Chlorine Toxicity Treatment & Management
Updated: Dec 11, 2015
Author: Gerald F O'Malley, DO; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD more...
SECTIONS
Approach Considerations
The most important aspect of treating patients exposed to chlorine gas is the provision of good supportive care. No antidotes are available. Emergency department (ED) personnel are at low risk for cross-contamination in cases of exposure to chlorine gas. However, the patient’s clothing should be removed if it has been contaminated with liquid chlorine. Wear appropriate protective gear during decontamination, especially if the exact toxin is not identified.
Evaluate the airway, breathing, and circulation. Provide supplemental oxygen (humidified if possible) as necessary; depending on the patient’s oxygen requirements, it may be delivered by nasal cannula, face mask, nonrebreather mask, noninvasive positive pressure ventilation, or intubation. Severe respiratory distress indicates the need for endotracheal intubation. Because of the risk of laryngospasm, several back-up modalities should be available at the time of intubation (ie, fiberoptic laryngoscope, cricothyrotomy tray).
Positive pressure ventilation with positive end-expiratory pressure (PEEP) set at 5-10 mm Hg may improve oxygenation in patients with noncardiogenic pulmonary edema and allow for lower fraction of inspired oxygen (FIO2) settings. An FIO2greater than 50% for longer than 24 hours may result in oxygen toxicity.
Closely monitor the patient's fluid input and output because of the potential of pulmonary edema. Fluid restriction may be required and diuretics may be used to treat impending pulmonary edema.
Treat initial bronchospasm with beta agonists such as albuterol. Ipratropium may be added. Poor responses may require terbutaline or aminophylline. Nebulized lidocaine (4% topical solution) may provide analgesia and reduce coughing.
Other medications that may be used in the treatment of chlorine gas exposure include nebulized sodium bicarbonate and inhaled or systemic corticosteroids; however, evidence of efficacy is mixed. No evidence supports the use of prophylactic antibiotics.
Patients with skin or eye exposure to chlorine require copious irrigation with saline. Consider ophthalmologic consultation for patients with significant ocular involvement.
Consider admission and observation for the following patients, even if they are initially asymptomatic, as they are at increased risk of progression to respiratory failure:
Patients exposed to large concentrations in an enclosed environment
Patients with underlying respiratory or cardiovascular disease
Children
Cases of chronic reactive airway disease after acute exposures to chlorine gas are described in the literature. Consider referring patients for pulmonary function testing.
Prehospital Care
Prehospital care providers should take necessary precautions to prevent contamination. The use of a chemical cartridge respirator or self-contained breathing apparatus with full face mask should protect against the effects of chlorine gas on the upper and lower airways. This corresponds to Occupational Safety and Health Administration (OSHA) level A or level B personal protective equipment (PPE), with positive pressure self-contained breathing apparatuses with full face plates as well as protective overgarments. [23, 36]
Chemical-protective clothing should be worn because chlorine gas can condense on the skin and cause irritation and burns.[4] Staging areas should be situated upwind of the chlorine gas site.
Care at the site consists of the following:
Remove the individual from the toxic environment
Bring the container (double-bagged and sealed) or material safety data sheets (MSDS), if applicable, so medical personnel can identify the toxic agent; a digital photo of the product label (if possible) is preferred over the product itself to limit healthcare facility contamination
Commence primary decontamination of the eye and skin, if necessary
Real-time measurement of chlorine gas, both quantitative and qualita
Updated: Dec 11, 2015
Author: Gerald F O'Malley, DO; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD more...
SECTIONS
Approach Considerations
The most important aspect of treating patients exposed to chlorine gas is the provision of good supportive care. No antidotes are available. Emergency department (ED) personnel are at low risk for cross-contamination in cases of exposure to chlorine gas. However, the patient’s clothing should be removed if it has been contaminated with liquid chlorine. Wear appropriate protective gear during decontamination, especially if the exact toxin is not identified.
Evaluate the airway, breathing, and circulation. Provide supplemental oxygen (humidified if possible) as necessary; depending on the patient’s oxygen requirements, it may be delivered by nasal cannula, face mask, nonrebreather mask, noninvasive positive pressure ventilation, or intubation. Severe respiratory distress indicates the need for endotracheal intubation. Because of the risk of laryngospasm, several back-up modalities should be available at the time of intubation (ie, fiberoptic laryngoscope, cricothyrotomy tray).
