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Emergency Medical Services
• Emergency Medical Services will be provided by the Galveston Area Ambulance Authority (GAAA). (See GAAA Terrorism Response Plan in Appendix)
• During a terrorist attack, communication will be established and maintained between UTMB and GAAA.
Decontamination of Patients and Environment
The need for decontamination depends on the suspected exposure and in most cases will not be necessary. The goal of decontamination after a potential exposure to a bioterrorism agent is to reduce the extent of external contamination of the patient and contain the contamination to prevent further spread. Decontamination should only be considered in instances of gross contamination.
Decisions regarding the need for decontamination should be made in consultation with local health departments and Healthcare Epidemiology. Decontamination of exposed individuals prior to receiving them at UTMB may be necessary to ensure the safety of patients and staff while providing care.
Depending on the agent, the likelihood for re-aerosolization, or a risk associated with cutaneous exposure, clothing of exposed persons may need to be removed. Patients may be decontaminated prior to entry into the Emergency Department or may be instructed (or assisted if necessary) to immediately shower with soap and water.
Potentially harmful practices, such as bathing patients with bleach solutions, are unnecessary and should be avoided.
Clean water, saline solution, or commercial ophthalmic solutions are recommended for rinsing eyes. If indicated, after removal at the decontamination site, patient clothing should be handled only by personnel wearing appropriate personal protective equipment, and placed in an impervious bag to prevent further environmental contamination. The FBI may collect clothing and other potential evidence for submission to FBI or Department of Defense laboratories to assist in exposure investigations.
Emergency Department
Many people who are ill from a bioterrorism agent will be seen in the Emergency Room. Healthcare workers must be aware of the signs and symptoms of each disease (See Clinical Information Pathways for each specific disease).
—In the best-case scenario, the disease of the affected patient will be recognized by the Emergency Medical Personnel and pertinent information shared via dispatch.
—Upon recognition or suspicion of a bioterrorism agent, Healthcare Epidemiology must be notified immediately. They in-turn will notify the Galveston County Health District, University Relations, the Medical Director, and Chief Operating Officer. Further communication with law enforcement, TDH, or the CDC will be done at the direction of the Galveston County Health District.
—The patient must be triaged for illness vs. exposure to disease and cared for appropriately. The attached Clinical Pathways include admission criteria for specific syndromes. People exposed to a biological agent may only require prophylaxis. See prophylaxis regimes for specific diseases.
—Upon discharge from the Emergency Department, the patient will be given specific educational material and instructions about medical follow-up including medications (See educational forms specific to each disease).
Triage and Management Planning for Large-Scale Events Triage and management planning for large-scale events may include:
• Establishing networks of communication and lines of authority required to coordinate on-site care.
• Planning for cancellation of non-emergency services and procedures.
• Identifying sources able to supply available vaccines, immune globulin, antibiotics, and botulinum anti-toxin (with assistance from local and state health departments).
• Planning for the efficient evaluation and discharge of patients.
• Developing discharge instructions for patients determined to be non-contagious or in need of additional on-site care, including details regarding if and when they should return for care or if they should seek medical follow-up.
• Determining availability and sources for additional medical equipment and supplies (e.g., ventilators) that may be needed for urgent large-scale care.
• Planning for the allocation or re-allocation of scarce equipment in the event of a large-scale event (e.g., duration of ventilator support of terminally afflicted individuals).
• With assistance from the Pathology service, identifying the institution’s ability to manage a sudden increase in the number of cadavers on site.
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