Details

Hazardous Materials Medicine

Treating the Chemically Injured Patient
1. Aufl.

von: Richard Stilp, Armando Bevelacqua
84,99 €
Verlag:	Wiley
Format:	PDF
Veröffentl.:	13.03.2023
ISBN/EAN:	9781119663935
Sprache:	englisch
Anzahl Seiten:	368

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Beschreibungen

Titelbeschreibung

Hazardous Materials Medicine Complete background on chemical exposures that create illnesses, including assessment, diagnosis, and treatment protocols Written on a level that can be understood by field practitioners and/or first responders, Hazardous Materials Medicine: Treating the Chemically Injured Patient provides an in-depth understanding of how to diagnose and treat toxic chemical exposures in a prehospital or emergency department setting. The protocols used in this book conform to the guidelines set forth in the NFPA 470 standard, and the medical guidance developed by FEMA for Type I, II & III Deployable Hazmat Response Teams. The hazardous materials medical protocols in this book have been fully vetted by three poison control toxicologists, multiple emergency physicians, and paramedics. Hazardous Materials Medicine: Treating the Chemically Injured Patient covers sample topics such as: <ul><li>Scene assessment, to help determine the cause of the exposure, and exposure assessment, to determine what physiologic systems are affected</li> <li>Toxic syndromes/toxidromes to appropriately treat the exposed patient, including corrosive and irritant, asphyxiant, cholinergic, and hydrocarbon and derivative toxidromes</li> <li>Science behind a chemical exposure, to allow for a complete understanding of both the chemistry and physiology of what is occurring because of the exposure</li> <li>Interfacing between the on-scene response team and the hospital, to ensure consistency and continuity of care from the field into the hospital</li></ul> Enabling public safety and health professionals to administer effective care while retaining their own personal safety, Hazardous Materials Medicine: Treating the Chemically Injured Patient is a must-have resource for emergency medical technicians, paramedics, hazmat technicians, and emergency physicians and nurses working in high-risk field situations with chemically injured patients.

