EMS chapter 26 - EMS operations and Hazardous response

cold zone

designated area at a hazardous materials incident that is well beyond the incident and where patients are cared for and placed into ambulances for transport.

due regard

appropriate care and concern for the safety of others.

extrication

coordinated removal of entrapped patients from vehicles and structures.

HAZWOPER

Hazardous Waste Operations and Emergency Response.

requirements:

• Written SOPs and a response plan

• Use of the incident command system

• Presence of a safety officer

• Use of minimum PPE such as SCBA and full turnout gear

• Presence of backup personnel and emergency medical support

hot zone

at a hazardous materials incident, the area immediately at the spill or release. where contamination is actually present

warm zone

designated area at a hazardous materials incident where decontamination of people and equipment occurs.

assessment

1. check for hazards

2. don’t enter if any

3. if 1st to arrive, call dispatch (verbal assessment of scene) and request additional resources soon

what does SPO stand for

standard operating procedures

phases of EMS response

• preparation (check equipment at START of shift.)

  • Assess vehicle engine and fluid levels - fuel, oil, transmission fluid, diesel exhaust fluid aka DEF, coolant, windshield washer. And make sure you have all needed personnel).

• dispatch (info they give you may be incomplete or incorrect)

• en route to the scene

• at the scene

• transfer of care (written accounts of incident may be useful)

• post call preparation

phase 3: en route to the scene

• use due regard when travelling there.

• Emergency lights MUST be on for ALL emergencies

• sirens used when there is traffic or approaching/going through intersections

• tell dispatch of any delays

phase 4: at the scene

1. position 50 feet before the scene

2. turn emergency lights on (if not already on)

3. watch for traffic

4. if possible, place car uphill and upwind from scene

5. notify dispatch of arrival

   • actual location of incident (if dispatch was wrong)

   • type of incident, any additional resources needed

   • # of victims

phase 6: post call

immediately prepare for next call - clean and disinfect equipment, restock supplies, and refuel the vehicle.

complete any needed paperwork (file reports).
finally, notify dispatch that you’re back in service

care accident scene safety ideas

1. make scene safe for others

2. request additional resources

3. gain access to patients

4. free trapped patients

5. evaluating patients + providing emergency care

6. quickly move patient’s away from dangerous areas

care accident scene safety steps

1. part vehicle 50 feet away - turn on emergency flashers

   • use headlights to light scene (don’t point at road - can blind other drivers)

2. look for spills + fire. Park uphill and upwind

3. can’t leave warning lights on if you leave vehicle - will drain power

4. set out flares, flashing lights, or cones to warn other drivers. On high speed roads, place at least one 250 ft from scene. On low speed roads place one at least 100 ft. Add 25 ft to both distances if the road is curved

5. as you approach, double check for leaking fuel or fires, unstable vehicles, downed electrical wires?

   • if wire down, check nearest pole number (so you can request power to be turned off)

6. find out # of patients (and if in car vs bike, or children) and report back to dispatcher

7. if scene safe, chock the wheels of the vehicle (place wedges against wheels to prevent movement), get access to patient, care

securing cars on slippery surfaces

sprinkle dirt, sand, ashes, or even cat litter and then chock the wheels

securing tilted vehicles

dont work below or downhill from.
Chock the wheels, and tie the front and back (not bumper) with rope to something sturdy, like a pole or tree or heavier stable vehicle.

securing stacked vehicles

chock wheels of BOTH vehicles, and use rope to secure BOTH vehicles.

stabilizing sideways car

1. chock between the roofline and the road surface

2. if still unstable, tie with ropes

3. try and enter car (through rear window). Don’t enter through broken windows

4. if you open a door, secure it with a rope

simple vs complex access of a patient

simple: no equipment needed

complex: need equipment

4 ways to gain access inside the car

1. open doors (if locked, use slim jim on older vehicles)

2. enter through window (to break: wear PPE, goggles, gloves. spring-loaded center punch on rear or side windows. Hit bottom corners)

