Mass casualty and hazardous substances 2014
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Transcript of Mass casualty and hazardous substances 2014
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MASS CAS + HAZ SUB 2014
MASS CASUALTY HAZARDOUS SUBSTANCES PROCEDURESDR CHRIS CRESSWELL
EMERGENCY PHYSICIAN
WANGANUI HOSPITAL
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Acknowledgements
Michelle Batterbee
Katie Edmonds
Simon Ward
Christie King
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Whole of hospital response to a mass incident
ED response
PPE and Decontamination procedures in ED
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Procedures revised based on Tasman Tanning Hydrogen Sulphide incident
2 patients GCS 3
Multiple other exposed factory staff
Multiple exposed emergency services staff
Potentially contaminated ED
HS: Volatile toxin with little risk of secondary exposure
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Multiple potential toxins in our city
Including allegedly the southern hemisphere’s largest stockpile of cyanide …
with a munitions factory nearby
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Hypothetical scenario
Ambo call:
National Party conference in the city
A package explodes releasing unknown white powder
A few people have blast injuries
~150 people inhaled the powder and are now coughing
First patients will arrive in 5 minutes
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First action?
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Lock Down
The hospital will be inundated with patients, relatives, worried people from 3 blocks away from the incident …
and paparazzi
“not pond scum, rather the scum that feed on the pond scum”
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Lock all the door
Then get orderlies, then security, controlling ingress and egress
Only staff with ID badges allowed in
Anyone is allowed out
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Declare a Mass Casualty Event
Senior ED nurse + duty nurse manager +/- ED senior doc decide if need to declare a Mass Casualty Event and if so what level. DNM is only one who can activate Mass Casualty Plan
Stage 1: ED only. Call in extra ED staff, lab, Xray etc. Managed by ED
Stage 2: ED + Hospital.
Stage 3: ED + DHB + EOC +/- regional or national support.
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Mass Casualty Plan
DNM talks to switchboard
Telephonist phones …
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STAGE 2 CALL Senior Manager on duty as directed by Duty Nurse Manager
DNM to advise on following contacts with correct message:1. TEXT PAGE ALL RMOs / Registrars on duty covering specialities: MSG “Stage 2 Mass Casualty Emergency
– expedite discharges and admissions from ED, report to senior doctor in ED” Surgical RMO Ortho RMO Medical RMO Surgical Reg Ortho Reg
2. CALL IN THEATRE STAFF: MSG “Stage 2 Mass Casualty Emergency, please report to the hospital”
0800 – 2200 hrs: Theatre Control Room / Theatre Manager 2200 – 0800 hrs (After Hours): Use On Call Theatre Call Back Procedure
SWITCHBOARD to anticipate staffing needs and liaise with Switchboard Manager / DNM / Manager of
emergency to authorise extra staff – (consider 2 extra to start?)
