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Parkland Hospital unveils new HazMat Unit

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April 27, 2017

Decon SWAT unit formed in new facility on constant alert for chemical and biological emergencies

When an Amtrak train had derailed on the major Washington-New York rail corridor running through Philadelphia on May 12, 2015, officials feared the worst.

Within minutes, at least seven hospitals in the greater Philadelphia area, including Temple, received warning to get ready to receive hundreds of patients, from busloads of walking wounded to critically injured patients coming in via ambulance.

There was one question on everyone’s mind, though, before the first casualty came through the door: Could this be a terrorist attack, and are we looking at a major chemical spill response?

Ironically, Einstein Healthcare Network was one of the Philadelphia hospitals that had been working to create a specialized response team to deal with future cases of Ebola or any other incident requiring a rapid response of individuals trained in decontamination or triage. In the case of the train crash, officials did not know at first if it was a terrorist attack or involved hazardous materials that could affect the safety of the hospital.

“I needed to know about bomb residue, chemicals, or radiation,” says Herbert Cushing, MD, FACP, and chief medical officer of Temple University Hospital. “We were about 40 minutes in and I couldn’t let [staff] them keep treating people if there was an issue. We were able to get information from the scene about whether or not there were [weapons of mass destruction] involved.”

Thankfully, there were not. Officials said the communication system in place allowed officials to make quicker decisions about how to prepare.

“We didn’t have to gear up, but certainly in the back of your mind you’re wondering if this was a terrorist incident, and if maybe one of the patients was involved,” says John Ward, director of safety and materials management for Einstein Health Network in Philadelphia.

But what if the situation had been different? What if hundreds of patients started coming in with hazardous chemicals on them? What if there had been a nuclear accident? What if it happened in a part of the country where hospitals aren’t as numerous or well-trained for such a nightmare scenario?

Most hospitals have at least a rudimentary plan in place for dealing with emergencies dealing with decontamination, but in some areas of the country awareness has been raised about how preparation for such events have not kept up with the threat—after all, some hospitals can’t afford the training and equipment necessary to stay on constant alert for something that may never occur.

In Dallas, Parkland Memorial Hospital just opened up a brand-new 1.7 million-square-foot, 862-bed facility meant to go beyond what the state and Joint Commission requires. Texas Department of State Health Services requires that hospitals maintain a decontamination room but not a team ready to respond, and Parkland officials decided that wasn’t enough.

“Just a few months after I joined the decon team, Ebola hit Dallas and my involvement was critical at that point,” said Jennifer Ochieng, an infection preventionist at Parkland, to Healthcare Facilities Management magazine.

In October 2014, Dallas was put on the map when the first-ever Ebola case in the U.S. hit the city. Thomas Eric Duncan, a Liberian national who was visiting family in Dallas, became the first confirmed U.S. case when he checked into Texas Health Presbyterian Hospital with symptoms. He later died; two nurses that had been caring for Duncan at the hospital also came down with symptoms, but were treated and recovered. In October, a New York City doctor who had been treating patients in Guinea tested positive for the virus and was later cured at Bellevue Hospital.

Also in late 2014, two large Virginia hospitals had their decon and Ebola response plans tested. The University of Virginia (UVA) Medical Center in Charlottesville and Virginia Commonwealth University (VCU) Medical Center in Richmond both had two separate patients who had been traveling in Africa who fell ill and were brought into their facility, suspected of having the Ebola virus.

"This was far and away the greatest outbreak of this magnitude, and everybody ramped up real quick," said William Rockwell, BE, CHFM, hospital engineer for UVA Health Care System, which later was picked by the CDC as one of the nation's 35 designated Ebola treatment centers.

Many large hospitals, including UVA, began thinking seriously about their Ebola plans after August 2014, when the first suspected U.S. case came into Emory University Hospital in Atlanta, and was followed later by Dallas. Following CDC advice, UVA decided to start its planning by focusing on the entry point of the ED.

