scholarly journals A Case of Dimethoate Poisoning Requiring Prolonged Skin Decontamination

2020 ◽  
Vol 5 (1) ◽  
pp. 11-15
Author(s):  
Ponampalam R ◽  
Keyword(s):  
Healthcare Workers ◽  
Emergency Services ◽  
Vital Signs ◽  
Chemical Exposure ◽  
Mass Casualty ◽  
Worker Safety ◽  
Uneventful Recovery ◽  
Chemical Agent ◽  
Skin Contamination ◽  
Skin Decontamination

Background Decontamination is a critical medical counter measure in reducing toxic exposure following poisoning. Little is known on the effectiveness of this procedure and its impact in the context of preventing secondary exposure of healthcare workers and secondary contamination of facilities. Presented here is a case of dimethoate poisoning that required a prolonged period of skin decontamination to remove residual skin contamination. Case Report A young gardener consumed dimethoate at the workplace witnessed by a colleague who called the emergency services immediately. Paramedics noted the patient to be drowsy with stable vital signs and 100% oxygen saturation. En-route to the hospital the patient vomited multiple times and was drenched in vomitus with a pungent odour. Upon arrival at the emergency department (ED), vital signs remained stable with a Glasgow Coma Scale (GCS) of 10. Due to gross external contamination from the vomitus and pungent odours emanating suggestive of chemical fumes off-gassing, the hospital decontamination shower was activated for patient decontamination. Staff donned protective suits and proceeded to disrobe and bag all the patient’s clothing before showering the patient for 10-minutes using soap and water. Post-decontamination a chemical agent monitor (CAM) were used to screen for residual chemicals following the hospital’s decontamination protocol. The chemical alarm was triggered twice, first around the left mastoid region and again just below the left breast. This required targeted re-showering for a further 10-minutes before patient was finally cleared of contamination. Subsequently, the patient was given atropine (2.4 mg) and pralidoxime (1 g) followed by an infusion at the intensive care unit (ICU). The patient made an uneventful recovery and was discharged 5-days later. Conclusion This case of dimethoate poisoning is notable for the prolonged period of skin decontamination to remove residual skin contamination and illustrates potential implications to patient and health care worker safety. Past mass casualty incidents involving chemicals, such as the sarin attack in Tokyo, highlight the high incidence of secondary exposures amongst healthcare workers due to the lack of casualty decontamination. As a result, many hospitals have developed capacity to conduct rapid and timely decontamination at their premises to prevent further complications from secondary chemical exposure. However, the effectiveness of this process of decontamination needs further evaluation.

Self-care Decontamination within a Chemical Exposure Mass-casualty Incident

2015 ◽  
Vol 30 (3) ◽  
pp. 288-296 ◽  
Author(s):  
Raymond G. Monteith ◽  
Laurie D. R. Pearce
Keyword(s):  
Self Care ◽  
Chemical Exposure ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Health Care Facilities ◽  
Chemical Agent ◽  
Viable Option ◽  
Publication Type ◽  
First Response ◽  
Care Facilities

AbstractGrowing awareness and concern for the increasing frequency of incidents involving hazardous materials (HazMat) across a broad spectrum of contaminants from chemical, biological, radiological, and nuclear (CBRN) sources indicates a clear need to refine the capability to respond successfully to mass-casualty contamination incidents. Best results for decontamination from a chemical agent will be achieved if done within minutes following exposure, and delays in decontamination will increase the length of time a casualty is in contact with the contaminate. The findings presented in this report indicate that casualties involved in a HazMat/CBRN mass-casualty incident (MCI) in a typical community would not receive sufficient on-scene care because of operational delays that are integral to a standard HazMat/CBRN first response. This delay in response will mean that casualty care will shift away from the incident scene into already over-tasked health care facilities as casualties seek aid on their own. The self-care decontamination protocols recommended here present a viable option to ensure decontamination is completed in the field, at the incident scene, and that casualties are cared for more quickly and less traumatically than they would be otherwise. Introducing self-care decontamination procedures as a standard first response within the response community will improve the level of care significantly and provide essential, self-care decontamination to casualties. The process involves three distinct stages which should not be delayed; these are summarized by the acronym MADE: Move/Assist, Disrobe/Decontaminate, Evaluate/Evacuate.MonteithRG, PearceLDR. Self-care decontamination within a chemical exposure mass-casualty incident. Prehosp Disaster Med. 2015;30(3):1–9.

scholarly journals The management of surgical patients in the emergency setting during COVID-19 pandemic: the WSES position paper

