# Industrial incident.



## NomadicMedic (Apr 30, 2022)

Scenario I’m working on for a class that I’m teaching. (This is a minor twist on a real incident)

You are a paramedic, your partner is an EMT. You work for a 911 dispatched EMS agency. You are in a regular ambulance, with no special equipment other than the typical ALS gear. It is an overcast, drizzly day, approximately 1630.

You are dispatched as an ALS unit for a industrial fire/incident. You respond to a large industrial park. You stage your ambulance away from the scene, and approach the command post. The incident commander reports that it is not a fire, however it is a chemical leak and the HazMat team is coming. The staff of 20 or so has been evacuated and is congregating around the entrance of the building. Currently on scene, a battalion chief who is the acting IC, two engines, a rescue company and a truck. You are the only EMS asset. 

Haz mat arrives with a team of 5. A captain and 4 techs. Two members of the Hazardous Material Team make entry with two members in level A suits to mitigate what you have now been told is a chlorine leak. There is a large ton container of chlorine used in an industrial process that has been struck by machinery and is now leaking. 

As you and your partner wait by the command post, you hear the radio erupt with a mayday call. One member of the hazmat entry team is down! The back up team is immediately sent in to retrieve him. A few minutes later, you see them dragging a person, in a level A suit, on a SKED towards you.

Now what? What problems do you foresee? Why are your next steps?


----------



## Chris EMT J (Apr 30, 2022)

NomadicMedic said:


> Scenario I’m working on for a class that I’m teaching. (This is a minor twist on a real incident)
> 
> You are a paramedic, your partner is an EMT. You work for a 911 dispatched EMS agency. You are in a regular ambulance, with no special equipment other than the typical ALS gear. It is an overcast, drizzly day, approximately 1630.
> 
> ...


Not a medic but I am going to take a shot on this one for learning. I am going to consider BSI and wear my mask, face shield, gown, gloves. Since it's a facility that works with hazardous material I would expose the patient and use the emergency chemical shower and clean them quickly. Access ABCs, get some vitals, establish a IV, and once they are external non-hazardous I would do a transport. Need the ABCs and vitals to say anything else.


----------



## Jim37F (Apr 30, 2022)

At the moment EMS is going to watch us hose draggers do an Emergency Decon amd Cut Out. Basically the Decon Firefighters who are already manning the technical decon corridor for the entry team and are either in Level A or B Hazmat suits will take an 1¾" hose and apply "copies amounts of water" and wash the contamination off. We'll do an emergency cut out, literally taking shears and cutting the down Tech put of his Class A suit and THEN he/she will be transferred over to EMS care, who should be waiting outside in the Cold Zone (unless they're trained/equipped for Warm Zone Ops).

This was essentially our training scenario last month for our annual HazMat First Responder Operations (FRO) recertification, running the technical decon and emergency decon stations for the HazMat Techs going in.I'm. 

So that's all on the Fire side before the EMS side, so from there, once we transfer the patient, it should be run more or less like a normal medical,  although you at least know chlorine exposure is the culprit, so you can follow the proper protocols for that.


----------



## DrParasite (May 1, 2022)

Jim37F said:


> At the moment EMS is going to watch us hose draggers do an Emergency Decon amd Cut Out. Basically the Decon Firefighters who are already manning the technical decon corridor for the entry team and are either in Level A or B Hazmat suits will take an 1¾" hose and apply "copies amounts of water" and wash the contamination off. We'll do an emergency cut out, literally taking shears and cutting the down Tech put of his Class A suit and THEN he/she will be transferred over to EMS care, who should be waiting outside in the Cold Zone (unless they're trained/equipped for Warm Zone Ops).


I'm going to to agree with Jim here; this is still a hazmat situation until the person is decontaminated and out of the suit. than ot becomes a "routine" medic call (I wouldn't say the cause is a chlorine exposure, as that might just have been a coincidence).


