Chlorine Release at the Community Pool
At 14:20, 11 people arrive from a community pool after a chlorine tablet spill. Three are children aged 6 to 10; two adults have severe dyspnea and cough; four are walking and complain of eye irritation; two are asymptomatic but worried. The emergency department has two decontamination showers and six negative-pressure rooms. Wind is blowing toward an elementary school 300 m away. Staff report a strong bleach odor in the ambulance bay. One child is drooling and has stridor. The hospital has not activated its external disaster plan.
1. What immediate actions should occur before and during patient entry, and how should decontamination be prioritized?
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Activate the external disaster plan and notify poison control and public health. Secure the ambulance bay and keep contaminated patients outside until decontamination is ready. Staff should wear chemical-protective PPE with fit-tested respirators. Remove patients' clothing and personal items, wash skin with soap and water, and irrigate eyes. Contain runoff to avoid contaminating the department.
Chlorine gas is heavier than air, so move patients to fresh air and keep them upright. Do not induce vomiting or give activated charcoal. The child with drooling and stridor needs immediate airway assessment, oxygen, and preparation for advanced airway management; stridor after chlorine exposure may reflect upper airway edema. Prioritize the two showers for the child and the two adults with severe dyspnea, then supervise walking patients for self-decontamination. Asymptomatic patients still need observation because pulmonary edema can be delayed. Do not let decontamination delay emergency airway care for the child.
2. Use a triage framework to sort the 11 patients and explain how you would allocate the two showers and six rooms.
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Immediate: the child with stridor and drooling, the two adults with severe dyspnea, and anyone with SpO2 below 90% or altered mental status. Delayed: the four walking patients with eye irritation and cough but normal oxygenation; observe and reassess. Minimal: the two asymptomatic patients; register them, provide eye wash, and give return precautions.
Allocate showers first to the child and the two severe adults, one at a time. Use the second shower for walking patients with supervision. Reserve negative-pressure rooms for the most symptomatic patients and for aerosol-generating procedures; cohort walking patients in a monitored area. Because wind is toward the school, notify incident command and public health to consider shelter-in-place; do not wait for laboratory confirmation. Reassess all patients at 30 and 60 minutes for delayed pulmonary edema, and document the triage rationale.