Chap 53 Haz Mat Traduc

Chapter 53
Hazardous Materials Incidents
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Objectives
Define 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

materials
Internal
External
Objectives
Outline 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 incident
Case Study
You 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.
Discussion
Should 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?

Hazardous Materials
Hazardous material (HAZMAT) substance

or material posing serious risk to health,
safety, property
Hazmat incidents create additional

responsibilities for paramedics
May involve large area, many agencies

Mass evacuations and mass decontaminations
may be needed
Laws and Regulations
Major incidents have attracted community

attention
More laws and regulations
OSHA and EPA rules for workers at hazardous

waste sites, releases or spills
Training requirements
Emergency plans
Medical checkups
Safety precautions
Legislation
Five groups who may respond to Hazmat

emergencies
First-responder awareness
First-responder operations
Hazardous material technicians
Hazardous materials specialists
On-scene incident commander
NFPA Standards
NFPA competency standards for EMS

personnel at Hazmat scenes
Paramedics who transport patients with no risk of

secondary contamination must be trained to NFPA
standard 473 Level-1
Paramedics who decon or assist in decon area
trained to NFPA standard 473 Level-2
Identifying Hazardous Materials
Informal product identification
Formal product identification
Placards
Shipping papers
Other hazmat information resources
Methods of
Informal Product Identification
Visual inspection with

binoculars
Location in building
Visual indicators
Container types
Senses
Signs and symptoms
Verbal reports
Occupancy type
Incident location
Informal Product Identification
Temporary means to determine the presence

of hazardous material
Should identify formally before activities posing

threat to safety of emergency responders begin
Formal Product Identification
American National Standards Institute
Label identifies hazard not chemical
U.S. Department of Transportation (DOT)
Labels and placards

Pictographs and printed hazard categories
Also requires specific information on shipping
manifests
United Nations Labeling System
Pictographs, symbols, or both

Similar to DOT
International Air Transport Association
United Nations pictographs and written emergency

measures if incident
National Fire Protection Association
Color and numbers (NFPA 704 System)

Degree of hazard for health, fire, reactivity
Diamond-shaped symbols required on fixed
facilities by many state and local fire codes
U.S. Department of Labor
Material safety data sheets (MSDSs) for

hazardous chemicals stored, handled, or used in
workplace
NFPA Placard
Placards and Shipping Papers
United 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 description
Hazardous Materials
Warning Placards and Labels
Material Safety Data Sheets
OSHA requires for chemicals produced,

stored, or used in United States
Supplied by manufacturer
Information for safe handling and storage of

material and emergency actions
Other Resources
North American Emergency Response

Guidebook
Regional poison control centers
CHEMTREC
CHEMTEL, Inc.
CAMEO
Other
EPP
Lesiones por exposicin a materiales

peligrosos relacionados a sustancias por su:
Toxicidad
Inflamabilidad
Reactividad
Dispositivos de proteccin
respiratoria
Dispositivos purificadores de aire
Atmosphere-supplying devices
SCBA
SABA
Clasificacin de ropa protectora
Categorizado como:
Uso limitado (desechable)

Multi-uso (reutilizable)
Variedad de materiales diseados para

ciertas exposiciones qumicas
Nivel A
Mximo nivel de
proteccin a la piel,
respiracin y
proteccin ocular
Nivel B
Alto nivel de
proteccin respiratoria
Bajo nivel de
proteccin a la piel
Nivel C
Concentraciones y tipos de sustancias aerbicas

conocidas
Criterios para usar purificador de aire son
reunidos
Nivel D
Uniforme de trabajo
permite mnima
proteccin
Solo para
contaminacin limitada
Clasificacin de ropa
protectora
A pesar del EPP usado:
Todas las vas por las cuales los mat-pel pueden

entrar al cuerpo, deben ser protegidas
Riesgos a la Salud
Rutas de exposicin
Los matpel pueden entrar al cuerpo a travs de:

