FIRST RESPONDERS’ FIRST LINE OF DEFENSE IN TERRORISM RESPONSES

BY SAM HANSEN AND ALAN VEASEY

At the end of World War I, U.S. Commander General Pershing said, “Whether or not chemical agents will be employed in the future is a matter of conjecture, but the threat to the unprepared is so deadly we cannot afford to neglect the question.” The wisdom of this statement was proven in 1995 when the terrorist group Aum Shinrikyo launched a chemical nerve agent attack within the Tokyo subway system. The Tokyo attack clearly demonstrated the potential of a new and insidious form of terrorism and escalated concerns among government and public safety response agencies regarding the potential for these types of attacks in the United States.

Following the terrorist attacks on the World Trade Center towers on September 11, 2001, a new terrorist threat emerged in America. In October 2001, envelopes containing deadly anthrax spores were mailed to U.S. political leaders and members of the news media. Five people died, and 17 were sickened as a result. The terrorist who committed these acts has not been apprehended to date.

This covert and deadly act of terrorism caused an epidemic of panic across America. Thousands of citizens were afraid to open their mail, and public safety agencies were overwhelmed with reports of suspicious letters and parcels. First responders in communities of all sizes across the nation were faced with the challenge of responding to “white powder” incidents with very little response information. Since 2001, responders have had to remain on guard and try to prepare to respond to the next major terrorist attack on U.S. soil; indications seem to be that it is a matter of when rather than if such an attack will occur.

Although the risk of terrorism may be perceived as low in most American communities, the impact of a terrorist attack with weapons of mass destruction (WMDs) to the community, its citizens, and the extreme personal risk of their first responders would be immeasurable. Public safety personnel, therefore, have been presented with the significant challenge of preparing to respond effectively to a terrorist event.

A MAJOR RESOURCE FOR THE FIRST RESPONDER

One of the best on-scene resources for first response to a terrorist incident is the federal Emergency Response to Terrorism Job Aid, which is intended to be used with the Department of Transportation (DOT) Emergency Response Guidebook (ERG) (photo 1).

(1) The Emergency Response to Terrorism Job Aid (left) is intended to be used along with the Department of Transportation’s Emergency Response Guidebook (right). (Photos by authors.)

The first edition of The Emergency Response to Terrorism Job Aid was published in May 1999 through a joint partnership between the Federal Emergency Management Agency (FEMA), United States Fire Administration (USFA), National Fire Academy (NFA), and United States Department of Justice (DOJ) Office of Justice Programs (OJP). More than 69,000 free copies of the first edition of the Job Aid (designated Edition 1.0) were distributed to emergency responders by the USFA. Edition 1.0 of the Job Aid used the B-NICE mnemonic to provide a memory trigger for the principal WMD hazards of biological, nuclear, incendiary, chemical, and explosive hazards.

In 2003, the second edition of the Job Aid (designated Edition 2.0) was published jointly by the Department of Homeland Security (DHS), FEMA, USFA, Office of Domestic Preparedness (ODP), and DOJ OJP. Version 2.0 of the Job Aid is available in an electronic format that can be downloaded from the USFA Web site and in a printed version with Tyvek® pages. Because of changes in the design and format, Version 2.0 is 15 pages shorter than Version 1.0, and the Tyvek® pages have given it a slimmer profile. The 2.0 version is very similar in content and format to version 1.0, but it uses the CBRNE mnemonic to represent the respective agents. Despite these changes, pertinent information on WMD agents and response recommendations are basically the same in both versions.

USE CONSIDERATIONS AND ORGANIZATION OF THE Job Aid

The Job Aid is designed for use by emergency services personnel, such as fire, police, EMS, and haz-mat teams, involved in the initial response to a terrorist incident involving WMD agents. The Job Aid should be used only during the initial response phase, the first hour following an attack. The Job Aid is crossed-indexed to specific hazard and action guides in the DOT ERG, making the ERG another important response resource for first response to a potential terrorist event. For example, Guide 158 (Table 1) is applicable for first response to incidents involving suspected biological agents until better information is available.

The Job Aid is a valuable information tool used to identify the hazards of WMD agents and to determine response actions first responders can take. Just as first responders are limited in the actions they can safely take at the scene of a WMD event, the Job Aid is limited in the amount of information it provides. Like the DOT ERG, the Job Aid is not intended to be used during the mitigation phase of an incident and, therefore, should not be used to determine mitigation methods for a WMD event.

For easy reference, the Job Aid is formatted in a checkbox design that provides the first responder with a specific sequence of topics that must be addressed when developing defensive operations at WMD incidents. It is a compact and durable reference source. The narrow profile allows the Job Aid to be easily carried in the pockets of a firefighter’s protective clothing. The pages are impervious to fluids and are resistive to tearing and bending. The Job Aid consists of five major sections that are color coded and divided with oversized tabs to accommodate a gloved hand.

