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© Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter 2 - 1 Health and Safety Chapter 2 Health And Safety.

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Presentation on theme: "© Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter 2 - 1 Health and Safety Chapter 2 Health And Safety."— Presentation transcript:

1 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Chapter 2 Health And Safety 37 Textbook Page

2 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Objectives Describe The Following Basic Toxicological Principles: Exposure Toxicity Acute And Chronic Exposures Acute And Chronic Effects Routes Of Exposure To Hazardous Materials Dose/Response Relationship Local And Systemic Effects Target Organs Identify The Seven Types Of Harm Created By Exposure To Hazardous Materials And Their Effects Upon The Human Body.

3 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Objectives Define The Following Terms And Explain Their Significance In The Risk Assessment Process: [NFPA (a)] Parts Per Million (PPM) Parts Per Billion (Ppb) Lethal Dose (LD50) Lethal Concentration (LC50) Permissible Exposure Limit (PEL) Threshold Limit Value/Time-weighted Average (TLV/TWA)

4 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Objectives Threshold Limit Threshold Limit Value/Ceiling (TLV/C) Threshold Limit Value/Short-term Exposure Limit (TLV/STEL) Immediately Dangerous To Life Or Health (IDLH) Emergency Response Planning Guideline (ERPG) Acute Exposure Guideline Levels (AEGL) Radiation Absorbed Dose (RAD Or RAD) Roentgen Equivalent Man (REM); Millierem (MREM) Roentgen ®

5 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Objectives Identify The Relative Advantages And Disadvantages Of The Following Heat Exchange Units Used For The Cooling Of Personnel In Chemical Protective Clothing [NFPA 472 – (d)]: Air Cooled Ice Cooled Water Cooled Identify The Physical And Psychological Stresses That Can Affect Users Of Specialized Protective Clothing [NFPA 472 – (g)].

6 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Objectives Identify The Signs And Symptoms And Emergency Care Procedures For Handling Heat Stress Emergencies. Identify Procedures For Reducing The Effects Of Heat Stress Upon Responders At A Hazmat Incident. Identify Procedures For Reducing The Effects Of Cold On Responders At A Hazmat Incident. Identify Procedures For Protecting Responders Against Excessive Noise Levels At A Hazmat Incident.

7 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Objectives Identify The Components Of A Medical Surveillance Program For Hazmat Responders As Outlined In OSHA (q). Identify The Components Of A Personal Protective Equipment (PPE) Program. Describe The Components Of A Site Safety Plan For Operations At A Hazmat Incident. List And Describe The Safety Considerations That Should Be Included In The Incident Action Plan Prior To Conducting Entry Operations At A Hazmat Incident [NFPA 472–6.3.5(c)].

8 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Objectives Describe The Procedures And Components For Conducting Pre- And Post-entry Medical Monitoring For Response Personnel Operating At A Hazmat Incident. Describe The Procedures For Establishing And Operating A Rehabilitation Sector At A Hazmat Incident.

9 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Introduction The Health And Safety Of All Emergency Responders Is A Critical Issue. Preventing Exposures To Hazardous Materials Is Always A Primary Concern. Command Personnel Must Also Evaluate The Physical Working Conditions, Work Intervals, And The Stress Of Working In Personal Protective Clothing And Equipment. It Is Everyone’s Goal to Have Responders Come Home Safe

10 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Introduction Hazmat Incidents Are Characterized By Work Environment Hazards, Which May Pose An Immediate Danger To Life And Health (IDLH) These May Not Be Immediately Obvious Or Identifiable. Protecting The Health And Safety Of Emergency Response Support Personnel, And The General Public, Must Always Be The Incident Commander’s (IC's) Primary Concern.

