Download Specific reactions that MAY indicate additional needs

Building resilience of
Medical Practitioners
to deal with Terror events
BHOPAL TRAGEDY 1984
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40 Tones of M.I.C accidentally released
20 Sq Km area affected
2—to 6 lac people affected
3000 died
After 10yrs approx 16000 of exposed people died.
How many health care givers were affected ,
probably not documented.
• Inability of plant personnel to accurately assess
the state of emergency impeded their ability to
communicate protective action
BHOPAL TRAGEDY 1984
• Medical Staff unprepared for a Mass Casualty
Incident.
• Medical Practitioners & Hospitals were not
aware of Treatment Modalities for Chemical
Exposures.
• Union Carbide Medical doctor had no
information on MIC properties
• No protection taken by medical service
providers against secondary contamination.
Tokyo Sarin Attack Personnel
Response and Victims
• Tokyo=(Almost 10 years after Bhopal)
20/03/1995 –Chemical war fare agent Sarin a
nerve gas was deliberately released in Tokyo subway
• 5510 Tokyo residents were affected, 4073
attended O.P.D. 984 treated with antidote
• 8 people died , 54 injured , including first
responders
Tokyo Sarin Attack Personnel
Response and Victims
• Thousands of personnel responded to the event
• Over 400 vehicles responded
• 692 Actual Victims from Sarin exposure
– 688 Transported to Hospitals by EMS
– Event involved many stations along sub way &
required wide area of command & control
Implications for the Community
• Results:
– Incident was not recognized as nerve agent attack until
approximately 3 hours after release.
– Only 688 of the 5,500 victims were medically
transported. The rest were transported by passers-by
or went themselves.
– 4,500 persons approximately were “walking well”
– Nearest Hospital saw 500 patients in the first hour.
– Over 1000 units of atropine were available
Implications for the Community
• Results:
– Mass decontamination was not performed.
• 135 responders suffered effects of exposure.
• 20% of the hospital workers suffered secondary
exposure.
– The fire department dispatched 340 units and 1364
personnel.
– The Transportation Authority re-established service to 2
of 3 subway lines during the same day.
Implications for the Community
• Results:
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Over 50% of those involved remain effected today.
Long term effects will surface after years
37% requested financial aid from the government.
$2.6 M was spent on medical expenses in first year.
10% of victims quit school or work.
Subway system rider-ship dropped by 30% the 1st week
following the incident.
– Personal belongings were placed into bags and returned
to victims who were told to burn them.
Long term effects
• Those exposed to hazardous material do
exhibit acute or chronic health effects ,
depending on concentration of the hazardous
material
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Mutagenic.
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Teratogenic
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Carcinogenic
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Chronic respiratory problems
• We should try & minimize the exposure
through use of P.P.E ,Medical surveillance
Medical Disaster Planning
Lessons Learnt
• Hospitals provide most of the initial care despite
availability of services at incident site.
• Only about 20% are t/ted at site
• High risk of secondary contamination
• Personal protective equipment is required
• Disaster planning must address terrorism & Hazmat
• Maximize use of existing resources
Self-Care: Are You Ready…Really?
• Evaluate your level of readiness to respond
• Do not assume that because you are experienced
you are ready to respond
• Give consideration to your physical and emotional
health
• If you have recently encountered a major life
stressor, it may be better for you and those who
need assistance from you , NOT to respond.
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Guidelines for Personal Safety
 Take time to evaluate the scene.
 Wear appropriate personal protective equipment
(PPE).
 Do not attempt to do anything you are not
trained to do.
 Get the help needed by notifying additional
personnel.
Potential Exposure Risk
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PPE for Medical First Responders
PPE for decontamination personnel
PPE for healthcare providers
Limitations of PPE
Staff rotation
PPE-Chemical Self Protection
• Level A – IDLH environments,
fully encapsulated, resistant to
liquid & vapor penetration
.Requires SCBA
• Level B -For chemicals or
substances with inhalation
hazard, requires SCBA or SAR
• Level C – Known contaminants,
concentration level below
hazardous level. Requires airpurifying respirator & filter
canister
PPE - Biological Self-Protection
• Treat every patient with respiratory complaints
and open wounds as an “infectious source”
• Normal standard universal precautions for most
BW agents
• HEPA filter mask upgrade for pneumonic
plague / smallpox / VHF
• Special protective garments usually not
necessary
• Precaution upgrades in areas of the hospital
where aerosols could be generated: lab
centrifuges, autopsy facilities, etc.
PPE - Radiological -Protection
• Respiratory - Particulate mask (level C minimum)
• Shielding
• Dosimeter
Decontamination
• Decontamination removes harmful substances
• Hospital preparedness for decontamination
• Decontamination of casualties arriving at the
healthcare facility
• Vapor exposure
– Liquid exposure
– Mass casualty incident
Decontamination
• Vapor verses liquid exposure
• Mass casualty incidents
– Ambulatory vs. non-ambulatory
– Decon methods
– Water vs. bleach
– Location of decon area
Decontamination
• Decon of casualties arriving at the hospital
– Already decontaminated
– Not decontaminated
• Decon of healthcare providers
– Decon Team Members
– Treating personnel
Staff Preparedness
• Plan for the needs of the
unaffected population
• Prepare to receive large
numbers of casualties
• Prepare to receive large
numbers of dead
• Rotate staff to avoid
congestion and fatigue,
especially personnel in PPE
Logistics / Supplies
• Highest priority: Gathering ,organizing & moving
the right resources to the right place at the right
time . Can be managed through mutual
assistance with other agencies
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Personal protective equipment and dosimeters
Medications / antidotes / vaccines
Mechanical ventilators
Isolation rooms remote from other patients
• Identify current inventory and augment as
necessary
• Develop a procedure to access external assets
What is Resilience?
 Positive adaptation in the
face of adversity, after
stressful & life changing
event .
 Ordinary--not extraordinary
 People commonly
demonstrate resilience & it
also comes through
experience.
 The “rule” not the
exception
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Promote Resiliency
• Everyone who experiences a disaster is touched by it
• We have the ability to “bounce back” after a disaster to a
“New Normal”. Capacity to mobilize personal resources, to
tolerate, cope with & overcome adverse events without
experiencing stress.
• Resilience can be supported & nurtured
• Prepare Psychologically: support resiliency in yourself and
other (psychological first aid )
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STRESS
• Stressors in hazmat events & in life of Emergency Medical
Responders are many & varied
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Chemical stressors
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Environmental stressors
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Psychological stressors
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Occupational health hazards
• All E.M.S members should undergo training program that
will increase their aerobic capacity & physical strength .
• Smoking cessation & alcohol restriction also help to maintain
healthy body & mind.
• Those with intact C.V.S & R.S. can respond to any emergency
call better than others
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Personal Resiliency Plan
• Understand how you react to stress.
• Do you feel it as: Shoulder pain, Headaches, Stomach
problems?
• Learn to recognize when you reach your stress limit.
• Remember what are the common reactions to stress.
• Use healthy coping skills – what has worked for you in
the past?
• Assisting others in physical or emotional pain may start
to affect you so you should be constantly aware of your
own reactions.
• Emotional pain and anxiety are “contagious” and will
affect you so continue to monitor yourself for stress
reactions.
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Specific reactions that need attention
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Difficultly thinking clearly or acting logically
Bizarre behavior
Lacking awareness of reality
Extreme stress reactions or grief
Confusion
Inability to concentrate or make decisions
Haunted by images or memories of the event
Complaining of physical symptoms , even,
after reassurance that there are none
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Building Responder Resilience
Pre-event
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Educate and train
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Build social support systems
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Instill sense of mission and purpose
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Create family communications plan ( you
will not be able to respond if you are
worried about your loved ones )
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Response
• If possible deploy as a team or use the buddy
system. Monitor your own & your co worker's
emotional well being
• Focus on immediate tasks at hand
• Monitor occupational safety, personal health,
and psychological well-being
• Know your limits
• Activate family communication plans
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Post-event (Recovery)
Monitor health and well-being
 Delayed reactions seen in general public and emergency
responders (onset >5 wks later)
 Give yourself time to recover
 Seek support when needed
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ALWAYS PRACTICE
Body Substance Isolation
• A strict form of infection control based on the
presumption that blood & other body fluids are
infectious .
• By taking B.S.I. precautions it is possible to take
care of patients safely, including those with
infectious diseases
ALWAYS PRACTICE
Body Substance Isolation
Precautions • Hand washing- Most important thing which can
prevent spread of infection.10-15-sec of washing with
soap removes 95% bacteria
• Cleaning - Washing a soiled object with soap & water.
• Disinfecting - Cleaning & using a chemical( bleach) to
clean an object. Disinfectant is used on items which
come in contact with intact skin.
• Sterilizing by super heated steam to kill all
microorganisms on equipments which come in
contact with open wounds, m.m.
• Using personal protective equipment
ALWAYS PRACTICE
Body Substance Isolation
• Always Discard Contaminated items properly.
( Label the bag as infected waste)
• Your Safety always comes First
• ALL BODY FLUIDS ARE CONSIDERED INFECTIOUS
& APPROPRIATE PRECAUTIONS MUST BE TAKEN
FOR ALL PATIENTS AT ALL TIMES.
Preparedness
Hospitals to become self sufficient to manage hazmat
events, in normal course of action.
Contaminated patient walking into hospital is
dangerous to all as shown by Tokyo incidence
Hospitals are also store houses of hazardous
materials such as Solvents, Anesthetic gasses ,
Radioactive substances.
There can be fire hazards in hospital.
So hospital staff should also be trained in
emergency response,& develop liaison between
other responding units
Preparedness
There are ever increasing Hazardous commodities &
some element of unknown about their toxic effects.
Looking towards future & based
on past experience
Protection of responders
Exposure prevention
Medical surveillance
Follow up medical
C.I.S.M.
SHOULD BE TOP PRIORITY FOR
WELL BEING OF E.M.S.
Conclusion
• The Key to an Effective Response
–Systematic Approach
– Training of the Responder
– Protection of the Responder
– and Resilience of Emergency
Responder.
5/25/2017
Last, but not the Least
• For Armed forces, it is said that :
• More you sweat in peace period,
• less you bleed on the battle field.
• Similarly , for all of us
More you learn & protect yourself
Less you suffer due to exposure to hazards
WORLD HAS CHANGED, WE HAVE NOT CHANGED
ARE WE WAITING FOR ANOTHER DISASTER TO HAPPEN?
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Basic reasons to monitor Responders
health status:
A.
To provide rapid and appropriate emergency
care and treatment at the scene of the incident for
response personnel and possible victims.
B. To associate the traumatic chemical event with
possible future health effects.
C. To document the types of exposures that an
employee has dealt with during his or her
career.
D. To follow guidelines when dealing with
hazardous substances.
Summary
• When dealing with hazardous material, the
approach must be much slower, more defined
& precise. All actions must be previously
established to avoid sudden exposure, serious
injury & sometimes death.
• Pre planning allows for all responders to know
, understand their role .in the system
• Planning is first step towards exposure
prevention & finding solutions to problems
Guidelines for Others’ Safety
 True scene safety is a continuous, not an
initial, process.
 Never move a patient unless there is
immediate danger.
 Continuously scan for possible hazards.
 Use appropriate emergency moves if in
immediate danger.
 Be alert for potential bystander dangers.
Conclusion
Specialized roles and responsibilities during a
hazmat incident may include recognition and
identification of hazardous material, scene
safety, containment and cleanup of the
material, extrication and decontamination of
exposed individuals, provision of emergency
care , and continual medical assessment of
team members involved in the incident.