By Casey Hayes
The events of Sept. 11, 2001 changed many things. The notion of honor in conflict was lost forever, as was the separation of targeting military and civilian assets and people. On that day, terror became the weapon of choice of radical regimes and movements. As a result, our thinking with respect to emergency preparation changed forever, as well.
The addition of possible intentional incidents to our emergency preparation plans broadens the universe of hazards and theaters dramatically. When accidents were the threat, it was easier to plan because the hazards and their locations were mostly known. Terror, by its definition, is the staging of the unknown and unexpected. So, planning is much more difficult.
For the purpose of this discussion, let's consider today's intentional incident preparation from the standpoint of a new or renovated facility design and then as separate add-on capabilities installed in existing industrial and/or emergency response facilities.
New Construction and/or Renovation
In many respects, it's easiest to start from scratch in preparing for today's challenges. Although it is vastly more expensive, new designs can make distinctions that were not possible or even considered in past years. For instance, the traditional hospital emergency room has always been a place that the injured enter as quickly as possible. The notion of the emergency room entrance acting as a barrier that separates the "contaminated world" from the controlled cleanliness of the emergency treatment area has given rise to placing decontamination assets outside of the building.
Consider the recently renovated Kaiser Permanente hospital and emergency facility in Walnut Creek, Calif. A $25 million, 32,000-square-foot expansion and renovation of the facility's emergency room was completed early last year. Featuring the latest in high-tech equipment, including decontamination units for a major chemical spill or bioterrorist attack, the new emergency room establishes the building walls as the separation between victims that are ready for treatment and those awaiting decontamination.
The new facility also offers 52 patient rooms, each separated by solid walls and doors, as opposed to the curtains used in the past. The idea was to provide greater privacy and comfort, as well as more direct care. All 52 beds have cardiac monitoring.
An on-site lab drawing station and digital imaging are available, which allows for emergency room patients to remain in the ER. This minimizes the need to move possibly contaminated or contagious patients to other departments.
A total of 140 computer monitors are located throughout the ER, facilitating rapid access to medical records and test results. Traditional X-ray equipment has been replaced with digital radiography – DR Technology – that allows digital images to be viewed by any Kaiser facility in Northern California for consultation purposes.
As mentioned earlier, the most telling feature of the Walnut Creek facility is outside the ER entrance. Subtly tucked in next to the main emergency room pedestrian entrance is a gated triage/prep area for victims requiring drench shower and/or eyewash treatment prior to administering emergency care. A row of six combination shower/eyewash units, including hand-held sprayers, stands ready for large-scale emergencies. According to Richard West, of Kaiser's National Facilities Services group, the outdoor location was chosen based on the desire to:
- Provide immediate showering and irrigation to mitigate further injury from contact with hazardous substances, and
- Assure that those hazardous substances remain outside of the emergency room facility to the greatest degree possible, thereby protecting staff and other patients.
Additionally, the facility features a single additional outdoor shower located right next to the ambulance entrance for use prior to entering the facility with the more critically injured.
The Kaiser facility also has three negative-pressure isolation rooms for cases involving highly contagious diseases or contamination cases. The main isolation room, also located right next to the ambulance entrance, has a built-in shower, in addition to an impressive array of high-tech cardiac care and computerized diagnostic equipment. While Kaiser's Walnut Creek facility is a case study in state-of-the-art emergency hospital design, many of the strategies employed can also be directly transferred to the industrial sector. In the future, on-site plant emergency treatment facilities may be expected to handle an entirely new set of circumstances – circumstances that include the potential for intentional damage and injury, as well as the use of biological and chemical agents heretofore not part of our thinking. The philosophy of preparation is mostly identical, regardless of industry or application.
Enclosed Emergency Environments (E3)
But, what about existing facilities that are not being renovated? How does one best prepare for today's challenges without major reconstruction? The science of emergency response, in these days of greater and unknown challenges, has also given birth to pre-packaged, custom-engineered, turnkey emergency systems called Enclosed Emergency Environments (E3). While they do not generally establish a contamination barrier via an outside wall, these tailored systems are the ideal approach to providing the utmost add-on response, in a "plug-and-play" package that can be integrated into virtually any operation.
