Biological Incident Addendum
This module was developed by the Johns Hopkins Evidence-based
Practice Center under Contract No. 290-02-0018 from the Agency for Healthcare
Research and Quality, Rockville, MD. The content of this module is intended
to provide guidance for hospital disaster drill evaluation and should not be
construed as representing standards of care or recommendations on how to respond
to specific types of disasters. No statement in this module should be construed
as an official position of the Agency for Healthcare Research and Quality or
of the U.S. Department of Health and Human Services.
Instructions: Attach to Incident Command, Triage, and Treatment Zone Modules for biologic drills.
Note: Circle
or check (_) as indicated. Y = Yes; N = No; U = Unclear;
NA = Not applicable
Observer: ______________________________________________________________ Date: ____/____/____
Observer title: ___________________________________________________________
Zone: __________________________________________________________________
Hospital: _______________________________________________________________
Period of time of evaluation: _____________ AM / PM (Circle one)
to _____________ AM / PM (Circle one)
|
Time Points
| Event |
Time |
BA1. Time that the zone became aware that
victims were affected by a biological illness: (Circle
one) |
_____________ AM / PM / U |
Comments (if comment refers to a specific item, give the item number):
|
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Information Flow
| Question |
Response |
| BA2. Was the incident commander
informed that a biological illness was present? |
Y / N / U |
BA3. How was the incident
commander notified? (Check all that apply)
|
a. [ ] FAX sent
b. [ ] E-mail sent
c. [ ] Person-to-person contact
d. [ ] Telephone message
e. [ ] Unclear
f. [ ] NA
g. [ ] Other (specify):
________________________________ |
BA4. If the incident commander
was informed of a biological illness, how long after the biological illness
was suspected did notification occur? (Check one) |
O < 30 min |
| O 30-59 min |
| O 1-2 hrs |
| O > 2 hrs |
| O Unclear |
| O NA |
BA5. Was the hospital epidemiologist
or designee informed that a biological illness was present? |
Y / N / U |
BA6. How was the hospital
epidemiologist or designee notified? (Check all
that apply) |
a. [ ] FAX sent
b. [ ] E-mail sent
c. [ ] Person-to-person contact
d. [ ] Telephone message
e. [ ] Unclear
f. [ ] NA
g. [ ] Other (specify):
________________________________ |
BA7. If the hospital epidemiologist
or designee was contacted, how long after the biological illness was suspected
did notification occur? (Check one) |
O < 30 min |
| O 30-59 min |
| O 1-2 hrs |
| O > 2 hrs |
| O Unclear |
| O NA |
Items BA8-16 are intended for the Incident Command Zone observer only. Observers in other zones should skip to item BA17.
| Question |
Response |
| BA8. Was the local and/or
State health department informed that a biological illness was present?
|
Y / N / U |
BA9. How was the local and/or
State health department notified? (Check all that
apply) |
a. [ ] FAX sent
b. [ ] E-mail sent
c. [ ] Person-to-person contact
d. [ ] Telephone message
e. [ ] Unclear
f. [ ] NA
g. [ ] Other (specify):
________________________________ |
BA10. If the local and/or
State health department was informed, how long after the biological illness
was suspected did notification occur? (Check one)
|
O < 30 min |
| O 30-59 min |
| O 1-2 hrs |
| O > 2 hrs |
| O Unclear |
| O NA |
BA11. Was the Centers for
Disease Control and Prevention (CDC) informed that a biological illness
was present? |
Y / N / U |
BA12. How was the CDC notified?
(Check all that apply) |
a. [ ] FAX sent
b. [ ] E-mail sent
c. [ ] Person-to-person contact
d. [ ] Telephone message
e. [ ] Unclear
f. [ ] NA
g. [ ] Other (specify):
________________________________ |
BA13. If the CDC was informed,
how long after the biological illness was suspected did notification occur?
