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Pain assessment plays an integral role in the ongoing efforts to improve overall pain management in the acute care setting. This chapter overviews the pain assessment process and outlines some pain rating tools that have been useful in the acute care setting. Some form of explicit pain assessment is necessary, since studies in myriad patient populations have failed to identify consistently reliable surrogate markers for pain. Despite pitfalls in self-reported pain scores, it is important for the objective pain rating to come from the patient. In clinical practice, the most commonly used rating scale is the verbal numeric rating scale. The advantages of the verbal numeric rating scale include ease of administration and high agreement with the visual analog scales used in most clinical pain management studies in acute care. In older adults who are cognitively intact, numerical rating scales or simple verbal reports of pain categories are preferred.
This study describes the epidemiology of hazardous materials (hazmat) incidents in Fresno County, California, and analyzes the emergency medical services (EMS) response to these incidents.
The study area has a population of 635,000 people living in an area of 6,004 square miles.
All Hazmat Emergency Response Team (HERT) reports and related prehospital, emergency department, and inpatient records from ljuly 1988 through 30 June 1989 were reviewed retrospectively.
There were 107 hazmat incidents involving 156 materials consisting of pesticides (24.4%), miscellaneous chemicals (17.3%), corrosives (16.7%), petroleum products (13.5%), airborne toxins (10.2%), organic solvents (7.7%), unidentified chemicals (5.1%), infectious medical waste (1.9%), empty containers with radioactive warning symbols but without detectable radiation (1.3%), heavy metals (1.3%), and alkali metals (0.6%). In ten (9%) of the 107 incidents, 68 patients required on-scene evaluation and 26 patients were transported to emergency departments. Four of these patients required admission, three because of injuries due to vehicular accidents, and one because of a coincidental cere-brovascular accident. Five incidents produced multiple victims from exposures to airborne toxins, accounting for 63 (93%) of 68 patients. Spills of solid or liquid pesticides occurred in four incidents involving patients. Ambulance personnel and/or equipment became contaminated in three of these four incidents.
1) Ambulances should be dispatched selectively to hazmat incidents because only 9% of incidents involved patients. 2) training should emphasize personnel protection and proper patient decontamination to help prevent contamination of EMS personnel and equipment. 3) Preparation of EMS personnel should emphasize exposure to airborne toxins because these produced 93% of patients.
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