Haz-Mat, MCI, and IMS

Any substance or material in a form which poses an unreasonable risk to health, safety, and property when transported in commerce

Hazardous Material. (Limmer & O'keefe)

Two federal agencies that developed regulations to deal with the increasing frequency of hazmat emergencies.

(OSHA) Occupational Safety and Health Administration and (EPA) the Environmental Protection Agency. . (Limmer & O'keefe)

-----------are responsible for determining, providing and documenting the appropriate level of training for each employee.

The employer. (Limmer & O'keefe)

This level of rescuer is expected to have advanced knowledge and skill sand to command and support activities at the incident site. A minimum of 24 hours of additional training is required.

Hazardous Materials Specialist. (Limmer & O'keefe)

This level of training is for those who initially respond to releases or potential releases of hazardous materials in order to protect people, property, and the environment. Minimum of 8 hours of training is required

First responder operations. (Limmer & O'keefe)

Rescuers at this level are likely to witness or discover a hazardous substance release. They are trained only to recognize the problem and initiated a response from the proper organizations.

First Responder Awareness. (Limmer & O'keefe)

This level is for rescuers who actually plug, patch, or stop the release of a hazardous material. A minimum of 24 hours of training is required.

Hazardous materials technician. (Limmer & O'keefe )

EMS should be trained to the.............level

Awareness level. (Limmer & O'keefe)

Your responsibility as an EMT at a hazardous materials incident include

Recognizing that a hazardous materials incident exists, controlling the scene, and identifying the substance. (Limmer & O'keefe)

Identification of a possible hazardous materials incident starts with...

Awareness of what exists in the community. (Limmer & O'keefe)

After the initial patients, -------are the most likely to become injured or killed

EMTs. (Limmer & O'keefe)

When you arrive at a hazardous materials incident you should...

Take a command position and stay a safe distance. (Limmer & O'keefe)

Once a hazmat is recognized, who should enter the immediate site

Only personnel trained to the technician level. (Limmer & O'keefe)

All patients leaving the site should be considered

Contaminated. (Limmer & O'keefe)

Your primary concerned at the scene of a hazardous materials incident are ........................

Your safety and the safety of your crew, the patient and the public. (Limmer & O'keefe)

If you arrive first at the scene of a hazardous materials incident, you should

Establish a "danger zone" and a "safe zone." (Limmer & O'keefe)

The area surrounding a hazmat incident; extends far enough to prevent adverse effects outside the zone

Hot zone. (Limmer & O'keefe)

Area where personnel and equipment decontamination and hot zone support take place; it includes control points for the access corridor and thus assists in reducing the spread of contamination

Warm zone. (Limmer & O'keefe)

Area where the Incident Command post and support functions are located

Cold zone. (Limmer & O'keefe)

The safe zone should be on the-----------level and --------from the hazardous materials incident

Same level and upwind. (Limmer & O'keefe)

If you are the first responder at the scene, you should

Call for help and implement your agency's incident management system. (Limmer & O'keefe)

You should establish and remain in command until.....

You are relieved. (Limmer & O'keefe)

EMTs should not risk personal safety by.........

Initiating rescue attempts. (Limmer & O'keefe)

You should station yourself in the ----------zone from the incident

Cold. (Limmer & O'keefe)

When there are multiple medical patients, think....

Hazmat. (Limmer & O'keefe)

As a responding EMT, you may be the first to recognize that a hazardous materials situation exists. You must make an attempt to

Identify the hazardous materials. (Limmer & O'keefe)

Contamination that occurs when a contaminated person makes contact with someone who previously was "clean

Secondary contamination. (Limmer & O'keefe)

To obtain information safely you should use...to look for identifying signs, labels, or placards from a safe distance

Binoculars. (Limmer & O'keefe)

System of placards that uses numerical and color coding to show the type and degree of health hazard, fire hazard, reactivity, and specific hazard contained within a fixed facility

National fire Protection Association (NFPA) 704 system. (Limmer & O'keefe)

Other ways to gather information about the substance includes looking for.....

