Archive for: Emergency Action Plans

Safety Month Showcase: Prevent workplace violence by recognizing threatening acts

By: June 25th, 2018 Email This Post Print This Post

The National Safety Council has designated June as its annual National Safety Month as a way to focus on “reducing leading causes of injury and death at work, on the road, and in our homes and communities.” In accordance with that, HCPro’s safety team will highlight a different healthcare-oriented safety topic each week in the month of June by sharing an excerpt from one of our many books, all available on HCMarketplace.com.

The focus this fourth and final week of June is workplace violence. The excerpt is from “Preventing Emergency Department Violence: Tips, Tools, and Advice to Keep Your Facility Safe,” authored by Lisa Pryse Terry, CHPA, CPP.

In her book, Terry provides healthcare personnel and security professionals with guidance for how to deal with violent patients and visitors, active shooters, uncooperative behavioral health patients, and disruptive prisoners. Terry also helps healthcare professionals recognize signs of violence, take steps to defuse tension, and respond appropriately. Plus, she offers real-life examples and training tools and provides sample response protocols and emergency department design ideas to help readers develop plans and make improvements in their facilities.

In this excerpt, Terry writes about recognizing threatening behavior in the ED.

The clock is ticking. The risk of a loved one not being treated quickly enough before her condition worsens causes great anxiety for a family member who begins pacing and becomes increasingly angry (potential risk). Seeing the crowded ED and assuming the staff are too busy to provide immediate attention for his family member triggers the perpetrator to seek immediate medical attention by commandeering staff to assist him (stimulus). An unattended door with a restricted access sign for employees only provides an opportunity for the perpetrator to grab and force a clinician to help now (opportunity to act). Violent behavior erupts, nurses are terrified, and chaos ensues.

The theoretical situation above could have been avoided with proper training and ability to recognize threats early. Understanding how perpetrators behave is key to managing threats. There are some commonalities among individuals who pose a threat. Recognizing threatening behaviors allows resources to intervene at the earliest possible stage.

Most all perpetrators consider, plan, prepare, and then act. This allows intervention at multiple points along the violence spectrum. But effective intervention to decrease threats is dependent on training and experience that enable security officers, public safety, and police officers to fully recognize and identify the early signals. Intervention also relies on nurses and healthcare staff understanding the signs of pending violence.

Nursing by nature requires staff to be physically close to patients who can quickly become agitated or violent. Close contact increases the likelihood that a nurse or other clinician will become the victim of physical violence, especially if the signs of violence are not recognized early. This increases the need for clinical staff training on the violence spectrum as well as related security training, de-escalation techniques, and personal safety training.

A collaborative effort and integrated training for healthcare security staff and clinicians increases safety for everyone. It also helps define roles and responsibilities if an event occurs. Collaboration reinforces what to expect if an event occurs and how resources can be quickly assimilated.

Security and healthcare staff who are able to proactively deal with threats and/or threatening behavior early—detecting threats early, evaluating them, and knowing how to address them—may be the single most important key to preventing and managing violence.

So how do security and healthcare professionals identify the signs to decrease threats?

In Chapter 3, we discussed the impact of the violence spectrum and the importance of managing threats of violence. All staff should be trained on the components of anger and impending violence, which present in three primary ways:

  • Physical reactions—These reactions include an individual’s response to anger, frustration, and potential violence such as an adrenaline rush, increased heart rate and blood pressure, and tightening of muscles for the “fight or flight”
  • Cognitive Experience—This involves how an individual perceives he or she is being treated. If he believes he is being treated unfairly, prejudicially, or in any negative way, the risk of becoming angry and violent escalates.
  • Behavior Changes—Individuals considering a violent action or response will display behavioral changes such as change in demeanor, verbal or voice changes, and nonverbal cues of agitation and frustration such as tapping fingers, rapid eye movement, or pacing.

Security and healthcare staff must understand the significance of verbal and nonverbal cues. Key threat management strategies focus as much on nonverbal communication as they do on verbal communication. According to various researchers, body language is thought to account for between 50 to 70% of all communication.

  • In a crowded waiting area, a family member feels claustrophobic and becomes agitated
  • A worried parent continually reaches out for the nurse’s arm in hopes of getting more attention
  • An agitated spouse paces back and forth in front of the doors leading to restricted treatment areas
  • The eyes of a frustrated patient dart back and forth continually.
  • An anxious spouse believes it is taking way too long to get an updated report on his wife, and begins clenching his jaw
  • A forensic patient visually scours the treatment room for a weapon of opportunity

These are all signs of potential violence. Space, touch, body movement, and perception of time are all ways people express their frustration and anxiety. Proactively identifying these particular behaviors of concern can help reduce the risk of violence in the ED and contribute to a better patient experience.

