Transport Operations Lecture

Emergency Vehicle Design

AN ambulance is a vehicle that is used for treating and transporting
patients who need emergency medical care to a hospital
o First motor-powered ambulance was introduced in 1906
o The hearse was the vehicle most often used as an ambulance for
decades
No room for EMT to fit in back with patient
Todays ambulance
o Designed according to government regulations
o Have enlarged patient compartments
First-responder vehicles have personnel and equipment to treat
patients until an ambulance can arrive
Modern ambulance contains
o Drivers compartment
o Patient compartment big enough for 2 EMTs and two supine
patients
o Equipment and supplies
o Two-way radio communication
o Design for maximum safety and comfort
Type I
o Conventional, truck cab-chassis with a modular ambulance body
Type II
o Standard van, forward-control integral cab-body ambulance
Type III
o Specialty van
Ambulance licensing or certification standards are established by state
The Star of Life emblem is affixed to the sides, rear, and roof of the
ambulance
Preparation Phase
Ensure equipment and supplies are in their proper places and ready for
use
o Only store new equipment after proper instruction on its use and
consulting with the medical director
o Should be durable and standardized
Store equipment and supplies according to how urgently and how often
they are used
o Items for life-threatening conditions at the head of the primary
stretcher
o Items for cardiac are, external bleeding, and blood pressure at
the side of the stretcher

Cabinets and drawer fronts should be transparent or labeled

o Should open easily and close securely
Medical equipment
o Basic supplies are common supplies carried on ambulances
o Airway and ventilation equipment
o CPR equipment
o Basic wound care supplies
o Splinting supplies
o Childbirth supplies
o AED
o Patient transfer equipment
o Medications
o The jump kit
Safety and operations equipment
o Personal safety equipment
o Equipment for work areas
o Any major roadmust wear yellow vest if out of ambulance
o Preplanning and navigation equipment
o Extrication equipment
o Lights
o Helmets
Personnel
o At least one EMT in the patient compartment during transport
o Two EMTs are strongly recommended
o Some services have a non-EMT driver and a single EMT in the
patient compartment
Perform daily inspections
o Ambulance inspection
o Inspect cleanliness, quantity, and function of medical equipment
and supplies
Review safety precautions
o Traffic safety rules and regulations
o Proper working order of safety devices
o Properly secure oxygen tanks
o Properly secure all equipment in cab, rear, and compartments

Dispatch Phase
Dispatcher should gather and record
o Nature of the call
o Name, present location, call-back number
o Location of patient
o Number of patients and severity of their conditions
o Other pertinent information

En Route to the Scene

Most dangerous phase for EMTs
Collisions cause many serious injuries
o Fasten seatbelts and shoulder harnesses before mobbing the
ambulance
o Review dispatch information
o Prepare to assess and care for the patient
Arrival at the Scene
Perform a scene size-up and report your findings to dispatch
o Safety hazards
o Evaluate need for additional units
o Determine MOI/NOI
o Evaluate need for spinal stabilization
o Follow standard precautions
Mass-casualty incident (MCI)
o Estimate and communicate number of patients to the incident
commander
o Request additional units through dispatch
o The incident command system will be established
o More patients than resources
o Get on scenego to incident commander
Safe parking
o Allow efficient traffic flow and control around an emergency
o Park 100 before or past the crash scene
o Do not park alongside a crash scene
o Police on scene go in front
o No policebehind
o Park uphill and/or upwind of smoke or hazardous
o Leave warning lights or devices on
o Keep distance between the emergency vehicle and operations
o Stay away from fires, explosive hazards, downed wires, and
unstable structures
o Set the parking brake
o Facilitate emergency medical care and rapid transport from the
scene
o If it is necessary to block traffic, wok quickly and safely
Traffic control
o Provide care and ensure scene safety first
Ensure orderly traffic flow

