Clinical care in the "Hot Zone"

Abstract

The threat of chemical, biological, radiological and nuclear incidents is unlikely to decrease and preparations to deal with this type of incident are well established in most European emergency medical systems. In the UK medical care is not currently provided in the ''Hot'' or contaminated zone. This article discusses the background to the current threat and suggests that, where survivors are present in the ''Hot Zone'', medical care should be started there to minimise delay and maximise the chances of survival.

Comparison of powered and conventional air-purifying respirators during simulated resuscitation of casualties contaminated with hazardous substances

“…Until recently it has been criticised that the UK medical response to a CBRN incident only started after the decontamination of casualties 20. Consequently, the UK Department of Health introduced the first units of Hazardous Area Response Teams to enable paramedic life support at the site of agent release.…”

Chest Compression With Personal Protective Equipment During Cardiopulmonary Resuscitation

“…1,2 Prompt medical care just after CBRN incidents can minimize delay and maximize the chances of survival. 3,4 As decontamination following a CBRN incident requires a minimum of 12 min per casualty to complete, 4 most of the time, healthcare workers (HCW) who wear CBRN—personal protection equipment (PPE) have to performed time-critical resuscitation procedures within the warm zone (between contaminated and decontaminated areas) prior to decontamination. 5,6 …”

“…According to the classification of US Environmental Protection Agency, PPE ranges from A to D, of which level C is commonly used by HCW as a minimum to attend a community emergency response plan. 3,4,6,7 However, although rigid prerequisites for the protective ability of PPE are obviously essential, it is also important to know whether the equipment impedes HCW during clinical procedures, particularly cardiopulmonary resuscitation (CPR) events such as external chest compression (CC) and endotracheal intubation. 8 …”

Utility of the Pentax-AWS in performing tracheal intubation while wearing chemical, biological, radiation and nuclear personal protective equipment: a randomised crossover trial using a manikin

“…Prompt advanced airway interventions following a CBRN incident can be directly associated with increased patient survival 3. However, time-critical airway interventions should be instigated within the warm zone prior to decontamination, while wearing CBRN-personal protective equipment (PPE),4 5 because decontamination following a CBRN incident requires a minimum of 12 min per casualty to complete 6…”