Responding to nonverbal cues may be as simple as providing a brief update on the status of a loved one; giving a person a reassuring smile and greeting; explaining that it’s important to conduct thorough testing to provide the best treatment possible; acknowledging a person’s feelings; or offering to get an anxious parent a cup of water while she waits. Eye contact can also indicate genuine interest and concern for a person and alleviate anxiety. In an overcrowded ED, speaking to the agitated person and offering to help him find a more comfortable place to wait can defuse anger.

Verbal communication is also an important indicator of agitation, frustration, and pending violent actions. Tone of voice, loudness, inflection, intonation, and rapid speech are red flags. Once verbal communication escalates to cursing, threats, and disrespectful language, rapid de-escalation is critical to lessen risks.

Working together, security and healthcare professionals can decrease or minimize threats to safety and block opportunities to act. They can integrate case management into the security management strategy to lessen the threats. Effective threat management strategies incorporate the STEP process.

  • S: De-escalate, contain, or control the subject who may take violent action
  • T: Decrease vulnerabilities of the target
  • E: Modify physical and cultural environment to discourage escalation
  • P: Prepare for precipitating events that trigger adverse reactions

 Utilizing the STEP Process is an effective means of managing threats. Some questions to ask in the process include:

  • What is motivating the individual to become a threat?
  • Has the individual communicated his/her intentions as a threat?
  • Is the individual demonstrating physical actions of threat?
  • Does the individual have access to weapons?
  • Are there unusual objects that could be used as weapons?
  • Are there bystanders to consider and remove from harm’s way?
  • Has the person taken aggressive action (pushing, striking)?
  • Is the person argumentative?
  • Is he/she displaying unwarranted anger?
  • What is the stimulus for action and how can it be removed?

Responding positively to verbal signs of anxiety is extremely important in the ED environment.  Keep your voice calm, repeat what you hear to reassure the person you understand, look the person in the eye when she is speaking, and seek to understand the underlying cause of agitation. People who visit the ED are usually nervous and fearful of a diagnosis or treatment process. Many things in the ED environment can put that fear into overdrive and then violence occurs. Watching for the earliest signs of violence and utilizing strategies to overcome fear and anxiety are an essential part of the healthcare security team’s job.

To purchase “Preventing Emergency Department Violence: Tips, Tools, and Advice to Keep Your Facility Safe,” please click here.

Safety Month showcase: Prep for emergencies by completing a hazard vulnerability analysis

By: June 4th, 2018 Email This Post Print This Post

The National Safety Council has designated June as its annual National Safety Month as a way to focus on “reducing leading causes of injury and death at work, on the road, and in our homes and communities.” In accordance with that, HCPro’s safety team will highlight a different healthcare-oriented safety topic each week in the month of June by sharing an excerpt from one of our many safety books, all available on HCMarketplace.com.

The focus this first week is on emergency preparedness.

The excerpt is from The Emergency Management Handbook, authored by Mary Russell, EdD, MSN, CEN, RN. Whether you need to launch a program or revamp your training, this resource provides the step-by-step road map for how to set up a program, obtain buy-in, and train staff. This excerpt focuses on completing a hazard vulnerability analysis.

One of the most valuable tools in your emergency planning repertoire is the risk assessment process. A hazard vulnerability analysis (HVA) is a tool designed to help you become familiar with hazards that your facility may face and to help you prioritize your planning, training, exercises, and corrective action improvements for your facility based on the likelihood of an event occurring.

Hospitals need to complete an HVA for their facility that identifies actual or potential events that can result in a demand for medical services or can affect the ability of the hospital to provide services. Your hospital’s HVA must consist of an assessment of each facility on its campus and any satellite outpatient centers it considers part of the hospital complex. The focus is to identify vulnerabilities that could affect the safety of patients, visitors, or employees during an emergency. It should also identify hazards within the larger community setting inclusive of the hospital’s campus. In this way, the HVA can uncover valuable opportunities for planning and mitigation to reduce vulnerabilities to specific threats. The HVA process will also identify scenarios that are a priority for your hospital to exercise.

