Emergency Management in the Laboratory PDF

Emergency Management in the Laboratory References GP36A Planning for Challenges to Clinical Laboratory Operations During a Disaster; A Report CLSI http://demo.nextlab.ir/getattachment/9613e330-bff2-4715-878a-9941c705e66d/CLSI-X4R.aspx Rodak's Hematology 6th Edition Clinical Principles and Applicat...

Emergency Management in the Laboratory References GP36A Planning for Challenges to Clinical Laboratory Operations During a Disaster; A Report CLSI http://demo.nextlab.ir/getattachment/9613e330-bff2-4715-878a-9941c705e66d/CLSI-X4R.aspx Rodak's Hematology 6th Edition Clinical Principles and Applications Authors: Elaine Keohane Catherine Otto Jeanine Walenga Emergency drill and evaluation periodic drills for all potential internal and external disasters Drills should address the potential accident or disaster before it occurs and test the preparedness of the workers for an emergency situation. Planning for the accident and practicing the response to the accident reduces the panic that results when the correct response is not followed  Emergency management plan Emergencies, sometimes called disasters (anything that prevents normal operation of the laboratory), do not occur only in the hospital-based laboratories. Freestanding laboratories, physician office laboratories, and university laboratories can be affected by emergencies that occur in the building or in the community. Emergency planning is crucial to being able to experience an emergency situation and recover enough to continue the daily operation of the laboratory. In addition to the safety risk assessment, a hazard vulnerability analysis should be conducted. Hazard vulnerability analysis helps to identify all of the potential emergencies that may have an impact on the laboratory. Emergencies such as a utility failure—loss of power, water, or telephones—can have a great impact on the laboratory’s ability to perform procedures. Emergencies in the community, such as a terrorist attack, plane crash, severe weather, flood, or civil disturbances, can affect the laboratory workers’ ability to get to work and can affect transportation of crucial supplies or equipment. When the potential emergencies are identified, policies and procedures should be developed and practiced so that the laboratory worker knows the backup procedures and can implement them quickly during an emergency or disaster situation. The emergency management plan should cover the four phases of response to an emergency, as follows: 1. Mitigation—measures to reduce the adverse effects of the emergency 2. Preparedness—design of procedures, identification of resources that may be used, and training in the procedures 3. Response—actions that will be taken when responding to the emergency 4. Recovery—procedures to assess damage, evaluate response, and replenish supplies so that the laboratory can return to normal operation Safety committee/department safety meetings—to communicate safety policies to the employees. Review of equipment and supplies purchased for the laboratory— for code compliance and safety features. Annual evaluation of the safety program—review of goals and performance as well as a review of the regulations to assess compliance in the laboratory. Categories of Incidents An overt incident manifests as a sudden catastrophic event, at a localized site or “hot zone.” Property damage may occur, and the victims are immediately and obviously injured. An explosion or bomb detonation is a type of overt incident. Laboratory staff is principally responsible for supporting the clinical medical response to trauma, chemical exposure, or other potential insults affecting a surge of presenting victims. A covert incident is classically represented by dispersal or spread of an infectious agent. Victims present over time, potentially at many geographically disparate sites. Early incident detection and epidemiology will be difficult. Laboratorians in this situation have a unique role in both incident recognition and agent identification. The Role of Public Health During a Disaster In the event of a disaster, the duty of public health officials (potentially including state, city, and/or county or even Federal health officers and epidemiologists) will be to assure that the number of future casualties is limited. These officials may want to know details concerning individual patients and casualties, and in some cases they may want samples and microbial isolates for further testing. Interaction with these public health officials may be perceived as a distraction to laboratorians whose priority it is to treat surviving patients. Their assistance, however, will be critical to protecting the public health.  