Decontamination victims

Of the overall chemical bum patients, the most common sites involved were the face, neck, and upper body (87%), and the eyes or eyelids were involved in 19% of overall cases [28]. In deliberate chemical assault victims, the face and neck were commonly injured, but the genital area was also involved in many victims. Acids, such as sulfuric acid, can be obtained at low cost in Jamaica. These authors note that many of the chemical assault injuries were devastating with facial destruction and blindness. Less than half of the victims decontaminated tliemselves with copious water inigation before presenting to hospital [28]. 

In the NSLIJHS protocol, victim decontamination is accomplished with soap and water (for 10 minutes), whereas fomite (i.e., contaminated clothing) decontamination is performed with a 1 10 dilution of bleach and water. Ambulatory victims decontaminate themselves. 

When dealing with large populations of injured, you need to have an effective public address system so that your instructions can be heard by aU. In a chemical event, clear lanes that separate hot, warm, and cold decontamination zones are imperative. This needs to be appropriately staffed and equipped. The faster the victims can be separated from the contaminant, the better off they will be. Each victim needs to first be approached with rescuer safety and victim decontamination in mind, along with the Advanced Life Support ABCDEs for cardiac, trauma, and hazardous materials. If a toxidrome is found where an antidote exists, this should be started immediately when possible. After the victim is clean, then a secondary survey exam needs to be performed to look for the severity and distribution of injury with continuing care as appropriate. 

C. Decontamination (see p 46). Note Rescuers must wear chemical-protective clothing and gloves when handling a grossly contaminated victim. If there is heavy liquid contamination with a solvent such as xylene or toluene, clothing removal and victim decontamination should be carried out outdoors or in a room with high-flow ventilation. 

In the majority of incidents, basic victim decontamination as outlined above will substantially reduce or eliminate the potential for secondary contamination of downstream personnel or equipment. Procedures for cleaning equipment are contaminant-specific and depend on the risk of chemical persistence as well as toxicity. 

Perform victim decontamination before transport to a hospital. 

For most victims, decontamination is aU the treatment that is needed. If there is substantial pulmonary exposure and the patient complains of severe dyspnea, treat like an asthma attack (oxygen and bronchodilators). 

For most victims, decontamination is aU the treatment needed. Some persons with preexisting reactive airway disease or allergies to OC products may show an exaggerated response. Treat these as you would an asthma attack. 

If a rescue is made of a contaminated, or possibly contaminated person, it is very important to prevent the spread of the contaminant. If at all possible the victim should be decontaminated, to the best of your ability, at the scene. After the decontamination, the victim, and the rescuers, will still be considered to be contaminated. If at all possible the victim should be transported by personnel who have not entered the contaminated area. 

After the victim has been transported to the hospital the ambulance vehicle must be decontaminated by trained personnel. 

Skin Contact Don respiratory mask and gloves remove victim from source immediately and remove contaminated clothing decontaminate the skin immediately by flushing with a 5% solution of liquid household bleach wash off with soap and water after 3-4 min to remove decon agent and protect against erythema seek medical attention immediately to prevent systemic toxicity, decontamination should be done as late as 2 or 3 h after exposure even if it increases the severity of the local reaction further cleans with soap and water. 

Skin Contact Remove victim from the source immediately decontaminate the skin immediately by flushing with copious amounts of water to remove any phosgene oxime which has not yet reacted with tissue seek medical attention immediately. Ingestion Do not induce vomiting seek medical attention immediately. 

Eye Contact Speed in decontaminating the eyes is absolutely essential remove victim from the liquid source, flush the eyes immediately with water by tilting the head to the side, pulling the eyelids apart with the fingers, and pouring water slowly into the eyes do not cover eyes with bandages but if necessary, protect eyes by means of dark or opaque goggles seek medical attention immediately. 

A relatively brief duration of effects (15-30 min) once the victim has escaped the contaminated atmosphere and has decontaminated (i.e., removed the material from his clothing). 

Victims exposed to chemical agents require removal of clothing, gross decontamination, and medical care. 

Use soap/water decontamination beginning with the most symptomatic victims. 

Eventually first responder personnel on scene will have to answer the basic question Do you have an attack or not Unlike exposure to chemical agents, exposure to biological agents does not require immediate removal of victims clothing and gross decontamination. With biological agents, inhalation is the most common route of entry to a victim s contamination. 

Gather important information the agent used was it aerosol, liquid, gas, powder or vapor location method of delivery do you have the necessary personal protective equipment (PPE) to deal with the hazard, or have you called for assistance by a specialized team are you sure that anyone who enters a contaminated area has the proper PPE and is trained in its use be sure to establish control — keep all victims, non-victims and bystanders at the crime scene (if there is any suspicion of an attack) until it is determined who among them may be a terrorist or a witness perform decontamination, triage if necessary, isolation, quarantine, search and locate evidence, maintain chain of control, and collect samples. 

Hospitals should be notified immediately that contaminated victims of an attack may arrive or present themselves at a hospital whether or not they have been decontaminated, or not. 

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