Meth Lab Explosion

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Simusid

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The scene is detailed here and you arrive to find this patient:

20110123-002048-pic-902423692_t607.jpg


He is likely to be the meth chef and following an explosion he fled the scene on fire and ran about 1/2 mile. Speculation is that his right hand is degloving and he's obviously suffered some severe burns. I understand that some of the chemicals used to make meth are extremely hazardous (lithium?).

I'd like to know how you'd manage this scene and patient in the next few minutes. You've got plenty of manpower. I doubt he is in a state of mind to just turn and sit on a stretcher.
 
lightsandsirens5

lightsandsirens5

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Simusid said:
The scene is detailed here and you arrive to find this patient:

20110123-002048-pic-902423692_t607.jpg


He is likely to be the meth chef and following an explosion he fled the scene on fire and ran about 1/2 mile. Speculation is that his right hand is degloving and he's obviously suffered some severe burns. I understand that some of the chemicals used to make meth are extremely hazardous (lithium?).

I'd like to know how you'd manage this scene and patient in the next few minutes. You've got plenty of manpower. I doubt he is in a state of mind to just turn and sit on a stretcher.
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Hope to God ALS is available for chemical restraint! Lol!

As for the chemicals used to make meth, have you looked them up? One heck of a dangerous cocktail! Stuff like lithium, red p, lye, bleach, anhydrous ammonia, sulfuric acid, all kinds of nice stuff. Mix it all together and cook it over a propane burner. When the wallpaper starts to come off in long yellow strips, it's ready. :p Absofreakinglutly disgusting and terrible if you ask me. I mean seriously! Some of that stuff by itself will do you in.
 
Cohn

Cohn

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Give HazMat a call....


My number is... jk don't call me ;)
 
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usalsfyre

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Dangit medicRob, you were warned :p

Big question, are you too close to the scene in the first place? Anhydrous is nasty stuff.

There's a few different ways of cooking meth, and some of the chemicals involved are specific to each method. Universal to all methods is that they're fairly toxic at some point in the process. FIRST and foremost he needs decon. Grossly I'd suggest hitting him with a firehose, scrubbing and repeating till your satified. Understandyou now have a hypothemic patient in severe pain. You can't make an omlette...

Beyond that, standard treatments for blast injuries and burns, consider the need for early airway control for airway burns (likely chemical and not thermal). Transport to a burn center by approprite means, understanding HEMS may not be real keen on transporting him.
 
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adamjh3

adamjh3

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usalsfyre said:
Dangit medicRob, you were warned :p

Big question, are you too close to the scene in the first place? Anhydrous is nasty stuff.

There's a few different ways of cooking meth, and some of the chemicals involved are specific to each method. Universal to all methods is that they're fairly toxic at some point in the process. FIRST and foremost he needs decon. Grossly I'd suggest hitting him with a firehose, scrubbing and repeating till your satified. Understandyou now have a hypothemic patient in severe pain. You can't make an omlette...

Beyond that, standard treatments for blast injuries and burns, consider the need for early airway control for airway burns (likely chemical and not thermal). Transport to a burn center by approprite means, understanding HEMS may not be real keen on transporting him.
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Why would HEMS not want to Tx this guy? Other than the fact that this looks like a suburban area and a hospital's likely not more than 20 mikes away.
 
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usalsfyre

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adamjh3 said:
Why would HEMS not want to Tx this guy? Other than the fact that this looks like a suburban area and a hospital's likely not more than 20 mikes away.
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Having a $7 million airframe (the cost of a new EC145, granted most aircraft are in the 1-4 mil range) out of service for decon is usually frowned upon by operators. Not to mention if there are still fumes present the result of getting lightheaded while flying a helicopter is less than desirable...
 
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nakenyon

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Obviously going to want him decontaminated be because of all the nasty stuff associated with cooking meth. If I don't have a burn center nearby, I consider HEMS if they are willing to fly him. Regardless of HEMS or not, I request ALS for possible airway burns and pain mangagement.
 
Sassafras

Sassafras

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Sounds like a recent situation my partner told me about at his other unit. Apparently my neighbor was involved and they got in a disagreement.

