hello and welcome to chapter 40 incident management of the emergency care and transportation of the sick and injured 12th edition after you complete this chapter and the related coursework you will be able to describe and apply in context the national incident management system or nims including describing command and general staff roles additionally you will be able to describe various specialized components of establishing incident command and its inherent responsibilities this chapter also describes the importance of using the instant command system in hazmat incidents and setting up ems branch operations control zones personal protective equipment and triage methods are also discussed okay the most challenging situations you can be called to are disasters and mass casualty incidents or otherwise known as mci's the mass casualty incident refers to any call that involves three or more patients or any situation that places such a great demand on available equipment or personnel that the system would require a multi-multi-aid dis response the agreement what a multi-aid response is is an agreement between neighboring ems systems to respond when local resources are insufficient to handle the response these events can be overwhelming because you will find a large number of patients and not enough resources use of the instant command system or ics makes it possible to do the greatest good for the greatest number of people as an emt you will typically be assigned to work within the ems medical branch under ics the national incident management system or nims was developed to promote efficient coordination of emergency incidents at a regional state and national levels so what is the national incident management system the secretary of homeland security implemented nims in 2004. it provides a framework to enable federal state and local governments as well as the private sector and non-governmental organizations to work together effectively the organizational structure must be flexible enough to be rapidly adapted for use in any situation the nims provide standardization in terminology resource classification personnel training and certification another important feature is the concept of interoperability which refers to the ability of agents agencies in different types or from different jurisdictions to communicate together the ics or instant command system is one component of nims the major nems components are as follows so you have a communication and information management resource management and command management the standard incident command structure are based on three key components okay so you have ics or instant command system multi-agency coordination systems and public information systems okay so the instant command system let's talk about that the incident command system is sometimes referred to as the incident management system the purpose of ics is to ensure responder and public safety to achieve instant management goals to ensure efficient use of resources and communication is the building block of good patient care and so they use common terminology and the use of clear text communications and it helps responders from multiple agencies work effectively together the goal of ics is to make the best use of your resources to manage the environment around the incident and to treat patients during an emergency the ics is designed to control duplication of effort and freelancing one of the organization's principles of ics is limiting the span of control of any one individual okay so organizational levels may include sections branches divisions and groups the figure on this slide illustrates the ics organizational structure okay so the ics rules and responsibilities the general staff includes command finance logistics operation and planning command staff includes a public information officer or pio a safety officer and a liaison officer so let's talk about command the incident commander or ic is in charge of the overall incident large incidents require a multi-agency or multi-jurisdiction response and need to use what's called a unified command a single command system is one in which one person is in charge even if multi agents multiple agencies respond so it is important that emts know who the ic is the instant commander is and how to communicate with the ic and where the command post is located if the incident is very large emts will report to a supervisor who is working under the ic an incident commander or ic may turn over command to someone with more experience in a critical area when an in incident draws to a close there should be termination of command an agency should be demobilized and they should have demobilization procedures to implement as soon as the situation de-escalates or continues or comes to the end finance so let's talk about finance they are responsible for documenting all expenditures at an incident for reimbursement various functions within the finance section are time unit procurement unit compensation or claims unit they could have a cost unit and then the next part is going to be logistics so the logistics section or section chief has responsibility for communications facilities food and water fuel light lighting medical equipment and supplies for patients and emergency responders then there's the operations section at a very larger complex incident the operations section is responsible for managing the tactical operations usually handled by the ic the operations section chief will supervise the people working at the scene of the incident who will be assigned to branches divisions and groups then you have planning so this section solves problems as they arise it obtains data about the problem and it analyzes the previous instant plan it works with who or what is needed to make the new plan work works closely with the operations finance and logistics sections another function is to develop an instant action plan which is the central tool for planning during a response to a disaster emergency it provides clear concise information about the incident activities including objectives tactics and assignments and then finally the command staff the safety officer monitors the scene for conditions and operations that will be present that will present a hazard