Hospitals are part of a community’s critical infrastructure because of their role in providing medical care and services for the ill and injured. Because of this role, however, there are inherent vulnerabilities in terms of daily operations. These include the following:

  • Twenty-four-hour-a-day operational needs
  • Critical power dependence due to lifesaving equipment and procedures that hospitals offer
  • An essential need for effective communication both within the hospital and externally to physician providers, other hospitals, EMS, and other partners
  • Utilities support, including electric, water, waste disposal, IT, and communication support
  • A high density of persons on-site at any one time, including inpatients, outpatients, employees, the medical staff, volunteers, visitors, students, vendors, service personnel, and others
  • Inpatients with high acuity levels, including a high percentage that could be non-ambulatory (the vast majority will require some level of assistance if an evacuation is necessary, as most persons are tethered to some form of equipment)
  • Hazardous materials in the form of pharmaceuticals, antineoplastic drugs, anesthetic gases, lab specimen solvents, formaldehyde, radiological materials, xylene, compressed gases, bulk liquid oxygen, biohazardous waste, on-site fuel, cleaning materials, and others
  • Structural aspects of hospitals (e.g., many small rooms) that can make evacuation difficult, especially in older structures that include dead-end corridors and added-on wings

Hospitals that proactively take steps to reduce their vulnerabilities for one hazard will benefit from doing so by providing a level of reduced risk for other hazards. For example, hospitals that use shuttering and window protection systems to shield from hurricane winds know that such systems also offer security protection during any other hazard. The same concept goes for perimeter fencing around a facility as a mechanism to restrict access and manage crowd control, regardless of the scenario.

The hospital should review their HVA annually with key community partners as well as with the hospital’s emergency management team and Environment of Care Committee. The review should also assess the hospital’s capability to respond to various threats, advance mitigation strategies, inventory resources and assets to manage an incident, and plan exercises to trend progress in meeting objectives.

The HVA is a living document. Some things will not change, such as your hospital’s geographic location and its major transportation routes. Other things, such as local businesses and industries, can change from year to year. Agencies that can assist you with the development or annual review of your HVA include, but are not limited to, the following:

  • Local fire-rescue services can be a great resource to update you on any new environmental threats in your area as fire inspectors become aware of new hazards in the community during business inspections and as part of their ongoing risk surveillance
  • Police are aware of crime statistics, substance abuse issues, and potential terrorist threats, including persons of interest or groups such as gangs and activists
  • Local, county, or regional emergency managers can be consulted to ensure that your HVA encompasses proximity to area hazards in which your facility may not be in the immediate impact zone but could be a receiving facility for casualties who flee the scene
  • Local utility companies for electricity, water, and communications can detail risk and their mitigation strategies that are proposed or already in place for the grid location of your hospital complex
  • Local chamber of commerce, which maintains an updated listing of population demographics, businesses, seasonal events, and other resource information
  • Your local healthcare coalition includes additional key community partners beyond those listed above that can contribute both threat and hazard information and knowledge of existing resources to a local or regional HVA that is also applicable to an individual hospital HVA

The following are five steps you can take to complete your HVA.

Step 1: Complete your HVA community profile

Completing a community profile will help you understand the surrounding community and give you a context within which your hospital will consider its priorities (e.g., social, economic, political, and legal realities). A profile contains details related to your geographic location; demographics of the community; resident, seasonal, and tourist populations; top employers; weather and climate; economic status of residents; educational levels; multimodal transportation systems; and other considerations.

Step 2: Identify all hazards in your community risk profile

Insert all known community and area hazards into a hazard vulnerability matrix to create a community risk profile. Request the assistance of your community partners to ensure that your list is complete. These stakeholders can help you determine the probability that the hazards you identify will occur, and your facility’s vulnerability to them. Hospitals can also identify hazards in a visual way using community maps or a summary PowerPoint slide. Provide clear detail on top-ranked hazards so that your hospital’s emergency management team, Environment of Care team, and HICS team can all clearly articulate each risk and what they are doing to prepare for such potential occurrences to the organization.

Step 3: Assess the hazard’s risk

The risk of a hazard is a product of its likelihood, and the impact or consequences of the hazard on the community, and how it would affect the hospital’s ability to manage such an event. Determine risk by estimating the potential number and types of casualties your facility could expect from a given hazard; in most cases, you should base your estimation on your community’s population.

The risk of a hazard occurring can be assigned a score based on expert judgment or actual intelligence, or it can be assigned to a category of risk—for example, low, medium, or high. Some hazards may not be applicable due to a hospital’s geographic location. Factors that influence ranking of hazards include history of prior occurrences, vulnerability of population and property, and probability for the hazard to occur, based on both short-term and long-term predictions.

