Beruflich Dokumente
Kultur Dokumente
For
Emergency Medical Sarvlcaa Personnel
Student Workbook
State -
of -
New
--York
-
George Pataki
Governor
June-1992
BYS EIIS-DZIIAT AWARBllBSS COURSB
student workbook
Page 2
New York State SECTION A
Department of Health
Emergency Course Schedule
Special Thanks
Table of Contents
Medical
Services
Program
HAZMAT AWARENESS
'i\ Continuing Education Course for EMS Providers"
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BYS BXS-BAZIIAT A1fJUUDIBSS COURSB
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Table of contents
Topic
Course Schedule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Section A
Special Thanks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Table of Contents.................................. 4
Section B
session one:
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-8
Introduction & Goals of The Course .••...•••..•.•.. 9-11
Why All The concern About Hazmat? •.....••..••••.••. 11-16
Hazardous Materials Definitions ..•.•..•••...•.•.•.. 16
Hazardous Materials Incidents by State .....•..••... 16-17
Hazmat Readiness . . . . • . . . . . . . . . . • . . . . . . . . . . • . . . . . . . . 17-21
Hazardous Materials Pre-Planning survey Form •...•.. 20-21
OSHA/NFPA Competencies ...•••........•.•.......••... 22-31
HAZMAT Classification & Identification .•...•••..••. 32-45
Guidebook Exercise ...•••....•.•.••••....•.•••....•. 46-49
Review of Incident Command System ..•...••••••••.... 49-54
The EMS Role in ICS ..•....••.......•...••..•••..... 54-57
Section c
Session TWo:
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
The Right to Know Law ......••......•....•.•.•...... 60-61
Material Safety Data Sheet Primer .....••....••..... 62-72
Herbicide Case study ....••.•...•.•.•........•.••..• 72
Field Stabilization & Treatment of Decontaminated
Patients .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72-74
The Stages of Decontamination .••....••••..........• 74-75
Protective Clothing ..•..•••......••..••••...•••..•. 76-78
Medical Monitoring & Documentation •.•..•••...•....• 78-80
Post Incident Considerations ••...•••..•.••..•••..•• 80
Annual Refresher Requirements & Course Summary .•••• 80-81
section D
Appendix:
Hazmat Glossary of Terms ....•....•....•.......... 83-95
References.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96-97
BLS Protocol. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98-99
Agencies For Special Assistance .••.•••...••..•••. 100-101
OFPC Hazmat Assistance Notification Form ••.•••..• 102
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New York State SECTION B
Department of Health
Emergency Sesslon#1
Objectives
Medical Introduction
Readiness
OSHAINFPA
ClassHication
Services & ldentHication
DOT Guidebook
Incident Command
HAZMAT AWARENESS
·"A Continuing Education Course for EMS Providers"
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NYS EMS-BAZMAT AWARENESS COURSE
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SESSION f 1
Objectives
Upon completion of this session, the student will be able to:
1.* Define "hazardous materials".
2.* Describe the risks associated when hazardous materials
are involved in an incident.
3.* Describe the potential outcomes associated with an
emergency created when hazardous materials are present.
4.* Describe the content of the 1989 OSHA Final Rule 29 CFR
Part 1910.120.
5. Discuss NFPA 472 Standard Professional Competence of
Responders to Hazardous Materials Incident and its
similarities to the OSHA regulations.
6. Discuss NFPA 473 (proposed) Standard for Competencies
for EMS Personnel Responding to Hazardous Materials
Incidents.
7. List methods of acquiring information about local hazmat
risks.
8.* Identify six sensory clues that might help the EMS
provider to reco9nize the presence of hazardous
materials in an incident.
9.* Describe methods of identifying hazardous mate~·ials.
10. Identify the function of a Material Safety Data Sheet.
11. State the function of CHEMTREC and CANUTEC.
12. List the components of pre-planning for hazmat
incidents.
13.* Describe the role of the first responder awareness
individual in the employer's (ambulance service)
emergency response plan including site security and
control and the U.S. D.O.T. Emergency Response
Guidebook.
14.* Describe when additional resources are needed at a
hazmat incident and how to make the appropriate
notifications to the communications center.
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*=OSHA competency
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HYS EMS-RAZKAT AWARENESS COURSE
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Your first question may very well be, "What is all this
concern about hazmat, we don't have a nuclear reactor or
chemical plant in the center of our town." Consider the
following cases:
1. Marine traffic on San Francisco Bay and aircraft above
were rerouted as a spill of 9,000 pounds of silicone
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NYS EMS-HAZKAT AWARENESS COURSE
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NYS BXS-BAZD'l' AftRBDSS COURSE
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NYS BMS-RAZMA'l' AWARENESS COURSE
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IIYS JUIS-DIDT A1'.ARBD88 COURSB
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HYS BIIS-BAZIIA'l' J\WARBNESS COURSB
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Ha.zmat Readiness
Now that you have reviewed the statistics and seen the
introductory videotape there are three key questions you must
ask yourself. Could a hazmat incident happen here in my
community? Would our emergency service providers be
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l!fYS BHS-BAZHA'l' AWARBHBSS COURSE
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Hazardous Materlils Pr•Plannlng
Survey Form
~ ~Poison9us
~f~~g:i1~ f ]if~~able Solids
5
Li8uids
Oxidizers & rganic Peroxides
& Etiologic [ ]R~dioactive Material
Corrosives [ ]Miscellaneous
STORAGE
Amount (Liters, Gallons, Barrels): - - - - - - - - - - -
Location and Storage: ________________
Segregated By:
Protected By:
-------------------
-------------------
REACTIVITY
[How· wi 1-1 this material react when ... ]
In Contact With: Explode Burn Give Off Toxic
Rapidly Heat Vapors
Water: '.
