When disaster strikes, is your lab prepared?

Medical Laboratory Observer, Jan, 1995 by Kathryn Miara-Rezutek, Karen Montoya, Michael Cross

A leaking vat of formalin forced these laboratories to evaluate and seal off their lab. Later, they reevaluated their emergency preparedness.

LAST YEAR OUR HOSPITAL LABORATORY experienced the unthinkable--a chemical spill that resulted in the complete shutdown of all laboratory functions. For nearly 8 hours, we were unable to go near the lab, let alone perform tests or issue blood. Although we have disaster procedures for all types of events, a chemical spill serious enough to cause a complete and lengthy evacuation of the laboratory seemed to be an extremely remote possibility at best.

We discovered to our dismay that not only does the remotely possible happen, it often does so at a time of day when all safety and administrative personnel have gone home, leaving immediate decision making and responsibility to those technologists and technicians on duty. How we respond depends on our training in disaster scenarios, the accessibility of necessary information, and the existence of backup plans.

* Flawed plans. Our intention in writing this article is to point out the flaws that may be present in even the best-written disaster procedures. Even though we try constantly to be optimally prepared for disaster through training, drills, safety manuals, etc., in most instances we have no way of knowing how ready we are until the actual disaster occurs. To help prepare others, we have included here:

* A brief overview of the events that took place on an otherwise normal Monday evening in the laboratory of our small Wisconsin hospital

* The response and actions of those involved

* An in-depth, retrospective review of our emergency/disaster preparedness, and consideration of what measures would have improved what was already a quick and appropriate response to a crisis.

* Chemical odor. The first sign that something was amiss was a chemical odor coming from the pathologist's office, which is located in the back of the lab. (Our layout puts all sections in one large open area; there are three offices in the back and a phlebotomy/reception area in the front.)

When author Miara-Rezutek entered the office to investigate the smell, she experienced immediate burning in her eyes and respiratory tract. Coughing and temporarily blinded, she left the office, shut the door, rinsed her eyes in the eyewash station, and tried to determine the source of the chemical fumes. After placing several calls to technologists who were more familiar with the pathologist's office, she discovered that the chemical was most likely formalin from a 5-gallon container.

She and author Montoya then searched for the safety manuals to find the procedure for handling a major chemical spill. Ironically, however, the manuals were stored in what had become a highly contaminated part of the laboratory. In retrieving the manuals, the authors were once again significantly exposed to the chemical fumes. Miara-Rezutek and Montoya--the laboratorians, along with a phlebotomist, on duty that evening--were administered inhalation therapy in the ER. Fortunately, following this treatment, there were no long-term adverse effects.

* Lab sealed off. We evacuated the lab and notified other hospital staff. The maintenance department shut down the air handling units in the laboratory. They also helped us seal off all doorways and windows with wet blankets to keep vapors from seeping into the main hospital corridors.

We posted warning signs on all laboratory entrances to prevent other hospital personnel from entering and becoming exposed. The emergency room RN supervisor, who was accustomed to handling crises, then called the fire department. Upon their arrival, we told them that the chemical was probably formalin but that we were unsure of the quantity spilled. The fire department determined our accident to be a level B chemical spill. Unable to deal with this serious a problem, they called in a hazmat (hazardous materials) team from another part of the state. The fire fighters then sealed off all hallways leading to the lab.

* Contingency lab created. When the hospital administrators realized the lab would not be functioning for a lengthy time, they made arrangements for a neighboring medical practice to serve as a contingency lab for Stat tests. Other area hospitals were notified of our situation and readily agreed to do any tests we needed that could not be done at the medical office.

The hazmat team finished decontamination procedures about 8 hours after we first noticed the spill. They determined that approximately 4 gallons of formalin had leaked out of the container onto the carpeting, which they subsequently removed for disposal. Once the fumes had dropped to nontoxic levels following ventilation of the area to the outside, we were allowed to go into the lab for short periods of time to do necessary testing. By the time the Tuesday day shift arrived at 6 am, operations were back to normal.

* Minimal service interruption. Everyone involved in the response and cleanup performed in a quick and level-headed manner, minimally interrupting patient care. In fact, patients and many of the hospital staff not immediately involved were never aware that a crisis existed.