Chapter 49 Hazardous Materials. National EMS Education Standard Competencies EMS Operations Knowledge of operational roles and responsibilities to ensure

Chapter 49Chapter 49

Hazardous Materials

National EMS Education Standard CompetenciesNational EMS Education Standard Competencies

EMS Operations

Knowledge of operational roles and responsibilities to ensure patient, public, and personnel safety.

National EMS Education Standard CompetenciesNational EMS Education Standard Competencies

Hazardous Materials Awareness

Risks and responsibilities of operating in a cold zone at a hazardous material or other special incident.

IntroductionIntroduction

• Hazardous material: any substance or material capable of posing an unreasonable risk to health, safety, or the environment when transported, used incorrectly, or not properly contained or stored.

Regulations and StandardsRegulations and Standards

• Regulations are created by OSHA and EPA.− HAZWOPER is the OSHA document.

− Training levels are:• Awareness

• Operations

• Technician

• Specialist

• Incident commander


• Awareness level should be able to:− Understand what hazardous substances are.

− Understand potential outcomes.

− Recognize presence of hazardous substances.

− Identify hazardous substances.

− Understand role in the response plan.

− Determine the need for additional resources.


• Consensus-based standards can help guide responders.

• All personnel should receive appropriate response training.

Paramedics and Hazardous Materials Incidents


• When on the scene of an incident you must rely on training and references sources.− Know how and when to access specific

toxicologic information.

− Understand how a hazardous materials scene is organized and where you fit in.



• Familiarize yourself with the following:− Different types of PPE

− How patients will be decontaminated

− How to assess and treat exposures



• Hazardous materials incidents may include:− Highway or rail incident in which a substance is

leaking from a tank or car

− Leak/rupture of underground natural gas pipe

− Buildup of methane or other by-products in sewers, sewage plants, landfills

Scene Size-UpScene Size-Up

• It is critical to ensure your own safety.

• It may not be possible to identify what hazards are present.

• Warning signs include:− Signs and symptoms from patients

− Placards and labels


• Always maintain a high level of suspicion during your first assessment of a scene.− You may identify leaks and spills by:

• A visible cloud or strange-looking smoke

• A leak or spill

• An unusual, strong, noxious, acrid odor


• You should suspect the presence of hazardous materials if you approach a scene where more than one person: − Has collapsed

− Is unconscious

− Is in respiratory distress


• Follow proper safety measures.− If signs suggest a hazardous materials incident,

stop at a safe distance (upwind and uphill).

− Once you rapidly size up the scene, isolate the hazardous area the best you can.

− If you do not recognize the danger until you are too close, leave the danger zone immediately.


• Provide as much information as possible when calling for additional resources.

• Don’t reenter or leave the hazardous area until a hazardous materials team clears you.

Identification of Hazardous Materials


• Information may come in the form of:− Observations

− Reports from bystanders

− Signs and symptoms of victims

− Labels and placards

− Shipping papers

− Material safety data sheets



• DOT’s Emergency Response Guidebook (ERG) should be carried on every response vehicle.

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• ERG guidebook provides information on: − Specific properties of hazards and substances

− What is shown on placards

− Recommended isolation distances



• DOT chemical families:− DOT Class 1: Explosives

− DOT Class 2: Gases

− DOT Class 3: Flammable combustible liquids

− DOT Class 4: Flammable solids, spontaneously combustible materials; and dangerous when wet materials/water-reactive substances



• DOT chemical families (cont’d):− DOT Class 5: Oxidizing substances and organic

peroxides

− DOT Class 6: Toxic and infectious substances

− DOT Class 7: Radioactive materials

− DOT Class 8: Corrosive substances

− DOT Class 9: Miscellaneous

Transportation Marking System


• US DOT marking system is characterized by labels, placards, and markings. C

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• Placards − Placed on all four

sides of vehicles

− Identify a broad hazard class

© Mark Winfrey/ShutterStock, Inc.



• Labels− Placed on boxes and smaller packages

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• Not all chemical shipments are marked.

• You may also identify hazardous materials in transport from:− The bill of lading or freight bill

− The waybill or consist



• CHEMTREC − Operates a 24-hour telephone line

− An extensive database of chemical information

− Must have information ready when calling

Fixed-Facility Marking SystemFixed-Facility Marking System

• Characterized by a placard with a set of diamonds

• Placards are colored, indicating specific hazards.


• Permanent manufacturing or storage facilities have material safety data sheets. − Chemical makeup of a substance

− Potential hazards it presents

− Appropriate first aid in the event of exposure.

