Perilous Materials Emergencies

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Perilous Materials Emergencies. Course Objectives:Describe regular courses of introduction to dangerous materialsDifferentiate presentation versus wellbeing hazardDiscuss the idea of auxiliary sullying and its suggestions for cleaning and triageDescribe pre-healing facility and ED reaction to casualties of hazardous materials presentation.

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´╗┐Dangerous Materials Emergencies Kent R. Olson, MD, FACEP Medical Director, SF Division California Poison Control System

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Hazardous Materials Emergencies Course Objectives: Describe basic courses of presentation to unsafe materials Differentiate introduction versus wellbeing danger Discuss the idea of optional defilement and its suggestions for disinfecting and triage Describe pre-clinic and ED reaction to casualties of hazardous materials introduction

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Types of Hazards Physical Explosion Fire Poisoning Corrosive or aggravation impacts Systemic toxic substances

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Physical States of Hazardous Materials Gas Liquid Vapor Mist/Aerosol Solid Fume Dust

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Potential Routes of Exposure Inhalation Skin & Eyes Ingestion Injection

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Toxic Effects Local damage Upper aviation route or lung harm Skin or eye copies Corrosive damage to GI tract Systemic impacts Dizziness, sickness, retching Coma, seizures, arrhythmias Cancer, Reproductive impacts

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Case Study A 44 yo man spilled focused phenol on his legs and did not wash it off quickly. Notwithstanding the compound blazes, he created disturbance, disarray, and seizures.

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Some Corrosives with Systemic Toxicity Agent Systemic Toxicity Formaldehyde metabolic acidosis (formate) Hydrofluoric acid hypocalcemia, hyperkalemia Permanganate methemoglobinemia Phenol seizures; extreme lethargies; liver and kidney damage Phosphorus liver, kidney harm Silver nitrate methemoglobinemia

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Inhalation Toxicology Irritant or destructive impacts Highly water solvent gasses and vapors, bigger fogs and exhaust upper aviation route Less dissolvable, littler bring down aviation route Systemic impacts Simple asphyxia Target organ danger

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Hazard is Determined By: TOXICITY and EXPOSURE Toxic + Significant Exposure = HAZARD Toxic + No Serious Exposure = No Hazard

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Dose-Response Concept "All substances are toxic substances; there is none which is not a toxin. The correct measurement separates a toxic substance and a cure." - Paracelsus (1493-1541)

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Dose is Determined By: Route of presentation Amount Duration

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Common Dose Terminology Inhalation: ppm: parts per million ppb: parts per billion mg/m 3 : mg for each cubic meter of air Ingestion, Injection, Skin retention: mg/kg: mg per kg of body weight LD 50 and LC 50 : Animal reviews: half mortality dosage

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Examples of Acute Oral LD 50 Substance: LD 50 (mg/kg) Ethyl alcohol 10,000 Sodium chloride 4,000 DDT 100 Nicotine 1 Dioxin 0.001 Botulinus toxin 0.00001

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Toxicity Ratings Rating LD 50 (oral) LC 50 (4 hr) Extremely toxic < 1 mg/kg < 10 ppm Highly toxic 1-50 10-100 Moderately toxic 50-500 100-1,000 Slightly toxic 0.5-5 g/kg 1,000-10,000 Pract. nontoxic 5-15 10,000-100,000 Relatively harmless > 15 > 100,000

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Workplace Exposure Limits Chronic normal day by day presentation: (8-hour Time-Weighted Average) TLV: Threshold Limit Value ACGIH prescribed standard PEL: Permissible Exposure Limit OSHA enforceable farthest point If the introduction is < TLV or PEL, it is alright for Hazmat operations

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Workplace Exposure Limits Brief higher exposures: (20-30 minutes or less) STEL: Short-Term Exposure Limit C: Ceiling limit IDLH: Immediately Dangerous to Life or Health Exposures in this range can bring about genuine damage - require defensive rigging

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Estimating Exposure Risk Vapor Pressure Multiply by 1,300 to gauge most extreme air focus in ppm from a fluid spill Vapor Density If > 1, vapor may gather in low-lying territories Warning Properties Odor Irritation

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Methylene Chloride Vapor Pressure = 349 mm Maximum air conc. = 453,700 ppm IDLH = 5,000 ppm Vapor Density = 2.9 Will gather in low-lying territories asphyxia Warning Properties Sweet, ether-like smell at > 200 ppm Olfactory weariness may happen w/constant exp.

