ASBESTOS: BREATHE EASY WITH A PREPLAN
SAFETY & HEALTH
“Respond to Memorial School, Code 3. Man down!” Sound like a fairly typical call? Maybe, but typical-sounding calls can and often do take unexpected and potentially dangerous twists.
As the responding units arrive at the school’s entrance, two masked men, cloaked head to toe in baggy, one-piece garments, run toward the ambulance. They pull their face masks off and explain to the rescue squad that they are asbestos removal workers. One of their coworkers is injured and trapped under the wreckage of collapsed scaffolding. The workers are unable to provide any pertinent information on the injured man’s condition, as he was shielded from their view by his protective clothing and by debris.
Initially the rescue squad members are tempted to rush in to assess the victim’s condition. Do they, or have they been trained in the potential hazards of asbestos? Can and do they initiate a preplanned response to this emergency? Do they view asbestos as an environmental problem and do they also consider it a health hazard that immediately threatens them and their victim?
LIMITED EXPERIENCE
Many firefighters might not consider asbestos to be harmful, mainly because of limited experiences with it growing up. We considered asbestos a friend: Movie curtains were made out of it, we learned about its beneficial properties in school, and our homes may have had pipes or a boiler insulated with it.
Although we normally think of a hazardous substance as causing immediate harm from exposure, some materials have harmful effects that only manifest themselves years after. Many harmful substances have the ability to do both, depending on the amount and duration of the exposure. The harmful effects of asbestos usually don’t appear until years after contact.
Asbestos is a naturally occurring group of minerals that has been mined for the properties of its, fiber form. Asbestos was woven into fabric, mixed with other materials and wrapped around pipes, troweled onto vessels and boilers, incorporated into roofing materials, formed into wall board, and sprayed onto ceilings and structural supports. It is in floor tiles, adhesives, brake shoes, and paving asphalts—it was commonly used in construction from the early 1900s through the ’60s and early ’70s.
In good condition, asbestos insulation poses no harm to building occupants, rescuers, or firefighters. However, should asbestos insulation become damaged (for example, if you check for fire extension by opening up a ceiling, or you pull a pipe out of the way during rescue operations) and asbestos fibers become free, they will become entrained into the air (invisible to the naked eye, fibers may remain suspended in the air for more than HO hours). Should this happen, you must consider respiratory protection, decontamination, and health concerns.
Three types of asbestos have been commonly used in a reported 3,600 products in the United States. Chrysotile accounts for approximately 93 percent of asbestos use; amosite and crocidolite comprise the remaining 7 percent. The type of asbestos is dictated by the properties required in the application. Chrysotile and crocidolite were often used in textiles or as reinforcement, whereas amosite was valued for its high temperature resistance.
HEALTH HAZARDS
Inhaled airborne asbestos fibers may become lodged in the alveoli and cause destruction of lung tissue— scars develop that result in reduced ventilation of the lungs and oxygenation of the blood. This and the subsequent effects on the rest of the body comprise the disease known as asbestosis. Airborne asbestos fibers also have been associated with mesothelioma (a rapidly fatal cancer of the chest and abdomen) and cancers of the lungs, esophagus, stomach, and colon. Airborne asbestos in conjunction with cigarette smoking significantly increases the likelihood of lung cancer. Studies of populations have shown a synergistic effect between smoking and asbestos fiber inhalation. An asbestos worker who is also a smoker may be 50 to 90 times more likely to develop lung cancer than his nonsmoking coworker. Such diseases caused by asbestos exposure have long latency periods—as long as 40 years. Because of these health hazards, the federal government has regulated asbestos use and exposures since 1971 and has passed legislation requiring public school systems to assess and control asbestos-related hazards, which has led to the removal of asbestos in many schools.
Asbestos emergency preplanning that includes educating emergency workers about the hazards of asbestos; an overview of the federal, state, and local laws governing its removal; and an outline of good work practices at the job site for responders will provide emergency responders with tools for evaluating the safety of a work area they are about to enter. Training should include the use and limitations of personal protective equipment as well as decontamination procedures. Most fire departments have not been concerned about asbestos or have not considered it a threat to personnel. However, with the increase in removal activity and government regulation, it is time to take asbestos seriously.
REMOVAL TECHNIQUES
Asbestos removal generally falls into two categories: glove bag technique and containment. Glove bagging involves (1) sealing a large plastic bag equipped with integral sleeves and gloves around the material to be removed and (2) doing the removal inside the sealed bag. Containments are various-sized structures covered with plastic, designed to keep any airborne fibers from escaping while ensuring a highly secure decontamination for the asbestos workers.
The asbestos containment areas may be as complex as houses, but unlike houses, their layout is not familiar to emergency response personnel. They have attached chambers including a clean room (locker room) and dirty room separated by showers. A negative-pressure system continuously removes air from the structure and, using high-efficiency particulate aerosol (HEPA) filters, removes nearly all asbestos fibers from the air. Workers enter the clean room, change from street clothes into protective clothing and respirators, and then enter the containment to do their removal work. When exiting the containment, they drop their protective clothing in the dirty room; shower, wearing only their respirators; and redress in the clean room. This procedure ensures that no fibers are carried home on the workers’ clothes or bodies. (Asbestos has a particular affinity for hair, requiring good hygiene practices for a successful decontamination.)
The greatest potential contact for emergency services personnel comes from containment situations. In complete isolation, workers encumbered by protective clothing often carry out their tasks in puddles of water created from wetting the asbestos-containing materials to minimize airborne fiber generation. Extension cords may be found criss-crossing through puddles or hanging from water-soaked scaffolding and ladders. Electric shock, slips, trips, and falls are often sources of injuries. Seasonal considerations include heat stress and cardiac concerns from high heat during the summer (50° to 60° above ambient temperature is typical) and the humidity environment often created in containments, while in winter the use of heaters may cause elevated carbon monoxide levels or ignition of combustible structural components.
Sensitivity to asbestos should be manifested in all emergency activities. In a rescue situation the squad members might cut up asbestos tile, generating a fine powder that becomes an airborne hazard. While pulling debris down during salvage and overhaul operations, it’s easy to crush asbestos pipe insulation, thus generating airborne particles of the substance.
PROTECTION AND DECON
Prepared emergency responders who are sensitive to these possibilities may attempt to direct the actions of uninjured workers until they themselves are properly prepared for entry or can secure the help of a haz-mat team. A positive-pressure, self-contained breathing apparatus offers the highest level of respirator)’ protection to the rescue worker. An asbestos worker’s protective suit is also necessary to prevent contamination of clothing and hair. Disposable Tyvek suits are often used and provide effective protection. Thorough decontamination upon leaving an active containment requires workers to strip and shower while wearing respiratory protection. Level A protection (full encapsulation) eliminates the need for personnel decontamination. Also, since the Level A suit is of a very smooth fabric, it tends to decontaminate well and not hold fibers. While turnouts with hoods in place, SCBA, gloves, and turnout pants may provide significant protection, a high level of personnel decon still will be required in order for the firefighter or EMT to leave an incident site in an uncontaminated state.
It is also likely that the turnouts and the SCBA may have to undergo professional decon; at least the protective clothing should be tested to ensure that it is free of asbestos fibers, especially if decontamination was conducted at the site. Unlike the Level A suit, the turnout’s coarse fabric provides many places for fibers to hide and makes decontamination difficult.
Site decontamination provisions are strictly regulated; therefore, removal contractors should adequately address decontamination requirements. Rescuers, patients, and any equipment leaving the contaminated area must be decontaminated. In the event of poor or nonexistent shower facilities, fire hoses may be used as long as runoff is contained for later filtering. Remember to adjust pressure, volume, and temperature to avoid injuries. Gently scrub skin and hair with a mild soap or detergent.
(Photos by Philip Silensky).
Wash and rinse all surfaces completely. You may have to dismantle some life support equipment for complete decontamination unless they’re sealed in a plastic bag that leaves only the disposable hose and catheter exposed. The ability to thoroughly decontaminate porous materials is questionable; therefore, use well-lacquered backboards and/or metal scoop stretchers instead of transport equipment made of porous materials. It is wise as well as cost-effective.
Should the patient’s condition dictate an abbreviated or hasty decontamination, medics should wear protective equipment during treatment and during transportation to a prenotified facility equipped to handle further decontamination. Prep ambulances by lining the patient compartment with polyethylene, by closing vents, and by removing any nonessential portable equipment. Provide additional protection by transporting the patient in a body bag, keeping his face exposed and continuously monitoring his condition.
