General considerations. The most important principles of successful medical management of a hazardous materials incident are the following:

1. Use extreme caution when dealing with unknown or unstable conditions.

2. Rapidly assess the potential hazard severity of the substances involved.

3. Determine the potential for secondary contamination of downstream personnel and facilities.

4. Perform any needed decontamination at the scene beforevictim transport, if possible.

Organization. Chemical accidents are managed under the incident command system and incident commander.The first priorities of the incident commander are to secure the area, establish a command post, create hazard zones, and provide for the decontamination and immediate prehospital care of any victims. However, hospitals must be prepared to manage victims who leave the scene before teams arrive and may arrive at the emergency department unannounced, possibly contaminated, and needing medical attention.

1. Hazard zones (Figure IV–1) are determined by the nature of the spilled substance and the wind and geographic conditions. In general, the command post and support area are located upwind and uphill from the spill, with sufficient distance to allow rapid escape if conditions change.