Safety

User and Staff Safety Responsibilities

Safe laboratory practices will be employed by all MEG staff and MEG Users to preclude any preventable accidents or occurrences. MEG staff will monitor MEG Users for compliance.

1. User Responsibilities - All MEG users:

a. Must attend MEG Orientation and Training before being allowed to operate any MEG lab equipment. Each person will be responsible for familiarizing themselves with the safe operation of all MEG equipment used in their experiment.

b. Must adhere to MEG Core Facility policies and procedures. The Policy and Procedures Manual will be located at the Analysis Console for reference and also on the NIH MEG website.

c. May NOT bring any “unapproved” or “special” equipment into the lab for use unless first approved by the Director and/or Staff Scientist. In addition, before any user’s equipment can be used in the lab it must be tested for electrical safety.

d. Must familiarize themselves with the properties of helium gas / liquid helium. Information on the safe handling of Helium is included in the Material Safety and Data Sheet (MSD) Manual located at the Analysis Console for reference.

e. Will be responsible for reporting any hazard or potential hazard.

i. Immediately notify MEG Core staff of any defective equipment, malfunction or any improperly working equipment or medical devices used for patient / subject testing using the Problem Report Form (under construction)

ii. All events, occurrences or variances to normal operations, policies, procedures, and practices involving any users, subjects / patients and / or equipment must be documented via the Problem Report Form (under construction).

ii. Users are responsible for identifying and labeling any non-functional or hazardous equipment with an “Out of Service / Do Not Use” sticker, in addition to completing the Problem Report Form (under construction)

f. Are encouraged to participate in the MEG Quality Assurance / Quality Improvement Program.

Users are encouraged to make suggestions and provide feedback to MEG staff, by directly contacting the lab manager (Anna Namyst), the staff scientist (Tom Holroyd), and director (Allison Nugent).

g. Are responsible for subject / patient safety while conducting studies in the MEG Core Facility.

i. Full details of user and scanning requirements are found in the [User Guidelines] Section of this guide.

ii. When scanning, subjects must be observed at all times. The subject must never be left alone in the MSR without a user in the control room for any reason.

iii. Two (2) operators are required to be in the room when scanning, one of which is capable of operating the equipment.

iv. All personnel attending scans must complete a MEG orientation.

v. Clinical coverage is required for all invasive studies; other patient studies may require the presence of individuals with CC clinical credentials at the discretion of MEG Core Facility Staff.

h. Must provide a safe environment for all patients and employees.

i. All passageways, doorways and exits are clear at all times. Shoes are not to be left in front of the MSR door.

ii. All power cords should be in good condition.

iii. When in use, all electrical cords are unwrapped.

iv. All cords and equipment cables are covered or routed to minimize the potential for falls or accidents.

i. Must maintain patient privacy and confidentiality, and not leave PII in the MEG laboratory.

i. Must adhere to the Clinical Center’s policies and procedures regarding safe laboratory practices.

2. Staff Responsibilities - The MEG Staff:

a. The MEG Core Facility staff will provide a safe working environment for all patients, users and employees.

b. Will maintain a clean, neat, and safe work environment.

c. Will maintain a respectful and professional work environment.

c. All employees are constantly alert for unsafe conditions within the work area. If unsafe conditions are discovered, employees initiate immediate corrective action.

d. Will report unsafe conditions beyond the capability of the employee to correct to the proper authorities for remedy.

e. Some measures to be taken to eliminate hazards and prevent accidents are:

i. All passageways, doorways and exits are clear at all times.

ii. All power cords are kept in good condition.

iii. When in use, all electrical cords are unwrapped.

iv. Power strips are kept at least 2 inches off the floor.

v. All cords and equipment cables are covered or routed to minimize the potential for falls or accidents.

vi. All file cabinet drawers are closed when not in use.

vii. Spills are cleaned immediately after they occur.

iix. All employees are informed about the location and use of the Material Safety Data Sheets (MSDS).

ix. All employees know the fire safety and evacuation plans.

MEG Lab System Monitors

MEG System Monitors evaluate the performance and integrity of MEG equipment. There are 3 monitors located in the MEG Lab.

PureAire Oxygen Monitor

1. The PureAire Oxygen Monitor - gives an indication of the air exchange in the MSR and/or the general integrity of the Dewar and related equipment. Measures the percentage of oxygen (O2) in the MEG lab. Remote display located in the MEG Lab on the wall just outside the MSR (Magnetically Shielded Room).

Normal Atmosphere	Oxygen Level 19.6-22%	O2 level should be at about 20.9%
Enriched Atmosphere	Oxygen 22.0% or more	*can promote fires (burning)
Deficient Atmosphere	Oxygen reading 19.5 or less	*can lead to a loss of consciousness and/or asphyxiation

2. If the AirPure Oxygen Monitor Sounds due to low oxygen:

a. Open the door to the MSR;

b. Open both doors to the lab;

c. Evacuate the lab if necessary;

d. Notify MEG Lab staff immediately.

Gilmont Gas Flow Meter

1. ::The Gilmont Gas Flow Meter monitors the rate of Helium boil off which gives an indication of the general integrity of the MEG Dewar and related equipment. Located inside the MSR near the back-left wall.

Helium Boil-off Gas Flow Rate

Normal Gas Flow Rate	28
High Gas Flow Rate	40 (*alarm will sound)

*Please note that the gas flow rate level normally fluctuates within a certain range.

