Medical Emergencies

AUTOMATIC EXTERNAL DEFIBRILLATORS (AEDs)
Automatic External Defibrillators (AEDs) are located near the Human Resources Office in the front lobby of Holloway Hall, near the Cashier’s Station in the Commons, and Maggs Center lobby, pool, training room and fitness center and University Police vehicle. Certain individuals are trained in their use, but these units are designed to be used by anyone in the event of an emergency.

In case of a medical emergency that involves the sudden stoppage of heart fibrillating activity, initiate the following emergency procedures:

• Check the victim for breathing and heartbeat

• Have someone call 911

• Obtain an AED

• Follow directions on the device

BLOODBORNE PATHOGENS
Exposure to bloodborne pathogens is possible whenever contact with blood or body fluids takes place. Exposure may occur when providing first-aid to a co-worker or handling waste that is soiled with blood or body fluids. Saliva or vomit mixed with blood due to an injury may pass to the caregiver during CPR. Handling waste contaminated with body fluids may allow a virus to pass to the worker. You and your supervisors should review tasks and identify actions that may cause contact with body fluids. Precautions you take should match the potential for possible exposure to body fluids. Although not all body fluids will cause infection, universal precautions can prevent exposure to fluids that, on rare occasion, may contain Hepatitis B or HIV. Wear personal protective equipment (PPE) that will protect you from illness.

The Following Steps Are To Be Taken After Each Exposure Incident:

1. Employee will be administered first aid.

2. Each incident is to be reported to the supervisor immediately.

3. The supervisor and the employee will complete an Employee’s Incident Report as soon as possible after the exposure incident (see EHS or HR Web site).

4. Each incident is to be evaluated by a licensed health care professional at Peninsula Regional Medical Center.

5. When the source individual is known, the source individual’s blood may be tested for the Hepatitis B virus. The individual may also be tested for HIV once informed consent has been obtained. The result of the evaluation will become a part of the employee’s medical record and shall be confidential. The employee shall be given information pertinent to the source individual as needed to make an informed decision concerning appropriate follow up measures.

6. When appropriate, the exposed employee’s blood will be tested for Hepatitis B and for HIV. Peninsula Regional Medical Center will provide the test results to the exposed employee and provide counseling as medically indicated, including referral to an infectious disease specialist, if indicated.

Precautions You Can Take:

• Look out for sharp objects or sharps (e.g. - razors, needles, broken glass, etc.).

• Use caution when cleaning and handling laundry. Sharps may be found dropped in sheets, down drains, or other places. Gloves may be used when handling trash bags. In all situations, grasp the bag and lift it away from yourself. Watch for objects sticking out of the bag.

• Do not handle sharps that are contaminated with blood. Health care workers are not even allowed to recap, bend or break scalpels and needles. Make sure you dispose of all sharp objects properly with minimal handling. Do not throw them into regular trash or leave them lying around. Dispose of sharps contaminated with blood in appropriate containers. Containers should be puncture- and leak-proof. Use a secondary container if leakage is possible. Fill sharps containers no more than ¾ full and tape shut.

• Properly label any containers or objects that may contain infected waste or blood. Containers holding the blood must be labeled with the biohazard symbol. It must be fluorescent orange or red with letters in contrasting colors. Contact Environmental Health & Safety Office for disposal.

• Wash hands and other skin surfaces after removing gloves or when contact with contaminated articles occurs. Use soap and water and wash for two minutes. Clean, disinfect and sterilize all reusable first-aid equipment. Disinfect Items (e.g., splints) contaminated with blood before reuse.

• Clean and decontaminate blood spills as soon as possible. Wear gloves to clean up blood. Wipe up blood with disposable towels and dispose of the towels in a properly labeled container. Use an EPA-approved germicide or a 10 percent mixture of household bleach (9 parts water to 1 part household bleach) to disinfect surfaces. For large spills, use the bleach straight from the bottle, if practical. Since bleach loses concentration with time, don’t allow the mixture to stand for several weeks. Allow enough contact time, approximately 20 minutes, to disinfect. Rinse tools with water after disinfecting and wear appropriate PPE (and ventilate) while disinfecting since bleach is corrosive and has a strong odor.

