Hermiston Herald
04/16/02
Emergency preparedness gets good report:
Problems exist, however, with medical training, communication
By Frank Lockwood
Staff writer
HERMISTON - An inspection team was "impressed" with
chemical weapons
emergency preparedness in Hermiston despite shortcomings in communications,
staff training, hospital security, and emergency care for children.
Good Shepherd Medical Center teams were locked out of the communication
loop
for more than an hour during January's exercise, a government
report
reveals. In addition, the exercise showed hospital personnel are
not trained
to treat children exposed to chemical agents. There was also
inadequate
chemical-exposure training of physicians and nurses in general.
Notwithstanding those problems, the Report of the Advisory
Group to the
Centers for Disease Control and Prevention, released this month,
said the
January inspection team was "impressed" with the level
of preparations to
ensure safety in the event of a chemical agent release, and that
areas that
needed further strengthening were "easily surmountable"
in view of past
achievements.
Among the areas said to need improvement were hospital preparedness,
coordination of medical and EMS care with the state of Washington,
pediatric
care, and communications. The media has often reported on the
lack of the
450 megahertz radio system requested by counties.
"In any disaster or exercise, one of the most common failings,
if not the
single greatest, is the communications system," the report
said. Here, the
distance between facilities and the lack of a preexisting base
radio system
further complicate this. "The limitations in communications
capabilities
makes coordination of the health and medical response of the Umatilla
CSEPP
operation ineffective," the report said.
Hospitals need rapid, detailed information regarding the extent
and location
of the exposure. Without that information, the first thing a hospital
would
do is lock down to protect their own patients and staff.
"Many providers, from EMS to the hospitals, were under-informed
and/or
informed late regarding the event in the drill," the report
said. "Hospitals
cannot communicate directly with the incident command center and
emergency
operations centers, and are given very limited information under
the current
protocols."
The present system provides only unidirectional communication
to the
hospital and allows no method for the hospital to initiate inquiries,
according to the report.
As an example, Good Shepherd was initially notified only by
a beeper that a
chemical weapons agent simulated event had occurred. Since the
wind
direction was from the depot, not knowing what the event was,
the hospital
immediately shut down and over-pressurized. There was no other
information
provided for one hour and 17 minutes, and then the hospital was
told only
that they could decontaminate patients.
No further details about the event were given, such as the
extent and
direction of the plume, expected number of casualties, or transport
times.
The hospital could not initiate their disaster plan nor call in
additional
staff until they knew more details about the event. Because of
the
vulnerable location of Good Shepherd Hospital they must know the
extent of
the release almost immediately in order to initiate their disaster
plan,
otherwise they must close the hospital, and some of their staff
will be
sheltering at home, according to the report.
For the above reasons, the report said, a regional radio system
must be
available and capable of allowing all components of the health
and medical
system to communicate with each other and with the incident command.
The team found little evidence that Good Shepherd Hospital's
disaster plan
is coordinated with that of the county, and none of the three
hospitals
visited had coordinated with the local law enforcement plans for
hospital
security in the case of a chemical agent emergency. "Good
Shepherd Hospital
stated very clearly that hermiston Police would not provide any
security,"
the report said.
Emergency treatment training should have included more expertise
in helping
children, the report said.
Because exposure to chemical weapons is a rare event, there
is little
routine training for these events and the treatment of chemical
agent-exposed patients in most health care curricula. What training
is
available focuses on treating adult patients, and "children
are often
overlooked," the report said. There is a potential for children
to be
exposed to a chemical agent release. Most of the CSEPP training
has focused
on pre-hospital and nursing personnel, while "few, if any,
of the front-line
physicians are trained in their response and treatment,"
the report said,
and "there has been little training in the treatment of children
exposed to
chemical weapons, nor were pediatric doses of antidotes stocked.
The report also found shortcomings with the so-called START
triage designed
to assess patients with traumatic injuries; START does not adequately
assess
the symptoms or findings associated with a chemical weapons exposure.
In addition, the report said, there are few physicians working
in the
emergency departments of the participating hospitals with training
in the
management of patients with chemical agent exposures. "While
the nursing
staff has had multiple training sessions, efforts to train physicians
have
had limited success thus far," the report said.
Physicians working in emergency departments may lack pediatrics
training,
the report said, local pediatricians may not have been trained
in diagnosis
and treatment of chemical agent-exposed children, and emergency
department
physicians and nurses have limited training in pediatric care
and have not
received chemical agent-specific pediatric training, all according
to the
report.