Inhalacin
Ingestin
Inyeccin
Absorcin
Cualquier va puede producir dao interno y
externo.
Exposicin
Puede producir lesiones o enfermedades
Toxicidad agda
Efecto inmediato
Toxicidad retardada
Efectos no inmediatos
Sntomas aparecen despus
Enfermedad o patologa retardada
Efectos sistmicos y locales
Efectos locales
Efecto inmediato en el
sitio
Progresin de efectos
como quemaduras
Respiratorio o tpico
Irritacin en la piel
Broncoespasmo
Efectos sistmicos
Cardiovascular
Neurolgicos
Hepatico
Renal
Respuesta fisiolgica
Depende 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 mdica
Centro de toxicologa
Otras autoridades apropiadas
Lesin fsica
Irritacin menor a enfermedades crnicas y/o

muerte
EPOC
Cncer
Consecuencias mutagnicas o teratognicas
Desarrollo fetal anormal
Cambios en la estructura gentica
Irritantes
Vapores pueden afectar:
Membranas mucosas
Como los irritantes se combinan en mezclas, reacciones
cidas o alcalinas pueden ocurrir
En el tracto respiratoria superior, medio y bajo
Ejemplos
Acido Hidroclrico
Halogenados
Ozono
Asfixiantes
Gases que desplazan el oxigeno, por dilusin

de la concentracin de oxigeno en el aire
Asfixiantes sencillos
Dixido de carbono
Metano
Propano
Hemotxicos o Qumicos asfixiantes
Los gases desplazan el oxigeno e interfieren

en la oxigenacin tisular
Interrupcin del transporte de oxigeno a las

clulas
Privacin de oxigeno al tejido corporal
Ejemplos
Cianuro de hidrgeno
Monxido de carbono
Sulfuro de hidrgeno
Neurotxicos,
Anestsicos y Narcticos
Actan sobre el sistema nervioso
Afectan ambos:
Mecanismos cerebrales de regulacin

cardiorespiratoria
Capacidad para transmitir impulsos necesarios
para las funciones respiratorias y circulatorias
Neurotxicos
Desarrollado por militares
Gases de guerra, gases nerviosos, o agentes nerviosos

Sustancias similares usadas en pesticidas slidos
La exposicin puede producir complicaciones fatales
Ejemplos
Carbamatos
Organofosforados
Parathion
Malathion
Anestsicos y Narcticos
Menos peligrosos que los neurotxicos
Exposicin contnua o exposicin a grandes

concentraciones puede producir insconciencia o
muerte.
Ejemplos
Etileno
Oxido nitroso
Alcohol etlico
Hepatotxicos
Causan dao al hgado
Acumulacin de txinas y destruccin de la

capacidad de funcionamiento del hgado
Ejemplo
Hidrocarburos clorados y halogenados
Cardiotxicos
Pueden inducir isquemia miocrdica y

disturbios en el ritmo cardiaco
Ejemplos
Nitratos alifticos
Dinitrato glicol etileno
Nefrotxicos
Destruyen el hgado
Ejemplos
Disulfuro de carbn
Plomo
Altas concentraciones de solventes orgnicos
Mercurio inorgnico
Neurotxicos
Toxicidad neurolgica y de comportamiento

pueden resultar de la exposicin a:
Arsnico
Plomo
Mercurio
Solventes orgnicos
Hemotxicos
Destruyen los glbulos rojos
Anemia hemoltica
Sustancias que producen anemia hemoltica
Anilina
Naftalina
Quinonas
Plomo
Mercurio
Arsnico
Cobre
Carcingenos
Causan cncer
Variedad de matpel carcingenos
Todos los combustibles fsiles y orgnicos

producen dioxinas, many of which are carcinogens
Burning wood produces carcinogenic formaldehyde
Positive-pressure SCBA needed to protect

against carcinogenic vapors and other
respiratory poisons
General Symptoms of Exposure
Vary by individual and depend on:
Chemical involved
Concentration of the chemical
Duration of exposure
Number of exposures
Route of entry
Personal Factors
Influence how individual is affected:
Age
Gender
General health
Allergies
Smoking habits
Alcohol consumption
Medication
Symptoms From HazMat Exposure
May be delayed
May be masked by:
Common illnesses (e.g., influenza)