2. :: Normal Conditions When The Alarm Might Go Off:

a. If it is windy outside (until the wind subsides).

b. After a fill the flow rate might get as high as 40 (but should go back down to 28 within a reasonable period of time).

3. :: What to do if the Helium Boil-Off alarm goes off

a. Re-set the alarm - if you know that it is windy outside re-set the alarm. Instructions are next to the alarm.

b. If you are unsure about resetting the alarm please seek MEG staff for assistance.

c. Notify MEG Core Facility Staff.

Optalarm Flowmeter

1. The Optalarm Flow Meter monitors the HE exhaust gas flow / measures the total flow rate of the MEG system and gives audible and visual alarm if flow rate is outside normal range which is an indication of the general performance and integrity of the MEG Dewar and related equipment. There is a high alarm and low alarm setting.

2. The meter is located outside the MSR on the back-left wall

3. During a liquid helium fill, after removing the Vent Port Safety Relief Cap the flow rate might get as high as 100 causing the alarm to go off. To prevent this, the alarm can be turned off during the fill. The level should go back down to 50 within a reasonable period of time after the fill.

4. The exhaust pipe is located on the roof of the building and the alarm may go off when it is windy outside. The solution is simply to re-set the alarm. Usually, if the problem is the wind the alarm can be re-set by pushing the Alarm Reset button (twice).

5/ However, if the alarm does not turn off after being re-set (stays on continuously) this might be an indication that there is a problem with the integrity of the system which is causing more boil-off (exhaust) than normal. In this case, notify MEG staff as soon as possible.

Optalarm Helium Gas Flow Meter

If the alarm goes off Alarm Reset Procedure: a. Press the RE-SET button twice. b. If the alarm continues to go off or stays on continuously after re-setting notify the MEG lab staff immediately.

AMI Model 135 Liquid Helium Level Monitor

1. The AMI Model 135 Liquid Helium Level Monitor measures the amount of helium inside the MEG Dewar. It is located on the stand just outside the MSR. This monitor lets MEG staff know when it is time to perform a helium fill. This is used and attended to by MEG staff only; MEG Users should never need to check this monitor.

Liquid Helium Level in the Dewar

Normal Range	1 - 38
Upper Limit	39.0
Lower Limit	0

*Should never go below 0 (zero)

2. Checking the Helium Level in the Dewar:

a. Plug in the monitor cable. The plug is located inside the MSR near the back-left wall.

b. Check and record the reading on the QA / Maintenance Log.

c. If the level is approaching 0 (zero) a liquid Helium Fill should be performed; notify appropriate lab personnel.

d. When filled the Liquid Helium Level should not exceed 39.0.

e. If an overfill occurs:

f. Keep the door to the MSR open;

g. Leave the Dewar at 55 degrees for 12 to 24 hours.

Laboratory Gas Safety / Safe Handling of Laboratory Gases

Liquid Helium

Users of Liquid Helium will be: 1) familiar with the properties and characteristics of the gases used in the MEG Lab and, 2) knowledgeable about the operation of gas cylinders to ensure that those gases are being used, stored and transported according to NIH safety guidelines and safe laboratory practices.

1. All MEG staff and users must familiarize themselves with the properties of Liquid Helium. Refer to the Material Safety and Data Sheet (MSDS) Manual.

2. The contents of Liquid Helium Storage Dewars must be identified with decals, stencils, or other markings on the outside of the Dewar.

a. Color codes alone or tags hung on the outside of the Dewar are not acceptable.

b. Dewars lacking proper identification must not be accepted from the vendors.

3. Liquid Helium Storage Dewars are transported by using the handle to pull the Dewar; they must never be pushed. Always keep the Dewar in the upright position.

4. Liquid Helium Storage Dewar will be transported with the Relief Isolation Valve OPEN so that pressure does not build up in the storage dewar.

5. The cylinder contents must be permanently attached to the outside of the Dewar. This identification shall not be removed, covered or defaced.

6. Liquid Helium will not be used in environmental rooms unless there is adequate ventilation and/or an oxygen monitor with an audible alarm is present and permission has been granted by the Safety Officer.

7. Liquid Helium will be handled using the appropriate care and protective equipment, i.e., face shield and cryogloves, as necessary because contact can cause severe frostbite.

8. The safety warnings located on the Helium Storage Dewar will always be followed.

9. Empty cylinders will be marked “EMPTY”.

What to do if there is a Helium Cylinder / Storage Dewar Leak

Indication: You might hearing hissing sound coming from the helium gas cylinder and / or feel air coming from the container.

Course of Action: 1. Cylinder Leak – if this happens: a. Notify MEG Core Staff immediately b. If there are reasons to believe that a cylinder is leaking, test for the leak by painting soapy water over the valves and connections. This will indicate most gas leaks. c. Do not attempt to repair leaks caused by loose valve stem packing. e. Leaking storage Dewars of liquid helium will be moved to a well-ventilated area. There is no potential harm if helium does not critically displace the amount of oxygen. f. The Dewar must be labeled indicating the problem. g. The vendor will be called for pickup. h. Assistance can be obtained from the Health and Safety Branch or by contacting the Safety Officer.

*Note: Leaks from cylinders of toxic or flammable gases require immediate attention.

