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Hospital Emergency Response Training (HERT) for Mass Casualty Incidents (MCI) Train-the-Trainer Course . Course Code: B461. HERT FOR MCI. Hospital Emergency Response Training (HERT) for Mass Casualty Incidents (MCI) Train-the-Trainer, B461 Course

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hospital emergency response training hert for mass casualty incidents mci train the trainer course

Hospital Emergency Response Training (HERT) for Mass Casualty Incidents (MCI) Train-the-Trainer Course

Course Code: B461

hert for mci
HERT FOR MCI
  • Hospital Emergency Response Training (HERT) for Mass Casualty Incidents (MCI) Train-the-Trainer, B461 Course
  • Resident Offering at Noble Training Center, Anniston, Alabama
  • 4.0 Days
  • Special offerings for hospital emergency departments, administration, and staff personnel
  • Prerequisites:
    • IS-195, Basic ICS
    • IS-346, An Orientation to Hazardous Materials for Medical Personnel

B461 Course

what hert for mci is not
What HERT for MCI is Not?
  • Not a HazMat Course. Need additional training under:
    • OSHA’s Hazardous Waste Operations and Emergency Response, 29 CFR 1910.120, par (q), 1990
    • OSHA 3152 Hospital and Community Emergency Response – What You Need to Know, 1997
    • OSHA’s Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving Hazardous Substance Releases, 2004
    • Department of Health and Human Services, CDC Recommendations for Civilian Communities Near Chemical Weapons Depots: Guidelines for Medical Preparedness, 1995
    • USACHPPM, Technical Guide 275, PPE for Military MTF Personnel Handling Casualties from WMD and Terrorist Events, 2003

B461 Course

what hert for mci is not cont d
What HERT for MCI is Not? (Cont’d)
  • Not a Hospital Emergency Incident Command System (HEICS) Course:
    • HERT stresses HEICS as a valuable tool for hospitals
    • Recognizes all Hospital Incident Management Systems (HIMS)
    • HERT emphasizes a hospital IMS during emergency response
    • HERT integrates its HIMS into all aspects of the course

B461 Course

what hert for mci is not cont d5
What HERT for MCI is Not? (Cont’d)
  • Not a Weapons of Mass Destruction (WMD) Course:
    • HERT emphasizes the handling of patients contaminated with CBRNE agents
    • Recognizes attendee’s prior training and skills concerning these agents
    • Attendees should receive additional training on WMD Events from ODP

B461 Course

what hert for mci is not cont d6
What HERT for MCI is Not? (Cont’d)
  • Not a National Incident Management System (NIMS) Course:
    • HERT emphasizes the use of an incident management system to comply with the NIMS
    • Recognizes attendee’s prior training in the NIMS
    • Has incorporated NIMS where it applies throughout the course
    • Participants wanting additional training should enroll in FEMA’s Online Courses in the NIMS:
      • IS 700 NIMS, An Introduction
      • IS 800 NRP, An Introduction

B461 Course

unit one

Unit One

Course Introduction: Origin of the Incident Command System (ICS)

objectives
Objectives
  • Review ICS as an incident management tool
  • List uses of ICS in emergency management
  • Describe the history of ICS
  • Discuss the evolution of HEICS
  • Define basic HEICS structure
  • Review ICS organizational chart

B461 Course

objectives cont d
Objectives (cont'd)
  • Develop an initial organizational structure
  • List minimum staffing requirements
  • Prepare an incident briefing
  • Participate in a planning meeting
  • Develop incident objectives and an Incident Action Plan (IAP)
  • Identify appropriate uses of resources

B461 Course

what is ics
What is ICS?
  • The model incident management tool for:
    • Command, control, and coordination of an emergency response
    • Providing a means to coordinate efforts of individual agencies
    • Allowing agencies to work toward a common goal for stabilizing an incident
    • Ensuring the protection of life, property, and the environment

B461 Course

when is ics used
When is ICS Used?
  • Hazardous materials incidents
  • Response to natural disasters
  • Fire and riot control
  • Incidents involving multiple casualties:
    • Weapons of Mass Destruction
    • Mass Casualty Events
  • Wide-area search and rescue missions

