(I) Individual protection of on-site disposal personnel
Entering within the environment with high chlorine concentration (such as the core area of chlorine leakage where there are comatose/dead cases or dead animals, or where the on-site rapid detection of chlorine concentration is higher than 88mg/m3), it is mandatory to use air-supplied air respirators and Class A protective clothing, and to wear chlorine gas alarms; entering into the periphery of the chlorine leakage area, or When entering the area around the chlorine gas leak, or when the concentration of chlorine gas is between 1mg/m3 and 88mg/m3 in the rapid on-site detection, a comprehensive type respiratory protector (refer to GB 2890-1995) equipped with No.7/7L canisters (yellow sign/yellow+white channel sign) or No.7 cartridges (yellow sign) must be used, and a chlorine gas alarm must be worn, and there is no special requirement for the protective clothing. Entering the environment which has been opened for ventilation and the concentration of chlorine gas is less than 1mg/m3 in the rapid on-site detection, it is generally not necessary to wear PPE. On-site disposal personnel should carry communication tools when conducting search and rescue and investigation.
On-site decontamination personnel should wear full-face respiratory protection equipped with No. 7/7L canisters (yellow marking/yellow + white channel marking) or No. 7 cartridges (yellow marking), Class C suits, rubber protective gloves, and boots when decontaminating patients suffering from burns from liquid chlorine/high chlorine concentration.
Protective gear is not required for medical rescuers when treating poisoned patients in the on-site medical area.
(II) Investigation of poisoning incident
After arriving at the poisoning site, the investigator should first understand the overview of the poisoning incident. The on-site investigation includes the site environmental conditions, meteorological conditions, ventilation measures, production process flow and other related situations, and early determination of the site air chlorine concentration. At the same time, recommendations are made to the on-site commanders on the incident site control measures (e.g., ventilation, cutting off the source of hazards, etc.), individual protection of rescuers, setting up of on-site isolation zones, and evacuation of personnel.
Investigate the poisoned patients and related personnel to understand the occurrence of the incident, the time, place and mode of personnel exposure to poison, the number of poisoned personnel, name, gender, type of work, the main symptoms of poisoning, physical signs, laboratory tests and rescue process. At the same time to the clinical treatment unit to further understand the relevant information (such as the rescue process, clinical treatment information, laboratory test results, etc.).
The on-site investigation of the information to make a good record, on-site photography, audio recording, etc.. Forensic materials should have the signature of the person under investigation.
(C) the detection of chlorine concentration in the air at the scene
The site air chlorine rapid detection equipment are with gas collection device, to be detected as early as possible on the scene of the air. Detection methods recommended to use the gas tube method or portable chlorine detector (Annex 1 and Annex 2).
(4) Confirmation and identification of poisoning events
1. Confirmation criteria of poisoning events
a) Poisoned patients have the opportunity of exposure to chlorine;
b) Poisoned patients have the clinical manifestation of respiratory damage within a short period of time;
c) Poisoned site air samples with elevated concentration of chlorine, or there is a clear evidence of exposure to chlorine.
The presence of all three of the above at the same time confirms an acute chlorine gas poisoning event.
2, the identification of poisoning events
Attention should be paid to the identification of poisoning events caused by other irritant gases such as ammonia and sulfur dioxide.
(E) on-site medical rescue
The primary measure of on-site medical rescue is to quickly move the poisoned patient away from the scene of poisoning to a fresh air place, take off the contaminated clothes, loosen the collar, keep the respiratory tract open, and pay attention to keep warm. When there is a large number of poisoned patients, on-site medical rescue resources are relatively insufficient, the first on-site inspection and classification should be carried out, prioritizing the treatment of red-labeled patients.
1, on-site injury classification
a) red label, with one of the following indicators:
pulmonary edema; coma; asphyxia; corneal burns.
b) Yellow label, with one of the following indicators:
Dyspnea; skin burns.
c) Blue label, with one of the following indicators:
Tears, photophobia, eye stinging, runny eyes, choking.
d) Black label with the following indicators:
No spontaneous respiration, loss of aortic pulsation, and dilated pupils.
2, on-site medical rescue
Red labeled patients should be immediately oxygenated, the establishment of intravenous access, dexamethasone 10mg ~ 20mg intramuscular injection or diluted intravenous injection. Asphyxiation, immediately open the airway, if necessary, tracheal intubation or tracheotomy; cornea and skin, mucous membrane burns, immediately to a large number of flowing water or saline rinse burns site for more than 15 minutes; cardiac respiratory arrest, immediately to be cardiopulmonary resuscitation and other symptomatic supportive treatment. Yellow labeled patients should be closely observed for changes in condition, with conditions that can be given oxygen, and take symptomatic treatment measures in a timely manner. Blue labeled patients in the environment, not special treatment, to observe changes in condition.
3, the patient transfer
Poisoned patients by the scene first aid treatment, should be immediately transferred to the nearest general hospital or poisoning treatment center to continue observation and treatment.
Three, the collection and detection of poisoning samples
(A) the choice of collecting samples
At the scene of poisoning emergencies, air samples are the first choice of collecting samples. In addition, other sample types can be determined according to the results of the on-site investigation of the poisoning incident.
(2) Sample collection methods for rapid on-site testing
Use the gas detector method or portable chlorine gas detector, the sampling method is described in the instrument manual.