Mass chemical disasters

Public awareness of neurotoxic chemicals comes from media descriptions of mass chemical disasters involving hundreds, if not thousands, of victims. Many mass chemical disasters fueled environmental movements, forced legislation of new laws, changed public perceptions of government and industry, and caused adverse health outcomes for many individuals. Most of my top 10 mass chemical disasters of psychiatric importance listed on p. xii (see box) produced significant psychosocial effects on communities, regions, nations, and even international relations. Other events affected fewer individuals but showed the importance of psychiatric assessment and treatment of chemical exposures. In some disasters, stress caused the... 

In the hospital or at the scene of a mass chemical contamination, nurses may be asked to accurately decide which patients need care, in what order should they receive care, and in situations of severely constrained resources, who should not receive care at all. This is an extremely difficult scenario for the nurse and will create personal emotional distress. This type of disaster triage is best practiced in field exercises and drills prior to participation in a real event (Veenema, 2003). 

Military support to civil authorities is the final tier in the nation s disaster response system. Federal resources that may be implemented in the event of a major biochemical or radiation disaster are the U.S. Army Special Medical Augmentation Response Teams. The mission of the SMART teams is to provide short-duration medical liaison to local, state, federal, and DOD agencies responding to disasters, civil-military cooperative actions, humanitarian assistance missions, weapons of mass destruction incidents, or chemical, biological, radiological, nuclear, or explosive incidents. There are 37 SMART teams, including two burn SMART teams operated by the U.S. Army Institute of Surgical... 

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. 

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... 

The framework of the book is consistent with the United States National Response Plan, the National Incident Management System, and is based on the Centers for Disease Control and Prevention s (GDC) Competencies for public health preparedness and the GDC Guidelines for response to chemical, biological, and radiological events. This textbook will provide nurses with a heightened awareness for disasters and mass casualty incidents, a solid foundation of knowledge (educational competencies) and a tool box of skills (occupational competencies) to respond in a timely and appropriate manner. 

By their very nature disasters involving chemicals pose special problems because they involve a large number of people in a state of panic. Most places are not equipped to deal with such a situation especially if there is confusion about the nature of the chemical. If the chemical is a pulmonary irritant, as is the case with MIC, there is a good likelihood of cyanide poisoning as happened in Bhopal and for a short period in Japan when miscreants exploded organophosphates in the subway. The other reason for mass confusion is the erroneous belief that there exist antidotes for every poison. 

The October 2001 anthrax events revealed that terrorist attacks do not have to cause many casnalties to create mass anxiety and disruption (1,4). Other than that experience, however, we have little historic data to tell us how the public will react following a large-scale biologic, chemical or radiological attack (1). Most available information comes from studies of pubhc reactions to natural disasters, conventional terrorist events, such as the Sarin attack in Tokyo and the September 11 attack, and nuclear accidents (1,5,6). Additional information is available from stnd-ies of soldier s reactions to military campaigns involving toxic agents (1). 

Figure 6. Interaction of the red and white plans for the evacuation of casualties following a disaster. The fire service are responsible for rescue and primary evacuation of casualties as far as the advanced medical post. Here, casualties are triaged and receive primary treatment. The hospital white plan for the management of mass casualties is extended to this point using medically manned mobile intensive care units which can carry out extensive early care before transporting the patient to the most appropriate hospital facility. In the case of a toxic release, this will be to a special reference hospital, manned and equipped to deal with casualties from a chemical-biological release...

The threat of chemical and biological terrorism, coupled with current world events, has caused the many disciplines responsible for the health and welfare of the public to evaluate their ability to respond adequately to an intentional use of a weapon of mass destruction. The national medical community—including public health agencies, emergency medical services, hospitals, and health care providers—would bear the brunt of the results of a chemical or biological attack. An attack of a chemical or biological agent could result in civilian mortality and morbidity that have not been seen in natural disasters or infectious outbreaks in the United States since the influenza epidemic of 1918-1919. 

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