BY ARMANDO BEVELACQUA
When I entered the fire service some 25 years ago, I was asked to become a part of a new unit called the “chemical team.” At the time, I wasn’t sure what the team was outlined to do, nor did I care. It was new, and I was new. What better way to gain the badge of courage? The chemical team soon became the hazardous-materials team. After a few years and a couple of calls, we realized that this new team was very serious business. A few more years passed, and the injuries of firefighters involved with hazardous materials began to emerge.
Fifteen years later, the ideas of chemical containment, strategies, and tactical deployment were pretty well established. Around this time, the notion of biological containment began to emerge. Reasons at the time were fuzzy, but the idea that haz-mat teams would have to manage a biological event crept into a few articles and lectures at the time. It seemed logical: Biological materials were in the U.S. Department of Transportation (DOT) placarding system. A few teams around the country had limited experience with these types of events. But in 1998, a small number of anthrax calls began to come in. Terrorism training had come out of the background, and more responders actually knew what things such as anthrax, plague, and tularemia were. However, our understanding of the issue was limited.
In October 2001, a moderately sized fire department in South Florida became involved in the decontamination process for federal authorities surrounding a real anthrax event. With that one experience and the large number of noncredible biological events to follow in the Northeast, the fire service, and mostly haz-mat teams, suddenly began handling biological incidents. Overnight, the fire service used whatever limited training and experience it had to manage such incidents. In some cases, fire response personnel used levels of protection specifically designed for chemical entry (level B and level A encapsulation), multiple alarms to handle one ounce of powder assumed to have hazardous qualities, and countless support resources. In some places, powder found outside donut shops and funnel cake stands had fire response personnel dressed in level A just for a cleanup.
History is a learning process and has a way of spelling out the future. Our history, knowledge, and technical education direct our future. At the time, very few responders had the proper education in the biological area of response. Even now, the educational level for responding to biologicals is low, although it is higher than it was before 9/11. What once was considered a health department issue has been delegated to the haz-mat response community. Your department must determine what its biological response capabilities and resources are.
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The rules change during a biological incident. The approach to a biological incident starts with good, solid responder education. This education is absolutely critical, as are a health/laboratory liaison, protocols, and enhanced technology. We must understand the huge difference between a biological incident and a chemical incident just as firefighters understand the difference between a Class A fire and a flammable liquid fire: The tactics and approaches are divergent yet similar. We must have protocols in place—actions that are followed and performed in conjunction with the public health service. A biological event is a public health response, and a health representative must be involved with the education, training, and tactical response so the system can act as one. The biological response must use elements from the health department, the laboratory, law enforcement, and so on, in unison toward the intended goal of proper scene management.
RESPONSE
Looking at what we should be doing and assessing our capabilities give us an idea of what we need at any incident. The real question involves the role the fire department has when called to a possible biological event. To answer that, we must determine what we are trying to achieve.
- Scene reconnaissance—validating the credible threat assessment. Do you have a systematic assessment approach to the credible threat? Can it be validated through law enforcement sources? Are those current biological alarms correlated with historical alarm loads, and can you validate the authenticity of the threat?
- Sampling. Which type of testing will you employ: evidentiary or presumptive? Presumptive testing results are used by the fire department or other agencies on-scene. Evidentiary testing involves law enforcement agencies, health agencies, and so on. Identification of the substance is limited as of this writing because of limited equipment, available training, and equipment costs. However, presumptive testing can provide additional clues for the first responder.
- Crime scene. If evidence is tested and the results indicate a biological event, the incident becomes a crime scene. Once officials establish a crime scene, responders must follow a recognized 12-step evidentiary process. Evidence recovery goes beyond collecting the biological material. In the case of a “letter,” recovery may include the material, letter, and envelope and looking at the material, text, handwriting, DNA, paper source, postal markings, stamps/metering, hair and fibers, and fingerprints. First responders must remember that they are a small part of the evidence collection process. A relationship must be established with the local Federal Bureau of Investigation’s weapons of mass destruction (WMD) coordinator to obtain guidance and collaboration in support of procedure and documentation.
