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The Golden First Minutes — Initial Response to a Chemical Hazardous Materials Incident


I. Introduction and Overview

 

1. Introduction

1.1 Purpose

This information has been developed by the National Library of Medicine, Division of Specialized Information Services to provide practical guidance for initial response to a chemical hazardous materials incident.  This information is applicable to both planning / preparedness and operations.

This information aligns with guidance being developed for medical response to Chemical Weapons of Mass Destruction (WMD) incidents by the U.S. Department of Homeland Security, Office of Health Affairs.

1.2 Organization

This information is organized and published in five parts:

  1. Introduction and Overview
  2. Incident Recognition and Response Activation
  3. Protecting Yourself and Others
  4. Response objectives and Immediate Actions
  5. Incident Management and Command Transition

1.3 Scope of Incidents and Response

This information focuses on initial response to chemical hazardous materials (HAZMAT) incidents during the first minutes of the event, when the first arriving responders must manage the incident with limited support from professional HAZMAT responders and Incident Commanders. 

1.4 Intended Audience/ Users

This guidance is intended for use by first responders (including fire, law enforcement and medical responders) who may not be trained for HAZMAT response beyond the Awareness level.  The information may also be useful to emergency planning and preparedness professionals.

 

2. Overview

In emergency medicine, the golden hour refers to a time period lasting for one hour or less following traumatic injury being sustained by a casualty or medical emergency, during which there is the highest likelihood that prompt medical treatment will prevent death.

In a chemical HAZMAT incident, the decisions made and actions taken in the first few minutes of a response will often establish the character of the overall response – and ultimately its success or failure.  This is even more true for mass casualty incidents resulting from mass exposures to toxic materials.  And the urgency is even greater in the event of a chemical Weapons of Mass Destruction (WMD) incident, such as a Chemical Warfare Agent release.  This critical period could be considered “The Golden First Minutes” of a HAZMAT event.

These key decisions and actions will often be made and taken by first arriving response personnel – those who are already at the scene or are initially dispatched.  These responders may be firefighters, law enforcement officers or emergency medical personnel, often with limited training for responding to and managing HAZMAT incidents.  They will have responsibility for recognizing the type and scale of the incident, activating the response system and managing the event until relieved.

This series provides practical advice for response during the golden first minutes of a chemical HAZMAT event.

 

3. Top Level Process

Figure 1 presents the initial response process for a chemical HAZMAT event.  This process will be used as the framework for organizing this information.

 

Initial response process for chemical HAZMAT incident

Figure 1.  Initial Response Process for Chemical HAZMAT Incident

 

Recognize the Incident

Your first action is to quickly size up the situation and recognize the type and scale of incident you are responding to.  If it is a HAZMAT incident, understand the initial scope and degree of hazard.

As with any response, as soon as you have sized up the incident, you should activate the response system.  If it is a HAZMAT incident, additional specialist resources will likely be needed.  If there are exposures and injuries, medical support will be needed – up to a Mass Casualty response.

 

Protect Yourself and Others

Your first and immediate priority is to protect yourself and others.  Establish an Isolation Zone and move outside it.  Alert others in the danger area to do the same.  Take only actions that you are equipped and trained to take.  DO NOT allow yourself to become a victim!

 

Determine Initial Response Objectives

Now you should take a mental step back and remind yourself of the critical objectives that should be addressed in the first minutes.  You can’t do everything – time and resources will be severely limited.  One of the most important decisions you will make is what to do with the precious time and resources you have – and what you should not attempt.  Remember – life safety is always your first priority – for victims, public AND responders.

 

Decide and Take Immediate Actions

Once you’ve decided on your priorities, you need to identify the decisions and actions to take that will support your objectives.  You’ll need to inventory and apply the resources at your disposal – and request additional resources that you need.  Then you must implement the decisions and manage the resulting actions.

 

Manage the Incident Until Relieved

There’s always an Incident Commander for an emergency – including chemical HAZMAT emergencies.  The first arriving responder is by default the Incident Commander until relieved.  You may be the Incident Commander until more senior or experienced personnel arrive.  You should control the incident scene and manage and apply resources as they arrive.  You should evaluate the changing situation and adapt your decisions and actions as needed.  You should communicate with the response system so that the right level of response can be generated as quickly as possible.

 

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II. Incident Recognition and Response Activation

 

1. Introduction

 

1.1 Scope of Incidents and Response

This information focuses on initial response to chemical hazardous materials (HAZMAT) incidents during the first minutes of the event, when the first arriving responders must manage the incident with limited support from professional HAZMAT responders and Incident Commanders. 

1.2 Intended Audience/ Users

This guidance is intended for use by first responders (including fire, law enforcement and medical responders) who may not be trained for HAZMAT response beyond the Awareness level.  The information may also be useful to emergency planning and preparedness professionals.

