Decon Article - CBRNE - Chemical Decontamination Author:...

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Author: Liudvikas Jagminas, MD, Physician-in-Chief of Emergency Medicine, Associate Professor of Emergency Medicine, Brown Medical School, Memorial Hospital of Rhode Island Contributor Information and Disclosures Updated: Jul 24, 2008 Introduction Emergency departments (EDs) and emergency medical services (EMS) are responsible for managing potential chemical disasters, whether they result from industrial accidents or terrorist activities. In recognition of this responsibility, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Occupational Safety and Health Administration (OSHA) require EDs to prepare for hazardous material incidents. In treating patients with chemical exposures, decontamination is of primary importance provided the patient does not require immediate life-saving interventions. Any plan must include contingencies for contamination sources within the hospital and for ED evacuation. The determination of a workable hazardous materials plan requires careful thought and often professional input from medical toxicologists, hazardous materials teams, and industrial hygiene and safety officers. Using a patient decontamination plan implemented without specific adaptation to the hospital and without practice can result in undesirable outcomes. Legal requirements apply to hospital-based decontamination. All EDs incorporated in an emergency response plan for hazardous materials incidents must meet OSHA requirements (29 CFR 1910.120[q]) for both staff training and response to hazardous materials, because they likely will be presented with a chemically exposed patient who has not been decontaminated at the scene. Under these regulations, emergency medical personnel who may decontaminate victims exposed to a hazardous substance should be trained at a minimum to the first-responder operational level. For response to an unknown hazard, OSHA regulations require level B protection, which includes a positive-pressure self-contained breathing apparatus and splash-protective chemical- resistant clothing. For more information, see Medscape’s Disaster Preparedness and Aftermath Resource Center . Purpose of Chemical Decontamination Chemical decontamination has 2 primary goals. First, decontamination helps prevent further harm to the patient from the chemical exposure. Methods of patient decontamination include chemical dilution and chemical inactivation. Second, decontamination helps protect health care providers and maintains the viability of the ED as a treatment center. Mismanagement may result in illness in health care providers and contamination of the ED; severe ED contamination may necessitate departmental closure, which is potentially catastrophic in a mass casualty incident. Decontamination is time consuming and requires resources. Nerve agents and
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Decon Article - CBRNE - Chemical Decontamination Author:...

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