What to do if there is an MEG Dewar Leak / Spontaneous Warm Up

Indication: 1. MEG Dewar Leak - If there is condensation on the inside of the dewar helmet, it is likely that the inside of the helmet is becoming "soft" (has developed a leak). 2. Spontaneous MEG Dewar Warm Up- If the vacuum on the inside of the Dewar becomes soft a spontaneous warm up of the liquid Helium will likely occur resulting in: a. Leaking of helium; b. Helium Level Meter reading will likely increase dramatically causing the Helium Boil-Off Alarm to go off. c. Pressure inside the Dewar MIGHT possibly build up causing helium to leak from the ports on the top of the dewar resulting in helium escaping into the magnetically shielded room (MSR) causing the Oxygen Alarm to go off.

Course of Action: 1. MEG Dewar Leak Notify MEG Core Facility Staff immediately 2. Spontaneous MEG Dewar Warm Up- if this happens: a. Open the door and evacuate the MSR. b. Open the door to the MEG lab. c. Turn off the rack. Discontinue scanning; the system can not be operated in the warm state. d. Turn off the Helium Alarm. e. Turn off the Oxygen Alarm. g. Notify MEG Core Facility Staff immediately

Compressed Helium Gas

Users of Compressed Helium Gas will be: 1) familiar with the properties and characteristics of the gases used in the MEG Lab and, 2) knowledgeable about the operation of gas cylinders to ensure that those gases are being used, stored and transported according to NIH safety guidelines and safe laboratory practices. Refer to the Material Safety and Data Sheets (MSDS) located in the MEG Lab.

1. Compressed Helium Gas Cylinders:

a. The contents of Compressed Helium cylinders must be identified with decals, stencils, or other markings on the cylinders. Color codes alone or tags hung around the necks of the cylinders are not acceptable. Cylinders lacking proper identification must not be accepted from the vendors.

b. Helium Cylinders will not be accepted from the vendors unless the valve safety covers are in place and properly tightened.

c. Compressed Helium cylinders will be secured always so they cannot fall.

d. Valve safety covers will be in place until pressure regulators are ready to be attached.

e. The cylinder contents are permanently attached to the cylinders. This identification shall not be removed, covered or defaced.

f. Cylinders will be moved on chain equipped hand trucks or carts; they are never rolled or dragged.

g. Employees will not attempt to repair cylinders or cylinder valves, or to force stuck or frozen cylinder valves.

h. The cylinder valve will not be opened or cracked without first attaching the proper pressure regulator.

2. Pressure Regulators and Needle Valves:

a. The valve fittings of Liquid Helium cylinders must be valves attachments that are safe for use with Liquid Helium. Use of adapters to connect regulators to cylinder valves defeats this safeguard and is not authorized. Only pressure regulators and needle valves approved for the compressed Liquid Helium gases may be used.

b. Threads and points of unions must be clean. These surfaces must be inspected before they are connected.

c. When attaching regulators or needle valves, the connections must be tightened firmly. Wrenches of the proper size should be used. Pliers should not be used as they damage the soft brass nuts.

d. Do not apply excessive force when attaching the regulator or valve. Need for excessive force often indicates that the regulators or needle valves do not fit the cylinders.

e. Leaks at the unions between the regulators and the cylinder valves are usually due to damage to the faces of the connections. Attempts to force a tight fit may damage the previously undamaged half of the connection.

f. If the cylinder valve faces are damaged, the cylinders will be returned to the vendors. Employees will not attempt to repair them.

g. Damaged regulators will not be used until repaired.

3. Cylinder Leaks:

a. Unless there are reasons to believe that cylinders are leaking, testing for leaks may be done after the pressure regulators are attached to the cylinder valves and the valves opened.

b. Soapy water painted over the valves and connections will be performed if a leak is suspected.

c. Personnel will not attempt to repair leaks caused by loose valve stem packing.

d. Leaking cylinder of compressed Helium gas will be returned to the vendor.

e. Assistance can be obtained from the Health and Safety Branch or by contacting the Safety Officer.

4. Empty Cylinders:

a. A small amount of gas must be left in the cylinders and the cylinder valves must be closed to prevent contamination of the inside of the cylinders.

b. Empty cylinders should be marked “EMPTY”.

c. Valve safety covers and the labels showing contents must be in place.

d. Empty cylinders should be stored separately from full cylinders.

e. Empty cylinders must be secured at all times so they can not fall.

Emergency Procedures

The MEG Lab has established emergency procedures, which are consistent with the Clinical Center's policies and procedures, to be followed in response to various potential emergency events.

Emergency Evacuation Plan

The Emergency Evacuation Plan has been created in order to facilitate the safe and orderly evacuation of staff, visitors and volunteers from the lab and/or building in case of an emergency. Refer to the MEG Emergency Evacuation Floor Plan Map which is posted inside the MEG Lab at each door and also outside the B1/D65B door.

1. One person will be designated the primary Evacuation Team Leader (ETL) for the MEG Core Facility. The evacuation team leader will be responsible for leading the evacuation and accounting for all staff, subjects, and visitors.

MEG Lab Emergency Evacuation Team Leaders (ETL) Building 10 / Floor: B1; Corridor D; Room: 65B
Primary ETL: Anna Namyst (lab manager) Phone: 301.402.2445 Bldg/Rm: 10 / B1D65B
Secondary ETL: Dr. Tom Holroyd Phone: 301.402.2362 Bldg/Rm: 10 / B1D65A

2. In the event that an evacuation is ordered, the ETL and/or other MEG Core Facility staff will evacuate the lab including all subjects / visitors.

