Decon
photo
Hospital Emergency Response
Team
MICHAEL D. WHALEN RN BSN CEN
What is H.E.R.T
y Hospital Emergency Response Team
y Multidisciplinary response to disasters, hospital
emergencies and mass gathering events
y Involves multiple departments and sub-teams
Advantages of H.E.R.T
y Increased number of available responders by
Cross training most members
y Decreases the additional expectations of the
ED staff during emergencies
y All hazards approach works in most situations
y Frequent team training allows for enhanced
response to actual events
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HOW TO “SELL” THE CONCEPT
y The Joint Commission Standards
y OSHA
y ASPR/HPP Grant funding requirements
y ENA Hazardous Material Position Statement
• www.ena.org
2008 Hazardous Material Exposure
ENA Position Statement
y Optimal Care best achieved by a systematic
approach
y Recognition of clinical features and treatment
regimes
y ED’s and associated Departments be prepared
y ED’s and hospitals shall plan and coordinate
with community response partners
Core group
y Patient Decontamination Team
y Emergency Department Staff
y Radiation Safety
y Security
y Spill Response
y Local Fire Department
y Emergency Medical Services
y Law enforcement
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H.E.R.T Truck
PA DOH Certified QRS Unit
y 10 cots, IV poles
y Basic First Aid bags
y 4 oxygen cylinders
y Burn supplies
y Large amount of O2 devices
y Trauma bandages
y Lifepack 15 monitor
y OB kits
y Advanced Airway
y Disposable blankets
y EZIO Available
y Linens
y IV insertion supplies
y Isolation PPE
y 4 cases of IV Solution
y Ambulance litter
y Rehabilitation
{ 3 Power Misters
{ 10 x 20 EZ-UP Tent (1)
{ 10 X 10 EZ-UP Tents (3)
y Backboard, cervical collars
y Hospital radios
y EMS-Fire band Radio
(pending)
H.E.R.T Truck
y Generator
y 2 sets of flood lights
y Rope
y Fire extinguisher
y Bull
ll h
horn
y Hand tools
y Tent tie down kits
y Ratchet straps
y Hospital EP Plan, ERG, Niosh Manual
y Helmets, work gloves
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H.E.R.T T-1 AND T-2
y Trailer 1
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y Trailer 2
Back up decontamination
Triage Tags (3,000)
N- 95 masks, g
gloves, g
gowns
2 sets of flood lights
300 PAPR filters
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Radiation response gear
700 Doff-it kits
Helmets
Portable negative pressure
Cases of Decontamination
gear (Suits, Boots, filters)
Patient Decontamination Team
y Cross Trained to Spill, Triage, medical care (within
scope of practice), off site response
y Basic training….then CDP
y All hazards approach to chemical
decontamination
y Gross, Secondary and Technical experts
y Continuing Education (mandatory)
y Exercises and competencies annually
http://cdp.dhs.gov/
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http://cdp.dhs.gov/
Emergency Department
y Disaster triage
{ R.P.M.
{ S.T.A.R.T.
{ Jump S.T.A.R.T.
{ OSHA 1920.120
1920 120
{ Level C protection
Education
Annual competency
Ù Skills lab
Ù
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Please include Physicians and extenders!
Radiation Safety Officer
y Review and edit Radiological Emergency Plan
y Validate monitoring equipment
y Train
a su
surveyors
eyo s to
o operate
ope a e in the
e warm
a
zone
o e
y Assist with exercise development
y Test the plan
y Oak Ridge Institute for Science and Education
HTTP://ORISE.ORAU.GOV/TRAINING/INDEX.HTM
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Security
y Scene control
y Remote ETA monitoring
y Communications (disaster radios)
y Monitor State Emergency
g
y Radio
y IC training
y TAZER, pepper spray,
handcuff trained
y CISM
Spill Team
y Haz mat Certified
{ Awareness
{ Operations
{ Technician
{ Cross train with Decon team
{
{
{
Material Safety Data Sheet (MSDS)
NIOSH manual http://www.cdc.gov/niosh/npg/
Emergency Response Guide (ERG)
www.phmsa.dot.gov/hazmat/library/erg
Environmental Services
y Spill
{ Control the scene
{ Activate spill response
{ Assist with logistics
{ Assist after spill is scene is stabilized and safe
{ Decontamination
Ù
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Assist with scene preparation
Clean up tear down after exercises
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Fire Department
y Assist with evacuation
y Perform gross decontamination
y Crowd control
y Scene safety
y
y Command post
y Communications
Education
y Outsourced
y In-house
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Education: Out-sourced
y Private Contractor
y FEMA: http://training.fema.gov/IS/crslist.asp
y CDC: http://www.cdc.gov/
http://www cdc gov/
y CDP: https://cdp.dhs.gov/
y Oak Ridge: http://orise.orau.gov/reacts/
Education: In-house
y Emergency Preparedness Committee
y Spill Team Leader
y Decontamination Team Leader
y Radiation Safety
y Officer
y Emergency Department
y Nursing Education
y Security
y Subject Matter Experts
Decontamination Techniques
y Initial arrival
y Scene preparation and safety
y Gross decontamination
y Rapid
p triage
g RPM/START
/
y Life saving care in the ETA
y Secondary decontamination
y Post decontamination triage
y Technical decontamation
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Emergent Medical Training
y S.T.A.R.T.
y Jump S.T.A.R.T.
y R.P.M.
y Intraosseous insertion
y Difficult Airway
y SCENE SAFETY
y Secondary Triage
Triage training
Training
y Begin simple
{
Table top each sub- specialty
y Function Training
PPE
Minor spill
{ Triage 25 “patients”
{ Controlled ambulatory patient decontamination
{ Controlled 1 patient non-ambulatory
decontamination
{ Team technical decontamination
{ Active Shooter threat
{ Evacuation
{
{
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Exercises
y Build each exercise in complexity
y Important to not set-up the new teams for failure
y Make exercises fun and original
y Table top first to prepare the team
y MUST include a Safety Officer in all live exercises
Mass casualty Exercise
Decontamination Exercises
y 1-4 ambulatory patients: Decon Room
y 5-10 ambulatory: unsupported team
y 10-20 ambulatory and non-ambulatory patients
y Large scale with community responders
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Full scale exercise
y Hospital Incident Command
y HERT
y ED Activation
y Fire
y Law enforcement (LE)
y EMS
Hospital Evacuation
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ED Preparation
Incident Command
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Planned Mass Gathering Response
y “WWII Weekend”: Hot/Humid/elderly
y 6-day County Fair: Rodeo/motorsports
y Hospital based running race
y National night out: multiple deployments
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Staffed by Physicians, PA, PHRN, RN
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