(Check one) |
O < 30 min |
| O 30-59 min |
| O 1-2 hrs |
| O > 2 hrs |
| O Unclear |
| O NA |
BA14. Was occupational health
informed that a biological illness was present? |
Y / N / U |
BA15. How was occupational
health notified? (Check all that apply) |
a. [ ] FAX sent
b. [ ] E-mail sent
c. [ ] Person-to-person contact
d. [ ] Telephone message
e. [ ] Unclear
f. [ ] NA
g. [ ] Other (specify):
________________________________ |
BA16. If occupational health
was informed, how long after the biological illness was suspected did notification
occur? (Check one) |
O < 30 min |
| O 30-59 min |
| O 1-2 hrs |
| O > 2 hrs |
| O Unclear |
| O NA |
Comments (if comment refers to a specific item, give the item number):
|
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Materials and Supplies
| Question |
Response |
| BA17. Were needed vaccines
available within the hospital? |
Y / N / U / NA |
BA18. Were vaccines requested
from an outside source? |
Y / N / U / NA |
| BA19. If vaccines were requested
from an outside source, did they arrive? |
Y / N / U / NA |
BA20. What was the approximate
time between request and delivery of vaccines from the outside agency? (Check
one) |
O < 2 hours |
| O 2-6 hours |
| O 7-12 hours |
| O 13-24 hours |
| O > 24 hrs |
| O Did not arrive |
| O NA |
Comments (if comment refers to a specific item, give the item number):
|
If using BIOLOGICAL INCIDENT ADDENDUM in
the INCIDENT COMMAND ZONE, STOP HERE, do not complete the rest of module.
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Victim Diagnosis
| Question |
Response |
| BA21. Was the cause of the
suspected biological illness known prior to the arrival of affected victims
in this zone? |
Y / N / U |
BA22. If the cause of the
illness was not known prior to victim arrival, how long after the first
victim arrived was the cause of the illness identified? (Check
one) |
O < 1 hr |
| O 1-4 hrs |
| O 5-8 hrs |
| O > 8 hrs |
| O Never Identified |
| O NA |
BA23. What was the cause of
the illness? (Check all that apply) |
a. [ ] Anthrax
b. [ ] Botulism
c. [ ] Plague
d. [ ] Severe Acute Respiratory Syndrome (SARS)
e. [ ] Smallpox
f. [ ] Tularemia
g. [ ] Viral hemorrhagic fever
h. [ ] Unknown
i. [ ] Other (specify):
________________________________ |
BA24. What resources were used to make
the diagnosis(es)? (Check all that apply)
|
a. [ ] Consultation with an in-hospital expert
b. [ ] Consultation with an expert from another hospital
c. [ ] Consultation with an expert from local health department
d. [ ] Consultation with an expert from State health department
e. [ ] Consultation with the Centers for Disease Control and
Prevention (CDC)
f. [ ] History and physical exam by the treating physician
g. [ ] Microbiological data
h. [ ] Radiologic data
i. [ ] NA
j. [ ] Other (specify):
________________________________ |
BA25. Were cameras used in
the drill to document cases? |
Y / N / U / NA |
Comments (if comment refers to a specific item, give the item number):
|
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Safety: Isolation Precautions
| Question |
Response |
| BA26. Was isolation required for the suspected
biological illness involved? (Isolation required for smallpox, plague,
viral hemorrhagic fever, certain pneumonias or rashes, and other symptoms
suggestive of a contagious infectious outbreak.) |
Y / N / U |
| BA27. If isolation was required,
were victims transported into an isolation room? |
Y / N / U / NA |
BA28. If they were transported
to an isolation room, was the room under negative pressure? |
Y / N / U / NA |
If no isolation was required, skip to the Screening and Prophylaxis section.
| Question |
Response |
| BA29. Were there enough isolation
rooms? |
Y / N / U |
BA30. If not enough isolation rooms, how
were victims isolated? (Check all that apply)
|
a. [ ] Conversion of other rooms/area (specify):
________________________________ |
b. [ ] Existing isolation room in other area (specify):
________________________________ |
| c. [ ] Overflow victims not isolated |
| d. [ ] Victims with the same suspected biological illness
placed in the same isolation room |
| e. [ ] NA |
f. [ ] Other (specify):
________________________________ |
BA31. Were there signs on
victims' doors that described the type of isolation required? |
Y / N / U |
| BA32. Were sign-in sheets
placed at each isolation room door? |
Y / N / U |
BA33. Did health care workers
sign in and out? |
Y / N / U / NA |
| BA34. Were any breaches in isolation precautions
identified? (If there were any breaches in the isolation precautions, specify
in comment box at end of this section.) |
Y / N / U |
| BA35. Were victims with similar
symptoms grouped together in the zone? |
Y / N / U / NA |
BA36. Were unaffected patients
removed from areas with affected victims? |
Y / N / U / NA |
| BA37. Were precautions taken
when handling materials or equipment that came into contact with potentially
infected victims? |
Y / N / U |
BA38. Were masks supplied
to unaffected victims in this zone? |
Y / N / U / NA |
| BA39. Were lists of exposed
and non-exposed victims generated? |
Y / N / U |
BA40. Did representatives
from infection control arrive in the zone to assess the appropriateness
of isolation precautions? |
Y / N / U |
Comments (if comment refers to a specific item, give the item number):
|
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Safety: Personal Protective Equipment (PPE)
| Question |
Response |
| BA41. Given the suspected biological illness,
was PPE needed to protect health care workers?