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Belinda De Simone ◽  
Elie Chouillard ◽  
Massimo Sartelli ◽  
Walter L. Biffl ◽  
Salomone Di Saverio ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Surgery ◽  
Healthcare Workers ◽  
Mass Casualty ◽  
Position Paper ◽  
Surgical Patients ◽  
Nasopharyngeal Swab ◽  
Emergency Setting ◽  
Open Approach ◽  
Rt Pcr

Abstract Background Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers. Method A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology. Results Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts’ opinion. Conclusions The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.

scholarly journals The Healthcare Sector Employer’s Duty of Care: Implications for Worker Well-Being

2021 ◽  
Vol 18 (11) ◽  
pp. 6015
Author(s):  
Melissa McDiarmid ◽  
Marian Condon ◽  
Joanna Gaitens
Keyword(s):  
Middle East ◽  
Healthcare Workers ◽  
Care Program ◽  
Well Being ◽  
Middle East Respiratory Syndrome ◽  
Worker Safety ◽  
Healthcare Sector ◽  
Duty Of Care ◽  
Protective Equipment ◽  
Extreme Risk

Pandemic diseases of this century have differentially targeted healthcare workers globally. These infections include Severe Acute Respiratory Syndrome SARS, the Middle East respiratory syndrome coronavirus Middle East respiratory syndrome coronavirus (MERS-CoV) and Ebola. The COVID-19 pandemic has continued this pattern, putting healthcare workers at extreme risk. Just as healthcare workers have historically been committed to the service of their patients, providing needed care, termed their “duty of care”, so too do healthcare employers have a similar ethical duty to provide care toward their employees arising from historical common law requirements. This paper reports on results of a narrative review performed to assess COVID-19 exposure and disease development in healthcare workers as a function of employer duty of care program elements adopted in the workplace. Significant duty of care deficiencies reported early in the pandemic most commonly involved lack of personal protective equipment (PPE) availability. Beyond worker safety, we also provide evidence that an additional benefit of employer duty of care actions is a greater sense of employee well-being, thus aiding in the prevention of healthcare worker burnout.

Torsion of the gallbladder: a rare but important differential to consider when treating acute cholecystitis non-operatively

2021 ◽  
Vol 14 (1) ◽  
pp. e237842
Author(s):  
Arun Ahluwalia ◽  
Matthew George Roy Allaway ◽  
Serena Giga ◽  
Richard James Curran
Keyword(s):  
Acute Cholecystitis ◽  
Inflammatory Markers ◽  
Epigastric Pain ◽  
Vital Signs ◽  
Rare Condition ◽  
Liver Function Tests ◽  
Uneventful Recovery ◽  
Imaging Characteristics ◽  
Gallbladder Torsion ◽  
Torsion Of The Gallbladder

A 79-year-old woman presented with postprandial epigastric pain. She had normal vital signs, inflammatory markers and liver function tests. Ultrasound and CT of the abdomen demonstrated features consistent with acute cholecystitis. Her medical comorbidities and extensive abdominal surgical history prompted the decision to treat non-operatively. Despite optimal medical management, worsening abdominal pain and uptrending inflammatory markers developed. She underwent an emergency laparoscopy which revealed a necrotic gallbladder secondary to an anticlockwise complete gallbladder torsion; a rare condition associated with significant morbidity and mortality if managed non-operatively. Laparoscopic cholecystectomy was achieved without complication and the patient had an uneventful recovery. Preoperative diagnosis of torsion of the gallbladder is difficult. However, there are certain patient demographics and imaging characteristics that can help surgeons differentiate it from acute cholecystitis; a condition which can be safely managed non-operatively in selected patients. The differentiating features are elaborated on in this case report.

scholarly journals Laboratory Safety, Biosecurity, and Responsible Animal Use

ILAR Journal ◽  
2019 ◽  
Author(s):  
Jessica McCormick-Ell ◽  
Nancy Connell
Keyword(s):  
Health And Safety ◽  
Chemical Exposure ◽  
Mitigation Strategies ◽  
Worker Safety ◽  
Environmental Health And Safety ◽  
Safety Research ◽  
Education Levels ◽  
Animal Safety ◽  
Animal Care