Heat: I !
•'
Air: l l I I
Ordinary Material: l . I
I
i I I I
I I
j
Oxidizing Material:
i
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-:l-0
Hazardous Materials Pre-Planning
Survey Form
TOXICITY
[Effect of material or vapors on the human body?]
~ ~
Toxic Nausea
Irritation of Skin Asphyxiation
Choking Headache
Irritation of Eyes and Nose ·
Tear Production [ ] Ch em i ca 1 Burn on Ski n
Other:
---------------------
PROTECTIVE CLOTHING REQUIREMENTS
[ ] SCBA [ ]Skin or Eye Protection [ ]Special Clothing
CONTROL INSTRUCTIONS
Fire:
-----------------------
spi l l or Le a k: -------------------
Cle an up:
----------------------
Ev acu at ion:
--------------------
D. O. T. EMERGENCY RESPONSE GUIDEBOOK INFORMATION
Chemical Name:
Chemical Number:
-------------------
------------------
Chemical GUIDE Number:
----------------
Isolation/Ev acu at ion Distance: - - - - - - - - - - - - -
Chemical Placard ID:
-----------------
CHEMTREC C 1-800-424-9300 l
24 Hour Hotline for Leak, Spill, Fire Exposure or
Accident
Be prepared to give the following information:
r . Name of Ca 11 er
[ .. Call Back Number
L. Carrier Name
L • Location of Problem
1 Local Weather Conditions
•
. Cons, gnee
1 Shipper or Manufacturer
. Rail Car or Truck Number
Container Type
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OSD competencies
Wherever OSHA rec,ulations are cited in this Student
Workbook. the regulation is listed verbatim. However to
better explain some of the complex parts of the regulations,
annotations have been added to the text which will appear in
brackets"[ ]". Please do not mix up the bracketed comments
with the actual regulation.
In addition, the term employer and employee are
frequently used throughout the OSHA regulations. For all
purposes the courts have determined that volunteer agencies
are employers and members of volunteer agencies are employees
regardless of whether they receive remuneration for their
services to the agency or community.
Paragraph Q - EMERGENCY RESPONSE TO HAZARDOUS SUBSTANCE
RELEASES
[ This paragraph covers employers whose employees are engaged
in emergency response no matter where it occurs. )
(6) Training. Training shall be based on the duties and
functions to be performed by each responder of an
emergency response organization. [ Where this should be
found is in the local emergency response plan which
clearly spells out the role of various agencies. It is
the role that the emergency response plan spells out for
your a~ency which helps to determine exactly what level
of training is needed for your personnel. For example,
if the ambulance service will be responsible for treating
and transporting patients in the cold zone that have
alread¥ been decontaminated the plan should say this. ]
The skill and knowledge levels required for all new
responders, those hired after the effective date of this
standard, shall be conveyed to them through training
before they are permitted to take part in actual
emer~ency operations on an incident. Employees who
participate, or are expected to participate, in emergency
response, shall be given training in accordance with the
following paragraphs:
(i) First responder awareness level. First responder
awareness level are individuals who are likely to
witness or discover a hazardous substance release and
who have been trained to initiate an emergency
response sequence by notifying the proper authorities
of the release. First responders at the awareness
level shall have sufficient experience to objectively
demonstrate competency in the following areas:
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llYS BHS-DZDT AWARDIBSS COURSB
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NYS BHS-IIAZHAT AWARENESS COURSE
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BYS BKS-DZD'r AWARBJfBSS COURSE
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llAIIIAT Classification, I4entification
container Shapes
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container.
An eliptical container with flat ends contains
nonpressurized liquid at atmospheric pressure such as
gasoline or fuel oil (DOT-406). Cylindrical containers with
somewhat rounded ends contain low pressure chemicals such as
flammables or poisons (DOT-407). A round container
surrounded with insulation to keep the contents warm will
have a flat bottom (DOT-407).
Tanks that are the smaller diameter usually carry
corrosive liquid which is heavier than water (DOT-412). A
material which is carried under high pressure such as
liquefied propane gas is carried in a cylindrical or
eliptical container with rounded ends (MC-331). This same
material if carried in a railcar would have a dome fitting
that is totally enclosed with a large cap. A specialized
tanker used to carry a cryogenic looks like the figure MC-338
below.
