Hospital staff face unknown threats

Workers fear chance of nuclear, biological and chemical hazards David Rider The Ottawa Citizen

Wednesday, November 07, 2001 A mother comforts her daughter as they wait for a doctor to examine her throat in an emergency room. (CP Archive/Ryan Remiorz) TORONTO -- Ottawa Hospital emergency room workers are worried about the threat posed to their safety by patients exposed to nuclear, biological or chemical hazards.

The concern is understandable, even though the workers have been trained to deal with such situations and avoid self-contamination, nursing education supervisor Kathy Slattery told the Ontario Hospital Association's annual conference.

"Are they scared? You betcha," Ms. Slattery said during a presentation on measures to deal with nuclear, biological and chemical (NBC) hazards in the Ottawa area.

"One of them said on Saturday: 'When you call, are you going to tell me it's an NBC event? Because, if you tell me that, I'm going to have to think for a second about whether I'm going to come in.'

"So for the first time ever our staff have had to think for themselves that they might come into danger while they are trying to rescue someone else's life."

Tests have shown that only about half the emergency room's 150 staff are physically and psychologically capable of wearing the oxygen mask and protective suit required to allow them to safely work in "warm" or "hot" contaminated zones, she said.

Many were unable to pass tests either because of health-related problems, or reactions to the suits and masks, which can be extremely hot and confining.

Ms. Slattery is part of the National Capital NBC Response Team. For more than three years, it has been busy preparing Ottawa for the types of threats virtually all hospitals are examining in the wake of the Sept. 11 terrorist attacks in the U.S.

Many of the 60 or so health-care professionals from across Ontario listening to Ms. Slattery said they thought Ottawa's level of preparation was far beyond that of any other city. They reacted with some alarm at the huge checklist of things to keep in mind. Potential contamination of staff and emergency rooms is one issue.

How to handle a flood of patients -- one hospital in Tokyo got 500 in one hour after the 1995 subway attack involving sarin gas -- is another.

Psychiatrists may be needed to help emergency workers suffering mental trauma from being at a scene of carnage such as the World Trade Center, she said, adding that the public has been shielded from the goriest details. Even members of the public with no direct connection to an event often panic and seek treatment.

Such events also turn some accepted wisdom in emergency medicine on its head.

For example, the urge to rush directly into a situation to help people in peril could result in more deaths, Ms. Slattery said, recalling the 343 firefighters who ran into the World Trade Center shortly before it collapsed. Instead, they have to carefully assess a scene, particularly if there are casualties but no obvious sign of physical trauma, suggesting a potential biohazard.

Also, the practice of treating the most seriously ill patients first might have to be discarded when faced with large numbers of patients, including those critically ill from a nuclear, biological or chemical cause, she said.

http://www.canada.com/components/printstory/printstory.asp?id={075E9FFC-F738-4D80-9C1B-42FB450C4B49}

"We might have to take a look at treating the less-seriously ill patients first. You might have to get a MASH mentality (where) you save your drugs and you save your resources for the people whose lives you will be able to make a difference in," Ms. Slattery said.

-- Martin Thompson (mthom1927@aol.com), November 08, 2001

Answers

<< How to handle a flood of patients -- one hospital in Tokyo got 500 in one hour after the 1995 subway attack involving sarin gas -- is another. >>

Not only that, but the main hospital -- Tokyo Metropolitan I think is the name -- started treating patients who had not been decontaminated before entering the Emergency Department. There was still sarin nerve "gas" (it's actually a liquid with volatility similar to water) on their clothing. Fumes from the sarin started causing symptoms among the doctors and other health care workers...the E.D. had to be temporarily shut down in the middle of the crisis, aired out, and the workers treated too. I don't think any of the symptoms among staff were life-threatening, so far as I recall reading.

