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May 27, 2011

Into the Hot Zone with Fletcher Allen's Hazmat Decontamination Team

FAHC photo #3 8:03 a.m. Wednesday morning: I'm about to get thoroughly soaped up, scrubbed down and hosed off by a grown man for the first time since I was a child. No, this doesn't reflect some radical, new lifestyle choice on my part — not that there's anything wrong with that, of course. Actually, it's an opportunity for me to help out the folks at Fletcher Allen Health Care Emergency Department in their regular hazardous materials decontamination training.

FAHC photo #5 Each month, the hospital's decon team suits up in its terrifyingly sci-fi-looking haz-mat gear and drills for a worst-case scenario, such as an overturned gasoline tanker on I-89 or a chemical explosion in a University of Vermont lab. The goal, explains John Berino in Fletcher Allen's Environmental Health and Safety office, is to put their safety team through its paces, in real time, in order to see what goes well and who forgot to duct tape their plastic trousers to their booties. Because if you're going to get an accidental snoutful of concentrated hydrochloric acid, better for it to happen during a drill than when real lives are on the line.

On a personal note, this was also payback for my years of working as a park ranger, EMT and search & rescue volunteer, during which I routinely tapped friends, co-workers and even my dog to serve as mock patients during similar mass-casualty drills. Call it critical-care karma.

Shortly after my arrival, Berino informs me that I'll be the first patient going through the inflatable blue tent. For drill purposes, I'm ambulatory, which means that I'm up and walking, breathing well, and get to remove my own clothing. That's a bit better than having some 6' 2" guy with thick rubber gloves and scissors that can cut through a soda can snip them off for me — "Hey! I LIKED those jeans!" — and possibly take off a minor appendage in the process.

Within minutes of my "arrival" at the emergency department ambulance bay, I'm up against a wall in the "hot zone" room. Basically, it's a negative-pressure room just off the ER that operates on its own ventilation system to keep hazardous vapors from circulating throughout the rest of the hospital. There's a shower, a high-pressure hose, some screens for privacy and a drain for catching the toxic soup that washes off patients and equipment.

What follows is a dramatically modified version of the Silkwood treatment: a warm shower complemented by a real weenie-shrinker of a hose-down. Next, my plastic-wrapped manservant/decon expert scrubs me with a hard plastic brush and Dawn dish soap — according to one member of the hospital staff, it's the best product for removing contaminants from the skin — followed by another washing and a towel wrap. From here, I'm led into the "warm zone," where my toxic towels are swapped with clean ones, whereupon I'm "admitted" into the ER for treatment.

FAHC photo#1 Considering that I woke up at 6:30 a.m. for this little exercise, my whole haz-mat adventure is over disappointingly quickly. Nevertheless, once my role as "patient" is complete, I'm allowed to observe as other, non-ambulatory patients are carried in on stretchers and backboards, their clothing surgically excised from their bodies, and are then similarly soaped and scrubbed for treatment and admittance. In a real-life haz-mat scenario, modesty is no one's top priority, but thankfully during this drill, no one gets to see just how cold the water is.

FAHC photo#4 After all six patients have been decontaminated and wheeled into the hospital proper, the entire decon team gathers in a hallway outside the ER for a "hot wash," or debriefing, on how the drill went. Clearly, Berino is pleased with the results.

"Within eight minutes we had someone suited up and in the ambulance bay ready to assist," Berino tells his people. "That's absolutely incredible. Our best time yet."

Next, the team discusses a few minor snafus that arose — only one scrub brush, not enough soap or towels — as well as some more important concerns, including the difficulty of lifting and transferring a heavy patient (including one who weighs over 240 lbs.) and communicating with a patient while wearing the plastic bunny suits.

Most importantly, the team also seeks feedback from the patients about how we felt the drill went.

"I felt pretty comfortable," says Sarah Lamb, a non-ambulatory victim who was supposedly exposed to some unknown chemical agent and was being treated for a broken arm. Lamb, 22, is also an EMT from Jericho who volunteers with Richmond Rescue, who says she wanted to get a patient's perspective on things. "No one was just standing around asking questions," she adds. 

Another patient volunteers that she really appreciated having a nurse outside at her side to talk to her and give her an icepack, though she admits she could have used a blanket to keep her warm, especially if she were in shock. 

During the drill, that nurse was Sue Mullen, an RN who's worked at Fletcher Allen for 38 years. Though she's not officially a member of the decon team, Mullen says she participates in virtually all the haz-mat drills just to keep her skills sharp. 

Mullen admits that's it's always a little scary when patients come in with a chemical exposure, especially if it's a scenario like this one, in which the contaminant is unknown. Still, going through the paces makes everything go smoother.

Mullen knows what those real-life scenarios are like. On May 27, 2007, a fire broke out in a UVM lab over Memorial Day weekend, sending 14 firefighters and one UVM police officer to the ER for decontamination and treatment.

"We still talk about the fact that I hit the showers with the whole fire department," Mullen jokes. "“I never showered with so many guys in my life."

So Ken has UVM told you how many and what types of hazardous materials they keep on campus? Seems to me that any sigificant incident on campus would have the potential to contaminate and shutdown our only hospital.

Actually, Tim, a discussion of what types, and what quantities of, hazardous materials are kept at UVM wasn't a part of this exercise. That said, whenever a hazmat team goes into a situation of this kind, determining the chemical(s) involved (and how they can potentially interact) is always a key component. That's why UVM labs are required to keep material safety data sheets on hand, and why trucks carrying hazardous materials bear the DOT placards with four-digit identifiers.

Here's my vote for you,as the press, to ask. You might be surprised what's lurking up there.

The Burlington Fire Dept. keeps records about what hazardous materials are stored where because they need to know what's in a building before they go in.

Unless I'm mistaken, this is public information.

Actually, one of the most if not the most haszardous chemical on the hill is found in both places... Botox, disrupts intracellular process and is used in scientific research. It also has obvious medical applications for those so inclined, but its main function is paralysis at a very low dose.

UVM labs don't report most hazardous materials to the fire department. Maybe some of the really toxic stuff, but nothing in any lab where I've worked. Environmental safety might, but they only check in with the lab a few times a year. Typically, the only requirement for the lab manager is to clearly label containers and have a red MSDS binder near the door, with a sticker on the door showing exactly where it's located. The information in that binder would be much more up to date than anything the fire department might have on file.

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