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Guard your turf during community responses on-site

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June 1, 2009

San Jose incident offers lessons for hospital–fire department cooperation

February 12 started as a routine day in San Jose, CA, at the Santa Clara Valley Medical Center (SCVMC), a hospital with the region’s largest ED. But by the end of the day, 91 people had been decontaminated as the result of a chemical incident, including 37 hospital employees, 46 patients and visitors, four police officers, and four firefighters. The local fire department shut down the ED, raising questions about who should be in charge at a hospital during an emergency management response.

The events began when a teenager attempted suicide at his home using unknown chemicals. The chemicals contaminated the teenager’s residence and the hospital’s ED—all while Peggy Albert, BSN, MA, SCVMC’s emergency management coordinator, and other managers were at a retreat in another building on campus. A full-blown decontamination effort followed. (See “Chronology of a decontamination incident” below for a rundown of the events.)

Fire department sets up command center

The incident yielded interesting issues for hospitals to consider regarding what group of responders should take the lead during emergency responses involving the community.

By the time Albert received notification to report to the ED—roughly 30 minutes after emergency medical services (EMS) arrived at the hospital with the contaminated teenager—the fire department and EMS had set up a command center on the property.

“I went out to the fire truck and immediately recognized that this issue was much larger than just a simple decon because they had already locked down the emergency room,” Albert says.

She contacted the hospital administrator, activated SCVMC’s incident command center plan, and got to work. The fire department had taken the lead and called for a hazardous materials team after fire officials determined the patient and ED staff members needed decontamination.

Five hours later, after all the parties involved had been decontaminated, the ED reopened. Most of the hospital employees involved in the incident were washed with soap and water by coworkers.

The unknown chemical was eventually identified as hydrogen sulfide, which is toxic, but only in much higher exposures than anyone likely encountered that day.

Hospital debates the bounds of authority

Hospital managers believe the fire department overreacted to the incident, Albert says.

Officials from the San Jose Fire Department did not respond to several calls for comment from Briefings on Hospital Safety.

The fire department and hospital agreed to clarify procedures for responding to future incidents, Albert says. In postmortem meetings, hospital representatives indicated that they felt the incident response put other patients in the hospital and community in possible danger by shutting down the ED for hours. They also believed a much smaller group required decontamination.

“The whole event took an extensive length of time,” Albert says. “Because we were having difficulty getting information from the scene of the event, we were dealing with an unknown chemical for a very long time.”

Since the incident, relations between responding agencies and the hospital have become stronger, she adds.

Facility learns from the situation

Because the response stemmed from a scary, although relatively harmless, event, officials consider it more of a real-time drill.

Albert says many lessons were learned, including the following:

  • Medical facilities must take control of actions on their property. “Hospitals are really in charge in this event,” she says. “This event should not have been led by fire, it should have been led by the hospital. In the future, we will say to the fire department, if there’s not an active fire inside, ‘Stop, this is our territory.’ ”
  • Hospitals must seek a role in decisions. San Jose’s EMS and fire department are adding language to their response plans that will defer decision-making to SCVMC during hospital incidents.
  • Prior relations will keep everyone cool during debriefings. Because responding agencies and the hospital worked together in earlier drills and responded to other recent incidents, they were able to work together without finger-pointing to analyze what went right and what went wrong after the decontamination event.

“We have had the opportunity to get to know each other and begin to get more comfortable,” Albert says.

(Want to learn more about how to deal with the media during an emergency response? See “Review the role of public information officer before your next disaster” below.)




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