Inhaltsverzeichnis

Author Biographies and Acknowledgments xvii Foreword xxi Preface xxiii 1 HazMat Medicine and the HazMat Medic 1 Introduction 1 Case Study – Sarin Attack in the Tokyo Subway 3 History 4 Events 7 Situational Assessment Continuum 8 Patient Presentation 9 Event Conditions (Scene Evaluation and Size- up) 9 Scene Assessment (Hazard Identification) 9 Summary 10 2 Exposures 11 Introduction 11 Case Study – Derailment in South Carolina, a No- Notice Evacuation Event 11 Patient Presentation 12 The Toxidrome Exam 14 Respiratory System 14 Overview 14 Respiratory System Anatomy and Physiology 16 External Respiratory System 16 Internal Respiratory System 19 Chemical and Physical Form of Respiratory Exposure 22 Gases, Vapors, and Fumes 22 Solid Particles 22 Aerosols/Mists 23 Concentration and Duration 23 Types of Injuries Resulting from Chemical Exposure 23 Chemically Induced Bronchiole Constriction 23 Atelectasis and Disruption of Surfactant 24 Chemically Induced Pulmonary Edema (Noncardiogenic Pulmonary Edema) 25 Chemical Sensitivity 26 Types of Chemicals that Injure the Respiratory System 26 Asphyxiants 26 Simple Asphyxiants 26 Chemical Asphyxiants 27 Irritants (Corrosives) 27 Respiratory System Injury Recognition (Assessment) and Diagnostics 27 Pulse Oximetry 27 Specific Oximetry Considerations When Assessing HazMat Exposures 28 Capnography 29 Masimo™/Rainbow Technology 32 Cardiovascular Abnormalities Related to Exposure 33 Description 33 Vasogenic Shock 33 Hypovolemic Shock 33 Heart Failure 34 Neurological Abnormalities Related to Exposure 34 Central Nervous System (CNS) Exposure 34 CNS Depression 34 CNS Stimulation 35 Parasympathetic Nervous System 35 Parasympathetic Stimulation 35 Parasympathetic Depression 36 Integumentary System (Skin) 36 Skin Anatomy and Physiology 36 Structure 37 Function 38 Types of Chemical Injuries to the Skin 38 Chemical- Related Irritation 38 Chemical Skin Burns 39 Ocular Exposure and Injury 41 Eye Anatomy and Physiology 42 The Globe 42 The Ocular Surface 42 Assessment of Eye Injury After Exposure 43 Normal Eye Assessment 44 Chemical Eye Burns 45 Surface Toxins 46 Treatment of Eye Exposure 48 Specialized Eye Equipment 49 The Morgan Lens 49 Nasal Cannula for Eye Irrigation 51 Gastrointestinal Exposure to Toxic Materials 51 Absorbing Chemicals and Nutrients 51 Liver 51 Phase I and II Detoxification 52 Environmental Exposures 53 The Hot Environment – Hydration and Hyperthermia 53 Physiology 54 Absorption of Water 55 Acclimation 57 Metabolic Thermoregulation 58 Determining Severity of Heat 60 Effects of Heat in an Encapsulated Suit 60 Factors Contributing to Heat Emergencies/Injuries 62 Treatment 63 The Cold Environment 64 Exposure to Liquefied Gas and Cryogenics 64 Frostbite Injuries 65 Assessment 66 Treatment 67 Summary 67 3 Toxidromes 69 Introduction 69 Case Study – Silver Cyanide Exposure 69 Assessment Capabilities 70 Blood Pressure 70 Increase in Blood Pressure 71 Decrease in Blood Pressure 71 Pulse 72 Toxidromes 72 Corrosives and Irritants Toxidromes 72 Chlorine (Cl 2) 72 Agent Identification 72 History 73 Pathophysiology 73 Signs and Symptoms 73 Where Is Chlorine Found 74 Decontamination 75 Emergency Field Treatment 75 Basic Life Support 75 Advanced Life Support 75 Ammonia (NH 3) 76 Agent Identification 76 History 76 Physiology 76 Signs and Symptoms 76 Where Is Ammonia Found 77 Decontamination 77 Emergency Field Treatment 77 Assessment/Treatment 77 Basic Life Support 77 Advanced Life Support 77 Phosgene, aka. Carbonyl Chloride 78 Agent Identification 78 History 78 Physiology, Signs, and Symptoms 78 Where Phosgene Is Found 78 Decontamination 79 Emergency Field Treatment (Chloramine, Ammonia, and Phosgene) 79 Basic Life Support 79 Advanced Life Support 79 Pediatric Considerations (Chlorine, Chloramine, Ammonia, Phosgene) 80 Hydrofluoric Acid and Fluorine- Based Chemicals 80 History 80 Pathophysiology 80 Signs and Symptoms of Exposure 82 Where Hydrofluoric Acid Is Commonly Found 82 Decontamination and Significant Danger to Rescuers 83 Treatment 83 Eye Injury Treatment (Hydrofluoric Acid) 83 Skin Burn Treatment (Hydrofluoric Acid) 84 Respiratory Injury Treatment (Hydrofluoric Acid) 84 Systemic Injury from Hydrofluoric Acid (Hypocalcemia) 85 Phenol (Carbolic Acid) 85 History 85 Pathophysiology, Signs, and Symptoms 86 Where Phenol Is Commonly Found 86 Field Treatment and Decontamination 87 Assessment/Treatment or Phenol 87 Lacrimatory Agent Exposure 87 Chemical Currently Being Used 88 Effect 88 Treatment 88 Asphyxiant Toxidromes 89 Effects of Hypoxia 90 Simple Asphyxiants 92 Experience; Death at McDonald’s: “Five Lousy Feet” 93 Assessment/Treatment for Simple Asphyxiants 93 Chemical Asphyxiants 93 Carbon Monoxide Poisoning 93 History 94 Pathophysiology 94 Concerns 96 Signs and Symptoms 97 Where Carbon Monoxide Is Typically Found 98 Decontamination and Danger to Responders 98 Field Treatment 98 Cyanide Poisoning – Hydrogen Cyanide, Cyanide