Unit Seven
Emergency Treatment Area (ETA)
for Triage, Decontamination,
Treatment, and Transport
Objectives
 Describe the emergency notification and call-out
procedures
 Establish emergency response procedures
 Design and set up the ETA
 Describe setup procedures for patient
decontamination station
 Review triage procedures before administering patient
care
 Outline patient decontamination procedures.
 Review dismantling procedures for the ETA
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Purpose of the ETA
 To handle contaminated patients from MCI, HMI,
or WMD event
 Set up as a controlled area
 Only one entrance and exit
 Exclusive for contaminated and suspected
contaminated patients:


DHS/NTC
Brought from incident site
Walking into the hospital
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Location of the ETA
 Uphill and upwind when possible
 Near required resources:

Water, power, easy access, etc.
 Out of visibility to public, if possible
 Sufficient distance from hospital site:

To minimize damage in event of an explosion:
• IED as secondary device


DHS/NTC
Ensure safety of personnel at work
Minimize facility damage
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Location of the ETA (cont'd)
 Near enough to hospital’s emergency department
or entrance to minimize:
 Traveling time for additional treatment
 Possible exposures during inclement weather
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Layout of the ETA
Hospital Decontamination Zone
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Notification of MCI
 At notification of a MCI, HMI, or a terrorist use of
a WMD
 Hospital notification and recall procedures will be
activated
 As team members arrive, the HERT will:
 Establish communications with the IC
 Prepare ETA for patient reception and decontamination
 Suit up in the appropriate CPC&E
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Standard Caller Information
 Required Information:
 Name of caller
 Date/time and location of incident
 Estimated number of victims
 Victim’s medical status and triage category
 Type of care already provided
 Radiation incidents:
 Have victims been surveyed?
 Exposed verse contamination
 Type of radiation, if known
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Standard Caller Information (cont'd)
 Explosive Device:
 Type of weapon (vehicle, briefcase, bomb, etc.)
 Number of victims
 Any secondary explosions
 Hazardous Materials Incident/WMD Event:
 Identity of substance/contaminant, if known
 Liquid, solid or gas/vapor
 Signs and symptoms of exposure
 Release on-going or terminated
 Potential crime scene
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Standard Caller Information (cont'd)
 Patient’s estimated arrival time at the hospital
 Means of transport vehicle(s):
 EMS, POV, etc.
 Any first responders at the scene?
 Fire department, EMS, police, etc.
 Solicit report from first responders
 Has initial decontamination been performed
 Nature of injuries
 Identification of materials (labels, placards, etc.)
Note: Never trust field decontamination as
thoroughly cleaning the patient/victim
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Standard Caller Information (cont'd)
 Call-back number for:

Verification and follow-up
 Actual incident versus hoax
 Design a checklist to capture critical information
 Disseminate information quickly to:





DHS/NTC
ED
Hospital Safety/Security Officer
HERT/Decon Team Members
Hospital staff
Administrator
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Pre-Arrival Actions
 Consultation with hospital staff and experts:
 MSDS
 CDC
 Poison Control Center
 ATSDR
 Product identification/information gathering:
 Chemical name (synonym & trade name)
 Physical and chemical properties
 Quantity of materials released
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Pre-Arrival Actions (cont'd)
 Pre-entry planning and preparation:
 Mobilize HERT
 Staging of equipment/supplies
 Pre-entry determination
 Who, what level of protection (LOP), etc.
 Set-up and test internal communications
 Preparing ED for possible contaminated patients:
 Stock and drape HAZMAT suite (1 or 2 victims)
 Set up Patient Decontamination Station (PDS)
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Pre-Arrival Actions (cont'd)
 Donning appropriate CPC&E
 Conducting pre-entry safety briefing:
 HERT
 Security and staff
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Preparation Procedures
 Set up with prevailing winds blowing from “Cold”
area to “Hot” area, when possible:

Preplanning consider prevailing wind directions
 Special isolation techniques and control procedures
are enforced
 Provide protection for staff, hospital facility,
equipment, and the environment
 Prevent spread of contamination outside the Patient
Decontamination Station (PDS)
 Develop a plan for shutting down HVAV and exhaust
fans with Plant Operations
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Preparation Procedures (cont'd)
 Hospitals/medical centers isolate contaminated
patients
 Provide separate ingress routes into medical
facility
 Establish new control patterns for:
 Vehicle traffic
 Foot traffic
 Consider “controlling access” early in plan
 Lock down procedures
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Preparation Procedures (cont'd)
 Resolve traffic control and routing issues
 Disseminated information to appropriate agencies
and authorities:
 Fire Department
 EMS
 HazMat team
 Hospital staff
 Public health department
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Preparation Procedures (cont'd)
 Prepare to handle all contaminated victims similar to:



Strict isolation precautions
Protocol for “dirty” surgical cases
HazMat protocol
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Control Zones
 Control Zones should be established for:


Entrance and exit
Operations inside the ETA
 The ETA has three distinct zones
 Zones are separated to:



Control access
Provide security
Minimize transfer of contamination
 Enables scene control of bystanders
 Established by barricades and isolation areas
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Hospital Decontamination Zones
(OSHA)
 Hospital Pre-decontamination Zone


Assessment, triage, and treatment
Similar to OSHA’s “Hot Zone”
 Hospital Decontamination Zone


Decontamination of patients
Similar to OSHA’s “Warm Zone”
 Hospital Post-decontamination Zone


Advance patient care and treatment
Similar to OSHA’s “Cold Zone”
 OSHA Best Practices for Hospital-based First
Receivers of Victims…, dated 9/2/2004
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“Hot” Zone
 First zone is called the “Hot” zone
 Exclusion zone (EZ) by OSHA
 Hospital Pre-decontamination Zone
 Considered the contaminated area
 “Hot” zone will be established at:
 Site of a HMI, MCI, or WMD event
 Entrance to the medical facility:
 Possible within the ETA
 Location of multiple contaminated victims
 HazMat Incident occurring at the hospital
 Possible terrorist’s event (suicide bomber)

DHS/NTC
Warrants this consideration
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Activities Within “Hot” Zone




Incident “size-up”
Scene control
Entry for triage
Ambulatory patient assembly
area

(Secondary triage)
 Triaged non-ambulatory
patients
 “Immediate” patients
treatment
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Actions After Patient Arrival
Incident “size-up” and assessment
Scene and bystander’s control
Establishment of site perimeters
Entry into “Hot” zone to assist victims:
 If it can be done safely
 With appropriate CPC&E
 Perform triage of victims
 Assess amount of contamination on victims
 Decontaminate victims as required




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“Warm” Zone
 The second zone is called the “Warm” zone


