1. Dr Stephanie Schlueter/ Dr Deanne Chiu
CME 20th March 2014
Sir Charles Gairdner Hospital
Emergency Procedures
CODE: CBR
PPE

2. Outline
• Case presentation
• Brief review of the response of SCGH ED to a CBR incident
• Demonstrate PPE required for a CBR response
• Practice Donning & Doffing

3. Case
0810 hrs: RED Phone rings
“ This is T.S. from the Department of Health:
Canisters containing unknown substances have been detonated at Fraser
Restaurant during the CHOGM morning breakfast meeting.
Expect Mass Casualties
Symptoms range from D&V to full cardiac arrest “
Outline your approach

4. Emergency Department Process
Code Brown/ CBR
Phases:
1. Notification
2. Preparation
3. Receival
1. Recovery

5. Emergency Department Process
Code Brown/ CBR
Phase 1- Notification
• Official phone call
• Name, Title and telephone number of caller
• Major incident declared or only potential
• Exact location of the incident
• Type of incident
• Hazards
• Access to site
• Number & type of casualties & expected arrival times
• Emergency services (present & required)
“ METHANE ”

6. Emergency Department Process
Code Brown/ CBR
• Confirmation
• DPMU/State Health coordinator
• Log onto WEBEOC- http://myeoc.health.gov.au/eoc7
• Activation
• Dial “55”- activate Code Brown
• Request to speak to Hospital Health Coordinator
• Switch will activate Emergency Response Team (ERT) and Emergency
Control Group (ECG)
• Code CBR announced over PA system

7. Emergency Department Process
Code CBR
Objectives:
– Modify workflow and resources
– Provide the greatest benefit for the most number of casualties
– To provide a Hospital Response Team (HRT) +/- Health Commander if
requested
– To return to a normal working environment as soon as possible
– To attend to welfare of relatives of patients and staff

8. Emergency Department Process
Code CBR
Phase 2- Preparation
• Meet with Emergency Response Team
• Review Code CBR Plans & Equipment
• Hospital Lockdown
• Brief ED staff
• Command and Communication
• Action Cards
• Prepare space
• Decanting ED safely
• Rearrangement of geographic function
• Teleconference
• Expand Resources
• Staff
• Hospital
• Equipment

9. Donning
PPE- CBR
• One Piece Positive Pressure Coverall
• Inner Butyl Gloves
• Pipe
• GIAT PAPR - Respirator C420
• Belt Assembly
• 2 Filter Cartridges per unit
• Lithium Battery

10. Before you get started
• Response Briefing - Know what you are going to do!
• Change into scrubs
• Drink 2 glass of water
• Go to the toilet
• Have your vital signs taken by the Safety Officer

11. PPE Heat Load Generation
- Body temperature rises 1.5 times as fast.
- Heart rate increases 80 per cent.
- Endurance times are reduced by 60 per cent.
- Weight loss is 40 per cent higher.
- Perspiration evaporation is halved

12. Heat related illness
• Warning signs will include:
• Changes in gait (staggering),
• Changes in speech (slurring)
• Changes in behaviour (erratic)
Many of these difficult to monitor in PPE – this makes
observation by “buddy” and use of a safety officer important.

13. PPE Hazards
• Impaired visibility
• Impaired mobility
• Impaired communication
• Sensory Impairment
• Psychological stresses (such as claustrophobia).

14. OHS- Requirements
• Maximum work time in PPE 30 minutes
• Minimum rest time 30 minutes
• Rest area
If any person is injured/unwell/feeling faint:
• Sit down where you are
• CODE WORD: NO DUFF
• All participants to stop what they are doing & await further instructions
• Exercise Controller to assess injured; and announces if exercise resumes if safe
to do so

15. Doffing
• Always self decontaminate in the suit first
• The suit and PAPR are waterproof
• Undo your boots and unzip the suit to your waist
• Undo your PAPR belt
• Remove your arms from the sleeves and lift your head off -
Try to touch the inside of the suit only
• Step out of the suit
• Continue decontaminating

16. QUESTIONS

17. Summary
• Challenging & overwhelming situation
• Be familiar with the Emergency Procedures Manual
• Regular practice of Donning & Doffing for medical staff is
essential
• Your safety 1st !!!
• Participate in any Disaster Exercise & MIMMS course

18. References
1. MIMMS Handbook, 2nd Edition
2. SCGH – CODE CBR , Emergency Procedures Manual, July 2009
3. Emergency Management Australia
Victoria DoH
Health Services Personal Protective Equipment and Decontamination
Hospital Staff Training Course Presenters Guide
A special thanks to
• Simone Thurkle (SDN)
• Gaby Hutchinson (SDN
• Emma Kubale (SDN)
for their time, experience and materials in preparation of this exercise.