Step 4: Analyze the vulnerability to each hazard

Analyze each hazard separately to determine the likelihood of it affecting your hospital in terms of susceptibility, impact, and consequences to the organization. Impact can be determined in terms of the human impact (patient or staff injury, workforce availability), property impact (damage to facility, flooding, equipment damage, debris), and operational impact (disruption of services, utility failure).

Step 5: Prioritize the vulnerabilities for hazards and identify risk interventions

It is not enough to fill out an HVA for your hospital simply to identify hazards and rank them. The next critical step is to look at the hazards you have identified to find common vulnerabilities across different scenarios and establish shared mitigation measures. A subsequent exercise can determine whether the mitigation was successful for a specific scenario; however, such interventions will reduce vulnerability for other threats too. The severity of a hazard can be identified by the magnitude of the incident as measured by potential human, property, or business impacts but mitigated by preparedness (preplanning, training, exercises), internal response (initiating an efficient and effective response and mobilizing resources), and an external (community or mutual aid) response.

The highest-priority vulnerability is for patient and staff safety concerns—that is, those hazards that can result in illness or death or other health risks. Another high-ranking concern is business continuity, which translates into minimizing service disruption or failure and maintaining the trust of the community.

Local residents expect that hospitals will do all they can to protect the facility from harm and to prepare both the facility and its staff for threats. Hazards that result in property damage are also important, as they can affect access to the facility and can cause disruption in services.

To purchase The Emergency Management Handbook, please click here. And, as we highlight Safety Month, check back next Monday for another free HCPro book excerpt that focuses on a different healthcare safety topic.

NFPA unveils new standard to help with response to active-shooter incidents

By: May 1st, 2018 Email This Post Print This Post

Early this year, the NFPA promised to fast-track a new standard to help first responders, healthcare providers, facility managers, and others prepare for an active-shooter incident, and they have delivered, complete with its own acronym.

NFPA 3000, a Standard for an Active Shooter/Hostile Event Response (ASHER), is now available in paperback for $52, or, as with other NFPA codes and standards, it is also available on the National Fire Protection Association’s website for free in a read-only format. The format cannot be printed, searched, or copied. But it is a quick read at only 48 pages.

Designed as a roadmap for the multidisciplinary response needed in the aftermath of an active-shooter incident, there is a separate chapter for “Hospital Preparedness and Response for Out-of-Hospital ASHER Incidents.”

The chapter outlines minimum expectations for hospitals in preparing for, reacting to, and receiving patients from an active-shooter event in the area. Among other things, it says hospitals should:
• plan and drill regularly with other local authorities having jurisdiction (AHJs)
• have at least two ways to communicate with public safety officials about how patients are being distributed to health care sites, and to test communications at least once a month
• expect spontaneous arrivals of injured patients and those looking for them
• have a way to identify victims and reunite children with their families
• and have a security plan to restrict access as needed, and to search the facility for devices and weapons if that becomes a concern

Other chapters detail expectations for the variety of first responders, government agencies, and other organizations who might be involved in an ASHER response to prepare, plan, and recover from an incident.

The publication marks only the second time the NFPA has fast-tracked a provisional standard.

While most standards or codes can take years of planning, the ASHER standard was born of an urgency brought by the request of Otto Drozd, the chief of Orange County Fire and Rescue in Florida, three months after the June 2016 shooting at the Pulse nightclub in Orlando.

In that attack, 49 people died and more than four dozen others were shot, with many of the injured walking to nearby hospitals or in some cases physically carried by friends or others down several blocks. Since then, hospitals nationwide have responded to mass shooting incidents at a church, a concert, and a high school, among others.

At the time of Drozd’s request for a standard, there was an abundance of guidance material available but “there was no consensus standard for the components of a multidisciplinary response for preparedness, response, and recovery to active shooter and/or hostile events,” notes the NFPA in the opening to NFPA 3000.

A committee of 46 experts from law enforcement, fire services, emergency medical services, hospitals, physicians’ groups, and others was formed to receive technical, expert, and public comments and arrive at a consensus of standards.

The fast-tracked standard will now move into the normal biennial review and update process for other NFPA publications, according to the NFPA.

Editor’s note: This blog post was written by A.J. Plunkett, our colleague over at DecisionHealth.

New report on emergency preparedness says U.S. healthcare system is improving

By: April 18th, 2018 Email This Post Print This Post

We recently published online an article from the upcoming edition of our Healthcare Life Safety Compliance newsletter about a recent report by the Johns Hopkins Center for Health Security that examined how the U.S. healthcare system has fared while responding to emergencies both large and small.

Their conclusion? The bigger the emergency, the less prepared healthcare facilities are for handling the crush of patients that come through their doors.

“Although the healthcare system is undoubtedly better prepared for disasters than it was before the events of 9/11, it is not well prepared for a large-scale or catastrophic disaster,” the authors wrote in the report, which was released in late February. “Just as important, other segments of society that support or interact with the healthcare system and that are needed for creating disaster-resilient communities are not sufficiently prepared for disasters.”

Their research, however, spanned from 2010 to 2015, meaning that responses to recent emergencies such as Hurricane Harvey, the wildfires that torched California, the harrowing mass shootings at a country music concert in Las Vegas and at Stoneman Douglas High School in Florida were not examined.

Now a new report has come out, this one concluding that hospital readiness for managing health emergencies has improved over the last five years.

From our colleagues at Patient Safety & Quality Healthcare:

The Robert Wood Johnson Foundation (RWJF) this week released the 2018 National Health Security Preparedness Index, which found that the U.S. scored a 7.1 out of 10 for preparedness, up 3% over the last year and almost 11% since the Index was begun in 2013.

The assessment found improvements in most states, but also noted serious inequities in health security across the country, according to a RWJF release. Maryland was the highest scoring state, 25% higher than the lowest-ranked states, Alaska and Nevada. The report found that states in the Deep South and Mountain West scored poorly compared to those in the Northeast and Pacific Coast.

“Five years of continuous gains in health security nationally is remarkable progress,” said Glen Mays, PhD, MPH, who led the University of Kentucky research team that developed the index, in the release. “But achieving equal protection across the U.S. population remains a critical unmet priority.”

The index found that 18 states had preparedness levels exceeding the national average, while 21 states fell below the average. Thirty-eight states and the District of Columbia increased their overall health security last year, with eight remaining steady and four declining.

So, while this new RWJF report suggests that the response of the U.S. healthcare system to emergencies has generally improved in recent years, a lot of work still needs to be done, which aligns with what the authors of the report from the Johns Hopkins Center for Health Security wrote a couple of months ago.

TJC creates new Sentinel Event Alert for violence against healthcare workers

By: April 17th, 2018 Email This Post Print This Post

The Joint Commission (TJC) is the latest healthcare heavy-hitter to call for better protection of healthcare workers, announcing on Tuesday the creation of Sentinel Event Alert 59, which addresses violence — physical and verbal — against healthcare workers.

TJC writes in this latest Sentinel Event Alert publication that the purpose of the new alert is to help hospitals and other healthcare organizations better recognize workplace violence directed by patients and visitors toward healthcare workers and better prepare healthcare staff to address workplace violence, both in real time and afterward.

TJC notes that Sentinel Event Alert 59 has some overlap with Alerts 40 and 57 — which were released in 2008 and 2017, respectively, and focused on the development and maintenance of safety culture — and therefore were not addressed in this alert.

Per the Occupational Safety and Health Administration (OSHA), about 75% of workplace assaults annually occurred in the healthcare and social service sector. Violence-related injuries are four times more likely to cause healthcare workers to take time off from work than other kinds of injuries, according to the Bureau of Labor Statistics (BLS).

TJC cites both of those facts in this Sentinel Event Alert publication and adds that TJC data show 68 incidents of homicide, rape, or assault of hospital staff members over the past eight years – and that’s mostly only what hospitals voluntarily reported.

TJC is calling for each incident of violence or credible threat of violence to be reported to leadership, internal security, and — if necessary — law enforcement, and TJC also wants an incident report to be created. Under its Sentinel Event policy, TJC says that any rape, any assault that leads to death or harm, or any homicide of a patient, visitor, employee, licensed independent practitioner, or vendor on hospital property should be considered a sentinel event and requires a comprehensive systematic analysis.

Additionally, TJC says it’s up to the healthcare organization to specifically define unacceptable behavior and determine what is severe enough to warrant an investigation.

This Sentinel Event Alert, which you can download here along with other resources, comes on the heels of an emergency preparedness rule from CMS that recently went into effect and efforts from the National Fire Protection Association to fast-track its new standard for active shooter events and other violent incidents. OSHA is also considering a standard to help protect healthcare and social workers from violence.

New HHS fact sheet gives guidance for handling long-term patient surge

By: February 27th, 2018 Email This Post Print This Post

One of the deadliest flu seasons in recent memory has prompted the Department of Health & Human Services (HHS) to release a fact sheet that gives guidance on handling an influx of patients flocking to healthcare facilities for treatment of the flu and other seasonal illnesses.