- Presumptive testing. With a crime scene established, presumptive testing is limited to the level of concern for the investigation unit’s entering the environment. It must follow recognized procedures such as using photographs of sampling areas with time/date stamps, incident action plans, identifying areas of concern, process of recovery, decontamination systems and processes, emergency procedures, and personnel involved. If the presumptive testing is to establish a credible alarm, the same procedures must be followed in case the incident becomes a real event.
If you are trying to validate a credible threat to “see what you are dealing with,” approach the incident in the same way as you would if you were “looking” for chemicals, but remember that the biological environment is somewhat different from the chemical environment. The equipment required is expensive and in some cases involves steep learning curves.
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(2) By using a systematic approach to sample collection and presumptive testing, law enforcement officials have a credible path they can follow. Evidentiary steps must be considered when a credible threat exists and a sample is taken for presumptive testing. Once the tests move the scene into a possible positive result, this scene becomes a crime scene. It is important to have communication with law enforcement and health services during such an event. (Photo used with permission of Safety Solutions, Inc.)
We have to look at this issue in terms of layers of response. What can the first-in companies provide? Like a “chemical” call, we can use low-level technical equipment associated with high-tech response. Many fire departments around the country outfit their units with M8 and M9 paper, haz-mat Smart Strips™, and Spillfyler™ chemical-impregnated paper for reaction change to specific chemicals. Other departments have placed electrochemical technology (four-gas meters) within their response networks for the first-in layer of chemical detection. Training responders about risk assessment, basic recognition, and identification procedures, along with a protocol that enhances the operations with associated agencies, is a strategic goal. Within the biological arena, the same logic can take place. Risk assessment and basic technology backed up with a higher layer of sophistication can give us the “safety net” of response.
FIRST-IN UNITS
As with all emergencies, first-arriving apparatus should start with the size-up process. On a fire alarm, a first-in report to the responding commander allows other units to determine what their responsibilities may be. At a haz-mat event, we call this risk assessment; it is called credibility assessment at a biological incident. This process is not as straightforward as fire scene size-up; however, the importance of gathering information and expressing one’s requirements is the same. At a biological incident, we may choose not to discuss this over public frequencies. However your organization has decided to communicate the information, the size-up of the situation with vital information must be identified and processed by the appropriate authority.
Understanding how a biological incident may be a part of a larger event within or beyond a local community is a portion of this credible-threat technique. The basic information remains as follows:
- How and when was the item or discharge noticed?
- What type of device was used (letters and packages have been the historical mode; leave your mind open to new ways of dissemination)?
- How many people are affected within the room of impact and outside the immediate area?
- Did the victims or group of victims move from the dissemination point? If so, where?
- What level of decontamination has been applied?
- Do you need a specialized team, or can the current haz-mat response handle the event?
- Have you organized smaller, more localized decontamination teams, or are you going to use your primary hazardous-materials decontamination resources? If so, are you applying your primary technical capability to a hoax or an actual event?
Given a few tools, first-in companies can start the assessment process. Add the following tools, and the presumptive testing process can start: pH paper, electrochemical technology (four-gas meters), a photoionization detector, and positive protein analysis. Through a mechanism of analysis and verification, the first-in company can now call for additional resources, either internal or external. The capabilities of the first-in response associated with the local hazardous-materials response team, health department, and law enforcement will provide the level of information required.
In some cases, limited information and the experience of the company officer are the foundation on which decisions are made. In a biological event, we as a fire service cannot base our decisions on conjecture, educated guesses, or experience; they must be based on hard facts. At an assumed biological incident, we must start to look at detection capabilities associated with sampling techniques to provide a reasonable level of tangible information to establish tactical and strategic goals.
Personnel protective equipment (PPE) is always part of the discussion at any of these events. The key issue to consider is if the environment has been identified strictly as a chemical or a potential biological. The fundamental answer comes from the air-monitoring/detection systems within the response agency. If your department carries such equipment, you must follow a specific protocol to rule out a chemical environment. This may be as simple as providing monitors for the first responders and allowing the first-in company to walk toward the event checking for chemicals in level C or level B ensembles remaining in outside environments only. Some departments use level A for the initial approach, allowing the responder to move from the outside environment into a structure to rule out chemical involvement. Each department has to address this for itself.
