Throughout the past era, worries about possible terrorist acts concerning weapons of mass destruction (WMD) directed Congress and the President to obtain a complete counteract terrorism strategy that was aimed at stopping a chemical, biological, or nuclear attack and improving domestic attentiveness. The organization of choice for national significance management has been the Department of Defense. Of the $1.2 billion taken in the FY 2000 business plan purposely for WMD reply, most of it went to DOW Overreliance on the military for domestic (Wynd, C. 2006) WMD defense, nevertheless, may reduce the military's war combating capacity and holds the potential for breach of individual rights. Given that these attacks are confronting to avoid and may take place anywhere and at any time, mass decontamination is one of the significant factors to controlling the distresses of such an occurrence, saving lives, and limiting the number of injuries.
To further study decontamination, it is essential to consider things like terrorism so we can understand why this method is needed. Terrorism, by definition, includes an unplanned act of violence guided against possessions or persons to intimidate and pressure governments for political, religious, or ideological determinations. Typically, these acts of violence are directed in opposition to the innocent, and devices of terror may involve several procedures. Terrorism is developing more prevalent in our people and has been called "the war of the future." Eruptions and bombings end in substantial property destruction and include large numbers of fatalities and as a result they are one of the most common techniques of terrorism employed currently. However, since the disbanding of the Soviet Union there has been a risen apprehension that terrorist sets will use nuclear, biological, and chemical weaponry of essence damage in the future. One of the most well-known occurrences of terrorism in current history including chemical agents happened in 1995, when associates of the Aum Shinrikyo cult discharged the deadly nerve agent sarin into an crowded Tokyo underpass, instigating more than 5000 wounds and developing in 12 deaths. Later that year, the Federal Bureau of Investigation exposed a terrorist plot to remove chlorine gas at the Disneyland theme playground in California.
Mass casualty crises, by definition, are described by the unexpected arrival of large amounts of casualties that exceed the competences of local emergency and medical reserves. An example from recent history is illustrative, such as the Korean Airline Flight accident. On August 6, 1997, Korean Airlines Flight 801, a Boeing 747-300 carrying 254 passengers and 6 crew collided dead into the Fonte Valley at the base of Nimitz Hill, Guam, just about one quarter of a mile short of the runway. The aircraft soared the top of a small hill and plummeted down a small abyss, prompting the fuselage to split open and burst into flames (Disaster Response: Principles of Preparation and Coordination, 1989). A lot of the passengers and crew on the plane either died immediately on impact or were burned alive in the subsequent fire. All through the early periods of the resultant rescue, 30 victims were found alive at the site of the crash, and for the first couple of hours there were more survivors than there were rescued and emergency personnel available to help. The United States Naval Hospital in Guam had gotten 20 patients, while the local civilian hospital received 12 patients. In spite of the relatively small number of fatalities, the supplies of both hospitals were rapidly topped. However, due to previous planning, preparation, and organization, morbidity and mortality were minimized with none other than the help of decontamination.
With that said, there is no absolute answer to mass casualty decontamination and no definite procedure or process can explain for all variables (danger, time, amount of victims, environmental situations, resources). These modernized Guidelines are planned to identify a fundamental, constant mass decontamination process that could be applied with reasonable effectiveness to any incident. In other words, to use the fastest method that will cause the least cost and make the most good for the bulk of the people. An ordered, well-planned way to any mass casualty disaster is critical. This is because terrorist happenings are characteristically more complicated and make the emotional components of anger and fear to an already unpleasant condition. Therefore, management and planning handle even a bigger authority for mass casualty emergencies following terrorist situation. Regrettably or fortunately depending on specific viewpoints or viewpoint, exceedingly few physicians have had any practical involvement with mass fatality emergencies. The fact is, until lately, outside of the military medical community, disaster medicine has gotten remarkably little regard, both in the medical literature and in graduate medical education. In truth, there were only 316 articles appearing in MEDLINE under the heading of terrorism prior to 9/11/, while there were 1432 articles from 9/11/01 to 9/11/02. A lot of studies recorded that a huge mass of civilian hospitals are unrehearsed for a mass casualty disaster subordinate to a terrorist event concerning weapons of mass destruction.
Triage and Decontamination
Triage and Decontamination both kind of go hand in hand. Firstly, the word triage is taking from the French verb trier, which clearly means to resolve. The idea of triage is well-known and accepted, but the actual part of triage is usually much more difficult. The most typically used method of triage includes sorting individual casualties proportional to their severity of injury and need for immediate care into one of four groups: immediate, postponed, smallest, or expectant (DA-az, G. 2005)). The values of triage as defined characteristically are rarely accomplished today. The usual management of pain proficient in emergency departments through the country varies considerably from the kind of trauma administration called for during a mass casualty disaster. In today's atmosphere, patients are transported to the hospital and considerable resources and manpower are employed to get the most of survival.
All possibly contaminated persons should receive a brief medical examination and triage prior to decontamination. Decontamination denotes to means that decrease the risk of a contaminant. There are two basic approaches of decontamination, physical removal and neutralization. Physical removal contains mechanical action with methods such as mild friction with a soft cloth or sponge, blotting, and cleaning (Disaster Response: Principles of Preparation and Coordination, 1989). Neutralization comprises methods and/or resources to counteract the negative effects of the contaminant. Health care services should guarantee that personnel familiar with pediatric specific subjects are comprised in this triage procedure. Next, individuals should be guided to the decontamination post.
Pediatric patients should be decontaminated in a parallel fashion as adult patients, using soap and water. Pediatric patients, both ambulatory and medically ill patients, will require additional help both for the physical act of decontamination as well as psychosocial care (Wynd, C. 2006). It is dangerous to make a decontamination system that permits for further support to be given to pediatric patients and other individuals who require assistance with decontamination, while permitting those who can self-decontaminate to carry on through the process. Frequently the decontamination station is positioned outside the health care resource to provide separation of contaminated parts from clean areas, so it is particularly rare that heat loss be diminished for the pediatric patient in order to prevent hypothermia. Heat lamps may be necessitated for pediatric patients.
The emphasis of mass casualty decontamination is only on physical deletion of the pollutant. The addition of neutralizing agents is probable to cause interruption in the implementation of mass decontamination, as well as create possible additional hazards and safety matters when decontaminating large amounts of employees not familiar with the decontamination progression. Tools such as decontamination tents and the use of condiments such as soap are best applied at the secondary decontamination point. If material possessions are limited, one possible way of secondary decontamination is rerunning victims through the first decontamination site, but at a slower and more purposeful speed that emphasizes thorough washing and elimination of all remaining agent. Liquid soap, if obtainable, should be allocated for victims' use all through this secondary decontamination.
Decontamination must be done securely but as fast as possible and warm blankets given to everyone following completion. Next, patients should be appropriately recognized and logged in as well as polluted things set in a plastic bag and protected. Proper diagnosis and tracking of unaccompanied minors is critical. Following decontamination, a secondary triage must occur to provide appropriate referral of patients to treatment or holding areas. In addition, antidotes may be given as needed. Patients with minimal to no injuries should be guided to large holding areas where information and psychosocial support can be given as well as continued monitoring for changes in medical status. A separate section for unaccompanied minors should be established, with a reliable identification system in place.
Patients with moderate to severe injuries or illnesses should be applied to the appropriate treatment area, reliable with the mass casualty plan. A separate pediatric group to whom pediatric patients are directed, or inclusion of a pediatric-trained provider at each treatment station, is crucial.
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