Infection Control Today - 09/2003: ES Personnel Play Key Role

ES Personnel Play Key Role in Responding to Triage

By John Roark

Environmental services personnel play avital role in every multi-casualty event. As an essential element of the triageequation, environmental services function is key to disaster management. In essence, the three main functions of environmental servicesin a triage situation are set-up, clean-up and transfer.

Set-up

Were notified by our safety department in coordinationwith our triage and emergency room areas as to what type of disaster weredealing with, says John Fitzgerald, CHESP, acting associate director foradministration and support, Veterans Administration of Greater Los AngelesHealthcare Center. Based on that, we start mobilizing our environmentalservices group, which would first include making sure that we look at theuniversal precautions or the personal protection equipment that is necessary forthat particular type of disaster. Thats how we would start off makingsure that theyre equipped with personal protective equipment.

Fitzgeralds environmental services team would thenimplement the setup of a triage area, either inside the emergency room or in thefield. In the event of, say, a dirty bomb, they would help set up ouremergency showers outside the hazmat interviewing and triage area that we haveoutside, he says. They would immediately help do any kind of set-ups. Atthis medical center were a casualty and collection area. So were equippedwith portable showers and tents in our setups right there at the emergency room.All we have to do is get people there.

If its inside the emergency room, then were there toassist the triage group with setting up the emergency room. So wherever thetriage point or command center is for the emergency room in triage, that wouldbe their first line of responsibility.

Fitzgerald says the greatest challenge is in ensuring that theenvironmental services staff get the set-up correct for the situation at hand: Making sure we have the appropriate waste containers rigid containers for syringes, making sure the waste containers are properlymarked and disposed of, making sure that all of the specific set-up material iscoordinated with the type of disaster that we have, he says.

The greater Los Angeles VA performs drills twice annually. Wererequired by the Joint Commission to do one drill per year, but we do two, hesays. We do our regularly-scheduled Joint Commission drill, and weparticipate in the state and county drill once a year. Were constantlytweaking our system. Our environmental services department, like all of ourdifferent departments here, have a specific role in our disaster trainingefforts.

In addition to the experience gained from practice, Fitzgeraldhas the advantage of belonging to a network of VA facilities nationwide. Thecumulative base of experience provides an invaluable perspective for allmembers. If, for example there was a hurricane down south, we would get themedical directors on the line, he says. They would say, heres whathappened, these are some of the things we did, and here are some of thechallenges. We have the opportunity to listen in on that. The VA facilitiesacross the country are very fortunate in that sense we can learn from eachother.

Clean-Up

Our personnel are specifically trained on the differenttypes of disasters we could deal with, says Fitzgerald. Theyreresponsible for making sure they have the right equipment, the right spill kits,making sure we have the trash containers appropriately marked for hazardouschemicals, and so on. They would be responsible for making sure they are a partof that triage team, making certain the area is clean between casualties, andmaking sure that the waste is collected and marked appropriately.

If faced with a situation involving a multitude of clean-upchallenges, for Fitzgerald, the solution lies in delegating the right person forthe right job. We make sure that we have the right people plugged into thetriage area, he says. People who are familiar with that type of role. Wemake sure that theyve got the personal protective equipment they need. Wevegot procedures for each scenario. We make sure they are properly trained anddrilled on proper procedures to use for the different scenarios.

Transfer

In our medical center we have a manpower pool, saysFitzgerald. Personnel who are not essential would go to that manpowerpool, and they would deal with transferring patients to the emergency room, tothe OR, from the ER to the ward areas, wherever the transfers had to go, andhowever that had to take place. Environmental services personnel would becomepart of that pool, and along with other nonessential personnel would be in theemergency room, the operating room, or in the patient care ward areas. All ofthose people would be used as needed to facilitate any transfers, to rungurneys, wheelchairs, that type of thing.

The Big Picture

Every time we drill, we find that something doesnt workas well as we would like it to, but weve drilled and drilled and drilled,says Fitzgerald. I feel like when it really comes down to crunch time, ourpeople are going to perform admirably. I think in any disaster there are goingto be things that dont go well, but weve just got to hope that the abilityto drill and meet and talk about it is going to help us in the end. The mostrecent drill that we had went extremely well. After each one of the drills wehave a critique. We critique with all of the key staff from each one of theareas.

We said after our critique on this last drill that if thedisaster ever goes as well as this drill went, well be in fine shape.

Fitzgerald is a firm believer in the role of environmentalservices in disaster planning and preparedness. I think that it is often oneof the things that is overlooked or minimized. I think people are finding moreand more as we go through these disaster drills and routines that environmentalservices plays a critical role in making the whole thing work.