DOT-406
DOT-412
DOT-407
MC-331 MC338
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NFPAHAZARD
IDENTIFICATION SYSTEM
FLAMMABILITY
SIGNAL-RED
t
HEALTH
., REACTIVITY
SIGNAL SIGNAL
BLUE
/ YELLOW
t
RADIOACTIVE
or
•••
•w
WATER REACTIVE
RANGE
0= Low Risk
4= Very High Risk
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The specific information listed below describe the significance of the numbers
placed on the NFPA 704 placards.
Health (Blue Section)
In general, health hazard in firefighting is that of a single exposure which may vary
from a few seconds up to an hour. Tfle physical exertion demanded in firefighting
or other emergency conditions may be expected to intensify the effects of any
exposure. Only hazards arising out of an inherent property of the material are
considered. Tfle following expranations are based upon protective equipment
normally used by firefighters and not the typical EMS outerwear.
Health: Four
Materials too dangerous to health to expose firefighters. A few wiffs of this vapor
could cause deatn or the vapor or liquid could belatal on penetrating the
firefighters normal full protective clothing. The normal full protective clothing and
breathing apparatus available to the average fire department will not provide
adequate protection against inhalation or SK.in contact with these materials.
Health: Three
Materials extremely hazardous to health but areas may be entered with extreme
care. Full protective clothing, including self-contained breathing apparatus, coat,
pants, gloves, boots and bands arouna the legs, arms and waist should be
provided. No skin surface should be exposecf.
Health: Two
Materials hazardous to health, but areas may be entered freely with full-faced mask
self-contained breathing apparatus which provides eye protection.
Health: One
Materials only slightly hazardous to health. It may be desirable to wear self-
contained breathing apparatus.
Health: Zero
Materials which on exposure under fire conditions would offer no hazard beyond
that of ordinary combustible material.
Flammability (Red Section)
Susceptibility to burning is the basis for assigning degrees within this category.
The method of attacking the fire is influencea by this susceptibility factor.
Flammability: Four
Very flammable gases or very volatile flammable liquids. Shut off flow and keep
cooling water streams on exposed tanks or containers.
Flammability: Three
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Materials which can be ignited under almost all normal temperature conditions.
Water may be ineffective because of the low flash point.
Flammability: Two
Materials which must be moderately heated before ignition will occur. Water spray
may be used to extinguish the fire oecause the material can be cooled below its
flash point.
Flammability: One
Materials that must be preheated before ignition can occur. Water may cause
frothing if it gets below the surface of the liquid and turns to steam. However1
water fog gently applied to the surface will cause a frothing which will extinguish
the fire.
Flammability: Zero
Materials that will not burn.
Reactivity/Stability (Yellow Section)
The assignment of degrees in the reactivity category is based upon the
susceptiE>ility of materials to release energy either by themselves or in
combination with water. Fire exposure was one of the factors considered along
with conditions of shock and pressure.
Reactivity /Stability: Four
Materials which in themselves are readily capable of detonation or of explosive
decomposition or explosive reaction at normal temperatures and pressures.
Includes materials which are sensitive to mechanical or localized thermal shock. If
a chemical with this hazard rating is in an advanced or massive fire, the area should
be evacuated.
Reactivity/Stability: Three
Materials which in themselves are capable of detonation or of explosive ·
decomposition of explosive reaction which require a strong initiating source or
which must be heated under confinement before initiation. Includes materials
which are sensitive to thermal or mechanical shock at elevated temperature and
pressures or which react explosively with water without requiring heat or
confinement. Firefighting would be done from an explosive resistant location.
Reactivity /Stability: Two
Materials which in themselves are normally unstable and easily undergo violent
chemical change but do not detonate. Includes materials which can undergo
chemical change with rapid release of energy at normal temperatures and
pressure or which can undergo violent chemical change at elevated temperatures
and pressures. Also includes those materials which may react violently with water
or which may form potentially explosive mixtures with water. In advance or
massive fires, firefighting should be done from a safe distance or from a protected
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location.
Reactivity/Stability: One
Materials which in themselves are normally stable but which may become unstable
at elevated temperatures and pressures or which may react witti water with some
release of energy, but not violently. Caution must be used in approaching the fire
and applying water.
Reactivity/Stability: Zero
Materials which in themselves are normally stable even under fire exposure
conditions and which are not reactive with water. Normal firefighting procedures
may be used.
Now using what you have learned about the NFPA 704 ·
System how would you compare the two placards below if you
found them on the outside of two different industrial
facilities?
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SODIUM DIBENZOYL
PEROXIDE
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Labels
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PllLDUllability
Health (Toxicity)
Reactivity
1. Explosives.
2. Oxidizers - release oxygen when combined with other
material.
3. Corrosives - may release explosive hydrogen gas when
combined with certain metals e.g. hydrochloric and
sulfuric acids.
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Guidebook Exercise
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disposal.
First Aid
* Move victim to fresh air and call emer9ency medical care:
if not breathing, give artificial respiration; if
breathing is difficult, give oxygen.
* In case of contact with material, immediatel¥ flush skin
or eyes with running water for at least 15 minutes.