to responders and patients he or she has the authority to stop an emergency operation whenever a rescuer is in danger a safety officer should remove hazards to ems personnel and patients before the hazards cause an injury the public information officer or pio provides public and media with clear and understandable information the pio must keep the media safe and for becoming part of the incident they may cooperate with pios from other agencies in a joint information center the liaison officer relies information and concerns among the command and general staff and with other agencies okay so communications and informations management communications has historically been the weak point of most major incidents it is recommended that communications be integrated all agencies should be able to communicate quickly and efficiently effortlessly via radios communications allow for accountability throughout the incident as well as instant communication between recipients okay so mobilization and deployment so when the incident has been declared and the need for additional resources has been identified a request is made for additional resources check in at the incident so on arrival at the incident you should check in with the incident commander checking in accomplishes different functions so it allows you to be assigned to a supervisor for job tasking it allows for personnel tracking throughout the incident and it ensures the cost pay and reimbursement can be calculated accurately initial incident briefing so when you report to your supervisor for an initial briefing it will allow you to get the information regarding the incident as well as a specific job function and responsibilities okay so record keeping of the incident if a large piece of equipment becomes inoperable it may be possible for the replacement costs to come from the incident record keeping allows for tracking of time spent on an actual incident for reimbursement purposes so accountability accountability means keeping your supervisor advised of your locations actions and completed tasks this includes advising your supervisor of the tasks that you have been unable to complete and what tools you need to complete them and then instant demobilization so once the incident has been stabilized and all of the hazards mitigated the incident commander will determine which resources are needed or which are not needed and when to begin demobilization this process allows for a prompt return of resources to their parent organizations to be placed back in service so let's talk about the ems response within this incident command system first you have to be prepared so preparedness involves the decisions made and basic planning done before the incident occurs sharedness in a given area involves decisions and planning about the most likely natural disasters for the area among other disasters your ems agency should have a written disaster plan that you're required to train and do regularly train to carry out a copy of the disaster plan should be kept in each ems physics vehicle your local ems organization should develop an assistance program for families of ems responders okay so the scene size up sizing up a scene starts with dispatch and when you arrive on scene you will make some initial assessments and some preliminary decisions the size up will be driven by three basic questions and those three are what do i have what do i need and what do i need to do the figure on the slide shows a mobile emergency room all right so establishing command a command should be established by the most senior official notification to other responders should go out and the necessary resources should be requested a command system ensures that resources are effectively and efficiently coordinated command must be established early preferably by the first arriving most experienced public safety official now communications so if possible use face-to-face communications to limit radio traffic if you communicate via radio do not use 10 codes or signals most communication problems should be worked out before the disaster happens by designated channels strictly for command during a disaster communications equipment must be reliable durable and field tested be sure there are backups in place the medical branch of instant command so let's talk about this and it is commonly known as medical branch of ics okay so the medical branch director will supervise the primary roles of the medical branch triage treatment and transport of injured people the medical branch director will help ensure that the ms units responding to the scene are working with the ics each medical division or group receives a clear assignment before beginning work at the scene responsible or personnel remain at their vehicle in the staging area until they are assigned their duties okay so on the figure on this slide illustrates the component components of the medical branch the triage supervisor ultimately in charge of counting and prioritizing patients ensures that every patient receives an initial assessment of his or her condition one of the most difficult parts of being the triage supervisor is that you must not begin treatment until all patients are triaged and you will or you will compromise your triage efforts then you have the treatment supervisor and this will locate and set up the treatment area with a tier for each priority patient it ensures the secondary triage of patients are performed and the adequate patient care is given and as resources allow and the treatment supervisor assists with moving patients to the transportation area and then we have the transportation supervisor so this person coordinates transportation and distribution of patients to appropriate receiving hospitals and helps to ensure the hospitals do not become overwhelmed by a patient surge documents and tracks the number of transport vehicles patients transported and the facility destination of each patient then you have the staging officer so a staging supervisor is assigned when a mass casualty incident or disaster requires a multi-vehicle or multi-agency response emergency vehicles must have permission from the staging officer or staging supervisor to enter the mass casualty scene and should only drive in the directed