By: Ethan Kuhleman
The tone goes off, and you hear, “unknown medical emergency aboard an aircraft.” Further dispatch information reveals you now have multiple patients with the same symptoms. This new information elevates the call to a whole new level.
Airfreight cargo is common as airlines ship as much as possible to increase their bottom line. More and more hazardous materials are being shipped in the cargo holds of aircraft, which presents a unique challenge for our first responders. With the potential of a hazardous materials release, first responders must ensure the jet bridge does not connect to the aircraft. If the aircraft is opened while connected to the jet bridge, hazardous material would have direct access to the terminal area. Ideally, the aircraft should be in an isolated area on the ramp and then connect mobile air stairs to the aircraft for entry/exit.
This is the time to exercise extreme caution, hold back EMS personnel, and send in our initial HazMat team. Do you go Level A? Bunker Gear with SCBA? Station uniform with gloves and N95 mask? In our department, we start with Bunker Gear with SCBA, which allows us to be protected from possible explosive atmospheres. After initial readings, we can adjust our PPE for maximum protection.
Once on-board, the HazMat team is to identify the hazardous environment, locate it, and mitigate the exposure. The Hazmat entry team will ask pilot or crew for any shipping papers and search the documents for potential hazards. HazMat teams will then access the aircraft with air-monitoring equipment and survey for radiological, biological, Volatile Organic Compounds (VOCs), Lower Explosive Limit (LEL), Oxygen levels, and Carbon Monoxide levels.
Remember to pay attention to readings and follow up with additional questions. For example, if I enter the aircraft and my O2 readings are dropping but are still above my action level, I still want to know what is displacing my O2 levels. The more information you can obtain on the atmospheric conditions inside the aircraft, the better decision you can make throughout the incident.
What is the best way to provide patient care?
Once we can clear the aircraft, we need to begin shifting our focus to patient care. Multiple things must be considered before patient contact with EMS personnel. Does the patient need to go through Decon? Where do we isolate sick passengers from those that are not? We will have to contact Medical Control & CDC and determine observation times. How will we transport the passengers to an observation area? Here we would utilize airport buses to transport the passengers to a location away from the terminal area. This raises additional concerns as responding MICUs will have to be routed to that location instead of the incident location. When passengers are cleared, we will have to transport them back to the terminal area to retrieve baggage.
Hurry up to slow down.
Remember, we want to get on scene in a safe amount of time, but with HazMat calls, we have to slow down and think through our actions. The worst thing we can do is rush the call and get more people sick or injured. Secure the aircraft away from the terminal, make entry with appropriate PPE, take air-monitoring equipment, locate the shipping manifest, locate the hazardous source and mitigate it, provide patient care, remove all passengers/crew from aircraft, treat/transport patients, scale down incident, secure and deny access to aircraft until proper decontamination occurs, and turn aircraft over to owners. Slow down and work through the problems.