Chemical and Biological Terrorism Research and Development to Improve Civilian Medical Response (1999) / Chapter Skim
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7 Patient Decontamination and Mass Triage
7 Patient Decontamination and Mass Triage
Pages 97-109
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From page 97... ...
DECONTAMINATION Fire departments and hazardous material teams have traditionally described the decontamination processes with two terms "technical decon" and "medical" or "patient decor." "Technical decon" is the process used to clean vehicles and personal protective equipment (PPE) and "medical" or "patient decon" is the process of cleaning injured or exposed individuals.
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From page 98... ...
Solution "A" contains 5 percent sodium bicarbonate and 5 percent trisodium phosphate and is used for inorganic acids, acidic caustic wastes, solvents and organic compounds, plastic wastes, polychlorinated biphenyls (PCBs) , and biologic contamination.
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From page 99... ...
Patient Decontamination Patient decontamination, which Hazmat teams have to undertake much less often than technical decon, is to be performed when the contaminant poses a further risk to the patient or a secondary risk to response personnel. Fire and EMS publications frequently describe how patient decontamination can be done, but few of the recommendations are based on empirical research.
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From page 100... ...
The CBIRF and MMST have much larger shower units, capable of decontaminating dozens to hundreds of victims with sodium hypochlorite solution, and are staffed at much higher levels than local Hazmat teams. However, neither will be immediately available unless predeployed (as was done, for example, at the Atlanta Olympics and State of the Union Address)
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From page 101... ...
, antidotes, or other emergency treatment, may receive that care during or after the decontamination process depending on the severity of the agents' effects and the ability of the decon team and available medical personnel to render that care. Nonambulatory patients pose much more of a decontamination and treatment burden than ambulatory patients, because most portable decontamination chambers require a person to stand.
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From page 102... ...
Aside from the issues related to effective decontamination procedures, training of emergency department personnel must also be considered. There are few courses emergency department personnel may attend to improve their level of preparation for decontamination of large numbers of people.
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From page 103... ...
Ideally, this guideline would address areas such as site management and crowd control, cleaning ambulatory and nonambulatory victims, handling the special needs of pediatric and geriatric populations, and a standardized patient assessment and triage process to be initiated by personnel wearing PPE to determine viability and need for decontamination. Besides the need for a step-by-step process for performing decon in the field setting and in the emergency department, there is no good way to determine when a patient is "clean." Few chemical or biological agents can be readily seen on the skin or quickly assayed to determine whether any residual product remains after washing.
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From page 104... ...
Although the commercial market can certainly produce needed decontamination hardware, development of more standardized methods for conducting patient decon will spur improvements in the suitability and cost of the equipment. Performing Mass Decon While the exact number of hazardous material accidents occurring each year may not be known, available data does suggest that for most incidents there are few, if any, injuries (Sullivan and Krieger, 1992~.
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From page 105... ...
The military model primarily addresses how to handle young healthy soldiers already wearing protective clothing and respiratory protection, and is not directly applicable to a heterogeneous, unprotected, and undisciplined population. The similar mass decon process envisioned by the MMST has not been utilized except in drills.
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From page 106... ...
No less important is the hospital's ability to process large numbers of victims in a timely fashion. Hospitals need to know how their decon systems should be organized and equipped, whether decon is best done inside or outside of the facility, what PPE emergency department personnel should wear, how the system should accommodate both walk-in and ambulance-delivered patients, and the patient volume that should be manageable in an emergency department that has 10,000, 25,000, or 60,000 visits a year.
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From page 107... ...
The triage process is the initial step taken to meet the primary objectives of a disaster response. The purpose of triage is to sort the injured by priority and determine the best use of available resources (e.g., personnel, equipment, medications, ambulances, and hospital beds)
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From page 108... ...
The curriculum should include the following: · site management/crowd control, · triage, · providing medical care while wearing PPE, · set-up of mass decon areas in the field and at hospitals, · performing mass decon on ambulatory and nonambulatory patients of all ages, and · proper recognition and management of the psychological aspects of undergoing decontamination and exposure to WMD.
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From page 109... ...
Such research should include: · the physical layout, equipment, and supply requirements for performing mass decon for ambulatory and nonambulatory patients of all ages and health in the field and in the hospital; · a standardized patient assessment and triage process for evaluating contaminated patients of all ages; · optimal solutionts) for performing patient decon, including decon of mucous membranes and open wounds; · the benefit vs.
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