This problem is a major one and hard to prevent. Although first responders and hospitals are now aware of the issue, the real problem will be "self-transported" victims who arrive at the E.D. and end up contaminating the facility. It will be mayhem trying to sort out these people from those already deconned, perhaps in the parking lot. And of course during a Weapons of Mass Destruction crisis other medical needs may continue (or increase due to the terrorist event) -- one can imagine car crashes, shotgun injuries, etc.

All in all, it's a mess.

-- Andre Weltman, M.D. (aweltman@state.pa.us), November 08, 2001.

As an R.N. it is my opinion that EVERY community needs to have a plan for these type of events including disaster trained Law Enforcement AT the Medical Facilities to help keep order.

-- diane (lurkergal@the.homestead), November 08, 2001.

Emergency Rooms Face Funding Crisis

Problem Is Statewide; Public’s Trust in Health Care System May Be Undermined

By EMILY WARREN Contributing Writer Thursday, November 8, 2001

Emergency rooms are in a state of financial crisis, the California Medical Association reports.

A study released Tuesday shows that emergency rooms throughout the state, including some in Alameda County hospitals, lost a total of $325 million in the 2000 fiscal year, $8 million more than was lost the previous year.

The instability of the state's health care system may undermine public trust in emergency rooms that may not be prepared to respond to a bioterrorist attack or flu epidemics, says the association.

Alameda County hospital emergency rooms reported some of the highest losses in funding compared to other counties in the state. The hospitals lost $24 million last year, $4 million more than was lost the previous year.

Since Sutter Health bought Berkeley's Alta Bates Hospital and Summit Hospital in Oakland, both hospitals have lost $25 million.

Alta Bates spokesperson Carolyn Kemp said in September that hospital officials were considering a consolidation of multiple departments to offset losses.

A consolidation would entail moving the oncology, maternity and infant services to Alta Bates Hospital and the orthopedics, medical surgery, cardiology and cardiovascular surgery services to Summit.

But officials appeared to have dropped the idea of downsizing, saying Sutter is optimistic about improving patient care at both hospitals.

"There's not going to be any changes in emergency services," Kemp said. "We hope to upgrade them."

Others have not been as fortunate. During the last 10 years, 60 emergency departments have shut down, including one each in San Francisco and Contra Costa counties, according to the report.

The closures mean that patients wait longer for treatment and that fewer doctors, nurses and technicians are available to provide care.

Fred Sievey, a member of the Service Employees International Union Local 250, a health workers union, said the problem is health care decisions are made without public input.

"The hospitals themselves make cutbacks," Sievey said. "There is no power on the part of the public or elected officials to stop the closures." In 1990, there were 407 emergency departments in hospitals in California. Today, there are 347 and 289 of those lost money, according to the medical association.

The report also noted that nearly 9.5 million patients were treated last year in emergency rooms at an average loss to hospitals of $48 per visit.

Medical association officials said the problem stems from the 7 million uninsured Californians who visit emergency rooms even though they do not require emergency care.

"Emergency rooms are the most frequently visited since they are the easiest access to health care," said Heather Campbell, spokesperson for California Medical Association.

Others, however, say the closures have occurred because emergency rooms are not seen as profitable departments.

"The problem reflects a crisis in the health care system as a whole," said Carl Bloice, spokesperson for the California Nurses Association. "The answer is to change the health care system and have a universal health care system to avoid the problem."

Bloice noted that the public has seemed to come to this realization in the aftermath of Sept 11.

The association compiled the report from data reported to the Office of Statewide Hospital Planning and Development. Hospitals that did not return data were not included in the findings.

http://www.dailycal.org/article.asp?id=6999

-- Martin Thompson (mthom1927@aol.com), November 08, 2001.

Well, I agree with diane; and Martin's post to follow sums up the problem. For what it's worth, my wife is a Board certified Emergency physician, and you can imagine the discussions we have around the dinner table (when our schedules collide!) around these issues...

Andre

-- Andre Weltman, M.D. (aweltman@state.pa.us), November 08, 2001.