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Both stores can store chemicals without needing to store large quantities. Chemicals exposed to the public need placards. Trucks carrying materials need placards and shipping labels. Some dangerous trucks carry multiple chemicals, each under 200 pounds. Secondary containment systems are used for dangerous chemicals. Different containers are used for different chemicals. Hazardous materials must be labeled and drivers must carry a listing of chemicals. Different containers are used for different chemicals. Placards and markings are used to indicate hazardous materials. The Emergency Response Guide helps in emergencies. Placards must be visible on all sides of transport vehicles and buildings. Both stores can do this without the motive to rely on or need it to store large quantities of a particular chemical. Any chemical that's stored that is exposed to the public needs to have a placard on all four sides. That's an aluminum placard that looks like a diamond that will tell specific information that we're going to talk about. If you have material that's stored inside a truck, the truck has to have a placard in each individual item has to have a shipping label. Some, less than 200 pounds of a particular, of those chemicals do not require a placard. That's why some of the most dangerous trucks on the road today, Walmart, Home Depot, Lowe's, because they could have 300 chemicals on there, but each one is less than 200 pounds. Mix them all together and you can have one hell of a conflagration or chemical spill. Some of these containers often are surrounded by secondary containment systems to help control an accidental release. You can tell how bad a chemical is by the type of secondary and even tertiary containment areas. If you have a big tank and a secondary containment area and then a containment area after that, whatever's in that tank, you don't want to touch. Do you know if they used to work for a warehouse and they never weighed whatever they put in the back of the truck? They just throw everything in there? Well, yeah, probably. They probably knew overall what was going to go in the truck. They probably knew based upon, I don't know, maybe they didn't care. But you're supposed to, if that truck gets pulled over and they're carrying more than 200 pounds, carrying a plackable hazmat item in your vehicle without putting a placard on, that's a serious fine, huge fine. Totes have a capacity ranging from 119 to 703 gallons and then you have all kinds of corrosive food grade and oxidizers and things like that. No secondary containment systems needed. And this is what you see. And these might be inside a truck. These wouldn't have to have placards on them. The truck would have to have a placard and these would have to have individual shipping labels. Right? Just a label that's taped on there that shows what they have. In a tractor-trailer that's transporting hazardous materials, the driver has to have an MSPS listing of all the chemicals in that truck. He carries it with him. If he goes into the diner to get a drink, to get some food, to go to the bathrooms, he has to take that with him, technically, because if there's a fire in that truck, your shipping papers are what's going to tell what's in the truck. If they're in the truck and burning in the truck, nobody's going to know what's in the truck. So you're supposed to keep those with you at all times. Intermodal tanks are both shipping and storage vessels, can hold between 5,000 and 6,000 gallons, and they can be pressurized and non-pressurized. You can tell they're pressurized because it'll have a valve, a gauge, and sometimes they'll even have a secondary containment system, which would look like this, but this is not a secondary containment system. This is a non-pressurized tank. This is a cage that's used to transport it on the back of a tractor trailer or on a train. That kind of, you can see where it mounts. So that's not a secondary containment area, that's a shipping cage, as they call it. Non-storage vessels hold commonly used chemicals and commercial and industrial chemicals. Drums are easily recognizable. You see the barrel light. Most of your drums today are actually plastic. You'll see them, they're blue or they're white or they're clear, they're plastic. Generally, the nature of the chemical dictates the construction of the drum. Bags are commonly used to store solids and powders, things like fertilizers, pesticides, concrete. They may be constructed of plastic paper or plastic lined paper. Pesticides have to be labeled because they are a dangerous chemical. Carboys transport and store corrosive and other type chemicals. Glass-packed plastic or steel containers, they hold from 5 to 15 gallons. Often have a protective wood foam or fiberglass or steel box. So that would be like that, the 5 to 15 gallon tub. They're called carboys. And you could have anything in that, from windshield washer fluid to antifreeze, milk, water, vinegar, whatever you're transporting. It happens to be that. Do you need a placard if you're transporting water? No, it's not hazardous. If you see a tractor trailer without a placard on it, it either has a non-hazardous chemical, no chemical, but they forgot