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EMS Resources

Medic Electives: WMD-Hazardous Materials

Level 4

Hazardous Materials or HAZMAT EMT Refresher Course EMSNeeds.com Continuing Education

Overview | Assessment | Treatment | Roles


Hazardous Materials or HAZMAT EMT Refresher Course

In this HAZMAT Basics course you will earn 2 CE hours. Since all levels of EMS are technically first responders, this course is for all levels of continuing education credit.

At the end of this course you will be able to:

  • Know and identify basic priorities in handling hazmat situations.
  • Assess a situation and clarify your role.
  • List basic signs and symbols of hazardous materials.
  • Understand your role based on your level of training and position at the time.

References for content used by permission are on the left side under "EMS Resources." A technical :word: when clicked instantly accesses the EMS glossary online.

There are four sections: Overview, Assessment, Treatment, and Roles. Take the section tests in order by clicking the Take Test button. Your results are saved if you are interrupted. Then do the next section—no lost time or effort with mini-test sections!

CE for all levels
Hazmat and terrorism are real. Hazardous materials, commonly called :hazmat:, occurs naturally in the environment and can also be man-made. When these harmful materials are used in destructive ways, they create dangerous conditions for everyone. Hazardous chemicals are prevalent throughout our society.  While industry is the primary user and maintainer of hazardous chemicals, we also have them in our homes, in our cars, at our places of work and recreation. Hazardous materials move through our region on highways, rail lines, pipelines, and by ship and barge.
Hazmat Symbol

Description of Causes

Most incidents involve petroleum products. However, hazardous materials may also be released as a secondary result of a natural disaster like earthquakes or floods.  In either case, buildings or vehicles can release their hazardous materials inventories when structurally compromised or involved in traffic accidents.  Pipelines can be exposed or ruptured from collapsed embankments, road washouts, bridge collapses, and fractures in roadways, and neighborhoods may include a natural gas pipeline.

Additional potential causes of hazardous materials releases may include terrorist incidents and illegal drug labs or dumping. Illegal drug labs present a special concern due to the fact that each must be treated as a chemical hazard site and decontaminated before the property can be used again. Illegal drug labs can be set up in homes, apartments, vacant buildings, shacks in the forest or even in a van parked on the street.

Homeless Area


  • Terrorism -  
    • U.S. Department of State – "premeditated, politically motivated violence perpetrated against noncombatant targets by sub-national groups or clandestine agents, usually intended to influence an audience."
    • FBI – "unlawful use of force against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in the furtherance of political or social objectives."
    • Webster’s Dictionary – "the act of terrorizing; use of force or threats to demoralize, intimidate, and subjugate, esp. such use as a political weapon or policy."
  • Hazmat – "hazardous materials that may endanger life"
  • Personal Protective Equipment (PPE) - "EMS equipment and body covering that prevents serious contamination of those helping victims"
Totals by Mode Incidents Hospitalized Non-Hospitalized Fatalities Damage
Air 17 0 2 0 $576,035
Highway 409 21 72 24 $47,920,109
Rail 98 11 6 0 7,258,507
Water 2 0 0 0 62,060

Emergency Stop






Knowing what to do is essential.


  • Look at the whole picture.
  • Do not rush in.
  • Think of the consequences.
  • Ask yourself, “Will my effort make the outcome better?”
  • You are the most important person!
patient assessment

Therefore remember these three key words as your initial actions as a first responder:

S – Safety
I – Isolate and Deny Entry
N – Notify Authorities

SIN is an easy way to recognize the critical elements of action.

  • First is your safety. Just as airlines instruct passengers to put the oxygen mask over themselves first before helping their children, you cannot help others if you do not first look out for your own safety.

  • Second, isolate the area and deny entry to others who may want to view the situation. Keeping unauthorized people out of harm's way is essential to prevent escalation of the hazmat event.

  • Third, notify the proper authorities. In each chain of command, the more information from you as a first responders on the scene, better decisions may be made by others in command.

Hazmat Resources Neede

What resources do you need?

  • More engines?
  • More ambulances?
  • Hazmat?
  • Police?
  • Bomb Squad?

Terrorism has become an undeniable reality in the United States today. In addition to conventional weapons, there is increasing concern that criminal individuals, terrorist groups, or nations may resort to the use of biological, chemical, or radiological weapons. There is a long history of use of biological and chemical weapons on the battlefield. While these weapons have been used on occasion in the United States, the events of September 11, 2001 and the anthrax mailings of October 2001 have made the potential danger evident. Physicians, nurses, first responders and other health care personnel in American cities can no longer afford to be uninformed about biological, chemical and radiological weapons.

Rapid recognition of a clinical syndrome consistent with a bioterrorist agent will facilitate not only appropriate early treatment of the victim, but will give public health officials time to conduct a rapid epidemiologic investigation to identify other exposed individuals and deliver appropriate prophylactic measures to prevent or ameliorate disease. For many biological weapons, a narrow window of opportunity exists during which a prophylactic measure can be administered to prevent or treat disease. Delay in recognition will cost lives. Delayed recognition of contagious bioterrorist agents, chemical agents, and radiological contamination will harm the affected patients by depriving them of the necessary appropriate treatment or decontamination and lead to infection or contamination of health care workers.

