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HOSPITAL BIOTERRORISM PREPAREDNESS

HOSPITAL BIOTERRORISM PREPAREDNESS. COUNTY OF LOS ANGELES EMERGENCY MEDICAL SERVICES AGENCY. Overview of the HRSA Grant. Authorized by the Public Health and Social Services Emergency Fund Section 319 of the Public Health Services Act, 42 U.S.C.247d

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HOSPITAL BIOTERRORISM PREPAREDNESS

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  1. HOSPITAL BIOTERRORISM PREPAREDNESS COUNTY OF LOS ANGELES EMERGENCY MEDICAL SERVICES AGENCY

  2. Overview of the HRSA Grant • Authorized by the Public Health and Social Services Emergency Fund • Section 319 of the Public Health Services Act, 42 U.S.C.247d • $125 million funded for hospitals through the Health Resources and Services Administration • Los Angeles County receiving $3.6 million • State of California receiving $9,962,905 County of Los Angeles Emergency Medical Services Agency

  3. Overview of the HRSA Grant • Awarded to State and 4 Jurisdictional Public Health Departments • The Emergency Medical Services Agency will administer and implement the plan in Los Angeles County County of Los Angeles Emergency Medical Services Agency

  4. Purpose of the HRSA Grant Develop and implement regional plans to improve the response to bioterrorism (or other outbreaks of infectious disease) incidents. County of Los Angeles Emergency Medical Services Agency

  5. Purpose of the HRSA Grant • Focus on: • Hospitals • Emergency Departments • Outpatient centers • EMS systems • Other collaborating health care entities County of Los Angeles Emergency Medical Services Agency

  6. HRSA Grant Requirements • Critical Benchmarks • First Priority Planning Areas • Second Priority Planning Areas County of Los Angeles Emergency Medical Services Agency

  7. Critical Benchmarks • Program Leadership • Coordinator • Medical Director • Support Staff • Hospital Bioterrorism Preparedness Planning Committee • Regional Planning County of Los Angeles Emergency Medical Services Agency

  8. Hospital Bioterrorism Preparedness Planning Committee MISSION: The Los Angeles County DHS/HASC Hospital Bioterrorism Preparedness Planning Committee (HBPPC) will provide guidance, direction and oversight to the Department of Health Services and its EMS Agency to ensure coordination, communication, and education of hospitals in planning for the County’s healthcare bioterrorism response. County of Los Angeles Emergency Medical Services Agency

  9. First Priority Planning Areas • Medications and vaccines • Recommended Hospital Pharmaceutical Stock • Personal Protective Equipment (PPE), Decontamination, Quarantine • Communications • Biologic Disaster Drills County of Los Angeles Emergency Medical Services Agency

  10. Second Priority Planning Areas • Personnel • Mobilization of staff to impacted area(s) • Training • Recognition of biological diseases • Use of PPE/decon equipment/quarantine • Assessment, stabilization, transport • Patient Transfer • Special needs populations • Designated facilities County of Los Angeles Emergency Medical Services Agency

  11. Coordination and Collaboration • Coordination of funding streams: • HRSA grant • CDC grant • MMRS grant • Collaboration with the State of California HRSA and CDC grant planning and response County of Los Angeles Emergency Medical Services Agency

  12. Needs Assessment • October 2001 Los Angeles County surveyed all eighty-one 9-1-1 receiving facilities to determine the level of preparedness to respond to a terrorist incident • Based on these findings Los Angeles County developed their plan for the HRSA grant County of Los Angeles Emergency Medical Services Agency

  13. Los Angeles County Plan Governing Principles: • 80% of the victims will flee the scene and seek medical care at the hospital that is familiar to them. Therefore all hospitals need to be prepared to deal with converging victims. • ALL HAZARDS approach used. • Current funding being directed to 9-1-1 receiving facilities. All eighty-one will be offered participation. • Current funding inadequate for addressing major hospital infrastructure needs such as isolation capabilities. • By participating, hospitals are committing to be a part of a system wide response to potential acts of terrorism. County of Los Angeles Emergency Medical Services Agency