• Bag laundry at the location of use and label appropriately. Soiled laundry should be handled as little as possible. Place soiled laundry and PPE in leak-proof bags while wearing gloves. Clean soiled laundry with detergent in normal laundry cycles (hot water at 160 degrees for 25 minutes) according to manufacturer’s instructions. PPE should be cleaned and dried according to the manufacturer’s instructions.

• Dispose of all contaminated waste in appropriate containers, as described within the current version of Salisbury University’s Exposure Control Plan.

Additional information is included within Salisbury University’s Exposure Control Plan and is available at the Environmental Health and Safety (EHS) Web site or by request (Ext. 66485 or 410-546-6485).

COMMUNICABLE DISEASE MANAGEMENT

Student Health Services, as an agent for Salisbury University, monitors communicable disease cases that may affect the well-being of students, faculty and staff.  In the event of a communicable disease event, Student Health Services consults with and receives guidance from the local and state health departments, as well as the Center for Disease Control.  The consulting agency is determined by the disease presented, the number of cases and other guidelines established by state and federal laws and recommendations.  Disease events are co-managed by SHS and the consulting agency to ensure the safety of individuals and the campus community. As an agent for the University, SHS may require quarantine or other action, as recommended. SHS informs the University administration, faculty, staff and students, as needed, to provide education to limit the impact of a communicable disease event.  SHS works with the offices of Public Relations, the President and Student Affairs to create methods of communication such as the use of e-mail, faculty announcements, awareness statements for coaches and other administrative staff, articles for student and campus newspapers, and residence hall awareness campaigns, as determined to be prudent or as mandated by a consulting agency.  Communicable diseases are defined as those that can be transmitted from one human to another and include tuberculosis, meningitis, chicken pox, SARS and others.  Individuals contracting a communicable disease should report the case to SHS immediately at Ext. 36262 or 410-543-6262.   (See also Mass Immunization)

EMERGENCY PSYCHIATRIC EVALUATIONS
University Police officers are authorized to take persons into custody and petition for emergency psychiatric evaluations.

In addition, State law HG10-622 grants authority to the county health officer or designee of the county health officer to petition for emergency evaluations. This law gives the same authority to a "clinical nurse specialist in psychiatric and mental health nursing and psychiatric nurse practitioner."

In accordance with this law, Judith A. Sensenbrenner, M.D., M.P.H., who serves as the Health Officer for Wicomico County has named the below listed Salisbury University employees as Wicomico County Health Department designees for emergency petitions:

This law gives these individuals authority to complete Petition for Emergency Evaluation forms. University Police are authorized to take emergency evaluee to the nearest emergency facility after the Petition for Emergency Evaluation form has been signed and submitted by the designated Salisbury University employee. Note: the language used in this law is "shall take.” This law does not require the authorized petitioner to accompany the officer.

EMPLOYEE INCIDENT REPORTING

Overview or Objective:
To facilitate the timely reporting of work injuries in a manner that will ensure that the employee’s injury gets proper treatment, medical bills are paid and employee is properly compensated for lost time.

Timing:
Every effort should be made to make sure injury is reported in 24 hours of its occurrence. The reporting process for the Human Resources (HR) Office takes about 10 minutes.

Steps:

• Employee has injury.

• Injury is reported to supervisor within 24 hours of occurrence.

• Employee completes Employee’s Incident Report form before treatment, if capable of doing so. This form (with instructions) can be found on the HR forms Web page. Upon completion, this form should be sent to HR via inter-office mail.

Note:
Depending on the incident, it may be advisable for the employee to complete the form after seeking proper medical care. If the employee is unable to return to work, the supervisor may complete the Employee’s Incident Report form via a phone interview. He/she will check the “phone interview” box and sign and date on the appropriate line.

