29.03.2013 Views

115 08/02 PARAMEDIC DISASTER CACHE Table ... - LAFD Training

115 08/02 PARAMEDIC DISASTER CACHE Table ... - LAFD Training

115 08/02 PARAMEDIC DISASTER CACHE Table ... - LAFD Training

SHOW MORE
SHOW LESS

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

<strong>PARAMEDIC</strong> <strong>DISASTER</strong> <strong>CACHE</strong><br />

<strong>Table</strong> Of Contents<br />

I. INTRODUCTION<br />

II. ACTIONS OF MEDICATION<br />

III. INDICATIONS FOR USE<br />

IV. DIRECTIONS FOR USE<br />

V. PRECAUTIONS FOR USE<br />

VI. MEMBER EXPOSURES<br />

<strong>115</strong> <strong>08</strong>/<strong>02</strong><br />

VII. STORAGE AND SECURITY PROCEDURES<br />

VIII. REPLACEMENT PROCEDURES<br />

IX. CONCLUSION


<strong>Training</strong> Bulletin #<strong>115</strong><br />

August 20<strong>02</strong><br />

Page 2<br />

I. INTRODUCTION<br />

Paramedic Disaster Cache Boxes are being placed into service following<br />

the September 11 terrorist attacks and are to be used in the event of a<br />

hazardous chemical emergency. Cache boxes will be distributed to all<br />

two-paramedic ALS units. The Cache Box consists of 30 Mark-I Auto-<br />

Injectors for treating nerve agent exposures (refer to <strong>Training</strong> Bulletin 107)<br />

and 36 Amyl Nitrite Ampules (three boxes of 12 ampules each) for treating<br />

cyanide exposures. Each cache is secured in a gray plastic box, and is<br />

sealed with a small green padlock seal.<br />

II. ACTIONS OF MEDICATION<br />

Cyanide compounds are highly toxic, causing harm by interfering with the<br />

body’s use of oxygen. Cyanide poisoning essentially causes suffocation in<br />

the victim by inhibiting the use of oxygen in metabolic pathways.<br />

Cyanide binds to iron within the cell, preventing it from using oxygen to<br />

produce energy. The oxygen metabolism at the cellular level is grossly<br />

hampered, which in turn leads to anaerobic metabolism. Cyanide is rapidly<br />

absorbed from the stomach, lungs, mucosal surfaces and unbroken skin.<br />

Amyl Nitrite (AM-il NYE-trite) is related to the nitrate family of medications.<br />

Amyl Nitrite is classified as an antianginal, antidote to cyanide poisoning<br />

and a diagnostic aid to determine cardiac functioning.


