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HOSPITAL BIOTERRORISM PREPAREDNESS
COUNTY OF LOS ANGELESEMERGENCY MEDICAL
SERVICES AGENCY
County of Los Angeles Emergency Medical Services Agency
Overview of the HRSA Grant
• Authorized by the Public Health and Social Services Emergency Fund– Section 319 of the Public Health Services Act,
42 U.S.C.247d
• $125 million funded for hospitals through the Health Resources and Services Administration
• Los Angeles County receiving $3.6 million – State of California receiving $9,962,905
County of Los Angeles Emergency Medical Services Agency
Overview of the HRSA Grant
• Awarded to State and 4 Jurisdictional Public Health Departments
• The Emergency Medical Services Agency will administer and implement the plan in Los Angeles County
County of Los Angeles Emergency Medical Services Agency
Purpose of the HRSA Grant
Develop and implement regional plans to improve the response to bioterrorism (or other outbreaks of infectious disease) incidents.
County of Los Angeles Emergency Medical Services Agency
Purpose of the HRSA Grant
• Focus on:– Hospitals– Emergency Departments– Outpatient centers– EMS systems– Other collaborating health care
entities
County of Los Angeles Emergency Medical Services Agency
HRSA Grant Requirements
Critical Benchmarks
First Priority Planning Areas
Second Priority Planning Areas
County of Los Angeles Emergency Medical Services Agency
Critical Benchmarks
• Program Leadership– Coordinator– Medical Director– Support Staff
• Hospital Bioterrorism Preparedness Planning Committee
• Regional Planning
County of Los Angeles Emergency Medical Services Agency
Hospital Bioterrorism Preparedness Planning
CommitteeMISSION:
The Los Angeles County DHS/HASC HospitalBioterrorism Preparedness Planning Committee(HBPPC) will provide guidance, direction andoversight to the Department of Health Servicesand its EMS Agency to ensure coordination,communication, and education of hospitals in planning for the County’s healthcare
bioterrorismresponse.
County of Los Angeles Emergency Medical Services Agency
First Priority Planning Areas
• Medications and vaccines– Recommended Hospital
Pharmaceutical Stock
• Personal Protective Equipment (PPE), Decontamination, Quarantine
• Communications• Biologic Disaster Drills
County of Los Angeles Emergency Medical Services Agency
Second Priority Planning Areas
• Personnel– Mobilization of staff to impacted area(s)
• Training– Recognition of biological diseases– Use of PPE/decon equipment/quarantine– Assessment, stabilization, transport
• Patient Transfer– Special needs populations– Designated facilities
County of Los Angeles Emergency Medical Services Agency
Coordination and Collaboration
• Coordination of funding streams:– HRSA grant– CDC grant– MMRS grant
• Collaboration with the State of California HRSA and CDC grant planning and response
County of Los Angeles Emergency Medical Services Agency
Needs Assessment
October 2001 Los Angeles County surveyed all eighty-one 9-1-1 receiving facilities to determine the level of preparedness to respond to a terrorist incident
Based on these findings Los Angeles County developed their plan for the HRSA grant
County of Los Angeles Emergency Medical Services Agency
Los Angeles County Plan
Governing Principles:• 80% of the victims will flee the scene and seek
medical care at the hospital that is familiar to them. Therefore all hospitals need to be prepared to deal with converging victims.
• ALL HAZARDS approach used.• Current funding being directed to 9-1-1 receiving
facilities. All eighty-one will be offered participation.• Current funding inadequate for addressing major
hospital infrastructure needs such as isolation capabilities.
• By participating, hospitals are committing to be a part of a system wide response to potential acts of terrorism.
County of Los Angeles Emergency Medical Services Agency
Los Angeles County Plan
• Personal Protective Equipment
• Decontamination Capabilities
• Pharmaceuticals and Disaster Staging
• Communications
County of Los Angeles Emergency Medical Services Agency
Hospital Participation
WHAT DO I GET?
WHAT DO I HAVE TO DO TO GET IT?
County of Los Angeles Emergency Medical Services Agency
Hospital Receivables
Basic Level
– Personal Protective Equipment (PPE)
– Training of Decontamination Team
County of Los Angeles Emergency Medical Services Agency
Hospital Receivables
Expanded Level
– Personal Protective Equipment
– Training of Decontamination Team
– Funding for Mass Casualty Decontamination Capability
County of Los Angeles Emergency Medical Services Agency
Personal Protective Equipment
• PPE worth $10,000
• Group purchased by Los Angeles County and given to the hospitals– Standardization– Purchasing power reducing cost
County of Los Angeles Emergency Medical Services Agency
Personal Protective Equipment
Level C– Reasonable level
of protection for hospital personnel to be equipped with and trained to use.