Positive pressure ventilation with positive end-expiratory pressure (PEEP) set at 5-10 mm Hg may improve oxygenation in patients with noncardiogenic pulmonary edema and allow for lower fraction of inspired oxygen (FIO2) settings. An FIO2greater than 50% for longer than 24 hours may result in oxygen toxicity.
Closely monitor the patient's fluid input and output because of the potential of pulmonary edema. Fluid restriction may be required and diuretics may be used to treat impending pulmonary edema.
Treat initial bronchospasm with beta agonists such as albuterol. Ipratropium may be added. Poor responses may require terbutaline or aminophylline. Nebulized lidocaine (4% topical solution) may provide analgesia and reduce coughing.
Other medications that may be used in the treatment of chlorine gas exposure include nebulized sodium bicarbonate and inhaled or systemic corticosteroids; however, evidence of efficacy is mixed. No evidence supports the use of prophylactic antibiotics.
Patients with skin or eye exposure to chlorine require copious irrigation with saline. Consider ophthalmologic consultation for patients with significant ocular involvement.
Consider admission and observation for the following patients, even if they are initially asymptomatic, as they are at increased risk of progression to respiratory failure:
Patients exposed to large concentrations in an enclosed environment
Patients with underlying respiratory or cardiovascular disease
Children
Cases of chronic reactive airway disease after acute exposures to chlorine gas are described in the literature. Consider referring patients for pulmonary function testing.
Prehospital Care
Prehospital care providers should take necessary precautions to prevent contamination. The use of a chemical cartridge respirator or self-contained breathing apparatus with full face mask should protect against the effects of chlorine gas on the upper and lower airways. This corresponds to Occupational Safety and Health Administration (OSHA) level A or level B personal protective equipment (PPE), with positive pressure self-contained breathing apparatuses with full face plates as well as protective overgarments. [23, 36]
Chemical-protective clothing should be worn because chlorine gas can condense on the skin and cause irritation and burns.[4] Staging areas should be situated upwind of the chlorine gas site.
Care at the site consists of the following:
Remove the individual from the toxic environment
Bring the container (double-bagged and sealed) or material safety data sheets (MSDS), if applicable, so medical personnel can identify the toxic agent; a digital photo of the product label (if possible) is preferred over the product itself to limit healthcare facility contamination
Commence primary decontamination of the eye and skin, if necessary
Real-time measurement of chlorine gas, both quantitative and qualita
tive, is possible through the use of mobile equipment
Chlorine gas is denser than air and accumulates close to the ground. Therefore, during chlorine-related accidents, people should be instructed to seek higher altitudes to avoid excessive exposure.
For related information, see Medscape's Disaster Preparedness and Aftermath Resource Center.
Hospital Admission
Patients who are asymptomatic on presentation and remain asymptomatic 6 hours after exposure may be discharged with appropriate instructions and in the presence of reliable family members. They should be advised that pulmonary edema may present in a delayed fashion after chlorine gas exposure.
Patients who present with symptoms that continue for 6 hours after exposure should be admitted for an observation period of at least 24 hours. If they are asymptomatic at 24 hours, they may be discharged with appropriate follow-up care. [37]
Consider admission and observation for the following patients, even if they are initially asymptomatic:
Patients exposed to large concentrations in an enclosed environment
Patients with underlying respiratory or cardiovascular disease
Children
Request critical care or pulmonary consultation for most admissions. Toxicology or poison control center consultation is recommended.
Skin and Eye Exposure
Skin exposures require copious irrigation with saline. Duration of skin irrigation, although not well studied, should probably be from 3-5 minutes. [4] If skin exposure is significant, wash with a mild soap and water.
In cases of suspected ocular injury, determine initial pH using a reagent strip capable of measuring the ranges 0-14. Irrigate the eye with normal saline until the pH returns to 7.4. Remove contact lenses (if present) prior to irrigation. Topical anesthetics help limit pain and improve patient cooperation during initial evaluation and management. [38]
After irrigation, evaluate the cornea with fluorescein staining under a slit lamp. Treat corneal abrasions with antibiotic ointment. Measure ocular pressures. Obtain ophthalmologic consultation for patients with significant ocular involvement.
Sodium Bicarbonate
In the past, several authors advocated nebulized sodium bicarbonate for treatment of chlorine gas exposure. The mechanism of action is believed to be the neutralization of hydrochloric acid formed in the airways. Most recommendations are based on anecdotal experience, and little supporting clinical data are available. [39,40, 41] Theoretically, an exothermic reaction may occur when bicarbonate mixes with hydrochloric acid. [1, 42, 19] Animal studies suggest that nebulized sodium bicarbonate may cause chemical pneumonitis.
