Excerpt from Hazmat

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One of the most challenging aspects of providing emergency medical care is attending to patients who have been contaminated with hazardous materials. HAZMAT is a term used to describe incidents involving hazardous materials or specialized teams who deal with these incidents. Hazardous materials are defined as substances that have the potential to harm a person or the environment upon contact. These can be gases, liquids, or solids and include radioactive and chemical materials. Biological organisms, such as viruses and bacteria, are not included as hazardous materials in this article.

Most hospitals in the United States lack plans or facilities for attending to patients exposed to hazardous materials, even though this can be a common problem in some areas. Recent terrorist activities in the United States, Japan, Europe, and Asia highlight the need for hospital preparedness. Federal statutes require hospitals to participate in the planning and care of persons exposed to hazardous materials and to train and provide protection for employees who may be exposed while providing medical care.

The potential for exposure to hazardous materials in the United States is significant. More than 60,000 chemicals are produced annually in the United States, of which the US Department of Transportation (DOT) considers approximately 2000 hazardous. More than 4 billion tons of chemicals are transported yearly by surface, air, or water routes. These shipments are initiated from more than 100,000 different locations, with more than 1 million people directly involved in the transportation process. More than 500,000 shipments of hazardous materials are made every day, totaling approximately 1.5 billion tons per year.

The incidence of hazardous materials exposures cannot be ascertained accurately because a national reporting system does not exist. In an attempt to better define the magnitude of this problem, the Agency for Toxic Substances Disease Registry developed the Hazardous Substances Emergency Events Surveillance (HSEES) system in 1990. Fifteen state health departments participate in the reporting system. In these states, the system has shown the following findings:

• About 9000 releases of hazardous substances occur annually, with 75% occurring at chemical facilities and 25% occurring during transportation.
• Most transportation-related incidents occurred during ground transport (85%) and 26% occurred in residential areas.
• Human error and equipment failure account for most releases.
• The most common substances involved were inorganic substances (24%) followed by volatile organic compounds (20%).
• More than 2000 people are victims of hazardous materials releases in these states each year. Approximately 50% of these are transported to hospitals. Respiratory and eye irritation are the most common types of injury. Over a 4-year period, 132 hazardous material–related deaths occurred.
• More than 7500 people required decontamination during HAZMAT events over a 4-year period in these states. Of these, 2643 were decontaminated at medical facilities.

Several important points can be drawn from the above statistics. Most importantly, this is not a rare problem. Cities, prehospital-care providers, and hospitals need to have plans for dealing with these incidents and caring for victims of hazardous material exposures. Because most incidents occur at fixed sites, knowing the industries that operate in the catchment area of a hospital and the chemicals used or stored at those sites is imperative. Trauma centers need to have a plan to care for trauma patients who are contaminated because 25% of the incidents occurred during transportation and 9% of victims of hazardous materials exposure also had traumatic injuries.

Please click here to view the full topic text: Hazmat