While the latest briefing from the CDC suggests that this flu season has peaked, the fact sheet provides useful information healthcare facility emergency planners should consider when developing plans to deal with a similar surge of sick patients in the future. Note that this fact sheet states “these considerations are different than those of planning to handle surge from a no-notice, short duration event” like the recent mass shootings in Orlando, Las Vegas, and Parkland, Florida.

The HHS fact sheet states that “all hospitals must have an emergency operations plan” to deal with a long-term surge. Among the strategies it recommends are expanding normal clinic hours to limit the number of clinic patients coming to the ED, rescheduling elective procedures to free up beds, and setting up “surge sites” such as tents or mobile units located next to the ED.

It also recommends preventive steps that could minimize the surge during a severe flu season, including the use of telehealth, telephone prescribing, virtual information, community paramedicine programs, and risk communications and creating media campaigns encouraging vaccinations, handwashing, and other infection control practices.

The HHS fact sheet states that “there is little an individual hospital or health system can do to prevent patient surge from seasonal illness, but a region or healthcare coalition, in partnership with public health, can use coordinated strategies to help provide situational awareness to support patient surge management throughout the community.”

To download the fact sheet from the HHS website, click right here.

CDC to brief healthcare professionals on responding to a nuclear detonation

By: January 9th, 2018 Email This Post Print This Post

Here’s your unsettling news release of the day: The CDC next week will hold a briefing teaching healthcare professionals how to respond to a nuclear bomb.

“While a nuclear detonation is unlikely, it would have devastating results and there would be limited time to take critical protection steps,” stated a CDC news release for a “Grand Rounds” session that included an image of a massive nuclear mushroom cloud. “Despite the fear surrounding such an event, planning and preparation can lessen deaths and illness. For instance, most people don’t realize that sheltering in place for at least 24 hours is crucial to saving lives and reducing exposure to radiation. While federal, state, and local agencies will lead the immediate response efforts, public health will play a key role in responding.”

Recent tweets by President Trump, who a week ago boasted that his “nuclear button” is “much bigger and more powerful” than North Korean leader Kim Jong Un’s, came to mind after seeing the release. But a CDC spokesperson told Stat News that the event has been in the works for a few months and pointed to a “radiation/nuclear incident exercise” that FEMA put on back in April.

The CDC’s presentation, which will be held January 16 from 1 to 2 p.m. ET at the CDC’s Roybal Campus in Atlanta, will educate healthcare professionals on what federal, state, and local public health officials have done to prepare for a nuclear detonation while also comparing and contrasting the planning and preparation methods to other emergency response situations.

For more information about the CDC’s briefing, here’s that news release.

Topics for last year’s CDC’s “Grand Rounds” sessions included maternal mortality, hearing health, neural tube defects, and emerging tickborne diseases.

UPDATE: CDC has changed the topic for this month’s “Grand Rounds” to a discussion on public health response to severe influenza due to “the spike in flu cases around the country.” CDC says, however, that the presentation on responding to a nuclear detonation will be rescheduled for a later date.

Hazards continue after the wildfire

By: December 7th, 2017 Email This Post Print This Post

Fires continue to rage in Southern California this December, continuing a long and brutal wildfire season for the state. Low rainfall and high winds have caused the Thomas fire (which spans 150 square miles as of this post) to spread through Venture and Los Angeles counties.

Once the flames die out, there will be weeks or months of cleanup and repair needed. Workers involved in the clean up will face a variety of hazards as they help affected communities. OSHA has updated it’s site with resources on common hazards associated with wildfires and highlight useful precautions for workers:

Read more on the OSHA website

Bizarre circumstances led to hospital’s hazmat response, ER lockdown

By: August 2nd, 2017 Email This Post Print This Post

Report: Suspicious package that prompted mini-emergency was letter from government agency

If you subscribe to HCPro’s monthly Briefings on Hospital Safety newsletter, you will recall the story of a hazardous material scare and emergency lockdown at Frederick Memorial Hospital in Maryland. Two men opened a piece of mail at home in May, discovered a suspicious substance inside, and began experiencing skin and respiratory irritation, so they went to the local ED—and brought the unknown substance with them. That, of course, sent hospital staff scurrying to contain the threat.