<strong>Training</strong> Bulletin #<strong>115</strong><br />

August 20<strong>02</strong><br />

Page 3<br />

Nitrites change the iron in hemoglobin to a form of iron, which binds<br />

cyanide (methemoglobin). Once cyanide is attached to methemoglobin, it<br />

is much easier for the body to metabolize and excrete with the help of a<br />

sulfur compound, which is administered in the Emergency Department<br />

(Lilly-Cyanide Antidote Kit).<br />

Amyl Nitrite comes in a glass ampule covered by a protective<br />

cloth. The cloth covering allows for the EMS responder to crush the glass<br />

capsule between your fingers, without causing injury.<br />

III. INDICATIONS FOR USE<br />

SIGNS AND SYMPTOMS OF CYANIDE POISONING<br />

Low Exposure Headache, faintness, vertigo, anxiety, burning in the<br />

mouth and throat.<br />

Moderate Exposure Nausea, vomiting, diaphoresis, flushed skin, tachypnea,<br />

tachycardia, hypertension. Bitter almond odor on breath.<br />

High Exposure/Lethal Bitter almond odor detected on breath, ALOC to<br />

unconsciousness, seizures, bradycardia, respiratory<br />

depression, hypotension, cardiac dysrhythmias &<br />

pulmonary edema. Note: absence of cyanosis may be<br />

present.<br />

The Amyl Nitrite ampules should only be used by trained personnel, after<br />

the following events have occurred:<br />

• All personnel have removed themselves from the affected area and<br />

initiated emergency decontamination (Mark-I auto-injectors and<br />

amyl nitrite ampules may be used prior to decontamination).<br />

• One or more of the following symptoms are present:<br />

• Altered Level of consciousness<br />

• Seizures<br />

• Apnea or patients requiring assisted ventilations


<strong>Training</strong> Bulletin #<strong>115</strong><br />

August 20<strong>02</strong><br />

Page 4<br />

IV. DIRECTIONS FOR USE<br />

TREATMENT BASED ON PORTAL OF ENTRY<br />

Inhalation Remove victim from exposure. Administer high flow oxygen. If<br />

breathing ceases, begin BVM ventilations. Do NOT use mouth-tomouth<br />

resuscitation. Administer antidote, if indicated.<br />

Skin Contact Remove victim from exposure. Immediately remove all contaminated<br />

clothing. Wash and decontaminate with copious amounts of water.<br />

Administer antidote, if indicated.<br />

Eye Contact Immediately irrigate with water for minimum of ten minutes.<br />

Administer antidote, if indicated.<br />

Ingestion Do not give anything by mouth. Administer antidote, if indicated.<br />

Cyanide Treatment Algorithm<br />

Low Exposure Apply high flow oxygen via mask, observe for deterioration. Make<br />

Base Contact. Decontaminate if indicated.<br />

No antidote is necessary.<br />

Moderate Exposure Apply high flow oxygen via mask, observe for deterioration, monitor<br />

respirations and LOC. Cardiac monitor and venous access. Make<br />

Base Contact. Decontaminate if indicated.<br />

Administer antidote in a seated position, if indicated:<br />

- Crush ampule<br />

- Place in a 4x4 Gauze<br />

- Allow victim to hold antidote and inhale vapor for 60 seconds<br />

- Administer a new ampule every 2-3 minutes<br />

Repeat all steps until IV antidote is available in the Emergency<br />

Department. Treat Cardiac dysrhythmias, seizures and hypotension<br />

as indicated per LA County Treatment Care Guidelines and DHS<br />

High<br />

Exposure/Lethal<br />

Reference 806.<br />

Assist ventilations via BVM. Venous access and cardiac monitor.<br />

Make Base contact. Administer antidote:<br />

• Crush ampule<br />

• Tape to inside of Mask/BVM<br />

• Ventilate for 60 seconds<br />

• Remove ampule<br />

• Ventilate for 15 seconds<br />

• Administer a new ampule every 2-3 minutes<br />

Repeat all steps until IV antidote is available in the Emergency<br />

Department<br />

Treat cardiac dysrhythmias, seizures and hypotension as indicated per<br />

LA County Treatment Care Guidelines and DHS Reference 806.


<strong>Training</strong> Bulletin #<strong>115</strong><br />

August 20<strong>02</strong><br />

Page 5<br />

Additional actions to be taken:<br />

• Contact Haz-Mat resources according to <strong>LAFD</strong> protocol indicated.<br />

(reference:<strong>LAFD</strong> policy)<br />

• Secure area and establish incident site according to <strong>LAFD</strong> protocol.<br />

