Mass casualty decontamination

Decontamination Mass-Casualty Triage Procedures R D Needs... 

Improvement Item GVW Fire Department did not have adequate resources to conduct decontamination activities for mass casualty situation. 

Improvement Item Decontamination logs were not accurate due to chaotic state at the scene. Gross decontamination performed but quickly overwhelmed Fire Department did not have adequate resources to conduct decontamination activities for mass casualty situation. 

Improvement Item Mass casualty plan was not implemented initially due to communication difficulties. Communication of patient status at decontamination was not well-coordinated with Red Cross shelter representatives. Persons at shelters were registered, but if they were sent to the hospital or left with friends/family, their status was unknown. 

Guidelines for Mass Casualty Decontamination During a Terrorist Chemical Agent Incident. Prepared by U.S. Army Soldier and Biological Chemical Command (SBCCOM). Aberdeen Proving Ground, MD (January) 2000. 

Children with special health care needs will require additional considerations during mass casualty or disaster care. These considerations include decontamination procedures following radiation or chemical exposure for children using wheelchairs, ventilators, or oxygen and decontamination procedures for children with gastrostomy tubes, tracheostomy tubes, indwelling bladder catheters, and indwelling central venous catheters. Replacement supplies would be needed once the cutaneous decontamination is completed. Such supplies may not be readily available, so provisions must be made to secure these items or to have comparable clean or sterile supplies on hand. 

Minimally, all hospital personnel (e.g., nurses, physicians, security, and triage) who have a designated role in a HAZMAT response must be trained to the first responder awareness level (Levitin Siegelson, 2002). Staff must be comfortable with knowing how to locate and use personal protective equipment and with the decontamination process (see chapter 26, Mass Casualty Decontamination, for further discussion). 

A large-scale chemical release with mass casualties will create a significant burden and may quickly overwhelm the existing health care system. Decontamination must be available and provided quickly to patients involved in chemical and other hazardous materials incidents. 

Emergency departments have a unique role in mass casualty decontamination. Nurses must use the appropriate level of personal protective equipment in order to keep themselves safe and avoid becoming a victim. 

Disaster events may create a sudden influx of patients who have been exposed to a chemical, radiation, or other hazard that requires decontamination. Protecting nurses and other health care workers who respond to chemical or hazardous materials (HAZMAT) mass casualty incidents is critical. Patient decontamination is an organized method of removing residual contaminants from the victim s skin and clothing and should be performed whenever known or suspected contamination has occurred with a hazardous substance through contact with either aerosols, solids, or liquids. The degree of decontamination performed will... 

When a patient presents to the ED, the nurse must ascertain that an exposure has taken place. Nurses should suspect chemical exposures for any mass casualty incident in which multiple ill persons with similar clinical complaints (point-source exposure) seek treatment at about the same time or in persons who are exposed to common ventilation systems or unusual patterns of death or illness. The ED may or may not receive notification in advance that a chemical explosion or leak has occurred. In either case, ED health care providers have the following three primary goals in treating a patient who has been exposed to a hazardous material and may be contaminated or who has not undergone adequate decontamination before arrival at the hospital ... 

Nursing education must help nurses attain the skill sets that will allow them to respond to large-scale disaster and mass casualty events while still providing for their own personal safety. These skills include rapid physical assessment and disaster triage, decontamination and the use of personal protective equipment and the allocation of scarce resources. 

PHNs working in a receiving station who observes people arriving with what appears to be dust on their clothing, should assume that it is radioactive and don the appropriate level PPE, notify HAZMAT and refer people to them for decontamination. (See chapter 26, Mass Casualty Decontamination, for further discussion.)... 

After stabilization and external decontamination, patients require assessment for radiation injury based on dose, specific isotope involved and the presence of internal contamination. By performing individual biodosimetry, physicians can predict the subsequent clinical severity, survivability and treatment required, as well as triage patients with subclinical or no exposure (2). The three most useful items for estimating exposure doses in a mass casualty situation are ... 

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