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Toxicological Disasters
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Dr. Salma Ibrahim

 Objectives
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• Define disasters
Definetext
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• Second
• Statelevel
the vulnerable groups during disasters
• Third level
• State thelevel
• Fourth toxicological disaster preparedness
• Differentiate
• Fifth level types of PPE

• Outline the response in toxic disaster

• Differentiate between zones of disaster site
• State types of disasters and possible toxic exposure
 Toxicological Disaster
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It is toxic
• Edit• Master textconsequences
styles of large scale exposure to ‘’hazardous
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•materials’’
Third level (HAZMAT) due to nature, major accidents or
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deliberate terrorism.
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 HAZMAT
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• EditAny material
Master that can cause harm to people,
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• property,
Second levelor the environment. Release of
• Third level
hazardous materials can include a large number
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• Fifth level
of toxins.
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• Second level
• Third level
• Fourth level
• Fifth level
 Fire
Click to edit Master title Smoke
style inhalation

• Smoke can suffocate people and sometimes also contains

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toxic chemicals produced by the burning substance. Some
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of these chemicals can damage the lungs or poison the
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body.
• Fourth level
• Carbon monoxide
• Fifth level is a gas produced in many fires.
• Inhalation of chemicals released in the smoke, such as
hydrogen chloride, phosgene, sulfur dioxide, toxic aldehyde
chemicals, and ammonia
 Vulnerable Groups Following
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Individuals within the general population who may be more
significantly affected than others and who are at greater risk for
• Editnegative
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outcomes.
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• •pregnant
Third level and nursing women (risk on mother and infant plus
associated
• Fourth levelphysiological changes)
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• Children ( short stature- large skin surface area to body mass-
thin skin- less subcutaneous fat- higher MV- decrease fluid
reserve- immature motor skills)
• older adults (more sensitive lung- less functioning body
organs- less motor activity)
• Patients with disabilities or chronic diseases e.g. asthmatic pts
 Toxicological Disaster Preparedness:
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• prior preparedness is critical
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level the effects on victims, rescuers, and other
Minimize
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emergency
• Fourth level personnel.
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Avoid toxic contamination in non-exposed sectors of the
community.
 Toxicological disaster preparedness:
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• Prepare for a wide range of disasters
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• Know the signs and symptoms consistent with Toxidromes
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• Acquire skills and practice on how to properly treat injuries associated
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with toxic exposures
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• Prepare to respond rationally, effectively recognizing and minimizing

dangers affecting rescuers personal safety

• Provide community education regarding the appropriate levels of

community concern and response to each type of toxicological disaster
 Priorities in response to a
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Is to enhance the safety of the medical and rescue personnel
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• Fourth level while saving the victims
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Click The first goal
to editmedical
Master is to enhance
title style the safety of the
and rescue personnel by
PPE who is exposed
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Degree of protection
what they are exposed to
how long are they exposed for
• Second
A level Airway, included vapor, skin (SCBA) how much are they exposed to
B• Third level Airway, skin (less)
C • Fourth level
Airway (less); skin (same as B)
D • Fifth level
No special protection

 Wearing PPE requires special

training.
 The level of PPE required in each
zone will be decided by the
incident commander and medical
coordinator.
Click to edit Response in toxic
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• A chain of command must be established.
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• An incident commander will need to oversee the scene and
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•establish
Third level contact with a nearby base hospital. In hazardous
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materials
• Fifth(HAZMAT)
level incidents, a medical toxicologist and/or
HAZMAT specialist, if available, should be designated as
medical coordinator and should be in contact with poison
control center to participate in the response.

• Set up appropriate zones for the management of the disaster

 Zones for the management of the disaster
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Theto edit
type Master
of disaster willtitle stylewhat zones are needed
determine

