Incident Response - Initial Response

Considerations at the event site include climate conditions. Responder protection includes staging: uphill, upwind and upstream as with hazardous materials incidents. While there are case reports of turning on the heating, ventilation and cooling systems of buildings to ventilate chemical agents if evacuation is lengthy these are controversial actions and likely require consultation with experts to avoid further spread of contamination and potential hampering of the scene mitigation and remediation. These considerations should be included in hospital disaster plans as hospitals can be considered potential soft targets of risk.

Patients who have been exposed to aerosol or vapor are likely to have the most rapid onset of symptoms and also the most severe. Direct contact to liquid agents should also be treated as significant exposures until proven otherwise. Awareness of the various common agents symptoms not unlike common chemical toxidromes can be beneficial in treatment decision making and choices. The provider should keep in mind that certain agents may have delayed symptom consequences or increased debilitation or death potential such as phosgene’s delayed pulmonary edema and potentiation with physical exertion. Decontamination capability of the healthcare facility and plan for protection of the facility if multiple ambulatory or self transported contaminated patients arrive. Security issues will also obviously need to be involved in these facility plans.

Explosive, incendiary or nuclear type of events may include structural collapses or severe damage. The knowledge of availability and means of notification of federal specially trained personnel including Urban Search and Rescue (USAR), heavy rescue, high angle rescue teams and tactical law enforcement personnel should be considered as well as the knowledge that they may be deployed to the scene locations and unavailable for hospital or healthcare facility assistance. Personnel who are generally available to the hospital or emergency health care environment may have conflicting demands and roles necessitating providers to take on or perform unaccustomed roles or procedures. Acknowledgement of various competing roles of healthcare personnel is important in preplanning and developing an agreement of which role these personnel will respond to and be willing to participate in. Recent research has shown a reticence of some healthcare personnel to respond to work in various types of disasters and their personal and family safety concerns as well as ongoing needs to remain in their job positions. The planned organization of mobilization of resources and assets are critical to a rapid and successful response.


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