In a randomized, controlled trial in 44 patients with reactive airways dysfunction syndrome (RADS) due to chlorine inhalation, forced expiratory volume in 1 second (FEV1) values at 120 and 240 minutes were significantly higher in patients treated with nebulized sodium bicarbonate (4 mL of 4.20% NaHCO3solution) than in those who received saline.[43] Treatment of all patients included corticosteroids and nebulized, short-acting β2-agonists. No significant difference in quality of life questionnaire scores was found between the two groups.
Corticosteroids
Inhaled and parenteral steroids have been used with many patients exposed to chlorine gas, but no strong clinical evidence supports their use except in patients with an exacerbation of underlying reactive airway disease. [41] Some animal studies demonstrate better lung compliance and arterial oxygen tension when inhaled steroids are initiated within 30 minutes of exposure.
Parenteral steroids are advocated by some authors to prevent short-term reactions and long-term sequelae. [44, 45] Other authors argue against this practice, because of insufficient clinical trials. [1]
Investigational Treatments
Several studies have found benefit in animal models with postexposure treatment with N-acetylcysteine (NAC) [46]and a combination of ascorbate and deferoxamine [47] on histopathological changes in pulmonary tissue compared with controls. However,
Chlorine gas is denser than air and accumulates close to the ground. Therefore, during chlorine-related accidents, people should be instructed to seek higher altitudes to avoid excessive exposure.
For related information, see Medscape's Disaster Preparedness and Aftermath Resource Center.
Hospital Admission
Patients who are asymptomatic on presentation and remain asymptomatic 6 hours after exposure may be discharged with appropriate instructions and in the presence of reliable family members. They should be advised that pulmonary edema may present in a delayed fashion after chlorine gas exposure.
Patients who present with symptoms that continue for 6 hours after exposure should be admitted for an observation period of at least 24 hours. If they are asymptomatic at 24 hours, they may be discharged with appropriate follow-up care. [37]
Consider admission and observation for the following patients, even if they are initially asymptomatic:
Patients exposed to large concentrations in an enclosed environment
Patients with underlying respiratory or cardiovascular disease
Children
Request critical care or pulmonary consultation for most admissions. Toxicology or poison control center consultation is recommended.
Skin and Eye Exposure
Skin exposures require copious irrigation with saline. Duration of skin irrigation, although not well studied, should probably be from 3-5 minutes. [4] If skin exposure is significant, wash with a mild soap and water.
In cases of suspected ocular injury, determine initial pH using a reagent strip capable of measuring the ranges 0-14. Irrigate the eye with normal saline until the pH returns to 7.4. Remove contact lenses (if present) prior to irrigation. Topical anesthetics help limit pain and improve patient cooperation during initial evaluation and management. [38]
After irrigation, evaluate the cornea with fluorescein staining under a slit lamp. Treat corneal abrasions with antibiotic ointment. Measure ocular pressures. Obtain ophthalmologic consultation for patients with significant ocular involvement.
Sodium Bicarbonate
In the past, several authors advocated nebulized sodium bicarbonate for treatment of chlorine gas exposure. The mechanism of action is believed to be the neutralization of hydrochloric acid formed in the airways. Most recommendations are based on anecdotal experience, and little supporting clinical data are available. [39,40, 41] Theoretically, an exothermic reaction may occur when bicarbonate mixes with hydrochloric acid. [1, 42, 19] Animal studies suggest that nebulized sodium bicarbonate may cause chemical pneumonitis.
In a randomized, controlled trial in 44 patients with reactive airways dysfunction syndrome (RADS) due to chlorine inhalation, forced expiratory volume in 1 second (FEV1) values at 120 and 240 minutes were significantly higher in patients treated with nebulized sodium bicarbonate (4 mL of 4.20% NaHCO3solution) than in those who received saline.[43] Treatment of all patients included corticosteroids and nebulized, short-acting β2-agonists. No significant difference in quality of life questionnaire scores was found between the two groups.
Corticosteroids
Inhaled and parenteral steroids have been used with many patients exposed to chlorine gas, but no strong clinical evidence supports their use except in patients with an exacerbation of underlying reactive airway disease. [41] Some animal studies demonstrate better lung compliance and arterial oxygen tension when inhaled steroids are initiated within 30 minutes of exposure.
Parenteral steroids are advocated by some authors to prevent short-term reactions and long-term sequelae. [44, 45] Other authors argue against this practice, because of insufficient clinical trials. [1]
Investigational Treatments
Several studies have found benefit in animal models with postexposure treatment with N-acetylcysteine (NAC) [46]and a combination of ascorbate and deferoxamine [47] on histopathological changes in pulmonary tissue compared with controls. However,
caution should be used in interpreting these studies because these interventions have not been studied in humans for this condition.
Deterrence/Prevention
Proper labeling and avoiding mixing chemicals facilitate prevention. Household cleaning products should not be mixed. Using proper precautions when handling swimming pool chemicals reduces risks. Adequate ventilation is necessary when handling any potentially noxious chemical.
As accidental occupational exposures to chlorine gas comprise a significant percentage of severe exposures, proper methods of training and supervision are beneficial. Enforcement of existing work safety regulations may lead to fewer exposures. On a larger scale, chemical warfare treaties between countries and the safe transportation and handling of industrial chlorine compounds facilitate deterrence.
Training prehospital and hospital providers in the management of chemical casualties can improve the treatment provided to exposed personnel while minimizing personal risks. Hospitals can establish mass casualty plans and perform drills to ensure that preparations are adequate in the event of a large-scale industrial accident.
Long-term exposure to small amounts of chlorine gas may contribute to pulmonary disease. The current US legal limit for occupational exposure to chlorine gas enforceable by the Occupational Safety and Health Administration (OSHA) is 0.5 ppm averaged over a 10-hour day or a 40-hour work week and a short-term exposure limit of 1 ppm. [48, 49]
Deterrence/Prevention
Proper labeling and avoiding mixing chemicals facilitate prevention. Household cleaning products should not be mixed. Using proper precautions when handling swimming pool chemicals reduces risks. Adequate ventilation is necessary when handling any potentially noxious chemical.
As accidental occupational exposures to chlorine gas comprise a significant percentage of severe exposures, proper methods of training and supervision are beneficial. Enforcement of existing work safety regulations may lead to fewer exposures. On a larger scale, chemical warfare treaties between countries and the safe transportation and handling of industrial chlorine compounds facilitate deterrence.
Training prehospital and hospital providers in the management of chemical casualties can improve the treatment provided to exposed personnel while minimizing personal risks. Hospitals can establish mass casualty plans and perform drills to ensure that preparations are adequate in the event of a large-scale industrial accident.
Long-term exposure to small amounts of chlorine gas may contribute to pulmonary disease. The current US legal limit for occupational exposure to chlorine gas enforceable by the Occupational Safety and Health Administration (OSHA) is 0.5 ppm averaged over a 10-hour day or a 40-hour work week and a short-term exposure limit of 1 ppm. [48, 49]
Forwarded from خبرهای فوری مهم 🔖
فرمانده انتظامی دزفول:
*شهروندان دزفولی اطراف محل حادثه نشت گاز را ترک کنند
*فرمانده انتظامی دزفول با بیان اینکه حضور شهروندان در محل حادثه نشت گاز کلر موجب کندی خدمات رسانی خودروهای امداد رسان شده است، گفت: شهروندان دزفولی هر چه سریعتر اطراف محل حادثه را ترک کنند. /شهروند
*شهروندان دزفولی اطراف محل حادثه نشت گاز را ترک کنند
*فرمانده انتظامی دزفول با بیان اینکه حضور شهروندان در محل حادثه نشت گاز کلر موجب کندی خدمات رسانی خودروهای امداد رسان شده است، گفت: شهروندان دزفولی هر چه سریعتر اطراف محل حادثه را ترک کنند. /شهروند
پس از ۵ ساعت تلاش بالاخره نشت گاز کلر واقه در کاشفیه کنترل شد
*همچنین از سایر شهروندان خواسته شده که همچنان نکات ایمنی را رعایت کنند.
*همچنین از سایر شهروندان خواسته شده که همچنان نکات ایمنی را رعایت کنند.
Forwarded from خبرهای فوری مهم 🔖
فرماندار ویژه دزفول خبر داد
تخلیه کامل منطقه گردشگری "علی کله" دزفول در پی نشت گاز کلر
حبیب آصفی، فرماندار ویژه دزفول:
🔹با توجه به نتایج بررسیها، گاز کلر از انبار شرکت آبیاری قدیم دزفول که در محدوده پل سوم و میدان مادر قرار دارد، نشت کرده است.
🔹در پی حادثه نشت گاز کلر، محدوده از پل سوم تا میدان مادر به طور کامل تخلیه شده است.