Decontamination of a rig or hospital will be expensive. It may take several days for an approved asbestos contractor to wet wipe and highefficiency vacuum all surfaces, filter the air, and then have the air monitored and analyzed. Rehearsed, efficient, on-scene decontamination is the best way to avoid this.
In a situation that generates airborne fibers, firefighters should use SCBA if remaining in the area. Fine water fogs will help to trap the fibers, especially if the water contains a soap that helps penetrate and bind the fibers. Use soap concentrate mixed with a foam eductor on the lowest eductor setting. If soap is not available, try foam or wet water at the lowest eductor setting. These techniques may improve the efficiency of the air scrubbing.
WHAT HAPPENED AT MEMORIAL SCHOOL?
Back at Memorial School, the squad captain calls for additional manpower and makes initial assignments: Two firefighters check to see that the HEPA machines are running and inspect the containment for breaches. They inspect the contractor’s decon provisions to see if they are adequate for this extrication. One EMT/FF suits up in protective clothing provided by the contractor (Tyvek suit and gloves) and a 60-minute air pack. He enters the containment with minimal first aid equipment (bandages, cervical collar, demand valve resuscitator), a radio in a plastic bag, and an explosimeter and is led to the scene by an asbestos worker.
The captain receives this radio message: “Captain: Scene is safe, negative electrical hazards, negative explosive atmosphere. One patient unconscious, good respirations, rapid pulse, suspect C-spine injury. Easy extrication. Need four men, the fiberglass backboard and scraps, 10-foot chain with hooks, a standard screwdriver, and crescent wrench.” The captain has already called for a private ambulance, knowing his men will be tied up for a while on decon, and he has alerted the hospital, but he plans to do a meticulous definitive decon.
Twenty minutes later the captain watches the patient being passed out of the contractor’s decon/clean room door. He and an EMT/FF inspect the naked patient for any signs of debris, then release the patient custody to the private ambulance crew. His attention turns to the decon of his crew. Half of them are already showering; the others stage equipment in two piles. The asbestos contractor will thoroughly decon the equipment in one pile and dispose of the other pile (porous materials that can’t be deconned, such as bandages and straps that were changed in the shower). SCBA harnesses are deconned by the contractor and tested hy an industrial hygienist before they’re put back in service.
Two hours later all units are back in service.
CLEANUP BY CONTRACTORS
Contractors place removed asbestos in double-wrapped leakproof bags. They label the outer bag to show that it contains asbestos. They then transport the asbestos to a secure site for burial. If the fire department finds such bags on a road or in a nonsecure area, they should treat them as they would any other hazardous material. The incident commander should ensure proper site security, minimize personnel contact, set up a good soap and water decontamination, and notify the local or state environmental agency of the incident. (Asbestos has a CERCLA RQ-reportable quantity of one pound.) The agency will usually procure a contractor to do the cleanup and pay the contractor’s bill if the owner of the asbestos can’t be found.
The DOT has placarding requirements in addition to labeling requirements for its jurisdiction (interstate transportation): Asbestos as a product will bear the DOT ID 2212 or 2590 (for blue or white asbestos, respectively); when transporting friable, noncommercial, waste asbestos above the reportable quantity of one pound, a placard 918 will be displayed. The white diamond-shaped placard, with black 9188 or the rectangular orange panel labeled 9188, is used to designate an ORM-E (“otherwise regulated material type E”). The most recent DOT Emergency Response Guide refers the user to Guide No. 31 for all types of asbestos including ORM-E waste, giving basic response recommendations. The “emergency action” section of Guide No. 31 would therefore apply to a transportation incident involving asbestos waste, but since asbestos does not bum, this is obviously a generic protocol.
Fire departments should not handle asbestos spills at all, but rather, a licensed contractor should remove the asbestos. Keep asbestos spills moist and the area above the spill misted whenever the spill shows signs of drying out to prevent entrainment into the atmosphere. All runoff should be considered contaminated and should therefore be contained and collected so it will not increase the asbestos pollution. Water conservation practices should be standard operating procedure under these conditions. Protect the wet asbestos from the wind. If necessary, cover the wet asbestos with a salvage cover.
The asbestos removal industry is strictly regulated, and its services are currently much in demand by building managers and owners nationwide. EMS and other rescue workers can expect increased response to these work sites. Protection of emergency and hospital workers depends on education, well-executed preplanned responses, and communication.
