Biomedical Engineering Reference
In-Depth Information
to them for direction. That being the case, a
basic knowledge of creating a perimeter for a
hazardous material incident should be understood
by responding EMS personnel.
EMS and responding personnel also need to
realize that by creating a perimeter we are keeping
people safe from the agent involved and there-
fore attempting to keep casualties low. What we
may not be able to do is keep people safe from
themselves. Remember that in many circumstances
we will be splitting up friends, co-workers, and
family members who end up on opposite sides of
the perimeter. These “halves” of families/friends
will work very hard to get back together. Taking
time (if it is possible) to explain the circumstances
to these “halves” may help to prevent creating
more victims. An example of one way to address
this issue is to ask that those looking for family
members in an affected area to congregate in
one place where a liaison between them and the
responding agencies can be established (e.g., a
briefing area).
8.5 Treatment Protocols
Part of pre-planning for a WMD event includes
the formation of treatment protocols. Examples are
attached in the appendix to this chapter.
Besides treatment protocols, appropriate medi-
cations need to be stockpiled and EMS respon-
ders need to be trained in their use. Specific
examples include auto-injectors of 2-pam chloride,
atropine, and diazepam for nerve agents. As well
as amyl nitrate, sodium nitrite, sodium thiosulfate
for cyanide poisoning.
Questions abound regarding where these medi-
cations should be stored, who should have access
to them and when. Different EMS systems have
come to varying conclusions regarding the storage
location of the WMD medications. Some services
store them at a local hospital, others at the service
headquarters. Still others store them in each indi-
vidual EMS unit or in a supervisor's unit.
For immediate use, they should be stored in
each responding EMS unit. This type of prepa-
ration comes with a price. The majority of these
medications will be wasted, as they are not used
frequently (if at all, in your typical EMS service).
But to truly be available to those who would have
need for them, they should be stored in each unit.
The other consideration with medications is
quantity. How much should be stored in an indi-
vidual unit? Perhaps enough for each crew member
and maybe one patient? Ten patients? Physical
space becomes an issue here. Some systems stock
their supervisory vehicles with larger amounts of
WMD medications. Others keep them stocked in a
local hospital pharmacy.
8.6.1 Establishing a Perimeter and
Treatment Zones
Upon recognition of a terror event, EMS should
establish a perimeter around the area. The process
for establishing a perimeter at an emergency scene
should be similar to the following:
1. If possible, identify the substance involved.
Using the North American Emergency
Response Guidebook, look up its ID number
from its name in the blue pages (if there). If
you do not know the exact name of the agent,
or its name is not listed, use the agent class. For
example, for nerve agents, use ID 2810. For
the blood agents use ID 1051. For the blister
agents, use ID 2810.
2. Look up the ID number in the green pages,
and read across to the initial
isolate
distance
and
protect
distance. You will need to know
if you are dealing with a
small
incident (less
than 55 gallons) or a
large
one (larger than 55
gallons), and if it is
day
(between sunrise and
sunset) or
night
(Figure 8.1).
8.6 Patient Decontamination
Before any treatment of the patient can happen,
decontamination must occur. (see Chapter 7).
Upon recognition of a potential WMD event,
creation of a perimeter and denying entry to
civilian personnel should become a priority.
Normally this is a job for law enforcement,
however EMS providers must realize that on many
occasions they may arrive prior to many law
enforcement officers and that civilians may turn
