EMT-Basic Exam: The Basics of Operations - Special Operations

As you already know, you need additional training if you hope to serve on a special response team. The more educated you are in the area of disaster planning and response, the more prepared you will be for mass-casualty situations and emergencies involving life-threatening and hazardous materials. Although not every person taking the EMT-Basic exam may have an interest in joining a specialized team, general questions about special operations will appear on the test.

1. Hazardous Material
Most EMT-Basics are required to complete a First Responder Awareness Level education program before they can respond to situations involving hazardous materials. Hazardous materials pose a serious threat to the lives of patients, emergency personnel, and bystanders. As an EMT, you may come in contact with hazardous materials during a motor vehicle accident or a situation involving weapons of mass destruction.

Completing a First Responder Awareness Level education program will ensure that you
- Understand your role in an emergency response plan.
- Recognize the presence of hazardous materials and their risks.
- Understand the various outcomes of hazardous material situations.

a. Safely Approaching the Scene
As always, your safety and the safety of the patient and other personnel is paramount when responding to a situation involving hazardous materials. These situations may also involve the safety of bystanders, witnesses, and the surrounding community. Before arriving on the scene of a hazardous materials situation, gather as much information about the incident as possible. If you suspect or are told that hazardous materials are on the scene, approach with extreme caution. Never enter any situation that could compromise your safety or the safety of others. Based on the information you receive, make sure you’re wearing the appropriate protective gear for the situation.
As you approach the scene, be sure to isolate and avoid the area where the hazardous material is located. As an EMT, you should recognize any sounds, odors, or clouds that may indicate the presence of hazardous materials. Report anything unusual to dispatch.

b. Sources of Information
One of the most valuable pieces of information you can obtain during a hazardous materials situation is the name of the chemical(s) involved. Knowing which chemicals you are dealing with will help determine how you proceed. The easiest way to identify a hazardous material is to locate the container. The size, shape, and the placard on the container will provide you with information about the toxin in question.



Hazardous materials symbols and placards.

The placard will you tell if the chemical is corrosive, flammable, or radioactive. In some cases, the placard will also tell you if the chemical is a liquid, a solid, or a gas.
If you can’t locate the container, there are other ways to identify the agent. If a vehicle is involved in the situation, the driver should be in possession of shipping papers that list all of the materials being transported. When a hazardous material emergency occurs at a power plant, in a lab, or at a factory, ask the supervisor for the Material Safety Data Sheets (MSDS). The United States Department of Labor requires companies, laboratories, and farms to keep public records of the chemicals they use. This information will be listed on the MSDS.
Once you are aware of the hazardous materials you’re working with, you may be instructed to call the Chemical Transportation Emergency Center, also known as CHEMTREC. This service operates 24 hours a day, 7 days a week. Operators can provide immediate assistance or advice on how to treat a patient who may have been exposed to a hazardous material.

Tip: If you have completed the First Responder Awareness Level education program and have the appropriate protective equipment, you may be able to act or intervene before other emergency teams arrive on the scene.

c. Emergency Procedures
Every hazardous materials situation is different; therefore, it is important to be prepared for any type of situation. Many EMS crews refer to the most updated version of Emergency Response Guidebook: A Guidebook for First Responders during the Initial Phase of a Dangerous Goods/Hazardous Materials Incident. If you haven’t received specialized training in working with hazardous materials, this book, which may be purchased from most major booksellers, will provide information on preserving your safety and securing the scene.
In general, no matter the contaminant, you should always complete the following procedures:

- Use caution while approaching the scene.
- Identify all hazardous materials and their sources.
- Make sure you’re wearing the proper protective gear for the situation.
- Follow the guidelines outlined in the Emergency Response Guidebook.
- Don’t allow anyone to enter the contaminated zone.
- Isolate all patients who have been in contact with or contaminated by the toxin.
- Call CHEMTREC or radio your medical direction physician for information on treating patients.
- Don’t walk through any puddles or clouds and don’t touch any spilled materials.
- Don’t inhale any questionable vapors, smoke, or fumes.

Remember that some toxins may be odorless or colorless. Don’t assume you’re safe simply because you don’t notice anything unusual. Use extreme caution if you suspect that a hazardous material might be present.

