JIST

Mass disaster due to toxicological exposure: a challenging task

Anand Mugadlimath, Mandar R Sane

Mass fatality is any situation in which there are more human bodies to be recovered and examined than can be handled by the usual local resources. In other words, anything which is overwhelming to the local mortuary services at that given time. Mass disasters are usually due to natural disasters or traffic fatalities; however, toxicological mass disasters pose special challenges. Mass toxicological events can be caused by chemical terrorism, accidents, combustions, consumption of poisonous substances [1] or leaks. [2] The situation drastically escalates to high levels when such deaths are due to totally new and unusual causes, e.g., the Bhopal Gas tragedy [3] or Minamata disease. There is an element of fear and uncertainty which further worsens the chances of protection and  dignified handling of the dead.

In the event of a mass toxicological incident, usually the morbid patients vary in severity and may range from mild patients to critically affected patients with compromised respiratory system. Such patients outnumber the fatalities and are managed in emergency areas of the hospitals. However, fatalities need a tailor made approach for management at the morgue and need necessary steps to be taken. These steps include[2]:

1.         Safety of the scene: The safety of the scene must be assessed, and clearance issued by the appropriate agency (chemical weapons disposal squad etc.) before the evaluation team enters. The evaluation team should be able to evaluate -the potential or real number of fatalities, condition of the bodies, level of  ytluc
fidin recovery – types and numbers of personnel and equipment needed etc.

2.         Ensure maximum protection for medical personnel: Toxicological agents in fatalities reporting to the morgue may not be  identified and in such a scenario, handling of corpses may pose additional risk to mortuary staff. The doctrine for managing such events should include guidelines tailored to the substance and severity of the exposure. As a matter of concern, it is advised that medical personnel & and mortuary staff should wear appropriate protective gear which may include Personal Protective Equipment (PPE). Such PPE must be readily available to all staff and protocols should be in place for proper disposal of PPE after its use.

3.         Removal of contaminated clothing: Remove the contaminated clothing of the corpses to prevent further exposure or spread of toxicological compounds to the body handlers. Emergency Departments are well equipped for such decontamination as it is the designated place for conducting decontamination of the victims reporting exposure to the same compound. Proper disposal of such contaminated clothes must be ensured.

4.         Triage[4]: Usually, hospital triage is divided into categories depending on the severity of the victims. As regards fatalities, corpses can be divided into two broad categories i.e., deaths due to certain toxicological exposure