1. Making a Case for Hospital Decontamination -A Community Issue- Presented by: Jan Glarum

2.  Discuss cases of hospital employee exposure to hazardous materials  Discuss common factors of exposures ◦ New Trends ◦ Probability  Discuss mitigation strategies

3.  About 9000 releases of hazardous substances occur annually, with 75% occurring at chemical facilities and 25% occurring during transportation.

4.  In 15 Study States: ◦ Fact: Most incidents occur at fixed sites- Application: Your hospital HVA should drive preparedness. ◦ Fact: One quarter of the exposures occur during transit – ◦ Application: Trauma centers need to have a plan to care for trauma patients who are contaminated

5.  > 2000 victims of hazardous materials releases each year.  Approximately 50% of these are transported to hospitals.  > 7500 people required decontamination during HAZMAT events. ◦ Of these, 2643 were decontaminated at medical facilities. (data from 15 study states )

6.  The Southampton Hospital Emergency Department entrance was shut down after a man attempted to commit suicide by mixing chemicals in his car, which was parked at the ER entrance.  Data indicates there were 75 chemical suicides during 1999-2010 with increasing numbers each year.

7.  The toxic gases most commonly formed by combining the chemicals in household cleaners are hydrogen sulfide and hydrogen cyanide.

8.  Hydrogen sulfide, odor is often described as that of rotten eggs, but even a short exposure can cause olfactory fatigue. At low doses, exposure to hydrogen sulfide can cause eye and respiratory irritation, headache, dizziness, loss of appetite, and upset stomach. Brief exposures to high concentrations can cause loss of consciousness and death.  Hydrogen cyanide is a bluish-white liquid or a colorless gas with a faint odor of bitter almonds and a bitter, burning taste. Hydrogen cyanide can cause changes in respiration depth, confusion, and asphyxia.

9.  Best option is to train ED staff to:  Suspect  Recognize  Decon and Treat  Be prepared for chemical suicide events.

10. Courtesy FEMA

11.  Suicide attempt by ingestion of 14 Oz of Malathion (organophosphate) and ETOH.  Symptoms - HR, respiratory depression, vomiting, diarrhea and diaphoresis.  ED Treatment included airway control (ET) and Atropine. Courtesy FEMA

12.  Good news – patient transported to ED with bottle of ingested poison.  Not So Good News – ◦ No decontamination in spite of emesis ◦ EMS not wearing appropriate PPE for hazard ◦ EMS did not notify ED staff of the product ingested Courtesy FEMA

13.  Strong chemical odor from patient – hospital staff exhibited signs/symptoms of poisoning  HAZMAT, Poison Control and County Health Contacted  ED evacuated and shut down Courtesy FEMA

14. Employee 1Employee 2Employee 3Employee 4Employee 5 Nausea, Eye Irritation, Dyspnea, Blurred Vision, Headache, Confusion, Restlessness, Agitation, Weakness, Asphyxia, Syncope and Slurred Speech Nausea, Vomiting, Dizziness, Headache, Dry Throat Nausea, Eye Irritation, Dizziness, Sore Throat, Dry Throat, Skin Irritation Nausea, Eye Irritation, Headache, Dry Throat, Skin Irritation Eye Irritation, lightheadedness, Skin Irritation NurseHousekeeperRespiratory Therapist Respiratory Technician Symptom Onset 15-30 minutes Symptom Onset within 2 hours Symptom Onset Immediate Symptom Onset within 1/2-2 hours Symptom Onset Unknown GlovesDouble Gloves, Mask, Hair Covering, Shoe Covering Mask and GlovesGloves, later a half mask respirator Unknown Hazmat Training Unknown

15.  Field notification of chemical poisoning and potential for secondary contamination and share with staff Courtesy FEMA

16.  Verification of decontamination of patient Courtesy FEMA

17.  Patient decontamination and treatment in well-ventilated area Courtesy FEMA

18.  Employees have access to immediate washing after direct exposure to body secretions or vomitus Courtesy FEMA

19.  Ensure training and exercises are adequate and appropriate PPE, supplies and antidotes are available as needed. Courtesy FEMA

20.  Initial priorities as taught in ICS are: ◦ 1. Life safety ◦ 2. Incident Stabilization Courtesy FEMA