The Gray Section: Introduction

The first section of the Job Aid contains gray pages that provide introductory information: the layout of the document, specific instructions for using it, and basic assumptions inherent in its development and use.

The Yellow Section: Operational Considerations

The second section of the Job Aid contains yellow pages that provide operational considerations for recognizing and responding to suspected terrorist attacks. Strategic and tactical objectives that should be addressed are included. Specific topics covered in the yellow section include the following:

This section recommends procedures for assessing security for response and initial approach to the incident scene. The recommended procedures differ based on whether single or multiple indicators of a possible terrorist event (as described below) are present. Mass decontamination following a WMD attack is very different from traditional technical decontamination used at hazardous-materials incidents. The Job Aid provides different decontamination guidelines for symptomatic patients, asymptomatic patients who have been contaminated or exposed, and remote site operations such as hospital emergency rooms.

The White Section: Incident Specific Actions

The white pages of the third section of the Job Aid provide information on specific actions that should be taken based on the type of terrorist incident or agent suspected. The information in this section is organized using the B-NICE mnemonic in Edition 1.0 and the CBRNE mnemonic in Edition 2.0. Specific recommendations for recognizing and responding to incidents that may involve chemical, biological, nuclear or radiological, explosive, or incendiary agents or devices are provided. For each type of incident, the white pages are cross-referenced to a specific hazard and action guide in the DOT ERG.

The Blue Section: Agency-Related Actions

The fourth section consists of blue pages that describe agency-related actions. They relate considerations and recommendations that should be addressed by fire, EMS, law enforcement, haz mat, and assisting agencies involved in the initial response to a potential terrorist event.

The Brown Section: Glossary of Terms

The fifth section is a glossary of terms printed on light brown pages. It defines and explains common terms significant to terrorism response. Throughout the Job Aid, terms included in the glossary are identified by a small icon of an open book.

RECOGNIZING INDICATORS OF POSSIBLE TERRORIST EVENTS

The Job Aid provides guidance in recognizing potential terrorist attacks during the initial response to an incident. A terrorist event is possible if any of the following indicators are present:

The response is to a target hazard or target event.
There has been a threat.
Multiple (nontrauma-related) victims are involved.
Responders are victims.
Hazardous substances are involved.
An explosion has occurred.
There has been a secondary attack/explosion.

Any locations or events that are politically or socially significant or controversial could be potential targets of terrorists. Examples include events attended by political figures, military installations, government offices or facilities, businesses or homes of controversial people, and abortion clinics.

It is also important to be aware of significant dates. For example, the Murrah Building in Oklahoma City was bombed on the second anniversary of federal agents’ storming of the Branch Davidian compound at Waco, Texas. It is also important to monitor the current Homeland Security Advisory System threat level and adjust precautions accordingly. Information on the advisory system is available through the Department of Homeland Security (www.dhs.gov/dhspublic).

Terrorists may also choose to attack targets of opportunity simply because they are convenient. For example, chemical storage locations in populated areas may be attacked with devastating effects on the community (photo 2). Any unusual occurrence or mass-casualty event may be a terrorist attack, even if the incident occurs at a sporting event or shopping mall. Although such events and locations seem politically insignificant, terrorists may choose them because of the ease of attack and the psychological effect of “soft targets.”

(2) Chemical storage locations in populated areas may be targets of convenience for terrorists.

ASSESSING SECURITY WHEN RESPONDING TO A SUSPECTED INCIDENT

The Job Aid directs public safety personnel to respond with a heightened level of awareness if an indicator of a possible terrorist attack is evident. If multiple indicators are evident, the Job Aid recommends that responders take several additional precautions:

Be aware that you may be on the scene of a terrorist incident.
Initiate response operations with extreme caution.
Be alert for actions against responders.
Evaluate and implement personal protective measures.
Consider the need for maximum respiratory protection.
Make immediate contact with law enforcement for coordination.
When considering response routes

-approach cautiously, from uphill/upwind if possible;

-consider law enforcement escort;

-avoid choke points or congested areas; and

-designate rally points or regrouping areas.
Identify safe staging locations for incoming units.

More specific guidelines and considerations are provided throughout the Job Aid. Emergency response personnel from all disciplines are instructed to isolate and secure the scene, deny entry, and establish control zones; establish command; evaluate scene safety and security; and stage incoming units.

Additional recommendations that vary according to the emergency responder’s response discipline (fire, EMS, or law enforcement) are also provided in the Job Aid.

ADDRESSING SAFETY CONCERNS AT THE INCIDENT SCENE

Prompt recognition is a critical aspect of responder safety during any WMD event. The Job Aid describes WMD indications all responders should look for on initial arrival at the scene of an incident. The indications will vary with the type of agents or devices used in an attack and are included in the white section of the Job Aid. The indicators are organized using the B-NICE mnemonic in Edition 1.0 and the CBRNE mnemonic in Edition 2.0-for example, the symptoms and signs of exposure to a chemical agent exposure might include difficulty breathing; redness, burning, and/or itching of the skin and/or eyes; irritation of the nose or throat; runny nose, excessive tears, and salivation; pinpoint pupils; pain in the eyes; headache; vomiting; and convulsions.

