医院如何对核化生突发事件受害者进行洗消的探讨

核化生突发事件发生后的人员洗消是应急医学救援的重要组成部分,对于终止中毒、防止对施救者和环境的污染,降低或消除事件后果均具有重要意义。目前,关于人员洗消的研究主要集中在新型洗消剂与洗消技术的研究^[1-2]、突发事件现场的洗消方法与程序2个方面^[3]。然而,核化生突发事件发生后,救援医院往往是核化生突发事件受害者第一时间出现的地方,     

核化生恐怖袭击现场医学救援中的洗消技术介绍

核化生恐怖袭击发生后,最有效的消除方法之一就是洗消,如处置不当易造成二次污染,使大批伤员得不到有效救治。目前,我国拥有先进的组合式洗消装备,有对多种对象实施洗消作业的多功能快速洗消装备,以及对染毒人员进行自救处理的个人洗消装备,形成了功能全面、技术手段齐备、能有效清除核生化污染的装备体系,为核化生恐怖袭击等应急条件下医学救援的顺利开展提供了强大的技术装备支撑。     

核化生恐怖袭击现场救援中洗消技术研究进展

核化生恐怖袭击发生后,最有效消除灾害影响的方法是洗消。现场医学救援队洗消组所承担的主要任务就是对污染伤员和从污染区撤出的救援队员进行洗消,并负责对污染物进行封存和处理。洗消方式：（1）物理洗消,主要是通过高压冲洗使毒剂水平降低,一般用于进行其他洗消前的初步消毒;     

沾染液体火箭推进剂时的个人洗消技术进展

目的 回顾与分析国内外有关沾染液体火箭推进剂时个人洗消技术和方法的研究资料，提出有效的个人洗消技术和方法，以尽可能地避免染毒或减轻染毒伤员的伤害程度。资料来源与选择 结合我们已进行的有关研究和参加抢救的临床救治体会，并引用国内外公开发表的相关论文及著作。资料引用 论文28篇及3部专著。资料综合主要针对个人洗消技术的有效性与安全性对文献作者采用的方法和指标进行分析和综合。结论 迅速及时地进行有效的洗消，以尽早彻底清除沾染的毒物，是防治液体火箭推进剂中毒的首要措施，可以明显避免或减轻染毒伤员的伤害程度。     

防疫尖兵迅驰援境外救灾赢赞誉

尼泊尔发生8.1级地震后，第十四集团军奉命组建防疫队，于5月3日分两批乘军机从昆明飞抵加德满都，主要担负加德满都周边城镇和乔塔拉附近州县的震后消毒防疫任务。该防疫队由60名防化、卫生等专业官兵组成，携带各型防护服150套、洗消器械90台（件）、消毒药剂5吨，在加德满都和乔塔拉两线作业，共计出动1091人次，消杀灭面积达71.9万平方米，洗消直升机8架、遇难者遗体4具、动物尸体1.1万头（只）、开展水源水质检测7处、处理垃圾200余吨、发放（英语和尼泊尔语）防疫常识宣传手册6000余份，为尼泊尔军队培训防疫骨干3批162人次，并为尼泊尔留下了洗消器械50余部、洗消药剂2.2吨，为尼泊尔军队留下了一支“带不走的防疫队”。     

美国陆军环境健康研究中心简介

1概况美国陆军环境健康研究中心（USACEHR）位于美国马里兰州的德特里克堡,其原来是一个生物战测试实验室,隶属于美国陆军医学研究和装备司令部（USAMRMC）下辖的陆军医学研究与开发实验室（USABRDL）。     

关于生物战剂的洗消问题

敌人使用生物武器,特别当喷洒生物战剂气溶肢时,可造成环境、物品与人体等广泛污染。生物战剂的洗消即是指用物理学或化学方法将上述污染对象表面的生物战剂杀灭或清除以使之无害化的处理。 什么情况下需要进行洗消实施全面的生物战剂洗消,消耗的人力与物力是     

洗消灵用于餐具消毒效果观察

洗消灵用于餐具消毒效果观察武警北京二总队医院田润明，张奎江，赵国增，耿润罗（北京１０００３９）洗消灵是一种无毒、高效含氯消毒洗涤剂，对微生物有较强的快速杀灭作用。我们自１９９０年应用该消毒剂对食堂餐橱具进行消毒收到良好的效果，现报告如下。１材料和方法...     