Contamination reduction zone (CRZ) by OSHA
Hospital Decontamination Zone
 Considered a buffer between the other zones
 Contiguous to the contaminated and noncontaminated areas
 Provides added controls and security
 Location of the Hospital Decontamination Zone
 Care is taken to prevent its contamination
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“Warm” Zone (cont'd)
 Once patients are admitted into the “Warm” zone:


Entry and exit of personnel and equipment must be
controlled
Personnel and equipment must be decontaminated before
leaving this zone
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Activities Within “Warm” Zone
 Removal of victim’s clothing
 Decontamination of:







Ambulatory patients
Non-ambulatory patients
“Immediate” patients
Provide B/ALS care
Clean/dress open wounds
Complete wash and Rinse
Redress/cover patients
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Actions During Patient
Care & Treatment
 Provide basic and advance life saving care
 Decontamination of victims/patients and rescuers
 Containment of wash/rinse solutions:

EPA Guidance, “First Responders’ Environmental Liability
Due to Mass Decontamination Runoff,” July 2000
 Neutralize residual contaminants/spills
 Containerize all waste materials/CPC&E
 Change outer gloves/aprons regularly
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“Cold” Zone
 The third zone is called the “Cold” zone


Support zone (SZ) by OSHA
Hospital Post-decontamination Zone
 Considered a non-contaminated area
 Last zone that patients go through before entering:


DHS/NTC
The hospital facility
Preferably the emergency department/room
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“Cold” Zone (Cont’d)
 Patient enters “Cold” zone only after proper
decontamination
 Personnel assigned to monitor this zone to ensure:

Only essential personnel and equipment enters
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Activities Within “Cold” Zone
 Clean treatment area
 Major care provided
 Rapid treatment area
 Life threatening injuries
 By-pass HDZ – “Immediate”
victims/patients
 Must weigh risk of patient care to
possible contamination of the ED
 Admission/transfer and/or
transport
 Further care and recovery
 Additional medical treatment
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Actions After Patient
Care & Treatment
 Admission for further care and treatment
 Transfer and/or transport to other medical facilities

Patients requiring special care and treatment
 Observation:


Some chemicals have delayed effects
Minimum 18 hours recommended
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Dismantling of the ETA
 ETA should not be dismantled until after joint
conference between:
 Incident Commander
 Hospital Safety Officer(s)
 Decontamination Officer(s)
 Hospital Administration
 Public Health Officials
 Other medical facilities:
 To determine victim/patient status, and
 Possible treatment requirements
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Dismantling Procedures
 Dismantling begins at “Cold” zone and proceeds
toward the “Hot” zone
 All waste items removed and containerized
 Entire area checked for residual contamination
 Washing and rinsing should be minimized
 Absorption/neutralization best control methods


Vermiculite, kitty litter, and other absorbents
Used to solidify containers of waste water and other liquids
 Ensure proper waste disposal and notifications
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Post-Incident Actions




Delegate final clean-up responsibilities
Decontaminate staff/equipment
Dismantle ETA and PDS
Post-entry evaluations/examination of:



HERT members
Decontamination Team members
Medical staff personnel
 Recordkeeping/After-action reporting
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Post-Incident Actions (cont'd)
 Complete analysis of response actions
 Recommendations to hospital emergency
management plan (HERP)
 Disposal of waste materials
 Appropriate notifications to proper agencies
 Local public owned treatment works, and
 Disposal authorities (EPA, NRC, etc.)
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Summary and Review
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Questions
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Break Time
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Unit Eight
Hospital Decontamination
Procedures
Objectives









Define decontamination
Describe methods of decontamination
List types of decontamination solutions
State decontamination during medical emergencies
List levels of protections for decontamination workers
Outline decontamination steps
Set up a personal decontamination station (PDS)
Utilize the PDS
Dismantle the PDS
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Purpose
To limit the spread of contamination
to clean areas of the hospital,
personnel, equipment, and to the
environment
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Contamination
 Contacting vapors, gases, mist, or particulates
 Being splashed by materials while carrying open
containers of liquids
 Walking through puddles or pools of liquids
 Standing in or walking through contaminated soil or
surfaces
 Handling contaminated patients
 Using contaminated instruments or equipment
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Contamination (Cont’d)
 While removing contaminated clothing
 When contaminants are transferred into clean areas
of the hospital
 Not following good decontamination procedures or
protocols
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Decontamination
 Physically removing contaminants or changing their
chemical nature to innocuous substances
 Extent of decontamination depends on types of
chemicals
 Harmful contaminants require a more extensive
decontamination process or plan
 Non-harmful contaminants requires less effort to
decontaminate
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Methods of Decontamination
 Dilution: Reduces concentration of harmful substances to
safe levels with water
 Absorption: Picking up spilled substances with an inert
absorbent material
 Degradation: Altering chemical structure of harmful
substance with an active chemical agent
 Isolation: Bagging and tagging materials which cannot be
successfully decontaminated
 Disposal: Removal of harmful substances to an approved
disposal site
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Initial Planning
 Assume all personnel and equipment leaving the “Hot
Zone” are grossly contaminated
 Washing and doffing process can further reduce the
spread of contamination (stations minimum of 3 feet
apart)
 Methods should be developed to prevent
contamination of workers and equipment
 Plan should be outlined in the Hospital’s Emergency
Management Plan
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Initial Planning (cont'd)
 Based on site-specific conditions:




Types of contaminants
The amount of contamination
The levels of protection required
The type of protective clothing to be worn
 Initial plan can be modified as necessary
 Disposable garments, boots, and gloves can be worn
to eliminate a wash and rinse station
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Initial Planning (cont'd)
 Contamination reduction corridor controls access to the
EZ (Size 75’X15’)
 Hospital Decontamination Zone
 All Zone boundaries are conspicuously marked
 CPC&E, monitoring equipment, and supplies are
maintained within the SZ
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Plan Modifications
 Based upon types of contaminants (degree of
toxicity)
 Amount of contamination (gross vs. mild)
 Level of protection worn (FECP or NECP)
 Work function (monitoring/sampling)
 Location of contaminants (upper/lower)
 Reason for leaving the hot area (air cylinder
change)
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Effectiveness
 No immediate method presently available
 Observable methods indicate surface contamination
 Swipe test and laboratory analysis of materials are
required
 Test indicates if surface contaminants have been
removed
 Penetration or permeation of materials may still exist
 Permeation data requires laboratory analysis
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Equipment







Selection is based on availability
Ease of equipment decontamination or disposability
Soft-bristle, long-handled scrub brushes.
Buckets or garden sprayers
Galvanized wash tubs or kiddy pools
Large plastic garbage bags
Traffic cones & barrier tape
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Equipment (cont'd)
 Metal or plastic drums or containers
 Paper or cloth towels for wiping
 Polyethylene or plastic sheeting (minimize surface
contamination):