ARRIVAL OF A SPECIALIZED TEAM
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Many departments have organized their haz-mat teams into small functional groups. Years ago, when one would call for a haz-mat team, several units and a cadre of individuals would respond. Since the anthrax incidents of 1998, we saw that large responses were not necessary and were actually dysfunctional. By the time we experienced the onslaught of biological responses during the winter of 2001, many departments had smaller strike teams, many of which consisted of the basic haz-mat unit or haz-mat members with a law enforcement component. Since that time, departments have streamlined these into three-person teams known as “Joint Hazard Assessment Teams” (JHAT). JHAT teams are comprised of two haz-mat personnel with a law enforcement representative [additional strike teams have developed into three-person teams comprised of a haz-mat person, an Explosive Ordinance Disposal (EOD), and a law enforcement crime scene officer or intelligence unit representative]. The idea is to gather a sample for laboratory analysis and a sample for fire department presumptive testing and to complete these tasks in an efficient manner that will track the evidence process. This main strategic goal is what we, as a responding agency, must look at with excessive detail.
Before the anthrax events in 2001, most health departments and response agencies had planned for health departments or environmental control agencies to handle a biological event until haz-mat teams and fire department members across the country were forced to respond without the tools of presumptive testing or sample collection. People will continue to call the fire department to mitigate what they feel constitute emergencies. Our members will continue to respond, so it is up to us to provide the training for safe and efficient handling of such incidents.
IMPLEMENTATION
To implement such a program requires some homework. In many areas of the country, health departments still consider these incidents their responsibility. However, many health departments and environmental agencies do not have the field force to deploy when the call load resembles what we witnessed in the winter and spring of 2001-2002. There were only limited testing techniques for haz-mat members, equipment was sparse, and the educational level was low.
The frequency of these responses has decreased, and we all must look at ways in which we can manage these incidents more efficiently for members’ safety and to ensure a safe and efficient manner of response. Response policies and procedures should be tailored to the type of event, including events that are centered on small groups of individuals, such as an office, or large events with a large social venue. The policies must include the level of physical presence each agency will have and the extent to which the media will be kept informed of the situation—how to inform the public while maintaining key points for law enforcement’s investigation.
Implementing your procedures will require partnerships with law enforcement and local health facilities such as hospitals, physicians’ offices, health departments, and environmental agencies at a minimum. For incidents that occur within a large venue, such as a football stadium, the list will increase tenfold. Just like a hazardous-materials response, a biological response requires a multitude of response agencies, each bringing with it a certain level of expertise.
KEY AREAS OF CONCERN
The main area of concern at a biological event is taking the sample, collecting it in a manner so it will have an evidence chain of custody along with a mechanism by which the responding agency can apply presumptive testing procedures. Preparing for an incident involving a biological requires a simple, easy-to-learn approach and precise techniques.
Until recently, the equipment required was beyond the budgetary scope of most fire departments. However, sampling kits have become much more affordable and simplified, especially for the first responder. It is best to find a sample kit that is systematic in procedure, meets law enforcement’s requirement of chain of custody, and has a mechanism that will follow the best practices for the biological side of sample collection—in other words, a procedure for collecting environmental samples while applying presumptive testing with evidentiary procedures. Presumptive testing and the required equipment are still additional costs to existing detection strategies, sometimes doubling or tripling the haz-mat detection budget. However, presumptive biological detection is now a part of the emerging techniques haz-mat personnel must learn and embrace.
During a biological event, having a verified order of procedure that can support each agency’s concerns is critical. For the fire service, the presumptive finding may be the overall goal. For law enforcement, however, the end state will be much different and long term. And the health service has yet another strategic objective: Each agency must find a common ground for each concern and goal.
