Overview Of Incidents Involving “Mass Casualty Weapons”

Mass Casualty Weapons (MCW) are weapons that are capable of eliciting MANFs. They include a variety of

A mass attack on injured (MANF) are events that generate sufficiently high number of victims to overwhelm the available medical resources. These include natural disasters (eg. As hurricanes) and various types of intentional and unintentional man-made events, including transportation disasters, losses of hazardous substances, explosions and mass shootings. “Mass Casualty Weapons” (MCW) are weapons that are capable of eliciting MANFs. They include a variety of chemicals Biological toxins (infectious) pathogen radiation sources explosives The weapon types are sometimes referred to as CBRNE (chemical, biological, radiological, nuclear, explosive) or NBC (nuclear, biological, chemical). The effects of a MCW-active agent may be local (on or near the site of exposure) or systemically (due to the absorption and distribution in the circuit). MCW’s sometimes referred to as weapons of mass destruction (WMD), but this term is less suitable because it implies considerable physical destruction of infrastructure, which only occurs with explosive MCW. Also, although a “weapon” means intentional use (eg., By warring states or terrorists), most MCW have unintended equivalents (z. B. an industrial or transportation leak of a toxic or radioactive substance, an outbreak of a contagious disease or an industrial explosion) for which the basic principles and the reaction are the same. Exposure under exposure refers to the contact with an epithelial surface, and absorption means the penetration of an epithelial barrier, leading to an internal dosage. In exposure radiation events may also include the passage of electromagnetic radiation through the body (called irradiation) mean, which can occur without physical contact with the radiation source. (Radiation exposure and contamination). In all types of MCW is contamination refers to a substance which, on the epithelial surface (external contamination) or in depots in the body (internal contamination) is located. Internal contamination refers most often exclusively on radioactive particles in the body than other MCW fabrics. The exposure to a MCW can readily be seen, as it exists during an explosion or visible leaks or overflow, and can even be announced in advance by a perpetrator. However, NB-exposure can also be hidden, even if the NBC sroff dispersed as a result of an explosion. Since most of NBC substances are not easily identifiable odor or appearance, and because usually a significant amount of time between exposure and development of symptoms or complaints is, an explosion may be some time later recognized as NBC exposure. An undisclosed exposure can be particularly difficult to detect or to distinguish from an outbreak of a natural disease. There is one exception at exposures to high doses of certain chemicals (eg. As cyanide, nerve agents) that can lead to obvious effects after a few seconds or minutes, v. a. if they are inhaled. Once spread in the environment, can MCW as a combination of solid, liquid, gas or vapor (the gas phase of a substance that is liquid at room temperature) are present. Fine dust particles or fine liquid droplets can be exposed as aerosols in the air (eg. As smoke, fog, mist, vapors). The state of the substance affects its persistence in the environment and potential routes of exposure. Persistent agents, typically solids and liquids with low volatility to remain in the environment under normal conditions for more than one day; some can persist for weeks. Non-persistent agents, typically gas liquids with high volatility, dispersed in <24 h. Special aerosols may go down in minutes to days, depending on the particle size and weather conditions on the ground, but then still act as surface contamination. In addition to dose and substance, the route of exposure is an important factor in the clinical manifestations of MCW event. Gases, vapors and particles can be inhaled. Solids and liquids may contaminate the skin, from where it is absorbed or transferred to the mouth and be absorbed. Contaminated objects (eg. As dirt from an explosion) can penetrate the skin and thus introduce NBC substances parenterally. Decontamination usually refers to external decontamination, removal of chemicals, toxins, or infectious agents of epithelial surfaces. The removal of radioactive substances from the body is referred to as internal decontamination. The first approach approach to a MCW-incident includes preventive detection Primary assessment and triage Secondary Rating therapy These steps often occur overlapping. Detection, Evaluation and Treatment can take place simultaneously, depending on the type, number and severity of accidents. Precautionary prevention, which is typically handled by citizens instead of medical facilities, eliminating the need for a medical response. However, if prevention fails, protective measures are crucial. Hospitals and emergency services must have a disaster plan and adequate supplies and equipment to respond to an MCW incident. For Disaster Reduction usually hear a threat vulnerability analysis (HVA) and protocols to enable additional staff and to use in certain places and tasks and allocate resources (eg. As beds, operating rooms, blood). Supplies and equipment typically include decontamination areas of drainage, floor coverings and protective equipment in order to minimize contamination, and stocks of