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NEW JERSEY HAZMAT EMERGENCY RESPONSE COURSE STUDENT GUIDE COURSE NUMBER: 06061

NEW JERSEY HAZMAT EMERGENCY RESPONSE COURSE STUDENT GUIDE COURSE NUMBER: 06061 Emegency Department Operations Hazmat/WMD Hospital Provider PRESENTED THROUGH: NEW JERSEY STATE POLICE-HOMELAND SECURITY BRANCH SPECIAL OPERATIONS SECTION, TECHNCIAL RESPONSE BUREAU HAZARDOUS MATERIALS RESPONSE UNIT (HMRU) STUDENT GUIDE 5th Edition 1004 TABLE OF CONTENTS Instructions for Scantron Forms Introduction ............................................................................................................................ 1 Planning for the Hazmat/WMD Incident ................................................................................ 3 Personal Protective Equipment............................................................................................... 7 Emergency Department Decontamination............................................................................. 21 T oxicology ............................................................................................................................... 41 T reatment Protocols ............................................................................................................... 57 Hazardous Materials Contamination....................................................................................... 79 Chemical Agent Contamination..............................................................................................107 Biological Agent Contamination..............................................................................................163 Explosive Agents .....................................................................................................................223 Radiological Agents .................................................................................................................231 Appendices..............................................................................................................................245 FUNDING FOR THE DEVELOPMENT OF THIS MANUAL WAS PROVIDED BY THE FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA) UNDER THE TERRORISM CONSEQUENCE MANAGEMENT PREPAREDNESS ASSISTANCE GRANT . The NJOEM Domestic Preparedness/Hazardous Materials Emergency Response Planning Unit would like to acknowledge the following agencies/individuals for their assistance in the develop- ment of this manual: Dr. William Gluckman, DO, Emergency Department Physician, University of Medicine & Dentistry of NJ–University Hospital Federal Emergency Management Agency, Emergency Response to Terrorism Job Aid Military Medical Operations Office, Armed Forces Radiobiology Research Institute Naval School of Health Sciences, Management of Chemical Warfare Injuries U.S. Military Field Manual, Treatment of Biological Warfare Agent Casualties NJ Department of Health and Senior Services, Epidemiology, Environmental & Occupational Health Mr. Eugene J. O’Neill, NREMT-B, University of Medicine & Dentistry of NJ–University Hospital Although the information set forth in this program is presented in good faith and believed to be correct, persons or agencies using this information must make their own determination as to its suitability for their purposes. This document may be reproduced in part or entirely, provided its use clearly indicates that it was prepared by the Domestic Preparedness/Hazardous Materials Emergency Response Planning Unit, New Jersey Office of Emergency Management, Division of State Police. INTRODUCTION The presence of hazardous materials or toxic chemicals at an incident location or other emer- gency situation adds a new dimension of risk to those handling and treating casualties. The fun- damental difference between a hazardous materials incident and other emergencies is the poten- tial for acute risk from contamination to both patient and responder. In some cases, traditional practices must be altered to avoid compounding a critical situation. Hospital emergency departments must protect their personnel and other people within the hos- pital, while providing the best care for the chemically contaminated patient. This guide is intended to help hospital emergency departments plan for incidents that involve haz- ardous materials and improve their ability to respond to these incidents appropriately. T o ensure appropriate and timely patient care, as well as optimal worker protection, emergency personnel must have an understanding of decontamination procedures and personal protective equipment that they do not generally receive in the course of their routine professional training. They should also be aware of community resources that could be called upon to assist in emer- gency response. Current training curricula for emergency physicians, nurses, and emergency medical technicians (EMT s) often do not adequately prepare these professionals to either manage the contaminated individual or decontaminate patients exposed to toxic substances. High-quality, specific, and con- cise guidance is needed to describe appropriate procedures to be followed by emergency med- ical personnel to safely care for a patient, as well as to protect equipment, hospital personnel, and others from risk of exposure. This guide for emergency department personnel is designed to familiarize readers with the con- cepts, terminology, and key considerations that affect the management of incidents of chemical contamination. It has been developed not only to present uniform guidance for emergency care of chemically contaminated patients, but also to provide basic information critical to advance planning and implementation of emergency medical services’ (EMS) strategies. It is intended to illustrate the characteristics of hazardous materials incidents that mandate modifications to tradi- tional emergency response and the preparatory actions that should be taken to respond effec- tively to hazardous materials incidents. All hospital and community emergency response systems may not be prepared to respond to a hazardous chemical incident to the same degree. This document may be used to assess capabil- ities with respect to potential community hazards and to develop response plans using national and community-specific resources. Worker safety and training are also key factors in effective management of medical emergencies. This document is intended to provide source material for developing local training and safety protocols. 