Hazmat Triage

Bob Harty explains how to categorize patients and what to do if they are involved in a hazmat emergency.


Pre-hospital providers operating at the scene of a hazardous materials incident notify a hospital emergency department that they have 14 patients with varying degrees of injury. The rescuers will be transporting five patients to the hospital. They consist of two "reds," one "yellow" and two "greens...


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Pre-hospital providers operating at the scene of a hazardous materials incident notify a hospital emergency department that they have 14 patients with varying degrees of injury. The rescuers will be transporting five patients to the hospital. They consist of two "reds," one "yellow" and two "greens" meaning two of them are in critical condition and the others have lesser injuries.

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Photo by Gregg Ellman
A fire in a plastics recycling plant in Mansfield, TX, in August 1996 sent flames shooting five stories high and produced a huge cloud of black smoke. The fire apparently was ignited when lightning struck a pile of discarded plastic.

The emergency department goes on "trauma alert" but lacks key information. What is the nature of the hazardous material involved? Are the patients contaminated or exposed?

There are many concerns associated with the management of hazmat patients both at the scene and in the emergency department. The number-one concern should always be protecting personnel in the field and in the hospital setting. Upon arrival at the scene of a hazmat emergency, we must determine whether the chemical or radiological agent involved poses a life or health risk.

Contaminated Or Exposed?

Confusion exists as to the difference between a contaminated patient and an exposure patient. An example of the difference between the two would be as follows: A patient is to go to a hospital radiology department for an X-ray. The X-ray is taken and the individual leaves. He has been exposed to radiation but is not contaminated. He is not a threat to others. If this same individual went to the nuclear medicine department and spilled iodine 131 (radioactive) on his skin, he becomes radiologically contaminated. He is a source of contamination and a threat to others.

The same would be true if a fire department responded to a location where a 55-gallon drum of benzene was leaking. People in the area may be exposed to the product, and smell it, but they are not contaminated. They could even exhibit symptoms associated with their exposure but they are not contaminated. If, however, they walk into the leaking benzene, they are contaminated and pose a threat to themselves and to others.

The chemical should dictate procedures in the field and in the hospital setting. The patient's medical condition is a concern but not always the primary concern; if a patient is contaminated with cyanide, for example, that is our primary concern.

When we as firefighters and emergency responders call into the hospital from the field and report that we are at the scene of a hazmat incident, we should categorize our patients. This will tell the incident commander, and any other responding agencies, what type of hazmat patients we have. We will be able to tell hospitals in the area more than just that we have 14 hazmat patients.

CATEGORY I Major injuries/illness; hazardous material contamination.
CATEGORY II Major injuries and illness; non-hazardous material contamination.
CATEGORY III Minor injuries/illness; hazardous material contamination.
CATEGORY IV Minor injuries/illness; non-hazardous material contamination.
CATEGORY V Major/minor injuries/illness; hazardous material exposure.

By using common sense and a very basic numbering system, we can identify our patients by not only chemical concerns, but also by medical condition. The categories are:

  • Category I. This category will identify the patient as your number-one concern, both in the field and hospital setting. This patent would meet the following criteria:
    1. Major injury/illness. This tells people at the scene, enroute to the scene and at the hospital that you have a medically unstable patient(s).
    2. Hazardous chemical contamination. The patient, in addition to being medically unstable, is contaminated with a hazmat agent.

This patient poses a threat to the EMS/fire/hospital staff. This patient must be grossly decontaminated prior to transport, as the chemical identification dictates this procedure.

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