  14. Los Angeles County Plan • Personal Protective Equipment • Decontamination Capabilities • Pharmaceuticals and Disaster Staging • Communications County of Los Angeles Emergency Medical Services Agency

  15. Hospital Participation WHAT DO I GET? WHAT DO I HAVE TO DO TO GET IT? County of Los Angeles Emergency Medical Services Agency

  16. Hospital Receivables Basic Level • Personal Protective Equipment (PPE) • Training of Decontamination Team County of Los Angeles Emergency Medical Services Agency

  17. Hospital Receivables Expanded Level • Personal Protective Equipment • Training of Decontamination Team • Funding for Mass Casualty Decontamination Capability County of Los Angeles Emergency Medical Services Agency

  18. Personal Protective Equipment • PPE worth $10,000 • Group purchased by Los Angeles County and given to the hospitals • Standardization • Purchasing power reducing cost County of Los Angeles Emergency Medical Services Agency

  19. Personal Protective Equipment Level C • Reasonable level of protection for hospital personnel to be equipped with and trained to use. • Powered Air Purifying Respirator Hood County of Los Angeles Emergency Medical Services Agency

  20. Personal Protective Equipment Level C • Splash Suit • Nitrile gloves • Boots • Patient Privacy Kit County of Los Angeles Emergency Medical Services Agency

  21. Decontamination Team Training • Operations level course on hospital decontamination for contaminated victims • County Disaster Training Unit will provide training at no cost • Course is 20 hours of instruction • No cost offset for staff attendance and/or replacement staff costs County of Los Angeles Emergency Medical Services Agency

  22. Mass CasualtyDecontamination Capabilities • Fixed turnkey warm water operation capable of decontaminating 50 ambulatory patients/hour • Minimum of $20,000 toward construction County of Los Angeles Emergency Medical Services Agency

  23. Hospital DeliverablesBasic and Expanded • Store, secure, maintain, and replace PPE • Establish a decontamination team • Identify Decontamination Team Safety Officer • Establish a Respiratory Protection Program • Establish Medical Monitoring Program • Training/Exercise • Conduct on-going decontamination team training at least quarterly • Conduct decontamination drill annually County of Los Angeles Emergency Medical Services Agency

  24. Hospital DeliverablesBasic and Expanded • Complete an Information Technology capabilities survey conducted by the County of Los Angeles Public Health Programs and Services • Identify hospital contacts • Bioterrorism incidents (clinician) • Radiological incidents • Other terrorism/disaster incidents County of Los Angeles Emergency Medical Services Agency

  25. Hospital Deliverables • Decontamination Capability Basic Level • Describe hospital’s capability Expanded Level • Fixed turnkey warm water structure capable of decontaminating 50 ambulatory individuals per hour County of Los Angeles Emergency Medical Services Agency

  26. Mass Casualty Decontamination at Hospitals County of Los Angeles Emergency Medical Services Agency

  27. Hospital Mass Casualty Decontamination The Challenge: • Hazardous materials incidents often involve civilians that have been exposed to potentially deadly chemicals. Also the possibility of NBC weapons released on civilian populations are increasing. • Prompt, safe and effective decontamination procedures are essential to protect both the victims and hospital/response members. County of Los Angeles Emergency Medical Services Agency

  28. Hospital Mass Casualty Decontamination Methods of decontamination: • The National Fire Protection Association standard • 472 identifies four basic methods. • Dilution • Absorption • Discarding • Neutralization • Additional methods include: • chemical and physical degradation, evaporation, • solidification, vacuuming County of Los Angeles Emergency Medical Services Agency

  29. Hospital Mass Casualty Decontamination Types of Decontamination: • Emergency • Respiratory • Primary • Secondary • Equipment • Mass Casualty -Incident Site -Hospital County of Los Angeles Emergency Medical Services Agency

  30. Hospital Mass Casualty DecontaminationDecontamination Process • Triage • Remove and bag clothes • Shower soak/flush • Detergent soap scrub with sponge • Shower rinse • Dry and dress County of Los Angeles Emergency Medical Services Agency

