Medical Aspects of Chemical Warfare (2008) - The Black Vault

Decontamination of Chemical CasualtiesTABLE 16-3Signs and Symptoms REPORTED BY TOKYO HOSPITAL WorkerS TREATING VICTIMS OFSarin Subway AttackS*SymptomNumber/percentage of the 15 physicianswho treated patients at UHNumber/percentage of 472 care providersreporting symptoms at SLIDim vision 11 73% 66 14%Rhinorrhea 8 53% No informationDyspnea (chest tightness) 4 27% 25 5.3%Cough 2 13% No informationHeadache No information 52 11%Throat pain No information 39 8.3%Nausea No information 14 3.0%Dizziness No information 12 2.5%Nose pain No information 6 1.9%*Data reflect reported survey of self-reported symptomatology of physicians at the University Hospital of Metropolitan Japan emergencydepartment and all hospital workers at Saint Luke’s International Hospital exposed to sarin vapors from victims of the Tokyo subway attack.SLI: Saint Luke’s International HospitalUH: University HospitalData sources: (1) Nozaki H, Hori S, Shinozawa Y, et al. Secondary exposure of medical staff to sarin vapor in the emergency room. IntensiveCare Med. 1995;21:1032-1035. (2) Okumura T, Suzuki K, Fukuda A, et al. The Tokyo subway sarin attack: disaster management, Part 1: communityemergency response. Acad Emerg Med. 1998;5:613-617. (3) Okumura T, Suzuki K, Fukuda A, et al. The Tokyo subway sarin attack:disaster management, Part 2: Hospital response. Acad Emerg Med. 1998;5:618-624.Close medical monitoring and treatment of casualtiesbefore, during, and after thorough decontaminationmust be an integral part of all patientdecontamination operations. Medical conditions canchange as individuals undergo the stressful process ofdecontamination. If the exposure is to a liquid agent, itmay take time for the agent to transit the skin layers. Apatient exposed to a liquid chemical agent may appearstable or well during decontamination but can becomeworse during or after the decontamination process.Decontamination Operator ProtectionHeat and musculoskeletal injury are primary concernsfor decontamination team members. Individualsmust perform heavy work (patient treatment, triage,and litter movement) while wearing IPE. Working ina hot environment lowers individual mental alertnessand physical performance. Increased body temperatureand physical discomfort can cause workers to overlooksafety procedures or divert their attention from hazardoustasks. These critical issues must be addressed beforeand throughout decontamination operations.Musculoskeletal injury can occur from liftingpatients, carrying litters, or falling while wearingprotective ensemble. Injury reduction strategies suchas removing tripping hazards, policing the decontaminationarea for debris, working at a safe pace,rehearsing ergonomically correct patient lifts, enforcingfrequent rest breaks, using special equipment toreduce lifting (such as wheeled litter carriers), andinsuring adequate staffing are all useful strategies toprevent worker injury.The chemical protective ensemble prevents an individual’ssweat from readily making contact with theair, which inhibits heat transfer from the body, makingit difficult for the body to cool itself, which can leadto heat injury. The National Institute for OccupationalSafety and Health publication Working in Hot Environmentsdescribes a variety of heat conditions includingheat stroke (the most life threatening), heat exhaustion,heat cramps, fainting, heat rash, and transient heat fatigue.69 All decontamination personnel must be trainedin preventative measures for these conditions, be ableto identify their signs and symptoms, and know whatto do when they occur. It typically takes humans 5 to7 days to adjust to working in hot temperatures. Heatstress can be reduced by reducing prolonged exposure541