* Remove and isolate contaminated clothing and shoes at the
site.
* Keep victim quiet and maintain normal body temperature.
Exercise fl
Exercise t2
A man runs into your EMS station saying that his truck is in
the parking lot leaking a large quantity of chlorine. What
color index would you look the material name up in? What
Guide number would be used as a basis of response?
Use the space below for your notes on this substance:
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Exercise t3
Over the past few years the term incident command system
or ICS has become second nature to most emergency service
agencies throughout the United States. This section will
briefly describe the history of ICS, discuss the major
components and functional areas of ICS and the EMS role. To
sum it up in one phrase - great leaps forward have
traditionally followed multiple tragedies.
As a result of a series of devastating wildfires which
roared across Southern California, burning over 600,000 acres
and 772 structures, in the Fall of 1970, a task force was
formed to develo~ a mana9ement system which allowed multiple
agencies in multiple jurisdictions to work together with a
common goal of life safety and property conservation. The
task force which developed the original incident command
system consisted of representatives from the California
Department of Forestry and Fire Prevention through the U.S.
Forest Service and the Federal Emergency Management Agency
along with the California State Fire Marshal's Office, the
Office of Emergency Services and FIRESCOPE (Firefighting
Resources of California organized for Potential Emergencies).
Though originally developed for fire services, ICS can
be adapted to serve all emergency response disciplines. The
system consists of procedure for controlling personnel,
facilities, equipment and communications. It is desi9ned to
begin developing from the time an incident occurs until the
requirement for management and operations no longer exists.
The National curriculum Advisory Committee on res emergency
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appears below:
Paragraph Q - EMERGENCY RESPONSE TO HAZARDOUS SUBSTANCE
RELEASES
(6) (v) On Scene Incident Commander
Incident commanders, who will assume control of the incident
scene beyond the first responder awareness level, shall
receive at least 24 hours of training equal to the first
responder operations level and in addition have competency in
the following areas and the employer shall so certify:
(A) Know and be able to implement the employer's incident
command system.
( B) Know how to implement the employer's emergency response
plan.
(C) Know and understand the hazards and risks associated
with employees working in chemical protective clothing.
( D) Know how to implement the local emergency response plan.
( E) Know of the state emergency response plan and of the
Federal Regional Response Team.
( F) Know and understand the importance of decontamination
procedures.
Non-OSHA states are required under the Environmental
Protection Agency (EPA) rules to use an res at hazardous
materials incidents also.
In 1987 the NFPA developed Standard 1500, under the
committee chair of Chief Brunacini, which establishes a fire
department occupational safety and health program. This
standard clearly states that all departments should establish
written procedures for an incident command system. The
standard goes on to require that all members be trained in
res, that the responsibility for safety be specified for all
supervisory personnel, that a system for accountability of
all personnel at an incident be developed, that the safety
requirements be outlined by the Department, and that
sufficient supervisory personnel be provided to control the
position and function of all employees operating at the scene
of an incident.
In 1990 NFPA issued Standard 1561 which defines fire
department emer~ency management systems. This standard
provides guidelines for what should be included in an
emergency management s¥stem. It emphasizes the importance of
agencies and jurisdictions that may work together in
emergency operations having a common emergency management
system.
Many states have dealt with this renewed interest in the
incident command system by developing training programs for
police, fire and EMS personnel to work together at large
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New York State SECTION C
Department of Health
Emergency Sesslon#2
Objectives
HAZMAT AWARENESS
·~ Continuing Education Course for EMS Providers"
ss
NYS EMS-HAZMAT AWARENESS COURSE
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SESSION f 2
--------------------------------------------~---------------
The Right to Know Law 30 min.
Herbicide Case Study 25 min.
Break 10 min.
Field Stabilization & Treatment of
Decontaminated Patients 40 min.
Break 10 min.
The Stages of Decontamination 15 min.
Medical Monitoring & Documentation 10 min.
Post Incident Considerations 10 min.
Annual Refresher Requirements & Summary 15 min.
PostQuiz & Course Evaluation 15 min.
Objectives
Upon completion of this session, the student will be able to:
23. Discuss the OSHA Hazardous Communication Standard
requirements and the steps your employer has taken to
compl~ with the right to know provisions.
24. Explain how to read and interpret the information
provided on container labels and MSDSs.
25. List operations in the ambulance service work area where
hazardous chemicals are used, stored or produced.
26. Discuss the MSDS for each product identified in
objective 25.
27. Ex~lain the proper use of protective equipment for the
daily contact with materials identified in objective 25
and explain when it is appropriate to call other
resources to manage a hazardous substance.
28. List steps in the general approach for the care of
hazmat victims.
29. Cite chemicals that require special handling.
30. Identif~ personnel that need to be medically assessed at
hazmat incidents.
31. Describe on-scene treatment of hazmat patients.
32. Explain the reason for designating receiving facilities
in hazmat situations.
33 • Describe the components of a medical surveillance
program.
34. Describe the medical monitoring of hazmat personnel.
35. Name complications from being in an encapsulated suit.
36. Describe the importance of communication and observation
of team members.
