Scene safety, scene safety, scene safety....

[Lone Star]

Yep my bad . Was trying to talk on the phone at the same time i was typing.. Thats what happens when you get to be my age, can't multi task worth a damn.

What is this 'multitask' that you speak of? ROFLMAO

[uglyEMT]

Ok I didnt see the video, stupid work protocols block youtube, I promise I will watch from home so i can make an even more informed response.

From a hazmat perspective, with some EMS thrown in for good measure.

As for the LEO first on scene, dispatch information is non realevent. He pulls up, see a tanker with a mist,smoke,for,vog,ect coming from it and sees casualties on the ground or in the car he should have immediatly informed dispatch of a hazmat situation and advised of current wind direction and /or safe approach direction. He doesnt need to know exactly what he is dealing with immediatly just the direction of wind and safe approach.

Now once he as done that and moved to a safe location he can use binoculars to see placards. Even if he cant see the UN numbers (if they are even palced) he can see class and division and can again advise dispatch so the FD, hazmat response team, EMS can begin to surmise what they are dealing with. If UN numbers are known then it really helps and you find out exactly what you are dealing with. Going by what you all described as a "smoke" coming from the rig can tell us alot. Your dealing with a liquid that is vaporizing at ambient temp thus a possible low flash point. You said ammonia so it would have white placards with a skull and crossbones on it and inhalation hazard stickers thus class 2.3, so even if you didnt know it was ammonia the placards alone let you know its something very nasty. Next I would be looking at the "smoke" to see if we are dealing with a heavier than air chemical. Again take these visual cues and relay to dispatch. FD hearing 2.3 alone now knows they will need full SCBA gear at a minimum if not full hazmat suits even before they get on scene. EMS now knows not to approach until the FD or hazmat team has done there thing as well.

I know it sucks that we all have to stand off and wait while we know people are probably dying a few feet (hundreds in this case) away from us. But unless we want to become a victim ourselves then we must protect ourselves.

Ok back to the scene. FD or hazmat arrives and finds out its UN 1005 they flip through the hazmat book and find out anhydrous ammonia is what they are dealing with. Now they know its not flammable thus the fire danger is reduced and also find out water will nutralize it. Thus they can spray down the tank and scene and offer some safety to there men. SCBA w/ full turnout will be enough protection so no need to break out the hazmat suits. They can go in and grab the victims as quickly and safely as possible and bring them to the warm zone. In the warm zone they will be deconed with water both FD and Pts. Also some triage can be done as far as the Pts go. Knowing the substance O2 is about the only thing we can do in the field so slap an NRB and get 15lpm going. After the decon they can be moved to the cold zone and further treated. Unfortunatly there is not much BLS or ALS can do in the field for these folks. Help with the breathing, treat any skin wounds caused by the gas, flush the eyes with water and transport.

Like I said i did not see the video just going by the descriptions you all gave and just adding what I know through my job training in dealing with hazmat situations (I work in the hazmat industry) and adding in my EMS training. When I get home and check the video out I can add more to the actual scene and what should or shouldn't have been done.

[DwayneEMTP]

Although there isn't a lot that ALS can do for these folks Ugly, there are certainly things that they should be considering....Right?

Dwayne

[uglyEMT]

Yes Dwayne there is. Not being ALS I might miss something but if I do I know folks will help out.

Just by going off of the chemical itself, again cant view the video, and its known antagonists there are a few things one would concider.

What are the immediate health effects of exposure to anhydrous ammonia?

Symptoms include burning of the eyes, nose, and throat after breathing even small amounts. With higher doses, coughing or choking may occur. Exposure to high levels of anhydrous ammonia can cause death from a swollen throat or from chemical burns to the lungs.

Eye exposure to concentrated gas or liquid can cause serious corneal burns or blindness.

Skin exposure will result in chemical burns.

Generally, the severity of symptoms depends on the degree of exposure.

So as an ALS provider if we know exposer was high some sort of intubation should be concidered to protect the airway from closing due to swelling. As far as chemical burns to the lung lining this would lead me to believe some sort of pain meds to ease suffering. I dont know if CPAP would help but, follow me here, knwing in COPD patients it forces some of the mucus out of the lungs and allow them to use oxygen more efficiently with less effort I would lean twords that. We are dealing with damaged lungs and possible asperation issues so anything that would relieve those symptoms might be good.

As for the eyes, again flush with copious amounts of water, pain meds maybe? Cover both eyes with sterile dressings.

Skin burns would be treated as any other burn. Flush with water to stop the reaction, dress the wounds with burn dressings and gel. Pain may or may not be present I would gather depending on the severity of the burns and coverage of affected area so again pain meds.

From all research i can find the effects of this chmical have to be treated by the body alone, medical intervention is to ease the symptoms that develope and not treatment of the effects.

So in an ALS capacity you would look to patent the airway, CPAP if indicated, and pain managment. The rest could be handled in a BLS capacity (burn dressing, eye dressings, O2 therapy)

Again once I see the video I will get a better handle on what the actual situation was. One thing that has bothered me though... anhydrus ammonia stinks to holy hell at as little as 50ppm and causes eye irritation and coughing at as little as 134ppm so I want to know how the trooper even began approaching the "smoke" without knowing something was a miss. BTW leathal doses in the way it has been described is around 5,000 ppm so imagine the smell and irritation factor at that scene.

Table 1. Exposure Levels and The Human Body.

