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CBRN Patient Treatment Methods
- 1. Topic 5.3: Treatment methods of patients Module 5: Risk assessmentonscene andhazard avoidance
- 2. Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Presentation5.3: Treatment methods of patients involvedin a CBRN incident
- 3. Priorities at incidentscene • Reduce the number of potential casualties • Triage • ABCDE guidance • Lifesaving interventions • Decontamination • CBRN Treatment • Secondary medical evaluation (Manage injuries and clinical symptoms) 3 Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident
- 4. CBRNEIncidentScene Medical management of a CBRNe incident scene 4 Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident
- 5. Reducethe number ofpotential casualties • Direct people outdoors to a location upwind from the release site and/or into a shelter • Instruct people indoors to remain in shelter and keep doors and windows shut 5 MELODY #5.3 Treatment methods of patients involved in a CBRN incident
- 6. TRIAGE Objective • Conventional triage: • Assign priority to those needing immediate lifesaving interventions • Disaster triage (field triage): • maximise survival / minimise disability within available resources 6 Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident
- 7. 7 = = = Immediate (red) Triage Categories: X = Patients requiring emergency lifesaving treatment Delayed (yellow) Minimal (green) Dead/expectant (black) Delay in medical treatment permitted, patient generally not able to walk Relatively minor signs and symptoms, patient able to walk independently Patient lacks vital life signs and unresponsive to stimuli Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident
- 8. TriageTag Mettag • AVPU – alert, verbal, painful, unresponsive • BP – blood pressure • RESP – respiratory rate. 8 Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident
- 9. 9 A AIRWAY B BREATHING C CIRCULATION D DISABILITY E EXPOSURE Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident ABCDE Guidance Undress – look for hidden injuries. To examine the patient properly, full exposure of the body may be necessary. Rapid assessment of a person’s conscious level (APVU): Alert, responds to Vocal stimuli, responds to Painful stimuli or Unresponsive to all stimuli Assess circulation: Temperature (warm or cold) and color of hands and fingers (blue or pink) Blood pressure/puls monitoring, shock, hypovolumnia. Fluids intravenously. No ventilation and proper circulation - cpr Look, listen and feel for the general signs of respiratory distress. Assess breathing, ventilation, chest movement. If required – high flow oxygenation. Assisted ventilation. Decompression of tension pneumothorax. Draining of haemo/pneumothorax Talk to patient, cervical spine protection, oxygen supplementation, airway assessment llf (look, listen, feel). If required, get expert help for intubation or for airway obstructed cricothyrotomy.
- 10. Decontamination • Decontamination should occur in parallel with triage and lifesaving intervention • Chemical and Biological incidents Prompt decontamination • Radiation incidents Prompt decontamination if no life-threatening injuries • Decontamination methods: Disrobe, dry decon, wet decon • Decontamination by appropriately trained personnel wearing PPE • Self-decontamination should be emphasized and supported by clear guidance and instructions 10 Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident
- 11. Lifesaving interventions • Apply immediate lifesaving interventions as usual • Stabilisation • Eg. management of airway, catastrophic haemorrhage 11 Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident
- 12. Pre-hospital treatment -Chemicalagents Symptoms of poisoning will appear shortly after exposure • Rapid decontamination • Supportive treatment – use the ABCDE protocol • Oxygen, bronchodilation • Symptomatic treatment • Antidotes if available 12 Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Chemical agent Treatment Nerve agents /organophosphates Atropine and oxime, diazepam if seizures Cyanide Hydroxocobalamin or sodium thiosulfate Opioids Naloxone Methanol Fomepizole
- 13. 13 Pre-hospital treatment -Biologicalagents • Exposure can lead to Infection, which can lead to Disease • Incubation period: Symptoms will appear days to weeks after exposure • Decontamination • Quarantine • Quick identification of agent or patient diagnosis Treatment: • Symptomatic/Supportive (E.g. rehydration, mechanical ventilation, dialysis) 13 Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident
- 14. Pre-hospital treatment – Radiologicalmaterial • Symptoms of acute radiation: Skin burns, nausea, vomiting and diarrhea • Decontamination is not relevant for a radiation exposure incident Decontamination after contamination with radiological agents: • Oral: brush teeth with toothpaste, rinse mouth with 3% citric acid • Pharyngeal region: gargling with plain water • Nose: rinse with tap water or physiological saline • Ears: rinse with water (the auditory canal using an ear syringe) • Hair: possibly cut hair • Measure RN contamination before and after decon 14 Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident
- 15. Secondarymedicalevaluation • Physical examination • Face and head • Chest • Musculo-sceletal • Abdomen • Neurologic • Skin 15 Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident
- 16. Furthertreatment • Alert medical teams • Seek expert medical advice • Transport to hospital 16 MELODY #5.3 Treatment methods of patients involved in a CBRN incident
- 17. Transportto the hospital General • Wear PPE • Avoid direct contact and contact with body fluids (aerosols, excrements, etc.) Biological agents: • Take precautions to prevent transmission of infectious agents. Transport of highly infectious disease (HID) patients requires: • special transportation systems • additional PPE (in case direct patient contact is needed) Chemical and Radiological agents: • External contamination Preferably after decontamination (if exposed) • Internal contamination No need for decontamination 17 MELODY Presentation 6.3.1: Triage related to CBRN
- 18. TakeHome Message • Medical treatment as usual • Different for CBRN incident: • Ensure wearing appropriate personal protective equipment (PPE) • Decontamination of patients • Apply CBRN specific antidotes and treatment if possible • Pre-hospital: mostly supportive/symptomatic treatment • Alert hospital and relevant medical teams, seek expert advice 18 Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident
- 19. Thank you for your attention 19 Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident
Editor's Notes
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Module 5: Risk assessment on scene and hazard avoidance Result: Trainees are made aware of the contents of this MELODY module Instructions for the trainer: Note that in this MELODY module various types of treatment methods of patients will be explained, relevant for all target audiences. Next: Go to next slide References for additional information: - Depicted illustration: Picture source & IP: Text source & IP: MELODY
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Presentation 5.3: Treatment methods of patients involved in a CBRN incident Result: Trainees are made aware of the contents of this MELODY module Instructions for the trainer: Note that in this MELODY module various types of treatment methods of patients will be explained. Next: Go to next slide. References for additional information: - Depicted illustration: Picture source & IP: Text source & IP: MELODY
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Priorities at incident scene Result: Trainees should know about priorities at the incident scene. Instructions for the trainer: On the slides are priorities at the incident scene. In this presentation the priorities are explained. Next: Go to next slide. References for additional information: - Depicted illustration: Picture source & IP: Text source & IP:
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: CBRN Incident scene Result: The trainees should keep the CBRN incident scene layout in mind when treating victims Instructions for the trainer: Remind the trainees of the build-up of a CBRN scene. Point out the zoning and corresponding appropriate PPE for the area. The Hot Zone is established for providing first aid, the Warm Zone for emergency medical treatment and the cold zone for advanced treatment. Which PPE is appropriate is subject of another module. The teacher can stimulate a discussion about the changing environment of a CBRN incident. Wind direction and speed can change, and an incident can escalade or become under control, which can change zoning. For instance, discuss the way changes in zoning should be accompanied by changes in subsequent appropriate medical aid performed in these locations. Next: Go to next slide. References for additional information: - NO Depicted illustration: P54, other picture made by Marcin available (ADD INFORMATION) Picture source & IP: Text source & IP:
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Reduce the number of potential casualties Result: Trainees know that the number of potential casualties can be reduced by immediately directing people to safe locations. Instructions for the trainer: As a first act, the number of potential casualties must be reduced by directing people to safe locations in order to prevent continued exposure. Evacuation from the hot zone and providing first aid is usually performed by first responders from the fire brigade or police department. First responders should be wearing appropriate PPE while giving such instructions. Next: Go to next slide. References for additional information: - NO Depicted illustration: Picture source & IP: Text source & IP:
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Triage Result: Trainees are familiarized with two types of triage. Instructions for the trainer: Conventional triage is to assign priority to those needing immediate lifesaving interventions - and assumes that there is no absolute resource limit disaster triage is to maximise survival / minimise disability within available resources. To do the greatest good for the greatest number of people. Next: Go to next slide. References for additional information: - NO Depicted illustration: Picture source & IP: Text source & IP:
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Triage categories Result: Trainees know the objective of sorting people during incident. Instructions for the trainer: Explain that the triage is the process of determining which victims require medical (lifesaving) treatment most urgently. With triage first responders and medical personnel employ a strategy to evaluate the severity of injury of each victim as quickly as possible and tag the victims in about 30–60 seconds. The groups are in general: immediate (red) - immediately life-threatening problems with high potential for survival; delayed (yellow) – serious injuries, require medical care but management can be delayed without increasing morbidity or mortality; minimal (green) - require minor care or no care without adverse effect; dead (black) – very serious injuries, patient lacks vital life signs and unresponsive to stimuli. Explain that the order presented on the slide is also the commonly used order of treatment. Remove (injured) people from the release site and move people upwind to designated triage category area. Next: Go to next slide. References for additional information: - Depicted illustration: Picture source & IP: Text source & IP: MELODY
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Triage Tag Result: Trainees are familiarized with the example of triage card as a part of triage protocol. Instructions for the trainer: A triage tag is a tool first responders and medical personnel use during a mass casualty incident. With the aid of the triage tags, the first-arriving personnel are able to effectively and efficiently distribute the limited resources and provide the necessary immediate care for the victims. The triage tags are placed near the head. Triage tag should also be used to record any treatment given The abbreviation used: APVU: Alert, responds to Vocal stimuli, responds to Painful stimuli or Unresponsive to all stimuli , BP – blood pressure, RESP – respiratory rate. Next: Go to next slide. References for additional information: - Depicted illustration: Picture source & IP: https://tacda.org/product/mt-501-salt-method-mettag-triage-tag/ Text source & IP
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: ABCDE Guidance Result: The trainees know the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) to assess the patient condition Instructions for the trainer: Explain to trainees the ABCDE methodology and how to assess the patients condition using this guidance. The ABCDE methodology guides the first responder to assess the vital functions in the following order: Airway, Breathing, Circulation, Disability, and Exposure (ABCDE). Apply ABCDE guidance as usual. Next: Go to next slide References for additional information: https://www.resus.org.uk/resuscitation-guidelines/abcde-approach/ Depicted illustration: N/A Picture source & IP: N/A Text source & IP: https://www.resus.org.uk/resuscitation-guidelines/abcde-approach/
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Decontamination Result: Trainees know about the basic principles and the role of decontamination. Instructions for the trainer: Decontamination contributes to the well-being of the patient. It should occur in parallel with triage and lifesaving intervention. For chemical and biological incidents prompt decontamination is very important. For radiation incidents the treatment of life-threatening injuries is more important than decontamination. Decontamination methods include disrobing, dry decon and wet decon. Topic 5.7 elaborates on decontamination. Next: Go to next slide. References for additional information: - Depicted illustration: Picture source & IP: Text source & IP: MELODY
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Lifesaving interventions Result: Trainees know which lifesaving actions to be performed at the scene Instructions for the trainer: Apply lifesaving procedures as usual. If lifesaving drugs are available, they can be administered on the scene. Lifesaving treatment is performed in the warm or cold zone, usually by ambulance personnel. Only apply life saving interventions if you have appropriate PPE. Next: Go to next slide. References for additional information: - Depicted illustration: Picture source & IP: https://pixabay.com/vectors/heart-heart-curve-medicine-life-5328718/ Text source & IP: MELODY
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Pre-hospital treatment - Chemical agents Result: Trainees know which treatments and drugs to apply in case of a chemical intoxication. Instructions for the trainer: As an introduction to the medical treatments and protection against chemical agents it should be emphasized that symptoms of poisoning will appear shortly after exposure and may lead to death , therefore therapy must start immediately. The treatment is based on general supportive treatment, oxygen or bronchodilation and on symptomatic treatment (pain relievers, mechanical ventilation etc.). Administration of antidotes (e.g. atropine – nerve agents) can be done if available Ensure wearing appropriate personal protective equipment (PPE). Next: Go to next slide. References for additional information: - Depicted illustration: Picture source & IP: Text source & IP:
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Pre-hospital treatment – Biological agents Result: The trainees are familiar with terms relevant for biological incidents: exposure, incubation period, decontamination and quarantine, and with treatment options. Instructions for the trainer: It should be emphasized that infection does not cause immediate symptoms, instead symptoms may appear after an incubation period of days or even weeks. So while supportive treatment on the scene may be needed, this will not be related to the infectious agent but to other injuries or panic. To prevent spread of the infection, Personal Protective Equipment must be used, and direct contact with patients or contact with body fluids (aerosols, excrement, etc.) must be avoided. Decontamination and quarantine measures can significantly reduce the number of casualties and should start as soon as possible. An early start of therapy such as antibiotic treatment will greatly benefit the patient, but this usually requires information of the infectious agent and more advanced medical knowledge, so will usually start at the hospital Next: Go to next slide. References for additional information: - Depicted illustration: Picture source & IP: Text source & IP:
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Treatment of radiological incidents victims Result: Trainees know the difference between exposure to radiation and contamination, including treatment options Instructions for the trainer: It should be emphasised that there are no immediate symptoms. Symptoms like erythema, nausea, vomiting and diarrhea may occur in minutes/ hours to follow up to days. Treatment of life-threatening and trauma injuries is more important than decontamination. Decontamination is not necessary when the incident involves exposure to radiation from a closed RN-source, i.e. a RN-source that is contained in a chemical inert material, that cannot be dispersed. If it cannot be confirmed that the RN-source is intact, the victims should be treated as contaminated. Next: Go to next slide. References for additional information: - Depicted illustration: Picture source & IP: Text source & IP:
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Secondary medical evaluation Result: Trainees should be familiarized with the possibility of secondary medical evaluation. Medical evaluation as usual Instructions for the trainer: Secondary medical or paramedical patient evaluation may be performed at the scene, after all lifesaving procedures have been carried out. Next: Go to next slide. References for additional information: - Depicted illustration: Picture source & IP: https://pixabay.com/photos/medical-emergency-first-aid-1057706/ Text source & IP:
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Further treatment Result: Trainees should know that for further treatment expert teams should be alerted Instructions for the trainer: Additional treatment methods are available and can be applied by ambulance personnel, emergency health services and hospitals. In 6.3 additional treatment methods are explained more in depth for these target groups. Next: Go to next slide. References for additional information: - Depicted illustration: Picture source & IP: https://www.publicdomainpictures.net/nl/view-image.php?image=264244&picture=ambulance Text source & IP:
- Module 6: Task specific response Topic 6.3: Medical treatment & Triage Presentation 6.3.1: Triage related to CBRN Learning objective: To familiarize with triage in relation to CBRN scenario's Title slide: Transport to the hospital Result: Trainees should know what to consider when transporting patients to the hospital. Instructions for the trainer: For safe transport to the hospital after triage, a number of considerations should be taken into account. People involved in transportation of victims should wear PPE and avoid contact with the victims and their body fluids. If contamination with an infectious agent is suspected, use special transportation and wear additional PPE. In case of contamination with C or RN, pay attention to decontamination of victims before entering the hospital, since hospitals have limited resources for decontamination. Decontamination is particularly important after external contamination, but also be aware of body excretions such as sweat after internal contamination. Next: Go to next slide. References for additional information: - NO Depicted illustration: Picture source & IP: Text source & IP:
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Take Home Message Result: Trainees should memorize these basic principles of treatment of CBRN victims Instructions for the trainer: Familiarise the trainee with the take home message Next: Go to next slide. References for additional information: - Depicted illustration: Picture source & IP: Text source & IP:
- Module: 5 Risk assessment on scene and hazard avoidance Topic: 5.3 Treatment methods of patients Melody Presentation: 5.3 Treatment methods of patients involved in a CBRN incident Learning objective: To recognize appropriate medical care towards patients involved in a CBRN incident Title slide: Thank you for your attention Result: Instructions for the trainer: Next: Final slide. References for additional information: - Depicted illustration: Picture source & IP: Text source & IP: