Hazardous materials patient decontamination

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. 

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 ... 

Hospitals receive not only field-decontaminated patients but also "walk-ins" who may have bypassed field decontamination. Despite Joint Commission on Accreditation of Healthcare Organizations standards calling for hospitals to have hazardous materials (Hazmat) plans and conduct Hazmat training, two recent reviews have suggested that most hospitals in the United States are ill prepared to treat chemically contaminated patients. 

Fire departments and hazardous material teams have traditionally described the decontamination processes with two terms—"technical decon" and "medical" or "patient decon." "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. 

Victims of chemical attack require very thorough decontamination. Use soap and lots of water for victims. Up to 10 to 15 minutes of irrigation with soap and water may be needed. The victims clothes can be a source of cross-contamination. Using hazardous material bags, double-bag all clothes. Control water runoff if possible, but do not delay decontamination of patients. When performing decontamination you must wear protective clothing, respiratory protection of at least Level C, and a fuU-face hood or shield. 

Have them remove their clothing, jewelry, and other items, including footwear and underwear, and place them in appropriate hazardous material bags that are labeled with the patient s name (Doff-it kits are good here). If at all possible, separate male and female patients during decontamination to respect modesty. You should be in Level B attire unless It has been determined that Level C is adequate (Figure S2.3). 

This book is part of a 15-hour basic training course. This course consists of a series of lectures about the various terrorist weapons and methods of attack and the proper way to respond to them. Along with the lectures will be demonstrations of various types of equipment needed to identify the weapon being used. The course also consists of four hands-on skill stations to teach how to use personal protective equipment (PPE), how to decontaminate patients, how to use the Nerve Agent Antidote Kit, and scenario exercises in how to respond to the various types of terrorist attacks. These same principles apply to responding to hazardous materials incidents and clandestine drug laboratories. 

Decontamination of the patient is necessary when a persistent toxic agent has been released and is present on the skin and clothing. The problems created by the need for decontamination in the context of the management of a hazardous materials (HAZMAT) incident are addressed in the next chapter. Here, we consider the basic techniques of individual and mass decontamination that should be understood by medical personnel. 

Physical decontamination of victims is the removal of hazardous substances to prevent or reduce toxicity. Decontamination reduces the amount of toxic material to which the victim is exposed and also reduces the risk of secondary contamination (cross-contamination) of rescuers and others at the scene or the hospital. Time is critical for patients needing decontamination, so all the equipment necessary to perform mass decontamination is best carried in a special vehicle such as a decon trailer or decon truck (Figure S2.1). 

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