11 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Toxicology Toxicology Is The Study Of Chemical Or Physical Agents That Produce Adverse Responses In The Biologic Systems With Which They Interact. Toxicity Is Defined As The Ability Of A Substance To Cause Injury To A Biologic Tissue. 41

12 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Toxicology A Number Of Factors Determine The Toxicity Of A Chemical: Exposure Means That You Have Had Contact With The Chemical. Dose Is The Concentration Or Amount Of A Material To Which The Body Is Exposed Over A Specific Period Of Time. Toxicity Refers To The Ability Of The Chemical To Harm Your Body Once Contact Has Occurred.

13 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Exposure Concerns Chemical Exposures And Their Health Effects Are Commonly Described As Acute Or Chronic. Acute Exposures Are An Immediate Exposure An Acute Health Effect Results From A Single Dose Or Exposure To A Material, Such As A Single Exposure To A Highly Toxic Material Or A Large Dose Of A Less Toxic Material Chronic Exposures Are Low Exposures Repeated Over Time Chronic Health Effects Result From A Single Exposure Or From Repeated Doses Or Exposures Over A Relatively Long Period Of Time.

14 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Routes Of Exposure Inhalation Skin Absorption Ingestion Direct Contact Injection

15 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Dose/Response Relationship The Dose/Response Concept Is Based Upon The Following Assumptions: The Magnitude Of The Response Is Dependent Upon The Concentration Of The Chemical At The Biological Site Of Action (I.E., Target Organ). The Concentration Of The Chemical At The Biological Site Of Action Is A Function Of The Dose Administered. Dose And Response Are Essentially A Cause/Effect Relationship.

16 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Dose/Response Relationship

17 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Dose/Response Relationship

18 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Effects Of Hazardous Materials Exposures A Local Effect Implies An Effect At The Point Of Contact. A Systemic Effect Occurs When A Chemical Enters The Bloodstream And Attacks Target Organs And Internal Areas Of The Human Body. Eyes Skin Liver Blood

19 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Term - Target Organ - Examples Hepatotoxins Nephrotoxins Neurotoxins Respiratory Toxins Liver Kidneys CNS Lungs Carbon tetrachloride, Vinyl chloride monomer, and nitroamines Halogenated hydrocarbons and mercury Lead, toluene nerve agents, organophosphate pesticides Asbestos, chlorine, and System hydrogen sulfide 45

20 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Term - Target Organ - Examples Hematotoxins Dermatotoxins Teratogens Mutagens Blood System Skin Fetus Mutagens Benzene, chlordane, and cyanides Skeletal System Bones Hydrofluoric acid and selenium irritants, ulcers, chloracne, tar compounds, and high levels and/or cause skin of ultraviolet light pigmentation disturbances) Lead and ethylene oxide Radiation, lead, and or organisms ethylene dibromide

21 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Hazardous Materials Harm Events Thermal —those Events Related To Temperature Extremes. Mechanical —those Events Resulting From Direct Contact With Fragments Scattered Because Of A Container Failure, Explosion, Bombing Or Shock Wave. Poisonous —those Events Related To Exposure To Toxins. Corrosive —those Events Related To Chemical Burns And/Or Tissue Damage From Exposure To Corrosive Chemicals.

22 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Hazardous Materials Harm Events Asphyxiation —those Events Related To Oxygen Deprivation Within The Body. Radiation —those Events Related To The Emission Of Radiation Energy. Etiological —those Events Created By Uncontrolled Exposures To Living Microorganisms.

23 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Toxicity Concerns Toxicologists List Four Categories Of Factors That Influence Toxicity: Concentration Or Dose Rate Of Absorption Rate Of Detoxification Rate Of Excretion

24 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Measuring Toxicity Lethal Dose, 50% Kill (LD50) —The Concentration Of An Ingested, Absorbed, Or Injected Substance Which Results In The Death Of 50% Of The Test Population. Lethal Concentration, 50% Kill (LC50) —The Concentration Of An Inhaled Substance Which Results In The Death Of 50% Of The Test Population In A Specific Time Period (Usually 1 Hour).