In prior terrorist attacks 80% of victims who presented for healthcare had not been exposed or infected with the agent in question, but were suffering from psychological effects. Such psychological effects can mimic the signs and symptoms associated with the agent of concern. If such persons are not appropriately recognized and triaged they will complicate diagnostic issues and deplete pharmaceutical stockpiles. Clinicians, as well as being first responders, must also be aware that they may be dealing with the perpetrator of the incident. Terrorists working with weapons of mass destruction (WMD) may be accidentally exposed to the agent during the perpetration of the attack. Clinicians should consider this possibility when dealing with patients exposed to WMD and act accordingly.
To prevent further spread of any harmful threats, shutting of the HVAC system is essential. An HVAC system controls the air system in a building. Request the location of the controls or report to authorities for help.

Hazards: Risk vs Gain

Calculate risk vs gain. For example, you respond to a water treatment plant for a man down. What are your considerations? Life safety first. Yours! Is it safe to enter? Is there a possible leak that caused the man to go down or did he have a heart attack? Always keep an open mind and consider options: What is the risk compared to the gain of entering the area. Think about life safety first. Your life first, and then theirs.
Water Treatment Plant

What questions do you ask?

  • Is there anyone still inside the cab? If so, can you get the driver out?
  • Is anything leaking?
  • Is hazmat coming?
  • Can the fire department put foam on the ground to control vapors?
Truck Overturned

You respond on a traffic collision and find this. What are you thinking?

  • Is it safe to approach?
  • What is the truck carrying?
  • Do we need hazmat?
  • Does the truck have mixed goods?
  • What's wrong with this picture? The truck is overturned with a fuel leak from the tank and civilian personnel are walking around. Keep civilians out until it is safe. Life safety is first.

  • Keep civilians out.

    Initial Decontamination of Victims

    • Call authorities if you do not have PPE. Proceed after evaluating risk vs gain.
    • Brush off the chemical if it is a powder.
    • Remove their clothes.
    • Use copious amounts of water.
    • Do not load the patient in the ambulance or take them into the ER unit until the patient is decontaminated.
    Hazardous Waste


    Many container labels will have diamond or a box that is divided into color coded sections: Health (blue), Flammability (Red), Reactivity (Yellow) and Other or Corrosive (white). Numbers of 0-4 will be assigned to each section of the diamond to indicate the degree of hazard; 0 indicates low hazard, and 4 is highest level of hazard.


    To learn more about signage, take the Signs and Symbols  course.

    4 dangers

    Roles and Responsibilities


    Triage is a term used to sort patients into groups based on the seriousness of their injuries. Your safety is important. Triage is vital as a first responder because over 80% of the time patients may suffer from psychological effects that mimic the signs and symptoms associated with the agent of concern.

    START (Simple Triage and Rapid Treatment) is a simple triage system that can be performed by lightly-trained lay and emergency personnel in emergencies. It is not intended to supersede or instruct medical personnel or techniques. It may serve as an instructive example, and has been (2003) taught to California emergency workers for use in earthquakes. It was developed at Hoag Hospital in Newport Beach, California for use by emergency services and has been field-proven in mass casualty incidents such as train wrecks and bus accidents, though it was developed for use by CERTs and firemen after earthquakes.

    Triage separates the injured into four groups and often color-coded:

    • BLACK: Dead or mortally wounded;
    • RED: Severly injured.
    • YELLOW: Moderately injured;
    • GREEN: Minor injuries.

    What do you see?

    If someone was in full cardiac arrest, could you enter their garage and attempt to revive them or is it too dangerous with these chemicals here?

    Yes, you could enter and move them outside to revive them. Chemicals are contained. Then call the Police Department and Hazmat.

    Legal Requirements

    Stay within your boundaries. Call authorities when in question.

    Hazardous Materials Impacts

    Many factors determine the impact of a potential incident including quick and solid decision-making by emergency officials, location and type of release, evacuation and shelter-in-place needs, public health concerns, and relevant economic considerations.  Additionally, while most incidents are generally brief, the resulting recovery and cleanup may take time to exact.

    A major incident involving significant injuries may severely tax regional medical services, as medical facilities aren’t generally designed to handle mass amounts of victims on short notice.

    Consequently, in the event of a major incident, hospitals and other medical facilities must still be able to provide their customary level of service to all patients, regardless of whether they were incident victims or not.

    Public education is a key component to reducing the risks associated with a hazardous materials release.  Educating the public on the fundamentals of shelter-in-place is also a key component. Citizens must know when, where, and how to shelter-in-place effectively, as this response mechanism is key to saving lives in a chemical emergency. 

    Being aware and attentive of emergency officials and their public safety directives during a hazardous materials release will help ensure the protection of vulnerable populations and may lessen the economic impact of a release to the business and industrial community.

    For More Information

    The Emergency Response Guidebook (ERG2004) was developed jointly by the US Department of Transportation, Transport Canada, and the Secretariat of Communications and Transportation of Mexico (SCT) for use by firefighters, police, and other emergency services personnel who may be the first to arrive at the scene of a transportation incident involving a hazardous material. It is primarily a guide to aid first responders in (1) quickly identifying the specific or generic classification of the material(s) involved in the incident, and (2) protecting themselves and the general public during this initial response phase of the incident. The ERG is updated every three to four years to accommodate new products and technology. The next version is scheduled for 2008.

    This free download, 2004 Emergency Response Book A GUIDEBOOK FOR FIRST RESPONDERS DURING THE INITIAL PHASE OF A DANGEROUS GOODS/ HAZARDOUS MATERIALS INCIDENT is 374 pages for future reference.


    Your safety is first. Remember risk vs gain. Can you safely risk your life to save a viable life? What are the chances a person is alive or dead? Life is always the first priority and your life counts.

    Chemicals in containers

    Personal Protective Equipment (PPE)

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