Salts, and Cyanide Containing Gases 99 History 100 Pathophysiology 101 Signs and Symptoms 102 Definitive Diagnosis 103 Where Cyanide Is Commonly Found 103 Decontamination of Patients 104 Emergency Medical Field Treatment 104 CyanoKit – Hydroxocobalamin (Preferred Treatment for Cyanide Poisoning) 105 (Lily or Pasadena) Nitrite- Based Cyanide Antidote Kit (Used for hydrogen sulfide or (Cyanide if the CyanoKit Is Not Available) 106 Hydrogen Sulfide Poisoning 106 History 107 Pathophysiology 107 Signs and Symptoms 108 Where Hydrogen Sulfide Is Commonly Found 108 Decontamination and Significant Danger to Rescuers 108 Field Treatment 108 Definitive Treatment and Follow- up Care 109 Nitrites, Nitrates, Nitrobenzene Poisoning 109 History 109 Pathophysiology 110 Signs and Symptoms 111 Where Are Nitrogen Compounds Found 111 Field Treatment 112 Cholinergic Toxidrome 113 Organophosphate Insecticide Poisoning 113 Experience: Novichok Nerve Agent Used Against Russian Dissident Has Dark History 114 Experience: Tokyo Subway, Site of an Attack Using Sarin Nerve Agent 115 Pathophysiology 115 Signs and Symptoms 116 Location of Organophosphate Insecticides 117 Decontamination and Significant Danger to Rescuers 117 Treatment 118 Experience: Malathion Overdose Treated Without Protopam 119 Treatment 119 Carbamate Poisoning 121 Treatment 121 Hydrocarbons and Derivatives Toxidrome 122 Hydrocarbon Toxicity 122 Pathophysiology 123 Cardiac Effects 124 CNS Effects 124 Emergency Medical Care 124 Signs and Symptoms 124 Treatment 125 Toxic Alcohols 127 Treatment 127 Etiological Toxidrome 127 Overview 127 Vancomycin- Resistant Enterococci (VRE) 130 Symptoms 130 Diagnosis 130 Treatment 130 Methicillin- Resistant Staphylococcus aureus (MRSA) 130 Pathophysiology 131 Signs and symptoms 131 Treatment 131 Clostridium Difficile (C. Difficile) 131 Overview 131 Symptoms 132 Other Risk Factors 132 Complications from C. Difficile Include 132 Prevention 132 Necrotizing Fasciitis 133 Overview 133 Symptoms 133 Cause 133 Treatment 133 Means of Entry 133 Virulence 134 Exposure 134 Radiological Toxidrome 135 Overview 135 Types of Radiation 136 Alpha Particles 136 Beta Particles 136 Gamma Rays 137 Neutrons 137 X- Rays 137 Measuring Radioactivity 137 Principles of Protection 139 Location of Radiation and Common Sites for Accidents 140 Types of Injuries 140 Rescue and Emergency Treatment 142 Treatment 143 Associated Toxic Conditions 144 Closed Space Fires 144 History 144 Fire Toxicology 145 Danger to Firefighters 147 Treatment 147 Wheezing Secondary to Toxic Inhalation 149 Overview 149 Tachycardia Secondary to Chemical Exposure 150 Hypotension Caused by Exposure 151 Seizures Post- Exposure 151 Opioids Overdose/Exposure 152 History 152 Opium Alkaloids 152 Synthetic Opioids 153 Semisynthetic Opioids 153 Today’s Fentanyl and Carfentanil 154 Signs and Symptoms 154 Summary 155 Reference 156 4 Event Conditions 157 Introduction 157 Case Study – Fertilizer Explosion in West Texas 158 Operational Hazards 159 Dispatch Information 159 Scene Safety 160 Upon Arrival – Stop, Look, and Listen 162 Weather Conditions 162 Witnesses Accounts 163 Risk Awareness 163 The North American Emergency Response Guidebook (ERG) 173 NIOSH Pocket Guide 175 Cameo 176 Marplot 177 Aloha 177 Wiser 177 ToxNet and the Hazardous Substance Database 177 Resources 178 Summary 178 5 Hazard Identification 181 Introduction 181 Case Study – Phosgene Exposure 182 States of Matter 182 Solid 184 Liquids 186 Vapors and Gases 186 Mists and Aerosols 186 Gases 186 Compressed Gas 186 Liquified Gas 186 Cryogenic Gas 187 Chemical and Physical Properties 187 Chemical Properties 188 pH (Corrosivity) 188 0005505303.indd 11 03-03-2023 13:18:02 Ignition Temperature (IT) 188 Flashpoint (FP) 188 Heat Transfer 188 Physical Properties 188 Appearance 189 Viscosity 189 Melting Point (MP) 189 Freezing Point (FrPt) 189 Boiling Point (BP) 189 Flammable Range 190 Density 190 Specific Gravity (SG) 190 Vapor Density (VD) 191 Vapor Pressure (VP) 192 Expansion Ratios 193 Properties and Their Medical Implications 193 Vapor Pressure, Medical Implications 194 Vapor Density, Medical Implications 195 Specific Gravity, Medical Implications 195 Solubility, Medical Implications 195 History of Toxicology 196 Exposure vs. Contamination 197 Toxin vs. Poison 198 Toxicity of a Poison or Toxin 198 Standards, Guidelines, and Acts Regulating Hazardous Materials 200 NFPA and OSHA 200 Environmental Protection Agency (EPA) 200 Time Weighted Average 201 Short- Term Exposure Limits (STELs) 201 Immediately Dangerous to Life and Health (IDLH) 201 Control Banding 203 Basic Toxicology Definitions 205 Acute Exposure 206 Sub- Chronic/Sub- Acute 208 Chronic Exposure 209 Noel, Noael, Loael 209 Levels of Concern 210 Dose Response and Exposure 210 Graded Response 211 Quantal Response 211 Response Curve 212 Lethal Concentrations and Lethal Doses 213 Chemical Time lines 214 Additional Toxic Effects 216 Toxic Influences 