EMS in the Fire Service - A New Trend in Patient Care

“Biological weapons are in essence a medical problem, and thus require a medical solution. The ultimate goal of bio-defense is to prevent suffering and loss of life. If biological weapons have minimal impact on the well-being of their targets, they are ineffective and thus cease to be a threat. Therefore, we must concentrate on developing appropriate medical defenses.” Dr. Ken Alibek, former deputy director of Biopreparat, the former Soviet Union’s now-defunct biological weapons program.

Dr. Alibek defected from the Soviet Union in 1992 after working in the USSR’s biological weapons program for over twenty years. Since then, he has served as a consultant to numerous U.S. government agencies, offering his expertise in the areas of medical microbiology, biological weapons defense, and biological weapons nonproliferation. His book, Biohazard, published in 2000 (by Arrow Publishing, a division of Random House), recounts with chilling accuracy the story of the largest covert biological weapons program in history. The book also discusses the development and use of biological weapons, and provides the reader with detailed information about the consequences of an attack with such weapons – eye-opening information, to say the least.

Experts in the biological weapons field say it is all but certain that some terrorist group is already attempting to create a unique chemical formula, or drug-resistant strain of a bacteria or virus, that could be unleashed without warning on innocent citizens of any number of countries, including the United States. Largely because of that possibility, America’s first responders – including policemen, firemen, and EMS (emergency medical services) personnel – are preparing for the worst while at the same time trying to improve their own ability to respond to any event involving weapons of mass destruction (WMDs).

In addition to preparing to cope with acts of terrorism, however, first responders also must be mindful of the several other types of “routine” chemical emergencies that occur every day.

There are approximately 100,000 chemicals of various types registered in the United States, and thousands more are developed each year. Most are commercial and household products, or chemicals used in farms and gardens or for industrial purposes. Most are produced, transported, and used in the United States itself – but many also are exported overseas. Inevitably, there are a certain number of accidental releases and exposures – and some intentional ones as well. Whether accidental or intentional, when such releases occur the local fire department is usually the first of the first responders to arrive on the scene and begin the process of containing the release while also starting to provide patient care, if such care is needed.

An Unfortunate Deficiency

Unfortunately, most current HAZMAT (hazardous materials) training programs, at the technician and specialist levels, are deficient in their teaching of such topics as the recognition and treatment of chemical and biological exposures. The same is true for most paramedic training programs.

Currently, fire departments of all sizes throughout the United States are taking a number of steps to bridge the skills gap in the critical area of treating those who have been exposed to chemical releases. New training programs, typically called hazmedic or toxmedic, focus on such specifics as how to recognize the signs and symptoms of certain types of exposures; there also is additional emphasis on antidotes, and on the medical management of acute chemical exposures. The goal of much of this training is to teach students how to recognize the signs and symptoms of acute chemical exposures and other poisonings, and to give the prehospital care provider the tools needed to treat such exposures. Generally speaking, a well-trained hazmedic should have the ability to, among other things:

  • Identify the setting of, or potential for, a chemical exposure or other toxicological exposures (such as an exposure to a biological-warfare agent).
  • Render appropriate and timely treatment for toxic industrial chemical exposures, and/or exposures to various weapons of mass destruction.
  • Recommend specific decontamination procedures to minimize the negative health effects caused by chemical and biological exposures.
  • Serve as a special toxicological resource on any incident in this field ranging from a mass-casualty attack to a single-patient incident.

In some fire-department response systems, those designated as hazmedics have a background in hazardous materials and, in addition to being licensed paramedics, also may be trained to the level of hazardous materials technician. Other fire departments opt to keep the two separate – the hazmedic is a licensed paramedic who receives the additional toxicological training needed to deal with hazmat incidents, and perhaps responds on an ambulance, or as a member of a paramedic-level engine company, but may not have completed any hazardous-materials training beyond the operational level. There are in any case a large number of implementation options – each department or agency involved must decide what works best for its own people.

There are several ways to obtain hazmedic training – for which, somewhat inexplicably, no national standards have yet been set. First, an agency may choose to conceive and implement a curriculum that is developed internally. This option may prove time-consuming, but it has the advantage of permitting maximum customization. The availability of a well-qualified subject-matter expert is the key to making this option not only workable but cost-effective as well.

Turnkey Training Available Through the NFA

If a turnkey training method is preferred, any department or agency interested may want to consider the program offered by the National Fire Academy (NFA) in Emmitsburg, MD. The NFA program offers a two-week that emphasizes basic chemistry, chemical substances, and the medical management of chemically exposed patients. Following, from the NFA website, is the course description:

This two-week course is designed for paramedic personnel who have an Advanced Life Support (ALS) emergency medical responsibility at hazardous materials incidents, and it promises a rigorous experience for the student. In-depth chemistry, as it relates to hazardous materials, the medical management of victims, and the development and management of the hazardous materials components of the medical support system are the three primary focuses of this course. Toxicology and decontamination procedures are covered from an advanced EMS [emergency medical services] viewpoint. Strategies for safe emergency medical interaction with contaminated victims are discussed in detail.

For more information on the NFA course, “Advanced Life Support Response to Hazardous Materials Incidents” [course code 0247], consult the United States Fire Administration.

Another training option is available at the University of Arizona Health Sciences Center in Tucson, Ariz. The center offers an intensive 16-hour program, called Advanced Hazmat Life Support (AHLS), that trains participants to rapidly assess hazmat patients, recognize several basic toxic syndromes, apply the poisoning treatment paradigm (a patented method to determine the appropriate course of action for treating an exposed patient), demonstrate the ability to medically manage hazmat patients, and identify specific antidotes for various exposure scenarios.

The AHLS program is offered several times a year both at the University of Arizona and at other sites throughout the United States. For additional information about the program consult the center’s website (http://ahls.org/).

From a national perspective, the value of providing more, and better, hazmedic training extends well beyond Alibek’s advice to “develop adequate medical defenses” against weapons of mass destruction. Such programs, if well planned and carefully implemented, will provide an important “add on“ to existing paramedic training programs that will enhance and expand the ability of individual paramedics, as well as the departments or agencies they work for, to provide better and more comprehensive medical care to the community they serve.

Rob Schnepp

Rob Schnepp is division chief of special operations (ret.) for Alameda County (CA) Fire Department. His incident response career spans 30 years as a special operations fire chief, incident commander, consultant, and published author. He commanded numerous large-scale emergencies for the Alameda County (CA) Fire Department, protecting 500 square miles and two national laboratories in the East Bay of the San Francisco Bay Area. He twice planned and directed Red Command at Urban Shield, the largest Homeland Security exercise in the United States. He served on the curriculum development team and instructed Special Operations Program Management at the U.S. Fire Administration’s National Fire Academy. He is the author of “Hazardous Materials: Awareness and Operations.” He has developed risk assessment, incident management, and incident command training for Fortune 500 companies, foreign governments, and U.S. national laboratories.



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