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

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Samuel Collins ◽  
Natalie Williams ◽  
Felicity Southworth ◽  
Thomas James ◽  
Louise Davidson ◽  
...  
Keyword(s):  
Vegetable Oil ◽  
Methyl Salicylate ◽  
Emergency Services ◽  
Mass Casualty ◽  
Additional Contribution ◽  
Uv Photography ◽  
Chemical Incidents ◽  
The Impact ◽  
First Time ◽  
Control Skin

AbstractThe 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 for the first time, the effectiveness of UK 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 Human volunteer study of the decontamination of chemically contaminated hair and the consequences for systemic exposure

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Samuel Collins ◽  
Thomas James ◽  
Felicity Southworth ◽  
Louise Davidson ◽  
Natalie Williams ◽  
...  
Keyword(s):  
United Kingdom ◽  
Methyl Salicylate ◽  
Systemic Exposure ◽  
Mass Casualty ◽  
Human Studies ◽  
Human Volunteer ◽  
Toxic Chemicals ◽  
Systemic Bioavailability ◽  
Volunteer Study ◽  
Careful Management

AbstractThe decontamination of exposed persons is a priority following the release of toxic chemicals. Efficacious decontamination reduces the risk of harm to those directly affected and prevents the uncontrolled spread of contamination. Human studies examining the effectiveness of emergency decontamination procedures have primarily focused on decontaminating skin, with few examining the decontamination of hair and scalp. We report the outcome of two studies designed to evaluate the efficacy of current United Kingdom (UK) improvised, interim and specialist mass casualty decontamination protocols when conducted in sequence. Decontamination efficacy was evaluated using two chemical simulants, methyl salicylate (MeS) and benzyl salicylate (BeS) applied to and recovered from the hair of volunteers. Twenty-four-hour urinary MeS and BeS were measured as a surrogate for systemic bioavailability. Current UK decontamination methods performed in sequence were partially effective at removing MeS and BeS from hair and underlying scalp. BeS and MeS levels in urine indicated that decontamination had no significant effect on systemic exposure raising important considerations with respect to the speed of decontamination. The decontamination of hair may therefore be challenging for first responders, requiring careful management of exposed persons following decontamination. Further work to extend these studies is required with a broader range of chemical simulants, a larger group of volunteers and at different intervention times.

Stress in the Prehospital EMS and Disaster Setting

1991 ◽  
Vol 6 (4) ◽  
pp. 483-484 ◽  
Author(s):  
Susan D. McHenry
Keyword(s):  
Emergency Services ◽  
The United States ◽  
Mass Casualty ◽  
Quarter Century ◽  
Complex Issue ◽  
The Past ◽  
Emergency Service Personnel ◽  
Public Safety Personnel ◽  
Area Of Concern ◽  
The Impact

While formal efforts have been made during the past quarter century in the United States to develop and coordinate emergency medical services (EMS) as a “system” of care, it was not until the past decade that we began to recognize and acknowledge the impact of stress on the lives of EMS and other public safety personnel, in both normal day-to-day response to emergencies as well as response to mass casualty incidents or disasters. The first significant writing on this complex issue, Emergency Response to Crisis, by Jeffrey T. Mitchell, PhD and H. L. P. Resnik, MD, provided a crisis intervention guidebook for emergency service personnel and early insight on crisis-worker stress and burnout. The most recent comprehensive discussion of this important area of concern can be found in Emergency Services Stress, by Mitchell and Grady Bray, PhD.

scholarly journals Ensuring Emergency Preparedness through Systematic Evaluations

2019 ◽  
Vol 34 (s1) ◽  
pp. s76-s76
Author(s):  
Gila Margalit ◽  
Orna Rachaminov ◽  
Yuval Levy ◽  
Bruria Adini ◽  
Amir Grinberg
Keyword(s):  
Emergency Preparedness ◽  
Trauma Center ◽  
Mass Casualty ◽  
Home Front ◽  
Administrative Professionals ◽  
Emergency Scenarios ◽  
High Level ◽  
Relative Change ◽  
Chemical Incidents ◽  
The Impact

