From bug spray to paint fumes and mace to carbon monoxide, there are numerous reasons why large numbers of people may experience similar symptoms. As an EMS provider, intentional exposures (such as terrorism) and accidental exposures (laced medications, spreading illness, spills, asbestos, etc.) should all be treated suspiciously until proven otherwise.
|Common and recent examples of exposure events|
Key points to remember
- Be aware. Be suspicious.
- It isn’t “normal” for large numbers of people to suddenly experience symptoms at the same time
- Do the surroundings match the story? If you get called to a chlorine leak at a swimming pool and see people coughing with watery eyes, that may fit. If you see those same people at a mall, that is not normal.
- Is this a high value target?
- What are the symptoms/signs?
- Call for help
- If you are first to arrive or early, make notifications
- Set a staging area based on size, type, wind, etc.
- Limit your exposure
- Apply appropriate PPE
- Stage at a safe distance
- Don’t touch unknown substances or known dangerous ones
- Follow command instructions for staging, entry, etc.
- Know hot, warm, cold zone areas
- Don’t become a victim
- Don’t relocate the incident
- Corral patients-give them a task, keep them calm, separate sick from not sick
- Call the nearest hospital as soon as feasible
- They can prepare for your arrival
- They might get POV patients before you transport
- Decon as appropriate and as necessary
What can you do to be more prepared?
- Know the signs and symptoms of various types of chemicals/drugs/illnesses.
- “SLUDGEM” is indicative of nerve agent and organophosphates/pesticides
- Know the difference between opiate and other drug signs and symptoms
- Check out Appendix J in the TEMS protocols for CBRNE and Hazmat treatment guidelines: http://tidewater.vaems.org/tidewater-ems-council/protocols/2016-tems-protocols/2016-apendixes/2204-appendix-j-hrmmrs-cbrne-and-hazmat-protocols-2016/file
- Check out various documents that cover signs and symptoms, treatment and/or PPE:
- Nerve Agents: http://www.naemt.org/docs/default-source/ems-preparedness/nerve-agent-info-for-ems-hospitals_08-21-2018_final.pdf?sfvrsn=9710c892_0
- Fentanyl/Opiates: https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final%20STANDARD%20size%20of%20Fentanyl%20Safety%20Recommendations%20for%20First%20Respond….pdf
- Emerging infectious diseases: http://www.vdh.virginia.gov/emergency-medical-services/emergency-operations/emerging-infectious-diseases-information/
- Emergency Response Guidebook (and app!): https://www.phmsa.dot.gov/hazmat/erg/emergency-response-guidebook-erg
- DEA Drugs of Abuse: https://www.dea.gov/sites/default/files/2018-06/drug_of_abuse.pdf
- Carbon Monoxide: https://www.cdc.gov/co/faqs.htm
- Various types of situations and emergencies:
As always, be safe, be suspicious, and never stop learning!