key: cord-0731937-s4s9cs3f authors: Davidson, Scott B.; Brunken, Nathan; Naughton, Shannon; VandenBerg, Sheri L. title: Burn patient decontamination outside of mass casualties date: 2020-10-17 journal: J Am Coll Emerg Physicians Open DOI: 10.1002/emp2.12280 sha: 6038dbcb0191c21221057c60559cc934de63a266 doc_id: 731937 cord_uid: s4s9cs3f OBJECTIVE: Decontamination protocols for victims of mass casualty events are well documented and emphasized to protect physicians, nurses and facilities. Decontamination practices outside of mass casualty events are unknown. This pilot study was undertaken to assess the current practices of burn patient decontamination outside of mass casualty events within level I and II trauma center emergency departments in the state of Michigan. METHODS: Using the Michigan Trauma Quality Improvement Project membership, a 10‐question online survey was sent to trauma program managers at all level I and II trauma centers in Michigan. Survey questions focused on institutional decontamination protocols and consistency of use. RESULTS: Survey response was 50%. Of the responding facilities, 31% did not decontaminate burn patients. Of the centers who indicated that they did decontaminate burn patients, 31% did not follow a standardized protocol. Our survey revealed that 69% of facilities used a protocol for decontamination: 45% used the protocol consistently on all burns, and 55% at physician discretion. Products used most frequently to decontaminate burn patients included water (100%) followed by soap (44%). CONCLUSION: This pilot survey of level I and II trauma centers in the state of Michigan revealed variability in the use of burn patient decontamination protocols and consistency of use. Additional research is warranted to determine if our results are reflective of trauma centers nationally. nurses as well as the integrity of the facility caring for these patients. [1] [2] [3] [4] Outside of the mass casualty scenario, the systematic routine decontamination of victims of chemical burns is also supported in the literature. [4] [5] [6] However, evidence of consistent decontamination of patients burned by flame and thermal mechanisms appears to be lacking. Failure to decontaminate in these circumstances may exacerbate the patient's injury as well as cause significant harm to physicians, nurses, and ancillary staff. In addition, the potential for secondary contamination impacting an emergency department or an entire hospital is a risk that could render an institution non-functional. 1,3,7-10 Structure and vehicle fires result in the breakdown of various materials such as plastics, foams, polyvinyl chloride, natural and synthetic fabrics, carpets, wood products, and asbestos-containing materials. Incomplete combustion of these materials causes many injurious chemicals to be released. Victims of these fires carry toxic substances on their clothing or skin while they are being transported and when they arrive at treatment facilities. 11 Lack of routine and timely decontamination of burn victims may result in harm to patients, those providing care, and the institution. 1,3,7-10 This pilot study was undertaken to assess the current practices of burn patient decontamination outside of mass casualty events within level I and II trauma center emergency departments in the state of Michigan. Responses to this initial survey will assist in developing an appropriate inquiry of practices nationwide. The Level III and IV trauma centers are not members of MTQIP, and therefore were not included in the survey. We did not stratify pediatric and adult trauma center responses. The survey asked if their trauma center treated and admitted burn patients, provided initial treatment only and transferred, or if burn patients were not seen or treated at their institution. We then asked if they decontaminated burn patients, and if the response was yes, the program managers were asked to indicate all types of burns they treated from a list that contained the following: flame, thermal, chem- Qualtrics analytics were used to collect and organize the survey responses. Outcomes were summarized using descriptive statistics. The response rate to our survey by trauma program managers was 50%. Of the responding centers, 18% treated and admitted burn patients, 76% provided initial treatment and transfer burns, and one center did not see or treat burns. The majority decontaminated burn patients (69%). Burn decontamination practices by type of burn are shown in Figure 1 . Our survey revealed that 69% of facilities used a protocol for decontamination: 45% used the protocol consistently on all burns, and 55% at provider discretion. Products used to decontaminate burn patients included water (100%), soap (44%), antibacterial solution (6%), and baby shampoo (6%). year was 0-10 (38%), 11-30 (25%), and >30 (31%). One center in this survey indicated that they were an American Burn Associationverified burn center. One respondent identified as a university program, 75% identified as university affiliated, and 19% identified as community programs. Survey responses by trauma center level are displayed in Table 1 . Limitations to our study include the moderate response rate to our Respondents may have modified their answers to avoid casting their institution in an unfavorable manner. This study provides an initial observation into the important process of burn patient decontamination outside of mass casualty events. Our survey of Michigan trauma centers indicated that burn decontamination is inconsistent in several aspects. Nearly one third of trauma centers in our survey did not decontaminate burn patients. Our survey revealed one third of the responding trauma centers do not use a decontamination protocol. Of the trauma centers who indicated that they did use a protocol, more than half followed the protocol only at provider discretion. This inconsistency can lead to contaminated patients being missed, thus placing physicians, nurses, ancillary staff and their institutions at risk for exposure to hazardous substances. Interestingly, our responses indicated that chemical burns were decon- The authors report no conflicts of interest. The authors have no source of funding to report. All authors made substantial contributions to the study concept, design, data analysis, and manuscript drafting and editing. Scott B. Davidson takes the final responsibility of the article. Scott B. Davidson MD https://orcid.org/0000-0002-7455-874X UD Department of Health and Human Services. Patient decontamination in a mass chemical exposure incident: national planning for communities Advanced Disaster Medical Response Manual for Providers Committee on Trauma, American College of Surgeons. Disaster Management and Emergency Preparedness A review of CBRN topics related to military and civilian patient exposure and decontamination Chemical burns revisited: what is the most appropriate method of decontamination? Water-based solutions are the best decontaminating fluids for dermal corrosive exposures: a mini review Hospital evacuations due to hazardous materials incidents The threat of secondary chemical contamination of emergency departments and personnel: an uncommon, but still occurring problem Decontamination and management of hazardous materials exposure victims in the emergency department No ED entry without decontamination for hazmat patients CBD-144. Toxic gases and vapours produced at fires. Canadian Bldg Digests MD, is a board-certified surgeon with Bronson Trauma Surgery Services in Burn patient decontamination outside of mass casualties