B461 Course

history of ics
History of ICS
  • Developed in the 1970s in response to major wild land fires in Southern California
  • Allowed for collaboration to form the:
    • Firefighting Resources of Southern California Organized for Potential Emergencies, or FIRESCOPE

B461 Course

history of ics cont d
History of ICS (cont'd)
  • FIRESCOPE identified several recurring problems involving multi-agency responses, such as:
    • Nonstandard terminology
    • Lack of flexibility to expand or contract resources as required
    • Nonstandard and nonintegrated communications
    • Lack of consolidated action plans
    • Lack of designated facilities

B461 Course

history of ics cont d14
History of ICS (cont'd)
  • Efforts to address these difficulties resulted in the development of an ICS model
  • Success of ICS has resulted directly from applying:
    • A command organizational structure
    • Key standardized management principles

B461 Course

niims versus nims
NIIMS (existing):

Incident Command System (ICS)

Training

Qualifications & Certification

Publications Management

Supporting Technology

NIMS (new):

Command & Incident Management

Preparedness

Resource Management

Communications Information & Intelligence Management

Science & Technology Management

NIIMS versus NIMS

B461 Course

hospital emergency incident command system heics
Hospital Emergency Incident Command System (HEICS)
  • Modeled after FIRESCOPE
  • Early work by the Northern California Hospital Council
  • California authorized a grant to Orange Country EMS for HEICS Project 91/92
  • Major rewrite of HEICS documents:
    • Now provide the current HEICS Plan
  • HEICS considered a model for hospital incident management system

B461 Course

heics attributes
HEICS Attributes
  • HEICS attributes:
    • Command, control, coordination, and intelligence
      • Functional incident management system
    • A dependable chain-of-command
    • Improved communications through common language
    • Flexibility in section (component) activation
    • Prioritization of duties
    • Adaptable to HazMat, WMD, and MCI

B461 Course

heics attributes cont d
HEICS Attributes (cont'd)
  • Organized documentation for improved financial recovery
  • Facilitates effective mutual aid with:
    • Other hospitals, and
    • Agencies

B461 Course

basic heics structure
Basic HEICS Structure
  • Basic units of structure:
    • Incident Commander
    • Section Chiefs
    • Directors
    • Unit Leaders
    • Officers

B461 Course

ics organizational chart
ICS Organizational Chart
  • Represents lines of authority and communications
  • Command element (IC and staff)
  • Four functional sections:
    • Planning
    • Operations
    • Logistics, and
    • Finance/Administration

B461 Course

ics organization

Incident

Command

Finance/

Planning

Operations

Logistics

Administration

Section

Section

Section

Section

ICS Organization

B461 Course

incident commander
Incident Commander
  • Incident Commander (IC):
    • Defines the mission and ensures its completion
    • Has overall control of incident or emergency response
    • Can appoint a deputy commander

B461 Course

command staff
Command Staff

Public Information Officer

IncidentCommand

Safety Officer

Liaison Officer

B461 Course

command staff cont d
Command Staff (cont'd)
  • Command Staff is:
    • Public Information Officer
    • Liaison Officer
    • Safety Officer
    • Officers can also have Assistants

B461 Course

general staff

Incident

Command

Planning

Operations

Logistics

Finance/

Section

Section

Section

Administration

Section

General Staff

B461 Course

planning section
Planning Section
  • Planning Section:
    • Determines and provides for the continuance of each response objective
    • Prompts and drives all Officers to develop:
      • Short-range action planning
      • Long-range action planning
    • Responsible for preparing the IAP

B461 Course

planning section cont d

Planning Section

Resource Unit

Situation Unit

Documentation Unit

Demobilization Unit

Planning Section (cont'd)

B461 Course

operations section
Operations Section
  • Operations Section:
    • Carries out the objectives to the best of the staff’s ability
    • Oversees and directs all response operations
    • Determines needs and requests additional resources

B461 Course

operations section cont d

Operations Section

Staging

Area(s)

Rescue

Medical

Multi-Casualty

HazMat Group

Branch

Branch

Branch

Operations Section (cont'd)

B461 Course

logistics section
Logistics Section
  • Logistics Section:
    • Provides a hospitable environment and materials for the overall objectives
    • Ensures service and support for responders