Consider possible slipping hazards
 Plastic or metal chairs (covered with plastic or
garbage bags)
 Assorted boxes or other cardboard containers
 Small plastic or metal folding tables
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Solutions
 Skin - use a mild soap and water solution
 CPC&E, sampling tools, and other equipment are
usually decontaminated by:
 Scrubbing with a mild detergent and water; and
 Rinsing with large amounts of water
 Household bleach at 0.5% can also be used
 Most contaminants can be removed this way
 Some materials require a chemical solution
(acetone, ethyl alcohol, etc.)
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Emergency Decontamination
 Basic considerations for the Hospital Site Safety
Officer (HSSO):





Training of the Response Team members
Arrangement with nearest medical facility
Consultation services with a toxicologist
Emergency eye washes, showers, and stations
First aid kits, blankets, stretchers, and resuscitators
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Emergency Decontamination (cont'd)
 Additional considerations for the HSSO:
 Methods for decontamination of personnel with
medical problems and injuries
 When procedures may aggravate or cause serious
health effects
 When prompt lifesaving first aid or medical treatment
is required
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Heat-Related Illnesses
 Range from heat fatigue to heat stroke
 Heat stroke requires prompt treatment to prevent
irreversible health damage or death
 CPC&E may have to be cut off without decontamination
 Lesser illnesses can become more serious with delayed
treatment or CPC&E removal
 Omit or minimize decontamination protocol to begin
immediate first aid treatment
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Chemical Exposure
 Injuries from direct contact with acids or toxins
 Potential injury due to gross contamination on
clothing or equipment
 Toxic exposure should be evaluated by a qualified
physician
 Skin and eyes should be flushed with water for a
minimum of 20 minutes
 Wash grossly contaminated CPC&E off rapidly

DHS/NTC
Reduce or minimize permeation of chemical
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Patient Decontamination –
Chemical Agent
 Direct patient/victim to Patient Decontamination Station

If chemical agent or hazardous substance is known or suspected
 Have patient/victim:


Remove clothing/items
Place clothing/items in plastic bags:
• Large bag for shoes and clothing
• Smaller bag for items (watch, rings, glasses, etc)
• Tag clothing/items for identification/possible evidence

Assess patient/victim for injury:
• Signs and symptoms of exposure to chemical agent
• Administer antidote (Mark I Kit, etc.)
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Patient Decontamination –
Chemical Agent (Cont’d)

Supervise shower, wash and rinse:
• Rinse for at least one minute
• Wash with warn soap and water solution, and
• Rinse thoroughly

Provide disposal towel for drying off and redress clothing:
• Collect and containerize all items used in decontamination process


Assess patient/victim for further signs and symptoms
Direct or assist patient/victim to emergency department
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Patient Decontamination –
Biological Agent
 Direct patient/victim to Patient Decontamination Station

If biological release is known or suspected
 Have patient/victim:


Remove clothing/items
Place clothing/items in plastic bags:
• Large bag for shoes and clothing
• Smaller bag for items (watch, rings, glasses, etc)
• Tag clothing/items for identification/possible evidence

Assess patient/victim for injury:
• Signs and symptoms of exposure
• Compare against known or suspected syndromes
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Patient Decontamination –
Biological (Cont’d)

Supervise shower and rinse:
• Rinse for at least one minute
• Wash with warn soap and water solution, and
• Rinse thoroughly

Provide disposal towel for drying off and redress clothing:
• Collect and containerize all items used in decontamination process


Assess patient/victim for further signs and symptoms
Direct or assist patient/victim to emergency department
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Patient Decontamination –
Radiological Material
 Direct patient/victim to Patient Decontamination Station


If radiological contamination is known or suspected
Survey patient for radiological contamination
 Have patient/victim:


Remove clothing/items
Place clothing/items in plastic bags:
• Large bag for shoes and clothing
• Smaller bag for items (watch, rings, glasses, etc)
• Tag clothing/items for identification/possible evidence

Assess patient/victim for injury:
• Signs and symptoms of exposure to radiation
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Patient Decontamination Radiological (Cont’d)

Supervise shower and rinse:
• Rinse for at least one minute
• Wash with warn soap and water solution, and
• Rinse thoroughly

Provide disposal towel for drying off and redress clothing:
• Collect and containerize all items used in decontamination process


Survey patient again for radiological contamination
Direct or assist patient/victim to emergency department
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Decontamination Area
Constructed between the Hot Zone and
the Support Zone, in the Contamination
Reduction Zone (CRZ) or in the Hospital
Decontamination Zone
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Patient Decontamination Stations
 Patient Decontamination Stations (PDS) can be:


Fixed
Portable
 PDS for ambulatory and non-ambulatory patients is
recommended
 Separate decontamination area for HERT members:


Set up for staff decontamination, and
Rotation to and from the “hot zone”
• Where triage and treatment is being performed by HERT
 Staffed by qualified decontamination workers

