Hazardous Materials Medicine

Treating the Chemically Injured Patient

Inbunden, Engelska, 2023

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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: Scene assessment, to help determine the cause of the exposure, and exposure assessment, to determine what physiologic systems are affectedToxic syndromes/toxidromes to appropriately treat the exposed patient, including corrosive and irritant, asphyxiant, cholinergic, and hydrocarbon and derivative toxidromesScience behind a chemical exposure, to allow for a complete understanding of both the chemistry and physiology of what is occurring because of the exposureInterfacing between the on-scene response team and the hospital, to ensure consistency and continuity of care from the field into the hospitalEnabling 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.

Produktinformation

Utgivningsdatum2023-04-12
Mått183 x 257 x 25 mm
Vikt885 g
FormatInbunden
SpråkEngelska
Antal sidor368
FörlagJohn Wiley & Sons Inc
ISBN9781119663928

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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.

Author Biographies and Acknowledgments xviiForeword xxiPreface xxiii1 HazMat Medicine and the HazMat Medic 1Introduction 1Case Study – Sarin Attack in the Tokyo Subway 3History 4Events 7Situational Assessment Continuum 8Patient Presentation 9Event Conditions (Scene Evaluation and Size- up) 9Scene Assessment (Hazard Identification) 9Summary 102 Exposures 11Introduction 11Case Study – Derailment in South Carolina, a No- Notice Evacuation Event 11Patient Presentation 12The Toxidrome Exam 14Respiratory System 14Overview 14Respiratory System Anatomy and Physiology 16External Respiratory System 16Internal Respiratory System 19Chemical and Physical Form of Respiratory Exposure 22Gases, Vapors, and Fumes 22Solid Particles 22Aerosols/Mists 23Concentration and Duration 23Types of Injuries Resulting from Chemical Exposure 23Chemically Induced Bronchiole Constriction 23Atelectasis and Disruption of Surfactant 24Chemically Induced Pulmonary Edema (Noncardiogenic Pulmonary Edema) 25Chemical Sensitivity 26Types of Chemicals that Injure the Respiratory System 26Asphyxiants 26Simple Asphyxiants 26Chemical Asphyxiants 27Irritants (Corrosives) 27Respiratory System Injury Recognition (Assessment) and Diagnostics 27Pulse Oximetry 27Specific Oximetry Considerations When Assessing HazMat Exposures 28Capnography 29Masimo™/Rainbow Technology 32Cardiovascular Abnormalities Related to Exposure 33Description 33Vasogenic Shock 33Hypovolemic Shock 33Heart Failure 34Neurological Abnormalities Related to Exposure 34Central Nervous System (CNS) Exposure 34CNS Depression 34CNS Stimulation 35Parasympathetic Nervous System 35Parasympathetic Stimulation 35Parasympathetic Depression 36Integumentary System (Skin) 36Skin Anatomy and Physiology 36Structure 37Function 38Types of Chemical Injuries to the Skin 38Chemical- Related Irritation 38Chemical Skin Burns 39Ocular Exposure and Injury 41Eye Anatomy and Physiology 42The Globe 42The Ocular Surface 42Assessment of Eye Injury After Exposure 43Normal Eye Assessment 44Chemical Eye Burns 45Surface Toxins 46Treatment of Eye Exposure 48Specialized Eye Equipment 49The Morgan Lens 49Nasal Cannula for Eye Irrigation 51Gastrointestinal Exposure to Toxic Materials 51Absorbing Chemicals and Nutrients 51Liver 51Phase I and II Detoxification 52Environmental Exposures 53The Hot Environment – Hydration and Hyperthermia 53Physiology 54Absorption of Water 55Acclimation 57Metabolic Thermoregulation 58Determining Severity of Heat 60Effects of Heat in an Encapsulated Suit 60Factors Contributing to Heat Emergencies/Injuries 62Treatment 63The Cold Environment 64Exposure to Liquefied Gas and Cryogenics 64Frostbite Injuries 65Assessment 66Treatment 