LEARNING OBJECTIVE: Recall rescue, patient care, and decontamination procedures for patients exposed to hazardous material.

After a safety zone has been established—and regardless of your level of training—you should follow the procedures outlined below:

Rescue from Exclusion Zone (Hot Zone)

The most dangerous element of any HAZMAT incident—both to the exposed victims and the rescuers—is the rescue from the hot zone. Rescue operations should always be performed using appropriate protective equipment (PPE). You must never enter the area unless you have been appropriately trained to do so. Let the experts handle this aspect of the rescue, but be prepared to provide supportive care once the victim is clear of the contaminated area.

As soon as the patient has been removed to safety, you should follow normal primary and secondary survey procedures, including interviews of the patient and bystanders. Observe the patient and provide basic life support. Give the patient supplemental oxygen, and monitor vital signs closely.

Patient Decontamination Procedures

Decontamination is the process of removing or neutralizing and properly disposing of contaminants that have accumulated on personnel and equipment. Decontamination protects site personnel by minimizing the transfer of contaminants, helps to prevent the mixing of incompatible chemicals, and protects the community by preventing uncontrolled transportation of contaminants from the site. All personnel, clothing, and equipment that leave the contamination area (exclusion zone) must be decontaminated to remove any harmful chemicals that may have adhered to them. Some decontamination methods include those listed below.

Dilution is the most frequently appropriate method of decontamination.

Decontamination requires the use of PPE, although the level of protection required may be less once the victim is out of the hot zone. A victim who is exposed to a gas may not require actual “decontamination” after rescue and only require cessation of exposure and an opportunity to breathe fresh air. However, if a victim is soaked with a liquid, the HAZMAT may pose an ongoing risk to the victim and to the rescuers or medical personnel. IT IS IMPORTANT TO ALWAYS ASSUME THAT THE VICTIM HAS BEEN CONTAMINATED WITH SOMETHING THAT COULD HARM YOU AND OTHERS UNTIL DETERMINED OTHERWISE. Do not be foolish or bold and presume that you or others will not be exposed and harmed!

Once the victim is medically evaluated, carefully remove any solid material that remains on the patient’s clothing. Be alert not to get any on yourself. If the material is dry, immediately remove the victim’s clothing while avoiding or minimizing contact with the HAZMAT or loss of the HAZMAT from the clothing. Unless specifically contraindicated by the hazardous nature of the HAZMAT and directed by the incident commander or the supporting medical advisor, flush the patient’s skin, clothing, and eyes with water. To the maximum extent possible, control or retain the runoff (which is contaminated) which will be containerized for proper disposal. Remove all of the victim’s clothing, shoes, and jewelry. Place everything that may have contacted the HAZMAT in a special container. Mark the container as contaminated. Continue flushing the skin with water for at least 20 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 decontamina­tion. 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.