Medical Monitoring of Hazardous Materials Entry Teams


Structural firefighting is a dangerous activity that is physically demanding. Firefighters who are members of Hazardous Materials (HazMat) Response Teams face the same dangers on a hazmat response as they do on a structure fire and then some. Health hazards faced by hazmat technicians include carcinogens, toxic agents, reproductive toxins, irritants, corrosives, sensitizers, heptaotoxins, nephrotoxins, blood, pulmonary, skin and eye poisons as well as temperature extremes.

In addition to the above named health hazards, hazmat technicians also face the same problems as structural firefighters when it comes to cardiac and heat related injuries, but on a higher magnitude. A firefighter involved in structural firefighting operations at a residential dwelling that suffers a cardiac arrest only has to be evacuated to the front yard for treatment to begin. A hazmat technician that suffers a cardiac arrest while working on top of a leaking anhydrous ammonia rail car presents a different set of circumstances entirely. The hazmat technician must be lowered from the top of the rail car. This will necessitate the deployment of the Rapid Intervention Team. Then the injured technician must be transported through the hot zone and decontaminated before any medical treatment can begin. This lag time will most certainly put the patient's treatment outside of the four to six minute window where brain death starts to occur.

Effective medical monitoring of the hazmat entry team may help to prevent this scenario from occurring.

Medical Monitoring of HazMat Entry Teams: An Overview

OSHA Standard 29 CFR 1910.120 mandates medical monitoring or surveillance for all HazMat Team members. Many people may think that this is merely the act of taking a pulse and blood pressure before the entry team enters the hot zone. While this part is true, the medical monitoring of a HazMat Team is actually an in-depth, four part process consisting of a baseline physical before the member joins the Team, annual physicals while the member is part of the Team, an exit physical when the member leaves the Team and any exposure specific physicals or follow up exams that are deemed necessary. These four steps are in addition to the medical monitoring done at the incident scene.

The baseline physical includes a detailed, comprehensive health history that includes any previous chemical exposure. A complete physical examination is also administered that includes sight and hearing tests and laboratory blood work. The lab work is extensive and tests for complete blood count, kidney and liver function, blood sugar and urea nitrogen, creatinine, sodium, potassium, chloride, magnesium, calcium, inorganic phosphorous, total protein, albumin, globulin, total bilirubin, alkaline phosphatase, lactate dehydrogenase, gamma glutamyl transpeptidase, aspartate aminotransferase, alanine aminotransferase, uric acid and urine tests. These tests are used to obtain baseline numbers for future reference should the member undergo a chemical exposure. Electrocardiograms and chest x-rays are also taken.

The annual physical is a repeat of the initial baseline physical. It is used to update the medical history of the member as well as to verify the member's fitness for duty.

The member also receives an exit physical when their tour on the HazMat Team comes to an end. This is also a repeat of the initial baseline physical and serves as an endpoint in terms of monitoring the member for possible chemical exposure. It helps to determine if later medical claims are related to their service on the Team.

The exposure specific physical is given whenever a member is exposed to a chemical, whether symptoms are present or not. This includes a routine physical examination and laboratory tests geared toward the specific chemical involved in the exposure.

Medical Monitoring of HazMat Entry Teams

Heat related injuries are one of the biggest concerns that HazMat Teams face during entry into the hot zone. This is especially true when dealing with longer incidents or incidents where higher temperatures are involved. "Higher" temperatures can be somewhat misleading. Heat related injuries must be planned for anytime the ambient temperature reaches 70