area the staging area should be established away from the scene so that the park vehicles are not in the way all right then as part of the medical branch of the instant command you could have physicians on scene and so it makes they make difficult triage decisions they provide secondary triage decisions in the treatment area deciding which priority patients are to be transported first and provide unseen medical direction for emts and they can provide care in the treatment sector as appropriate then you have a rehabilitation supervisor so this person establishes an area that provides protection for responders from the elements of the situation so the rehabilitation area should be located away from the exhaust fumes and crowd and out of view of the scene itself rehabilitation is where a responder's needs for rest food fluids and protection from the elements are met and it monitors responders for signs of stress all right so extrication and special rescue this determines the type of equipment and resources which are needed for the situation the morgue supervisor so they work with area medical examiners coroners disaster mortuary assistance teams and law enforcement agencies to coordinate removal of bodies and body parts the morgue supervisor should attempt to leave dead victims in the location found if possible until their a removal and storage plan can be determined the morgue area should be out of the view of living patients and other responders and it should be secured from the public and mass casualty incidents an emergency situation that involves three or more patients places great demand on the ems system and or has the potential to produce multiple casualties all systems have different protocols for when to declare a mass casualty incident and initiate the ics so as an emt ask yourself the following questions when considering whether the call is a mass casualty incident so how many serious injured or ill can you care for effectively and transport in your ambulance what happens when you have three patients to deal with how long will it take for additional help to arrive and what happens in the number of patients exceeds the number of available ambulances so you and your team cannot treat and transport all of the injured patients at the same time you so at an mci you will often experience an increased demand for equipment and personnel you should never leave the scene with patients if there are still other patients present who are sick or wounded if there are multiple patients and not enough resources to handle them without abandoning victims you should declare an mci request additional resources and initiate ics and triage procedures so let's talk about triage this simply means to short patients based on the severity of their injuries the goal of doing the greatest good for the number greatest number means that triage assessment is brief and that the patient condition categories are basic so you have a primary triage and that's the initial triage done in the field then you have a secondary triage and this is done as patients are brought into this treatment area during primary triage patients are briefly assessed and then identified in the same way such as by attaching a triage tag or triage tape after the primary triage the triage supervisor should communicate with the following information to the medical branch director so he should tell them the number of patients the number of patients in each triage category recommendations for extrication and movement of the patient and resources needed to complete triage and begin movement of patients when the initial triage has been completed secondary triage or some people call it a re-triage allowing for the mt to reassess all remaining patients and to upgrade the triage category if necessary okay so let's talk about the triage categories there are four common triage categories first you have the immediate and that is red then you have delayed that is yellow then you have minor or minimal which is green expectant is black and that means that they're likely to die and then possible additional of an orange tag so that's an immediate category between the red and yellow and a patient could be more appropriately prioritized if treatment or transport of his condition requires a specific destination that was not a trauma center okay so the table on the slide defines the four categories of triage okay so triage tags tagging patients early assist in tracking them and can keep the accurate record of their condition so triage tags should be waterproof and easily read the patient tags or tape should be color coded and should clearly show the category for the patient the tags will become part of the medical patient's record and however labeling system is used or whatever labeling system it is imperative for the transport officer to be able to identify which patient was transported by which unit and to which destination and the priority of the patient's condition so let's start with let's start talking about start triage and this is one of the easiest methods of triage it stands for simple triage and rapid treatment it uses a limited assessment of the patient's ability to walk respiratory status hemodynamic status or pulse and neurologic status the first step is performed on arrival at the scene by calling out to all the patients at the disaster study and and then directing them to an easily identified landmark the injured persons in this group are the walking wounded and those are considered green or third priority patients the second step is directed towards non-walking patients we want to move the first non-ambulatory patient and assess the respiratory status if the patient is not breathing then open the airway by using a simple maneuver okay a patient who is still does not begin to breathe is triage as expectant and this is black if the patient begins to breathe tag him or her as an immediate place the patient in the recovery position and move to the next patient if the patient is breathing make a quick estimation of the respiratory rate okay a patient breathing faster than 30 minutes breaths a minute or less than 10 is triaged as immediate okay if the patient is breathing from between 10 and 29 breaths a minute move to the next step all