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Hazardous Materials

Five Goals of the First Responder:

1.To protect themselves and other prehospital responders from any significant toxic exposure
2. To obtain accurate information on the identity and health effects of the hazardous materials and the appropriate prehospital evaluation and medical care for victims
3. To minimize continued exposure of the victim and secondary contamination of health carepersonnel by ensuring that proper decontamination (if necessary) has been completed priorto transport to a hospital emergency department
4. To provide appropriate prehospital emergency medical care consistent with theircertification
5.To prevent unnecessary contamination of their transport vehicle

The protocols are intended to include an overview of hazardous materials for use
by hazmat teams and/or hazmat tox medics. All personnel should be aware of the dangers of the situation and should review these protocols thoroughly.

Note: These are common protocols used in the state of Florida.

TOXIDROMES

Toxidromes are clinical syndromes that the patient presents with. These patterns of
signs and symptoms are essential for the successful recognition of chemical
exposure. The toxidromes identified in this protocol are chemical exposure based
while others such as the opioids are found within general medical protocol. These
chemical toxidromes are identified clinically into five syndromes:

Irritant Gas Toxidrome
Asphyxiant Toxidrome
Corrosive Toxidrome
Hydrocarbon and Halogenated Hydrocarbons Toxidrome
Cholinergic Toxidrome

Each can present as a clinical manifestation of the chemical/poisoning involved with
some cross-over between toxidromes. This list combines the toxic syndromes found
within NFPA 473 (A.5.4.1(2) and traditional syndromes.

EMS Responder Definitions, Training and Roles

PURPOSE
It is the intent of these Hazardous Materials Medical Care Protocols to facilitate rapid medical
identification and possible intervention of a victim or victims of a chemical exposure within the
response community, at a medical event and/or at the scene of a Hazardous Materials Incident, or
Weapons of Mass Destruction event. It is a layered response approach dependent on the human
and physical resources a department/agency may have available.

TYPES OF RESPONDERS
It is the responsibility of all individuals involved in this type of response to take precautions to
reduce secondary exposure while at the same time rendering appropriate medical care. It is the
responsibility of those responders designated as:

EMS Core Responder – is defined as a BLS qualified responder that has successfully completed
an Operational Core curriculum competencies as identified in NFPA 472 2008 ed. Their role at a
Hazmat/WMD incident is limited to support functions.

HazMat/WMD Rescuer is defined as either a BLS or ALS responder that has successfully
completed an Operational Core competencies and mission specific competencies for victim
rescue, personal protective equipment, technical and mass decontamination as defined NFPA
472 2008 ed. Their role at a Hazmat/WMD incident would be to perform life saving rescue
within the limits of the personal protective equipment provided to them by their employer and to
perform or assist with mass and technical decontamination.

Toxmedic – is defined as an ALS responder (State of Florida Certified Paramedic) and has
successfully completed and demonstrated Operational Core and mission specific competencies
for victim rescue, personal protective equipment, technical and mass decontamination as defined
NFPA 472 2008 ed. In addition, the Toxmedic shall meet and demonstrate competency in NFPA
473 ALS 2008 ed. as well as treatment modalities for any additional toxic syndromes addressed
in this document.

HazMat Medic – is defined as an ALS responder (State of Florida Certified Paramedic) and has
successfully completed and demonstrated competency as a Hazardous Materials Technician in
accordance with NFPA 472 2008 ed. In addition, the HazMat Medic shall meet and demonstrate
competency in NFPA 473 ALS 2008 ed. as well as treatment modalities for any additional toxic
syndromes addressed in this document .Individual must maintain working knowledge of the level of medical care their training and service agency provides, which are contained within these medical protocols and are associated to general care protocols with the agency and training levels as identified by the State Emergency Response Committee (SERC).

POLICY
In addition to the providers general Medical Care Protocols, the response agency should develop
Hazardous Materials Medical Care Protocols for the emergency treatment and handling for nonspecific
exposure and specific exposure conditions.

The possibility of secondary contamination shall be recognized and measures taken to reduce the
chance of such contamination. Appropriate protective gear shall be worn at all applicable times
during treatment procedures. When feasible contamination shall be left at the scene of the
emergency with appropriate precautions for the definitive care facility.
If there will be extended operations with the possibility of exposure, or victims transported for
definitive medical care from a medical call involving Hazardous Materials/WMD, EMS
personnel should notify the closest appropriate medical facility, advising the emergency
department of the nature, possible number of victims, and extent of operations from the scene.
This advance notification will alert the hospital of the need to set up decontamination and / or
isolation areas for treatment of exposed individuals. The report should include if possible
specific names of chemicals involved, specific amounts, and the type of exposure expected, i.e.
inhalation, skin absorption, ingestion, or injection.

PROCEDURE
Site and personal safety is of paramount concern for the responder. Site Safety “standard
practices” shall include baring entry into the Hot Zone without proper precautions, proper
protective clothing based on the risk, and knowledge and permission of the Incident Commander.
Treatment can begin when it is safe to do so this would include but not limited to Basic Life
Support procedures. Patients should be evaluated for contamination and decontaminated
accordingly.

The following Hazardous Materials medical care guidelines are designed and applied based on
the level of training the responder possess and maintains along with the equipment levels at the
responders disposal. These are classified within three levels of HazMat medical response. At
each level the prerequisite procedures apply.

EMS Core
- Secure airway
- Avoid all body fluids and protect against secondary contamination
- With history of ingestion protect against secondary contamination due to burping and/or emesis
- Supplemental Oxygen as indicated; record and monitor vitals
- Obtain a history
- Method of exposure (Inhalation, topical, ingestion)
- Specific agent involved
- Exact time of exposure
- Duration of exposure
- Quantity and concentration of substance involved in the exposure
- Specific symptoms and duration of symptoms since exposure
- Identifying positive symptom consistent with chemical exposure
- Identifying negative symptoms that are not consistent with exposure
- Past medical history, medications, allergies, and/or exposures
- Transport in vehicle with open windows and good ventilation; properly prepared.
- Contact local Emergency Department
- Contact the Regional Poison Control Center (1-800-222-1222)
- If from a facility any documents such as MSDS brought to the ED
- Auto injectors may be administered if the responder has been qualified by the medical director.

Hazmat/WMD Rescuer
In addition to the actions identified for the EMS Core Responder, the Hazmat/WMD Rescuer
shall:

-Conduct life saving rescuer within the limits of the PPE available.

-Perform or assist with mass or technical decontamination ToxMedic

The Toxmedic
The Toxmedic shall perform all of the EMS Operations functions along with ALS General
Medical and ALS Specific HazMat/WMD Medical Guidelines. Assistance from the HazMat
Medic or HazMat Techncian is recommended based upon the hazards and risks associated with
the incident in order to ensure safety, procedures, and considerations from the hazardous
materials aspect are addressed.

HazMat Medic
The HazMat Medic shall perform the functions of the EMS Operations, ALS treatment
modalities, evaluation for toxidromes (toxic syndromes) and have communication with the
Regional Poison Control for the development of a medical plan. The HazMat Medic has additional skill level which allows him/her to operate as a HazMat Technician, utilizing his/her analyzing ability to characterize the chemical into a chemical family, hazard class, or potential analog, by using air monitoring techniques, and/or chemical observations.

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