EMERGENCY MEDICAL SERVICE'S & THEIR RESPONSE TO CHEMICAL BIOLOGICAL AND RADIOLOGICAL ATTACKS

Emergency Medical Service's & their response to Chemical Biological and Radiological attacks



Emergency Medical Service's and their response to Chemical Biological and Radiological attacks

There are >192,000 emergency medical service (EMS) providers throughout the United States who provide both emergency medical care and inter-facility transportation for the sick and injured. (Total numbers of certified emergency medical service providers at all levels, which would include first responders whose primary role is not emergency medical care, totaled over 840,669 certified EMS providers in a 2004 survey by the National Association of Emergency Medical Service Directors.)

Emergency medical services in the US are provided by a vast network of organizations and individuals, including fire departments, private companies, volunteers, hospitals, and 3rd services. However, all states require a trained and certified EMS responder to provide emergency medical care in the event of a mass-terrorism chemical weapons attack (MTCWA), and if the state permits, the administration of antidotes.2 Traditional methods of hazardous materials response involve identifying the event, isolating the area, and then, demarcating the area into three zones: (1) a hot zone, or exclusion zone, where contamination exists; (2) a warm zone, or contamination reduction zone, where victims and responders disrobe, are decontaminated, and transition into the next zone; and (3) the cold zone, or support zone, where no contamination exists, and victims are transported to definitive medical care.3 Emergency medical services responders work in the cold and warm zones.4 According to the Emergency Responder Guidelines of the (US) Office of Domestic Preparedness, there are three training levels for EMS responders: (1) Awareness-Level responders are expected to identify the MTCWA and retreat; (2) Performance Level-A EMS responders provide medical care in the warm and cold zones; (3) and Performance Level-B EMS responders who will provide medical care in the warm and cold zones, but have some special training in rescuing or assisting in caring for victims in the highly-contaminated hot zone.

There are four different levels for personal protective equipment (PPE): (1) Level A provides the highest degree of respiratory and skin protection by means of a totally encapsulating, chemical-protective suit with a self-contained breathing apparatus that is worn in the hot zone when the risks are unknown; (2) Level B provides the same high degree of respiratory protection, but less skin protection, with the self-contained breathing apparatus being worn on the outside of the chemically-resistant suit, and used in hot zones when the chemical is known; (3) Level C is worn in the warm zone, and utilizes an air-purifying respirator and chemical-resistant suit—it is used in environments when the chemical is known, the concentration in the air is known, and there are sufficient levels of oxygen; and (4) Level D is a work uniform affording minimal protection and typically would be worn in the cold zone.6 Emergency medical services providers traditionally utilize Level C and D PPE depending on whether their agency permitted them to work in the warm or the cold ...