Essays

Principles/Purpose of Hospital Hazards Management Planning 1. BACKGROUND As a matter of general public health policy, waste minimization, recycling, and reuse are the preferred methods for reducing the volume of hazardous wastes and associated public health hazards. However, it is recognized that not all hazardous waste can be eliminated and that wastes need proper management and disposal. In some situations, such as the remediation of hazardous waste at Superfund sites, a review of all remedial technologies may indicate the use of mobile incinerators as the preferred method of permanently eliminating or reducing potential public health hazards posed by those wastes. Selection of incineration as the remedy of choice for some sites has led to an increased number of requests for health information related to incineration. When selected as a site remedy, incineration should be conducted in a manner that protects human health. 2. PUBLIC HEALTH CONSIDERATIONS With careful attention to design and proper operation of the facility, significant quantities of hazardous waste can be reduced to smaller volumes of material that can be managed safely. With the vigilance of the regulatory community and the involved citizenry, the facility can operate as specified in the CERCLA operation and maintenance plan. 3. PRINCIPALS OF HAZRD MANAGEMENT PLANNING. Develop the Hazard Vulnerability Analysis (HVA). Author Emergency Management Plan to include the following proprietary tools: Emergency Operations Plan (EOP) : o Activation Matrix o Order of Succession o Incident Facilities Matrix o Department Emergency Operation Plans. o HICS Job Action Sheets and HICS Forms Reformat and Organize Critical Event Annexes. Provide a Compliance Matrix 4. Hospital Incident Command System The Incident Command System (ICS) is a standardized, all-hazard incident management system that enables hospitals and others to organize resources, staff and facilities in order to remain operational during an emergency and promote the restoration of day-to-day operations. Planning and consulting services. With proper management, chaos is minimized, normal operations resume sooner, the cost of the event is monitored, safety is maximized, and there is more efficient use of personnel. 5. Hospital Hazards Readiness Preparing for disaster-prone incidents is a daunting task, as unique issues and challenges must be considered for each type of event. Preparedness activities require hospitals to work with different people, solve different problems and use different resources and strategies than those for routine emergencies. 6. Drills / Exercises A comprehensive, systematic exercise program enhances a hospital's readiness posture and moves the organization toward a more resilient stance. Exercises require careful planning and clearly identified goals and objectives in order to effectively evaluate and improve organizational capabilities and performance. For example, an exercise may be developed to test event recognition, management notification, and plan activation procedures. An exercise may also be used to fine-tune incident command capabilities, resource management, and coordination procedures with outside agencies. Outcome measures can be used by the hospital to validate emergency plans and procedures, examine decision-making processes, and evaluate response and recovery capability. 7. Decontamination Planning and Program Development The foundation of a successful emergency decontamination program includes: Clearly articulated response objectives; Comprehensive policy and procedure development; Thorough training; and Resource management Without each of these elements the proficiency of a decon program will wane over time. DQE has guided hundreds of hospitals in implementing an emergency decontamination program. A multidisciplinary team using a combination of remote data review and onsite interviews, facility tour and meeting with key organizational stakeholders accomplishes the project. The final deliverable is a functional Emergency Decontamination Operation Plan that establishes the foundation of your program. Planning and Program Development focuses on the following areas: Notification and plan activation procedures Command, control and communications Response thresholds Special considerations (weather extremes; night decontaminated; ambulatory, semi-ambulatory, and non-ambulatory victims; children; language issues; evidence collection; white powder and radiological events; etc.) Personal Protective Equipment requirements (including respiratory protection; medical surveillance; equipment inspection, maintenance, and replacement; selection and use; etc.) Systems deployment and operations Training (initial and ongoing; various levels of training depending on designated roles and responsibilities) Standard Operating Guidelines/Procedures (e.g., donning and doffing PPE; decontamination; Decon Area setup; Decon Area cleanup; etc.) Decon Team member Job Action Sheets Documentation forms and procedures (product identification forms; pre- and post decon procedural reports; medical surveillance; post-decon cleanup; equipment inspection, maintenance and repair; etc.) Pre, during and post decontamination safety Detection/survey equipment Mutual aid agreements/resources TREATMENT AND DISPOSAL TECHNOLOGIES FOR HEALTH CARE WASTE PRRODUCTS 1. PUBLIC HEALTH CONSIDERATIONS ITEMS The following items should be considered when evaluating incinerators: the