Download I - Distance Learning

MASTER TEACHING NOTES
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Detailed Lesson Plan
Chapter 43
Hazardous Materials
90–120 minutes
Case Study Discussion
Teaching Tips
Discussion Questions
Class Activities
Media Links
Knowledge Application
Critical Thinking Discussion
Chapter 43 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
I.
5
6
Master Teaching Notes
Introduction
Case Study Discussion
A. During this lesson, students will learn about special considerations related to
hazardous materials emergencies.
B. Case Study
1. Present The Dispatch and Upon Arrival information from the chapter.
2. Discuss with students how they would proceed.
II. Identifying Hazardous Materials—What Is a Hazardous Material?
A. Poses a threat or unreasonable risk to life, health, or property if not properly
controlled at all times
B. Includes chemicals, wastes, and other dangerous products
C. Poses risks of toxicity, flammability, and reactivity
D. TRACEM: Thermal, Radiological, Asphyxiation, Chemical, Etiological, and
Mechanical damage
1. Asphyxiation
2. Skin irritation
3. Increase of risk of cancer
4. Poisoning of liver or nerves
5. Loss of coordination
6. Altered mental status
7. Burns
8. Respiratory distress
9. Nausea and vomiting
10. Tingling or numbness in the extremities
11. Blurred or double vision
E. Can cause widespread destruction and loss of life
F. Safety of EMT, patient, and public is primary concern.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 43
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How would you determine whether any
hazardous materials were involved in
the incident?
 What will your role be in a situation
involving hazardous materials?
Discussion Question
What are some locations in your community
that use or store hazardous materials?
Knowledge Application
Students should be able to apply the
knowledge in this section to the
identification of hazardous materials.
PAGE 1
Chapter 43 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
9
3
Content Outline
Master Teaching Notes
III. Identifying Hazardous Materials—Placards and Shipping Papers
A. U.S. Department of Transportation (DOT) requirements
1. All vehicles containing hazardous materials must be marked with hazard
labels or placards.
2. Drivers of such vehicles should carry shipping papers identifying the
substance, quantity, origin, and destination.
B. Placards
1. Four-sided, diamond-shaped sign
2. Contains important information that can aid EMT
3. Four-digit U.N. identification number
4. Color of placard indicates class of hazard in vehicle.
5. Legend on placard indicates whether flammable, radioactive, explosive,
or poisonous.
6. National Fire Protection Association—NFPA 704 system
a. Placard divided into four smaller diamonds
b. Background colors and numbers of smaller diamonds
i. Blue: health hazard
ii. Red: fire hazard
iii. Yellow: reactivity hazard
iv. White: symbols that give additional information
v. Numbers zero through four indicate level of risk, with zero being
lowest.
C. Shipping papers
1. Name of substance, classification (such as flammable or explosive), and
four-digit U.N. ID number
2. Required by law to be carried
a. In cab of motor vehicle
b. By train crew member in engine or caboose
c. In holder on bridge of water vessel
d. By aircraft pilot
Class Activity
Have students write down the information
from three different DOT placards and bring
them to the next class for identification.
IV. Identifying Hazardous Materials—Using Your Senses
A. You may see clues on the scene.
1. Smoking or self-igniting materials
2. Extraordinary fire conditions
3. Boiling or spattering of materials that have not been heated
4. Wavy or oddly-colored vapor over a container of liquid
5. Characteristically-colored vapor clouds
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 43
PAGE 2
Chapter 43 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
6. Frost near a container leak (indicates liquid coolant)
7. Unusual condition of containers (peeling, discoloration of finish,
deterioration, deformity, unexpected operation of pressure-relief valves)
B. You may not be able to see or smell the presence of hazardous materials;
many are odorless and colorless.
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V. Identifying Hazardous Materials—Resources
A. Printed materials—Emergency Response Guidebook
1. Published by U.S. Department of Transportation, Transport Canada, and
Secretariat of Communications and Transportation of Mexico
2. Updated every four years
3. Compact enough to carry with your gear
4. Lists more than 1,000 hazardous materials with U.N. four-digit ID
numbers
5. U.N. ID numbers cross-referenced to complete emergency instructions.
6. Available in print, electronically, and in handheld PDAs
B. Chemical Manufacturer’s Association—Chemical Transportation Emergency
Center (CHEMTREC)
1. Can answer any questions on how to handle any emergency materials
2. Will locate shipper of materials for follow-up
3. 24/7 operators at 1-800-424-9300
C. Chemtel, Inc. at 1-800-255-3924 (US and Canada) or 1-813-979-0626
(outside US and Canada)
D. State and local agencies including specialized “hazmat” teams and regional
poison control center
E. Information to provide when calling an organization
1. Your name, call-back number, and fax number
2. Nature and location of product
3. U.N. ID number or name of product
4. Name of carrier, shipper, manufacturer, consignee, and point of origin
5. Type of container and size (rail, truck, housed open)
6. Quantity of material
7. Local weather conditions
8. Number of injuries and/or exposures
9. Emergency services that are present or responding
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 43
Teaching Tip
Provide examples of Emergency Response
Guidebooks and material safety data
sheets.