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 • Hot zone (primary zone)
ClickAt todisaster
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Area of continuous danger ( e.g. ongoing fire, exposure to
toxic material)
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No medical
• Second level treatment in this zone if needed establish
• •Warm zone (decontamination)
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Outside the hot zone
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Highly contaminated with hazardous material
Patient can be stabilized and decontaminated in this zone
• Cold zone (support)
No threat of secondary contamination
Definitive treatment and triage of the patients
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No one
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text the general public or media should be allowed
styles
• Second level
• Thirdinto
level any of these zones. A key point in disaster scene
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management
• Fifth level is the prevention of unauthorized entry and exit
between zones.
Types of Disasters
• Natural Disasters (different
according community)e.g.
Earthquakes and volcanic
eruption
fire
• Common toxins include:
- Carbon monoxide
- Cyanide
- Animal poisons
• Human-Caused Disasters
Biological
Radiation
Thermo-mechanical (e.g. explosion)
Chemical
• industrial accidents or terrorism
• Fairly quick
• Need rapid identification of the hot zone
• Rapid identification of type and state of toxins involved
Common toxins: chlorine gas
 Biological disasters Chemical disasters
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Example
title– COVID-19
style CO – Chlorine gas
Onset Delayed Rapid
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identification Hard Easy
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Zone identification
• Third level Hard Easy
Victim• distribution
Fourth level Widely distributed Around the source
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First responder Medical workers, nurses Emergency medical
services (EMS), Hazmet
time, fire fighter……
Isolation Necessary Unnecessary
Decontamination Unnecessary Necessary
Treatment AB, vaccines, ABCD, antidotes,
symptomatic supportive
 The role of the poison control
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• Providing information about toxic exposures and

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identification
• Second level of different chemicals.
• Third level
• Management
• Fourth level of exposed patients
• Fifth level

• Gathering data regarding exposures (e.g., locations, types of

injuries) needed for surveillance and follow-up.
 General principles of management in
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toxicological disasters
• Stabilization (ABC)
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• Second
• Decontamination
level
• Third level
• Fourth level
• Antidotes
• Fifth level

• Physical examination

• Investigations
 Carbon monoxide
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sources
• EditCO is found
Master in fumes produced any time you burn fuel in cars or trucks,
text styles
small engines, grills, fireplaces, gas ranges, or furnaces.
• Second level
CO can
• Third build up indoors.
level
Properties
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an odorless, colorless, and tasteless gas
C/P
headache, dizziness, weakness, upset stomach, vomiting, chest pain, and
confusion.
Silent killer
 Treatment
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• When suspect CO poisoning
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• ABCD
• Second level
• Third level
• Remove the patient from site of exposure.
• Fourth level
• Fifth level
• Allow the patient to breath uncontaminated air.

• Supplemental oxygen (100%) via face mask.

• Hyperbaric oxygen needed in sever and vulnerable patients

but it is not available at disaster situation
 Chlorine
Click to editgas
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sources
Industries, storage tank damage or industrial tube damage.
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level source
Household
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Chemical
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Properties
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Yellow- green with bleach odor
C/P
Burning sensation in throat, cough, lacrimation, tachypnea up to
sever bronchospasm up to pulmonary edema and dysfunction
according to severity of exposure and pre-existing pulmonary
disease.
 Treatment
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• Remove the patient from site of exposure.
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Allow text styles to breath uncontaminated air.
the patient
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• Third level
• Supplemental
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oxygen via face mask.
• Fifth level
• Surface decontamination of skin and eyes (decontamination
zone).

• Bronchodilators and nebulizers.

 Case 1
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• You are working in a large hospital at 2.30 Am when an
earthquake of magnitude 7 on the Richter scale occurs.
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Building textandstyles
bridge have collapsed on the hundreds of
• Second
peoplelevelin a downtown area and others are victims of
•explosion
Third level and fires.
• Fourth level
• Several hours
• Fifth level about 25 individuals arrive at the hospitable in
private vehicles. They complain of headache, nausea and
some are weak and dizzy. They were near a fire place.
• How would you asses these individuals?
• Should they be considered emotionally impacted or are
suffering from a toxic exposure?
 • How would you asses these individuals?
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• ABC
• Decontamination
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Examination styles
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• •Investigations
Third level
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• Fifth level
• Should they be considered emotionally impacted or are
suffering from a toxic exposure?
• Suffer from CO poisoning
 Case 2
Click to are
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in duty title style
in PCC-ASU hospital when a radio reports
come in that a disaster has occurred in an outlying village of
about 10,000 people. Witnesses reported that there was an
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explosion textat the nearby industry with a green- yellow cloud
styles
of gas
• Second passed over the village.
level
• •Reports
Third level came in that hundreds of victims are unresponsive at
the• scene and some complaining of burning eye, profuse
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lacrimation, eyelid edema with others have trouble breathing,
• Fifth level

coughing.
• What is the potential toxic gas that has been released?
• What are simple live saving techniques needed?
• What elements will you need for managing gas related
crisis?
 • What is the potential toxic gas that has been released?
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• Chlorine gas
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• Whatlevel
• Second are simple live saving techniques needed?
• •ABCD measures
Third level
• Fourth level
• Fifth level
• What elements will you need for managing gas related
crisis?
• PPE
• Supplemental o2, face mask, nebulizers, bronchodilator