Chapter 64 - Hazmat

PPE 2

- Level B - Highest level of respiratory protection - Lower level of skin and eye protection - Typically for protection from splash or particulates - Positive pressure SCBA - Chemical-resistant clothing - provide treatment for decontamination - (overalls and long-sleeved jacket; coveralls; hooded, two-piece, chemical splash suit; disposable, chemical-resistant coveralls; or fully encapsulated, nonvapor-tight suit) - Level C - When type of airborne substance is known - Concentration has been measured - Criteria for air-purifying respirator has been met - Skin exposure is unlikely - Full face air-purifying respirator or a powered air purifying respirator - Chemical-resistant clothing - (one-piece coverall; hooded, lwo-piece, chemical splash suit; disposable/chemical resistant overalls) - Level D - Work uniform - Turnout gear - Not worn where skin or respiratory hazards - offers no chemical protection

Training requirements 2

2)Operations: - Personnel who respond to protect nearby people, property, and the environment from the effects of a hazardous materials incident are trained to operate in a defensive manner and not make direct, intentional contact with the hazardous substance - Operate in a defensive manner - Do not make direct, intentional contact with substance - Training objectives: - Minimum 8 Hour training requirement - However, because of the combination of cognitive and practical training required to meet the objectives established for this level of training most courses are a minimum of 40 hours in length - Many agencies provide this level training for the paramedics - Paramedics must be trained to the operations level if they might treat patients who have been only partially decontaminated or not decontaminated at all - Knowledge of basic hazard and risk assessment techniques - Knowledge of how to select and use proper PPE - Understanding of basic hazmat terms - Knowledge of performing basic control, containment, and or confinement operations wthin the capabilities of the resources and ppe available to their unit - Knowledge of implementing basic decontamination procedures - Understanding of relevant SOPs (standard operating procedures) and termination procedures

Clues 2

3) Markings and colors - NFPA 704 (at fixed facilities) - Railcars must have name of substance stenciled on side 4) Placards and labels - May not always be present due to low quantities - Legally only certain materials must be placarded - company names, ID numbers, and telephone numbers often are found on container - License number of vehicle can help identify the owner and eventually the cargo 5) Shipping papers - Usually an extremely accurate source for determining the identity of hazardous cargos - must list emergency number - Must get close to substance to retrieve - Re ponders should never attempt to enter a hazardous materials scne to obtain shipping papers unless they have received proper training and are wearing appropriate protective equipment 6) Use of Senses - Most senses require proximity to hazard - Visual signs - Vapor clouds, liquid spills, dead people - Visual signs, such as visible vapor clouds, liquid, or solid products; dead or incapacitated people or animals; dead vegetation; or odor an irritation to the skin or eyes can signal the presence of hazardous materials - use of sight, preferably aided by binoculars can provide valuable information from a safe distance - Some are able to impair the sense of smell, such as hydrogen sulfide - It is detectable at low concentrations but at higher levels causes olfactory fatigue (desensitiztion of the sense, of smell). - The odor will disappear, leading responders to believe they are in a safe area

Training Requirements 3

3) Technician: - Responders who are usually members of a hazardous materials team make direct, intentional contact with a spilled material to 1essen the problem - The technician level has a minimum 24-hour training requirement (most courses are a minimum 80 hours in length) - Make direct, intentional contact with spilled material to decrease problem - Training objectives: - Knowledge of how to implement employer's emergency response plan - Knowledge of classification, ID, verification of known and unknown materials by using field survey equipment - Ability to function within assigned role in ICS - Knowledge of how to select and use proper specialized PPE - Understanding of hazard and risk assessment techniques - Ability to perform advanced control, containment, confinement operations - Understanding of and ability to implement decontamination - Understanding of termination procedures - Understanding of basic chemical and toxicologic terminology and behavior 4) Specialist: - Senior hazardous materials responders who respond in support of technicians have a specialized! focused knowledge about an aspect of the response - They also act as liaisons to state and federal response agencies - The specialist level has a minimum 24-hour training requirement equal to the technician level as well as competency in additional obiectives. - the length of specialist level training can vary greatly - Specialized, focused knowledge about an aspect of response - Training objectives - Knowledge of how to implement local emergency response plan - Understanding of classification, ID, verification of known/unknown materials by using advanced survey equipment - Knowledge of state emergency response plan - Ability to select and use proper specialized chemical PPE - Understanding in-depth hazard and risk techniques - Ability to perform specialized control, containment, confinement operations - Ability to determine and implement decontamination - Ability to develop site safety and control plan - Understanding of chemical, radiological, toxicological terminology and behavior 5) Incident command: - Responer trained to takes control of incident and direct the response operation - The incident command level has a minimum 24-hour training requirement that is equal to the operations level as well as competency in the following areas: - Training Objectives: - Knowledge and ability to implement employer's ICS - Knowledge of how to implement employer's emergency response plan - Knowledge and understanding of hazards and risks associated with employees working in chemical PPE - Knowledge of how to implement local emergency response plan - Knowledge of state emergency response plan and Federal Regional Response Team - Knowledge and understanding of importance of decontamination procedures National Fire Protection Association (NFPA): They have developed voluntary training competencies for personnel who respond to hazmat incidents - Of special interest to EMS responders is NFPA 473. - This standard is designed for EMS personnel who respond to hazardous materials incidents - designates two levels of training - Level 1 - Expected to perform patient care in cold zone - This zone should be free of contamination - Response activities in this area represent a minimal risk - Level 2 - Patient care using PPE and perform patient care activities during decontamination procedures in the warm zone - (the area where personnel and equipment decontamination takes place) at hazardous materials incidents

Material safety data sheet (MSDS)

A document that contain) information about the specific identity of a hazardous chemical; information includes exact name and synonyms, health effects, first aid, chemical and physical properties, and emergency telephone numbers.

Beta particle

A negatively charged particle emitted by certain radioactive materials.

Alpha particle

A positively charged particle emitted by certain radioactive material.

Cold zone

A safe area isolated from the area of contamination; also called the Support zone. This zone has safe and easy access. It contains the command post and staging area for personnel vehicles, and equipment. EMS personnel are stationed in the cold zone.

Flammable solids

A solid material other than an explosive that is liable to cause fires through friction, retained heat from manufacturing or processing, or that can be ignited readily; when ignited, they burn so vigorously and persistently that they create a serious transportation hazard (e.g., phosphorus, lithium} magnesium, titanium, calcium resinate)

Hazardous materials

A substance ( solid, liquid, or gas) capable of posing an unreasonable risk to health, safety, environment, or property.

Gamma rays

A type of electromagnetic radiation that can travel great distances; can be stopped by heavy shielding, such as lead.

Occupational Safety and Health Administration (OSHA)

A unit of the U. S. Department of Labor that establishes protective standards, enforces those standards, and r aches out to employers and employees through technical assistance and consultation programs.

Post Incident Concerns

After a hazardous materials incident has ended, numerous items must still be addressed - Procedures must be in place to prevent Secondary contamination after the incident is concluded Secondary contamination prevention: - Residual contamination of equipment - Residual contamination of ambulance Incident debriefing & postincident analysis review should follow every hazmat response - Cause should be assessed - Response procedures assessed - Procedures in place to deal with Emotional stress

Permissible exposure limit

Allowable air concentration of a substance in the workplace as established by OSHA; these value are legally enforceable.

Boiling liquid expanding vapor explosion

An explosion that can occur when a vessel containing a pressurized liquid ruptures.

Acute exposure

An exposure that occurs over a short timeframe (less than 24 hours); usually occurs at a spilI or release.

Chronic exposure

An exposure to low concentrations over a long period.

Transportation of Hazardous Materials

An understanding of how chemicals are transported, stored, and handled assists responders recognizing and identifying hazardous materials at an incident scene Governed by U.S. DOT: - Hazardous materials transportation is governed by the U.S. Department of Transportation (DOT) regulation known as the Hazardous materials Transportation Act (HMTA) Regulates: Types of Containers Markings on the containers Mode of transportation used Documentation needed Transportation containers: - Containers are used to transport hazardous and nonhazardous materials - They include bulk and nonbulk containers Nonbulk: - Smaller, individual packages - Bags and sacks: solid materials - Bottles: solids & liquids - Boxes: used for outside packaging for other nonbulk packages - Drums: solids & liquids - fiber drums and open-top drums are commonly used to contain solids - Tight or closed head drums are commonly used to transport liquids - Drums can be made from plastic (commonly used for corrosives) or steel (commonly used for solvents and fuels - Various types of nonbulk containers below - Intermodal container Carboys: - nonbulk container - Glass or plastic container - May have an outer casing - commonly carry corrosive products

Explosive

Any chemical compound, mixture , or device, the primary or common purpose of which is to function by detonation or rapid combustion (ie., with substantial instantaneous r lea e of gas and heat); found in liquid or solid forms (e.g., dynamite, TNT, black powder, fireworks, ammunition).

