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HAZARDOUS MATERIALS
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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
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Training required by law
OSHA EPA Levels of training First Responder Awareness First Responder Operations Hazardous Materials Technician Hazardous Materials Specialist
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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
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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
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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
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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)
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Identify the substance, it’s properties and danger
*danger of spreading *what senses tell you How many victims Secondary contamination
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Obtaining information
Binoculars Placarding system diamond shape placards Four digit ID number Invoices, bill of lading (trucks), shipping manifests (trains) Material Safety Data Sheets
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Interview those leaving the hot zone
Study found that as many as 50% of placards found are incorrect
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2008 Emergency Response Guidebook
Chemtrec Chem-Tel Inc. Give: Name, call back number, and fax number Explain nature and location of problem
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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
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Local conditions weather terrain proximity from schools, hospitals etc Injuries and exposures All local emergency serivces that have been notified
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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
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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
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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
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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
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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
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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
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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
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Mechanisms for decontamination
emulsification chemical reaction disinfection dilution absorption and adsorption removal disposal
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Decontaminating
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Multiple Casualty Incidents
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An event that places a greater demand on EMS equipment and personnel resources
Operations Disaster plan written well-publicized realistic rehearsed
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NIMS National Incident Management System Command Operations Logistics Finance
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Triage S T A R T Simple Triage and Rapid Treatment Based on R P M Respiration Pulse Mental Status 30 seconds per patient
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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
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Respirations Not breathing and attempt to open airway do not ventilate Priority 0 If breathing starts priority 1 Respirations <30 Priority 2
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Pulse Unresponsive, no breathing, no pulse Priority 0 Breathing but no pulse Priority 1 LOC Alert Priority 2
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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
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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
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CISD
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EMS RESPONSE TO TERRORISM
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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
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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
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Type of terrorism incidents-CBRNE
Chemical Biological Radiological Nuclear Explosive often referred to as WMD
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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
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Identify the threat posed by the event
Deliberate targeting of responders secondary devices consider to be a crime scene Operate under incident command
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Clues to a terrorist incident
O T T O Occupancy or location Type of Event Timing of the event On-scene warning signs
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Occupancy or location Symbolic and historical targets Public buildings or assembly areas Controversial business Infrastructure systems Type of event Explosions Firearms Non-trauma MCI
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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
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TRACEM-P Thermal Extreme heat or cold Radiological Alpha particles, beta particles, or gamma rays Asphyxiation Lack of oxygen in the atmosphere
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Chemical Toxic or corrosive materials Etiological Causes of disease Mechanical Physical trauma Psychological Violent or traumatic event
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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
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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
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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
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Self-protection measures at a biological incident
Limit exposure and contamination Self-protection Use buddy system Rapid Intervention Team Civilian protection
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Biological agents microorganisms or toxins that can cause disease processes Bacterium Small free-living microorganisms Virus Requires a host cell to live and reproduce
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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
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Virulence Relative severity of a disease Toxicity Relative severity of illness or incapacitation produced by a toxin Incubation period Time between exposure and symptoms
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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
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Environmental factors
Temperature Relative humidity Atmospheric pollution Ultraviolet light Sunlight
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Bacteria Anthrax Cholera Plague Q fever exposure to domestic livestock Tuleremia bites from domestic animals, deer flies, ticks, mosquitoes
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Toxins Not volatile Botulism Ricin derived from the bean of the castor plant
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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
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Trichothecine Mycotoxins
Produced from fungal metabolism Soluble in water and heat resistant Can penetrate intact skin
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Viruses Smallpox Encephalitis Viral hemorrhagic fevers ebola dengue fever yellow fever
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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
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Radioactive / nuclear devices
Military nuclear devices Improvised nuclear devices Dirty bombs Sabotage
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Effects of radiation Three body systems most effected Blood-forming system more specifically bone marrow GI CNS
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Incendiary devices Molotov cocktails Propane bombs
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Strategies and Tactics
Life safety Incident stabilization Protection of property Responders Equipment Organizational function continuity
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Strategies Broad, general plans designed to achieve desired outcomes Tactics Specific operational actions responders take to accomplish their assigned tasks
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Isolation Initial considerations Scene control Ensure public safety Evaluation of severity of danger Isolating the danger Establish work zones early
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Establishing perimeter control
Handled by law enforcement Outer perimeter Most distant control point Inner perimeter Hot zone Think about the possibility of secondary device
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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
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Notification The initial radio report by an EMT is often the “trigger device” for notification Identification Principles of hazmat management
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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
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