Hazemat and mass casuality

Identification of the Emergency Response Subject

  • Importance of identifying the subject for effective emergency response.

Emergency Response Guidebook (ERG)

  • Definition: An ERG is an emergency response guidebook that is required for ambulances to have on board.

  • Availability: Aside from the physical book, there are also mobile applications that can help lookup information quickly.

  • Usage: If an ambulance sees a placard on a vehicle (e.g., a semi-truck), the number associated with that placard can be used to reference the ERG for essential information regarding hazardous materials.

Understanding Hazards From Placards

  • Placards have assigned numbers indicating the hazardous material name.

    • Example: Anhydrous ammonia is identified with placard number 1005.

    • Referencing Number: Upon finding the placard number, one must look it up in the ERG, eventually leading to a guide number (e.g., 125).

    • Content of ERG: The ERG provides information on potential hazards (i.e., health hazards, fire hazards) and necessary safety equipment (like protective clothing).

    • Emergency Protocols: It also details evacuation strategies (distance information), which is critical during hazardous spill incidents.

Incident Management

  • Generally, fire departments are primarily involved in initial handling of hazardous materials, while EMS usually waits in the cold zone until necessary.

  • Cold Zone: The safe area where EMS waits to treat affected persons, categorized as upwind and uphill from the incident.

Contamination Prevention

  • Contamination: Awareness of avoiding contamination in ambulances and treatment areas is emphasized to ensure EMS vehicles remain decontaminated post-incident.

  • In situations resulting in contaminant exposure, patients and EMS staff need proper decontamination protocols followed, including disposal of contaminated attire (double bagging precautions).

Patient Decontamination Procedures

  • Two Types of Decontamination:

    1. Gross Decontamination: Involves the preliminary removal of major contaminants.

    2. Residual Decontamination: More thorough to eliminate remaining contaminants.

  • Tools mentioned for decontamination include buckets, brushes, decontamination solutions, and tubs for runoff management.

  • Those wearing PPE must also undergo decontamination processes to ensure no contaminants remain.

Mass Casualty Incidents (MCI)

  • Definition: An MCI occurs when the number of casualties exceeds the immediate resource capacity.

    • Triggering threshold can vary (e.g., three or more patients in McLean County).

  • National Incident Management System (NIMS): Originated in 1968, largely influenced by wildfire management situations in California.

    • Structure divides into incident command (operations, planning, logistics, finance). Smaller MCI scenarios may streamline this process to key areas without needing full organizational deployment.

Incident Command Structure

  • Assumption of Command: The most senior individual from the first responding service assumes command until someone from a higher rank arrives.

  • Triage Responsibilities: One designated individual manages incident command and communication with the dispatch center, allowing others on scene to focus on triaging and treating patients.

Scene Management

  • Early organization is critical in avoiding confusion or a chaotic scene. If the scene lacks command and organization, immediate leaders are required to step in and designate roles clearly.

  • Establish control points for tracking patients and responding teams, potentially designating secretarial roles for accountability.

Triage Process During MCI

  • Triage consists of managing patients based on severity (red, yellow, green, black tags).

    • START Triage Protocol: Focuses on three primary assessments: ability to walk, respiratory rate, and radial pulse.

    • Walking patients tagged as Priority 3.

    • If unable to walk, assess respiration rates:

      • >30 respirations/min: Tag as Priority 1 (Red).

      • <30 respirations: Check for pulse; actions include opening the airway and re-assessing.

    • No pulse and not breathing: Priority 4 (Black Tag).

    • Assessing breathing can yield further responses (e.g., respiratory failure leads to black tagging).

Transportation and Hospital Notification

  • Once triaged, transportation must be prioritized based on severity, always ensuring that the most critical patients are taken first.

  • Hospital Communication: Critical to inform hospitals as soon as the MCI is declared to prepare for incoming patients, distributing them across available facilities depending on severity and resources.

  • Short, efficient communication with dispatch is emphasized, to minimize air traffic during such incidents.

On-Scene Support and Psychological Considerations

  • Psychological first aid may be necessary for victims as well as responders to manage stress and trauma encountered in high-pressure environments like MCIs.

  • A debriefing process is intended post-MCI to ensure the capacity for mental health support and recovery for all involved personnel.

Conclusion

  • Effective handling of MCIs requires preparation, clear communication, and a structured approach based on both the tactical operation and emotional support needs of victims and responders alike.

  • Practice and familiarity with localized MCI protocols are vital in ensuring readiness for stressful scenarios.