1 PLANNING FOR THE HAZMAT/ WMD INCIDENT 3 ADVANCE PLANNING FOR A HAZMAT/WEAPONS OF MASS DESTRUCTION (WMD) INCIDENT Advance pre-planning is the most essential phase of preparation for a HAZMAT/WMD incident. I. External Pre-planning External pre-replanning should involve coordination with local agencies such as fire, EMS, and HazMat teams, along with local chemical or industrial sites. It will be important to establish an integrated plan that outlines a common response philosophy AND the roles and responsibilities that should be taken in the event of a HAZMAT/WMD case. For example, it will be important to know the following types of information in the preparation for a HAZMAT/WMD incident: 1. What are the sources of Hazardous Material accidents in the community? 2. Where is the nearest HazMat team located? 3. Which local EMS organization and fire departments are trained and equipped to respond to a HazMat incident? 4. Do any of the local industrial sites have HazMat teams that can be called upon for assistance in response to a HazMat incident? 5. How will victims from a HAZMAT/WMD incident be handled? 6. Will all contaminated/injured patients be decontaminated prior to transport to the hospital? Does this include trauma patients? Are there any exceptions? Who will per- form field decontamination? 7. T o what extent will patients be decontaminated? (i.e. gross, partial or fully decontam- inated) 8. Which local hospitals are trained and equipped to handle hazardous material accident victims? 9. How will a hazardous material incident involving mass casualties be handled? How will the patient load be dispersed in this type of incident? 5 6 II. Internal Pre-planning A formal written HAZMAT/WMD Response Plan should be developed as part of the overall Hospital Disaster Plan. It should be developed in conjunction with the local EMS organization, fire department, HazMat team and local industry. It should be comprehensive in addressing all possi- ble situations involving hazardous material accident patients: • walk in patient(s) • announced pre-hospital delivered patients • unannounced pre-hospital delivered patients • stable vs. unstable patient • mass casualties incident The formal plan should address the following types of issues: A. Determine the responsibilities of the department ranging from emergency medicine, admin- istration and security to clinical specialist such as toxicology, laboratory medicine and occu- pational medicine. B. Determine the responsibilities of emergency department personnel who will be involved in the handling of a hazardous material accident patient. C. Selection and set-up of an outside or external decontamination area. D. Selection and set-up of an inside or internal decontamination area. E. Selection of decontamination equipment and supplies. F . Selection of proper personal protective clothing. G. Establish pre-hospital notification procedure. H. Development of a list of resource organizations that can be contacted in the event of a HazMat incident. REMEMBER: Coordinate your planning efforts with JCAHO and Office of Emergency Management Standards. Essential Public Health Services • Monitor health status to identify community health problems • Diagnose and investigate health problems and health hazards in the community • Inform, educate, and empower people about health issues • Mobilize community partnerships to identify and solve health problems • Develop policies and plans that support individual and community health efforts • Enforce laws and regulations that protect health and ensure safety • Link people to needed personal health services and assure the provision of health care when otherwise unavailable • Assure a competent public health and personal health care workforce • Evaluate effectiveness, accessibility, and quality of personal and population-based health services • Research for new insights and innovative solutions to health problems From “Public Health in America.” Public Health Functions Steering Committee, 1994. PERSONAL PROTECTIVE EQUIPMENT (PPE) 7 Introduction Dealing with a HAZMAT/WMD incident is risky business. The first responder initially deals with unknown factors which can clearly be hazardous to his health. As such, he must handle the inci- dent differently than he would normally and with much more caution. Greater care should be given to personal protection of the emergency services personnel with more detail given to approach and operational procedures. The availability of proper protective equipment, or the lack of it, has a direct bearing on how and if an approach is made; what the incident mitigation objectives can be; how work area assignments are made and defined; and how the establishment of working limits (operating time, work zones, and personal protection) are determined. The most critical factor here is the life threat to E.D. personnel. Without knowledge of exactly what personal protection equipment is necessary for the materials involved in the incident and the protective limits of the equipment, the incident response team can get into immediate seri- ous trouble. The first concern should be uploads/Geographie/ guide 2 .pdf