Smoke inhalation
Seek Medical Attention If
Confusion
Lightheadedness
Changes in skin color or

blushing
Shortness of breath
Burning of upper airway
Coughing
Painful respiration
Anxiety, dizziness
Chest tightness
Dim, blurred, or double
vision
Seek Medical Attention If
Salivation
Nausea, vomiting
Drooling, rhinorrhea
Abdominal cramping
Tingling or numbness of
extremities
Diarrhea
Involuntary urination
and/or defecation
Unconsciousness
Loss of coordination
Seizure
External Damage
Surface tissue injured
Corrosive properties or become corrosive

when mixed with water
Chemical burns and severe tissue damage

Examples
Hydrochloric acid
Hydrofluoric acid
Caustic soda
Soft Tissue Damage Corrosives
Acids or bases
Exposure may cause pain on contact

Alkalis often burn more than acids
Exposing to a base corrosive such as lye may
result in a breakdown of fatty tissue
Liquefaction
Greasy or slick feeling of skin
Decontaminate and seek medical attention
Decontamination
Decontamination begins by:
Dont neutralize an acid or base
Brushing off powder

Flushing skin copiously with water
Can produce heat and cause more burns
Transport
Cryogenics
Refrigerant liquid gases
Can freeze human tissue on contact
Vaporize when released

Use caution near refrigerated liquids
Freeze burns, frostbite
Freon, liquid oxygen, and liquid nitrogen
Chemical Exposure to the Eyes
Damage ranges from superficial inflammation

to severe burns
Local pain
Visual disturbance
Tearing
Edema
Redness of surrounding tissues
Flush eyes with water

Response to Hazmat Emergencies
During response consider:
Rescuer safety
Type and degree of potential hazard
Involvement of other agencies.
Preplanning and early coordination is

imperative
Advise medical direction early

Hazard and Risk Assessment
Hazards 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 billion

PEL permissible exposure limit
TLV-C threshold limit value-ceiling level
TLV-STEL threshold limit value-short-term

exposure limit
Terminology
Alpha radiation
Beta radiation
Boiling point
Flash point
Flammable/exposure
limits
Gamma radiation
Ignition temperature
Specific gravity
Vapor density
Vapor pressure
Vapor solubility
Risk
Possibility of suffering harm or loss
Risk levels vary related to:
Hazardous nature of material

Quantity of material
Containment system
Type of stress applied to container
Proximity of exposure
Available resources
Potential hazards
Risk of primary contamination to patients

Exposure to substance
Only harmful to person exposed
Little chance of exposure to others
Risk of secondary rescuer contamination
Exposure to substance
Substances easily transferred by touching
Hazards Versus Risk
If product identified EMS should find:
Potential health hazards

Personal protective equipment
First aid
Safe distance factor
Approaching the Scene
Approach scene uphill and upwind
Note environmental clues such as:
Wind direction
Unusual odors
Leakage
Vapor clouds
Use 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 safe
Approach cautiously
Resist urge to rush in

Cannot help others until you know what you are
facing
Identify the Hazards
Placards, container labels, shipping papers,

and knowledgeable persons on scene are
valuable information sources
Evaluate and consult guide page

New information from CHEMTREC expert can
change some guide page warnings
Secure the Scene
Dont enter immediate hazard zone
Isolate area
Ensure safety of people and environment
Move people away from scene and perimeter

Allow room to move EMS equipment
Obtain Help
Advise dispatch to notify responsible

agencies
Call for help from experts
Decide on Site Entry
Weigh rescue attempts against risks to EMS
Enter area with appropriate protective gear (if

trained to do so)
Do not walk into or touch spilled material

Avoid inhalation of fumes, smoke, vapors
Even if no hazmat known to be involved
Gases may be harmless even if no odor
Control of the Scene
First arriving agency at scene
Detect and identify materials involved

Assess risk to rescuers and others
Consider potential for fire or explosion
Gather information
Confine and control incident
Establish a command post
Define safety distances and zones
Safety Zones
If hazardous materials present:
Separate scene into hot, warm, and cold zones

Establish and enforce zones early in incident
Hot Zone
Area that includes hazmat
Any surrounding area exposed to gases,

vapors, mist, dust, or runoff
Rescuers and vehicles outside this zone

Personnel in this zone must wear protective
clothing
Only specially trained personnel perform patient
care in this zone
Warm Zone
Larger area that surrounds hot zone
Safer working environment

Requires protective clothing
Most EMS activities performed in this zone
Cold Zone
Surrounds warm zone
Restricted to emergency personnel

Requires minimal protective clothing
Contains command post and other support
agencies
Zones at a Hazmat Incident
Medical Monitoring and Rehabilitation
Personnel safety critical
Medical surveillance should be included in all

