Biomedical Engineering Reference
In-Depth Information
most situations and would be locked up in a closet
with all of the other patient belongings that the Secu-
rity Department collected that day. Obviously, over
the past several years, the paradigm has yet again
shifted. Hospitals now need to take a long, hard look
at their decontamination and property collection and
storage practices.
Very few hospitals were in the practice of
“gross” and “technical decontamination” prior to
the events of 9-11-01. Very few hospitals have
arranged for a response team of clinical personnel
in fully encapsulated suits with Powered Air Puri-
fying Respirators (PAPRs) to respond outside of
the ED entrance to greet victims from a potential
exposure. In this day and age, the hospital has to
learn from lessons of the past and adhere to recom-
mendations from state and federal agencies that are
providing funding to enhance emergency prepared-
ness. These recommendations consider the Anthrax
attacks from 2001, they assume that a chemical
agent is hazardous and that an infectious disease is
in imminent danger of life and health and is poten-
tially lethal when transmitted. The practice of “All
Hazards” preparedness raises the eyebrow of the
clinical practitioner and influences this clinician to
make decisions based on the best interest of the
Hospital and the staff as well as the patient. Patient
care cannot be diligently performed by clinical staff
who have been affected with the same agent via
patient off-gassing or airborne contamination.
As discussed, the healthcare arena in the post
9-11 world is beginning to consider “All Hazards”
and the potentiality of seeing hoards of victims
from one single incident. Stories have emerged
from incidents such as the Aum shinrikyo's [5].
Sarin gas release in the Tokyo subway system in
1995 and other mass disasters that have introduced
contaminated victims into unsuspecting hospitals.
Statistics show that the “Psychological Footprint”
(Figure 22.6) of patients showing up at ED imme-
diately after a mass-casualty event exceeds the
number of medically injured by a factor of 10 or
more [6].
The hospital large-scale drill should consider
all of these factors, which can lead to a compre-
hensive scenario that involves multiple disci-
plines, from multiple departments and external
psychological
“footprint”
Medical
Footprint
Figure 22.6
Relationship between true casualties and the
“worried well.”
agencies. The decontamination-specific procedures
may require the purchase of additional equipment
to perform the decontamination function. This
may also force hospitals to enter into an agree-
ment with their local Fire Department or EPA
to assist in the decontamination procedures for
numerous victims.
In 2005 the Occupational Safety and Health
Administrations (OSHA's) released the: “Best
Practices for Hospital-Based 1st Receivers of
victims from mass-casualty incidents involving the
release of hazardous substances” document [7].
“This document is designed to provide hospitals
with practical information to assist them in devel-
oping and implementing emergency management
plans that address the protection of hospital-based
emergency department personnel during the receipt
of contaminated victims from mass-casualty inci-
dents occurring at locations other than the hospital.
Among other topics, it covers victim decontamina-
tion, personal protective equipment, and employee
training, and also includes several informational
appendices.” [8].
The hospitals are beginning to conform to
the recommendations within this document as
it provides a realistic look at
the needs of a