Minimum training OSHA “Operations Level”
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Suggested Cut-Out Procedures
(Non-ambulatory Patient’s Clothing)
Refer to Handout, “Suggested Cut-Out Procedures”
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Suggested Decontamination
Area Layout for HERT Members
Hot Line
ED
Clean Line
DECONTAMINATION AREA
Wash & Rinse
Chair
PAPR Drop
Table
HOT
ZONE
Entrance from
Hot Area
OB/B
OG
Drum
Chair
OS
Drum
SUPPORT
ZONE
Chair
IS
IB/B
FF
IG
PAPR Change Out Route
Entrance to Hot Area
CONTAMINATION REDUCTION
LEGEND
OB/B – Outer Boots/Booties
IB/B – Inner Boots/Booties
OG – Outer Gloves
IS  Inner Suit
OS – Outer Suit
FF  Facepiece
ZONE
IG – Inner Gloves
ED – Equipment Drop
Face &
Hands
Wash
Station
Lunch Time
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MCI Field Exercise
Group 1:
CPC&E - Donning/Doffing
APR – Donning/Doffing
Group 2:
Decontamination – Set-up and
Use of Decon Unit
Group 3:
PAPR – Donning/Doffing
Break Time
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MCI Field Exercise
Group 2:
CPC&E - Donning/Doffing
APR – Donning/Doffing
Group 3:
Decontamination – Set-up and
Use of Decon Unit
Group 1:
PAPR – Donning/Doffing
MCI Field Exercise
Group 3:
CPC&E - Donning/Doffing
APR – Donning/Doffing
Group 1:
Decontamination – Set-up and
Use of Decon Unit
Group 2:
PAPR – Donning/Doffing
MCI Field Exercise
Review and Discussion
of Field Exercises
End of Day Two
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Unit Nine
HIMS and Unified
Command (UC)
Objectives
 Select and develop a command structure that is
appropriate for a major incident
 Identify factors that may require expanding the
command structure
 Identify potential issues regarding coordination and
communication with other command structures and
develop strategies for resolving the issues
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Objectives (cont'd)
 Discuss the advantages of using UC
 Describe the applications and features of UC
 Analyze an incident and develop an appropriate UC
structure
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Unified Command
DHS/NTC
Policies,
Objectives,
Strategies
Jurisdictions,
Agencies
Organization
Unified
Command
Structure
Resources
Personnel,
Equipment
Operations
Operations
Section Chief
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Advantages of Unified Command
What are the advantages of using Unified
Command?
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Unified Command Applications
A
B
More than one political
jurisdiction
C
A
Fire,
Law,
Health
A
B
C
E
DHS/NTC
D
Multiple agencies within a
jurisdiction
Several political and
functional agencies
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80
Multi-jurisdictional Incident
Unified Management Structure
Jurisdiction A
Jurisdiction B
Jurisdiction C
Unified Objectives
Command Staff
Operations
Section
DHS/NTC
Planning
Section
Logistics
Section
B461 Course
Finance/
Administration
Section
81
Multi-agency Incident
Unified Management Team
Fire
Police
Hospital Public Health/
Department Department Administrator
Other
Unified Objectives
Command Staff
Operations
Section
DHS/NTC
Planning
Section
Logistics
Section
B461 Course
Finance/
Administration
Section
82
Unified Incident Command
Sheriff
Fire
Departments
EMS
Operations Section Chief (Law)
Deputy (Fire)
Deputy (Health)
Staging Areas
Law
LawBranch
Branch
Fire Branch
Medical Branch
Divisions
Divisions
Divisions
Resources
Resources
(Single/Teams/Task Forces)
Resources
Resources
DHS/NTC
B461 Course
83
Hospital On-Scene Emergency
Response Structure
Incident
Commander
Public
Information
Safety
Federal
On Scene
Coordinator
Government
Liaison
State On Scene
Coordinator
Operations
Planning
Logistics
Finance/Admin
Hospital Incident Management
System (HIMS)
DHS/NTC
Responsible
Party
B461 Course
Unified Command (UC)
84
HIMS to UC Transition
Federal
On Scene
Coordinator
State On Scene
Coordinator
Responsible
Party
Potentially
Responsible
Party
(PRP/RP)
State
On-Scene
Coordinator
DHS/NTC
B461 Course
85
Relationship Between
HIMS and UC
 UC brings together IC of all major organizations
 UC becomes the essential elements of the incident
management team (IMT)
 The UC is responsible for the overall management of the
incident
 It creates the link between responding organizations at
the incident
 It provides a forum for these entities to make consensus
decisions
DHS/NTC
B461 Course
86
Relationship Between
HIMS and UC (cont'd)
Unified
Command
Participants Include:
State Official(s)
Federal Official(s)
Responsible Party
Hospital Director
Safety
Information
Liaison
Operations
Planning
Logistics
Finance/Admin
Reference: NRT ICS/UC Technical Assistance Document, Fig.2, page 15.
DHS/NTC
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87
Relationship Between
HIMS and UC (cont'd)
 No agency relinquishes authority or responsibility, or
accountability, however:
 The Federal and/or State OSC has ultimate responsibility for
a successful response effort
 Each may be required to perform the role as “lead
agency” (LA) during the response
 Organizations not a part of UC may assign
representatives to appropriate Sections
Reference: NRT ICS/UC Technical Assistance Document, Para 2.3, page 14.
DHS/NTC
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88
Assigned Representatives
 Serve as an agency or company representative
 Provides stakeholder input to the Liaison Officer
(LO) for environmental, response action, economic,
or political issues
 Provides feedback to agency/company they
represent, who has direct contact with the LO
 Serve as a Technical Specialist in the appropriate
section (Operations or Planning), and/or
 Provide input to other UC members
Reference: NRT ICS/UC Technical Assistance Document, Para 2.2.4, page 14.
DHS/NTC
B461 Course
89
OSC/RPM in Unified Command
OSC/RPM*
Participants Include:
Federal Official(s)
State Official(s)
Hospital Director
Responsible Party
Representative(s)
Safety
Information
Liaison
Operations
Planning
Logistics
Reference: Fig 1a, 40 CFR 300.105 (e)(1)
DHS/NTC
B461 Course
Finance/Admin
*Remediation Project Manager
90
Strong Command Presence




Needed whether functioning as an ICS, HIMS, or UC
Essential to an effective response
If in command – be in “command”
UC may assign Deputy ICs

Assists in carrying out IC responsibilities
 UC members may also be assigned individuals for:

Legal and administrative support from their own
organizations or agencies
Reference: NRT ICS/UC Technical Assistance Document, Para 2.2.3, page 14.
DHS/NTC
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91
Advantages of an
HIMS/UC





Use common language and response culture
Optimizes combined efforts
Eliminates duplicative efforts
Establishes a single command post
Allows for collective approval of operations, logistics,
planning, and finance activities
 Encourages a cooperative response environment
DHS/NTC
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92
Advantages of an
HIMS/UC (cont'd)
 Allows for shared assets and resources:
 Reducing response cost
 Maximizing efficiency and effectiveness; and
 Minimizing communications breakdowns
 Permits responders to develop and implement one
consolidated IAP
Reference: NRT ICS/UC Technical Assistance Document, Para 2.3.1, page 16.
DHS/NTC
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93
Unified Command Features




Single integrated incident organization
Shared facilities
Single planning process and IAP
Shared Planning, Logistics, and
Finance/Administration activities
 Coordinated resource ordering
DHS/NTC
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94
Command Meeting
 Includes responsible officials
 Provides opportunity to:

Discuss important issues
 Reach agreement
DHS/NTC
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95
Incident Action Planning Meeting