right so we're just moving right along the next step is to assess the hemodynamic status of the patient by checking for bilateral radial pulses an absent pulse implies the patient is likely hypotensive so tag him or her as an immediate priority the final assessment is to assess the patient's neurologic status by assessing the patient's ability to follow simple commands a patient who is unconscious or cannot follow simple commands is an immediate priority okay so we're going to talk about jump start patients next and so we use start triage for the adults and we're going to use jumpstart triage for the pediatric patients and this is intended for use in children younger than one year or who appear to weigh less than 100 pounds okay so it begins by identifying the walking wounded just as the adults infants and children not developed enough to walk though or follow commands including children with special needs should be taken as soon as possible to the treatment sector for immediate secondary triage there are several differences within the respiratory status assessment compared to start okay so if you find a pediatric patient who's not breathing we're going to immediately check for a pulse of course if there's no pulse label the patient as expected or black if the patient is not breathing but has a pulse open the airway with the manual maneuver if the patient does not begin to breathe we're giving them five rescue breaths and check respirations again a child who does not begin to breathe should be labeled as expected the most common cause of a cardiac arrest in children is respiratory rest so the next step is to assess the appropriate rate of respirations the next assessment is the hemodynamic status of the patient so we're going to assess the pulse and to what you're going to do is feel the most competent and comfortable checking okay so if there's absence of the distal pulse label the child as immediate priority and move to the next patient the final assessment for neurologic stats so it's a modified avpoo and a child who's unresponsive or responds to pain by posturing or with incomprehensible sounds or is unable to localize pain is tagged as immediate so triage special considerations patients who are hysterical and disruptive to rescue efforts may need to be handled as immediate priority and transport off the site even if they are not seriously injured a responder who becomes sick or injured during the rescue effort should be handled as an immediate priority and be transported offsite as soon as possible hazardous materials or hazmat and weapons of mass destruction incident forced the hazmat team to identify patients as contaminated or decontaminated before the triage process begins all right so destination days decisions so let's talk about this all patients triaged as immediate or delayed so red or yellow should preferably be transported by ground ambulance or air ambulance if available in extremely large situations a bus may transport the walking wounded immediate priority patients should be transported two at a time until all are transported from the site then patients in the delayed category couldn't be transported two or three at a time until all are transported finally the walk and wounded are transported expecting patients who are still alive would receive treatment and transport at this time dead victims are handled and transported according to the standard operating procedure for the area early notification and re of receiving facilities will allow the hospitals to increase staffing and move patients within their facility as required okay so let's talk about disaster management a disaster is a widespread event that disrupts functions and resources of the community and threatens lives of property many disasters may not involve personal injuries on the other hand many disasters such as floods fires and hurricanes will result in widespread injuries unlike an mci which generally lasts no longer than a few hours emergency responders will generally be on scene of an astro natural disaster for days to weeks and sometimes months so only elected official can declare a disaster your role in a disaster is to respond when requested and to report to the incident command for assigned tasks in a disaster with an overwhelming majority of casualties area hospitals may decide they cannot treat all the patients in their facility they may mobilize medical and nursing teams with equipment so using the facility such as a warehouse near the disaster scene will they will set up a casualty collection area so they'll perform triage provide medical care transportations to the hospital on a priority basis if a casualty collection area is established it will be coordinated through the instant command in the time same way as all other branches and areas of the operation so let's talk about some hazmat so a little bit of an introduction when you arrive at a possible hazardous or hazmat incident you must first step back and assess the situation rushing into an unsafe scene can have catastrophic results so if overcome you will be able uh if overcome you will be unable to assist patients because of the unique aspects of responding to and working at hazmat incident osha has published a set of guidelines known as hazardous waste operational operations and emergency response it's called hazwoper standard okay first responders at an awareness level should have sufficient training and expert experience to demonstrate the following competencies an understanding of what hazardous substances are and the risk associated with them and an understanding of the potential outcomes of an incident the ability to recognize the presence of a hazmat or hazardous substance the ability to identify the hazardous substance if possible the understanding of the role of the first responder awareness individual in the emergency response plan and the ability to determine the need for additional resources and to notify the communication center okay so recognizing the hazardous material a hazardous material is any material that poses an unreasonable risk of danger or injury to persons property or the environment if it is not properly controlled during handling storage manufacture processing packaging use and disposal and transportation