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Currents To Medical Center Employees: The recent tragic incident resulting in the death of Anthony Pirraglia, transplant coordinator and flight nurse, and injuries to Mandy Larson, neonatal intensive care nurse, has deeply affected all of us at MUSC. Our hearts are with the families. I have never been a part of anything like this in my entire career. During the past few years we have discussed violence in the workplace and some training has been conducted, but we were not prepared for this tragic irony of health care professionals being shot while attempting to give aid. As we give our support to families and friends, may we also be inspired by the professionalism demonstrated by Anthony and Mandy. A fund has been created to assist the family of Anthony Pirraglia. Contributions can be made by mailing donations to the Anthony Pirraglia Memorial Fund, MUSC Transplant Center, 150 Ashley Avenue, Post Office Box 250586, Charleston, South Carolina 29425. Thank you very much. W. Stuart Smith Vice President for Clinical Operations and Executive Director, MUSC Medical Center   Weapons of mass destruction plan updated MUSC continues to upgrade and refine its plan for dealing with situations involving weapons of mass destruction. Members of the MUSC/Medical University Hospital Authority (MUHA) task force presented specific updates at the Jan. 28 communications meeting, focusing on the communication/notification process and protocols in managing situations involving chemical and/or biological agents. Al Nesmith, disaster control officer, who heads the MUSC/MUHA Bioterrorism Preparedness and Response Team, said MUSC has been working to refine the system from an internal standpoint, as well as to effectively incorporate plans generated at the state and national levels. “We need you to know this is an evolving process. The Centers for Disease Control and Prevention are constantly updating information,” Nesmith said. “This is the latest concrete version.” Nesmith detailed the communication plan that would be activated in the event of an emergency involving weapons of mass destruction. “We have all the benefits of the manpower pool and other auxiliary systems incorporated in the MUSC/MUHA disaster plan.” He said a security perimeter around the health care community located on the peninsula of Charleston has been designated in collaboration with the city of Charleston Police Department, MUSC Public Safety and Medical University Hospital Authority Security to control access to health care facilities in the event of large-scale disaster. Roper has also been integrated into the plan, he said, to handle surge capacity should the need arise. Charleston Memorial Hospital and the Veterans Administration Hospital have likewise been incorporated into the plan. The chemical agents plan was presented by George Bryan, M.D., associate director of Emergency Medicine, who chairs the chemical agents effort. “Decontamination is the key,” he said. “The sooner, the better.” Bryan said 80 percent of contaminates are removed when the clothing is removed and bagged. Types of chemical agents include nerve agents, blistering agents, visicants, blood agents, pulmonary damaging agents. Bryan cited sarin gas as an example of a nerve agent that can be dispensed in liquid or vapor form. Symptoms include salivation problems and gastrointestinal distress. Death occurs from seizures and respiratory compromise. Atropine reverses the symptoms and pralidoxine is an antidote. Blistering agents, such as mustard gas, cause distress of the mucosa of the eyes and respiratory tract. Treatment includes decontamination and supportive care. Priorities in managing an emergency situation involving chemical agents are as follows. Provide: Protection of the current patients, staff and facilitates The best possible medical care to the most people Supportive care to non-injured and “worried well” Environmental protection The activation plan includes: Recognize the event; Prepare staff, decontamination and treatment areas; Initiate plans for crowd control; and Clear Emergency Department of existing patients Primary triage involves: Patient screening prior to decontamination; Appropriate staff in personal protection equipment; Patients directed to medical (wet) decontamination; and Patients directed to non-medical (dry) decontamination. Medical decontamination involves those with moderate or major illness. First, the patient will need to be identified. After clothes are removed and double bagged, the patient will shower and be transferred to treatment areas. A non-medical decontamination involves minor or no apparent illness. The patient will sign in, disrobe and bag clothes, put on temporary clothing (paper scrubs) and then will be placed in an observation area to see if symptoms develop. Patients may also need psychiatric care. Bob Cantey, M.D., director of MUSC Infectious Diseases, gave an update on biological agents. “Recognition of the likely agent is most important, and our ability to do this is improved,” he said, adding that the management of patients exposed to biological agents is similar to that used for chemical weapons. Initial triage of patients exposed to biological agents is very similar to that of patients exposed to chemical weapons. Cantey focused on several potential threats. “The response of anthrax to medical treatment has proved much better than expected among cases treated since the anthrax exposures,” he said. “Early treatment is crucial, however.” In the case of smallpox, patients are urged to stay home unless acutely ill. “If you’re sick with smallpox, stay at home,” he said. Botulism, plague and tularemia, he said, are not as likely to be used as weapons because of difficulties associated with deployment. MUSC is safe haven for abandoned babies MUSC Medical Center policy C-66 covers Daniel’s Law concerning abandoned babies. Gale Horinbein, MUSC Suspected Child Abuse and Neglect (SCAN) coordinator, gave an overview of the policy to the Management Team at the Jan. 28 communications meeting as part of the MUHA Policy Management Committee update. Any infant brought to hospital property and left with a staff member will be taken to the Pediatric Emergency Department. The infant will be placed in confidential status and labeled as baby “AB.” The person bringing in the infant is not required to disclose his or her identity. Hospital staff must: Establish the age of the infant; Establish the infant is in good health; Complete a physical exam (physician); Establish parent/caregiver’s intent to leave and not return; Offer information concerning the legal effect of leaving the infant; Attempt to gather medical or family history of parents, including the identity of any parent other than the person leaving the infant; and Offer DSS forms with prepaid envelope to DSS. The Emergency Department will notify a social worker and the administration. Child Protective Services will be notified by the social worker to coordinate discharge with foster care placement. For more information about the policy, contact Horinbein at 792-8947. MUSC OIG site visit complete The Federal Office of the Inspector General (OIG) of the Department of Health and Human Services was on site on Jan. 28-29, focusing on Medical Center issues. According to Reece Smith, manager, Compliance, the visit went well. “All the departments did a fantastic job,” Smith said. The three areas visited were Hospital Patient Accounting, Revenue Systems and Audit and Medical Records Coding. “The visit went very, very well,” Smith said. “I would like to thank everyone.” Policy revision regarding PTO A minor revision has been made to the employee Paid Time Off (PTO) policy, reported Susan Carullo, manager for Employment, Compensation and Employee Relations for Medical Center Human Resources. A forfeiture clause has been added regarding sick leave for those leaving employment at MUSC.  The revision does not change any previous practices and is being made, based upon legal advice, to ensure for no misunderstandings. Carullo also thanked those who played a part in the “What I Want to Be” program for the Charleston County School District. She said the district has asked that the program also be taken to James Island and West Ashley. New employees named Suzanne Cole, R.N., will serve as interim manager of 8 West, replacing Colleen Corish, who was recently named as clinical services director of Oncology and Medical/Surgical Services at MUSC and HCC. Cole, who has 15 years in oncology nursing, was formerly the senior charge nurse on 8 West. Linda Randazzo was named QI/Staff Development Coordinator, replacing Ruth Baker. She began work Jan. 28 and was previously employed by Hill-Rom.