217 General Health 217 Diet 217 Previous Exposure 218 Age 218 Gender 219 Genetics 220 Sleep 220 Biochemistry 221 Detoxification 221 Phase I and Phase II Reactions 221 Detoxification by the Lungs 224 Chemical Toxic Qualities 224 Chemical Excretion 225 Nanotoxicology 225 Determining the Level of Medical Surveillance 226 Risk Assessment and Detection 226 Identification of Hazards 227 Assess Hazards to Determine the Risks 227 Develop Controls to Manage the Risks 227 Implementing Controls 227 Supervise and Evaluate the Process 228 Summary 230 6 Team Capabilities 231 Introduction 231 Case Study – Sodium Nitrate Overdose 231 Technician Operational Considerations 232 Personnel Protective Equipment (PPE) 232 Rehabilitation 235 Decontamination 236 Occupational Safety and Health Administration 237 National Fire Protection Association 237 Environmental Protection Agency 237 Science Behind Decontamination 237 Types of Decontamination 239 Gross Decontamination 239 Secondary Decontamination 240 Tertiary Decontamination 240 Emergency Decontamination 240 Techniques 240 Physical Decontamination 241 Factors to Consider During Decontamination 241 Equipment Uses 242 Choosing a Decontamination Site Location 243 Detection and Monitoring 243 The Approach 244 The System of Detection 245 Radiation 246 pH 247 Oxygen 247 Organic Compounds 247 Biologicals 249 Detection and Monitoring Responses 249 Current Detection Technologies 250 Radiation Detectors 250 pH Paper and Impregnated Papers 252 KI Paper or Oxidizer Paper 252 Wet Chemistry 252 Electrochemical Sensors 253 Catalytic Bead 253 Colorimetric Tubes 254 Photoionization Detection (PID) 254 Flame Ionization Detection (FID) 255 Ion Mobility Spectroscopy (IMS) 255 Infrared Spectroscopy (FT- IR) 256 Raman Spectroscopy 256 Positive Protein 257 Handheld Immunoassay (HHA) 257 Polymerase Chain Reaction (PCR) 258 Mass Causality Incidents 259 Triage Considerations (Non- START Triage) 259 Stilp and Bevelacqua Exposure Score 259 Cardiovascular 260 Breathing (Respiratory) 261 Rx – Immediate Basic Treatment 261 Neurological 261 Mass Decontamination 261 Initial Operations 261 HazMat Alert 262 Hospital Interface 263 Casualty Collection Points (Field Treatment Site) 266 Temporary Medical Care Units (Alternate Care Facilities) 266 The Medical Reserve Corp 266 Hospital Decontamination Considerations 268 PPE in the Hospital Environment 268 Hospital Isolation Rooms 269 Notification and Preparation 269 Hospital Scenario Possibilities 270 Hospital Decontamination Corridor 271 Hospital Decontamination Sequence Model 272 Summary 274 7 HazMat Safety Officer 275 Introduction 275 Case Study – Lieutenant Dan 275 Medical Assessment 276 0005505303.indd 14 03-03-2023 13:18:02 Medical Surveillance 278 Initial Baseline Physical and Annual Physical 279 Pre- Entry Physical 281 Considerations of the Entrance Physical 283 Post- Entry Physicals 285 Use of Findings 286 Preventive Health Screening 288 Post- Exposure Physicals 288 Biological Monitoring 289 Team Exit and Retirement Physicals 290 Program Review 290 ADA, Civil Rights, and Health Insurance Portability and Accountability Act (hipaa) 290 Critical Incident Stress Debriefing 291 Developing a Medical Surveillance Program 293 Summary 294 8 Terrorism 297 Introduction 297 Case Study – Salmonella Salad Bar 298 Terrorism Using Chemical Warfare Agents 299 Nerve Agents (Cholinergic Toxidrome) 299 Military Nerve Agents 299 Physical Properties and Routes of Entry 300 Decontamination 301 Treatment 301 Blood Agents – Asphyxiants Toxidrome 301 Military Blood Agents 301 Physiology 302 Physical Properties and Routes of Entry of Cyanide Agents 302 Decontamination 302 Treatment 302 Choking Agents – Irritant Gas Toxidrome 302 Military Choking Agents 303 Physiology of Respiratory Irritant Injury 304 Physical Properties and Routes of Entry 304 Decontamination 304 Treatment 304 Vesicants – Corrosive Toxidrome (Military Blister Agents) 305 Military Blister Agents (Vesicants) 305 Physiology of Blister Agent Exposure 306 Physical Properties and Routes of Entry 306 Decontamination 306 Treatment 306 Lacrimators (Riot Control Agents) 306 CN and CS 307 Oc 307 Decontamination 307 Treatment 308 Terrorism Using Biological Agents 308 Bacteria 308 Viruses 309 Biological Toxins 309 Bacterial Agents 309 Anthrax (B. anthracis) 309 Cholera (Vibrio cholerae) 310 Pneumonic/Bubonic Plague (Y. pestis) 310 Tularemia (F. tularensis) 311 Q Fever (Coxiella burnetii rickettsia) 311 Salmonellae (Salmonella typhimurium) 311 Viral Agents 312 Smallpox (Variola virus) 312 Venezuelan Equine Encephalitis (VEE) 312 Viral Hemorrhagic Fevers (VHFs) 313 Biological Toxins 313 Botulinum Toxin 313 Staphylococcal Enterotoxin B (SEB) 314 Ricin 315 Trichothecene Mycotoxins (T2) 315 Explosives and Incendiary Devices 316 Bomb Incidents 316 Anatomy of Explosives 316 Expected Effects from Explosions 317 Physiology of Blast Effects 318 Blast Effects 318 Summary 320 Epilogue 323 Index 325