B461 Course

logistics section cont d

Logistics Section

Service Branch

Support Branch

Supply Unit

Ground Support Unit

Food Unit

Communications Unit

Medical Unit

Facilities Unit

Logistics Section (cont'd)

B461 Course

finance administration section
Finance/Administration Section
  • Finance/Administration Section:
    • Provides funding for present objectives
    • Stresses facility-wide documentation to maximize:
      • Financial recovery, and
      • Reduction of future liability

B461 Course

finance administration section cont d

Finance/Admin Section

Cost Unit

Time Unit

Procurement Unit

Compensation/Claims Unit

Finance/Administration Section (cont'd)

B461 Course

future of the ics
Future of the ICS
  • Continues to expand throughout U.S.:
    • Law enforcement
    • Government agencies
    • Hospitals and HCF
  • Will be revisited to ensure:
    • It remains relevant to response agencies, and
    • Current with standardized ICS models
  • Must be adaptable to include an ICS/UC structure for HMI, MCI, and WMD events
  • Should incorporate NIMS as adopted on March 1, 2004

B461 Course

unit two

Unit Two

Hospital Incident Management System (HIMS)

objectives36
Objectives
  • Describe Hospital Incident Management System for:
    • Planned & unplanned events
    • Mass casualty incidents
    • HazMat incidents
    • CBRNE events
  • Describe transfer of command

B461 Course

hims operations section members
HIMS – Operations Section Members
  • HIMS Operations Section could consist of:
    • Operations Section Chief
    • Group/Division Supervisors
      • CBRNE or HazMat Group
      • SHED or Cafeteria Division, etc.
        • Team Members
    • Triage and Treatment Unit Leaders
      • Triage and Treatment Team Members
    • Hospital Emergency Response Unit (HERU)
      • Team Members

B461 Course

hims operations section organization

Operations Section

CBRNE Group

SHED Division

Cafeteria Division

HIMS – Operations Section Organization

B461 Course

medical care group division members
Medical Care Group/DivisionMembers
  • Medical Care Group/Division could consist of:
    • Medical Group/Division Supervisor:
      • Triage Unit Leader
        • Triage personnel
      • Treatment Unit Leader
        • Treatment Dispatcher Manager
        • Treatment Managers
          • Immediate, Delayed and Minor
    • Patient Transport Group Supervisor
      • Medical Communications Coordinator
      • Air/Ground Ambulance Coordinator

B461 Course

medical care group division members cont d
Medical Care Group/DivisionMembers (Cont’d)
  • Command from the top down
  • Staff from the bottom up:
    • Start with Team or Unit when possible
    • Staff up as span of control is exceeded
  • Maintain unity of command
  • Divisions are geographical:
    • North/South; East/West; 1st floor/2nd floor

B461 Course

medical care group division members cont d41
Medical Care Group/DivisionMembers (Cont’d)
  • Groups are functional:
    • Security, medical care
    • CBRNE or HazMat
  • Groups can have Units:
    • Triage
    • Treatment
    • Hospital Emergency Response Unit (HERU)
  • Units may have Teams
    • Decontamination

B461 Course

medical care group division organization

Medical Care Group

/Division Supervisor

Medical Supply

Coordinator

Triage Unit

Treatment Unit

Leader

Leader

Treatment Dispatch

Triage Personnel

Manager

Immediate Treatment

Manager

Morgue Manager

Delayed Treatment

Manager

Minor Treatment

Manager

Medical Care Group/Division Organization

B461 Course

hazmat cbrne unit members
HazMat/CBRNE Unit Members
  • HazMat/CBRNE Unit Leader
  • Entry Team Leader
  • Hospital Site Access Control Leader
  • Safe Refuge Area Manager
  • Decontamination Team Leader
  • Technical Specialist
  • Assistant Hospital Safety Officer – HazMat

B461 Course

hazmat cbrne unit organization

HazMat/CBRNE

Unit

Entry

Hospital Access Control

Safe Refuge Area

Decontamination

Technical Specialists

HazMat/CBRNE Unit Organization

B461 Course

hospital emergency response unit heru
Hospital Emergency Response Unit* (HERU)
  • HERU Leader
    • Hospital Emergency Response Team (HERT) Leader
  • Initial Assessment & Triage
  • Immediate Treatment
  • Delayed Treatment
  • Minor Treatment