− Other data for safe handling of the material


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ContainersContainers

• Vessel or receptacle that holds a material− Type, size, and material can provide clues

about the nature of the substance inside.

− Often there is no correlation between the color of the drum and the possible contents.

Bulk Storage VesselsBulk Storage Vessels

• Found in buildings that rely on and need to store a large amount of a particular chemical

• Secondary containment is a method to control spills.


• Large volume horizontal tanks − Above-ground storage tanks

− Underground storage tanks

− Can hold a few hundred gallons to several million gallons of product


• Totes− Hold 119 to 703

gallons

− Portable plastic tanks surrounded by stainless steel

− Can contain any type of chemical © Ulrich Mueller/ShutterStock, Inc.


• Intermodal tanks − Hold 5,000 to

6,000 gallons

− Pressurized or nonpressurized

− Usually shipped, stored, and returned to the shipper

Courtesy of UBH International, Ltd.

Nonbulk Storage VesselsNonbulk Storage Vessels

• Drums− Barrel-like

containers

− Store a variety of substances

− The nature of the chemical dictates the construction of the drum.

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• Bags− Used to store

solids and powders

− Constructed out of plastic, paper, or plastic lined paper.

− Pesticide bags must be labeled with specific information.

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• Carboys− Transports and

stores corrosives and other chemicals

− Holds 5–15 gallons

Courtesy of EMD Chemicals, Inc


• Cylinders− Hold liquids and gases

− Uninsulated compressed gas cylinders store various substances.

− Sizes vary.

Roadway Transportation of Hazardous Materials


• Cargo tank: Bulk package that may or may not be permanently attached to a vehicle− May be loaded or unloaded without being

removed from the vehicle



• MC-306/DOT 406 flammable liquid tanker − Most common and reliable vessel

− Carries 6,000 and 10,000 gallons of product

− Nonpressurized

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• MC-307/DOT 407 chemical hauler − Holds 6,000 to 7,000 gallons

− May be insulated or uninsulated

− May have higher internal working pressure

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• MC-312/DOT 4012 corrosive tanker − Transports corrosives

− Reinforcing rings around the tank

− Operates at 15 to 25 psi

− Holds 6,000 gallons

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• MC-331 pressure cargo tanker − Holds 1,000 to 11,000 gallons

− Constructed of steel

− Operates at 300 psi

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• MC-338 cryogenic tanker − Low-pressure tanker

− Relies on tank insulation to maintain low temperature

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• Tube trailers− Carry compressed gasses

− Made up of individual cylinders

− Operate at 3,000 to 5,000 psi

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• Dry bulk cargo tanks− Carry dry bulk goods

− Not pressurized

− Usually V-shaped

Courtesy of Polar Tank Trailer, L.L.C

Establishing Safety ZonesEstablishing Safety Zones

• If dispatched to a hazardous materials incident:− Protect yourself first.

− Isolate the incident.

− Notify dispatcher and other responders.

− Inform incoming responders of observations.

Establishing Safety ZonesEstablishing Safety Zones

• Hazardous materials specialists will establish hot, warm, and cold zones.

Initial Isolation and Protection Distances


• The green section of ERG provides resources on evacuation distances.

• Hazardous materials teams use air-monitoring equipment to determine:− Explosive limits

− Oxygen levels

− Concentration of hydrogen sulphide

− Carbon monoxide



• Hazardous materials teams can determine the pH of spills.

• CAMEO is one of many programs that help predict downwind concentrations of hazardous materials.

Personal Protective Equipment (PPE)


• Usually the hazardous materials team will determine the appropriate PPE.

• You should understand what hazards certain garments create.



• Level A ensemble− Provides greatest

respiratory and skin protection

− Covers full body and self-contained breathing apparatus



• Level B ensemble− Used when a high

level of respiratory protection is needed and there is no threat of skin absorption

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• Level C ensemble− Designed to

protect against a known substance

− Worn with an air-purifying respirator (APR) or powered air-purifying respirator (PAPR)

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• Level D ensemble− Worn when there is

little to no threat posed by the substance

Contamination and ToxicologyContamination and Toxicology

• Health hazards posed by hazardous materials depends on its ability to get into the body and interfere with the body’s processes.

Primary and Secondary Contamination

Primary and Secondary Contamination

• Primary contamination− Directly from a hazardous material

• Secondary contamination − Hazardous material is transferred to a person

from a person or contaminated object.

