1	Chapter 11 Hazardous Materials Incidents
2	Topics The Role of the Paramedic in Hazardous Materials Incidents Incident Size-up and Hazard Recognition Terminology Toxicology Review Decontamination Equipment
3	A hazardous materials emergency can involve countless substances and can occur in many situations. Warning placards on a truck should immediately alert you to the possible need of a “hazmat” team.
4	"A hazardous material is any..." A hazardous material is any substance that causes adverse health effects upon human exposure.
5	"Generally paramedics do not perform..." Generally paramedics do not perform containment and control functions at a hazmat response.
6	Hazmat Standards OSHA publication CFR 1910.120 EPA regulation 40 CFR 311 NFPA standard 473
7	Levels of Training Awareness level Recognition EMS Level I (operations level) Patient care in cold zone EMS Level II (technician level) Patient care in warm zone
8	Incident Size-up Priorities for a hazmat incident are the same as for any other major incident. Life safety Incident stabilization Property conservation
9	Incident Awareness Every emergency site has the potential to be a hazmat incident.
10	Don’t take any chances. Use binoculars to make a visual inspection of potentially hazardous situations—such as a suspicious storage tank—from a safe distance.
11	Hazardous Materials Areas Transportation Fixed facilities Terrorism
12	Transportation incidents involving hazardous materials
13	"Do not rule out the..." Do not rule out the presence of a hazardous material at an MVC just because you do not see a placard.
14	Weapons of Mass Destruction (WMD) Chemical, biological, or nuclear devices used by terrorists to strike at government or high-profile targets Designed to create a maximum number of casualties
15	Potential Terrorist Targets Public buildings Multinational headquarters Shopping centers Workplaces Sites of assembly
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17	Hazardous Materials Recognition Two systems: Placards Fixed facilities
18	Placards Many vehicles are required to carry placards, but the absence of one doesn’t mean there is not a hazard.
19	Vehicles carrying hazardous materials are required to display placards indicating the nature of their contents.
20	Sample labels and placards required by the DOT for all packages, storage containers, and vehicles containing hazardous materials
21	Hazard Classes and Placard Colors
22	UN Number A specific identification number given to a specific chemical
23	NFPA 704 System Identifies hazardous materials at a fixed site Uses diamond-shaped figures divided into four sections: Red—Flammability Blue—Health hazard Yellow—Reactivity White—Specific information
24	NFPA 704 hazardous materials classification
25	NFPA 704 labeling on a tank
26	Substance Identification Emergency Response Guidebook Shipping papers Material safety data sheets (MSDS) Databases Hazmat telephone lines (CHEMTREC, CHEMTEL, Inc.) Poison control centers Toxicologists References
27	Have the latest edition of the Emergency Response Guidebook in your vehicle at all times.
28	An example of a Material Safety Data Sheet (MSDS)
29	Hazardous Materials Zones It is important to set up zones around an incident to assure safety of yourself, your crew, other responders, and the public.
30	The three zones typically established at a hazmat incident
31	Terminology Boiling point Flammable/ explosive limits LEL UEL Flash point Ignition temperature Specific gravity Vapor density Vapor pressure Water solubility
32	Alpha Radiation Alpha Very weak Stopped by paper, clothing, or intact skin Hazardous if inhaled or ingested
33	Beta Radiation More energy than alpha particles Will penetrate a few millimeters of skin
34	Gamma Radiation High energy Example: X-rays Penetrates most substances Can damage any cells in the body Heavy shielding required
35	Alpha, beta, and gamma rays
36	Contamination and Toxicology Review
37	Types of Contamination Primary Direct contact. Secondary A contaminated person or object comes in contact with an uncontaminated person or object.
38	Routes of Exposure Respiratory inhalation Topical absorption Parenteral injection Gastrointestinal ingestion
39	Effects of Poisons Acute effects Delayed effects Local effects Systemic effects Biotransformation Synergism
40	Treatment of Common Exposures
41	Corrosives (1 of 2) Brush off dry particles. Flush liquid corrosives with large quantities of water. Tincture of green soap may help in decontamination. Irrigate eye injuries, possibly with proparacaine hydrochloride to assist.
42	Corrosives (2 of 2) If the corrosive has been ingested, do not induce vomiting. If the patient can swallow and is not drooling, give the person 5cc/kg water up to 200 cc. Support the ABCs.