Autorenportrait

Richard Stilp MA, RN started his career in the fire service in 1976 and has worked in many positions in the fire service including firefighter/paramedic, engineer, lieutenant, district chief, and fire chief. During his career he served as a paramedic program chair for a local college, emergency department registered nurse, executive director of the fire academy, worked in administration for a large hospital system. Armando Bevelacqua is a 38 year veteran of the fire service, writes free-lance, publishing articles, instructional materials and educational textbooks in the field of hazmat response. Has served during the course of his career as a firefighter-paramedic, HazMat technician, High Angle rescue, below grade rescue, Dive rescue, chief officer and flight medic.

Back cover copy

Complete background on chemical exposures that create illnesses, including assessment, diagnosis, and treatment protocols Written on a level that can be understood by field practitioners and/or first responders, Hazardous Materials Medicine: Treating the Chemically Injured Patient provides an in-depth understanding of how to diagnose and treat toxic chemical exposures in a prehospital or emergency department setting. The protocols used in this book conform to the guidelines set forth in the NFPA 470 standard, and the medical guidance developed by FEMA for Type I, II & III Deployable Hazmat Response Teams. The hazardous materials medical protocols in this book have been fully vetted by three poison control toxicologists, multiple emergency physicians, and paramedics. Hazardous Materials Medicine: Treating the Chemically Injured Patient covers sample topics such as: <ul><li>Scene assessment, to help determine the cause of the exposure, and exposure assessment, to determine what physiologic systems are affected</li> <li>Toxic syndromes/toxidromes to appropriately treat the exposed patient, including corrosive and irritant, asphyxiant, cholinergic, and hydrocarbon and derivative toxidromes</li> <li>Science behind a chemical exposure, to allow for a complete understanding of both the chemistry and physiology of what is occurring because of the exposure</li> <li>Interfacing between the on-scene response team and the hospital, to ensure consistency and continuity of care from the field into the hospital</li></ul> Enabling public safety and health professionals to administer effective care while retaining their own personal safety, Hazardous Materials Medicine: Treating the Chemically Injured Patient is a must-have resource for emergency medical technicians, paramedics, hazmat technicians, and emergency physicians and nurses working in high-risk field situations with chemically injured patients.