Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-23T18:30:29.276Z Has data issue: false hasContentIssue false
  • English
  • Français

Lessons Learned from Chlorine Intoxications in Swimming Pools: The Challenge of Pediatric Mass Toxicological Events

Published online by Cambridge University Press:  28 June 2012

Ofer Lehavi ,
Adi Leiba ,
Yehudit Dahan ,
Dagan Schwartz ,
Odeda Benin-Goren ,
Rama Schwartz ,
Arie Augarten ,
Josef Ben-Ari ,
Yoram Ben-Yehuda  and
Gali Weiss
...Show all authors
Ofer Lehavi
Affiliation:
Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
Adi Leiba
Affiliation:
Home Front Command Medical Department, Israel
Yehudit Dahan
Affiliation:
Home Front Command Medical Department, Israel
Dagan Schwartz
Affiliation:
Israeli National EMS (Red Shield of David), Israel
Odeda Benin-Goren
Affiliation:
Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
Rama Schwartz
Affiliation:
Schneider Children Hospital, Petach-Tikura, Israel
Arie Augarten
Affiliation:
Safra Children Hospital, Sheba Medical Center, Israel
Josef Ben-Ari
Affiliation:
Pediatric Intensive Care Unit, Dana Children Hospital, Tel-Aviv, Sourasky Medical Center, Israel
Yoram Ben-Yehuda
Affiliation:
The Edith Wolfson Medical Center, Holon, Israel
Gali Weiss
Affiliation:
Home Front Command Medical Department, Israel
Yeheskel Levi
Affiliation:
Israel Defense Forces Medical Corps, Surgeon General Headquarters, Israel
Yaron Bar-Dayan*
Affiliation:
Home Front Command Medical Department, Israel
*
16 Dolev St. Neve Savion Or-Yehuda, Israel E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

The classical doctrine of mass toxicological events provides general guidelines for the management of a wide range of “chemical” events. The guidelines include provisions for the: (1) protection of medical staff with personal protective equipment; (2) simple triage of casualties; (3) airway pro-tection and early intubation; (4) undressing and decontamination at the hos-pital gates; and (5) medical treatment with antidotes, as necessary. A number of toxicological incidents in Israel during the summer of 2005 involved chlo-rine exposure in swimming pools. In the largest event, 40 children were affected. This study analyzes its medical management, in view of the Israeli Guidelines for Mass Toxicological Events.

Methods:

Data were collected from debriefings by the Israeli Home Front Command, emergency medical services (EMS), participating hospitals, and hospital chart reviews. The timetable of the event, the number and severity of casualties evacuated to each hospital, and the major medical and logistical problems encountered were analyzed according to the recently described methodology of Disastrous Incident Systematic Analysis Through-Components, Interactions, Results (DISAST-CIR).

Results:

The first ambulance arrived on-scene seven minutes after the first call. Emergency medical services personnel provided supplemental oxygen to the vic-tims at the scene and en route when required. Forty casualties were evacuated to four nearby hospitals. Emergency medical services classified 26 patients as mild-ly injured, 13 as mild-moderate, and one as moderate, suffering from pulmonary edema. Most children received bronchodilators and steroids in the emergency room; 20 were hospitalized. All were treated in pediatric emergency rooms. None of the hospitals deployed their decontamination sites.

Conclusions:

Event management differed from the standard Israeli toxico-logical doctrine. It involved EMS triage of casualties to a number of medical centers, treatment in pediatric emergency departments, lack of use of protec-tive gear, and omission of decontamination prior to emergency department entrance. Guidelines for mass toxicological events must be tailored to unique scenarios, such as chlorine intoxications at swimming pools, and for specific patient populations, such as children. All adult emergency departments always should be prepared and equipped for taking care of pediatric patients.

Keywords

chlorine intoxicationmass-casualty incidentmass toxicological eventpediatricsswimming pool
Type
Research Article
Information
Prehospital and Disaster Medicine , Volume 23 , Issue 1 , February 2008 , pp. 90 - 95
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Israeli Ministry of Health: Mass Toxicological Event Doctrine for Hospitals. MTE Committee. October 2004.Google Scholar
2. Szinicz, L: History of chemical and biological warfare agents. Toxicology 2005;214(3):167–181.CrossRefGoogle ScholarPubMed
3. LoVecchio, F, Blackwell, S, Stevens, D: Outcomes of chlorine exposure: A 5-year poison center experience in 598 patients. Eur J Emerg Med 2005;12(3):109–110.CrossRefGoogle ScholarPubMed
4. Parimon, T, Kanne, JP, Pierson, DJ: Acute inhalation injury with evidence of diffuse bronchiolitis following chlorine gas exposure at a swimming pool. Respir Care 2004;49(3):291–294.Google Scholar
5. Vinsel, PJ: Treatment of acute chlorine gas inhalation with nebulized sodium bicarbonate. J Emerg Med 1990;8(3):327–329.CrossRefGoogle ScholarPubMed
6. Sexton, JD, Pronchik, DJ: Chlorine inhalation: The big picture. J Toxicol Clin Toxicol 1998;36(1–2):87–93.Google ScholarPubMed
7. Agabiti, N, Ancona, C, Forastiere, F, et al. : Short-term respiratory effects of acute exposure to chlorine due to a swimming pool accident. Occup Environ Med 2001;58(6):399–404.CrossRefGoogle ScholarPubMed
8. Di Napoli, A, Agabiti, N, Ancona, C, et al. : Respiratory effects of exposure to chlorine vapors during a swimming pool accident in a recreational center in Rome. Epidemiol Prev 2002;26(5):240–247.Google Scholar
9. Decker, WJ: Chlorine poisoning at the swimming pool revisited: Anatomy of two minidisasters. Vet Hum Toxicol 1988;30:584–585.Google ScholarPubMed
10. Decker, WJ, Koch, HF: Chlorine poisoning at the swimming pool: An over-looked hazard. Clin Toxicol 1978;13(3):377–381.CrossRefGoogle Scholar
11. Wood, BR, Colombo, JL, Benson, BE: Chlorine inhalation toxicity from vapours generated by swimming pool chlorinator tablets. Pediatrics 1987;79:427–430.CrossRefGoogle Scholar
12. Sexton, JD, Pronchik, DJ: Chlorine inhalation: The big picture. Clin Toxicol 1998;36:87–93.Google ScholarPubMed
13. Leiba, A, Schwartz, D, Talor, E, et al. : DISAST-CIR—Disastrous incidents systematic analysis through components, interactions and results application to a large-scale train accident. J Emerg Med 2007. Online.Google ScholarPubMed
14. Epler, GR: Diseases of the Bronchioles. New York: Raven Press, 1994, pp 204–206.Google Scholar
15. Urbanetti, JS. Battlefield Chemical Inhalation Injury. In: J, Loke, (ed.) Pathophysiology and Treatment of Inhalation Injuries. New York: Marcel Dekker, 1988, pp 281–348.Google Scholar
16. Avitzour, M, Libergal, M, Assaf, J, et al. : A multicasualty event: out-of-hospital and in-hospital organizational aspects. Acad Emerg Med 2004;11(10):1102–1104.CrossRefGoogle ScholarPubMed