train yourself to take the time to look at the whole scene so that you can identify the critical visual indicators and fit into what is known as about the problem hazardous materials may be involved in any of the following situations so you could have like a truck or train crash in which the substance is leaking from the truck or the train or the railroad tank car leak or fire or any emergency that added industrial plant refinery or a complex where chemicals or explosives are produced used or stored and leak or rupture of an underground natural gas pipe you could also have a degradation of underground fuel tanks and seepage of the oil or gasoline into the surrounding ground buildup of methane or other by-products of waste decomposition in sewers or sewage processing plants or a motor vehicle crash resulting in ruptured gas tanks it is important to approach the scene from a safe location and direction the traditional rules of staying uphill and upwind are a good place to start so use binoculars and view the scene from a safe distance if possible be sure to question anyone involved in the incident the figure on this slide shows two examples examples of a hazardous materials incident so occupancy and location okay so let's talk about this a wide variety of chemicals are stored in a wide range of occupancies and locations the location and type of the building are two good indicators of the possible presence of a hazardous material senses the senses can be safe can be safely used are the sight in sound okay so using any of the other senses that brought you in proximity to a chemical should be done with caution or avoided clues that are seen and heard from a distance may enable you to take precautionary steps so containers a container is a vessel or receptacle that holds the material often the container type size and material of construction provide important clues about the nature of the substance do not though rely solely on the type of container when making a determination of a hazmat incident hazmat incident so one way to distinguish containers is to divide them into two categories based on their capacity so you could have bulk or non-bulk storage containers container volume so a bulk storage container could be a fixed tank a highway cargo tank railroad tank cars totes intermodular tanks in general bulk storage containers are found in buildings that rely on and need to store large quantities of a particular chemical often these bulk storage containers are surrounded by a secondary containment system to help you control if an accidental release happens secondary containments is an engineered method to control a spill or release products if the main containment vessel fails so a large volume horizontal tanks are also common totes have the capacities ranging from about 119 gallons to 703 gallons they can contain any type of chemical including flammable liquids corrosives food grade liquids or oxidizers shipping and storing totes can be hazardous because they have no secondary containment system and on the figure on this slide shows totes all right so then intermodular tanks are both shipping and storage vessels and they could hold between 5 000 to 6 000 gallons of a product and can be pressurized or non-pressurized so the figure on this slide shows one of those interim module or tanks okay and then you have non-bulk storage vessels so all types of containers other than bulk are considered non-bulk they hold commonly used commercial and industrial chemicals such as solvents industrial cleaners and compounds drums are easily recognizable and they're barrel shaped containers bags are commonly used to store solids and powders an example of this would be like pesticides bags and it when those when you have a pesticide bag it must be labeled with specific information okay then you have carboys and those are used to transport and store corrosives and other types of chemicals the figure on this slide shows a carboy okay an uninsulated compressed gas cylinders are used to store substances such as nitrogen argon heligen helium and oxygen the department of transportation or dot marking system so let's talk about this you have labels placards and other markings and they're used on buildings packages boxes and containers marking systems such as the presence of a hazardous material from a safe distance and provide clues about the substance the figure on this slide shows examples of labels plaque cards and markings placards are diamond shape indicators that are placed on all four sides of the highway transport vehicle railroad tank cars and other forms of transportation carrying hazardous materials labels are smaller versions of placards and they're placed on all four sides of the individual boxes and smaller packages being transported so the figure on the slide shows examples of placards now let's talk about some other considerations the dot system does not require that all chemical shipments be marked with placards or labels in most cases cases the package or cargo tank must contain a certain amount of hazardous material before a placard is required the kersham commercial package delivery services often carry small amounts of hazardous materials that fall below that weight limit the vehicle's exterior will not display placards to warn of dangers so some chemicals are so hazardous that shipping any amount of them requires the use of labels placards as such and they are explosives poisonous gases water reactive solids high level radioactive substances okay okay so let's talk about the erg and this is a reference it's called the emergency response guidebook what it does is it offers a certain amount of guidance for responders operating as a hazmat site it's updated every three or four years it provides information on approximately 4 000 chemicals then there's the material safety data sheets or msds it's a common source of information about a particular chemical it provides basic information about the chemical makeup of the substance the potential hazards if present the appropriate first aid in the event of an exposure other pertinent data for safe handling of the material all facilities that use or store chemicals are required by law to have an msds on file for each chemical stored at the