If an injury needs medical attention (other than basic first aid), the employee is sent to Main Street Med Center. For more serious work injuries or injuries that occur after business hours, refer employee to PRMC Emergency Room. Although these places are recommended, the employee may see their private physician.

If the employee cannot transport himself/herself to any necessary medical treatment, the supervisor or University Police should arrange for the transportation.

The supervisor should complete the Supervisor’s Incident Report form and submit a copy to HR. This form (with instructions) can be found on the HR forms Web page.

If there are any witnesses to the incident, the Witness Incident Report form will be completed and returned to HR. This form can be found on the HR forms Web site.

As a general rule, HR has up to three days, from time of incident, to report the information to IWIF (Injured Workers’ Insurance Fund) for further investigation. Prompt attention and completion of each form (including the Witness Incident Report form—if applicable) will ensure that the injury gets proper treatment, medical bills are paid and the employee is properly compensated for lost time.

MASS IMMUNIZATION
The Wicomico County Health Department has recommended that mass immunization of the University community in case of a bio-terrorism incident be conducted on campus. With 1,000 plus employees and more than 7,300 students, of which 1,700 live on campus and another 2,000 (estimated) live within walking distance, it is prudent to plan for immunization on campus. Mass immunization will be coordinated through Student Health Services with the possible assistance of the nursing faculty. Possible sites include Maggs, Devilbiss or Henson halls. Since Maggs is a designated shelter, Devilbiss or Henson halls may be used as alternative locations because they are proximate to Maggs. This will make security, servicing and resource allocation simpler to coordinate.

Supplies will be provided by the Health Department from the Strategic National Stockpile. The estimated delivery time to the county is 12-14 hours. The on- campus site will be identified and mobilized within that time frame. A Health Department representative will assist in mobilizing the selected site. Issues to consider include the necessary forms and registration/record keeping, the actual inoculation and follow-up, and storage and security of the vaccine. Kathleen Lanigan, Susan Battistoni and Karen Badros from the nursing faculty have volunteered for this.

Student Health Services will maintain a list of licensed persons who are qualified to administer the vaccine. This would include SHS and nursing faculty, etc. Others will be identified to assist with the administration of the inoculations, as needed, depending on the nature and extent of the situation.

Once a specific site is identified, i.e. Devilbiss or Henson halls, all appropriate personnel will be notified. The necessary training will be provided during that time frame while awaiting the vaccine to arrive. (See also Communicable Disease Management)

PUBLIC HEALTH RESPONSE TO UNIDENTIFIED SUBSTANCE

This protocol is to be used for the Public Health component in the investigation and response to a potential BT event such as a white powder incident, unidentified toxic substance exposure, etc. It is meant to be used by Public Health entities (local and state) but is also meant to be an integrative protocol. It should be integrated and incorporated into response protocols within Public Health agencies, Fire/Rescue/EMS/HazMat and law enforcement agencies.

Background

• The fundamental goal of public health is to prevent injury and illness to an individual and to the community.

• In the post-2001 era, public health has taken on additional responsibility as an emergency response component and integrates further with law enforcement and Fire/Rescue/EMS/HazMat.

• Public Health has not only additional responsibilities but also additional resources to bring to the field of response including but not limited to investigation tools, preventative medications, public information messages, follow-up capacity, and laboratory resources.

• Public Health is within itself more formally organized than before to respond to such incidents and, because of the increased attention to terrorism and public health emergencies overall, is under more formal accountability than ever before.

• All response is locally driven. However, as incidents progress and/or as experience evolves, assistance in expertise, resources and authority may be available at the state and federal levels.

• Although every attempt will be made by all parties to share intelligence and background information, this is not always possible; therefore continuous flow of basic information that may impact on individual response is a necessity in an emergency response community.