Follow direction from ED or DNM -Contact or CALL IN “Stage 2 Mass Casualty Emergency, please report to the hospital”
Clinical Nurse Manager ED (if not already on site) Clinical Director of Emergency Department (or delegate)
On Call Physician On Call Surgeon
On Call Ortho Surgeon On Call Anaesthetist On Call Paediatrician
Lab (on call) XRay (on call) CT (on call)
USS (on call) Pharmacy (on call)
Consultant Medical Staff – not on call
Follow direction from Nurse / Business manager (a/h on duty)-CALL IN “Stage 2 Mass Casualty Emergency, report to ED Coordinator, Red Vest ED, Room 3”
Media Liaison – immediate report required- Advise switchboard of message for public
- Advise switchboard number to transfer all media calls Manager of Social Workers – 0276887095 Page 117 Spotless 24 hour help line – 027 288 7451 Page 041
1. Orderlies x 2 to ED – via SPOTLESS as above2. Security (ON / OFF site) – via SPOTLESS as above
3. Kitchen/cleaning manager alerts as requestedNotify WDHB Emergency Phone “Stage 2 Mass Casualty Incident” (Single Point of Contact – DNM 027 222 0926 or
page 085)
You may be requested to call in specific personnel / services: Supply Department
Centre for Patient Safety Manager – stand by / set up EOC Director Maori Health – Maori Liaison to ED / Mauri Ora
Chaplain Facilities Management – 0274918385 Page 144
ICT Service ManagerIN and OUT OF HOURS - INFORM as directed by DNM “Stage 2 Mass Casualty Emergency – please report to
the hospital and follow your Mass Casualty Plan” ASSOCIATE DIRECTOR OF NURSING
MANAGER OF OPD – if space needed to overflow from ED MANAGER OF WAM (Lu Gribble – 0277171665)
MANAGER OF HEALTH RECORDS – send admin assistance to ED if required
SWITCHBOARD TO EXPECT INCREASED EXTERNAL CALL LOAD Direct families / whanau to info point in staff café, tunnel access
Direct volunteers / staff called back to main entrance, signs to Medlab, on left, door marked “Training Room” – HR check in
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STAGE 2 CALL Senior Manager on duty as directed by Duty Nurse Manager
DNM to advise on following contacts with correct message:1. TEXT PAGE ALL RMOs / Registrars on duty covering specialities: MSG “Stage 2 Mass Casualty Emergency
– expedite discharges and admissions from ED, report to senior doctor in ED” Surgical RMO Ortho RMO Medical RMO Surgical Reg Ortho Reg
2. CALL IN THEATRE STAFF: MSG “Stage 2 Mass Casualty Emergency, please report to the hospital”
0800 – 2200 hrs: Theatre Control Room / Theatre Manager 2200 – 0800 hrs (After Hours): Use On Call Theatre Call Back Procedure
SWITCHBOARD to anticipate staffing needs and liaise with Switchboard Manager / DNM / Manager of
emergency to authorise extra staff – (consider 2 extra to start?)
Follow direction from ED or DNM -Contact or CALL IN “Stage 2 Mass Casualty Emergency, please report to the hospital”
Clinical Nurse Manager ED (if not already on site) Clinical Director of Emergency Department (or delegate)
On Call Physician On Call Surgeon
On Call Ortho Surgeon On Call Anaesthetist On Call Paediatrician
Lab (on call) XRay (on call) CT (on call)
USS (on call) Pharmacy (on call)
Consultant Medical Staff – not on call
Follow direction from Nurse / Business manager (a/h on duty)-CALL IN “Stage 2 Mass Casualty Emergency, report to ED Coordinator, Red Vest ED, Room 3”
Media Liaison – immediate report required- Advise switchboard of message for public
- Advise switchboard number to transfer all media calls Manager of Social Workers – 0276887095 Page 117 Spotless 24 hour help line – 027 288 7451 Page 041
1. Orderlies x 2 to ED – via SPOTLESS as above2. Security (ON / OFF site) – via SPOTLESS as above
3. Kitchen/cleaning manager alerts as requestedNotify WDHB Emergency Phone “Stage 2 Mass Casualty Incident” (Single Point of Contact – DNM 027 222 0926 or
page 085)
You may be requested to call in specific personnel / services: Supply Department
Centre for Patient Safety Manager – stand by / set up EOC Director Maori Health – Maori Liaison to ED / Mauri Ora
Chaplain Facilities Management – 0274918385 Page 144
ICT Service ManagerIN and OUT OF HOURS - INFORM as directed by DNM “Stage 2 Mass Casualty Emergency – please report to
the hospital and follow your Mass Casualty Plan” ASSOCIATE DIRECTOR OF NURSING
MANAGER OF OPD – if space needed to overflow from ED MANAGER OF WAM (Lu Gribble – 0277171665)
MANAGER OF HEALTH RECORDS – send admin assistance to ED if required
SWITCHBOARD TO EXPECT INCREASED EXTERNAL CALL LOAD Direct families / whanau to info point in staff café, tunnel access
Direct volunteers / staff called back to main entrance, signs to Medlab, on left, door marked “Training Room” – HR check in
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Calling back staff
Don’t call in people who are due on the next shift – you are going to need them fresh
ED nurses call in ED nurses
ED doctors call in ED doctors
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If the telephonist calls you
Don’t ask questions! The telephonist does not have time!
