FROM THE BENCH
Preparing and Practicing for Chemical Threats in Florida
By Lylah J . Seaton , MPH , MLS ( ASCP ) CM , chemical threat laboratory manager , Florida Bureau of Public Health Laboratories-Jacksonville ; Angela Ren , MS , chemical threat preparedness coordinator , Florida Bureau of Public Health Laboratories-Tampa ; and Michelle Latona , MPA , MT , chemist / chemical threat coordinator , Florida Bureau of Public Health Laboratories-Jacksonville
The Florida Bureau of Public Health Laboratories Chemical Threat ( CT ) group annually hosts the statewide Chemical Threat Exposure Exercise ( CTEE ), which simulates a widespread chemical exposure event and tests the emergency response plans of Florida hospitals and their ability to receive and treat patients . As part of the exercise , hospitals have an opportunity to practice collecting and shipping specimens to the Jacksonville CT laboratory where they are evaluated by the staff using the Laboratory Response Network ’ s Chemical Specimen Packaging and Shipping Exercise ( SPaSE ) criteria .
An Annual Undertaking
With the CTEE normally conducted during the last week of February or the first week of March , the initial planning starts in the fall . Participants get an overview of the planned exercise on an initial conference call , including the date of the exercise , location of the chemical release , numbers of patients affected , the chemical agent and the routes of exposure . The information gathered from the call is used for developing documents to be used in the exercise , including an exercise plan , controller-evaluator handbook , exercise evaluation guide , and participant feedback survey . These documents , generated using Homeland Security Exercise and Evaluation Program guidelines , are then emailed to the participants .
Participants meet two more times via conference call . After the second call , a list is compiled of the activities each facility wants to participate in during the exercise . Activities may include phone call drills to the Poison Information Center or testing a facility ’ s incident command system or emergency department patient surge capacity . The facility can select as many activities as they wish to exercise and have the option to create some of their own . Hospitals participating in the SPaSE are sent email attachments including manifest for specimens , collection flowchart , the “ FL Just in Time Training Manual ” and an example of the scoring / points for the activity . The final call serves to reiterate the exercise dates / times , make announcements or important reminders , provide a summary of activities occurring and review action items , such as feedback forms . This call will help answer questions the participants have regarding the overall exercise , and also remind everyone to take “ action photos ” that may be used in future trainings .
Many facilities participating in the specimen collection , packaging and shipping activity also express interest in attending a one-hour chemical threat outreach training that is offered by the Chemical Threat coordinators located in Jacksonville and Tampa . Hospitals and other facilities contact the coordinators to schedule on-site training for their group in order to best prepare for their CTEE SPaSE . This course briefly covers the history of chemical terrorism and details the different types of toxic agents that can be found during a chemical exposure . APHL ’ s Chemical Agents poster
and realworld examples from the news are used to describe potential threats for the first 30 minutes of the course . The second half is a hands-on demonstration , where the trainer acts as a facilitator , while participants work in groups and follow the manual to properly collect , package and ship both types of clinical specimens . Most of the trainings occur in January and February before the start of CTEE . The trainers also get requests for training throughout the year . For instance , if a facility onboards new staff or if the hospital lab director was not satisfied with their CTEE SPaSE score , they may request additional training .
Preparing to Respond to Mustard Gas
The 2022 CTEE scenario involved the accidental release of sulfur mustard gas when a canister was unearthed during an excavation in a densely populated area with an elementary school , shopping center and elder care facility nearby . In Florida , a cooling mist system is typically employed for the perimeter of a site to keep the construction area cool and reduce dust . In the scenario , this misting system aerosolized the liquid sulfur mustard , which affected a widespread area of the population .
Twenty-six hospitals , two county health departments and three poison information control centers — totaling almost 350 individuals — participated in the exercise . The Jacksonville CT laboratory received and evaluated 16 packages from participating facilities and each one received a scored SPaSE report so they could learn from this experience .
The creators of the CTEE purposely keep the scenario vague , so facilities can enhance their response to the exposure . For example , one hospital added a “ shelter in place ” component and another facility tested their continuity of operations plan based on the event by closing local roadways .
On the last day of the exercise , there was a conference call where participants shared what worked well and described any problems they experienced . The exercise was very well received with positive feedback from many of the participants . The 2023 CTEE runs February 28 through March 3 and Volatile Organic Compounds ( VOC ) is the selected chemical agent . The scenario involves jet fuel inhalation and direct skin / eye contact with a rapid onset of symptoms . Hundreds of patients of all ages will begin presenting to “ your local hospital ” with mild to severe symptoms . g
6 LAB MATTERS Spring 2023