Critical Thinking Discussion
If you needed to find a material safety data
sheet at your place of employment, where
would you look, or whom would you ask?
Weblinks
Go to www.bradybooks.com and click on
the mykit link for Prehospital Emergency
Care, 9th edition to access web resources
on the Emergency Response Guidebook,
CHEMTREC, and FEMA information about
hazardous materials.
PAGE 3
Chapter 43 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
3
10
Content Outline
Master Teaching Notes
VI. Identifying Hazardous Materials—Training Required by Law
A. First Responder Awareness
1. Those likely to witness or discover a hazardous materials emergency
2. Trained to recognize a problem but not to take action
3. Call for proper resources and prevent others from entering the scene
4. Required for all operating EMTs
B. First Responder Operations
1. Those who initially respond to emergencies in order to protect people
and property
2. Trained to use specialized personal protective equipment
3. Trained to help contain the emergency
C. Hazardous materials technician plugs, patches, or stops release of
hazardous material.
D. Hazardous materials specialist provides command and supports activities at
site of emergency.
E. National Fire Protection Association Standard #473 deals with competencies
for EWMS personnel at hazardous materials emergencies
Teaching Tip
VII. Guidelines for Hazardous Materials Rescues—General Rules
A. Never attempt a rescue unless you have had the necessary special training;
instead, radio immediately for help.
B. Keep yourself and bystanders upwind, uphill, upstream, and away from the
danger.
C. Avoid contact with any unidentified material.
D. Avoid risking your own life or health if there are no human victims.
E. At First Responder Awareness level, remember the acronym RAIN.
1. R—Recognize that a hazardous materials incident has occurred.
2. A—Avoid contact with the hazardous substance.
3. I—Isolate the area.
4. N—Notify the appropriate authorities or response agencies.
5. Cordon off the area and evacuate bystanders.
6. Use your best judgment to determine if the risk to the rescuers is
justified by the possibility of saving lives and consider the following.
a. Difficulty of the rescue
b. Flammability of the materials
c. Possibility of explosion
d. Time/distance constraints
e. Available escape routes
Teaching Tip
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 43
Provide details on the level of training
required for EMS providers in your state.
Weblink
Go to www.bradybooks.com and click on
the mykit link for Prehospital Emergency
Care, 9th edition to access the U.S. Fire
Administration site on hazardous materials.
Discuss local policy and procedure for
response to hazardous materials incidents.
Discussion Question
What actions should you take to isolate the
area of a hazardous materials incident?
PAGE 4
Chapter 43 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
f. Probability of victim survival
F. If you decide to begin rescue operations and have the necessary level of
training
1. Act quickly.
2. Secure the scene and limit exposure of rescuers and bystanders.
3. Make sure you have the equipment and personnel to handle the
emergency.
4. Make sure that everyone has adequate protective equipment.
a. Positive-pressure self-contained breathing apparatus (SCBA)
b. Full suit of chemical-protective clothing; all gaps or openings sealed
with wide duct tape
c. At least two layers of gloves
d. Boots
e. Helmet
f. Eye protection
g. Lifelines
5. Do not allow anyone who is not trained to the First Responder
Operations level or higher to enter the scene.
VIII. Guidelines for Hazardous Materials Rescues—Incident
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Management
Weblink
A. Preincident planning
1. Appoint a command officer to be responsible for all rescue decisions.
2. Establish a clear chain of command between officer and rescuers.
3. Establish a system of communications.
a. Accessible to all rescuers
b. All rescuers able to use
4. Designate receiving facilities.
a. Capacity for large number of patients
b. Capable of surgery
c. Have established decontamination procedures.
B. Implementing the plan
1. Establish an incident command system and a command post.
a. Nature of the problem
b. Identification of hazardous material(s) involved
c. Type and condition of containers
d. Existing weather conditions
e. Presence of fire
Go to www.bradybooks.com and click on
the mykit link for Prehospital Emergency
Care, 9th edition to access a web resource
on managing acute chemical exposures.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 43
Discussion Question
What information do you need to implement
a hazardous materials response plan?
PAGE 5
Chapter 43 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
f. Time elapsed since emergency occurred
g. What has already been done at the scene
h. Number of victims
i. Danger of victimizing more people
2. Be aware that even if there is no fire, smoke from hazardous materials
spreads toxins and particles through the air.
