Establish<unk>  Plan
Affected patients need to stay in designated hot zones until decontaminated (staff can be injured secondary contamination inhalation of volatile gases)
Patients may arrive by EMS, private vehicle, walk ins
Establish security perimeter to enforce hot zone
Affected patients need to stay in designated hot zones until decontaminated (staff can be injured secondary contamination inhalation of volatile gases)
Patients may arrive by EMS, private vehicle, walk ins
Establish security perimeter to enforce hot zone
Protect yourself and staff
Personal chemical protective equipment:
Level A: Positive-pressure self-contained breathing apparatus (SCBA), fully encapsulated chemical-resistant suit, double chemical-resistant gloves, chemical-resistant boots, and airtight seals between suit, gloves, boots
Level B: SCBA, nonencapsulated chemical suit, double gloves, boots
Level C: Air-purification device, suit, gloves, boots
Level D: Common work clothes
Level A: Positive-pressure self-contained breathing apparatus (SCBA), fully encapsulated chemical-resistant suit, double chemical-resistant gloves, chemical-resistant boots, and airtight seals between suit, gloves, boots
Level B: SCBA, nonencapsulated chemical suit, double gloves, boots
Level C: Air-purification device, suit, gloves, boots
Level D: Common work clothes
Prehospital/In decon areas:
Hydrotherapy - irrigate skin and ocular burns immediately and continuously (>15 min)
Contraindicated only for elemental metals (Na, K)
Can allow patient to wash themselves if limited staff with protective gear
Dispose of all clothes/bandages/IVs
Hydrotherapy - irrigate skin and ocular burns immediately and continuously (>15 min)
Contraindicated only for elemental metals (Na, K)
Can allow patient to wash themselves if limited staff with protective gear
Dispose of all clothes/bandages/IVs
Contraindicated only for elemental metals (Na, K)
Aggressive supportive care, analgesia
Antidotes if available
Pulmonary involvement
O2, albuterol, intubate
O2, albuterol, intubate
Chemical burns
Strong alkali, needs irrigation for hours
IVF 3cc/kg/TBSA, 1/2 given in first 8 hours
Hydrofluoric acid burn
Calcium gluconate via topic gel (10ml 10% sol'n applied topically), SC, or intra-arterial
IV calcium gluconate and magnesium for systemic toxicity
Phenol burns
Polyethylene glycol 300 +/- isopropyl alcohol to remove phenol from skin
Nitrites
Concern for Methemoglobinemia
Treat levels >30% with HF O2 and IV methylene  blue (1-2mg/kg slow IV, not recommended for <6 y/o, >6 y/o 1mg/kg IV/IM)
Cyanide
Hydroxocobalamin (5mg IV /5 min, repeat once)
Elemental metals (Na or K)
Water is contraindicated
Cover with oil under substance can be debrided from skin
Strong alkali, needs irrigation for hours
IVF 3cc/kg/TBSA, 1/2 given in first 8 hours
Hydrofluoric acid burn
Calcium gluconate via topic gel (10ml 10% sol'n applied topically), SC, or intra-arterial
IV calcium gluconate and magnesium for systemic toxicity
Phenol burns
Polyethylene glycol 300 +/- isopropyl alcohol to remove phenol from skin
Nitrites
Concern for Methemoglobinemia
Treat levels >30% with HF O2 and IV methylene  blue (1-2mg/kg slow IV, not recommended for <6 y/o, >6 y/o 1mg/kg IV/IM)
Cyanide
Hydroxocobalamin (5mg IV /5 min, repeat once)
Elemental metals (Na or K)
Water is contraindicated
Cover with oil under substance can be debrided from skin
Calcium gluconate via topic gel (10ml 10% sol'n applied topically), SC, or intra-arterial
IV calcium gluconate and magnesium for systemic toxicity
Polyethylene glycol 300 +/- isopropyl alcohol to remove phenol from skin
Concern for Methemoglobinemia
Treat levels >30% with HF O2 and IV methylene  blue (1-2mg/kg slow IV, not recommended for <6 y/o, >6 y/o 1mg/kg IV/IM)
Hydroxocobalamin (5mg IV /5 min, repeat once)
Elemental metals (Na or K)
Water is contraindicated
Cover with oil under substance can be debrided from skin
Hazmat exposure
Caustic cocktail
Drugs of abuse
Electrical injuries
Dirty bomb
Trauma 
Gun shot wounds
Sexual assault