1. HOSPITAL BIOTERRORISM PREPAREDNESS COUNTY OF LOS ANGELES EMERGENCY MEDICAL SERVICES AGENCY

2. County of Los Angeles Emergency Medical Services Agency 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. County of Los Angeles Emergency Medical Services Agency 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. County of Los Angeles Emergency Medical Services Agency Purpose of the HRSA Grant Develop and implement regional plans to improve the response to bioterrorism (or other outbreaks of infectious disease) incidents.

5. County of Los Angeles Emergency Medical Services Agency Purpose of the HRSA Grant Focus on: –Hospitals –Emergency Departments –Outpatient centers –EMS systems –Other collaborating health care entities

6. County of Los Angeles Emergency Medical Services Agency HRSA Grant Requirements  Critical Benchmarks  First Priority Planning Areas  Second Priority Planning Areas

7. County of Los Angeles Emergency Medical Services Agency Critical Benchmarks Program Leadership –Coordinator –Medical Director –Support Staff Hospital Bioterrorism Preparedness Planning Committee Regional Planning

8. County of Los Angeles Emergency Medical Services Agency 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 County’s healthcare bioterrorism response.

9. County of Los Angeles Emergency Medical Services Agency First Priority Planning Areas Medications and vaccines –Recommended Hospital Pharmaceutical Stock Personal Protective Equipment (PPE), Decontamination, Quarantine Communications Biologic Disaster Drills

10. County of Los Angeles Emergency Medical Services Agency 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. County of Los Angeles Emergency Medical Services Agency 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. County of Los Angeles Emergency Medical Services Agency 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. County of Los Angeles Emergency Medical Services Agency 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. County of Los Angeles Emergency Medical Services Agency Los Angeles County Plan Personal Protective Equipment Decontamination Capabilities Pharmaceuticals and Disaster Staging Communications

15. County of Los Angeles Emergency Medical Services Agency Hospital Participation WHAT DO I GET? WHAT DO I HAVE TO DO TO GET IT?

16. County of Los Angeles Emergency Medical Services Agency Hospital Receivables Basic Level –Personal Protective Equipment (PPE) –Training of Decontamination Team

17. County of Los Angeles Emergency Medical Services Agency Hospital Receivables Expanded Level –Personal Protective Equipment –Training of Decontamination Team –Funding for Mass Casualty Decontamination Capability

18. County of Los Angeles Emergency Medical Services Agency Personal Protective Equipment PPE worth $10,000 Group purchased by Los Angeles County and given to the hospitals –Standardization –Purchasing power reducing cost

19. County of Los Angeles Emergency Medical Services Agency 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. County of Los Angeles Emergency Medical Services Agency Personal Protective Equipment Level C –Splash Suit –Nitrile gloves –Boots Patient Privacy Kit

21. County of Los Angeles Emergency Medical Services Agency 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. County of Los Angeles Emergency Medical Services Agency Mass Casualty Decontamination Capabilities Fixed turnkey warm water operation capable of decontaminating 50 ambulatory patients/hour Minimum of $20,000 toward construction

23. County of Los Angeles Emergency Medical Services Agency Hospital Deliverables Basic 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. County of Los Angeles Emergency Medical Services Agency Hospital Deliverables Basic 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. County of Los Angeles Emergency Medical Services Agency Hospital Deliverables Decontamination Capability Basic Level –Describe hospital’s capability Expanded Level –Fixed turnkey warm water structure capable of decontaminating 50 ambulatory individuals per hour

26. County of Los Angeles Emergency Medical Services Agency Mass Casualty Decontamination at Hospitals Mass Casualty Decontamination at Hospitals

27. County of Los Angeles Emergency Medical Services Agency Hospital Mass Casualty Decontamination 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. The Challenge:

28. County of Los Angeles Emergency Medical Services Agency 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 Hospital Mass Casualty Decontamination

29. County of Los Angeles Emergency Medical Services Agency Types of Decontamination: Types of Decontamination: Emergency Respiratory Primary Secondary Equipment Mass Casualty -Incident Site -Hospital Hospital Mass Casualty Decontamination

30. County of Los Angeles Emergency Medical Services Agency Hospital Mass Casualty Decontamination 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. County of Los Angeles Emergency Medical Services Agency 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 Hospital Mass Casualty Decontamination

32. County of Los Angeles Emergency Medical Services Agency Setting up the Contamination Reduction Corridor: Personnel Water Decon solutions Air supplies Protective clothing Electricity/utilities Miscellaneous tools

33. County of Los Angeles Emergency Medical Services Agency Setting up the Contamination Reduction Corridor: SafeRefugeArea Wind Exclusion Zone Support Zone ContaminationReductionZone Air Cart Manager/ Safety Officer Washer Rinser Welfare Decon Leader Staging&TreatmentArea Down Slope Safe Refuge Manager/ Triage 100 feet CRC

34. County of Los Angeles Emergency Medical Services Agency

35. Setting up the Contamination Reduction Corridor: Planning Equipment Identification Coordinating Training Exercising Documentation Will become part of the employers emergency plan Will become part of the employers emergency plan What is required:

36. County of Los Angeles Emergency Medical Services Agency 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. County of Los Angeles Emergency Medical Services Agency 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. Setting up the Contamination Reduction Corridor:

38. County of Los Angeles Emergency Medical Services Agency 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 Setting up the Contamination Reduction Corridor:

39. County of Los Angeles Emergency Medical Services Agency 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 When the decontamination operation is over: Setting up the Contamination Reduction Corridor:

40. County of Los Angeles Emergency Medical Services Agency Site security Force protection Evidence Collection Must be “coordinated with law enforcement”. ADDITIONAL CONCERNS: Setting up the Contamination Reduction Corridor:

41. County of Los Angeles Emergency Medical Services Agency Draw back of portable equipment Number of people needed to set it up The time it takes to set it up

42. County of Los Angeles Emergency Medical Services Agency Draw back of portable equipment

43. County of Los Angeles Emergency Medical Services Agency Fixed Mass Casualty Decon Conex Trailers or Permanent Tents

44. County of Los Angeles Emergency Medical Services Agency Fixed Mass Casualty Decon Corridor or Alleyway

45. County of Los Angeles Emergency Medical Services Agency Fixed Mass Casualty Decon Corridor or Alleyway

46. County of Los Angeles Emergency Medical Services Agency Fixed Mass Casualty Decon Corridor or Alleyway

47. County of Los Angeles Emergency Medical Services Agency Fixed Mass Casualty Decon Corridor or Alleyway

48. County of Los Angeles Emergency Medical Services Agency Mass Casualty Decontamination Capabilities Issues being addressed Water run-off containment Office of Health Planning and Development requirements for Healthcare facilities

49. County of Los Angeles Emergency Medical Services Agency 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. County of Los Angeles Emergency Medical Services Agency 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 CEO’s in August 2002 Contracts completed by December 2002

51. County of Los Angeles Emergency Medical Services Agency Contact Information Dr. John Celentano, M.D., Disaster Medical Officer (323) 890-7588, jcelentano@dhs.co.la.ca.us Kay Fruhwirth, RN, MSN Hospital Bioterrorism Preparedness Coordinator (323) 890-7583, kfruhwirth@dhs.co.la.ca.us Carol Gunter, RN, MHA; Assistant Director (323) 890-7539, cgunter@dhs.co.la.ca.us

52. County of Los Angeles Emergency Medical Services Agency Questions?