AbstractResearch with animals presents a wide array of hazards, some of which overlap those in the in vitro research laboratory. The challenge for environmental health and safety professionals when making their recommendations and performing the risk assessment is to balance worker safety with animal safety/welfare. The care and husbandry of animals require procedures and tasks that create aerosols and involve metabolized chemicals and a variety of physical hazards that must be assessed in addition to the research related risks, all while balancing the biosecurity of the facility and NIH animal care requirements. Detailed communication between health and safety, research, and animal care teams is essential to understand how to mitigate the risks that are present and if modifications need to be made as the experiments and processes progress and change over time. Additionally, the backgrounds and education levels of the persons involved in animal research and husbandry can be quite broad; the training programs created need to reflect this. Active learning and hands-on training are extremely beneficial for all staff involved in this field. Certain areas of research, such as infectious disease research in high- and maximum-containment (biosafety level 3 and 4) facilities, present challenges that are not seen in lower containment or chemical exposure experiments. This paper reviews potential hazards and mitigation strategies and discusses unique challenges for safety at all biosafety levels.

Evaluating the impact of decontamination interventions performed in sequence for mass casualty chemical incidents

2021 ◽  
Author(s):  
Samuel Collins ◽  
Natalie Williams ◽  
Felicity Southworth ◽  
Thomas James ◽  
Louise Davidson ◽  
...  
Keyword(s):  
Vegetable Oil ◽  
Methyl Salicylate ◽  
Emergency Services ◽  
Mass Casualty ◽  
Human Volunteer ◽  
Additional Contribution ◽  
Uv Photography ◽  
Chemical Incidents ◽  
The Impact ◽  
Control Skin

Abstract The Initial Operational Response (IOR) to chemical incidents is a suite of rapid strategies including evacuation, disrobe and improvised and interim decontamination. IOR and Specialist Operational Response (SOR) decontamination protocols involving mass decontamination units would be conducted in sequence by UK emergency services following a chemical incident, to allow for safe onward transfer of casualties. As part of a series of human volunteer studies, we examined the effectiveness of IOR and SOR decontamination procedures alone and in sequence. Specifically, we evaluated the additional contribution of SOR, when following improvised and interim decontamination. Two simulants, methyl salicylate (MeS) with vegetable oil and benzyl salicylate (BeS), were applied to participants’ skin. Participants underwent improvised dry, improvised wet, interim wet, specialist decontamination and a no decontamination control. Skin analysis and UV photography indicated significantly lower levels of both simulants remaining following decontamination compared to controls. There were no significant differences in MeS levels recovered between decontamination conditions. Analysis of BeS, a more persistent simulant than MeS, showed that recovery from skin was significantly reduced following combined IOR with SOR than IOR alone. These results show modest additional benefits of decontamination interventions conducted in sequence, particularly for persistent chemicals, supporting current UK operational procedures.

scholarly journals Simple Emergency Triage (SET) – the new perspective on mass casualty incident triage

2020 ◽  
Vol 7 (2) ◽  
pp. 120-123
Author(s):  
Jerzy Jaskuła ◽  
Marek Siuta
Keyword(s):  
Personal Experience ◽  
Emergency Services ◽  
Statistical Data ◽  
First Aid ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Starting Point ◽  
Analysis And Synthesis ◽  
The Subject ◽  
New Perspective

The aim: Incidents with large number of casualties present a major challenge for the emergency services. Incident witnesses are always the first on scene. Authors aim at giving them an algorithm arranging the widely known first aid rules in such way, that the number of potential fatalities before the services’ arrival may be decreased. Material and methods: The authors’ main aim was creating an algorithm for mass casualty incident action, comprising elements not exceeding first aid skill level. Proceedings have been systematized, which led to creation of mass casualty incident algorithm. The analysis was based on the subject matter literature, legal acts and regulations, statistical data and author’s personal experience. Results: The analysis and synthesis of data from various sources allowed for the creation of Simple Emergency Triage (SET) algorithm. It has been proven – on theoretical level – that introducing an organized way of proceeding in mass casualty incident on the first aid level is justified. Conclusions: The SET algorithm presented in the article is of an implemental character. It may be a supplement to basic first aid skills. Algorithm may also be the starting point for further empirical research aimed at verifying its effectiveness.

scholarly journals Pemberdayaan Perawat dalam Penerapan Nurse Early Warning System untuk Memantau Kondisi Pasien di Rumah Sakit

2020 ◽  
Vol 2 (2) ◽  
pp. 135
Author(s):  
Junaedi Yunding ◽  
Masyita Haerianti ◽  
Evidamayanti Evidamayanti ◽  
Evawaty Evawaty ◽  
Indrawati Indrawati
Keyword(s):  
Early Warning ◽  
Early Warning System ◽  
Emergency Services ◽  
Vital Signs ◽  
Warning System ◽  
Independent Practice ◽  
Knowledge And Skills ◽  
Detection Tool ◽  
Service Institution ◽  
Implementation Method

