Cdc; usamriid; who

Tried to find those on internet but didn't manage to go get real figures, sorry

External contamination is almost completely removed by removal of clothing and showering. This would include radioactive dust from a "dirty bomb", "white powder" incidents, or clothing contamination from an organophosphate.

For normal business, would you expect support from the fire services?

Do you have a nearby industrial complex or transport of these substances which increase possibility of multiple victims? If so what are these chemicals, etc?

Our ambulance service would not knowingly transport a patient who needed decontamination, without this occurring at the scene. What are your risks of self-presenters? St. Luke's in Tokyo had about 500 self presenters after the Sarin event.

We have a single showerhead for a single patient, and then fixed shower heads in 3 rows for multiple victims (males/females/staff). What would you do with a non-ambulant self presenter.

Need guidelines for staff, about PPE, on, off, communication, monitoring.

Where does the water go? Are there laws/regulations about letting the effluent into the drainage system.

For patients with internal contamination, ingestion, radioactive pellet into soft tissue, they possibly should have external decontamination, but still need ongoing  measures to protect staff from off-gassing, or radioactive pellet.

Dear John,

Thanks for your comments. We have world's second petrochemical port including nuclear power plant  in our catchment area. There is continuous and concentrated  transport by road and train of all kinds of related products. Had an incident with a bromine transport once but almost any product passes by.

In normal bussiness there would be suport of civil protection on sitebut the risk of self presenters is big. It was seen in a previous incident with a mass casualty fire in a hotel party area where all hospitals of our city were flooded with self referred  burn patients out of the regular EMS system.Another hospital had a self referal tsunami after a mass carbon monoxide intxication before regular EMS triage was established (lucky enough no contamination problem but proof of the risk).

We treat frequently isolated incidents (max 3-4 patients) with problems of acid spills, chlorine or phenol spills etc where decon is performed on the production site. We fear problems in case of mass casualty incidents on production sites and/or transportation incidents.

Concerning waste we will have to collect the effluent apart from normal sewer system.

Hospital managers however use another risk estimation and are hardly convinced of the necessity to prepare.

Kind regards

There are multiple resources on this.  The best I know of are in Iran (because they dealt with it in real life) and the US Army Medical Research Institute for Chemical Defense (USARICD), which collaborates its curriculum with USAMRIID.

The problem with most facilities is a lack of advanced warning.  Research industrial accidents and the Aum Shinrikyo Sarin attacks.  Almost universally, most patients self-ambulate to the emergency department.  They are inside your facility before you know what is happening.

This is a guidance manual developed by the State of Victoria in Australia.

It is more focused in procedures than in actual requirements, but I think it can be useful for you.

Best Regards,

Juan

Hi Luc

long time no see, hope to see you at WADEM

Have you tried the JCI website they have a lot of material for accrediting hospitals and it does in part cover this area though I have not had to look at it in detail

mick