Patients decontamination procedures

Patient Decontamination Procedures. These procedures are written for chemical warfare, but are useful for all NBC. Medical personnel performing the decontamination should wear mask, gloves, and protective overgarments. 

The primary mission of the Decontamination Element is to turn chemical/biological victims into patients through mass decontamination procedures by establishing a site capable of providing initial and sustained operational decontamination of Force personnel (rescue workers), ambulatory, and non-ambulatory patients. The Decontamination Element also handles decontamination of CBIRF members, attachments, vehicles, and equipment that have entered the incident site controls access into and out of the incident site handles processing of surety material and evidence while maintaining chain of custody through the site and handles limited area decontamination of the incident site. 

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). 

External decontamination procedures are designed to minimize internal contamination of patients and the individuals providing care. Radionuclides on the intact skin surface rarely produce a high enough absorbed dose to be hazardous to patients or to medical staff. However, this is not the case for chemical hazards. Prior to implementing decontamination procedures, a patient should be moved to an upwind position outside of the area of contamination. 

During radiological decontamination efforts, caregivers should consider the chemical nature of the contaminant, the medical needs of the patient, the seriousness and extent of contamination, and the presence of wounds. Prior to implementing decontamination procedures, remove all outer clothing from the contaminated individual and place the clothing in a sealed container such as a plastic bag. Save clothing so... 

Reducing further exposure to a toxicant is crucial and may include removal of the patient from a toxic environment and the application of decontamination procedures. Immediate decontamination reduces absorption of toxic compounds and represents a primary essential aspect of the treatment regimen. 

Nurse responders must approach contaminated sites with great caution an6 be prepared to self-decontaminate. Nurse receivers need to have a solid understanding of how to stay safe while participating in decontamination procedures and patient care at the hospital. 

Because central vision tends to recover spontaneously even without treatment, patients with acute quinine toxicity should generally be managed by supportive measures alone. Hyperbaric oxygen has been used in an attempt to increase oxygen delivery to the retina. The use of oral activated charcoal or any other gastric decontamination procedures does not improve clinical outcome and may, in fact, be harmful to the patient. It is important to emphasize preventive measures, such as patient education and dispensing of quinine in child-resistant containers. 

Basic and advanced life support measures should be utilized as necessary for atropine exposure. Gastric decontamination procedures should be employed based on the patient s history and current symptomatology. Activated charcoal can be given to adsorb atropine. The mainstay of treatment is supportive care. Physostigmine, a cholinesterase inhibitor, can be given to patients to reverse signs and symptoms of... 

Basic and advanced life-support measures should be implemented as necessary. Gastrointestinal decontamination procedures should be used as appropriate based on the patient s level of consciousness and history of ingestion. Activated charcoal can be used to adsorb the benzodiazepines. The patient s level of consciousness and vital signs should be monitored closely. Obtunded patients with reduced gag reflex should be intubated to prevent pulmonary aspiration. Respiratory support, including oxygen and ventilation, should be provided as needed. If hypotension occurs it should be treated with standard... 

Basic and advanced life-support measures should be performed as necessary. Gastrointestinal decontamination procedures should be considered for substantial recent ingestions. Activated charcoal will adsorb codeine. Patients with respiratory or CNS depression can be treated with intravenous boluses of naloxone. A continuous naloxone infusion may be necessary if the toxic effects of codeine persist longer than the duration of action of naloxone. 

In asymptomatic patients, activated charcoal and observation may be all that is necessary. In the unlikely event that patients exposed to hydrangea develop symptoms consistent with cyanide poisoning, ignore gastric decontamination procedures until life-support measures have been instituted. Cyanide antidote kit administration may be necessary. 

Basic and advanced life-support measures should be implemented as necessary. Gastrointestinal decontamination procedures should be used as appropriate based on the patient s level of consciousness and... 

If dermal or eye contact with the liquid occurs, the affected areas should be flushed thoroughly with water for at least 15 min and the patient observed for resulting skin or eye irritation. In case of inhalation, the victim should be moved to fresh air and the patient should be monitored for respiratory irritation and pulmonary edema. If ingestion occurs, basic and advanced life-support measures should be utilized as necessary. Gastrointestinal decontamination procedures are unlikely to provide clinical benefit. The use of methylene blue should be considered in the treatment of nitroethane-induced methemoglobinemia. Repeat doses of methylene blue may be necessary for patients with profound methemoglobinemia. 

Poisoning emergencies are a common occurrence. In 2002, The Toxic Exposure Surveillance System of the American Association of Poison Control Centers reported 2 380028 toxic exposures and 1153 resultant fatalities. Of these total exposures, 548 093 (22.2%) were managed in a healthcare facility and 72 877 were admitted to a critical care unit (3.1%). The mortality rate associated with these overdose patients was less than 1%. Thorough evaluation, adequate supportive care, and the use of a few specific antidotes have resulted in lowered morbidity and mortality if the poisoned patient arrives at the hospital in time for the healthcare team to intervene. In select cases, decreasing further toxin absorption by various decontamination procedures may be of benefit. 

Respiratory and cardiovascular function should be supported with oxygen, assisted ventilation, and parenteral fluids. If eyes or skin are contaminated, they should be washed immediately. Gastrointestinal decontamination procedures should be used appropriately depending on the patient s level of consciousness and the amount of rotenone ingested. Oils or fats should not be administered because they can promote rotenone absorption. Activated charcoal should be used to block absorption with oral exposure. In animals, 10 mg of menadione (intravenously) reversed rotenone s blocking of mitochondrial... 

The past few years have seen an increase in research into procedures and protocols for patient decontamination and the development of a range of equipment to facilitate that process at the scene and in hospitals. A detailed account of recent developments in this field is provided below. Depending on the type of agent released, speedy decontamination can be a critical part of preventing or limiting harm and controlling the spread of contamination. 

Always keep the rotorwash of the helicopters in mind when evacuating patients, especially in a contaminated environment. A helicopter must not land too close to a decontamination station (especially upwind) because any trace of contaminants in the rotorwash will compromise the decontamination procedure. 

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