Haz Mat for WV Hospitals: An Awareness Level Course

1. Haz Mat for WV Hospitals:An Awareness Level Course Module I

2. This course was developed by EnMagine, who we wish to gratefully acknowledge. The material has been modified by WV DHHR in cooperation with the West Virginia Hospital Association’s Disaster Preparedness Task Force in the teaching of Hospital Decon. We especially wish to thank Kevin Davis of Weirton Medical Center for his work in modifying this material.

3. HazMat: hazardous materials Decon: decontamination FRA: first responder awareness FRO: first responder operations WMD: weapons of mass destruction MSDS: materials safety data sheet Abbreviations

4. Hospital personnel “who are likely to be exposed to patients that have been contaminated due to a hazardous substance release/incident or a bioterrorism incident coming to the hospital.” Who needs to take the Awareness Level Course?

5. Hospital personnel “who are part of a Hospital HazMat Decon Team that is part of the initial response in a defensive action.” Who needs to take the Operations Level Course?

6. The Occupational Safety and Health Administration has a mandate to ensure that employers provide a safe and healthful workplace. OSHA has recommended a minimum of 8 hours of training for Healthcare Workers who may come in contact with hazardous or bioterrorism materials. Regulations

7. Objectives What are: Hazardous/Bioterrorism Material? The risks and problems that can occur? HazMat for Healthcare at the Awareness Level

8. How can we: Recognize a contaminated patient Identify characteristics of a chemical/bioterrorism incident Implementing the Hospital HazMat Response Process Respond safely and effectively Make proper notifications Isolate the patient/patients and deny entry Conduct Directed Self-Decon Awareness Objectives (continued)

9. S = Safety I = Isolation N = Notifications Contaminated Patients Definition - SIN SIN

10. There is no one definition. OSHA definition: Hazardous Chemical: Any substance to which exposure “results or may result in adverse affects on the health or safety of employees:” or “any chemical which is a physical hazard or a health hazard.” 29 CFR 1910.1200 (c) Definition of a Hazardous Material

11. "Hazardous substance" means any substance designated or listed under (A) through (D) of this definition, exposure to which results or may result in adverse effects on the health or safety of employees: [A] Any substance defined under section 101(14) of CERCLA; [B] Any biologic agent and other disease causing agent which after release into the environment and upon exposure, ingestion, inhalation, or assimilation into any person, either directly from the environment or indirectly by ingestion through food chains, will or may reasonably be anticipated to cause death, disease, behavioral abnormalities, cancer, genetic mutation, physiological malfunctions (including malfunctions in reproduction) or physical deformations in such persons or their offspring. [C] Any substance listed by the U.S. Department of Transportation as hazardous materials under 49 CFR 172.101 and appendices; and [D] Hazardous waste as herein defined. What does the regulation state?

12. Chemicals that cause cancer Biohazards or infectious materials Chemicals that can burn the skin or eyes on contact Radioactive materials Examples of Hazardous Materials(OSHA Hazardous Waste Operations and Emergency Response Standard 29 CFR 1910.120 [Title 8 §5192 CCR])

13. Chemicals that can catch fire or explode Chemicals that can cause violent chemical reactions Poisons Unknown chemicals Examples of Hazardous Materials(Continued)

14. To YOU To the EMERGENCY DEPARTMENT To the HOSPITAL To your COMMUNITY What is the impact of a Hazardous Materials incident:

15. Watch Closely

16. TLA’s - Three Letter Acronyms Glossary Nomenclature and Accuracy SIN WMD PPE ERG

17. Hazard Classes and things that act like them

18. Commercial explosives Fireworks Ammunition Fertilizer bombs (Ammonium nitrate & fuel oil) Hydrazine (A flammable liquid. Forms explosive mixtures [hypergolic] - a high energy rocket fuel, corrosive and poisonous) Explosives (Class 1)

19. Acetylene Propane Oxygen Nitrogen Nitrous Oxide Carbon Dioxide Anesthetic Gases Medical Air Argon Hydrogen Sulfide Phosgene Methyl Bromide Ammonia Compressed Gases (Class 2)

20. Diesel Alcohols Xylene Gasoline Acetone Methanol Flammable/Combustible Liquids (Class 3)

21. Naphthalene Sodium Carbon Barium Flammable Solids (Class 4)

22. Oxygen (actually a compressed gas or cryogenic liquid) Peroxyacetic Acid Red Fuming Nitric Acid (a corrosive) Nitrogen Tetroxide Ammonium Nitrate Methyl Ethyl Ketone Peroxide Fluorine, Chlorine (also poison, compressed gas, corrosive) Oxidizers & Organic Peroxides (Class 5) Boston Harbor

23. Phenol (Carbolic Acid) Chemotherapy drugs Biohazardous Waste Blood Borne Pathogens Solvents Sewage Vesicants (blistering agent, Doxorubicine, Vincristine) Mercury ETO (ethylene oxide) Glutaraldehyde & Formaldehyde Pesticides WMD (Sarin, VX) Solvents Bioterrorism Tear Gas Vesicants (mustard, Lewisite) Poisonous & Infectious Materials (Class 6)

