By Patrick D. Horan, Jr., MBA, NRP
The first 10 minutes of a hazardous materials call are rarely clean, calm or clearly labeled. EMS may be dispatched for “difficulty breathing,” “multiple sick persons,” “unknown odor,” “overdose,” “industrial accident” or “person down.” The word “hazmat” may not appear in the initial dispatch at all.
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I have seen that reality firsthand. EMS was once dispatched for a fall victim — the kind of call that could easily become a routine lift assist, patient assessment or basic transport decision. When the crew arrived, something did not make sense. There was an unusual odor in the home. The family did not know what was happening, and nothing about the original dispatch suggested a hazardous materials incident.
To their well-deserved credit, the crew did not ignore the clue. They directed the family to leave the residence and requested additional resources, in this case, the fire department. The fire department eventually determined that there was a significant hydrocarbon release in the basement, with vapors emanating throughout the household. A routine EMS response had quickly and quietly become a hazardous materials incident. That is what makes the first-arriving EMS crew so important.
One of the first lessons I learned when I joined a hazmat team came from Chief Benjamin Herskowitz: “Rule #1: Do not become victim #2.” It was simple, blunt and impossible to misunderstand. His second rule was just as direct: “If it is wet, sticky and not yours, do not touch it. If you must, wear the appropriate PPE.”
Those two rules have stayed with me because they are memorable enough to survive stress and serious enough to save a responder’s life. They also capture the mindset EMS needs during the first few minutes of a possible hazmat incident.
Our instinct is to move toward the patient. Our responsibility is to make sure we do not become the next one.
The initial responders may not identify what the chemical is and likely won’t stop the release. But they can make decisions that will directly impact whether the incident remains controlled or if EMS becomes part of the problem.
The first 10 minutes are not about heroic entry. They are about disciplined restraint, early recognition, clear communication and protecting the ability of the system to respond.
Rule #1: Do not become victim #2
EMS providers are trained to move towards those suffering. That instinct is what helps save lives in a cardiac arrest, major trauma and respiratory failure. In a hazardous materials incident, that same training is more likely to injure responders, contaminate the ambulance and create more patients.
Chief Herskowitz’s first rule — do not become victim #2 — should be the mental stop sign for every EMS crew approaching an unknown exposure. Before stepping out, before grabbing the airway bag, before walking toward the patient, the crew has to ask: “Can we reach this patient without becoming patients ourselves?”
For EMS, this means the first decision is not “How fast can we reach the patient?” The first decision is “Can we reach the patient safely with the training, PPE and information we currently have?”
If the answer is uncertain, stop. Stage. Reassess. Request the right resources.
A patient lying in a contaminated area is not helped by adding two paramedics, one EMT and an ambulance to the hot zone.
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Size up before you step out
The first-arriving EMS unit should begin the hazmat size-up before opening the door. What can be seen, smelled or heard from a distance? Are people evacuating? Are multiple patients presenting with similar symptoms? Is there vapor, smoke, liquid, dead vegetation, distressed animals, a placard, a container, a tanker, a railcar or an industrial process nearby?
These clues are far from perfect. Odor is deeply flawed and dangerous as a decision-making tool. But what does matter are patterns. A single patient with shortness of breath may be a simple medical call. Five patients with shortness of breath, all spending time outside of the same building, may be a hazardous materials incident until proven otherwise.
EMS should resist the urge to fixate on the dispatch labels. A “sick person” call can easily transform into carbon monoxide exposure. An “overdose” call can become an exposure to deadly pesticides. An “assault” can be the result of a chemical exposure. “Industrial accident” can be a crush injury with a patient who is contaminated. Even a “fall victim” call can become a hydrocarbon release once the crew realizes that the scene does not match the dispatch notes.
The job of the first crew arriving is not to solve the chemistry. It is to recognize that the scene does not behave like a routine EMS call.
Rule #2: If it is wet, sticky and not yours, do not touch it
Chief Herskowitz’s second rule sounds like firehouse humor, but it is also a working hazmat risk assessment: “If it is wet, sticky and not yours, do not touch it. If you must, wear the appropriate PPE.”
Unknown liquids, powders, residues, vapors and contaminated surfaces should not be treated as harmless simply because a patient needs help nearby. Contact with the wrong material can turn a provider, stretcher, monitor, jump bag or ambulance into an extension of the incident. This is especially important for EMS because we bring so much equipment close to the patient. A monitor, airway bag, drug box, stretcher, radio strap or bunker-style coat can all become contaminated. Once contaminated, those items may carry the incident into the ambulance, the station or the emergency department.
In hazmat response, touching the wrong thing is not a small mistake. It can change the scope of the incident.
Park like you may need to escape
Ambulance placement is a clinical decision. It affects responder safety, patient movement, command organization and hospital protection. The first EMS unit should avoid parking directly in front of the incident, downhill, downwind, in visible vapor clouds, near drainage pathways or in a location that blocks incoming hazmat, fire or law enforcement units. Crews should consider wind direction, slope, access, egress and the possibility that the incident may expand.
