Management of Chemical Incidents

Management of a chemical incident

Proper drilling of the facility or group appropriate response plan for a MCI:

MaHIM, HEICS, ICS, NIMS - this should be done locally or regionally. [1]

HVA - Defining potential hazards within the local geographic area is essential to prepare all-inclusive realistic plans. [1]

Integrate plans to handle a chemical WMD into the existing disaster planning.

Define - chain of command, critical assets and define the roles of the members in the chain (this should be handled under the MaHIM etc).

Define objectives for the staff to achieve during the incident and define SOP that must be enacted during an incident.

Additionally recognize the differences in staffing levels, etc during different periods of the day/week.

Clearly appoint a safety officer to monitor the well being of staff working in PPE, to maintain contamination control, and various other hazards. This officer should also ensure proper decontamination of all patients, staff, and equipment. Most importantly the officer will maintain the well being of the staff and prevent compromise of the staff by chemical agents.
A clear plan to decontaminate patients should be established (See Jane's manual for details on how to decontaminate). HAZMAT should handle decontamination; however, this will not always be the case. Thus, on site decontamination will need to be incorporate into planning.

The facility must, according to JCAHO, work with and coordinate with the community. This will help to mitigate the impact of a large scale incident.

A notification and communication system should be established to ensure clear and concise delivery of relevant info during an incident to all groups.

Steps to prepare public health agencies for chemical attacks include the following (MMWR, 2000):

Enhance epidemiologic capacity for detecting and responding to chemical attacks.

Enhance awareness of chemical terrorism among EMS personnel, police officers, firefighters, physicians, and nurses.

Stockpile chemical antidotes.

Develop and provide bioassays for detection and diagnosis of chemical injuries.

Prepare educational materials to inform the public during and after a chemical attack.

Communication and information dissemination - thus staff must be prepared to shift locations and facilitate communication. Cell phones will more than likely be inundate. Thus land lines, electronic mail, or even radio can be used to communicate across the channels.

Hospitals will also need to prepare for inquires into patient status from family/friends of those involved in the incident.
Surge plans may need to be enacted depending on the scale of the incident, thus, Mutual Assistance agreements should be in place or external sites identified to place patients.
Identify and work with external healthcare providers (pharmacists, nurses, doctors, etc) to help treat patients.
Information should be communicated accurately to the media, fake press conferences are a terrible idea (I'm looking at you FEMA). This information should be communicated by the designated information officer.

At all times, personnel need to be protected, security and PPE wise.

The decontamination area must be clearly demarcated, cold, warm, hot and patients triaged.

All patients belongings tagged and bagged. patients decontaminated, triaged and admitted as needed.

Photograph/barcode patients and their belongings to assist in tracking.

Activate access to the strategic national stockpile, if warranted.
Maintain human remains, as this is a crime scene.

Broader, establish counseling to deal with psychological aspects during and post incident.

Map out the region, define congestion points and establish clear evacuation routes during emergencies.

Define a logistical plan to provide equipment and supplies to staff and patients.

Define a broader security plan; work with local police to protect the facility (Riot syndrome).

Train, train and train again. Drill, Drill and Drill again...

Post incident, an after action analysis should be done to identify what was done right, wrong and to help adjust for improvements.
Lastly, cleanup the areas contaminated or infected.

Decontaminate all collected belongings. Follow chain of custody. Establish and prep psych plans for the community.
Source and citation:
1.        Gum, Robert M., and John D. Hoyle. "CBRNE - Chemical Warfare Mass Casualty Management." CBRNE - Chemical Warfare Mass Casualty Management. eMedicine. http://www.emedicine.com/emerg/topic895.htm.