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

Set-up

Were notified by our safety department in coordination with our triage and emergency room areas as to what type of disaster were dealing with, says John Fitzgerald, CHESP, acting associate director for administration and support, Veterans Administration of Greater Los Angeles Healthcare Center. Based on that, we start mobilizing our environmental services group, which would first include making sure that we look at the universal precautions or the personal protection equipment that is necessary for that particular type of disaster. Thats how we would start off making sure that theyre equipped with personal protective equipment.

Fitzgeralds environmental services team would then implement the setup of a triage area, either inside the emergency room or in the field. In the event of, say, a dirty bomb, they would help set up our emergency showers outside the hazmat interviewing and triage area that we have outside, he says. They would immediately help do any kind of set-ups. At this medical center were a casualty and collection area. So were equipped with 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 to assist the triage group with setting up the emergency room. So wherever the triage point or command center is for the emergency room in triage, that would be their first line of responsibility.

Fitzgerald says the greatest challenge is in ensuring that the environmental 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 properly marked and disposed of, making sure that all of the specific set-up material is coordinated with the type of disaster that we have, he says.

The greater Los Angeles VA performs drills twice annually. Were required by the Joint Commission to do one drill per year, but we do two, he says. We do our regularly-scheduled Joint Commission drill, and we participate in the state and county drill once a year. Were constantly tweaking our system. Our environmental services department, like all of our different departments here, have a specific role in our disaster training efforts.

In addition to the experience gained from practice, Fitzgerald has the advantage of belonging to a network of VA facilities nationwide. The cumulative base of experience provides an invaluable perspective for all members. If, for example there was a hurricane down south, we would get the medical directors on the line, he says. They would say, heres what happened, these are some of the things we did, and here are some of the challenges. We have the opportunity to listen in on that. The VA facilities across the country are very fortunate in that sense we can learn from each other.

Clean-Up

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

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

Transfer

In our medical center we have a manpower pool, says Fitzgerald. Personnel who are not essential would go to that manpower pool, and they would deal with transferring patients to the emergency room, to the OR, from the ER to the ward areas, wherever the transfers had to go, and however that had to take place. Environmental services personnel would become part of that pool, and along with other nonessential personnel would be in the emergency room, the operating room, or in the patient care ward areas. All of those people would be used as needed to facilitate any transfers, to run gurneys, wheelchairs, that type of thing.

The Big Picture

Every time we drill, we find that something doesnt work as 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, our people are going to perform admirably. I think in any disaster there are going to be things that dont go well, but weve just got to hope that the ability to drill and meet and talk about it is going to help us in the end. The most recent drill that we had went extremely well. After each one of the drills we have a critique. We critique with all of the key staff from each one of the areas.

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

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

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