*Unit can be replaced by a Team

B461 Course

heru hert organization

HERU/HERT Leader

Delayed

Treatment

Initial

Assessment/

Triage

Immediate

Treatment

Minor

Treatment

HERU/HERT Organization

B461 Course

decon team members
Decon Team Members
  • Decontamination Team Leader
  • Initial Contact
  • Decon Triage*
  • Decon Site Access Control
  • Decon Set-up and Support

*Patient/victim is continually triaged

B461 Course

decon team organization

Decon Team Leader

Initial Contact

Decon Triage

Decon Site

Decon Set Up/

Access Control

Support

Decon Team Organization

B461 Course

scenario objectives
Scenario Objectives
  • Identify initial incident objectives
  • Incident priorities
    • Life Safety (staff and patients)
    • Incident Stability
    • Property preservation
  • Activate ICS
  • Fill positions as appropriate for the event
  • Key points:
    • Span of control (3 – 7)
    • Unity of command

B461 Course

scenario planned event
Noble Hospital is planning their annual fundraiser:

A two day Fish Fry Festival.

Saturday and Sunday,

Noon to 10 pm

Menu:

Fried catfish, Cole Slaw, Beans, Hush Puppies, Cornbread

Ice Cream Cones

Beer

Soda

Entertainment:

8 bands, 2 magician shows

Vendors:

20 Arts & Craft booths

Children’s Play area

Scenario – Planned Event

B461 Course

section considerations
Section Considerations
  • Initial Incident Objectives
  • What are the main functions for:
    • (Operations, Logistics, Planning and Finance/Admin)?
  • Should the functions be divided?
    • If so, how?

B461 Course

scenario unplanned event
Scenario – Unplanned Event
  • A complete, community-wide power outage has occurred approximately 20 minutes ago. United Electric Company has just informed you that there is a 50 mile blackout, cause is unknown. Outage expected to last 5-7 days.
  • Emergency generators functioning with enough fuel for 1.5 days at current emergency load. Emergency equipment is working only.
  • The following departments are not on emergency power:

Business office Registration

Infection Control Administration

Physical Therapy All offices in hospital

Pneumatic tube system

B461 Course

scenario unplanned event cont d
Scenario – Unplanned Event (Cont’d)
  • Departments on emergency power for critical functions:

Emergency Dept ICU/CCU Medical gases

Lab XRay Nursery

Surgery Recovery Nursing Units

Pharmacy Switchboard

  • Summer weather - 90°/58°
  • Population 250,000
  • Two hospitals, multiple clinics in area

Noble Hospital – 250 beds/85% full; total hospital staff 1800

B461 Course

section considerations54
Section Considerations
  • Initial Incident Objectives
  • What are the main functions for:
    • (Operations, Logistics, Planning and Finance/Admin)?
  • Should the functions be divided?
    • If so, how?

B461 Course

scenario mass casualty event
There was a stadium collapse at the fairgrounds.

Capacity of the stadium is 5000 people. Report from

EMS indicate over 300 people injured with many fleeing

the scene in private vehicles. The county Mass Casualty

Plan has been activated.

Summer weather - 90°/58°

Population 250,000

Two hospitals, multiple clinics in area

Noble Hospital – 250 beds/85% full; total hospital staff 1800

ED has 20 beds – currently has 16 patients

Scenario -- Mass Casualty Event

B461 Course

section considerations56
Section Considerations
  • Initial Incident Objectives
  • What are the main functions for:
    • (Operations, Logistics, Planning and Finance/Admin)?
  • Should the functions be divided?
    • If so, how?

B461 Course

scenario haz mat incident
Scenario – Haz Mat Incident

Continuation of stadium collapse

There were 20 people that were contaminated

With Organophosphate when the holding tank

was punctured from a piece of the stadium

Some have left the scene en-route to the

hospital. EMS will be transporting 6 after

gross decontamination (clothing removed

and field shower)

B461 Course

section considerations58
Section Considerations
  • Initial Incident Objectives
  • What are the main functions for:
    • (Operations, Logistics, Planning and Finance/Admin)?
  • Should the functions be divided?
    • If so, how?

