Medical treatment facility contamination

If any mustard remains on the skin, thorough decontamination later will prevent the further spreading to other areas. After several hours, spreading will have occurred because oily substances flow on warm skin. Decontamination now, however, will prevent mustard from spreading to personnel who handle the casualty and possible contamination of medical treatment facilities (MTFs). By the time skin lesions develop, most mustard will have been absorbed and fixed to tissue. Unless the site was occluded, the remaining unabsorbed agent will have evaporated. 

If the medical treatment facility (MTF) or hospital becomes contaminated with chemical agent, not only does it become useless to render care, but it also exposes the staff and all other patients to chemical contamination. All precautions must be used to avoid this issue. Only very limited access to the hospital or MTF should be permitted. At most, only one or two entrances to the hospital should be used by incoming patients and employees. At these entrances, proof of decontamination or noncontamination, in the form of checking the individual with a chemical agent monitor (CAM) for contamination, must be presented before admission. AU other entrances must be locked down. Security guards posted on the inside of aU entrances would prevent unauthorized entrance from outside. Remember, people exiting the hospital could hold the door open to admit contaminated individuals from the outside. 

FIGURE 24.2 Representative diagram of a casualty treatment site. (From U.S. Army Medical Research Institute of Chemical Defense, Chemical Casualty Care Division, June 2001.) Hot Line= possible hquid contamination downwind (left side of line), negative liquid contamination upwind (right side of line). N.B. Possible positive vapor present on either side of hot line. VCL — vapor-control line possible positive vapor on downwind side of line (left side of line), negative vapor on upwind side of line (right side of line). EMT, emergency medical treatment MTF, medical treatment facility. 

A. Upon entering a medical treatment facility, patients from a contaminated area should be decontaminated and monitored for radiation. Monitoring by trained health physics personnel may be required to determine when it is proper to discontinue isolation techniques. Such personnel are usually located at the medical group level (see section 3.1). 

Mission Provide medical/technical advice and detection equipment for the treatment of radiologically contaminated patients to on-scene health care or medical treatment facilities. 

Second, the risk of chemical contamination of medical equipment and medical treatment facilities is an added threat, and precautions need to be taken to ensure that patients are properly decontaminated before being brought into designated uncontaminated treatment areas. Frontline medics faced with many casualties can only be expected to administer lifesaving procedures, such as opening the airway or preventing further hemorrhage decontamination can be expected to be minimal. 

A clearing company or a clearing company team will set up ambulance exchange points, which have a treatment squad to perform first aid and the capability to perform patient decontamination before further evacuation. As a rule, contaminated ambulances operate from the FLOT, transporting contaminated casualties back to the exchange point, while clean vehicles transport decontaminated casualties to Echelon III medical treatment facilities. 

To that end, procedures and quahty control methods have been developed that are applicable in other situations too. Glean room technology that is essential for maximizing usable chip production is equally valuable in biological research and medical treatment facilities, applied physics laboratories, space exploration, aeronautics repair and maintenance facilities, and any other situations in which steps to protect either the environment or personnel from contamination must be taken. 

The possibility of contamination of patients may be determined in the field, en route to a treatment facility, or at a treatment facility, depending on the condition of the patients. The facility receiving the patients should be informed of the estimated number of casualties, the natures of their injuries, and details on any suspected contamination that may be present. Injured personnel should be sorted and treated according to standard medical guidelines. If possible, individuals suspected of being contaminated should be separated from other patients and receive preliminary decontamination prior to treatment (see Section 7.3 for decontamination procedures). 

If respiratory distress is experienced, immediately remove the individual from the contaminated area to fresh air. If the person is not breathing, artificial respiration should be provided. Seek immediate medical attention. If breathing is difficult, transport the individual to a medical care facility for treatment, and if available, give the individual supplemental oxygen. 

Healthcare facilities need to expect that in case of a chemical event, many people are likely to self-evacuate and present to medical facilities. In order to maintain some control, it is recommended that all access and egress at treatment facilities be controlled and monitored to prevent contamination of noncon-taminated individuals and facility areas. It is helpful to have law enforcement involved to provide security and crowd control. 

In the event of an enemy attack with chemical agents, those in the military medical departments must consider first aid, treatment, evacuation, and decontamination procedures of contaminated casualties—some of whom may have injuries made by conventional weapons in addition to their chemical injuries. The ultimate objective in the management of all contaminated casualties is to provide the earliest and most effective treatment without compounding injuries or contaminating medical personnel and treatment facilities. 

