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HOSPITAL BIOTERRORISM PREPAREDNESS. 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

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hospital bioterrorism preparedness

HOSPITAL BIOTERRORISM PREPAREDNESS

COUNTY OF LOS ANGELES

EMERGENCY MEDICAL SERVICES AGENCY

overview of the hrsa grant
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

County of Los Angeles Emergency Medical Services Agency

overview of the hrsa grant3
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

County of Los Angeles Emergency Medical Services Agency

purpose of the hrsa grant
Purpose of the HRSA Grant

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

County of Los Angeles Emergency Medical Services Agency

purpose of the hrsa grant5
Purpose of the HRSA Grant
  • Focus on:
    • Hospitals
    • Emergency Departments
    • Outpatient centers
    • EMS systems
    • Other collaborating health care entities

County of Los Angeles Emergency Medical Services Agency

hrsa grant requirements
HRSA Grant Requirements
  • Critical Benchmarks
  • First Priority Planning Areas
  • Second Priority Planning Areas

County of Los Angeles Emergency Medical Services Agency

critical benchmarks
Critical Benchmarks
  • Program Leadership
    • Coordinator
    • Medical Director
    • Support Staff
  • Hospital Bioterrorism Preparedness Planning Committee
  • Regional Planning

County of Los Angeles Emergency Medical Services Agency

hospital bioterrorism preparedness planning committee
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.

County of Los Angeles Emergency Medical Services Agency

first priority planning areas
First Priority Planning Areas
  • Medications and vaccines
    • Recommended Hospital Pharmaceutical Stock
  • Personal Protective Equipment (PPE), Decontamination, Quarantine
  • Communications
  • Biologic Disaster Drills

County of Los Angeles Emergency Medical Services Agency

second priority planning areas
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

County of Los Angeles Emergency Medical Services Agency

coordination and collaboration
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

County of Los Angeles Emergency Medical Services Agency

needs assessment
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

County of Los Angeles Emergency Medical Services Agency

los angeles county plan
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.

County of Los Angeles Emergency Medical Services Agency

los angeles county plan14
Los Angeles County Plan
  • Personal Protective Equipment
  • Decontamination Capabilities
  • Pharmaceuticals and Disaster Staging
  • Communications

County of Los Angeles Emergency Medical Services Agency

hospital participation
Hospital Participation

WHAT DO I GET?

WHAT DO I HAVE TO DO TO GET IT?

County of Los Angeles Emergency Medical Services Agency

hospital receivables
Hospital Receivables

Basic Level

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

County of Los Angeles Emergency Medical Services Agency

hospital receivables17
Hospital Receivables

Expanded Level

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

County of Los Angeles Emergency Medical Services Agency

personal protective equipment
Personal Protective Equipment
  • PPE worth $10,000
  • Group purchased by Los Angeles County and given to the hospitals
    • Standardization
    • Purchasing power reducing cost

County of Los Angeles Emergency Medical Services Agency

personal protective equipment19
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

County of Los Angeles Emergency Medical Services Agency

personal protective equipment20
Personal Protective Equipment

Level C

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

County of Los Angeles Emergency Medical Services Agency

decontamination team training
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

County of Los Angeles Emergency Medical Services Agency

mass casualty decontamination capabilities
Mass CasualtyDecontamination Capabilities
  • Fixed turnkey warm water operation capable of decontaminating 50 ambulatory patients/hour
  • Minimum of $20,000 toward construction

County of Los Angeles Emergency Medical Services Agency

hospital deliverables basic and expanded
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

County of Los Angeles Emergency Medical Services Agency

hospital deliverables basic and expanded24
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

County of Los Angeles Emergency Medical Services Agency

hospital deliverables
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

County of Los Angeles Emergency Medical Services Agency

slide26

Mass Casualty

Decontamination

at Hospitals

County of Los Angeles Emergency Medical Services Agency

slide27

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.

County of Los Angeles Emergency Medical Services Agency

slide28

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

County of Los Angeles Emergency Medical Services Agency

slide29

Hospital Mass Casualty Decontamination

Types of Decontamination:

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

County of Los Angeles Emergency Medical Services Agency

hospital mass casualty decontamination decontamination process
Hospital Mass Casualty DecontaminationDecontamination Process
  • Triage
  • Remove and bag clothes
  • Shower soak/flush
  • Detergent soap scrub with sponge
  • Shower rinse
  • Dry and dress

County of Los Angeles Emergency Medical Services Agency

slide31

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

County of Los Angeles Emergency Medical Services Agency

slide32

Setting up the Contamination Reduction Corridor:

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

County of Los Angeles Emergency Medical Services Agency

slide33

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

Air Cart

Manager/

Safety

Officer

Support Zone

County of Los Angeles Emergency Medical Services Agency

slide35

Setting up the Contamination Reduction Corridor:

What is required:

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

Will become part

of the employers

emergency plan

County of Los Angeles Emergency Medical Services Agency

slide36

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.

County of Los Angeles Emergency Medical Services Agency

slide37

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.

County of Los Angeles Emergency Medical Services Agency

slide38

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

County of Los Angeles Emergency Medical Services Agency

slide39

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

County of Los Angeles Emergency Medical Services Agency

slide40

Setting up the Contamination Reduction Corridor:

ADDITIONAL CONCERNS:

  • Site security
  • Force protection
  • Evidence Collection

Must be “coordinated with law enforcement”.

County of Los Angeles Emergency Medical Services Agency

draw back of portable equipment
Draw back of portable equipment
  • Number of people needed to set it up
  • The time it takes to set it up

County of Los Angeles Emergency Medical Services Agency

draw back of portable equipment42
Draw back of portable equipment

County of Los Angeles Emergency Medical Services Agency

fixed mass casualty decon conex trailers or permanent tents
Fixed Mass Casualty DeconConex Trailers or Permanent Tents

County of Los Angeles Emergency Medical Services Agency

fixed mass casualty decon corridor or alleyway
Fixed Mass Casualty DeconCorridor or Alleyway

County of Los Angeles Emergency Medical Services Agency

fixed mass casualty decon corridor or alleyway45
Fixed Mass Casualty DeconCorridor or Alleyway

County of Los Angeles Emergency Medical Services Agency

fixed mass casualty decon corridor or alleyway46
Fixed Mass Casualty DeconCorridor or Alleyway

County of Los Angeles Emergency Medical Services Agency

fixed mass casualty decon corridor or alleyway47
Fixed Mass Casualty DeconCorridor or Alleyway

County of Los Angeles Emergency Medical Services Agency

mass casualty decontamination capabilities48
Mass Casualty Decontamination Capabilities
  • Issues being addressed
    • Water run-off containment
    • Office of Health Planning and Development requirements for Healthcare facilities

County of Los Angeles Emergency Medical Services Agency

hospital preparedness
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

County of Los Angeles Emergency Medical Services Agency

hospital agreement
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

County of Los Angeles Emergency Medical Services Agency

contact information
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

County of Los Angeles Emergency Medical Services Agency

questions

Questions?

County of Los Angeles Emergency Medical Services Agency