Flammable gases

Any compressed gas that meets requirements for lower flammability limit, flammability limit range, flame projection, or flame propagation as specified in CFR Title 49, Sec. 173.300(b) (e.g., acetylene, butane, hydrogen, propane.

Corrosive

Any liquid or solid that can destroy human flesh on contact or have a severe corrosion rate on steel

Storage & Handling of hazardous materials

As in transportation, the way that hazardous materials are stored and handled provides information to emergency response personnel Storage containers: Fixed facilities: Chemicals are stored at fixed facilities in nonbulk and bulk container - Bulk-nonpressure (atmospheric) storage tanks - Above-ground vertical tanks with various types of roof designs, horizontal tanks, and underground storage tanks - Bulk-low pressure - Spheroid - Spheroid and Noded - Bulk-high pressure - Spheres - Rounded-end pressure vessels Bulk containers may have marking systems, may include - ID numbers - Name of product - Storage capacity Some pipelines may be marked to show what they are carrying - Not required by federal law

Hazard Assessment

Boiling point and vapor pressure are closely related - Vapor pressure controls the product's boiling point - This is why liquified gasses (chlorine, ammonia, and liquified petrolium gas) can be kept in a liquid state inside a container even though the temperature is well above its boiling point - Liquefied gases usually have an extremely high expansion ratio - The expansion ratio determines how much vapor results when liquids evaporate - Once a liquefied gas is released from its container, it will create an extremely large vapor cloud. - When containers of liquids and liquefied gases under pressure are suddenly breached, the product may rapidly boil and expand Boiling liquid expanding vapor explosion - When pressurized containers with liquids are suddenly breached, liquid rapidly boils and expands - If flammable, fireball may result - this is known as boiling liquid expanding vapor explosion Physical properties also can be used to predict the movement of gases and vapors. The property of vapor density is similar to specific gravity Vapor density - Weight of volume of pure gas compared with weight of equal volume of pure dry air - air is given constant of 1 - less than 1 is lighter than air and rises when released , greater than 1 sinks when released - most vapors have density greater than 1 - Heavier air vapors create greater risk of exposure and fire if reach ignition source - Heavier air vapors can flow and settle in low areas, presenting a greater risk of exposure and fire if they reach an ignition source

Treatment for common hazardous materials - Pulmonary irritants

Both chlorine and ammonia act as pulmonary irritants and an cause severe damage to lung tissue - They can cause corrosive damage to the eyes or any moist tissue - Chlorine reacts with water to forms hydrochloric acid ~ widely used in the manufacture of chemicals, plastics, and paper ~ also used in water purification and in swimming pools ~ Chlorine gas is greenish-yelIow gas with a characteristic odor Anhydrous Ammonia reacts with water to forms ammonium hydroxide ( a strong alkali) - a colorless water- soluble, alkaline gas ~ used as a fertilizer and as an industrial refrigerant ~ also used in dyeing, synthetic fibers, and as a neutralizing agent - Liquified ammonia may cause frost bite -They can cause damage by Inhalation, ingestion, or skin/eye contact - May cause: - Pulmonary edema - Hypotension - Eye irritation - Chemical skin burns - May form strong alkali in respiratory system Treatment: - Adequate decontamination if skin irritation is present - Manage airway - Ventilate as necessary - Consider intubation at first sign of upper airway obstruction - Consider bronchodilator use (albuterol) - Monitor for pulmonary edema - Monitor cardiac rhythm and treat dysrhythmias - IV at 30 mL/hr - Watch for fluid overload - Vasopressor if hypotensive with normal fluid volume - Flush eyes with water if contaminated, continuously irrigate during transport

Asphyxiants

Chemicals that impair the body's ability to either get or use oxygen.

Chemical asphyxiants

Chemicals that prevent the transportation of oxygen to the cells or the use of oxygen at the cellular level

Hazard Classes

Class 1: explosives - Explosive placards and labels are orange and have a symbol showing an exploding ball with fragments on the top and a division number (1.1 to 1.6) on the bottom. The word "explosive" or a four-digit ID number appears in the center of the symbol - has 6 divisions - Division 1.1: Mass detonation hazard Division 1.2: Mass detonation hazard with fragments Division 1.3: Fire hazard with minor blast or projectile hazard Division 1.4: Explosive substances that present no significant hazard Division 1.5: Very insensitive explosives Division 1.6: Extremely insensitive explosives Class 2: gases - Compressed or liquefied gas placards and labels are red (flammable), green (nonflammable), or white (poison); have a fire symbol, gas cylinder symbol, or a skull and crossbones on the top; and a division number (2.1 to 2.3) on the bottom. These symbols have "flammable gas," "nonflammable gas, II or "poison gas" labeling or a four-digit 10 number in the center. - has 3 divisions - Division 2.1: Flammable gases - Division 2.2: Nonflammable gases - Division 2.3: Poisonous gases Class 3: flammable, combustible liquids - Flammable or combustible liquids placards and labels are red, have a flame symbol on the top, and a division number (3.1 to 3.3) on the bottom. They have the wording "flammable liquid" or "combustible liquid" or a four-digit 10 number in the center. - has 3 divisions - Division 3.1: Liquids with flash pOints <0° F - Division 3.2: Liquids with flash points 1rom 0° to 73° F - Division 3.3: Liquids with flash points 1rom 73° to 141°F - Combustible liquids Class 4: flammable solids - Flammable solid placards and labels are red and white striped (flammable solids), red over white (spontaneously combustible solids and liquids), or blue (dangerous when wet); have a flame symbol on the top; and a division number (4.1 to 4.3) on the bottom. They have the wording "flammable solid," "spontaneously combustible " or "dangerous when wet" or a four-digit 10 number in the center. - Has 3 divisions - Division 4.1: Flammable solids - Division 4.2: Spontaneously combustible or pyrophoric solids and liquids - Division 4.3: Dangerous when we

Hazard Classes 2

Class 5: oxidizing substances - Oxidizing substances placards and labels are yellow, have a symbol showing an "0" with flames on the top, and a division number (5.1 to 5.2) on the bottom. They have the wording "oxidizer" or "organic peroxide" or a four-digit ID number in the center. - Has 2 divisions - Division 5.1: Oxidizing substances - Division 5.2: Organic peroxides Class 6: poisonous, infectious substances - Poison liquid and solid material and infectious material placards and labels are white; have either a skull and crossbones. biomedical symbol, or grain stock with an x through it (depending on material) on the top; and a division number (6.1 to 6.2) on the bottom. These symbols have the wording "poison," "infectious material," "keep away from foodstuffs" or a four-digit 10 number in the center - Has 2 divisions - Division 6.1: Poisons - Division 6.2: Infectious substances Class 7: radioactive substances - Radioactive materials placards and labels are yellow over white, have the radioactive "propeller" symbol on the top, and the number 7 on the bottom. Labels must identify the radionuclide and the amount of activity in the package. They will have the Roman numerals I, II, or III in the center to identify the level of hazard and type of container and space to write in specific information. The I, II, or III numbering deSignates the amount of radiation detectable from outside the package. Labels have the wording "radioactive material" or a four-digit 10 number in the center. Class 8: corrosive material - Corrosive materials placards and labels are white over black, have a symbol showing a test tube spilling liquid onto a human thumb, and a piece of steel on the top and have the number 8 on the bottom. The word "corrosive" or a four-digit 10 number appears in the center. Class 9: miscellaneous hazardous materials - Miscellaneous hazardous materials placards and labels are black and white striped over white and have the number 9 on the bottom. They have a four-digit 10 number ;n the center.

