Evidence-Based Patient Decontamination: An Integral Component of Mass Exposure Chemical Incident Planning and Response

Abstract

Decontaminating patients who have been exposed to hazardous chemicals can directly benefit the patients' health by saving lives and reducing the severity of toxicity. While the importance of decontaminating patients to prevent the spread of contamination has long been recognized, its role in improving patient health outcomes has not been as widely appreciated. Acute chemical toxicity may manifest rapidly-often minutes to hours after exposure. Patient decontamination and emergency medical treatment must be initiated as early as possible to terminate further exposure and treat the effects of the dose already absorbed. In a mass exposure chemical incident, responders and receivers are faced with the challenges of determining the type of care that each patient needs (including medical treatment, decontamination, and behavioral health support), providing that care within the effective window of time, and protecting themselves from harm. The US Department of Health and Human Services and Department of Homeland Security have led the development of national planning guidance for mass patient decontamination in a chemical incident to help local communities meet these multiple, time-sensitive health demands. This report summarizes the science on which the guidance is based and the principles that form the core of the updated approach.

Évaluation du risque par les professionnels de la santé et les équipes de secours lors d’incidents chimiques

“…Dès lors, une formation commune aux équipements de protection immédiate pour les équipes d'intervention est recommandée. Quant aux mesures de protection collective (EPC) à l'hôpital, elles comprennent, entre autres, les zones de décontamination et toutes leurs composantes (1,27). À ce titre, les paramètres de vulnérabilité au sein même de l'institution doivent être revus (en matière de lacunes de gestion, administratives, effectives, etc.)…”

“…Ces zones doivent être structurellement agencées afin de rendre rapidement disponible le matériel de protection. En effet, les personnes qui se sont présentées à l'hôpital n'ont pas toutes eu un contact avec l'équipe d'intervention médicale sur place et n'ont pas toujours reçu les mesures de décontamination et de protection appropriées (27). En Belgique, selon Mortelmans et al (9), 42 % des 100 hôpitaux enquêtés présentent une zone de décontamination au sein du département d'urgence.…”

Maintaining Preparedness to Severe Though Infrequent Threats—Can It Be Done?

“…Collective exposure to toxic materials may lead to a chaotic situation, derived from a lack of communication between varied stakeholders and response teams, scarcity of human and material resources, or deficient infrastructure for provision of patient care [3,19,20]. The severe potential consequences of exposure to toxic materials necessitate the establishment of strategies for life-saving procedures, the implementation of an immediate response, a rapid decontamination process, triage of patients, and on-site and hospital medical treatment procedures [21][22][23]. Protocols and Standard Operating Procedures (SOPs) concerning the treatment of contaminated patients need to be established, the systemic operation of medical entities has to be designed and incorporated in the overall healthcare systems' disaster plans, and safety procedures have to be defined and integrated in advance to prevent staff's exposure to toxic materials without adequate protection [7,20].…”

Managing CBRN mass casualty incidents at hospitals—Find a simple solution for a complex problem: A pilot study

“…Agents commonly used during terrorist attacks are acids, chlorine or chlorine compounds, riot control agents, cyanides and Bacillus anthracis [3]. Rapid evacuation and immediate decontamination are crucial factors, that in uence medical outcome of the casualties [4]. Decontamination should be carried out directly on-scene by prehospital specialists [5].…”