BY TODD McKEE
Have you noticed that many times we have not begun to train in some areas until firefighters have died in the scenarios depicted in those new training drills? Firefighters need to develop the mindset that looks at situations that might be “rare” or “unusual” for their departments but that still can cause firefighters to die. When these issues present themselves, the new approach should lead you to think, “If a firefighter can die if this type of incident occurs in our district, let’s research the issue and train on it because this situation could present itself here.”
SOME “UNUSUAL” INCIDENTS
Among the calls that may fit into the unusual category for some departments are anthrax, mercury, and Methicillin-Resistant Staphylococcus Aureus (MRSA).
Anthrax
This serious bacterial infection is caused by Bacillus anthracis and occurs primarily in animals, including cattle, sheep, horses, mules, and some wild animals. Humans and swine are generally quite resistant to anthrax. Humans become infected when the spores of B. anthracis enter the body by contact with infected animals or contaminated animal products, insect bites, ingestion, or inhalation. Aerosolized (“weaponized”) spores of B. anthracis can potentially be used (misused) for biological warfare and bioterrorism.
Cutaneous anthrax, the most common form of the disease, is characterized by a localized skin lesion with a central eschar (scab) surrounded by marked edema (swelling). Inhalation anthrax (woolsorters’ disease), which typically involves hemorrhagic mediastinitis (bleeding into the midchest) and rapidly progressive systemic (bodywide) infection, carries a very high mortality rate. Gastrointestinal anthrax is much rarer and is also associated with a high mortality rate.1
Most human anthrax comes from skin contact with animal products contaminated by anthrax. The hallmark of skin anthrax is a carbuncle, a cluster of boils, that ulcerates. Typically, the carbuncle has a hard black center surrounded by bright red inflammation. This dramatic appearance accounts for its name, “anthrax,” the Greek word for “coal,” a burning coal. The cutaneous form of anthrax is treated with antibiotics such as penicillin, tetracycline, erythromycin, and ciprofloxacin (Cipro®). The pulmonary form of anthrax constitutes an emergency and calls for early continuous intravenous administration of antibiotics such as penicillin in combination with streptomycin.
The General Accountability Office (GAO), the investigative arm of the U.S. Congress, in a 1999 report stated that anthrax was a “possible” biologic threat for terrorism but noted that a virulent strain of the bacterium is difficult to acquire and that it would take sophistication to manufacture and disseminate the bacterium. The GAO assessed the lethal effects of anthrax as “very high.”
In the autumn of 2001, anthrax was no longer a “possible” biologic threat. Its distribution through the mail in the United States made anthrax a 21st-century agent of bioterrorism.
On the day of our first response to an anthrax call, our chief arrived at the firehouse from a countywide chiefs’ meeting. His first words were, “We need to look over the new county protocol for anthrax; it could happen to us.” Approximately two minutes later, he was reading the protocol to us on the way to a possible anthrax threat. On arrival at the scene, the homeowner was standing outside in a state of panic; he was concerned about being exposed to the post-9/11 threat of anthrax. We were suited up in our turnout gear, breathing from our self-contained breathing apparatus. We entered the residence through the unlocked front door and opened up the freezer and put the Twinkie box the homeowner said contained anthrax in our trash bag, in accordance with county protocol, and gave it to the first county deputy we saw. The next few days, our tones were nearly nonstop for these types of calls. After doing the extensive research, we found that this was not a call our department should be handling. We began to think outside the box before someone was exposed. We had to call a hazmat team; we needed additional resources. Please keep in mind that we are a very small volunteer fire department that receives only 200 calls a year.
Mercury
As kids, we all played with mercury on our front porch. We watched it break up and make more little balls and moved it back and forth. In 2006, our community had four cases involving mercury. They caused a restaurant to shut down for two weeks, a school to close for a week, and a county courthouse to shut down for days. This seemed to be “unusual.” I wondered why suddenly mercury was a big deal. I had to be proactive. I did some research and found that mercury is an inhalation hazard. It continues to break into small pieces that the naked eye can’t see and can cause respiratory infections and even distress. For example, if mercury were placed in a shop vacuum cleaner and if the vacuum were run for a few minutes, you would not see any changes, and you might think that the test was a failure. However, if you were to place a black light above the vacuum cleaner, you would find that the product broke up into very fine particles.
Now imagine that if someone wanted to cause harm, he could put mercury into a ventilation system. This would cause great harm to several victims and would constitute a health threat. I learned that the best way to contain a small spill of mercury such as that in the restaurant or the county courthouse referred to above would be to take a can of foam-type shaving cream and spray it on top of the product.2 The cream, effective for small amounts of mercury, acts as a smothering agent and does not allow the product to break apart. I do not know if someone was trying to cause harm to the public in the above mercury incident, but I know that the incidents were “unusual,” and I made sure I was prepared to respond to any future mercury emergencies. How should we respond to these kinds of emergencies? First responders must take precautions such as wearing full personal protective equipment and being aware of their surroundings.
MRSA
Ohio had hundreds of MRSA incidents—in schools, churches, and firehouses—in a three-week period during 2007. There were 600,000 reported cases of staph infection; 350,000 of them were MRSA. Thirty percent of our firefighters or one of their family members has had MRSA. Again, I researched the topic to try to determine why this is happening in such a large number of cases. I discovered that MRSA is a type of staph infection and the first case was reported in the United Kingdom in 1947. I also learned that the majority of Americans have MRSA on their skin, but it is dormant. I called several universities; none could tell me how it becomes active. Was this a case similar to anthrax? Was this a case of someone’s trying to infect the public? How could this infection be stopped? To date, we do not know, and neither do the state and local health departments. The proper response to a large MRSA breakout is to have adequate resources for decontamination and to transport the victims to an emergency facility.
Terrorists like to test our security status. They sometimes do this by checking to see where the first responders place their apparatus and the response routes they take. Keep in mind that a terrorist is not necessarily associated with foreign-based organizations or groups. A terrorist is anyone who wants to harm people, property, and the environment. As first responders, we need to be aware of our surroundings when we arrive on the scene and notice if something does not look right. In these cases, move your command post from its usual location, and look for any secondary explosive devices, which could harm you and the other responders. Terrorists believe that if they disrupt police and fire personnel, more deaths will occur because there will be fewer responders to help the public. Train on such responses before firefighters die. These are all “unusual” occurrences for which we as firefighters need to train so we can be prepared when these rare emergencies happen in our districts.
Endnotes
1. medterms.com.
2. www.michigan.gov/documents/mdch/WhenMercurySpills_214576_7.pdf/. Accessed January 4, 2009.
TODD McKEE is a firefighter and an 11-year veteran of the fire service. He is a member of the Eastern Knox County Joint Fire District in Danville, Ohio. He is a weapons of mass destruction instructor for the University of Findlay in Findlay, Ohio; a State of Ohio fire instructor; a hazardous materials instructor; and a hazmat technician, specialist, and commander.
