MAJOR INCIDENT460 Administrative and Legal Issues
(a) wet – the patient is wetted down with water to prevent
any powder residue from being disturbed and potentially
spreading when clothing is removed
(b) strip – the patient’s clothes are removed by cutting
longitudinally on the anterior aspect of the body. Clothing is
then folded back on itself and tucked under the patient’s body,
leaving the relatively clean inner surface on the outside. The
patient can then be log rolled, and the contaminated clothing
removed, bagged, sealed and labelled with identifying details
(c) wash – the patient’s entire body is gently washed down with
warm, soapy water taking care to avoid dermal abrasion and
thus enhancing absorption of any toxic agents. Ears and eyes
may require irrigation with saline
(d) redress – patients are dressed in appropriate clean clothing.
(v) The patient is then ready to be transported across the ‘Clean-
Dirty line’ by staff on the clean side of the line sliding him or her
off the dirty trolley onto a clean trolley.Chemical incident
An incident involving an industrial chemical or weaponized chemical agent has
the potential for large numbers of casualties following accidental or deliberate
release.
1 Appropriate PPE and patient decontamination are essential. Most patients
will require admission for a period of observation, even if apparently asymp-
tomatic.
2 Chemicals are broadly categorized into four groups based on their injury
pathophysiology including blood agents, nerve agents, vesicants and choking
agents.
(i) Blood agents
(a) volatile agents that evaporate quickly, which are hazardous by
both inhalation and ingestion
(b) largely composed of the cyanogens, which bind to cellular
cytochrome oxidase to stop cellular aerobic metabolism
despite adequate blood oxygenation
(c) quick acting, with casualties showing rapid onset of
symptoms that consist of dyspnoea, gasping, confusion,
convulsions, collapse, coma and ultimately respiratory arrest
(d) the skin may be cherry pink and cyanosis is unusual. The
pupils are normal or dilated and secretions are minimal
(e) mouth-to-mouth ventilation poses a risk to the rescuer and
should not be performed
(f) antidotes are unnecessary in a patient who is conscious and
breathing normally within 5 min after removal from source.
Give simple oxygen therapy