APPROACH WMD EVENTS WITH A NEW MINDSET

BY CHASE SARGENT

I get the calls and have the discussions every day with friends and colleagues across the county: “My department is purchasing level A suits for many of our rigs.”

“We are purchasing 10 mass-casualty decontamination units.”

“We are planning and training for triage in the hot zone at a weapons of mass destruction (WMD) event.”

“There’s a fight brewing between our EMS third service and fire about who’s going to take care of the patients in the hot zone.”

“The cops are running rampant!”

“Our command staff still wants to run WMD events like industrial haz-mat events.”

As if that were not enough, a new “research project” reports that our respiratory equipment is no longer any good for protecting in a chemical/biological/radiological/nuclear (CBRN) environment! Of course, we have not seen the complete report, test methods, and processes, but everyone is up in arms and screaming that the sky is falling. Yet, despite that, we have major departments indicating that they will no longer approach a potential CBRN event and will stand off in a totally defensive mode. Never mind the fact that people are using power air-purifying respirators (PAPRs) without certification or that the buddy breathers we have on our SCBAs are not National Institute of Occupational Safety and Health (NIOSH) approved! Forget the fact that no one even bothered to look at the chemistry that will be involved in the environment most events will produce.

I am convinced the fire service has lost its collective mind. All of this money and talk of terrorist attacks, the color-coded alerts, and our scramble to obtain our piece of the pie like seagulls fighting over a piece of meat have turned our minds to mush. Although it is likely that we will be attacked again, and there is a high potential that chemical, nuclear, or biological agents supported by explosives or incendiaries will be involved, we are not developing practical, applicable, rapid, and rational response procedures. This failure is being reinforced by large-scale drills in which major cities and multiple agencies are thrown together for a WMD scenario that teaches very little and provides almost no “team decision making” and, therefore, makes no institutional, organizational, or operational changes.

We have all been there:

The tabletop exercises, the full-scale field exercises in which between 30 and 100 “patients” created by some form of terrorist attack in a building stream forth.
We see the first-due engine company, like some medieval knights attempting to hold the patients off with a pike pole. Although brave in their stance, they are overrun.
We see the haz-mat teams in their level A suits taking inordinate amounts of time to take physicals and doff the moon suits, forgetting that this is a game of minutes.
We see the decontamination area with its opposing engines and its ladder truck towering like some great dragon breathing fire as it spits water.
We see patients—untouched, not decontaminated—lying, walking, and squirming on the training grounds like fish pulled from the water.

A CHANGE IS NEEDED

We are witnessing a failure in the making—one that will haunt the system for years to come if we do not change our method and approach. This failure is caused by the inability to address and commit resources to a new risk because we are locked into old dogma, which has come to be known in military circles as “risk adverse leadership.”

The second issue is that the new threats of today must be approached in a manner that is different from the way we did things in the past. I suggest that our current approach to dealing with an initial response to WMD events and the subsequent mass casualties they are likely to produce are better suited to the artificial world of training than the real world of operational missions. The difference between success and failure is the ability to perform functions under great stress with “brain and muscle memory.”

Forget about biologicals because chances are that we will not even know they are there. Forget about radiologicals because until you use definitive monitoring you won’t know they are there either. (As an example of dogma change, in this day and age, every apparatus should be equipped with radiation pagers.)

We had better make the preeminent assumption that any building, area, or people involved in an explosion or a collapse at this point in history are dirty until proven otherwise. That doesn’t mean our first response units will not be met by a multitude of fleeing people who have little regard for responders’ safety or have no desire to listen to initial orders and directions. The goals of these people are to get away from the threat and to get some relief if they are contaminated or hurt. If responders are not met by the masses, it will mean that the people are dead or they escaped; therefore, the human emergency would be over.

