Awareness Level Hazardous Materials Training

1. Awareness Level Hazardous Materials Training HOSPITAL’S NAME HERE

2. INTRODUCTION Hospitals are sometimes called upon to treat patients who were accidentally or intentionally exposed to (contaminated by) hazardous materials (haz mat).

3. INTRODUCTION Haz mat includes three main categories of substances -- nuclear, chemical and biological -- that could pose risks to health or safety.

4. INTRODUCTION Because haz mat substances can be harmful under certain circumstances, special precautions to protect caregivers and others who may come into contact with the victim are necessary.

5. INTRODUCTION Sometimes hospitals may not know in advance they are receiving victims who were exposed to haz mat, so ...

6. INTRODUCTION … As a hospital employee or volunteer, you may unintentionally come into contact with a patient who has been exposed to or contaminated by hazardous materials.

7. INTRODUCTION Your safety is a priority. Therefore, this training has been developed to protect you by teaching you to: • understand haz mat materials and risks • recognize haz mat events/victims • protect yourself from haz mat exposure • identify your role in responding to haz mat events

8. INTRODUCTION THIS TRAINING ALONE DOES NOT QUALIFY YOU TO HANDLE HAZARDOUS MATERIALS!

9. INTRODUCTION The training includes information on: NUCLEAR HAZARDS CHEMICAL HAZARDS BIOLOGICAL HAZARDS SUMMARY

10. NUCLEAR/RADIATION

11. NUCLEAR OBJECTIVES UNDERSTAND: • what is radiation • types of radiological hazards • effects of radiation contamination and exposure • self-protection and management of radiation casualties

12. WHAT IS RADIATION?

13. RADIATION BASICS RADIATION IS... • invisible particles of energy that travel through air and other substances. • You can’t see, taste, or smell radiation… • But it can be inhaled, swallowed, or absorbed through skin

14. RADIATION BASICS • There are 4 types of radiation: • ALPHA:Shielded by clothing or paper • BETA:Shielded by thick clothing or aluminum • GAMMA:Shielded by lead, steel or thick cement • NEUTRON:Goes through anything, but is rare

15. RADIATION BASICS This is the universal symbol for radioactive materials:

16. WHAT TYPES OF RADIOLOGICAL HAZARDS EXIST?

17. NUCLEAR HAZARDS • ACCIDENTAL -- (Industries) • Nuclear reactor accidents • Medical or laboratory errors • Nuclear fuel spills/releases • INTENTIONAL -- (Nations or Terrorists) • Nuclear bombs triggering nuclear reactions • Explosive devices w/ radioactive materials • Radioactive isotopes planted to spread radiation

18. HISTORICALLY Reactor Incidents Laboratory or Medical Accidents Nuclear Waste Accidents Thermonuclear War Nationally Sponsored NOW THE SAME THREATS EXIST Terrorists and Rogue Nations NUCLEAR HAZARDS

19. HISTORICALLY Bomb Shelters Public Siren Systems Public Education • NOW • First Responders • Governmental Planning • Hospital Planning NUCLEAR PREPAREDNESS

20. NUCLEAR HAZARDS NUCLEAR INCIDENT EXAMPLES • Three Mile IslandMiddleton, PA (1979)Nuclear power plant meltdown. 100,000 residents flee. No injuries. • Chernobyl, Ukraine (1986)Nuclear power plant incident contaminated 100,000 square miles, and killed 125,000. • Springfield, MA(1991)Truck carrying nuclear fuel to a power plant collided with car. No one contaminated. • 1999 reportable incidents: 1310 medical, 2 occupational, and 1 fire at a plant.

21. WHAT IS THE EFFECT OF RADIATION CONTAMINATION OR EXPOSURE?

22. RADIATION EFFECTS • RADIATION SICKNESS:Large amounts of radiation. Day of exposure symptoms may include vomiting, diarrhea, hemorrhage. • RADIATION INJURY:Usually large amount of Beta radiation. Local injuries, such as skin burns and lesions, usually to hands from handling. • RADIATION POISONING:Dangerous amounts of internal radiation. Causes delayed injuries like anemia or cancer.

23. RADIATION EFFECTS Radiation sickness, injury and poisoning are NOT contagious or infectious.Treating or helping victims who were exposed to radiation, but are no longer near the source, will not expose you. For example: An x-ray will expose you to radiation, but you are not contaminated by an x-ray.

24. RADIATION EFFECTS However, if a victim arrives covered in radioactive dust or debris, the radioactive material can contaminate you.

25. RADIATION EFFECTS SEVERITY OF RADIATION’S EFFECTS = AMOUNTandTYPE of radiation + DISTANCEfrom radiation + type ofSHIELDING + TIMEexposed

26. HOW DO YOU PROTECT YOURSELF FROM RADIOACTIVE EXPOSURE?

27. PROTECTING YOURSELF FROM RADIATION The first step to protecting yourself is recognizing the risk of exposure. CLUES MAY INCLUDE: • The location a victim came from (i.e., laboratory or radiation oncology clinic) • The victim’s occupation (i.e., truck driver, lab technician, power plant employee) • An explosion of unknown origin • History of an unknown substance • Patients from one area with similar symptoms

28. PROTECTING YOURSELF FROM RADIATION If you suspect you, or someone in the near proximity to you, were potentially contaminated with radioactive material, here is what to do…