Local Health Departments

• Will be notified of incidents immediately or as soon as possible in order to have necessary input into the evaluation of the incident. Depending on local protocol this may be through the 911 centers, units on the scene or the coordinating agency during the event. Late notification could result in inadequate resources and flow of information and negative outcome to the person(s) exposed.

• Will assist in the evaluation of the event. Local Health Department personnel will assist in making determination regarding the exposure credibility of the event per The Matrix. Determination of exposure credibility will assist in formulating recommendations re: prophylaxis therapy and laboratory testing.

• Will assist in facilitating discussions with DHMH Laboratories Administration personnel, as necessary, and will ensure HazMat screening for chemicals, explosives and radiation before transport to DHMH. Depending on local protocol, transportation of samples may be conducted by or through the LHD. In all cases, chain of custody must be maintained throughout collection and transportation. Referral of samples to the state lab for testing will not be accepted unless the LHD is involved and part of the assessment process.

• Will notify DHMH BT MD On Call (410-407-6154) immediately or as soon as possible. Notification should not be delayed beyond two hours. Notification will include at minimum: determination of clinical and criminal assessments, number of people potentially at risk, need for prophylaxis, need for laboratory testing and the likelihood that the general public will become aware of the incident. The decision regarding the need for prophylaxis may be made in conjunction with DHMH and may be a reason for early notification and involvement of DHMH. Public awareness may be related to media coverage of the event, high profile location or parties involved, etc.

• Will follow any and all protocols regarding reporting and notification internal to the LHD and local response plans.

• Will follow up with response agencies regarding after action reviews to improve response and coordination.

• When laboratory results are received, will develop, as necessary, further response strategy with the assistance of DHMH, as necessary.

DHMH BT On-Call MD

• Will assist the LHD, as necessary, with determinations regarding the exposure credibility, determination of need for prophylaxis and laboratory testing.

• Will assist the LHD and other responder agencies, through communications with the LHD, regarding expertise specific to the potential agents, environmental surety, etc. This expertise may be as a result of specific knowledge or resources may be related to specific law enforcement intelligence or other ongoing incidents, etc.

• If notified of an incident prior to being notified of the incident by the LHD, will contact the LHD through existing protocols. The LHD and the BT On Call MD will negotiate who will follow-up on the incident. It is always preferred that the LHD is lead for health however, in some circumstances DHMH may take the lead.

• Will notify DHMH leadership and response partners of the event. This communication will occur in the following fashions:

• According to the BT On Call Emergency Communications Protocol for Health Alerts, Advisories, Notifications and Updates, a brief notification via text message will be sent.

• Communication format will be according to the BT On Call Emergency Communications Protocol for Health Alerts, Advisories, Notifications and Updates

• As necessary, a conference call can be set up emergently to provide additional detailed information and to develop strategy should there be a major response.

• As necessary, a FRED alert can be posted if widespread dissemination is necessary.

• Will assure results to the LHD, BT On Call MD and the referral agency are communicated and will assist, as necessary, in developing strategy depending on these results.

DHMH Laboratories Administration

• Law Enforcement should determine the seriousness of the sample by assessing credible threat and credible exposure (along with local health officials).  If Law Enforcement determines that there is both a credible threat and a credible exposure (along with the local health officials), then the 24/7 On Call Contact Person for the Laboratories Administration (Office of Laboratory Emergency Preparedness and Response) should be called. The contact numbers in order are: during normal working hours: 410-767-6096 (office), 410-471-0595 (pager), and 410-925-3121 (cell phone).  After hours, the numbers to call in order are: 410-471-0595 (pager), 410-925-3121 (cell phone), and 410-408-7521 (pager 2).

• The Laboratory Emergency Preparedness and Response 24/7 On Call Contact Person will obtain basic contact information to include: caller, agency, and contact phone number.

