They call them dangerous goods—an oxymoron if there ever was one considering their contents, especially if those contents suddenly and unexpectedly reveal themselves outside their intended container. They’re most often referred to as hazardous materials and have quirky, unpronounceable names like Methyldichlorosilane, Dichlorodifluoromethane, Isocyanatobenzotrifluorides and McDonaldssecretsauce.
Every day, over 2,000 forms of potentially precarious gases, solids and liquid materials with befuddling names are being transported throughout this great mobile country of ours. By themselves they’re often harmless substances, but when combined with other elements—such as a Moo Milk truck colliding with a Rice Krispies cargo truck—the situation can become explosive.
EMS providers are bound to respond to at least one hazmat transportation incident (also known as holy #[email protected]! Let’s get the %[email protected]# out of here!) during their career. Though most of us have had minimal training in hazardous materials, I’ve found the FLEEE (fervently leave exposed environment expeditiously) principle quite effective—especially when I come across a diamond-shaped placard on the front, back and sides of any cargo transportation apparatus bearing a skull and crossbones with words like “explosive,” “flammable,” “toxic,” “danger,” “poison,” “infectious,” “corrosive,” “radiation,” “combustible,” “hazardous,” or “yesterday’s meals on wheels.”
Placards also display hazardous materials identification and guide numbers, but if you can read that number without the aid of binoculars, your number may already be up. Call it instinct or just plain laziness, but I’ve never felt the urge to rush into scenes of any kind, much less those involving dangerous goods that leak, spill, or emit smoke, vapors or fumes. I always make it a habit to approach scenes upwind—an essential skill I learned from partners who are prone to a hypermethane-producing metabolism.
So what are some signs you may be approaching a potentially hazardous environment, other than your appendages extemporaneously falling off?
- Firefighters dressed in hazmat cocoons are applying the FLEEE principle in the opposite direction you are walking.
- It begins to rain … birds, insects and a cat previously stuck in a tree.
- A triage officer breathing with the aid of an SCBA puts a black triage tag on your wrist.
- People with binoculars are scanning your body for a placard.
- Fellow responders are pillaging your ambulance for your entire stock of atropine and are applying it immediately intramuscularly into their thighs.
- The incident commander code names the hot zone with your name.
- Everyone around you appears to be taking a siesta, but with their eyes wide open.
Oftentimes however, even though EMS may have been staged far away from the exposure of harmful elements, patients already subjected to these hazards are transferred to the EMS staging area after exiting the hot zone—but ideally not until Dcon units have had the opportunity to thoroughly neutralize toxic agent exposure. This process not only cares for the patient, but also protects the healthcare providers who will provide subsequent care. This is a no-brainer, right? Yet, this same principle of exposure prevention isn’t often applied to our day-to-day patient contact scenarios.
People are also a cargo transportation apparatus of hazardous material encased in a swath of dermal tissue and sphincter musculature conjunctures. When we respond to spillage of human raw material, it doesn’t come with placards warning of a harmful liquid, solid or airborne element. We can identify the obvious fluid hazards of the human body (blood, sputum, emesis, urine and bowel), but they’re just the importer of potential harmful elements.
Gloves are a prime example of protection from prospective toxins and are used routinely as part of our patient care. However, there’s no guaranteed process of preventing a transfere of the hazardous spillage once the gloves have served their original purpose. In other words, there’s no glove Dcon follow-up.
I was once watching a medic treat a patient leakage scenario in the back of an ambulance. He was wearing gloves at the time, but didn’t take them off until after he proceeded to touch the cardiac monitor, O2 bottle, ambulance door latches and a borrowed stethoscope. There was no Dcon process to prevent further hazardous exposure after the initial incentive to prevent exposure was completed.
I now have a partner who dutifully wipes everything with germicidal disposable wipes at the beginning of every shift. Some crewmembers jokingly call her a germaphobe. I know I’m just lucky to have such a partner PLACARD (policing legitimate ambulance contaminated areas risking disease).
Until next time, remember: Once you’ve given the love, eliminate the glove.