Unexplained Illness (Something doesn't seem right...)

[Just Plain Ruff]

In your opinion, what would constitute acceptable risk in this case? well this was an acceptable risk to me. As long as after you determined it might be poisoning and need of decon you already have been exposed to a significant degree. Just take the guys clothes off and wash him off if you can. You already have pt. contact so you cant' run away with the excuse - oh he's contaminated we cant treat him until he's decon'ed, you are already exposed. Just deal with it the best you can.

What would be your deciding factors in risking the decontamination process yourselves? The guys gonna code if you don't do anything - you are already contaminated - see above.

Do you feel adequately trained and equipped to manage a specific case like the one that has been presented? Absolutely

Would you even attempt it regardless of the patients condition and wait time? Yes I'd take all his clothes off , turn the hose on and wash him off in the house. Then move my butt and get him to the ER.

There certainly comes a time when your safety and that of your partner becomes priority? Is this one of those times? I feel relatively comfortable in this type of situation as long as I know the risks and issues. I would definately contact the hospital and let them know what i had. But unfortunately I'm already exposed and as long as I limit my exposure by removing the toxin from the area and the patient then I relatively feel safe in continuing to treat this patient.

I would probably call for a 2nd unit anyway so they could meet up with us or follow us in in case me and my partner start to have symptoms. I'm giong to be very cognizent of how I feel as well as how my partner feels.

I'd expect a full workup by the ER on myself and my partner if we even remotely started to exhibit any symptoms.

[firedoc5]

As far as exposure to the first rescuers there, I've known some guys that would think, "So what? I'm already contaminated. No one else come around us and deal with my illness later." And I've known some that would totally back off until an actual HazMat crew arrived. I'm guilty of doing a little of both. In this instance, if I was the first to make contact, I would have wound up in the shower with him getting soaked. I was fortunate enough to have a few partners that wouldn't back off if I told them to and wind up in the same boat. Luckily as of '89 we were all HazMat certified and had complete HazMat Responder kits on every unit. They were bulky, but worth it a number of times.

We had intercepted with other units for meds and other equipment, even with other agencies. We had very good cooperation with each other.

[Doczilla]

A better idea, once you know you've been exposed, is to call for another unit, administer the Mark1 kit to the patient, decon the hell out of the patient (in the yard, rather than the house, to limit inhalational exposure), then turn the patient over to the arriving crew for transport, and set about decon for yourself and your partner. Once the patient is stripped naked and outside of a closed environment, inhalational exposure is at a minimum, and nitrile gloves will do a decent job of protecting your hands, which should really be the only part touching him. You don't have to be in a full suit and SCBA to do good decon on this guy. HAZMAT can help you decon yourselves and your gear when they arrive. The patient will be decontaminated again upon arrival at the hospital to make sure he's nice and clean.

Significant exposure will render you relatively helpless to the patient once you get symptomatic. Watery eyes alone will limit your effectiveness, not to mention vomiting and diarrhea. Decon is not merely being a p*ssy, it limits exposure for the patient and prevents him from absorbing more and getting sicker.

We carry the Duodote kits, so giving atropine without 2-Pam each time is not possible.

'zilla

[p3medic]

We have the mark 1's for WMD purposes, but carry multiple vials of atropine and lyophylized pralidoxime for use as well.

[Richard B the EMT]

I mentioned this string to an associate of mine, a haztec guy from another jurisdiction. He mentioned that the decon should be done on a concrete flooring, so as to not introduce whatever the chemicals at work here don't get into the ground, and then the groundwater.

He also mentions most sewage treatment plants are not set up for this type hazardous or biohazard material, so by doing the well intentioned home shower decon, all the pipes from that drain to the treatment plant are now contaminated, spread out over how many miles?

His final cautionary is, even in the double plastic bagging of the victim's clothing, it becomes the responsibility of the hazardous materials team. The ambulance does not transport the clothing. This is supposed to be New York State law.

[reaper]

No offense, but this is most likely fertilizer or pesticide. It is already in the ground and ground water!

[CBEMT]

I almost forgot- every ambulance in my state now carries at least 2 Level C hazmat suits with PAPRs for exactly this scenario- caring for and transporting a contaminated patient that has received field decontamination but still carries some residual contaminants. Hi-fidelity scenario-based simulation testing at our trauma center has demonstrated that ALS-level care by suited providers is both possible and effective.

[Richard B the EMT]

No offence taken, reaper. The information I quoted was from a Paramedic who teaches HazMat in another state than where we met.

[Arizonaffcep]

Unfortunately Doc the only way we carry 2pam is in the Mk I kits. I wish we carried more atropine IV, but "3 is the most we can give in a code so why would we ever need more than that?" :roll: :roll:

That said, we won't get into the lack of IV atropine in our WMD protocol in the first place. We're too dumb for anything but autoinjectors. :evil:

Interesting. In Arizona, one of the required drugs is a multi-dose vial of atropine. As well as 3-4 bristojets.