3. pry open doors (very time consuming, not best option)

4. cut through metal (fire dep. usually does this)

patients pinned beneath vehicles

1. call rescue squad immediately

2. lift cars off patient w/ jack or pry bar

   • dont crush other side of patient w/ other side of vehicle

3. others secure it as you lift it

4. chock the vehicle

5. care ONLY once vehicle is stable

vehicles w/ patients pinned inside

1. remove wreckage from on top and around patient

2. Carefully move a seat forward or backward.

3. Carefully lift out the back seat.

4. Remove a patient’s shoe to free a foot, or cut away clothing caught on wreckage.

5. Cut seat belts but be sure to properly support the patient during the cutting and after the tension has been released.

6. Follow manufacturer and agency guidelines for working around vehicles with deployed and undeployed airbags.

7. Check the steering wheel beneath the deployed airbag for damage indicating the patient might have struck it.

how to identify high voltage cables

thick and brightly colored

breaking into buildings legally

1. request additional resources if needed

2. First, try opening and entering through unlocked doors or windows.

3. Look for spare keys hidden under mats or other exterior locations.

4. Ask bystanders and neighbors if they have keys.

5. Break glass to unlock doors or windows.

breaking building window

1. Make certain the patient is not lying near the other side of the glass.

2. Use a hammer or similar blunt object to strike the glass near one of its edges. A nightstick or an aluminum flashlight will break most window glass. If you do not have tools, use a rock or a similar object to strike the glass.

3. Carefully clear all glass from the frame and reach in to unlock the door or window.

4. Make certain you are stepping onto a safe floor. Be sure you do not have an unusual drop when entering. Take a moment to visually inspect the floor for damage or test the floor for signs of weakness.

what does grayish yellow smoke mean?

a dangerous mix of incomplete combustion and burning plastics or rubber.
DONT OPEN DOORS can cause explosion

what to do in smokey rooms

stay close to floor, crawl to safety. Cover mouth and nose w/ damp cloth

what does SCBA stand for?

Self contained breathing apparatus.

electrical issues scene safety

1. park at least 1 utility pole away from damaged poles

2. alert dispatch (to call power company)

3. dont approach cars that collided w/ transformer boxes

   • alert dispatch and request special rescue assistance

4. if victim is in car (near electric source) have them stay there and dont touch metal

   • if fire, have them jump from car (dont touch car and ground at same time - completes a circuit and might get electrocuted)

when to instantly assume hazardous materials are there?

at every industrial site and every farm, truck, train, ship, barge, and airplane emergency incident

5 levels of Hazmat Training

1: first responder awareness (secure area, notify proper people)

2: first responder operational (don’t stop issue, just protect around it)
3: Hazardous materials technician: on hazardous material team
4: hazardous material specialist: has lots of knowledge and is team leader
5: incident commander: person who assumes command

what to tell dispatch about

• your name and callback number

• Nature and location of the problem

• Type of material + how much

• Name or identification number of the material. Look for labels or placards

• Name of the shipper or manufacturer. From a safe point or with binoculars, look for names on railroad cars, trucks, or containers. Ask bystanders, drivers, or railroad or factory personnel.

• Type of container. Is the material in a rail car or a truck? Is it in open storage, covered storage, or housed storage? Is the container still intact, or is liquid leaking, gas escaping, or a powder spilled? Report if the material is stable or if it is flaming, vaporizing, or blowing into the air.

• Weather conditions. Rain and wind are major concerns because they will carry hazardous materials to other locations.

• Estimate of the number of possible victims both in the area closest to the spill and nearby.

• Other significant problems at the scene, such as fire, crowds, and traffic.

info on SDS (safety data sheet)

• chemical and common names

• Physical and chemical properties

• Physical hazards

• Health hazards

• Primary routes of exposure

• Exposure limits

• Safe handling procedures

• Emergency and first-aid measures

• Contact individual or company

decontamination (decon)

takes place in warm zone. everything must be decontaminated before entering cold zone.
all warm + hot zone people are considered contaminated