Determine operational activities
Establish resource requirements and availability
Assign resources
Establish a unified operations section
Establish combined Planning, Logistics, and
Finance/Administration functions, if necessary
DHS/NTC
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96
Use of Deputies Under
Unified Command
Unified Command
A
Operations
A
Deputy - B
DHS/NTC
B
Planning
B
Deputy - A, C
C
Logistics
A
Deputy B
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Finance
A
97
Single Resource Ordering
Advantage: Procedures can be determined in
advance
DHS/NTC
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98
Unified Command Guidelines
 Understand how UC works
 Collocate essential functions
 Implement UC early
DHS/NTC
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99
Unified Command Guidelines (cont'd)
 Concur on Operations Section Chief and general
staff members
 Designate one IC as spokesperson
 Train often as a team
DHS/NTC
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100
Summary and Review
DHS/NTC
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101
Break Time
DHS/NTC
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102
Unit Ten
HIMS and Hospital Emergency
Response Plan (HERP) Integration
Objectives
 Describe purpose of the Hospital Emergency
Response Plan (HERP)
 List requirements for the HERP
 Review components of the plan
 Discuss the divisions of the plan
 Describe how HERP and HIMS integrate
 State how the plan is tested and validated
DHS/NTC
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104
Hospital Emergency Response
Plan (HERP)
 The HERP is necessary to minimize employee injury
and property damage
 It is a critical document which ensures hospital and
medical staff are prepared to respond to:
 Hazardous materials incidents
 Terrorist’s use of WMD
 Mass Casualty Incidents (MCI)
DHS/NTC
B461 Course
105
Hospital Emergency Response
Plan (HERP) (cont'd)
 The HERP describes:
 Policies, procedures, and guidelines to be followed in
handling these emergency situations
DHS/NTC
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106
Legal Requirements for the Plan
 Current Joint Commission for the Accreditation of
Healthcare Organizations (JCAHO), Accreditation
Manual for Hospitals
 National fire codes
 Emergency Operations Plan
 The Community Emergency Preparedness Plan
 Community fire and sanitation ordinances
 Applicable State and Federal regulations
DHS/NTC
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107
Elements of the HERP
 Pre-emergency drills implementing the hospital's
emergency response plan
 Practice sessions using ICS with other local
emergency response organizations
 Lines of authority and communication between the
incident site and hospital personnel regarding
hazards and potential contamination
 Designation of a Decontamination Team, including
emergency department physicians, nurses, aides,
and support personnel
DHS/NTC
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108
Elements of the HERP (cont'd)
 Description of the hospital's system for immediately
accessing information on toxic materials
 Designation of alternative facilities that could provide
treatment in case of contamination of the hospital's ED
or for surge capacity
 Plans for managing emergency treatment of noncontaminated patients
 Decontamination procedures and designation of
decontamination areas (either indoors or outdoors)
DHS/NTC
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109
Elements of the HERP (cont'd)
 Hospital staff use of CPC&E based on routes of
exposure, degree of contact, and each individual's
specific tasks
 Prevention of cross-contamination of airborne
substances via the hospital's ventilation system
 Air monitoring to ensure that the facility is safe for
occupancy following treatment of contaminated
patients; and
 Post-emergency critique of the hospital's emergency
response
DHS/NTC
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110
Main Divisions of the Plan
 Basic plan
 Supporting annexes

HazMat
 Terrorism
 Occupational and health
 Implementation guidelines
DHS/NTC
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111
Mass Casualty Surge Capacity
Estimation Tool
Factor
A = 5%
.05
B = 10%
.10
C = 15%
.15
D = 10%
.10
E = 15%
.15
F = 40%
.40
G = 5%
.05
DHS/NTC
2x normal capacity
(multiply by factor)
B461 Course
5x normal capacity
(multiply by factor)
112
Why HIMS/HERP Integration?
 Predictable chain of management
 Accountability of position function
 Flexible organizational chart allows flexible
response to specific emergencies
 Improved documentation of facility

Completed for each shift
DHS/NTC
B461 Course
113
Why HIMS/HERP Integration? (cont'd)
 Common language to facilitate outside assistance
 Prioritized response checklists
 Cost effective emergency planning within health
care corporations
 Assist in the development of Incident Action Plans
(IAP) during emergencies
 Governmental requirements as is the case with
public hospitals
DHS/NTC
B461 Course
114
HERP and HIMS Integration
Incident
HERP
• Take information
from HERP
• Combine with
information from
the
incident/situation
Incident Action Plan
DHS/NTC
B461 Course
• Create an
Incident Action
Plan to control
and bring the
incident to a safe
conclusion
115
Training and Exercises
 To test and validate the HERP and HERT
 Participants involved in exercises:
 First responders (e.g., fire, police, EMS, public works)
 Medical providers
 Support personnel (e.g., communications, transportation,
etc.)
 EOC personnel
 Mutual aid partners
 Federal/State OSCs
DHS/NTC
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116
Training and Exercises (cont'd)





Medical facility Administrators
Voluntary agency personnel
The media
Public utility personnel
Others
 Exercises will reveal strengths and weakness in
the HERP and HERT
 Annually refresher training is required
 Drills and exercises every 6 months:

DHS/NTC
More is better to maintain proficiency
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117
Related Standards
 For further information on applicable standards, refer
to:






DHS/NTC
29 CFR 1910.120 - Hazardous Waste Operations and
Emergency Response
29 CFR 1910.1030 - Bloodborne Pathogens
29 CFR 1910.1200 - Hazard Communication (Appendix AHealth Hazard definition; Appendix B-Hazard Determination;
Appendix C-Information Sources)
29 CFR 1910.38 - Employee Emergency Plans and Fire
Prevention Plans
29 CFR 1910.132 - Personal Protective Equipment
29 CFR 1910.134 - Respiratory Protection
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118
Questions
DHS/NTC
B461 Course
119
Break Time
DHS/NTC
B461 Course
120
Unit Eleven
Hospital and Laboratory Response Network
(LRN) and Centers for Disease Control
(CDC) Coordination (Bioterrorism
Preparedness and Response Plan)
Objectives
 Describe HHS and CDC programs that impact
hospitals
 Describe the function of the Laboratory Resource
Network (LRN)
 Discuss how hospitals, CDC, HHS, and other health
agencies interface within the HIMS
DHS/NTC
B461 Course
122
Identification and Evaluation of
Biological Agents
 Prior to the recent biological attacks, there were few
coordinated programs/systems for:

Detection
 Rapid identification
 Response
 Coordination
DHS/NTC
B461 Course
123
Department of Health and Human
Services (HHS)

Department of Health and Human Services (DHHS)
provided funding
• CDC to develop Public Health plans for Bioterrorism and
widespread outbreaks
• HRSA funds for Hospitals and EMS
 Based on a needs assessment
 Multi-year
 Preparedness
DHS/NTC
B461 Course
124
Local Public Health
Agencies’ Concerns
 Unusual outbreaks of disease first noticed by local
health care providers
 Difficulty: Naturally occurring outbreaks and
intentional releases of pathogens may closely
resemble one another
 Ability to respond to rare, unusual, or unexplained
illness at the local level
 Requirement: Resources, support, and increased
awareness
DHS/NTC
B461 Course
125
Biological Outbreaks are
Resource Intensive