The E3 concept has gained great traction in the marketplace because emergency equipment manufacturers – with their core competencies in design and specification – design and build a balanced, self-contained package of equipment that specifically meets each application's individual needs.
Since E3 booths are needed in a variety of environments, ranging from ultra-clean rooms to refineries or remote locations lacking water supplies and/or power, their construction and materials vary. Booth designs and successful installations exist, ranging from the use of plastic and resin compounds through all stainless steel construction.
E3s can be designed for indoor or outdoor installation in any weather conditions – hot or cold, wet or dry. Seasonal weather fluctuations can also be accommodated in booth construction materials and internal componentry specified.
Another advantage is that because the E3 is an enclosure, it protects the individual and the emergency equipment from both the elements and a possibly corrosive atmosphere. And, an enclosure answers once and for all the issue of victim privacy. But, in this case, the variety of booth configurations generally allow sufficient space inside for emergency assistance to be performed by a second individual, while the victim is being showered and/or irrigated. Walk-through designs can also be provided.
While a booth configuration serves to keep the outside elements out, it also keeps warmth from tempered water or cool-reverse tempered water temperatures in, serving to make the victim much more comfortable, obviously aiding in their using the equipment for a full drench or irrigation cycle. ANSI Z358.1 requires that emergency shower and eyewash water be between 60°F and below 100°F at the outlet for the full 15-minute irrigation and/or drench cycle to avoid hypothermia and scalding, as well as to maximize the comfort of the victim. E3s are specifically configured to maintain the required outlet water temperature range.
In many industrial environments, the snarl of pipes, ducts, racks, conveyors and the like can often obscure the visibility of emergency equipment. This is yet another advantage of E3s. Their size and color most often act as a billboard of sorts, facilitating a panicked victim's ability to find them in a hurry.
As mentioned earlier, most E3s are engineered to be "plug-and-play." That is, they are pre-engineered packages usually having a single water inlet connection, a single electrical connection and a single outlet connection for possibly sharing functions, such as tempered water, with other emergency equipment installations.
A variety of booth sizes and configurations are available, depending on need and componentry to be used. Each has sufficient doors and access panels to ease both use and maintenance.
A complete spectrum of emergency showers, eyewashes and eye/face washes can be specified for E3 use. As mentioned, tempered water, using either an integral hot water heater or external steam heat, is available. Reverse tempering is also available, where either high ambient temperatures – heating nearby water – or high water temperatures in hot climates are present. And, for certain conditions, a combination of both tempering and reverse tempering can be specified. Additionally, E3s can be equipped with integral booster or re-circulation pumps to assure sufficient water pressure or maintain a prescribed temperature range.
Likewise, a variety of electrical classifications can be specified in any voltage requirement while also meeting hazardous, weather-proof or corrosion-resistant standards, or any combination thereof.
For remote locations, air-charged systems are also available. This would handle remote situations where there might be power available, but not a suitable supply of water.
E3s provide great flexibility in preparing for the challenges of potential intentional incidents, as well as more traditional accident response. While E3s are appropriate for stationary, plumbed-in installations, there are also portable shower products available for rapid mobile response operations. These compact, lightweight showers can be erected in minutes at virtually any location.
Whether a particular plan includes a major renovation or the addition of enclosed emergency environments or the use of portable response products, there are approaches that can be taken to better prepare for almost any eventuality.
Incident Still in Progress
Until now, we've addressed mostly accidental injuries in an open and direct manner. Our preparation, planning and placement of emergency response assets has been driven by a need for quick response. Today, we need to also consider containment of the situation in our planning, due to the greater potential for the incident to still be in progress when we're brought into the picture. This is especially true in industrial locations, where intentional introduction of a hazard into the environment may still be in progress, when the first victims are identified.
So, placement of emergency response assets may need to command a neutral, defensible position while also adhering to ANSI's accessibility and time-to-response requirements. Bottom line: The rules have changed and we need to review and possibly change our approach to guarding the welfare of employees and others. There are a number of approaches that can be taken to accomplish this much more difficult, but still "do-able" objective.
Casey Hayes is the engineering manager at Haws Corp., located in Sparks, Nev. He can be reached at (775) 353-8320 or [email protected] Haws Corp. (www.hawsco.com) designs, manufactures and distributes drinking fountains and emergency equipment.