antidotes or formal regulations to this obtained from other sources. The plans generally requirements for regular formal exercises which, although only a distant approximation of an actual MCI, but help to make employees familiar with the process, including (with the situation of the written procedure, supplies and equipment are in particular for decontamination) .Erkennung Manss with explosives, weapons and transport to detect crashes is straightforward. However, it requires a high degree of clinical suspicion by first responders and physicians to recognize covert MCW events. Health care providers need to recognize that an event or a group of disorders may be the use of a MCW first. You must then determine the type of MCW and grade of the active ingredient. Detecting a MCW-incident can the secret or the announcement of the perpetrators, instructions from the environment (eg. B. dead or dying animals, strange smells) or environmental monitoring (chemical, biological or radiation) derive, not available in every hospital can be. The only clue may be observations of a large number of people who present with unusual symptoms. However, the first reports on the identity of the substance used in a MCW-incident or substances are often incomplete or incorrect, and a high index of clinical suspicion is invaluable. If victims are examined, characteristic symptoms and complaints can be detected. Toxidrome (constellations of symptoms and complaints that are typical of exposure to a class of substances) exist for several classes of chemicals and toxins (available see Table: Common Toxic Syndromes (Toxidrome)) and are crucial for the clinical detection. Ultimately, the laboratory analysis of clinical or environmental samples may be required. However, it may be necessary for diagnosis and first treatment must be made without laboratory confirmation, v. a. in chemical substances with short Latenzzeiten.Primäre assessment and triage Primary assessment and triage of victims of an MCI is different from ordinary Trauma Assessment and Triage (see table: triage classification). The large number of victims in a MANF requires that the first confrontation and decision making to happen quickly, v. a. which may arise in the injured substances with low latency. The Triage can be particularly difficult because many patients who are harmed by MCW, no visible injuries, and because many people (at or near a MANF that were not exposed to the substances, stress reactions such. As hyperventilation, tremor, nausea , weakness) may have that mimic the effects of MCW. Some incidents had up to 80% of patients who were admitted to hospitals, only a stress response. The differentiation of purely psychological effects and toxic, infectious or radiological effects can be difficult. A good first step is to go patients who are able to separate from those that this is no longer able. This differentiation will identify the most affected. However, often a new triage of outpatients is necessary to order those whose condition deteriorated after a latency time detect. Triage Classification Classification Notes morgue No pulse not breathe instant life-threatening injury or poisoning Delayed findings Severe injury or poisoning, but not life-threatening minimal Low or declining injury or poisoning The hot zone is the area immediately surrounding the release of the MCW-substances. The risk of contamination of medical services is greatest in the hot zone, and usually only emergency personnel will be allowed with appropriate personal protective equipment in this zone. Such a device usually comprises a protection equipment toxicological means (TAP) Step A, which provides a complete encapsulation of self-contained breathing apparatus. The warm zone (decontamination corridor) is adjacent to the hot zone. A comprehensive, full body detox (thorough decontamination) should take place in this zone. The medical personnel may need protective equipment for initial assessment, triage and initial treatment of victims, v. a. Patients who are exposed to chemicals. This equipment is typically a B TAP equipment, belonging to the air-purifying respirators. To the cold zone (clean zone) includes the emergency rooms of hospitals. Since the decontamination should be carried out in the warm zone, the medical staff should be safe in the cold zone usually with standard precautions. However, hospitals still require decontamination potential because many patients who have circumvented the triage and decontamination (d. H. Leave the area independently and have even made their way) can come. Accidental entry of contaminated patients in a hospital emergency room is its classification to a warm or even hot zone ändern.Sekundäre assessment Because definitive information is missing often early in a MANF may be incorrect or incomplete initial assessment of the substances involved. Thus, it is important to assess individual patients and the overall situation with a rapid and reproducible method systematically new. Such a procedure should use a logical development that each of the 3-component substance, environment and host (patient) responds -the epidemiological triad and these rated (or thinks) Possible substance (s) status of the substance (s) in the environment transfer of the substance to the patient (input paths or routes of exposure and absorption) Clinical effects of the agent, including whether the effects are local (at or near the point of entry), systemically (due to the distribution in the bloodstream), or