AbstractSevere adverse events such as cardiac arrest and death are often marked by abnormal vital signs a few hours before the event. Majene Regional General Hospital is the only hospital in the Majene Regency and is a reference center for all puskesmas in the Majene and surrounding districts. As a health service institution that organizes health services, it is closely related to the responsibility of providing emergency services. The Nurse Early Warning System (NEWS) is a development in emergency services for patients treated in hospitals, which serves as an early detection tool so that if there is a decrease in the patient's condition it can be known earlier can be handled more quickly. The purpose of this activity is to increase the knowledge and skills of nurses in the application of the nurse early warning system (NEWS) in monitoring the condition of patients in the care room. The implementation method starts from identifying the problem, delivering material about NEWS, demonstrating the assessment of the patient's condition and the nurse's independent practice in using NEWS. The evaluation results of this activity are the increase in knowledge and skills of nurses using NEWS in monitoring the condition of patients in the care room.

Preparedness for Mass Casualty Incidents: The Effectiveness of Current Training Model

2021 ◽  
pp. 1-9
Author(s):  
Seema Biswas ◽  
Hany Bahouth ◽  
Evgeny Solomonov ◽  
Igor Waksman ◽  
Michael Halberthal ◽  
...  
Keyword(s):  
Disaster Management ◽  
Emergency Services ◽  
Traumatic Event ◽  
Management Training ◽  
Training Model ◽  
Mass Casualty ◽  
The Public ◽  
Physical Injuries ◽  
Nation States ◽  
State Infrastructure

Abstract The importance of MCI organization and training was highlighted by the events of September 11, 2001. Training focuses on the management of physical injuries caused by a single traumatic event over a well-defined, relatively short timeframe. MCI management is integrated into surgical and trauma training, with disaster management training involving the emergency services, law enforcement, and state infrastructure agencies. The COVID-19 pandemic revealed gaps in the preparedness of nation states and global partners in disaster management. The questions that arose include ‘has training really prepared us for an actual emergency,’ ‘what changes need to be made to training to make it more effective,’ and ‘who else should training be extended to?’ This article focuses on the importance of involving multiple sectors in mass casualty training and asks whether greater involvement of non-medical agencies and the public, in operational drills might improve preparedness for global events such as the COVID-19 pandemic.

scholarly journals (P2-82) Developing and Implementing an Emergency Preparedness and Trauma Research Program in a New Level One Trauma Center

2011 ◽  
Vol 26 (S1) ◽  
pp. s163-s163
Author(s):  
T.E. Rives ◽  
C. Hecht ◽  
A. Wallace ◽  
R. Gandhi
Keyword(s):  
Emergency Preparedness ◽  
Trauma Center ◽  
Emergency Services ◽  
Mass Casualty ◽  
Senior Executives ◽  
Research Administration ◽  
Trauma Research ◽  
Uninsured Patient ◽  
Research Relationship ◽  
Trauma Surgeons

Our level one trauma center with a service area covering a population of approximately four-million people treats approximately 80,000 patients per year. In 2010, we anticipate more than 23,000 patients admitted, and to experience more than 850,000 patient encounters within the network. Trauma research is an important component to any level one trauma center, as well as a requirement of the American College of Surgeons/Committee on Trauma (ACS/COT). Our trauma center has recently gained level one designation and began an emergency preparedness research and trauma research (EPR/TR) program in earnest. We are fortunate to have support from executive administrators. Stewardship is a necessary element of our planning, in part because we are a county hospital serving a large uninsured patient population. The following are a few of the necessary steps we took to build an (EPR/TR) department from the beginning, to the point of submitting abstracts, manuscripts, funding grants, and presentations to regional, national, and international conferences, journals, and agencies. Structure the Emergency Preparedness Office to be a component of Trauma Services, allowing a unique opportunity for real-time disaster and mass casualty research. Secure a commitment from senior executives. Secure an experienced researcher, capable of research administration. Ensure the (EPR/TR) director, trauma medical director, trauma services director, and emergency preparedness coordinator can be a cohesive team with complimentary skills. Encourage trauma surgeons to perform research with assistance from the (EPR/TR) Office. Seek federal and foundation funding. Seek alliances with appropriate consortiums and associations. Develop a research relationship with pre-hospital emergency services. The above steps represent only some of the components used to build our (EPR/TR) department. We anticipate the planned expansion of the above steps will take our EPR/TR to the next level and increase extramural funding.

Sign in / Sign up

Export Citation Format

Share Document