Chemical accident on-site first aid manual (1)

The more complete concept of first-aid emergency on chemical accidents is: in the event of a chemical accident, all medical rescue actions and measures taken at the scene of the accident in order to reduce injuries, rescue victims, and protect the health of the population.

The significance and purpose of first-aid emergency on chemical accidents include:

1 save lives: through timely and effective first-aid measures such as cardiopulmonary resuscitation for patients with heartbeat respiratory arrest to achieve the purpose of saving lives;

2 stable condition: on the scene of the patient's symptomatic, support and appropriate special treatment and treatment, so that the disease is stable, for the next step to save a fight;

3 Reducing disability: When a chemical accident, especially a major or catastrophic chemical accident, occurs, not only may there be group chemical poisoning, chemical burns, but also various types of trauma, potential diseases or deterioration of some of the original diseases. In the first aid on the spot, properly flushing, dressing, repositioning, fixing, carrying and other corresponding treatment of the sick and wounded can greatly reduce the disability rate;

4 relieve pain: through the general and special care to stabilize the patient's emotions, reduce the patient's pain.

Section I Organization and Implementation of First Aid on Site

I. Overview

The key to emergency on-site accidents in chemical accidents puts the two words “emergency” and “rescue”. Urgently - In the rescue operation, we must fully reflect the rapid build-up and rapid response. At this moment, it truly reflects "Time is life." There must be feasible measures to ensure that the wounded and the sick can be given medical care in the shortest possible time.

The key to the success of the first aid in the field is not only superb medical technology and perfect equipment, but more importantly, time. Rescue—refers to the correct and effective rescue measures and measures for the sick and wounded, and the proper disposal of them. It shows excellent technical standards and a good spirit, as well as the ability to work in a random manner.

Practice has proved that the key to the success of a chemical accident emergency rescue is often on-the-spot first aid, and the success of on-site first aid depends to a large extent on the organization and implementation of on-site first aid. Due to the suddenness, complexity, hazard, and groupness of chemical accidents, especially in the case of major or catastrophic accidents, the on-the-spot rescue work is different from the general medical rescue work, and has its specific connotations, plus the chemical accident emergency. Rescue work often involves the coordination and coordination of multiple departments and multiple rescue professional teams. Therefore, the organization of first aid on the scene of chemical accidents is particularly important.

Second, the implementation of on-site emergency procedures

The on-site first aid for chemical accidents must follow a certain procedure.

1. Report

Refer to a request for rescue instruction or request for rescue. Receiving a newspaper is the first and important step in the implementation of the rescue work. The respondent is generally served by the rescue team on duty. The respondent should do the following tasks.

1 Ask the reporter's name, company, department, and contact number.

2Ask how the time, location, accident unit, cause of the accident, main toxicant, nature of the accident ( poisoning, explosion, burning ), the scope and extent of the damage, and the specific requirements of the rescue unit, and make a telephone record, necessary Ask about the route of action during the rescue.

3 Report to the unit leader on the status of the report and ask for a rescue team.

4 notify the relevant departments of the unit to prepare for the rescue.

5 Report the situation to higher authorities and reflect the requirements and recommendations.

2. Assembly

Rescue unit leaders or rescue duty watchers ordered the regrouping of medical rescue teams based on the status of the reports and the strength of the rescue unit. Rescuers should gather at designated locations according to the specified time and requirements, and bring their own responsible equipment and equipment.

3. Departure

Check out personnel and equipment and start immediately. On the way , contact the rescue unit and the accident unit via car phone or mobile phone ( or walkie-talkie ) to report the action status at any time.

4. Report

After the rescue team reached the rescue site, they reported to the accident site command. Its purpose is to understand the situation on the site, accept rescue missions and make rescue suggestions.

5. Selection points

Select a favorable terrain ( place ) to set up an on-site emergency medical point. It is necessary to be cautious when the selection work involves whether it is possible to carry out on-site emergency treatment and protect its own safety. The following points should be considered when setting up an emergency medical point on site.

1 The non-polluting area should be selected on the wind, but do not stay away from the scene of the accident so that the wounded can be rescued nearby.

2 Location: As close as possible to the accident site command to keep in touch.

3 road section: should be close to the intersection of the traffic convenience area, in order to facilitate the transit of the wounded and sick transfer vehicles and the emergency transfer of emergency medical points.

