Overview of HazMat and Mass Casualty Incidents

Overview of HazMat

• Hazardous Materials• Any substance capable of

creating harm to:• People• Property• Environment

• Types• Explosives –Gases

–Flammable/combustible liquid Flammable solids –Oxidizing substances Poisonous/Infectious substances –Radioactive substances Corrosive substances –Miscellaneous hazmat

General Info

• Common problem• Actual extent unknown• Safety is primary

concern• Providers

• EMT-B and crew• Pt• Public

Approaching the Scene

• Identification• Occupancy• Containers –size/shape• Placards• Shipping papers

• “Bill of lading”- Road transport• “Way Bills” – Transport by rail • Usually in cab of truck • Chemical name, transport name, ID numbers

• Senses• Material Safety Data Sheets (MSDS)

• -1st. Aid, Decontamination, routes of exposure, S/S• protective equipment, past med Hx. Complications

• Pts at the scene• Multiple pt with same S/S suggests exposure

• i.e Nausea, vomiting, SOB, unresponsiveness

Approaching the Scene

• General procedures• Park upwind and uphill• Keep unnecessary people away• Isolate area

• Keep people out• Do not enter without proper equipment and SCBA

• Local Resources• Local HazMat response teams• CHEMTREC = 1-800-424-9300• Hazardous Materials, The Emergency Response Handbook

• Published by US DOT

HazMat Zones

• Hot Zone• Where the hazardous material is

spilled• Only trained individuals/appropriate

clothing• Warm Zone

• Transmission zone• Where decontamination occurs• Control point between Cold and Hot

zones• Suitable training and clothing

• Cold Zone• “Clean zone”• Where pt are brought for EMS

assessment prior to transport• Staging supplies and command

Treatment

DecontaminationHazardous Material

HazMat Decontamination

• Mechanical Removal• Clothing Removal• Rinsing• Dilution• Absorption• Chemical Washes• Disposal/Isolation

MCI: Classification

• Multiple/Mass Casualty Incident• A situation in which the needs is more

than the initial responding personnel and equipment can meet

• Open Incident• Easy access to victims from different

locations • May be spread over a large area

• Closed Incident• Physical/geographical barriers that

prevent speedy access to victims • Active

• Forces that contributed to the disaster are still active

• On going risk to rescuers, public, victims

• Contained• Forces responsible for the disaster

are exhausted

Incident Management Systems

• What are they?• Organized system of roles, responsibilities, and

standing operating procedures to manage emergency operations.

• What do they do?• Provides orderly means for communication and

information for decision making • Makes interactions with other agencies easier

Incident Management SystemsStructure

• Command• Mobile site near the MCI• Overall command of the incident is

coordinated • Extrication

• Coordination of personnel/resources during extrication

• Triage• Initial triage occurs at pt side• Pt relocated to “secondary triage”

• Treatment• Organized sector where major field

treatments are administered • Priority treatment may start at the side of pt

before transport• Transportation

• Responsible for overall transport of supplies, equipment, personnel, pt, other resources

• Staging• Area where ambulances stage to receive pts

and assignment of receiving hospital• Supply

• Area where supplies are stockpiled • Rehabilitation

• Area where care is given to rescuers • Physical and psychological support are

offered

Incident Management SystemsDocumentation

• A major event log• # of pts• Conditions and triage categories• Vehicles at scene• Personnel at scene• Hospital availability • # of individuals transported • Hospital disposition• Mode of transport

Initial Roles of Responders

• Rescuers will be assigned specific duties within one of the sectors

• Upon arrival• Report to sector officer

• Once assigned a specific task

• Complete it • Report back to sector

officer

Triage

• Heroic resuscitative efforts NOT appropriate• Too much time• Requires equipment used for salvageable patients• Staffing intensive

• Concentrate on salvageable patients

MCI Procedures

• Est. type of incident • Determine specific location and ID best access routes• 1 EMT approaches scene and determines:

• Estimates # of pt• Estimates injury types• If incident is open/closed and active/contained

• 2nd EMT stays with ambulance and determines:• Possible staging areas• Traffic routes into area

• Both EMTs should ascertain • Approx # of pts• Specific location of incident• Whether incident is open/closed and active/contained• Need for special resources • # of additional ambulances needed• Potential dangers to public safety and personnel