As stated above, many health agencies are very reluctant to allow haz-mat teams to provide this level of service. Considering the techniques that must be employed, they are probably right. But we are an extension of the public health system—the eyes, the ears, and the deployable workforce of the community’s public health system. It is truly the health department’s incident, and we need to follow its requirements, policies, and procedures.
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This comes into play when you have a large venue, such as an airport or a train station, and the media or the bad guy has called in a threat. The fire department will respond, but it needs a system by which it can identify the levels of concern. An established protocol to move a sample to a gold standard lab to allow it to conduct presumptive testing is the ideal situation. This reduces wasted time and limits sample destruction. A sample is rarely a representation of its complete contents. We don’t want field-testing to destroy the entire representative sample, miss some vital piece of the incriminating evidence, or destroy that one hair/fiber or DNA particle that may be needed for a conviction.
If the technologies at our disposal show a negative reading, we wait for the gold standard protocols to confirm the reading’s accuracy. However, if the technologies identify a positive hit, then we as a fire service can start making proactive decisions based on credible confirmation. Larger response teams comprising health/laboratory personnel can be called, and enhanced technologies can be employed. More importantly, the fire service, along with other responders, can be directed toward proactive health strategies, which may include the dispersal of antibiotics for prophylaxis. For the families of these responders, negative results ease the mind. Positive results give us a path. Sequestering these responders may be the choice; but without information, that choice cannot be made. On-scene testing is a real advantage for first responders because it allows them to have immediate feedback about whether the environment with which they are involved is potentially hazardous.
The protocols illustrated are more about a processing scheme, not gathering a sample for identification/credibility. This process is a small part of the entire operation. When taking a sample, we enter the world of rules of evidence (protocols, warrants, elements of the offense, for example). For a credible WMD event, the documentation requirements and communications go far beyond what has been illustrated in this article. These protocols, while intended for “public safety” sampling, may conflict in many ways with the health department and law enforcement objectives. Education and training with health and law enforcement officials must start before the event. A working relationship among all responding agencies supports the overall operation.
September 11, 2001, served as an awakening of first responders to the real threats that exist in the world and against the United States. Most had never before witnessed an attack on our homeland, and many never thought they would. That day and the biological events that surround that date have changed the fire service’s perspectives on health, safety, and public service response.
The development of modern biology has not only helped us to save and enhance life styles, but it has also helped create a knowledge based on how to successfully cultivate biological agents. This wisdom has led to man’s ability to control and disperse biologicals as a means to cause harm and terror. In the world that now exists, there must be methods to quickly detect these silent and invisible lethal biologicals before any harm is done to our communities, our families, and ourselves.
ARMANDO BEVELACQUA is the special operations chief for the Orlando (FL) Fire Department. He is a member of the Interagency Board, State, and Local Terrorism task forces among a variety of federal working groups looking at chem/bio response. He has been involved with the fire service for more than 25 years, having served as company officer, training officer and, in his present position, district chief. He is the coauthor of the Delmar books Emergency Medical Response to Hazardous Materials Incidents (1997), Terrorism Handbook for Operational Responders (2004), Hazardous Materials Field Guide (1998), and A Citizen’s Guide to Terrorism Preparedness (2001) and the author of Hazardous Materials Chemistry (2001).
SAMPLE COLLECTION
So how do we provide a sample, and what are some of the issues involved? Sample collection is a pretty simple technique but one that requires practice. The learning curves are fairly low but only when practiced. We use this sampling technique after someone has initiated a credible threat assessment. In some cases, this may require a sampling procedure to assist the decision-making process. If sampling is provided for the use of a credible threat assessment, the evidentiary process must be followed. As soon as a test comes out positive using the presumptive testing process, the incident becomes a crime scene.
A proper sampling technique, along with strict procedures, is necessary because of a degradable skill set (photo 1). Training on this technique is not difficult, but it is time-consuming. Add to this the interpretation of data gathered from detection systems, and constant training will become competitive with all other training issues within the modern fire service.
 (Photo used with permission of Safety Solutions, Inc.) |
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The elements of a sampling procedure follow.
