Biomedical Engineering Reference
In-Depth Information
dissemination. Special needs for equipment can be
identified at this time. Examples include the need
for decontamination, the process for decontami-
nation, antidotes, and effective treatments. Other
needs may also be identified, such as for large
amounts of medications, antibiotics or radiological
measuring devices.
Communication with state and local health
departments may prove valuable at this time. They
may have a lot of important intelligence regarding
epidemiology of incident and can provide technical
expertise and support.
important. This is again a place in which your
Health Department or possibly the military
(CST) or Fire Department could help.
4. Set up your decontamination area so
that patients who are cleaned are not
re-contaminated. Setting up a decontamination
trailer backwards will cause this to happen.
5. Consider using a surrogate marker (food
coloring, fluorescein) to validate full decon-
tamination.
6. Decontamination depends on contaminant.
Poison Control, Department of Environmental
Protection (DEP), Department of Public Health
(DPH ), etc., staff may be able to aid in iden-
tifying decontamination needs.
9.8 Decontamination
Once the need for decontamination is identified,
the facility will need to prepare to administer it.
This can be down in either a specially prepared
room before entry into the emergency depart-
ment or outside the hospital in tents with showers
and hoses. Some hospitals have agreements with
local fire departments to provide decontamination.
However reliance solely on the local fire depart-
ment may not be advisable; just like the police
department, they may be deployed at the incident
site and not be available.
Many patients arriving by ambulance will have
had a decontamination done in the field by public
safety officers (Fire, EMS, Hazmat). Patients who
come by private vehicle will not; they and whoever
drove them to the hospital may need to be decon-
taminated.
The hospital will need to make predetermined
decision that anyone coming in from the field is
either OK to enter or needs to be completely decon-
taminated.
Some basic concepts for all patients who need
decontamination:
Once patients start arriving, determining if they
have been decontaminated or not will be important.
A likely clue will be what they are wearing.
Patients without their own clothes
will
have most
likely been decontaminated.
9.8.1 Who Needs to be Decontaminated
Of the likely patients to be seen from a terror event,
only those exposed to chemical or radiological
attacks will need to be decontaminated. Victims
of biological attacks will be infectious and may
need to isolated or quarantined. Although, with a
biological attack, it is likely that some casualties
will present to the emergency department before
a pattern is recognized. A plan to mitigate this
possibility is strongly advised.
Patients exposed to explosive or incendiary
devices need not be decontaminated, other than
routine cleaning and irrigation of wounds. The
exception to this would be those who were exposed
to a dirty bomb or
toxic substance from the
explosion.
Once patients have been decontaminated, they
can be treated according to their injuries.
1. Removal of patient clothing will remove >
80% of contaminants.
2. Warm soapy water with some vigorous scrub-
bing will remove most contaminants.
3. Detection devices should be set up outside
of the decontamination area, and before the
patient enters the emergency department.
Knowledge of what you looking for here is
9.9 Staff Needs
For prolonged ED operations, certain needs must
be taken into account. With additional staff called
in, supplemental food will need to be provided.