Say “Yes I can come in” or
“I can’t come in, I will find someone else, and I will let …… know who I have found” or
“I can’t come in, sorry I don’t have any phone numbers, please call ….”
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Send out the teletubbies
A triage nurse outside front door and in ambo bay
In PPE if a HAZ SUB event
+ an assistant with a phone/radio
+ security
Triage non-emergency patients away, and stable patients to a holding area eg chairs/ stretchers/bus outside
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Minimise the number of people getting into ED
And once they leave ED (eg CT) they don’t come back
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Inpatient teams
Cancel elective procedures
Get your patients out of ED
Discharge as many patients as you can from wards
Send a few docs, nurses, HCAs down to ED if possible
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ED
Appoint nursing coordinator
Open the Mass Cas box
Follow coordinators instruction sheet
Give out vests and job cards
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Mass Casualty Box
Folders with ED cards, Xray and lab forms, ID bracelets
Some “unidentified” labels
Try to identify all patients and use usual patient registration processes
(Later boxes are more useful eg automatic arrival of LOTS of drugs, linen other consumables)
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If several unconscious or unknown patients
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Vests are for ED staff only
Helpers from other wards wear usual uniforms + lanyard
Makes it easy for all to recognise the “locals” who tend to know where things live and how things work in ED
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Task cards
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Back door triage nurse based outside fishbowl closest to ambo door with ED
cards
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ED coordinator based outside the fishbowl, outside room 3
+ orderly
+ transport nurse
Red folder has an excellent list of tasks
+ patient log
+ staff log
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Eg Outpatients or SDU
Eg multiple chairs in AAU
Eg WAM
Eg GP
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Maximise cohort care
Minimise one-on-one care
Allocate areas/rooms to ED staff and further dividing as more staff arrive
Allocate extra help to ED teams as needed
= Small teams with ED staff + helpers from elsewhere
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Corral extra staff eg in fish bowl or whanau room
You may get more help than you can use
They may get in the way / make inappropriate decisions
ED teams in resus bays
other senior staff by invitation
Eg Christchurch: ED and anaesthetists in bays, other consultants corralled in fishbowl and Dr Jan Bone summoned as needed
Eg Kandahar: ED + military medics in bays. Stabilise give to anaesthetist and surgeon when ready
for surgery => increased survival
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Intra-department communication
Public address system
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OK, we’re ready for some HAZSUB
Get in the Zone
General principle: no potentially contaminated person gets into hospital
Otherwise we might have to shut down the hospital
Hot zone: outside
Warm zone: decontamination shower
Cold zone: inside hospital
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Teletubbies to the shower
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Tape over cuffs
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Patients who have been decontaminated,
or considered not contaminated, by the Fire Service
can enter ED by front door or ambulance door
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Everyone else gets washed
“All Hazards Approach”
Detergent
Sponge
Lots of water
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Preserve clothing
Strip ‘em
Put clothing in biohazard bag
Label the bag with a patient ED sticker, date, time, clinician name and signature (if possible/time) Police may want it
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Non ambulatory patient
Wash on ambulance stretcher
Wash stretcher
Patient and stretcher go through into cold zone
Ambulance officer in ED to help work the stretcher
Don’t drown the patient
Has a PhD in stretchero-logy
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No clothes, used towels, PPE or teletubbies to go from warm zone (shower) into cold zone (ED)
Ambulant patients get a poncho
Put a clean sheet or towel over stretcher patients
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Decontaminated patient enters ED
Medical treatment continues as needed
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Complete the cycle
Treat all patients
Track all patients
Ensure staff are fed and watered and get a break
Support and reconcile with families
Declare end of emergency
Restock
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Debrief
Learn and improve
Prevention
Exercises / test the system
Educate staff