37. Define the rescuer's role as related to documentation.
38. Describe the refresher requirements of the OSHA
training.
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IDUfflTY(AII IJNdMUIIIIIUIII Lill)
J•anni•' • M&CJiC: Cl•an•~
Section I
illlonnlliallil ......... -~----·inlliallltlfllll.
llilole: 8llnlr . . - - - ,.,,,,,.,_, • .,, . . . . . . . . . . . . flt flO
Section I must indicate the product name as it appears on the container label; the name,
address and telephone number of the manufacturer; emergency telephone number; and the
date the MSDS was prepared or last revised. An MSDS may include the signature of the
preparer and additional product identifiers such as chemical class, commonly used trade
names, and chemical synonyms.
The MSDS must list commonly accepted chemical names and established exposure
limits for:
Exposure limits are estimates of the maximum amount of a substance in air that most
workers can breathe regularly without experiencing adverse health effects. Limits arc
usually expressed as parts per million (ppm) or milligrams per cubic meter (mg/m3). The
lower the limit. the more hazardous the substance. There are three types of exposure limits:
64
Section 111- Physical/Chemlcal Charecteristlcs
Boi1ngP0tnt 133°F Spaciic: Gravnr (~ 0 • 1J
C56"C! al 60"F t20"CI 0.19
Vapor Pt.....,1'11 (mm Hg) ld&ftl'IQ P01m -70.6",
at ill"F (20" C! 110 !Ml liq C-95"Cl
Vapor 0ensrty (AIR• 1) Evapot111,an Ra!•
2.0 (8uly!Alcelal8•1) 7.7
Solubil!ly 1n Waler
Completely mi1cibl•
Appearance and Odor
Clear liquid llifit.h aff'4'1\0nia-lilt• odor
Boiling Point is the temperature at which a substance changes from a liquid to a gas.
The most obvious example is water heated until it becomes steam. Flammable materials
with low boiling points may present a special fire hazard. The boiling point of gasoline is
100°F.
Vapor Pressure is an indication of how quickly a substance will evaporate. Most vapor
pressures are reponed in millimeters of mercury (mm Hg) at room temperature (usually
68°F or 20°C) to allow comparisons between materials. Substances with vapor pressures
above 20 mm Hg may present a hazard, particularly in enclosed areas with poor ventilation.
Melting Point is the temperature at which a substance changes from a solid to a liquid.
The most common example is ice melting to form water at 32°F.
Vapor Density is the comparison of the weight of the vapor given off by a substance to
air. Vapors heavier than air (greater than 1.0) will fall to the ground and spread, concentrating
in low or enclosed areas. Vapors that are lighter than air (less than 1.0) will rise in air and
tend to dissipate, unless they are confined. The vapor densities of the products being used
should be considered in the design and operation of workplace ventilation systems.
Flammable vapors that are heavier than air can spread to sources of ignition and flash back
to the source. ·
Evaporation Rate is the rate at which a substance evaporates compared to butyl acetate
(designated as 1.0). Evaporation rates greater than 3 (acetone, 5.6) are considered fast; rates
between 0.8 and 3 (ethyl alcohol, 1.4) are moderate; and rates below 0.8 (water, 0.3) are
slow. Evaporation rates are a better indicator of potential inhalation hazards than vapor
pressures.
65
Solublllty In Water is a term indicating the percent by weight of a substance that can be
dissolved in water. Solubility is expressed as:
Appearance and Odor should accurately describe the product including color, physical
state (powder, liquid, gas) and odor. ff the description does not match, the product may
have decomposed, become contaminated or been mislabeled.
This section provides information and recommendations for fighting fires concerning
substances that will bum or contribute to the burning of other materials. The fact 'mat a
product does not pose a fire or explosive hazard should also be noted in this section.
Flash Point is the lowest temperature at which a flammable liquid gives off enough
vapor to ignite in air. The lower the flash point, the greater the danger of combustion. A
material should not be stored or handled at temperatures above its flash point without
special precautions.
Flammable Limits indicate the range of percentages of a substance in air that will burn.
Below the lower limit there is not enough substance (or fuel). Above the upper limit there is
not enough air.
Extinguishing Media lists any method that should be used in the event of a fire.
Options are usually water, foam or dry chemical extinguishers designed for specific types
of fire: Class A - combustibles {e.g., wood); Class B - flammables {e.g., gasoline);
Class C - electrical; and Class D - metal and metal alloys.
Unusual Fire and Explosion Hazards are any properties of a product that affect fire
fighting effons. Water, for example, should not be used on fires involving concentrated
corrosives, calcium carbide or reactive metals such as sodium.
Many substances will change, sometimes violently, when mixed with other materials or
when exposed to physical conditions such as moisture, heat or sunlight. This section
indicates whether a product has special storage requirements.
Incompatibility identifies materials known to react chemically with the product. Toxic
fumes or other hazardous chemicals may be released or fire hazards created by chemical
reaction. Materials listed here should be stored separately.