4 conditions: emergency medical treatment can be located outdoors or indoors, the area should be as large as possible to facilitate the rescue of many people at the same time, while ensuring as much as possible the source of water and electricity.

5 mark: The emergency medical point should set up eye-catching signs to facilitate the identification of rescue workers and the wounded. It is best to fly the Red Cross white flag of light fabrics, which will make it easier for emergency personnel to keep abreast of changes at the site.

6. First inspection and retest

Refers to the preliminary medical examination of the wounded and sick, classified according to light, medium, heavy and dead. The initial examination is different from the clinical diagnosis. The purpose is to quickly classify the rescued person so that the ambulance personnel can be identified and given different treatment. The first-time inspectors should be staffed by experienced doctors and arrange the physicians of the appropriate departments according to the nature of the accident.

The initial inspection deals with life-threatening or developing life-threatening diseases or injuries. During this phase, special attention should be paid to basic injury assessments and airway, respiratory and circulatory system tests (ABCS) . Because over-stretching of the head and neck may exacerbate existing cervical spine injuries, the lower jaw should be lifted or the jaws pushed in to ensure airway opening. Once a smooth airway has been established, the respiratory system can be checked by "seeing, listening, feeling". See: that is to judge the respiratory function by observing the movement of the chest wall; Listen: Use one ear as close as possible to the mouth and nose of the victim to listen to the sound of gas exchange;

Feeling: At the same time as listening, feel the presence or absence of air flow. Circulatory system examination, adults can touch the carotid artery pulse, baby

The initial inspection should distinguish those who have life-threatening injuries but can be rescued quickly after treatment, and identify those who will not die in time and who will surely die. It is best to resuscitate first and fix important parts ( such as the spine ) before moving the injured .

The initial inspection procedure is shown in Figure 3 - 1 .

The re-examination is carried out after the life-threatening injuries have been identified, and the further damage to the wounded and wounded has been reduced to a minimum. Its purpose is to identify other less important injuries that may be present in the wounded and sick. During the re-examination, the physical examination of the wounded and sick person from head to toe should be systematically observed, touched, deafened and listened to. It can get a simple history and symptoms of the cause of the injury. When the examiner and the sick and wounded are unable to communicate properly, such as coma, pediatric and deafness, the retest is even more important. The most ideal re-inspection should be to complete the assembly of the wounded and wounded people away from the scene of the accident. According to the information obtained during the inspection, the sick and wounded can be properly reclassified, and the steps of the first inspection in Figure 3-1

1 Begin by checking the head, touching the top of the head and back of the head, and the facial bones, looking for wounds, bruises, contusions and deformations.

2 Check for ear and nose bleeding and cerebrospinal fluid.

3 Check pupil size and response to light.

4 Open the mouth and check for bleeding, wounds and foreign objects such as fractured teeth or dentures.

5 Check the neck for cervical deformity and tracheal position.

6 When the sick and wounded person is on the side, they can quickly touch the clavicle, scapula, tibia, elbow, ulna and ulna and hand to determine if there is deformity, tenderness and swelling. When the hand can be palpated, check the degree of capillary congestion and press the finger to assess hand neurovascular function. After removing this side limb injury, measure the pulse and blood pressure. If the limb is damaged, the examiner should measure the contralateral upper limb.

7 Auscultate the lungs and heart, and check the sternum and ribs at the same time to see if there is any tenderness or tenderness. Check the chest for wounds, bruises or contusions.

8 Check the abdomen for wounds, bruises, bruises, stiffness, tenderness, and swelling.

9 Shake the pelvis and check for completeness of the pelvic girdle.

10 Examine the lower extremities near the examiner and touch the femur, tibia, patella, and foot. The capillary filling of the foot was examined, and the toe was pressed to estimate the neurovascular function. Then check the contralateral lower limb.

(11) Turn over the patient in a prone position, check and touch the back and hips. The wounded person carrying the injury sign may be red, yellow, green, or black with different colors of cloth or armbands, with the words heavy, medium, light, and death printed on it. When a large number of burn patients are encountered, the sign of injury is still on. Need to indicate whether there is respiratory burn. There is also a better way to set up a “rescue card”. Different types of different types of colors are used to save cards. At the same time, “basic conditions”, “preliminary diagnosis” and “treatment measures” are set up on the card. Other projects, which facilitate the recording of patient development and treatment measures during the on-site and trans-shipment, serve as a simple “case record card” to provide the basis and reference for subsequent treatment. This kind of rescue card can play a good role in both the on-site emergency treatment and the emergency department ( room ) rescue when a large number of wounded and sick people need emergency treatment . It is worth adopting.

