9.4  Organizing the Emergency Chain

it possible to take action during the first 10 s and generally avoid the consequences of chemical splashes, even with solids. The use of an active rinsing solution in lieu of water is a key to success. If the risk is multifaceted, it is essential to have polyvalent solutions, such as Diphoterine®, in order not to waste time in identifying the burning agent. A wrong specialist solution could aggravate the problem.

9.3.2  After an Accident

on the Public Highway

The lack of suitable emergency facilities and, often, of qualified staff may lead to situations that get complicated. Recommending quick rinsing with water and training the population is one of the keys to facilitating subsequent treatment. The accident at home follows this scheme unfortunately too often. Following misuse by a child or because of mishandling, it is highly regrettable that families are not aware, as in industrial environments, of the hazards posed by household products and of what to do in case of splashes.

9.3.3  Industrial Accidents

Accidents, such as that in Bhopal or the explosion of an ammonia lorry in Dakar, involve a very large number of casualties. The time to set up the emergency services and the complexity of a 15-min rinse with water require the use of active solutions to reduce the time to action and expect a sufficient reliable effect by stopping the action of the chemical, pending possible management in suitable hospital facilities.

9.3.4  Attacks

They can be likened to industrial accidents, by the number of casualties and their unexpected nature associated with everyday life, such as in the underground or in department stores, or during special events, such as sporting events or big concerts. In this case, emergency facilities are always prepositioned. The use of an active positive solution avoids having to identify the product, which delays management too much, and stops the aggressive action of the product before appropriate treatment. The advantage of polyvalent solutions is that they can be used easily and delegated to nonspecialists, if necessary.

9.3.5  Lack of Initial Care

Finally, there is a case where the injured has not been administered care before arrival at the hospital, which may be several hours after the accident. If the symptoms unfortunately appeared and progressed, it is absolutely necessary to stop the action of the chemical before initiating treatment. Polyvalent active solutions, such as Diphoterine®, are the most effective solutions to stop the chemical, avoid aggravation, and consider secondary therapy under the best possible conditions.

9.4  Organizing the Emergency Chain

The keys to successful management of a chemical casualty are the following:

•Early rinsing reduces complications, and action during the first 10 s is ideal. Action during the first minute will usually avoid complications with a polyvalent active solution.

•Water rinsing complicates emergency aid when there are a large number of casualties because of its ineffectiveness and the amounts necessary for a 15-min rinse.

•Whatever the time between the accident and management, effective rinsing is always essential to be able to administer suitable care thereafter. Stopping the action of the chemical and removing it is key to successful subsequent treatment.

•The risk assessment and prepositioning of emergency facilities, as well as personnel training in occupational environments will usually avoid disasters, because management can be very quick.

•Training the population into the need for early rinsing increases the chances of success.

•The need for identifying the chemical is always a waste of time, which delays the critical effect of rinsing.

•Calling specialist structures as early as possible reduces the time of action of the dangerous product.

The organization of the emergency chain should answer the following questions on:

1.The number of persons involved

2.The awareness of the risk

3.The possible prepositioning

9.5  Treatment of Ocular Injury:

The Importance of the Emergency Chain for Care

9.5.1  Emergency Chain Definition

The emergency chain, in the management of chemical splashes in the eye both in occupational and domestic environment is that allowing quick and coordinated management of any type of emergency to limit morbidity or mortality.

In traumatology, it is easy to understand that any delay in management can but aggravate the injuries, all the more as the aggression is “persistent,” as that due to a corrosive chemical. In such a situation, each lost second results in longer contact with the human tissue. The chemical injury aggravates with a real risk of very quick loss of tissue vitality.

Broadly, the emergency chain involves:

1.Early alert

2.Suitable first care

3.Specialist care, if necessary

In a traumatic situation that is not immediately lifethreatening, a “response sheet” such as the following can be proposed:

1.Quick recognition of the type of problem and alert

2.Action to remove the risk or move away from the risk

3.Detailed care protocols

9.5.2  Safety Obligations

The safety of witnesses and first aiders is essential. That is why, during missions of the mobile emergency medical services, the first fundamental gesture is that which ensures the safety of the team.

Therefore, in any emergency, whatever its seriousness, the practical and effective sequence will always be of the following type:

1.Quickly recognize the type of problem and, if possible, the precise nature of the risk to trigger a first “simple” alert level.

2.Shield the victims and response persons from the risk or move them away from the risk.

3.Alert the emergency medical care services (112, emergency number in Europe).

4.Administer first care or have first care administered or, if necessary, send the victim to structures that may make more specific diagnostic reviews and decide the implementation of specialist care.

Chemical risk is usually quickly recognized but often more easily and quickly in occupational environments than in domestic environments, less “trained” in this type of situation.

Removing the risk or moving away from the risk is, unfortunately, easier to say than to do. Contrary to “fire or explosion” risks, which are more visible and brutal, chemical risks are more insidious. However, when they are recognized, only quick reaction will affect mortality and morbidity.