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Medical operations at hazmat incidents
The Journal of EmergencyMedicine, Vol 12, NO 3, pp 423-426, 1994 Copyright 0 1994Elsevier ScienceLtd Printed in the USA. All rights reserved
Pergamon
0736-4679/94 $6.00 + .OO
----
Revkws: Bebob and Other Media
Cl CURRENT EMERGENCY DIAGNOSIS & TREATMENT. Edited by Charles E. Saunders and Mary T. Ho. Norwalk, Connecticut, Appleton & L.ange, 1992, 1015 pages, paperback, $39.95.
mended P-agonist therapy for acute asthma is below currently practiced dosing. Labetalol is not listed under options of treating hypertensive urgencies. There are no color plates. The new American Heart Association protocols are not incorporated. Bright spots include brief chapters on poisoning, legal aspects of emergency care, emergency medical services, and multicasualty incidents. Despite some significant limitations, at $39.95 this is a fair value in introductory emergency medicine texts. For rotating residents on an emergency medicine elective, students, or as a general review for emergency medicine physicians, the book has little competition in this price range.
The Lange series of medical review books are well known and frequently serve as information sources for nonspecialists in different medical areas. The fourth edition of the text on emergency medicine incorporates many of the features common in this series: paperback construction, economical pricing, and multiple authors. Forty-five authors contributed; fewer than 10 are active emergencyphysicians. It has been said that emergency medicine is an algorithmic specialty. However, some algorithms featured are so hard to see that any benefit to the reader is questionable. This still youthful (under 40) reviewer could barely decipher the tiny print. Some algorithms include 40 boxes on a 7 x 9 inch page. Some duplicated material will be present in any problem-oriented text, but the amount of redundant material seemsexcessive.Airway management is discussed in several chapters, and the discussions are not always in strict agreement. Congestive heart failure is also discussedin chapters on chest pain, respiratory failure, and cardiac emergencies.Intravenous nitrates are mentioned in one discussion only; nitroglycerin ointment is recommended in other discussions. Statements are scattered in some chapters regarding certain treatment options that should be started, “only in an intensive care unit.” From this, the reader might conclude that such therapies are beyond the ability of emergencyphysicians. Other problems seem to stem from some authors who apparently do not work in emergency departments but write about emergencytreatments. Recom-
J. Stephen Huff, MD, FACEP Department of Emergency Medicine Eastern Virginia Graduate School of Medicine Norfolk, Virginia 07364679(94)EOO15-N
0 HAZMED I, EMERQENCY DEPARI”#lENT RESPONSE TO A HAZAUDOW MA’f&WAL ACCIDENT PATIENT. RMC Medical, 3021 Darnell Road, Philadelphia 19137, 1991, Video (23 minutes) and training manual, 32 pages, $195 (preview available). 0 MEDICAL OPEf?ATlO?JS AT HAZMAT INCIDENTS. Emergency Film Group, 225 Water Street, Plymouth, Massachusetts 02360, Video (26 minutes), $395 (rental and previews available).
Reviews of books and other media, which keep readersinformed of important publicationsin the emergency
medicinefield, is coordinatedby Edward J. Otten,
MD,
423
AssociateProfessorand Director of Toxicology,Depart-
424 Hazardous materials accidents are unusual events, but when they do occur system resources are often strained. These training programs were produced to help emergency personnel prepare for the management of the chemically contaminated patient. RMC Medical is a small corporation that has been active in radiation emergency response for years and more recently in hazardous material response. The Emergency Film Group has been making emergency response films for over 15 years. HAZMED I outlines the hospital-based response to a chemical emergency. Planning before the incident is stressed, including preparation of external and internal decontamination areas. An overview of techniques of chemical decontamination is presented. Decontamination of a chemically contaminated patient is realistically simulated. Appropriate protective clothing for hospital personnel is discussed, including dressing and undressing techniques. An ideal emergency department response to a chemically contaminated patient is illustrated with discussion springing from the simulation. The response presented is an all-or-nothing event. Coordination with other hospital resources is reviewed. Hazard assessmentand decision-making processes are not addressed. Respiratory protective devices are mentioned briefly. The training manual reinforces information introduced in the video. Brief quizzes to be administered before and after the training session are included. Production quality is professional. Medical Operations at HAZMA T Incidents is produced with the fire and EMS responder in mind. The requirements of professional competence for EMS personnel as specified in the National Fire Protective Association documents are addressed. The multiple roles of EMS at a scene are discussed, including medical support of rescue personnel. Equipment for EMS response is delineated. Approach to the scene and scene safety is stressed. Emergency decontamination is illustrated in detail. Antidotes are only mentioned in passing. Most of the video is a simulation of a HAZMAT scenario with the discussion following from the video. Operations in the hot zone, warm zone, and cold zone are presented in a common-sense manner. Incident command and interactions with other agencies are mentioned. Basic patient care and medical monitoring at the scene are illustrated. Communication with medical control is stressed. A highlight is an excellent discussion on the principle of secondary contamination and the decision as to whether decontamination should be performed. Brief discussions on routes of exposure and dose accumulation are included in a basic toxicology discussion.