7. Classification

The classification of the sick and wounded person refers to the order in which the wounded and wounded are classified and treated. The disaster sick and wounded classification gives priority to the sick and wounded who can obtain maximum medical results from on-site treatment, instead of first dealing with the most severely wounded and sick. The classification of modern disaster sick and wounded only gives the highest priority to those who have only been treated and survived, but it does not give to those untreated survivors who are still alive and those who have died. Priority treatment.

In disasters with a large number of sick and wounded people, the classification of the sick and wounded should be conducive to the implementation of life-saving measures. Applying the above principles, the highest priority can be given to disposing the wounded and sick, so as to minimize the mortality rate and at the same time maximize the limited medical personnel and medical forces. The vital signs data obtained from the initial examination and re-examination can be used to calculate the score of the wound. The wounded and sick person can be treated promptly and correctly by using the trauma scoring method. Method and traumatic wounds meter points score corresponding survival rates are shown in Table 3 - 1 and Table 3 - 2.

(1) Priority treatment

In general, wounded scored 4 to 12 points should be treated immediately and evacuated. These wounded have life-threatening injuries but are in a state of possible rescue. They often suffer from shock and severe blood loss, loss of consciousness, or unresolved respiratory problems, severe chest ( or ) and abdominal open or closed injuries. In addition, the following three kinds of burns can also be life-threatening, so they should also be quickly handled and evacuated: a. Burns that endanger breathing; b. III degree burns up to 10 %; c. II degree burns> 30 %.

(2) priority treatment

Trauma scoring 13, 14 or 15 points of the wounded, should be considered an emergency, but generally can casualty staging area with appropriate emergency treatment measures to stabilize the condition. These wounded include: a. Back injuries with or without spinal cord injury; b . 500 to 1000 ml of moderately wounded wounded; c . GCS total points> 12 of conscious head injury to wounded. The most preferred candidates for treatment were: a. wounded individuals with III degree burns < 10 % and no respiratory injury; b. casualties with II degree burns <30 % without respiratory impairment.

(3) Delayed processing

The wounded with a score of 16 points was the lightest wounded person, or at least the wounded who did not have much change in physiology after injury. The handling and evacuation of these wounded personnel was not very urgent. Including: a. Mild fractures; b. Mild burns;

c. Mild soft tissue injury: such as bruises, contusions.

(4) Treatment of casualties

The range of wounded casualties is limited to those who have suffered fatal injuries, who must have died, or whose wound scores are less than or equal to 3 points. Including: a. Grade II or III degree burns> 60 %, combined with other serious injuries; b. Severe head or chest injury; c. Severe head injury to the brain; d. No spontaneous breathing or cardiac arrest Beats more than 15 minutes, and the cardiopulmonary resuscitation is not possible due to severe injuries.

If each observation item, index, and score condition of this table can be mastered, the effect and role in practical use is quite obvious. According to the score of the trauma and the corresponding survival rate, statistics were made to prove the actual guidance of the trauma score.

A multi-color disaster casualty card division system is commonly used abroad. Its color design is as follows: red card - immediate processing; green card - sub-priority processing; yellow card - deferred processing; gray card - sudden death or death. The use of this sorting card system can provide an easily identifiable mark for the wounded and wounded and who should be prioritized and evacuated.

In addition, certain factors (see Table 3--3) as the way of injury, mechanism and the sick and wounded of age, should also be taken into account in the classification. By its very nature, the risk of death is high and some wounded, but through the rapid specialist treatment may reduce mortality, and the sick and wounded and age have a major impact on the prognosis, even if the injury is not heavy This is also the case.

Table 3 - 3 Other factors to consider when classifying

1. Damage mechanism: When any one of the following items is present, it should be quickly sent for special treatment.

1 Thoracic, abdominal, head, neck and groin penetrating injury

2 two or more proximal long bone fractures

3 Burns ( facial or airways ) with area > 15 %

4 even chest

5 Evidence that strongly affects the body

a. Falling above 18m

b. Colliding at 32km/h

c. The wounded was thrown out of the cabin

d. The passenger cabin is impacted and caught in more than 38cm

e. Deaths due to passengers in a passenger plane

2. The age of the sick and wounded:

Persons aged < 5 years old or> 55 years old should be considered for rapid evacuation and specialist treatment, especially for those who have heart and lung disease.