both. Time course (duration of exposure, exposure time, latency time, current trend of the symptoms and prognosis) differential diagnosis and simultaneous exposures or conditions Possible interactions between the simultaneous exposures or conditions A useful shortcut to facilitate rapid secondary judgment is "asbestos" (see Table "ASBESTOS": Secondary assessment of mass casualties due to chemical or radiological weapons). "ASBESTOS": Secondary assessment of mass casualties due to chemical or radiological weapons Initial When evaluating injuries caused by chemical weapons in the evaluation of injury from beam weapons agents (agents) type (there is a Toxidrom?) Estimated dose type (? , ?, ?, neutron) Estimated dose state (state (s)) If the agent is a solid liquid gas vapor * * Aeroso l Combination The same as for chemical weapons body part (s) (body site (s)) entryways (exposure and absorption): Exposure (passage through the body)? Where? External contamination? Where? Internal contamination? Where? Combinations? Effect (s) Distribution Local complications Systemic Both The same as for chemical weapons severity of effects of exposures, the same as for chemical weapons over time (time course) past (beginning, latency) Today (Better or worse? Stable?) Future (expected forecast ) The same as other (chemical weapons Other) diagnoses? Instead (differential diagnosis) addition (co-existing diagnoses) The same as for chemical weapons synergism Combined effects of multiple exposures, the same as for chemical weapons * The most common stages of therapy Initial treatment of MCW victims aims healthcare providers to protect contact with the active ingredient to stop (the patient from exposure to remove, patients of the contamination) patients taken away medically stabilize a useful mnemonic are the ABCDDs: Airway, Breathing, Circulation, Immediate Decontamination and Drugs. (Airway, breathing, circulation, immediate decontamination, drugs) However, these steps are done so at the same time as possible and not following a strict order. For example, bronchospasm in patients who were exposed to nerve agents, be so severe that the patient as long as can not be ventilated (B) until they receive atropine (D) and medication can possibly be as long as ineffective as the chemicals in contact with the patient are. While these steps are taken, first responders need to take at NBC emergencies, especially in chemical, be careful and get yourself out of the danger zone (from the environment and direct losses) before supply other. Airway, breathing, and circulation are as described elsewhere in the MSD Manual treated. These steps are usually done first, whether the cause is physical or NBC trauma. may be an exception exists in certain patients with exposure to chemicals (eg. B. nerve agents) for the immediate decontamination and administration of antidotes lifesaving (and prevent the development of respiratory or respiratory problems or their effective treatment allows). A medical stabilization of ABC's must be done sometimes in the warm zone. The priority derDekontamination varies depending on the nature of the MCW-substances and medical condition of the patient. exposed patients dispersed aerosols of biological or radiological substances were (radiation exposure and contamination: External decontamination), typically skin and / or clothing contaminants. Since most of these funds are not quickly penetrate the intact skin, stripping and showers for decontamination are usually sufficient; this decontamination should not be unduly delayed, but not as much as when certain chemicals are involved. As certain chemical agents (eg. As mustard gas, liquid nerve agents) on contact penetrate the skin and may also begin immediately to damage the tissue that require patients who are exposed to such agents, immediate decontamination to stop recording and to prevent the spread of contamination to other areas of the patient and the medical staff and facilities. Immediate decontamination is most effective with a specially designed commercial topical skin decontamination product (reactive skin decontamination lotion or RSDL®), the nerve agents and mustard gas on the skin inactivated (it should not be used in eyes or wounds). However, soap and water are also effective. Water is less effective alone oily chemicals, but should still be used when soap is not available. A 0.5% solution of sodium hypochlorite (by diluting Standard 5% household bleach in a 1: 9 ratio of bleach to water) is also effective, but should not be used in eyes or in wounds. In an emergency, all available adsorbents (eg., Paper towels, handkerchiefs, talc, clay speech, bread) can be applied to the affected area for a few seconds and then removed by copious flushing. Wounds must be investigated and all deposits are removed; Wounds must then be rinsed with water or saline. Drugs for initial stabilization should be administered as needed, as with any unstable patients. With most definitive drug treatments for MCW victims can be maintained until the instruction is done in a hospital. The exceptions are treatments of shock and treatments of acute effects of chemicals such as cyanide and nerve agents. Suitable antidote for these substances should be available for rapid treatment at a emergency. Reproduced in this article is the opinion of the author and does not reflect the official policy of the Department of Army, Department of Defense or the US Government.

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