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MRH Scope and Intensity of Services in Response to Victims of Biological or Chemical Events 


STATEMENT OF PURPOSE:  
The purpose of this policy is to define the intensity and scope of services Millinocket Regional Hospital is capable of providing in responding to the health needs of patients who may be victims of chemical or biological agents.

The attached plan will serve as a procedural guide to employees in providing these services, and will be the basis on which training (to include mock disaster drills) and education is provided to all staff.

POLICY:  
In planning our response to a biological or chemical event, leaders at Millinocket Regional Hospital have coordinated and are in agreement with the recommendations of local, state, and federal officials:

CDC, Maine Bureau of Health, Maine Department of Defense, OSHA, MEMA, Millinocket Fire and Police, and state and local HAZMAT.

We have also considered and contemplated the recommendations of the AHA (American Hospital Association), and have instituted measures on a scale that is functional and within the capabilities of our organization.

Millinocket Regional Hospital has coordinated a response plan that maximizes internal and external resources, working within a community network that is committed to the health and safety of the people we serve.

Initial Communication and Notification
Notification of local and state officials will be carried out per state government recommendations

Personal Protective Equipment (PPE)
Millinocket Regional Hospital will follow the recommendations of the CDC in PPE for employees caring for patients exposed or suspected to be exposed to biological or chemical agents commonly considered being a threat

When a scenario involves an unknown or aerosolized agent, standard PPE may not be appropriate and will not be depended upon.  In coordination and agreement with local Fire and HAZMAT, Millinocket Regional Hospital will notify local Fire and they will coordinate resources with HAZMAT as appropriate.

Millinocket Regional Hospital Processing of Biological Agents Most Common in the Threat of Bioterrorism

MRH Chapman Laboratory is a level A lab and does not have the equipment necessary to perform all tests required in identification of biological agents

MRH Chapman Laboratory will not accept any random cultures from any department or office marked ďsuspicious for anthraxĒ.  All these cultures require pre-approval from the Department of Health and will be transported by designated law enforcement officials.  These cultures must be accompanied by a chain of custody form and are processed by the Health and Environmental Testing Laboratory (HETL).

Separate procedures are available to Millinocket Regional Hospital Microbiology Laboratory staff that are working up regular (non-suspicious) cultures and isolate colonies they believe to be presumptive B. Anthrax

Facility Resources
Millinocket Regional Hospital has lockdown capability, an emergency generator for auxiliary power source, a 550 gallon and fuel supply to last up to forty hours.  We are not equipped with portable negative air machines, but have two negative pressure isolation rooms.  Millinocket Regional Hospital does not have any water purification equipment, but we do have forty gallons available on site and a verbal agreement with a bottled water company to pick up water from  them.  Personnel / employee quarantine areas have been designated.  Practical alternatives for expanded patient isolation facilities include off site physician practices in the event of a mass casualty scenario.

Decontamination 
Patients will not knowingly be allowed to enter the facility prior to decontamination.  In the event a patient has entered we are equipped to provide limited decontamination.

If a patient arrives at Millinocket Regional Hospital or on the grounds requiring emergency treatment and is visibly contaminated with an unidentified chemical or agent, healthcare providers will contact local Fire to command the situation and resource HAZMAT EMTís to be first responders to the victim.  Directly responding to this type of situation is not within the capabilities of the institution and therefore would not be a violation of EMTALA.  Our responsibility is to facilitate an emergency screening by HAZMAT EMTís who have the capabilities  / equipment to safely respond.

Pharmaceutical Supply  
Millinocket Regional Hospital recommended drug therapy for biological substances is contained in the plan, and is consistent with CDC recommendations and guidelines.  The amount of drug on hand and availability varies and is indicated.  These PAR levels will be maintained, as availability allows.  The National Pharmaceutical stockpile is estimated to be available within four to twenty-four hours of notification.

For chemicals such as blood agents, nerve agents, vesicants and choking agents, Millinocket Regional Hospital does have limited stock of antidotes and antitoxins available,  i.e. British antiLewisite, pralidoxime, and atropine.   The amount of drug on hand and availability is indicated within the plan.

Medical Surgical Supply  
Medical Surgical equipment is inventoried, PAR levels established, and is contained within the plan.  Most critical are ventilators, Millinocket Regional Hospital has three.  This supply is limited  at this time to those PAR levels and will serve as quick reference to aid in triage of patients in a disaster situation.

Procedure
Millinocket Regional Hospital will use the Millinocket Regional Hospital Chemical and Biological Response Plan as a guide in providing care to patients suspected or who are the victims of  biological or chemical exposure.  In the event of mass casualties the Internal and External Disaster Plans will be initiated.

Part I:  Emergency Response

Part II:  Millinocket Regional Hospital Resources