43	Pulmonary Irritants Cannot be decontaminated. Remove patient’s clothing. Flush exposed skin with large quantities of water. Irrigate eyes with water; proparacaine hydrochloride may assist. Treat pulmonary edema with furosemide and albuterol. Support the ABCs.
44	Pesticide Actions S—Salivation L—Lacrimation U—Urination D—Diarrhea G—Gastrointestinal distress E—Emesis Involuntary muscle contraction Pinpoint pupils
45	Pesticide Treatment Remove all clothing and jewelry. Maintain and support ABCs. Suction if needed. Administer atropine 2 mg IV push until SLUDGE symptoms resolve. If an adult has seizures, administer 5–10 mg of diazepam. If the patient can swallow, give 5cc/kg up to 200 cc of water.
46	Chemical Asphyxiants The most common chemical asphyxiants include: Carbon monoxide Has a high affinity for hemoglobin and displaces oxygen in the red blood cells Cyanides Inhibit cytochrome oxidase that enables oxygen to create adenosine triphosphate (ATP) required for muscle energy
47	General Treatment for Chemical Asphyxiants Decontamination is usually not necessary. Remove from the toxic environment. Remove patient’s clothes to prevent trapped gases.
48	Treatment for CO Exposure Oxygenate patient. Hyperbaric therapy is necessary in some cases.
49	Treatment for Cyanide Use a cyanide kit. Administer amyl nitrate. Administer sodium nitrite, 300 mg IV push over 5 minutes. Follow with an infusion of thiosulfate, 12.5 g IV push over 5 minutes. Repeat at half doses if necessary.
50	Hydrocarbon Solvents Decontaminate the exposed area with warm water and tincture of green soap. If the patient has ingested the solvent, do not induce vomiting. If the patient can swallow and is not drooling, administer 5 cc/kg up to 200cc of water. If the patient has seizures, give 5–10 mg diazepam. Support the ABCs.
51	Methods of Decontamination
52	Dilution Application of large quantities of water to the person. Water is the universal decontamination solution. Water may be aided by soap.
53	Absorption Use of pads or towels to blot up the hazardous material. Usually applied after lavage. More commonly used during environmental cleanup.
54	Neutralization Almost never used by EMS personnel. A substance reduces or eliminates the toxicity of another substance.
55	Isolation/Disposal Involves separating the patient or equipment from the hazardous substance. Zones are established to prevent further contamination.
56	Field Decontamination When dealing with unknowns, do not attempt to neutralize. Brush off dry chemicals. Apply large quantities of water with green soap if available.
57	Two-Step Process Usually a fast-break method. Remove patient’s clothing and jewelry. Wash and rinse the patient two times.
58	Eight-Step Decontamination Process (1 of 2) Rescuers enter the decontamination area at hot end of corridor and mechanically remove contaminants. Rescuers drop equipment in a tool-drop area, and remove outer gloves. Decontamination personnel shower and scrub all victims and rescuers using gross decontamination. Victims can be moved to step 6 or step 7. Rescuers remove and isolate their SCBA.
59	Eight-Step Decontamination Process (2 of 2) Rescuers remove all protective clothing. Victims who are still clothed have their clothes removed. Rescuers remove all personal clothing. Rescuers and victims receive a full-body washing. Patients receive rapid assessment and stabilization before transport.
60	Hazmat Protection Equipment (1 of 2) Level A Highest respiratory and splash protection Fully encapsulating Level B Full respiratory protection Non-encapsulating, but chemically resistant
61	Hazmat Protection Equipment (2 of 2) Level C Uses an air-purifying respirator Nonpermeable suit, boots, and eye and hand protection Level D Structural firefighting gear
62	"The level of protection needed..." The level of protection needed depends on the chemical or substance involved.
63	Assisting with an air tank
64	Putting on a mask
65	Assisting with a hood
66	Hazmat team, fully suited
67	Medical Monitoring and Rehabilitation
68	Entry Readiness Blood pressure Pulse Respiratory rate Temperature Body weight ECG Mental/ neurological status
69	After-Exit “Rehab” The team completes decontamination and reports to rehab. Measure and document the same parameters as during entry readiness. Rehydrate the members of the team. Team members are not allowed to re-enter the hot zone until their parameters are within normal limits.
70	Heat Stress Factors Take into account: Temperature and humidity Prior hydration status Duration and degree of activity Level of protective suit used
71	Rescuer involved in the decontamination process
72	Summary The Role of the Paramedic in Hazardous-Materials Incidents Incident Size-up and Hazard Recognition Terminology Toxicology Review Decontamination Equipment