Safe Response 2

Cold zone - AKA Support Zone - an area under responder control but is located safely away from the emergency - All support and rehabilitation functions are located in the cold zone - Ensure adequate decontamination has been performed - Transfer patient from decontamination personnel to medical caregivers to limit contamination spread - Limit contamination spread - Place patient on clean backboard, stretcher - Perform basic, advanced life support as required - To establish these zones, start with a visual survey of the immediate environment - Consider the locations of the agent and possible movement patterns - Once hazardous materials resource are on scene, data from detection devices should be reviewed - Consider distances needed to prevent an explosion or fire from affecting personnel outside the hot zone by using your reference manuals - If this is a response to a terrorist attack, the possible areas of secondary device concealment should not be overlooked. - sincce entry personell will be wearing protective equipment, the distance they have to travel to reach the hot zone should not be excessive - Make sure that the physical area of the safe area is large enough to support site operations

Treatment for common hazardous materials - Corrosives

Corrosives: - Any liquid or solid that causes visible distruction of the human skin tissue or has a severe corrosion rate on steel or aluminum - EPA defines a co rrosiv product a having a pH of 2 or less or 12.5 or more ~ Include both acids and bases - Ex: hydrochloric acid, sulfuric acid, hydrofluoric acid, sodium hydroxide (lye), and caustic potash - can cause damage by inhalation, ingestion, or contact with the skin or eyes S/S: Exposure can cause severe irritation or burns to skin - Upper airway burns and edema - Circulatory collapse - Severe skin burns - GI perforation - Hemorrhage - Peritonitis - Toxic systemic effects Treatment: - Adequate decontamination is essential to limit tissue damage - Manage airway, early intubation may be needed if early signs of airway obstruction - Do not induce vomiting, use emetics - Monitor for pulmonary edema and treat dysrhythmias - IV at 30 mL/hr (watch for fluid overload) - Treat seizures with benzo's - Flush eyes with water, irrigate, and continue during transport - Cover skin burns with dry/sterile dressings - Do not attempt neutralization

Hazard Potential- Corrositivity

Corrosivity: - Damages human tissue or highly corrosive to steel - Assesed based on the chemicals PH scale - Acids and bases - On the pH scale 7 is neutral - Acids are materials with a pH value less than 7 - Bases, or caustic, are materials with a pH value greater than 7 - Te lower the number the stronger the acid and the higher the number the stronger the base The EPA defines an extremely corroive product as one with a pH value of 2 or less or 12.5 or greater - Both strong acids and strong alkalis cause extensive tissue damage Both sides of the scale are corrosive Strong alkalis usually result in deeper burns because of their ability to penetrate tissue. When assessing the hazards of a corrosive chemica; also asses vapor pressure Chemicals with high vapor pressure evaporate, and the corrosive vapors cause inhalation exposure and tissue damage. Corrosive vapors cause inhalation exposure and tissue damage

Treatment for common hazardous materials - Chemical Asphyxiants

Cyanide and carbon monoxide are both chemical asphyxiants, but they work in different ways. Cyanide - can cause damage by inhalation, ingestion, skin absorption, and skin and eye contact - may be found in liquid, solid, or gaseous form - solid form: it is white, with a faint bitter almond odor - used as a fumigant, in metal treatment, and in the welding and cutting of heat-resistant metals. - Used in paper manufacturing, photography, electroplating, blueprinting, and engraving - it is a thermal decomposition product of many plastics and other combustible products and is present in most smoke inhalation cases - It brings cellular respiration to a halt Carbon monoxide: - a colorless, tasteless, and odorless gas formed when organic material undergoes incomplete combustion - found in exhaust fumes of internal combustion engines and furnace flues - also is used in metallurgy, organic syntheis, and the manufacture of metal carbonyls - enters the body by inhalation - the oxygen transport function of hemoglobin in the blood is reduced when it binds with CO, forming carboxyhemoglobin ~ carboxyhemoglobin cant bind with oxygen - Causes death by hypoxia - Decontaminate as necessary ~ CO victims do not usually need decontamination Treatment: - Decontaminate Cyanide thoroughly, CO may not need it Manage airway Ventilate as necessary Do not induce vomiting Monitor for pulmonary edema, cardiac rhythm IV at 30 mL/hr * Administer cyanide antidote kit Treat seizures with diazepam or lorazepam per protocol Flush with water, continue irrigation during transport * Consider hyperbaric O2 for optimal treatment

Transportation 2

Cylinders: - Nonbulk Container - Liquefied gasses - Nonliquefied gasses - Mixtures under pressure - May contain liquids or solids - Typical cylinder types include Aerosol containers - Uninsulated containers - cryogenic (products cooled to less than -90°C - 130° F] cylinders - Service pressures can range from a few to thousands psi (pounds per square inch) Bulk containers: - Large container and tanks - Used to transport large quantities of hazardous materials - Large bulk bags are used for transporting solids such a pesticides and fertilizers Intermodal tank containers (portable tanks) - Bulk Container - Can be transported by Highway, rail, water - These containers can be Pressure, nonpressure, high pressure tube module, refrigerated tank container - enclosed in a metal supporting frame Portable Bins: - portable tanks used to transport bulk solids Ton cylinders - Pressure tanks appx 3ft x 8 ft - Transport liquefied gases - such as chlorine, sukfur dioxide, and phosgene Radioactive materials protective packaging - Boxes - used for kow kevel shipments - Overpacks - may be cylindrical or boxlike - Casks - rigid metal packages that range from 10' dia x 50'L Cargo tanks - Transport bulk liquefied or compressed gases, liquids, solids, molten materials - May be Nonpressurized, pressurized, or specialized design - nonpressurized transport liquids MC 306/DOT 306 - tank trailers designated as motor carriers - Commonly seen on the highway - Elliptical shaped cross section with flat ends and are commonly made of aluminum - They are usually compartmentalized - Hold up to 9000 gallons of product that is Liquid lighter than water - Ie Hydrocarbons (gas/diesel fuel) MC 307/DOT307 - Tank Trailers - Circular type cross section and flat ends and are general purpose chemical carriers - 5000−6000 gallons - Liquid heavier than water - Corrosives MC 311 - Pressurized liquids or gasses - smaller rounded cross sectionand rounded ends and carry liquified gas - 5000−6000 gallons - Liquid heavier than water - liquified petrolium gas or anhydrous ammonia

Local damage

Damage present at the point of chemical contact.

Decontamination

Decontamination operations should be established before allowing entrance into the hot zone for any reason including rescue Contamination corridor established in warm zone - Should contain separate areas to decontaminate responders, patients, equipment - Selection of a decontamination site should be based on availability; water supply; ability to contain runoff; and the proximity of drains, sewers, streams, and ponds - Shelters such as schools, firehouses, garages, indoor car washes, and swimming pools may be used after initial rinse at the scene for thorough decontamination - Hospital decontamination can be conducted outside the emergency department with portable equipment - As anyone exits the hot zone they must be decontaminated - Equipment must be decontaminated as it leaves the hot zone Product, life threat, route of exposure, and need for decontamination identified - If the exposure is from an unknown material, a worst case scenario should be considered Trained, protected responders can manage essential patient treatment at th same time as decontamination Responder decontamination: Must be decntaminated when leaving the hot or warm zone - All personnel - Clothing - Equipment Patient care equipment should be changed to clean equipment when the patient is transferred to the cold zone Dry decontamination can be used if contamination is minimal - Dry decontamination involves using disposable clothing and systematically removing the garment in a manner that precludes contact with the contaminant Patient decontamination: Ambulatory patient decontamination: Wear PPE Have them Exit contaminated area Provide shelter Remove clothing ect and isolate them in plastic bags - Clothing - Jewelry - Shoes Rinse patient with copious warm water - If possible, warm water, 32° C to 35°C (90 degrees F to 95 F) should be used so that extensive washing can be accomplished - Never use hot water, too cold water can cause hypothermia - use low water pressure and a gentle spray to avoid aggravating any soft tissue injuries Baby shampoo or mild liquid soap Contacts removed asap when patient hands cleaned The should pay special attention to hair nail bed , and skin folds - Soft brushes and sponges may be used. - Patients should then rinse with copious amounts of water

Olfactory fatigue

Densitization of the sense of smell.