The ambulance should not become the collection point for contaminated patients. Once contamination enters the patient compartment, the incident has followed EMS to the next location.
If patients are walking toward the ambulance, that is a warning sign. It may be necessary to direct them to stop, move to a safer area, remove grossly contaminated outer clothing when appropriate and wait for decontamination support. That is difficult for EMS providers who want immediate contact, but scene control is patient care in a hazmat incident.
Think toxidrome, not just product name
We often desire to know the name of the chemical involved in an exposure incident, and I am not saying that it doesn’t matter. However, that information may not be available within the first 10 minutes of the call. Instead of waiting for the exact product identification, crews should begin focusing on what they can observe clinically.
Are patients tearing, coughing and complaining of burning eyes?
Are they confused, seizing or salivating?
Are they cyanotic?
Are there multiple patients with headache, dizziness and nausea?
Are vital signs pointing toward a cholinergic toxidrome, asphyxiant exposure, irritant gas, corrosive injury or simple anxiety layered on top of a real exposure?
This is where EMS adds value. Hazmat teams bring technical expertise. EMS brings patient-pattern recognition.
The first crew on scene should communicate patient signs and symptoms early. “We have four patients from the same building with headache, nausea and dizziness” is more useful than “unknown medical.” “We have tearing, coughing and throat irritation in multiple patients near the loading dock” gives command and incoming units a direction.
Request resources early
The first 10 minutes of a call are when delays begin. If the first EMS crew waits until the situation is obvious, the response is already behind.
Early requests may include fire suppression, hazmat team, additional EMS units, EMS supervisor, law enforcement for isolation, emergency management, poison center consultation, medical command, hospital notification, and utility or facility representatives.
Of course, this is not to suggest overreacting to each and every unusual odor. It means realizing that hazardous materials incidents are often resource-dependent. It takes time for the necessary resources to mobilize, arrive, set up and operate effectively. Early recognition and notification are paramount to preserving time.
When possible, EMS should assess for additional information from their dispatchers while remaining vigilant. The exact location, business name, on-site products, the safety data sheet, visible placards, contacts with the facility, wind direction and speed, and if anyone has left the scene and may be self-presenting to the emergency department are all simple pieces of information that can provide extensive amounts of actionable data.
Protect the hospital early
Hazmat incidents do not end at the scene. They often migrate.
A contaminated patient who self-transports or is transported without recognition can affect an emergency department, ambulance crew, triage area and waiting room. EMS has a responsibility to communicate early with receiving facilities when contamination is suspected.
The message does not need to be perfect. It does need to be early.
A useful notification may sound like this: “We are operating at a possible hazardous materials exposure with multiple symptomatic patients. Product is unknown. Decontamination status is not yet confirmed. Please prepare for possible contaminated patients and stand by for updates.”
That one call may give the hospital time to protect its staff, redirect entry, prepare decontamination capability and avoid bringing contamination inside.
Document decisions, not just actions
Hazmat calls are decision-heavy. Documentation should reflect that.
The PCR should go beyond simply stating “Patient was transported.” It should go into appropriate levels of detail and explain the scene conditions, staging decisions, concerns over contamination, protective equipment that was utilized, what type of decontamination was performed, the patient’s signs and symptoms, what notifications were made, and the interaction with command, of course, disposition determined with rationale.
The same requirements should also exist within the hazardous materials and the command team. If EMS staged uphill and upwind, requested a Haz Mat Team response, delayed transport to ensure the patient was decontaminated, made early notification to the hospital, and transferred the patient after decontamination occurred, all should be documented effectively.
Good documentation protects the patient, the crew, the agency and the system. It also creates the material needed for after-action review and future training.
The first 10 minutes set the tone
Most EMS providers will never be hazmat technicians. They do not need to be. But every EMS provider may be first on scene to a hazardous materials incident disguised as a routine medical call.
In those first 10 minutes, EMS has several jobs: recognize the possibility, avoid contamination, stage intelligently, communicate clearly, request help early, protect the hospital and document the decisions that matter.
A fall victim could be a hydrocarbon release. A sick person could be carbon monoxide exposure. An unknown odor could mean multiple contaminated patients. The dispatch label is only the starting point.
Hazmat response begins before the hazmat team arrives. It begins when the first EMS crew decides not to rush in blindly.
That restraint is not hesitation. It is professionalism.
ABOUT THE AUTHOR
Patrick Horan is an EMS educator, clinician and emergency services leader with a background spanning paramedicine, hazardous materials response, emergency management, quality improvement and healthcare education, with professional experience that includes EMS instruction, program development, clinical training, after-action review work and leadership in hazardous materials response. His work focuses on building stronger emergency care systems through practical education, evidence-informed training, human factors, preparedness and operational improvement.