WMD: CURRENT METHODOLOGY

The way we are preparing for attacks involving chemical or biological warfare agents presents several shortcomings:

Initial response depends too much on past dogma and haz-mat events. Many teams still preach level A, slow, and easy. Many command structures still believe that the approach to WMD events is the same process we use for industrial events, resulting in “risk adverse leadership.”

The following principles no longer apply:

—Time is no longer our friend. We cannot take physicals, read, and research MSDS and assess, assess, and reassess and expect our first-response personnel to stand and wait.

—We cannot expect the incident to wait for us to mitigate it; in most cases, the chemical will not be around long enough. Additionally, in many instances the aftermath of the incident is going to come to us, and we had better be prepared to meet it.

Our approach to response and control is not based on our knowledge of chemistry and the physical properties of chemical warfare agents.
We are worrying too much about what we cannot save and are not focusing enough on what we can save.
Our approach to initial decontamination is not rapid or functional, and it is impractical for the numbers and types of victims.
We have forgotten the keep-it-simple principle and the basic concept that “if it’s stupid and works, it’s not stupid.”
Our rush to purchase CBRN-compliant SCBA is a “snake oil” correction to a problem of limited duration.

VICTIMS

Let’s look at some of the scenarios that take place in most communities that have been impacted by the Department of Justice (DOJ), Department of Defense (DOD), Federal Emergency Management Agency (FEMA), Office of Domestic Preparedness (ODP), and other WMD grant processes for preparing for CBNR events.

Even the 2003 TOPOFF exercises in major cities demonstrated the inability of many teams and command staff to break with past dogmas. The result was contaminated patients with no definitive decontamination. While haz-mat personnel were suiting up and measuring the risk, first responders were waiting to do something with the potentially contaminated victims. In some cases, the “victims” waited for treatment or decon for up to 60 minutes.

WMD events involving chemicals or biologicals produce three classes of victims: those who are dead, those showing various degrees of signs and symptoms, and those not affected. The impact on victims may be immediately recognizable in chemical events; in the case of biologicals, it may take days or weeks for symptoms to develop.

Initial response units likely would be faced with large numbers of victims in various conditions according to their proximity to the agent at the time of release. These people might be trying to remove themselves from a location with limited or extensive exits, most likely places of public assembly such as malls, restaurants, theaters, shopping centers, sporting arenas, and the like. If you think that a level A haz-mat team is going to solve this initial problem, you just made your first mistake.

As an additional consideration, some of these victims would be contaminated by the agent deployed or injured by the accompanying explosives or incendiary effects. Those not directly contaminated (first-arriving units, of course, will have no knowledge of this as the victims are locked in an escaping crowd) will attempt to flow freely from the exits. Faced with these circumstances, very few approaches would be successful.

For any approach to be successful, it must meet the following parameters:

It must be rapid and provide protection for the first responders using the tools and personal protective equipment (PPE) they have with them. In other words, setup and implementation must be rapid and easy to accomplish with limited resources and by the first-arriving personnel, just like on the fireground.
Command officers must break with the past dogma of wait, research, slow and easy, and transition to a rapid size-up and commitment where feasible, working under a new set of risk-benefit guidelines.
The plan must address the “greatest good for the greatest number” and be capable of handling large throngs of people in a short time.
It must be reality based: We must accept what we can and cannot accomplish in the first hour of an event.
First-arriving units must have a plan for providing rapid emergency decontamination while at the same time separating, in a timely manner, the injured and those impacted by an agent from those who are not.

Although a proper size-up is important, it would virtually be impossible to stand outside or wait several blocks away while people pour out of a structure. Additionally, wearing level A suits, and to some extent even level B suits, for initial response would not enable the responders to move rapidly enough to maintain equilibrium with the event and does not address victims’ immediate needs. Moreover, this level of protection is unnecessary based on our initial responsibilities, the chemistry of the agents, and the locations at which the vast majority of our personnel and units would be working within the first hour.

The stark reality is that personnel must be ready to deal with large numbers of victims while using turnout gear and breathing apparatus and the limited monitoring and detection equipment and the initial apparatus and resources brought to the incident. It must be simple, rapid, easily remembered, and repeatable time after time. Haz-mat entry procedures, extensive detection and monitoring, and large-scale complex decontamination setups (tents, multiple apparatus) are follow-up services that are impractical and serve limited purpose in the first hour of an event.

CHEMISTRY

You don’t need the two-week chemistry haz-mat course to make sound decisions about what is and what is not possible in this arena. In fact, a 10-minute understanding of basic chemical properties followed by a five-minute discussion of the toxicity and lethality of these products are all you need for a rational and operationally functional approach to response and mitigation (see “Basic Chemistry for Weapons of Mass Destruction”).

THE FIRST 30 MINUTES

Let’s look at some levels of products that might occur after a release and what might happen to someone caught within range of a given release.

The military uses milligrams per meter cubed (Mg/M3) to describe concentrations of product; 200 Mg/M3 is considered the battlefield dose of certain nerve agents. Levels of agents released on civilian populations by chemical weapons may be 2,000 Mg/M3 or 10 times the battlefield dose because of the product’s being released in an enclosed area. How does this compare with parts per million (ppm) or parts per billion (ppb) measurements?

Table 1 lists the toxicities of some chemical warfare agents that might be encountered.

There are two lessons here. First, most nerve agents except VX want to become a gas, and most vesicants want to stay a liquid. (Mustard freezes at 57°F.) Thus, it is very difficult to make nerve agents stay around and to turn vesicants into vapor. Second, it takes very little in terms of dose and concentration to affect humans.

The effects could be one of four scenarios: (1) I am dead, (2) I have been exposed to enough that I am in severe threat of dying without proper intervention, (3) I am showing signs and symptoms but am not critical, and (4) I am clean or relatively clean.

So, save what you can; write off the remainder. Don’t be concerned about that aspect of this mission; there is nothing you can do to change it. You can rapidly decontaminate contaminated victims and rapidly triage patient populations into groups who will survive with limited to extensive intervention and those you hope you will have time to treat while protecting yourself and other responders.

Consider the following:

If victims come in contact with liquid nerve agents (skin contact), they are dead or dying.
If victims come in contact with liquid vesicants (skin contact), the damage is done; decontamination and definitive care of the wounds are needed.
If you can walk, crawl, or run from the event, you are unhurt or more than likely would be salvageable with rapid decontamination and treatment.
Don’t forget about nonchemical injuries such as trauma from cascading crowds; heart attacks from stress; and injuries resulting from falls, trips, and panic.

Decontamination must be rapid and easily implemented by first-due units.

I am not aware of too many departments that have unlimited resources or can spare enough units to set up the type of decontamination systems used at these prestaged, preplanned chemical warfare drills and that can decontaminate at multiple locations within the first two minutes of arrival. The reality is, each engine company is going to have to fend for itself based on the position it finds itself in during the initial response. Tactical application of decontamination must be rapid, repeatable time after time, provide some limited protection, and address large numbers of people.

Setting up your ladder with an engine on both sides and allowing people to walk to it meets none of those criteria. In fact, it does not even meet the needs of nonambulatory victims, who are in greatest need of rapid, on-site decontamination. Neither does your very nice shower, heated or not.

A SYSTEM THAT MEETS THE CRITERIA

The following system will meet the above criteria and does not necessitate additional equipment to provide rapid, repeatable decontamination.

On arrival, all personnel should be in full turnout gear and breathing apparatus; the driver operator should strive to don the SCBA as soon as possible.
Lay a supply line going in; a five-inch line will be fine. Treat it as a structure fire. If you don’t need the water, you can pack it back up. If you need it, you will not run out of water just about the time the massive horde makes it to you.
Position yourself in such a manner that you can get in service at least one 13/4-inch line, possibly two lines, directed at the victims. This does three immediate and critical things:

—It provides immediate flushing of ambulatory and nonambulatory contaminated patients. You can direct the stream to the victim instead of expecting the victim to come to you. (Remember wet, strip, flush, cover.)