Transfer Phase
Patient must be packaged for transport
o Secure patient to backboard, scoop stretcher, or wheeled
ambulance stretcher
o Lift the patient into compartment
o Secure the patient with at least 3 straps
Transport Phase
Excessive speed is unnecessary an dangerous
When you are ready to leave with the patient, inform dispatch of:
o Number of patients
o Name of receiving hospital
o Beginning mileage of ambulance
Monitor patients condition en route
o 15 minutes vs. 5 minutes
Contact receiving hospital
Do not abandon the patient emotionally
Inform them of whether you are basic or paramedic
Delivery Phase
Notify dispatch of your arrival that hospital
Report your arrival to the triage nurse
Physically transfer the patient
Present a complete verbal report
Complete a detailed written report
Restock items, if needed
En Route to the Stain
Inform dispatch whether you are in service and where you are going
Back at the station
o Clean and disinfect the ambulance and equipment
o Restock supplies
Postrun Phase
Complete and file additional written reports
Inform dispatch again of status, locaton, and availability
Perform routine inspections
Refuel the vehicle
Cleaning: process of removing dirt, dust, blood, or other visible
contaminants from a surface of equipment
Disinfection: the killing of pathogenic agents by directly applying a
chemical made for that purpose to a surface or equipment

High-level disinfectant
After each call
o Strip linens from the stretcher and place them in a plastic bag or
designate receptacle
o Discard medical waste
o Wash contaminated areas with soap and water
o Disinfect all nondisposable equipment used for patient care
o Clean the stretch with germicidal/virucidal solution or 1:100
bleach dilution (quarter cup of bleach: 1 gallon of water)
o Clena spillage or other contamination with one of those same
solutions

Defensive Ambulance Driving Techniques

An ambulance involved in a crash delays patient care, at a minimum
Intersections are biggest cause of these accidents
Drier characteristics
o Some states require an emergency vehicle operations course
o Physical fitness and alertness are necessary
o Emotional maturity and stability
o Respect for other motorists
Safe driving practices
o Speed does not save lives; good care does
o Wear seatbelts and shoulder restraints
o Become familiar with how the vehicle accelerates, corners,
sways, and stops
o Stay in the extreme left-hand lane on multilane highways
Siren risk-benefit analysis
o The decision to activate the emergency lighting and sirens will
depend on
Local protocols
Patient condition
Anticipated clinical outcome of the patient
Driver anticipation
o Always assume that motorists around your vehicle have not ehad
your siren/public address sytem or seen you
o You must always drive defensively
The cushion of safety
o Maintian safe following distance
o Try to avoid being tailgated from behind
o Ensure that blind spots do not prvent you from seeing vehicles or
pedestrians
o Never get out of the ambulance to confront a driver
Problem of excessive speed

o Unncessary, dangerous, and does not increase patients chance

of survival
o Makes it difficult to provide care in the patient compartment
o Hinders drivers reaction time
o Increass time and distance need to stop the ambulance
Recongition of siren syndrome
o Sirn syndrome causes drivers to drive faster in the preence of
sirens, due to increased anxiety
Vehicle size and distance judgment
o Crashes often occur when the vehicle is backing up, so use a
spotter
o Size and weight influence braking and sotpping distances
Road positioning and cornering
o TO keep ambulance in proper lane when turning, enter high in
the lane, and exit low
Weather and road conditions
o MAublances have longer braking time/stopping distance
o Weight is unevenly distributedprone ot roll over
o Be alert for hydroplaning, water on roadway, decreased visibility,
and ice and slippery surfaces
More slippery when little rain than a lot of rain
o Oil rises upcompletely washed away with a lot of rain

Laws and Regulations

If you are on an emergency call and are using your warning lights and
siren, you may be allowed to do the following
o Park or stand in an illegal location
o Proceed through a red light or stop sign
Stop, look both ways and then proceed through stop sign
or red light
o Driver faster than the speed limit
o Drive against the flow of traffic
o Travel left center to make an illegal pass
An emergency vehicle is never allowed to pass a school bus that has
stopped to load or unload children
o Until yellow flashing, you cannot pass
Use of warning lights and siren
Unit must be true emergency call
Both audible and visual warning devise must be used
simultaneously
Use of escorts
o Only use as a guide when you are in unfamiliar territory
Intersection hazards

o Intersection crashes are the most common and most serious

o If you cannot wait for traffic lights to change, still come to a
momentary stop
Highways
o Shut down emergency lights and sirens until you have reached
the far left lane
Unpaved road
o Lower speed

