Management of victims

VolansAP. Sarin guidelines on the management of victims ofa nerve gas attack. JAccidEmerg Med 1996 May 13(3) 202-6. 

PLANNING THE EMS RESPONSE AND THE MANAGEMENT OF VICTIMS THE FRENCH APPROACH... 

Laurent JF, Richter F and Michel A (1999). Management of victims of urban chemical attack the French approach. Resuscitation, 42, 141-149. 

B. Obtain toxicity information. Detennine the acute health effects and obtain advice on general hazards, decontamination procedures, and medical management of victims. Resources include the following ... 

Management of Victims at the Scene of the Accident. At facilities with radioactive sources, trained personnel on every shift should normally provide any first aid required. In case of serious injury, medical personnel from suitable off-site medical centers should be available. The purposes of medical response on-site are to treat traumatic injuries, to assess contamination and perform limited decontamination. If anyone receives high doses exceeding threshold for deterministic effects, it is usually recommended that he or she be transported directly to a highly specialized medical hospital for complete medical examination, treatments, and assessment of the dose. 

Management of Victims at the First Off-Site Stage. The task of medical staff at the first off-site stage should be to identify the type, origin, severity, and urgency of the cases. The basic principle is that treatment of serious or life-threatening injuries must take priority over other actions. The following is a simple classification system. 

The role of cytokine therapy in the management of radiation accident victims has been summarized (152). In GoiBnia in Brazil in 1987, eight radiation accident victims were treated with GM-CSF one month after radiation exposure. Marked increases in granulocyte production were induced in five persons, although this did not prevent death. 

In the veterinary as in the human patient, neoplasms are often metastatic and widely disseminated throughout the body. Surgery and irradiation are limited in use to weU-defined neoplastic areas and, therefore, chemotherapy is becoming more prevalent in the management of the veterinary cancer victim (see Chemotherapeutics, anticancer). Because of the expense and time involved, such management must be restricted to individual animals for which a favorable risk—benefit evaluation can be made and treatment seems appropriate to the practitioner and the owner. In general, treatment must be viewed not as curative, but as palliative. 

The nowadays system for supply and receipt of information does not always answer the current needs. In such conditions, it is impossible to consider the information on the concerned subject of management as being objective, since it is coming in too late. Unreliable untimely information sometimes results in errors during the decision-making administrative process and in extraordinary situations can cost the life or be the instrument for worsening the condition of victims. As a result, the necessity becomes clear to develop and... 

Isolation Procedures Once a victim of chemical or biological agents or weapons gets to the hospital or another healthcare facility, that person may have to abide by patient isolation procedures. These include Standard Precautions, Airborne Precautions, Droplet Precautions, and Contact Precautions. These precautions are spelled out in the third edition of Medical Management Of Biological Casualties Handbook published by the U.S. Army Medical Research Institute of Infectious Disease located at Fort Detrick in Frederick, Maryland. 

Medical Management Victims may have a feverish respiratory syndrome without chest x-ray abnormalities, and diagnosis is usually clinical. Medical and emergency medical services personnel should be aware of and should report any number of victims showing up within a limited amount of time presenting typical symptoms and instances of SEB pulmonary exposure as being indicative of being an intentional attack with SEB toxin. 

Medical Management Immediate decontamination after exposure is the only way to prevent damage to victims, followed by symptomatic management of lesions. Hospital care tends to be supportive. It should be repeated that liquid arsenical vesicants produce more serious lesions on dermal surfaces than do liquid mustard. In toxic victims, liberal fluids by mouth or intravenous, and high-vitamin, high-protein, high-carbohydrate diets could be indicated. For those victims where shock is in evidence, provide the usual supportive measures such as intravenous administration, blood transfusions, or other vascular volume expanders should be indicated. 

Decontamination immediately after exposure is the only way to present damage, with symptomatic management of lesion/blisters thereafter. All victims and first responders shall be decontaminated when leaving the Hot Zone. Clothes should be removed if at all possible, and no one should be transported to a hospital until he of she has been thoroughly decontaminated. Care in a hospital is strictly supportive. First responders have to ensure that every one contaminated goes through an efficient decontamination procedure. 

Even with a serious exposure, poisoning is rarely fatal if the victim receives prompt medical attention and good supportive care. Careful management of respiratory failure, hypotension, seizures, and thermoregulatory disturbances has resulted in improved survival of patients who reach the hospital alive. 

By and large the drug treatments for AD merely attempt to diminish the impact of the psychiatric symptoms. Major and minor tranquilizers and antidepressants, which we will be discussing shortly, can help in the management of AD victims in the early stages of the condition. Attempts have been made to treat apparent decreases in the amount of acetylcholine in the hippocampal area of the brain. This is due to lower choline acetyl transferase activity. Acetylcholinesterase... 

Gathering together all this technical knowledge introduces a new philosophy in the approach to chemical ocular bum lesions, in particular at the initial stage of victim management with increased practicality, specificity, and efficacy. 

The chemical and toxicologic characterization of the electrophilic nature of the reactive acetaminophen metabolite has led to the development of effective antidotes—cysteamine and N-acetylcysteine. Administration of A-acetyl cysteine (the safer of the two) within 8-16 hours following acetaminophen overdosage has been shown to protect victims from fulminant hepatotoxicity and death (see Chapter 59 Management of the Poisoned Patient). 

SME. In this area, France and the UK may have a lot to learn from Sweden s use of policy objectives with respect to promoting a culture of chemical safety in industry and through supply chains. For France, adopting a more hazard-based approach to risk management could limit the occurrence of victim associations . 

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