1. 2.10 HazMat for WV Hospitals: An Operations Level Course Module II

2. 2.10 This course was developed by EnMagine, who we wish to gratefully acknowledge. The material has been modified by WV DHHR in cooperation with the West Virginia Hospital Association’s Disaster Preparedness Task Force in the teaching of Hospital Decon.

3. 2.10 Objectives Describe the purpose and need to implement the Hospital Emergency Incident Command System. Apply basic hazard and risk assessment techniques to hazardous materials incidents for action planning. Demonstrate the use of the Department of Transportation Emergency Response Guidebook. Describe the aspects of control, containment, and confinement within your resources. Describe protective actions and rescue options available to first responders, within their capabilities and resources.

4. 2.10 Operations Level Objectives CIACIA PCPPCP DDDDDD Command Identification Action Plans Protective Equipment Containment / Control Protective Actions Decon Disposal Documentation

5. 2.10 Command (C) Scene Management System Purpose of Scene Management (Decon area) –Provide workable system –Efficiently/effectively use resources –Minimize impacts of incident Hospital Emergency Incident Command System is required under JCAHO.

6. 2.10 Scene Management System (Decon Area) Goal: Protect –Life –Environment –Property Need one system for all responders

7. 2.10 What is HEICS? Hospital Emergency Incident Command System Organized system –Of roles, responsibilities & procedures To manage & direct –All emergency operations

8. 2.10 Benefits of HEICS More efficient use of resources More effective management Safer response

9. 2.10 Who’s In Charge? HazMat requires establishing Command early, but… Common HazMat deficiency is poor management (i.e. Command)! –Early assumption of Command reduces chaos and aids in management

10. 2.10 HEICS Organization Command/IC (overall management) –Operations (manages tactical operations) –Planning/Intel (does incident action planning) –Logistics (procures incident resource needs) –Finance/Admin (manages financial aspects)

11. 2.10 HazMat Group

12. 2.10 HEICS HazMat Organization Hazardous Materials Group Positions –Decon Group Supervisor –Technical Reference –Site Access Control –Decon Leader –Entry Leader –Assistant Safety Officer* *Reports to Safety Officer

13. 2.10 Job Action Sheets Guidance for each position with: –Basic information –Mission –Tasks (immediate, intermediate, long-term)

14. 2.10 How bad is this? What do I know? What don’t I know? Quantity and Concentration Characteristics of Hazardous materials –Toxicity –Reactivity –Ignitable/ Flammable –Corrosive

15. 2.10 How bad is this? Population at risk to exposure--the ED Environment at risk— the entire hospital

16. 2.10 Information Resources Container Labels MSDS Poison Control Emergency Response Guide (ERG) Computer programs People ChemTrek

17. 2.10 Info Sources NFPA 704 System –Blue = Health –Red = Flammability –Yellow = Reactivity –No color = special hazards

18. 2.10 Info Sources DOT Emergency Response Guidebook (ERG) ERG purpose: –Basic safety tool –Basic identification –Initial actions

19. 2.10 Info Sources ERG Organization WhiteWhite — Basic info & instructions YellowYellow — UN #, guide # & material name BlueBlue —Material name, guide # & UN # OrangeOrange —Chemical information GreenGreen —Isolation & Protective Actions

20. 2.10 Info Sources ERG—Good But Limited Classification of hazard Guides — “most essential guidance” Isolation/evacuation distances — guides Use table of placards only if no ID Intended use

21. 2.10 Info Sources People –Patient –Witnesses

22. 2.10 Acronyms and Terms TWA - Time Weighted Average –Average concentration that a worker can be exposed to during a 40 hour week/8 hour day without adverse effects. STEL - Short Term Exposure Limit –Fifteen minute time-weighted average exposure Ceiling –Instantaneous levels which should not be exceeded

23. 2.10 Acronyms and Terms IDLH -Immediately Dangerous to Life & Health –Maximum level from which a worker could escape without any escape impairing symptom or irreversible health effect PEL - Permissible Exposure Limit –OSHA standards - therefore are legal limits –Based on TLV’s and many are identical –Include 8 hour PEL, 15 minute STEL, and Ceiling Limit