Labels , check invoices, bills of lading, and shipping manifests. (Limmer & O'keefe)

Sheets with information about a chemical product that are maintained at the work site

(MSDS) material safety data sheet. (Limmer & O'keefe)

To gather information you may also interview

Workers or others leaving the hot zone. (Limmer & O'keefe)

This essential booklet, published by the U.S. Department of Transportation, transport Canada, and the Secretariat of Communications and Transportation of Mexico, provides the names of chemicals and concise descriptions of the actions.

Emergency Response Guidebook (ERG 2008). (Limmer & O'keefe)

Group established in Washington, DC, as a service of the Chemical Manufacturers Association. They can provide you with information about the hazardous material through a 24-hour toll-free telephone number for the United States and Canada.

Chemical Transportation Emergency Center (CHMETREC). (Limmer & O'keefe)

This emergency response communication service can be reached 24 hours a day

CHEM-TEL, Inc. (Limmer & O'keefe)

This source is often overlooked during a hazardous materials situation. They can provide essential guidance in the decontamination and treatment of patients affected by hazardous materials.

Regional poison control centers. (Limmer & O'keefe)

EMS personnel have two responsibilities at a hazmat incident: to -------------- and ----------- the hazmat team members and to take ----------

Monitor and rehabilitate hazmat team members and care for the injured. (Limmer & O'keefe)

To address the needs of the rescuers who are wearing chemical-protective clothing during rescue operations, you should....

Establish an area of operations called rehabilitation (rehab). (Limmer & O'keefe)

The rehab area should be located in the cold zone, protected from weather, large for multiple personnel, free form exhaust fumes, and should allow for ---------------------------into the emergency operation

Rapid re-entry. (Limmer & O'keefe)

When the hazmat team members show signs of fatigue or when they have had 45 minutes of work time, they are sent to ---------

Rehab area. (Limmer & O'keefe)

If a team member heart rate exceeds 110 beats per minute, you should...

Take an oral temperature. (Limmer & O'keefe)

If a member's temperature exceeds ---------the rescuer must stay in rehab until his pulse slows and temperature returns to normal.

100.6 F�. (Limmer & O'keefe)

In addition to medical monitoring, rehab should be set up for ----------rest, and in some cases nourishment of hazmat team members.

pre-hydration and hydration. (Limmer & O'keefe)

During physical exertion members should consume at least -------of water per hour.

One quart. (Limmer & O'keefe)

If electrolyte drinks are used they should be ----------to ---------------

Diluted to half strength. (Limmer & O'keefe)

A chemical and/or physical process that reduces or prevents the spread of contamination from persons or equipment; the removal of hazardous substances from employees and their equipment to the extent necessary to preclude foreseeable health effects

Decontamination. (Limmer & O'keefe)

The decontamination of patients and of hazmat team members is done on the -----

Decontamination corridor of the warm zone. (Limmer & O'keefe)

EMS is responsible for setting up the..............area in the ----zone to receive ---------------------patients.

Treatment area in the cold zone to receive decontaminated patients. (Limmer & O'keefe)

EMTs most remain in the cold zone unless......

They are trained to the hazmat technician level. (Limmer & O'keefe)

Even if patients are decontaminated before EMTs receive them , there is a chance of ...

Secondary contamination. (Limmer & O'keefe)

To prevent secondary contamination, EMS personnel need to wear ---------------

PPE such as Tyvek coveralls and booties, and a double layer of gloves. (Limmer & O'keefe)

Solid or particulate contaminants should be lightly-------------prior to washing (wet decontamination)

Brushed off (dry decontamination). (Limmer & O'keefe)

Viscous liquid contaminants including (vesicants, which are blistering agents) should be....

