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CBRN & HAZMAT PLAN (Chemical, Biological, Radiological, Nuclear & Explosion

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CBRN & HAZMAT PLAN (Chemical, Biological, Radiological, Nuclear & Explosion Document Owner: N.Clark Emergency Planning Manager NC/07/2014 V1.2 1 PLAN MAINTANENCE PROCEDURES This plan will be reviewed annually
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CBRN & HAZMAT PLAN (Chemical, Biological, Radiological, Nuclear & Explosion Document Owner: N.Clark Emergency Planning Manager NC/07/2014 V1.2 1 PLAN MAINTANENCE PROCEDURES This plan will be reviewed annually and following any major incident requiring the plan to be used. Comments on this plan should be provided in writing to: Norma Clark Emergency Planning Manager Lewes House George Eliot Hospital NHS Trust College Street Nuneaton CV10 7DJ Tel: RECORD OF AMENDMENTS Amendment Number Amendment Dated Description By Whom Sign off by Page Addition of CBRN Action Norma Clark QAC 07/2011 V1.1 Cards Emergency Planning Manager 06/ /2014 V1.2 Plan update in line with EPRR changes and Norma Clark Emergency Planning QAC 09/2014 Pages / /2014 V1.2 Action card format changed to easier to read format following feedback from EMERGO Test Manager Norma Clark Emergency Planning Manager QAC 09/2014 2 CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR AND HAZMAT INCIDENTS INDEX PAGE Section 1 2 Introduction Triggering the chemical incident Plan Page No Initiation Procedure General Principles 7 5 General Layout of Incident scene 8 6 Prevent Information 8 7 Departmental Preparation Location of Incident Room & Equipment Layout of decontamination area Use of PPE Preparation of and use of PPE Decontamination Process Triage and treatment of patients including modified triage sieve Documentation Health & Safety and COSHH Ad-hoc arrangements for dealing with mass casualties in event of CBRN/HAZMAT incidents 16 Questionnaire for chemical or biological casualties Chemical Sampling Kit National Preparedness Major Incident Bulk Carriers arrangements for access Cage Inventories Contents of equipment pods 19 Containment Information Chlorine Hydrogen Cyanide Phosgene Mustard Gas Organophosphate Nerve agents WM Protocol dealing with suspect powder packages CBRN Action Cards 1. INTRODUCTION The risk of a Chemical or Biological, Radiological and Nuclear Incidents is small but real and in the event of such an incident, the number of contaminated casualties is likely to be small. However, the Trust is required to have in place adequate arrangements for managing such incidents. The aim of this plan is to provide help and guidance to the staff of George Eliot Hospital s A&E department in the event of a chemical, biological, radioactive or nuclear incident. A CBRN incident is described as an event occurring in the community that involves chemical, biological, radiological or nuclear contamination of a person or persons. These events can be either accidental spills or deliberate acts of terrorism. Accidental contamination is referred to as a HAZMAT incident. The principles outlined in this plan will largely follow the same process for each variation of incident. The main principles to be adopted are: - containment, decontamination, resuscitation, primary treatment and then definitive care. This plan explains the processes and procedures that should be adopted in such incidents. The plan also deals with the health and safety and COSHH issues around such an incident. In the event of large numbers of contaminated casualties then the Trust must activate the mass casualty plan. Adequate facilities must be provided for the decontamination of casualties and also for the protection of staff that may be involved in this process. A system must also be put in place to isolate the decontamination area from the public and the rest of the receiving hospital. A flow must be set up such that only decontaminated, i.e. chemically or biologically clean patients, enter the receiving hospital. A triage system must be set up which prioritises patients appropriately in terms of their need for decontamination. A documentation system must be set up which allows determination of likely contaminants. 4 A disposal system must be set up for removal of contaminated fluids and clothing. Children will be decontaminated the same way as adults but special arrangements for counselling afterwards must be arranged. 