The first priority of those involved in emergency-response operations, necessarily, is to ensure the safety of the first responders themselves. To ensure that that is done, particularly during a HazMat (hazardous materials) incident, requires both appropriate training for EMS (emergency medical services) teams and all other response personnel involved, as well as the right equipment – and enough of it.
The traditional EMS role is to take victims to the hospital – after first rendering whatever care is necessary both at the scene of the incident and en route to the hospital. EMS personnel – who usually are assigned to the operations section of the on-scene ICS (Incident Command System) – routinely carry out that assignment at any incident to which they have been summoned.
This EMS role on-scene is (or should be) performed entirely in the “cold zone” – i.e., an area believed to be free of contamination – and for that reason the personal protective equipment (PPE) worn by EMS personnel is the same as that worn while treating trauma victims or ill patients. It is mandatory, in HazMat incidents, that all patients be decontaminated prior to coming under EMS care, because their PPE does not protect against hazardous materials.
EMS Support for HazMat Entry
EMS resources that are reserved for protection of the HazMat team members themselves should be considered “assigned.” This means that, if requests for additional resources are made (for patients or other first responders, for example) to the staging area, the EMS teams allocated to supporting the HazMat operations remain assigned. Reflecting their status, the EMS personnel carrying out their duties at the scene of the incident are assigned to the ICS’s medical support unit.
Pre-entry screening for team members is essential to ensure that those members are fit to endure the stresses of entry. Many HazMat teams have members who have been specially trained to carry out these evaluations. Although the skill sets needed to perform the screenings are well within the abilities of an emergency medical technician (EMT), the criteria for entry approval and the issues related to these decisions may not be part of the EMT training. Pre-incident training of the EMS staff – and/or written guidance – would easily overcome this potentially troublesome issue.
The Zone of Maximum Peril
The EMS support of the HazMat team’s may be performed in either the cold zone or the warm zone. The latter – which encompasses any decontamination areas that have been established –serves as a transition area between the hot and cold zones. As with the tasks previously mentioned, the PPE sets that are routine supplies on an ambulance should be sufficient for the work carried out in the cold zone. EMS personnel, who have the appropriate training, and the additional PPE gear needed, also can operate in the warm zone providing care during the decontamination process.
The establishment of entry criteria for stabilization of injuries within the hot zone, the area considered contaminated (including areas where contamination may spread), is an evolving mission for EMS. It is important to recognize the limitations that a contaminated environment imposes on the delivery of care. Only those treatments that are critical to patient survival and cannot wait for decontamination –and/or will not worsen contamination of the patient – should be attempted in the hot zone. The EMS resources assigned to this task should be considered part of the HazMat group under ICS.
To the members of many other specialized units – e.g., police tactical entry teams, and urban search and rescue teams – the value of having EMS support available for the team up front has become more and more apparent. HazMat incidents are no exception. It is critical to recognize not only that all of these teams are trained and equipped to operate in hazardous environments, but also that their front-line EMS support teams must be similarly trained and equipped. _____________________________________________
Links for additional information:
Learn more about the incident command system https://training.fema.gov/is/courseoverview.aspx?code=IS-100.c
EMS NHTSA (the federal agency overseeing EMS) https://www.nhtsa.gov/node/103856
HazMat U.S. Department of Transportation https://www.transportation.gov/tags/hazardous-materials
Some on-line HazMat courses from FEMA https://training.fema.gov/is/courseoverview.aspx?code=is-5.a
Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.