Chapter 231: Hazmat Patient Management

INTRODUCTION

Hazardous materials (hazmat) incidents occur most often during the transport of chemicals or at industrial site accidents. The work places, transportation, and hazardous substances are labeled with standard government labels or placards (Figure 231-1) 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 be performed by Emergency Medical Service (EMS) providers 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 or be transported by EMS using specialized equipment (Figure 231-2).^3-8 Basic decontamination by Emergency Department personnel can be safely performed in a designated decontamination area.^6,9,10

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 health care personnel, other patients, and visitors.^5-7 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 health care 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.^3,11

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...