Trust Demographics PAHT. In the District of GREATER MANCHESTER U.K

Transcription

1 It Could Happen To You! Allan Cordwell E.P.M. / C.B.R.N.E. Tactical Co-ordinatorordinator PAHT Emergency Planning Resilience & Response Unit

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3 Personal History 15 years in A&E Nurse / Charge Nurse 3 Years Territorial Army including 7 months operational deployment in Iraq 3 years Emergency Planning / Resilience in Acute Hospital Management

4 Trust Demographics PAHT 4 Hospitals In the District of GREATER MANCHESTER U.K

5 MANCHESTER

6 C.B.R.N.E. Definitions This is a deliberate murderous act, the intention of which is to kill, sicken or prevent society from continuing with their normal daily business Hazmat Is an accidental release of a substance, agent or material which may result in illness or injury to the public, or the denial of an area or the interruption of the food chain

7 Mitigation Broadly the same ***** Recognition ***** Isolation Containment Decontamination Treatment

8 Nature of Events Medium Risk TIC s High Impact Create anxiety, uncertainty & confusion Often creates a disruptive & disproportionate response Potential for loss of E.D. / Hospital Continuity

9 Historical Background Commonwealth Games 2002 All Ambulance & Acute Hospital Emergency Departments issued with NHS Specified Personal Protective Equipment (PPE) 2001 P.R.P.S. Chemical Suits & Mobile Decontamination Unit. Ambulance Trusts tasked to train acute hospital trainers

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11 P.A.H.T. C.B.R.N.E. / Hazmat Activations 2010 August White Powder Attack Perceived C.B.R.N.E. (Manchester City Centre; 1) (NMGH) 2010 October Unknown Substance Hazamt (Warrington; 4) (NMGH) 2010 October Toluene Attempted Chemical Suicide (7) (TROH) 2011 April White powder Hazmat (TROH) (Stoke; 4) 2011 July Sodium Chlorate - Hazmat (11) (NMGH) 2011 December Potassium Cyanide & Thallium Sulphate Chemical Suicide (Mental Health Facility; **(1)**) (FGH) 2012 March Lime (Hazmat) Rochdale Urgent Care Centre (1) 2012 December Chlorine / Cyanide / Unknown (NMGH) (3+5)

12 CASE STUDY 2 nd July 2011 (22:55 Hrs) Patient arrives at NMGH E.D. Courtesy call via ambulance service and taken directly into E.R. and met by E.R. Staff. Incident History; Patient found weed killer in her late husbands shed. Taken into family kitchen and began to separate the congealed material with garden hand fork and reconstituted the crystals with hot water over a 3 hr period. Collapsed? Cause.

13 At patient handover in E.R. the nursing sister recognised the incident as chemical in nature and initiated the P.A.H.T. Broken Arrow Response The E.R. was quarantined, including all personnel, patients & patients relatives. An Emergency Action Message was relayed to the E.D. coordinator s desk. Chemical Incident Activated. Warm / cold zones identified. Alternative clean E.D. entrance identified. Air con shutdown. Substance investigation initiated via Toxbase. Service continuity plans initiated. Secondary E.R. opened. First Strike Decontamination Team identified and began process of responding. Liaison with HPU CHaPD.

14 Affected Personnel Patient & Relative Two PAHT E.R. Nurses Two Paramedics One student nurse Two student paramedics

15 SODIUM CHLORATE Non selective herbicide with powerful oxidising properties weed killer & Bleaching agent Very Toxic and poisoning carries a high mortality rate All pesticides containing chlorates withdrawn in UK in 2009 Potential delay of up to 12 hours before systemic toxicity manifests Nausea, vomiting, abdo pain, diarrhoea, convulsions followed by coma.

