弗雷德·哈斯（Fred Haas）
Providing care to a patient suffering the effects of chemical exposure presents a challenge to emergency medical responders. Symptoms of exposure are often vague, masking a potential illness. Patients may require decontamination, a skill that is not performed routinely. The treatment of some chemical exposures involves antidotes not found in the everyday emergency medical services (EMS) medical kit. A ToxMedic program may benefit departments as they address serving these patients.
毒剂是EMS提供者，他们接受了有关危险材料暴露的医疗保健培训。培训的数量和类型将取决于您服务的当前人员人员类型和级别。例如，消防服务EMS提供商可能已经对技术人员的水平进行了基线危险品培训。他将已经熟悉风险评估，暴露途径，个人防护设备（PPE）和去污。将需要进行毒理学，化学暴露生理学和使用解毒疗法的其他培训。另一方面，主要执行EMS操作的系统很可能还需要在传统EMS培训中未涵盖的Hazmat响应技术中进行培训。
There are many goals behind establishing a ToxMedic program; of primary importance is responder safety. A ToxMedic works closely with the safety officer to ensure that risks are identified and minimized. In addition, responders are informed about possible chemical symptoms to quickly recognize exposure. ToxMedics work in the “warm zone,” triaging patients entering the decontamination process. They quickly identify those exposed and symptomatic to direct urgent decontamination and treatment. Finally, ToxMedics provide the medical support to the hazmat response team. This can include medical monitoring and surveillance, rehab assessment, and treatment of team members suffering illness or injury. Although ToxMedics are prepared to care for civilian patients exposed to chemicals, the same antidotes used on patients will also benefit responders who become affected while operating on scene. This concept is the most valuable reason to implement a ToxMedic program in your department.
The first step a department should take in determining the need for a ToxMedic program is to conduct a needs assessment. Are there medications that do not exist under your current EMS standard of care? What level of hazmat experience do your EMS responders possess? What are the chemical risks in your community that require special medical treatment considerations? Many existing programs were established with the risk of chemical terrorism in mind. Although this unknown risk is something for which you need to prepare, remember that the treatment of many chemical weapons of mass destruction will be similar to treatment of industrial chemical exposures. A ToxMedic program will be beneficial in high-profile events as well as in many of the common operations you face every day.
回答上面的问题需要一些再保险search and outreach. Your department will benefit from identifying key stakeholders in the community who can provide information and resources to help implement your program. An important first contact is the department’s medical director or the local authority that regulates EMS responders. Determine what medical resources already exist. Will you need to make any changes to the EMS scope of practice to allow for new antidote medications? Hospitals may already have preparedness efforts in place; EMS can partner to extend those resources to the incident scene.
State, county, and local emergency management agencies (EMAs) are also important allies to help you to not only identify local needs but also provide assistance in locating resources necessary to establish a program. A community’s local emergency planning committee is a source of information to determine what chemicals are present in your region. That list may identify specific risks based on amounts present or medical impact. Using that chemical inventory will allow your planners to evaluate the need for any special antidotes.
Also, don’t forget your own department resources. Review incident reports on hazmat responses to determine what chemicals your department routinely sees. Your preplanning can be used to identify chemical risks. While making contacts to conduct site surveys, assess existing treatment capabilities at that location. Some industries have medical treatment facilities and may already have antidotes available. In these situations, the chemical facility will initiate care. Protocols and policies will be required to permit EMS responders to continue this care during transport.
从逻辑上讲，有许多部署模型可以最好地满足您部门的需求。每个EMS单元都可以配备设备和解毒剂，以确保在任何事件中都会出现毒药单元。该模型在库存大量药物时提出了挑战。到期日期加上不使用的日期意味着经常交换过时的药物；这导致成本增加。
A second deployment option would be to equip special units only. Perhaps the department has special operations vehicles that respond to incidents involving hazardous materials. Stocking a limited number of units lowers costs. However, consider the possibility that one of these special vehicles may be assigned elsewhere and may not be available for a needed response.
除了部署药物外，另一个问题是您部门的人员将培训成为该计划的一部分。毫无疑问，培训是您部门在建立有毒计划时遇到的最大障碍。培训时间，回填以提供覆盖范围，课程材料和学费，都可以迅速加起来。与解毒剂的部署一样，在培训医务人员时，有许多选择要考虑。
较小的部门可能会受益于培训所有人员。可以通过该部门的继续教育工作来完成毒品培训。对于大多数州的重新认证流程，可用的许多培训计划值得多个小时的信用。通过训练所有人，很容易确保将在任何有毒暴露的现场出现毒剂。
In a larger department, training everyone may not be practical, financially and for skill retention. These departments may opt to train a small cadre of providers who staff units typically assigned to hazmat incidents. This plan has the advantage where the department can invest training resources to a small number of medics, providing more intense training.