Elements of a Laboratory Disaster Plan 1. Implementing triage testing to ensure the most urgent testing is available 2. Maintaining resources 3. Maintaining supply links with manufacturers and alternative suppliers 4. Increasing surge personnel capacity 5. Maintaining a communication system 6. Maintaining links with reference laboratories 7. Ensuring security of the area  A menu of laboratory tests will be necessary for acute care and must be maintained during the crisis. These tests include the following: Blood-gases and co-oximetry Electrolytes Hepatic and basic metabolic profiles Hemograms and coagulation studies Laboratory Tests Pseudocholinesterase, if available There may be laboratory tests not used for acute care, but ordered at an unusually high level or needed for longer-term care, such as: Microbiological, serology Laboratory tests are most likely to be ordered for send-out to an appropriate referral laboratory such as: Microbiological, serology - Toxicological Laboratory Instrumentation Laboratory instrumentation may need to be moved to a point of emergent care on very short notice. Examples include: Blood-gases and co-oximetry, definitely - Electrolytes - Possibly hemoglobin and hematocrit  Laboratory Supplies If the disaster/crisis situation exists for more than 24 hours, the laboratory must maintain delivery of critically needed supplies It is appropriate to consider and cooperate with community response plans (which may include resource-sharing) in the laboratory's own plan. The following are appropriate activities. Working with vendors to prepare plans for resupply during a crisis. Identifying other users of the laboratory's reagent/supplies within the community who could be called on during a crisis. Speaking with vendors early on in the crisis to determine the impact on expected supplies or resupplies (usage of reagents may go up in a disaster), as well as whether the prearranged plan needs to be put into effect. Specimen Transport Backup plans for transporting specimens within the facility to the laboratory are needed. For example, if current system is mechanical/electrical (e.g., pneumatic tube), backup plans are needed in case of electric outage. Individuals (e.g., laboratory staff, backup personnel, volunteers) providing transport will need to be identified. - A plan must be in place for transporting specimens to reference laboratories.  Because it is difficult to predict the biological and chemical toxins and radiological materials that are likely to be encountered in a man-made disaster, the laboratory and institution should be prepared to seek outside guidance when such encounters do occur. In situations where identification of chemical or biological toxins is necessary, the institution should have a list of laboratories that are Control of available to perform the identification. Biological, If radiation exposure is a concern for the laboratorian, radiation meters can be used to detect and measure radiation from clinical specimens. Chemical, and Consult the institution's radiation safety office to ensure that the appropriate meter is used for the radioactive source material occurring Radiological and that the proper personal protective equipment is utilized. Materials For the laboratorian handling specimens, radiation rings, badges, and meters can be worn to detect and monitor radiation exposure. Access points into the laboratory area should be minimized during a crisis, and the remaining access points should be staffed with a security review to permit only authorized laboratory personnel to have access. Institutions may want to consider placing locks on all laboratory doors on a routine basis. Failure of Utilities The laboratory must assume that during an emergency there is a high risk for the institution’s main power to be lost and that the institution will need to depend on emergency power. It is the laboratory’s responsibility to assure that key instrumentation is plugged into emergency power outlets or UPS devices — sites that the institution knows will be able to deliver emergency power during a power outage Self Check: emergency power audit Will electrical failure expose laboratory personnel to unsafe conditions? Will hoods work and not backflush into common spaces? Airflow reversals can occur in hoods connected to exterior exhaust systems. Will instruments require cleaning because of stoppage in sampling or dispensing cycles, thus exposing personnel to unusual cleanup? Is the laboratory’s water supply dependent on electrical power? Type I water is a necessary consumable for many laboratory instruments, and the laboratory needs to be assured of a constant supply. Are there alternative sources of water available, i.e., bottled/boxed water that would suffice in an emergency? Has the laboratory reviewed power-down procedures? Are personnel facilities (e.g., a bathroom) available with emergency power? Will heavily instrumented testing areas, where refrigerators are also commonly placed, experience elevated room temperatures? Emergency power systems may not support optimal temperature regulation throughout the facility. Room temperature may exceed the acceptable operating limits of modern instruments and compromise some blood banking procedures. The temperature may reach unacceptable levels within minutes. Availability of large cooling fans and portable air conditioners can be critical, especially during the summer season Will there be loss of some (or all) overhead lighting in critical laboratory and patient care areas? Phlebotomy may discover that supplemental portable lighting (flashlights, other) is required in some hospital areas. Have all emergency power plugs been tested? In rare instances, emergency power plugs and strips are found to not actually be “hot” under emergency conditions. Extension cords are invaluable. Does the morgue have emergency lighting? Do morgue body coolers have emergency power? Does sufficient fuel exist for facility generators? Secure immediately. Will auto-flush systems in bathrooms function? Will blood culture instruments, incubators, and hoods function on emergency power?