Trauma Review Industrial Chemical Exposure Reference:

Definition of hazardous materials: Substances that have the potential to harm a person or the environment upon contact

Can be in the form of: Gases Liquids Solids Radioactive materials Chemical materials Biological organisms (viruses and bacteria)

 More than 60,000 chemical are produced annually in the United States  The department of transportation considers approximately 2000 of these to be hazardous  Over 4 billion tons of chemicals are transported yearly  Over 1 million people are directly involved in the transportation process  About 9,000 releases of hazardous material occurs annually  75% occur at a chemical facility  25% occur during transportation

Early erythema in the frontal and antelateral right side of the chest 5 days after the exposure to an iridium-192 source (185 GBq, 5 Ci) mounted in a pen-size source holder for industrial radiography, which was placed to the pocket of the worker's overall and kept there for about 2 hours. Image courtesy of the WHO.

Early erythema 11 days after exposure. Image courtesy of the WHO.

Tense painful bulla of the left palm on day 20 evolving from erythema with early blistering, which had appeared on day 10 after the initial contact for a few minutes with the iridium-192 source. Image courtesy of the WHO.

An ulcer in subacute stage and 5 ulcers following self-healing with depigmentation caused by being unawarely exposed 4-8 months earlier to the same164 GBq (4.4 Ci) cesium-137 source (placed in a pocket of a trench coat used as a blanket). Image courtesy of the WHO.

Desquamation and skin necrosis 21 days after exposure. Note: the white areas correspond to silver ointment. Image courtesy of the WHO.

Triage Principles Rapid assessment of patient’s who present to ED Determination of the severity of illness or injury Across the room assessment Subjective assessment Objective assessment Triage decision TNCC 6 th ed

Decontamination The first step is to recognize that an unusual substance is present Eradicate all harmful substances from the skin, hair, mucosa, lungs and gi tract Implement containment measure to prevent further exposure Remove all contaminated clothing and double bag and label Wash the skin thoroughly with soak and warm water or flush the skin with copious amounts of water TNCC 6 th ed.