Routes of ExposureRoutes of Exposure

• Four primary methods of entry:− Ingestion

− Inhalation

− Injection

− Absorption


• Local effect − Reddening of skin

− Localized pain

− Blisters

• Systemic effect− Damage occurs

inside the body


• Your records should include:− Elements required by AHJ or medical director

− Description of the scene

− Anything you were told about the substance

− How your patient looked initially

− Treatment rendered

− Positive or negative changes


• The dose effect principle applies no matter of the route or type of exposure.− The greater length of time or concentration of

the material, the greater the effect on the body.

Chemical TermsChemical Terms

• Vapor pressure− Amount of pressure between top of liquid and

container it is held inside

− Correlates to the speed at which a material will evaporate once it is released from its container


• Vapor density− Comparison of hazardous material gas to air

• If the gas is heavier than air it will sink.

• If the gas is lighter than air, it rises and dissipates.


• Flash point − Temperature at which liquid fuel gives off

sufficient vapors that will result in a flash fire

− Low flash point liquids typically have high vapor pressures.


• Ignition temperature − Temperature at which liquid fuel will ignite

without an external ignition source

• Flammable range− Defined by upper and lower limits

• Lower flammable limit or LFL

• Upper flammable limit, or UFL


• Specific gravity − Must be determined when applying water to a

chemical

− If hazardous material will sink or float in water

Toxicology TermsToxicology Terms

• Threshold limit value (TLV)− Concentration that a

person can be exposed to for a 40-hour workweek over a typical 30-year career

• Threshold limit value/short-term exposure limit (TLV-STEL)− Concentration that a

person can be exposed to for a limited number of brief time periods


• Threshold limit value/ceiling (TLV-C)− Concentration that a

person should never be exposed to

• Threshold limit value/skin − Concentration that

direct or airborne contact could result in significant exposure


• Lethal dose (LD)− Single dose that

causes the death of a specified number of test animals exposed by any route other than inhalation

• Lethal concentration (LC) − Concentration in air

that is expected to kill a specified number of test animals over time


• Toxic− A chemical that has an LD50 of more than 50

but not more than 500 milligrams per kilogram of body weight when administered orally to albino rats weighing between 200 and 300 grams


• Toxic (cont’d)− A chemical that has an LD50 of more than 200

but not more than 1,000 milligrams per kilogram of body weight when administered by contact for 24 hours to albino rabbits weighing between 2 and 3 kilograms


• Toxic (cont’d)− A chemical that has an LD50 of more than 200

but not more than 2,000 parts per million by volume, or more than 2 but not more than 20 milligrams per liter, when administered by inhalation for 1 hour to albino rats weighing between 200 and 300 grams


• Highly toxic − A chemical that has an LD50 of 50 milligrams or

less per kilogram body weight when administered orally to albino rats weighing between 200 and 300 grams.


• Highly toxic (cont’d)− A chemical that has an LD50 of 200 milligrams

or less per kilogram body weight when administered by contact for 24 hours to albino rabbits weighing between 2 and 3 kilograms


• Highly toxic (cont’d)− A chemical that has an LC50 in air of 200 parts

per million by volume or less, or 2 milligrams per liter or less, when administered by inhalation for 1 hour to albino rats weighing between 200 and 300 grams


• Immediately dangerous to life and health (IDLH)− Atmospheric concentration of substance that

will pose: • An immediate threat to life

• Irreversible or delayed adverse effects

• Serious interference for team members

Decontamination and Treatment

Decontamination and Treatment

• You cannot immediately begin care until you fully understand the situation.− Decontamination is the highest priority when a

substance provides an unacceptable risk to responders.

DecontaminationDecontamination

• Method depends on:− Type of hazardous material

− Stability of the scene

− Number, condition and location of patients


• Four types of decontamination methods seen in the field:− Dilution

− Absorption

− Neutralization

− Disposal


• Emergency decontamination− Removing the bulk of contaminants from a

person as quickly and completely as possible

− Water: universal decontamination solution

Mass DecontaminationMass Decontamination

• Decontamination corridor − Fog-stream shower

set up between two fire engines

− Patients disrobe on one end and enter single file. Courtesy of Master Sgt. Jim Varhegy/U.S. Air Force

Technical DecontaminationTechnical Decontamination

• Thorough cleaning process used by responders to clean PPE, tools, and equipment

• Differs from jurisdiction to jurisdiction

Treatment of Patients Exposed to Hazardous Materials

Treatment of Patients Exposed to Hazardous Materials

• Invasive procedures should be minimized.

• Familiarize yourself with references and how to access technical expertise.

• You are the eyes and ears of the physician.

Corrosives: Acids and BasesCorrosives: Acids and Bases

• Chemicals that include acids and bases

• Can cause severe burns to the skin eyes and mucous membranes

• Once decontaminated, treatment is supportive.

