Emergency Response to TerrorismTC: Emergency Medical Services

Unit 2: Safety

2-2

Terminal Objective

Given a simulated potential target hazard for a B-NICE incident, the student will be able to develop a safety plan that addresses the potential for secondary contamination, personal protective equipment, decontamination & monitoring considerations for personnel operating in the multi-casualty branch

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Enabling Objectives

Identify factors that contribute to the potential for secondary contamination

Identify the precautions necessary for body fluid exposures

Identify the resource needs and procedures for the decontamination of EMS personnel

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Enabling Objectives (Cont.)

Identify the level of personal protection needed by EMS personnel based upon their location and job function

Identify the role of the Safety Officer and the Incident Safety Plan

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Secondary Contamination

Contamination by contaminated victims Not limited to people only Key factors in a pre-hospital setting for

determining potential secondary contamination

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Body Fluid Precautions

Body substance isolation Dissemination of a biological agent Responders operating in CPC Responders treating/transporting patients

still require PPE for body substances Proper containment of sharps

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Supervisory Briefings

Material(s) involved or suspected # of contaminated civilians & responders Estimated time of release Physical & chemical properties of the

material Actions taken Hazard zones established & boundaries

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Supervisory Briefings (cont.)

Establishment of dedicated water supply for decon

Response of technical assistance & estimated time of arrival

Dedicated radio channel for responders operating in CPC

Appropriate level of PPE for each zone

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Responder Briefings

Briefing includes: Location of hazard zone boundaries Location of decon lines Proper radio frequency Proper PPE & equipment needed Incident assignment

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EMS Responder Decon

Prompt, safe and effective decontamination (decon) protects against & reduces effects of exposure.

NFPA definition OSHA definition Working definition

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EMS Responder Decon (cont.)

Phases of decon Gross Secondary Tertiary (usually at medical facilities)

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7 Mechanisms for Performing Decon

Emulsification Chemical reaction (e.g., neutralization,

oxidation, degradation)

Disinfection Dilution Absorption and Adsorption Removal Disposal

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Decon Situations

Obvious contamination with known substance Suspected contamination with known

substance Any likelihood of exposure to a hazardous

substance Prevent spread of contaminant Environmental protection

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Contamination Reduction Corridor

Key difference is whether or not responders are in proper PPE

Lines for those with PPE Lines for responders who become

symptomatic

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Basic Decon Equipment

Buckets & brushes Decon solution & tubs Dedicated water supply Tarps or plastic sheeting Containment vessel for runoff & pump A-frame ladder Appropriate PPE

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Objectives of Responders

Determine appropriate level of PPE based on materials & hazards

Properly wear & operate in PPE Establish operating time log Set up & operate decon line Conduct triage & communicate while in

PPE

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Decon of PPE - Responders

Rinse, head to foot Scrub suit with brush, head to foot Attend to heavily contaminated areas,

i.e., hands, feet, front of suit Rinse again, head to foot Assist responder in removing PPE

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Decon Supervisor

PPE limits vision, so it should not be worn Responsible for final walkthrough of

corridor Ensures supplies & runoff containment Once decon begins, only PPE equipped

personnel in zone

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Decon Supervisor(cont.)

Remains in radio contact with CP Supervises decon from outside the line

Medical Quality Control Watches for need for medical intervention Assigns tasks to decon and support

personnel In position to observe all leaving hot zone

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PPE for EMS Responders

CPC protects from patients CPC protects skin & eyes from chem May be different levels of PPE at site There is no all-hazard-type ensemble EMS needs competency-based PPE

training Two types of suits

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3 Areas of CPC Testing

Permeation

Penetration

Degradation

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Levels of Protection

Level A - vapor proof, totally encapsulating

Level B - splash and high respiratory protection, not vapor proof

Level C - similar to B, uses lower respiratory protection

Level D - work uniform

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Conditions for Selecting - Level A

Confined Enclosed High splash IDLH dermal High concentration

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Conditions for Selecting - Level B

High respiratory O2 less than 19.5% Minimum for

unknown materials Moderate splash Not IDLH dermal

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Conditions for Selecting - Level C

No IDLH respiratory or dermal

Contaminant known Air purifying

respirator criteria met

> 19.5 % O2

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Conditions for Selecting - Level D

No chemical hazards present Might include aprons, gloves and

eye protection for “lab” type activities

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NFPA Standard 1991

Defines vapor protective suit Worn when chem present IDLH Test all parts of suit to 17 chemicals plus Suit undergoes pressurization test Test burst strength Technical data package

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Other NFPA PPE Standards

NFPA 1992 - Splash Protective Garments Chemical compatibility test Puncture and tear Temperature

NFPA 1993 - Support Protective Garments Used in support areas and roles Areas of minimal potential for contamination

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PPE Effects On Wearer

Thermal stress Restricted movement Restricted vision Impaired hearing Impaired communication Promotes claustrophobia Offers no thermal protection

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Military vs. Firefighter

Aberdeen Proving Grounds Effectiveness of firefighter protective

clothing Found to have limited effectiveness

against chemical agents (only for rescue)

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Military PPE

Mission Oriented Protective Posture (MOPP) Overgarment Charcoal liner Mask Hood Overboots Gloves

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Firefighter Protective Clothing

Shell, vapor barrier and liner Severe limits to

dermal protection Positive pressure

SCBA High levels of

respiratory protection

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Medical Monitoring for PPE Wearers

Heat stress Physical condition Psychological, mechanical &

physiological stressors Heat rash, cramps, exhaustion, stroke Pre- and post-entry medicals according to

local protocol

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Proper Hydration

No eating, drinking, or smoking at HazMat assignment

Fluids prevent heat-related emergencies Drink fluids prior to start of tour & continue

throughout Avoid caffeine & alcohol

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Proper Hydration (cont.)

Fluid loss Usually underestimated SCBA or APR use affects mucous

membranes Wearing of CPC will increase amt of fluid

loss Rehydration

Plain water is best

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7 Mechanisms of Harm

TEAM CPR (formerly TRACEM) Thermal Etiological Asphyxiant Mechanical Chemical Psychological Radioactive

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Role of Incident Safety Officer

Ensure Responders wear PPE Work in teams Have back up Use accountability system for tracking Follow safety practices Follow those practices during training

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Incident Safety Plan

Location & size of zones Proper level of PPE in each zone Location & setup of decon line Rapid intervention team with CPC Medical monitoring of responders in CPC Emergency evacuation signals Responder accountability Responder medical treatment team

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Weather Conditions

Present & forecasted weather Inversion gradient Neutral gradient Lapse gradient Humidity Barometric pressure Clear skies & clouds

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Controlled Weather

Inversion Lapse Humidity Clear skies Cloud cover

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Impact of Weather

Factors that wear you out make many agents more effective!

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Additional Monitoring

Geographic Weather Size of zones Patient monitoring

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Activity 2.1

Emergency Response Plan Development

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Summary

Prevention of contamination Safety officer Incident safety plan Monitoring needs Recognizing TEAM CPR Wearing appropriate PPE Decontamination