Biomedical Engineering Reference
In-Depth Information
tissue. It should not be used in the eye, on neuro-
logical tissue, or in the abdomen or chest cavity.
Dakin's solution (pH 4-8) may cause less tissue
injury but will hydrolyze agent at a much slower
rate and may not be worth the risk to tissue. High
volume irrigation with standard irrigants is prob-
ably preferable. Waste irrigants should be consid-
ered contaminated. A radiologic survey meter can
be used to detect radiation. Team members should
wear monitoring badges.
Surgical team members should wear a pair of
well-fitting (thin) butyl rubber gloves or double
latex surgical gloves and to change them often
until all potential contaminates are removed from
wound. Thin butyl rubber gloves will last 60
Water (
soap/detergent)
Absorbent Particulates (Sand, etc.)
Hypochlorite (Bleach)
M291 Resin
Reactive Skin Decontamination Lotion (RSDL)
Foams
±
Figure 7.4
Skin Decontamination Agents.
numbers of ambulatory patients who are lightly or
minimally exposed should not be underestimated.
Wind direction, Hot, Warm, and Cold zones,
water availability, weather (warm vs. cold), and
drainage all will impact planning and implemen-
tation. The decontamination facilities will require
adequate supplies of towels, alternative clothing,
soap, shampoo, a contaminated clothing disposal
method as well as a means of preserving question-
ably contaminated items of value (Figure 7.4). The
wearer of a $1500 designer suit would be expected
to be somewhat reluctant to part with his apparel
if he is being processed only as a precaution.
Advanced medical care (life saving interven-
tions) should be available in the hot zone. This
requires the presence of a physician, physician's
assistant, or advanced practice nurse together
with appropriate equipment and supplies (see
Figures 7.5, 7.6, and 7.7).
+
min in an aqueous base. Double latex gloves last
29min. Wound should be explored with instru-
ments not fingers [1].
7.5 Site Security
Physical security of the decontamination site is
critical. Advanced planning and participation of
trained security officers is an obvious prerequi-
site. Crowd control, protection of patient valuables,
and maintenance of the integrity of hot vs. cold
zones are paramount. Training for security officers
should include testing for vulnerability.
7.7 Patient Identification
The traditional hospital wrist band continues to
be the favored system in mass-casualty scenarios.
Infant ID bands are especially useful since they
come as sets of identically numbered bracelets.
Patient valuables can be accounted for and secured
with a higher degree of surety if labeled with the
identical system (Figures 7.8 and 7.9). Personal
property control is likely to be a major source
of strife among minimally contaminated ambula-
tory patients. Wallets and purses, money, watches
and jewelry, shoes and clothing are likely to be
surrendered only upon assurances that they will
be secured and returned promptly. A clearly orga-
nized, visibly secure system of labeling and phys-
ical security by trusted personnel is essential. The
huge potential for theft during mass-casualty oper-
ations will not be lost on the public.
7.6 Site Layout
A decontamination site is best placed a distance
from the emergency department. It should be
accessible to staff but not so close as to obstruct
entrances or threaten the hospital by a shift in
wind or from contaminated runoff water. Site
selection involves a series of trade-offs and is
entirely hospital specific. Some hospitals prefer
to have their own, self-designed, self-run systems.
Others prefer preconfigured portable or mobile
systems operated by local fire personnel. Access to
water, drainage, power, shelter, storage of supplies
(clothing, personal effects, emergency treatment
supplies), privacy considerations, security, and a
means of identifying patients are all necessary
considerations. The expected need to manage large