In a higher-echelon medical facility, all immediate patients will be sent through decontamination for entry into the clean area. However, the casualty might require stabilization at the contaminated emergency treatment facility before entry into the lengthy decontamination process. 

Treatment of life-threatening injuries should almost always take precedence over measures to address radioactive, chemical, or biological contamination or exposure. Injured individuals should be stabilized if possible and immediately transported to a medical facility. It is recommended that an individual with training in the areas of radioactive, chemical, and biological hazards accompany the first patients to the hospital and serve as an advisor to the medical team. 

Low-Level Waste Low-level waste (LLW) consists of contaminated dry trash, paper, plastics, protective clothing, organic liquids such as liquid scintillation samples, and the like. LLW is produced by any facility that handles radioactive materials such as nuclear power plants, medical facilities, colleges, and so forth. In the United States, commercial LLW is sent to one of three disposal sites (Barnwell, South Carolina, Richland, Washington, and Clive, Utah). Due to the limited size of these sites (and similar disposal sites through the world) and steeply escalating costs for waste disposal, the primary goal of LLW treatment prior to disposal is volume reduction, either by incineration or compaction, followed... 

Three types of EHS system resources are critical to responding to any sort of MCI facilities, personnel, and materials. Health facilities serve as the location for patient care and shelter. These facilities require specialized resources for decontamination, isolation, and medical and surgical treatment. However, these facilities are not immune to being impacted by disasters. As seen in the California earthquakes and Florida hurricanes, disasters can affect those facilities, making the health facility both a victim and responder. Also, health facilities can be contaminated, further limiting access. Planners must consider the likelihood and potential impact of the degradation or loss of health facilities in any disaster plan and consider alternate facilities to render care (Aghababian, Lews, Cans, Curley, 1994 Chavez Binder, 1996). 

If the victim has ingested aluminum phosphide, emesis should not be induced. Phosphine gas will be produced in the stomach when aluminum phosphide contacts the resident gastric fluids. A slurry of activated charcoal may be administered at 1 g charcoal per kg body weight. Any victim who has ingested aluminum phosphide should be immediately transported to a medical facility for treatment and monitoring. Rescuers need to be aware of any solid phosphide contamination on the victim s clothing, skin, or hair which will produce phosphine following contact with water, as well as any vomitus which could off-gas phosphine. 

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. 

These facilities include battalion aid stations, hospital and medical companies, casualty receiving and treatment ships, fleet hospitals, and hospital ships. Provision of medical care in a contaminated environment is extremely difficult due to the encapsulation of medical personnel in their individual protective ensembles. 

Medical facilities treating chemical casualties must divide their operations into two categories contaminated (dirty) and uncontaminated (clean). Contaminated operations include triage, emergency treatment, and patient decontamination. Uncontaminated operations include treatment and final disposition. All activities conducted in the Casualty Decontamination Center (CDC) and not inside a collective protection shelter must be conducted at MOPP 4. Operational flexibility is essential. Therefore, the number and arrangement of functional areas will be adapted to both medical and tactical situations. 

Clinics located at depots with a chemical surety mission should have an area designated for the decontamination of exposed patients. Generally the treatment area for these patients is separate from the normal patient treatment areas. These facilities are rarely used for an actual chemically contaminated patient, however. A conscious effort must be made to keep these rooms at 100% operational capability. To maintain this capability, the medical staff must develop standing operating procedures (SOPs) that are comprehensive and detailed. 

Staffing. At least two physicians and three support staff should be trained aimually in the risks, precautions, and treatment of exposed and contaminated patients. In addition, a radiation specialist experienced in dealing with radiation and contamination (e.g., from a research facility) should be assigned to the facility at the time of the event. Provision should also be in place to train additional medical staff at the time of the event if necessary. 

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. 

At all stages of medical care, the treatment of highly contaminated individuals will require special facilities or isolated facilities with the specif procedures that limit the spread of contamination and disposal of contaminated waste. For the deteetion of radioaetive eontam-ination, radiation equipment should be available, such as specialized radiation monitoring instruments, whole body counter, and iodine thyroid counter. Usually a radiation protection officer or health physicist performs the measurements. For the purpose of dose reeonstraction, different instruments and methods can be used, such as electronic paramagnetic resonance (EPR) spectrometry and cytogenetic dosimetry. Because of this, collection of various tissues (blood, hair, and teeth) and clothes of exposed persons should be organized. Provisions (plastic bags, labels, etc.) should be made in advance. 

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