3. Treatment

The medical treatment measures for the wounded and sick people who must be on-the-spot first aid: On-site emergency treatment generally adopts common treatment, and the special wounded and sick person is given corresponding individual treatment. In the treatment, we must follow the principle of “preserving life first, treating illness later, being heavier and lighter, and first urging and then slowing down”, and use limited medical resources to the most urgent and most needed places. To give cardiopulmonary resuscitation, patients with shock traumatic hemorrhage should immediately stop bleeding and other shocks. For those who are dead and hopeless for treatment, it is not appropriate to expend excessive human and material resources in order to allow more and more need for medical treatment, and to treat the wounded who are in a hope of being rescued as soon as possible.

4. Forward

After the classified treatment, the wounded person was transferred to the hospital or outside the hospital. For different types of wounded and sick people, different types of vehicles can be used to transfer them. For example, the lightly wounded patients can use general vehicles, the heavier ones need ambulance vehicles, and the serious ones need emergency ambulances. In other words, for patients requiring further rescue, the patient's transfer should not be ordinary transportation, but should be transferred safely in the medical surveillance - that is, medical ambulance transportation. Medical surveillance during transit is a continuation of on-site first aid. It is the "chain" of on-site emergency and hospital emergency. The emergence of new concepts for modern medical ambulance transport has ended the traditional “universal vehicle” as the “transportation tool”, and the “transportation tool” with the basic model of “mobile hospital” or “active first aid station” has emerged. The place where the emergency patient is rescued is the concentration of the emergency room. It is a modern emergency vehicle and aircraft with transportation, rescue, and monitoring functions.

5. Report

This refers to the problem that the on-site command must coordinate to solve during the rescue or when the rescue is over, report the rescue situation to the on-site command center or the rescue unit, as well as the transfer, withdrawal, and return instructions.

6. Evacuation

After the rescue work was completed, and with the consent of the relevant authorities, the on-site emergency medical treatment was abolished and the rescue personnel evacuated and returned. When evacuating, the site should be cleaned up, inventory of equipment and equipment, and statistics work should be done.

7. Report

After the rescue work is over, the written materials will be used to report the rescue work to higher authorities, sum up experiences and lessons, put forward rectification plans, and recommend commendation of rescue personnel.

Third, on-site emergency precautions

1. Precautions for the evacuation of personnel in the affected area

(1) Do a good job of protection and then withdraw. Before evacuating personnel in the affected area, they should help themselves or help each other to wear a gas mask or a wet towel to cover their nose and mouth, and wear protective clothing or raincoats ( windbreakers ) to protect the exposed skin from damage.

(2) quickly identify the upper hand. Personnel who evacuate the site should quickly determine the direction of the wind. They can use flags, branches and handkerchiefs to identify the wind direction.

(3) Prevent secondary injuries. People in the affected areas should make use of the rapid upward movement of the vehicles to make a rapid transfer. When evacuating, you should choose a safe evacuation route to avoid crossing the center of the poison area or dangerous areas to prevent secondary injury.

(4) First aid should be implemented in a safe area. The sick and wounded person who suffers from respiratory and cardiac arrest should immediately be transported out of the affected area and immediately undergo artificial heart-lung resuscitation on the spot, and notify other medical personnel to come to the rescue, or be transferred to the nearest hospital while doing artificial resuscitation.

(5) To promote mutual help and help. Infected area personnel should help their peers withdraw from the affected area on the basis of self-rescue, and need rescue from others if they are injured or poisoned.

2. Responsible personnel entering into the affected area

(1) Rescue workers must first understand the topography of the affected area, the distribution of buildings, the danger of explosion and combustion, the types of poisons and their approximate concentrations, and choose appropriate anti-virus products. If necessary, wear protective clothing.

(2) At least 2 to 3 persons should act collectively to monitor each other. The rescue equipment used must have an explosion-proof function.

(3) The personnel entering the affected area must specify a responsible person to direct and coordinate rescue operations in the affected area. It is advisable to have a walkie-talkie contact the on-site command center and other rescue teams at any time.

