Introduction to

BASIC HAZMAT MEDICAL SUPPORT

Prof V. Anantharaman
Department of Emergency Medicine
Singapore General Hospital
 Introduction
Hazmat Incident: a situation where a
chemical or number of chemicals have
accidentally or intentionally released from
their controlled environment thereby
threatening to cause or causing a large
number of deaths or injuries, damage to
infrastructure and pollution.
Accidental release of industrial hazmat agent, methyl-isocyanate,
from pesticide factory very close to densely populated township in
Bhopal, India (1984) resulted in more than 200,000 casualties
including more than 2,000 acute fatalities.
Previous incidents in Indonesia
1. HAZMAT – Indonesian archipelago –
Indonesia

EDIS Number: HZ-20100819-27473-IDN

Date / time: 19/08/2010 02:47:37 [UTC]
Event: HAZMAT
Area: Indonesian archipelago
Country: Indonesia
State/County: Sumatra
City: Lampung
Number of Dead: None or unknown
Number of Injured: 184 persons
Chemical: Cyanide
 2: Ammonia / Maleic anhydride
Class/Quality ***
Year 2004
Summary Overheated machine in chemical plant caused major
Fire, several explosions, release of maleic
Anhydride, pollution of air, evacuation, closure
Of pipeline and 70 casualties
Country RI
Activity PROCESSING
Location CHEMICAL FACTORY
Chemicals Ammonia, Maleic anhydride
Cause Technical-failure
Fatalities/Injuries 4 / 66
Occurrences or Block-of-system, Collapse/Destroy, Evacuation, Explosion,
events Fire, Fire, Fire fighting/Emergency response, Ignition,
Ignition, Overheating, Pollution/Contamination, Release,
Smoke-emission
 Chemical Accidents in Indonesia
• steam / other toxic gases (1979) • ammonia (1999)
• liquefied natural gas (1983) • benzene (2000)
• chlorine gas (1993) • fuel oil (2009)
• methane (1994) • natural gas (2010)
• acrylonitrile butadiene styrene • olefines / aromates
or ABS monomer (2000) (2011)
 Impact on Health and Health Services
• 1944: release of chlorine gas from leaking transporter into New York
subway station -- 418 casualties -- 208 admitted or observed in hospitals.
33 casualties required > one-week hospitalization
• 1976: Seveso, Italy -- uncontrolled release of trichlorophenol, sodium
hydroxide and tetrachlorobenzo dioxine from factory dispersed chemicals
over wide area. No immediate casualties. Many children developed
corrosive injuries when they used surrounding playgrounds. Many weeks
to months later, nearby residents developed chemical skin lesions
• 1995: Tokyo, Japan -- intentional release of organophosphate-like chemical
warfare agent, Sarin, on crowded subway system resulted in mass
casualties numbering more than 5,000. Many emergency medical
response personnel and hospital staff affected through secondary
contamination which disrupted medical infrastructure and services.
Issues in Medical Response to Hazmat Incidents
Operational Issues
1. Emergent vs Anticipated Situation
2. Mass casualties.
3. Unfamiliar and Unfriendly environment.
4. Decontamination
5. Personnel Protection
6. Essential medical equipment and antidotes
Issues in Medical Response to Hazmat Incidents
Clinical Issues
7. Mixed chemical and conventional injuries
8. Delay or Difficulty in initial diagnosis
9. Delayed presentation
10. Limitations in provision of emergency
medical care within the hot and warm zone
11. Potential for psychological casualties
 Pre-Hospital Medical Response
• BaSARNas -- first rescue group on-scene
– to provide initial basic medical care in first few minutes
– can set up initial First Aid Post (FAP) in cold zone
– paramedics trained and protected with PPE can provide
BLS to severely injured or toxic casualties prior to and
during decontamination in hot and warm zones

• Medical Teams -- take over running of FAP on arrival

– On-site medical teams to provide basic, essential medical
care during rescue and extrication of trapped casualties in
cold zone.
 Hospital Medical Response
• Upon activation, receiving hospitals to set up
decontamination stations
• Be prepared to receive casualties from the
incident site and those coming on their own
• All casualties to be triaged, decontaminated and
re-triaged prior to entry into the UGD
• Hospital civil disaster plans activated to cater to
the increased number of casualties especially
those requiring ventilatory support, burns care
and extended observation
Hazmat and Toxicological Information

• Early identification of the hazmat agent

• Material Safety Data Sheets (MSDS)

• Use of chemical detectors, sampling and analysis

• Need for a Toxicology Advisory Team (TAT)

 Objectives of BHMS Course
1. To educate and train first responders on the effects
of hazardous chemicals on man
2. To teach the various steps in decontamination of
chemical casualty
3. To teach effective triage schemes to prioritize the
management of mass casualties in Hazmat incident
at disaster site and hospitals.
4. To provide guidance on standardized treatment
systems for Hazmat casualty.
Course Duration and Format
• Course conducted over two full days
• Consists of didactic lectures and small group
discussions interspersed with hands-on practice
sessions on various aspects of hazmat
management
• Learners expected to read before presenting
themselves for the course
• Learners encouraged to actively participate in
discussions and hands-on sessions
• Post-test at end of course
 At end of course, participants will be
able to:
1. Be part of a field medical team sent out from hospital to
chemical disaster site.
2. Be better able to provide on-site medical and nursing care
to Hazmat casualties.
3. Triage, evaluate and manage Hazmat casualties prior to
decontamination at disaster site.
4. Serve at triage point of hospital decontamination stations
triaging contaminated casualties.
5. Provide initial management of Hazmat casualties in
Emergency Department following decontamination.