1. Overview of HazMat and Mass Casualty Incidents

2. Overview of HazMat Hazardous Materials Any substance capable of creating harm to: People Property Environment Types Explosives –Gases – Flammable/combustible liquid Flammable solids –Oxidizing substances Poisonous/Infectious substances –Radioactive substances Corrosive substances – Miscellaneous hazmat

3. General Info Common problem Actual extent unknown Safety is primary concern Providers EMT-B and crew Pt Public

4. Approaching the Scene Identification Occupancy Containers –size/shape Placards Shipping papers “Bill of lading”- Road transport “Way Bills” – Transport by rail Usually in cab of truck Chemical name, transport name, ID numbers Senses Material Safety Data Sheets (MSDS) -1 st. Aid, Decontamination, routes of exposure, S/S protective equipment, past med Hx. Complications Pts at the scene Multiple pt with same S/S suggests exposure i.e Nausea, vomiting, SOB, unresponsiveness

5. Approaching the Scene General procedures Park upwind and uphill Keep unnecessary people away Isolate area Keep people out Do not enter without proper equipment and SCBA Local Resources Local HazMat response teams CHEMTREC = 1-800-424-9300 Hazardous Materials, The Emergency Response Handbook Published by US DOT

7. HazMat Zones Hot Zone Where the hazardous material is spilled Only trained individuals/appropriate clothing Warm Zone Transmission zone Where decontamination occurs Control point between Cold and Hot zones Suitable training and clothing Cold Zone “Clean zone” Where pt are brought for EMS assessment prior to transport Staging supplies and command

8. Treatment Decontamination Hazardous Material

9. HazMat Decontamination Mechanical Removal Clothing Removal Rinsing Dilution Absorption Chemical Washes Disposal/Isolation

10. MCI: Classification Multiple/Mass Casualty Incident A situation in which the needs is more than the initial responding personnel and equipment can meet Open Incident Easy access to victims from different locations May be spread over a large area Closed Incident Physical/geographical barriers that prevent speedy access to victims Active Forces that contributed to the disaster are still active On going risk to rescuers, public, victims Contained Forces responsible for the disaster are exhausted

11. Incident Management Systems What are they? Organized system of roles, responsibilities, and standing operating procedures to manage emergency operations. What do they do? Provides orderly means for communication and information for decision making Makes interactions with other agencies easier

12. Incident Management Systems Structure Command Mobile site near the MCI Overall command of the incident is coordinated Extrication Coordination of personnel/resources during extrication Triage Initial triage occurs at pt side Pt relocated to “secondary triage” Treatment Organized sector where major field treatments are administered Priority treatment may start at the side of pt before transport Transportation Responsible for overall transport of supplies, equipment, personnel, pt, other resources Staging Area where ambulances stage to receive pts and assignment of receiving hospital Supply Area where supplies are stockpiled Rehabilitation Area where care is given to rescuers Physical and psychological support are offered

13. Incident Management Systems Documentation A major event log # of pts Conditions and triage categories Vehicles at scene Personnel at scene Hospital availability # of individuals transported Hospital disposition Mode of transport

15. Initial Roles of Responders Rescuers will be assigned specific duties within one of the sectors Upon arrival Report to sector officer Once assigned a specific task Complete it Report back to sector officer

16. Triage Heroic resuscitative efforts NOT appropriate Too much time Requires equipment used for salvageable patients Staffing intensive Concentrate on salvageable patients

17. MCI Procedures Est. type of incident Determine specific location and ID best access routes 1 EMT approaches scene and determines: Estimates # of pt Estimates injury types If incident is open/closed and active/contained 2 nd EMT stays with ambulance and determines: Possible staging areas Traffic routes into area Both EMTs should ascertain Approx # of pts Specific location of incident Whether incident is open/closed and active/contained Need for special resources # of additional ambulances needed Potential dangers to public safety and personnel IMMEDIATELY relay this info to communications center