3. All staff and subjects and visitors will report to ETL.

4. Individuals with disabilities will be assisted by one or more persons (aides) assigned by the ETL. The aides will assist the individual(s) to the nearest elevator lobby to await evacuation by the fire department.

5. Elevators must NEVER be used for emergency evacuation unless the elevators are under the direction of the fire department, or are equipped with special systems and are pre-approved for evacuation.

6. Alternate exits should also be used if the primary exit is inaccessible. Refer to the MEG Emergency Evacuation Floor Plan.

7. Upon exiting the building, assemble far enough away as not to interfere with the arrival of fire apparatus and the activities of emergency responders, in an area that provides adequate safety for evacuees. Report to the ETL so that everyone is accounted for then wait for further instruction from the ETL.

8. Occupants may return to the building only when authorized by the Senior Fire Officer, Police Officer, or the Occupant Emergency Coordinator (OEC).

9. The nearest Fire Extinguisher is located just outside the MEG Core Facility.

10. Fire Alarm Pull Stations are located at each end of the NMR Center main corridor and at all Emergency Exits.

Emergency Evacuation Routes

1. If an evacuation is ordered, MEG Core Facility staff will evacuate the lab, including all subjects / visitors via the primary evacuation route (the nearest exit) as directed by the ETL. The secondary exit should be used if the primary exit is inaccessible. And the alternate route should only be used if both the primary and secondary exit are not an option.

PRIMARY EVACUATION ROUTE – To Loading Dock: *There are 4 or 5 stairs leading down to the sidewalk.
• From the MEG Corridor, turn left down the main NMR Center corridor.
• Turn RIGHT at the first corridor (MRI Corridor).
• At the end of the MRI Corridor, turn left down the Animal Corridor; go through the double doors.
• Turn right at the exit sign to the loading dock.
• Go through the EMERGENCY EXIT double doors to the back loading dock.

If for some reason the primary evacuation route is blocked by smoke or inaccessible the WEST SIDE (SECONDARY) EMERGENCY EXIT may be used to evacuate the building.

SECONDARY EVACUATION ROUTE – West Side Emergency Exit / outside Bld. 10: *There are 6 or 7 stairs leading down to this exit.
• From the MEG corridor, proceed left down the main NMR Center corridor towards room B1D67 (past the signs for the Laboratory of Cardiac Energetics).
• Go through the EMERGENCY ONLY EXIT door down the stairs to the outside of the building.
• This exit leads to the west side of Building 10.

If during an emergency, the Primary Evacuation and the Secondary Evacuation Routes are blocked by smoke or other hazards use the Alternate Exit. The Alternate Exit should only be used if the Secondary Exit is inaccessible.

ALTERNATE EVACUATION ROUTE– Towards Cafeteria/ Elevators / Front of Building 10:
• From the MEG corridor, turn right down the main NMR Center corridor towards the nearest exit.
• Go through the EXIT door.
• Follow the sign to the cafeteria.
• This exit leads to the main building towards the cafeteria and elevators, i.e., toward the front of Building 10

Fire Safety Plan

The MEG Lab has established a Fire Safety Plan in order to define the scope and method for immediate, positive and orderly action to safeguard life and property during a fire emergency.

1. The NIH utilizes a zoned evacuation system. When and if the fire alarm signal sounds and the flashing emergency strobe light has been activated in a particular area the occupants in that zone or area of the building must evacuate the building. This alarm is usually followed by recorded instructions to the occupants. Other areas may not be required to evacuate unless their zone fire alarm system has been activated as well.

2. The MEG Core Facility Evacuation Team Leader(s) (ETL) may designate Assistant Team Leaders (ATL) to help with the evacuation.

3. During a fire emergency:

a. The ETL will be responsible for the orderly evacuation of and accounting for all staff, subjects and visitors;

b. The ATL will help to carry out the instructions of the ETL and assists all patients / visitors in the case of an evacuation.

Remember:

R.A.C.E.
R - Rescue anyone in danger.
A - Activate the nearest fire alarm box and Dial 911 to notify others in the area of the emergency.
C - Confine the fire by closing all doors.
E - Evacuate the lab.

4. If there is a small fire which may be contained using a fire extinguisher:

a. The nearest fire extinguisher is located outside the MEG Lab.

b. Extinguish the fire only if it can be done without endangering anyone, after notifying the NIH Fire Department.

c. When using a fire extinguisher, fight the fire from a position accessible to an exit to avoid entrapment; if in doubt, evacuate the area and wait for the NIH Fire Department to arrive.

Remember:

P.A.S.S.

A. Pull the safety pin

B. Aim the nozzle

C. Squeeze the handle and

D. Sweep from side to side at the base of the fire until it goes out.

5. Fire Evacuation Procedures:

a. Close all doors as you leave (close the MSR door if safe to do so).

b. Walk to the nearest FIRE ALARM PULL STATION which is located in the NMR Center main corridor on the wall between the Waiting Area and the door leading to the main building; activate the alarm.

c. Dial 111 from the nearest phone.

d. All staff, subjects, users and visitors must evacuate the zone or the building using the Primary Evacuation Route.

e. If the Primary Evacuation Route is blocked or inaccessible use the Secondary Route.

f. The ETL will designate a place away from the building for everyone to meet.

g. Everyone (all staff, subjects, users and visitors) will report to the ETL and remain
outside at the designated area until all persons have been accounted for or until otherwise instructed by the ETL.

h. Refer to the MEG Emergency Evacuation Floor Plan Map which is posted inside the MEG Lab at each door and also outside the B1/D65B door.

