HAZARDOUS MATERIALS

Definition according to the U.S. DOT Any substance or material in a form which poses an unreasonable risk to health, safety, and property when transported in commerce

Training required by law OSHA EPA Levels of training First Responder Awareness First Responder Operations Hazardous Materials Technician Hazardous Materials Specialist

Responsibilities of the EMT-B Recognize a hazmat incident highways truck terminals chemical plants places where chemicals are used delivery trucks agricultural and garden centers railway incidents laboratories

Never assume the scene is safe Assess the situation first Take a command situation at a safe distance All victims leaving the site should be considered contaminated until proven otherwise

Control the scene Establish a danger zone and a safety zone Safe zone should be at the same level and upwind from the accident site Call for help fire service special rescue personnel Hazardous materials experts Law enforcement

Implement Incident Management System Establish command Establish control zones Hot zone (area of contamination) Warm zone (decontamination corridor) Cold zone (equipment and other emergency rescuers)

Identify the substance, it’s properties and danger *danger of spreading *what senses tell you How many victims Secondary contamination

Obtaining information Binoculars Placarding system diamond shape placards Four digit ID number Invoices, bill of lading (trucks), shipping manifests (trains) Material Safety Data Sheets

Interview those leaving the hot zone Study found that as many as 50% of placards found are incorrect

2008 Emergency Response Guidebook Chemtrec Chem-Tel Inc. Give: Name, call back number, e-mail and fax number Explain nature and location of problem

ID number of the material Name of the carrier, shipper, manufacturer, consignee, and point of origin Container type and size, if it’s on rail car, truck, open storage or housed storage Estimated quantity transported and released

Local conditions weather terrain proximity from schools, hospitals etc Injuries and exposures All local emergency serivces that have been notified

Keep a line of communications open at all times Treatment Sector Rehabilitations Operations Monitor Hazmat team members Must include an EMT-B or EMT-BA

Rehab Sector Located in the cold zone Protected from weather Large enough to accommodate multiple rescue crews Easily accessible to EMS units Free from exhaust fumes Allows for rapid reentry into the Emergency Operation

Baseline VS should be taken when team members are suiting up Exit VS should be taken VS tracked on a flow sheet Monitor for dehydration and nourishment

Care of injured and contaminated patients Prompt, safe and effective decontamination procedures are essential EMS is responsible for setting up cold zones to receive decontaminated patients and hazmat team members

Treatment and Transport of hazmat patients Field-decontaminated patients are not completely clean PPE to prevent secondary decontamination Consider used equipment as disposable Structural firefighting clothing is not designed or recommended for hazmat

Patients prior to arrival of hazmat team Follow the Emergency Response Guidebook Manage critical and life threats…..ABCs When irrigating cut clothing off try to contain runoff use tepid or warm water after treating, decontaminate yourself

Phases of decontamination Gross decontamination Removal or chemical alteration of the majority of the contamination Secondary decontamination’ Alteration or removal of most of the residual product contamination

Mechanisms for decontamination emulsification chemical reaction disinfection dilution absorption and adsorption removal disposal

Decontaminating

Multiple Casualty Incidents

An event that places a greater demand on EMS equipment and personnel resources Operations Disaster plan written well-publicized realistic rehearsed

NIMS National Incident Management System Command Operations Logistics Finance

Triage S T A R T Simple Triage and Rapid Treatment Based on R P M Respiration Pulse Mental Status 30 seconds per patient

Priority 3 Green tag walking wounded Only 3 treatments provided during START Open an airway and insert OP Apply dressing to bleeding Elevate an extremity

Respirations Not breathing and attempt to open airway do not ventilate Priority 0 If breathing starts priority 1 Respirations <30 Priority 2

Pulse Unresponsive, no breathing, no pulse Priority 0 Breathing but no pulse Priority 1 LOC Alert Priority 2

AMS Priority 2 Re-triage priority 3 patients Secondary triage and treatment In the treatment area Each treatment area should have it’s own supervisor

Transportation and Staging logistics No ambulance transports without the authority of the treatment area supervisor Communicating with hospitals Alert to nature of MCI incident or disaster Transportation supervisor In large scale reports limited to patient priority significant presenting problem number of patients

CISD

EMS RESPONSE TO TERRORISM

Defined A violent act dangerous to human life, in violation of the criminal laws of the United States or any segment, to intimidate or coerce a government, the civilian population or any segment thereof, in furtherance of political or social objectives

Domestic Terrorism Involves groups or individuals whose terrorist activities are directed at the government or population, without foreign direction International Terrorism Involves groups or individuals whose terrorist activities are foreign-based and/or directed by countries or groups outside the targeted country or whose activities cross national boundries

Type of terrorism incidents-CBRNE Chemical Biological Radiological Nuclear Explosive often referred to as WMD

Terrorism and EMS First Responders as targets Stay alert Never assume the scene is safe until verified by appropriate agency or authorities Weigh the threat or risk against the benefit of your actions

Identify the threat posed by the event Deliberate targeting of responders secondary devices consider to be a crime scene Operate under incident command

Clues to a terrorist incident O T T O Occupancy or location Type of Event Timing of the event On-scene warning signs

Occupancy or location Symbolic and historical targets Public buildings or assembly areas Controversial business Infrastructure systems Type of event Explosions Firearms Non-trauma MCI

Timing of the event Significant anniversaries and holidays On-scene warning signs Unexplained patterns of illness or deaths Unexplained signs and symptoms Chemical containers, spray devices or lab equipment

TRACEM-P Thermal Extreme heat or cold Radiological Alpha particles, beta particles, or gamma rays Asphyxiation Lack of oxygen in the atmosphere

Chemical Toxic or corrosive materials Etiological Causes of disease Mechanical Physical trauma Psychological Violent or traumatic event

TIME / DISTANCE / SHIELDING Minimize time at a dangerous scene Distance Maximize distance from the hazard area or the projected hazard area Shielding Appropriate shielding to address specific hazards

Response to Terrorism Use principles of time / distance / shielding Biological incidents Bacteria, viruses, toxins Ingestion is a common route of infection biological agents in food or drink accidental swallowing Injection vector (disease carrying organism) jagged glass or metal syringes high-pressure devices

Exposure vs. contamination Substance is taken into the body through one of the routes of exposure Contamination Substance clings to surface of the body or clothing

Self-protection measures at a biological incident Limit exposure and contamination Self-protection Use buddy system Rapid Intervention Team Civilian protection

Biological agents microorganisms or toxins that can cause disease processes Bacterium Small free-living microorganisms Virus Requires a host cell to live and reproduce

Toxins Not living organism Certain features that influence potential for use as a weapon Infectivity The relative ease with which the microorganism establish themselves in a host

Virulence Relative severity of a disease Toxicity Relative severity of illness or incapacitation produced by a toxin Incubation period Time between exposure and symptoms

Transmissibility Biological agents can be transmitted from person to person Lethality Relative ease with which an agent causes death in a susceptible population Stability Viability of a biological agent is affected by various environmental factors

Environmental factors Temperature Relative humidity Atmospheric pollution Ultraviolet light Sunlight

Bacteria Anthrax Cholera Plague Q fever exposure to domestic livestock Tuleremia bites from domestic animals, deer flies, ticks, mosquitoes

Toxins Not volatile Botulism Ricin derived from the bean of the castor plant

Ricin interrupts the body’s protein-manufacturing process at the cellular level by altering the RNA needed for proper proteins-results in the cellular death and necrosis. Staphylococcal enterotoxin B Affects the GI tract----food poisoning After aerosolization and inhalation produces a potentially deadly syndrome

Trichothecine Mycotoxins Produced from fungal metabolism Soluble in water and heat resistant Can penetrate intact skin

Viruses Smallpox Encephalitis Viral hemorrhagic fevers ebola dengue fever yellow fever

Lassa fever They change the clotting characteristics of blood and permeability of the capillaries Results in systemic hemorrhage and liquefaction of solid organs and associated with a fever

Radioactive / nuclear devices Military nuclear devices Improvised nuclear devices Dirty bombs Sabotage

Effects of radiation Three body systems most effected Blood-forming system more specifically bone marrow GI CNS

Incendiary devices Molotov cocktails Propane bombs

Strategies and Tactics Life safety Incident stabilization Protection of property Responders Equipment Organizational function continuity

Strategies Broad, general plans designed to achieve desired outcomes Tactics Specific operational actions responders take to accomplish their assigned tasks

Isolation Initial considerations Scene control Ensure public safety Evaluation of severity of danger Isolating the danger Establish work zones early

Establishing perimeter control Handled by law enforcement Outer perimeter Most distant control point Inner perimeter Hot zone Think about the possibility of secondary device

Perimeter control factors Amount and type of resources on hand Don’t attempt actions beyond training Self-protection Behavior of a material is not determined by whether it was accidental or deliberate

Notification The initial radio report by an EMT is often the “trigger device” for notification Identification Principles of hazmat management

Protection People Vehicles Equipment and supplies EMT protection include Initial scene survey to determine security threats Request protection via radio asap Establish vehicle staging and triage/treatment areas in protected locations Advise EMS command about protection/security concerns Immediately report suspicious people or activities