Hazmat Medical Life Support

A Basic Provider Manual

Hock Heng Tan, Mark Leong, R Ponampalam, Chun Yue Lee, Jimmy Goh

• Publisher: WSPC
• Year: 2014
• eBook ISBN: 9789814583176
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

The Hazmat medical life support basic provider course book aims to equip medical responders to a hazmat incident — chemical, radiological or biological — with essential skills and knowledge to safely manage casualties. It includes basic information about hazmat agents and provides easy to remember algorithmic approaches for the on-scene management of a hazmat event. Essential information on setting up medical operations, triaging and approach to hazmat event, personal protective equipment, decontamination, wound management, life support as well as paediatric-specific issues are discussed in this book.

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Contents:

• • Introduction and Objectives (Mark Leong & Tan Hock Heng)
  • Historical Perspectives (Mark Leong & Tan Hock Heng)
• Part 1 — Chemical Hazmat:
  • Basic Toxicological Principles (R Ponampalam & Sohil Pothiawala)
• Part 1a — Industrial Hazmat Agents:
  • Introduction to Industrial Chemicals (R Ponampalam)
  • Asphyxiants (Sohil Pothiawala & R Ponampalam)
  • Irritant Gases (Kenneth Tan & R Ponampalam)
  • Corrosives (R Ponampalam & Gregory Cham)
  • Hydrocarbons (Sohil Pothiawala & R Ponampalam)
• Part 1b — Chemical Warfare Agents:
  • Nerve Agents (Lee Chun Yue)
  • Drug Therapy for Nerve Agent Poisoning (Kenneth Tan & Lee Chun Yue)
  • Non-Nerve Gas Chemical Warfare Agents (Phua Dong Haur & Lee Chun Yue)
• Part 2 — Approach to Hazmat Casualties:
  • Medical Response to Hazmat Incidents (Chan Kim Chai, Lim Ghee Hian & Mark Leong)
  • General Approach and Triage (Jimmy Goh)
  • Personal Protective Equipment (Tan Hock Heng & Adeline Ngo)
  • Decontamination Procedures (Adeline Ngo & Tan Hock Heng)
  • Management of Open Wounds in Hazmat Casualties (Goh Siang Hiong)
  • Provision of Life Support for Hazmat Casualties (Goh Siang Hiong)
  • Hazmat and the Paediatric Patient (Gene Ong & Ng Kee Chong)
• Part 3 — Radiological and Biological Hazmat:
  • Radiation Emergency Management (Goh Siang Hiong & Steven Lim)
  • Biological Agents and the Management of Bioterrorism (Suresh Pillai & Steven Lim)

Readership: Emergency first responders and receivers including nurses, paramedics, doctors as well as incident managers will find this book an essential tool when responding to a hazmat incident. It could be used by junior staff with no experience in hazmat response as the information provided is quite basic. On the other hand, those experienced in this field including hazmat event managers would find this book a useful resource not only for themselves but as a tool for training their staff.

Introduction and Objectives

Objectives

1.To define hazardous materials (hazmat).

2.To give an overview of Hazmat Medical Life Support Programme and its courses.

3.To outline the Basic Provider Course.

Introduction

Hazardous materials (hazmat) are any substances (radiological, chemical or biological) capable of causing harm to people, animals, property or the environment. With industrialization, technological advancement and increasing urbanization, humans are facing increasing risk of exposure to hazardous materials. Exposure can be:

1.Non-intentional ( accidental), usually in an industrial setting e.g., during manufacturing (fixed facility) or transportation.

2.Intentional ( deliberate) e.g., terrorism, conflicts.

Besides being used in greater quantities, hazardous materials are often found in close proximity to populated areas due to space constraints. There has been much improvement in hazardous material management with good planning, preparation and mitigation procedures from chemical production to waste disposal. However, there is always the residual risk of exposure to the general population. Accidental or deliberate release of hazardous substances can produce multiple casualties presenting with similar clinical signs and symptoms (toxidrome). The prospect of mass casualties, which has the potential of overwhelming responders and the public health system, is one of the dreaded consequences of a hazmat incident.

Classification

The United Nations broadly groups hazardous materials into nine classes on the basis of their specific characteristics. This classification is used in the transport of dangerous goods (see Table 1.1). Each chemical can be identified by their unique chemical abstract service (CAS) number. This is important to allow rapid identification and to avoid mistaken identification. The Globally Harmonized System of Classification and Labelling of Chemicals ( GHS) is an internationally agreed-upon system, created by the United Nations since 2002, and is now in its fourth version published in 2011. Under the GHS there are 16 physical hazards, 10 health hazards and 2 environmental hazards. It is designed to replace the various classifications and labelling standards used in different countries by using consistent criteria for classification and labelling on a global level. To date 67 countries have agreed to implement the GHS classification and labelling system.

