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A hazardous material is defined as “a substance (either matter - solid, liquid, gas - or energy) that when released is capable of creating harm to people, the environment, and property…” and may mean little to most EMS providers and medical directors in their daily practice, despite that they are all around us. 1 In addition to the recognition that hazardous materials are common components of our personal and occupational lives, it is important to consider the potential of a large-scale hazardous materials (HAZMAT) incident in any EMS system. Most EMS physicians are well versed in the occupational component of hazardous materials as it pertains to the Occupational Safety and Health Administration (OSHA) regulations that apply to the work environment but may not be fully prepared to respond in support of a hazardous materials incident operation and may not even be familiar with the principles laid out in 29 CFR 1910.120 (Hazardous Waste Operations and Emergency Response: HAZWOPER) or the availability of various publications on the topic provided by OSHA, NIOSH, FEMA, and the EPA. HAZMAT incidents occur in all areas affecting every community (Figure 72-1). This chapter will serve as a primer aimed at the EMS physician as a component of the response to a HAZMAT incident.

FIGURE 72-1.

US Department of Transportation Pipeline and Hazardous Materials Safety Administration Office of Hazardous Material Safety 2005–2014. (Reprinted from Accessed September 1, 2014.)


  • Discuss basic principles to the approach to a hazardous materials incident.

  • Discuss some specific concerns based on different types of hazards.

  • Describe PPE types and appropriate use of each.

  • Describe decontamination operations.

  • Describe the resources, equipment, and methods available for product/hazard identification.

  • Describe factors impeding medical operations in a hazardous materials environment.


Response to serious, large-scale, hazardous materials incidents is not a common operational event for the average EMS physician. Special training and experience are key components to a successful hazardous materials operation. Although most EMS physicians are not HAZMAT technicians there are still roles for a physician responding to these events (Box 72-1). Because of the importance of these physician-specific roles, those EMS physicians that are HAZMAT technicians should not become involved in the operation inside the hot or warm zones unless there is a specific and unusual medical intervention that can only be provided by the physician. The EMS physician is expected to serve as a medical content expert in all areas of prehospital care and toxicology is no exception. Serving as on-scene medical control for the sick and injured victims of a serious HAZMAT-associated incident allows providers to provide toxin-specific care without complicated radio communication and it also allows for rapid communication of special needs (eg, antidotes and secondary decontamination preparation) to the receiving hospital(s) ...

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