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© 2011 National Safety Council 25-1 SPECIAL OPERATIONS LESSON 25
© 2011 National Safety Council 25-2 Introduction Special response situations include hazardous material incidents, rescue situations such as water and ice rescues and natural disasters and terrorist attacks Advanced training is required for these emergencies Always remember that your personal safety is first priority
© 2011 National Safety Council 25-3 Hazardous Materials
© 2011 National Safety Council 25-4 Hazardous Materials Incidents Hazardous materials are common and pose a special hazard Hazardous materials include: Poisonous substances Explosives Flammable gases, liquids and solids Chemicals and substances that react with other substances Radioactive materials
© 2011 National Safety Council 25-5 Assessing for Hazardous Materials Check for clues while approaching: -Spilled chemical or liquid -Smoke or vapors -Smell of fumes Hazardous materials are not limited to industrial sites or vehicles transporting substances Homes contain potentially hazardous materials Some hazardous materials are explosion hazards
© 2011 National Safety Council 25-6 Hazardous Materials Placards Those who transport or store hazardous materials must post placards that identify material
© 2011 National Safety Council 25-7 Hazardous Materials Placards (continued)
© 2011 National Safety Council 25-8 If you do not see a placard but suspect hazardous material: Try to obtain additional information before approaching scene Do not enter scene retreat and call for help Most fire departments have specially trained HAZMAT teams for managing hazardous materials incidents Hazardous materials spills under the jurisdiction of National Incident Management System (NIMS) Hazardous Materials Placards (continued)
© 2011 National Safety Council 25-9 When Hazardous Material Is Present Primary responsibility is personal safety, maintaining safety for bystanders and patient Manage scene and keep others from scene while awaiting HAZMAT team Try to identify substance involved, give this information to dispatch and arriving EMS personnel Remain upwind of scene
© 2011 National Safety Council Hazardous Materials Training Do not attempt to manage hazardous substance without special training Typical levels of training: -Hazardous materials awareness training -Hazardous materials operations training -Hazardous materials technician -Hazardous materials specialist HAZMAT guidelines mandated by OSHA
© 2011 National Safety Council Managing the Scene Never enter scene unless trained as hazardous materials technician and fully protected Park upwind or uphill at safe distance Goal is to isolate area and keep unnecessary people away Avoid any contact with material Don’t provide ignition source
© 2011 National Safety Council Managing the Scene (continued) Move at-risk patients to safe area only if no exposure risk to yourself Patient who has been exposed should be decontaminated Once patient is removed, perform basic care
© 2011 National Safety Council Identifying Hazardous Material If you are first on scene, try to identify specific hazardous material Federal regulations require that hazardous materials are clearly labeled
© 2011 National Safety Council Identifying Hazardous Material (continued) Drivers carrying hazardous materials must have shipping papers that identify substance All vehicles transporting hazardous materials must have placards identifying materials and hazards
© 2011 National Safety Council Placards Color and design indicate hazard 4-digit number on placard identifies material Try to read placard from safe distance using binoculars Report this information to HAZMAT team and other personnel on site The Emergency Response Guidebook identifies hazardous materials codes
© 2011 National Safety Council National Fire Protection Association Warnings National Fire Protection Association system used on storage and industrial buildings Placards identify specific hazard by color: Red = flammable Blue = health hazard Yellow = instability hazard such as explosive or unstable material White = other information Placards also rate hazard level, ranging from very low hazard (0) to a very high hazard (4) W
© 2011 National Safety Council Water Rescue
© 2011 National Safety Council Water and Ice Rescue Emergency involving person in water or ice is dangerous If you cannot safely approach, stay away and call for specialized help Crew with appropriate training and equipment will be dispatched
© 2011 National Safety Council Water Rescue Situations Non-swimmer may have gotten into deep water Swimmer may have sustained injury or sudden illness Any patient with hypothermia Someone in deep water who cannot reach safety Unresponsive person as a result of drowning, injury or illness usually needs immediate BLS after rescue Choice of water rescue technique depends on: -Type of situation -Equipment and objects at hand -Circumstances
© 2011 National Safety Council Stay Out of the Water Resist temptation to jump immediately into water to save person Drowning person is panicked Lifeguards receive special training in how to break victim’s hold It may be appropriate to swim to unresponsive patient
© 2011 National Safety Council Safe Water Rescue Techniques Priority techniques: Reach Throw Go
