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

HOSPITAL BIOTERRORISM PREPAREDNESS

COUNTY OF LOS ANGELESEMERGENCY MEDICAL

SERVICES AGENCY

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

• $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


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


Purpose of the HRSA Grant

Develop and implement regional plans to improve the response to bioterrorism (or other outbreaks of infectious disease) incidents.


Purpose of the HRSA Grant

• Focus on:– Hospitals– Emergency Departments– Outpatient centers– EMS systems– Other collaborating health care

entities


HRSA Grant Requirements

Critical Benchmarks

First Priority Planning Areas

Second Priority Planning Areas


Critical Benchmarks

• Program Leadership– Coordinator– Medical Director– Support Staff

• Hospital Bioterrorism Preparedness Planning Committee

• Regional Planning


Hospital Bioterrorism Preparedness Planning

CommitteeMISSION:

The Los Angeles County DHS/HASC HospitalBioterrorism Preparedness Planning Committee(HBPPC) will provide guidance, direction andoversight to the Department of Health Servicesand its EMS Agency to ensure coordination,communication, and education of hospitals in planning for the County’s healthcare

bioterrorismresponse.


First Priority Planning Areas

• Medications and vaccines– Recommended Hospital

Pharmaceutical Stock

• Personal Protective Equipment (PPE), Decontamination, Quarantine

• Communications• Biologic Disaster Drills


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


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


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


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.


Los Angeles County Plan

• Personal Protective Equipment

• Decontamination Capabilities

• Pharmaceuticals and Disaster Staging

• Communications


Hospital Participation

WHAT DO I GET?

WHAT DO I HAVE TO DO TO GET IT?


Hospital Receivables

Basic Level

– Personal Protective Equipment (PPE)

– Training of Decontamination Team


Hospital Receivables

Expanded Level

– Personal Protective Equipment

– Training of Decontamination Team

– Funding for Mass Casualty Decontamination Capability


Personal Protective Equipment

• PPE worth $10,000

• Group purchased by Los Angeles County and given to the hospitals– Standardization– Purchasing power reducing cost



Level C– Reasonable level

of protection for hospital personnel to be equipped with and trained to use.

• Powered Air Purifying Respirator Hood



Level C– Splash Suit– Nitrile gloves– Boots

• Patient Privacy Kit


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


Mass CasualtyDecontamination

Capabilities• Fixed turnkey warm water

operation capable of decontaminating 50 ambulatory patients/hour

• Minimum of $20,000 toward construction


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


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


Hospital Deliverables

• Decontamination CapabilityBasic Level– Describe hospital’s capability

Expanded Level – Fixed turnkey warm water structure

capable of decontaminating 50 ambulatory individuals per hour


Mass Casualty Decontamination

at Hospitals


at Hospitals


Hospital Mass Casualty Hospital Mass Casualty DecontaminationDecontamination

Hazardous materials incidents often Hazardous materials incidents often involve civilians that have been exposed involve civilians that have been exposed to potentially deadly chemicals. Also the to potentially deadly chemicals. Also the possibility of NBC weapons released on possibility of NBC weapons released on civilian populations are increasing. civilian populations are increasing.

Prompt, safe and effective Prompt, safe and effective decontamination procedures are essential decontamination procedures are essential to protect both the victims and to protect both the victims and hospital/response members.hospital/response members.

The Challenge:The Challenge:The Challenge:The Challenge:


Methods of decontamination:Methods of decontamination:Methods of decontamination:Methods of decontamination:

The National Fire Protection Association standard472 identifies four basic methods.

• Dilution• Absorption• Discarding• Neutralization

Additional methods include:chemical and physical degradation, evaporation,solidification, vacuuming



Types of Decontamination:Types of Decontamination:Types of Decontamination:Types of Decontamination:

• Emergency • Respiratory• Primary• Secondary• Equipment• Mass Casualty -Incident Site -Hospital



Hospital Mass Casualty Hospital Mass Casualty

DecontaminationDecontamination Decontamination Process

• Triage• Remove and bag clothes• Shower soak/flush• Detergent soap scrub with sponge• Shower rinse• Dry and dress


Factors That Affect Decontamination Process:Factors That Affect Decontamination Process:Factors That Affect Decontamination Process: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



Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:

• Personnel

• Water

• Decon solutions

• Air supplies

• Protective clothing

• Electricity/utilities

• Miscellaneous tools


Setting up the Contamination Reduction CorridorSetting up the Contamination Reduction Corridor::Setting up the Contamination Reduction CorridorSetting up the Contamination Reduction Corridor::

SafeSafeRefugeRefugeAreaArea

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Exclusion ZoneExclusion Zone

Support ZoneSupport Zone

ContaminationContaminationReductionReduction

ZoneZone

Air Cart Manager/SafetyOfficer

Washer

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Welfare

DeconLeader

StagingStaging&&

TreatmentTreatmentAreaArea

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• Planning Planning

• Equipment Equipment

• IdentificationIdentification

• Coordinating Coordinating

• TrainingTraining

• ExercisingExercising

• DocumentationDocumentation

Will become Will become part part

of the of the employers employers

emergency emergency planplan

Will become Will become part part

of the of the employers employers

emergency emergency planplan

What is required:What is required: What is required:What is required:



The key is through pre-event planning that The key is through pre-event planning that identifies and documents all aspects for the identifies and documents all aspects for the decontamination of either ambulatory or decontamination of either ambulatory or non-ambulatory patients.non-ambulatory patients.

Any system that fails to prioritize, manage and Any system that fails to prioritize, manage and control patients through the decontamination control patients through the decontamination process will fail without proper planning.process will fail without proper planning.


Consideration of all safety aspects of the deconoperation 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.



Determining Effectiveness of DecontaminationDetermining Effectiveness of Decontamination

• Visual examination

• Meters, instruments, test paper

• Testing by qualified lab

• Analysis of test swatches or samples

• Consulting with appropriate health officials

Setting up the Contamination Reduction CorridorSetting up the Contamination Reduction Corridor::Setting up the Contamination Reduction CorridorSetting up the Contamination Reduction Corridor::


You must also have a formal system to terminate your decontamination operations that will bepart of your operational plan.

• Decontaminate the decon team

• Decontaminate or dispose of equipment

• Clean-up options

• Debriefings

• Record keeping

When the decontamination operation is When the decontamination operation is over:over: When the decontamination operation is When the decontamination operation is over:over:



• Site security

• Force protection

• Evidence Collection

Must be “coordinated with law enforcement”.

ADDITIONAL CONCERNS:



Draw back of portable equipment

• Number of people needed to set it up

• The time it takes to set it up


Draw back of portable equipment


Fixed Mass Casualty Decon

Conex Trailers or Permanent Tents


Fixed Mass Casualty Decon

Corridor or Alleyway



Capabilities• Issues being addressed

Water run-off containmentOffice of Health Planning and

Development requirements for Healthcare facilities


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


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


Contact Information

Dr. John Celentano, M.D., Disaster Medical Officer

(323) 890-7588, [email protected]

Kay Fruhwirth, RN, MSN

Hospital Bioterrorism Preparedness Coordinator


Carol Gunter, RN, MHA; Assistant Director



Questions?

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

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