Primary care personnel
Hospital ED staff
EMS personnel
Public health professionals
Other emergency preparedness personnel
Laboratory personnel
Law enforcement
DHS/NTC
B461 Course
126
Preparation Public Health Agencies
 Strengthen capacities for detection
 Make diagnostic resources available
 Magnify communications to deliver accurate and
timely information
 Train health care community
 Plans to acquire vaccines and drugs
 Surveillance for unusual microbial strains
DHS/NTC
B461 Course
127
Preparation of Hospitals








Recognition of unusual diseases
Appropriate management of the diseases
Communication to appropriate agencies
Implementation of systems for ongoing management if
multiple cases are suspected
Plans for inclusion of partners as needed
Hospital Incident Management Systems
Know partners before incidents/emergencies
Exercises/drills
DHS/NTC
B461 Course
128
Are Hospitals Ready?
 Preparedness level depends upon the biological
agent and the community disease onset
 Development and implementation of HERP
 Incident management system
 Activation of plan
 In an emergency, “local medical care capacity may
be supplemented with Federal resources”…
 Hospital will have to operate without resources for
the first 24 to 36 hours
DHS/NTC
B461 Course
129
National Disaster Medical
System (NDMS)
 Teams of professional medical personnel to be
deployed to support local public health officials in the
event of a national emergency:





DHS/NTC
Disaster Medical Assistance Team (DMAT)
National Nurse Response Team (NNRT)
Disaster Mortuary Operations Response Team (DMORT)
Veterinary Medical Assistance Team (VMAT)
National Pharmacy Response Team (NPRT)
B461 Course
130
Incident Response and Management Teams
 FEMA DHS

Urban Search & Rescue
 USFA Incident Management Team
 Incident Support Team
 Disaster Mortuary Response Unit
 Other federal government

US Forest Service IMT
 USCG Strike Teams
 FBI HMRU
DHS/NTC
B461 Course
131
Identifying Potentially
Dangerous Microbes
 Increase Laboratory Capacity
 Additional Labs – Chemical and Biological
 LRN – Laboratory Resource Network
 Bio-safety trained personnel
 Resources and protocols to immediately identify
agents used for bioterrorism
 Communication network
 Functional emergency ICS
DHS/NTC
B461 Course
132
Identifying Potentially
Dangerous Microbes (Cont’d)
 BioWatch





DHS/NTC
Air samplers to test for threat agents
Located in undisclosed cities
Monitor the air 24/7
Data is sent to LRN BioWatch labs from the samplers
Rapid identification of agents
B461 Course
133
Laboratory Network
 Public Health Labs supplement hospital labs to:




Perform diagnostic testing that is not available at the local
level
Conduct specialized testing
Create Viral cultures
Identify Agents with BT potential
DHS/NTC
B461 Course
134
Laboratory Capability and Capacity
 Public Health lab capacity has been increased for
identification of:
 Biological agents
 Chemical agents
 Mechanism for response agencies to share
laboratory information in an organized manner
DHS/NTC
B461 Course
135
Laboratory Response Network
(LRN)
 LRN (Laboratory Resource Network):
 CDC, FBI, and Association of Public Health

Laboratories
Created a network of labs:
 to rapidly identify
 to evaluate suspect infectious agents
 CDC National Quality Control Lab:
 Rapid Response and Advanced Technology Lab
(RRAT)
DHS/NTC
B461 Course
136
Support Available to States
 Metropolitan Medical Response System (MMRS)
 HRSA provided assets
 Strategic National Stockpile
 Chempacks
 Emergency stockpiles
 National Nurse Response Team
 National Pharmacist Response Team
DHS/NTC
B461 Course
137
Health Alert Network (HAN)
 CDC advisory network
 Local centers for public health preparedness
 25,000 direct recipients
 Hospitals
 Public Health
 Response agencies
 On September 11, 2001, HAN transmitted messages to
over 250 health officials in 50 states
DHS/NTC
B461 Course
138
Federal Goals
 State emergency health preparedness programs:
 Increase in epidemiologists
 Additional training
 Increased research for dealing with bio-terrorism
 Agency for Toxic Substances and Disease Register
DHS/NTC
B461 Course
139
Epidemic Intelligence Service (EIS)
 CDC’s “Disease Detectives Program”
 Over 2,500 officers have graduated from the EIS
Program
 9/11 over 125 officers were deployed to assist State
& local jurisdictions for controlling anthrax-related
issues
DHS/NTC
B461 Course
140
Presidential Action
February 3, 2003
 Project BioShield
 Provide “next-generation” resources for medical
countermeasures
 Improved vaccines and anti-toxins
 Strengthening National Institute of Health [NIH] in
“speeding research and development”
 Empower FDA to make newest treatments available
in a crisis
DHS/NTC
B461 Course
141
Project BioShield
Coordination Between:
 Secretary of Homeland Security
 Secretary of Health & Human Services
 NIH Programs:
 Focused upon bioterrorism threats
 Increase resources & personnel
 FDA Emergency Use Authorization: “Applying
innovations for protecting America by identifying
new treatments that are most needed… to
strengthen our overall biotechnology
infrastructure…”
DHS/NTC
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142
Questions
DHS/NTC
B461 Course
143
Break Time
DHS/NTC
B461 Course
144
Unit Twelve
Hospital Incident Management
System (HIMS) and the Incident
Action Plan (IAP)
Objectives
 Describe how members of a HIMS organization
contribute to the IAP
 Describe the roles and responsibilities of the ICS
personnel developing the IAP
 Describe how operational periods are used as a basis
for planning for an incident
DHS/NTC
B461 Course
146
Incident Action Plan
Considerations
 Two or more jurisdictions are
involved
 The incident will continue into
another operational period
 Several agencies have been or
will be activated
 Written plans are required by the
Emergency Operations Plan
(EOP)
DHS/NTC
B461 Course
147
Written Incident Action Plans
 A clear statement of goals and actions
 A basis for measuring work effectiveness and cost
effectiveness
 A basis for measuring work progress and for
providing accountability
DHS/NTC
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148
Operational Periods
 Length of time available or needed to achieve
operational objectives
 Availability of fresh resources
 Future involvement of additional jurisdictions
and/or agencies
 Environmental considerations
 Safety considerations
DHS/NTC
B461 Course
149
ICS Forms
Title
 Incident Briefing
 Incident Goals
 Organization
Assignment List
 Unit Assignment List
 Supporting material
DHS/NTC
Form #
 ICS Form 201
 ICS Form 202
 ICS Form 203
 ICS Form 204
 ICS Forms 205 and 206
B461 Course
150
Planning Process