67Summary 673 Toxidromes 69Introduction 69Case Study – Silver Cyanide Exposure 69Assessment Capabilities 70Blood Pressure 70Increase in Blood Pressure 71Decrease in Blood Pressure 71Pulse 72Toxidromes 72Corrosives and Irritants Toxidromes 72Chlorine (Cl 2) 72Agent Identification 72History 73Pathophysiology 73Signs and Symptoms 73Where Is Chlorine Found 74Decontamination 75Emergency Field Treatment 75Basic Life Support 75Advanced Life Support 75Ammonia (NH 3) 76Agent Identification 76History 76Physiology 76Signs and Symptoms 76Where Is Ammonia Found 77Decontamination 77Emergency Field Treatment 77Assessment/Treatment 77Basic Life Support 77Advanced Life Support 77Phosgene, aka. Carbonyl Chloride 78Agent Identification 78History 78Physiology, Signs, and Symptoms 78Where Phosgene Is Found 78Decontamination 79Emergency Field Treatment (Chloramine, Ammonia, and Phosgene) 79Basic Life Support 79Advanced Life Support 79Pediatric Considerations (Chlorine, Chloramine, Ammonia, Phosgene) 80Hydrofluoric Acid and Fluorine- Based Chemicals 80History 80Pathophysiology 80Signs and Symptoms of Exposure 82Where Hydrofluoric Acid Is Commonly Found 82Decontamination and Significant Danger to Rescuers 83Treatment 83Eye Injury Treatment (Hydrofluoric Acid) 83Skin Burn Treatment (Hydrofluoric Acid) 84Respiratory Injury Treatment (Hydrofluoric Acid) 84Systemic Injury from Hydrofluoric Acid (Hypocalcemia) 85Phenol (Carbolic Acid) 85History 85Pathophysiology, Signs, and Symptoms 86Where Phenol Is Commonly Found 86Field Treatment and Decontamination 87Assessment/Treatment or Phenol 87Lacrimatory Agent Exposure 87Chemical Currently Being Used 88Effect 88Treatment 88Asphyxiant Toxidromes 89Effects of Hypoxia 90Simple Asphyxiants 92Experience; Death at McDonald’s: “Five Lousy Feet” 93Assessment/Treatment for Simple Asphyxiants 93Chemical Asphyxiants 93Carbon Monoxide Poisoning 93History 94Pathophysiology 94Concerns 96Signs and Symptoms 97Where Carbon Monoxide Is Typically Found 98Decontamination and Danger to Responders 98Field Treatment 98Cyanide Poisoning – Hydrogen Cyanide, Cyanide Salts, and Cyanide Containing Gases 99History 100Pathophysiology 101Signs and Symptoms 102Definitive Diagnosis 103Where Cyanide Is Commonly Found 103Decontamination of Patients 104Emergency Medical Field Treatment 104CyanoKit – 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) 106Hydrogen Sulfide Poisoning 106History 107Pathophysiology 107Signs and Symptoms 108Where Hydrogen Sulfide Is Commonly Found 108Decontamination and Significant Danger to Rescuers 108Field Treatment 108Definitive Treatment and Follow- up Care 109Nitrites, Nitrates, Nitrobenzene Poisoning 109History 109Pathophysiology 110Signs and Symptoms 111Where Are Nitrogen Compounds Found 111Field Treatment 112Cholinergic Toxidrome 113Organophosphate Insecticide Poisoning 113Experience: Novichok Nerve Agent Used Against Russian Dissident Has Dark History 114Experience: Tokyo Subway, Site of an Attack Using Sarin Nerve Agent 115Pathophysiology 115Signs and Symptoms 116Location of Organophosphate Insecticides 117Decontamination and Significant Danger to Rescuers 117Treatment 118Experience: Malathion Overdose Treated Without Protopam 119Treatment 119Carbamate Poisoning 121Treatment 121Hydrocarbons and Derivatives Toxidrome 122Hydrocarbon Toxicity 122Pathophysiology 123Cardiac Effects 124CNS Effects 124Emergency Medical Care 124Signs and Symptoms 124Treatment 125Toxic Alcohols 127Treatment 127Etiological Toxidrome 127Overview 127Vancomycin- Resistant Enterococci (VRE) 130Symptoms 130Diagnosis 130Treatment 130Methicillin- Resistant Staphylococcus aureus (MRSA) 130Pathophysiology 131Signs and symptoms 131Treatment 131Clostridium Difficile (C. Difficile) 131Overview 131Symptoms 132Other Risk Factors 132Complications from C. Difficile Include 132Prevention 