Reducing secondary contamination risk:

Determining if the patient is completely decontaminated is difficult in the field. Ensure patient and crew protected during transport - Nonessential equipment should be removed before transport - Cover walls and ceiling of ambulance with plastic, may be helpful to cover stretcher/floor/bench - Adequate ventilation in transport vehicle ~ because inhalation is the quickest and most vulnerable route of exposure ~ Ambulances should have both intake and exhaust fans operating to ensure maximal ventilation in the patient care compartment Another method sometimes recommended is Reverse isolation: - These procedures include postdecontamination isolation of the patient in specially designed contaminated patient transportation bags, pIastic, sheets, blankets, or Zip-front body bags - It reduces secondary risk to to responders, but may cause increased contamination to the patient ~ increases temp, which opens pores and dilates peripheral blood vessels - Vomit isolation in plastic bag immediately ~ May contain toxins ~ could eb an inhalation hazard - contaminate patient - Follow local medical direction recommendations Vomitus may contain volatile compounds PPE worn during transport - Respiratory PPE EMS personnel may wish to wear respiratory protective and chemical protective clothing when transporting patients who may have been contaminated - Chemical protective clothing Air Transport Contraindicated - The helicopter may travel through an unsafe area, or the rotor wash from the helicopter may affect vapor or fumes at the scene - If decontamination is not complete, the flight crew could experience symptoms of exposure - contraindicated unless rapid transport is absolutely necessary and the patient is completely decontaminated or was exposed to a chemical with no risk of secondary contamination

Mydriasis

Dilation of the pupils.

Carboys

Glass or plastic bottles commonly used to transport corrosive products.

Transport Identification Systems

Hazard classes: - DOT requires containers be marked - under DOT 49 CFR - DOT organizes hazmats according to the International hazard classes - Composed of 9 classes - many of these classes are further divided into categories that represent various degrees or types of hazards - knowing these will help understand the hazards associated with their release - Listed in North American Emergency Response Guidebook - assist responders in remembring the different hazard classes and placards Placards: - diamond shaped signs placed on the sides and ends of bulk transport container that carry hazardous materials - They relay info by four means: - Color - Symbol at top - International hazard class at bottom Hazard class wording or a 4 digit id number (known as ID number) in the center DOT & international labels are smaller versions of the plaqauards - Used on individual, nonbulk containers Certain hazardous materials, regardless of the quantity, must always be placarded when transported: -Most explosive products -Poisonous gases -Water-reactive flammable solids -Most radioactive substances - Others do not need to be placarded unless >1001 lb gross weight is carried Under certain circumstances when a mixed load is carried a placard that reads "dangerous" may be used Many products can fit into multiple hazard classes - e.g., flammable and poison - DOT has determined that these usually only have to have 1 placard (the greatest hazard) on the outside of the bulk container (the actual containers need all labels) Empty tank trucks must remain placarded until they are cleaned Empty rail tanks may be placarded as residue - The tanks may contain up to 30% of the tank's capacity Four-digit identification numbers - UN (united nations) or North American ID number or product id numbers - often can be found on the sides and ends of bulk transport containers - often are found on the placard or an orange panel located adjacent to the placard - They also may b found in the center of a placard sized white panel for hazardous substances and wastes not requiring a placard - Identifies product in emergency response guide book

Patient Transport

Hospital communication: - Early notification to the hospital is important ~ Some victims may have self-transported by the time everything gets set up ~ Once media gets out people who were in the vicinity may think they were exposed and call the hospital for advice ~ Early on the hospitals may be swamped with potentially contaminated patients ~ Gives them time to research ~ notify all hospitals in the area Number of patients Nature of incident: Agent involved Route of exposure Associated trauma Duration of exposure Victim examination findings and vital signs Decontamination status Other relevant patient information ETA

Treatment for common hazardous materials - Hydrocarbon Solvents

Hydrocarbons are colorless cIear liquids with a faint odor Found in solvents, degreasers, wetting agents , agricultural chemicals, laboratory reagents, and antifreeze - Also used in the application and manufacture of varnish , lacquers, paints, and detergents Damage by inhalation, ingestion skin absorption and skin and eye contact. S/S Skin and eye irritation Dysrhythmias Pulmonary edema and respiratory failure Seizures and paralysis Brain and kidney damage Treatment: Adequate decontamination Manage airway Ventilate as necessary Consider bronchodilator for bronchospasm Do not induce vomiting Monitor for pulmonary edema, cardiac rhythm IV at 30 mL/day Treat seizures with benzos Flush eyes Avoid epinephrine and beta agonists - Unless in cardiac arrest - Myocardium irritable may lead to vf

Hazardous Material Team Support

In addition to patient care activities for those exposed to a chemical incident, the paramedic will likely be involved in the medical monitoring and rehabilitation of members of the hazardous materials team, as required by OSHA - an ongoing process to evaluating the response of personnel who are at risk from exposure to the chemical substance and the effects of heat, cold, stress , and increased physical activity in protective clothing Preentry examination: - Before entry into the hot zone, all personneI required to use level B protection must have a brief health screening conducted to determin baseline levels - Medical monitoring and rehabilitation of team - Level A or B protection worn - Determine baselines - Vitals - Temperature - Weight - these can help provided early signs of heat stress and dehydration - examine skin for wounds, rashes, irritations that may allow entry of chemical substances Mental status, gait & Neurological functions - to determine any change after exiting the hot zone - Baseline ECG Recent illness in past 72 hours - Fever, diarrhea, cough, nausea, vomiting & any meds that were taken - Pay particular attention to the prenetry of diuretic or other medications that can lead to dehydration and heat stress . - Prehydrate with 8-16 oz water or diluted sports drink to offset the losses that will occur while in chemical protective clothing Denial of entry into hot zone: Body temperature >99.2°F Pulse >110 beats/min BP >150/90 mm Hg Respiratory rate 24 breaths/min New onset of: ● Cardiac complaints ● Respiratory complaints ● Hypertension ● Nausea ● Vomiting ● Diarrhea If team members demonstrate any change in gait, speech or behavior, they should be immediately removed from the hot zone, decontaminated, and evaluated, as should any member with a report of chest pain, dizzines , shortness of breath, weakness, nausea, or headache - these can be signs of heat stress or exposure to chemical agent

Safe Resoponse Practices

Initial response: - First priority: protect responders - Safe zone - Uphill - Upwind - Upstream - Because gases and vapors spread the fastest and go the farthest, upwind is the most important factor in selection of a safe zone - Establish command (if no one else is there) - Set up ICS - If ICS is set up, report to the IC or staging areas as directed - No rescues from contaminated areas attempted until chemical identified and properly trained responders w/ appropriate ppe are avaialable - Screen bystanders and witnesses for exposure - get names/addresses in case future information is needed - Consider evacuation needs - Mass evacuations may complicate the response by exposing the evacuating population to the agent or by choking off access to emergency responders - 1n some cases a better strategy may be protection in place (also called in-place sheltering) - In a'll cases, decisions must be approved by the incident commander Scene management: Site Security is necessary: - Limit access to properly trained response personnel Hot zone - aka Exclusion zone - Contamination currently exists or areas that may be contaminated in a short period - Rapid patient removal (attention to c spine injuries) - If trapped, stabilization and care - medical or trauma stabilization care may be required (medical procedures must be carried out by qualified personnel). Because of the contaminated environment. invasive procedures must be kept to an absolute minimum - Airway control - Isolation of airway with an escape mask, SCBA, filtered bag-mask, or ventilator - Rapid removal when extrication procedures are complete Warm zone - AKA contamination reduction zone - Transition area between contaminated and clean areas - designed to reduce the probability that the clean areas will become contaminated or affected by scene hazard - area of potential contamination that must be adequately contained - Medical care during decontamination - ABC2DE - Airway - Breathing - Circulation (hemorrhage control) - C Spine stabilization - Decontamination - Evaluate for systemic toxicity - O2 administration - Limited invasive procedures - CPR as necessary, feasible

National Fire Protection Association (NFPA)

International voluntary membership organization that promotes improved fire protection and prevention and establishes safe guards against loss of life and property by fire; writes and publishes national voluntary consensus standards.

Labeling 2

Labels are often found on hazardous substance containers: - OSHA Hazard Communication Standard: referred to as HAZCOM - requires that containers of hazardous substances be labeled so that workers are informed of their respective hazards - Many types of labels are used - Manufacturer usually include a label on their containers that specifies the name of the manufacturer, name of the chemical, major hazards associated with the chemical and a telephone number to call for additional information - A common method is to supplement the manufacturer's label with Hazardous Material Identification System or Hazardous materials Identification Guide label - These two systems use a label similar to the NFPA 704 system Hazardous Materials ID System (labels) - Product name - Protective equipment needs - Health hazards - Flammability - Reactivity hazards EPA Hazardous Waste Label - Name of waste - ID numbers - Name of waste generator - Accumulation start date (the date when the waste was first placed in the container) EPA requires labels for pesticides containers - Name of pesticide - Signal word indicating toxicity - (e.g., Danger-High, warning-Moderate, Caution-Low) - EPA registration number - Precautionary statement - Hazard statement - Names of active ingredients

Bulk containers

Large containers and tanks used to transport large quantities of hazardous materials.

