1. CBRNE Training Academy HazardsHazards

2. Lecture Goals Define what a hazard is Define “all hazards” approach Describe where hazards exist Explain hazard recognition Define what a hazard is Define “all hazards” approach Describe where hazards exist Explain hazard recognition

3. What is a hazardous substance? Any substance... –Solid –Liquid –Gas –Other Capable of harming... –People –Property –Environment Any substance... –Solid –Liquid –Gas –Other Capable of harming... –People –Property –Environment

4. What is a hazardous substance? Any substance to which exposure –“Results or may result in adverse affects on the health or safety of employees” –“Any chemical which is a physical hazard or a health hazard” OSHA 29 CFR 1910.1200 (c) Bottom line: Adversely affects health or safety (not only chemicals...) Any substance to which exposure –“Results or may result in adverse affects on the health or safety of employees” –“Any chemical which is a physical hazard or a health hazard” OSHA 29 CFR 1910.1200 (c) Bottom line: Adversely affects health or safety (not only chemicals...)

5. “All Hazards”

6. Knowledge that you have Applied to unknown situations Common, standard approach –Instills confidence –Quells fear –Ensures safety, always Prepared for the mundane = Prepared for the exotic Knowledge that you have Applied to unknown situations Common, standard approach –Instills confidence –Quells fear –Ensures safety, always Prepared for the mundane = Prepared for the exotic

7. Hazards = Potential Events Awareness identifies hazards “Guns don’t kill people...” Potential depends on scale and scope –Spill coffee –Spill sarin –Spill oil (tanker) Awareness identifies hazards “Guns don’t kill people...” Potential depends on scale and scope –Spill coffee –Spill sarin –Spill oil (tanker)

8. What’s in your hospital? Lab Pharmacy OR Building Services Engineering Environmental Services Bio-med Central Supply Lab Pharmacy OR Building Services Engineering Environmental Services Bio-med Central Supply Respiratory Dietary Radiology Nuclear Medicine Oncology Laundry EMS ED Med Air / O2

9. Where do hazards exist? EVERYWHERE Setting is artificial distinction –Familiarity creates false comfort Things we know, context we don’t –Medical O 2 vs. Industrial O 2 Location doesn’t modify nature* Awareness recognizes potential harm EVERYWHERE Setting is artificial distinction –Familiarity creates false comfort Things we know, context we don’t –Medical O 2 vs. Industrial O 2 Location doesn’t modify nature* Awareness recognizes potential harm

10. All Hazards People at risk = hazard Site independent Preparation and prevention is the same Scale and scope is different Intent is the confounding factor Remove intent, left with event People at risk = hazard Site independent Preparation and prevention is the same Scale and scope is different Intent is the confounding factor Remove intent, left with event

11. Specific hazards Things that are infectious Things that explode Things that burn, shock Things that are corrosive Things that are radioactive Things that cause cancer Things that are poisonous through other means “Others” Things that are infectious Things that explode Things that burn, shock Things that are corrosive Things that are radioactive Things that cause cancer Things that are poisonous through other means “Others”

12. D.O.T. Classification

13. Specific examples Scale, scope and intent Things that are familiar Things in unfamiliar context Things with malicious intent Scale, scope and intent Things that are familiar Things in unfamiliar context Things with malicious intent

14. Flammable liquids Found in all environments Often overlooked, ignored as risk Fire and explosive risk Let’s take a look at a familiar example… Found in all environments Often overlooked, ignored as risk Fire and explosive risk Let’s take a look at a familiar example…

15. Flammable liquids Ethyl alcohol

16. Flammable liquids Gasoline

17. Flammable liquids

18. All Hazards Everything is a potential hazard Hazards have many faces Recognize the potential exists Remove the intent Prepared and ready Everything is a potential hazard Hazards have many faces Recognize the potential exists Remove the intent Prepared and ready

19. Gases Found everywhere in a hospital Flammable, compressed –Boiling Liquid Expanding Vapor Explosion (B.L.E.V.E.) Some are toxic Let’s take a look at another familiar example… Found everywhere in a hospital Flammable, compressed –Boiling Liquid Expanding Vapor Explosion (B.L.E.V.E.) Some are toxic Let’s take a look at another familiar example…

20. Chlorine gas Severe pulmonary toxin Causes delayed lung injury Severe pulmonary toxin Causes delayed lung injury Normal chest x-ray ARDS chest x-ray Cl 2 + = =

21. My bathroom January 10, 2005 HCl HOCl + + Cl 2

22. South Carolina January 6, 2005

23. Ypres, Belgium April 22, 1915

24. Other gas examples Oxygen & other compressed gases

25. In a different context

26. All Hazards Everything is a potential hazard Hazards have many faces Recognize the potential exists Remove the intent Prepared and ready Everything is a potential hazard Hazards have many faces Recognize the potential exists Remove the intent Prepared and ready

27. Oxidizers Enhance / cause combustion of others Cause fire by itself, or by releasing O 2 Involved in reactive processes Enhance / cause combustion of others Cause fire by itself, or by releasing O 2 Involved in reactive processes

28. Oxidizers Ammonium nitrate

29. Oxidizers Ammonium nitrate

30. Oxidizers

31. All Hazards Everything is a potential hazard Hazards have many faces Recognize the potential exists Remove the intent Prepared and ready Everything is a potential hazard Hazards have many faces Recognize the potential exists Remove the intent Prepared and ready

32. Toxins or poisons Vast category, hard to generalize Found everywhere –Especially in healthcare –Home –Industry Lets take a look at an example from the hospital lab... Vast category, hard to generalize Found everywhere –Especially in healthcare –Home –Industry Lets take a look at an example from the hospital lab...

33. Toxins or poisons

36. All Hazards Everything is a potential hazard Hazards have many faces Recognize the potential exists Remove the intent Prepared and ready Everything is a potential hazard Hazards have many faces Recognize the potential exists Remove the intent Prepared and ready

37. Radioactivity Cause harm through energy Background radiation and specific sources –Radiology department –Nuclear medicine –Power plants –Industry Lets take a look at an example from the nuclear medicine department... Cause harm through energy Background radiation and specific sources –Radiology department –Nuclear medicine –Power plants –Industry Lets take a look at an example from the nuclear medicine department...

38. Internal, External, Other

41. All Hazards Everything is a potential hazard Hazards have many faces Recognize the potential exists Remove the intent Prepared and ready Everything is a potential hazard Hazards have many faces Recognize the potential exists Remove the intent Prepared and ready

42. Where can we learn more? On-scene personnel –Police, Fire, EMS, HazMat, etc. –Industrial Safety officer Poison Control Center Labels Material Safety Data Sheets (MSDS) Emergency Response Guidebook (ERG) Agency for Toxic Substance & Disease Registry (ATSDR) Internet resources On-scene personnel –Police, Fire, EMS, HazMat, etc. –Industrial Safety officer Poison Control Center Labels Material Safety Data Sheets (MSDS) Emergency Response Guidebook (ERG) Agency for Toxic Substance & Disease Registry (ATSDR) Internet resources

43. Questions?