(Isolation required for smallpox, plague,
viral hemorrhagic fever, certain pneumonias or rashes, and other symptoms
suggestive of a contagious infectious outbreak.)
If needed, were these safety materials available for the health care workers? |
Y / N / U |
If a safety item was not available, circle "N"
in column "a" and go to the next row.
| Safety Materials |
a. Available? |
b. Used by staff? |
c. Adequate Supply? |
| BA42. Passive (negative pressure)
filtration (e.g., N95 or N99 masks) |
Y / N / U/ NA |
Y / N / U/ NA |
Y / N / U/ NA |
| BA43. Powered (positive pressure)
filtration (e.g., PAPR) |
Y / N / U/ NA |
Y / N / U/ NA |
Y / N / U/ NA |
| BA44. Self-contained breathing
apparatus |
Y / N / U/ NA |
Y / N / U/ NA |
Y / N / U/ NA |
| BA45. Level B or higher suits
(e.g., heat bound or serged seams) |
Y / N / U/ NA |
Y / N / U/ NA |
Y / N / U/ NA |
| BA46. Other (specify): _______________ |
Y / N / U/ NA |
Y / N / U/ NA |
Y / N / U/ NA |
| BA47. Other (specify): _______________ |
Y / N / U/ NA |
Y / N / U/ NA |
Y / N / U/ NA |
| BA48. Other (specify): _______________ |
Y / N / U/ NA |
Y / N / U/ NA |
Y / N / U/ NA |
| Question |
Response |
| BA49. Did you observe staff
without PPE interacting with contaminated victims? |
Y / N / U/ NA |
BA50. If the staff were interacting
with contaminated victims without PPE, what types of staff were they? (Check
all that apply) |
a. [ ] Ancillary staff
b. [ ] Nurses
c. [ ] Physicians
d. [ ] Did not observe
e. [ ] NA
f. [ ] Other (specify):
__________________________________ |
Comments (if comment refers to a specific item, give the item number):
|
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Screening and Prophylaxis
| Question |
Response |
BA51. Were prophylactic medications
available for staff exposed to plague or anthrax? | Y / N / U / NA |
| BA52. Were prophylactic medications
available for victims exposed to plague or anthrax? |
Y / N / U/ NA |
BA53. Were vaccinations available
for health care workers exposed to smallpox? |
Y / N / U / NA |
| BA54. Were vaccinations available
for victims exposed to smallpox? |
Y / N / U/ NA |
BA55. Where were victims who
needed screening for exposure and/or prophylaxis managed? (Check
all that apply) |
a. [ ] Emergency department
b. [ ] Referred to health department clinic
c. [ ] Referred to hospital clinic
d. [ ] Triage
e. [ ] Other (specify):
________________________________ |
Comments (if comment refers to a specific item, give the item number):
|
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Laboratory Specimens
| Question |
Response |
BA56. How were specimens transported
to the lab? (Check all that apply) |
a. [ ] Hand carried
b. [ ] Packaged for sending to outside labs
c. [ ] Other (specify):
________________________________ |
BA57. Were guidelines available
for packaging and transporting microbiological specimens? |
Y / N / U |
| BA58. Was the "chain of custody"
implemented?a |
Y / N / U |
a Chain
of custody is defined as securing items continuously and marking evidence
gathered by date, time, location, and when, how, and by whom acquired. It
includes signatures of all persons successively responsible for custody.
It must be conducted so the validity of the chain of custody will hold up
in court.
Comments (if comment refers to a specific item, give the item number):
|
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