Because the men live across the street from the U.S. Army’s Fort Detrick, a hub for biodefense research, there was added concern that the substance might be a biological agent. That turned out not to be the case. Investigators quickly identified the substance as a relatively common household chemical. But the circumstances leading up to that hazmat scare and lockdown, as reported in the local newspaper, are still baffling.

The substance that caused the hubbub was ultimately determined to be an ingredient found in rat poisoning, The Frederick News-Post’s Jeremy Arias reported last week. That substance was delivered in an envelope from the National Institute of Standards and Technology (NIST) in Gaithersburg, Maryland, to the home address of Jay Zimmerman, who said he had held a position with NIST for 33 years. The envelope also reportedly contained a letter from NIST informing Zimmerman that he would be removed from his position.

Zimmerman, who retired from NIST in June, told the News-Post that he believes his former employer used the substance to target him as an act of retaliation because Zimmerman had filed a complaint against NIST earlier this year alleging discrimination and harassment on account of his sexual orientation and disability. A spokesperson for NIST declined to comment on the allegations, citing the Privacy Act.

Investigators reviewed surveillance footage at NIST that shows the suspicious package being sealed, Frederick police Sgt. Andrew Alcorn told the News-Post.

“There is nothing on the video that appears to be suspicious or that indicates any of that substance was put into the package at that point,” Alcorn said.

Although the case was officially suspended without any charges being filed, the resulting response gave Frederick Memorial an opportunity to test its own emergency preparedness.

“When events like this take place,” said Phil Giuliano, the hospital’s director of public safety and security, “I think it’s a reminder for hospital staff, hospital leaders, and community members as a whole how important it is to have strong relationships, to maintain strong relationships with those other partners you have in your county, in your jurisdiction, in your area of operations.”

For more on this story and how Frederick Memorial kept its workers and patients safe, be sure to read the News-Post’s full report and the August edition of Briefings on Hospital Safety.

Workers’ Memorial Day: A somber reminder of progress made, work left to do

By: April 28th, 2017 Email This Post Print This Post

Carrie Rouzer was caring for a patient last July at Parrish Medical Center in Titusville, Fla., when a stranger barged in and gunned down both Rouzer, 36, and her 88-year-old patient before being subdued by security guards.

The shocking case, which drew attention to workplace violence as a real threat to healthcare workers, was certainly on the minds of groups who gathered Friday in Jacksonville and Miami in observance of Workers’ Memorial Day. The two sites were among hundreds nationwide holding local ceremonies commemorating the lives of those killed on the job, whether by violence or accidents.

The annual event is held on April 28, the day OSHA was established in 1971, as a reminder of the progress made in workplace safety in recent decades and the work yet to be done. Rouzer’s story, sadly, is among many others collected over the years.

Among the thousands of occupational fatalities recorded across all industries, between 100 and 150 occur in the healthcare and social assistance sectors each year, according to the Bureau of Labor Statistics. In 2015, there were 109. (Finalized numbers for 2016 will be released this December.)

When you consider how many hours workers put in, those 109 fatalities translate to a fatal injury rate of 0.6 per 100,000 full-time equivalent workers. That’s much less than the overall rate across all industries, which was 3.4 in 2015, according to BLS data. Workers in transportation and warehousing, by contrast, suffered a fatal injury rate of 13.8—which is 23 times higher than the rate in healthcare.

Within the healthcare sector, the numbers are broken down into three categories. Ambulatory healthcare services, which saw 47 fatalities in 2015, had a rate of 0.7. Nursing and residential care facilities, which saw 24 fatalities, had a rate of 1.1. And hospitals, which saw 21 fatalities, had a rate of 0.4. All of these numbers are down slightly from rates reported for 2006.

Although the fatal injury rate in healthcare remains low compared to other industries and has declined slightly in recent years, OSHA continues to look for ways to improve safety. Those improvements should be balanced against other considerations. But let’s take Workers’ Memorial Day as an opportunity to reflect on Rouzer’s story and others like it. Are we doing all we can reasonably do to protect workers? Is there more?

BLS-worker-fatality_Page_14

A summary report on the number and rate of workplace fatalities by industry and sector published by the U.S. Bureau of Labor Statistics groups healthcare with educational services. Full report: https://www.bls.gov/iif/oshwc/cfoi/cfch0014.pdf

 

Healthcare needs to get real about active shooters

By: October 27th, 2015 Email This Post Print This Post

I had the pleasure yesterday of spending a day at the 2015 annual conference of the American College of Emergency Physicians (ACEP), which is being held here in my beautiful hometown of Boston.

