I first began identifying issues hospitals had in common relative to hazardous materials preparedness after I led the development of the course Hospital Emergency Response Training for Mass Casualty Incidents at the Center for Domestic Preparedness. In teaching this course to hundreds of hospital personnel over the years it became apparent that many suffered from the same challenges in their decontamination program back home. This is one of the main reasons for my book Hospital Emergency Response Teams .The book was designed to capture the components necessary to build and sustain a reasonable level of preparedness for hospitals. 
Today I spend a good deal of time working with hospital clients to develop and sustain their hazardous materials decontamination or Hospital Emergency Response Team (HERT) programs. Working with a large number of organizations across the country I have found that hospitals generally need assistance in one or more of five key areas.
Do you see these problems at your hospital?
- Facilities: While most facilities have some type of fixed decontamination room found in close proximity to the Emergency Department, this space too often serves as a storage location for miscellaneous items not related to the process of decontamination, leading to confusion and disarray when the room is required for use.
- Staffing: People move to other positions, facilities, or lose interest in knowing what to do in the case of a decontamination emergency. Few hospitals have enough trained staff for a sustained, viable program.
- Equipment/Supplies: Many hospitals were recipients of equipment purchases through federal grants. They feel compelled to keep these purchases regardless of the ease of operation, whether anyone was trained to use this equipment, or to consider easier alternatives.
- Training: Annual training for such a low frequency/high risk task is problematic. Hospitals often lack quality instruction and time to devote for more training.
- Documentation: A high percentage of decontamination programs survive partly through documentation (miscellaneous plans, policies, and procedures) and partly through the institutional knowledge of staff. A consistent approach to decontamination procedures is rare.
Over the next few weeks I will look at these five keys to a successful program, the common challenges that hospitals face with each, and potential solutions and improvements that hospitals should consider.
I hope you’ll join in the discussion and help others benefit from solutions you’ve implemented.
Excellent article Sir! I look forward to the follow up posts.
I saw many of the same issues when working with USAF Medical Teams at both clinics and hospitals.
The two greatest obstacles we see are team member retention and simply finding time to train in such a lean environment. We moved to non-nursing personnel for the majority of the member base in an attempt to increase availability by using more ancillary staff. However, we quickly discovered availability of all dtaff is at a premium. We currently have an asset rich situation with severe shortsge of available bodies to put those assets in action.
Great comment Stacy. When you say asset rich I assume you mean you don’t suffer from lack of equipment and/or supplies, just the trained warm bodies to utilize them correct?
It seems to me that states could have “Ready Teams” trained and equipped to respond within a few hours to these emergent situations. They would be prepared to deploy, stabilize and train existing hospital staff for operational handoff within a relatively short period of time. Using a system such as this reduces problems of individual hospitals trying to maintain fully trained response teams. A similar approach is used for search and rescue with 28 federal teams under FEMA’s National Urban Search and Rescue System. Texas Task Force 1 (TX-TF1) is composed of multiple organizations and members who train together and respond together. This system provides a diverse range of professional experience and training, probably more diverse than can be found in any one hospital.
There are resources at varying levels of government JC but the challenge comes in on the more probably contaminated patients that walk-in and or arrive but private car directly to the hospital. Hospitals need to have the capacity to quickly manage these patients to protect not just the staff and the facility from cross contamination, but also necessary for treating the patient(s). You are correct that there may be opportunities for collaboration among facilities to back-fill each others staff and I will be discussing that in a future post.
Agree with many of the comments on sustaining the team membership. Many of us constantly struggle with staff turnover so it makes it difficult to retain the same team membership. Within our coalition, we recently adopted the same CBRN trainer (16 hour FROT Course) to come to all the facilities (including our military partners) as well as purchase same equipment sets to develop a more regional approach to building hospital CBRN capability. This was all supported by grant funding which was the only way we could do it regionally. Now it is a matter of program sustainment: train-the-trainer, sustaining equipment sets, refresher training, etc. This is our next phase which is not without is challenges either. Let’s hope the grant funds hold out as this is the main funding stream to support this capability.
Sounds like your coalition is making some good decisions Donna. I will be offering some potential solutions to the challenges you mention in post coming up in the next few weeks. I hope you’ll continue to read and offer your ideas.
I agree with all of the comments that you have made above Jan and would like to offer one more issue – security of the site (ED or hospital) involved in the CBRN incident. I have observed poor security on a regular basis in ED and hospitals. During a CBRN incident, security is even more important to prevent people accessing the ED that are potentially contaminated. There needs to be an increased understanding of the importance of hospitals as part of critical infrastructure. We also owe it to ourselves, our colleagues and our patients to get decontamination and security right! If you allow a contaminated patient into the ED, you end up having to shut down parts of the ED, your core business may be impacted and your staff may be contaminated. We definitely have to lift our game in this area, Diana
You’re quite right Diana and in many hospitals security staff are stretched quite thin. This is another reason why I advocate for establishing your decon corridor at some other location than your ED. I’d much rather have a breach into my foyer than patient treatment areas.
This is a serious challenge for hospitals. In addition to the issues listed in this article, a significant issue that probably goes hand in hand with complacency is the lack of a positive return on investment. Hospital administrators and finance are responding to the new pay for performance reimbursement structures. All their efforts are trying to create new ways to cut operating costs and maximize revenue to maintain daily operations. Purchasing high prices supplies for decontamination, overtime for training, and other programmatic sustainment needs are areas Administrators are not making a decon capability a high priority. This is especially true with smaller or rural hospitals that do not receive large sums of grant money. Hospitals outside the high priority cities or DHS UASI regions are experiencing far more challenges in maintaining preparedness.
You raise a number of real issues Joe. I hope you keep a look at for my posts coming up as I will hit on most of your issues and may have some ideas for you.