Power Failure

In the event of a power failure, the appropriate action will be determined by the MEG Evacuation Team Leader (ETL). If the power fails, the emergency backup lights in the lab and the MSR will automatically activate. The ETL will determine whether to evacuate the MEG Lab; if evacuation is necessary the Lab will be evacuated in a safe and orderly manner.

1. Discontinue testing and evacuate all staff and subjects / patients.

2. Turn off all computers and other electrical equipment, if safe to do so.

3. Call / contact Maintenance at 496-5862 to report the power outage.

4. Notify MEG Core staff.

5. If determined appropriate, evacuate to the nearest area which does have power; listen for emergency communications/ announcements over the PA system.

6. Return to the facility when power has been restored and / or when it has been determined that it is safe to do so.

7. All emergency backup lights and flashlights will be tested once a year to assure that they are operable.

Flashlights are located on the top shelf of the "Supply Cabinet' nearest the B1D65B door. Batteries are located in the "Equipment Cabinet".

Chemical / Biological Incident

1. If a biological incident were to occur, it is important to take immediate and appropriate action in order to:

a. limit exposure to the potentially harmful chemical or biological substances

b. to evacuate the immediate area of the contamination and

c. to contain or close-off the contaminated area.

2. Procedure:

a. Evacuate the room and close doors.

b. Call the Fire Department by dialing 111 (on campus).

c. Notify MEG Core Facility staff immediately.

d. Remove contaminated clothing and wash any parts of the body which may have come in contact with the hazardous material.

e. Do not permit anyone to enter the room/area until the appropriate authorities determine that the area is safe.

f. After safely evacuating, any person(s) who may have become contaminated should be restricted to a single staging area and not permitted to move freely to other locations. Moving to other locations may create a contamination concern to other occupants and/or other areas of the building.

g. If a patient or subject is involved, notify the physician in charge and the Chief of Nursing Service or the Nursing Supervisor, along with the institute clinical director

The nearest Emergency Eye Wash Stations in the NMR Center are located in the Patient Prep Rooms (B1D 302 and B1D 304).

The nearest showers are located on the 1st floor directly above the MEG Lab (Rm 1D 070).

Medical Emergency - Possible Seizure Event

In the event a possible seizure / medical emergency were to occur in the MEG Lab the following steps should be taken to provide immediate action. A seizure is a medical condition where a person may or may not lose consciousness. There might be jerking of a body part, incontinence, tongue biting, a lack of responsiveness / blank stare or other neurological symptoms. It is important that any person observing the event assures that the victim does not injure him/herself and that they get immediate assistance / medical care, if at all indicated.

1. In the event of a suspected seizure without loss of consciousness:

a. Immediately go into the MSR to assist the subject. It is not necessary to stop the acquisition.

b. If seated, slide the subject/person out of the chair; If necessary, help the person lie down on the floor. Do not attempt to operate the controls for the chair.

c. Assure that the person does not injure himself. Try to remove harmful objects from the person's pathway or coax the person away from those objects.

d. Do not try to restrain the person; you cannot stop the seizure. Do not agitate the person.

e. If the person appears to be angry or aggressive, do not approach the person if you are alone.

f. Observe and document details of the event:

i. Record the sequence of events.

ii. Note body parts involved.

iii. Record length of event.

g. Assess the subject’s level of consciousness.

h. Stay with the individual.

i. After the event escort victim (or transport via wheelchair) to the Clinical Center office of Occupational Medical Services (OMS) 10/6C306 7:30 am-4:00pm and / or recommend that the subject seek immediate medical care from their physician.

j. Ask subject if they have a history of seizures; ask subject if he has any memory of the event. Document information.

k. If the subject subsequently loses consciousness and/or the seizure does not terminate after about 5-10 minutes call a Code Blue (111).

l. Notify MEG Core Facility Staff

2 In the event of a suspected seizure WITH loss of consciousness:

a. Immediately go into the MSR to assist the subject. It is not necessary to stop the acquisition.

b. Slide the subject out of the chair down to the floor; do not attempt to operate the controls for the chair.

c. Assure that the subject does not injure himself.

i. Put something soft under the head.

ii. Remove any eyeglasses.

iii. Loosen any tight clothes.

iv. Clear the area of sharp or hard objects.

d. DO NOT force anything into the subject’s mouth.

e. Do not try to restrain the person; you cannot stop the seizure.

f. Observe and document details of the event.

i. Record the sequence of events.

ii. Note body parts involved.

iii. Record length of event.

g. Assess the subject’s level of consciousness.

h. Stay with the individual.

i. Call 111 to report a Medical Emergency.

j. If the subject recovers before emergency personnel arrive, turn the person to one side (rescue position) to allow saliva to drain from the mouth.

k. Do not offer the person any fluid or drink.

l. Access/monitor for respiratory or cardiac compromise. If necessary, begin rescue breathing or CPR until emergency medical personnel arrives.

m. Notify MEG Core Facility Staff

Medical Emergency - Suspected Cardiac or Respiratory Event

In the event a possible cardiac or respiratory emergency were to occur in the MEG Lab the following steps should be taken to provide immediate action. It is important that any person at the scene provide immediate aide and call for medical assistance as soon as possible.

