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Toxic Training

Course prepares San Antonio EMS to treat victims of hazardous materials exposure

February 2005

by Melissa J. Smith

Around 5 a.m. June 27, 2004, two trains collided in Southwest Bexar County. The collision caused 40 railcars to derail. Four of those cars were punctured, emitting plumes of chlorine gas and ammonium nitrate into the air. As area residents fled their homes, emergency services moved in to contain the leak and treat those unable to flee.

Overall, three people died from gas exposure and 50 were treated at local hospitals for breathing problems, headaches and other related illnesses. A dire situation, but it would have been an excellent time to deploy a team of "tox-medics," specially trained to treat victims of toxic exposures.

Tox-medic training

An Advanced HazMat Life Support course, initiated for the San Antonio Fire Department by the Health Science Center, will help prepare city of San Antonio paramedics and emergency medical technicians (EMTs) to handle situations involving chemicals and hazardous materials.

"This course will give trainees the additional skills and knowledge needed to handle victims of either a weapons of mass destruction or hazardous materials incident," said Terry Eaton, assistant clinical professor in the department of emergency health sciences, who coordinates the course. "They’ll be our future tox-medics."

Tox-medics undergo training that covers antidotes and symptoms of toxic exposures, but also explores how the body metabolizes poisons. This knowledge will help them quickly identify potential toxins.

The Tox Box

EMS units are built like mini-emergency rooms and are equipped to handle most emergencies. They carry medications, IV fluids, bandaging and splinting material, burn sheets and other materials. They also carry protective masks, chemical suits and antidote kits. However, not enough kits are available on board to treat multiple victims in the case of a mass poisoning accident.

The Tox Box is a special antidote kit developed specifically for disaster scenes. Tox-medics will use it to begin treatment on victims of poisoning or of a chemical release, such as a chlorine gas leak.

The kits contain drugs and antidotes not usually found in ambulances. These drugs include methylene blue, which treats methemoglobinemia, a condition that occurs when the blood cannot deliver oxygen; and extra atropine, which treats symptoms caused by exposure to nerve agents. The kit also includes extra sodium bicarbonate to treat symptoms caused by exposure to chlorine gas.

"Victims will be treated immediately without having to wait to be transported to an emergency room," Eaton said. "This will save time and lives."

The Health Science Center was the first to bring the Tox Box to San Antonio. Two boxes have been assembled and will be carried by San Antonio’s HazMat units.

Training for the Future

In December, the Health Science Center provided training to 18 EMS paramedics and members of EMS Special Operations and Rescue and HazMat units from around San Antonio. Health Science Center faculty members extended the course by a full day in an effort to certify more people to teach the course.

"We would like to offer training twice a year. With the help of grant money I hope to have larger classes," Eaton said. "We want to create a corps of instructors to conduct our own classes."

The three-day course in December was funded by a grant from the San Antonio Emergency Operating Center. Plans are in place to expand the training to regional paramedics and EMTs.

Robert Dugie, a licensed paramedic and team leader for the Medical Special Operations Unit, participated in the three-day training. The Medical Special Operations Unit responds whenever the hazardous materials unit is called to the scene of an emergency.

"This training has raised my awareness level and reinforced the training I’ve already had," Dugie said. "Anytime you can get a refresher course on chemicals, it is worth it. The Tox Box provides us with more medications to treat patients, and anythingextra that is included in the Tox Box gives us an advantage."

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Updated 7/30/14