chap 53 haz mat traduc

ObjectivesDefine hazardous materials terms

Identify laws related to EMS related to hazardous material

Describe resources for identifying and managing hazmat incidents

Describe effects of exposure to selected hazardous materialsInternalExternalCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

ObjectivesOutline the prehospital response to hazmat materials emergency

Describe medical monitoring and rehabilitation of rescue workers who respond to a hazmat emergency

Describe decontamination and care of patients in a hazmat emergency

Outline eight steps to decontaminate rescue personnel and equipment at a hazmat incidentCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Case StudyYou are responding to a vehicle collision. As you near the scene, you can see black smoke rising from a tanker truck that is turned on its side. You stop the ambulance and radio dispatch with your initial size-up while bystanders vigorously wave for you to approach the scene.Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

DiscussionShould you proceed into the scene?

What methods will you use immediately to determine if this is a hazmat scene?

How will you decide where to position your ambulance?

If a hazmat substance is identified, how will you know what health hazards to expect?

What additional resources will you need?Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Hazardous MaterialsHazardous material (HAZMAT) substance or material posing serious risk to health, safety, property

Hazmat incidents create additional responsibilities for paramedicsMay involve large area, many agenciesMass evacuations and mass decontaminations may be neededCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Laws and RegulationsMajor incidents have attracted community attention

More laws and regulations

OSHA and EPA rules for workers at hazardous waste sites, releases or spillsTraining requirementsEmergency plansMedical checkupsSafety precautionsCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

LegislationFive groups who may respond to Hazmat emergenciesFirst-responder awarenessFirst-responder operationsHazardous material techniciansHazardous materials specialistsOn-scene incident commanderCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

NFPA StandardsNFPA competency standards for EMS personnel at Hazmat scenesParamedics who transport patients with no risk of secondary contamination must be trained to NFPA standard 473 Level-1Paramedics who decon or assist in decon area trained to NFPA standard 473 Level-2Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Identifying Hazardous Materials Informal product identification

Formal product identificationPlacardsShipping papersOther hazmat information resourcesCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Methods ofInformal Product IdentificationVisual inspection with binoculars

Verbal reports

Occupancy type

Incident location Location in building

Visual indicators

Container types

Senses

Signs and symptomsCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Informal Product IdentificationTemporary means to determine the presence of hazardous materialShould identify formally before activities posing threat to safety of emergency responders beginCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Formal Product IdentificationAmerican National Standards InstituteLabel identifies hazard not chemical

U.S. Department of Transportation (DOT)Labels and placardsPictographs and printed hazard categoriesAlso requires specific information on shipping manifestsCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Formal Product IdentificationUnited Nations Labeling SystemPictographs, symbols, or bothSimilar to DOT

International Air Transport AssociationUnited Nations pictographs and written emergency measures if incidentCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Formal Product IdentificationNational Fire Protection AssociationColor and numbers (NFPA 704 System)Degree of hazard for health, fire, reactivityDiamond-shaped symbols required on fixed facilities by many state and local fire codes

U.S. Department of LaborMaterial safety data sheets (MSDSs) for hazardous chemicals stored, handled, or used in workplaceCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Placards and Shipping PapersUnited Nations ID number and North American number (UN/NA number) displayed on bottom of placard or on shipping paper after shipping name

Sometimes replaces written name of hazard class in shipping paper descriptionCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Material Safety Data SheetsOSHA requires for chemicals produced, stored, or used in United States

Supplied by manufacturerInformation for safe handling and storage of material and emergency actionsCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Other ResourcesNorth American Emergency Response Guidebook Regional poison control centersCHEMTRECCHEMTEL, Inc. CAMEO OtherCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Dispositivos de proteccin respiratoriaDispositivos purificadores de aire

Atmosphere-supplying devices

SCBA

SABACopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Clasificacin de ropa protectoraCategorizado como:Uso limitado (desechable)Multi-uso (reutilizable)

Variedad de materiales diseados para ciertas exposiciones qumicasCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Clasificacin de ropa protectoraNivel CConcentraciones y tipos de sustancias aerbicas conocidasCriterios para usar purificador de aire son reunidos

Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Clasificacin de ropa protectoraA pesar del EPP usado:Todas las vas por las cuales los mat-pel pueden entrar al cuerpo, deben ser protegidasCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Riesgos a la SaludRutas de exposicinLos matpel pueden entrar al cuerpo a travs de:InhalacinIngestinInyeccinAbsorcinCualquier va puede producir dao interno y externo. Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

ExposicinPuede producir lesiones o enfermedadesToxicidad agdaEfecto inmediatoToxicidad retardadaEfectos no inmediatosSntomas aparecen despusEnfermedad o patologa retardadaCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Efectos sistmicos y localesEfectos localesEfecto inmediato en el sitioProgresin de efectos como quemadurasRespiratorio o tpicoIrritacin en la pielBroncoespasmoEfectos sistmicosCardiovascularNeurolgicosHepaticoRenalCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Respuesta fisiolgicaDepende de la concentracin del qumico en el sitio de accin (dosis-respuesta)Concepto esencial para la descontaminacin

Drogas pueden causar efectos sinergticos

Tratamiento guiado por:Direccin mdicaCentro de toxicologaOtras autoridades apropiadasCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Lesin fsicaIrritacin menor a enfermedades crnicas y/o muerteEPOCCncerConsecuencias mutagnicas o teratognicasDesarrollo fetal anormalCambios en la estructura genticaCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

IrritantesVapores pueden afectar:Membranas mucosasComo los irritantes se combinan en mezclas, reacciones cidas o alcalinas pueden ocurrirEn el tracto respiratoria superior, medio y bajo

EjemplosAcido HidroclricoHalogenadosOzonoCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

AsfixiantesGases que desplazan el oxigeno, por dilusin de la concentracin de oxigeno en el aire

Asfixiantes sencillosDixido de carbonoMetanoPropanoCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Hemotxicos o Qumicos asfixiantesLos gases desplazan el oxigeno e interfieren en la oxigenacin tisularInterrupcin del transporte de oxigeno a las clulasPrivacin de oxigeno al tejido corporal

EjemplosCianuro de hidrgenoMonxido de carbonoSulfuro de hidrgenoCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Neurotxicos, Anestsicos y NarcticosActan sobre el sistema nervioso

Afectan ambos:Mecanismos cerebrales de regulacin cardiorespiratoriaCapacidad para transmitir impulsos necesarios para las funciones respiratorias y circulatoriasCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

NeurotxicosDesarrollado por militaresGases de guerra, gases nerviosos, o agentes nerviososSustancias similares usadas en pesticidas slidos

La exposicin puede producir complicaciones fatales

EjemplosCarbamatosOrganofosforadosParathionMalathionCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Anestsicos y NarcticosMenos peligrosos que los neurotxicosExposicin contnua o exposicin a grandes concentraciones puede producir insconciencia o muerte.

EjemplosEtilenoOxido nitrosoAlcohol etlicoCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

HepatotxicosCausan dao al hgadoAcumulacin de txinas y destruccin de la capacidad de funcionamiento del hgado

EjemploHidrocarburos clorados y halogenadosCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

CardiotxicosPueden inducir isquemia miocrdica y disturbios en el ritmo cardiaco

EjemplosNitratos alifticosDinitrato glicol etilenoCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

NefrotxicosDestruyen el hgado

EjemplosDisulfuro de carbnPlomoAltas concentraciones de solventes orgnicosMercurio inorgnicoCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

NeurotxicosToxicidad neurolgica y de comportamiento pueden resultar de la exposicin a:ArsnicoPlomoMercurioSolventes orgnicosCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

HemotxicosDestruyen los glbulos rojosAnemia hemoltica

Sustancias que producen anemia hemolticaAnilinaNaftalinaQuinonasPlomoMercurioArsnicoCobreCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

CarcingenosCausan cncer

Variedad de matpel carcingenosTodos los combustibles fsiles y orgnicos producen dioxinas, many of which are carcinogensBurning wood produces carcinogenic formaldehyde