Introduction:Hospitals are required to maintain emergency preparedness 24/7. In order to maintain readiness, Israeli hospitals operate Emergency Committees comprised of medical, nursing, and administrative professionals who are responsible for capacity building including the development of plans, infrastructure, equipment, training, crisis management, and learning lessons. The Ministry of Health (MOH) and Home Front Command (HFC) conduct a comprehensive, structured evaluation of emergency preparedness in every hospital every two to three years.Aim:To assess the impact of a periodical evaluation on levels of emergency preparedness over time in a level one trauma center.Methods:Evaluation of emergency preparedness is conducted by approximately 12 evaluators from the MOH and HFC, encompassing mass casualty incidents (MCIs), mass toxicological/chemical incidents (MTEs), radiological and biological events, earthquakes and conflicts. Evaluations are based on objective parameters, relayed to hospitals prior to the evaluation. The hospital’s level of emergency preparedness is graded and improvements that must be implemented are delineated. The grades of four evaluations conducted from 2011 to 2018 were compared to identify trends in preparedness.Results:Mean levels of emergency preparedness in the 2018 versus 2011 evaluations presented an increase concerning all threats, including MCIs (92 vs. 90), MTEs (99 vs. 77, respectively), biological events (96 vs. 73, respectively), radiological events (91 vs. 79), earthquakes (87 vs. 60, respectively), and conflicts (95 vs. 74). The relative change in levels of preparedness was more noted concerning biological events and earthquakes.Discussion:A periodical evaluation by governing authorities seems to motivate the hospital’s administrations to invest efforts in building and maintain a high level of emergency preparedness. Systematic evaluations conducted bi-annually contributed to improved readiness for diverse emergency scenarios, including for threats that less frequently materialize.

Editorial

2012 ◽  
Vol 11 (1) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Patient Safety ◽  
Young Male ◽  
Final Diagnosis ◽  
Mass Casualty ◽  
Major Incident ◽  
Spare Capacity ◽  
Acute Medical Unit ◽  
Infected Urine ◽  
Temporary Closure ◽  
The Impact

The snow and freezing temperatures will hopefully have passed by the time this edition reaches you; the sight of daffodils may be asignal that the relief of spring is not far off. Winter frequently stretches AMU resources to the limit – in recent years we have had epidemics of seasonal and swine f lu, but this year Norovirus seems to have been the bigger challenge. Ward closures from diarrhoea outbreaks have traditionally been more of a ‘downstream’ problem (no pun intended), but the impact of closure of the AMU would be substantial.At the time of writing this has still, thankfully, been avoided in my own hospital; however it remains a circumstance for which we have to be prepared. This edition’s ‘Viewpoint’ article describes how temporary closure of the AMU was managed in a London hospital. The use of an empty ‘winter pressures ward’ eased the burden in this case, enabling the AMU service to be maintained. Even with the luxury of this spare capacity, there was clearly significant disruption, requiring close collaboration between a variety of departments, which is well described by the authors. Many hospitals have become highly dependent on a functioning AMU to provide timely, safe and effective care for medical emergencies. Major incident plans are in place to deal with mass casualty incidents; we need to consider similar contingencies to deal with AMU closure if patient safety is going to be maintained. This article is a timely reminder of the need for forward planning. Maintaining patient safety is a mantra which will be familiar to acute physicians, particularly those who attended any of the recent SAM meetings, where this theme has been well rehearsed. An acute medical unit can provide significant safety benefits by concentrating resources in a single area. However, for the 60% who cannot go directly home from the AMU, this model creates the need for care to be transferred at some point. It is well recognised that transfer is a time at which patient safety can become compromised; so if safety is our mantra, acute physicians and nurses have a responsibility to manage this process effectively. The article by David Hindmash and Liz Lees provides an important addition to the limited literature in this area. Structured checklists are becoming an increasing part of medical practice; this paper highlights how a checklist can be used to improve the quality of handover from AMU. The authors emphasise the need to keep the form simple, and the importance of regular reinforcement to ensure that it is used. What skills and attributes does an acute physician require? With interview season approaching it’s a question that many prospective trainees will be contemplating – remaining calm under pressure, communication skills and teamworking are some of the standard responses; but what about a good sense of smell? Most of us recognise the characteristic odour of melaena , or the whiff of infected urine. But the absence of body odour might be equally revealing. Luther and Yap noted their patient to be ‘remarkably clean’ – unusual, perhaps, for a young male patient on the AMU; along with his persistent demands to use the showering facilities, this was a clue to the final diagnosis of Cannabis Hyperemesis Syndrome.It’s a case worth reading and highlights the importance of lateral thinking, particularly when patients repeatedly attend – as well as having a ‘good nose’ to sniff out something unusual!

Comprehensive Study on the Effect of CuO Nano Fluids Prepared Using One-Step Chemical Synthesis Method on the Behavior of Waste Cooking Oil Biodiesel in Compression Ignition Engine

2019 ◽  
Vol 11 (4) ◽  
Author(s):  
Ramanathan Velmurugan ◽  
Jaikumar Mayakrishnan ◽  
S. Induja ◽  
Selvakumar Raja ◽  
Sasikumar Nandagopal ◽  
...  
Keyword(s):  
Chemical Synthesis ◽  
Vegetable Oil ◽  
Diesel Fuel ◽  
Synthesis Method ◽  
Waste Cooking Oil ◽  
Compression Ignition ◽  
Cooking Oil ◽  
One Step ◽  
Ci Engine ◽  
The Impact

