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Hazardous materials (hazmat) incidents occur most often during the transport of chemicals or at industrial site accidents. Hazmat incidents may strike any community at any time.1 Every Emergency Department must be prepared to respond to victims of a hazmat exposure.

Decontamination is the procedure of eliminating or reducing to a safe level any harmful substances on persons and equipment.2 Decontamination of victims in the field should always be performed by Emergency Medical Service (EMS) providers or before the patient enters the Emergency Department. However, this does not always occur. Patients may be too ill for lengthy decontamination procedures prior to transport. Exposed patients may leave the scene and present to the Emergency Department on their own.35 Basic decontamination by Emergency Department personnel can be safely performed outdoors in a designated decontamination area.6,7

Exposure to a hazmat contaminated patient who has been inadequately decontaminated or not decontaminated at all is a real possibility. This can result in exposure and secondary injury to healthcare personnel, other patients, and visitors.5 The Emergency Department may be closed in part or in whole until the facility can be decontaminated. The panic and fear induced by rumors or odors can lead to unnecessary facility closure, delayed or inadequate patient treatment, and psychogenic illness in both healthcare personnel and bystanders.3,4

The three primary goals for the Emergency Department are to isolate and contain the contamination; decontaminate and treat exposed patients while protecting staff, other patients, and visitors; and maintain normal services, or reestablish them, as soon as possible.3

Early recognition of potentially hazmat contaminated patients will aid in preventing secondary contamination and Emergency Department closures. Numerous clues may identify a patient for hazmat contamination at triage.3,4 These include accidents at agricultural or industrial sites, accidents involving chemical transports, suspected mass casualty incidents, a cholinergic toxidrome, mucous membrane irritation, chemical burns, soiling with unidentified liquids or powders, intentional overdose with chemicals, unexplained unconsciousness or cardiac arrest, and symptoms occurring in Paramedics or Emergency Medical Technicians (EMTs) after patient transport.

Information management is critical to the response.4 Designate a person to obtain as much information as possible on the involved substance. Even preliminary and general information is useful and should be immediately conveyed to the treating Emergency Physician.1 The maintenance of material safety data sheets (MSDS) is mandatory for each chemical used or stored at an industrial site or during transport. Request information on the MSDS from fire or EMS services at the scene. Further information resources are listed after the “References” section of this chapter. Verify all information for accuracy by cross-referencing several sources.4

This chapter describes a general approach to the management of the hazmat contaminated patient. The Emergency Department response and patient management will have to be tailored to the specific agent(s) and circumstances, ...

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