Blotted off prior to washing. (Limmer & O'keefe)

When transporting a decontaminated patient, you should be aware of possible water runoff from the patient, you should ----

Protect the ambulance from contamination. (Limmer & O'keefe)

Open wounds should be irrigated starting from the area ---the body core and working -----------

Near the body core and working outward. (Limmer & O'keefe)

Once the wound has been cleaned you may use --------------to isolate the wound

Plastic wrap. (Limmer & O'keefe)

If you are confronted with contaminated patients prior to the arrival of the hazmat team

Use PPE, follow the first aid measures listed in the ERG, and manage patients' critical needs. (Limmer & O'keefe)

If treatment calls for irrigation with water, - cut the patient's clothing off and irrigate the patient's body with large amounts of water. Try to contain the runoff. After treating the patient

Decontaminate yourself; your clothing may need disposal. (Limmer & O'keefe)

The severity of any poisoning depends on the substance,

Route of entry, dosage, and duration of contact. (Limmer & O'keefe)

If scene decontamination is not performed, patients must be decontaminated at an --------------------before they enter the emergency department

at an appropriate hospital decon site. (Limmer & O'keefe)

The two major phases of decontamination are

Gross decontamination and secondary decontamination. (Limmer & O'keefe)

The removal or chemical alteration of the majority of the contaminant.

Gross decontamination. (Limmer & O'keefe)

The alteration or removal of most of the residual product contamination

Secondary decontamination. (Limmer & O'keefe)

A process for decontamination that neutralizes, degrades, or otherwise chemically alters the contaminant. Not recommended for use on living tissue.

Chemical reaction. (Limmer & O'keefe)

A process of decontamination that produces a suspension of ordinarily immiscible (unmixable) insoluble materials using an ---------agent such as a surfactant, soap, or detergent

Emulsification. (Limmer & O'keefe)

Process that removes the biological contamination hazards as the it destroys microorganisms and their toxins

Disinfection. (Limmer & O'keefe)

A process for decontamination that reduces the concentration of the contaminants. Huge quantities of solvent may be required for even small volumes of contaminants

Dilution. (Limmer & O'keefe)

The process for decontamination that requires the penetration of a liquid or gas into another substance. An example is water soaking into a sponge

Absorption and adsorption. (Limmer & O'keefe)

The physical process of removing contaminants by pressure or vacuum.

Removal. (Limmer & O'keefe)

The aseptic removal of a contaminated object form a host, after which the object is disposed of

Disposal. (Limmer & O'keefe)

Patients wearing PPE should be decontaminated y rinsing from head to toe, scrub the suit with a brush, rinse again, then

Assist the responder (patient) in removing PPE, contain the runoff. (Limmer & O'keefe)

When decontaminating patients who are not wearing PPE , the most concern is for ....

Responder safety. (Limmer & O'keefe)

Use the public address system to direct ambulatory patients to a

Decontamination line. (Limmer & O'keefe)

Alert patients should be instructed to begin decontamination by ..

Removing their clothing. (Limmer & O'keefe)

Next the patients should receive a ----------minute water rinse

2 to 5 minute. (Limmer & O'keefe)

An event that places great demand on EMS equipment and personnel resources

Multiple-casualty incident (MCI). (Limmer & O'keefe)

The most common MCI is an

Automobile collision with three or more patients. (Limmer & O'keefe)

For any MCI plan to be effective, it must be............ and .........enough to be used from small three patient incidents to large scale incidents of 15 or more patients.

Flexible and expandable. (Limmer & O'keefe)

One way to minimize the operating difficulties of a large-scale MCI is for every EMT to be familiar with the local

Disaster plan. (Limmer & O'keefe)

Features common to every good disaster plan are: written to address the events that are conceivable for a particular location, well publicized, realistic and ..........................

Rehearsed. (Limmer & O'keefe)

The management system used by federal, state, and local governments to manage emergencies in the United States.

National Incident Management System (NIMS). (Limmer & O'keefe)

A subset of the NIMS designed specifically for management of multiple-casualty incidents

Incident Command System (ICS). (Limmer & O'keefe)

The first on the scene to establish order and initiate the Incident Command System, is the person in ----------

Command. (Limmer & O'keefe)

The ICS system's components include; Command, Operations, Logistics, Planning, and Finance. The most commonly used are

Command and Operations. (Limmer & O'keefe)

The person who assumes responsibility for incident management.

Incident Command. (Limmer & O'keefe)

ICS recognize that the manageable span of control is ----people

Six. (Limmer & O'keefe)

Unless the incident is very complex, the most common function designated is

Operations. (Limmer & O'keefe)

Two methods of command defined under NIMS are...