外军卫勤研究系列讲座(12)以色列核化生防护的组织体制及主要做法

1概况由于特殊的历史和国情,早在20世纪60年代中期,以色列议会就通过一项法律,要求为每位公民都配备防毒面具和阿托品注射器等防护装备。海湾战争后,以色列每位公民的家庭中都配备了个人防护装备。可以说,以色列在全民核化生防护方面处于世界一流水平。2组织体制以色列的核化生防护工作主要由国防部、卫生部和环境部负责。2·1国防部国防部系统中与核化生防护工作相关的部门主要有核化生防护局、后方司令部和国防军医疗部队。(1)国防部核化生防护局。该局始建于海湾战争后,主要任务是研究开发与核化生防护相关的技术和装备。①职责范围:制定核化生防护的研发方向;管理核化生防护的基础设施;发展核化生防护的研究实验室或研究中心;组织进行核化生防护研究项目的可行性论证;研制大规模防护装备等。②工作内容:制定个人和集体防护方案;研发侦检工具与方法;进行污染洗消;实施医学治疗;进行核化生威胁分析与危险评估;研究污染物质的扩散规律;为以色列国防军提供核化生防护政策和威胁分析方面的咨询。(2)国防军后方司令部。其职责是:战时指挥国家紧急应对部门开展工作;为以色列公民提供一系列防护措施,如制定建筑物的耐受标准、发放与保养个人防护装备、管理疫苗和医疗服务...     

战时数字化卫勤保障研究进展

1美军数字化卫勤保障 1．1概述美军于1975年建立了三军医疗信息系统,于1985年开发了“综合医疗信息收集系统（CHCS）”。根据综合信息管理计划（CIM）,美军开发了国防血液供应标准系统、国防医疗后勤标准保障系统、国防牙科标准系统和战区卫勤信息系统。为了加强伤员后送过程中的管理,美军开发了“运输司令部管理、指挥与控制伤员后送系统（TRACCES）”。1993年,美军开始野外试验远程医疗系统,并确认为“21世纪部队”使用技术和装备。这些系统的开发和应用,显著提高了伤病员救治率,降低了伤残率。     

Operation Castle Cascade: managing multiple casualties from a simulated chemical weapons attack

In the wake of the recent terrorist attack on the United States, there is an ever-increasing need for the defense against weapons of mass destruction. The use of explosive devices in combination with chemical agents could result in a community disaster with multiple traumatic and medical injuries. Military medical personnel may be the first called upon due to their unique training and equipment. Operation Castle Cascade was a large-scale exercise on a military instillation involving the apprehension of hostages and detonation of an explosive device containing dimethyl sulfate. We will provide details on the medical management of 50 patients with simulated chemical and traumatic injuries. Issues relating to on-site chemical identification, triage, decontamination, treatment, casualty collection, and transportation of casualties are addressed in this article.     

南京日遗化武处置的医学防护和毒剂洗消

侵华日军在第二次世界大战结束时,将大量化学武器遗弃在我国境内。目前,中日双方正对部分日遗化武进行联合处置。作为任务的医疗保障和应急救援力量,针对日遗化武处置现场化学事故具有突发性、复杂性、破坏性等特点,本文对可能发生的化学战剂事故进行医学防护和洗消方面的探讨,有利于提高对日遗化武危害性的认识和应急处置能力,减少和避免日遗化武处置过程中对相关人员的伤害和环境污染,更好地完成好日本遗弃在华化学武器处置的医学保障任务。     

How would military hospitals cope with a nuclear, biological, or chemical disaster?

In any nuclear, biological, or chemical (NBC) attack, it is clear that the hospitals may be overwhelmed with casualties. In these deliberate accidents, there will be an additional problem of contamination. Military hospitals must be prepared for NBC disasters with a detailed incident plan. Within this plan, decontamination facilities and shower systems are needed primarily to protect the hospital from self-contamination. Physical and collective protection measures of the staff should be taken into account, with evacuation routes under such an attack. Within this conjunction, the required equipment, including protective suits, detection means, drugs, antidotes, and vaccines, should be provided and stored properly. Qualified personnel should be assigned to the NBC first-aid and rescue team organized within the hospital, equipped, and trained according to such a possible task. Medical staff must be aware of the effects of the agents, and must be experienced in decontamination and first-aid to victims exposed to these agents. Therefore, this information must be put into practice by giving attack scenarios and responses to the hospital administration. It can be conclusively pointed out that military hospitals especially should be better prepared than any other civilian health unit to such attacks of weapons of mass destruction.     

防化医学研究现状及未来发展策略

目的总结国内外防化医学研究现状和发展动态,提出未来我国防化医学发展方向和建设重点。方法采用情报调研方法,检索近10年来国内外相关领域研究论文、综述、研究报告和论著,分析该学科领域取得的新进展和发展趋势。结果国外防化医学新进展主要体现在化学战剂现场快速侦检装备研发及在体生物标志物检测技术的建立;在神经性毒剂及全身中毒性毒剂损伤防治药物,以及窒息性毒剂及糜烂性毒剂致伤机制研究上,均取得显著进展,相关创新性研究成果已装备部队。国内防化医学新进展主要包括：基本形成针对重点化学战剂损伤医学防护能力;较好完成防化医学的任务职能定位与转型;将防化医学研究领域由单纯应对化学战拓展至化学突发事件、化学恐怖袭击等非战争军事行动应急医学救援。结论未来的防化医学研究,应以需求为牵引,在注重对传统化学战剂损伤防治药物研究的同时,更加关注非传统化学战剂、化学恐怖剂及军事作业相关毒物损伤效应和防治措施研究。     

