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With the constant threat of accidental releases of hazardous materials and the potential criminal use of chemical weapons, local emergency response providers must be prepared to handle victims who may be contaminated with chemical substances. Many local jurisdictions have developed hazardous materials (HazMat) teams; these usually are composed of fire, environmental, and paramedical personnel trained to identify hazardous situations quickly and take the lead in organizing a response. Health care providers such as ambulance personnel, nurses, physicians, and local hospital officials should participate in emergency response planning and drills with their local HazMat team before a chemical disaster occurs.

  1. General considerations. The most important principles of successful medical management of a hazardous materials incident are the following:

    1. Use extreme caution when dealing with unknown or unstable conditions.

    2. Rapidly assess the potential hazard severity of the substances involved.

    3. Determine the potential for secondary contamination of nearby personnel and facilities.

    4. Perform any needed decontamination at the scene before victim transport, if possible.

  2. Organization. Chemical incidents are managed under the Standardized Emergency Management System (SEMS). Integral to this system is the use of the incident command system. The incident commander or scene manager is usually the senior representative of the agency that has primary traffic investigative authority, but this authority may be delegated to a senior fire or health official. The first priorities of the incident commander are to secure the area, establish a command post, create hazard zones, and provide for the decontamination and immediate prehospital care of any victims. However, hospitals must be prepared to manage victims who leave the scene before teams arrive and may arrive at the emergency department unannounced, possibly contaminated, and needing medical attention.

    1. Hazard zones (Figure IV–1) are determined by the nature of the spilled substance and the wind and geographic conditions. In general, the command post and support area are located upwind and uphill from the incident, with sufficient distance to allow rapid escape if conditions change.

      1. The exclusion zone (also known as the "hot" or "red" zone) is the area immediately adjacent to the chemical incident. This area may be extremely hazardous to persons without appropriate protective equipment. Only properly trained and equipped personnel should enter this zone, and they may require comprehensive decontamination when leaving the zone.

      2. The contamination reduction zone (also known as the "warm" or "yellow" zone) is where victims and rescuers are decontaminated before undergoing further medical assessment and prehospital care. Because of the limitations posed by protective equipment, patients in the exclusion zone and contamination reduction zone generally receive only rudimentary first aid and/or immediately life-saving interventions until they are decontaminated.

      3. The support zone (also known as the "cold" or "green" zone) is where the incident commander, support teams, media, medical treatment areas, and ambulances are situated. It is usually upwind, uphill, and a safe distance from the incident.

    2. Medical officer. A member of the HazMat team should already have been designated to be in ...

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