Training EMS Personnel to Handle Hazardous Materials Incidents

Training EMS Personnel to Handle Hazardous Materials Incidents

TRAINING

The star of life symbol does not make EMS personnel immune from the effects of hazardous materials. To effectively operate in toxic atmospheres, emergency medical personnel must be properly trained. Outlined here is a suggested program for training all levels of EMS personnel who respond to hazardous material incidents.

Warning: Do not attempt a rescue when an accident involves hazardous materials unless you have been trained to do so . . .” (Emergency Care, Third Edition, Harvey Grant, et al.)

Both EMT and paramedic textbooks recommend that emergency care personnel obtain training in hazardous materials, giving the impression that hazardous materials courses are a routine part of EMS training programs. In reality, training in hazardous materials for emergency care personnel is very limited in many jurisdictions, and in most jurisdictions, it’s nonexistent.

With the increasing number of hazardous materials incidents, the fire service has recognized the need for hazardous materials training. Programs have been developed by local departments and also are available through various professional organizations and private consultants. Many of the courses are designed to train ail emergency response personnel in the handling of hazardous materials incidents. The result is that while these training programs try to meet the needs of everyone involved in hazardous materials, they really do not meet the specific needs of the specialty areas, such as emergency medical services.

Why has there been so little attention paid to EMS training in hazardous materials? One reason is that hazardous materials incidents have not been looked upon as a priority area of concern by EMS personnel. Little statistical information is available as to the real impact of hazardous materials incidents on illness and injuries, while statistics are readily available demonstrating the magnitude of mortality and morbidity associated with conditions such as heart attacks and trauma. This situation is gradually changing.

With the development of sophisticated response teams for hazardous materials and the increased public awareness of the hazardous materials problem, a greater emphasis is being placed on the health and safety aspects, bringing to light the need for more EMS involvement in hazardous materials response.

If EMS personnel are to be providers of care at hazardous materials incidents and not victims, they must be adequately trained. Programs specifically focused on EMS for hazardous materials incident management must be developed to fill the current void. In developing a training program, certain factors must be considered:

  • Type of EMs service—fire service/EMS, third service (strictly EMS) or private sector.
  • Training levels will differ with the various ty pes of provider services. The EMT fire fighter will have had more experience in emergency response to incidents of a hazardous nature than a private sector emergency care provider. Differences w ill be noted also in the type of equipment available on ambulances of different services. Again as an example, fire service ambulances may carry more self-protective gear than third service or private sector vehicles carry. The type of service also w ill determine the responsibility of the EMS personnel during a hazardous materials incident, and this must be taken into account when developing the training program.

  • Types of hazards. Training programs should encompass all of the various types of hazardous materials emergencies that can be encountered, but there also needs to be a special emphasis on the types of emergencies that are common to a local jurisdiction.
  • Resources available. An inventory of all the informational resources must be performed for inclusion in the training program. Manpower resources, equipment and supply availability are other factors that must be considered in the development of training programs. The type of medical control for providing pre-hospital direction will influence not only the training program, but the future hazardous materials responses.

One of the prime considerations in developing training levels for EMS personnel is the functions to be performed by the EMS personnel. There are primarily two roles that EMS personnel can fulfill in the management of hazardous materials incidents: an EMS provider or an EMS specialist with a hazardous materials response team. Depending on the organizational response for hazardous materials incidents, in some areas individuals may have to fulfill a combined role, that of specialist and provider. The differences in utilization of EMS personnel, therefore, dictate that there be two different types of levels of training available.

EMS provider

EMS providers can be defined as the individuals who respond to an incident as the primary source of pre-hospital emergency medical care. They may respond in conjunction with specialized hazardous materials teams, a fire fighting force or as the sole emergency response unit. Since the type of hazardous materials incident may vary from minor, capable of being handled by the initial response crew (spill of a chemical container in a home), to a major hazardous materials disaster affecting an entire community. Training for pre-hospital emergency care providers should include as a minimum:

  • Recognition of hazardous materials problems.
  • Resources for identification and consultation.
  • Response and initial management of hazardous materials incidents.
  • Self-protection for emergency care personnel.
  • Evacuation of ”contaminated” persons.
  • Pre-hospital care of hazardous materials victims—types of injuries associated with hazardous materials incidents; principles of pre-hospital emergency care management of hazardous materials victims.
EMS personnel receive training in operating at hazardous materials incidents while using encapsulated suits and SCBAs.

A recommended curriculum for meeting the needs of the EMS provider includes:

  1. Introduction to hazardous materials, including definition of hazardous materials, recognition of problems, references and resources.
  2. Response and initial management of hazardous materials, including decision-making, agency coordination, self-protection and evacuation of patients.
  3. Pre-hospital emergency medical management of hazardous materials victims, including types of injuries, pre-hospital treatment.
  4. Decontamination.

This curriculum outline can be adapted for both basic and advanced life support providers. Pre-hospital medical protocol should be incorporated in the presentations on pre-hospital treatment. Since most of the treatment administered to hazardous materials victims is symptomatic in nature, general treatment protocols can be utilized. Ideally, there should be a cadre of specialized hazardous materials protocols developed to cover situations in which specific antidotes are indicated.

If the emergency care providers have not had experience using self-protective gear, practical sessions will have to be incorporated into the training program to allow them to become familiar with wearing SCBA and turnout gear.

EMS specialist

This level of training is directed towards EMS personnel serving as EMS specialists with hazardous incidents response teams or EMS control. The responsibilities of these individuals are broader and extend beyond just responding to an incident. The EMS specialist needs to be involved in preincident planning, which includes the identification of hazards within the community (both location and type of hazards found), identification of resources to be utilized by EMS personnel, development of procedures and protocols, and working with the team members to ensure that they receive adequate physical examinations and any necessary immunizations.

EMS personnel serving as part of hazardous incidents response teams should also be involved in the training evolutions of the team. This is generally a necessity, since team members are usually required to be able to fulfill dual roles if the need arises.

Ideally, the individual serving as an EMS specialist with hazardous materials response teams or as EMS control lor hazardous materials incidents, should have not only basic, but advanced life support training and capabilities. This level of training is preferred in order for the individual to understand the basics of the toxicology involved with hazardous materials problems.

The additional training for the EMS specialist should include:

  • Preplanning health hazards, including health hazard analysis, identification of specific health hazards within the community, evaluating resources for dealing with specific problems, and development of protocols for specific health hazards.
  • Decision-making for EMS personnel.
  • Toxicology of hazardous materials.
  • EMS disaster operations.

The following is a sample curriculum that can be utilized for the training of EMS specialists for hazardous materials response. It is important to remember that this is in addition to generic hazardous materials response training.

  1. Introduction to the hazardous materials/life safety problem.
  2. EMS pre-incident planning for hazardous materials response.
  3. Identification and consultant resources for EMS.
  4. Decision-making for EMS personnel.
  5. Response and initial management of hazardous materials incidents.
  6. Self-protection, including four levels of protective gear, special needs for special problems.
  7. Hazardous materials disaster management.
  8. Decontamination.

The sample curriculum presents the minimum amount of training needed for an EMS specialist. The program can be expanded to include case study presentations and various work group exercises to reinforce the learning. The section on pre-hospital medical management can be expanded depending on the needs of the jurisdiction and the availability of toxicologists who can provide more in-depth training on the toxicology of the hazardous materials.

Training materials

Availability of audiovisual training aids for EMS training in hazardous materials is extremely limited. Individuals developing training programs should search out slides, video tapes, and movies from jurisdictions that have experienced hazardous materials incidents. In addition to contacting fire departments within these jurisdictions, it is recommended that the local television stations be contacted for video coverage of the incidents.

Within the past two years, numerous articles on various hazardous materials problems have appeared in the EMS journals for field providers. The professional journals for physicians and nurses are another source of reference materials. Much of the information in these articles is also applicable to the pre-hospital phase. Some books and pamphlets that can be used as resources in developing EMS training programs on hazardous materials are:

  1. Hazardous Materials Injuries—a Handbook for Pre-hospital Care, Douglas R. Stuz, et al.
  2. Hazardous Materials—1980 Emergency Response Guide Book, Department of Transportation.
  3. Pocket Guide to Chemical Hazards, NIOSH/OSHA.
  4. Chemical Energency Action Manual, American Lung Association of Western New York.
  5. Recognition and Management of Pesticide Poisoning, Third Edition, U.S. Environmental Protection Agency.
  6. Occupational Health Guidelines for Chemical Hazards, NIOSH/ OSHA.

One of the primary objectives in the management of hazardous materials incidents is to prevent the loss of life. If the lives of the victims of the incident, response personnel, and the EMS providers themselves are to be protected, then it is necessary that EMS response personnel have appropriate training. Only in this way can they minimize the health hazard and effectively treat victims.

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