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Biodefense | |||||
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Imagine these worst-case scenarios: Sarin gas, the nerve agent used by terrorists in Japan in 1995, is released during a Boston Bruins game at the Fleet Center. Thousands are affected and brought to area hospitals. Or a bomb explodes in Cambridge, causing several buildings, including an elementary school, to collapse. Or a child is brought to Children’s Emergency Department with an unusual rash. ED staff suspect smallpox, a highly infectious viral illness not seen in the United States since 1949. The terrorist attacks of Sept. 11 and the ensuing anthrax scare have gradually receded from our daily thoughts. But for a dedicated band of experts from across Children’s, emergency management planning focused on the development of protocols to deal with biological, chemical, radiological and mass casualty events has become a daily part of their jobs. Staff from Security, Facilities, Infection Control, Emergency Services and a myriad of other departments work daily and meet weekly to ensure that Children’s will be able to carry on its mission of caring for patients and families in the face of a man-made disaster. The Biodefense Committee, led by Connie Crowley Ganser, MSN, RNC, director of Quality Improvement, Risk Management, and Medical Affairs, Michael Shannon, MD, MPH, associate chief of Emergency Medicine, and Jean Bennett, MSN, MSM, RN, project manager for Biodefense and Medical Affairs, had a good start on its emergency planning, according to Crowley Ganser, because Children’s already had extensive Emergency Preparedness plans in place. These plans address everything from damage to the facility from natural disasters to management of an influx of trauma patients. Moreover, a number of Children’s physicians have been looking at the medical aspects of terrorism for almost three years. “We were awarded a grant in October 2000 to work on bioterrorism education for physicians and to develop responses to bioterrorism,” says Shannon. “We had already created a surveillance tool, now in place in all the Boston hospitals, for early identification of infectious outbreaks or to recognize patterns of symptoms that would provide an early alert to a possible bioweapon attack.” Since last fall, members of the Biodefense Committee have been meeting regularly with representatives from the “first responders” in a chemical, radiation, or mass casualty event, such as the Boston Fire Department and Boston EMS, to ensure that our emergency plans will dovetail effectively with their practices. In addition, closer collaborations have been forged with Disaster Control Groups of the Boston teaching hospitals, as well as emergency management teams at the Boston Public Health Commission, Massachusetts Department of Public Health and the Massachusetts Emergency Management Agency. According to Bennett, “Biodefense Committee” is really a misnomer, as the group is developing plans for a range of events. Sub-committees led by staff from Infection Control, Nursing, Radiation Safety and Safety are developing policies, procedures and protocols for management of biological, radiological, chemical and mass casualty events. The Biological sub-committee first focused on anthrax exposure guidelines and then moved on to smallpox, which has been identified by federal intelligence and public health officials as one of the most likely terrorist weapons. The sub-committee’s smallpox infection control protocol, which details the isolation and care of confirmed smallpox cases, is in final draft form. This protocol will also contain personal protection protocols for clinical staff and the policy on activating Code Access. “Code Access is a plan to manage flow of patients, families, staff and all others into and out of the institution during an event when city, state or federal public health agencies may require Children’s to go into a full or partial ‘lock down’,” says Bennett. “This maximizes our ability to deliver proper care to patients coming to our door.” A revised Code Triage plan is also nearing completion. Before Sept. 11, the plan outlined procedures for taking care of mass casualties, which were defined as more than 10 unexpected visits from acute trauma at once. New public health and Joint Commission on Accreditation of Healthcare Organization guidelines recommend developing protocols to manage mass casualties in the hundreds. The group working on Code Triage has identified 62 critical care and 63 non-critical bed spaces that Children’s could activate in a major emergency. The Chemical and Radiation sub-committees have focused on obtaining a decontamination facility and choosing and procuring the appropriate level of personal protective equipment. Portable decontamination showers are now on site to be deployed to the designated decontamination area in the ambulance bay adjacent to the ED. The committee leaders believe that they are about 40 percent of the way to full preparedness, which will then become a way of life for all Children’s staff and employees. They expect that biodefense awareness will be incorporated into new employee orientation and the mandatory yearly review process. Just as all employees must know the RACE drill in the case of a fire, Crowley Ganser envisions that the hospital will ask all employees to know their role in the event of a major disaster. “Biodefense education and training will be incorporated into continuing education for some staff, and emergency management competencies will be in many job descriptions,” says Crowley Ganser. “In keeping with Children’s reputation as a leader in pediatric care, our emergency management strategies will also serve as a national model.” —BA |
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