Accreditation

Ammonia leak tests hospital's disaster plans

Accreditation Connection, April 26, 2004

The scenario On Thursday, February 12, an anhydrous ammonia leak from a 3/4 in x 2 in pipe was discovered at a pork-processing plant with 1,800 workers, located within 2 mi of Avera McKennan Hospital in Sioux Falls, SD.

The leak produced a large, coffee-colored cloud above the plant where an estimated 19,000 lbs of the chemical was expelled. At 11:48 a.m., the hospital received its first alarm, followed by a disaster code 10 minutes later.

Thirty-eight of the 66 injured plant workers sought treatment at Avera McKennan Hospital.

The reaction

When the alarm sounded that Thursday, David Kapaska, DO, senior vice president of medical affairs at Avera McKennan Hospital, knew there was a potential disaster heading their way.

Within 10 minutes, the hospital called a disaster code. "The first thing you think is it's a drill because it has always been a drill," Kapaska says. "Once we heard, we just got busy; you realize saying, 'Oh damn,' isn't going to help."

Luckily, Avera McKennan Hospital hospital practices disaster drills twice a year throughout the community, so it was well-prepared to handle the ordeal.

The hospital's control center notified everyone of the emergency and then used a phone tree to get disaster-response staff moving. Throughout the day, hospital staff received frequent updates through the intranet.

The response

By 12:20 p.m., the command center notified Kapaska that the hospital's ventilation system should be shut down to ensure that none of the contaminated air outside the hospital got inside.

In addition, the hospital went into a partial lockdown. They didn't know how much ammonia was in the air but weather began to play a factor.

"At the time, the wind was coming out of the north and [heading] our way," Kapaska says.

Complicating matters was the fact Kapaska's security director was in Texas on business. However, the director's work had proved itself. "We were really thanking her in those moments for all the drills she made us take part in," Kapaska says.

Patients began to arrive at the facility suffering from skin, eye, abdominal, and respiratory complaints, which the facility was prepared for.

"We had ventilators prepared," he says. However, the hospital ultimately didn't know how many patients it would end up treating.

"We didn't have 1,800 ventilators," Kapaska says.

Although 66 patients visited various hospitals in the area after the incident, 38 were admitted to Avera McKennan.

"Once we realized there would be 40-50 patients, that gave us a realm. We knew how many beds and patients we had, so we started to spread out our resources," he says.

"Prior to that, we went ahead and made schedules. We had the maximum capacity to take care of a full hospital, and everyone else started to fill in over the 24 hours."

The hospital's disaster plan makes sure there are enough staff available at all times, Kapaska says.

In addition, Kapaska also took the time to print out information about ammonia in order to speak to the media about the incident and the chemical's side effects.

The challenges

Although the majority of the plans went smooth ly inside the hospital, Kapaska admits that there were definitely some issues for which they couldn't prepare.

For example, 50 languages are represented among the 1,800 people who work at the pork-processing plant, Kapaska says.

"Communication was a challenge," he says. "Several interpreters came to the hospital under contract, and others worked in the hospital."

The hospital also couldn't predict the range of emotions from patient's families who came in droves to the hospital searching for their relatives. "I think that was the biggest surprise," he says. "You have wailing family members who are confused and upset." A center was set up in the hospital's cafeteria to help patients' families.

 

Lessons learned that you can use

Even though their first disaster response went well, there are still many incidents during the event that Avera McKennan Hospital couldn't plan for, says David Kapaska, DO, senior vice president of medical affairs.

He shared the following lessons his facility learned and what adjustments it will make to its disaster plan for the future:


Be prepared to set up a family center somewhere in your hospital. Avera McKennan staff selected its cafeteria, but underestimated patients' families emotions and the need for communication. "Thinking ahead about a communication center where you can hook up 10 phones would've helped," he says.


Create a standard response for family members searching for their relatives. Family members of workers showed up at the hospital wondering whether their relatives were harmed. The Health Insurance Portability and Accountability Act of 1996 made this particularly challenging for the hospital when dealing with family members who wanted to know whether their relative was even in their hospital since it couldn't divulge who had been admitted or to which hospital, says Kapaska.


Order different colored vests or hats to denote different roles in emergencies. While Avera McKennan had ordered different colored vests, they hadn't arrived yet. The color coding can allow staff to easily tell what job someone does should an emergency professional need, for example, a nurse or phlebotomist.


Prepare for an influx of staff who want to help. "Everyone was anxious to do something," he says. "Controlling human resources is a challenge-as far as making sure you have the right people."


Know your community demographics. Be certain you have interpreters on staff or on contract should you need them in a disaster.


Think ahead about dealing with the media. If patients were exposed to a certain chemical, make sure to print out information about the chemical and its side effects immediately. This way you can speak intelligently about the incident and how the hospital is responding.

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