2. TRIGGERING THE CHEMICAL INCIDENT PLAN A chemical incident may be heralded by any of the following triggers: Warning from the emergency services, industrial sites, the military or other sources. The unannounced presentation of small or large numbers of casualties with collapse, skin blistering/burns, visual disturbances, sweating, breathing difficulties, lachrymation, salivation, convulsions, muscle tremors, hoarseness or major Gastro Intestinal Tract disturbance. A combination of the above 3. INITIATION PROCEDURE A chemical incident plan will be put into effect if a trigger event occurs. It would be usually to notify: The Accident and Emergency Department will be alerted by the Ambulance Service to receive contaminated patients. The A & E HAZMAT Lead will ensure that the following are contacted: Local Emergency Services On-Call Public Health/Health Protection Agency Chemical Incident Provider Unit (or National Poisons Information Service) Biological and/or chemical incidents: The need to activate the Major Incident Plan will be decided by the Accident and Emergency Consultant in consultation with the Public Health Officer on duty depending on the nature of the incident and chemicals/agents involved. Radiological and Nuclear incidents: The Major Incident Plan, in line with guidance from the Department of Health, should be activated for all such incidents. 5 Full activation of the CBRN incident plan will be initiated by the Ambulance Control Duty Officer, West Midlands Fire Service Duty Officer or by the A&E Consultant after the presentation of casualties with symptoms suggestive of exposure to noxious agents. STANDBY AND ACTIVATION PROCEDURES for a major chemical incident will be the same as those used for major incident except that the nature of the incident in terms of CBRN/HAZMAT will be clearly identified in the message as follows: The initial alerting message will be: MAJOR CBRN/HAZMAT INCIDENT STANDBY Action upon receipt of this message will be as for Major Incidents with the exception of the additional actions detailed in this plan. NO FURTHER ACTION WILL BE REQUIRED BY THE SWITCHBOARD UNTIL FURTHER INFORMATION IS AVAILABLE WITH REGARD TO THE INCIDENT In the event that a full major CBRN/HAZMAT incident is declared then this will be done using the words: MAJOR CBRN/HAZMAT INCIDENT DECLARED ACTIVATE PLAN Action upon receipt of this message will be as for Major Incidents with the exception of the additional actions detailed in this plan. If the incident does not develop into a major CBRN/HAZMAT incident, the Hospital Incident Controller will make the decision to stand down. This will be done using the phrase: MAJOR CBRN/HAZMAT INCIDENT STANDBY STAND DOWN This decision will be made in liaison with the emergency services. 6 COMMAND AND CONTROL The Trust incident control team as per the Major Incident Plan (v1.6 Page 31) will lead the incident internally in conjunction with the decontamination team i.e. A&E Shift Co-ordinator, A&E Chemical Incident Co-ordinator, Decontamination Safety officer, 1 st out Triage officer, Dirty team leader, & Dirty team members. 4. GENERAL PRINCIPLES AT THE SCENE - ZONES Prime responsibility for dealing with chemical incidents at the scene lies with the emergency services. The fire service has control over the general area and will divide the scene into zones. The central HOT zone is the inner area of maximum contamination. Within this area only staff trained in the use of full PPE will be allowed. This is an area of high contamination and patients within this area are presumed to be heavily contaminated. An intermediate WARM zone is set up around the central zone. Within this area staff will wear intermediate PPE and it is within this area that ambulance service staff will carry out decontamination of patients. An outer COOL zone will receive decontaminated patients for initial treatment prior to transport to receiving hospitals. There is no need to wear PPE within this area. 7 5.GENERAL LAYOUT OF INCIDENT SCENE AMBULANCE IN COLD ZONE WARM ZONE FIRST AID AREA DECON AREA HOT ZONE AMBULANCE OUT 6. PREVENT Raising Concerns Should any member of staff have concerns relating to an individual s behaviors which indicates that they may be being drawn into terrorist related activity, they will need to take into consideration how reliable or significant the behavior is. Existing arrangements for reporting concerns are already in place i.e. governance and risk and safeguarding practices. If you are concerned or would like more information Building Partnerships, Staying Safe document can be found on the Department of Health website or the Trust Safeguarding intranet site under: Directorates Patient Safety Adult Safeguarding 8 Self Presenters: When a patient who has left the scene of the incident, without being decontaminated and subsequently self-presents to the A & E department, the Department becomes contaminated by their presence. As this is now a contaminated area PPE must be worn. When a patient presents at the A&E department, they must be contained (if possible) in the reception area to stop the spread of the contaminant. Patients must be decontaminated before entering the Emergency Department. Entrances to the department must be closed and no patient must enter the unit until they are deemed CLEAN. It is vital that the patient is questioned to the route they used into the A&E department through the hospital. By tracking the patient s route, it can be assessed which areas of the hospital must be closed to be decontaminated and to assess alternative ACCESS to the A&E department. Ambulance Control must be alerted to inform crews of the alternative route in the A&E department if required No patient or staff must leave the unit, until a safe exit route is established. Patients brought in by Ambulance: In general terms patients who have been through the emergency service decontamination system must also be decontaminated upon their arrival at the A&E department. 