—It provides an immediate standoff weapon that offers limited protection to the crew, much more than a pike pole.

—It creates immediate chemical triage of victims. Patients who are contaminated and hurting will seek the water, regardless of the outside temperature. Those not impacted by the agent will shun the water, so you instantly create two groups.

This simple, quick, repeatable approach, which can be used by every engine company in your jurisdiction, covers large segments of people. It buys you time to set up those ladders, engines, and tents.

CBRN-COMPLIANT SCBA

The bottom line is, you might—and I say might—need a dozen CBRN-compliant SCBA for your haz-mat team members. Of course, they will be encapsulated when they make entry or perhaps be placed with limited level B. Purchasing them for the entire department is ridiculous and fiscally irresponsible.

Review the basic chemistry information presented in this article in relation to PPE. Now, let’s examine the testing mechanism used to create a CRBN SCBA.

First, the intent is to ensure that CBRN agents will not permeate or penetrate components of the SCBA and enter the wearer’s respiratory system at levels NIOSH and the U.S. Army Soldier Biological Chemical Command (SBCCOM) consider maximum credible threat concentrations. This addresses positive-pressure SCBAs—without cylinder but with all integral components and whatever accessories the manufacturer designates for testing—and must meet specified pass-fail criteria for penetration of mustard (HD) and sarin (GB). Tests are run while the SCBA is operating on a breathing machine at a flow rate of 40 liters per minute for a six-hour maximum service life—a very noble cause and, taken at face value, a great addition to our health and safety. Tests for HD vapor are run at 300 mg/m3 for 30 minutes and at 0.86 ml for 360 minutes for liquid, to obtain a maximum service life of six hours. GB vapor is run at 2,000 mg/m3 for 30 minutes for a maximum service life of six hours.

When these tests are run, we discover that silicone, the most comfortable, most durable, and best-sealing facepiece skirt for more than three decades, does not meet the six-hour requirement. However, it will stand up to less than two hours of exposure to mustard and three hours of sarin. What does that mean for us?

It means that butyl rubber, a product that does not hold up as well or as long in a fire environment, is now the product of choice when creating a CBRN mask. Additionally, other high-impact plastics used in second-stage regulators may need to be changed as well.

The question is, Why is CBRN-compliant SCBA a sham? Look at the concentrations used over time. Look at the chemistry chart. If you are in those concentrations, you are dead, have been dead for a while, and will stay dead forever! Additionally, unless we have a dispersion machine that is constantly running, these concentrations will not stay at these levels for very long, considering that these products turn to vapor and rapidly disperse. Even if you do have concentrations that remain for six hours, what possibly could be in that environment that would lead you to try to retrieve it and enter without wearing a level A suit with your SCBA enclosed in the suit, which would prevent exposure? Again, I ask, What is there in this environment that we would need? Evidence? It can wait!

Next, who is going to wear a breathing apparatus for six hours in an environment contaminated at these levels with the SCBA exposed? Who is going to do it even for three hours (the silicon permeation time)? So, why do we need these suits? A terrorist might set off a secondary device and dump this level of concentration on us while we are working, you say? So what? The silicon mask will last for three hours if you are stupid enough to stay around a vapor cloud of sarin or mustard. If you are not seeking escape within minutes, you are probably not smart enough to wear an SCBA in the first place.

TYPES OF ENTRIES

We make two types of entries, emergency and deliberate. Emergency entries are made to remove victims (rescue) and are done rapidly and until we see nothing but dead people, a clue that the LD50 is off the scale. Deliberate entries (take your time, don your suit, do your physical) are done to collect evidence or bodies or to stop a leak at very high concentrations. In most emergency entries, you are in turnouts and SCBA and are exposed for limited times and at limited concentrations working with victims who are alive or showing signs and symptoms. If they survived completely unprotected, you should do very well in turnouts and SCBA. In deliberate entries, your bottle is covered in a level A suit or is on the outside of a level B suit. Again, are you going to spend two or three hours in the space with a one-hour bottle?