SolventsSolvents

• May be liquids, solids, or gases

• Capable of dissolving other substances

• May give off potent vapors

• May require extensive decontamination

PesticidesPesticides

• Can produce a collection of signs know by the mnemonic SLUDGEM

• In addition, exposures can also produce:− Tachycardia or bradycardia

− Twitching muscles

− Excessive pulmonary secretions

PesticidesPesticides

• Treatment includes:− Aggressive decontamination

− Intubation and frequent suctioning

− High-flow oxygen

− Use of atropine

− Pralidoxime may be recommended.

Chemical AsphyxiantsChemical Asphyxiants

• Interfere with the use of oxygen at the cellular level

• Cyanide treatment (nonsmoke inhalation patients):− Amyl nitrate ampules

− IV administration of sodium nitrate, followed with sodium thiosulfate

Chemical AsphyxiantsChemical Asphyxiants

• Cyanide treatment for smoke inhalation: − Hydroxocobalamin (Cyanokit)

• Carbon monoxide treatment:− Removal of patient from the source

− Administration of 100% supplemental oxygen

Toxic Products of CombustionToxic Products of Combustion

• Hazardous chemical compounds released when a material decomposes under heat

• A host of chemical by-products are created and found in the smoke.

Toxic Products of CombustionToxic Products of Combustion

• Other toxic substances found in smoke:− Soot

− Carbon monoxide

− Carbon dioxide

− Water vapor

− Formaldehyde

− Cyanide compounds

− Many oxides of nitrogen

Transportation ConsiderationsTransportation Considerations

• Paramedics should be standing by to transport patients to the ED.

• Do not assume that patients received are completely decontaminated.− Never transport if there hasn’t been sufficient

decontamination.

Transportation ConsiderationsTransportation Considerations

• You can prepare for transportation in several ways.− Reduce the amount of supplies and equipment

that the patient will contact.

− Plan to wrap the patient in a plastic barrier.

− Give the ED plenty of notice.

Medical Monitoring and Rehabilitation


• You may be asked to assist with medical monitoring of the hazardous materials team.− PPE often causes heat stress.

− Toxins they are working with can cause serious health effects.



• Medical monitoring includes documentation of incident factors:− Hazardous materials involved

− Toxic effects

− PPE worn

− PPEs resistance to permeability

− Type of decontamination



• Assess before they enter and after they leave the hot zone.− Complete set of vital signs

− ECG

− Temperature

− Body weight



• Before reentry, evaluate again.− Hydration status

− Vital signs

− Symptoms for potential exposure

• Reassess vital signs, and perform a neurologic assessment.

SummarySummary

• Thousands of hazardous materials incidents occur each year.

• Hazardous materials emergencies require specialized training and equipment.

• Never enter a hazardous scene without understanding the problem.

• OSHA levels of training: awareness, operations, technician, and specialist.

SummarySummary

• The roadway is where a majority of hazardous material emergencies happen.

• Signs of hazardous materials include vapor clouds, strange odors, spilled liquids, and multiple victims.

• Labels and placards, transport documents, material safety sheets, and the DOT’s ERG are resources about hazardous materials.

SummarySummary

• Hazardous materials incident management follows the principles of NIMS and ICS.

• There are hot, warm, and cold zones at incidents.

• Do not enter the hot and warm zones without the correct personal protective equipment and training.

• PPE levels: level A, level B, level C, and level D

SummarySummary

• Primary contamination comes from direct contact with a toxin.

• Secondary contamination spreads by people, clothing, or objects.

• Effects may be local or systemic.

• Inhalation, ingestion, absorption, and injection are routes of exposure.

• Rescue and decontamination of victims is second to protection of rescuers and public.

SummarySummary

• Decontamination is based on the nature of the containment.

• Treatment of victims is usually symptomatic and supportive of the ABCs.

• To avoid introducing contamination, invasive procedures should be avoided.

• Paramedics may be asked to provide medical monitoring to the hazardous materials team.

CreditsCredits

• Chapter opener: Courtesy of London Ambulance Service

• Backgrounds: Orange—© Keith Brofsky/Photodisc/Getty Images; Gold—Jones & Bartlett Learning. Courtesy of MIEMSS; Green—Jones & Bartlett Learning; Red—© Margo Harrison/ShutterStock, Inc.

• Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the American Academy of Orthopaedic Surgeons.

Documents

Chapter 49 Hazardous Materials. National EMS Education Standard Competencies EMS Operations Knowledge of operational roles and responsibilities to ensure