Evaluations over the medical emergency responding to chemical terrorist attack

The use of chemical warfare agents intentionally has become a great concern in the arena of the cold war. On the other hand, there has always been a threat on civilian population due to their mass destruction effects, including psychological damage and a great deal of discussion how to respond to it in terms of medical management. It is very important to provide the best lifesaving medical care and triage in a chemical-contaminated area. Mass casualties exposed to chemical agents require immediate medical intervention to save their lives and should be classified in accordance to medical care priorities and available medical sources, including antidotes and sophisticated health facilities. Establishing the decontamination area for chemical casualties where it is located at the suitable place with respect to the wind direction is necessary. To overcome the mass destruction effects of chemical warfare agents following the terrorist attack, we must have the emergency medical response plan involving experienced triage officers and medical care providers to be able to perform medical management in the chemical-contaminated area and health facilities.     

Treatment of chemical and biological warfare injuries: insights derived from the 1984 Iraqi attack on Majnoon Island

The potential use of chemical and biological weapons, while being banned by international treaties, has never been higher than now. The current Persian Gulf crisis, and the easy availability of these weapons by "terrorist nations," makes the danger all too real. The experience derived from the Iraqi attack on Majnoon Island demonstrates the devastating effects of these weapons when used during modern warfare. Exposure to the agents used during the 8 years of the Iran-Iraq War results in a triad of injuries: skin burns, ocular damage, and pulmonary distress. Specific antidotes are available for some agents used in warfare; however, the clinical presentation following exposure to the different toxins is extremely similar, making a bedside diagnosis of the specific agent involved almost impossible. The Majnoon Island experience has shown the value of prevention, when possible, and decontamination, of both casualties and equipment. The prompt implementation of general treatment strategies, as well as specific antidotes, are paramount for the successful management of patients after a chemical weapons attack.     

Clinical aspects of percutaneous poisoning by the chemical warfare agent VX: effects of application site and decontamination

O-ethyl S-(2-diisopropylaminoethyl) methylphosphonothioate (VX) is an extremely toxic organophosphate nerve agent that has been weaponized and stockpiled in a number of different countries, and it has been used in recent terrorist events. It differs from other well-known organophosphate nerve agents in that its primary use is as a contact poison rather than as an inhalation hazard. For this reason, we examined the effects of application site and skin decontamination on VX toxicity in anesthetized domestic swine after topical application. VX applied to the surface of the ear rapidly resulted in signs of toxicity consistent with the development of cholinergic crisis, including apnea and death. VX on the epigastrium resulted in a marked delayed development of toxic signs, reduced toxicity, and reduction in the rate of cholinesterase depression compared with animals exposed on the ear. Skin decontamination (15 minutes post-VX on the ear) arrested the development of clinical signs and prevented further cholinesterase inhibition and death. These results confirm earlier work that demonstrates the importance of exposure site on the resultant toxicity of this agent and they also show that decontamination postexposure has the potential to be an integral and extremely important component of medical countermeasures against this agent.     

装甲车辆舱内有害气体自动监测与净化装置研究

目的研制适用于装甲车辆舱室环境的有害气体自动监测与净化装置。方法系统设计为传感器组、控制器和空气净化机3个模块,采用集成化和数字化测试技术、物理吸附结合化学催化技术以及耐低温与抗冲击减振技术研制样机,并对样机进行模拟实验和环境适应性实验。结果样机实现了对模拟舱内CO、NO2、SO2、挥发性有机物(VOCs)和烟/粉尘实时监测与自动净化的功能,启动14～16 min后舱内有害气体浓度均符合相关标准规定。结论该装置净化效果明显,满足装甲车辆车载设备环境适应性要求,具备了应用于实车的技术条件。     

装甲车辆舱内有害气体自动监测与净化装置研究

目的研制适用于装甲车辆舱室环境的有害气体自动监测与净化装置。方法系统设计为传感器组、控制器和空气净化机3个模块,采用集成化和数字化测试技术、物理吸附结合化学催化技术以及耐低温与抗冲击减振技术研制样机,并对样机进行模拟实验和环境适应性实验。结果样机实现了对模拟舱内CO、NO2、SO2、挥发性有机物（VOCs）和烟/粉尘实时监测与自动净化的功能,启动14～16 min后舱内有害气体浓度均符合相关标准规定。结论该装置净化效果明显,满足装甲车辆车载设备环境适应性要求,具备了应用于实车的技术条件。     

Laboratory conditions and safety in a chemical warfare agent analysis and research laboratory

Toxic chemicals have been used as weapons of war and also as means of terrorist attacks on civilian populations. Research focusing on chemical warfare agents (CWAs) may be associated with an increased risk of exposure to and contamination by these agents. This article summarizes some of the regulations concerning designation and safety in a CWA analysis and research laboratory and medical countermeasures in case of an accidental exposure. The design of such a laboratory, coupled with a set of safety guidelines, provides for the safe conduct of research and studies involving CWAs. Thus, a discussion of decontamination and protection means against CWAs is also presented.