1. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 11 Hazardous Materials Incidents

2. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics The Role of the Paramedic in Hazardous Materials Incidents Incident Size-up and Hazard Recognition Terminology Toxicology Review Decontamination Equipment

3. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ A hazardous material is any substance that causes adverse health effects upon human exposure.

5. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Generally paramedics do not perform containment and control functions at a hazmat response.

6. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hazmat Standards OSHA publication CFR 1910.120 EPA regulation 40 CFR 311 NFPA standard 473

7. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Incident Size-up Priorities for a hazmat incident are the same as for any other major incident. –Life safety –Incident stabilization –Property conservation

9. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Incident Awareness Every emergency site has the potential to be a hazmat incident.

10. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hazardous Materials Areas Transportation Fixed facilities Terrorism

12. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Transportation incidents involving hazardous materials

13. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Do not rule out the presence of a hazardous material at an MVC just because you do not see a placard.

14. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Potential Terrorist Targets Public buildings Multinational headquarters Shopping centers Workplaces Sites of assembly

16. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ At terrorist incidents, remember that a secondary device may exist!

17. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hazardous Materials Recognition Two systems: –Placards –Fixed facilities

18. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Placards Many vehicles are required to carry placards, but the absence of one doesn’t mean there is not a hazard.

19. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Vehicles carrying hazardous materials are required to display placards indicating the nature of their contents.

20. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Sample labels and placards required by the DOT for all packages, storage containers, and vehicles containing hazardous materials

21. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hazard Classes and Placard Colors

22. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ UN Number A specific identification number given to a specific chemical

23. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ NFPA 704 hazardous materials classification

25. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ NFPA 704 labeling on a tank

26. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Have the latest edition of the Emergency Response Guidebook in your vehicle at all times.

28. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ An example of a Material Safety Data Sheet (MSDS)

29. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The three zones typically established at a hazmat incident

31. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Terminology Boiling point Flammable/ explosive limits –LEL –UEL Flash point Ignition temperature Specific gravity Vapor density Vapor pressure Water solubility

32. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Alpha Radiation Alpha –Very weak –Stopped by paper, clothing, or intact skin –Hazardous if inhaled or ingested

33. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Beta Radiation More energy than alpha particles Will penetrate a few millimeters of skin

34. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Gamma Radiation High energy Example: X-rays Penetrates most substances Can damage any cells in the body Heavy shielding required

35. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Alpha, beta, and gamma rays

36. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Contamination and Toxicology Review

37. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Types of Contamination Primary –Direct contact. Secondary –A contaminated person or object comes in contact with an uncontaminated person or object.

38. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Routes of Exposure Respiratory inhalation Topical absorption Parenteral injection Gastrointestinal ingestion

39. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Effects of Poisons Acute effects Delayed effects Local effects Systemic effects Biotransformation Synergism

40. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Treatment of Common Exposures

41. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pesticide Actions S—Salivation L—Lacrimation U—Urination D—Diarrhea G—Gastrointestinal distress E—Emesis Involuntary muscle contraction Pinpoint pupils Blocks acetylcholinesterase (AChE) causing:

45. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ General Treatment for Chemical Asphyxiants Decontamination is usually not necessary. Remove from the toxic environment. Remove patient’s clothes to prevent trapped gases.

48. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Treatment for CO Exposure Oxygenate patient. Hyperbaric therapy is necessary in some cases.

49. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Methods of Decontamination

52. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Dilution Application of large quantities of water to the person. Water is the universal decontamination solution. Water may be aided by soap.

53. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Absorption Use of pads or towels to blot up the hazardous material. Usually applied after lavage. More commonly used during environmental cleanup.

54. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Neutralization Almost never used by EMS personnel. A substance reduces or eliminates the toxicity of another substance.

55. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Isolation/Disposal Involves separating the patient or equipment from the hazardous substance. Zones are established to prevent further contamination.

56. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Two-Step Process Usually a fast-break method. Remove patient’s clothing and jewelry. Wash and rinse the patient two times.

58. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Eight-Step Decontamination Process (1 of 2) 1.Rescuers enter the decontamination area at hot end of corridor and mechanically remove contaminants. 2.Rescuers drop equipment in a tool-drop area, and remove outer gloves. 3.Decontamination personnel shower and scrub all victims and rescuers using gross decontamination. Victims can be moved to step 6 or step 7. 4.Rescuers remove and isolate their SCBA.

59. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Eight-Step Decontamination Process (2 of 2) 5.Rescuers remove all protective clothing. Victims who are still clothed have their clothes removed. 6.Rescuers remove all personal clothing. 7.Rescuers and victims receive a full-body washing. 8.Patients receive rapid assessment and stabilization before transport.

60. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The level of protection needed depends on the chemical or substance involved.

63. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Assisting with an air tank

64. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Putting on a mask

65. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Assisting with a hood

66. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hazmat team, fully suited

67. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Medical Monitoring and Rehabilitation

68. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Entry Readiness Blood pressure Pulse Respiratory rate Temperature Body weight ECG Mental/ neurological status

69. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Heat Stress Factors Take into account: Temperature and humidity Prior hydration status Duration and degree of activity Level of protective suit used

71. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Rescuer involved in the decontamination process

72. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary The Role of the Paramedic in Hazardous-Materials Incidents Incident Size-up and Hazard Recognition Terminology Toxicology Review Decontamination Equipment