty Decon Corridor or Alleyway
47
Fixed Mass Casualty Decon Corridor or Alleyway
48
Mass Casualty Decontamination Capabilities

• Issues being addressed
• Water run-off containment
• Office of Health Planning and Development
  requirements for Healthcare facilities

49
Hospital Preparedness

• A facility that can demonstrate that they have
  already purchased comparable PPE and/or have
  constructed a fixed decontamination capability
  will still be eligible to receive the funding.
• PPE - 10,000
• Decontamination Capability Minimum of 20,000

50
Hospital Agreement

• To receive funding each hospital will need to
  sign an agreement with the County of Los Angeles.
• Letters of Interest will be mailed to Hospital
  CEOs in August 2002
• Contracts completed by December 2002

51
Contact Information

• Dr. John Celentano, M.D., Disaster Medical
  Officer
• [phone], jcelentano_at_dhs.co.la.ca.us
• Kay Fruhwirth, RN, MSN
• Hospital Bioterrorism Preparedness Coordinator
• [phone], kfruhwirth_at_dhs.co.la.ca.us
• Carol Gunter, RN, MHA Assistant Director
• [phone], cgunter_at_dhs.co.la.ca.us

52
Questions?