1. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ CHAPTER 35 Special Operations

2. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Hazardous Materials Incidents

3. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Hazardous Materials Found virtually everywhere Safety is primary concern EMT–B and crew Patient and bystanders

4. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ EMT–B Responsibilities at Hazardous Materials Incident Recognize a hazmat incident. Control the scene. Identify the substance. Establish a treatment sector.

5. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Know locations of potential hazmat incidents. Develop pre-incident plans. Control the impulse to rush in and help. Recognizing a Hazardous Material Incident

6. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Approaching the Scene Procedures Park upwind, uphill. Keep a safe distance away. Keep people away from area. Avoid contact with material. Recognizing A Hazardous Material Incident Continued…

7. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Procedures Do not enter hazmat scene unless trained and equipped. Assume all patients are contaminated. Recognizing a Hazardous Material Incident Approaching the Scene

8. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Establish danger zones and safe zones. Safe zone is upwind & same level as danger zone. Call for help. Utilize Incident Management System. Control the Scene

9. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Incident Management System Provides orderly means for communication and decision making Interaction between agencies easier with unified command

10. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Hazardous Materials Identification From: Occupants/driver Containers Shipping papers Senses

11. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Identify substances from a distance.

12. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Hazardous Material Placard

13. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Vehicle with Placard

14. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Hazardous Material Identification Resources Local hazmat resources CHEMTREC (800-424-9300) CHEMTEL (800-255-3924) DOT Emergency Response Guidebook

15. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ DOT Emergency Response Guidebook

16. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Establish a Treatment Sector To monitor and rehabilitate members of the hazmat team To care for anyone injured Continued…

17. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Locate in the cold zone. Protect from weather. Large enough for incident. Easy to access/egress. Establish AaTreatment Sector

18. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Essential to protect against, or reduce the effects of, exposure to both victims and first responders A chemical and/or physical process that reduces or prevents the spread of contamination from persons or equipment Decontamination

19. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Decontamination EMT–Bs may have patients who are: Uninjured & not contaminated Injured & not contaminated Uninjured & contaminated Injured & contaminated

20. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Follow guidelines and PPE listed in Emergency Response Guidelines. Treat ABCs. Remove clothing and irrigate as indicated. “Decon” yourself after treatment. Treatment

21. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Gross Decontamination Removes majority of substance Secondary Decontamination More thorough removal Phases of Decontamination

22. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Multiple-CasualtyIncidents

23. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Multiple-Casualty Incident (MCI) K ey Term An incident that places a great demand on EMS equipment and personnel

24. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Incident Management System

25. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Incident Management System Provides orderly means for communication and decision making Interaction between agencies easier with unified command

26. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Initial Role of EMT–B During an MCI Size up the scene. Provide a calm radio report of situation & request resources. Organize resources into incident management system.

27. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ EMS Sectors in Incident Management Extrication Triage Staging Treatment Transportation Supply Command

28. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Triage K ey Term Sorting multiple casualties into priorities for care or transportation. Priorities are established for 3 levels.

29. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Triage of Patients Rapidly assess each patient into a treatment priority. Stop only to secure an airway and/or stop major bleeding. More thorough treatment begins after all patients are triaged.

30. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Priority 1 Treatable Life Threats Airway and breathing difficulties Uncontrolled or severe bleeding Decreased mental status

31. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Patients with severe medical problems Shock Severe burns Priority 1 Treatable Life Threats

32. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Priority 2 Serious but Not Life-Threatening Burns without airway problems Major or multiple bone or joint injuries Back injuries

33. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Priority 3 “Walking Wounded” Minor injuries to extremities Minor soft-tissue injuries

34. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Priority 4 Dead/Fatally Injured Injuries incompatible with life, such as: Cardiac arrest Decapitation Incineration May also be called Priority 0

35. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ START Simple Triage And Rapid Treatment 30 seconds per patient Utilizes the parameters of: Respiration Pulse Mental Status

36. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Only three treatments during triage: Open an airway and insert an OPA. Apply pressure to bleeding. Elevate an extremity. START Simple Triage And Rapid Treatment

37. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ START Before beginning assessment: Ask all patients who can walk (considered priority 3) to move to designated area. This leaves priority 1, 2, and 4.

38. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ If patient is not breathing, and opening airway does not cause patient to start, he is priority 4. START Step #1: Assess respirations.

39. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ START Step #1: Assess respirations. If patient is breathing, and the rate is: Less than 30 per minute, she is priority 2. More than 30 per minute, he is priority 1.

40. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ If the patient has no pulse, is unresponsive, and is not breathing, he is priority 4. START Step #2: Assess radial pulse.

41. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ If the patient has a pulse, and is not breathing, he is priority 1. If the patient has a pulse, and is breathing, she is priority 2. START Step #2: Assess radial pulse.

42. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ If the patient is alert, he is priority 2. If the patient has an altered mental status, she is priority 1. START Step #3: Assess mental status.

43. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Assess all the patients who walked to the designated area using the same 3 steps. START Re-triage the walking wounded.

44. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Multiple-Casualty Triage Tag

45. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ MCI Procedures Assign available personnel and equipment to priority 1 patients first. Transport decisions based on Priority Resources Destination

46. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ 1. What should an EMT–B do when first to arrive at a hazmat scene? 2. What resources are available to identify hazardous substances? Review Questions

47. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ 3. List the EMS sectors in incident command. 4. What is the purpose of triage? Review Questions

48. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ As EMS command, what are some of the things you need to do? What information do you expect first from the triage officer? S TREET S CENES

49. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ How will you decide what patients go to what hospital? Is there a need for a safety officer in this scenario? S TREET S CENES

50. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ How should patient information be transmitted to the hospitals? What information should you be sharing with police command and fire command? S TREET S CENES

51. Limmer et al., Emergency Care Update, 10th Edition © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Sample Documentation