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Development of Models for Emergency Preparedness

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Development of Models for Emergency Preparedness Bioterrorism and Other Public Health Emergencies Tools and Models for Planning and Preparedness Development of Models for Emergency Preparedness Personal Protective Equipment, Decontamination, Isolation/Quarantine, and Laboratory Capacity Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Rd. Rockville, MD 20850 www.ahrq.gov Contract No. 290-00-0023 Prepared by: Science Applications International Corporation Homeland Security Support Division Principal Investigator Bettina M. Stopford, RN Contributing Authors Laura Jevitt Michele Ledgerwood Christa Singleton, MD, MPH Martin Stolmack, EMT-P AHRQ Publication No. 05-0099 August 2005 AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services. Suggested Citation: Stopford BM, Jevitt L, Ledgerwood M, Singleton C, Stolmack M. Development of Models for Emergency Preparedness. Prepared by SAIC under contract No. 290-00-0023. AHRQ Publication No. 05-0099. Rockville, MD: Agency for Healthcare Research and Quality. August 2005. Funding to support Development of Models for Emergency Preparedness was provided by the U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, under Contract No. 290-00-0023. The authors of this report are responsible for its content. No statement in the report should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted, for which further reproduction is prohibited without the specific permission of copyright holders. ii Contents Development of Models for Emergency Preparedness Chapter 1. Introduction ......................................................................................................3 The Threat.........................................................................................................................3 AHRQ Bioterrorism Initiative ..........................................................................................3 Project Goals.....................................................................................................................4 Research Methods.............................................................................................................4 Technical Approach.....................................................................................................4 Findings and Conclusions.................................................................................................5 Appendix A—Subject Matter Interview Questions and Experts...........................................7 Personal Protective Equipment.........................................................................................7 Interview Questions .....................................................................................................7 Subject Matter Experts.................................................................................................8 Decontamination...............................................................................................................13 Interview Questions .....................................................................................................13 Subject Matter Experts.................................................................................................13 Isolation/Quarantine..........................................................................................................17 Interview Questions .....................................................................................................17 Subject Matter Experts.................................................................................................18 Laboratory Capacity..........................................................................................................20 Interview Questions .....................................................................................................20 Subject Matter Experts.................................................................................................22 Chapter 2. Personal Protective Equipment ........................................................................27 Background.......................................................................................................................27 Emergency Medical Services.......................................................................................36 Health Care Facilities...................................................................................................38 PPE Classifications ...........................................................................................................41 Guidelines for Building the Model ...................................................................................54 Adaptability—Is the Best Practice Suitable for Use in Any Region? .........................55 Throughput—How Many Victims of a WMD Attack Will the Best Practice Aid? ....55 Cost—How Much Will It Cost Regions to Implement the Best Practice?..................55 Operational Impact—What Are the Operational Considerations of Implementing Best Practices? .............................................................................................................57 Training—What Level of Training Does This Best Practice Require? .......................57 Resources—Does the Practice Build on Existing Practices/Infrastructure? Are There Available Resources to Implement the Practices?.............................................57 Morbidity and Mortality—What Impact Will This Practice Have on Saving Lives? .58 Evidence-based Practice Versus Theory—Is There a Body of Professional Research Supporting This Practice or Is It Theoretical? .............................................59 Regulatory Compliance—Does the Practice Comply with Existing Regulations or Does It Require a Regulatory Change? ...................................................................59 The Bottom Line—Guidelines for Selecting PPE .......................................................60 Appendix A—References and Bibliography .........................................................................63 iii References.........................................................................................................................63 Bibliography .....................................................................................................................64 Appendix B—Emergency Medical Services PPE Model......................................................66 Appendix C—Healthcare Facility PPE Model ......................................................................67 Chapter 3. Decontamination ..............................................................................................69 Background.......................................................................................................................69 Regulatory.........................................................................................................................70 Assumptions......................................................................................................................71 Best Practices....................................................................................................................72 Decontamination Methods................................................................................................75 Method I.......................................................................................................................76 Method II. ....................................................................................................................76 Method III. ...................................................................................................................76 Method IV....................................................................................................................77 Procedures.........................................................................................................................79 Decontamination Shelter...................................................................................................80 Disrobing ..........................................................................................................................82 Belongings and Evidence Collection................................................................................83 Water Pressure/Temperature.............................................................................................84 Decontamination Solutions...............................................................................................84 Soap and Water............................................................................................................84 Bleach and Water.........................................................................................................85 Non-Aqueous Methods .....................................................................................................85
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