to put a placard on it. So that's why you never assume that a truck without a placard doesn't have anything on it. If it has a place for a placard, at some point or another it's transporting hazardous material and they have one in it, they just didn't put the placard on it. Uninsulated compressed gas cylinders are used to store substances such as nitrogen, argon, helium, and oxygen. You guys are intimately knowledgeable of that because you've been dealing with the O2 tank. So, Department of Transportation marking system. This is a national, technically an international marking system. We have this Canada, United States, and Mexico all use the same international marking system. Labels, placards, and other markings are used on buildings, packages, boxes, and containers. This marking system indicates the presence of a hazardous material at a safe distance and provides substance clues. So, we're going to talk about this. This is called the ERG, the Emergency Response Guide. This is what we were talking about. A set of binoculars and this has to be in every ambulance in the United States. This is set up, this is developed by a consortium of chemical manufacturers. Dow, DuPont, you know, pharmaceuticals like AstraZeneca. They all get together and they come up with this particular book. This has got about 4,500 different chemicals. And what it does is it allows you to tell what to do in an emergency based upon it. So, the ERG, first of all, in the first few pages, will have, as you can see, the first page has this. This is the placard marking system. And I'm going to go through each one of these. Then you'll have the yellow area. The yellow area designates a number with a chemical. So, there's a number that's on the placard. If you can see it, you can look up the number in the yellow guide. 2931, oh, that's vandosulfate. Whatever the hell that is. Then if you go to the blue section, you can look up the chemical and it will have the corresponding number. So, let's look up vandosulfate. Vandosulfate. Vandosulfate. 2931, oh look, 2931. So, this is the number guide. This is looking up the chemical, if you know the chemical name, by the MSCS. And what they're all designed to do is they'll all bring you to the orange section. The orange section is an overview of a particular class of chemicals and what to do. So, let's look up, I looked up vandosulfate and it said go to guide. So, I found a chemical number here and it gives me a guide number. Or I looked up the chemical here and it gives me a guide number. That was 131. So, I go to 131 in the guide, in the orange section. See 131? Now, if you look at 131, it says flammable liquid toxic. So, it's going to tell me health hazards, fire or explosion hazards, public safety threats, protective clothing, evacuation, how to evacuate and the size of an area to cordon off, fire response, spill or leak protection, and what's most important to you on the bottom, first aid for the chemical. So, I would look at the placard and I see 2931. Let me look up 2931. Oh, that's vanadium. Oh, that's 131. Now, I read this and now I know how to keep that scheme safe. This does not tell me how to mitigate the disaster. It doesn't tell me how to clean it up. It tells me what to do to protect myself and the patient and the public until hazmat arrives. Right? So, the first page shows you the type of placards that you'll have. So, you'll see these placards, but then there'll be a number on them. That's the number you're looking for. So, this particular one, it based upon, and if you look, see that 127, 118? If you look in this guide, it tells you the same thing. That's the orange page. So, if I have a placard that looks like this, I go to 127 in my emergency guide. And 127 says, flammable liquids, water, miscible. Okay? So, this is going to tell me where to go. I don't necessarily need to know the chemical. This is going to tell me where to go in the orange section, which is the most important section for you to look at. But, you'll have dangerous materials, blasting agents, flammable gas, combustibles, toxic inhalation hazards, non-flammable gas, explosives, flammable solids, combustibles, dangerous gases, poisons and toxins, biologic or infectious waste, radioactive and ORMD, other regulated materials, along with corrosive. Okay? So, that gives me an overview of the chemical, but doesn't tell me the exact chemical. So, if I see the placard from a distance, and that's all I see, I know where to go in the orange guide. If I find out what the chemical is, I can look it up in the blue section, or I can look it up based upon the placard number in the red section, in the yellow section. Placards are diamond-shaped, placed on four sides of transport vehicles and buildings. It must be on four sides. It has to be visible. Remember, if a vehicle rolls over and crashes, you might not be able to see it. So, these placards right here, now I can look these up. So, we see that flammable. So, I can look that up. Oh, that tells me to go to 127, because there it is right there. But, wait a minute. 1993, I can look that up. 1-9-9-3, which is combustible liquids, compound cleaning liquids, compound tree or weed killing, diesel fuel, flammable liquids, fuel oil, and it tells me all to go to 128. That's the health hazard, which we're going to talk about next. So, this is flammable, flammable, other regulated materials, corrosive, flammable. So, I can look those up. I can look up the individual number, and that's the health hazard. Because you look at the description, look at the picture. Yeah, because if you look up at 118, it probably has some of the, it probably has an overlap. That's gases, flammable, corrosive. Yeah, there are multiples. And they overlap. They overlap a lot of them. So, what you do is you would look up that. If that's all you had, then that's what you'd look up. But, you'd look that up to start. You'd hopefully see it. If that's all you had, then that's what you'd look up. But, you'd look that up to start. You'd hopefully see that at some point. But, if that's all you had, it doesn't matter. Both of those would have the same response. 118 and 128 are pretty close. Yes, yep. It could be what they call a, what do they call that? They have multiple compartments. In a tanker, they could have five compartments in a tanker. The private transportation system does not require that all chemical shipments be marked. We talked about that. If it falls below a certain amount, about 200 pounds, it doesn't have to be. But, you can have multiple chemicals. But, the driver of that truck has to have the shipping labels or the MSDS for those chemicals with him in the front. So, he can identify what's in the front. This is your ERG response guide. This comes out every four years. It's put out by the Department of Transportation through that consortium of chemical companies. They all contribute to it. The MSDS is a common source of information. You can look up the MSDS of any chemical. All you have to do is type in vanadium sulfate MSDS, and you can get it right off the internet. It provides basic information about the chemical makeup, potential hazards, appropriate first aid, and other pertinent details. Basically, the MSDS is the orange section. All the general information of the MSDS you would find in the orange section correlating to that chemical. Shipping papers, they have to go with that truck at all times. TENSTRAC, Chemical Transportation Emergency Center. Remember how I told you don't call poison control, call medical control? That's for poisons. But for chemical spills, call TENSTRAC. 24 hours a day, seven days a week, this is run. It's like poison control for chemicals. You've got a question on a spill, call them. They'll run through a series of questions. They have an algorithmic process in their computers just like poison control, and they'll tell you exactly what to do. And they can even get in touch with local emergency response that would be adequate for your particular situation. And the phone number is right in here. It's in the front of the book, it's in the back of the book. Despite the availability of resources, identification may still be difficult. So look for things like visible clouds of strange-looking smoke escaping from a substance, especially if it's coming out of the back of a truck or a tractor-trailer or a train car. Leak or spill from a tank, container, truck, or railroad car. Unusual, strong, notches, harsh odors in the area. Again, if you can smell it, you're probably too close already. If any signs suggest a hazmat incident has occurred, stop at a safe distance, uphill or upwind. Call a hazmat team, try to assess the situation, and provide them as much information as possible. To include the safest direction for ingress, how they get there, how they get into the scene. Do not re-enter the scene until it's safe to do so and avoid contact with all materials. Remember, if you trace them through the scene and you realize it's a hazardous scene and you leave, don't get in your ambulance because you're going to drag it from your shoes into the ambulance. It could be on your clothes. Use the ambulance public address system to alert people locally. Everybody who can hear my voice, come to my voice, come out of the scene, walk to me. Establish your control zones. You want to set up a perimeter, make sure that nobody enters the scene to the best of your ability. Obviously, if it's a half-mile-sized scene, you're not going to be able to patrol a half-mile around the scene. This would be a hazardous scene. This is kind of how we work it. We've got the hot zone. This is the actual zone of emergency. This is the warm zone. The warm zone is a set distance, usually set up by, the information would be in this orange area, but the fire department or the hazmat would know it. And they'd set up that distance, and then the only way into the hot zone and out of the hot zone is through that decontamination corridor. Nobody's allowed to walk through this. So you walk in and out through the decontamination corridor. And then people like the incident command and the command post are here. I'd be like right up here. You call me when the patient is ready, and I'll come get you because I'm not going anywhere near that. The hot zone, this is where he's probably coming through the hot zone. They're going to wash him off. This is a level A fully encapsulated suit. This is a level B suit. Level A, his SCBA is inside the suit. Level B is outside. And he's being washed down, and all those fluids will be considered hazardous, and they'll collect them, and they'll bring it up to a hazardous mitigation area. Most likely, what they're washing him off with is palmolive, dove, or ivory soap, dish soap. That's probably the number one chemical washing item that they use. They use ivory soap. The warm zone. So you've got the hot zone is the emergency zone. The warm zone is the corridor between, and then the cold zone is where everybody else goes. Thank you. You're welcome. Role of the EMT. Triage, treat, transport, rehab. It doesn't say asthma remediation. It doesn't say special rescue. It doesn't say tactical. It doesn't say fire suppression. The NFPA, National Fire Protection Act, Seminal 4, Hazardous Material Classification, classifies materials based on the health hazard toxicity, fire hazard, chemical reactivity hazard, and special hazard. And that's all found in the ERG. Toxicity levels measure the health risk the substance poses on the patient. The higher the number, the greater the toxicity. And that's that number you saw at the bottom. 1, 2, 3, 4, 5, 6, 7, 8, 9. That is the health hazard. So, this is the toxicity level of a hazardous material, and this level goes 1 to 4. So, zero is little or no hazard. Milk. Right? Little or no hazard. Unless you're lactose intolerant. What if you have a noise problem and have some scars on top of them? You can say 1, and then you have a scar. Well, that's probably a special exception. That's probably an exception to that one. You'd have to look up that in the ERG and we'll tell you why. A 1, slightly hazardous, SPVA level C suit only. That might be Windex or like Clorox bleach or detergent or something like that. Antifreeze, which you'll watch the floor for. 2, this is also slightly hazardous, but this SPVA level C suit only, but it's a higher level. It's a more, maybe like full chlorine, which is more concentrated. 3 is extremely hazardous, full protection. That's a level A or B suit. Level B, the SPVA is outside. Level A is all inside the suit. Literally, when you take the left, if you open up in a summer day, if you look inside the suit, it'll have a puddle in it, and that's your sweat, literally. 4, minimal exposure causes death, like cyanide. That's a level A suit only. PPE level indicates the amount of type of protective gear you will need. A level A is the most hazardous. Everything is inside the suit. It's taped with duct tape seal. No air gets in or out, nothing. You're completely separated from the outside. Level B is, again, completely sealed, but your SPVA is outside. Level C, kind of just face mask or respirator. You guys, no skin is exposed. Level D is what you guys are wearing. This is a level A suit. As you can see, it's not really accurate. That should be taped down there and taped here. This is the level B. The SPVA is outside. This is level C, which is there's no exposed skin. And then this is the level D. You guys would wear level D. You'd have, you know, your chemical-resistant or, you know, your blood-resistant or fluid-resistant gown, mask, gloves, that's what you'd be wearing. It is practical only to provide the simplest assessment and essential care in the hazard zone because of dangerous time constraints and multi-protective gear. You can't do much in hazmat material, in hazmat gear. We did training for Ebola, and we used the PAPRA suits, which are basically like that suit, and the enclosed suit. You can't do IVs. You might be able to do compressions. You might be able to do ventilations, but that's about it. Put a patient on oxygen, and you don't want to be moving around because you don't want to tear the suit and expose yourself. So your care must address the following issues. Any trauma that's resulted from a mechanism, but then also the toxic substance. So you have the, let's say it's a motor vehicle crash. You've got the trauma from the accident, plus you've got the hazardous exposure. Most hazard exposures will have a trauma component because patients got exposed. Most serious injuries in depth usually result from airway. Patients inhaled it, and it caused severe airway issues. In some cases, the hazmat team may find a patient who needs immediate treatment, and they've only got to do minimum necessary to maintain them until they get them to decontamination. Decontamination can take a couple of minutes. It's not just like walking through. You'll need to increase the amount of protective clothing you wear to care for these patients. Things like STBA. Guess what? We don't carry them in ambulances, at least not in the private sector. In a rescue, you might. In a municipality, you might. That's self-contained breathing apparatus. If you go in the water, you use scuba, self-contained underwater breathing apparatus. Two pairs of gloves, goggles, a face shield, protective coat, respirator. Protective coat, respiratory protection, and a disposable fluid in part of this glove. Remember that the exam gloves you would carry are not chemical resistant. So what is the purpose of the Incident Command System? Well, you know it, Katie, but let's read it. Ensure responder and public safety. Achieve the incident management goals, which would be identify what we have, make it safe, rescue, recovery, scene mitigation.