3. Only trained firefighters should attempt to extinguish fires.
C. Establishing safety zones
1. Hot zone—Contamination is actually present.
a. Area immediately adjacent to accident site
b. Single point for entrance/exit of all rescue personnel
c. Designated emergency exit
d. No smoking, eating, drinking (risk of ingesting hazardous material)
e. Restricted to trained rescuers
f. Hazard analysis, control of hazard or release, and rescue by trained
personnel wearing appropriate protective equipment
2. Warm zone (contamination reduction zone)—Immediately adjacent to
hot zone
a. Appropriate protective gear
b. Life-saving emergency care (airway management, immobilization)
c. Initial decontamination
3. Cold zone—Immediately adjacent to warm zone
a. Remove contaminated protective gear before entering.
b. Decontaminate patients as fully as possible before bringing them in.
c. Continue emergency care.
d. Triage patients to determine the order of care.
e. Perform necessary treatment and stabilize patients prior to
transport.
Discussion Question
What activities should occur in the hot,
warm, and cold zones?
IX. Guidelines for Hazardous Materials Rescues—Emergency
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Procedures
A. Anyone entering hot or warm zone must be properly trained and wearing
appropriate protective equipment.
B. Perform initial decontamination at the entry to the warm zone.
C. Perform primary assessment of victims in the warm zone; complete
decontamination and assess patient condition.
D. Treat major injuries, immobilize/splint as needed, and move patient to cold
zone.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 43
PAGE 6
Chapter 43 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
E. Remove all protective equipment before entering cold zone.
F. In cold zone, take patient’s vital signs and history and prepare him for
transport.
G. Cover exposed areas of your vehicle with thick plastic sheeting, secured with
duct tape.
H. Leave all clothing and equipment at scene if used/worn in hot or warm zones
for proper containment for decontamination/disposal.
I. Trained rescuers must decontaminate any corpses before transporting to
morgue.
J. If exposed to hazardous materials
1. Wash skin with mild detergent or green soap and plenty of running
water.
2. Irrigate skin for at least 20 minutes (longer if there is still discomfort).
3. Seek medical attention.
4. Report what happened to your employer.
K. Seek medical help if, in hours or days after incident, you develop the
following.
1. Headache
2. Nausea or vomiting
3. Abdominal cramps/diarrhea
4. Difficulty breathing
5. Dizziness
6. Lack of coordination
7. Blurred vision
8. Excessive salivation
9. Irritation of eyes, nose, throat, or respiratory tract
L. Decontaminate equipment and vehicle by washing thoroughly inside and
out.
M. Do not take your personal clothing home to launder since it may contaminate
your home and the sewer system.
X. Guidelines for Hazardous Materials Rescues—Radiation
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Emergencies
A. Exposure and contamination
1. Exposure
a. Patient is in presence of radioactive material.
b. Radioactive material has not touched his clothing or body.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 43
Discussion Question
What are exposure and contamination with
respect to radiation accidents?
Critical Thinking Discussion
How can you find out what potential
PAGE 7
Chapter 43 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
c. Exposure may harm patient but does not render him radioactive nor
make him a source of contamination to others.
2. Contamination
a. Patient has come into direct contact with source of radioactivity or
with radioactive materials.
b. Radioactive material is present on patient’s clothing or skin.
c. Contaminated patient is a source of contamination and a risk to
others.
B. Guidelines for radiation emergencies
1. Your first priority is to protect yourself and others from contamination.
2. No EMT should ever attempt to decontaminate a radiation patient.
3. Wait for a radiation safety officer (RSO).
4. If no RSO is available to come to the site, transport the patient to the
hospital.
a. Place the patient in a body bag up to the neck.
b. Cover his hair completely with a cap or towel.
c. Use disposable wipes to clean his face.
d. Put used wipes in a plastic bag, seal it, and take it with you for
disposal.
5. Time is the critical factor in managing radiation emergencies.
a. Trained personnel should remove the patient from the source of
radiation as quickly as possible.
b. Increase the distance between yourself and the radiation source.
c. If necessary, shield yourself and the patient from the radiation
source.
i. For alpha rays—Clothing shield
ii. For beta rays—Aluminum or similar shield
iii. For gamma rays—Lead shield
C. Procedures for radiation emergencies
1. Priorities (in order of importance)
a. Protect the safety of all rescuers and victims.
b. Provide patient care.
c. Decontaminate clothing, equipment, and rescue vehicle.
2. Scene safety
a. Survey the area visually for radiation symbol on vehicles, machinery,
and containers.
b. Determine the location of the radiation source.
c. Be alert for the presence of other hazardous materials.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 43
sources of radiation are in your community?
Weblink
Go to www.bradybooks.com and click on
the mykit link for Prehospital Emergency
Care, 9th edition to access information from
the CDC about radiation emergencies.