1.Adult Victim: The most common medical emergency in an adult victim is usually a heart attack. Symptoms of a heart attack might include: pressure / achy pain in the chest, back (between the shoulder blades), jaw, perhaps radiating to the arm, nausea, dizziness, sweating, agitation, indigestion, denial on the part of the subject.

' The greatest impact on improving the survival from adult sudden cardiac arrest is immediate bystander CPR and defibrillation within 5 minutes. The key to survival is early defibrillation. For an adult victim call first.

2. Child/Pediatric Victim: The most common cause of sudden cardiac arrest in kids (infants and children) is a lack of oxygen to the heart muscle and brain caused by severe breathing emergencies, respiratory arrest, or shock. Symptoms of a choking victim might include: gasping for air, hand around the neck, cyanosis or pallor and eventually loss of consciousness.

' The greatest impact on improving the survival chances of a pediatric victim and the key survival to is early ventilation. For a pediatric victim call EMS after 5 cycles (or 2 minutes) of CPR.

3. Procedure:

a. Immediately go into the MSR to assist the subject. It is not necessary to stop the acquisition

b. Do not attempt to operate the controls for the chair; simply slide the subject out of the chair down to the floor.

c. Check for victim's responsiveness.

d. Shout out for "HELP!" / have the other (second) MEG operator/observer go get /call help.

e. Call X111 for the emergency medical team.

Remember: For an adult victim call first; for a pediatric victim call EMS after 5 cycles (or 2 minutes) of CPR.

f. Assess the victim / Initiate CPR:

i. Open airway;

ii. Look, listen, feel for breathing;

iii. Attempt 2 breaths;

iv. If breathes do NOT go in / unable to ventilate there is possibly an obstruction:

• Re-position the head and attempt ventilation again; if still unable to ventilate;

• Give 5 abdominal thrusts (if pregnant or obese - chest thrusts);

• Open then check mouth, sweep to remove seen objects;

• Attempt to ventilate, if no air goes in, re-position and try again, etc. Continue to try to ventilate along with abdominal thrusts until successful in dislodging obstruction or victim begins breathing on his own.

v. Check for pulse and respiration after 2 minutes (5 cycles).

vi. Check for signs of circulation (or lack thereof) – respiration & heart beat / pulse.

•. If NO pulse (no circulation) and NO respiration, begin chest compressions and continue to ventilate;

• If NO pulse (no circulation) but there is respiration, perform chest compressions only,

• If pulse is present, but NO respiration continue to ventilate by giving rescue breaths,

vii. If heartbeat and breathing present, turn victim onto the side (in the Rescue or Recovery position to maintain the airway.

An Emergency Cardiac Defibrillator is located in the NMR Center main corridor on the wall next to Room B1D69 (the NMR Center Office) opposite the entrance to the Signa Corridor.

*Guidelines and instructions for performing CPR:
https://www.ors.od.nih.gov/sr/dohs/Documents/CPR%20Study%20Guide%20041106_revised_1.pdf

Emergency Contact Information / Numbers

In case of an emergency contact:

MEG Director: Dr. Allison Nugent, 301/451-8863

MEG Lab Manager: Anna Namyst, 301/405-2445

MEG Staff Scientist: Dr. Tom Holroyd, 301/402-2362

FOR LIFE-THREATENING EMERGENCIES

(e.g., Fire, Explosion, Chemical Spill, Radiation Release, Natural Gas Odor, Suspicious/Dangerous Activity)

Fire / Ambulance	call 911 or 301 / 496-9911 from cell phone
Police	call 911 or 301 / 496-9911 from cell phone
Chemical / Biological / Radiological	call 911 or 301 / 496-9911 from cell phone
Engineering	call 108 or 301 / 496-9911 from cell phone
Bdg 10 Employee/Visitor life threatening emergency*	call 111

*otherwise report to OMS 10/6C306 496-4411 7:30am – 4:00pm

FOR NON-LIFE-THREATENING EMERGENCIES

(e.g., Damaging Leaks / Flood, Power Outage)

Fire Department	301 / 496-2372
Police	301 / 496-5685
Occupational Medical Service / Work Related Injuries	301 / 496-4411
Building Maintenance	301/ 435-8000

Emergency Communications Center

Emergency Evacuation Coordinator Bldg. 10/4A13 – Jim Wilson 301/496-2862

The Emergency Communication Center can be contacted for the following: • Locked out of a lab or office • Reporting lost or stolen NIH property or personal property • Additional assistance for non-life-threatening emergencies 311 (from campus phone) or 301 / 496-4685 (from cell phone)

In Case of an Emergency - you might need to know where to locate these items:
FIRE EXTINGUISHER - The nearest Fire Extinguisher is located just outside the MEG Core Facility.
FIRE ALARM PULL STATION - Fire Alarm Pull Stations are located at each end of the NMR Center main corridor and at all Emergency Exits.
EMERGENCY EYE WASH STATION - The Emergency Eye Wash Station in the NMR Center is located in room B1D 302 and B1D 304.
SHOWER - The nearest shower is located on the 1st floor directly above the MEG Lab - Rm. 1D-70.