--------------------------------------------------------------------------------

Exposure (ppm) Effect on the Body Permissible Exposure

--------------------------------------------------------------------------------

50 ppm Detectable by most people No injury from prolonged, or repeated exposure

--------------------------------------------------------------------------------

134 ppm Irritation of nose and throat Eight hours maximum exposure

--------------------------------------------------------------------------------

700 ppm Coughing, severe eye irritation,

may lead to loss of sight One hour maximum exposure

--------------------------------------------------------------------------------

1,700 ppm Serious lung damage,

death unless treated No exposure permissible

--------------------------------------------------------------------------------

2,000 ppm Skin blisters and burns

within seconds No exposure permissible

--------------------------------------------------------------------------------

5,000 ppm Suffocation within minutes No exposure permissible

--------------------------------------------------------------------------------

Edited December 8, 2010 by UGLyEMT

[Lone Star]

Ok, before I get crucified for being a 'heartless bastid', this needs to be said....

In my opinion, the 'take away lessons' here are:

1. ALWAYS be aware of your surroundings! Unfortunately, the officer in this case didn't have all the information available. This led to his 'tunnel vision', concentrating only on the victim on the ground. Since this was anhydrous ammonia, the victim was probably already deceased by the time the officer arrived on scene.

Yes, we're trained to mitigate a whole host of 'bad situations' and the general public's opinion of what we do includes rushing blindly in to 'save the day'.

As the video clearly shows, this course of action can have fatal results. While the officer attempted to 'save the victim', he was unaware when he rolled up that he'd only succeed in a 'body recovery'.

2. It's been said many times in many different ways that the rescuer is of no use to the victim if they have to be rescued themselves. As calm and collected as the officer appeared when he rolled up on scene, I'm surprized that he just ran into the vapor cloud without checking to see what it was, and how potentially dangerous this action would be.

3. In EMS, we're educated and trained to save lives, not sit idly by and watch people we're supposed to be helping die. Unfortunately, this video clearly shows that when you do not pay attention to your surroundings, and take the appropriate precautions; all we're going to end up doing is increasing the body count.

4. As Ugly pointed out (from the standpoint of someone who routinely works with hazardous substances), the firefighters did things as they were supposed to do. Bunker gear and SCBA were the appropriate safety gear for this situation. Since the airway was protected and the risk of exposed skin was minimized as much as possible, any exposed skin (neck, upper chest, ears, scalp,etc) could be decontaminated by hosing them down on scene with a full shower upon returning to the station.

5. Routinely, in EMS we are not equipped to rescue the victim. As much as this sucks 'the big one', we HAVE to wait on the sidelines until the appropriate personnel can get them out, or until the victim can come to us.

Scene safety doesn't end just because we've walked off the scene. This could have been any number of substances that could have been carried back to the hospital, station,...home...

There is a myriad of 'evil stuff' out there. We HAVE to pay attention and take the appropriate response actions, otherwise we're becoming part of the problem instead of part of the solution.

[Richard B the EMT]

Lone Star, your point 2 is what's been drilled into me as Rule One of Rescue: Never do anything in a rescue causing you to also need rescuing.

[Eydawn]

Officer's first mistake: The second he got within visual range and could see a tank and a cloud, he should have gunned it into reverse. Second mistake: Actually entering the cloud of vapor.

This was too sad to watch... made me cry. I thought LEO's had the same kind of scene safety training that we all get on day 3 of EMT class? The rule of thumb and all that? I could swear all the cops I know have had at least that minimum of training.

Fire department's major mistake: Parked WAY too close to the scene. They should have stopped at a much further distance back. Once they determined wind direction and substance, they could have entered the "hot zone" with the apparatus to use the water... but they shouldn't have darted right in like that.

Sucks all around, here. Lots to be learned, unfortunately, but at way too high a price.

Wendy

CO EMT-B

[Richard B the EMT]

I thought LEO's had the same kind of scene safety training that we all get on day 3 of EMT class? The rule of thumb and all that? I could swear all the cops I know have had at least that minimum of training.

Different regions, different training, or level(s) of training. However, I agree, if the LEO had the basic HazMat Awareness Level training, he forgot it while attempting the rescue of the "man down".

[Navyvet]

I was only a volunteer fire fighter about 1/3 of the way through Fire I when I had to move, but in order to go on calls, we had to have a basic level of knowledge. The first thing that my chief drilled into all of us was that we had to think of ourselves first. We had to make sure that our own gear was on properly before helping someone else and we had to make sure that we didn't put ourselves in a situation where the rescuer needed to be rescued. I would think that anyone in law enforcement, fire fighting, and EMS should have to follow that, especially if the situation is outside the scope of your job. The officer, while he meant well, should have waited until the FD arrived with the proper training and gear to perform a rescue. As to the FD arriving in full gear, in most places it is standard operating procedure to be in full turn out gear when you get to the scene of a car accident. I do think that the fire fighters should have just grabbed the officer under the arms and dragged him as opposed to taking the time to bring in a back board. I doubt that it would have changed to outcome though.

As far as dispatch goes, I know that they don't always have the correct or complete information to pass on. I also know that sometimes the dispatcher just doesn't have a clue as to what info you really need. Example, I went on a call with the FD to a fall with injury. I swear dispatch made it sound like someone fell out of a tree. What did we find when we got there? A sky diver...

[Richard B the EMT]

As far as dispatch goes, I know that they don't always have the correct or complete information to pass on. I also know that sometimes the dispatcher just doesn't have a clue as to what info you really need. Example, I went on a call with the FD to a fall with injury. I swear dispatch made it sound like someone fell out of a tree. What did we find when we got there? A sky diver...

I'm glad you prefaced with that.

As for the backboard, perhaps their training is, for any "Man Down" (unknown situation) calls, presume the patient to have fallen, with associated C-Spine involvement, so do immobilization.

Just saying...

Edited December 10, 2010 by Richard B the EMT