facility and then there's shipping papers okay so they are required whenever materials are transported from one place to another includes the names and addresses of the shipper and the receiver identify the material being shipped and specify the quantity and weight of each part of the shipment shipping papers from road and highway transportations are called bills of lady or frequent bills freight bills and are located in the cab of the vessel or vehicle then you have chemtrack let's talk about chemtrac so chemtract is operated by the american chemistry council it provides invaluable technical information for first responders of first responders of all disciplines who are called upon to respond to a chemical incident when you call chemtruck be sure to have the following basic information ready the name of the chemical the name of the caller and callback telephone number the location of the actual incident problem the shipper manufacturer of the chemical container type rail car or vehicle markings or numbers the shipping carrier's name the recipient of the material and the local conditions an exact description of the situation identification so let's talk about identification so despite the availability of resources identification can still be difficult little consistency is used on labels and placards and dishonest transporters sometimes will not label containers or vessels appropriately okay so always maintain a high index of suspicion when approaching a scene of a truck or train tanker accident in the event of a spoiler leak a hazardous incident is often indicated by the president's presence of the following so if you can see a visible cloud or strange looking smoke from escaping substance a leaker spill from the tank container truck or railroad car with or without hazmat placards or labels or an unusual strong harsh odor in the area could be an indicator a large number of hazardous gases or fluids are essentially odorless even when the they leak or spill has occurred so if you approach the scene where more than one person has collapsed or is unconscious in respiratory distress you should assume that there has been a hazmat leak or spill and that the uh the scene is unsafe okay the safety of you and your team and the other responders and the public must be your first priority and concern if you approach any sign suggests that the hazmat incident has occurred you should stop at a safe distance and park upwind and uphill from the incident after rapidly sizing up the scene call for hazmat if you do not recognize that danger until you are too close immediately leave the danger zone try to rapidly assess the situation and provide as much information as possible when calling the hazmat team do not re-enter the scene and do not leave the area until you have been cleared by the hazmat team do not allow citizens to enter the scene if possible and avoid all contact with material hazmat scene operations so focus your efforts on activities that will ensure the safety and survival of the greatest number of people use ambulances public address systems to alert individuals near the scene and direct them to move to a safer area you want to establish a control zone so control zones are established at a hazmat incident based on the following so if you have a chemical or physical properties of the release material environmental factors at the time of the release and general layer layout of the scene so securing access to the incident helps ensure that no one will accidentally enter the contaminated area if the incident takes place inside a structure the best place to control access is at the normal points of in egress and ingress doors if the incident occurs outside control intersections on and off ramps perhaps service roads and other access routes to that scene all right so control zones may expand or contract as needed the hot zone is the area immediately surrounding the release which is also the most contaminated area all personnel and equipment must be decontaminated when they leave this hot zone the warm zone is where personnel and equipment transition into and out of the hot zone the decontamination area is set up in the warm zone the cold zone is the safe area where personnel do not need to wear any special protective clothing for safe operation personnel staging the command post ems providers and the other area for medical monitoring support and treatment after decon are all located in the cold zone so your role of an as an emt your job is to report to a designated area outside with hot and warm zones and you're going to provide triage treatment transport and rehabilitation classification of hazmat materials so nfpa or the national fire protection association 704 hazardous materials classification standard classifies hazmat materials according to and there's four ways so health hazard or toxicity level fire hazard chemical reactive hazard and special hazards toxicity levels measure the health that the substance health risk that the substance poses to someone who's come into contact with it the higher the number the greater the toxicity okay so you have zero and that would cause little if any health problem you have one and that would cause some irritation but contact uh but only mild two includes material that would cause temporary damage three involves materials that are extremely hazardous and four involves materials that are so hazardous that minimal contact will cause death all health hazard levels with the exception of a zero require special training in respiratory and chemical protective gear that is not standard on most ambulances the table on this slide lists the toxicology toxicity levels of a hazmat incident personal protective level so let's talk a little bit about that and the equipment levels indicate the amount and type of protective gear that you will need to prevent injury from a particular substance level a that's the most hazardous that requires fully encapsulated chemical resistant protective clothing that provides full body protection as well as an scba and special sealed equipment level b it requires non-capsulated protective clothing or clothing that is designated to protect against a particular hazard also eye protection and breathing devices that contain your air or