Patient 1 Zinc Phosphide 23 y/o male ingested rodent pellets: Zn 3 P - - PDF document
Using the Poison Center as a Hazmat Resource Susan Smolinske MD, PharmD, DABAT, FAACT Director New Mexico Poison and Drug Information Center Patient 1 Zinc Phosphide 23 y/o male ingested rodent pellets: Zn 3 P 2 Awake but intubated
Negative pressure
Phosphine monitoring
SCBA and Level 2
Level > STEL
Staff refused to enter
Patient self-extubated Sensor positioned at
Repositioned to staff
breathing space
Safe levels Patient reintubated
Levels rapidly dropped
Patient recovered
At 18 hours staff report strong odor in room SCBA and Ph3 sensors brought in by Hazmat
One sensor had level above STEL ICU evacuated Patient moved to negative pressure room Patient had transient anemia and pulmonary
36-year-old man presented to ED 2 hours after ingesting
Intubated, profused gray, green material came up
Material had garlic odor, causing pulmonary and ocular
Patient moved outdoors, resuscitated 1 hour and died PPE was gloves, gowns, N-95 masks, higher levels not
31 year old man
Resuscitated at the
Transported to local
Intubated Supportive care antidote
Hazmat was in the area doing a massive
Patient died and concern raised about autopsy;
The poison center was never given the IC name
Hazmat removed remaining packets of KCN
Patient called 911 reporting mercury poisoning Paramedics called Poison Center to ask about
2 paramedics + 1 firefighter arrive on scene. Patient admitted to ED for bloody diarrhea.
Patient brought contaminated grease pan with
DOH urged paramedics and firefighters to be
Ambulance used to transport patient temporarily
Jerome analyzer rented and ambulance was
Results for paramedics and firefighter were not
Patient’s house (a rental) was cordoned off after
DOH paid for an environmental consulting
Patient discharged on same day, under
EPA uses ATSDR mercury action levels:
DOH discovered the EPA has a National
Team mobilized to residence. EPA contractors conducted mercury monitoring
They tested the grease pan and clothes
Also tested the ER chair where patient sat
Ambulance tested and the biohazard bag was >
No New Mexico protocol for clearing ambulance EPA suggested action level of 3 ug/m3 for “an
Once bag removed, air in ambulance below 3
DOH + EMS Bureau then cleared (via letter) the
EPA Team conducted air monitoring for mercury
2 children playing with vial, broke in bed, estimate 1 tsp
Recommendations:
Clean up per MI guidelines Shower and change clothes (resulted in drain being
Stat blood mercury Provided DOH phone number
MD calls with mercury level of 67 mcg/L Chelation recommended directly to MD from consultant
Began to initiate process to obtain succimer
Family calls and still seeing beads in flooring after
History obtained that child has baseline developmental
Child goes to ED to get Rx and resident says admission
EPA notified and agreed to send a team
NRC notified (required to get EPA involved)
DOH notified Toxicology met EPA at patient’s home
Bedroom level exceeded limit of Lumex (> 50,000)
Required self-contained breathing protection
Clean-up efforts included
Mercury binding solution
Mercury vacuum
Heat and vent cycles
Entire room drywall and insulation removed
Two washing machines disposed (tried wash cycle with binding solution)
Wood flooring deemed the cause of remaining vapors
Sealed floor with polyurethane (ineffective)
Sealed floor with DuraPoxy (certified barrier)
Declared clear after 17 days of cleaning
Involve LEPC, NRC, DOH early if > 1 thermometer Get complete history (medical conditions, seafood consumption) Have family evacuate as soon as discovered Remove clothes and shoes then wipe with washcloth before
showering
Be more questioning about “pending labs” Wash hair with Selsun Blue or equivalent Use Selsun blue on dogs (not cats) Put all clothes, shoes and washcloths in sealed bags Figure out a better way to get succimer to patients
Call the poison center early When in doubt, remove patient’s clothes before transport to
prevent contamination in ER
We can activate Chempack and hazmat Identify an Incident Commander Double NG tube Lavage and WBI closed circuit Alert Hazmat early to obtain monitoring equipment Alert Hazmat early to obtain proper PPE Negative pressure room Limit patient movement to other areas Consult poison center regarding fatal hazmat cases
Cost analysis
PCCs save $13.00 for every $1.00 spent on PCC
It only takes 10 calls to prevent one unnecessary
We can reduce LOS (average 3 days)
We can reduce ICU overutilization We can reduce resource allocation We can reduce hospital admission costs
During a potential public health emergency or
The on-scene Incident Commander, Emergency
The Poison Information Specialist will contact
Emergency
1-800-222-1222
Cell phone issues
505-272-2222 ssmolinske@salud.unm.e
http://nmpoisoncenter.unm
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