67
dllliD••!, n•uut, iDS99£diMtion, 1111 Pf 1 M!Sb, fl:ftliDIII t 11d NY r11Mlt in set IDbtltSiPD If ln
cancntradon• over a lon9 period My caun irdudon of ti,. rHP1rat.ory 'tract, coul)bift9 and uadadl•.
Skln-prolon9ecl or repoat•d contact MY cauH dry1nq of okin, r - a a . irritation and J.ncr••- doll of
Iniectlon. Vapors NJ eau1• aye irritation. ln.. ,t~on .,.Yea.Ya• lrrlt~tlon of th• Gi ~ract.
NTP?
No
MedcalCondiliOM
O-alyAggra¥111adbyE1pOSUn1 Penons with liver or kidney diauH ahould chack with their physician before
Erneigonc:y and Firsr A,,11 Pl'OCtldUNIS ty•• - fluth with water for IS llinutea. Skin - r••ovo contall111&tod clothint,
fli&Sh ti1ith pl•nt.y pf water. lnh&lf\iOn - r.-OVe t.O fresh air, giv• OAY91!'.! 01' lrt.ffiCifl refpiQ\iOftc if
nece,,ary. lnte•tion - ••ell IU<lical attention or contact nearest poison control enter. ln all.,. ..,, •••k
Mdlcal atunUon. if necesury.
The health hazards presented by a specific product depend on the chemical and physical
propenies of the product components and the manner in which if is used. When used
properly, even highly toxic substances present little risk. When used improperly, even
substances with very low toxicities can be dangerous. This section describes the ways in
which the product can enter the body, adverse health effects, symptoms of exposure and
what to do in an emergency.
Route(s) of Entry
Chemicals can enter the body through the lungs by inhalation, through the skin or eyes
by direct contact or elevated airborne concentrations and through the mouth by ingestion.
An MSDS should indicate what routes of entty may contribute to exposure.
Health Hazards
This section lists all adverse health effects known or expected to occur as a result of
overexposure to the product or its components. The description of health hazards must
include the specific parts of the body that can be affected (lungs, nervous system, skin, etc.).
Exposure hazards are classified in two ways:
Acute health hazards are the effects of brief exposures to a substance, usually as a result
of an accident, leak or spill. The resulting effects usually appear quickly. Many acute
effects are reversible and will disappear soon after exposure stops. However, depending
on the substance and the level of exposure, the effects of acute exposures can vary
greatly in severity from minor irritation to death.
Chronic health hazards are the effects of repeated exposures to a substance. The effects
of chronic exposures develop over a long period of time and are usually not reversible.
Lung disease resulting from prolonged exposure to dusts and adverse reproductive
effects are examples of chronic health hazards.
Carcinogenicity
Product components determined to be carcinogens (cancer-causing) by OSHA, the
National Toxicology Program (NTP) or the International Agency for Research on Cancer
(IARC) must be identified. On some MSDS's, this information may be included under
Section II - Hazardous Ingredients.
69
Medical Conditions Aggravated by Exposure
Chemical exposures can make an existing health problem worse. For example. the
effect of carbon monoxide or carbon dioxide on the heart can be dangerous for individuals
with heart conditions. Some health problems can interfere with the body's ability to deal
with chemical exposures. Individuals with diseases of the liver or kidneys may be more
sensitive to organic solvents.
Precaunonst0BeTaMn1n~andlingandStonng Stor•qe ~u·•• shoul'CS be cool ano vel.: ventil•ted aw.ay from he.at,
oxidizinq aqe~~s and direct sunliqnt, Containers snould DP kcrt tiqhtly Closed •nd kept free froffl d•m•qe.
£iectrlcai o~tlets snould be cxp~osior. proof.
01ne, Precauuons
Waste Disposal Method often states simply that the material should be disposed of
according to city, state and federal regulations. Available methods can vary from location
to location and may depend on what cleanup procedures are used. Many materials can be
disposed of with normal trash if they are properly treated. Other materials must be specially
packaged and treated as hazardous waste.
Precautions to Be Taken in Handling and Storing describes how the product should
be used or stored considering the information found under Section V - Reactivity.
10
Other Precautions include any special training or equipment necessary to use the
product in a safe manner.
Yu Exclosion-proof ventilation
Mechancal /Gent,ra/J
Yu
Pn:IIIICIIYll Gloves
.Butyl rubber or natural rubber
I Eye Pr01ea,on
Safety qlaues
Olher Pr018C1NB Clothing or Equ~meotSoots, apro:ir face shield and respirator ,u:y ~ necessary to prevent e•po2ure ~
Slnlts, shower, and eye"'esh ttation.t should Q:e readily available,
Won<!Hyg-lC P,acr,ces
Launder contaminated clothing be!Ot.'11! reuse.
Respiratory Protection should identify respirators approved for use with the product
or its components. Depending on exposure levels, several options may be given. Generally,
exposures should be controlled through ventilation and engineering controls. If respirators
are used, employees must be trained in proper respirator use and maintenance.