Infection Control

In order to interrupt the spread of infection at the point of transmission between the source and host, the following policies and procedures have been established. All staff, MEG Lab users and subjects are required to comply with NIH Clinical Centers infection prevention / infection control policies and procedures, in addition to MEG Lab practices.

Hand Hygiene

Hand Hygiene is one of the most important steps in infection control in order to prevent the spread of germs. Cleaning your hands often using either soap and water or alcohol hand gel is required by the NIH Clinical Center and the MEG Lab.

1. In general, it is important to wash / clean your hands in each of these situations:

a. After reporting to work (at the beginning of your shift).

b. Before and after subject / patient contact.

c. Before donning gloves.

d. After removing gloves and other personal protective equipment.

e. After touching objects that are likely to be contaminated with microorganisms (e.g., equipment or other items, keyboards, telephones / cell phones, doorknobs, stair banister, elevator buttons, etc.

f. Whenever hand are visibly soiled.

g. After sneezing, coughing or blowing your nose.

h. After contact with blood, or other potentially infectious material and equipment or articles.

i. When hands are likely to be contaminated with blood, body fluids, secretions or excretions.

j. After handling any equipment that comes in contact with subjects with a known infection.

2. In addition when in the MEG Lab, it is important to wash / clean your hands in each of these situations:

a. At the beginning and end of each MEG scan.

b. Before setting up a subject.

c. After setting up an EEG / EMG subject.

d. After abrading the skin.

e. After applying, handling and processing electrodes.

f. After Brainsight coregistration.

3. If you use Alcohol Hand Gel to clean your hands, you must wash your hands with soap and water if they are visibly soil and/or after every 10 uses of gel.

The Centers for Disease Control also have useful information on the use of hand sanitizer: Handwashing: Show Me the Science

Use of Personal Protective Equipment (PPE) / Protective Barriers

Personal Protective Equipment (PPE) - gloves, gown, plastic apron, masks, protective goggles and impervious barrier will be used, if transfer, aerosolization or splattering of particulate matter is likely to occur. If item(s) are visibly soiled dispose of in a Medical Pathological Waste (MPW) Box otherwise disposed in the trash.

1. Gloves will be used when:

a. Abrading skin,

b. Cleaning, disinfecting or handling equipment used on abraded skin,

c. Handling all soiled instruments and equipment,

d. In contact with a patient/subject with a known infectious disease,

e. During Brainsight localization,

f. In accordance with Universal / Standard Precautions, Transmission Based Precautions and CC Infection Control guidelines.

2. Workspace Protective Impervious Barrier are used: -

a. To cover the work area when abrading the skin to place “contaminated/used” equipment or supplies.

b. When temporarily maintaining any item considered contaminated if needed for additional use,

c. To place all soiled instruments and equipment,

d. To place items that have come in contact with a patient/subject with a known infectious disease,

e. In accordance with Universal / Standard Precautions, Transmission Based Precautions and CC Infection Control guidelines.

f. Any items placed on this barrier will be considered contaminated and must be disposed of or cleaned using Dispatch or Asepti-Wipe II.

g. The barrier will be discarded after each use and the physical work surface will be disinfected using Hydrogen Peroxide Disinfectant, Dispatch or Asepti-Wipe II.

Studies Requiring A Blood Draw or Infusion/Injection during a MEG Scan

During an MEG scan that involves drawing blood or Infusion/Injection MEG infection control procedures must be followed. All nurses participating in drug studies / protocols must follow all MEG Lab Infection Prevention / Infection Control Policies and Procedures and must comply with all Clinical Center Infection Control Policies and Procedures.

1. All nurses participating in drug studies in the MEG Lab must attend MEG Lab specific Infection Control training.

2. Gloves will be used when drawing blood or whenever touching the blood draw syringe or any potentially contaminated items.

3. “Contaminated” gloves will be discarded before touching any other items in the MEG lab.

4. After gloves are removed, hands must be washed / sanitized before touching any other “clean” items including MEG equipment, telephone and any computer keyboards.

5. All surfaces (prep table, cabinets) will be wiped with Dispatch after use.

6. All MEG Lab staff will monitor participants for compliance.

Non-Disposable Equipment in Contact with Abraded Skin

All non-disposable electrodes, EEG caps and other equipment that comes in contact with skin that has been abraded will be considered “contaminated” and taken to Sterile Processing Services (SPS) for disinfection / sterilization. It is the responsibility of the MEG User to place any used / "contaminated" equipment in a hospital approved transport container, fill out the appropriate SPS form and then place the container on the SPS cart in the MEG lab. SPS staff will collect and transport all MEG equipment that requires disinfection/sterilization.

Each User	- will be responsible for preparing the “used / contaminated” item(s) for disinfection/sterilization by SPS after each use.
Sterile Processing Services (SPS)	- will provide disinfection and sterilization services in compliance with standard operating procedures. - will be responsible for transporting the equipment to SPS for disinfection/sterilization.
MEG Core Staff	- will provide each user instructions regarding preparing “used”/contaminated MEG equipment for disinfection/sterilization.

1. Non-Disposable Electrodes

REMEMBER!

