Jun 192016

If your staff attend a training session such as the one provided by the Center for Domestic Preparedness (CDP) they learn the process of establishing and operating a decontamination corridor.  I trained hundreds of hospitals personnel after developing the CDP course and it has value.  On the other hand each facility needs a training program which will allow for consistency in approach, clear standards of performance and the necessary policies.

If you look at the decontamination equipment stored at most hospitals you would think they have two dozen trained Hospital Emergency Response Team (HERT) members to set-up and operate the decontamination corridor.  Many hospitals were recipients of a cache of decontamination equipment as part of a grant program and/or donations from nearby fire departments upgrading theirs.  Equipment typically includes large tents and pallet loads of supplies and equipment.  The problem is that many hospitals have just a handful of HERT trained personnel.  Your training program needs to be customized for your facility, staff, equipment, threats and desired outcomes. Picture1

Equipment and staffing are important factors when looking at training options.  It’s much safer and wiser to scale your HERT program based upon the number of staff you can realistically field rather than how much equipment you can set up given enough time.  Decontamination is a process and there are literally dozens of way to meet the objective of ensuring someone is clean enough not to represent a hazard to staff.

If you can’t staff more than 1-4 people a shift, your decontamination corridor should be simple and your training process built around standard operating procedures you want your staff to follow.  Expecting a contaminated patient in duress to wait while extensive equipment is set-up is not realistic and one of two things will happen. Option one – Medical staff will attend to the patient prior to any decontamination or donning of appropriate Personal Protective Equipment (PPE). Option two – the patient will tire of your antics and breach your facility though some door.

Training your staff to be able to quickly set-up a basic decontamination system with staff on duty and readily available will serve you better in most cases than waiting on teams to bring loads of equipment and set-up a “traditional” decontamination tent system. Topics you need to have in your training program include:

  • PPE – Selection,use and disposal
  • HICS – How the HERT will function and fit in with your facility HICS structure
  • Hazard Vulnerability Analysis – What hazards are they likely to encounter
  • Decontamination Corridor – How to establish and operate (with realistic staffing)
  • Triage – Process to determine who gets decontaminated first
  • Decontamination – Methods and desired outcomes
  • Hospital policies relative to contaminated patient management

Develop your in-house trainers or collaborate with other facilities in your region to form coalitions of trainers. This can help standardize procedures, sustain programs and build back-up staffing for member hospitals for the rare major hazardous materials event.  Your training program does not have to be hundreds of pages but it does need to provide new and existing HERT members the foundation to safely and efficiently manage the contaminated patient.  I invite you to share success stories you’ve experienced when it comes to building your HERT program.


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May 302016

In my experience staffing is one of the biggest challenges hospitals face when trying to sustain a Hospital Emergency Response Team (HERT) program.  Staff members get selected based upon their job description (e.g ED, security, facilities) or volunteer for training. Typically this is a “duty-as-assigned” and does not come with any compensation other than getting to wear Personal Protective Equipment (PPE) and sweat a lot.

After 17 years of volunteering as a fire-fighter paramedic, I’ve learned something about why people volunteer and, more importantly, why they continue to volunteer for years.  Some of these lessons translate well to building and sustaining your HERT for the long haul:

  • Interest
  • Ability to respond
  • Embrace the “team” aspect
  • Use Lessons Learned in Training
  • Reward participation

Interest – Just like joining the fire department, being a member of a HERT requires a certain level of interest in the topic. Members must have a desire for understanding the hazards of the environment they will work in, the necessary protective equipment, and how to perform tasks safely as a member of a team.  Offering an overview of HERT at your annual employee in-service fair may stir someone’s interest. Some people will agree to try HERT based upon their conversations with people already on the team. Give your current HERT members a great story to tell and to sell others other on the opportunity.

Ability to Respond – Selecting someone to be on your team based only upon their current job title is risky.  While I would never discourage anyone from seeking more education, hospitals must ensure that HERT members can actually drop what they are doing and show up to help.  Using staff with critical or unique skill sets on HERT are building in a predictable barrier to having a consistent HERT response.  A core group on all shifts who can respond quickly requires several things. First, there must be buy-in from supervisory staff since they will likely have a gap to fill once in awhile.  Second, hospitals need efficient operations. Your HERT should be able to spin up fast and demobilize quickly in order to get back to normal operations.  This ability to respond means using the Incident Command System — I will talk more about this in a later post.