• IMMEDIATELY relay this info to communications center

MCI Procedures Cont’d

• Most knowledgeable EMT on scene initially assumes Triage Officer• Request additional help• Perform initial assessment of all pts

• START Triage• Assign available personnel/equipment to critical pts• Secondary Triage

• In depth assessment of pt• In treatment area OR en route to ER

• Pt transport is based on:• Prioritization• Destination facilities• Transport resources

• Triage officer remains in scent to:• Assign/coordinate: Personnel, equipment, vehicles

Triage Stages

• 1st Stage• No treatment is rendered • Victims are tagged with

tape/cards • Category of injury• Likelihood of survival

• 2nd Stage• Begins after removal of pt and

transport to safer area• More thorough assessment • Recategorized by priority • Collection point of all pts• Ensure appropriate treatment

and transport• ALS procedures

• 3rd Stage• Certain specific cases • Creation of field hospital on

site• ALS procedures

START Triage

• “Simple Triage and Rapid Treatment”• Technique for quick primary triage • Assesses:

• Ability to walk• Respirations• Pulse• Mental Status

START Triage:Minimal Treatment

• Only THREE patient interventions are:• Open the airway Open the airway• Stop gross bleeding • Safe patient positioning

• Shock position• Recovery position

START Triage Procedure

• Walking• Walking pt= “Walking Wounded” = Green• Remain in location OR• Walk to treatment area

• Breathing (open airway)• If absent = Dead/Dying = Black• Rate less than 10 or greater than 30 = Critical = Red

• Pulse/Perfusion• If absent= Dead/Dying = Black• No radial/Present Carotid= Critical = Red • Radial and Carotid present= Assess mental status

• Mental Status• Ask pt to perform two simple tasks

• Motor = Lifting arm• Mental= Stating name, day, year

• If they can do both = Delayed = Yellow• If they fail one = Critical = Red

Radial Pulse Absent

Pt CategorizationMinor

• Green- Hold Priority • Definition

• Pt with minor injuries• Injuries of an

ambulatory nature • Pt Diagnosis

• Minor fractures• Minor wounds• Burns less than 10%

BSA• No airway problems

• Psychological problems

Pt CategorizationDelayed

• Yellow- Delayed Priority • Definition

• Pt requiring care but whose condition will not worsen with prompt (vs. immediate) transport

• Pt Diagnosis • Burns• Multiple/major fractures• Spinal cord injuries• Uncomplicated head

injuries

Pt Categorization Immediate

• Red- Immediate Priority • Definition

• Critical pt wit life threatening conditions who have a chance to survive with early stabilization and transport

• Require hospital care within 1 hour

• Pt Diagnosis • Airway/Respiratory difficulties• Sever burns• Cardiac problems• Uncontrollable/severe

hemorrhage • Open chest/abdominal wounds• Severe head injury• Severe medical problems• Shock • AMS

Pt CategorizationDeceased

• Black- Deceased • Definition

• Pt found without signs of life

• Obvious mortal injuries

• Pt Diagnosis • Pt who have expired• Pt with injuries

incompatible with survival

Patient 1

• Airway open• Respirations 20 bpm• Radial pulses present• Minor abrasions to arm/hands• Pt is walking

• Green

Patient 2

• Airway is open• Reparations 30• Singed nasal hairs noted• Absent radial pulses• Unable to walk

• RED

Patient 3

• Airway open• Respirations 22• Radial Pulses Present• Follows commands• Cannot walk• Burns to one arm

• Yellow

Patient 4

• Unresponsive• Airway closed• No respirations with jaw thrust • Absent radial pulses

• BLACK

Patient 5

• Pt responsive• Airway open• Respiratory rate 36• Thready radial pulses• Unable to walk• Flail chest noted

• RED

Patient 6

Unresponsive No respirations after jaw thrust Thready radial pulse Open femur fracture

BLACK

And so it finally ends…Welcome to EMS

Random Humorous EMS Sites

• Murphy’s Laws of EMS• http://www.uvm.edu/~jbettenc/ems1.htm• Rules of EMS• http://www.thelunatick.com/ems/rules.html• You Might be in EMS if…• http://www.thelunatick.com/ems/mightbe.html• Realistic Trauma Scores• http://www.thelunatick.com/ems/trauma_scales.htm• The Memo• http://www.thelunatick.com/ems/memo.htm• EMT Buff Test• http://www.thelunatick.com/ems/ems_buff_test.htm