The Journal of Emergency Medicine
Information sources are discussed. Production quality is professional. The videos are targeted at different audiences and are complementary in content. These videos at first glance seem expensive for the material supplied. The cost only is justifiable if the cost of instructors’ time is considered. Supplemented with other lecture materials, these products would provide the core for a realistic training course for emergency physicians, residents, and emergency department staff.
J. StephenHuff, MD, FACEP Department of Emergency Medicine Eastern Virginia Graduate School of Medicine Norfolk, Virginia 0736-4679(94)EOO16-0
• ! PEDIATRIC EMERGENCY MEDICINE. By Earl J. Reisdorff, Mont R Roberts, and John G. Wiegenstein. Philadelphia, Saunders, 1993, 1192 pages, hardcover, $129.00.
The newly recognized field of pediatric emergency medicine has been the subject of several textbooks in the past 10 years. The purpose of this book is to bring the field of pediatric emergency medicine to the audience through the eyes of emergency physicians. This text has brought together an excellent group of both emergency medicine teachers and pediatrics-based educators trained in pediatric emergency medicine. The text is divided in an interesting but still physiological approach. The initial General Emergency section is followed by the organ system areas of cardiovascular, pulmonary, gastrointestinal, renal-genitourinary, obstetrics/gynecology, endocrine, hematology, oncology, dermatology, infectious disease, ENT/Eye, and so forth. There follows a detailed section on environmental emergencies, trauma, orthopedics, neurology, and psychosocial disease. One of the unique areas in each chapter is a small part of each section dedicated to the emergency medicine service considerations for each of the “symptoms” or disease entities discussed in the text. Although this text is generally very brief, it does give a sense of where the prehospital care and management would best be undertaken for some of the specific entities treated in emergency departments. The General Emergency section of the book is well
Pergamon
0736-4679/94 $6.00 + .OO
----
Revkws: Bebob and Other Media
Cl CURRENT EMERGENCY DIAGNOSIS & TREATMENT. Edited by Charles E. Saunders and Mary T. Ho. Norwalk, Connecticut, Appleton & L.ange, 1992, 1015 pages, paperback, $39.95.
mended P-agonist therapy for acute asthma is below currently practiced dosing. Labetalol is not listed under options of treating hypertensive urgencies. There are no color plates. The new American Heart Association protocols are not incorporated. Bright spots include brief chapters on poisoning, legal aspects of emergency care, emergency medical services, and multicasualty incidents. Despite some significant limitations, at $39.95 this is a fair value in introductory emergency medicine texts. For rotating residents on an emergency medicine elective, students, or as a general review for emergency medicine physicians, the book has little competition in this price range.
The Lange series of medical review books are well known and frequently serve as information sources for nonspecialists in different medical areas. The fourth edition of the text on emergency medicine incorporates many of the features common in this series: paperback construction, economical pricing, and multiple authors. Forty-five authors contributed; fewer than 10 are active emergencyphysicians. It has been said that emergency medicine is an algorithmic specialty. However, some algorithms featured are so hard to see that any benefit to the reader is questionable. This still youthful (under 40) reviewer could barely decipher the tiny print. Some algorithms include 40 boxes on a 7 x 9 inch page. Some duplicated material will be present in any problem-oriented text, but the amount of redundant material seemsexcessive.Airway management is discussed in several chapters, and the discussions are not always in strict agreement. Congestive heart failure is also discussedin chapters on chest pain, respiratory failure, and cardiac emergencies.Intravenous nitrates are mentioned in one discussion only; nitroglycerin ointment is recommended in other discussions. Statements are scattered in some chapters regarding certain treatment options that should be started, “only in an intensive care unit.” From this, the reader might conclude that such therapies are beyond the ability of emergencyphysicians. Other problems seem to stem from some authors who apparently do not work in emergency departments but write about emergencytreatments. Recom-
J. Stephen Huff, MD, FACEP Department of Emergency Medicine Eastern Virginia Graduate School of Medicine Norfolk, Virginia 07364679(94)EOO15-N
0 HAZMED I, EMERQENCY DEPARI”#lENT RESPONSE TO A HAZAUDOW MA’f&WAL ACCIDENT PATIENT. RMC Medical, 3021 Darnell Road, Philadelphia 19137, 1991, Video (23 minutes) and training manual, 32 pages, $195 (preview available). 0 MEDICAL OPEf?ATlO?JS AT HAZMAT INCIDENTS. Emergency Film Group, 225 Water Street, Plymouth, Massachusetts 02360, Video (26 minutes), $395 (rental and previews available).