• The Laboratory Emergency Preparedness and Response 24/7 On Call Contact Person will then contact the appropriate Laboratories Administration division chief (or their designee) and provide them with the contact information for them to call and get needed information and answer any questions that the submitter may have.  The division chiefs (or designee) will assist and make recommendations regarding alternative testing locations or mechanisms at this time.   Laboratories Administration scientists will advise when preliminary and final results would be expected. 

• The Laboratories Administration division chief (or their designee) will then contact the Laboratory Emergency Preparedness and Response 24/7 On Call Contact Person and inform him of the results of their call (type and number of samples, when they expect them to be delivered, etc.)

• If there is both a credible threat and exposure, then Laboratories Administration personnel will arrange to meet Law Enforcement at the Central Laboratory outside of normal business hours.  Samples associated with a credible threat and/or exposure should be sent under chain of custody and therefore should not be entrusted to a courier.  If there is not a specific credible threat and/or exposure, and testing is still requested, then the sample should be stored according to the local protocol developed by local law enforcement and LHD and arrangements made to deliver the sample the next business day.

• The Laboratory Emergency Preparedness and Response 24/7 On Call Contact Person will send out an ARCH wireless message to the BT Notify Group when a sample/specimen is going to be delivered to the Laboratories Administration.

• All samples should be screened by local Hazmat teams for chemicals, radiation, and explosives before they are submitted to the DHMH laboratories for testing.  Although some jurisdictions may have access to a portable infra-red (IR) instrument, these will not reliably detect small amounts of bacteria and/or toxins.  Therefore, even samples identified by IR should still be submitted to the Central Laboratory for testing if there is a credible threat and/or credible exposure.  If only small amounts of powder are present, the entire sample should be submitted to the DHMH Laboratories Administration.  Currently available field tests (so called “smart tickets”) may be unreliable for the presence of bacteria and/or toxins and therefore, these tests are not encouraged or recommended by DHMH or the Centers for Disease Control and Prevention.

• Samples should be triple bagged so that powder is completely contained.  Miscellaneous request forms must be completed for each sample and indicate each required test.  If these are not completed prior to sending the sample, personnel bringing the sample will be required to complete the forms.

• Samples must be smaller than 18” by 24” or wipe/powder samples must be collected by the Hazmat team and the wipe or powder sample submitted for testing.

• The sample(s) should be taken to the Central Laboratory as soon as Hazmat has screened the sample(s) for chemicals, radiation, and explosives. When a sample is being sent to the Laboratory, both the local Health Department and the local BT Coordinator will be notified (by the BT On Call MD).  

• When the sample arrives at the Laboratories Administration, the receiving scientist is to notify the Laboratory Emergency Preparedness and Response 24/7 On Call Contact Person (using the same contact numbers as above).  The Laboratory Emergency Preparedness and Response 24/7 On Call Contact Person will then send out an ARCH wireless message to the BT Notify Group that the sample/specimen has been delivered (arrived) to the Laboratories Administration.

• In general powder samples received by the Laboratories Administration are tested first for the presence of Bacillus anthracis (overnight) before they can be tested for other biological and chemical agents.

• If other biologic and chemical agents are suspected, requests must be communicated to the Laboratory Emergency Preparedness and Response 24/7 On Call Contact Person (using the same contact numbers as above). 

• When each unit has completed their testing of the sample (i.e., anthrax, ricin, chemistry), they will phone the Laboratory Emergency Preparedness and Response 24/7 On Call Contact Person (using the same contact numbers as above).  He will send out partial results by ARCH wireless message to the BT Notify Group.

• When the Laboratory Emergency Preparedness and Response 24/7 On Call Contact Person receives the Final Result, he will send out an ARCH wireless message to the BT Notify Group.

• As each unit completes their testing of the sample, they will provide results to the referral agency and the LHD.

• The BT On Call MD will notify the LHD (if they have not been previously notified).

THE MATRIX

Both a credible exposure and a credible threat analysis MUST be performed in order to make decisions regarding the safety of the people exposed, the necessity for prophylaxis and the appropriateness of laboratory testing.