Mass Illness and Mass Exposure (Agent)

From bug spray to paint fumes and mace to carbon monoxide, there are numerous reasons why large numbers of people may experience similar symptoms. As an EMS provider, intentional exposures (such as terrorism) and accidental exposures (laced medications, spreading illness, spills, asbestos, etc.) should all be treated suspiciously until proven otherwise.

Common and recent examples of exposure events

Nursing home, day care or cruise ship residents sick with a virus
90+ people overdosed on K2 in Connecticut park over 2 days
12 people treated after accidental mace discharge in store in Massachusetts
Nearly 30 people treated for opiate exposure at Ohio jail
USPS employees had to give up clothing after mercury spill in Norfolk
10 people sent to hospital for fumes from coral in home fish tank in England
5 people critically ill/dead after exposure to nerve gas in England (two separate events)
12 hotel guests sickened by carbon monoxide leak at hotel in Texas

Key points to remember

Be aware. Be suspicious.
- It isn’t “normal” for large numbers of people to suddenly experience symptoms at the same time
- Do the surroundings match the story? If you get called to a chlorine leak at a swimming pool and see people coughing with watery eyes, that may fit. If you see those same people at a mall, that is not normal.
- Is this a high value target?
- What are the symptoms/signs?
Call for help
- If you are first to arrive or early, make notifications
- Set a staging area based on size, type, wind, etc.
Limit your exposure
- Apply appropriate PPE
- Stage at a safe distance
- Don’t touch unknown substances or known dangerous ones
- Follow command instructions for staging, entry, etc.
- Know hot, warm, cold zone areas
- Don’t become a victim
Don’t relocate the incident
- Corral patients-give them a task, keep them calm, separate sick from not sick
- Call the nearest hospital as soon as feasible
  - They can prepare for your arrival
  - They might get POV patients before you transport
- Decon as appropriate and as necessary

What can you do to be more prepared?

Know the signs and symptoms of various types of chemicals/drugs/illnesses.
- “SLUDGEM” is indicative of nerve agent and organophosphates/pesticides
- Know the difference between opiate and other drug signs and symptoms
Check out Appendix J in the TEMS protocols for CBRNE and Hazmat treatment guidelines: http://tidewater.vaems.org/tidewater-ems-council/protocols/2016-tems-protocols/2016-apendixes/2204-appendix-j-hrmmrs-cbrne-and-hazmat-protocols-2016/file
Check out various documents that cover signs and symptoms, treatment and/or PPE:
- Nerve Agents: http://www.naemt.org/docs/default-source/ems-preparedness/nerve-agent-info-for-ems-hospitals_08-21-2018_final.pdf?sfvrsn=9710c892_0
- Fentanyl/Opiates: https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final%20STANDARD%20size%20of%20Fentanyl%20Safety%20Recommendations%20for%20First%20Respond….pdf
- Emerging infectious diseases: http://www.vdh.virginia.gov/emergency-medical-services/emergency-operations/emerging-infectious-diseases-information/
- Emergency Response Guidebook (and app!): https://www.phmsa.dot.gov/hazmat/erg/emergency-response-guidebook-erg
- DEA Drugs of Abuse: https://www.dea.gov/sites/default/files/2018-06/drug_of_abuse.pdf
- Carbon Monoxide: https://www.cdc.gov/co/faqs.htm
Various types of situations and emergencies:
- Various hazards: https://emergency.cdc.gov/hazards-specific.asp
- NIOSH: https://www.cdc.gov/niosh/
- OSHA: https://www.osha.gov/

As always, be safe, be suspicious, and never stop learning!