132Necrotizing Fasciitis 133Overview 133Symptoms 133Cause 133Treatment 133Means of Entry 133Virulence 134Exposure 134Radiological Toxidrome 135Overview 135Types of Radiation 136Alpha Particles 136Beta Particles 136Gamma Rays 137Neutrons 137X- Rays 137Measuring Radioactivity 137Principles of Protection 139Location of Radiation and Common Sites for Accidents 140Types of Injuries 140Rescue and Emergency Treatment 142Treatment 143Associated Toxic Conditions 144Closed Space Fires 144History 144Fire Toxicology 145Danger to Firefighters 147Treatment 147Wheezing Secondary to Toxic Inhalation 149Overview 149Tachycardia Secondary to Chemical Exposure 150Hypotension Caused by Exposure 151Seizures Post- Exposure 151Opioids Overdose/Exposure 152History 152Opium Alkaloids 152Synthetic Opioids 153Semisynthetic Opioids 153Today’s Fentanyl and Carfentanil 154Signs and Symptoms 154Summary 155Reference 1564 Event Conditions 157Introduction 157Case Study – Fertilizer Explosion in West Texas 158Operational Hazards 159Dispatch Information 159Scene Safety 160Upon Arrival – Stop, Look, and Listen 162Weather Conditions 162Witnesses Accounts 163Risk Awareness 163The North American Emergency Response Guidebook (ERG) 173NIOSH Pocket Guide 175Cameo 176Marplot 177Aloha 177Wiser 177ToxNet and the Hazardous Substance Database 177Resources 178Summary 1785 Hazard Identification 181Introduction 181Case Study – Phosgene Exposure 182States of Matter 182Solid 184Liquids 186Vapors and Gases 186Mists and Aerosols 186Gases 186Compressed Gas 186Liquified Gas 186Cryogenic Gas 187Chemical and Physical Properties 187Chemical Properties 188pH (Corrosivity) 1880005505303.indd 11 03-03-2023 13:18:02Ignition Temperature (IT) 188Flashpoint (FP) 188Heat Transfer 188Physical Properties 188Appearance 189Viscosity 189Melting Point (MP) 189Freezing Point (FrPt) 189Boiling Point (BP) 189Flammable Range 190Density 190Specific Gravity (SG) 190Vapor Density (VD) 191Vapor Pressure (VP) 192Expansion Ratios 193Properties and Their Medical Implications 193Vapor Pressure, Medical Implications 194Vapor Density, Medical Implications 195Specific Gravity, Medical Implications 195Solubility, Medical Implications 195History of Toxicology 196Exposure vs. Contamination 197Toxin vs. Poison 198Toxicity of a Poison or Toxin 198Standards, Guidelines, and Acts Regulating Hazardous Materials 200NFPA and OSHA 200Environmental Protection Agency (EPA) 200Time Weighted Average 201Short- Term Exposure Limits (STELs) 201Immediately Dangerous to Life and Health (IDLH) 201Control Banding 203Basic Toxicology Definitions 205Acute Exposure 206Sub- Chronic/Sub- Acute 208Chronic Exposure 209Noel, Noael, Loael 209Levels of Concern 210Dose Response and Exposure 210Graded Response 211Quantal Response 211Response Curve 212Lethal Concentrations and Lethal Doses 213Chemical Time lines 214Additional Toxic Effects 216Toxic Influences 217General Health 217Diet 217Previous Exposure 218Age 218Gender 219Genetics 220Sleep 220Biochemistry 221Detoxification 221Phase I and Phase II Reactions 221Detoxification by the Lungs 224Chemical Toxic Qualities 224Chemical Excretion 225Nanotoxicology 225Determining the Level of Medical Surveillance 226Risk Assessment and Detection 226Identification of Hazards 227Assess Hazards to Determine the Risks 227Develop Controls to Manage the Risks 227Implementing Controls 227Supervise and Evaluate the Process 228Summary 2306 Team Capabilities 231Introduction 231Case Study – Sodium Nitrate Overdose 231Technician Operational Considerations 232Personnel Protective Equipment (PPE) 232Rehabilitation 235Decontamination 236Occupational Safety and Health Administration 237National Fire Protection Association 237Environmental Protection Agency 237Science Behind Decontamination 237Types of Decontamination 239Gross Decontamination 239Secondary Decontamination 