Biomedical Engineering Reference
In-Depth Information
in a specially designed room within the hospital.
Frequently this task is relegated to the PCA and
aide staff, perhaps under the supervision of a
nurse or physician. It is likely that the PCA will
have the closest contact with the contaminated
patient. Appropriate training in various types of
PPE and the equipment used in decontamination
are important. The skill needed to decontaminate
patients while dressed in PPE needs to be practiced
frequently if they are expected to be proficient at
it. The need for realistic drills with live patients
who “get wet” is invaluable.
Besides the decontamination aspect of their job,
the PCA/aide staff are the support staff that make
the emergency department work. Training in the
use and location of specialized equipment that is
used in the event of a terror attack (where the
disaster cache is located) and how it should be
distributed are all-important aspects of this role.
Knowing where the cyanide antidote kit, or where
the multi-port oxygen regulator is and how to set
it up can be lifesaving.
The PCA and aide staff while the lowest level of
healthcare providers can often be essential to emer-
gency department operations during a disaster.
The group of emergency department health-
care providers likely to be the group that will
be expected to have the most varied training are
nurses and paramedics. From a patient care stand-
point they will need to know the presentations
and treatments of the patients they will receive.
From a logistics perspective, they will need to
receive training to make those treatments happen.
The decontamination procedures and PPE use will
also have to be practiced and learned. Commonly
nurses and paramedics will assist both physicians
in the treatment of the patient and the PCAs and
aides with logistics and patient decontamination.
As a hospital, training should consist of the
Hospital Emergency Incident Command course
for those expected to be in leadership positions.
Practice realistic drills and making changes to the
emergency plan after the drill to accommodate
weaknesses identified. After a terror attack, civil-
ians will be in a state fear. They will look for lead-
ership and structure, and they will expect it from
the hospital staff. The best way to have structure
is to function under a well-practiced plan. Many
hospitals fail to have realistic drills. This in turn
may lead to the assumption that all is well with the
plan until an actual event occurs and the opposite
is learned. There is no substitute for a well planned
drill with live patients.
9.3 Planning
When planning for a emergency department
response to a terror attack, some basic concepts
will need to be addressed. These include the flow
of patient traffic into and through the emergency
department, security of the emergency depart-
ment, establishing decontamination and accessing
specialized equipment caches. Other items to
consider include staff call back and supplementa-
tion, research on the type of incident and parking.
When a hospital compiles its plan, consider-
ation must be given to planning with and
around the hospital as a whole. Plans should be
focused as “all-hazards” with annexes based upon
threat/incident. Early integration of the hospital
plan with the local city, county and statewide plan
will need to be taken into consideration. Planning
by hospitals is all too often done in a vacuum.
Partnering with outside agencies during the plan-
ning phase will prevent unexpected surprises when
a disaster strikes.
A good example here is planning on the police
to be able to lockdown the facility, without first
checking with them. There is a great likelihood
that they will not be available.
9.4 Patient Flow
How many entrances are there to the Emergency
Department? Most have an ambulance entrance, a
walk-in entrance and one or more entrances from
the main hospital. How will you receive patients
during a terror attack? Will it make a difference
which entrance they use?
By limiting access to the Emergency Depart-
ment, you can control the areas that are potentially
contaminated by patients. (While many hospitals
have decontamination showers that can be set up
outside of the hospital entrance, most do not have
