hazardous materials. definition according to the u.s. dot any substance or material in a form which...
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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 lawOSHAEPALevels 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
highwaystruck terminalschemical plantsplaces where chemicals are useddelivery trucksagricultural and garden centersrailway incidentslaboratories
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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 servicespecial rescue personnelHazardous materials expertsLaw 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, e-mail 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 decontaminationemulsificationchemical reactiondisinfectiondilutionabsorption and adsorptionremovaldisposal
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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
writtenwell-publicizedrealisticrehearsed
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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 1Respirations <30
Priority 2
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Pulse• Unresponsive, no breathing, no pulse
Priority 0• Breathing but no pulse
Priority 1LOCAlert
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 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
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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 systemsType 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• ThermalExtreme heat or cold• RadiologicalAlpha particles, beta particles, or gamma
rays• AsphyxiationLack of oxygen in the atmosphere
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• ChemicalToxic or corrosive materials• EtiologicalCauses of disease• MechanicalPhysical trauma• PsychologicalViolent or traumatic event
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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
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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
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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
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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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• 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
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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
eboladengue feveryellow 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 perimeterMost distant control point • Inner perimeterHot 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 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