Hospital Planning and Response for Sudden Chemical Mass Casualty Incidents

Sudden exposure of multiple people to a chemical agent may be classified as a sudden chemical mass casualty incident (SCMCI). The vast majority of the contaminated patients will be mildly contaminated (“walking wounded”). The majority of contaminated patients will self-evacuate or be transported by nonrescue personnel to local hospitals. Although decontamination at the scene is desirable, it is time consuming in an unplanned, sudden event, and therefore unrealistic. Most critical patients, usually those with respiratory distress, will probably expire by the time scene decontamination is available. Therefore, critical contaminated patients should be transported rapidly to hospitals by first responders who must have personal protective equipment (PPE). Removal of all clothing may reduce contamination by 80–90% and should be done prior to getting into the ambulance. Once in the ambulance, patient can be kept covered and warm with blankets and sheets. High probability that a large number of self-evacuated patients will flood the hospital campus. Hospitals should plan to prevent patient flooding, have a decontamination facility, and further manage patients from a SCMCI.