minutes. Again, try to retain the runoff.
Using
available items like towels or clean rags, mechanically
remove the HAZMAT by wiping; avoid rubbing the
skin too vigorously. Dry the skin and provide
uncontaminated dry clothing or coverings.
The nature of the HAZMAT involved and the
threat to the health of others (rescue team, other
victims, medical personnel, transport crew)
determines the degree of decontamination necessary
before treatment or transporting the patient. Generally,
it is preferred that decontamination be accomplished
before treatment or transport. However, the patient’s
immediate medical condition may be more serious
than the contamination itself. For example, ingested
HAZMAT may pose little immediate threat to nearby
personnel, but be an imminent threat to the victim’s
life. Therefore, the consequences of delaying the
emergency care of the patient’s injuries to accomplish
gut decontamination must be carefully evaluated. In
some cases, decontamination and emergency medical
care can be carried out simultaneously. In rare
instances of great urgency, the victim may require
transportation to the hospital before decontamination.
In these unusual cases, notify both the hospital and
transportation crew of the patient’s medical condition
and contamination. Depending on the situation, the
transportation crew will have to appropriately prepare
to carry and care for the contaminated victim;
otherwise, the crew themselves could be contaminated
and/or be affected by the contamination. For example,
the transport crew may need to wear level A or B suits
and/or respirators.
Remember, if the victim is
contaminated and the transport requires personal
protective devices, it is likely that the vehicle will be
contaminated and require appropriate decontamina-
tion.
There is also a potential to contaminate the
receiving medical facility and its staff.
Diagnosis, Treatment, and Transport
As soon as the victim has been removed to safety,
follow normal primary and secondary survey
procedures, including interviews of the patient and
bystanders. Observe the patient and provide the ABCs
of basic life support (airway, breathing, circulation)
and add “D” and “E” for disability and exposure. Look
for signs of trauma and provide proper exposure (i.e.,
remove clothing) to fully assess the victim. Monitor
vital signs and the victim closely! As a guideline, give
the patient supplemental oxygen (4 to 6 liters per
minute), and start an IV at an area of skin not exposed
to the hazardous material (or at least that has been
thoroughly decontaminated).
If the HAZMAT victim has swallowed a known or
identified toxic material, treat the victim as a poisoned
patient using the information provided above. Dress
wounds and prepare the patient for transport to a
medical treatment facility.
Finally, transport the victim to a medical treatment
facility for complete medical evaluation and treatment.
Care should be taken during transport to stabilize the
victim by maintaining normal body temperature,
administering oxygen, and treating shock.
SUMMARY
In this chapter, we discussed the assessment and
treatment for poisoning, drug abuse, and hazardous
material exposure, along with the rescue and
decontamination procedures for patients exposed to
HAZMAT. In our rapidly changing environment, we
must be up to date on the latest changes in assessment
and treatment for these conditions. You may stay
informed through contact with the local Poison
Control Center, MEDIC releases, or via the World
Wide Web on the Internet.
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