24. Nuclear Medicine Terrorist use Military Facilities Nuclear Reactors Commercial/Research facilities Industrial x-ray material Radioactive Materials (Class 7)

25. Lab acids (e.g., Hydrochloric Acid) Boiler treatment caustics Pool chemicals Sulfuric acid Nitric acid Muriatic acid Sodium Hydroxide Chlorine, Fluorine Corrosive Materials (Class 8)

26. Hazardous waste Asbestos Anesthetics Pepper spray/mace Molten Sulfur Miscellaneous. Hazardous Materials (Class 9)

27. Limitless Unknown chemicals

28. Incidental Spill - Spill that can be cleaned up in first 10-15 minutes without risk of overexposure to employees under normal conditions. Emergency Response Spill - Requires Haz Mat Response if risk of overexposure to employees. (On Scene Decon) Definition of Spill Types

29. Any one of these factors can affect the type of Decon: Product Time - Vapor levels rise above regulatory levels that they were exposed to Volume of Spill – Body surface area covered Concentration Ventilation - Type and location Personnel Location - closer = worse Key Factors In Assessing a Patient/Patients

30. Intentional Events So now, let’s talk about Terrorism and WMD

31. We all know what terrorism is, but the official definition is: “The unlawful use of force against persons or property to intimidate or coerce a government, the civilian population, or any segment there of, in the furtherance of political or social objectives.” Terrorism

32. B - Biological N - Nuclear I - Incendiary C - Chemical E - Explosive Types of Weapons of Mass Destruction (WMD)

33. Terrorism is a “menace, with malice.” • A biological terrorism event (the “B” of B-NICE) is an “Infectious Disease Outbreak”. • A chemical terrorism event (the “N&C” of B-NICE) is a “Hazardous Materials Incident”. • A fire or explosion terrorism event (the “I&E” of B-NICE) is a “Burn and/or Mass Casualty-Trauma Incident”.

34. Types of Agents Bacteria Anthrax Plague Tularemia Viruses Smallpox Hemorrhagic Fevers (Ebola) Venezuelan equine encephalitis (VEE) Toxins Botulism Ricin Biologic TerrorismIs an Infectious Disease Event

35. Types of Agents Nerve - Sarin VX Blister (vesicants) - Mustard Lewisite Blood - Cyanide Choking - Chlorine Phosgene Irritating - Tear Gas Pepper Spray Chemical TerrorismIs a HazMat Event

36. Potential Probability vs. Impact NUCLEAR WEAPON BIOLOGICAL AGENT IMPROVISED NUCLEAR DEVICE CHEMICAL AGENT OR TOXIC INDUSTRIAL CHEMICAL POTENTIAL IMPACT RADIOACTIVE MATERIAL PROBABILITY / LIKELIHOOD

37. Recognition leads to safety Safety leads to lives preserved Hazardous Materials Recognition & Safety

38. Traffic accident Medical aid Fire, person down, etc. Not Always Reported as HazMats Initial report may not indicate presence of hazardous materials!

39. HazMat Recognition Clues Markings and Colors Placards and Labels

40. Should be available for each HazMat in the workplace Required by OSHA Hazard Communication regulations Provides valuable information MSDS Diforsuranol Make out your will. It’s all over.Death imminent. No hope for you pal! Bad stuff! Touch this and you die. Call 911 now! HazMat Recognition Clues Material Safety Data Sheets (MSDS)

41. Patient has an unusual odor Patient has a strange liquid/powder on them Patient was involved in a chemical fire Patient talks about being in a strange vapor Patients skin is an unusual color Clues from the Patient

42. They are: Warnings Notes of caution Indications of things to come But not always all the answers! “Clues” are “Clues”!

43. Liquids or powders on the patient Odors What were they doing when this happened? Where were they? How long ago did the accident occur? Triage Clues Need to recognize and act fast and save your ED !

44. Information Resources • Container Labels • MSDS • Poison Control • Emergency Response Guide (ERG) • Computer programs • People • ChemTrek ERG Do not rely on only one source of information. Be skeptical!!

45. Don’t be a Dead Hero! Get the big picture. Can you handle it? What are the risks? What do you know? What don’t you know? SAFETY (First, last, and always) SIN

46. Isolate the scene and deny entry. (If someone has something on them don’t let them go away. If others haven’t been exposed don’t let them have contact with the chemicals.) ISOLATE SIN

47. Purpose of Perimeters & Control Zones Ensure safety and isolation Control the scene (ED and Decon Area) Limit spread of contamination Allow for safe working area Perimeters & Control Zones

48. Control Zones Yellow Zone Hot Zone Green Zone

49. Follow Your Hospital’s Plan! Call your Supervisor Activate your HazMat response team?? Utilize your Hospital Emergency Incident Command System (HEICS) NOTIFY SIN

50. What are your first concerns? Is this patient contaminated with a hazardous material? Review the clues! How can contamination of the ED and its occupants (patients and staff) be minimized? How can the patient bemanaged so that he can receive medical care? Ask Yourself