Distractions
Minimize distractions from
o Mobile dispatch terminals and GPS
o Mounted mobile radio
o Stereo
o Cell phone
o Eating/drinking
Focus on driving and anticipating roadway hazards
Fatigue
Recognize when you are fatigued, and alert your partner or supervisor
Air Medical Operations
Air ambulances are used to evacuate medical and trauma patients
o Fixed-wing units
o Rotary-wing units (helicopters)
Specially trained crews accompany air ambulance flights
o EMTs provide ground support
Medical evacuation (medivac) is performed by helicopters
o Capabilities, protocols, and procedures vary
Medivac may receive extra training
Why call for medivac?
o Transport time by group is too long
o Road, traffic, or environmental conditions prohibit the use of
ground transport
o Patient requires advanced care
o Multiple patients will overwhelm resources at the hospital
reachable by ground transport
Who receives a medivac?
o Patients with time-dependent injureis or illnesses
o Stroke, heart attack, or spinal cord injury
o Scuba diving accidents, near-drownings, or skiing and wilderness
accidents
o Trauma patients

o Candidates for limb replantation, burn center, hyperbaric

chamber, or bite center
Whom do you call?
o Generally, dispatcher should be notified
o IN some regions, EMS may be able to communicate with the
flight crew after initiating the medivac request
Establish a landing zone
o Hard or grassy level surface between 60x60 and 100x100
(recommended (in MA, 100x100 is mandatory)
o Cleared of loose debris
o Alert the flight crew of overhead or tall hazards
o Mark the landing site using cones or vehicles
o Move nonessential persons and vehicles
o Communicate the direction of strong wind to the flight crew
Landing zone safety and patient transfer
o Keep a safe distance from the aircraft whenever it is on the
ground and hot
o Stay away from the tail rotor
o Never approach the helicopter from the rear
Keep guidelines in mind:
o Become familiar with hand signals
o Do not approach unless instructed and accompanied by crew

Vehicle Extrication and Special Rescue Lecture

Safety
Extrication requires mental and physical preparation
o Consider the safety of yourself and team
o Safety begins with proper mind-set and personal protective gear

Incident Management Lecture

National incident Management System
Provides consistent nationwide template
Enables federal, state, and local governments to work together
o As well as private and nongovernmental organizations
Organizational structure must be flexible enough to be rapidly adapted
Provides standardization in
o Terminology
o Resource classification
o Personnel training

o Certification
Major NIMS components
o ICS
o Command and management
o Preparedness
o Resource management
o Communications and information management
o Supporting technologies
o Ongoing management and maintenance

Incident Command System

Sometimes referred to as the incident management system
The purpose of the ICS is to
o Ensure responder and public safety
o Achieve incident management goals
o Ensure the efficient use of resources
Controls duplication of effort and freelancing
Limits the span of control
o One supervisor fro three to seven workers
Organizational divisions include sections, branches, divisions, and
groups
Operations, Planning, Logistics, Finance
o Each goes to branch and then to division or group
EMSTriage, Treatment, and Transport
Command
o Incident commander (IC) is in charge
o It is important that you know how the IC is, where the command
post is located, and how to communicate with your supervisor
o An IC may turn over command to someone with more experience
in a critical area
Finance
o Documenting expenditures at an incident for reimbursement
Logistics
o Equipment, facilities, food and water, fuel, lighting, and medical
equipment/supplies
Operations
o Managing tactical operations usually handled by the IC
o Supervise people working at the scene
Planning
o Solves problems as they arise
o Develops an incident action plan
Command staff

o Public information officer (PIO) provides the media with clear

information
o The liaison officer relays information and concerns among
command and the staff
o The safety officer monitors the scene for conditions or operations
that may present a hazard
Communications and Information Management
Communication= weak point
It is recommended that communications be integrated
o All agencies should be able to communicate quickly via radios
o Communications allow for accountability and instant
communication
Mobilization and Deployment
Accountability means keeping your supervisor advised of your location,
actions, and completed tasks
Once the incident ahs been stabilized, the IC will determine which
resources are needed and when to begin demobilization
EMS Response Within the Incident Command System
Preparedness
o Decisions made and basic planning done before an incident
occurs
o Involves decisions and planning about he most likely natural
disasters for the area
o Your EMS agency should have written disaster plans that you are
regularly trained to carry out
Scene size-up
o Make an initial assessment and some preliminary decisions
What do I have?
What do I need to do?
What resources do I need?
Establishing command
o Command should be established by most senior official
Communications
o If possible, use face-to-face communications to limit radio traffic
o If you communicate via radio, do not use codes or signals
o Equipment must be reliable, durable, and field-tested
o Be sure there are backups in place
Medical Incident Command
Also known as the medical (or EMS) branch of ICS
o Primary roles: triage, treatment, and transport of injured people

Triage supervisor
o In charge of counting/prioritizing patients
o Ensures that every patient receives initial assessment of his or
her condition
o Do not begin treatment until all patients are triaged
Treatment supervisor
o Locates and sets up the treatment area with a tier for each
priority of patient
o Ensures that secondary triage is performed and that adequate
patient care is given
o Assists with moving patients t the transportation area
Transportation supervisor
o Coordinates transportation and distribution of patients to
appropriate receiving hospitals
o Communicates with the area hospitals
o Documents and tracks the number of vehicles transporting,
patients transported, and the facility destination
Staging supervisor
o Should be assigned when scenes require response by numerous
emergency vehicles or agencies
o The staging area should be established away from the scene
o Place ambulances in separate area and call them in when
neededprevents cluster
Physicians on scene
o Make difficult triage decisions
o Secondary triage decisions in the treatment sector
o Provide on-scene medical direction for EMTs
o Provide care in treatment sector as appropriate
Rehabilitation supervisor
o Establishes an area that provides protection from the elements
and situation
o Monitors responders for signs of stress
o Rehabilitation is where a responders needs for rest, fluids, food,
and protection from the elements are met
Extrication and special rescue
o Determines type of equipment and resources needed for the
situation
o Usually function under the EMS branch of the ICS
Morgue supervisor
o Works with area medical examiners, coroners, disaster mortuary
assistance teams, and law enforcement agencies to coordinate
removal of bodies and body parts
o The morgue area should be out of view of the living patients and
other responders

Mass-Casualty Incidents
A mass-casualty incident (MCI) is:
o Any call involving three or more patients
o Any situation that requires a mutual aid response
o Any incident that has the potential for one of these situations
o Any event that overwhelms your resources
Bus or trains crashes and earthquakes are examples
o Other causes, smaller in scope, are more common
Triage
Triage means to sort patients based on the severity of their injuries
o Assessment is brief and patient condition categories are basic
o Primary triage is done in the field30 seconds per patient
o Secondary triage is done as patients are brought to the
treatment area
Four common categories give the order of treatment and transport
o Immediate (red)
Pregnant
Paralysis
Chest pain
Extreme pain
o Delayed (yellow)
Significant soft-tissue
Severely broken bones
o Minor or minimal (green; hold)
Walking wounded
Have the ability to walk
o Expectant (black; likely to die or dead)
Tagging patients early assists in tracking them and can help keep
accurate record of their condition
o Tags should be weatherproof, easily read, and color-coded
START Triage
o Simple Triage And Rapid Treatment
o Call out to patients and direct them to an easily identifiable
landmark
o Injured persons are the walking wounded
o Asses the respiratory, hemodynamic, and neurologic status of
the nonambulatory patients
JumpSTART triage for pediatric patients
o Intended for use in children younger than 8 years or who appear
to weigh less than 100 lb
o Begin by identifying the walking wounded

o If a child has no pulse or does not begin to breathe after rescue

breaths, label him or her as expectant
Triage special considerations
o Patients who are hysterical and disruptive to rescue efforts may
need to be made an immediate priority
o A rescuer who becomes sick or injured during the rescue effort
should be handed as an immediate priority
o Identify patients as contaminated or decontaminated in HazMat
incidents
Destination decisions
o All patients triaged as immediate or delayed should be
transported by ground or air ambulance
o In large situations, a bus may transport the walking wounded
o Immediate-priority patients should be transported two at a time
until all are gone
o Then patients in the delayed category can be transported two or
three at a time
o Finally, the slightly injured are transported
o Expectant patients whoa re still alive would receive treatment
and transport last
o Dead victims are handled or transported according to the SOP for
the area

Disaster Management
A disaster is a widespread event
o Disrupts the functions and resources of the community
o Threatens lives and properties
o Many disasters may not involve personal injuries, but many
disasters (floods, fires, hurricanes) result in widespread injuries
Your role is to respond when requested and report to the IC for
assigned tasks
o A casualty collection area may be established in a disaster with
an overhwlming number of casualties
Introduction to HazMat
Arrivalfirst step back and assess situation
According to HAZWOPER, first responders at the awareness level
should have sufficient training or experience in following areas
o An understanding of what hazardous substances are and the
risks associated with them
o An understanding of the potential outcomes of an incident
Department of Transportation Marking System
Explosive (1)

G (2)
Flammable (3)
S (4)
Oxidizer (5)
P (6)
Radiactive (7)
Corrosive
Misc.

References
MSDS
o Explain chemical
Book on each ambulance
HazMat Scene Operations
Hot Zone
o Hazardous material
o Only HazMat crew allowed
o Area immediately surrounding the release
o Most contaminated area
o Everyone leaving hot zone must be decontaminated
Warm Zone
o Decontamination corridor
o Where people are washed and cleaned
Cold Zone
o Incident Commander
o Command Post
If you can walkgo to warm zone as directed
Decontamination tent lays across warm/cold zones
EMTs work solely in the cold zone
Level A, B, C, D for HazMat Suits
EMT= Level D

Terrorism Response and Disaster Management

What is Terrorism?
Only a small % of groups actually turn toward terrorism to achieve
their goals
Terrorist forces began since early civilizations
o Common in Middle East
Terrorism does not truly attack a certain party, it is used to institute
fear into people
Violent religious groups/doomsday cults
o Map participate in apocalyptic violence
Extremist political groups
o Include violent separatist groups and those who seek political,
religious, economic, and social freedom
Technology terrorists
o Those who attack a populations technological infrastructure
Single-issue groups
o Include antiabortion groups, animal rights groups, anarchists,
racists, ecoterrorists
Weapons of Mass Destruction
Also called weapons of mass casualty
Any agent designed to bring about:
o Mass death
o Casualties
o Massive damage to property and infrastructure
B-NICE and CBRNE and mnemonics for the kinds of WMDs
B-NICE
o Biologic
o Nuclear
o Incendiary
o Chemical
o Explosive

Explosives have been the preferred WMD

Chemical agents consist of
o Vesicants (blister agents)
o Respiratory agents (choking agents)
o Nerve agents (e.g. organophosphates; pesticides)
o Metabolic agents (cyanides)
Biologic terrorism/warfare
o Biologic agents are organisms that cause disease
o The primary types are
Viruses
Bacteria
Toxins
Nuclear/radiologic terrorism
o Only two publicly known incidents: Hiroshima and Nagasaki
o These materials are far easier for a determined terrorist to
acquire and less expertise to use
o Dirty bombs can cause widespread panic

EMT Response to Terrorism

Basic foundations of patient care remain the same
o However, treatment can and will vary
Recognizing a terrorist event
o Most acts of terror are covert
o You must know the current threat level issued by the Department
of Homeland Security (DHS)
Severe
High
Elevated
Guarded
Low
Homeland security advisory system alerts responders to the potential
for an attack
o Specifics of current threat will not be given
On every call, you must make the following observations:
o Type of location
o Type of call
o Number of patients
o Victims statements
o Preincident indicators
Response Actions
Responder safety

o The best form of protection is preventing yourself from coming in

contact with the agent
o Contamination occurs when you have direct contact with the
WMD
o Cross-contamination occurs when you come in contact with a
contaminated person
Notification procedures
o Notify dispatcher of
Nature of event
Any additional resources that may be required
Estimated number of patients
The upwind or optimal route of approach
o Establish a staging area
o Trained responders in PPE are the only persons equipped to
handle the WMD
Establishing command
Secondary device or event
o Additional explosives are se to explode after the initial bomb
o Intended primarily to injure responders and to secure media
coverage
o May include types of electronic equipment such as cell phones or
pagers

Chemical Agents
Liquids or gases that are dispersed to kill or injure
o Persistent (nonvolatile) agents can remain on a surface for long
periods
o Nonpersistent (volatile) agents evaporate rapidly
Route of exposure is a term used to describe how the agent most
effectively enters the body
o Agents with a vapor hazard enter through the respiratory tract in
the form of vapors
E.g. Anthrax (85% death rate through respiratory tract)
o Agents with a contact hazard give off very little vapor or no
vapors and enter through the skin
Vesicants
Primary route is the skin
o If vesicants are left on the skin long enough, they produce vapors
that can enter the respiratory tract
Cause burnlike blisters to form on the victims skin and in the
respiratory tract
Usually cause most damage to damp or moist areas of the body
Signs of vesicant exposure on the skin

o Skin irritation, burning, and reddening

o Immediate, intense skin pain
o Formation of large blisters
o Gray discoloration of skin
o Swollen and closed or irritated eyes
Sulfur mustard (H)
o Brownish, yellowish oily substance
o Generally considered very persistent
o Attacks vulnerable cells within bone marrow and depletes the
bodys ability to reproduce white blood cells
o Begins an irreversible process of damage to the cells
Lewisite (L) and phosgene oxime (CX)
o Produce blister wounds very similar to those caused by mustard
Vesicant agent treatment
o No antidotes for mustard or CX exposure
o Ensure that patient has been decontaminated before the ABCs
are initiated
o Transport as soon as possible
o Generally, burn centers are best equipped to handle the wounds
and infections