EVIDENCE RECOVERY FORM DOCUMENTED AND COMPLETED
Because we do not know if this potential event is a biological incident, an evidence recovery form is required on all incidents when the suspicion has been raised to the level of law enforcement involvement. The haz-mat officer will need to complete a chain of custody form identifying the origin of the sample (with photo), sample taker, and the time the sample was collected.
BIO-SAMPLE RECOVERY TEAM
The Bio-Sample Recovery Team should have its members implement all safety procedures at all times, including the use of chemical detection, donning the appropriate level of PPE, and maintaining situational awareness of the surroundings. The minimum level of personal protection is a chemical-resistant coverall (taped at the neck, arms, and ankles), chemical boots, gloves, and positive air-purifying respirator (PAPR) with OVA/HEPA P100 cartridge once the environment has been cleared for chemicals. (If the environment has a potential for chemical involvement, higher levels of respiratory and/or skin protection may be required.) The team will have at least two entry personnel, one identified as dirty and the other identified as clean (some agencies have identified a minimum of three entry members—one as dirty; one as clean; and one to photograph, document, and provide safety procedures within the environment). Other team members to support the operation include an individual in the same level of protection as decontamination and the company officer as the liaison to law enforcement, management of the sampling procedure, and as scene manager.
SAMPLE COLLECTION
Sample collection should be determined by the logical progression (migration) of the biological using information of air patterns and HVAC considerations. This should lead toward the number of samples that need to be taken for presumptive testing and evidentiary sample collection. The number of samples and sampling strategies should be discussed before entry into the target area (hot zone).
Areas of sampling consideration include the following:
- Immediate area of potential release,
- Obvious areas of product (powders, liquids, etc.),
- Computer screens within the target room or area,
- Counter tops and shelves (large surface areas), and
- Air-handling systems intake (this may give false readings because of normal biological flora).
- Set up personnel by using designated clean/dirty person procedures.
- Given the incident dynamics, as a minimum use four sample jars (it is preferred that Biological Safety Level [BSL] 3 glass jars be used for chemicals and polyethylene or polypropylene for most biologicals). Some areas are using BSL-3 plastic jars (polyethylene) especially for ricin. Here, the reasoning is the test that ricin must go through in the laboratory—i.e., the enzyme-linked immunosorbant assays (ELISAs) test the residue found in glass and picked up through the ELISA test. This same chemical is used for differentiation when protein-based toxins, such as ricin, are analyzed.
- Place the Laboratory Reference Sample (sample 1) within one sample jar (this sample is sealed for laboratory evaluation and turned over to the appropriate authorities for further testing).
- Place the second sample in a second sample jar (for responder chemical processing and biological presumptive testing).
- Use control jars for environment and system (all containment vessels are certified clean).
Sampling
—.Environment in which sampling occurs (testing for ambient substance, environmental background).
—.System control: Jar remains sealed for use in the laboratory to ensure the background of the sampling system.
- Place the Laboratory Reference Sample jar (first jar) that is routed to the laboratory in an overpak container.
- Place the overpak (containing the first sample jar) and the environmental/system control jars into a self-sealing plastic biological hazard transport bag.
- Take the second sample jar to the edge of the target area and test it.
—.Once tests are completed, note the results of the tests on a sample recovery form.
—.Place the presumptive testing materials (positive protein, HHA, and pH) along with the sample jar into a self-sealing plastic biological hazard transport bag.
- Place both sealed bags within their own tamperproof sealed bag with the decontaminated evidence chain of custody forms. Then turn over the bags to the appropriate authorities.
Sample analysis and presumptive testing
This is the method by which possible chemicals and radiologicals are ruled out before presumptive biological testing is completed. The following decision tree should be used:
- Testing for pH: measurements between 4 and 10 indicate a possible pH environment for biologicals.
- Identify the lack of a vapor pressure and radiation by using PID and/or electrochemical (four-gas meter) for oxygen displacement within a closed environment (evidence sampling bag) and a radiation detector for radiation. If no radiation is found, run an infrared spectroscopy on the substance to rule out chemical involvement. Infrared spectroscopy is based on the optical/magnetic property of substances. It will show faint but distinct frequencies and when compared to known fingerprints by a point-by-point analysis of all wavelengths, a wave form may show the presence of a potential biological.