Ventilation will indicate whether normal room ventilation is sufficient in a work area or
that additional engineering controls may be required including local exhaust fans, fume
hoods or enclosed systems. Work area ventilation should be evaluated by an industrial
hygienist to determine what modifications or changes in work practices are necessary.
Protective Gloves should identify specific materials (butyl rubber, nitrite, PVC, etc.)
recommended for use with the product and its components. Simply specifying "impervious
gloves" is not enough. Chemicals can pass through or dissolve the wrong type of glove and
may make skin exposures worse by keeping the chemical in contact with the skin.
Eye Protection should be worn whenever a splash hazard exists. Safety glasses,
chemical goggles or face shields may be indicated.
Other Protective Clothing or Equipment may include· such items as eye wash
stations, splash-proof aprons or boots and temperature resistant gloves.
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Control as needed.
9. Transport of patients and team members for definitive
care as is necessary.
The role of the EMT with only EMS Hazmat Awareness
training is in the cold zone. EMTs in the warm zone will
require additional training above the awareness level.
SAMPLE
DECONTAMINATION CORRIDOR
.J-
0 Equipment Drop
...
... ~ Gross Decontamination
Hot Zone • \..:..J
I============+;::::=:====~====~
Warm Zone /.::-...
/ 5 '- ,,,(J) Protective Clot1ing Removal
*Medical Redress .,,, .,,, .J-
Monitoring .,,,
of Vital Signs ~ © SCBA Removal
by EMT in Tank Change .J-
Protective
Clothing @ Personal Clothing Removal
...
© Body Washing
...
(]) Dry Off & Dress in Scrubs
Warm Zone
Cold Zone
Medical Monitoring:
Assessment of Patients
· & Post-Suit Exam
Transport For Definitive Care
(As Needed}
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Level B
Level B protection should be worn when the highest level
of respiratory protection is needed but a lesser level of
skin and eye protection. Level B protection is the minimum
level recommended on initial site entries until the hazards
have been further identified and defined by monitoring,
sampling and other reliable methods of analysis. Level B PPE
includes the following:
1. Positive-pressure (pressure demand), self-contained
breathing apparatus (SCBA).
2. Chemical resistant clothing (overalls and long-
sleeved jacket, coveralls, hooded two piece chemical
splash suit, disposable chemical resistant coveralls).
3. Gloves, inner, chemical resistant.
4. Gloves, outer, chemical resistant.
5. Boots, chemical resistant, steel toe and shank.
6. Two-way radio communications (intrinsically safe).
7. Hardhat (under suit).
Level C
Level C protection should be selected when the type of
airborne substance is known, the concentration has been
measured, criteria for respiratory protection are met and
skin and eye exposure are unlikely. Periodic monitoring of
the air must be performed. Level C is commonly found at work
sites as routine protection being worn. It is rarely
appropriate during a hazardous materials incident. Level C
PPE includes the following:
1. Positive-pressure (pressure demand), self-contained
breathing apparatus (SCBA).
2. Chemical resistant clothing (one piece coverall,
hooded two piece chemical splash suit, chemical resistant
hood and apron, disposable chemical resistant coveralls).
3. Gloves, outer, chemical resistant.
4. Boots, inner, chemical resistant, steel toe and shank.
5. Two-way radio communications (intrinsically safe).
6. Hardhat (under suit).
The chart on the next page is a good illustration of why
different chemicals require different protective suits to be
worn.
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New York State SECTION D
Department of Health
Emergency Appendix:
Glossary
Medical References
BLS Protocol
Agencies for
Special Assistance
Services
Program
HAZMAT AWARENESS
·~ Continuing Educati.on Course for EMS Providers"
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changes.
Decontamination - the process of removing or neutralizing
contaminants from personnel or equipment.
Degradation - the loss in beneficial properties caused by
exposing gloves, protective clothing, and other elastomeric
samples to various liquid chemicals.
Diking - application of a barrier which ~revents passage of a
hazardous material to an area where it will produce more
harm.
Dilution - the use of water to flush a hazardous material
from protective clothing and equipment.
Direct acting chemicals - chemicals that are able to cause
harm without first being transformed or changed.
Direct readini instruments - a portable device that measures
and displays in a short time period, the concentration of a
contaminant in the environment.
Director - ICS title for individuals responsible for command
of a branch.
Dispatch Center - a facilit¥ from which resources are
directly assigned to an incident.
Dispatch - the implementation of a command decision to move a
resource or resources from one place to another.
Diversion - controlled movement of a hazardous material to an
area where it will produce less harm.
Division - that organizational level having responsibility
for o~erations within a defined geographical area. The
division level is organizational between the single resource,
task force or strike team and the branch.
DOT - the Department of Transportation, the federal agency
which regulates the transportation of hazardous materials
also publishes aids for emergency response.
DOT Hazard Classification - the hazard class designations for
specific hazardous materials as found in DOT regulation.
DOT Emergency Response Guidebook - Department of
Transportation reference book which lists hazardous materials
and indicates health hazards and emergency actions.
Downwind - in the direction in which the wind is blowing,
unsafe in a hazardous materials incident.
