Biomedical Engineering Reference
In-Depth Information
public safety agencies and may require substan-
tial revision of those agencies' existing policies,
procedures, and mutual aid agreements:
to direct patients and families to appropriate
entrances will speed emergency implementation
and improve compliance. All doors with outside
access should be numbered in a simple, consec-
utive fashion, so that staff may be sent to secure
“door number two” rather than “northwest access
1.4.” Once in place, this numbering system can
be added to facility floorplans and shared with
public safety agencies for routine, emergency,
and disaster response.
Meet with local law enforcement agencies
:
Hospitals are essential resources during disas-
ters and may be targets of terrorism. Law
enforcement must see protection of hospitals
as a high priority. Everyday security resources,
where present, are likely to be insufficient
during disasters, particularly those involving
terrorism. If possible, special units may be iden-
tified and preassigned to hospitals; this ideal
arrangement removes a decision step during an
incident.
•
1.14 Decontamination
Focus on the achievable. The biggest step is
to be able to decontaminate a single patient
without endangering staff, patients, or visitors and
without rendering the ED unavailable to incoming
traffic [36]. Only when and if that step is
achieved is it appropriate to examine multi-patient
scenarios. Industrial incidents can contaminate
several patients, making multi-patient capability
particularly important for hospitals in industrial
areas. Most incidents resulting in contaminated
patients occur at fixed facilities or in agricultural
applications [37], but they can happen anywhere
there is a transportation route; moreover, contam-
inated patients do not always go to the nearest
hospital. The leap from multi-patient to mass
decontamination is expensive, requires far more
extensive training and drilling, and may be unre-
alistic (both in capabilities and likelihood) for
smaller facilities. For facilities where mass decon-
tamination is considered a legitimate potential
need, temporary facilities will likely need to
be established; either “dry” decontamination or
self-disrobement and decontamination (“strip and
shower”) [38] should be seriously considered.
Whether in the form of trailers, tents, canopies, or
large open areas, equipment (and training) must
be provided with the foreknowledge that it will be
used rarely if at all. This is an important consid-
eration: the greatest likelihood is that employees'
only exposure to the knowledge, skills, abilities,
and decision-making processes involved in mass
decontamination will be gained and applied only
in training and exercises.
•
Consider private security to provide or augment
protection
: Although private security guards do
not have powers of arrest, they can provide
substantial numbers for securing facility access.
Some private security companies provide
bonded personnel, trained and equipped for use
of lethal and non-lethal force, but the pres-
ence of a trained, uniformed staff may be the
most important. Contrary to popular percep-
tion and many exercise scenarios, panicking
mobs overrunning hospitals are not a realistic
expectation [32-35]. If numerous self-referred
patients arrive at a hospital and are met with
clear information and directions, they will
likely comply. Incorporation of private secu-
rity personnel into emergency plans should
include specifications of available staff, call-
up procedures, and consultation with local law
enforcement regarding policies and procedures
for disasters.
Make lockdown a realistic part of the plan
:
Facilities in a multi-hospital region should reach
consensus on a functional definition and share
it with local emergency management and public
safety providers. All staff should understand
the purpose of lockdown and when and how
it is to be implemented. Internal training and
resources should include readily understandable
designation for building entrances and exits.
Prepositioned, or readily available, signage and
pre-scripted messages (both for public address
systems and local media broadcast as needed)
•