 

2. Overview

In emergency medicine, the golden hour refers to a time period lasting for one hour or less following traumatic injury being sustained by a casualty or medical emergency, during which there is the highest likelihood that prompt medical treatment will prevent death.

In a chemical HAZMAT incident, the decisions made and actions taken in the first few minutes of a response will often establish the character of the overall response – and ultimately its success or failure.  This is even more true for mass casualty incidents resulting from mass exposures to toxic materials.  And the urgency is even greater in the event of a chemical Weapons of Mass Destruction (WMD) incident, such as a Chemical Warfare Agent release.  This critical period could be considered “The Golden First Minutes” of a HAZMAT event.

These key decisions and actions will often be made and taken by first arriving response personnel – those who are already at the scene or are initially dispatched.  These responders may be firefighters, law enforcement officers or emergency medical personnel, often with limited training for responding to and managing HAZMAT incidents.  They will have responsibility for recognizing the type and scale of the incident, activating the response system and managing the event until relieved.

This series provides practical advice for response during the golden first minutes of a HAZMAT event.

 

3. Top Level Process

Figure 2 presents the initial response process for a HAZMAT event.  This process will be used as the framework for organizing this guidance.

 

Initial response process for chemical HAZMAT incident

Figure 2.  Initial Response Process for Chemical HAZMAT Incident

The overall process is described in Part1:  Introduction and Overview.  This volume addresses the first step:  incident recognition and response activation.

 

4. Recognize the Incident

A chemical HAZMAT incident can often be identified by first responders before professional hazardous materials teams or emergency medical personnel arrive on scene – if they know what to look for.  Easily-observed event indicators, as well as victim signs and symptoms, should lead to rapid and confident recognition of the event.

4.1 How Event Recognition Happens

Event recognition involves the gathering of key information about an emergency incident (called cues) and then using those cues to trigger recognition of what incident is taking place.  The result is situational understanding. – “Oh, I know what’s going on here.” 

The gathering and processing of event cues can be:

  • Fully automated:  systems monitor predefined cues and alert when specified thresholds or combinations occur
  • Procedural:  responders (typically response leaders) use predefined Standard Operating Guidelines (SOGs) and checklists to identify the event
  • Experience-based:  responders use experience, training and judgment to mentally match the key cues they observe to event types they know about

First responders use experience-based recognition much more often than other methods.

4.2 Early and Rapid Recognition

To have the greatest chance of success, recognition of a HAZMAT incident should be both early and rapid.

EARLY:  The first arriving responder should briefly but immediately assess the event upon arrival.  The recognition process should be continued and repeated by next arriving resources as more information becomes available. 

Note:  The first arriving responder will often be a law enforcement officer, firefighter or emergency medical responder.  The first arriving responder may be trained at the HAZMAT awareness level or may have no formal HAZMAT training.

Note:  It is possible that enough cues will be available to the Dispatcher to make the call even before responders arrive on the scene.

RAPID:  If properly trained, recognizing a HAZMAT incident should take seconds to a minute or two.

 

4.3 Three Phases of Event Recognition for a HAZMAT Incident

As shown in Figure 3, there are three levels of recognition for a HAZMAT incident:

Chemical HAZMAT Incident:  The imminent or actual release of a chemically harmful substance into the environment at levels that require urgent response to contain the release and protect humans and the environment.  Chemically hazardous materials come in the form of explosives, flammable / combustible substances and toxic substances.

Chemical Mass Exposure Incident (MEI):  A chemical HAZMAT incident that produces multiple exposed victims.  The event will be similar to but more complex than a Mass Casualty Incident.  The victims will often:

  • Be contaminated with the hazardous material, requiring decontamination or special precautions by responders (e.g., wearing personal protective equipment [PPE])
  • Be located in the dangerous or highly contaminated Hot Zone, requiring special precautions by responders for rescue and treatment
  • Require urgent medical attention to diagnose and treat potentially life-threatening affects from the exposure
  • Require specialized medical treatment to address unfamiliar health effects

A chemical MEI will often exceed the immediately available resources to decontaminate and/or treat victims – or will exceed the specialized expertise needed to respond (e.g., operating in PPE).

Chemical Weapons of Mass Destruction (WMD) Incident:  A chemical MEI resulting from the deliberate release of chemicals intended to cause widespread harm.  A chemical WMD incident may involve the release of a toxic industrial chemical or a chemical warfare agent.  Chemical warfare agents can produce many more casualties than industrial chemicals and can result in hundreds of victims or even more.  Highly urgent medical response may be needed to avoid fatalities, and response may require specialized techniques and medical countermeasures.

Classes of chemical warfare agents include:

  • Nerve Agents
  • Cyanides
  • Vesicants / Blister Agents
  • Pulmonary / Choking Agents

The three levels of event recognition for a chemical HAZMAT incident

Figure 3.  The three levels of Event Recognition for a Chemical HAZMAT Incident

 

4.4 Guidance for Rapid and Confident Event Recognition

The key to event recognition is gather the minimum number of cues that give an initial responder confidence to declare that a Chemical HAZMAT, Chemical MEI or Chemical WMD incident is occurring.  This is easier said than done!

Tables below list the essential event and patient cues to watch for in the first seconds and minutes after arriving at the incident scene (as well as before arriving – through information from Dispatch and other sources).  Each cue is rated for its confidence in identifying the type of incident.

Sufficient confidence that an incident is occurring is reached when the responder confirms:

  • Any ONE of the symptoms rated “HIGH
  • Any TWO of the symptoms rated “MODERATE

Once this threshold is reached, the responder should declare the incident and notify Dispatch.  If time is available and resources are on hand, the first responder may confer and confirm the declaration with a designated authority, such as the Poison Control Center serving the area of the event.

KEY RESPONSE NOTE: Once sufficient confidence in an event is reached, the responder should declare the event, notify and act IMMEDIATELY.  DO NOT WAIT for further indicators!

Detection of additional cues should give the responder further confidence in the decision and can be reported as confirmation following the initial declaration.

The following sections present the keys cues to watch for in each phase of recognizing a Chemical HAZMAT incident.

 

4.5 Recognition:  Chemical HAZMAT Incident

Indicators of a Chemical HAZMAT Incident include event-related, environment-related and victim-related cues.  The event- and environment-related cues listed are those that can reasonably be observed by non-HAZMAT personnel at a protective distance away from the scene.  The victim-related cues are those that can be observed or obtained from witnesses by a non-medical responder located at a protective distance from the incident.

Table 1.  Key cues for recognition of a Chemical HAZMAT Incident

Event-Related Cues

Confidence

Observation of a chemical release

High

HAZMAT labeled container (e.g., placard or chemical name) nearby with damage or breach

High

Chemical-related container (e.g., storage tank, tanker truck, rail tank car) nearby with damage or breach

High

An unexplained plume or cloud (e.g., not from a fire)

High

Colored cloud or plume (e.g., green, yellow)

High

Unexplained odors (e.g., bleach, ammonia, bitter almonds)

High

Chemical-related facility (e.g., production, processing, storage, use, waste treatment, disposal) or container (e.g., storage tank, tanker truck, rail tank car) nearby

Moderate

 

Environment-Related Cues

Confidence

Low-lying clouds or fog not explained by the weather

High

Unusual number of dead or injured animals in the area

High

Dead fish, aquatic birds and/or insects in and around water sources

High

Unexplained liquid puddle or powder deposit

Moderate

Oily sheens, coatings or droplets on surface

Moderate

Clouds of dust or particles not explained by the weather or incident (e.g., building collapse)

Moderate

Unusual and unexplained dead, discolored or withered plant life in area

Moderate

 

Victim-Related Cues

Confidence (IF OBSERVED IN MULTIPLE VICTIMS)

Casualties with no apparent reason or trauma

High

Casualties clustered in a geographic area, especially downwind from incident scene or in low-lying areas

High

Same medical symptoms in multiple victims not explained by the incident

High

Breathing difficulty, coughing not otherwise explained (e.g., building collapse)

High

Burns or irritation on skin (not from fire)

High

Tearing of eyes not otherwise explained (e.g., building collapse)

Moderate

Disorientation not otherwise explained (e.g., explosion)

Moderate

 

4.6 Recognition:  Chemical MEI

Life safety is always the top priority in an emergency response.  Once an incident has been recognized as a Chemical HAZMAT Incident, the next stage in recognition is to identify the scope of the human health impact.  Basically – can this incident be medically managed with locally available resources, or is it a Mass Casualty / Mass Exposure Incident?  Observation or judgment of the number of actual or potential victims is the key to this determination.

 

Table 2.  Key cues for recognition of a Chemical MEI

IF A Chemical HAZMAT Incident AND

 

Event-Related Cues

Confidence

More than 10* victims observed that are “down” or require urgent and medical treatment.

High

Potential that more than 10* persons have been contaminated by or are in the Isolation Zone for the Chemical HAZMAT Incident

High

Any incident that could cause multiple casualties combined with potential exposures or contamination (e.g., major transportation accident, building collapse) at a location where 10 or more* persons could be affected

High

*Use local definition of number of patients for MEI if known.

 

4.7 Recognition:  Chemical WMD Incident

A Chemical WMD Incident is expected to be many times more dangerous and medically urgent than other chemical HAZMAT incidents. Initial responders may be reluctant to declare this level of event because of the implications for response, but they should have the mindset of an abundance of caution.  Early recognition and declaration of a Chemical WMD Incident can save literally hundreds of lives. 