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Appendix: References
The following sources provide information on the topics in
this course:
American Academr of orthopedic Surgeons, 1991, Emergency~
and Transportation of the Sick and Injured. Fifth Edition,
Park Ridge, Illinois, AAOS.
American Academy of Orthopedic Surgeons, 1990, Basic Rescue
and Emergency care. First Edition, Park Ridge, IL, AAOS.
Borak, J., et al., 1991, Hazardous Materials Exposure
Emergency Response and Patient Care. Englewood Cliffs, NJ,
Prentice Hall, Inc.
Bronstein, A., currance, P., 1988, Emergency Care for
Hazardous Materials Exposure. st. Louis, MI, c.v. Mosby Co.
Caroline, N., 1991, Emergency Care in the Streets. Fourth
Edition, Boston, MA, Little, Brown and Co.
Emergency Handling of Hazardous Materials in Surface
Transportation, Washington, DC, Association of American
Railroads, 1981.
Emergency Response Guidebook, Washington, DC, US Department
of Transportation.
Grant, H., Murray, R., Bergeron, J., 1990, Emergency Care.
Fifth Edition, Englewood Cliffs, NJ, Prentice Hall, Inc.
Hafen, B., Karren, K., 1992, Prehospital Emergency Care and
Crisis Intervention. Fourth Edition, Englewood, co, Morton
Publishing Co.
Lefevre, M.J., First Aid Manual for Chemical Accidents. Van
Nostrand Reinhold, New York, NY 1980.
Lockert, E., et al, 1991, Emergency Medical Update, Volume 4,
Number 9, & Volume 5 Number 2, Lockart-Jackson Associates,
Winslow, WA.
Martin, H.F., ed., 1989, Hazardous Materials Response
Handbook. First Edition, Quincy, MA, National Fire Protection
Association.
Meyer, E., Chemistry of Hazardous Materials, Brady Books,
Englewood Cliffs, NJ, 1989.
Morgan, D.P., Recognition and Management of Pesticide
Poisonings. Washington, DC, US Environmental Protection
Agency, 1989.
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BASIC LIFE SUPPOR.T PROTOCOL:
'.,Jl:~lrfJflilTfiti~,
Notify yolD' dispatcher to comact all Pre-Planned appropriate emergency agencies of the chemical
release. Local Fue Depanmcm. Haz-Mal. Team. Police Depanmcm. and Local Hospira! Triage Teams.
CAUTION!
TAKE PRECAUTIONS NOT TO CONTAMINATE SELF OR OTHERS
90
BASIC LIFE SUPPORT PRarocoL:
I I AIRWAY MANAGEMENT ~
Administer high flow oxygen to all patients who present signs of breathing difficulties (even patients
with known C.O.P.D.), especially those victims involved in a fire related incident (respiratory bums).
IF CHEMICAL IS A LIQUID ~
The patient you receive in your SAFE Z.ONE should be DECONTAMINA1ED. Always check to make
sure. There should be no contaminated clodling or jewelry on lhe victim. Flush the decontaminaled areas
with copious amoums of water.
Any patient you receive should again be DECONTAMINATED. If small amounts of a powdery substance
arc still present. BE CAREFUL not to spread it over unaffecled areas. Flush skin with copious amounts of
water.
Irrigate the eyc(s) with copius amounts of wau:r or saline solution continuously. Make sure the patient
blinks during irrigation.
CAUTION:
DO NOT CONTAMINATE THE UNINJURED EYE WITH THE
RUN OFF IRRIGATION FLUIDS FROM mE CONTAMINATED EYE.
1. Treat the patient ror shock (refer to ~ shock Protocol - Page 37)/
l. Cover· all burns with· dry sterile (if poai"ble) sheets or burn .pack; •··•···.•· .•. . .. . ...•
. ) ..•. \DO NOT PUNCl1JRE<UNBROK.EN SECOND DEGREEBURN.'BLISTERS! ..··· /t i <
3~·0btain' and record aJl.vitalsipsncf repeattbe~lood preaur~·proce.cJure OD Opposite arm While····
: enroute. Take all vital sigm as often ..s necmarJ.
Make sure you fill nut the Pre-Hospital Care ·
at
.'Report Form{before :you arrive Hie hospital y':, . . · •· · . . . ·. . { \t) •.·.·. .
4. Transport patient in a wana. mriron:mmt.This is important .sincf borD patients tend to lose body
beat and become bypothmnic. ·
)r~!tUL:;:·:~-·:::
New Ymt State Basic Life Suppon Protocol
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Note:
Most State agencies have field offices in various areas
throughout the State. The telephone numbers of those offices
should be included in the local Hazardous Materials Emergency
Plan.
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N.Y.S. DEPT. OF STATE - OFFICE OF FIRE PREVENTION & CONTROL
HAZARDOUS MATERIALS TECHNICAL ASSISTANCE
24 HR. HOTLINE -1-518-474-6746
EMERGENCY NOTIFICATION INFORMATION
• Tell the operator you are .requesting Hazardous Mate~iaJs assistance. Be prepared before you call
to give the following infonnation: