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Kippnich M, Schorscher N, Sattler H, Kippnich U, Meybohm P, Wurmb T. Managing CBRN mass casualty incidents at hospitals-Find a simple solution for a complex problem: A pilot study. Am J Disaster Med 2024; 19:25-31. [PMID: 38597644 DOI: 10.5055/ajdm.0471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Chemical, biological, radiological, and nuclear (CBRN) incidents are a major challenge for emergency medical services and the involved hospitals, especially if decontamination needs to be performed nearby or even within the hospital campus. The University Hospital Wuerzburg has developed a comprehensive and alternative CBRN response plan. The focus of this study was to proof the practicability of the concept, the duration of the decontamination process, and the temperature management. METHODS The entire decontamination area can be deployed 24/7 by the hospitals technical staff. Fire and rescue services are responsible for the decontamination process itself. This study was designed as full-scale exercise with 30 participants. RESULTS The decontamination area was ready for operation within 30 minutes. The decontamination of the four simulated patients took 5.5 ± 0.6 minutes (mean ± SD). At the end of the decontamination process, the temperature of the undressed upper body of the training patients was 27.25 ± 1°C (81.05 ± 2°F) (mean ± SD) and the water in the shower was about 35°C (95°F). CONCLUSION The presented concept is comprehensive and simple for a best possible care during CBRN incidents at hospitals. It ensures wet decontamination by Special Forces, while the technical requirements are created by the hospital.
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Affiliation(s)
- Maximilian Kippnich
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, Subsection Emergency and Disaster Relief Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Nora Schorscher
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, Subsection Emergency and Disaster Relief Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Helmut Sattler
- Fire Department Wuerzburg, Office for Civil Defence and Fire Protection, Wuerzburg, Germany
| | - Uwe Kippnich
- Bavarian Red Cross, Headquarters, Munich, Germany
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Thomas Wurmb
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, Subsection Emergency and Disaster Relief Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
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Silverberg SL, Puchalski Ritchie LM, Gobat N, Murthy S. COVID-19 infection prevention and control procedures and institutional trust: Perceptions of Canadian intensive care and emergency department nurses. Can J Anaesth 2021; 68:1165-1175. [PMID: 34046822 PMCID: PMC8158085 DOI: 10.1007/s12630-021-02028-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/29/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Healthcare workers must ensure effective infection prevention and control (IPC) to prevent nosocomial spread of SARS-CoV-2, the virus that causes COVID-19. This questionnaire study aims to evaluate Canadian critical care and emergency department nurses' readiness to follow IPC guidelines in their workplace, and to understand their perceptions of trust in organizational preparedness, communication, and infection risk. METHODS We adapted an internationally distributed survey for the Canadian context. This cross-sectional questionnaire, incorporating validated scales for items including institutional trust, was distributed by email to nurses via the Canadian Association of Critical Care Nurses and the Canadian Association of Emergency Physicians networks between 16 March and 25 May 2020. We evaluated intensive care unit and emergency department nurses' adherence to IPC protocols, barriers and facilitators to IPC guideline adherence, and their level of institutitonal trust. RESULTS Three hundred and nineteen nurses responded to the survey. There was higher trust in organizational preparedness among nurses who were older (B = 0.31, P < 0.001) and more experienced (F = 18.09, P < 0.001), and particularly among those with previous experience working in outbreak settings (F = 7.87, P = 0.005). Compared with those without experience working in outbreak settings, respondents with this experience reported higher levels of fear of becoming ill and fear of providing care for COVID-19 patients (χ2 = 21.48, P = 0.002 and χ2 = 12.61, P = 0.05, respectively). Older and more experienced nurses reported greater comfort with IPC skills and easier access to personal protective equipment. While the vast majority (96%) of respondents reported using masks and gloves, only 83% had access to isolation facilities for suspected or confirmed COVID-19 cases. CONCLUSION Canadian nurses had strong self-reported adherence to IPC measures and personal protective equipment use. There were high levels of trust in health system leadership to ensure protective measures are present and reliable. Trust was particularly high among older and more experienced nurses despite these populations reporting higher levels of fear of personal illness.
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Affiliation(s)
- Sarah L Silverberg
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
- Department of Pediatrics, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Lisa M Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nina Gobat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Collins S, James T, Carter H, Symons C, Southworth F, Foxall K, Marczylo T, Amlôt R. Mass Casualty Decontamination for Chemical Incidents: Research Outcomes and Future Priorities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3079. [PMID: 33802722 PMCID: PMC8002470 DOI: 10.3390/ijerph18063079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 01/22/2023]
Abstract
Planning for major incidents involving the release of hazardous chemicals has been informed by a multi-disciplinary research agenda which has sought to inform all aspects of emergency response, but with a focus in recent years on mass casualty decontamination. In vitro and human volunteer studies have established the relative effectiveness of different decontamination protocols for a range of chemical agents. In parallel, a programme of research has focused on communicating with and managing large numbers of contaminated casualties at the scene of an incident. We present an accessible overview of the evidence underpinning current casualty decontamination strategies. We highlight where research outcomes can directly inform response planning, including the critical importance of beginning the decontamination process as soon as possible, the benefits of early removal of contaminated clothing, the evidence under-pinning dry and wet decontamination and how effective communication is essential to any decontamination response. We identify a range of priority areas for future research including establishing the significance of the 'wash-in' effect and developing effective strategies for the decontamination of hair. We also highlight several areas of future methodological development, such as the need for novel chemical simulants. Whilst considerable progress has been made towards incorporating research outcomes into operational policy and practice, we outline how this developing evidence-base might be used to inform future iterations of mass casualty decontamination guidance.
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Affiliation(s)
- Samuel Collins
- Chemicals and Environmental Effects Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot OX11 0RQ, UK;
| | - Thomas James
- Chemicals and Environmental Effects Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot OX11 0RQ, UK;
| | - Holly Carter
- COVID-19 Behavioural Science and Insights Unit, Public Health England, Public Health England, London SE1 8UG, UK; (H.C.); (C.S.); (R.A.)
| | - Charles Symons
- COVID-19 Behavioural Science and Insights Unit, Public Health England, Public Health England, London SE1 8UG, UK; (H.C.); (C.S.); (R.A.)
| | - Felicity Southworth
- Behavioural Science, Emergency Response Department Science & Technology, Health Protection Directorate, Public Health England, Porton SP4 0JG, UK;
| | - Kerry Foxall
- Toxicology Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot OX11 0RQ, UK; (K.F.); (T.M.)
| | - Tim Marczylo
- Toxicology Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot OX11 0RQ, UK; (K.F.); (T.M.)
| | - Richard Amlôt
- COVID-19 Behavioural Science and Insights Unit, Public Health England, Public Health England, London SE1 8UG, UK; (H.C.); (C.S.); (R.A.)
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE1 1UL, UK
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Larner J, Durrant A, Hughes P, Mahalingam D, Rivers S, Matar H, Thomas E, Barrett M, Pinhal A, Amer N, Hall C, Jackson T, Catalani V, Chilcott RP. Efficacy of Different Hair and Skin Decontamination Strategies with Identification of Associated Hazards to First Responders. PREHOSP EMERG CARE 2020; 24:355-368. [PMID: 31251095 DOI: 10.1080/10903127.2019.1636912] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: Established procedures for mass casualty decontamination involve the deployment of equipment for showering with water (such as the ladder pipe system [LPS] and technical decontamination [TD]). This necessarily introduces a short, but critical delay. The incorporation of dry decontamination to the incident response process offers the potential to establish a more rapid and timely intervention. Objectives: To investigate the effectiveness of various dry (DD) and wet decontamination strategies for removing a chemical warfare simulant (methyl salicylate; MS) from the hair and skin of human volunteers. Methods: The simulant was applied to volunteers via whole body exposure to an aerosol. Three decontamination protocols (dry, LPS and technical decontamination) were applied, singly and in various combinations. The efficacy of the protocols was evaluated by fluorescent photography and analysis of residual MS from skin/hair swabs, decontamination materials and air samples. Results: Dry decontamination was effective, with the greatest reduction in skin and hair contamination arising from the "Triple Protocol" (DD+LPS+TD). Secondary hazards associated with contaminated individuals and equipment decreased as the number of decontamination procedures increased. In particular, dry decontamination reduced the potential contact and inhalation hazard arising from used washcloths, towels and vapor within the TD units. Discussion: The introduction of dry decontamination prior to wet forms of decontamination offers a simple strategy to initiate treatment at a much earlier opportunity, with a corresponding improvement in clinical outcomes and substantial reduction of secondary hazards associated with operational processes.
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Siman-Tov M, Davidson B, Adini B. Maintaining Preparedness to Severe Though Infrequent Threats-Can It Be Done? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072385. [PMID: 32244530 PMCID: PMC7177483 DOI: 10.3390/ijerph17072385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/26/2020] [Accepted: 03/28/2020] [Indexed: 11/16/2022]
Abstract
Background: A mass casualty incident (MCI) caused by toxicological/chemical materials constitutes a potential though uncommon risk that may cause great devastation. Presentation of casualties exposed to such materials in hospitals, if not immediately identified, may cause secondary contamination resulting in dysfunction of the emergency department. The study examined the impact of a longitudinal evaluation process on the ongoing emergency preparedness of hospitals for toxicological MCIs, over a decade. Methods: Emergency preparedness for toxicological incidents of all Israeli hospitals were periodically evaluated, over ten years. The evaluation was based on a structured tool developed to encourage ongoing preparedness of Standard Operating Procedures (SOPs), equipment and infrastructure, knowledge of personnel, and training and exercises. The benchmarks were distributed to all hospitals, to be used as a foundation to build and improve emergency preparedness. Scores were compared within and between hospitals. Results: Overall mean scores of emergency preparedness increased over the five measurements from 88 to 95. A significant increase between T1 (first evaluation) and T5 (last evaluation) occurred in SOPs (p = 0.006), training and exercises (p = 0.003), and in the overall score (p = 0.004). No significant changes were found concerning equipment and infrastructure and knowledge; their scores were consistently very high throughout the decade. An interaction effect was found between the cycles of evaluation and the hospitals’ geographical location (F (1,20) = 3.0, p = 0.056), proximity to other medical facilities (F (1,20) = 10.0 p = 0.005), and type of area (Urban vs. Periphery) (F (1,20) = 13.1, p = 0.002). At T5, all hospitals achieved similar high scores of emergency preparedness. Conclusions: Use of accessible benchmarks, which clearly delineate what needs to be continually implemented, facilitates an ongoing sustenance of effective levels of emergency preparedness. As this was demonstrated for a risk that does not frequently occur, it may be assumed that it is possible and practical to achieve and maintain emergency preparedness for other potential risks.
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Affiliation(s)
- Maya Siman-Tov
- Department of Emergency Management and Disaster Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel;
| | - Benny Davidson
- Division of Emergency & Disaster Management, Ministry of Health, Tel Aviv 6744300, Israel;
| | - Bruria Adini
- Department of Emergency Management and Disaster Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel;
- Correspondence: ; Tel.: +972-54-804-5700
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Affiliation(s)
- Fred M Henretig
- From the Division of Emergency Medicine and Poison Control Center, Children's Hospital of Philadelphia, and the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (F.M.H.); the Department of Homeland Security, Washington, DC (M.A.K.); and the Division of Medical Toxicology, Department of Emergency Medicine, University of Connecticut Health Center and Hartford Hospital, Hartford (C.A.M.)
| | - Mark A Kirk
- From the Division of Emergency Medicine and Poison Control Center, Children's Hospital of Philadelphia, and the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (F.M.H.); the Department of Homeland Security, Washington, DC (M.A.K.); and the Division of Medical Toxicology, Department of Emergency Medicine, University of Connecticut Health Center and Hartford Hospital, Hartford (C.A.M.)
| | - Charles A McKay
- From the Division of Emergency Medicine and Poison Control Center, Children's Hospital of Philadelphia, and the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (F.M.H.); the Department of Homeland Security, Washington, DC (M.A.K.); and the Division of Medical Toxicology, Department of Emergency Medicine, University of Connecticut Health Center and Hartford Hospital, Hartford (C.A.M.)
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Smith SJ, Farra S, Ulrich DL, Hodgson E, Nicely S, Matcham W. Learning and Retention Using Virtual Reality in a Decontamination Simulation. Nurs Educ Perspect 2016; 37:210-214. [PMID: 27740579 DOI: 10.1097/01.nep.0000000000000035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM The purpose of this study was to examine the longitudinal effects of virtual reality simulation (VRS) on learning outcomes and retention. BACKGROUND Disaster preparation for health care professionals is seriously inadequate. VRS offers an opportunity to practice within a realistic and safe environment, but little is known about learning and retention using this pedagogy. METHOD A quasiexperimental design was used to examine the use of VRS with baccalaureate nursing students in two different nursing programs in terms of the skill of decontamination. RESULTS Results indicate that VRS is at least as good as traditional methods and is superior in some cases for retention of knowledge and performance of skills. CONCLUSION VRS may provide a valuable option for promoting skill development and retention. More research is needed to determine how to prepare nurses for skills that may not be required until months or even years after initial introduction.
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Affiliation(s)
- Sherrill J Smith
- Sherrill J. Smith, PhD, RN, CNL, CNE, is assistant dean of undergraduate programs and associate professor, Wright State University College of Nursing and Health, Dayton, Ohio. Sharon Farra, PhD, RN, CNE, is assistant professor, Wright State University College of Nursing and Health, Dayton, Ohio. Deborah L. Ulrich, PhD, RN, ANEF, is associate dean and associate professor, Wright State University College of Nursing and Health, Dayton, Ohio. Eric Hodgson, PhD, is director, SMALE Interactive Visualization Center, Miami University Interactive Media Studies, Oxford, Ohio. Stephanie Nicely, EdD, RN, is assistant professor, Miami University Department of Nursing, Oxford, Ohio. William Matcham, PhD, RN, CNOR, is an assistant professor, Wright State University College of Nursing and Health, Dayton, Ohio. For more information, contact Dr. Smith at
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Kirk M, Iddins CJ. Resources for toxicologic and radiologic information and assistance. Emerg Med Clin North Am 2014; 33:69-88. [PMID: 25455663 DOI: 10.1016/j.emc.2014.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Most approaches toward chemical and radiological/nuclear (CRN) incidents focus on the clinical skills of the first receiver. These skills are certainly important and are addressed throughout this article. Management skills are often overlooked. The following are basic competencies in information management for the emergency medicine physician to handle large-scale CRN incidents: planning information; incident management information; toxicant management; disposition/definitive care management; and recovery management. Information management and synthesis are crucial throughout the phases of the disaster cycle: planning, response, mitigation, and recovery.
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Affiliation(s)
- Mark Kirk
- Chemical Defense Program, Health Threats Resilience Division, Office of Health Affairs, US Department of Homeland Security, 245 Murray Lane, SW, Mailstop: 0315, Washington, DC 20528, USA
| | - Carol J Iddins
- U.S. DOE, Radiation Emergency Assistance Center/Training Site, ORISE, ORAU, PO Box 117, MS 39, Oak Ridge, TN 37831, USA.
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