Incidents Caused by Hazardous Material

Abstract

A chemical incident can be defined as any event in which individuals are, or could have been, exposed to hazardous materials that may be harmful to their health. The main principles of the rescue activities for chemical incidents are similar to those for all other types of incidents; there are, however, some essential – for the rescue workers possibly critical – specialities: The use of personal protective equipment (PPE), the decontamination of the contaminated victims, and the management of toxic trauma. These topics are emphasised in this chapter; however, a chemical incident could also involve an explosion, a fire, or a traffic accident. Consequently, the victims in such incidents can also suffer from “conventional” trauma or burns. Patient treatment guidelines are written as a guiding thread, covering the treatment of victims from the incident site to definitive hospital care. Although chemical incident measures are, in terms of organization, divided into the prehospital and hospital measures, we should at all times strive to treat victims comprehensively and to ensure that the transition from the evacuation to the provision of definitive treatment in a hospital is as smooth as possible. All staff in the emergency medical service rescue chain must keep in mind the fundamental postulates of rescue activities in the event of chemical incidents: 1. The rescue workers’ safety always has to come first (using the appropriate PPE and determining a suitable treatment area) 2. Timely identification of the hazardous substances involved ensures safer and more rational rescue activities 3. Decontamination of the victims must be timely and thorough 4. Before decontamination, only the most urgent first-aid measures are provided: clearing the airways, protection of the cervical spine, and control of bleeding by applying compression 5. As a rule, only symptomatic treatment is provided in the field; there are only a few urgent, specific antidotes that should be administered on-site, if indicated. Good tissue oxygenation and sufficient circulation are the preliminary conditions for successful antidotal treatment 6. Because of the related toxicokinetic and toxicodynamic processes, victims suffering from toxic trauma must be monitored particularly carefully, i.e., frequent re-triages 7. Before making decisions for the next step, check which of the prescribed victim treatment measures have already been carried out and which are still to be undertaken, complemented, or repeated