YAS crews may on occasions (rarely) bring us a Major Trauma patient that meets the criteria for bypass to the MTC because they have a problem that the crew cannot manage, or they won’t survive to LGI e.g. an unmanageable airway/ incompressible haemorrhage. In these instances we will get a pre-alert either from the crew or more likely the Major Trauma Triage Co-ordinator in EOC with some information but primarily the reason the patient is coming to us.
Category: MAJAX
Paediatric Blast Injury
Save the Children, have published a used full guide on management on blast injuries in children. Taking you through pre-hospital, ED and inpatient care.
Although blast injury is rare in the UK it’s worth a read as an adjunct to APLS/ATLS training.
- Recognising “Blast Lung” – which may be subtle initially and develop over hours (p51)
- Prophylactic antibiotics
- Compartment syndrome and fasciotomy (p105)
- Burns Fluids and escharotomies (p112)
Massive Transfusion Pathway
In the case of patient with Massive Haemorrhage weather that be from Trauma, Surgical, O&G, UGIB, you can activate the MTP
Remember:
- Do the Basics – don’t forget ABCD
- Inform Transfusion and get someone to run a G&S sample down
- FFP can take up to 45min and platelets come from Leeds
- If you no longer need the MTP – inform transfusion and return products ASAP
Major Incident/MAJAX Guide
NHS England have published this fantastic resource [Click here] covering Major Incidents including; gunshot, crush, nerve agents and much more.
This is not to replace our trusts “Major Incident Plan”, however its a great learning resource and worth going through Read more
2. HAZMAT – Suspected Contamination Incident
So a patient comes to ED after white powder thrown is at them what do you do? Your initial response can help them and everyone in the department!
- Ask them to leave the department
- Going to garage was useful
- Inform Nurse in Charge and Consultant
- Dynamic risk assessment
- Performed by nursing/medical staff while outside
- Decontaminate
- Non-caustic chemicals: Dry decontamination
- Caustic, Biological, Radiological: Wet decontamination
- Retain clothing and wipes, double bagged as evidence/disposal
- Patient Disrobing Instruction Card
- Return to ED
If you haven’t seen the Initial Operational Response (IOR) training video please watch it.
The patient can then be thoroughly assesses, to identify the substance involved (this may involve witnesses, police info and symptomatology), and treated appropriately.
- Public Health England are a useful source of advice.
- Organophophate/Nerve agent – PHE
Police should be informed of the incident for several reasons: 1. Public safety, 2. To collect the evidence and possible find out what it was for you. (if this is not a criminal act Public health England can advise on return/disposal of personal effects)
Inform Manager On-Call of incident as it may disrupt the functioning of ED and can provide support.
Patient symptom-free and substance unknown
In our recent case Public Health England advised
- 4-6hr observation
- Discharge with advice:
- “if developing symptoms to return to the ED via ambulance but the patient must be aware that they must inform 999 of the original exposure.”
Resourses
- Public Health England (PHE) Advice – Lines
- PDF: PHE – Organophosphate – Inc. signs/symps and management of organophosphate poisoning & chain of evidence form
- Action Card – mobile patients
- NHS England (HAZMAT/CBRN) – inc. national stocks
- Home Offices (2015)
- Disrobing – pg 20
- DRY decontamination – pg 21
- WET decontamination – pg 22
Paediatric Ketamine Sedation
RCEM 2022 Safe sedation in the ED and RCEM Ketamine for paediatric procedural sedation guideline. Please read these documents in full or participate in RCEM learning for further information.
Adult Sedation
This guideline is a brief summary of the RCEM 2022 Safe sedation in the ED and RCEM – Pharmacological Agents for Procedural Sedation and Analgesia in the Emergency Department – March 2019. Please read these documents in full or participate in RCEM learning elearning for further information. Read more
3. HAZMAT – CBRNe (Chemical, Biological, Radiological and Nuclear) incidents
NHS England, Public Health England and the Health Protection Agency have produced several very useful resources for us to use – BUT First.
Remove – Remove – Remove
Basics
Contacts
- Health Protection Agency Teams – HERE
- West Yorkshire
- In hours: 0113 386 0300
- Out of hours: 114 304 9843
- West Yorkshire
-
ECOSA (Emergency Coordinated Scientific Advice System) – 0300 3033 493
- UK NPIS – 0344 892 0111
Guides
- PHE: CBRNe Guide – covers from initial contact to specific threats
- HPA: New Disease New Threats – images and info to aid identification
- PHE: Suspected Novichock in ED – guide to management
- NHS England: Guide to Major Incident and Mass Casualty – covers most MAJAX issues inc. ballistics, explosive, chemical
- Local: Ram-Gene – External Radioactive Contamination
- PHE: Radiation (internal only) – we have Rotem Ram-Gene
1. HAZMAT – First Contact
REMOVE – REMOVE – REMOVE
Remove Them..
At reception ask them to go outside to designated area and staff will be with them shortly. Inform Nurse in Charge!
Remove Clothes..
Use the disrobing card to get the patient to safely remove and bag up clothes. Do your best to maintain privacy. CARD HERE
Remove Substance..
- Burning/Irritant – WET-Decon HERE
- Not Burning/Irritating – DRY-Decon HERE
- Patient Disrobing instruction Card
If we have ample warning or the number of patients will be significant, it may be worth deploying the decontamination tent but remember setting this up is time consuming.
Rare Antidotes – how to get
Getting some of the rarer antidotes has recently been clarified across Yorkshire (Accessing rarely used antidotes-SOP)