Patient covered in chem burns. Neighbor says decon him. Partner says not until we know what he's covered in. Patient says "not tellin'"

Since patient won't talk, they throw him in the rig and 10 minutes into the transport, the staff get overwhelmed by fumes and now are have respiratory issues.

My question was only this..."he wouldn't tell you? Why?"

Partner said I guess he was afraid of the cops

To which I replied if he's afraid of the cops, and isn't talking I'd bet my *** it was a meth lab explosion.

Probie won the award for knowing what was going on. When the patient finally did talk after making every pass out, it was indeed a meth lab explosion.

Why hazmat wasn't called is beyond me.
 
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jjesusfreak01

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Except in extremely extreme circumstances, patients should be deconned before entering the back of the truck. Your friendly neighborhood fire fighters will be happy to oblige.
 
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Seaglass

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When in doubt, decon before anything. If you make it into the ER with a patient who's giving off fumes, you're likely to shut it down.

Then dry sterile dressings and transport. The image isn't enough to give me a good view of his face, but I'd be worried about that airway.
 
ffemt8978

ffemt8978

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jjesusfreak01 said:
Except in extremely extreme circumstances, patients should be deconned before entering the back of the truck. Your friendly neighborhood fire fighters will be happy to oblige.
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Dilution is the solution to decon. Copious amounts of Dihydrogen-Monoxide liberally applied from a safe distance.
 
medicRob

medicRob

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adamjh3 said:
Why would HEMS not want to Tx this guy? Other than the fact that this looks like a suburban area and a hospital's likely not more than 20 mikes away.
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@usalsfyre Yes, I was. he he.


Now, speaking as both a paramedic and my background in chemistry, I can speak from both perspectives.

First and foremost, in ALL Meth lab situations.. Scene Safety and Hazmat. Futhermore, you do not want Red Phosphorous (which in the case of over-heating becomes white phosphorous a military grade explosive), Iodine (or H2P02), Muriatic (Hydrochloric) Acid, or NaOH (Sodium Hydroxide, Strong Base) on you.. Moreover, the fumes given off can be deadly (Particularly in the early stages of the reduction. Also, NaH2PO2 can be quite explosive.

The fumes would be a big concern. Once the patient has been Decon'd, take airway measures as soon as possible, the patient should be in respiratory distress, but if they are not, they certainly will be soon, especially with the swelling of the airways.
 
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usalsfyre

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Simusid said:
Suppose he has 2nd degree burns over 30% of his body. Still the firehose? And what happened before that? Did we let the boys in blue rush him and wrestle him to the ground?
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Very simple. If he agrees to decon and cooperates, he gets a gentle flushing with the firehose opened part of the way. If he tries to bolt, is threatening or any action other than the above he gets a riot-style full on blast from the hose, burns or no burns. Why? Because at this point he represents a threat to not only responders safety, but to public health as well. Considering we're not sure what he's stewing in, letting him run free through the neighborhood ranks up there on the list of bad ideas. Granted you've still got runoff to contend with, but at least it won't be going in the neighbor's house taking them hostage while off-gassing. I'm not normally one for something that some would consider cruel, but there is a time and a place for everything. Once he's been knocked down and grossly deconed, walk over and ask if he wants your assistance. If he does, heavy, heavy doses of IN or IM narcotics right then and there. If not, the guys with the stainless steel bracelets will probably want to talk to him.
 
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truetiger

truetiger

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Your #1 responsibility while on duty: to go home at the end of every shift. I'm not going anywhere near this guy or this scene until hazmat has cleared it/him. My rig and myself will be in the cold zone and we'll treat this guy once they have deconned him.
 
usafmedic45

usafmedic45

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Suppose he has 2nd degree burns over 30% of his body. Still the firehose?
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Yup. You don't have any practical way of telling if they are chemical or thermal. Better to protect yourself by assuming they are chemical and treating them in such a way that it's going to stop the burning process regardless of the underlying cause.

WP is an incendiary
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Shake and bake.

which in the case of over-heating becomes white phosphorous a military grade explosive
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Pop quiz kiddies: What's the chemical historically used to treat WP burns? Why?

Bonus question: Why is WP fun at raves?
 
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