Management of the Incident
Disaster planning, which is a process familiar to many anesthesiologists,
provides a good model of how to approach toxic releases. A toxic release is a special
case of disaster and may be accidental or deliberate. Plans put in place for a terrorist
release of a CBW agent can be equally valuable for the more likely case of accidental
release. Moles[89]
summarized the essential points
of disaster planning as follows:
- Risk assessment is important; not all listed hazards are identifiable risks.
- Preplanning is essential and should bring together all the different emergency
agencies (e.g., fire, civil defense, police) that would be involved in CBW incident
management.
- A phased response, based on exercises and assessment, is important.
Personal Protection
Protection is a key feature of incident management, and anesthetists
should be familiar with personal protection levels ( Table
64-13
), protective suits and masks, and techniques of decontamination.
As Table 64-13
shows, there
are several levels of protection used in the management of toxic releases, but the
appropriate level for medical intervention is level C, which allows reasonable tactile
dexterity and contact with the patient to provide essential life support and antidote
therapy on site.[20]
Level C protection ( Fig.
64-10
) is equivalent to that used by the military to provide protection
against the most toxic chemical warfare agents and virulent biological warfare organisms.
Level A protection with a self-contained air supply used by fire services is designed
to protect against highly corrosive chemicals and is not essential for CBW protection.
Detection and Identification of the Hazard
Unlike military CBW releases, civilian incidents may not provide
early information about the nature of the hazard. Patterns of signs and symptoms
of presenting victims may be the first indication of the nature of the causative
agent. Detection and monitoring devices for established military
Figure 64-10
Civil (A) and military
(B) level C protective respirators and suits. (Courtesy
of Service d'Aide Médicale Urgente [SAMU] de Paris, France.)
TABLE 64-13 -- Levels of personal protection in HAZMAT incidents
|
Level A |
|
Positive-pressure self-contained breathing apparatus (SCBA) |
|
Fully encapsulating chemical-resistant suit |
|
Double layer of chemical-resistant gloves |
|
Chemical-resistant boots |
|
Airtight seal between the suit and the gloves and boots |
|
Level B |
|
Positive-pressure SCBA |
|
Chemical-resistant, long-sleeved suit |
|
Double layer of chemical-resistant gloves |
|
Chemical-resistant boots |
|
Level C |
|
Full-face air-purification device (respirator) |
|
Chemical-resistant suit |
|
Chemical-resistant outer gloves |
|
Chemical-resistant boots |
|
Level D |
|
Equipment does not provide specific respiratory or skin protection
and usually consists of regular work clothes. |
chemical warfare hazards exist but are not widely available in the civil context.
Intelligence information may be available for terrorist attacks. In the case of
accidental toxic agent release, information is available from the HAZMAT system and
the appropriate identification codes.