18. MCI Procedures Cont’d Most knowledgeable EMT on scene initially assumes Triage Officer Request additional help Perform initial assessment of all pts START Triage Assign available personnel/equipment to critical pts Secondary Triage In depth assessment of pt In treatment area OR en route to ER Pt transport is based on: Prioritization Destination facilities Transport resources Triage officer remains in scent to: Assign/coordinate: Personnel, equipment, vehicles

19. Triage Stages 1 st Stage No treatment is rendered Victims are tagged with tape/cards Category of injury Likelihood of survival 2 nd Stage Begins after removal of pt and transport to safer area More thorough assessment Recategorized by priority Collection point of all pts Ensure appropriate treatment and transport ALS procedures 3 rd Stage Certain specific cases Creation of field hospital on site ALS procedures

20. START Triage “Simple Triage and Rapid Treatment” Technique for quick primary triage Assesses: Ability to walk Respirations Pulse Mental Status

21. START Triage: Minimal Treatment Only THREE patient interventions are: Open the airway Open the airway Stop gross bleeding Safe patient positioning Shock position Recovery position

22. START Triage Procedure Walking Walking pt= “Walking Wounded” = Green Remain in location OR Walk to treatment area Breathing (open airway) If absent = Dead/Dying = Black Rate less than 10 or greater than 30 = Critical = Red Pulse/Perfusion If absent= Dead/Dying = Black No radial/Present Carotid= Critical = Red Radial and Carotid present= Assess mental status Mental Status Ask pt to perform two simple tasks Motor = Lifting arm Mental= Stating name, day, year If they can do both = Delayed = Yellow If they fail one = Critical = Red

24. Radial Pulse Absent

25. Pt Categorization Minor Green- Hold Priority Definition Pt with minor injuries Injuries of an ambulatory nature Pt Diagnosis Minor fractures Minor wounds Burns less than 10% BSA No airway problems Psychological problems

26. Pt Categorization Delayed Yellow- Delayed Priority Definition Pt requiring care but whose condition will not worsen with prompt (vs. immediate) transport Pt Diagnosis Burns Multiple/major fractures Spinal cord injuries Uncomplicated head injuries

27. Pt Categorization Immediate Red- Immediate Priority Definition Critical pt wit life threatening conditions who have a chance to survive with early stabilization and transport Require hospital care within 1 hour Pt Diagnosis Airway/Respiratory difficulties Sever burns Cardiac problems Uncontrollable/severe hemorrhage Open chest/abdominal wounds Severe head injury Severe medical problems Shock AMS

28. Pt Categorization Deceased Black- Deceased Definition Pt found without signs of life Obvious mortal injuries Pt Diagnosis Pt who have expired Pt with injuries incompatible with survival

29. Patient 1 Airway open Respirations 20 bpm Radial pulses present Minor abrasions to arm/hands Pt is walking Green

30. Patient 2 Airway is open Reparations 30 Singed nasal hairs noted Absent radial pulses Unable to walk RED

31. Patient 3 Airway open Respirations 22 Radial Pulses Present Follows commands Cannot walk Burns to one arm Yellow

32. Patient 4 Unresponsive Airway closed No respirations with jaw thrust Absent radial pulses BLACK

33. Patient 5 Pt responsive Airway open Respiratory rate 36 Thready radial pulses Unable to walk Flail chest noted RED

34. Patient 6 Unresponsive No respirations after jaw thrust Thready radial pulse Open femur fracture BLACK

35. And so it finally ends… Welcome to EMS

36. Random Humorous EMS Sites Murphy’s Laws of EMS http://www.uvm.edu/~jbettenc/ems1.htm Rules of EMS http://www.thelunatick.com/ems/rules.html You Might be in EMS if… http://www.thelunatick.com/ems/mightbe.html Realistic Trauma Scores http://www.thelunatick.com/ems/trauma_scales.htm The Memo http://www.thelunatick.com/ems/memo.htm EMT Buff Test http://www.thelunatick.com/ems/ems_buff_test.htm