Chemical incidents hospital response

Chemical incidents pose a special risk to rescuers and hospitals since the spread of contamination to staff may adversely affect their performance and long-term health. There have been many reports on secondary contamination of healthcare staff and facilities during chemical incident response, sometimes as a result of a single contaminated patient. In the USA, it has been estimated that secondary contamination of healthcare staff occurs in 0.4 % of accidental industrial chemical incidents. In contrast, the deliberate release of chemicals is associated with a higher risk of spread of contamination due to a number of factors ... 

Emergency medical personnel managing toxic trauma in hospitals may be involved in the incident itself either as part of the pre-hospital response teams, as is the case in France and other European countries, or because of the need to manage contaminated casualties who arrive at the emergency department without having been processed through a chemical incident management system (HAZMAT). Such contaminated casualties may pose a serious risk to the hospital personnel and their activities. 

For many years, the identification of specific collections of signs and symptoms following exposure to toxic agents has formed the basis of early medical responses in diagnosis and treatment. This has particularly been the case in the military world for the management of chemical warfare agent exposure. In the civil setting where identification of the released substance may not be immediate, toxidromes have assumed an equal importance and are part of established paramedical pre-hospital response to HAZMAT incidents. 

Key elements of the hospital response to a chemical release incident will include ... 

Victims of chemical contamination need prompt and effective treatment, both at the scene of the incident and in hospital. Ambulance or emergency medical services and hospital emergency rooms provide the front line health response and most will already have tried and tested contingency arrangements for accidental chemical releases - often referred to as HAZMAT or HAZCHEM (hazardous materials and hazardous chemicals) protocols. Whether for an accidental or deliberate chemical release contingency arrangements need to address the following key objectives ... 

Since the appearance of the first edition, toxic trauma from deliberate exposure to chemical warfare agents has continued in the Syrian Civil War, causing many thousands of casualties. The fear of further use of chemical weapons by terrorist organisations continues, and thus readiness to deal with chemical casualties in the urban civil setting remains more important than ever. In industrial and domestic settings, the accidental release of toxic chemicals continues and no hospital department can afford not to prepare for such incidents, both in daily practice and as part of disaster-response planning. The hazards of toxic trauma remain therefore as real as ever, and I hope that the new edition of this book will help to inform and to prepare responses accordingly. 

---