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Mass-casualty incidents involving hazardous materials may overwhelm all hospitals in a community. There may not be enough doctors and nurses, supplies, equipment or bed space to treat victims. Without a pre-plan that makes contingencies for mass-exposure incidents, the impact of the disaster on the community will only be compounded by the medical system. Once plans are developed, they must be practiced and personnel trained to follow them.
Hazmat and terrorist training generally focuses on emergency responders. In many areas, however, little attention is given to training doctors, nurses and other emergency room personnel to decontaminate victims and provide treatment for chemical and biological exposure.
Preparation to treat biological exposure is of critical importance. Emergency departments may be the first to see patients from a biological exposure. Victims may report to emergency departments, clinics or doctors' offices. Some victims may even be brought in by ambulance without EMS personnel realizing that the patients are victims of biological exposure. Symptoms of biological agents can be confused with the flu or other illnesses, and patients may be sent home.
When dealing with a known biological incident, decontamination should be performed. The decontamination solution should be a disinfectant or bleach, followed by a soap-and-water rinse if the exposure is confirmed. If the presence of a biological agent is not confirmed, as in the case of the recent anthrax scares, soap-and-water decontamination is sufficient. The Centers for Disease Control (CDC) may be consulted to determine proper disinfectant solutions.
Preparing The Emergency Department
Emergency room personnel should be able to recognize hazards from chemical and biological exposure and determine appropriate protective equipment. When reports from the field of patient conditions include nausea, dizziness, itching/burning eyes or skin, or cyanosis, personnel should recognize that hazardous materials could be involved. It is important that emergency room personnel have positive identification of the hazardous material and determine its toxic characteristics.
Photo by Robert Burke
A cart carrying decontamination equipment and protective clothing is set up outside a hospital emergency department.
A number of databases are available for emergency room personnel to research hazardous materials. Call-up systems can be accessed through telephone lines or database systems that are available in house on a local personal computer. Books and telephone resources, such as CDC and Chemtrec, are also available.
Personnel should also be aware of basic chemical terminology and toxicology. This is necessary for personnel to be able to communicate effectively with responders in the field, read and understand Manufacturer Safety Data Sheets (MSDS) and other resources, access toxicology databases and provide proper patient care. Important toxicological information includes routes of exposure, target organs, effects of acute and chronic exposure, local and systemic toxic effects, minimum lethal doses, dose/ response and occupational exposure limits.
Emergency department personnel also need varying degrees of personal protective equipment (PPE), including chemical protective clothing and, in some instances, respiratory protection. The amount and type of protective equipment is determined by the frequency of incidents that occur in a given area, the types of chemicals present in and transported through the community, proximity to industries or major transportation routes that have a potential for hazardous materials incidents, and the funding available to purchase the equipment. In some areas, incidents occur so infrequently that using the services and resources of the local fire department or hazmat team may be necessary to accomplish not only decontamination, but provide for PPE needs.
If the decision is made to maintain an ability to perform decontamination in house, appropriate PPE and training for donning and use will be necessary. Personnel must be trained in the use of PPE before they use it in an incident. Training and equipment must also conform to Occupational Safety and Health Administration (OSHA) and other applicable regulations and standards. OSHA's 29 CFR1910.120 final rule as it applies to emergency medical personnel states that: "Training shall be based on the duties and functions to be performed by each responder of an emergency response organization." In addition, protective equipment in emergency departments also requires routine maintenance, cleaning and resupply when used.