Triage HAZMAT

Describe the differences among daily hospital triage, mass casualty incident triage, disaster triage, tactical-military triage, and special conditions (hazmat) triage. 

Zones for Disaster Triage During Chem/HAZMAT Incidents... 

Minimally, all hospital personnel (e.g., nurses, physicians, security, and triage) who have a designated role in a HAZMAT response must be trained to the first responder awareness level (Levitin Siegelson, 2002). Staff must be comfortable with knowing how to locate and use personal protective equipment and with the decontamination process (see chapter 26, Mass Casualty Decontamination, for further discussion). 

Once the HazMat response is in place, you can move appropriately protected medical personnel in to assess the patients while decontamination commences. This is also tme at the hospital. There are limited interventions that can be initiated in a contaminated environment. These revolve around Basic Cardiac Life Support, Advanced Cardiac Life Support, Advanced Trauma Life Support, and Advanced HazMat Life Support (BCLS, ACLS, ATLS, and AHLS, respectively, with trademarks) ABCDE s (Establish responsiveness, Airway/C-Spine, Breathing, Circulation/Control Hemorrhage, Dmgs/Defibrillation/Dehnitive Care/Disability (Neurologic)/Decontamination, Exposure/ Environmental/Elimination). The triage process would determine the level of responsiveness, along... 

Figure 7. Plan Piratox (red plan) arrangement of HAZMAT zones [LHA, liquid hazard (hot) zone VHA, vapour hazard (warm) zone]. Triage is conducted (1) to detect contamination, and (2) for medical status in the triage point or the AMP. Later modifications of the plan allow for the provision of early life support (TOXALS) when required inside the warm zone...

Backup EMS or HazMat personnel should set up a decontamination tent at the staging area and have the ambulatory patients remove their contaminated clothing and take a shower. These patients should then be given paper coveralls to wear until they can get fresh clothes. Once the patients have been decontaminated (see Practical Skills 2 ), you should perform a rapid assessment and triage. Most of the ambulatory patients will be triaged priority three ( green tag, or delayed). You may find a few priority two ( yeUow tag, or potentially unstable). Your nonambulatory patients will usually make up your priority one ( Red t, or critical), the majority of your priority two, and all of your priority four ( black tag, or critical but unsalvageable). 

If a three-zone HAZMAT response is necessary, initial triage should be carried out in the warm zone by the most senior physician or paramedical person available. If this is not possible, primary triage should be carried out immediately after leaving the warm zone in the advanced medical post. In toxic trauma, frequent re-triage is necessary due to developing conditions as a result of latency. 

Hospital emergency departments must consider themselves part of the overall response which starts with the HAZMAT organisational, rescue primary medical care and decontamination on site. Contact must be established and maintained with the on-site emergency teams and particularly with the ambulance services who are involved in the evacuation to ensure that patients are properly triaged and distributed to the receiving hospitals available. 

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