technology used or proposed to be used at a site is proven to be appropriate for, and compatible with, the materials to be burned; in selecting a site for a CERCLA incinerator, proximity to residential and other populations and local meteorological conditions is considered to ensure a location that minimizes prevailing wind transport of air emissions to affected populations; recognized, acceptable, and when possible, EPA-approved air modeling is used to help screen and identify potentially impacted areas as mentioned previously; trial burns, with appropriate stack sampling and analysis, and subsequent continuous emissions monitoring are conducted to demonstrate that the incinerator performs as specified; adequate training is provided to incinerator operators to ensure that the incinerator is operated in a manner that does not adversely affect the operators' or the community's health; an active inspection program is instituted; where the incinerator must be at a site close to neighboring populations, local ambient air monitors are used to detect possible site releases to the air requiring corrective or emergency action; Proper management of residual ash is part of the design and operation of the incinerator; and, Procedures consistent with the community right-to-know philosophy are instituted. . 2. INCINERATOR DESIGN AND OPERATING CONSIDERATIONS The goals of the modern hazardous waste incinerator are to reduce or destroy the organic contaminants, and to reduce the volume of waste materials, thus minimizing the amounts of potentially hazardous substances needing final disposal. To achieve those goals, the incinerator must be able to provide controlled burning (combustion) conditions that ensure the proper mixture of air, temperature, and gas, and time to allow thorough destruction of organic constituents to take place. A deficiency in any of those requirements can result in incomplete combustion and the production of smoke and possibly harmful air emissions. Such emissions are a potential public health hazard because nearby communities may be exposed to site contaminants via the air transport pathway. It should also be recognized that human exposure to airborne incinerator contaminants can occur indirectly by consumption of animals or plants raised in areas where deposition of emissions takes place. In addition to the potential health hazard to communities from air emissions of hazardous substances, the design and operation of an incinerator have implications for the workers at the facility. Inadequate work practices and poor industrial hygiene conditions at an incinerator have the potential to cause adverse health effects in workers. 3. STANDERIEZD PROCEADURE/REQIREMENT OF HAZARDEOUS WASTE MANAGEMENT (INCINERATOR) a. Principal Organic Hazard Constituents (POHCs) Also as a part of the hazardous waste incinerator permitting process, certain constituents of the wastes, or POHCs, and operating conditions are selected for trial burns. Trial burns are conducted to demonstrate an incinerator's performance under the worst conditions that would be allowed during future routine operations. POHCs are selected based on their degree of toxicity, their prevalence in the waste mix, and/or their difficulty to burn. A new incinerator must demonstrate, through trial burns, that it can successfully meet all emission standards. For POHCs, that standard is a destruction and removal efficiency (DRE) of at least 99.99%. That means that no more than 0.01% of the selected POHC compounds fed into the incinerator may be emitted to the atmosphere. If polychlorinated biphenyls (PCBs) or dioxins are to be burned, the DRE requirement is 99.9999%. When individual states are authorized to administer hazardous waste incineration regulations, EPA must at least as stringent as those issue such regulations. b. Products of Incomplete Combustion (PICs) When hazardous waste or virtually any other material is burned, products of incomplete combustion (PICs) can be formed. PICs can be partial breakdown products from the waste being burned, or they can be new species of compounds formed by the recombination of other breakdown products. PICs can be relatively harmless, or they can be even more toxic than the parent compounds of the waste fed to the incinerator. Benzo-a-pyrene and 2,3,7,8-tetrachlorodibenzo-p-dioxin are examples of potentially harmful PICs that may be emitted if an incinerator is inadequately designed or improperly operated. The public and the regulatory community alike are concerned about PIC emissions, particularly because they are difficult to predict and, therefore, to regulate. In an attempt to address that concern, EPA researched the formation of PICs during test burns conducted at hazardous waste incinerators throughout the United States, and at incinerators used strictly for research. Testing was done under steady-state (normal) and upset operating conditions. Using test burn findings, EPA states that, if the incinerator is meeting the stack emission requirements, particularly the CO limit of 100 parts per million by volume, available field test data show that PIC emissions are limited to concentrations that do not pose unacceptable risks . That position is founded upon cancer-based health risk assessments for identified PICs. It should be noted that although research has not identified all PICs, and other potential health outcomes (non-cancer) have not been thoroughly evaluated, the evaluation of cancer risks typically results in allowable exposure levels much lower than would be allowed for non-cancer health outcomes. Because there is no recognized threshold exposure level for the cancer health outcome, even extraordinarily low exposures to carcinogenic substances are assumed to pose some risk of cancer. Only very low exposure levels are allowed by regulatory agencies in order to keep that risk at an acceptable level (usually either one cancer in a lifetime per 100,000 exposed individuals or one cancer in a lifetime per 1 million exposed individuals). For organics of particular concern, or for inorganic contaminants such as metals, hydrogen chloride, or chlorine, emission limits can be formulated specifically for the incinerator and the geographic area of concern. The EPA guidance manuals recommend that such limits be based on anticipated stack releases of the particular contaminant (usually worst case), local meteorological conditions, geographical site features, and proximity to local populations. c. Ash Another public health concern that citizens often raise about hazardous waste incineration pertains to disposal of ash generated by the process. By definition, such ash is considered hazardous waste and must be managed as such in a permitted hazardous waste treatment, storage, or disposal facility, such as a permitted hazardous waste landfill. If EPA can be shown that the ash is non hazardous, the ash can be disposed of in a licensed municipal waste landfill. Minimally, evidence would have to be provided showing that the ash is not corrosive, reactive, or flammable, and that it will not release water-soluble toxic substances, such as heavy metals, to groundwater or surface waters, at levels above EPA levels of concern. d. Design Considerations To minimize the public's potential exposure to site emissions, an incinerator must be designed and operated properly. What constitutes a state-of-the art, well designed, and properly operated incinerator' The incinerator must be designed to burn waste materials thoroughly. The combustion chambers must be of a size and arranged in a way to provide adequate time for the gases produced by burning waste to mix with proper amounts of combustion air, and to maintain the high temperatures needed to ensure that the burning is completed. When an incinerator is designed, the waste to be burned must be characterized for such properties as heat content (fuel value), percent moisture, chlorine content, metals content, and physical characteristics. The size and physical layout of the incinerator should be based on those waste properties. The incinerator must be designed and operated in a manner that minimizes production of non-stack, fugitive emissions. That can be accomplished by ensuring proper seals at all system connections, maintaining negative gas pressures throughout the combustion gas flow path, and by limiting the waste feed to prevent excessive and rapid releases of volatile compounds. Careful attention must also be given to the design and operation of waste handling systems to minimize fugitive emissions. ATSDR public health assessors have found that excavation and handling of soils at some Superfund sites, and waste unloading and repackaging operations at some RCRA facilities, have been major sources of airborne contaminants that have resulted in exposure of workers and/or nearby residents. Another critical part of the incinerator design is the pollution control system . Pollution control systems directly influence the levels and kinds of pollutants that are released and that can potentially reach the public. Most modern hazardous waste incinerators are designed with extensive air pollution removal systems. For example, a common pollution control system might include a system that cools or "quenches" gases produced by burning waste, followed by a system that reduces acid gas emissions, and ultimately followed by a particulate removal system such as fabric filters (baghouses), electrostatic precipitators, and others. 4. REGULATORY CONSIDERATIONS Automatic waste feed shutoffs, continuous emissions monitors, and destruction and regulatory authorities depending on the type of wastes being incinerated and the regulatory authority of the involved state set removal efficiencies. If the incinerator burns hazardous waste, it is regulated as a hazardous waste incinerator subject to federal hazardous waste regulations. 5. OTHER CONSIDERATIONS OF IMPORTANCE TO PUBLIC HEALTH a. Training of Operators Even with all the proper design features, skilled operators are essential for a safe, effective incineration program. Operators should understand the principles of good combustion and be thoroughly familiar with all major and support systems at their plants. Careful attention to proper waste burn rates and waste blending, as needed, helps to ensure that the combustion systems are not overloaded and that the AWFSOs are not activated excessively. Routine maintenance, inspection, and instrument calibrations should be conducted and recorded. Safety and emergency response plans that thoroughly address likely failure scenarios (including power, systems, and operational failures) must be in place, documented, and shared with local officials. Emergency "release" drills should be conducted periodically with the knowledge and involvement of local emergency response personnel. In addition, all employees should be adequately trained in appropriate health and safety procedures for the safe