ASKING THE HARD QUESTIONS

Level A suits have limited value in the first hour of an event because of the following:

Any victim in a concentration that requires a responder to enter in a level A (or a level B suit, for that matter) is dead. Why do you need to go in there at that time?
Level A is great for evidence collection later in the event—to obtain the dispersion device, to retrieve bodies, and to check for other devices that may be planted. Note: A law-enforcement duty with support from haz mat.
Emergency responders in turnout gear and breathing apparatus can remove and come in contact with the vast majority of victims who need their help. Whenever possible, staying out of large vapor clouds and liquid should be a no-brainer, regardless of the level of PPE.

The chemistry of the agents tells you what you can and cannot get away with. If you are relatively smart, it will tell you to stay out of heavy vapor concentrations (people are dead there anyway) and stay away from liquids. You can do all you need to do to take care of the initial response and the greatest numbers of salvageable victims in turnouts and SCBA.

Initial decontamination is not accomplished by fancy tools or time-consuming setups. It is accomplished by treating the event as a structure fire and putting wet stuff on the red stuff quickly and rescuing survivable victims from areas of threat. The first five minutes of this event will set the stage for the next five hours.

Expecting to treat this event as an industrial haz-mat event, an overturned tanker truck, or a leaking 55-gallon drum is a critical command error. Time is not your friend. The released product is the least of your problems. Failure to change your initial mindset and train your personnel appropriately leads to risk adverse leadership, which costs lives and time.

EVALUATE YOUR ORGANIZATIONAL APPROACH

Evaluate what you and your organization have learned and have been taught over the past several years. Examine the arguments presented here, and ask yourself the following questions:

Have we been heading down the wrong path, based on training that has been provided us or our involvement in artificial drills that use a linear approach to learning? In other words, they give us a problem or a series of problems and simply let us run until we reach the end, with no constant, ongoing, and continual feedback that allows us to learn and change our processes as we go? Too often the exercise planners assume that the participants in a large-scale drill are already a “high performance team” with the ability to make team decisions. In most of the cases I have witnessed, this is a false and dangerous assumption in terms of what is learned and then repeated during and after these exercises.
Do we need to evaluate our standard operating procedures and adjust the first responders’ approach to contaminated populations in potential chemical warfare incidents to a simpler, more universal protocol? Are we living in the past using outdated haz-mat practices to address today’s problems?
Do we need to provide updated training for our members? Realizing that initial training may not have been realistic or based on the assumptions of the time, do we have to examine what we have learned since our initial training and update accordingly?
Are our command officers committed to risk adverse leadership by failing to understand the necessity to commit resources quickly and effectively in support of the operations? The most common clue that this is happening during a drill is having haz-mat team members sitting in chairs getting physicals and companies standing around 20 minutes into the event while victims are lying on the ground and wandering around. There is no attempt to make initial and rapid contact with the victims and provide decontamination with handlines. It could cost civilian and responder lives.
Are we so unwilling to review and hear the truth about a drill we conducted that we would rather transfer a command officer who says “Hey, we messed this up” than admit there is a procedural problem?

Take time to think about your current approach to business and your ability to deploy assets and repeatedly provide a rapid assessment and solution each and every time. Think about it now, because tomorrow you may not get the chance.