  31. Hospital Mass Casualty Decontamination Factors That Affect Decontamination Process: • Physical & chemical properties of the material • Amount & location of contaminant • Contact time & temperature • Level of protection & work function • Reason for leaving hazard site County of Los Angeles Emergency Medical Services Agency

  32. Setting up the Contamination Reduction Corridor: • Personnel • Water • Decon solutions • Air supplies • Protective clothing • Electricity/utilities • Miscellaneous tools County of Los Angeles Emergency Medical Services Agency

  33. Setting up the Contamination Reduction Corridor: Exclusion Zone Safe Refuge Area Safe Refuge Manager/ Triage CRC Contamination Reduction Zone 100 feet Washer Down Slope Decon Leader Rinser Wind Welfare Staging & Treatment Area Air Cart Manager/ Safety Officer Support Zone County of Los Angeles Emergency Medical Services Agency

  34. County of Los Angeles Emergency Medical Services Agency

  35. Setting up the Contamination Reduction Corridor: What is required: • Planning • Equipment • Identification • Coordinating • Training • Exercising • Documentation Will become part of the employers emergency plan County of Los Angeles Emergency Medical Services Agency

  36. Setting up the Contamination Reduction Corridor: • The key is through pre-event planning that • identifies and documents all aspects for the • decontamination of either ambulatory or • non-ambulatory patients. • Any system that fails to prioritize, manage and • control patients through the decontamination • process will fail without proper planning. County of Los Angeles Emergency Medical Services Agency

  37. Setting up the Contamination Reduction Corridor: • Consideration of all safety aspects of the decon • operation area prior to selecting the site is • paramount. Issues such as drainage, trip hazards, • lighting, overhead obstructions and ability to control • access must be addressed. Secondary decon sites or back-up plans also must be considered. County of Los Angeles Emergency Medical Services Agency

  38. Setting up the Contamination Reduction Corridor: Determining Effectiveness of Decontamination • Visual examination • Meters, instruments, test paper • Testing by qualified lab • Analysis of test swatches or samples • Consulting with appropriate health officials County of Los Angeles Emergency Medical Services Agency

  39. Setting up the Contamination Reduction Corridor: • When the decontamination operation is over: You must also have a formal system to terminate your decontamination operations that will be part of your operational plan. • Decontaminate the decon team • Decontaminate or dispose of equipment • Clean-up options • Debriefings • Record keeping County of Los Angeles Emergency Medical Services Agency

  40. Setting up the Contamination Reduction Corridor: ADDITIONAL CONCERNS: • Site security • Force protection • Evidence Collection Must be “coordinated with law enforcement”. County of Los Angeles Emergency Medical Services Agency

  41. Draw back of portable equipment • Number of people needed to set it up • The time it takes to set it up County of Los Angeles Emergency Medical Services Agency

  42. Draw back of portable equipment County of Los Angeles Emergency Medical Services Agency

  43. Fixed Mass Casualty DeconConex Trailers or Permanent Tents County of Los Angeles Emergency Medical Services Agency

  44. Fixed Mass Casualty DeconCorridor or Alleyway County of Los Angeles Emergency Medical Services Agency

  45. Fixed Mass Casualty DeconCorridor or Alleyway County of Los Angeles Emergency Medical Services Agency

  46. Fixed Mass Casualty DeconCorridor or Alleyway County of Los Angeles Emergency Medical Services Agency

  47. Fixed Mass Casualty DeconCorridor or Alleyway County of Los Angeles Emergency Medical Services Agency

  48. Mass Casualty Decontamination Capabilities • Issues being addressed • Water run-off containment • Office of Health Planning and Development requirements for Healthcare facilities County of Los Angeles Emergency Medical Services Agency

  49. Hospital Preparedness A facility that can demonstrate that they have already purchased comparable PPE and/or have constructed a fixed decontamination capability will still be eligible to receive the funding. • PPE - $10,000 • Decontamination Capability – Minimum of $20,000 County of Los Angeles Emergency Medical Services Agency

  50. Hospital Agreement To receive funding each hospital will need to sign an agreement with the County of Los Angeles. • Letters of Interest will be mailed to Hospital CEO’s in August 2002 • Contracts completed by December 2002 County of Los Angeles Emergency Medical Services Agency

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