----------



## Summit (May 1, 2022)

I'm definitely wanting to know how a tech in an Level A suite went down in a simple punctured Cl tank leak. Once I'm reassured that this is "only" Cl and assured that this is a simple "suit failure" situation, I'll wait for the decon team, having deconn'd the patient, to deliver me a patient that is going to get O2, IV access, vitals monitor, consider narcotic pain control. I'm concerned about pulmonary edema, mucous membrane edema, and irrigating the eyes.

Hopefully I don't have to pee on an abd pad and breath through it.


----------



## akflightmedic (May 1, 2022)

ChrisEMTA said:


> Not a medic but I am going to take a shot on this one for learning. I am going to consider BSI and wear my mask, face shield, gown, gloves. Since it's a facility that works with hazardous material I would expose the patient and use the emergency chemical shower and clean them quickly. Access ABCs, get some vitals, establish a IV, and once they are external non-hazardous I would do a transport. Need the ABCs and vitals to say anything else.





ChrisEMTA said:


> I talked with my therapist, a paramedic friend, and my employer. My paramedic friend informed me that something is holding me back from getting intercepts and my therapist identified that as fear. I now see that the fear is about being judged for unnecessary intercepts. I talked with my employer and they agreed to down grade my position to a EMT basic and will allow be to shadow a medic and re take the AEMT course. I have been making mistakes for a little while and now because of fear of intercepts those mistakes aren't being corrected. So I will work with a medic as a basic until I retake a AEMT course and *WILL NOT be continuing to engage on this forum as it is not improving my care but worsening my mental health. *Maybe after redoing my AEMT and I feel more comfortable as a provider I will update the forum but I am taking time away from patient care to re learn the basic up to my level.



Veracity. Integrity.

Stick to your plan which is developed to improve YOUR health and eventually your patient care. 

Top Post: Saturday night
Bottom: Friday night

Fell off wagon hard! But yes, go take care of yourself! You have a solid plan.


----------



## Tigger (May 1, 2022)

First I’m going to wonder what broke down for me to end up so close to this, and then I’m going to back up  and ensure a proper decon is done by other hazmat members. If it is possible to establish communicate with a medically trained hazmat member I’d ask for that to start figuring a presumed treatment plan. It’s far from a guarantee that the regional response will even have more than one EMT here. 

Once decon is done this is a more “normal” patient. I’d like to talk to the other entry team members about what happened and whether or not there are other materials at play. Would also call poison control.


----------



## DrParasite (May 1, 2022)

there are a few other EMS things I would be doing... first off, requesting 2 additional ambulances (either ALS or BLS, depending on the location's entry protocols), and maybe an EMS supervisor.  This just went from a "routine" hazmat call to a possibly really bad day, and I will need more help.

I haven't heard any confirmation that the tech's suit was breached, but I do want to speak to the hazmat captain to find out what happened.  Was it a breach of his suit, and he's been exposed to chlorine, or did he simply have a medical emergency in the suit?

I'm going to make the assumption that the FD's engine companies have already set up decon, so they will be handling the decon section (in class B attire), so once they are grossly deconned, I'm going to assess the patient.  FD tends to be EMTs, so if they can give me an ABC assessment once the suit is opened, that will help determine what my next steps will be.  Am I going to pull a Dr Carter and run into the decon area and intubate the downed firefighter?  probably not, but we need more information on the downed hazmat tech to proceed further


----------



## CCCSD (May 1, 2022)

I’d treat the dehydrated FF after all Decon was done.


----------



## NomadicMedic (May 3, 2022)

Most of you have said the right thing… that you would wait until the downed hazmat tech comes through the decon corridor before you spring into action and start doing paramagic. 

However, before we get to the decon, let’s stop for a moment. 

What are some questions that you need answered immediately?


----------



## PotatoMedic (May 3, 2022)

Wind direction, where am I in relation to said wind direction.  And how long can I hold my breath?

Also curious what the suspected reason he went down.

Probably a lot more that I should know... But I'm just a canary.


----------