3. Precautions when carrying out on-site emergency services

(1) Do your own protection. Prepare anti-virus masks and protective clothing, and pay attention to changes in the direction of the wind in the on-site emergency treatment. If emergency medical points are found to be contaminated in the downwind direction, immediately protect themselves and the sick and wounded, and quickly transfer to the safe areas. , Resetting emergency medical services on site.

(2) Implement division of labor and cooperation. In particular, the scene is the case of a large number of sick and wounded, on-site rescue personnel should carry out a division of labor, so that task to the people, clear responsibility, solidarity and cooperation.

1 Injury classification group: responsible for the initial inspection and classification of the wounded and sick.

2 Critical patient emergency team: Responsible for on-site emergency treatment of critically ill patients such as cardiopulmonary resuscitation and other emergency treatment.

3 General patient care team: Responsible for general patient treatment such as flushing, neutralization, hemostasis, bandaging, reduction, fixation, and other general ambulance work.

4 patient transport group: Assess the condition of the patient to give local treatment and arrange the transfer of the vehicle. The special patient is transferred under medical supervision.

5 On-site investigation and monitoring group: Investigation and analysis of the accident site, air monitoring, etc.

Site rescue medical team must clear a captain, vice captain of 1 to 2, responsible for on-site first aid work of organizing, directing, coordinating.

(3) First aid treatment is programmed. In order to avoid cluttering the on-site treatment work, the on-site emergency procedures that should be taken for different types of chemical accidents can be designed in advance. If the group chemical poisoning accident, can take the following steps: First remove the clothes contaminated by the wounded and sick - and then rinse - common treatment - personalized treatment - transferred to the hospital.

(4) Pay attention to protecting the eyes of the wounded and sick. In the process of medical treatment for the wounded and sick, the eyes of the wounded and sick should be protected as much as possible, and remember not to miss the examination and treatment of the eyes.

(5) Deal with pollutants. Pay attention to the treatment of the contaminated clothing of the wounded to prevent secondary damage. Especially when artificial respiration is performed on patients with certain poisonous poisons ( such as cyanide and hydrogen sulfide ) , it is necessary to guard against rescue workers from causing poisoning again. Therefore, mouth-to-mouth artificial respiration is not suitable.

(6) The procedures for delivery and receipt must be complete. For the wounded and sick after on-site emergency treatment, one person and one card ( rescue card ) should be done . The basic situation, preliminary diagnosis, and treatment measures should be recorded on the card, and should not be on the patient's chest or on the wrist for easy identification. Also facilitate the next step of diagnosis and treatment. The procedures for transferring patients should be complete.

(7) Do a good job in registration statistics. Should do a good job of statistical work on the scene of the first aid work, so that the data integrity, accurate data for the accumulation of first-hand experience in the accumulation of first-hand information. Should generally include the following: the accident unit, time, place, poison name, poisoning and injured personnel, the number of deaths, the cause of the accident, the treatment process, the degree of harm, economic losses, successful experience and lessons learned from failure.

4. Precautions for transferring to the sick and wounded

(1) Arrange vehicles properly. In the case of insufficient ambulances, emergency personnel should be transferred to critical patients in the case of medical supervision. Moderate ambulances should be arranged for moderately wounded patients, and buses or trucks can be collectively transferred for minor patients. .

(2) Reasonably selected hospital. When transferring the sick and wounded, it should be transmitted in a targeted manner according to the conditions of the wounded and sick person and the technical strength and characteristics of the nearby medical institutions, so as to avoid further referral. For example, patients with carbon monoxide poisoning should be transferred to hospitals with hyperbaric oxygen chambers nearby. Patients with brain trauma should be transferred to hospitals with brain surgery as much as possible, and those with severe burns should be transferred to hospitals that have the power to burn as much as possible. However, care must be taken to avoid delays in the rescue of hospital conditions.

On-site first aid is a complex task that requires medical rescue personnel to understand the physical and chemical characteristics and toxicity characteristics of chemical dangerous goods in addition to certain medical emergency techniques. Understand protection knowledge, but also to understand the weather and terrain environment knowledge, so that it can more effectively implement the rescue and can protect their own security. In addition, the situation on the scene is ever-changing. Rescue workers must be flexible and adaptable. Avoid mechanical and dogma.<

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