day-to-day operation of the incinerator. b. Sitting of the Incinerator, another consideration relevant to public health and frequently raised by the public is the location of the incinerator with respect to the community. More specifically, what are the possible health impacts associated with living or working in the path of incinerator emissions' To address those concerns, when reviewing the location of an incinerator, regulatory agencies use generally accepted air dispersion models in conjunction with local meteorological data to determine the permit conditions necessary to protect human health and the environment. Such modeling results can be particularly helpful in identifying prevailing wind transport patterns and their effect on downwind pollutant concentrations. Ideally, the site should not be where modeled high ground-level concentrations of stack emissions coincide with population centers. Dispersion models can also help evaluate the need for, and the location of, off-site air monitors used to detect fugitive emissions associated with incinerator operations and related hazardous materials-handling activities. If there is concern about the impact of incineration on a specific major food resource, such as a fish hatchery, and ATSDR has data regarding the uptake of the contaminants of concern by the particular food chain species, dispersion modeling can serve to estimate the concentration of emissions that would be available at ground level for food chain uptake. Finally, it should be noted that there is little flexibility in selecting a site for a Superfund incinerator, except with regard to where it is placed within the boundaries of the actual site. However, modeling as mentioned here is still useful in reviewing whether or not to use incineration for cleanup of a particular site. c. Storage of Materials In addition to the aforementioned issues regarding the incineration process, other concerns of relevance to public health need to be addressed. For example, hazardous waste to be fed to the incinerator and process effluents resulting from the incinerator should be stored in a manner that does not allow for uncontrolled environmental releases of potentially harmful substances. Dry, dusty materials should be enclosed or otherwise stored to prevent windborne transport of contaminated particulates. Wastes containing volatile organic compounds should be stored under conditions that safely collect and remove gases released from the wastes. Similarly, wet wastes or process effluents should be stored in chemically compatible, leak-resistant containers. Storage areas for such liquid-bearing materials should have dikes or be designed to contain leakage. Processing of wastes, such as blending or shredding operations, may provide opportunities for aerosolization of contaminants. Such conditions should be adequately considered and waste-processing areas designed to minimize the potential exposure to workers on-site, as well as to people living or working nearby. d. Transportation of Wastes to the Incinerator Finally, the means of transporting hazardous waste into the incinerator plant should be carefully considered. Routes of access should be selected to minimize accident (release) potential and to avoid residential and play areas if possible. For the remediation of Superfund sites, for which no over-the-road hauling is required, care is still needed to avoid spills and releases when transporting the wastes on site. e. Maintaining Good Performance Some considerations relevant to public health concerns about modern and effective incineration systems have been described. However, local health officials and citizens of communities with hazardous waste incinerators have expressed their concern that they may not be able to judge a good operation, or that, once the initial trial burns and inspections SUMMARY Emergency management is most simply defined as the discipline dealing with risk and risk avoidance. Risk represents a broad range of issues and includes an equally diverse set of players. The range of situations and events that could potentially involve emergency management or the emergency management system is extensive. It is undeniable that emergency management is integral to the security of our daily lives, and as such it should be integrated into our daily decisions rather than being called upon only in response to major disasters. Emergency management is an essential role of government. The Constitution tasks the States with responsibility for public health and safety – hence they are responsible for public risks. Significant changes to emergency management that have occurred in response to the different disasters, this fundamental philosophy continues to guide the government function of emergency management. Based on this strong foundation, the validity of emergency management as a government function has never fallen into question. Entities and organizations fulfilling emergency management needs have existed at the State and local level since long before the Federal government became involved. But through time, as political philosophies changed and as the Nation developed, the Federal Government role in emergency management has steadily increased to become the multi-billion dollar programme completed, the system may not be operated in the same manner as during the testing phase. Citizens also have expressed concerns that burning rates will be exceeded or monitoring systems will be overridden.