Positive-pressure SCBA needed to protect against carcinogenic vapors and other respiratory poisonsCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

General Symptoms of ExposureVary by individual and depend on:Chemical involvedConcentration of the chemicalDuration of exposureNumber of exposuresRoute of entryCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Personal FactorsInfluence how individual is affected:AgeGenderGeneral healthAllergiesSmoking habitsAlcohol consumptionMedicationCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Symptoms From HazMat Exposure May be delayed

May be masked by:Common illnesses (e.g., influenza)Smoke inhalationCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Seek Medical Attention IfConfusion

Lightheadedness

Anxiety, dizziness

Chest tightness

Dim, blurred, or double visionChanges in skin color or blushing

Shortness of breath

Burning of upper airway

Coughing

Painful respiration

Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Seek Medical Attention IfSalivation

Drooling, rhinorrhea

Tingling or numbness of extremities

Loss of coordination

SeizureNausea, vomiting

Abdominal cramping

Diarrhea

Involuntary urination and/or defecation

UnconsciousnessCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

External DamageSurface tissue injured

Corrosive properties or become corrosive when mixed with waterChemical burns and severe tissue damageExamplesHydrochloric acidHydrofluoric acidCaustic sodaCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Soft Tissue Damage CorrosivesAcids or basesExposure may cause pain on contactAlkalis often burn more than acidsExposing to a base corrosive such as lye may result in a breakdown of fatty tissueLiquefactionGreasy or slick feeling of skinDecontaminate and seek medical attentionCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

DecontaminationDecontamination begins by:Brushing off powderFlushing skin copiously with water

Dont neutralize an acid or baseCan produce heat and cause more burns

TransportCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

CryogenicsRefrigerant liquid gases

Can freeze human tissue on contactVaporize when releasedUse caution near refrigerated liquidsFreeze burns, frostbiteFreon, liquid oxygen, and liquid nitrogenCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Chemical Exposure to the EyesDamage ranges from superficial inflammation to severe burnsLocal painVisual disturbanceTearingEdemaRedness of surrounding tissues

Flush eyes with waterCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Response to Hazmat EmergenciesDuring response consider:Rescuer safetyType and degree of potential hazardInvolvement of other agencies.

Preplanning and early coordination is imperative

Advise medical direction earlyCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Hazard and Risk AssessmentHazards chemical properties of material that may cause danger or peril

IDLH immediately danger to life and health

LD-50 lethal dose, 50% kill

ppm/ppb parts per million/parts per billionCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Hazard and Risk AssessmentPEL permissible exposure limit

TLV-C threshold limit value-ceiling level

TLV-STEL threshold limit value-short-term exposure limitCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

TerminologyAlpha radiationBeta radiationBoiling pointFlash pointFlammable/exposure limitsGamma radiationIgnition temperatureSpecific gravityVapor densityVapor pressureVapor solubilityCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

RiskPossibility of suffering harm or loss

Risk levels vary related to:Hazardous nature of materialQuantity of materialContainment systemType of stress applied to containerProximity of exposureAvailable resourcesCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Hazard and Risk AssessmentPotential hazards Risk of primary contamination to patientsExposure to substanceOnly harmful to person exposedLittle chance of exposure to othersRisk of secondary rescuer contaminationExposure to substanceSubstances easily transferred by touchingCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Hazard and Risk AssessmentIf product identified EMS should find:Potential health hazardsPersonal protective equipmentFirst aidSafe distance factorCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Approaching the SceneApproach scene uphill and upwind

Note environmental clues such as:Wind directionUnusual odorsLeakageVapor cloudsCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Approaching the SceneUse binoculars to observe scene from safe distance

Dont drive through leakage or vapor clouds

Dont enter incident area until it has been determined that it is safeCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Identify the HazardsPlacards, container labels, shipping papers, and knowledgeable persons on scene are valuable information sourcesEvaluate and consult guide page New information from CHEMTREC expert can change some guide page warningsCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Secure the SceneDont enter immediate hazard zone