Being in the safety business, I sat in on a session about active shooter response preparation in healthcare facilities, led by an emergency physician and security director with Carolinas Medical Center in Charlotte. I didn’t leave with that feeling like we have our collective act together.

Are we really ready for someone to come into our hospitals with a gun, bent on causing mass carnage?

First, let’s start with the numbers. From 2000-2007, there were “only” about 6 shootings a year. From 2007 to today, the numbers jumped to 17 per year.

Many facilities are following the government’s recommendations to “run, hide, and fight” when confronted with a gunman. That’s fine training, if you’re in an office building. Run first, hide when you can, and fight back as a last resort.

But that won’t fly in hospitals and clinics where people are counting on you to help them survive. Poll numbers I heard quoted estimate that at least 40% of healthcare staff wouldn’t leave their patients’ sides, even when confronted with a shooter.

Hospitals need to train their staff to stay alive. Most active shooter incidents end within 7 minutes, and doctors and nurses are then required to turn around and treat the wounded and prevent as much death as possible.

So my question is this: What are you doing to prepare for an active shooter in your facility? Do you have specific plans? Are you training your staff, and what resources are you using?

Please drop me a line at jpalmer@hcpro.com and share your thoughts on this very real threat.

Thanks!

John Palmer

 

October is time to review fire safety

By: October 6th, 2015 Email This Post Print This Post

Dan Scungio, MT(ASCP), SLS, is a laboratory safety officer for Sentara Healthcare, a multihospital system in the Tidewater region of Virginia and otherwise known as “Dan, the Lab Safety Man.”

Every year I love to use autumn as the time to discuss fire safety. After all, many other organizations promote fire safety ever since October was designated as National Fire Prevention Month in 1922. This year, as always, I do want lab safety professionals to be “fired up” about safety, but there have been some questions about regulations in this area that need special discussion.

The College of American Pathologists (CAP) is the accrediting agency for many labs in the United States, and they have specific regulations about fire safety on their General Checklist.

One regulation states: “If the fire safety plan includes laboratory staff use of fire extinguishers, personnel are instructed in the use of portable fire extinguishers.”

If fire extinguishers are present in your laboratory, their purpose is to be used by the staff in the department, whether or not the safety plan includes staff using them or not. OSHA has something to say about this as well:

“If fire extinguishers are available for employee use, it is the employer’s responsibility to educate employees on the principles and practices of using a fire extinguisher and the hazards associated with fighting small or developing fires.”

The CAP checklist strongly recommends that staff have hands-on fire extinguisher operation that includes the actual use of the device (or a simulator). They do not indicate how often this training should occur. Many labs I have inspected only provide the training once, but OSHA states that it must be provided upon hire and annually thereafter. That makes sense, and lab staff should be ever-ready and able to extinguish a small fire should that become necessary.

Some facilities offer fire extinguisher training as they need to empty out their refillable extinguishers (typically CO2 extinguishers). However, if that does not happen where you are, you have other options. One is to contact your local fire authority. They may happily provide fire extinguisher training for your staff. Another option is to provide the training yourself. You may be able to obtain a test extinguisher or you may simply have to use a full extinguisher without actually discharging it. The important thing is to go through all of the steps of PASS (Pull, Aim, Squeeze, and Sweep) and to let the staff actually handle the fire extinguisher.

If you are providing the training, make sure you give some information about fires that people may not know. Describe the different classes of fires (A, B, and C) and the types of fire extinguishers used to fight them. Remind them not to use more than one extinguisher at a time so they do not blow a small fire onto another person. Tell them to always keep themselves between the fire and the exit. If the fire gets too big or out of control, make sure they leave the firefighting to the professionals.

Inspect your lab for fire risks. Are electrical cords frayed? This is a major cause of fires in the laboratory. Are items stored too close to the ceiling? This may block the action of your sprinkler system. Are ceiling tiles missing or out of place? This disrupts an important fire and smoke barrier. Who performs these inspections? You can, or your local fire authority can as well.

Autumn is a great time to raise fire safety awareness in your laboratory, but this is something that must be done all year. Drill your staff, make sure they know how to react to a real fire. Train them in the use of fire-fighting equipment. Walk your evacuation routes annually. Your staff truly cannot be too prepared.

Have you performed fire drills this year? Have your staff had hands-on fire extinguisher training? If not, it’s a great time to perform these tasks. Many people in history have lost their lives to fires, and laboratory fires are more common than you may think. Be aware, be ready, and ensure your staff remains safe if a fire situation does occur in your workplace.

 

 

 

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