HAZMAT incidents
Predefine normal values
Determine criteria to take personnel out of the
game
Medical surveillance programs include:
Needed medical care

Medical monitoring
Record keeping
Evaluation of medical surveillance program
Medical monitoring includes:
Pre-suit medical examination

Prehydration
Advising personnel of expected symptoms of
illness of exposure before entry
Assessment for heat illness and dehydration
Documentation
Hazardous materials substance

Toxicity and danger of secondary
contamination
PPE use and any breakthrough that occurred
Decontamination performed or required
Use of antidotes and other medical treatment
Method of transportation and destination
Non-critical Patient
Eight step decontamination process
Patient care activities, triage, and evacuation part

of preplanned ICS structure
May take time to identify hazardous substance
Rescue efforts, decontamination, possible evacuation,
and treatment of toxic exposures is very important
Primary Goals of Decontamination
Reduce patients dosage of material

Decrease threat of secondary contamination
Reduce risk of rescuer injury
Specific substance and route of contamination will

affect triage and decontamination methods
Guidelines for rapid decontamination

Gross decontamination
Decontamination decision making
Decontamination Process
Longer-Duration Events
Rescue not attempted for patients in hot zone
Wait for Hazmat team and decon corridor to be

established
Longer-duration events allow for:
More thorough decontamination

Better PPE
Less chance of secondary contamination
Better environmental protection
Preparing Ambulance for Transport
Minimize contamination
Follow hospital's decontamination protocol
Do not return to service until rescue personnel,

vehicle, and equipment have been monitored for
contamination
Decontamination of Rescue Personnel
Eight step process
Begins in the decontamination corridor
If Exposed to Hazardous Materials
Do not touch face, mouth, nose, or genital area

before decontamination
Shower with warm water, soap, sponge, and brush
Repeat shower and rinse

Shampoo hair several times and rinse
Avoid shaving
Use clean dry towels after each shower

Care and Maintenance of

Clothing and Equipment
After incident
Dispose 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 clothing
Maintain personal SCBA
Conclusion
Specialized 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.
Questions?

Chap 53 Haz Mat Traduc

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Chap 53 Haz Mat Traduc

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Chapter 53

Hazardous Materials Incidents

Define hazardous materials terms

Identify laws related to EMS related to hazardous

Describe resources for identifying and managing

Describe effects of exposure to selected hazardous

Outline the prehospital response to hazmat materials

Describe medical monitoring and rehabilitation of

Describe decontamination and care of patients in a

Outline eight steps to decontaminate rescue

Should you proceed into the scene?

What methods will you use immediately to determine if

How will you decide where to position your ambulance?

If a hazmat substance is identified, how will you know

What additional resources will you need?

Hazardous material (HAZMAT) substance

Hazmat incidents create additional

May involve large area, many agencies

Laws and Regulations

Major incidents have attracted community

More laws and regulations

OSHA and EPA rules for workers at hazardous

Five groups who may respond to Hazmat

NFPA competency standards for EMS

Paramedics who transport patients with no risk of

Identifying Hazardous Materials

Informal product identification

Formal product identification

Visual inspection with

Signs and symptoms

Informal Product Identification

Temporary means to determine the presence

Should identify formally before activities posing

Formal Product Identification

American National Standards Institute

Label identifies hazard not chemical

U.S. Department of Transportation (DOT)

Labels and placards

Formal Product Identification

United Nations Labeling System

Pictographs, symbols, or both

International Air Transport Association

United Nations pictographs and written emergency

Formal Product Identification

National Fire Protection Association

Color and numbers (NFPA 704 System)

U.S. Department of Labor

Material safety data sheets (MSDSs) for

Placards and Shipping Papers

United Nations ID number and North

Sometimes replaces written name of hazard

Material Safety Data Sheets

OSHA requires for chemicals produced,

Information for safe handling and storage of

North American Emergency Response

Lesiones por exposicin a materiales

Dispositivos purificadores de aire

Clasificacin de ropa protectora

Uso limitado (desechable)

Variedad de materiales diseados para

Clasificacin de ropa protectora

Clasificacin de ropa protectora

Clasificacin de ropa protectora

Concentraciones y tipos de sustancias aerbicas