24. 2.10 Acronyms and Terms LD/LC 50 –Lethal Dose 50% –Lethal Concentration 50% PPM/MgM 3 –Parts Per Million measured as volume of contaminant to volume of liquid or air collected in sample –Milligrams Per Cubic Meter measured as weight of contaminant to volume of air collected in sample

25. 2.10 Understanding Toxicity 101 Time of Exposure Concentration Euphoria Mental Impairment Nausea Coma Respiratory Arrest Courtesy of Mike Callan

26. 2.10 Toxicity Relationships Dangerous Unsafe Safe 25000 200 Safe Unsafe Dangerous Methanol Safe 1200 35 Unsafe Carbon Monoxide Dangerous CO 25 300 Safe Unsafe Dangerous Ammonia Safe 100 10 Dangerous H2S HCL Unsafe H2SH2S 10 0.5 Un. Dangerous Chlorine Safe Chlorine 5 0.1 Un. Dangerous Acrolein S. Acrolein Dangerous 0.00001 0.0001 VX

27. 2.10 Acronyms and Terms UEL and LEL – Upper Explosive/Lower Explosive Limit FR and FL –Flammable Range/Flammable Limit FP –Flash Point

28. 2.10 Routes of Entry into the Body Inhalation: Breathing it in! Ingestion: Swallowing it by mouth! Absorption: Through the skin! Injection:Puncture!

29. 2.10 Routes of Entry and Preventing Exposure Inhalation: Most common route of entry –Isolate and deny entry –Wear air supplied respirator (SCBA or airline respirator) if unsure of what it is or how much is there –Just stay away!

30. 2.10 Preventing Exposure Isolate and deny entry Don’t eat, drink, smoke around contaminated areas Wear proper PPE Engineering controls

31. 2.10 Remember! Many hazmats are odorless, colorless and tasteless! You may be exposed before you know it! Wear PPE Approach safely - UUU Above/ UpgradeUp Hill Different VentilationUp Wind Out of flowUp Stream

32. 2.10 Acute vs. Chronic Exposure –Acute: short-term,limited,one time –Chronic: long-term, repeated, continuous Effects –Acute: may not show immediately –Chronic: not detectable for years. May differ from acute effects

33. 2.10 Action Planning Components of action plans –ID the problem –ID resources available –Use available resources to solve problem

34. 2.10 Action Planning Capabilities & Resources Personnel Equipment Policies/Procedures Facilities

35. 2.10 Site Safety Plan Required and necessary for a safe and effective response –Decon area –Route of entry –Adequate vehicle access Much of the information should be pre- planned

36. 2.10 Containment and Control (C) Hazmat Counter measures

37. 2.10 Eventual Outcome All HazMat Incidents Eventually Stabilize –Actions by responders should contribute to the solution, not the problem!

38. 2.10 When Not to Intervene Action would be unsafe Lack of response resources Lack of proper PPE

39. 2.10 Why Non-Intervention? Responders are there to save, not risk lives! Any level of responder can follow this strategy

40. 2.10 Decon Dilute it! Remove it!

41. 2.10 Can we handle this Incident?

42. 2.10 Our Roles What can I do as a: –First Responder Awareness: Understand hazardous materials –First Responder Operations: Conduct decon –Technician Level: Contain releases, clean up the hazmat spill What can my hospital do: –Hospital’s role

43. 2.10 Standard Operating Procedures Policies and Procedures Safety Manual Disaster (Emergency Preparedness) Plan –Example: Management of the Contaminated Patient What happens if you need to deviate from the plan? –Be flexible

44. 2.10 Watch Closely

45. 2.10 Module II Ops Summary Understand HEICS Understand available resources –ERG Terminology: LD50, PPM, FP Routes of exposure and Preventing Entry When to intervene Various roles

46. 2.10 Questions?