2. Incident Management Systems
State or local agencies create and organize incident management systems to ensure efficient and effective responses by fire departments, police departments, and EMS crews. Such systems help every member of every crew understand their individual responsibilities. This eliminates confusion and guarantees that no one overlooks or forgets to complete a task. Communication is a key component of a successful incident management system.
Incident management systems are often used in situations involving hazardous materials or multiple extrications. They are also used when an incident requires specific resources or equipment, such as the use of air medical transport.

a. Sectors
Once a major incident has been declared, an incident commander is chosen. The incident commander then establishes sectors. Some of the most common sectors you’ll encounter on the job include the following:
- Staging sector—This sector is responsible for the movement of all transportation vehicles that arrive at and depart from the scene. This team also handles communications with the media and international aid agencies such as the Red Cross and Salvation Army.
- Transportation sector—This sector involves the use of ambulances and helicopters to transport patients, personnel, and equipment to and from hospitals. This team coordinates its efforts with the staging sector and the support/supply sector.
- Support/supply sector—This sector records all requests for and receipts of supplies and support services. Members of this team track the use of all additional personnel, resources, and equipment. They coordinate with the transportation center frequently.
- Extrication sector—This sector is responsible for removing trapped or entangled patients. If the rescued patient is in critical condition, members of this team will perform an initial assessment and provide treatment. If the patient is stable, members of this sector will transport the patient to the treatment sector.
- Treatment sector—This sector receives patients from the triage and extrication sectors. Members of this team perform initial assessments, obtain focused histories, and complete physical examinations. They also prioritize patients for transport.
- Triage sector—This sector is responsible for continued reassessment and further treatment of patients. In most incidents, this sector is combined with the treatment sector.

The incident commander appoints a leader to each sector who coordinates the members of his or her team by assigning specific tasks and responsibilities. EMT-Basics with disaster training are often designated sector leaders. Sectors are often marked on scene using colored flags. In most situations, sector leaders will stay off the radio to keep the airways clear for the incident commander to give instructions to and maintain contact with other agencies.

b. Role of EMT-Basics
Within an incident management system, EMT-Basics must consult with their sector leader or incident commander before making any decisions. EMT-Basics’ responsibilities are often assigned according to the time that they arrive on the scene. The incident commander and triage sector leader are chosen from the first crew to arrive on scene. As more help arrives, other sectors are established. If you arrive on scene after the incident management system is completely functional, you will most likely be directed to the staging sector for an assignment. Once you complete your assignment, return to the staging sector and request another task.

3. Mass-Casualty Situations
Rarely will you arrive on the scene of a mass-casualty situation and find that an incident management system is not in place. Dispatchers will often notify EMS crews of mass-casualty situations before first responders even arrive on the scene. During such incidents, confusion can arise quickly. Having an incident management system organizes the chaos and helps emergency workers understand their individual responsibilities. Some examples of mass-casualty situations include bus and train collisions, bombings or explosions, building or bridge collapses, and earthquakes.

a. Patient Prioritizing
During mass-casualty situations, an EMT’s most important task is performing patient triage. Triage is a method of categorizing patients according to the severity of their injuries. Emergency responders use a tagging system to indicate which patients require immediate treatment and transport. These color-coded or numbered tags indicate one of the following conditions:
- Life-threatening, requiring immediate transport
- Moderate, requiring transport as soon as possible
- Minor, requiring delayed transport
- Not injured, no transport necessary
- Deceased, no transport necessary

Some tags may also include information about the patient’s vital signs, the treatment he or she received from EMT-Basics, or the location of his or her injuries. The highest priority is given to patients who have airway obstructions, severe bleeding, altered mental status, symptoms of shock, severe burns, or multiple bone or joint injuries. Other high-priority patients include those who are experiencing a serious medical issue, such as cardiac or respiratory arrest.

b. Procedures
As in many other incident management systems, those that are created for mass-casualty situations require that an incident commander and a triage sector leader be appointed when the first crew arrives on scene. The most knowledgeable and capable member signs on as incident commander and then quickly appoints a triage sector leader. While sizing up the scene, help from additional crews and agencies should be requested.
The triage sector leader performs quick assessments of all patients, but he or she will only provide treatment if a life-threatening condition exists. If no life-threatening conditions are discovered, the incident commander will tag each individual and assign other EMT-Basics to move the patients to the treatment sector. After the patients receive additional assessment and treatment from the treatment sector, EMT-Basics move the patients to the transportation sector, where they will await transport according to their priority level.

Related Topics You Should Review:
- Hazardous material placards and labels
- First Responder Awareness and Operations Programs
- Hazardous Materials Technician Programs
- Hazardous Materials Specialist Programs
- On-Scene Incident Commander training