Pulmonary Agents
Gases that cause immediate harm to persons exposed to them
Primary route is through respiratory tract
Symptoms:
o Dyspnea
o Tachypnea
Chlorine (CL)
o Initially, produces upper airway irritation and a choking sensation
o May later experience
Shortness of breath
Chest tightness
Hoarseness and stridor
Gasping and coughing
Phosgene
o Product of combustion
o Very potent agent with a delayed onset of symptoms
Treatmnet
o Remove patient from cotnamianted atmosphere
o ABCs
Nerve Agents
Among most deadly chemicals

Can cause cardiac arrest

G series
Tabun, Sarin, Soman, V agent
Nerve agents all produce similar symtpoms but have varying routes of
entry
SLUDGEM
o Salivation, sweating
o Lacrimation
o Urination
o Defecation, Drooling, Diarrhea
o Gastric upset
o Emesis
o Muscle twitching/miosis (pinpoint pupils)
Treatment
o Mark 1 Nerve Agent Antidote Kit (NAAK)
Ctonains atropine and 2-PAM
o Multiple doeses may need to be administered

Metabolic Agents
Hydrogen cyanide (AC) and cyanogen chloride (CK)
High doeses
o Tachycardia
o Tachypnea
o Seizures
o Coma
o Apnea
o Cardiac arrest
Cyanide agent treatment
o All clothes removed to prevent off-gassing in the ambulance
o ABCs
o No antidotetransport
Biologic Agents
Can be almost completely undetectable
Communicability: how easily the disease is able to spread
Incubation: period of time between the person becoming exposed to
the agent and when symptoms begin
Dissemination is the means by which a terrorist will spread the agent
A disease vector is an animal hat spreads disease to another animal
Viruses
Germs that require a living host to multiply and survive
Replicates itself to spread through host after invading host

Smallpox is highly contagious

o Examination gloves
o HEPA
o Eye protection
o Observe the size, shape, and location of the lesions
Ciral hemorrhagic fever (VHF)
o Blood in body to seep out from tissues and blood vessels
o Flulike symtpmsinternal/external hemorrhaging

Bacteria
Need no host to multiply and live
Most fought with antibiotics
Most begin with flulike symptoms
Inhalation and cutaneous anthrax
o Caused by deadly bacterium that lays dormant in a spore
o Routes: inhalation, cutaneous, and gastrointestinal
o Pulmonary anthrax is most deadly
o Antibiotics can be used to treat anthrax successfully
Plague
o Natural vectors are rodents and fleas
o Infects lympathic system and creates buboes
Neurotoxins
Most deadly substances known to humans
Botulinum toxin
o Most potent neurotoxin
o Produced by bacteria
o Voluntary muscle control diminishes
o Causes muscle paralysis, leading to respiratory arrest
o Affects nervous system
Ricin
o Causes pulmonary edema and respiratory and circulatory failure
leading to death
o Treat: cardiovascular support and respiratory support as need
o Quite stable and extremely toxic
Other EMT Roles
Syndromic surveillance
o Monitoring of patients presenting to EDs and alternative care
facilities
o Patients with signs and symptoms that resemble influenza are
important

o Quality assurance and dispatch need to be aware of an unusual

number of calls from patients with unexplainable flu
Points of distribution (POD)
o Established in the time of need for the mass distribution of
antibiotics, antidotes, vaccinations, and other medications
o Deliver push packs to anywhere in country within 23 hours

Radiologic/Nuclear Devices
Alpha/beta/gamma
Incendiary and explosive devices
Notify authorities and safely evacuate the area
Always remember that there is a possibility of a secondary device
Primary, secondary, and tertiary blast injuries
o (Primary: hollow organ injury)
o Secondary: debris
o Tertiary: thrown against something
gre