Understand the situation
Establish incident goals and objectives
Develop operational direction and make
assignments
DHS/NTC
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151
Planning Process (cont'd)
 Prepare the plan
 Implement the plan
 Evaluate the plan
DHS/NTC
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152
Essential Elements of
Information





What has happened?
What progress has been made?
Is there a current plan? If so, how good is it?
What is the incident growth potential?
What are the present and future resource
availability and organizational capability?
DHS/NTC
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153
Incident Goals
 Attainable
 Measurable
 Flexible
DHS/NTC
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154
Incident Goals (cont’d)
 Make good sense
 Within acceptable safety limits
 Cost effective
DHS/NTC
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155
Goals and Objectives
Goal: Identify the potential issues and priorities
for processing mass casualties patients
contaminated with a suspected chemical agent
Objectives:
 Ensure the safety of the hospital staff
 Plan for auxiliary treatment facilities
 Protect facilities from contamination
 Establish crowd control measures
 Set up triage and decontamination areas
DHS/NTC
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156
Small Incident Planning
Develop the plan:
 Develop incident goal(s)
 Develop objectives
 Identify appropriate operations
 Make operational assignments
 Disseminate the plan verbally
DHS/NTC
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PLAN
157
Advance Planning
 All participants must come prepared
 Agency representatives must be able
to commit their agencies
 All participants must adhere to the
planning process
 No radios or cellular phones should
be allowed at planning meetings
DHS/NTC
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Operational Planning Worksheet






Incident work location
Work assignments
Kind and type of resources
Current availability of resources
Reporting location
Requested arrival time for additional resources
DHS/NTC
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159
Evaluating the
Incident Action Plan
 Review the plan before release
 Assess the plan regularly
 Adjust the plan as necessary
Incident Site
Fourth
Street
I-281
Queen Street
Street
Street
Street
Second
DHS/NTC
King
Main
Third
Street
B461 Course
160
Questions
DHS/NTC
B461 Course
161
Lunch Time
DHS/NTC
B461 Course
162
Practice Response
Group 1,2,3:
Incident Command
Table Top Exercise
Hospital Incident
Management System
(HIMS) Hands-on
Exercise - Overview
Break Time
DHS/NTC
B461 Course
165
Table Top Exercise
Hospital Incident
Management System
(HIMS) Hands-on
Exercise - Report Out
Break Time
DHS/NTC
B461 Course
167
Practice Response
Group 1:
Decontamination Team
Group 2:
Entry Team
Break Time
DHS/NTC
B461 Course
169
Practice Response
Group 2:
Decontamination Team
Group 1:
Entry Team
Practice Response
Response Debriefing, Analysis
and Critiques
Summary and Review
DHS/NTC
B461 Course
172
Questions
DHS/NTC
B461 Course
173
End of Day Three
DHS/NTC
B461 Course
174
Emergency Response
Group 1:
Decontamination Team
Group 2:
Entry Team
Group 3:
Incident Command System
Break Time
DHS/NTC
B461 Course
176
Emergency Response
Group 1:
Incident Command System
Group 2:
Decontamination Team
Group 3:
Entry Team
Break Time
DHS/NTC
B461 Course
178
Emergency Response
Group 1:
Entry Team
Group 2:
Incident Command System
Group 3:
Decontamination Team
Emergency Response
Response Debriefing, Analysis
and Critiques
Unit Thirteen
Drill/Exercise: Response
Debriefing, Analysis, and
Critique
Objectives





Review notification and call-out procedures
Rehearse incident/emergency response drill
Identify strengths and weaknesses of HERP
Discuss and resolve problems with HERT
List areas requiring administrative or procedural
changes
DHS/NTC
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182
Objectives (cont'd)




Discuss and outline areas of improvement
Identify areas for additional training
Create a list of action items
Establish timeline for the completion of action items
DHS/NTC
B461 Course
183
Post-incident Activities
 After a hazardous materials incident, or emergency
response
 A debriefing, a post-analysis, and critique should
be conducted by the IC
 With all response personnel and support staff
 This conference should be informal
 Open to honest and uncensored comments
DHS/NTC
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184
Response Debriefing, Analysis,
and Critique
 Time for sharing information that will better equip the
ERT and other participants:
 In performing their duties and responsibilities
 Respond more safely and confidently
─ During the next MCI, HMI, or WMD
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Response Debriefing, Analysis,
and Critique (cont'd)
 Time to review:
 What team did right
 What team did wrong
 What lessons can be learned
 This is very important and beneficial
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Debriefing
 The debriefing should include determining exposures
to personnel
 Contamination of equipment and vehicles
 Assigned specific responsibilities to team leaders and
team members
 Perform an effective analysis and critique of the:
 HMI
 MCI
 Incident involving WMD
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Post-incident Analysis
 The post-incident analysis is done by reconstructing
the incident or emergency response
 A systematic process should be developed