Indicators of a chemical HAZMAT Incident include both event-related and victim-related cues.  The event-related cues listed are those that can reasonably be observed by non-HAZMAT personnel at a protective distance away from the scene.  The victim-related cues are those that can be observed or obtained from witnesses by a non-medical responder located at a protective distance from the event.

Table 3.  Key cues for recognition of a Chemical WMD Incident

IF A Chemical HAZMAT Incident OR a CHEMICAL MEI AND

 

Event-Related Cues

Confidence

Credible threat of a terrorist attack applicable to the area

Moderate

Bomb or munition-like debris

Moderate

Debris that could have been caused by an explosion

Moderate

Unexplained persons wearing personal protective equipment (PPE)

Moderate

Unexplained discarded PPE

Moderate

Explosion with little or no structural damage

Moderate

Device that may have dispersed a mist or vapor

Moderate

Oily sheens, coatings or droplets on surface

Moderate

Unusual or unauthorized spraying in the area

Moderate

Suspicious persons urgently leaving the area

Moderate

 

Victim - Related Cues

Confidence

Multiple casualties exhibiting similar symptoms

Moderate

Mass casualties with no apparent reason or trauma

Moderate

Sudden unexplained weakness, collapse, apnea, or convulsions

Moderate

Dimmed or blurred vision

Moderate

Hypersecretion signs and symptoms (such as drooling, tearing, and diarrhea)

Moderate

Inhalation signs and symptoms (eye, nose, throat, chest irritation; shortness of breath)

Moderate

Burn-like skin signs and symptoms (redness, blistering, itching, sloughing)

Moderate

 

These cues are rated as moderate because individually they can be associated with non-WMD incidents.  But if two or more of these cues are detected, the responder should declare at least a “potential chemical WMD Incident.”

More specific medical signs and symptoms exist for each class of Chemical Warfare Agent.  Detection of these cues may be beyond the capacity or expertise of an initial responder in the first minutes of an incident.  A good quick reference guide to these cues has been published by the Employee Education System for the Office of Public Health and Environmental Hazards, Department of Veterans Affairs and can be found online.

 

5. Declare and Activate Response System

5.1 Notification

Recognition of a Chemical HAZMAT, Chemical MEI or Chemical WMD Incident should trigger immediate notification of the emergency response system / network.  This will usually be communicated by an initial responder back to Dispatch.

Immediate notification is particularly critical in a Chemical MEI or Chemical WMD Incident because rapid activation of large and specialized resources will likely be necessary to save lives.

KEY RESPONSE NOTE: Recognition of a Chemical HAZMAT, Chemical MEI or Chemical WMD should trigger immediate notification of the emergency response system / network.

The notification should include a short form of key information about the event, as prescribed by local protocol or SOG.  In the absence of a local SOG, a variation of the widely used METHANE protocol can be used:

  • Major Incident: Declare a HAZMAT or Mass Casualty Incident
  • Exact location: The precise location of the incident
  • Type: Chemical HAZMAT, Chemical MEI, or Chemical WMD Incident
  • Hazards: Both present and potential
  • Access: Best route for emergency services to access the site, or obstructions and bottlenecks to avoid
  • Numbers: Estimate of numbers of contaminated, casualties, dead and uninjured on scene
  • Emergency services: Which services are already on scene, and which others are required

 

6. Further Information and Useful Links

  1. Ramesh AC, Kumar S. Triage, monitoring, and treatment of mass casualty events involving chemical, biological, radiological, or nuclear agents. J Pharm Bioallied Sci. 2010 Jul;2(3):239-47. [Free PubMed Central Article]

  2. Madsen, J. Overview of Incidents Involving Mass Casualty Weapons (Consumer version)

  3. Madsen, J. Overview of Incidents Involving Mass Casualty Weapons (Professional version)

  4. Madsen, J. Chemical Weapons (Consumer version)

  5. Madsen, J. Chemical Warfare Agents (Professional version)

  6. Geyer, BC. Chapter 112 – Nerve Agent Mass Casualty Incidents. Ciottone's Disaster Medicine (Second Edition), 2016, Pages 651-655

  7. Chemical/Biological/Radiological Incident Handbook (CIA)

  8. Chemical Threats (FEMA)

  9. 2016 Emergency Response Guidebook (PDF - 4.7 MB) (DOT PHMSA)

  10. Hazardous Materials Incidents (FEMA)

  11. How to Recognize if Chemical Agents Have Been Used (PDF - 175 KB) (North Dakota Department of Health)

  12. Chemical Terrorism General Guidance - Pocket Guide (PDF - 251 KB) (Employee Education System for the Office of Public Health and Environmental Hazards, Department of Veterans Affairs)

 

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