29. PROTECTING YOURSELF FROM RADIATION DO NOT SPREAD THE CONTAMINATION! • To the extent possible, do not move; avoid touching yourself, objects, or people; and do not leave the room • Inform others in the areawho may have had contact to remain calm and to stay still too • Call out or telephone for assistance. Make it clear that a hazardous substance may be involved

30. WHAT IS EXPECTED FROM AN AWARENESS LEVEL RESPONDER?

31. AWARENESS LEVEL STAFF ROLES • Know who to contactif you are the first to recognize a potential nuclear contamination event/victim • Know to whom to report for response instructions, and follow his/her directions carefully • You may be asked to: • assist in securing the containment area • directing the flow of patients and staff • appropriate tasks outside the contaminated area • HOSPITAL ADD APPROPRIATE FUNCTIONS HERE

32. AWARENESS LEVEL STAFF ROLES But, NEVERwork inside the containment area or handle contaminated items. You are not trained to wear special protective equipment or to handle nuclear hazardous materials.

33. CHEMICAL

34. CHEMICAL OBJECTIVES UNDERSTAND: • what is a chemical hazard • types of chemical hazards • effects of chemical contamination and exposure • self-protection and management of chemical casualties

35. WHAT IS A CHEMICAL HAZARD?

36. CHEMICAL HAZARD BASICS CHEMICAL HAZARDS ARE... • Liquids, gases or solids that can cause injury by reacting with the body’s tissues. • You may be able to see, taste, or smell chemicals, but this is not always true. • Chemicals can be inhaled, swallowed, injected or absorbed through skin.

37. CHEMICAL HAZARD BASICS CHEMICAL EXAMPLES: • Explosive: dynamite • Flammable: gasoline • Thermal: dry ice • Toxic/Poisonous: arsenic • Corrosive: acids • Anesthetic: chloroform • Asphyxiating: carbon monoxide • Noxious: tar gas • Blistering: mustard gas • Nerve agent: sarin

38. CHEMICAL BASICS These are some of the chemical hazard symbols: Flammable Poison

39. WHAT TYPES OF CHEMICAL HAZARDS EXIST?

40. CHEMICAL HAZARDS • ACCIDENTAL -- (Industry and Home) • Manufacturing, shipping, or storage accidents • User error-- failed safety precautions • Combining harmless chemicals to create a dangerous reaction • INTENTIONAL -- (Terrorists and Warfare) • release of agents using bombs, aerosols, or other disbursement mechanisms

41. CHEMICAL HAZARDS CHEMICAL HAZARD EXAMPLES • Union CarbideIndia (1984) Tank leaked extremely reactive chemical -- over 100,000 treated, 50,000 hospitalized, and 2,500 dead • CultJapan (1995) Released sarin gas in subway system -- 12 killed, thousands sought care • Refinery explosion Arkansas (1999) Killed 3; sent 3 to burn unit. Released smoke plume. • Rail yard spill California (2000) Mixed hydrochloric acid and jet fuel -- 1,000 evacuated, 2 hospitalized

42. WHAT IS THE EFFECT OF CHEMICAL CONTAMINATION OR EXPOSURE?

43. CHEMICAL EFFECTS • The effect of a chemical exposure depends on the type of chemical(s) • Some are harmless; others are deadly • Symptoms and severity of the reaction vary depending upon the amount and/or duration of exposure and the form -- solid, liquid or gas.

44. CHEMICAL EFFECTS Examples of symptoms include: Unconsciousness Confusion Drooling and tearing eyes Light-headedness or dizziness Blurred or double vision Coughing or painful respiration Change in skin color or blushing Anxiety Tingling or numbness of extremities Nausea, vomiting, abdominal cramping and diarrhea Changes in behavior or mannerisms Loss of coordination Burns or burning sensation

45. CHEMICAL EFFECTS Chemical exposures are not contagious or infectious.Treating or helping victims who were exposed to chemicals, but are no longer exposed to the source, will not expose you.

46. CHEMICAL EFFECTS However, if a victim arrives with chemicals on his/her clothing, shoes, or body, the chemicals can contaminate you. You may not know a victim has been contaminated because not all chemicals can be detected easily by sight or smell.

47. HOW DO YOU PROTECT YOURSELF FROM CHEMICAL EXPOSURE?

48. HOW DO YOU PROTECT YOURSELF FROM CHEMICAL EXPOSURE? The first step to protecting yourself is recognizing the risk of exposure. CLUES MAY INCLUDE: • The location a victim was near (i.e., hardware store, industrial park, truck accident, gas station) • The victim’s occupation (i.e., garbage removal, lawn care, construction, transportation, medicine) • An explosion or gas cloud of unknown origin • An unknown liquid, oil, gas or powder • Patients from one area with similar symptoms • Unidentified smells or tastes

49. PROTECTING YOURSELF FROM CHEMICALS If you suspect you, or someone in the near proximity to you, were potentially contaminated with a chemical, here is what to do...

50. PROTECTING YOURSELF FROM CHEMICALS DO NOT SPREAD THE CONTAMINATION! • Avoid touching the suspected liquid or solid, or breathing fumes. If you may have touched a chemical, do not touch yourself, objects or people. • Remove yourself from immediate risklike fumes or additional contamination, but stay as near to the source as possible. • Inform others in the areato minimize all contact and to stay calm. • Call out or telephone for assistance, making it clear that a hazardous substance may be involved. • Immediately, report all routes takenby the victim or anyone with secondary contamination.