“We knew they would present there, the staff were going to ask where they have been, and you’re going to go live right there,” Rockwell said.

His philosophy has been the cornerstone of many preparations in hospitals nationwide in the relatively quiet three since the Ebola outbreak, but many facilities know it’s only a matter of time before a major biological, chemical, or nuclear disaster tests the ability of ER staff to effectively treat incoming patients while maintaining the health and safety of their own staff.

So many larger hospitals, including Parkland, have turned to not only meeting the requirements of accreditation agencies that want the hospitals to have the ability to respond to “all hazards,” but also train specialized SWAT teams ready to provide expert care at a moment’s notice should an overwhelming incident occur.

In some hospitals, it’s questionable about who would respond if someone walked into the facility’s ED with symptoms of Ebola, or if several patients presented with exposure to radioactive materials without prior notification. Knowing this, Einstein formed what they call a Special Infectious Disease Response Team (SIDRT) that would be first on the scene as soon as the symptoms are identified. The team consists of seven ER physicians, 22 critical care nurses, four respiratory therapy assistants, and a radiological team that would swing into action with their specialized skills. An Ebola response plan has been mapped out that involves blocking certain areas of the hospital off, designating certain rooms as off limits, and pre-stocked carts that can be wheeled into place at a moment’s notice.

“Our plan was to be able to take care of one person for a week,” says Ward. “It’s been nothing but training and they are very motivated.”

At Parkland, officials wanted to go above and beyond the Joint Commission requirement of hospitals to identify hazards and address them. Because Parkland identified the potential to receive contaminated patients as a hazard, it created their new decon team to go along with the new facility.

The team includes a disaster management staff, which is responsible for overseeing decontamination activities, including the training of team members who may be called into service at a moment’s notice.

The team has been in development since as far back as 2004, when an explosion hit a manufacturing plant just south of Dallas. Some of the plant’s employees were taken to Parkland Memorial Hospital because of a concern that they potentially were exposed to a cyanide release. The incident caused the health system to develop a mass casualty decontamination team, and the newest venture is an attempt to make sure the hospital is ready for anything.

“Although there are terrorist-type activities that can lead to exposure to or contamination from hazardous materials, it’s more likely to be the result of a natural disaster or accident,” David McCarty, an emergency management officer at Parkland, told Healthcare Facilities Management. “A tornado or a flood could wipe out a chemical plant or an accident at home could result in a dangerous situation.”

Located outside the hospital’s ER, a room has been built that can house up to 10 patients for decontamination before they even enter the hospital. From there, they can have their clothes removed and be thoroughly scrubbed with soap and water before receiving hospital-issued gowns and being taken into the facility.

In the event of a major event involving more than 10 patients exposed to hazardous materials or contaminated, the new unit at Parkland is equipped with an exterior decontamination unit complete with privacy curtains and running water where patients can be washed.

About 100 staff members from throughout the Parkland health system have received classroom and hands-on training, and respond whenever the decon team is activated—the idea in most cases is to have staff members on duty at all times who could respond to such an incident.

Team members are taught how to don and doff personal protective equipment such as gowns, boots, gloves, and masks, including those with self-contained filtration systems. They are also instructed in how to safely and thoroughly rid contaminants from patients.

Of course, new equipment only goes so far. You can have the best equipment money can buy, but if you don’t practice, chances are that employees won’t know how to use it when the real thing hits.

At Temple Hospital, each employee goes through a mass casualty response course, as well as an eight-hour decontamination course, and then is required to take an annual refresher. In addition, drills are an everyday part of working there, and a busy ER and trauma department allows staff to constantly be using their skills.

“Ever since the Boston [marathon bombing] happened, we’ve been training,” says Wesley Light, Temple’s manager of emergency preparedness, who mentioned that the Philadelphia equivalent, the annual Broad Street Run, sends up to 40,000 people right through the hospital’s campus every May and gives them the perfect training scenario.

“It starts a mile north of us and sends big packs of people through here,” he says. “We had just recently drilled on a mass casualty bomb scenario."