Here’s how one ED manages suspected anthrax patients
Here are the steps that take place in the ED at North Broward Hospital District in Fort. Lauderdale, FL, when a patient calls 911 to report possible anthrax exposure:
The ED is notified to expect a patient who reported being exposed to an unknown powdery substance. Staff are informed that gross decontamination has occurred at the scene. (If a patient comes directly to the ED saying he or she has been exposed to anthrax, HazMat is called because the ED doesn’t have the required level of protective gear to do gross decontamination. HazMat then comes and sets up a gross decontamination area in the ED parking lot.)
The ED sets up its decontamination area outside the department, to protect staff and patients from contamination.
A minimum of two staff members get dressed in protective gear, including protective suits, masks, goggles, gloves, and boots, with two staff members assisting them in dressing.
When the patient arrives, ED staff tell the emergency medical services (EMS) unit that the patient may be offloaded.
If the patient is hemodynamically stable with vital signs within normal limits, then EMS personnel, in full protective gear, walk the patient into the decontamination area. (The area between the EMS unit and the decontamination area is designated as the "red zone," where the highest level of contamination may occur, so only individuals who are in full protective gear can enter.)
The patient goes through another fine decontamination washing series before being brought back to treatment areas. ED staff continue with scrubbing the patient, including underneath the fingernails.
The patient’s clothing and belongings are put into biohazard bags, and the patient is dressed in paper disposable scrubs.
The patient is then moved from the "red zone" into the "yellow zone." (In the yellow zone, staff don’t have to be dressed in full protective gear, but there is still the potential for contaminants).
The patient is moved into the "green zone" which is low risk for contamination. A nurse walks the patient to a treatment room, usually an isolation room with reverse airflow.
The patient is assessed by the physician.
Unless the patient is symptomatic with joint pain, cough, or fever, he is discharged. If he is symptomatic, he is worked up as an infected patient, and steps are taken to determine what caused the infection.
The patient is given a discharge information sheet with a hotline number for the state department of health.
(To see "Children and Anthrax: A Fact Sheet for Parents," click here. Also, see "Frequently asked questions about anthrax" in this issue.)
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