To review each aspect of the incident or emergency
response
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Post-incident Analysis (cont'd)
 A checklist should be constructed which highlights:
 Policies, guidelines, and procedures
 The Hospital’s Emergency Response Plan (HERP)
 This would facilitate in outlining all necessary steps
and response actions the HERT should have
followed during the HMI, MCI, or incident involving
WMD
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Critique
 The critique is required to:
 Compile
 Provide documentation to management
 Suggests better methods, guidelines, and procedures
 Improve the team's response during
 Future MCI, HMI, or WMD event
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Critique (cont'd)
 The critique should consist of the following
minimum components:
 Review of notification and call-out procedures
 Rehearsal of incident/emergency response procedures
 Identifying strength and weakness of written HERP
 Discussing and resolving of problems with the HERT’s
performance
 Listing of all areas requiring administrative or procedural
changes
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Critique (cont'd)
 Components (continued):
 Discussing and outlining all areas requiring improvement
 Identifying and listing all areas requiring additional training
 Creating a list of action items and team leaders
responsible for follow-up
 Establishing a timeline for the completion of each action
item
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Follow-up Procedures
 Follow-up procedures include notification of:
 Federal, State, or local agencies
 Internal management
 Completing any necessary incident or accident reports
 To be forwarded as required
 Closure of all opened action items
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Summary and Review
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Questions
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Break Time
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Unit Fourteen
Hospital Incident Management
System (HIMS) and Emergency
Operations Center (EOC) Interface
Objectives
 State the purpose of the EOC
 List the agencies/departments that may be
represented at the EOC
 Give examples of how the EOC supports and
coordinates field activities during an
emergency
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EOC Purpose
To provide a central location where
government at any level can provide
interagency coordination and executive
decisionmaking for managing response
and recovery.
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Advantages of a Single Location
A single location:
 Centralizes direction and control
 Facilitates long-term operations
 Increases continuity
 Provides ready access to all available
information
 Simplifies information verification
 Aids resource identification and use
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EOC Functions
The EOC’s five functions are:
 Direction and control
 Situation assessment
 Coordination
 Priority establishment
 Resource management
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EOC Staff
 Staff should be carefully
selected, trained, and led
 EOC leadership is critical
 The CEO is responsible for
the emerging response
 The CEO depends on
assistance from the EOC
staff
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EOC Organizational Chart
Chief Executive
Policy Function
Emergency
Management
Director
Human Services
Branch
Mass
Care
Public Information
Branch
Public
Health
Donations
Donated
Services
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Infrastructure
Restoration
Branch
Emergency Service
Operations Branch
Animal
Protection
Law
Enforcement
Fire &
Rescue
Donated
Goods
Support Staff
Unmet
Needs
HazMat
Disaster
Medical
Services
Military
Support
Transportation
Damage
Assessment
Communications
Public
Works
Energy
Search &
Rescue
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EOC Public Information Branch
Chief Executive
Policy Function
Emergency
Management
Director
Public Information
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The City Emergency Organization
NOTE: Thick-sided shadow boxes denote
supervisory role
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Summary
The EOC is the “Voice of Government”
during an emergency or disaster.
The EOC exists:
 To protect the population and property
 To return the community to normalcy
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Questions
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Break Time
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Unit Fifteen
Lessons Learned
Objectives
 Describe actions to be taken during an MCI
 Recognize problems associated with providing good
patient care
 Describe the steps for treating MCI patients
 Improve hospital preparations as a result of lessons
learned
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Emergency Care for
MCI Patients
 Hospital will have rules and procedures to quickly
assess and treat patients
 In routine situations, these procedures normally work
very well
 Dealing with a HMI or MCI:
 Other variables come into play that can throw these
procedures into havoc
 Therefore, hospitals should establish procedures for
dealing with all types of emergencies
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Patient Assessment
and Triage
 Triage refers to the process used to assess patients
and determine the degree of urgency to treat the
persons
 For a HMI, the triage area should be established in the
Emergency Treatment Area (ETA)
 Priority should be given to medical and radiological
problems
 A standardize “triage” system should be used:
 START
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Patient Assessment
and Triage (cont'd)
 Serious medical problem:
 Such as radiological exposure, or
 Chemical burns will always have priority over other medical
concerns
 In most cases, immediate assessment of the victim’s
airway, breathing, and circulation should be assessed
 Necessary lifesaving measures performed
 Hospital staffs should adhere to the “Standard of
Care”
 Rules dictated by their hospital’s administration
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Treatment Procedures
for MCI Patients (Cont’d)
 Non-contaminated patients can be cared for like other
emergency cases
 Victims of exposure without contamination do not
pose a threat to others
 Contaminated patients should be taken immediately
to a decontamination area for treatment
 Good judgment is essential in determining decontamination
priorities
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Treatment Procedures
for MCI Patients (cont'd)
 The type of chemical contamination affects treatment
 Chemical contaminants may be flammable, corrosive,
toxic, or combination
 Attention may have to be given to decontamination
first
 Before providing medical treatment to the patient
 Prevents secondary contamination and chemical
injury to medical and staff personnel
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Treatment Procedures
for MCI Patients (cont'd)
 Basic treatment procedures for MCI are similar in both:
 Radiation, and
 Non-radiation exposed patients
 Although other assessments may be required
 Based upon information from technical sources:
 Material safety data sheets
 The Centers for Disease Control and Prevention
 Agency for Toxic Substance and Disease Registry (ATSDR)
 United States Army Medical Research Institute of Chemical
Defense (USAMRICD), Chemical Casualty Care Division at:
CCC@apg.amedd.army.mil
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Treatment Procedures
for MCI Patients (cont'd)
 After basic care is provided, the last steps in treatment
would involve:
 Final survey and cleanup
 Patient transfer
 hospital cleanup
 Staff exiting
 Transfer of patients through prearranged written
agreements
 Physician at tertiary hospital notified and has accepted
the patient
 Record patient transfer and management status
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Hospital-Specific
Considerations
 As a result of natural disasters and acts of terrorism
in the U.S., there is a growing body of direct and
relevant experience regarding MCIs
 This experience reinforces the need for:
 Hospital specific planning
 Easy to follow emergency response plans
 Regular drills utilizing these plans, and
 Supplies and all types of CPC&E, etc.
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Hospital-Specific
Considerations (cont'd)
 Hospitals must develop hospital-specific plans and
procedures
 Several topics are mentioned for consideration
when building the HEMPs
 These topics are based on lessons learned by
hospital personnel with first-hand experience in MCI
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Initial Response Resources
 Local response community must bear brunt of
incident
 Victims arrive early75% do not arrive via EMS
 Must handle response for first 24 hours until State
and Federal resources are mobilized
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Emergency Response Plan
 Must meet applicable standards
 Short, concise, and easy to follow
 A tool to be used during an actual response
 Form the basis of semi-annual drills
 Reflect hospital and local emergency response
organization’s activities during an incident
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Personnel Distribution
 Too many people
 Identification/role of people difficult to determine
 Need system for personnel identification
 System for outside help (credential checks/cooperation
agreement)
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Communication Systems
 Telephone systems jammed

Telephone tree will fail
 Cell phone systems jammed


Cellular site will go down
Portable cell site are available for emergencies
 Security radios provide an alternative
 Maintain communications with EMS personnel
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Media
 Should have public affairs personnel to interface with
media
 Media can be asset to get information to the public
 Media can add to confusion if information is not
correct
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Patient Care Areas
 Divide patient care into areas:
 Critical
 Serious
 Minor
 Expectant
 Discharge
 Plan where each area will be
 Include area for families
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Command Structure
 Incident Commander - who is it?



Most qualified in handling hospital MCI
Qualification based on education, training, and experience
Not necessarily position!
 Physician, RN, and Administrator in charge
 Coordinate their respective resources
 Other personnel should be used such as:
•
•
•
•
•
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Pharmacist
Physical Therapist
Respiratory Therapist
Chaplain
External Support
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Critical Incident Stress Debriefing
 Aftermath of the incident should be considered in
the HERP
 Plan should address:
 Demobilization activities
 Defusing activities
 Debriefing activities
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Break Time
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Unit Sixteen
Implementing HERT at your
Hospital of HCF
HERT Levels of Training
 Awareness
 Operations
 Technician
 Specialist
 Incident Commander
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Final Examination
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Closing Comments/Course Critique




Review Student Expectations
Final Comments
Course Critique
Pass out Certificates
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Graduation Exercise
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Course Concluded
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