( reference: <strong>LAFD</strong>)<br />

• A laminated quick-reference sheet will be placed inside each cache<br />

box as a reference.<br />

V. PRECAUTIONS FOR USE<br />

1. Side effects of Amyl Nitrite administration may include:<br />

• Orthostatic hypotension<br />

• Flushing of the face and neck<br />

• Headache<br />

• Nausea/vomiting<br />

• Dizziness/lightheadedness<br />

If conscious, treat in a prone/seated position.<br />

2. Ensure decontamination procedures are completed before<br />

transport to receiving facility.<br />

3. Wear personal protective equipment.<br />

VI. MEMBER EXPOSURES<br />

During combustion of nitrogen-containing natural and synthetic<br />

products(wool, silk, plastics), large amounts of cyanide can be produced.<br />

Over 300,000 tons of cyanide byproducts are produced annually in the<br />

U.S. and most are commonly found in the following:<br />

• Printing Industry<br />

• Agricultural/Fumigants<br />

• Photography<br />

• Manufacturers of paper and plastics<br />

• Electroplating and metallurgy


<strong>Training</strong> Bulletin #<strong>115</strong><br />

August 20<strong>02</strong><br />

Page 6<br />

A member who is exposed while on-duty to toxic dust, fumes or vapor<br />

such as those present in nitric acid spills, chlorine leaks, organic<br />

phosphate insecticides and hallogenated hydrocarbons, shall be handled<br />

as follows:<br />

1. Decontaminate member following prescribed procedures outlined in<br />

Book 37, Hazardous Materials.<br />

2. Immediately treat signs and symptoms utilizing BLS or ALS protocols<br />

as needed.<br />

3. If necessary, transport the member to the appropriate medical facility<br />

adhering to proper protocol.<br />

4. Complete the following notifications, reports, and records:<br />

• Notify the on-duty EMS Captain (if member transported)<br />

• Notify the Medical Liaison Unit during Business hours or On-call (if<br />

member is transported)<br />

• Notify the Department Safety Officer if the situation has the<br />

possibility of creating an unusual safety hazard or deemed<br />

appropriate by the incident commander or supervisor on-scene -<br />

Bus. Hours/on-call<br />

• F-2 entry<br />

• PRB entry<br />

• F-166B (if member is transported)<br />

• DWC-1 (if member is transported or seeks medical care)<br />

• Haz-Mat Exposure Report (NSS)<br />

• Contact Medical Alert Center at (323) 722-8073, if the cache is<br />

used during a medical emergency (refer to DHS Reference 807.)<br />

VII. STORAGE/SECURITY PROCEDURES<br />

Amyl Nitrite is a controlled drug, and therefore, shall be secured in the<br />

following way:<br />

• The Paramedic Disaster Cache will be inventoried with the other<br />

controlled drugs at least daily and anytime there is a change in<br />

personnel.<br />

• The inventory will consist of verifying the lock number on the<br />

disaster cache case. This will be recorded on the Daily Controlled<br />

Drug and Key Inventory Form (Reference No. 7<strong>02</strong>.2).<br />

• Whenever the lock is changed or broken, a manual count of the<br />

amyl nitrite and Mark-I auto-injectors shall be conducted and<br />

recorded in the F-2, Journal, and on the Daily Controlled Drug and<br />

Key Inventory Form (Reference No. 7<strong>02</strong>.2).


<strong>Training</strong> Bulletin #<strong>115</strong><br />

August 20<strong>02</strong><br />

Page 7<br />

VIII. REPLACEMENT PROCEDURES<br />

A damaged, unserviceable, or opened Paramedic Disaster Cache<br />

must be stocked or exchanged on a one-for-one basis. Replacement<br />

of lost or stolen kits, or contents, shall be requested on an F-225 with<br />

an F-80 Stores Requisition. The F-225 shall be forwarded to the<br />

Bureau of Emergency Services.<br />

Restock of any part of the Paramedic Disaster Cache will be done<br />

through the District Captain. A laminated tag, with the drug expiration<br />

dates, will be attached to the exterior of the cache. As the medication<br />

nears its expiration date, a one-for-one exchange shall be done to<br />

ensure security of the medication.<br />

IX. CONCLUSION<br />

Amyl Nitrite is useful as a temporizing measure for patients with cyanide<br />

toxicity until definitive care can be provided. Amyl Nitrite administration<br />

should never preclude airway, breathing and circulation. The mainstay of<br />

prehospital therapy is rapid removal from the exposure site and<br />

administration of high flow oxygen. As always, attention to scene safety<br />

and use of proper PPE remain paramount.

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!