Before reviewing training, review an example of how one department developed its ToxMedic program. Sussex County (DE) Emergency Medical Services (SCEMS) is a third-party advanced life support (ALS) service. EMS is provided in cooperation with 21 basic life support ambulances operated by volunteer fire departments throughout the county. SCEMS staffs eight dual-medic, nontransport ALS units along with two district supervisors on duty each shift. Initially, each medic truck had a fully stocked “ToxBox” (photo 1) as part of its equipment supply. ToxBox contents are listed in Table 1.
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| （1）作者的照片。 |
特拉华州EMS医疗办公室directors (with strong involvement by state ALS providers) developed ToxMedic protocols to address the needs of the state’s industrial base as well as to prepare for chemical terrorism. Each county ALS service is free to implement the program in a manner that best meets its individual needs. SCEMS initially trained 20 paramedics—all members of the Hazardous Materials Medical Response Team. ToxMedics were split among four shifts. Initially, this worked well, but as shift assignments changed and promotions occurred, keeping the roster balanced among four shifts proved challenging. Also, as previously mentioned, stocking and maintaining 10 ToxBoxes full of antidotes presented its own challenge.
To address these challenges, SCEMS recently changed its deployment model to remove the antidotes from the standard field units. This allowed it to maintain better stocked kits on the two supervisor units. An EMS supervisor routinely will be present on the scene of any major incident, including hazmat. This system has been more efficient and just as effective. Your challenge will be to set up a deployment method that bests suits your department and community.
There are many existing training programs to consider when educating your medics; Table 2 lists just a few. Departments should research these training programs to determine which works best to meet their needs; include your medical director and those developing the care protocols in this decision. Some of these programs can be run for no cost through preparedness grants. Contact your local EMA for assistance.
基于非火灾部门的EMS提供商可能需要额外的Hazmat培训。技术员级培训为响应者提供了场景规模，研究，净化和PPE的经验。尽管Toxmedic的主要作用是处理安全和医学，但技术人员级培训提供了对现场其他响应者正在处理的情况的理解。SCEMS Toxmedics除了高级Haz Mat Life Support类外，还获得了完整的技术人员课程。
持续医学教育是ToxMedIC计划的主要组成部分。需要年度复习培训才能维持技术人员认证。由于很少使用药物和方案，因此所有毒剂都应定期收到更新和协议审查。可以组织设备以帮助记住协议。在SCEMS中，Toxbox是一份口袋指南，列出了每个TOX协议并包括解毒剂信息。指南是颜色编码以匹配协议和解毒剂的。例如，抗胆碱能治疗方案是蓝色的。用于治疗抗胆碱能暴露的阿托品和pralidoxime的小瓶周围有蓝色胶带，使其易于识别（照片2）。
Frequent drilling will not only refresh toxicology and treatment knowledge, but it will also identify areas where standard treatments may not work in a hazmat environment. For example, the majority of antidotes are administered intravenously. As paramedics drill, they quickly identify that tactile skills, such as establishing an intravenous (IV) line, are difficult to perform while wearing high levels of hazmat PPE (photo 3). As an alternative, departments may look to other routes for medication access such as intraosseous (IO) devices (photo 4). The majority of antidotes may be administered through an IO if an IV cannot be established.
气道管理是许多有毒暴露的关键干预措施之一。早期保护的气道为否则会屈服于伤害的患者提供了足够的通风。佩戴PPE时进行气管插管将对护理人员提出另一个挑战（照片5）。使用双lumen气道或其他不需要气道可视化的设备可能是毒剂的重要补充（照片6）。
A ToxMedic program is a valuable addition to a department’s hazardous materials incident response. It can effectively treat patients exposed to toxic chemicals using specialized antidotes and, more importantly, it can be an important asset to ensure the health and safety of your firefighters and emergency responders.
FRED HAAS，NREMTP，是苏塞克斯县（DE）紧急医疗服务（SCEMS）的医护人员区主管。他是一名毒和危险材料技术人员，SCEMS的危险材料医疗响应小组。Haas还是特拉华州紧急医疗服务办公室和Selbyville（DE）志愿消防公司的EMS队长的紧急准备协调员。
弗雷德·哈斯（Fred Haas）将于4月11日（星期五）上午10:30至下午12点至15点在印第安纳波利斯（FDIC）举行的2014年FDIC。
188金宝搏是正规吗消防工程档案