Single and unified. (Limmer & O'keefe)

An agency controls all resources and operations

Single incident command. (Limmer & O'keefe)

Command organization in which several agencies work independently but cooperatively

Unified command. (Limmer & O'keefe)

Is assumed by the most senior member of the first service on the scene

Incident command. (Limmer & O'keefe)

Once command is established two modes or phases of action must then be undertaken: --------

Scene size-up;/triage and organization/delegation. (Limmer & O'keefe)

First, command and the crew do an initial scene size up, start the triage process, and.

Call for backup. (Limmer & O'keefe)

While waiting for help, --------------- is completed and Command gets ready for arriving resources

Initial triage. (Limmer & O'keefe)

In a single incident command mode, one person acts as Command, and EMS would typically be group under the -------------

Operations section. (Limmer & O'keefe)

After performing a scene size up of the incident, you should

Radio in an initial scene report and call for additional resources. (Limmer & O'keefe)

To distinguish yourself and your incident location form other personnel and incidents that may be using the same radio system you should

Give yourself a unique Command name. (Limmer & O'keefe)

Accordingly, the only unit talking to the communications center and requesting resources is

Command. (Limmer & O'keefe)

Uncoordinated or undirected activity at the scene.

Freelancing. (Limmer & O'keefe)

On larger incidents, Command may have an aide to assist with communications as well as a ---------officer and a ------officer

Public information officer and a safety officer. (Limmer & O'keefe)

Under NIMS, in a very large and complex multiple-casualty incident, EMS will function as a branch under the --------------------section

Operations. (Limmer & O'keefe)

EMS operations generally include the following: command center, extrication, staging area, triage area....area, ....area ........area

Mobile command center, extrication, staging area, triage area, treatment area, transportation area, rehabilitation area. (Limmer & O'keefe)

EMT arriving at the scene would be expected to report to an area supervisor for assignment of specific duties. Once assigned a specific task, the EMT should complete the task then ...................

Report back to the area supervisor. (Limmer & O'keefe)

The process of quickly assessing patients at a multiple-casualty incident and assigning each a priority for receiving treatment

Triage. (Limmer & O'keefe)

The triage supervisor is ----------------------EMS provider

The most knowledgeable. (Limmer & O'keefe)

You should quickly classify each patient into one of four groups: Priority 1 includes patients with.....

Priority 1: treatable life-threatening illness or injuries. (Limmer & O'keefe)

You should quickly classify each patient into one of four groups: Priority 2 patients are those who.............

Priority 2: serious but not life-threatening illness or injuries. (Limmer & O'keefe)

You should quickly classify each patient into one of four groups: priority 3 patients have..........

Priority 3: "walking wounded." Patients with minor musculoskeletal injuries or minor soft-tissue injuries. (Limmer & O'keefe)

You should quickly classify each patient into one of four groups: priority 4 includes patients who.........

Priority 4: (or priority 0): dead or fatally injured. (Limmer & O'keefe)

Patients with airway and breathing difficulties, uncontrolled or severe bleeding, decreased mental status, severe medical problems, shock, and or severe burns are considered priority

One. (Limmer & O'keefe)

Patients who have burns without airway problems, major or multiple bone or joint injuries, and/or back injuries with or without spinal cord damage are considered priority

Two. (Limmer & O'keefe)

Patients with minor musculoskeletal injuries or minor soft-tissue injuries

Three. (Limmer & O'keefe)

Examples of these patients include exposed brain matter, cardiac arrest (no pulse for over 20 minutes except with cold-water drowning or severe hypothermia), decapitation, severed trunk, an incineration are considered priority...