B461 Course

transfer of command
Transfer of Command
  • Transfer command to an equal or more qualified person
  • Transfer of command requires:
    • Briefing of incident face to face
    • Notification of staff that transfer has occurred AND the name of the new person

B461 Course

transfer of command cont d
Transfer of Command (Cont’d)
  • Command transfers to a more qualified IC when necessary
  • The new IC will always receive a transfer-of-command briefing
  • Hospitals and healthcare facilities must identify and train deputy ICs

B461 Course

summary
Summary
  • ICS can be used for planned AND unplanned events involving the hospital
  • Make the response fit the event – only fill the positions that are needed
  • Maintain span of control (3 – 7 people)
    • Use branches and divisions as needed
    • Expand and contract assignments as needed
  • Transfer of Command must be done consistently and completely

B461 Course

summary cont d
Summary (Cont’d)

Incident priorities:

  • Life safety of care providers
  • Patient stability and treatment
  • Property conservation
  • Protect the environment

B461 Course

unit three

Unit Three

Topic 3-1: Chemical and Biological Agents in Terrorism

objectives64
Objectives
  • Overview of potential biological agents used in terrorism
  • Overview of potential chemical agents used in terrorism
  • Overview of common syndromes
  • Define clinical management procedures for chemical/biological agents
  • Define guidelines for response plans

B461 Course

bioterrorism cdc definition
Bioterrorism (CDC Definition)

“Bioterrorism is the intentional or threatened use of viruses, bacteria, fungi, toxins from living organisms or other chemicals to produce death or disease in humans, animals or plants.”

B461 Course

potential bioterrorism agents
Bacterial Agents

Anthrax

Brucellosis

Cholera

Pneumonic plague

Tularemia

Q Fever

Viruses

Smallpox

Venezuelan Equine Encephalitis

Viral Hemorrhagic Fever

Biological Toxins

Botulinum

Staph Entero-B

Ricin

T-2 Mycotoxins

Potential Bioterrorism Agents

B461 Course

mandatory reporting guidelines
Mandatory Reporting Guidelines

> Know your state and local guidelines

> Include them in your plans

AND

> Train your staff

B461 Course

cdc category definitions of diseases agents
CDC Category Definitions of Diseases/Agents
  • Category A - Highest priority
    • Can be easily disseminated or transmitted from person to person
    • Results in high mortality rates and have the potential for major public health impact
    • Might cause public panic and social disruption
    • Require special action for public health preparedness
  • Category A – Agents
    • Anthrax (Bacillus anthracis); Botulism (Clostridium botulinum toxin); Plague (Yersinia pestis); Smallpox (variola major); Tularemia (Francisella tularensis); and Viral hemorrhagic fevers (filoviruses [e.g., Ebola, Marburg] and arenaviruses [e.g., Lassa, Machupo])

B461 Course

cdc category definitions of diseases agents cont
CDC Category Definitions of Diseases/Agents (cont)
  • Category B – Second highest priority
    • Moderately easy to disseminate
    • Result in moderate morbidity rates and low mortality rates
    • Require special enhancements of CDC’s diagnostic capacity and enhanced disease surveillance
  • Category B – Agents
    • Brucellosis (Brucella species); Epsilon toxin of Clostridium perfringens; Food safety threats (e.g., Salmonella species, Escherichia coli O157:H7, Shigella); Glanders (Burkholderia mallei); Melioidosis (Burkholderia pseudomallei); Psittacosis (Chlamydia psittaci); Q fever (Coxiella burnetii)

B461 Course

cdc category definitions of diseases agents cont71
CDC Category Definitions of Diseases/Agents (cont)
  • Category B – Agents (Cont)
    • Ricin toxin from Ricinus communis (castor beans); Staphylococcal enterotoxin B»Typhus fever (Rickettsia prowazekii); Viral encephalitis (alphaviruses [e.g., Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis]); and Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)

B461 Course

cdc category definitions of diseases agents cont72
CDC Category Definitions of Diseases/Agents (cont)
  • Category C – Third highest priority
    • Includes emerging pathogens that could be engineered for mass dissemination in the future because of

