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.

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 lawOSHAEPALevels of training• First Responder Awareness• First Responder Operations• Hazardous Materials Technician• Hazardous Materials Specialist

Responsibilities of the EMT-B• Recognize a hazmat incident

highwaystruck terminalschemical plantsplaces where chemicals are useddelivery trucksagricultural and garden centersrailway incidentslaboratories

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 servicespecial rescue personnelHazardous materials expertsLaw 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 decontaminationemulsificationchemical reactiondisinfectiondilutionabsorption and adsorptionremovaldisposal

• Decontaminating

Multiple Casualty Incidents

An event that places a greater demand on EMS equipment and personnel resources

Operations• Disaster plan

writtenwell-publicizedrealisticrehearsed

• 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 1Respirations <30

Priority 2

Pulse• Unresponsive, no breathing, no pulse

Priority 0• Breathing but no pulse

Priority 1LOCAlert

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 supervisorCommunicating with hospitals• Alert to nature of MCI incident or disaster• Transportation supervisor• In large scale

reports limited to patient prioritysignificant presenting problemnumber 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 systemsType 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• ThermalExtreme heat or cold• RadiologicalAlpha particles, beta particles, or gamma

rays• AsphyxiationLack of oxygen in the atmosphere

• ChemicalToxic or corrosive materials• EtiologicalCauses of disease• MechanicalPhysical trauma• PsychologicalViolent or traumatic event

TIME / DISTANCE / SHIELDING• Time

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 / shieldingBiological incidents• Bacteria, viruses, toxins• Ingestion is a common route of infection

biological agents in food or drinkaccidental swallowing

• Injectionvector (disease carrying organism)jagged glass or metalsyringeshigh-pressure devices

Exposure vs. contamination

• Exposure

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

• TransmissibilityBiological agents can be transmitted from

person to person• LethalityRelative ease with which an agent causes

death in a susceptible population• StabilityViability 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

eboladengue feveryellow 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 perimeterMost distant control point • Inner perimeterHot 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 suppliesEMT 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