© 2011 National Safety Council “Reach” Rescue Let responsive person hold on to pole while you slowly pull him or her to edge Hook unresponsive patient’s body and pull to safety Use anything available to reach patient If patient is close enough, you may reach with your body
© 2011 National Safety Council “Throw” Rescue Throw anything that floats to responsive person Swimming pool and boating equipment may include life ring, rescue tube or lifejacket Some boats carry a throw bag If no throwable rescue device is available, use anything that will float Tie line to object if possible
© 2011 National Safety Council “Go” Rescue Don’t enter water to go to patient except a small child or unresponsive patient Look for other ways to go to patient Wear a personal flotation device, take something person can hold on to
© 2011 National Safety Council Unresponsive Patients in Water Unresponsive patient should be assumed to have potential spinal injury Stabilize head and neck Turn patient face up to allow breathing or rescue breathing If patient is breathing, do not attempt removal alone wait for other EMS If alone, stabilize patient’s head and back
© 2011 National Safety Council Unresponsive Patients in Water (continued) With 2 responders, one holds patient at shoulder and hips while other supports head and neck in line If patient is not breathing and you are alone, float patient into shallow water for rescue breathing Check patient’s pulse Don’t remove patient with pulse, but continue rescue breathing until additional EMS personnel arrive If patient is pulseless, remove him or her from water to give CPR Try to support patient’s head and spine during removal, but do not delay CPR
© 2011 National Safety Council Skill: Turning A Patient in Water Using a Head Splint 1.Bring patient’s arms along both sides of head 2.Holding both of patient’s arms against sides of head, rotate patient toward you 3.Maintain head stabilization while assessing breathing
© 2011 National Safety Council Walking Assist With Sloping Bottom Once at depth where patient can stand, help patient exit with a walking assist Support patient as you walk him or her out of water
© 2011 National Safety Council Beach Drag Remove unresponsive patient from shallow water on a gradual shoreline with beach drag Slowly back out of water, dragging patient out Support patient’s head with your arms
© 2011 National Safety Council Ice Rescue Ice rescues are dangerous Cold-water immersion is very serious Call immediately to summon appropriate emergency personnel Attempt ice rescue using same priorities as a water rescue: reach-throw-go
© 2011 National Safety Council Ice Rescue: Reach-Throw-Go Use pole or tree limb to reach to person who has broken through ice Throw a rope or any buoyant object tied to a rope Only as an extreme last resort try to go to person Lie down to distribute your weight over larger surface area Push branch or other object ahead of you to patient Patient is likely to need treatment for hypothermia
© 2011 National Safety Council Special Response Situations
© 2011 National Safety Council Special Response Situations Many emergencies and rescues require teams with special training and equipment Call for assistance and provide as much information as possible
© 2011 National Safety Council Confined Space Emergencies Hazards may include: -Low oxygen levels -Toxic or explosive gases -Risk of collapse -Hypothermia or heatstroke Rescue teams are organized by fire departments, industrial organizations and other agencies Special equipment and training are needed Report situation, keep bystanders out of area and provide support to rescue team After removal of patients, assist other EMS personnel in providing care
© 2011 National Safety Council Rural and Agricultural Settings Emergency response may differ from that in urban areas: Longer response times Limited cell phone coverage Workers often alone and not immediately discovered EMRs and other EMS personnel are frequently volunteers
© 2011 National Safety Council Differences in Rural EMS and Health Care Facilities May not have sophisticated equipment or advanced training Small rural hospitals may not have continuous emergency department coverage or lack resources Patients may let chronic medical problems become emergencies
© 2011 National Safety Council Agricultural Hazards and Injuries Deaths among farm workers are higher than most other occupations Equipment entanglement may involve lengthy extrication procedures Hazardous chemicals are common Temperature extremes frequently contribute stress in emergencies
© 2011 National Safety Council Responders in Rural and Agricultural Settings Be prepared for patient conditions that have deteriorated because of response time Get to know area and types of hazards Get training for medical care needed during longer periods awaiting EMS resources Have right equipment and supplies Get advanced training in special skills such as hazardous materials incidents Recognize need to keep your skills updated
© 2011 National Safety Council Industrial Settings Particularly hazardous: -Hazardous machinery and equipment -Presence of hazardous materials -Risks of fire and explosion -Confined spaces An industrial response team is often present, with specialized training
© 2011 National Safety Council Responders in Industrial Settings Learn about special industrial response teams and how to contact them If site has emergency plan, ensure it is activated Your personal safety is your first priority Talk to on-site managers and staff to learn about specific hazards before entering scene Be aware of potential for multiple patients in an industrial incident, activate Incident Command System (ICS)
© 2011 National Safety Council Natural Disasters and Terrorist Acts Often cause widespread damage and injury
© 2011 National Safety Council Natural Disasters and Terrorist Acts (continued) EMRs reporting to ICS may have many roles NIMS directs response involving state and local disaster agencies Report within command structure and focus on your specific task assignments
© 2011 National Safety Council General Roles and Responsibilities in any Disaster Maintain personal and patient safety Provide patient care Operate within the Incident Command System Assist with other operations at scene
© 2011 National Safety Council Terrorist Acts NIMS has planned response to wide range of possible attacks -Explosions in structures -Nuclear explosions -Crashes of airliners, trains, ships, etc. -Release of biological agents such as anthrax -Release of chemical agents such as toxic gases -Release of radioactive material EMRs receive special training about their role in different types of attacks
© 2011 National Safety Council Weapons of Mass Destruction B = Biological agents N = Nuclear devices I = Incendiary devices C = Chemical substances E = Explosive devices
© 2011 National Safety Council EMR Awareness Maintain awareness of different types of terrorist attacks Be observant whenever responding to unusual emergency scene Be watchful and suspect terrorist incident when arriving at scene involving: -Large number of patients -Patients with unusual signs and symptoms possibly related to an exposure -Any incident at a facility or public place that may be targeted by terrorists -Other unusual incidents
© 2011 National Safety Council Secondary Explosive Devices Be aware of possibility of secondary device Devices timed to explode later to injure emergency personnel
© 2011 National Safety Council With Any Suspected Exposure Treat emergency scene as hazardous materials incident Stay at a safe distance to prevent exposure
© 2011 National Safety Council Responsibilities at the Emergency Scene Maintain personal safety Evaluate scene carefully before entering Report emergency as quickly and fully as possible Protect bystanders and help maintain scene safety Follow your chain of command for large-scale incidents Assist other emergency personnel at the scene
© 2011 National Safety Council Personal Safety Always the first priority Ensure scene safety before entering and use PPE Time, distance and shielding to prevent exposure: -Minimize exposure time as much as possible -Stay at a distance until scene is known to be safe -Shield yourself as appropriate from potential exposure Greater good: wait until scene is safe
© 2011 National Safety Council EMS Operations in Terrorist Incidents Ensure scene is safe before approaching Use appropriate equipment Summon additional help as needed Maintain an ongoing assessment of scene for potential secondary device or attack Maintain communication with law enforcement personnel Perform within the Incident Command System Assist in maintaining the perimeter Follow instructions for escape plan and mobilization point at terrorist incidents
© 2011 National Safety Council Nerve Agents Can be very deadly in small amounts Not easily detected initially May be inhaled, absorbed through the skin or ingested Be prepared to administer an antidote to yourself or other responders
© 2011 National Safety Council Signs and Symptoms of Exposure to Nerve Agent Salivation, tearing, urination, defecation, vomiting, pupillary constriction Blurred or dim vision Difficulty breathing Slow or fast pulse Muscle twitching, weakness or paralysis Slurred speech Sweating Seizures Loss of consciousness Death
© 2011 National Safety Council Acronym SLUDGE for Key Signs and Symptoms S = Salivation L = Lacrimation (tearing) U = Urination D = Defecation or diarrhea G = GI distress E = Emesis (vomiting)
© 2011 National Safety Council In Case of Possible Exposure to Nerve Agent Maintain scene safety Remove self or others from contaminated environment Use personal protective equipment Perform decontamination Remove contaminated clothing Maintain the airway, ventilate, provide oxygen Administer a nerve agent antidote auto-injector
© 2011 National Safety Council Administering Nerve Agent Antidote Administer only with serious signs and symptoms Do not administer if only mild signs and symptoms such as tearing and a runny nose Antidote auto-injectors: atropine and pralidoxime chloride -Mark I kit contains 2 auto-injectors, 1 with each drug -DuoDote kit contains both drugs in same auto-injector Procedure similar to emergency epinephrine auto-injector for anaphylactic shock
© 2011 National Safety Council Administration Technique Confirm correct drug and check expiration date With Mark I kit, use atropine auto-injector first and then repeat with pralidoxime chloride auto-injector Press injector firmly against outer upper thigh at 90- degree angle Hold for 10 seconds Check for needle to ensure drug was injected Dispose of the used auto-injector appropriately Reassess signs and symptoms
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