Emergency departments decontamination

It is also important to consider the issue of patient decontamination. Many hospitals rely on local fire or HAZMAT resources to decontaminate patients prior to arrival at the emergency department. This model is almost always effective as the typical HAZMAT or chemical exposure is an isolated event in which a limited access/egress quarantine can be established, and in which patients can be controlled and decontaminated. However, as was demonstrated during the sarin gas attack in Tokyo, in a disaster, there is no control over the scene or scenes. Patients will self-refer to emergency departments without being decontaminated (Auf der Heide, 2006 Okumura, Suzuki, Fukuda, 1998 Okumura, Takasu, Ishimatsu, 1996). 

Report any special information obtained (e.g., identification of toxic chemical, decontamination or any special emergency condition) to appropriate personnel in the receiving area of the hospital (e.g., emergency department), HCC and/or other receiving facilities. ... 

Cyr (1988) reported on 345 children exposed to a farmer s insecticide spraying. Sixty-seven children were transported to the local emergency department, with local decontamination treatment administered. No children were hospitalized or suffered ill effects. 

Emergency Treatment. Upon arrival in the emergency department, patients field decontamination should be complete, and the emergency personnel can focus on... 

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. 

Warm/Dirty Adjacent to the hospitai, usuaiiy near the Emergency Department (remote to the reiease site) Hospitai decontamination area. This area needs a source of water (coid ciimates require a warm water source) for decontamination and barriers to controi entrance and exit from the area, which must be tightiy controiied. Personnei working in this area (first receivers) have potential to be exposed to the contaminant(s) and, therefore, must wear the appropriate level of PPE (level C minimum). At the entrance to the Warm Zone is the initial triage station. All ambulance and walk-in cases must enter the facility after going through this triage station. Victims who are clearly not contaminated skip the Warm Zone and enter the Cold (Clean) Zone directly. All others proceed into the Warm Zone for decontamination. 

Children presenting to the emergency department needing decontamination require special consideration. When dealing with children in a disaster situation, nurses must not only work to identify, triage, and... 

Cox, R. D. (1994). Decontamination and management of hazardous materials exposure victims in the emergency department. Annals of Emergency Medicine, 23(4), 761-770. 

Special decontamination areas outside the hospital emergency department or in the field are the best locations for decontamination (7). If the decontamination area is within the hospital, its ventilation system should be separate from the rest of the hospital or turned off to prevent the spread of contamination. If it is necessary to turn the ventilation system off, the hospital should follow OSHA regulations on atmospheric monitoring, especially if health care workers are using air-purifying respirators (9,10). 

Fortunately, skin or wound contamination rarely presents a life-threatening risk to either patients or health care personnel (5). The best possible scenario is decontamination in the field before transport however, following an attack with a radiologic dispersion device (ROD), patients suffering trauma will most likely present to emergency departments before undergoing external contamination. 

There were inadequate facilities in the Emergency Department at St Luke s to permit a large number of casualties to remove contaminated clothing and to shower formal decontamination was, therefore, impossible. In addition, the ventilation in the patient reception area was poor. Consequently, some of the medical staff complained of eye or throat pain, nausea, or miosis (Okumura et al, 1996). This was relieved by improving ventilation and by rotation of affected staff to other locations within the hospital. Secondary exposure of medical staff from patients affected by sarin vapour was limited. No medical staff required pharmacological treatment for their signs and symptoms. 

Morby P, Murray V, Cummins A et al. (2000). The capability of accident and emergency departments to safely decontaminate victims of chemical incidents. J Accid Emerg Med, 17, 344-347. 

C. Decontamination (see p 46). Rescuers should wear appropriate protective gear to prevent accidental skin or inhalation exposure. If solid phosphoms is brought into the emergency department, immediately cover it with water or wet sand. 

Prepare in advance a hose with 85°F water, soap, and an old gurney for rapid decontamination outside the emergency department entrance. Have a child s inflatable pool or another container ready to collect water mnoff, if possible. However, do not delay patient decontamination if water runoff cannot be contained easily. 

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. 

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. Another issue is how the cost for being prepared could be recovered by the hospital. Unlike other modernization efforts, a decontamination unit is not going to pay for itself with new patients and fees for the hospital. 

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