EMS World

JUL 2018

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36 JULY 2018 | EMSWORLD.com ISSUE FOCUS: MCI & DISASTER RESPONSE hair, or clothing, the more irradiated that person will be. Removing those radioac- tive particles can be achieved by doffing contaminated clothing and showering (with soap, preferably) and shampooing. If water is not available, decontamina- tion should be performed using a cloth or soft brush. Further, if the hair cannot be shampooed, it should be cut off as close to the scalp as possible to prevent continued exposure to radioactive particles. Finally, skin folds should be cleaned to prevent contaminated water or fallout particles from accumulating. If EMS personnel can do nothing else, decontamination in this manner will save lives! The most important consideration for emergency responders following a nucdet is to resist the urge to respond to calls. It is vitally important that people "get inside, stay inside, and stay tuned" to shelter themselves from radioactive fallout. This includes first responders, because dead first responders don't save lives! Vehicles provide no protection. Shelter in a building until directions are received about when it is safe to leave and where the dangerous fallout zone is (it will change with time). In general, responders should plan on staying put for at least 12 hours. During decontamination and treatment, personnel should wear personal protec- tive equipment including a full-facepiece air-purif ying respirator with a P100 or high-efficiency particulate air (HEPA) fil- ter—N95 masks do not provide sufficient respiratory protection. This level of PPE does not provide protection against ion- izing radiation, only against external and internal contamination. Personnel should change PPE and shower as possible, but certainly before ingesting food or water. All personnel should refrain from smoking. Healthcare System Impacts EMS personnel must understand how a nucdet would affect the healthcare sys- tem in order to set expectations for patient management and how the system would interact with the larger healthcare system. Close-in impacts—Close in to ground zero, the healthcare system would suffer four forms of adverse impact. First, any surviving healthcare facility in the MDZ or LDZ would probably be affected by the loss of critical infrastructure such as electricity, air conditioning, water supply, and external data communications. Second, a tidal wave of walking wounded would inundate such facilities with demands for treatment. Third, medical supplies would be quickly depleted and unable to be replenished (perhaps for weeks or months). Finally, medical person- nel would be in short supply. One could expect medical facilities in the MDZ, LDZ, and perhaps as far away as 20 miles from ground zero to be operating under crisis conditions, including a modi- fied form of patient triage and significantly reduced treatment regimens. Remote impacts—Hospitals far ther from ground zero would be able to deliver healthcare that is closer to normal. How- ever, patients would need to be distributed throughout the U.S. healthcare system. In some cases this will tax the remote health- care systems (see Figure 3). Burn bed availability—Nowhere will this be more evident than in the treatment of burn patients. American College of Sur- geons data from 2011 shows there were 1,918 beds in 128 "verified" burn centers across the United States. 4 FEMA estimates as many as 320,000 casualties following a nucdet in Washington D.C. 5 Using blast injury patterns from terrorist bombings as a proxy, we can assume that 9% of patients presenting to hospitals would be burned. 6 This means there would likely be (at a minimum) nearly 30,000 burn patients to be treated—more than 15 times the total number of burn beds in the United States. Furthermore, at any given point in time, most burn beds across the nation are filled. 7 Ventilator needs—A similar situation would exist for patients needing ventila- tors, as the demand would exceed supply. The healthcare system would have to mobilize on a national level to respond to a nucdet. Medical personnel and resources would be shifted closer to ground zero. The federal government would mobilize mili- tary and civilian resources such as Disaster Medical Assistance Teams (DMATs), and EMS agencies would be called upon to pro- vide mutual aid to affected areas as well as serve as the backbone for moving patients to more remote facilities. A massive mental healthcare response would be needed. Although an act of nuclear terrorism would be catastrophic, it would not be apocalyptic. EMS would be front and center in assisting. However, EMS won't be able to respond effectively if administrators and personnel do not plan for such an event. References are available at www.ems- world.com/article/220625 ABOUT THE AUTHOR Erik Gaull, NRP, CEM, CPP, MEP, is a Master Firefi ghter/Paramedic III with the Cabin John Park (Md.) Volunteer Fire Department and an of fi cer in the Reserve Division with the D.C. Metropolitan Police Department. He is a member of EMS World's editorial advisory board. Figure 3: Resource Availability and Standard of Care by Distance from Ground Zero *Source: Department of Health and Human Services. Medical Planning and Response Manual for a Nuclear Detonation Incident: A Practical Guide, 2015.

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