> availability

> ease of production and dissemination

> potential for high morbidity/mortality

rates and major health impact

  • Category C – Agents
    • Nipah virus and hantavirus

B461 Course

most common syndromes in biological events
Most Common Syndromes in Biological Events
  • Flu-like illnesses
  • Acute respiratory symptoms with fever
  • Gastrointestinal symptoms/syndromes
  • Skin lesions (small pox)
  • Acute neuromuscular syndromes

Compliments of CDC/NIP/Barbara Rice

B461 Course

clues to biological potential events
Clues to Biological Potential Events
  • Increase in the number of patients with similar symptoms
  • Large number of deaths
  • Cluster of an illness from single area
  • Infection that is not endemic to area
  • Common infections in unusual seasons
  • Increase/large number of sick/dead animals
  • Intelligence from law enforcement
  • Stated threat

B461 Course

priorities for response all hazards
Priorities for Response(All Hazards)
  • Life safety
    • Staff
    • Victims
  • Incident stability
  • Property preservation
  • Protection of the environment

B461 Course

response considerations for biological event
Response Considerations for Biological Event
  • Planning:
    • Develop policies and procedures for:
      • recognition
      • notification
      • isolation/quarantine
  • Pre-exposure:
    • Active immunization
    • Prophylaxis
    • Intelligence information

B461 Course

response considerations for biological event cont d
Response Considerations for Biological Event (Cont’d)
  • Incubation Period:
    • Diagnosis
    • Active/passive immunization
    • Antimicrobial treatment
    • Public Health needs (isolation/quarantine)
  • Active Disease Period:
    • Diagnosis
    • Treatment (guided by diagnosis & symptoms)
    • Public Health needs (isolation/quarantine)

B461 Course

clinical consideration for biological event
Clinical Consideration for Biological Event
  • Basic supplies/address surge capacity:
    • Beds/linens
    • Waste management
    • Lab supplies
    • Medical supplies:
      • IV solutions and supplies
      • Antibiotics (if needed)
      • Other medications

B461 Course

clinical consideration for biological event cont d
Clinical Consideration for Biological Event (Cont’d)
  • Additional needs:
    • Extended staffing plan (clinical/non-clinical)
    • Medical staffing plan
    • Mass casualty plan
    • Mass fatality plan
    • Media management plan (Joint Information Center)
      • Mechanism to provide updates/info to staff

B461 Course

clinical consideration for biological event cont d80
Clinical Consideration for Biological Event (Cont’d)
  • Additional needs:
    • Infection Control Practitioner (from hospital)
    • Public Health representative
    • Considering activating the hospital ICS/UCS
    • Family support area
    • Pharmaceutical stockpiles

B461 Course

key points
Key Points
  • Some exposures may require decontamination but most do not
  • Large events may overwhelm your system
  • Assure that the right people are notified and included in the response
    • Implement Incident Command System

B461 Course

reminders
Reminders
  • Determine alternate care sites in the Planning Phase
  • Work with community partners in the Planning Phase

B461 Course

potential chemical agents
Potential Chemical Agents
  • Nerve Agents
  • Blister Agents (vesicants)
  • Pulmonary Agents
  • Blood Agents (cyanides)
    • Toxic Industrial Chemicals
  • Riot Control Agents

View from World Trade Center. Compliment of CDC.

B461 Course

comparative toxicity of agents
Comparative Toxicity of Agents

6000

5000

4000

Ct50

(mg-min/m3)

3000

2000

1000

0

CL

CG

AC

H

GB

VX

AGENT

(L)

(L)

(L)

(L)

(L)

(L)

B461 Course

nerve agents
Nerve Agents
  • Actions:
    • Interferes with the action of the nervous system
    • Similar to organophosphates
  • Types:
    • Sarin (GB)
    • Tabun (GA)
    • Soman (GD)
    • GF
    • VX

Tokyo, Japan Response to Sarin Attack.

B461 Course

blister agents
Blister Agents
  • Actions:
    • Cause cellular damage leading to cellular death (skin, mucous membranes, eyes, systemic effects)
    • Effects begin immediately, but blisters may be delayed (mustard)
  • Types:
    • Mustard aka “mustard gas” (H)
    • Sulfur mustard (HD)
    • Lewisite (L)
    • Mustard and Lewisite (HL)
    • Phosgene Oxime (CX):
      • Pulmonary agent with vesicant effects

Iran Victim of Mustard Agent Attack, CDC

B461 Course

pulmonary agents

Pulmonary edema. Compliments of CDC.

Pulmonary Agents
  • Actions:
    • Damages the lining in the lung and cause fluid leakage
    • Delayed pulmonary edema
  • Types:
    • Phosgene (CG)
    • Chlorine (CL)
    • Ricin

B461 Course

blood agents cyanides
Blood Agents: Cyanides
  • Actions:
    • Blocks the use of oxygen in the cells of the body
      • Causing asphyxiation in each cell
    • Least toxic of the “lethal” chemical agents
  • Types:
    • AC and CK
  • Toxic industrial chemicals (TIC):
    • Chlorine, ammonia, arsenic
    • Hydrocarbon (benzene)
    • Highly toxic, corrosive and irritating chemicals
  • Likely terrorist’s targets of opportunity

B461 Course

riot agents
Riot Agents
  • Actions:
    • Causes irritation to eyes, mouth, throat, lungs and skin
    • Immediate symptoms are intense and cause people to try and stop the effects
  • Types:
    • Mace
    • Pepper Spray

B461 Course

clues to potential chemical exposure
Clues To Potential Chemical Exposure
  • Shortness of breath/respiratory difficulty
  • Itchy/burning/watery eyes
  • Runny nose
  • Skin irritation
  • SLUDGE
  • Patients reporting odor just prior to symptoms

B461 Course

clues to potential chemical exposure cont
Clues To Potential Chemical Exposure (Cont)
  • Increase number of patients with same symptoms
  • Sick/dead animals and birds
  • Sick/affected first responders
  • Intelligence from lawenforcement
  • Stated threat

B461 Course

planning considerations for chemical agents
Planning Considerations for Chemical Agents
  • Planning Phase
    • Hazard assessment
    • Designate Triage and Decon areas
    • Develop Respiratory Protection Program
    • Develop Decontamination Program
    • Implement Incident Command System
    • Purchase equipment
    • Develop policies and procedures
    • Train staff
    • Practice and exercise

B461 Course

response plan considerations for chemical agents
Response Plan Considerations for Chemical Agents
  • Recognition
  • Prevent secondary contamination
    • Escort patient immediately outside/to decon area
  • Initiate hospital HazMat response:
    • Notify appropriate staff
    • Don appropriate CPC&E

B461 Course

response plan considerations for chemical agents cont
Response Plan Considerations for Chemical Agents (Cont)
  • Determine need for decontamination
  • Decontaminate patients
    • Provide appropriate medical care
  • Decontaminate staff
  • Secure area
  • Decontaminate equipment, as appropriate

B461 Course

antidotes are available for some chemical agents
Antidotes Are Available forSome Chemical Agents
  • Nerve agents/organophosphates
    • Atropine – blocks the effects of the chemical that causes over stimulation
    • 2PAMCl – neutralizes the nerve agent actions
    • CANA – Convulsive Antidote, Nerve Agent
      • Diazepam, when required
  • Cyanide
    • Cyanide Kit contains
      • Amyl nitrate (inhalant)
      • Sodium nitrite (injectable)
      • Sodium thiosulfate (injectable)

B461 Course

hospital partners for biological chemical response plans

PIO

ED Staff

Legal

Risk & Materials Management

Housekeeping

Patient

Laboratory

Clinical Services

Infection Control

Hospital Emergency Management

Plant Operations

Administration

Hospital Partners for Biological & Chemical Response Plans

HazMat Team

B461 Course

community partners for biological chemical response plans

EMS

CDC

Local Health Dept

LEPC

County Emergency Management

Local Haz Mat Team

Hospital

State Lab

Law Enforcement

Elected Officials

Media

State Health Dept

Coroner

FBI

Community Partners for Biological & Chemical Response Plans

B461 Course

key points98
Key Points
  • Some exposures may require decontamination but you must determine if patient was actually contaminated
  • Large events may overwhelm your system quickly and without notice
  • Notified and included the right people in the response

B461 Course

summary99
Summary
  • Routes of exposure for chemical and biological agents
  • Overview of some potential biological and chemical agents used in terrorism
  • Overview of common syndromes
  • Guidelines for response plans

B461 Course