Diagnosis, Treatment, and Transport

minutes. Again, try to retain the runoff. Using available items like towels or clean rags, mechanically remove the HAZMAT by wiping; avoid rubbing the skin too vigorously. Dry the skin and provide uncontaminated dry clothing or coverings. The nature of the HAZMAT involved and the threat to the health of others (rescue team, other victims, medical personnel, transport crew) determines the degree of decontamination necessary before treatment or transporting the patient. Generally, it is preferred that decontamination be accomplished before treatment or transport. However, the patient’s immediate medical condition may be more serious than the contamination itself. For example, ingested HAZMAT may pose little immediate threat to nearby personnel, but be an imminent threat to the victim’s life. Therefore, the consequences of delaying the emergency care of the patient’s injuries to accomplish gut decontamination must be carefully evaluated. In some cases, decontamination and emergency medical care can be carried out simultaneously. In rare instances of great urgency, the victim may require transportation to the hospital before decontamination. In these unusual cases, notify both the hospital and transportation crew of the patient’s medical condition and contamination. Depending on the situation, the transportation crew will have to appropriately prepare to carry and care for the contaminated victim; otherwise, the crew themselves could be contaminated and/or be affected by the contamination. For example, the transport crew may need to wear level A or B suits and/or respirators. Remember, if the victim is contaminated and the transport requires personal protective devices, it is likely that the vehicle will be contaminated and require appropriate decontamina- tion. There is also a potential to contaminate the receiving medical facility and its staff. Diagnosis, Treatment, and Transport As soon as the victim has been removed to safety, follow normal primary and secondary survey procedures, including interviews of the patient and bystanders. Observe the patient and provide the ABCs of basic life support (airway, breathing, circulation) and add “D” and “E” for disability and exposure. Look for signs of trauma and provide proper exposure (i.e., remove clothing) to fully assess the victim. Monitor vital signs and the victim closely! As a guideline, give the patient supplemental oxygen (4 to 6 liters per minute), and start an IV at an area of skin not exposed to the hazardous material (or at least that has been thoroughly decontaminated). If the HAZMAT victim has swallowed a known or identified toxic material, treat the victim as a poisoned patient using the information provided above. Dress wounds and prepare the patient for transport to a medical treatment facility. Finally, transport the victim to a medical treatment facility for complete medical evaluation and treatment. Care should be taken during transport to stabilize the victim by maintaining normal body temperature, administering oxygen, and treating shock. SUMMARY In this chapter, we discussed the assessment and treatment for poisoning, drug abuse, and hazardous material exposure, along with the rescue and decontamination procedures for patients exposed to HAZMAT. In our rapidly changing environment, we must be up to date on the latest changes in assessment and treatment for these conditions. You may stay informed through contact with the local Poison Control Center, MEDIC releases, or via the World Wide Web on the Internet. 5-26