CBRN Phosgene Oxime (CX) Exposure with Penetrating Trauma

Set in a woodland environment, the learner responds to a scene where there was an attack and suspected dirty bomb. The patient has suffered a gunshot wound to the left chest, developing tension pneumothorax that requires decompression. There is blood in the chest when a tube is placed and the patient will be hypotensive and tachycardic, requiring blood resuscitation along with TXA. Appropriate decontamination should be completed in conjunction with medical management.

Learning Objectives

– Recognizes potential hazardous material exposure and calls for appropriate supplies for decontamination

– Appropriately mitigates exposure risk to minimize exposure and contamination:
a. Dons appropriate PPE, including an appropriate mask, and gloves
b. Identifies environmental threats including vapor hazard, liquid, confined space and low oxygen environments
c. Moves the casualty away from the threat or agent, using the principles of fresh air, upwind, uphill, upstream, time, distance and shielding

– Assesses casualty to determine agent of concern, conducting triage and recognizing symptoms:
a. C – Consciousness
b. R – Respirations. Are they present, labored, or absent
c. E – Eyes, pupil size
d. S – Secretions. Are they increased or absent
e. S – Skin. Is there diaphoresis, cyanosis, is it dry and hot

– Evaluates the casualty at the point of injury for life threats and performs immediate interventions if indicated

– Identifies severe traumatic brain injury and performs appropriate interventions

– Performs a secondary assessment and efficient decontamination at the Dirty CCP
a. Evaluates circulation
b. Prevents hypothermia and evaluates for potential head injury
c. Prepares for extraction

– Performs a visual contamination and detector check before crossing the cold line