—.Positive Protein Test (PPT) is a screening test for the presence of potential protein. These tests are for the presumptive identification of environmental proteins only.
—.Handheld immunoassay test strips are an antigen/antibody-based system used to look for specific points on specific locations on the surface of the bacterium or virus.
Most fire department haz-mat teams have addressed this simple process for the presumptive testing of a biological; however, the gold-standard protocols for the presence of the biological threat must have a confirmatory analysis. Portable Polymerase Chain Reaction Tests (PCR) have entered the market along with phase contrast microscopy, which, simply put, means the PCR takes any DNA that may be found in the suspicious substance and amplifies it so that the instrument can now read the DNA response. From the DNA response, the instrument can correlate the DNA found with identifiable DNA to state the percentage of possibility. The phase contrast microscope enables the user to look at a biological without the need for staining. Although staining bacteria is a technique for identification (the difference between gram-positive and gram-negative bacteria), it uses light at different angles to see bacterial structures and mobility. These field instruments are very accurate. When placed within the above logic process, what we have done is move the suspicious substance through several technologies. If all the technologies identify the possibility of a biological, associated with the credible threat indicators, you now have a very high possibility of a biological event with test results to support your strategic decisions.
ROUTING OF SAMPLE
Termination routing of the sample is always a concern. If the incident has a low credible threat and the presumptive testing was negative, the sample will still need a confirmatory analysis. Conversely, if presumptive testing proves positive or produces an outcome that is more positive than negative, the sample is again routed to the laboratory for analysis. In each case we need to use the 12-step evidentiary process (inclusive of protocol and procedure) and deliver the sample in a containment jar to the laboratory for further analysis. The routing of this sample should maintain the appropriate level of laboratory technique associated with containment and three layers of packaging for transport. Identify the sample as a biohazard with a chain of custody form. Photographs, sample collection maps, the technician’s name, and method by which the sample was acquired all need to follow the sample to the laboratory for evaluation.
TERMINATION
This is a misnomer for a biological event. Here, as in haz mat, the end of the event is well after the responders have left the scene. Even after you have collected the sample, placed it in the appropriate level of bio-containment, and delivered it to the proper authorities, finalization is far from complete. When dealing with a biological and presumptive tests indicating that there is a good possibility of a bio threat, restoration and recovery of the premises will have to occur. Sampling will continue to evaluate the level of biologicals still existing in the building’s environment. Termination for the responder is the stage at which the fire department resources are no longer required as an integral part of the operation and thus will conclude their scene functions. This is an easy question to answer when the presumptive testing reveals negative results. When the tests give positive results, the issue of termination will depend on the resources that the state or federal agencies require at such incidents. Immediate response crews may be returned to service, with additional personnel assigned to the operation. Positive results with multiple technologies may constitute a 24/7 operation over several weeks or months. This will affect local resources, personnel, and equipment and the amount of physical resources dedicated to this operation. Establishing 12-hour shifts (alpha/bravo shifts of 12 hours in duration) can impact daily operations in terms of personnel, but, more importantly, a level of management will have to be associated with the operation and the crews on alpha/bravo.
 (Photo by Lt. Frank Montilli, Boca Raton Fire Rescue.) |
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Evaluate your resources and establish action plans that will accommodate long-term operations (photo 2). Changing shifts to 12 hours assists in replenishing the scene with fresh personnel, but it also can limit your daily operational pool of employees. Additionally, all those at this incident must be haz-mat-qualified and have a clearly defined incident action plan.
Decontamination will also be of concern and should be directed by the health department professionals. In the past, using hypochlorite solutions has been suggested. Fire departments should use soap and water. Soap and water is the only and best choice for decontaminating humans. When decontaminating equipment, levels of precaution (PPE), solution decontamination (technical decon), and isolation techniques can be employed.