🔹حال فعلی افراد دچار مسمومیت خوب گزارش شده است./ایسنا #اجتماعی
✅ @Khabar_Fouri
تخلیه کامل منطقه گردشگری "علی کله" دزفول در پی نشت گاز کلر
حبیب آصفی، فرماندار ویژه دزفول:
🔹با توجه به نتایج بررسیها، گاز کلر از انبار شرکت آبیاری قدیم دزفول که در محدوده پل سوم و میدان مادر قرار دارد، نشت کرده است.
🔹در پی حادثه نشت گاز کلر، محدوده از پل سوم تا میدان مادر به طور کامل تخلیه شده است.
🔹حال فعلی افراد دچار مسمومیت خوب گزارش شده است./ایسنا #اجتماعی
✅ @Khabar_Fouri
Forwarded from A R
عصر ایران:
افزایش آمار مسمومین ناشی از نشت گاز کلر در دزفول
رییس دانشگاه علوم پزشکی دزفول از مسمومیت بیش از ۱۰۰ نفر از شهروندان منطقه ساحلی دزفول خبر داد/ وبدا
asriran.com
@MyAsriran
افزایش آمار مسمومین ناشی از نشت گاز کلر در دزفول
رییس دانشگاه علوم پزشکی دزفول از مسمومیت بیش از ۱۰۰ نفر از شهروندان منطقه ساحلی دزفول خبر داد/ وبدا
asriran.com
@MyAsriran
Forwarded from خبرهای فوری مهم 🔖
زلزله ۶/۶ ریشتری غرب اندونزی را در استان بانگوکولو لرزاند
🔹هنوز گزارشی از خسارات احتمالی منتشر نشده است./ایرنا #بین_المللی
✅ @khabar_fouri
🔹هنوز گزارشی از خسارات احتمالی منتشر نشده است./ایرنا #بین_المللی
✅ @khabar_fouri
بحران نیوز:
💢سرقت شیر سیلندر علت نشت گاز کلر در دزفول
⭕️حبیب الله آصفی فرماندار دزفول به ایرنا گفته این حادثه به دلیل دستکاری شیر سیلندر گاز کلر برای سرقت آن از انبار تاسیسات شرکت سهامی آبیاری قدیم دزفول بوجود آمده است
⭕️به گفته وی، سارق قصد سرقت شیر سیلندر گاز کلر را داشته که به علت نشت گاز از محل فرار کرده است
⭕️نشت گاز کلر از انبار تاسیسات شرکت سهامی آبیاری خام دزفول شنبه شب موجب مسموم شدن 362 نفر شد
⭕️بیش از 30 نفر از آسیب دیدگان این حادثه همچنان در بیمارستان های دزفول بستری
💢سرقت شیر سیلندر علت نشت گاز کلر در دزفول
⭕️حبیب الله آصفی فرماندار دزفول به ایرنا گفته این حادثه به دلیل دستکاری شیر سیلندر گاز کلر برای سرقت آن از انبار تاسیسات شرکت سهامی آبیاری قدیم دزفول بوجود آمده است
⭕️به گفته وی، سارق قصد سرقت شیر سیلندر گاز کلر را داشته که به علت نشت گاز از محل فرار کرده است
⭕️نشت گاز کلر از انبار تاسیسات شرکت سهامی آبیاری خام دزفول شنبه شب موجب مسموم شدن 362 نفر شد
⭕️بیش از 30 نفر از آسیب دیدگان این حادثه همچنان در بیمارستان های دزفول بستری
بحران نیوز:
افزایش تعداد مسمومین حادثه نشت گاز کلر در دزفول/ یک نفر فوت شد
رئیس دانشگاه علوم پزشکی دزفول:
🔹آمار مسمومین حادثه نشت گاز کلر در دزفول به صورت ساعتی در حال افزایش است.
🔹تاکنون بیش از 350 نفر بر اثر استنشاق این گاز دچار مسمومیت شدهاند و به بیمارستانها مراجعه کردند.
🔹همچنین در این حادثه شب گذشته یک مرد 42 ساله، قبل از رسیدن به بیمارستان گنجویان، فوت کرد که هنوز به صورت رسمی مرگ این فرد به علت مسمومیت گاز کلر قطعی نشده است.
افزایش تعداد مسمومین حادثه نشت گاز کلر در دزفول/ یک نفر فوت شد
رئیس دانشگاه علوم پزشکی دزفول:
🔹آمار مسمومین حادثه نشت گاز کلر در دزفول به صورت ساعتی در حال افزایش است.
🔹تاکنون بیش از 350 نفر بر اثر استنشاق این گاز دچار مسمومیت شدهاند و به بیمارستانها مراجعه کردند.
🔹همچنین در این حادثه شب گذشته یک مرد 42 ساله، قبل از رسیدن به بیمارستان گنجویان، فوت کرد که هنوز به صورت رسمی مرگ این فرد به علت مسمومیت گاز کلر قطعی نشده است.
Amir:
شهردار دزفول به دلیل مسمومیت نتشی از گاز کلر در اورژانس بیمارستان دزفول بستری شد.
شهردار دزفول به دلیل مسمومیت نتشی از گاز کلر در اورژانس بیمارستان دزفول بستری شد.
Babak Noorelahı:
◀️ افزایش آمار مسمومهای شب گذشته دزفول؛ ۳۶۲ نفر
🔻مطابق اعلام اورژانس کشور، تا بامداد امروز ۳۶۲ نفر برای مسمومیت ناشی از نشت گاز کلر به دو بیمارستان دزفول ارجاع داده شدند؛
🔻 ۲۷۲نفر در بیمارستان گنجویان و ۹۰ نفر در بیمارستان نبوی
🔻 ۳۰نفر همچنان در بیمارستان گنجویان بستری هستند و ۵ نفر در بیمارستان نبوی
◀️ افزایش آمار مسمومهای شب گذشته دزفول؛ ۳۶۲ نفر
🔻مطابق اعلام اورژانس کشور، تا بامداد امروز ۳۶۲ نفر برای مسمومیت ناشی از نشت گاز کلر به دو بیمارستان دزفول ارجاع داده شدند؛
🔻 ۲۷۲نفر در بیمارستان گنجویان و ۹۰ نفر در بیمارستان نبوی
🔻 ۳۰نفر همچنان در بیمارستان گنجویان بستری هستند و ۵ نفر در بیمارستان نبوی
350نفرمسموم و مرگ یک نفر بر اثر نشست گاز کلر در دزفول
🔹یوسف پریدار، رییس دانشگاه علوم پزشکی دزفول به ایسنا گفته:
🔻آمار مسمومین حادثه نشت گاز کلر در دزفول به صورت ساعتی در حال افزایش است.
🔻تاکنون بیش از ۳۵۰نفر بر اثر استنشاق این گاز دچار مسمومیت شدهاند و به بیمارستانها مراجعه کردند.
🔻در این حادثه شب گذشته یک مرد ۴۲ساله، قبل از رسیدن به بیمارستان گنجویان، فوت کرد که هنوز به صورت رسمی مرگ این فرد به علت مسمومیت گاز کلر اعلام نشده است.
🔹یوسف پریدار، رییس دانشگاه علوم پزشکی دزفول به ایسنا گفته:
🔻آمار مسمومین حادثه نشت گاز کلر در دزفول به صورت ساعتی در حال افزایش است.
🔻تاکنون بیش از ۳۵۰نفر بر اثر استنشاق این گاز دچار مسمومیت شدهاند و به بیمارستانها مراجعه کردند.
🔻در این حادثه شب گذشته یک مرد ۴۲ساله، قبل از رسیدن به بیمارستان گنجویان، فوت کرد که هنوز به صورت رسمی مرگ این فرد به علت مسمومیت گاز کلر اعلام نشده است.
Forwarded from باشگاه خبرنگاران جوان
🔸دستکم ۳۰ کودک در یک بیمارستان دولتی هند براثر کمبود اکسیژن جان خود را از دست دادند.
🔹اکسیژن این بیمارستان که درایالت شمالی اوتار پرادش واقع است درپی پرداخت نشدن هزینه قطع شده بود.
@YjcNewsChannel
🔹اکسیژن این بیمارستان که درایالت شمالی اوتار پرادش واقع است درپی پرداخت نشدن هزینه قطع شده بود.
@YjcNewsChannel
مطلب در خصوص موج گرما ارسال شده توسط دفتر مدیریت بیماری های واگیر وزارت👆👆
@disastermanagement
@disastermanagement
اخبارحوادث وعملیات های امدادو نجات:
کیف کمک های اولیه حلما برای اولین بار در جهان
این کیف به منظور سرعت بخشیدن در عملیات امداد و نجات و همچنین در اختیار گرفتن کلیه ابزار و وسایل مورد نیاز نجاتگران
کیف کمک های اولیه حلما برای اولین بار در جهان
این کیف به منظور سرعت بخشیدن در عملیات امداد و نجات و همچنین در اختیار گرفتن کلیه ابزار و وسایل مورد نیاز نجاتگران