Occupational Health Hazards of Commissioned Corps Officers in a Field Medical Station

1
Occupational Health Hazards of Commissioned Corps
Officers in a Field Medical Station

• CDR Nancy Sahakian MD, MPH (FOH)
• CDR Lisa Iwaszko (FDA)

2
Overview

• Mission goals
• RDF-2 team composition
• Occupational health hazards
• Recommendations

3
Mission Goals for RDF-2

• Set up two Federal Medical Stations (FMS)
• one for use by RDF-3
• one for use by RDF-2
• Care for special needs persons evacuated prior to
  landfall of Hurricane Gustav
• Maintain state of readiness to receive special
  needs persons evacuated prior to landfall of
  Hurricane Ike

4
Chain of Command
Governor of Louisiana
Incident Response Coordination Team (IRCT)
RDF-2
HHS had committed 600 FMS beds to the Governor of
Louisiana
5
RDF-2 Sections

• Command Staff 8
• Planning 8
• Administration/Finance 11
• Logistics 14
• Operations 58
• Safety/Preventive Medicine 18

6
Planning and Administration/Finance Sections
7
Logistics Section
provided and logged out supplies as needed by
staff
tri-fold cartons used as barricade
jack pallet used to move heavy containers
8
Operations Section
barricade
9
Safety/Preventive Medicine Section
Electrical outlets above ground level outdoors
Mastak tape over cords
Musculoskeletal injury
10
RDF-2 Deployment

• 8/29 left DC
• 8/30 set up 150 bed FMS in Baton Rouge LSU
  sports arena
• 8/31 set up 200 bed FMS in Alexandria
  convention center and received 123 evacuees (99
  special needs persons and 24 caregivers)
• 9/1 Hurricane Gustav makes landfall in SE
  Louisiana
• 9/1 181 evacuees (135 special needs persons, 46
  caregivers)
• Set up 100 extra cots for surge
  capacity
• 9/4 began discharging patients
• 9/6 47 occupied beds
• 9/11 all evacuees discharged. Waiting to be
  released as a LA asset (there was a possibility
  that the FMS was we utilized in response to a
  Hurricane Ike evacuation).
• 9/13 Hurricane Ike makes landfall in Galveston,
  TX
• 9/14 pack up durable equipment and unused
  supplies
• 9/15 return home

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Occupational Health Hazards

• Sleep deprivation
• Poor nutrition
• Biohazards
• Environmental conditions
• Musculoskeletal strain

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Sleep Deprivation
13
Sleep deprivation
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Causes of Sleep Deprivation

• Long travel schedule
• Long initial work hours
• 12-hour work schedule
• Shared sleeping area for day and night shift
  workers
• Uncomfortable cots

15
First 3 Days

• 8/28 1300 hours Team officially activated
• 8/28 2200 hours E-mail telling us o go to bed
  and not wait for travel orders
• 8/29 2300 hours Depart from DC
• 8/30 0100 hours Arrive in Baton Rouge
• 8/30 0300 hours Billeted at FEMA Carville, LA
  facility
• 8/30 0730 hours Blue team departs for Baton
  Rouge LSU sports arena to set up FMS
• 8/30 1800 hours Blue and Gold Teams travel to
  Alexandria
• 8/30 2100 hours Arrive at Alexandria Riverfront
  Convention Center and begin to set up FMS
• 8/31 0600 hours Gold team begins day shift
  rotation and begins receiving evacuees. Blue
  team goes to bed.
• Blue Team Work/travel 48 hours
• continuously (except for 3 hours sleep) then
• assigned to night-shift for deployment

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Staff Sleeping Area
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Poor Nutrition

• Non-nutritive
• Greasy
• Spoiled
• Monotonous
• Unpalatable
• Less available for PM shift

18
Over-cooked vegetables
19
Grease
20
Unpalatable food
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Spoiled produce
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Biohazards

• Misuse of porta-sinks resulting in overflow
• Misuse of biohazard receptacles resulting in
  overflow and potential sharps injury
• Misuse of laundry bins

23
Protection against biohazards
disinfectant spray
sharps container
Biohazard trash receptacle
24
Sharps Needle Survey

• Diabetic patients (N20)
• Insulin-dependent patients (N10)
• Self-administered insulin (N6)
• - Spoke with 4 of 6 (67)
• - All disposed of needles in general or
  biohazard trash
• ACTION
• Patients educated on proper disposal
• Individual-sized sharps containers ordered

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Porta-sinks
Supply
Wastewater
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Laundry Bins
cotton blankets
bath towels
wool blankets
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Cold ambient temperature
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Hypothermia Patient Study

• Room temperature
• - as low as 66.0ºF
• - as low as 68.9ºF after additional heater
  turned on
• Patient study
• - 24 non-ambulatory persons from all
  sections of
• the room were selected for the
  study
• - 23 of 24 (95) participated

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Patient Hypothermia Study (N23)
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Musculoskeletal pain among staff

• Uncomfortable cots
• Unpacking/ repacking supplies and equipment
• Patient transfers

31
Patient Beds
Improvised bariatric bed
Standard hospital bed
Cots
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Cot construction

• Lightweight aluminum construction
• - collapses if patient is obese
• - difficult to reposition patient without
  securing cot

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Low cot height

• Poor body mechanics with patient transfers

cot
18
22
17
34
Unused mechanical patient lift
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Patient Lifting Study
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Actions

• Ordered and received standard hospital beds
• Trained staff on how to use a mechanical patient
  lift and proper patient transfer techniques

37
Recommendations for staff billeting

• Provide all staff with air mattresses
• Provide a sleeping area for staff sufficient in
  size to allow a minimum of 3 feet between beds

38
Recommendations for nutrition of staff

• Allow staff to purchase food from local grocery
  stores
• Date and refrigerate nutritious food (e.g. canned
  or fresh fruit) provided by food vendors not
  consumed at one meal

39
Recommendations to minimize back injuries of staff

• Include in cache
• sufficient number (15) of hospital beds or
  bariatric beds
• mechanical patient lift with a smaller base (more
  maneuverable in bathroom)
• disposable patient belts for mechanical patient
  lift so that patients can be hoisted on to the
  toilet seat

40
Recommendations to minimize back injuries of staff

• Train staff prior to and during deployment
• on
• proper use of the mechanical patient lift
• proper patient transfer techniques

41
Log and track staff injuries and illness
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Recommendations to minimize biohazard risks

• Include individualized size sharps containers in
  cache
• Instruct patients using insulin on the use of
  sharps containers upon admission
• Instruct staff on what is biohazardous trash
  prior to and early in deployment

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Thank You!