7. DEPARTMENTAL PREPARATION Contact porters to erect the decontamination tent outside Ambulance entrance by the automatic doors. Inform estates and inform them the tent is to be erected. Chemical incident equipment, which includes body, hand and respiratory PPE, buckets, sponges & soft brushes, detergent, cloth & paper towels, blankets, sheets can be found in the chemical incident room. The key to the chemical incident room is in the RED major incident box in the Major Incident Cupboard in the A&E seminar room. It has a red ribbon attached for easy identification. 9 Contact the HPA (Health Protection Agency) on-call rota for the appropriate area in which the incident is or where you need advice. If you are unsure of which rota you need to access then the First Response call taker will be able to assist you in determining the correct HPA on-call rota First Response The First Response call taker will contact the HPA on-call person for the appropriate area and ask them to contact you it is essential that you give a return telephone number. Ensure access to an external (preferably warm) water supply. This is situated outside the ambulance entrance doors to A&E and the attachments for it are located in the decontamination shed that contains the decontamination tent. (on the left hand side when exiting from the ambulance entrance.)the code for the combination lock is 3185 Form a decontamination team of 4 personnel. They will be clothed in PPE, and deployed to the decontamination area at the entrance to the Emergency Department in the area of ambulance set down. Only Staff trained in the use of PPE should be deployed. Allocate a senior nurse to the role of chemical incident - Primary Triage Officer who will set up a triage control point and operate the chemical incident triage sieve. Decontamination is carried out by the decontamination team under the direction of the Primary Incident Triage Officer. The nurse in charge of the department will decide if the Emergency Department should be cleared of non-incident patients using procedures developed for conventional major incidents. Where CBRN/Hazmat casualty numbers exceeds three, consider implementing Major Incident Plan. The nurse in charge must inform the A and E Clinical Manager (on-site, out of hours) who will activate the Major Incident Standby call out as per the Major Incident Plan. If the number of chemically contaminated casualties exceeds the departmental capacity then a Major Incident must be declared by the A and E Clinical Manager (on site, out of hours) and the Major Incident Call out activated as per the Major Incident Plan. All non-contaminated walking wounded receptions will continue to arrive through normal A&E reception route. All non-contaminated ambulance 999 patients are to be directed through EMU reception (nurse in charge to liaise with ambulance control. All Coronary 10 Care Unit patients to arrive via EMU entrance and to go to Coronary Care Unit via corridor. To remain in contact via 2055 with Ambulance Control. Warwick Ambulance Control will inform other Ambulance Controls. If there is not capacity in EMU then the Nurse in Charge should activate the Major Incident Plan as per above. Alert Severn Trent Water Authority. Water Services and Emergencies 24 hour number: Ensure that no patients are allowed into the A&E department until it has been confirmed that they have not been involved in the chemical incident or that they are chemically clean. Liaise with Ambulance Control to discuss alternative route into and out of the hospital to maintain normal hospital services. Nominate a Doctor to act as Secondary Triage Officer for patients following decontamination. A&E Consultant / Senior Doctor to ensure that all patients not directly involved in the incident are moved to other areas of the department/hospital, in attempt to remove them form any contamination. Ensure safe entry and exit routes for patients and staff. Ensure department Air Conditioning switched off. Secure all entry and exit points to the Accident and Emergency Department /hospital 8. LOCATION OF DECONTAMINATION ROOM & EQUIPMENT. Chemical incident room. The key to the chemical incident room is in the RED major incident box in the Major Incident Cupboard in the A&E control room. It has a red ribbon attached for easy identification Decontamination Suits Sponges Detergent Buckets Bleach 11 Equipment is to be checked every month by A & E staff. Decontamination showers and tents: situated outside the ambulance entrance doors to A&E and the attachments for it are located in the decontamination shed that contains the decontamination tent. (on the left hand side when exiting from the ambulance entrance.)the code for the combination lock is LAYOUT OF DECONTAMINATION AREA As far as is reasonably practicable, No contaminated patients will be allowed into the Emergency Departments. Patient flows will be set up in one