Abstract

This interim guidance is aimed at healthcare workers who may receive patients exposed to chemical weapons at their healthcare facilities. The guidance follows the case management flowchart on the next page. It provides questions to guide the identification of contaminated patients, recommendations on personal protection, procedures for decontamination, guidance for triage and identification of categories of exposure, and treatment regimens for individual chemicals. Users should study the contents of this document carefully and apply the principles and framework to their own situation and health care facilities. Clinical work in this field should be accompanied with complete and practical training.

PROTECT YOURSELF AND OTHER PERSONNEL
KEY PRINCIPLES
> Healthcare workers are mainly exposed to toxic chemicals through direct contact
with the agent on patients’ skin / clothing or by inhalation or mucosal contact
with a vapour hazard.
> The effective use of PPE is dependent on availability, training and an
understanding of the mechanisms of secondary exposure.
> Appropriate standards and levels of PPE are dependent on the resources at
different healthcare facilities and on the properties of the chemical agent.
> All PPE confers a loss of mobility, dexterity, vision and ability to communicate
freely. PPE also places an increased physiological burden on the user.
> Even at higher levels of protection, PPE does not completely eliminate the risk of
agent penetration due to eventual break-down in protective barriers.
> PPE should be removed carefully to avoid touching contaminated areas. It should
be removed in a designated location and disposed of as hazardous waste
General principles should be employed to provide a minimum level of staff p
Personal Protective Equipment (PPE) is essential to first responders and personnel responsible for decontamination, triage and emergency treatment at the healthcare facility. The main contact hazard can be prevented by wearing appropriate gloves (nitrile or butyl rubber, not latex). The number and thickness of the gloves used will depend on the dexterity required by the user. Chemically-resistant clothing should
also be worn if available. If not available, then as a minimum disposable, fluidresistant clothing or gowns should be utilized and regularly changed. Standard medical and surgical masks offer no respiratory or mucous membrane protection from toxic vapours.
An air-purifying respirator, e.g. with an activated charcoal filter, or selfcontained breathing apparatus is required. Respirators require training, safety testing and fit testing. They can only be worn by users for limited time periods.

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