New HazMat Challenges for Modern EMS Units

A major dilemma in establishing, and operating, modern EMS (Emergency Management Systems) units is that many smaller political jurisdictions field proportionately smaller EMS agencies – many of them manned principally by volunteers. Leadership of these agencies is often a balancing act, therefore, between meeting minimum requirements – e.g., ensuring that there is a certified emergency medical technician (EMT) on every ambulance – and overwhelming the local volunteers, already overworked in many jurisdictions, with a heavy load of additional “required training.”

The lack of adequate staffing is, in fact, often the most significant controlling factor that keeps many jurisdictions from fielding their own specialized EMS units. For that reason alone, it should always be remembered that establishing any specialized new unit (in almost any field) to provide an operational service is not simply a matter of collecting the equipment needed and assigning staff to a vehicle or predesignated space. Simply “wanting to do it” because it seems like a goodea is not enough.

As a corollary, it also should be recognized that there are almost always at least three special considerations that must be addressed prior to the purchase of even the first piece of equipment: legal authorities, established procedures, and detailed planning requirements. Following are brief summaries of the principal issues usually involved.

Authorities & Procedures 

Before taking any substantive actions, local leaders must first answer the question, “Does the agency [being established] have the legal authority needed to field (and operate) this unit?” This authority may come from a legal statute or an executive-branch decree. This step should also answer not only to what degree the agency is obliged to provide such a unit but also the penalties that might be imposed for any gaps in service.

In addition, a comprehensive set of procedures and regulations must be adopted to tell staff and other responders, in very specific terms, what is expected of them, including the full details of required certifications as well as any restrictions on staff activity. The certifications required not only document the fact that the member has the base of knowledge needed in the subject discussed, but also affords the unit some initial legal protection by attesting that the certifying agency has provided either the appropriate training or testing required, or both. In addition, by basing the regulations adopted on national or international standards, the unit is afforded an even stronger degree of shelter from legal risks and does not have to start from scratch in developing its own standards.

Response Planning 

Many of the nation’s larger cities – New York City, Los Angeles, and Pittsburgh, for example – maintain specially trained and equipped EMS units that respond primarily if not exclusively to hazardous materials (hazmat) incidents. These special units usually have the capacity not only to deal with “routine” day-to-day incidents but also to cope with most if not quite all CBRNE (chemical, biological, radiological, nuclear, explosive) threats as well.

Regional Teams: A Cost-Effective & Sometimes Mandatory Approach 

A dedicated core group of members may be enthusiastic about fielding a specialized unit, but there simply may not be a sufficient number of trained staff members to avoid gaps in coverage. One example of the potential problems that might develop: It is often possible, in many jurisdictions both large and small, to collect the donations needed to fully equip a unit. But all types of equipment eventually break down, and the initial stocks of expendable supplies are used up or expire. Very careful planning is needed, therefore, to determine if, or how, these items will be replaced on an ongoing basis. The inability to meet so-called “routine” or continuing costs are one of the principal reasons, in fact, that well intended in-kind donations may not always be worth accepting.

Many smaller communities address staffing and ongoing costs by sharing regional or county resources – a fully capable hazmat team, for example. In this instance, it may be more effective for many relatively small EMS agencies to provide equipment and staff as part of a regional team, rather than expecting each agency to field its own local team – from an obviously much smaller personnel pool. The main drawback of this model is political in nature. Regional teams and local EMS agencies should but do not always recognize that the members they share in common belong to the specific agency that puts them in the field to cope with a specific incident. Largely for that reason, all members must fully understand what role they are playing in each incident to which they might be assigned.

Another way to meet staffing needs during (but preferably long before) a hazmat event occurs is through use of the so-called “cold zone” model, where EMS staff remain safely out of Harm’s Way in the clean, or cold, area around an event and patients are brought to the staff’s staging area – after the patients have been decontaminated by the hazmat team and/or other responders. This model has two big advantages: (a) no additional training for EMS staff is required; and (b) it is much easier, and safer, to keep staff members themselves in relatively safer areas. The downside is that some patients need medical care much faster than the time it takes to decontaminate the patients prior to taking them to the clean/cold area designated.

In short, there are several ways to provide adequate hazmat response coverage, and having more than one option available allows emergency response leaders to provide the protection from chemical hazards needed in the modern environment – while also guaranteeing a certain but not overly ambitious level of legal and political protection before, during, and after CBRNE incidents.

Joseph Cahill
Joseph Cahill

Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.



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