25 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Parts Per Million vs. Parts Per Billion 49

26 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety The Hodge Sterner Table

27 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Exposure Values And Guidelines Exposure Values Are Only Guidelines, NOT Absolute Boundaries Between Safe And Dangerous Conditions. Common Exposure Values And Guidelines Are: Threshold Limit Value/Time Weighted Average (TLV/TWA)— the Maximum Airborne Concentration Of A Material To Which An Average Healthy Person May Be Exposed To Repeatedly For 8 Hours Each Day, 40 Hours Per Week Without Suffering Adverse Effects. Permissible Exposure Limit (PEL) And Recommended Exposure Levels (REL)—the Maximum Time-weighted Concentration At Which 95% Of Exposed, Healthy Adults Suffer No Adverse Effects Over A 40-hour Work Week.

28 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Exposure Values And Guidelines Short-term Exposure Limit (STEL) —or Threshold Limit Value/Short-term Exposure Value. The 15-minute, Time- weighted Average Exposure That Should Not Be Exceeded At Any Time, Nor Repeated More Than Four Times Daily With A 60-minute Rest Period Required Between Each STEL Exposure. Threshold Limit Value/Ceiling (TLV/C) —the Maximum Concentration That Should Not Be Exceeded, Even Instantaneously. (The Lower The TLV/C, The More Toxic The Substance Threshold Limit Value/Skin —indicates Possible And Significant Exposure To A Material By Way Of Absorption Through The Skin, Mucous Membranes.

29 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Exposure Values And Guidelines Immediately Dangerous To Life Or Health (IDLH)—an Atmospheric Concentration Of Any Toxic, Corrosive, Or Asphyxiant Substance That Poses An Immediate Threat To Life, Or Would Cause Irreversible Or Delayed Adverse Health Effects, Or Would Interfere With An Individual’s Ability To Escape From A Dangerous Atmosphere. Emergency Response Planning Guidelines (Erpg-2)—the Maximum Airborne Concentration Below Which It Is Believed That Nearly All Individuals Could Be Exposed For Up To One Hour Without Experiencing Or Developing Irreversible Or Other Serious Health Effects Or Symptoms That Could Impair An Individual’s Ability To Take Protective Action.

30 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Exposure Values And Guidelines Acute Emergency Exposure Guidelines (AEGL) —Referred To As “Eagles” And Developed By The National Research Council’s Committee On Toxicology, These Are Intended To Provide Uniform Exposure Guidelines For The General Public The Terms Used To Describe Chemical Toxicity And Exposures Can Seem Complicated, And Some Have Similar Meanings, Further Complicating The Issue Remember: Health Hazard = Exposure + Toxicity

31 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety

32 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Controlling Personnel Exposures The Primary Objective Of Using These Various Exposure Guidelines Is To Minimize The Potential For Both Public And Responder Exposures. Three Basic Atmospheres At An Incident Involving Hazardous Materials: Safe Atmosphere — No Harmful Hazmat Effects Exist. Unsafe Atmosphere — If One Is Exposed To The Material Long Enough, Some Form Of Either Acute Or Chronic Injury Will Often Occur. Dangerous Atmosphere —these Are Environments Where Serious Irreversible Injury Or Death May Occur.

33 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety What Is Safe? All Of These Guidelines Have One Thing In Common — Remain Below These Values And The Exposure Is Considered Safe To The Average Healthy Adult By All Information That Is Known By Today’s Health And Safety Professionals. 55

34 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety What Is Unsafe? A General Rule For Responders Should Be That If The Material Has Been Released From Its Container, Assume That An Unsafe Atmosphere May Exist And Some Form Of PPE Is Required.

35 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety What Is Dangerous? When Concentrations Continue To Increase Above Unsafe Levels, There Is A High Potential For Life- threatening Injuries Or Death To Occur. This Concentration Level Is The IDLH There Are Four General IDLH Atmospheres: Toxic Flammable Oxygen Deficient Oxygen Enriched

36 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Physical Indicators Of Likely IDLH Conditions Outside Or Open Air Environment Visible Vapor Cloud Release From A Bulk Container Or Pressure Vessel Large Liquid Leaks Inside Or Limited Air Environment Below Grade Rescues Or Release Confined Spaces Artificial Or Natural Barriers

37 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Physical Indicators Of Likely IDLH Conditions Biological Indicators (Using Your Common Sense!) Dead Birds, Discolored Foliage, Sick Animals Physical Senses And “Street Smarts” — Be Aware Of Strong Odors And Other Sensory Warnings Hazmats With A Potential For Quick And Rapid Harm Poison Gases Explosives and Some Oxidizers Materials With Very Low IDLH Values Firefighting Overhaul Operations

38 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Carcinogens Carcinogens Are Physical Or Chemical Agents That Cause Abnormal Cell Growth And Spread. There Are As Many As 2000 Substances That Various Scientific And Regulatory Groups Have Labeled As “Suspect,” “Probable,” Or “Definite” Human Carcinogens. While Some Carcinogens May Have A TLV Value, Many Do Not.

39 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Radioactive Materials Radiation Is The Emitting Of Energy From An Atom In The Form Of Either Particles Or Electromagnetic Waves. Radiation Can Be Classified Into Two Types: Non-ionizing Radiation—characterized By Its Lack Of Energy To Remove Electrons From Atoms. Ionizing Radiation—characterized By Its Ability To Create Charged Particles, Or Ions, In Anything That It Strikes. Four Types of Ionizing Radiation Alpha Particles Beta Particles Gamma Rays Neutron Particles

40 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Radioactive Materials Half-life Is The Time It Takes For The Activity Of A Radioactive Material To Decrease To One Half Of Its Initial Value Through Radioactive Decay. Exposure Versus Contamination Exposure Means That The Human Body Has Been Subjected To Radiation Emitted From A Radioactive Source. Contamination Means That The Actual Radioactive Material Has Come In Direct Contact With One’s Body Or Clothing (I.E., The Person Is “Dirty”). Exposure Guidelines For Radioactive Materials Are: Time - Distance - Shielding

41 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Units Of Measurement For Radiation and Dose 60

42 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Exposure To Environmental Conditions Exposure To Weather Conditions Can Adversely Affect Both The Physiological And Psychological Conditions Of Response Personnel. Factors That Influence An Individual’s Susceptibility To Environmental Conditions Include: Lack Of Physical Fitness Acclimatization To The Elements Age and Obesity Dehydration Alcohol And Drug Use (Including Prescription Drugs) Infection Or Chronic Disease Allergies

43 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Heat Stress Experience Over The Last 20 Years Has Shown That Responders Wearing Chemical Protective Clothing (CPC) Are More Likely To Be Injured As A Result Of Heat Stress Than A Chemical Exposure. A Key Indicator Of Body Heat Levels Is The Body Core Temperature. Physical Reactions To Heat Include The Following: Heat Rash — Inflammation Of The Skin Resulting From Prolonged Exposure To Heat And Humid Air And Often Aggravated By Chafing Clothing.

44 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Heat Stress Physical Reactions To Heat Also Include The Following: Heat Cramps — Cramp In The Extremities Or Abdomen Caused By The Depletion Of Water And Salt In The Body. Heat Exhaustion — Mild Form Of Shock Caused When The Circulatory System Begins To Fail As A Result Of The Body’s Inadequate Effort To Give Off Excessive Heat. Heat Stroke — Severe And Sometimes Fatal Condition Resulting From The Failure Of The Temperature Regulating Capacity Of The Body. Heat Stroke Is A True Medical Emergency Requiring Immediate Transport To A Medical Facility.

45 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Heat Stress Emergencies

46 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Minimize The Effects Of Heat Stress Administrative Controls, Work/Rest Scheduling, Rehab, And Fluid Replacement PPE Options Are Outlined Below: Air-cooled Jackets And Suits Ice-cooled Vests Liquid-cooled Vests And Suits Provide Plenty Of Liquids, Including Prehydration With 8 To 16 Ounces Of Fluids.

47 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Cold Temperature Exposures Exposure To Severe Cold Even For A Short Period Of Time May Cause Severe Injury To Body Surfaces, Especially The Ears, Nose, Hands, And Feet. Two Factors Significantly Influence The Development Of Cold Injuries Ambient Temperature Wind Velocity.

48 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Cold Temperature Exposures Response Personnel Should Also Understand Body Heat Is Lost It Is Essential That The Layer Next To The Skin, Especially Socks, Be Dry

49 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Noise Hazardous Materials Incidents Can Often Involve Excessive Noise Levels. The Effects Of Excessive Noise Levels Can Include The Following: Personnel Being Annoyed, Startled, Or Distracted Physical Damage To Ears, Pain, And Temporary And/Or Permanent Hearing Loss Interference With Communications, Which May Limit The Ability Of ERP To Warn Of Danger Or Enforce Proper Safety Precautions (Verbal And Radio) Standardized Hand Signals Should Be Developed For Situations Where Excessive Noise Levels Make Verbal Or Radio Communications Impossible.

50 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Health And Safety Management Program A Health And Safety Management Program Should Be An Integral Element Of Any Emergency Response Organization. The Components Of A Health And Safety Management System Are Outlined In OSHA , Hazardous Waste Site Operations And Emergency Response (HAZWOPER). Key Areas Within The Regulation Include Medical Surveillance, Personal Protective Equipment, And Site Safety Practices And Procedures. 68

51 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Medical Surveillance The Primary Objectives Of A Medical Surveillance Program Are: To Determine That An Individual Can Perform His Or Her Assigned Duties, Including The Use Of Personal Protective Clothing And Equipment To Detect Any Changes In Body System Functions Caused By Physical And/Or Chemical Exposures.

52 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Medical Surveillance The Success Of Any Medical Program Depends On Management Support And Employee Involvement. Confidentiality Of All Medical Information Is Paramount. Responders Should Be Encouraged To Document Any Suspected Exposures, Regardless Of The Degree.

53 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Medical Surveillance Program Pre-employment Screening Periodic Medical Examinations Emergency Treatment Non Emergency Treatment Recordkeeping Program Review Critical Incident Stress

54 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Pre-Employment Screening The Objectives Of Pre-employment Screening Are To Determine An Individual’s Fitness For Duty, Including Respirator And Protective Clothing Use. The Screening Should Focus On The Following Areas: Occupational And Medical History Physical Examination Baseline Laboratory Profile

55 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Periodic Medical Examinations Periodic Exams Must Be Used In Conjunction With Pre- employment Screening. Under The OSHA Requirements, Such Exams Shall Be Administered Annually. In Addition, More Frequent Intervals May Be Required Depending On The Nature Of Potential Or Actual Exposures. Periodic Screening Exams Can Include Medical History Reviews That Focus On Health Changes, Illness And Exposure-related Symptoms.

56 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Emergency Treatment EMS Personnel And Units Must Be Available At Each Hazmat Incident. OSHA (q)(3)(vi) Requires That "Advanced First Aid Support Personnel, As A Minimum, Shall Stand-by With Medical Equipment And A Transportation Capability At Hazmat Emergencies." Advanced First Aid Personnel Are Considered As Individuals Who Have Been Trained To The Red Cross Advanced First Aid Level Or Higher Medical Equipment Is Not Required To Be On Scene But Must Be Available For Immediate Response.

57 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Emergency Treatment Specific Responsibilities Of EMS Or Medical Group Personnel Include The Following: Provide Technical Assistance To Responders In The Development And Analysis Of EMS-related Data And Information. Designate A Treatment And Triage Area Perform Pre-entry And Post-entry Medical Monitoring Coordinate And Supervise All Patient Handling Activities Communicate And Coordinate With Local Hospitals And Specialized Treatment Facilities, Including The Poison Control Center, As Necessary.

58 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Emergency Treatment Hazmat Training Competencies For EMS Personnel Can Be Found In NFPA 473, Competencies For EMS Personnel Responding To Hazardous Materials Incidents Standard Operating Procedures (SOPS) For The Clinical Management And Transportation Of Chemically Contaminated Patients Must Be Developed As Part Of The Planning Process.

59 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Emergency Treatment Basic Principles Of Handling Chemically Contaminated Patients: Always Ensure That EMS Personnel Are Properly Protected As A Rule Of Thumb All Patients Should Receive Gross Decontamination. The ABCs Can Be Administered To A Contaminated Victim If Rescuers And EMS Personnel Are Protected. It’s A Much Better Option Than Having A Fully Decontaminated But Dead Patient. Always Coordinate With Your Local Medical Facilities.

60 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Nonemergency Treatment The Signs And Symptoms Of Certain Chemical Exposures May Not Be Present For 24 To 72 Hours After Exposure. Personnel Operating At An Incident Should Be Medically Evaluated Before Being Released. In Addition, The Termination Procedure Should Provide For A Briefing For All ERP On The Signs And Symptoms Of Exposure, Documentation And Completion Of Health Exposure Logs Or Forms, Post-incident Points Of Contact, And How To Get Immediate Treatment If Necessary.

61 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Recordkeeping And Program Review Recordkeeping Is An Important Element Of The Medical Surveillance Program. Individual Records Should Be Kept For All Personnel. Individual Medical Records Should Include All Medical Exams Completed, Their Purpose, The Examining Physician’s Observations And Recommendations, And If They Were A Result Of A Specific Exposure.

62 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Recordkeeping And Program Review Regular Evaluation of the Medical Surveillance Program and Review The Following Elements On An Annual Basis: Ensure That Each Accident/Illness Is Promptly Investigated To Determine Its Root Cause And Update Health And Safety Procedures, As Necessary. Evaluate The Effectiveness Of Medical Testing In Light Of Potential And Confirmed Exposures. Add Or Delete Specific Medical Tests As Recommended By The Medical Director And By Current Industrial Hygiene And Environmental Health Data. Review All Emergency Care Protocols.

63 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Critical Incident Stress Critical Incident Stress Should Be Recognized As An Issue That Can Potentially Impact The Health And Welfare Of Responders. Medical Debriefings As Part Of The Incident Termination Phase Are Essential Elements In Reducing The Level Of Stress. Employee Assistance Programs (EAP) And Critical Incident Stress Management (CISM) Teams Can Be An Effective Post incident Resource And Should Be Used As Necessary.

64 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Personal Protective Equipment Program The Objectives Of A PPE Program Are To Protect Personnel From Both Chemical And Physical Safety And Health Hazards. A Comprehensive PPE Program Should Include The Following: Hazard Assessment Medical Monitoring Of Personnel Equipment Selection And Use Training Program Inspection, Maintenance, And Storage Program

65 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Personal Protective Equipment Program A Written PPE Program Outlining These Elements Is Required Under OSHA (g)(5). Copies Should Be Made Available To All Employees. A Well- rounded PPE Training Program Often Reduces Associated Maintenance Expenses. A Written Respiratory Protection Program Is Also Required Per OSHA (c)(1). Certain Personal Features Jeopardize Responder Safety Including The Following: Facial Hair (Beards) And Long Hair Eyeglasses With Conventional Temple Pieces Gum And Tobacco Chewing Prescription Drug Use

66 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Site Safety Practices And Procedures Safety Is An Attitude, A Behavior, And A Culture. The Operating Philosophy Should Be, “If We Cannot Do This Safely, Then We Will Not Do It At All.” There Are Two Phases Of An Incident Where The Potential For ERP Injury And Harm Is Greatest During Initial Response Operations When The Incident Shifts Gears From The Emergency Phase To The Clean-up And Recovery Phase. Gaining And Maintaining Control Of The Incident Scene Is One Of The Most Difficult Tasks, Everyone Wanting To Get As Close As Possible To The Action. 75

67 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Safety Truths “What Occurs During The Initial 10 Minutes Will Dictate What Will Occur For The Next Hour, And What Occurs During The First Hour Will Dictate What Will Occur For The Next Eight Hours.” “There Is Nothing Wrong With Taking A Risk. However, Always Remember That There Are Good Risks And Bad Risks—if There Is Much To Be Gained, Then Perhaps Much Can Be Risked. Of Course, If There Is Little To Be Gained, Then Little Should Be Risked.”

68 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Safety Truths “ Safety Must Be More Than A Policy Or Procedure…it Is Both And Attitude And A Responsibility” “Protective Clothing Is Not Your First Line Of Defense But Is Your Last Line Of Defense.” “Final Accountability Always Rests With The Incident Commander.”

69 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Site Safety Plan Although A Site Safety Plan Is Not Required Under OSHA , Paragraph (q), Site Safety Must Be An Integral Element Of On-scene Response Operations. Sops And Checklists Should Be Used Both To Verify And Document That Safety Elements. Advantages Of Using Operational Checklists To Meet The Site Safety Requirements Are The Ability To Ensure That Specific Organizational Guidelines And Sops Are Followed.

70 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Standard Site Safety Practices Minimize The Number Of Personnel Operating In The Contaminated Area. Avoid Contact With All Contaminants, Contaminated Surfaces, Or Suspected Contaminated Surfaces. Advise All Entry Personnel Of All Site Control Policies Including Entry And Egress Points, DECON Layout And Procedures, And Working Times.

71 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Standard Site Safety Practices Always Have An Escape Route. Ensure That Everyone Knows The Emergency Evacuation Signals. Ensure That All Tasks And Responsibilities Are Identified Before Attempting Entry. If Necessary, Practice Unfamiliar Operations Prior To Entry. Use The Buddy System For All Entry Operations. Always Ensure That Properly Staffed And Equipped Back-up Crews Are In Place.

72 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Standard Site Safety Practices Maintain Radio Communications Between Entry, Backup Crews, And The Safety Officer (Whenever Possible). Prohibit Drinking, Smoking, And Any Other Practices That Increase The Possibility Of Hand-to-mouth Transfer In All Contaminated Areas. Follow Decontamination And Personal Cleanliness Practices Before Eating, Drinking, Or Smoking After Leaving The Contaminated Area.

73 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Safety Officer And Safety Responsibilities Under The OSHA HAZWOPER Regulation, The Safety Function Must Be Addressed At Every Incident In Which Hazardous Materials Are Involved. At Small, Level 1 Incident Scenarios, The Safety Function Can Be Easily Managed By The Incident Commander. At Incidents Where An HMRT Is Operating, Safety Responsibilities Will Often Be Divided Into Two Sreas The Safety Of All Units Operating On The Incident Scene And Under The Control Of The Incident Safety Officer The Safety Of Those Operating Within The ICS Hazmat Group And Under The Control Of The Hazmat Group Safety Officer.

74 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Safety Officer And Safety Responsibilities Overall Site Safety Ensure That The Safety Officer Is Identified To All Personnel. Ensure That All Personnel And Equipment Are Positioned In A Safe Location. Ensure That Hazard Control Zones Are Established, Identified, And Constantly Monitored And That Their Locations Are Communicated To All Personnel. When Necessary, Designate A Security Officer To Maintain Overall Site Security. Ensure That All Personnel In Controlled Areas Are In The Proper Level Of Personal Protective Clothing.

75 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Safety Officer And Safety Responsibilities Entry Operations Coordinate With The Medical Officer To Ensure That Pre-entry Medical Monitoring Has Been Conducted. Hold A Pre-entry Safety Briefing Prior To Recon Or Entry Operations. Coordinate Entry Operations With Backup Crews And The DECON Unit. Monitor Entry Operations And Advise Entry Personnel And The IC Of Any Unsafe Practices Or Conditions. During The Termination Phase, Advise All Personnel Of The Possible Signs And Symptoms Of Exposure And Ensure That Health Exposure Forms Are Documented.

76 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Pre And Post Entry Medical Monitoring Medical Monitoring May Be Defined As An Ongoing, Systematic Evaluation Of Individuals At Risk Of Suffering Adverse Effects Of Exposure To Heat, Stress, Or Hazardous Materials As A Result Of Working At A Hazardous Materials Emergency. The Objectives Of Medical Monitoring Are To Identify And Preclude From Participation Individuals Who Are At Increased Risk To Sustain Either Injury Or Illness To Facilitate The Early Recognition And Treatment Of Personnel With Adverse Physiological And/Or Emotional Responses. 81

77 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Pre- And Post Entry Medical Monitoring Components Of The Pre-entry Exam Should Include The Following: Vital Signs Skin Evaluation Lung Sounds Mental Status (Alert And Oriented To Time, Location, And Person). Recent Medical History Pre-hydration With 8 To 16 Ounces Of Water. Criteria Should Be Established For Evaluating ERP Prior To Entry Operations. These Criteria Should Not Supersede Any Existing Criteria Established By The Local Medical Control.

78 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Exclusion Criteria For HRT Entry Entry Shall Be Denied If The Following Criteria Are Not Satisfied: Blood Pressure —BP Exceeds 100 Mm Hg Diastolic. Pulse — greater Than 70% Maximum Heart Rate (>115) Or Irregular Rhythm Not Previously Known. Respirations — respiratory Rate Is Greater Than 24 Per Minute. Temperature — oral Temperature Less Than 97°f Or Exceeds 99.5°f. Core Temperature Less Than 98°F Or Greater Than 100.5°f. Body Weight — No Pre-entry Exclusion

79 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Exclusion Criteria For HRT Entry Entry Shall Also Be Denied If The Following Criteria Are Not Satisfied: EKG — Dysrhythmias Not Previously Detected Must Be Cleared By Medical Control. Mental Status — Altered Mental Status (E.G., Slurred Speech, Clumsiness, Weakness). Other Criteria, Including: Skin — Open Sores, Large Skin Rashes, Or Significant Sunburn. Lungs — Wheezing Or Congested Lung Sounds. Medical History

80 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Post-Entry Medical Monitoring Post-entry Medical Monitoring Is Performed Following Decontamination Any Signs Or Symptoms Of Chemical Exposure, Heat Stress, Or Cardiovascular Collapse Vital Signs Skin Evaluation Mental Status Hydration Vital Signs Should Be Monitored Every 5 To 10 Minutes, With The Person Resting, Until They Return To Approximately 10% Of The Baseline

81 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Emergency Incident Rehabilitation The IC Should Consider The Circumstances Of The Incident And Make Adequate Provisions Early In The Incident For The Rest And Rehabilitation. The Incident Commander Should Establish A Rehabilitation Sector. At Most Hazmat Incidents, Rehabilitation Will Be The Responsibility Of The Hazmat Medical Group.

82 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Emergency Incident Rehabilitation The Rehabilitation Area Should Meet The Following Parameters: Be In A Location That Provides Physical Rest By Allowing The Body To Recuperate From The Hazards And Demands Of The Emergency. Be Located In A Safe Location Within The Cold Zone. Provide Suitable Protection From The Prevailing Environmental Conditions. Be Large Enough To Accommodate Multiple Crews, Based On The Size Of The Incident.

83 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety Summary Personnel Protection Is The Number 1 Priority At Any Hazmat Incident. The Health And Safety Concerns Of ERP At Any Incident Include: Exposures To Hazardous Materials Physical Environment Toxicity And Health Exposure Guideline The Components Of A Hazmat Health And Safety Management System Site Safety Practices And Procedures

84 © Hazardous Materials - Managing the Incident 2005 Managing The Incident HAZARDOUS MATERIALS Chapter Health and Safety O.T. and The Kid


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