Silver/Silver Chloride Disc Electrodes, Gereonics Silver /Silver Chloride Electrodes, Grass Gold Electrodes and all non-disposable electrodes that come in contact with skin that has been abraded will be considered “contaminated” and must be sent to Sterile Processing Services (SPS) for disinfection / sterilization.

a. Latex rubber gloves must be use whenever handling and/or processing electrodes used on abraded skin. For individuals sensitive to latex, nitrile rubber gloves may be used.

b. Place the disk end of the electrode in the zippered section of the 2 pocket zip lock plastic bag.

c. Place the cable / wire end in the un-zippered pocket of the zip lock plastic bag.

d. Place the plastic bag containing the “contaminated” electrode(s) in the top tray of the three (3) piece amber OSHA approved Biohazard Container.

e. Place the lid on the Biohazard Container.

f. Place the Biohazard Container on the top shelf of the CHS Processing Cart.

g. Fill out a “Sterilization Request Form” for each container and place the form on the top of the appropriate closed Biohazard Container.

h. SPS staff will collect the Biohazard Container and take to their facilities for disinfection/sterilization.

i. Biohazard Containers with “contaminated” equipment will be logged in and out according to SPS procedures.

2. Non-Disposable EEG Cap – i.e., Easy Cap

All EEG caps, including the EasyCap, that come in contact with skin that has been abraded will be considered “contaminated” and taken to Sterile Processing Services (SPS) for disinfection / sterilization.

a. Latex rubber gloves must be used whenever handling and/or processing an EEG Cap that has been used on abraded skin. For individuals sensitive to latex, nitrile rubber gloves may be used.

b. All electrodes will be removed from the cap and processed separately from the electrodes.

c. The cap will be placed in the top tray of the three (3) piece amber OSHA approved Biohazard Container.

d. The Biohazard Container will then be placed on the top shelf of the SPS processing cart.

e. Place the lid on the Biohazard Container.

f. The Sterilization Request Form will be filled out for each container and placed on top of the appropriate closed container.

g. MEG staff will transport the Biohazard Container to SPS for disinfection / sterilization.

3. The VSM EasyCap and Electrodes

Currently, VSM EasyCap and electrodes are used exclusively by the NINDS EEG Department. VSM EasyCap and electrodes will be cleaned and disinfected per manufacturers’ instructions in the NINDS EEG Department. Cleaning / disinfection will be performed using NIH approved chemical disinfectants according to Hospital Epidemiology Service requirements in hospital approved designated area(s) only. Additional laboratories wishing to use the VSM EasyCap should work with the MEG Core Facility and Hospital Epidemiology Service to deploy appropriate cleaning / disinfection procedures.

4. Other Non-Disposable Equipment

All Electrode Bars / Stimulating Bars / Twisted Pair / Ground Electrodes that come in contact with skin that has been abraded will be considered “contaminated” and taken to Sterile Processing Services (SPS) for disinfection / sterilization.

a. Latex rubber gloves must be use whenever handling and/or processing electrodes used on abraded skin. For individuals sensitive to latex, nitrile rubber gloves may be used.

b. Place the disk / bar / electrode end in the zippered section of the 2 pocket zip lock plastic bag.

c. Place the cable / wire end in the un-zippered pocket of the zip lock plastic bag.

d. Place the plastic bag containing the “contaminated” electrode(s) in the top tray of the three (3) piece amber OSHA approved Biohazard Container.

e. Place the lid on the Biohazard Container.

f. Place the Biohazard Container on the top shelf of the SPS Processing Cart.

g. Fill out a “Sterilization Request Form” for each container and place the form on the top of the appropriate closed Biohazard Container.

h. SPS staff will collect the Biohazard Container and take to their facilities for disinfection/sterilization.

i. Biohazard Containers with “contaminated” equipment will be logged in and out according to SPS procedures.

Non-Disposable Equipment in Contact with Non-abraded Skin

1. All Portable Non-Disposable equipment, i.e., head localization coils and Brainsight stylus, that comes in contact with un-abraded and otherwise intact skin (including sweat) will be cleaned using a hospital approved disinfectant such as Hydrogen Peroxide, 70-90% ethyl alcohol or isopropyl alcohol.

a. Wash hands.

b. Wipe the Head Localization Coils with alcohol.

c. Adhesive Remover may be used occasionally to remove any adhesive buildup or sticky residue.

d. Wash hands.

2. Known Infectious Disease (Abraded or Un-Abraded Skin)

a. All Portable Non-Disposable / Reusable Equipment used by a patient with a known infectious disease will treated as equipment used on abraded skin ( See Non-Disposable Equipment in Contact with Abraded Skin) and be sent to Sterile Processing Services for disinfection /sterilization.

Disposable / single use equipment

1. Routine Procedure for Single Use Equipment used on Abraded or Un-abraded Skin

a. All Disposable / Single Use Equipment used abraded skin will be disposed of in the trash. Gloves will be used when abrading the skin.

2. Known Infectious Disease (Single Use Equipment)

b. All Disposable / Single Use Equipment used by a patient with a known infectious disease must be disposed of in a Medical Pathological Waste (MPW) Box.

Non-portable non-disposable / reusable equipment

1. All Non-Disposable Immobile or Non-Immersable equipment that comes in contact with a subject/patient will be routinely cleaned by the person(s) conducting the MEG scan using a hospital approved disinfectant such as Hydrogen Peroxide, 70-90% ethyl alcohol or isopropyl alcohol after each subject/patient use.