ED nurses vulnerable during chemical exposure incident
ED nurses vulnerable during chemical exposure incident
Protect yourself and your patients
(Editor's note: We sent an e-mail alert about the recent incident of chemical exposure at EDs in the St. Louis area. If you didn't receive it, we don't have your e-mail address. Please contact customer service at [email protected] or (800) 688-2421 so you won't miss out on future alerts.]
It's one of the worst-case scenarios outlined in a hospital's disaster plan: Patients walking into ED waiting rooms covered in dangerous chemicals, with absolutely no warning. Every single person in the ED is put in harm's way.
That's exactly what happened at several EDs in St. Louis after eight workers were exposed to the highly toxic chemical nitroaniline at an industrial plant. Three of these individuals walked into St. Anthony's Medical Center after pulling up in a pickup truck.
"The triage nurse could tell something was wrong right away, because one of the patients was literally blue," says Patty Wors, RN, nursing director of the ED. "Before we could stop them, they walked through our doors. That put a whole different light on things."
The charge nurse called the house supervisor, and the ED immediately was quarantined. The patients were escorted to two treatment rooms right off triage. Nurses gowned up with masks, goggles, shoe covers, gowns, and gloves. "The sickest one had a pulse oximetry of only 80%," says Wors. "The first thing we did was get their clothes off and wash them down. They were walking and talking, so we had them do that first. We didn't even know what it was at that time."
Just a month earlier, nurses had an anthrax scare that turned out to be a hoax, but it brought the topic of decontamination to the forefront. In this case, nurses weren't sure whether only the patients or the entire ED had to be decontaminated. "In the end, we wound up having to decontaminate everybody — patients and staff — as a precaution," says Wors.
At Barnes-Jewish Medical Center, the situation was quite different. Emergency nurses already had gotten word about the incident, and didn't expect to receive any patients. "But about two hours later, we got an EMS report that they were bringing us a patient involved in the incident," says Keith Outlaw, RN, assistant clinical manager of emergency services. "His oxygen saturation was low, and his heart rate was fast."
ED nurses jumped into action and carefully followed well-rehearsed policies for chemical exposure. "We found out that he had self-decontaminated at home — he took two showers and changed his clothes — but we needed to make sure he wasn't still contaminated," says Outlaw.
Outlaw put the man into the decontamination shower before he entered the ED, and he then was placed in the trauma bay. ED nurses put on protective gear, started an intravenous line, and gathered medications and supplies.
Here, ED nurses had another big advantage: They knew what substance they were dealing with. "So we started our normal process of pulling up our MSDS [material safety data sheets] sheets and trying to figure out what the chemical was made of," says Outlaw. "It causes loss of oxygen to the blood, so we gave him methylene blue to counteract that." The patient was admitted for observation.
Outlaw credits the smooth ED visit with the training given to all nurses, including a four-hour annual class that covers when and why to put on personal protective equipment. The class is given by various instructors including Outlaw and staff in Environmental Health and Safety and Radiation Safety. "We also have two ED physician residents that give hands-on training involving taking care of a contaminated patient," he says. "As far as our decontamination process goes, I would rate that as excellent.
If you suspect your patient's symptoms could be due to chemical exposure, take immediate action, urges Outlaw. "The first thing to think of is not only their safety, but also your safety and the safety of your facility," he says. "They can start off gassing and affecting you right away, so you need to minimize that exposure to you or any of your co-workers. Don't let them into your ED without being deconned."
(Editor's note: We sent an e-mail alert about the recent incident of chemical exposure at EDs in the St. Louis area. If you didn't receive it, we don't have your e-mail address. Please contact customer service at [email protected] or (800) 688-2421 so you won't miss out on future alerts.]Subscribe Now for Access
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