Isolate area

Ensure safety of people and environmentMove people away from scene and perimeterAllow room to move EMS equipmentCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Obtain HelpAdvise dispatch to notify responsible agencies

Call for help from experts Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Decide on Site EntryWeigh rescue attempts against risks to EMS

Enter area with appropriate protective gear (if trained to do so)Do not walk into or touch spilled materialAvoid inhalation of fumes, smoke, vaporsEven if no hazmat known to be involvedGases may be harmless even if no odorCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Control of the SceneFirst arriving agency at sceneDetect and identify materials involvedAssess risk to rescuers and othersConsider potential for fire or explosionGather information Confine and control incidentEstablish a command post Define safety distances and zonesCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Safety ZonesIf hazardous materials present:Separate scene into hot, warm, and cold zonesEstablish and enforce zones early in incidentCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Hot ZoneArea that includes hazmat

Any surrounding area exposed to gases, vapors, mist, dust, or runoffRescuers and vehicles outside this zonePersonnel in this zone must wear protective clothingOnly specially trained personnel perform patient care in this zoneCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Warm ZoneLarger area that surrounds hot zoneSafer working environmentRequires protective clothingMost EMS activities performed in this zoneCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Cold ZoneSurrounds warm zoneRestricted to emergency personnelRequires minimal protective clothingContains command post and other support agenciesCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Medical Monitoring and RehabilitationPersonnel safety criticalMedical surveillance should be included in all HAZMAT incidentsPredefine normal valuesDetermine criteria to take personnel out of the gameCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Medical Monitoring and RehabilitationMedical surveillance programs include:Needed medical careMedical monitoringRecord keepingEvaluation of medical surveillance programCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Medical Monitoring and RehabilitationMedical monitoring includes:Pre-suit medical examinationPrehydrationAdvising personnel of expected symptoms of illness of exposure before entryAssessment for heat illness and dehydrationCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

DocumentationHazardous materials substanceToxicity and danger of secondary contaminationPPE use and any breakthrough that occurredDecontamination performed or requiredUse of antidotes and other medical treatmentMethod of transportation and destination Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Non-critical PatientEight step decontamination processPatient care activities, triage, and evacuation part of preplanned ICS structureMay take time to identify hazardous substanceRescue efforts, decontamination, possible evacuation, and treatment of toxic exposures is very importantCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Primary Goals of DecontaminationReduce patients dosage of materialDecrease threat of secondary contaminationReduce risk of rescuer injurySpecific substance and route of contamination will affect triage and decontamination methodsGuidelines for rapid decontaminationGross decontaminationDecontamination decision makingCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Longer-Duration EventsRescue not attempted for patients in hot zoneWait for Hazmat team and decon corridor to be established

Longer-duration events allow for:More thorough decontaminationBetter PPELess chance of secondary contaminationBetter environmental protectionCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Preparing Ambulance for TransportMinimize contamination

Follow hospital's decontamination protocolDo not return to service until rescue personnel, vehicle, and equipment have been monitored for contaminationCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Decontamination of Rescue PersonnelEight step process

Begins in the decontamination corridorCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

If Exposed to Hazardous MaterialsDo not touch face, mouth, nose, or genital area before decontamination

Shower with warm water, soap, sponge, and brushRepeat shower and rinseShampoo hair several times and rinse

Avoid shaving

Use clean dry towels after each showerCopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Care and Maintenance ofClothing and EquipmentAfter incidentDispose of damaged protective clothing Clean all clothing and equipment Do not wash or dispose of clothing or equipment at home Follow local laws regarding disposal or decontamination of equipment and clothingMaintain personal SCBACopyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

ConclusionSpecialized roles and responsibilities during a hazmat incident may include recognition and identification of hazardous material, scene safety, containment and cleanup of the material, extrication and decontamination of exposed individuals, provision of emergency care , and continual medical assessment of team members involved in the incident.Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Questions?Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

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chap 53 haz mat traduc

Documents

affiliate of elsevier

hazmat emergencyoutline

hazmat scenesparamedics

hazmat incidentcopyright

hazardous waste sites

ems personnel

rescue personnel

additional resources