CHASE SARGENT, a 24-year decorated fire and rescue service veteran, is a division chief of the 2nd Division and homeland security coordinator for the Virginia Beach (VA) Department; a task force leader with Virginia Task Force II, FEMA US&R Task Force; the IST White Team operations chief for the FEMA US&R program; an instructor for the FEMA US&R Structural Collapse Technician program; and the East Coast task force leaders representative. He is also president of Spec. Rescue International, a training and consulting firm. He has developed courses for the Commonwealth of Virginia, Department of Fire Programs, Heavy and Tactical Rescue Team since 1981. He has a bachelor’s degree in forestry and wildlife from Virginia Polytechnic Institute and State University, has a master’s degree in public administration from Golden Gate University, and is a graduate of the National Fire Academy’s Executive Fire Officer Program. A national registered paramedic, he is chief tactical paramedic for the FBI Norfolk Division SWAT team and a paramedic for the City of Virginia Beach, a certified hazardous materials technician, a bio-chemical haz mat technician, and a WMD EMS technician. He is the author of Confined Space Rescue (Fire Engineering, 2000).

BASIC CHEMISTRY FOR WEAPONS OF MASS DESTRUCTION

Solid, liquid, or gas. In most instances, to get hurt by a liquid or a solid we have to get intimate with it, we have to contact it, we have to get it on or in us, or it has to detonate.

Gases, vapors, or mists, on the other hand, will come after us. Any product that can come after you is more dangerous than one that you have to go after. Additionally, a gas will quickly dissipate unless kept in a closed area with no ventilation and nowhere to go.

Lesson: Avoid liquid and heavy vapor concentrations.

Persistence. This refers to a chemical’s ability to “stay around”—in other words, how long does it stay in one place? Chemicals are persistent if they stay around for more than 24 hours; they are nonpersistent if they go away in 24 hours or less.

Lesson: Some chemicals stay around longer than others. Liquids or solids are most likely to be persistent.

Means of attack. You won’t find this in your fancy chemistry book because I made it up. It means, How does a chemical harm or attack us? Ingestion, absorption, injection, and inhalation are all methods of attack. The first three require a high level of stupidity or a short attention span when working in an environment where chemical warfare agents have been used.

Lesson: When it comes to chemicals, the greatest threat to first responders is attack through inhalation.

Vapor pressure. How rapidly does a chemical change from liquid or solid to gas when exposed to the environment—in other words, what is the chemical’s affinity to change to a gas?

Lesson: Based on temperature, pressure, and other parameters, chemicals can change form.

Vapor density. How heavy is a gas? Air is 1, anything heavier is a number greater than 1, and anything lighter is a number smaller than 1.

Lesson: Stuff can come at you low, high, or in between.

Parts per million (ppm) and parts per billion (ppb). A unit of measure that means absolutely nothing unless you have something to compare it with. Here’s a comparison that’s usually used: 1% = 10,000 ppm (one shot of vodka in a 10,000-gallon tanker of vermouth). That measure still means nothing unless you know how many ppm are toxic, lethal, or incapacitating. Needless to say, neither of these measurements represents a very, very small amount.

Lesson: It does not take a whole lot of this stuff to kill or incapacitate a human.

LD50. The amount of product—solid, liquid, or gas—that will kill 50 percent of a population exposed to it.

Lesson: Rats may die more quickly than humans, but everything dies above a given threshold.

MCt50. The amount of product that will cause an exposed population to exhibit signs and symptoms.

Lesson: There will be people alive showing similar signs and symptoms.

LCt50. The statistically derived LCT50 is the lethal concentration of 50 percent of the population based on time and dose.

Lesson: Time and exposure at a given concentration level determine your fate, or, the longer you are underwater and the more you inhale, the more likely you are to drown.

Mg-min/m3. Concentration over time within a defined volume of a meter cubed. This is a relative constant, even with a difference in concentration over time (Harper’s Law). As an example, 4 mg-min/m3 for 10 minutes is 40 mg/min/m3, so is 8 mg/min/m3 for five minutes. This is the measurement usually used to explain the concentration distributed over a battlefield (open space) or an enclosed area (such as a mall, shopping center, movie theatre).

Lesson: Releases in enclosed areas create greater concentrations over time and result in greater casualty and fatality rates, especially close to the release point.