Four (sometimes zero). (Limmer & O'keefe)

Once ample resources are available, patients in arrest become priority

One. (Limmer & O'keefe)

The first triage cut can be done rapidly by using a bullhorn, PA system, or loud voice to direct all patients capable of walking to move to a particular area. This patients most likely are priority

Three. (Limmer & O'keefe)

If priority 3 patients are nearby and well enough to help, they may be employed to assist you by

Maintaining an airway or direct pressure on bleeding wounds of other patients. (Limmer & O'keefe)

Priority four patients -----------------treatment unless no other patients are believed to be at risk of dying or suffering long-term disability

Do not receive treatment. (Limmer & O'keefe)

Extensive treatment does not occur at the --------------------since it is in a hazard zone

Hazard zone. (Limmer & O'keefe)

The most common method of prioritizing patients in the United States is the

START method of triage. (Limmer & O'keefe)

START stands for

Simple Triage and Rapid Treatment. (Limmer & O'keefe)

The parameters to remember when using the mnemonic RPM for the use of the START triage method,

Respiration - pulse - mental status. (Limmer & O'keefe)

START triage is intended to be completed in ----------seconds

30. (Limmer & O'keefe)

START triage patients who are able to walk - should be considered

Green or priority 3. (Limmer & O'keefe)

On START triage patients who cannot walk, and who are not breathing you should,,,,

Position airway. (Limmer & O'keefe)

After positioning the airway on the non-breathing patient, patient begins to breath, you should prioritize ...........

Red or priority 1. (Limmer & O'keefe)

If after positioning the airway on the non-breathing patient, patient does not breathe on his own, patient is a priority

Black 4 or 0. (Limmer & O'keefe)

Using START triage your patient is breathing faster than 30 per minute, should be considered priority

Red or one. (Limmer & O'keefe)

Using START triage your patient is breathing at a normal rate but has no good pulses and not good skin signs and capillary refill greater than 2 seconds should be considered a .....

Red or one. (Limmer & O'keefe)

Using START triage your patient is breathing at a normal rate with good pulses and good skin signs and capillary refill less than 2 seconds plus good mental status and follows simple commands....should be considered a .....

Yellow or priority 2. (Limmer & O'keefe)

Patient who does not follow simple commands should be considered

Red - Priority one. (Limmer & O'keefe)

Start making your triage sweep methodically by avoiding patients who are ----------

Obviously conscious. (Limmer & O'keefe)

The only three treatments provided during STRT triage are to:

Open an airway and insert an oropharyngeal airway, apply pressure to bleeding and elevate an extremity. (Limmer & O'keefe)

When you complete the triaging of non-walking patients you should...

Re-triage the priority 3 patients. (Limmer & O'keefe)

Patients with altered mental status, or absent radial pulse or respirations of greater than 30/minute

Priority 1 red. (Limmer & O'keefe)

Patients who are alert, and have radial pulses present, have respirations less than 30/minute are tagged

Priority 2 yellow. (Limmer & O'keefe)

Patients who are not breathing (after an attempt to open the airway), or have no pulse and are not breathing

Priority 0 or 4 (black). (Limmer & O'keefe)

As you move among patients to conduct initial triage, you should

Affix a triage tag. (Limmer & O'keefe)

The area in which patients are treated at a multiple-casualty incident

Treatment area. (Limmer & O'keefe)

Person responsible for overseeing treatment of patients who have been triaged at a multiple-casualty incident

Treatment supervisor. (Limmer & O'keefe)

Is generally performed at a patient collection point or triage area from which patients are assigned to a treatment group

Secondary triage. (Limmer & O'keefe)

The treatment supervisor should re-triage the patients in the area to

Determine the order in which they will receive treatment. (Limmer & O'keefe)

Secondary triage is important to ensure that the

Patients are treated and transported according to their priority. (Limmer & O'keefe)

Transportation to the hospital is done according to

Triage priority. (Limmer & O'keefe)

The person responsible to maintain a list of patients and the hospitals to which they are transported

Transportation supervisor. (Limmer & O'keefe)

Because radio communication channels will be heavily used, the ------------------------not individual EMTs, should communicate with the hospitals

Transportation officer. (Limmer & O'keefe)

Adequately managing a patient during an MCI may require you to administer -----------. This may be talking with a terrified parent, child, or witness.

Psychological first aid." (Limmer & O'keefe)

If an EMT becomes emotionally incapacitated, the EMT should be treated as a patient and

Removed to an area where they can rest without viewing the scene. (Limmer & O'keefe).