Acids

Materials that have a pH value less than 7 (e.g., hydrochloric acid, sulfuric acid).

Air-reactive materials

Materials that react with atmospheric moisture and rapidly decompose.

Bases

Materials with a pH value greater than 7 (e.g., sodium hydroxide, potassium hydroxide).

Immediately dangerous to life or health concentrations (IDHLs)

Maximal environmental air concentration of a substance from which a person could escape within 30 minute without symptoms of impairment or irreversible health effects.

Decontamination 2

Nonambulatory patient decontamination: Wear PPE Must be remove from contaminated area Provide shelter Remove and isolate - Clothing - Jewelry - Shoes Brush off contaminants from body so it wont react with water Blot visible liquid contaminants from the body with absorbent material before washing Do not damage skin Rinse patient with copious amounts of warm water - use low water pressure on hose to control the spray and avoid tissue damage - Avoid overspray and splashing - use gental running water for eyes Decontaminate head and face first - Brush or blot visible contaminants away from the mouth and nose, and then soap and rinse in the same manner - Isolate the patient's airway with an oxygen mask, bag-mask, or SCBA as soon as possible Decontaminate areas of skin damage, gross contamination next - Take care not to allow contamination into areas of tissue damage. gently covering areas of tissue damage with a plastic cover or wrap helps prevent this Rinse with copious warm water ● Contacts removed as soon as possible Mass casualty decontamination: - Some agencies use Emergency decontamination ~Decontaminate extremely large numbers in short periods of time ~ Use Fire apparatus or hoses - The emergency decontamination operation can be established in a number of ways - The simplest way is to use one fire fire department engine ~ One 1.5" Hose is deployed to spray water from one side, & a second nozzle is placed on a discharge gate to provide water spray from 2 directions ~ Fire hoses from two directions - The second way is Two fire engines side by side approximately 20' apart ~ Establishes a decontamination corridor and a focal point for victims to move toward ~ Hose nozzle are placed on the engine's discharge gates so water from each engine sprays to the center of the corridor ~ patients are directed to walk though the water spray ~ If time allows, ladders can be placed across the top of the engines bridging the tops & hoses are run over the top of the ladder with nozzles pointing down ~ Tarps can be placed over top to allow for privacy Possible issues with emergency decontamination: - Uses cold water which can cause hypothermia - If clothes are left on during this type of decontamination operation, contamination could be driven into the skin, so it is better for people to disrobe before going through - This procedure is not effective with nonambulatory patients ~ they must be carried through, so only the front is decontaminated - Because of these issues Many teams use decontamination trailers, or rapidly deployed tents ~ Easy to set up and provide shelter and privacy during the decontamination process water heater and decontamination solution mixer units are available to supply heated decontamination and rinse water through fixed shower nozzles to improve decontamination efficiency and reduce the effects of hypothermia. ~ Air heaters can be used to warm the structures ~ patient roller systems or carts can be used ~ if not available immediately these can be used after for a more thorough decontamination

Cylinders

Nonbulk containers that normally contain liquefied gases, nonliquified gases, or mixtures under pressure; cylinders also may contain liquid or lids.

Hazard references

North American Emergency Response Guidebook: - This is the reference most familiar to responders - The DOT Emergency Response Guidebook & the Canada dangerous goods initial emergency response book were combined to make this one - a quick response guide written for first reponders to use at a hazardous materials emergency A chemical can be referenced by - Placard - Chemical name - Four-digit ID number Information can be found in guidelines that have been developed for chemicals with similar hazards and management needs, including: - Fire and explosion hazard - Health hazard - Public safety information - PPE needs - Evacuation concerns - Fire response - Spill or leak response - Basic first aid information - Protective distances Material safety data sheets (MSDS) Readily available for each chemical at worksite - Under OSHA's Hazard communication standard (Workers Right to Know) - employers must provide chemical information to their employees by ensuring that containers are labeled and a (MSDS) is readily available for each chemical with which workers may come in contact - MSDSs are supplied by the chemical manufacturer - Usually found in the industrial setting OSHA required information - Chemical name - Physical data - Chemical ingredients - Fire and explosion hazard data - Health hazard data - Reactive data - Spill or leak procedures - Special protection and precaution information Computer-aided management of emergency operations (CAMEO) - a computer based program developed by the EPA's Office of emergency Management and the National oceanic and Atmospheric Administration Office EPA database - developed for emergency responders to assist in the response to chemical emergencies and can be used to access, store, and evaluate information critical for developing emergency plans - contains database for 6000 hazardous chemicals - 80,000 synonyms and trade names - Searches by name, synonym, ID number - Available online Base program has chemical-specific information for: - Chemical identifiers section - Hazards section - Response recommendations - Physical properties - Regulatory information - Alternate chemical names Telephone references: - Available 24/7 - Possible mistakes when transcribing information Chemical Manufacturers Association - CHEMTREC - MEDTREC - Telephone contact resources designed to provide emergency responders with immediate response information - makes contacts with manufacturers, shippers, and product experts when more detailed info is needed Regional Poison Control Center - Immediate toxicological information - staffed by specially trained medical personnel, including toxicologists

Hazardous Waste Operations and Emergency Response (HAZWOPER)

OSHA and EPA regulations regarding worker safety when responding to hazardous material emergencies.

Hazard Communication Standard (HAZCOM)

OSHA standard regarding worker protection when handling chemicals.

Training Requirements

OSHA, EPA - Occupational Safety & Health Administration - Environmental Protection Agency - They established mandatory safety procedures for responders who deal with hazardous materials - Osha's Hazardous Waste Operations and Emergency Response (HAZWOPER) standard covers safety of responders - provides for the safety of personnel who work on hazardous waste cleanup sites or hazardous waste treatment storage and disposal sites or who respond to hazardous materials emergencies EPA also has parallel ro HAZWOPER standard for those not covered under OSHA standards - it extends coverage to governmental employees and volunteers who would not normally be covered under OSHA standards HAZWOPER training standard: - training for emergency responders is broken down into the following five levels - all EMS responders must be trained at least to the awareness level - Some states require them to be trained to the operations level 1)Awareness: - They are trained to recognize hazardous materials - Isolate the area - Call for appropriate assistance - Training objectives - Doesnt have set training hour requirements, but it is usually an 8 hour course and the following criteria must be met - It is designed to recognize hazardous material incidents, so they must wait for a higher trained technician to make the scene safe before approaching the scene - Understanding of what hazardous substances are & associated risks - Understanding of potential outcomes associated with an emergency when the substance is present - Ability to recognize presence of material - Ability to identify a hazardous substance if possible - Understanding of role of first responder awareness individual in the employer's emergency response plan, including site security and control and the U.S. Department of Transportation's North American emergency Response Guidebook - Ability to realize need for appropriate personnel & make appropriate notifications to the communication center

Treatment for common hazardous materials - Pesticides

Organophosphates and carbamates - found as liquids, dusts, wettable powder, concentrates, and aerosols with a garlic-type odor Organophosphates are among the most poisonous chemicals - Commonly used for pest control - They are related to the chemical warfare agents soman, sarin, tabun, and VX - These chemicals can cause damage through Inhalation, ingestion, skin and eye contact, skin absorption Can cause respiratory failure due to - Chemically mediated pulmonary edema - Respiratory muscle paralysis - They inhibit acetylcholinesterase, causing overstimulation of the parasympathetic nervous system, striated muscle, sympathetic ganglia, and the central nervous System - result in: - miosis - bradycardia - hypotension - pulmonary edema - SLUDGE-BBM • Salivation • Lacrimation • Urination • Defecation • Gastrointestinal distress • Emesis • Bradycardia • Bronchoconstri ction • Miosis Treatment: Adequate decontamination Manage airway Ventilate as necessary Consider intubation at first sign of upper airway obstruction Consider bronchodilator use Monitor for pulmonary edema Monitor cardiac rhythm and treat dysrhythmias IV at 30 mL/hr (watch for fluid overload) Vasopressor if hypotensive with normal fluid volume - Atropine per protocol (correct hypoxia before giving atropine) - Pralidoxime chloride per protocol - Treat seizures with atropinization and hypoxia correction - Succinylcholine, other cholinergic agents, and nophylline contraindicated Flush eyes, continue irrigation during transport

Ionizing radiation

Particles or pure energy that produce changing matter by creating ion pairs.

Decontamination 3

Patient decontamination: - Runoff should be contained if possible - Child Wading pools, commercially manufactured units or tables, draft tanks, or improvised plastic and frame units can be useful ~ Patient decontamination should not be delayed to wait for these ~ If no containers are immediately available, try to channel runoff to a containment area - Local and state officials should be notified if runoff cannot be contained ~ First responders are not held liable for environment regulations if runoff water cannot be contained during a mass casualty decontamination operation

Neutron radiation

Penetrating radiation that can result in whole body irradiation.

Cryogenic

Pertaining to extremely low temperature .

Support 2

Post Entry Exam: After member is removed from hot zone and is decontaminated must be evaluated for heat stress/exposure: - this also helps determine if they can be given another assignment - if there are any changes, monitor vitals every 5-10 minutes Changes in gait, speech, behavior Chest pain Dizziness Shortness of breath Weakness Nausea Headache Heat stress - Greatest risk to team members - Wearing chemical protective clothing does not allow heat loss and is similar to being in a sauna - The ambient air temp is a determinant in developing heat stress, as well as the surface they are working on - Due to nature of chemical suit - The physical nature of chemical protective clothing does not allow heat loss by radiation. The air within the chemical suit simply heats up and create a warm pocket of air that surrounds the occupant - convective heat loss does not occur because air currents cannot move across the skins surface, and evaporative losses cannot occur because the chemical suit is impermeable - In addition to preventing heat loss chemical protective clothing adds weight to the team member, which requires greater energy expenditure and an increase in the production of heat by the body - Heat production increases approximately 13 % for each 1 degree F rise in body temp this heat cannot be dissipated; therefore the development of heat stress increases exponentially the longer the team member is in protective clothing - hypothermia can develop also if prolonged decontamination in cold water If the team member shows no adverse effects or indicators of chemical exposure at the post-entry evaluation, he or she should remain in the rehabilitation area until rested and rehydrdted, with vital signs returned to normal Chemical exposure - Monitor vitals every 5-10 minutes until back to baseline

Hazmat Documentation

Preentry exam Postentry exam Treatment provided Response to treatment Recommendation of paramedic and IC as to ability to accept additional assignments

Hazardous Materials Recognition

Presence is not always apparent Certain indicators may suggest the presence of hazardous materials at an emergency scene - The types of reported injuries may be an indication of hazardous materials involvement - Multiple patients with similar symptoms - Difficulty breathing - Seizures - Nausea - Disorientation - Eye irritation - Blisters - Rashes - Dead animals, vegetation, lawnsthat are discolored/weathered may be an indication of chemical release - Low lying cloude or foggy conditions not explained by normal surroundings - Numerous surfaces with oily films or droplets - may sense unexplained odors or symptoms of irritation - Recognition and identification of materials involved most important - Personnel must always be aware of their surroundings and be on the lookout for the presence of hazardous matrials

PPE

Purpose: shield from chemical, physical, biological hazards Exposure to the chemical agent itself is considered primary exposure or primary contamination PPE must be adressed before any response activity PPE must be based on responder involvement Activities in clean, safe areas, such as management of decontaminated patient I can be safely carried out in PPE commonly used for standard precautions - includes gloves, mask, eye protection, and a suit to keep liquids from getting on the responders uniform. - not adequate for use in the contaminated area or during primary decontamination activities In contaminated areas: - chemical protective equipment is needed, including chemical-resistant clothing and gloves specifically compatible with the chemical an either an air purifying respirator or a self-contained breathing apparatus (SCBA) Respiratory protection: Air-purifying respirators Positive-pressure SCBA Positive-pressure supplied-air respirators Based on the following Factors: - O2 concentration in area - Identity concentration of substance - Chemical and physical properties - Warning properties of substance - Area in which responders must operate - Specific tasks to be completed Chemical protective clothing: The predominant physical and chemical or toxic properties of the agent dictate the type and degree of protection required - The maximal 1evel of protection can only be determined when complete identification of a hazard has been made Vapor protective clothing - Highest protection against skin destruction and absorption - Fully encapsulating vapor tight suit - Highest degree of respiratory protection Chemical splash protective clothing - Protects against liquid splash or particulates - Limited vapor protection EPA designations - divided protective clothing and respiratory protection into four categories - Level A - Highest level of respiratory, skin, eye, and mucus membrane protection - usually used for protection against skin toxic or corrosive vapors - Includes positive pressure SCBA - Fully encapsulating vapor tight suit - inner gloves - chemical resistant outer gloves - chemical resistant boots - used to rescue victims from the hot zone

Hazard Potential- Radioactivity

Radioactivity is the spontaneous disintegration of unstable nuclei accompanied by the emission of nuclear radiation Ionizing radiation is in the form of particles or pure energy that produces changes in matter by creating ion pairs Radioactivity: Spontaneous disintegration of unstable nuclei with emission of nuclear radiation Produces changes in matter Most common types of radioactive sources: Alpha particles: - Largets radioactive particle - Same size as nucleus of helium atom - Travel no further than 10 inches - Can be stopped by piece of paper Beta particles: - Same size as electron - Travel 10 feet - Stopped by piece of aluminum 1 mm thick Gamma rays - Weightless forms of pure energy - Travel great distances - Stopped by heavy shield (lead) Neutron radiation - Very penetrating - Can result in whole-body irradiation - few natural emitters exist - Can be found in Reactors, research accelerators, and after nuclear detonations Half-life: - is a measure of the rate of decay of a radioactive material - indicates the time needed for half of a given amount of a radioactive material to change to another nuclear form or element Protection - Time - Distance - Shielding For particle radiation such as alpha, beta, and neutrons, respirators, protective clothing, and decontamination procedures must be used to prevent the contamination from entering the body Responders and patients exposed to electromagnetic radiation sources emitting gamma rays are irradiated - they are not contaminated and pose no risk to secondary contamination Exposure to particle radiation sources (alpha and beta particles, neutrons, protons, and positrons) in the form of dust, liquid, or gas results in contamination and presents a secondary contamination risk because of the contamination particle on the person In all cases, the shorter the exposure time, the further the distance from the source, and/or the greater the shielding, the lower is the absorbed dose

Hazard Potential- Reactivity

Reactivity: - May Interact to produce heat, increased corrosivity, increased toxicity when mixed with other chemicals - some may ignite and burn when in contact with air or water - Chemicals also frequently become more toxic when they decompose under fire or heat conditions (toxic products of combustion) The yeIlow section on the NFPA 704 marking indicates reactivity but uses strict criteria - The NFPA reactive criteria include reaction with water and the ability to explode - They may not reflect reactivity when multiple chemicals are mixed Water-reactive materials - React after contact with water - Materials that violently decompose and/or burn vigorously when they come in contact with moisture Air-reactive materials - React with atmospheric moisture - Materials that react with atmospheric moisture and rapidly decompose Pyrophorics - Self-ignite in air - Substances that form self-ignitable flammable vapors when in contact with air Oxidation ability - Release O2 to stimulate combustion - The ability of a substance to release oxygen readily to stimulate combustion.

NFPA 704 System

Red Section: Flammability Hazard 4: Materials that rapidly or completely vaporize at atmospheric pressure and normal ambient temperature or that are readily dispersed in air and that burn readily. 3: Uquids and solids that can be ignited under almost all ambient temperature conditions. 2: Materials that must be moderately heated or exposed to relatively high ambient temperatures before ignition can occur. 1: Materials that must be preheated before ignition can occur. 0: Materials that do not burn. Blue Section: Health Hazard 4: Materials that on very short exposure could cause death or major residual injury. 3: Materials that on short exposure could cause serious temporary or residual injury. 2: Materials that on intense or continued, but not chronic, exposure could cause temporary incapaCitation or possible residual injury. 1: Materials that on exposure would cause irritation but only minor residual injury. 0: Materials that on exposure under fire conditions would offer no hazard beyond that of ordinary combustible material. Yellow Section: Reactivity Hazard 4: Materials readily capable of detonation or of explosive decomposition or reaction at normal temperatures and pressures. 3: Materials capable of detonation or explosive decomposition or reaction but require a strong initializing source, or that must be heated under confinement before initiation, or that react explosively with water. 2: Materials that readily undergo violent chemical change at elevated temperatures and pressures, or that react violently with water, or that may form explosive mixtures with water. 1: Materials that are stable but can become unstable at elevated temperatures and pressures. 0: Materials that are normally stable, even under fire explosion conditions, and are not reactive with water.

EMS Responders

Responders may come in contact with exposed patients - They also may be dispatched to a scene where the presence of a hazardous material hasnt been recognized yet May have patients who have come in contact with hazardous materials - Management may require changes to normal response practices - Toxic material may change body response to illness and injury - May necessitate triage protocol changes - Adequate management may require changes in normal response practices - may need decontamination protocols Cause harm in many ways - Flammable, corrosive, toxic, radioactive, reactive Hazardous materials harm - chemical threat - may have trauma from the damage to the container that contained the chemical - Heat stress from PPE (it is a high risk for responders) - Hazmat responders prone to heat stress from PPE

Hazard Potential - Flammability

Responders should assess flammability, corrosivity, reactivity, radioactivity, and toxicity Flammability: Must predict the damage a chemical can do A chemical's flammability can be assessed by knowing its flash point, autoignition temperature, lower flammable limit, and upper flammable limit Flashpoint: - Minimum temperature at which substance evaporates fast enough to form ignitable mixture with air near the surface of the substance Auto ignition point: - Temperature at which substance burns without an ignition source Lower flammable limit: - The minimum concentration of fuel in the air that will ignite - Below this point too much oxygen and not enough fuel are present to burn (too lean) Upper flammable limit: - concentration of fuel in the air above which the vapors can not be ignited - above this point too much fuel and not enough o2 are present to burn (too rich) Flammable range: - The concentration of fuel and air between the lower flammable limit and the upper flammable limit - The mixture of fuel and air in the flammable range supports combustion

Toxicology 2

Routes of exposure: Damage may be localized to the exposed area, systemic, or both - Local damage is present at the point of chemical contact - Systemic damage is remote to the site of exposure or absorption Inhalation: - Quickest - Most common - The human pulmonary system has an enormous surface area available for absorption - Gas, vapor, and liquid water solubility determine how far Into the respiratory tract the substance reaches and the onset of symptom - Highly water soluble (ammonia), reacts in upper respiratory tract: upper airway irritation, immediate onset of symptoms like coughing - Lower water soluble (phosgene), penetrate lower respiratory tract - Lung damage - Pulmonary edema - usually delayed onset - Asphyxiants are chemicals that impair the body's ability to get or use oxygen - Simple and chemical asphyxiants impair ability to get or use O2 - simple: inert gases and vapors that displace O2 in inspired air - chemical: prevent the transportation of O2 to the cells or the use of O2 at the cellular level (carbon monoxide) Ingestion: - Particulate matter can be breathed in & impacts into oropharynx, then swallowed - can be in food/water Skin or eye exposure: - Possible systemic toxicity - intact skin is usually an effective barrier to many hazardous chemicals and toxic agents - some substances can easily pass through the skin - the eyes, scalp, and groin absorb chemicals many times faster than the feet or hands - Skin absorption is increased in hot weather and in cases of skin damage Injection: - Subcutaneous - slowest - Intramuscular - medium - IV routes- fastest One a chemical is absorbed across a body membrane (such as the lungs, skin, eyes, or gastrointestinal tract), it is distributed throughout the body - It can then be metabolized, stored in organs or adipose (fat) tissue, excreted, and/or cause damag to specific organs Chemicals are usually metabolized by the liver - byproducts of this metabolism may be more toxic than the original compound Excretion occurs by the lungs, kidneys, skin, and gastrointestinal system Specific organs that can be damaged are referred to as target organs - Typical target organs include the brain, heart, lungs, liver, and kidneys

Hazard Assessment

Safe and efflcient response to a hazardous materials incident mandates a basic knowledge of chemistry and toxicology Agent pattern and potential outcome - Predict exposure and level - Anticipate potential injuries CHEMICAL MOVEMENT: Extremely important for responders because it allows them to - Stage safely - Predict pattern of exposure - State of matter has impact on the type of victim exposure - State of matter - Vapors: Pose the greatest exposure risk - Liquids and solids: Secondary contamination risk from making contact with contaminated patients - State of mater is determined by assessing the chemicals melting and boiling points - Melting point: Temp. at which solids become liquids (ice melts to water at 32 degrees F) - Boiling point: Temp at which Liquids becomes vapor (water boils at 100 degrees C or 212 degrees F) Once the state of matter has been identified, movement of the agent can be predicted by assessing other physical properties - Movement of a liquid contaminant in water can be predicted by looking at the chemical's specific gravity and water solubility - Specific gravity: Liquid's weight compared to water - ratio of a liquid's weight compared with an equal volume of water - Water is given a constant 1 - Materials w/ sg less than 1 float, greater than 1 float - Sink or float - Most hydrocarbons (gas) float on water - Water solubility: Degree to which material/vapors are soluble in water - Materials that are completely soluble in water are called miscible, or polar, solvents. - Alcohols are miscible in water - Insoluble materials are called immiscible, or nonpolar, solvents How quickly the chemical will evaporate and present an inhalation hazard can be assessed by looking at the chemical's vapor pressure and sublimation (transforming from solid to vapor) ability - Volatility: How quickly material passes from liquid to vapor/gas state - The greater the volatility, the greater its rate of evaporation. - Vapor pressure is a measure of volatility - Gasoline is more volatile and evaporates faster than diesel fuel - Vapor pressure: Pressure exerted by vapor against sides of closed container - It is Temperature dependent - As temp increases so does vapor pressure - Used as an indicator of how quickly a liquid evaporates - Water has a vapor pressure of approximately 20 mm Hg at 21°C (700 F) and evaporates slowly at room temperature - If a chemical has a higher vapor pressure, it evaporates faster and presents an increased inhalation hazard Must know water solubility and vapor pressure properties - Inhaled chemicals with lower solubility can result in lower airway symptoms - Chemical with high vapor pressure result in increased inhalation risk - Inhaled chemicals that are highly water soluble result in upper airway symptoms, and chemicals with lower solubility have a tendency to result in lower airway symptoms

Sagfety Plan

Safety plan: - Scene operations should be managed by incident-specific safety plan - should be User friendly - Shuld be a Guide/checklist for resolving the incident - It also serves to document the response activities and serves as a briefing tool for reponders - It is a dynamic plan that changes as scene conditions change

Contamination reduction zone

See Warm zone.

Hazardous Material

Solid, liquid, or gas that when released from a container is capable of harming people, environment, or property They may be found nearly everywhere Found in: Industrial locations Swimming pools Hospitals Agricultural areas Homes They are transported by rail, boat, truck, and in limited quantities, air Incidents may occur in transport or while being stored or used May be seen in common household cleaning chemicals or pesticides, labs, or terrorist activities May be a single patient or mass casualty event

Transport 3

Specialized cargo tanks: MC 338 - Cryogenic tank - Heavily insulated - cylindrical tanks with a characteristic wagonlike structure on the rear - Cryogellic products (e.g., liquid oxygen and nitrogen) are stored and transported in an extremely cold state Trucks and semi-trailers include flatbed and box designs - Flatbed trailers can carry intermodal containers, ton cylinders, or nonbulk containers - Box semi-trailers may carry any type of nonbulk container Tube trailer - Carry multiple cylinders of pressurized gas - - Pneumatic hopper trailers have V-shaped compartments with bottom openings. They are commonly used to transport dry solids Rail Cars - can be non pressure type, pressure type; specialized type, such as hopper and gondola cars, flat cars, box cars Nonpressurized liquid - Liquids - May have vapors under up to 100 psi - Unloading valves on bottom of car -nonpresure cars transport liquid - even though they are nonpressurized they may hold vapor pressure up to 100 psi - they may be insulated or thermally protected - most can be identified by visible fittings on the top of the car and unloading valves on the bottom Pressurized - transport Liquefied gasses - May be insulated - some may be thermally protected - All valves on top - typically identifid by the presence of a single protective housing (dome) on the top of the car that contains all the valves and fittings Specialized tank cars include cryogenig and high pressure (tube) cars - cryogenic cars transport extremely cold liquids. - Heavily insulated tanks within a tank and are usually identifted by the lack of fitting on the top of the car Hopper cars - Transport Bulk solids - Have 2+ sloping sided bays on the bottom - may be open top, closed top, or pneumatically unloased Boxcars: - enclosed rail freight cars with doors - used to transport nonbulk containers Pipelines - Are also transportation container - should be marked with the product, owner, and emergency telephone number - The emergency phone number conncts the caller with a control room, where an operator monitors pipeline operations and can begin shutdown procedure in case of an emergeny - May carry different products at different times, some carry only one - many are monitored through a computrized program that log tile time and date a product was injected into the pipe line and it estimated delivery date and time

Use of recognition and identification clues

The National Fire Academy/National Emergency Training Center manual, Recognizing and identifying Hazardous Materials, outlines the following six clues that may confirm the presence of hazardous materials - These clues provide limited pieces of information, which then must be used with other sources to provide a clear picture of the situation 1) Occupancy and location: - Know types of containers/materials within community - Manufacturing facilities - Refineries - Laboratories - Construction sites - Hazardous waste sites - Agricultural areas - Transportation of hazardous materials through community is a potential problem - Limitations: - Inspections provide information only on the chemicals present on the day and time of the inspection, which may change daily - Chemical reporting requirements usually involve only extremely hazardous substances as defined by the law and then only in certain quantities - In an emergency situation, other chemicals may be extremely dangerous. - Many things can be overlooked or missed 2) Container Shape - one of the first things to look at, if they are present there is an indication that a chemical may be involved - Knowledge of containers - Provide clues of state of matter that may be released - In most cases solids, liquids, and gases are packed in dist.inctive containers. - Material may give a clue - ex: corrosives are usually in plastic drums - Although the container shape may not identify the exact chemical involved, it may provide preliminary information with which to assess the scene. - ex: pressurized products usually present a greater hazard during a release than do liquid products

Oxidation ability

The ability of a substance to readily release oxygen to stimulate combustion.

Lethal concentration 50% (LC50)

The air concentration of a substance that kills 50% of the exposed animal population; this denotes the concentration and the Iength of exposure time that results in 50% fatality in the exposed animal population; also commonly noted as LCt50.

Hot zone

The area in which contamination currently exists or areas that may be contaminated in a short period; also called the exclusion area. Patients are removed from this area to the warm zone for decontamination. Entrance to the hot zone requires proper PPE

Flammable

The capacity of a substance to ignite.

Flammable range

The concentration of fuel and air between the low r flammable limit r lower explosive limit and the upper flammable limit or upper explosive limit; the mixture of fuel and air in the flammable range supports combustion.

Contamination

The deposition or absorption of chemical, biologic, or radiologic materials onto personnel or other materials.

Half-life

The measure of the rate of decay of a radioactive material; indicates the time needed for half of a given amount of a radioactive material to change to another nuclear form or element.

Lower flammable limit

The minimal concentration of fluid in the air that will ignite; below this point too much oxygen and not enough fuel to burn (too lean) are present; also called the lower explosive limit

Flashpoint

The minimum temperature at which a substance evaporates fast enough to form an ignitable mixture with air near the surface of the substance

Lethal dose 50% (LD50)

The oral or dermal exposure dose that kills 50% of the exposed animal population in 2 weeks.

Decontamination

The physical and chemical process of reducing and preventing the spread of contamination from persons and equipment used at a hazardous materials incident; also referred to as contamination reduction.

Emergency decontamination

The process of decontaminating people exposed to and potentially contaminated with hazardous materials by rapidly removing most of the contamination to reduce exposure and save Iives, with secondary regard for completeness of decontamination.

Autoignition point

The temperature at which a material ignites and burns without an ignition source.

Boiling point

The temperature at which the vapor pressure of the material being heated equals atmospheric pressure (760 mm Hg); water boils to steam at 100C (212°F).

Melting point

The temprature at which a solid changes to a liquid (e.g., ice meIting to water at 0 C 32° F

Hazard Potential- Toxicology

Toxicology: Dose/response relation: - Toxic effects of exposure can be estimated according to exposure level - One measure of toxicity is called the Lethal dose system-based on animal research - It rates chemicals on the measure of lethal dose & lethal concentration - LD50: Oral or dermal exposure that kills 50% of exposed animals in 2 weeks - LC50: Air concentration that kills 50% of exposed animals - Helps determine potentially dangerous exposure levels - The studies are based on lethal effects, not the amount of agent that would cause harm or injury - Threshold limit value - Exposed daily without adverse effects - The airborne concentrations of a substance; represents conditions under which nearly aIl workers are believed to be repeatedly exposed day after day without adverse effects - Permissible exposure limit - Allowable air concentration in workplace as established by OSHA - Immediate dangers to life or health concentrations (IDHLs) - Maximal environmental air concentration from which a person could escape within 30 minutes without impairment symptoms or irreversible health effects Dose/response guidelines exist for safe occupational exposures - These levels have been developed by governmental, industrial, and private groups to identify potentially dangerous levels of exposure The immediate danger to health and life (IDHL) level was established by the EPA and the National Institute of Occupational Safety and Health (NIOSH) - Immediate evacuation and the use of appropriate-level personal protective equipment (PPE) must be emphasized when dealing with IDHL concentrations Many private companies establish their own in-house exposure limits - The safe level of exposure may vary from agency to agency, so the lowest established level should be used - These levels don't consider age or other health factors and are only based on work settings, not home These limits are usually reported in parts per million (ppm) (parts of gas or vapor per milIion parts of air) or parts per billion (ppb) for gases and vapors - They also may be found in milligrams of a substance per cubic meter of air (mg/mJ) for substances that are respirable as a liquid mist or solid particle mass Some are known or suspected to have the ability to cause caner - known as carcinogens - NIOSH and OSHA designate potential carcinogenic chemicals with a "Ca" notation Duration of exposure - Shorter exposure, less absorbed, lower response - Acute exposure - over a short time less than 24 hrs - Chronic- low concentration over time (daily basis at work)

Transportation Documentation

Transportation documentation: - according to DOT regulations shipping papers must accompany hazardous materials to identify the material being transported - Shipping name - Hazard classification - ID number - Number and type of packages - Packing group - Correct weight - 24 hour emergency contact number - RQ identification - Identifies that the chemical has a reportable quantity listed in the EPA regulations - If a specified quantity is released, must immediately notify National Response Center in Washington, DC Shipping papers identify hazardous materials in the shipment either by listing them first on the manifest, listing them in a contrasting color, or by check marks placed in a hazardous materials identifying column In trucks the papers can be found in the cab - usually in a plastic envelope attached to the inside of the drivers door On trains they are located in the lead engine On air shipments, they can be found in the cockpit. On ships, papers are found on the bridge or wheelhouse. Under current DOT regulations, shipping papers must have a 24-hour emergency contact telephone number Regulations also state that written emergency response information must accompany the shipment

Fixed facility marking and labeling systems

Variolls hazardous materials markjng systems are used at facilities NFPA 704 most popular - Provides information on material inside tank, building, laboratory - Diamond-shaped sign with four quadrants that are color coded - Red on top: fire hazard - Blue on Left: health hazard - Yellow Right: reactivity - White on Bottom: other special information - Use 0−4 to indicate hazard, 4 is severe, 0 is minimal - Numbers in the red, blue, and yellow quadrants indicate the degree of hazard Special information symbols, such as OXY for an oxidizing product or a W with a slash indicating a product that is dangerous when wet, may be found in the white quadrant Limitations: - When used on the outside of a building or laboratory, it tells you that the structure contains hazards that meet the markings, but It does not specify exactly what the material is, the quantity, or the exact location - When used on a single container, such as a tank, the information is specific - The system is designed under strict criteria and sometimes is not properly interpreted - ex: the health hazard is based on acute toxicity, so doesn't account for chronic toxicity - The reactivity hazard is based on the susceptibility of materials to release energy either by themselves or in combination with water - Water reactivity, fire exposure, shock, and pressure were factors considered. - This system may not identify reactivity with other chemicals. For example, chlorine is highly reactive with almost everything, but it carries a zero reactivity hazard in the NFPA 704 system

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mass casualty decontamination

Common Postentry Care

• Body temperature greater than 1000 F: have the team member rest in cool environment • Body temperature greater than 102° F: have the team member rest in cool environment and apply cold packs to neck, groin and underarms • Weight lOSS less than 3% without signs and symptoms: give 8 oz water for each '/2 Ib of body weight lost • Weight loss greater than 3% with signs and symptoms: rehydrate with IV fluids and consider transport

Information needed to be communicated to the receiving hospitals

• Number of patients and potential additional patients • Initial signs and symptoms • Nature of incident • Treatment administered • Agent involved • Current signs and symptoms • Route of exposure • Decontamination carried out? • Duration of exposure • Need for further decontamination? • Associated trauma • Estimated time of arrival • Victim examination findings and vital signs