Discussion Question
What procedures should you follow when
responding to a radiation accident scene?
PAGE 8
Chapter 43 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
d. Park your vehicle
i. Upwind of the incident
ii. Away from any liquid spills and any leaking vehicles
iii. Away from any cracked or damaged containers
e. Put on positive-pressure self-contained breathing apparatus and
protective clothing.
3. Personal protection
a. Time—The less time spent near the radiation source, the less
exposure to radiation.
b. Distance—The greater the distance from the radiation source, the
lower the dose.
c. Shielding—The denser the shield, the greater the protection.
d. Quantity—The less radioactive material, the less exposure; remove
the patient from the radioactive material or the radioactive material
from the patient.
4. Patient care
a. Concentrate on immediate threats to the patient’s life.
b. Remove him from the source of radiation as quickly as possible.
c. Conduct a primary and secondary assessment and manage injuries
as you normally would.
d. In cases of radiation, consult with medical direction and a poison
control center.
5. Personal decontamination
a. Report and document your exposure to the radiation source.
b. Follow hospital recommendations or local protocol.
6. Vehicle/equipment decontamination
a. Any equipment used to care for patient (blankets, towels, cots, and
so on) must be checked for contamination before using them again.
b. Wash the transport vehicle inside and out.
c. Remove radioactive dust from the vehicle.
d. Pay special attention to tires and other contact points.
e. Use a commercial decontamination solution on equipment (never on
your skin).
f. Dispose of any equipment or tools that cannot be decontaminated.
D. Problems caused by radiation
1. Radiation sickness
a. Caused by exposure to large amounts of radiation
b. Symptoms manifest themselves from hours to days after exposure.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 43
Discussion Question
How is radiation decontamination
accomplished?
PAGE 9
Chapter 43 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
c. Sickness lasts from a few days to seven to eight weeks.
d. Symptoms
i. Nausea and vomiting
ii. Diarrhea
iii. Hemorrhage
iv. Weight and appetite loss
v. Malaise
vi. Fever
vii. Sores in the throat and mouth
viii. Lowered resistance to disease and infection
2. Radiation injury
a. Local injury generally caused by exposure to large amounts of lesspenetrating particles
b. Signs and symptoms include hair loss, skin burns, and generalized
skin lesions.
3. Radiation poisoning
a. Occurs when patient has been exposed to dangerous amounts of
internal radiation
b. Causes cancer, anemia, other serious diseases
E. Protection from radiation
1. Factors determining amount of radiation damage from unshielded
radiation source
a. Amount and type of personal shielding
b. Strength of radiation source
c. Distance from radiation source
d. Type of radiation
e. Length of exposure
f. Amount of body that is exposed
2. How to reduce risk
a. Divide the work among many small teams of rescuers.
b. Teams should relieve one another such that no one is exposed to
more than 25 roentgens.
c. Shield the radiation source (can use bricks, concrete, or dirt if lead
shield is not available).
d. Know your community’s plan for hazardous materials emergencies.
e. Know how to reach your Radiation Safety Officer (RSO).
f. Always wear your protective gear.
g. Never smoke in an area contaminated by radiation.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 43
PAGE 10
Chapter 43 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
h. Never eat food from a contamination site.
XI. Guidelines for Hazardous Materials Rescues—Terrorist Attacks
5
Involving Weapons of Mass Destruction
A. See Class 2 Poisonous Gas, Class 6 Irritants and Poisons, and Class 7
Radioactive for chemicals commonly used in terrorist attacks.
B. Enroll in a counterterrorism class.
XII.
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Follow-Up
Case Study Follow-Up Discussion
A. Answer student questions.
B. Case Study Follow-Up
1. Review the case study from the beginning of the chapter.
2. Remind students of some of the answers that were given to the
discussion questions.
3. Ask students if they would respond the same way after discussing the
chapter material. Follow up with questions to determine why students
would or would not change their answers.
C. Follow-Up Assignments
1. Review Chapter 43 Summary.
2. Complete Chapter 43 In Review questions.
3. Complete Chapter 43 Critical Thinking.
D. Assessments
1. Handouts
2. Chapter 43 quiz
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 43
What does “uphill, upwind” mean?
Class Activity
Alternatively, assign each question to a
group of students and give them several
minutes to generate answers to present to
the rest of the class for discussion.
Teaching Tips

Answers to In Review and Critical
Thinking questions are in the appendix
to the Instructor’s Wraparound Edition.
Advise students to review the questions
again as they study the chapter.
 The Instructor’s Resource Package
contains handouts that assess student
learning and reinforce important
information in each chapter. This can be
found under mykit at
www.bradybooks.com.
PAGE 11