16 It s All Going Very Well!! 23:25 Emergency Action Message from E.R. - E.R. is now Hot Zone, Primary contaminant situated under E.R. nursing desk. Staff showing signs of secondary exposure E.R. instructed to standby. (Decontamination of quarantined personnel had begun). Dynamic risk assessment conducted and a volunteer requested to don PRPS and execute emergency extraction of contaminant. Completed at 23:35 Decontamination of affected patients and NHS personnel completed at 00:45 Actions commended by GMF&RS Hazmat Team

17 Further Complications Two further patients in primary location & more of the reconstituted contaminant GMF&RS Hazmat response Contaminated ambulance outside E.D. Contaminated waste water, PRPS suits, other response waste and Primary Contaminant outside E.D. Cordoned and guarded Recovery considerations Decontamination of E.R. area, equipment, equipment replenishment psychological effects, debrief and evidence gathering for reporting process. Continuity of E.D. post incident, Two senior staff down

18 Case Study Summary Hazmat Incident - (Not COMAH, Not terrorists) On Scene recognition Issues Despite Ingress of contaminant, a well trained proportionate response maintained E.D. continuity and protected the hospital by damage limitation 11 persons decontaminated and admitted to N.M.G.H. M.A.U. for observation All clothing and personal effects of contaminated persons destroyed Deep clean of E.D. (CHaPD advice) Return to normal working at 03:30 hrs Hazardous waste removed by contractors at 08:00 Hrs.

19 P.A.H.T. RESPONSE MODEL Generic Can be applied and utilised by any Acute trust. Provides a consistent approach. Covers all aspects of C.B.R.N.E. / HAZMAT. Generates engagement, ownership & awareness. Mitigates risk and promotes Service Continuity Improves staff and patient safety Dovetails into Lockdown procedure Links into training modules with security & reception teams

20 Based on; Operational experience Live Exercises Table Top Exercises Training Reviews Extensive risk assessments D.H. guidance Networking

21 WHY? Training provision since 2002 sparse, fragmented, inconsistent & utilised pre hospital management models. Only C element content- No B.R.N.E. Promote generic approach across 3 PAHT sites? adopt GM, Regional, National & International PAHT training subject to A&E operational pressures. Lack of paediatric element. Highly complex response. Dovetail with lockdown requirements. Dovetail into training of support staff to facilitate response: Reception & Security. Structured model of approach specific to Acute Hospital management, promotes best chance of service continuity. Staff & patient safety, Mitigation Unrealistic guidance / expectations

22 HOW?? June 2009, formation of PAHT CBRNE / HAZMAT faculty. July 2009, extensive risk assessments carried out on PAHT CBRNE / HAZMAT response with H&S & Governance. August 2009, modules written to mitigate all key identified risks / gaps and tested. November 2009, CBRNE / HAZMAT identified as A&E core skill. December 2009, achieves mandatory training status and E&T agree to input data and monitor E.S.R. First cohort of PAHT personnel attend the course. A&E Nurse Managers agree protected time for leads August 2010, production of dedicated Acute Hospital Management manual/book.

23 C.B.R.N.E / HAZMAT Study Day 1 08:45 Registration. 09:00 Welcome & Venue Orientation. Allan Cordwell- EPM 09:10 Introduction Lecture (including scenario). Mike Lock NMGH CBRNE lead 10:00 Chemical/Biological/Radiological Lecture. Allan Cordwell-EPM (Specific Treatment & Antidotes) 10:45 Break- 11:00 N.H.S. Specified P.P.E. Allan Cordwell- EPM / C.N. Trevor Norman NMGH lead 12:00 Scenario Assessment/Debrief. 12:15 Lunch 13:00 Donning/Doffing NHS Specified P.P.E. Practical (AC/ ML/ TN) 14:15 Break- 14:30 Biological / Nuclear & Radiation Contamination Management (Allan Cordwell E.P.M.) 14:45 Radiation Monitor Training (Practical). (AC / ML/ TN) 16:30 Closing Speech. Allan Cordwell- EPM Allan Cordwell & Pennine Acute Hospitals NHS Trust 2011

