PreHospital Management of Contaminated Patients

1
Pre-Hospital Management of Contaminated Patients

• Centers for Disease
• Control and Prevention

2
While En Route to a Hazmat Scene

• Look for hazmat clues
• Note wind direction ground incline
• Gather incident information
• Type, amount physical state of material
• Number of victims live/dead
• Signs symptoms
• Route duration of exposure
• Establish support contacts
• Fire Department (FD)
• Hazardous Material Response Team (HMRT)
• Technical Support Databases

3
3 Zones of a Hazmat Incident Site

• Hot Zone
• Exclusion
• Warm Zone
• Decontamination
• Cold Zone
• Support

WARM
HOT
4
Approaching the Scene of a Hazmat Incident

• Always
• approach
• hazmat
• sites from
• an upwind
• location

5
Arriving at a Hazmat Scene

• Scene safety assessment
• Unless appropriately trained and protected,
  responders must not attempt entry into the
  Exclusion Zone to rescue patients or to recover
  shipping papers ATSDR
• Dont attempt rescue unless trained and equipped
  with appropriate PPE for the situation ATSDR
• Integration with on-scene incident command

6
Assessment

• Hot Zone
• Basic Life Support Only
• Warm Zone
• Decontamination with/without
• Advanced Life Support
• Cold Zone
• Secondary Survey

WARM
HOT
7
Primary Goals of Medical Hazmat Emergency
Response

• Terminate exposure
• Remove patient from danger
• Initiate treatment

8
Decontamination of Medical Personnel

• Minimize exposure in hot zone
• Wet Vs. dry decontamination
• Wet - washing rinsing suits
• Dry - disposable suits

9
Communications

• Effective communications are essential to
  incident control.
• Hazmat responses require multiple dedicated radio
  frequencies
• Inherent difficulties in communicating while
  wearing PPE

10
Patient Management Issues

• EMS en route to a hazmat scene
• Arrival at the scene
• Patient assessment triage
• Patient decontamination
• Considerations for patient treatment
• Transport to hospital
• Emergency department protection

11
Patient Decontamination

• Remove, label and isolate all clothing and
  personal effects
• Decon from head to toe
• Start with wounds mucosa
• Cover clean wounds to prevent recontamination
• limit mechanical or chemical irritation of the
  skin. Use warm water, never hot
• Contain all waste runoff EPA

12
Considerations for Hazmat Patient Treatment

• Highest priorities
• Decontamination
• ABCs
• Reassess frequently
• Treat according to symptoms
• There are few antidotes available
• No invasive procedures in contaminated areas

13
Pre-Hospital Transport of The Hazmat Patient

• Ambulance protective equipment
• 6 mm Construction Plastic Drapes
• Disposable sheeting fiberglass backboards
• Hazardous waste disposal bags
• Ambulance personnel wear PPE

14
Pre-Hospital Transport of the Hazmat Patient

• Report to ED ASAP
• Type nature of incident
• Number of patients, signs symptoms
• Any info known about material involved
• Extent of patient decon in the field
• Estimated time of arrival

15
Protection of the Emergency Department

• Park at designated Hazmat receiving area and/or
  away from ED entrance
• Do not bring hazmat patients into ED before
  receiving permission from hospital staff ATSDR
• After unloading the patient
• Decontaminate EMS personnel
• Decontaminate ambulance
• Dispose of hazardous waste