Education and training in clinical consequences following hazmat exposure have largely not found their way into the traditional medical and nursing curriculum. In the event of a hazmat incident, personnel onsite and at healthcare facilities are the ones that will encounter these hazmat casualties. Primary exposure (from the source of exposure) and also secondary exposure (from contaminated casualties or objects) are thus real threats to all involved. The risk of exposure poses unique challenges that are different from the conventional mass casualty events with injuries due mainly to trauma. Hence, it is important for the health care workers (HCW) to understand the unique properties of different types of hazardous substances, as well as their clinical effects and management strategy. Critical knowledge needed for responding to hazmat events include the ability to detect and diagnose a hazmat event, wearing appropriate personal protective equipment, knowing how to decontaminate casualties and the timely treatment with antidotes where available. Not being prepared will result in harm to the responder and suboptimal treatment for the casualties.

HMLS programme

The Hazmat Medical Life Support ( HMLS) Programme is designed to provide HCWs with the basic knowledge of recognition, diagnosis, treatment and disposition of hazmat casualties. This is particularly relevant to the HCW who may have the role of first responder or first receiver of casualties in hazmat incidents. First responders are usually fire fighters, paramedics and field medical teams from hospitals responding to a hazmat situation on site. First receivers are members of a hospital team receiving casualties at the triage, decontamination and reception stations.

Table 1.1 UN Hazmat Classification

HMLS follows the algorithmic approach used by many life support courses as well as a system response framework in managing the hazmat casualty. There are four courses under this programme. The Hospital Provider Course is a didactic course designed to provide busy hospital-based clinicians with information on the clinical recognition and management of hazmat casualties. The Hazmat Medical Operations Course is a practical hands-on course to train HCWs to protect themselves in a contaminated environment while having to provide initial medical care to hazmat casualties. The Hospital Decontamination Course is designed to impart the principles of hazmat decontamination to both HCWs and hospital operations staff.

The Basic Provider Course (BPC) is currently a one-and-a-half day programme providing education to first responders and first receivers in the clinical effects of hazmat exposure and specific and supportive therapeutic options. Hazmat medical operations on site and in hospitals are covered, and this course provides individual responders with a system and organizational perspective of how mitigation activities are organized.

Summary 1.Hazardous materials are used in greater quantity today, and pose a threat either in accidental or deliberate release. 2.Chemicals are identified by their CAS number and classified according to their hazard classes. 3.First responders and first receivers need to be prepared for hazardous material incidents. 4.The HMLS basic provider course is aimed at equipping first responders and receivers with a clinical approach to hazmat events.

Suggested readings

United Nations Economic Commission for Europe (UNECE). Globally Harmonized System of Classification and Labelling of Chemicals (GHS), 4th revised edition. Available at: http://www.unece.org/trans/danger/publi/ghs/ghs_rev04/04files_e.html. Accessed March 27, 2013.

United Nations Economic Commission for Europe (UNECE). UN Recommendations on the Transport of Dangerous Goods: Model Regulations, 17th revised edition. Available at: http://www.unece.org/trans/danger/publi/unrec/rev17/17files_e.html. Accessed March 27, 2013.

World Health Organization. Manual for the Public Health Management of Chemical Incidents. 2009.

Self-learning questions

1.Hazardous materials and the HMLS programme:

a.Hazardous materials are any substances capable of causing harm to people and the environment.

True /False

b.One method of classification of hazardous material is the UN hazmat classification.

True /False

c.Medical responders to a hazmat incident do not need special preparation as the fire fighters will remove all possible contamination.

True /False

d.The basic provider course of the HMLS programme is designed to train medical responders to be ‘chemical spill’ management experts.

True /False

Historical Perspectives

Objectives

1.To describe a non-intentional release of hazardous material from an industrial source and its consequences.

2.To describe an intentional release of hazardous material in a public space and its consequences.

3.To highlight lessons learned from the incidents described and how this may help in better preparedness and response.

Introduction

Throughout history and especially over the last 30–40 years, a number of large-scale hazardous material disasters have occurred. These incidents have resulted in many changes in policy and global approach to hazardous materials and taught us valuable lessons on the medical management of hazmat events. Learning from these inci¬dents will help us to be better prepared for future incidents.

General characteristics of hazmat incidents

Hazmat incidents do occur in developed countries with advanced management systems for chemicals. Large-scale hazmat disasters are actually uncommon, but small-scale incidents occur quite frequently. Data on hazmat incidents from the United States show various characteristics that would be helpful in shaping our understanding on how to approach hazmat chemical incidents in general.

1.60–80% of all hazmat incidents originate from fixed facilities (e.g., chemical plants, storage facilities, etc.).

2...

Table of contents

• Cover
• HalfTitle Page
• Title Page
• Copyright Page
• Contents
• Contributors
• Foreword
• Preface
• Chapter 1 Introduction and Objectives
• Chapter 2 Historical Perspectives
• Part 1 Chemical Hazmat
• Part 2 Approach to Hazmat Casualties
• Part 3 Radiological and Biological Hazmat
• Answers
• Acronyms
• Colour Plates
• Index