• Powered Air Purifying Respirator Hood
County of Los Angeles Emergency Medical Services Agency
Personal Protective Equipment
Level C– Splash Suit– Nitrile gloves– Boots
• Patient Privacy Kit
County of Los Angeles Emergency Medical Services Agency
Decontamination Team Training
• Operations level course on hospital decontamination for contaminated victims– County Disaster Training
Unit will provide training at no cost
– Course is 20 hours of instruction
– No cost offset for staff attendance and/or replacement staff costs
County of Los Angeles Emergency Medical Services Agency
Mass CasualtyDecontamination
Capabilities• Fixed turnkey warm water
operation capable of decontaminating 50 ambulatory patients/hour
• Minimum of $20,000 toward construction
County of Los Angeles Emergency Medical Services Agency
Hospital DeliverablesBasic and Expanded
• Store, secure, maintain, and replace PPE • Establish a decontamination team
– Identify Decontamination Team Safety Officer– Establish a Respiratory Protection Program– Establish Medical Monitoring Program
• Training/Exercise– Conduct on-going decontamination team
training at least quarterly– Conduct decontamination drill annually
County of Los Angeles Emergency Medical Services Agency
Hospital DeliverablesBasic and Expanded
• Complete an Information Technology capabilities survey conducted by the County of Los Angeles Public Health Programs and Services
• Identify hospital contacts– Bioterrorism incidents (clinician)– Radiological incidents– Other terrorism/disaster incidents
County of Los Angeles Emergency Medical Services Agency
Hospital Deliverables
• Decontamination CapabilityBasic Level– Describe hospital’s capability
Expanded Level – Fixed turnkey warm water structure
capable of decontaminating 50 ambulatory individuals per hour
County of Los Angeles Emergency Medical Services Agency
Mass Casualty Decontamination
at Hospitals
Mass Casualty Decontamination
at Hospitals
County of Los Angeles Emergency Medical Services Agency
Hospital Mass Casualty Hospital Mass Casualty DecontaminationDecontamination
Hazardous materials incidents often Hazardous materials incidents often involve civilians that have been exposed involve civilians that have been exposed to potentially deadly chemicals. Also the to potentially deadly chemicals. Also the possibility of NBC weapons released on possibility of NBC weapons released on civilian populations are increasing. civilian populations are increasing.
Prompt, safe and effective Prompt, safe and effective decontamination procedures are essential decontamination procedures are essential to protect both the victims and to protect both the victims and hospital/response members.hospital/response members.
The Challenge:The Challenge:The Challenge:The Challenge:
County of Los Angeles Emergency Medical Services Agency
Methods of decontamination:Methods of decontamination:Methods of decontamination:Methods of decontamination:
The National Fire Protection Association standard472 identifies four basic methods.
• Dilution• Absorption• Discarding• Neutralization
Additional methods include:chemical and physical degradation, evaporation,solidification, vacuuming
Hospital Mass Casualty Hospital Mass Casualty DecontaminationDecontamination
County of Los Angeles Emergency Medical Services Agency
Types of Decontamination:Types of Decontamination:Types of Decontamination:Types of Decontamination:
• Emergency • Respiratory• Primary• Secondary• Equipment• Mass Casualty -Incident Site -Hospital
Hospital Mass Casualty Hospital Mass Casualty DecontaminationDecontamination
County of Los Angeles Emergency Medical Services Agency
Hospital Mass Casualty Hospital Mass Casualty
DecontaminationDecontamination Decontamination Process
• Triage• Remove and bag clothes• Shower soak/flush• Detergent soap scrub with sponge• Shower rinse• Dry and dress
County of Los Angeles Emergency Medical Services Agency
Factors That Affect Decontamination Process:Factors That Affect Decontamination Process:Factors That Affect Decontamination Process:Factors That Affect Decontamination Process:
• Physical & chemical properties of the material
• Amount & location of contaminant
• Contact time & temperature
• Level of protection & work function
• Reason for leaving hazard site
Hospital Mass Casualty Hospital Mass Casualty DecontaminationDecontamination
County of Los Angeles Emergency Medical Services Agency
Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:
• Personnel
• Water
• Decon solutions
• Air supplies
• Protective clothing
• Electricity/utilities
• Miscellaneous tools
County of Los Angeles Emergency Medical Services Agency
Setting up the Contamination Reduction CorridorSetting up the Contamination Reduction Corridor::Setting up the Contamination Reduction CorridorSetting up the Contamination Reduction Corridor::
SafeSafeRefugeRefugeAreaArea
Win
d
Exclusion ZoneExclusion Zone
Support ZoneSupport Zone
ContaminationContaminationReductionReduction
ZoneZone
Air Cart Manager/SafetyOfficer
Washer
Rinser
Welfare
DeconLeader
StagingStaging&&
TreatmentTreatmentAreaArea
Dow
nS
lop
e
SafeRefuge
Manager/Triage
10
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County of Los Angeles Emergency Medical Services Agency
County of Los Angeles Emergency Medical Services Agency
Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:
• Planning Planning
• Equipment Equipment
• IdentificationIdentification
• Coordinating Coordinating
• TrainingTraining
• ExercisingExercising
• DocumentationDocumentation
Will become Will become part part
of the of the employers employers
emergency emergency planplan
Will become Will become part part
of the of the employers employers
emergency emergency planplan
What is required:What is required: What is required:What is required:
County of Los Angeles Emergency Medical Services Agency
Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:
The key is through pre-event planning that The key is through pre-event planning that identifies and documents all aspects for the identifies and documents all aspects for the decontamination of either ambulatory or decontamination of either ambulatory or non-ambulatory patients.non-ambulatory patients.