supply such as an scba that's a level b then level c like level b it requires the use of non-permeable clothing and eye protection in addition face masks with the filter uh in that filter inhaled air must be used then level d that's your work uniform such as coveralls it provides provides minimal protection all levels of protection require the use of gloves and two pairs of rubber gloves are needed for protection in case one pair must be removed before the heavy contamination or because of heavy contamination the figure on this slide shows all four levels so you have a b c and then d so caring for patients at hazmat incident all right so it is practical only to provide the simplest assessment in essential care in a hazardous zone right before they are deconned because there's dangers time restraints and then bulky protective gear that team members wear to avoid entrapment and spread of contaminants no bandages or splints are applied okay except for the pressure dressings that are needed to control bleeding so the emt providing care in the treatment area should assess and treat the patient in the same way that they would any other patient who has been previously assessed and treated your care of the patients at a hazmat incident must address the following two issues so first any trauma that has resulted from another related mechanism such as a vehicle collision fire or explosion and the injury and harm that has resulted from that exposure to the toxic hazardous substance most serious injuries and deaths from hazardous materials result from airway breathing problems if the patient appears to be in distress give them oxygen at 12 to 15 liters via non-rebreather and then assist ventilations if needed with a back valve mask and high flow oxygen treat the patient's injuries in the same way that you would treat any injury your treatment for the patients exposure to the toxic substance should focus mainly on supportive care and initiating transport to the hospital it may be necessary to simply cut away all the patient's clothing and do a rapid rinse to remove the majority of the contaminating matter before before transport you will need to increase the amount of protective clothing you wear and you want to wear an scba two pairs of gloves goggles or face shield a protective coat respiratory depression and disposable fluid impervious apron or some type of similar outfit to make decontaminating the ambulance easier tape the cap cabinet door shut any equipment kits monitors and other items that will be used in round should be removed from the patient compartment in place in the front of the ambulance or on the side compartments before loading the patient turn the power vent ceiling fan on and patient compartment air conditioning unit fan okay so when you leave the scene inform the hospital that you're transporting a critically injured patient who has not been fully deconned you need to let them know okay so that concludes chapter 40 of the incident management lecture so let's see what we have learned okay so what is the purpose of an instant command system so we want to make the safety we want to achieve goals and we want to ensure effect efficient use of resources so d all of the above okay so upon arriving at a scene in which the instant command system is being activated you should um expect to let's see we know we want to talk to ic or report to ic but we should expect to be passed from sector to sector as needed in between assignments okay when ems responds to a disaster as part of their response with the ics ems would start with the scene size of what is the next step for the first responding units okay so we need to probably establish command i think that's probably the next yep so we arrive we look around we establish command okay which of the following best describes a mass casualty incident okay so right away looking at all four of these i think the best answer is when the patient count exhausts the resources available yeah that's exactly what it is which of the following patients would have the highest priority treatment okay so right away i'm going to look at that we have an unconscious snoring respiration severe burns we have a pulses okay full cardiac arrest those are those are expectant expectant and then 32 open head exposed brain matter no carotid pulse so b c and d those are all expectants right so the one that we're going to go to is a how does a disaster differ from an ass match casualty incident okay so disasters may not involve personal injuries as a disaster you must may be on yet and only elected officials can declare yep so we know it's d all of the above a large tanker truck has overturned on the highway when we arrive we see clear liquid leaking from the rear the driver appears to be unconscious is still in the vehicle and is bleeding heavily what should we do so we want to fully assess the situation and request the appropriate assistance yeah we do not want to make ourselves part of the problem which of the following situations most likely involves a hazardous material milk a tractor-trailer rig that is emitting a cloud moving van that collided with head-on with a small car or a pickup truck from a gas company that struck a tree i think that they want you to do b because that's that spill or leak right a visible cloud so visible cloud is the answer when dealing with the hazardous materials incident you should set up your decontamination area so decon is going to be in that warm zone right okay so the decon should be set up in the hazardous zone in the treatment area this way patients cannot bring any hazardous materials into the treatment area and decon so see see between the hazardous zone and the treatment area it's usually the warm zone right okay which toxicity level would you assign a hazardous material spill that could cause a person temporary damage or residual injury unless prompt medical treatment is given which one do we think that is okay be level two so level two is the correct answer and thank you once again for joining me for chapter 40 instant management lecture if you like this lecture go ahead and subscribe to the channel because we're going to complete the whole books of lectures okay so all 41. thank you for joining us and have a great night