direction such that all patients who exit the decontamination area will be chemically clean and can therefore be treated within the Emergency Departments as normal patients. An ambulance circuit will be established so that contaminated patients can be offloaded and ambulances can immediately exit the decontamination area and return to duties. A bin system will be provided for safe disposal of personal effects. The decontamination area will be isolated by biohazard tape and will be considered to be a warm area of potential contamination. No staff will be allowed into that area unless they are wearing PPE. Consider use of Warwickshire Fire Service and/or West Midlands Ambulance Service to assist with decontamination of casualties at Hospital site if sufficient available capacity 12 10. USE OF PERSONAL PROTECTIVE EQUIPMENT Decontamination PPE is easy to use and provides high levels of protection in both chemically and biologically contaminated environments. If the suits are applied appropriately then the wearer will be safe whilst working in a contaminated environment. The suits employ a positive airflow through the facemask and helmet system. Whilst wearing the suits the wearers will sweat and become warm. They will only be able to work in these suits for a limited period (DEGRADATION TIME). Beyond this period other staff will need to take over the decontamination process. Sufficient sets of PPE have been purchased to allow more than one decontamination team. Gloves that are used with the system are relatively thick and stiff. They will therefore make active clinical intervention difficult. The wearer should not therefore expect to be able to carry out complex clinical work whilst within the decontamination area. Clinical interventions will be limited to simple life saving procedures such as basic airway management. The prime role of workers within the decontamination will be to decontaminate. All staff that work within the decontamination area will wear personal protective equipment (PPE). Only staff members that have been trained in the use of PPE will be allowed to work in the decontamination area. A buddy system will be used to ensure that both the process of dressing and undressing with PPE will be both efficient and safe. All staff will use a standard process of dressing and undressing. Theatre garments will be worn underneath the suits so as to increase periods of working within the suit and to simplify the dressing and undressing process. 13 PREPARATION AND USE OF PPE Respirex Suit Label Preparation for Use The suit is supplied in a sealed bag, fully tested and in full working order. Nevertheless it is advisable for the following checks to be carried out in a clean area prior to donning the suit. Visually inspect the suit for any damage that may reduce the level of protection; pay particular attention to the seam areas and gloves. Check the suit is free from contamination both externally and internally. Check vision through the visor is not impaired by scratches or heavy scuff marks. Check the zip operates correctly and the pull tag is in good condition. Verify the breathing tube and remote warning device are connected to the AFU (fig 2). 14 Fit the battery to the AFU (fig3). Switch on the AFU. The AFU will beep, the lights on the remote warning device will cycle for a short time, then the green light will remain illuminated (fig 4). At this point the 60 minute timer begins. Remove the small plastic screw caps and fit the two filters to the suit (figs 5 & 6). Important: The clear plastic filter lids should remain in place whilst the filters are in use. 15 An option air check can be carried out at this point as follows. I Remove the breathing tube from the air filter unit. II Insert the airflow indicator tube into the air filter unit outlet. III Hold the AFU so that the tube is vertical and at eye level. IV Verify the ball has risen above the black line on the tube (fig 7). V Remove the airflow indicator tube and refit the breathing tube. To check warnings block the breathing tube outlet by putting a hand into the head space and covering the open end of the tube with a flat hand (fig 8). Ensure that after a short time the buzzer begins to beep and the red light begins to flash. Remove hand from the outlet. The red light will go out, all three lights will cycle for a short time then the green light will remain illuminated (fig 9). The suit is now ready for use. 16 At this point the AFU can be switched off until the user is ready to don the suit. When the AFU is restarted the lights will cycle for a short time, then the green light will remain illuminated. The 60 minute timer will re-set. Indicator Lights and Warnings Throughout normal operation the green light will remain illuminated. 60 minutes after switching on the AFU the amber light will illuminate intermittently and the buzzer will beep for 10 seconds. After 75 minutes (additional 15 minutes) the amber light will remain illuminated and the buzzer will beep for 10 seconds. In an alarm condition the red light will flash and
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