Vegetable oil is considered as one among the promising alternatives for diesel fuel as it holds properties very close to diesel fuel. However, straight usage of vegetable oil in compression ignition (CI) engine resulted in inferior performance and emission behavior. This can be improved by modifying the straight vegetable oil into its esters, emulsion, and using them as a fuel in CI engine showcased an improved engine behavior. Waste cooking oil (WCO) is one such kind of vegetable oil gained a lot of attraction globally as it is generated in a large quantity locally. The present investigation aims at analyzing various parameters of single cylinder four stroke CI engine fueled with waste cooking oil biodiesel (WCOB), waste cooking oil biodiesel water emulsion (WCOBE) while the engine is operated with a constant speed of 1500 rpm. Furthermore, an attempt is made to study the impact of nanofluids in the behavior of the engine fueled with WCOB blended with nanofluids (WCOBN50). This work also explored a novel method of producing nanofluids using one-step chemical synthesis method. Copper oxide (CuO) nanofluids were prepared by the above mentioned method and blended with waste cooking oil biodiesel (WCOBN50) using ethylene glycol as a suitable emulsifier. Results revealed that brake thermal efficiency (BTE) and brake specific fuel consumption (BSFC) of WCOBN50 are significantly improved when compared to WCOB and WCOBE. Furthermore, a higher reduction in oxides of nitrogen (NOx), carbon monoxide (CO), hydrocarbon (HC), and smoke emissions were observed with WCOBN50 on comparison with all other tested fuels at different power outputs. It is also identified that one-step chemical synthesis method is a promising technique for preparing nanofluids with a high range of stability.

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 The impact of prehospital emergency services on the outcome of trauma patients

2020 ◽  
Vol 9 (3) ◽  
pp. 139
Author(s):  
Moloud Balafar ◽  
Mahboub Pouraghaei ◽  
SamadShams Vahdati ◽  
Payman Moharamzadeh ◽  
Laleh Abrishami
Keyword(s):  
Emergency Services ◽  
Trauma Patients ◽  
Prehospital Emergency ◽  
The Impact

scholarly journals Robust capacity planning for accident and emergency services

2020 ◽  
Vol 54 (6) ◽  
pp. 1757-1773
Author(s):  
Elvan Gökalp
Keyword(s):  
Capacity Planning ◽  
Emergency Services ◽  
Simulation Optimization ◽  
Patient Flow ◽  
Waiting Times ◽  
Model Parameters ◽  
Planning Problem ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
The Impact

Accident and emergency departments (A&E) are the first place of contact for urgent and complex patients. These departments are subject to uncertainties due to the unplanned patient arrivals. After arrival to an A&E, patients are categorized by a triage nurse based on the urgency. The performance of an A&E is measured based on the number of patients waiting for more than a certain time to be treated. Due to the uncertainties affecting the patient flow, finding the optimum staff capacities while ensuring the performance targets is a complex problem. This paper proposes a robust-optimization based approximation for the patient waiting times in an A&E. We also develop a simulation optimization heuristic to solve this capacity planning problem. The performance of the approximation approach is then compared with that of the simulation optimization heuristic. Finally, the impact of model parameters on the performances of two approaches is investigated. The experiments show that the proposed approximation results in good enough solutions.

scholarly journals Sustaining ocular emergency and trauma services in corona crisis during the era of pan lockdown

2021 ◽  
Vol 8 (3) ◽  
pp. 1425
Author(s):  
Suhani Sharma ◽  
Anju Kochar ◽  
Rashmi Joshi
Keyword(s):  
Emergency Services ◽  
Ocular Trauma ◽  
Tertiary Care ◽  
Visual Outcome ◽  
Late Presentation ◽  
Limited Resources ◽  
Age Group ◽  
Remote Areas ◽  
Pediatric Age Group ◽  
The Impact

Background: The impact of covid pandemic and pan lockdown on the ocular trauma and emergency department has proved the importance of ocular trauma services deliverance on national vision statics. The un-availability of ophthalmic services in remote areas and limited resources have large impact on prognostic outcomes of ocular emergencies. The presentation of ocular emergency cases and their demographic pattern is important in planning and programming of national strategy to cope up with and sustain the ocular emergency services during such pandemics.Methods: Retrospective cohort study at tertiary care center.Results: The incidence of ocular trauma was increased in male pediatric age group with most common mode of injury was wooden objects. The prognosis of visual outcome was ill- affected due to late presentation and un-availability of ocular emergency services in remote areas.Conclusions: The strategy of “Reassess-Reinforce-Resume” was proved successful in sustaining the emerging trend of ocular trauma during COVID pan- lockdown.

Sign in / Sign up

Export Citation Format

Share Document