240Tertiary Decontamination 240Emergency Decontamination 240Techniques 240Physical Decontamination 241Factors to Consider During Decontamination 241Equipment Uses 242Choosing a Decontamination Site Location 243Detection and Monitoring 243The Approach 244The System of Detection 245Radiation 246pH 247Oxygen 247Organic Compounds 247Biologicals 249Detection and Monitoring Responses 249Current Detection Technologies 250Radiation Detectors 250pH Paper and Impregnated Papers 252KI Paper or Oxidizer Paper 252Wet Chemistry 252Electrochemical Sensors 253Catalytic Bead 253Colorimetric Tubes 254Photoionization Detection (PID) 254Flame Ionization Detection (FID) 255Ion Mobility Spectroscopy (IMS) 255Infrared Spectroscopy (FT- IR) 256Raman Spectroscopy 256Positive Protein 257Handheld Immunoassay (HHA) 257Polymerase Chain Reaction (PCR) 258Mass Causality Incidents 259Triage Considerations (Non- START Triage) 259Stilp and Bevelacqua Exposure Score 259Cardiovascular 260Breathing (Respiratory) 261Rx – Immediate Basic Treatment 261Neurological 261Mass Decontamination 261Initial Operations 261HazMat Alert 262Hospital Interface 263Casualty Collection Points (Field Treatment Site) 266Temporary Medical Care Units (Alternate Care Facilities) 266The Medical Reserve Corp 266Hospital Decontamination Considerations 268PPE in the Hospital Environment 268Hospital Isolation Rooms 269Notification and Preparation 269Hospital Scenario Possibilities 270Hospital Decontamination Corridor 271Hospital Decontamination Sequence Model 272Summary 2747 HazMat Safety Officer 275Introduction 275Case Study – Lieutenant Dan 275Medical Assessment 2760005505303.indd 14 03-03-2023 13:18:02Medical Surveillance 278Initial Baseline Physical and Annual Physical 279Pre- Entry Physical 281Considerations of the Entrance Physical 283Post- Entry Physicals 285Use of Findings 286Preventive Health Screening 288Post- Exposure Physicals 288Biological Monitoring 289Team Exit and Retirement Physicals 290Program Review 290ADA, Civil Rights, and Health Insurance Portability and Accountability Act (hipaa) 290Critical Incident Stress Debriefing 291Developing a Medical Surveillance Program 293Summary 2948 Terrorism 297Introduction 297Case Study – Salmonella Salad Bar 298Terrorism Using Chemical Warfare Agents 299Nerve Agents (Cholinergic Toxidrome) 299Military Nerve Agents 299Physical Properties and Routes of Entry 300Decontamination 301Treatment 301Blood Agents – Asphyxiants Toxidrome 301Military Blood Agents 301Physiology 302Physical Properties and Routes of Entry of Cyanide Agents 302Decontamination 302Treatment 302Choking Agents – Irritant Gas Toxidrome 302Military Choking Agents 303Physiology of Respiratory Irritant Injury 304Physical Properties and Routes of Entry 304Decontamination 304Treatment 304Vesicants – Corrosive Toxidrome (Military Blister Agents) 305Military Blister Agents (Vesicants) 305Physiology of Blister Agent Exposure 306Physical Properties and Routes of Entry 306Decontamination 306Treatment 306Lacrimators (Riot Control Agents) 306CN and CS 307Oc 307Decontamination 307Treatment 308Terrorism Using Biological Agents 308Bacteria 308Viruses 309Biological Toxins 309Bacterial Agents 309Anthrax (B. anthracis) 309Cholera (Vibrio cholerae) 310Pneumonic/Bubonic Plague (Y. pestis) 310Tularemia (F. tularensis) 311Q Fever (Coxiella burnetii rickettsia) 311Salmonellae (Salmonella typhimurium) 311Viral Agents 312Smallpox (Variola virus) 312Venezuelan Equine Encephalitis (VEE) 312Viral Hemorrhagic Fevers (VHFs) 313Biological Toxins 313Botulinum Toxin 313Staphylococcal Enterotoxin B (SEB) 314Ricin 315Trichothecene Mycotoxins (T2) 315Explosives and Incendiary Devices 316Bomb Incidents 316Anatomy of Explosives 316Expected Effects from Explosions 317Physiology of Blast Effects 318Blast Effects 318Summary 320Epilogue 323Index 325