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Secondary Contamination Substance is poisonous . . . also, . . . Is probably going to be carried on casualty's attire, hair or skin in adequate adds up to undermine others

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Secondary Contamination Serious potential for pollution: Poisons with high skin poisonous quality eg, organophosphate pesticides Volatile fluids eg, methylene chloride Radioactive tidies or fluids Etiologic operators (infections, microorganisms)

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Secondary Contamination Little or no danger of sullying: Gasses eg, carbon monoxide Vapors (unless buildup happens) eg, methylene chloride Non-unpredictable fluids with no skin lethality eg, ethylene glycol (radiator fluid)

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Secondary Contamination Implications for Decontamination: Serious danger of auxiliary defilement: Decontamination is obligatory Decon may take need over casualty Rx No hazard: Decon discretionary Victim treatment is need

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Case Study A 21 yo understudy spilled focused sulfuric corrosive on herself when the jug slipped off the rack. Test: Your first administration need is: ABCs Give Diazepam Determine her protection scope Immediately wash completely with water

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Case Study A 32 year old farmworker was intensely drenched with fluid parathion from a capacity holder. He is lying in a pool of fluid, and he is writhing. Test: Your first administration need is: Airway (ABCs) Diazepam for the seizures Atropine Rescuer security & casualty Decon before Rx

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Case Study A 22 yo laborer breathed in chlorine gas delivered when he blended dye with a corrosive chemical. He instantly created serious hacking and wheezing. Test: Your first administration need is: Criticize him for blending the chemicals Give oxygen and bronchodilators Perform careful Decon BEFORE R x

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Basic Goals for EMS Hazmat Responders Recognize Hazmat episode Protect yourself & others Identify poisonous material(s) Determine lethality and danger Use suitable defensive apparatus Decontaminate before transport Provide particular treatment

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Hazmat Scene Zones HOT ZONE DECON ZONE SUPPORT ZONE Spill Properly secured faculty just EMS and other bolster work force

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Recognize Hazmat Incident Scene signs: People down, dead creatures Vapor cloud Fire Warning properties (might be temperamental) : Odor Color Irritation

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Protect Yourself & Others Prevent essential presentation: Approach circumspectly, upwind, tough Isolate range and preclude section Stay out from claiming Hot Zone Prevent auxiliary pollution: Determine danger of optional tainting If Decon required, ought to be finished by legitimately ensured staff

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Identify the Toxic Material(s) DOT Guide Placards Labels Shipping papers NFPA stamping framework names Material Safety Data Sheets (MSDS) On-scene compound examination

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Determine Toxicity & Hazard Regional Poison Control Centers Back-up by therapeutic toxicologists C HEMTREC : 1-800-424-9300 Large record of MSDSs Contacts in key concoction businesses Written materials Books On-line databases

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Determine Toxicity & Hazard Specific data that might be accessible from the local Poison Control Center: Toxicity/indications of introduction Level of defensive rigging required Potential for optional sullying Decontamination required? Particular treatment

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Respiratory Protective Gear Air-refining respirators (gas veils) Do not give oxygen Must be compound particular Chemical may get through Air-provided respirators (SCBA) Safe air supply Limited term of tanks All apparatus must be fit-tried

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Chemical Protective Clothing Completely or halfway typifying Completely epitomized requires SCBA Varying imperviousness to chemicals Need synthetic similarity and leap forward information for every substance Serious hazard if utilized disgracefully Not fire safe Chemical entrance Heat push

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Chemical Protective Clothing EPA Levels A-D: A: SCBA in addition to embodying (sealed shut) suit B: SCBA in addition to in part exemplified suit C: Air-sanitizing cover in addition to fractional enc. suit D: No uncommon rigging (work garments) EPA levels don't address FF equip: SCBA in addition to fire safe (not substance safe) "fortification" apparatus

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Protective Gear in Hot Zone Known or suspected respiratory danger? SCBA required Known or suspected skin peril? Level An or B No skin danger FD turnouts alright

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Heat Illness Variables that influence body temperature: Ambient (ecological) temperature Level of physical movement State of hydration Ability to sweat evaporative cooling Heat push disorders: Heat weariness Heat stroke (LIFE-THREATENING!)

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Heat Stress Monitoring & Prevention Enforced breaks Rest Force liquids Rotate work groups Safety officer or other assigned individual Monitors every individual in defensive apparatus Looks for: modified mental status, expanded heartbeat rate, hoisted body temperature

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Victim Management in Hot Zone Only prepared and appropriately secured staff may enter Limited action in Level An or B outfit: Open aviation route (with C-spine insurances) Brush off gross contaminants Carry on backboard or drag to Decon zone Note: mobile patients might have the capacity to evacuate their own attire and stroll to Decon range

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Decontamination Area Medical mediation still constrained Access confined to prepared faculty with defensive apparel Protective rigging limits capacity to survey understanding, begin IVs, and so forth Decontamination Determine if necessary, in view of casualty's Sx and potential for auxiliary pollution Have casualty help, if conceivable

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Basic Decontamination Brush off/splash up gross contaminants Cut away or expel sullied dressing Flush with overflowing plain water Head to toes bearing 3-5 minutes (eyes: no less than 5 min) If slick or follower, utilize cleanser or cleanser Do not utilize "Decon Solutions" Collect spillover, if conceivable

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Decontamination Decision Algorithm Was introduction to gas or vapor as it were? NO YES Vapor dense on garments or skin? YES DECONTAM