For those of us who respond to hazardous materials emergencies and for those of us who will be first responders at an incident involving weapons of mass destruction (WMD), you have to ask the question, "what happens if something goes wrong and I get exposed to this stuff"... Do you have a contingency plan?

States including Arizona, Texas and Florida I know for sure have what is called a toxmedic program. As this discussion site grow, hopefully some of these trained fire deparment medics will be able to share more specific information about the program and how you can benefit from establishing your own program.

None of us have a problem with running into a burning building... OK, maybe some of us question the sanity of why we do what we do for a living but all of you have to admit that even the craziest firefighter out there has some serious second thoughts about donning level A PPE, making entry and exposing one's self to the methyl-ethyl-death. For those responders out there that participate in this "extreme firefighting operation", it seems only fair to have a plan in place that enables the appropriate antidotes and medical treatment to be available in the cases where things just go wrong; and they do, a lot...

I was one of the primary authors for the California State Hazardous Materials Technician and Specialist program in the mid 80's. This enabled me to teach the course all over the state. What was disturbing was the number of firefighters I personally met with that shared horror stories of how they were cared for after being exposed to various hazardous materials.

One guy was climbing on a ladder inside a toluene tank that contained minimal liquid and a lot of vapors. Another firefighter was just above him, climbing the ladder after securing a dead body / victim inside a stokes litter. This firefighter slipped on the ladder and his boot made contact with the firefighter below, temporarily moving the mask off his face... he took one partial breath before getting the mask back on. He told me that he did not remember continuing to climb up the ladder and down the ladder on the outside of the tank. What he did remember was having an out of body experience, watching them do CPR on him. He didn't recall anything else until he woke up in ICU. Once climbing off the ladder and onto the ground, he dropped... full cardiac arrest... This was an easy one because it was obviously a asphyxiant with know toxic properties. The firefighter recovered but was retired due to permanent lung damage that had occurred.

Several firefighters shared now their local hospitals had told them that if only they were better informed by the fire department that the specific hazards existed they could have done a better job and that they would do better next time now that they had more awareness to the need to be prepared for this type of problem, etc. These were only some of the excuses for poor medical care that I heard as I traveled and taught firefighter's across the country. When teaching different subjects, I always tried to find an excuse to ask if anyone had been exposed to a hazardous material on a call and to share with them the need to control their own destiny verses relying on the hopes that those with the charge of providing medical care know what they are doing. Do not be afraid to challenge the status quo. Your life may depend on it.

So how do you improve your odds for survival in the case of an accidental exposure? Below is the course outline for what it takes to become a toxmedic. I see no reason to get flowery here, I just want to get the information out there so you can discuss this with your local contacts that can help you get this program started in your home town. I'm over simplifying the process but take a look at this outline and ask yourself, are you prepared to take care of your own if something gets out of the "hazmat" box?

Toxmedic Course Description: Provides paramedics with continuing training in identification, assessment, and treatment of victims exposed to hazardous materials.

Performance Objectives: Upon completion of this course, a student will be able to do the following:

1. List the steps involved in managing a hazardous materials incident.
2. Describe the role of medical direction in the management of a hazardous materials incident.
3. Identify the human and material resources necessary for the management of a hazardous materials incident.
4. Discuss the procedures and equipment necessary for personal protection in a hazardous materials incident.
5. Demonstrate the protocol used for medical monitoring of emergency workers responding to a hazardous materials incident.
6. Identify the types of hazardous materials to which an emergency medical patient may be exposed, including the toxicity and the signs and symptoms of each type.
7. Describe the routes by which an emergency medical patient may be exposed to a hazardous material.
8. Demonstrate the decontamination procedure for an emergency medical patient exposed to a hazardous material.
9. Assess the status of an emergency medical patient exposed to a hazardous material, including recording a patient history and conducting a physical examination of the patient.
10. Demonstrate the proper medical management of an emergency medical patient exposed to each type of hazardous material.
11. Identify the contents of a hazardous materials drug box.
12. Identify and describe the pharmacokinetics of drugs which may be included in a hazardous materials drug box.

Course Outline:

I. General Principles

A. Incident locations

1. Fixed Industrial / Workplaces (Most incidents)
2. Roads
3. Homes
4. Railways
5. Other

B. Incident Management Priorities

1. Personal Protection (Highest Priority)
2. Evaluation
3. Evacuation
4. Medical Management
5. Containment and Clean Up

II. Patient Management

A. Decontamination

1. Routes of Exposure
2. Skin Decontamination
3. Eye Decontamination
4. Inhalation Decontamination

B. Initial assessment and resuscitation

1. A = Airway
2. B = Breathing
3. C = Circulation
4. D = Disability (Neurological)
5. E = Exposure (Associated injuries, trauma, etc)
6. F = Field Antidote

III. Toxic Inhalations

A. Respiratory Irritants

1. Upper airway injury
a. Selected Gases
b. Pathophysiology

1. Factors
2. Edema
3. Irritation

c. Signs and Symptoms

1. Secretions
2. Laryngospasms
3. Airway Obstruction

d. Treatment

1. Decon
2. Airway Management
3. Ventilation
4. Oxygenation

2. Lower airway injury
a. Selected Gases
b. Pathophysiology

1. Factors
2. Alveolar Destruction
3. Surfactant Loss

c. Signs and Symptoms

1. Cough
2. Dyspnea
3. Wheezing
4. Bronchi spasms
5. Non Cardiogenic Pulmonary Edema

d. Treatment

1. Decon
2. Supportive care
3. Airway Management
4. Ventilation
5. Oxygenation
6. Suctioning
7. Bronchodilators
8. PEEP

B. Simple Asphyxiants

1. Selected Asphyxiants
2. Pathophysiology
3. Signs and Symptoms
4. Treatment

C. Systemic Asphyxiants

1. Carbon Monoxide
a. Sources
b. Pathophysiology
c. Signs and Symptoms
d. Treatment

2. Cyanide
a. Sources
b. Pathophysiology
c. Signs and Symptoms
d. Treatment

3. Hydrogen Sulfide
a. Sources
b. Pathophysiology
c. Signs and Symptoms
d. Treatment

4. Methemoglobin Formers
a. Selected Methemoglobin Formers
b. Pathophysiology
c. Signs and Symptoms
d. Treatment

IV. Pesticides

A. Insecticides

B. Cholinesterase Inhibitors

1. Pathophysiology
2. Signs and symptoms
3. Treatment

V. Corrosives

A. Acids
B. Alkalis
C. Routes of Exposure
D. Pathophysiology
E. Signs and Symptoms
F. Treatment

VI. Solvents

A. Aliphatic Hydrocarbons
B. Aromatic Hydrocarbons
C. Halogenated Hydrocarbons
D. Pathophysiology
E. Signs and Symptoms
F. Treatment

VII. Miscellaneous Agents

VIII. Haz-Mat Antidotes

A. Atropine
B. Cyanide Kit
C. Diazepam
D. Methylene Blue
E. Pralidoxime
F. Propanolol
G. Terbutaline