Any system that fails to prioritize, manage and Any system that fails to prioritize, manage and control patients through the decontamination control patients through the decontamination process will fail without proper planning.process will fail without proper planning.
County of Los Angeles Emergency Medical Services Agency
Consideration of all safety aspects of the deconoperation area prior to selecting the site is paramount. Issues such as drainage, trip hazards, lighting, overhead obstructions and ability to control access must be addressed.
Secondary decon sites or back-up plans also must be considered.
Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:
County of Los Angeles Emergency Medical Services Agency
Determining Effectiveness of DecontaminationDetermining Effectiveness of Decontamination
• Visual examination
• Meters, instruments, test paper
• Testing by qualified lab
• Analysis of test swatches or samples
• Consulting with appropriate health officials
Setting up the Contamination Reduction CorridorSetting up the Contamination Reduction Corridor::Setting up the Contamination Reduction CorridorSetting up the Contamination Reduction Corridor::
County of Los Angeles Emergency Medical Services Agency
You must also have a formal system to terminate your decontamination operations that will bepart of your operational plan.
• Decontaminate the decon team
• Decontaminate or dispose of equipment
• Clean-up options
• Debriefings
• Record keeping
When the decontamination operation is When the decontamination operation is over:over: When the decontamination operation is When the decontamination operation is over:over:
Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:
County of Los Angeles Emergency Medical Services Agency
• Site security
• Force protection
• Evidence Collection
Must be “coordinated with law enforcement”.
ADDITIONAL CONCERNS:
Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:Setting up the Contamination Reduction Corridor:
County of Los Angeles Emergency Medical Services Agency
Draw back of portable equipment
• Number of people needed to set it up
• The time it takes to set it up
County of Los Angeles Emergency Medical Services Agency
Draw back of portable equipment
County of Los Angeles Emergency Medical Services Agency
Fixed Mass Casualty Decon
Conex Trailers or Permanent Tents
County of Los Angeles Emergency Medical Services Agency
Fixed Mass Casualty Decon
Corridor or Alleyway
County of Los Angeles Emergency Medical Services Agency
Fixed Mass Casualty Decon
Corridor or Alleyway
County of Los Angeles Emergency Medical Services Agency
Fixed Mass Casualty Decon
Corridor or Alleyway
County of Los Angeles Emergency Medical Services Agency
Fixed Mass Casualty Decon
Corridor or Alleyway
County of Los Angeles Emergency Medical Services Agency
Mass Casualty Decontamination
Capabilities• Issues being addressed
Water run-off containmentOffice of Health Planning and
Development requirements for Healthcare facilities
County of Los Angeles Emergency Medical Services Agency
Hospital Preparedness
A facility that can demonstrate that they have already purchased comparable PPE and/or have constructed a fixed decontamination capability will still be eligible to receive the funding.– PPE - $10,000– Decontamination Capability –
Minimum of $20,000
County of Los Angeles Emergency Medical Services Agency
Hospital Agreement
To receive funding each hospital will need to sign an agreement with the County of Los Angeles.
• Letters of Interest will be mailed to Hospital CEO’s in August 2002
• Contracts completed by December 2002
County of Los Angeles Emergency Medical Services Agency
Contact Information
Dr. John Celentano, M.D., Disaster Medical Officer
(323) 890-7588, [email protected]
Kay Fruhwirth, RN, MSN
Hospital Bioterrorism Preparedness Coordinator
(323) 890-7583, [email protected]
Carol Gunter, RN, MHA; Assistant Director
(323) 890-7539, [email protected]
County of Los Angeles Emergency Medical Services Agency
Questions?