24 C.B.R.N.E / HAZMAT Study Day 2 08:45 Registration. (A.C / M.L. / T.N.) 09:00 Debrief of day 1 (Allan Cordwell- EPM / M.L & T.N.) 09:15 Blast Injuries/Explosives (Allan Cordwell-EPM) 09:45 Forcible Decontamination (Allan Cordwell-EPM) 10:05 Entry Control / Safety Officer Training ( Allan Cordwell E.P.M.) 10:50 Break- 11:00 Management of the Deceased (Allan Cordwell E.P.M.) 11:15 Emergency Rescue / Retrieval ( Theory & Demo) (AC / ML / TN) 11:30 G.M. Fire & Rescue D.I.M. Team (Stn Officer Gary O Neil) 12:00 Decontamination Facility D.V.D.(P.A.H.T. C.B.R.N.E Team) 12:15 Lunch 12:55 Practical Exercise Safety Briefing 13:00 Decontamination Unit Erection ( Practical) (AC / ML / TN) 14:00 Emergency Rescue & Retrieval (Practical) (AC / ML / TN) 15:30 Break- 15:45 Exam 16:25 Evaluation 16:30 Closing Speech ( Allan Cordwell E.P.M.) Allan Cordwell & Pennine Acute Hospitals NHS Trust 2011

25 Course Valid for 5 years providing annual refresher training completed with A&E CBRNE / HAZMAT leads Annual refresher training: PRPS Suit Radiation Monitor Decontamination Unit Completion of E- learning package Monitored by E&T dept. R.A.G. alert to A&E Managers & Practice Educators. New manual to support course 80 % pass mark for written exam

26 WHO?? Consultants Middle grade Doctors Nurse Managers E.N.P. s Sisters / Charge Nurses Staff Nurses HCA s Practice Educators L.S.M.S. H&S / Governance Mortuary Operatives Regional Burns Nurses GMF&RS D.I.M.

27 Compliance Stats ; 39 % of PAHT A&E staff attended non mandatory 1 day Chemical Incident course. January 2010 April 2012 ; 85% of PAHT A&E staff have attended mandatory 2 day CBRNE / HAZMAT course (approx 300)

28 P.A.H.T. CBRNE / HAZMAT Live Exercises & Major Incident Table Tops G.M.F&RS D.I.M. N.W.A.S. H.A.R.T. Links The Structured Approach to Security Management of C.B.R.N.E. (Chemical /Biological / Radiological / Nuclear & Explosive) & HAZMAT (Hazardous Material) INCIDENTS Lockdown & LSMS GM Police Counter Terror Unit ARGUS, SENTINEL & PREVENT The Structured Response of the E.D. Reception Team to C.B.R.N.E. (Chemical /Biological / Radiological / Nuclear & Explosive) & HAZMAT (Hazardous Material) INCIDENTS

29 ALPHA TEAM FACULTY STRUCTURE P.E.R.F. EPM CBRNE Tactical H&S / Governance PAHT RPA NMGH Lead 1 Lead 2 Lead 3 (RAD) Practice Ed H&S / Gov TROH Lead 1 Lead 2 Lead 3 (RAD) Practice Ed H&S / Gov FGH Lead 1 Lead 2 Lead 3(RAD) Practice Ed H&S / Gov R.U.C.C. Lead 1 Lead 2(RAD) H&S / Gov

30 Pennine Emergency Response Faculty E.P.M. H&S / Governance L.S.M.S Specialist Operational Response Teams (S.O.R.T.) ALPHA BRAVO DELTA ECHO CBRNE / Hazmat N.M.G.H. T.R.O.H. F.G.H. R.U.C.C. E.D. CBRNE Leads E.D. Radiation Leads H&S / Governance E.D. Practice Educator Major Incident N.M.G.H. T.R.O.H. F.G.H. R.U.C.C. Physicians E.D. M.I. Leads H&S / Governance E.D. Practice Educator M.A.U. M.I. Leads Pre Hospital Teams N.M.G.H. T.R.O.H. Physicians E.D. P.H.T. Leads H&S Governance E.D. Practice Educator Lockdown CONTEST / PREVENT N.M.G.H. T.R.O.H. F.G.H. R.U.C.C. E.D. L / S Lead E.D. C.B.R.N.E Lead E.D. M.I. Lead H&S / Governance E.D. Practice Educator

31 PAHT C.B.R.N.E. / HAZMAT S.O.R.T. ALPHA Training Arm

32 The Future

33 And Finally!!!

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