Reviews of books and other media, which keep readersinformed of important publicationsin the emergency
medicinefield, is coordinatedby Edward J. Otten,
MD,
423
AssociateProfessorand Director of Toxicology,Depart-
424 Hazardous materials accidents are unusual events, but when they do occur system resources are often strained. These training programs were produced to help emergency personnel prepare for the management of the chemically contaminated patient. RMC Medical is a small corporation that has been active in radiation emergency response for years and more recently in hazardous material response. The Emergency Film Group has been making emergency response films for over 15 years. HAZMED I outlines the hospital-based response to a chemical emergency. Planning before the incident is stressed, including preparation of external and internal decontamination areas. An overview of techniques of chemical decontamination is presented. Decontamination of a chemically contaminated patient is realistically simulated. Appropriate protective clothing for hospital personnel is discussed, including dressing and undressing techniques. An ideal emergency department response to a chemically contaminated patient is illustrated with discussion springing from the simulation. The response presented is an all-or-nothing event. Coordination with other hospital resources is reviewed. Hazard assessmentand decision-making processes are not addressed. Respiratory protective devices are mentioned briefly. The training manual reinforces information introduced in the video. Brief quizzes to be administered before and after the training session are included. Production quality is professional. Medical Operations at HAZMA T Incidents is produced with the fire and EMS responder in mind. The requirements of professional competence for EMS personnel as specified in the National Fire Protective Association documents are addressed. The multiple roles of EMS at a scene are discussed, including medical support of rescue personnel. Equipment for EMS response is delineated. Approach to the scene and scene safety is stressed. Emergency decontamination is illustrated in detail. Antidotes are only mentioned in passing. Most of the video is a simulation of a HAZMAT scenario with the discussion following from the video. Operations in the hot zone, warm zone, and cold zone are presented in a common-sense manner. Incident command and interactions with other agencies are mentioned. Basic patient care and medical monitoring at the scene are illustrated. Communication with medical control is stressed. A highlight is an excellent discussion on the principle of secondary contamination and the decision as to whether decontamination should be performed. Brief discussions on routes of exposure and dose accumulation are included in a basic toxicology discussion.
The Journal of Emergency Medicine
Information sources are discussed. Production quality is professional. The videos are targeted at different audiences and are complementary in content. These videos at first glance seem expensive for the material supplied. The cost only is justifiable if the cost of instructors’ time is considered. Supplemented with other lecture materials, these products would provide the core for a realistic training course for emergency physicians, residents, and emergency department staff.
J. StephenHuff, MD, FACEP Department of Emergency Medicine Eastern Virginia Graduate School of Medicine Norfolk, Virginia 0736-4679(94)EOO16-0
• ! PEDIATRIC EMERGENCY MEDICINE. By Earl J. Reisdorff, Mont R Roberts, and John G. Wiegenstein. Philadelphia, Saunders, 1993, 1192 pages, hardcover, $129.00.
The newly recognized field of pediatric emergency medicine has been the subject of several textbooks in the past 10 years. The purpose of this book is to bring the field of pediatric emergency medicine to the audience through the eyes of emergency physicians. This text has brought together an excellent group of both emergency medicine teachers and pediatrics-based educators trained in pediatric emergency medicine. The text is divided in an interesting but still physiological approach. The initial General Emergency section is followed by the organ system areas of cardiovascular, pulmonary, gastrointestinal, renal-genitourinary, obstetrics/gynecology, endocrine, hematology, oncology, dermatology, infectious disease, ENT/Eye, and so forth. There follows a detailed section on environmental emergencies, trauma, orthopedics, neurology, and psychosocial disease. One of the unique areas in each chapter is a small part of each section dedicated to the emergency medicine service considerations for each of the “symptoms” or disease entities discussed in the text. Although this text is generally very brief, it does give a sense of where the prehospital care and management would best be undertaken for some of the specific entities treated in emergency departments. The General Emergency section of the book is well