Over the years, I have had opportunities to work with some of the best HAZMAT Teams in North and South America on some really large scale incidents and through these experiences I have learned more than I could ever teach. But one thing that causes so many teams so many problems is their on-scene medical monitoring. Here are some very easy and cheap methods to help rectify these potential deficiencies…
For about $100.00 and a trip to Target or Walgreens ( I own NO stock in either business!) you can have your on-scene medical monitoring program FULLY EQIPPED. And the best part of this whole plan, you do not need an RN/PLN, EMT-P, or Doctor on scene to administer it. Your First-Aid trained personnel can do it, as it is VERY EASY and FULLY POWERED by AA, AAA, and D batteries!
You need to purchase the following equipment:
Wrist Blood Pressure Monitor = $29.99
HoMedics 1-sec. Ear Thermometer = $29.99
Whynter Digital Body Fat and Hydration Scale = $39.99
Now there is one small trick to making this system work and be as accurate as possible…REQUIRE your responders to wear wet/dry shirts and shorts. Do NOT let them wear cotton shirts and jeans under their LEVEL A, B, or C ensembles, as the cotton will absorb the sweat and provide inaccurate readings on our scales (e.g. the sweat will still be on you – just not in you!)
I have been though this type of medical screening and was suited up in LEVEL A in less than 15 minutes using this system! While I am on the scales getting my weight and hydration %, someone is putting on my wrist blood pressure cuff and while it is working, they use the ear thermometer to get my core temp. All four readings are done in less one minute. KEEP IN MIND, we are not so concerned on the accuracy of these first tests, just the CONSISTENCY between testings of each responder. By this, I mean if the scale says your hydration is 55%, don’t worry, as long as your next test says the same thing! We are looking for CHANGES in your medical conditions and not whether we should be curbing your trips to your favorite fast food chain!
Here are some GUIDELINES you can consider when starting your on-scene medical monitoring program. PLEASE NOTE that your facility MUST consult with your LHCP to develop your official standards!!! Using the same LHCP that you used to conduct your annual medical evaluations would be a great idea.
HEART RATE
Count the radial pulse during a 30-second period as early as possible in any rest period. If the heart rate exceeds 110 beats per minute at the beginning of the rest period, the next work cycle should be shortened by one-third.
ORAL TEMPERATURE
Do not permit an end user to wear protective clothing and engage in work when his or her oral temperature exceeds 100.6°F (38.1°C). Use a clinical thermometer (three minutes under the tongue) or similar device to measure oral temperature at the end of the work period (before drinking), as follows:
If the oral temperature exceeds 99.6°F (37.6°C), shorten the next work period by at least one-third.
If the oral temperature exceeds 99.6°F (37.6°C) at the beginning of a response period, shorten the mission time by one-third.
BODY WATER LOSS
Measure the end user’s weight on a scale accurate to plus or minus 0.25 pounds prior to any response activity.
Compare this weight with his or her normal body weight to determine if enough fluids have been consumed to prevent dehydration.
Weights should be taken while the end user wears similar clothing, or ideally, in the nude.
The body water loss should not exceed 1.5% of the total body weight loss from a response.
I hope everyone can afford $100 and has a first-aid trained responder on scene that can administer this program. It is cheap, easy and accurate and that is what we need. This program is also MUCH MORE in line with OSHA/EPA expectations than the old “2-bottle rotation” policy. These days, with SCBA bottles lasting 60 minutes, the old policy of 2-bottle rotation and then off to rehab may not be enough to limit your aggressive responders from over doing it.
Byran