Embrace the Team Aspect – If I were building a HERT from the ground up, I would look for staff who 1) have an interest in learning; 2) ability to respond; and, most importantly, 3) enjoy being part of a team. As I like to say, with HERT as in hockey, you win or lose as a team. Everyone has a role to fill and it takes different skill sets to get it done right. Finding the right niche for anyone who wants to be involved means you have the documentation (policies, procedures, and operational guidelines) in place to support the team structure.  We’ll talk more about the importance of documentation in a later post.

Use Lessons Learned in Training – Look, no one likes to ride the bench!  If staff show enough interest to join your HERT and attend the training, it’s the responsibility of HERT team leaders to make sure they get to use their skills on a regular basis. Nothing will cause team members to bail faster than not having a reason to use their new knowledge. Dole out monthly assignments to team members to research hazards close to your facility and develop simple one-page guides. Every quarter, practice a perishable skill set necessary to establish and operate your HERT. At least once a year, conduct an exercise. Lastly, review your documentation for criteria that triggers your HERT. If you can stand up and demobilize your HERT efficiently, you may find more cases to deploy staff.

Reward Participation – Reward does not necessarily mean in the financial sense. Many volunteer fire departments have a point system for attending drills and training as well as responding to calls. Points correspond to everything from mad money to breaks on a utility bill. While these perks are not why they volunteer, these small acts do acknowledge the time and effort put in by team members to provide a service for the community. Your hospital should also find ways recognize and encourage HERT members — a meal voucher in the cafeteria or a Starbucks card can buy a lot of good will.

Staffing can be one of the issues that really makes or breaks a HERT program.  I’d love to hear your success stories and ideas to help others.

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Feb 062016

I think it’s hard to argue that prevention of disease in the case of the Zika virus does beat a pound of cure. We are unlikely to have a vaccine in the near future and there is no specific treatment for the illness.   The mixed good/bad news is that roughly 80% of those infected are unlikely to even know they have the disease.  The bad news is if the patient happens to be a a female who is in any stage of pregnancy, it raises the potential for a serious birth defect of the brain called microcephaly.  We have the 2016 Olympics coming up in Rio de Janeiro in August.  More than one million visitors and athletes are expected for the games in Brazil.  If you’re in healthcare, what advice would you give to an individual?  If you’re in emergency management or public health what advice would you give in order to try and prevent the disease from returning to your community?zika

While the mosquito is the primary vector, there is concern now that the disease can spread via blood transfusions from an ill donor and also through sexual contact with an ill person.  Since November 2015, Brazil has seen 404 confirmed cases of microcephaly in newborns. Seventeen of those cases have a confirmed link to the Zika virus. Fifteen babies have died from the condition, with five linked to Zika. An additional 56 deaths are under investigation, and authorities are investigating 3,670 suspected cases.  CDC Director Dr. Tom Frieden recently said: “The priority is protecting pregnant women,” “If you’re pregnant, and you’re thinking about traveling to a place were Zika is spreading, please don’t.”  “Men who live in or travel to areas of active Zika infections and who have a pregnant sexual partner should use latex condoms correctly, or refrain from sex until the pregnancy has come to term.”

I think this raises some interesting questions regarding what information is being provided regarding the disease, prevention and potential complications of illness.  I expect that the majority of our athletes will be in the child bearing and/or child producing age bracket.  I accessed the Team USA Road to Rio website while writing this post and there is zero mention of Zika in Brazil.  Do you think there should at least be links to CDC and/or WHO information to help athletes make an informed decision?  Certainly bragging rights for medal counts does not trump the personal safety of athletes does it?

My personal opinion is that athletes will be more likely to be injured in a motor vehicle accident than contracting Zika if they take reasonable precautions to prevent mosquito bites.  I can’t speak to any issues of ingredients in bug spray that may show up as daughter products of a performance enhancing drug.  I understand there is a shortage of bug spray and mosquito netting in Brazil so visitors better pack their own. Remember only 3.4 ounces if you’re putting it in your carry on. I would hate to see TSA confiscate your bug spray and increase your risk of contracting disease and consequently importing it back into the country.

I’m curious what you would do if you were the athlete and/or planning on visiting during the games?