Decontamination of a Pesticide-Exposed Worker
A farm worker is brought to your decontamination station by a colleague. He was spraying a field with an organophosphate pesticide (parathion) when the hose ruptured, covering his arms, chest, and face. He is sweating profusely, has pinpoint pupils, and is drooling. He is confused and complains of nausea. His clothing is soaked. You have a decon tent with a shower, soap, water, and disposable clothing. You have Level C PPE with organic vapor cartridges. The nearest hospital is 30 minutes away and has been notified. The ambient temperature is 60°F. You have two other technicians to assist.
1. What are the immediate decontamination procedures and how do you protect yourself and others?
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PPE: Organophosphate pesticides can be absorbed through skin; wear chemical-resistant gloves (e.g., nitrile), apron, and eye protection; Level C with organic vapor cartridges is appropriate for vapors but not for direct contact. Use double gloves. Decon: Remove contaminated clothing immediately, cutting off if necessary, and double-bag. Wash skin thoroughly with soap and water, starting from head down, paying attention to skin folds. Flush eyes with water for 15 minutes if exposed. Runoff control: Contain runoff to prevent environmental contamination. Medical: Symptoms indicate cholinergic crisis; administer antidotes (atropine, pralidoxime) if trained and authorized, but priority is transport to hospital. Protection: Avoid spreading contamination; use disposable towels. Documentation: Record decon and exposure details.
2. What are the signs and symptoms of organophosphate poisoning and what is the priority for medical treatment?
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Signs/symptoms: SLUDGEM (Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis) and DUMBELS (Defecation, Urination, Miosis, Bradycardia, Emesis, Lacrimation, Salivation). Also muscle fasciculations, weakness, confusion, seizures, respiratory depression. Priority: Airway, breathing, circulation. Administer oxygen. If symptoms severe, atropine and pralidoxime are antidotes, but should be given by medical personnel. Transport: Rapid transport to hospital; decontamination before transport to protect hospital staff. Communication: Notify hospital of suspected organophosphate poisoning so they can prepare antidotes. Safety: Ensure responders wear appropriate PPE and avoid contact with contaminated clothing or vomit.