104 MEDICAL RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY FICHE Treating the injured persons in the operating theatre ACTION TO TAKE IN A 1ST LINE HEALTHCARE FACILITY 35 Prepare the operating theatre • Close the ventilation system: operating theatres function under positive pressure with or without air recycling. This ventilation system must be closed. In the case of an open circuit, it may even be under slight negative pressure. • Protect the operating theatre: install vinyl sheeting (pre-cut, number and draw a positioning plan) and protect the biomedical equipment with transparent covers. Particular situations • “Stripping” the patient: if the victim has not been intubated, it is vital to protect the respiratory tract at this stage. • Bronchial aspiration: keep the suction probe to measure the contamination. • Wound: prepare the skin, working from the periphery towards the centre. Trim the wounds using detection equipment. The use of an intraoperative probe set to X-ray mode to detect sentinel nodes is an interesting option. • Tissue excision: send the tissues (see sampling procedure) for anatomopathological examination. Before a surgical intervention, the patient is undressed if possible in a dedicated room identified in advance. Responders • Healthcare facility personnel: RRH RN and other 1st line healthcare facilities + Adapt the medical management TYPE OF PATIENT LEVEL OF RISK APPLICABLE MEASURE Decontaminated: no external contamination None Usual precautions (personnel in usual operating theatre clothing). Has fixed contamination Low Dedicated (or protected) operating theatre and medical team in surgical clothing. Incompletely decontaminated For example: non-decontaminated wound Moderate Dedicated operating theatre and medical team protected (Personal Protective Equipment – PPE – appropriate for the operating theatre). Cases of Absolute Urgency (AU), including Extreme Urgencies (EU): non-decontaminated, sometimes still dressed High Don appropriate protective equipment (PPE) for the operating theatre • Theatre nurses and anaesthesia team: non-woven garment type 5-6, overboots and FFP3 mask or, failing this, FFP2. • Surgical team: surgical clothing with reinforced protection (orthopaedics gown), overboots and FFP3 mask or, failing this, FFP2 mask, safety glasses. • If possible use long-sleeved surgical gloves (used in obstetrics department), double pair of gloves. SEE SHEET 30 SHEET
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