Responders should be especially suspicious if multiple victims display the same symptoms. It is not unusual for one victim to have seizures at a public event, but multiple victims simultaneously having seizures at the same event should serve as an immediate warning to responders.

Responding personnel must remain safe to be able to help the victims in an emergency. This is especially true of WMD events, where terrorists may directly target the first responders. Exposure of victims to the hazards of a WMD event may not be avoidable, but exposure of emergency responders most likely would occur because of inadequate hazard assessment and failure to understand the nature and magnitude of the event.

Safety guidelines for personnel involved in response activities at the scene of a terrorist attack are listed throughout the Job Aid. The safety precautions center on using the incident command system (ICS) to maintain personnel safety and promote an efficient response. The Job Aid recommends that command be established, an incident safety officer be designated, and personnel on-scene initiate practical safety precautions such as the following:

Initiate on-scene size-up and hazard/risk assessment.
Designate safe staging areas for incoming units.
Ensure that personal protective measures and shielding are used.
Assess emergency egress routes, and position apparatus to facilitate rapid evacuation.
Designate rally points for reassembly following evacuation of personnel.
Ensure personnel accountability.
Assess command post security.
Consider assigning liaison and public information positions.
Assess decontamination requirements.
Consider the need for additional specialized resources such as fire, EMS, haz mat, law enforcement, explosive ordnance disposal, emergency management, public health, public works, and environmental agencies.
Look for indicators and warning signs of WMDs as listed in the Job Aid.
Consider the potential for a secondary attack with chemical dispersal devices, secondary explosive devices, or booby traps.
Reassess initial isolation/standoff distances, and establish outer and inner perimeters.
Dedicate EMS for responders.
Prepare for gross decontamination operations for responders.
Coordinate with law enforcement to provide security and control of perimeters.
Implement self-protection measures.
Commit only essential personnel, and minimize exposure.
Conduct a full hazard/risk assessment before initiating rescues.

INCORPORATING THE JOB AID INTO TRAINING

If a terrorist attack involving WMDs occurs, it will be critical for first responders to make sound decisions. In responding to such a high-stress event, emotion can easily displace logic in the decision-making process, with the result that response personnel will rush into the situation and become part of the problem. By providing a step-by-step decision-making checklist, the Job Aid can help responding personnel to avoid this deadly trap. However, for the Job Aid to be used effectively, responders must become thoroughly familiar with it before using it at a WMD incident. Response personnel should be trained in using the publication.

One effective method of training with the Job Aid is to conduct in-service training and drills with all shift personnel. Introduce the Job Aid to all trainees, and then assign scenarios to which the trainees can “respond” using the Job Aid.

The scenarios should be realistic and based on local target hazards or other locations terrorists might attack in your community. Trainees should be able to use the Job Aid to identify the hazards and determine the response actions they should take based on the likely WMD agents involved in the scenarios. Copies of the Job Aid Edition 2.0 may be purchased at your local government bookstore or from other emergency response equipment vendors.

When training with the Job Aid, keep in mind that it is not a training manual and is not intended as a substitute for the more specific terrorism-based responder. Response actions must never exceed the level of training and equipment available to response personnel.

Note: Contact Sam Hansen at hansen@uab.edu for a free copy of a Power Point® presentation outlining use of the Job Aid.

SAM HANSEN, EMT-P, EFO, CFO, CET, a 34-year veteran of the fire service, is a battalion chief with the Vestavia Hills (AL) Fire Department. He has a B.S. degree in public safety administration and associate’s degrees in emergency medical services and fire science. He has completed the National Fire Academy’s Executive Fire Officer Program (2002) and the Commission on Fire Service Accreditation’s Chief Officer Designation (2006). Hansen is a WMD/hazardous materials instructor for the University of Alabama at Birmingham, Center for Labor Education & Research, and the National Emergency Response and Rescue Training Center, Texas A&M University. He co-authored Confined Space Entry and Emergency Response (2002) and Emergency Responder Training Manual for the Hazardous Materials Technician (2004).

ALAN VEASEY, MAEd, MPH, is program director for the Workplace Safety Training Program at the University of Alabama at Birmingham’s Center for Labor Education and Research. He has a master of public health degree in occupational safety and health and a master of arts degree in education. He formerly served as a firefighter/EMT and is a certified trainer for hazardous materials emergency response and first response to terrorism incidents involving weapons of mass destruction. Veasey has been providing occupational safety and health-related training to the public and private sectors since 1988. He has coauthored several textbooks, written numerous magazine and peer-reviewed journal articles, and served as coordinator and technical advisor for the History Channel during the filming of the segment “HazMat” for the Suicide Missions video series.