Cathy Boldizsar, center, portrays a patient with a head injury as she is led out of the decontamination shower by members of Vanderbilt's Environmental Health and Safety department. The mass destruction drill was held Sept. 28.(photo by Dana Johnson)
Preparing for the worst
Keith Robinson and Johnny Vanderpool of Environmental Health and Safety assist patient Lara Tosh through the decontamination shower. (photo by Dana Johnson)
Johnny Vanderpool hoses down patient Nancy Johnson to decontaminate her before being taken into the Emergency Department. (photo by Dana Johnson)
Kendra Coleman is led out of the decontamination shower area by Kelley Work of Environmental Health and Safety. (photo by Dana Johnson)
Vanderbilt University Medical Center tested a new hazardous materials decontamination area in conjunction with a citywide weapons of mass destruction drill on Sept. 28.
Emergency workers from across the city focused on an attack at Adelphia Coliseum that “injured” over 300 people.
Biological and chemical terrorism is a growing concern for emergency departments. A 1995 Sarin attack in the Tokyo subway system resulted in 11 deaths and more than 5,000 emergency medical evaluations at Tokyo emergency departments.
The drill at Adelphia involved the release of Sarin gas and required emergency decontamination for all patients. Decontamination consists of the person affected removing outer clothing and being washed down with large amounts of water. This protects the patient from further decontamination as well as contaminating other patients and areas of the medical center.
In the Tokyo incident, large numbers of patients arrived at the emergency departments before they had been through decontamination.
“If we let people in the emergency department before they are decontaminated, it would shut the emergency department down,” explained Ken Browning, VUMC director of Plant Services.
VUMC is using a method developed during the Gulf War to decontaminate victims. Dubbed the “Israeli model,” it consists of 10 shower heads permanently fixed in the ceiling of a sidewalk area outside the Emergency Department. Large curtains drop to form separate lines for men and women.
“We use parallel runs for men and women for privacy,” Browning said. “The curtains drop, temperature controlled water is turned on and the showers are activated. Patients walk through the corridor of shower heads and come out clean at the end of the walk.”
An estimated 200 people can be decontaminated in an hour and the system is designed to be set up and operating within five minutes.
Pam Hoffner, VUMC weekend administrator, came up with the fixed shower area while attending a medical disaster conference.
Browning said the focus would now turn to improving processes associated with the new procedure.
“We’ll focus on traffic flow problems, elements of the patients disrobing, bagging their clothing and tracking their belongings, and logistical problems,” he said.
Volunteers played an integral role in the drill and in the process improvement procedure.
“We couldn’t do it without the help of our volunteers,” he explained. “Volunteers are the most important element of any drill.”
Over 75 medical center employees and students volunteered for the event at VUMC and Adelphia.
Browning said volunteers were more than just actors playing the role of a patient.
“Their views on the process and possible solutions to the process are invaluable,” he said. “We record their comments following the exercise during the formal critique. We couldn’t improve the process without their help.”
One VUMC nursing instructor echoed his comments by requiring her students to participate in the decontamination process.
“The students who participated in the drill are in their pre-specialty year in the course N245, the clinical component,” said Maria Overstreet, a nursing school lecturer in the acute care nurse practitioner level. “This is a foundational course where the students will gain knowledge of basic nursing skills that they will build on for the rest of their professional career.”
Overstreet said the experience gained by the students would prove to be invaluable.
“At this point in their career, they have had limited amount of experiences in the hospital environment and with medical personnel,” she explained. “My hope is that it will give them a perspective of the magnitude of what a disaster entails and a chance to see in action different professions in the medical field and all their interacting.”
The entire process was filmed by a crew from the U.S. Department of Justice for possible use in a national training video. The video will focus on a terrorist attack, decontamination procedures and the nationally recognized incident command structure. Vanderbilt is one of few hospitals in the nation that utilizes the same incident command structure in use by fire, police and EMS agencies.
“We got some excellent footage and hope to include Vanderbilt’s work in the training video we are developing,” said Pamela Frank with Community Research Associates. CRA has been contracted by the Department of Justice to do the filming and video preparation.
“The decontamination process at Vanderbilt is unique and an excellent use of space,” Frank said. “We certainly hope to use it in our upcoming training video as a model for other hospitals across the nation to follow.”