BY CHRISTOPHER BRENNAN
On arrival at the address OF the single-engine response to which you have been dispatched for an “odor investigation,” you find four people with runny eyes staggering around on the front lawn, coughing, choking, and spitting. What do you do?
As the first-arriving unit, and likely the only unit to be present for some time, you have much to think about and consider and very little time in which to figure things out.
To simplify things, you can begin by using the five-step incident management process: Isolate, Identify, Notify, Mitigate, Terminate.1 This system is not used in linear fashion; it serves as a comprehensive checklist. As additional responders with more technical capabilities arrive, they will revisit these steps and may enhance actions you have already taken.
ISOLATING THE INCIDENT
Keep the affected people you encountered on your arrival from carrying whatever contaminants they may have encountered any farther, and keep everyone else out of the contaminated area. You can achieve quick isolation by parking the apparatus so that it blocks off the street and directing the affected people to stay in a particular area until they can be decontaminated. Have a member unroll a few hundred feet of barrier tape, and presto! You have an isolation zone.
IDENTIFY THE CONTAMINANT
Since you have spent hours considering terrorist threats in the post-9/11 world, you recognize that the people in front of you are exhibiting symptoms that might be the result of exposure to organophosphate pesticides, toxic nerve agents such as sarin (GB) and soman (GD), and the extremely lethal nerve agent VX. Or, they may have encountered a riot control/harassing agent such as OC pepper spray or CN and CS tear gases. You must address the type of exposure issue right away. If a nerve agent is involved, you have only minutes to minimize the health threats. If the substance is a harassing agent, the symptoms most likely will begin to subside after the victim is treated.
CALL FOR HELP
Notify all the resources you may need. More than a single company is needed to deal with the situation. Depending on your department’s policies, this incident might warrant a hazardous-materials response, a multiple-ambulance EMS response, a “general alarm,” or some combination of these resources. You will need at least the following resources: another engine company; decontamination for and medical evaluations of the victims; a company with air-monitoring ability to determine exactly what caused the problem; and a chief officer so that you, as the company officer, will be able to do your job without having to try to run the entire operation. You will also need to know the wind direction and speed so you can establish a staging area for the responders.
MITIGATION STRATEGIES
In this case, the mitigation strategy is to implement emergency decontamination of the victims. As the hazardous-materials team arrives, the mitigation strategy may change. Until then, you must work with what you have. Are the victims all one gender or mixed genders? Will you start with a gross wash, or will you have the victims doff their clothes for decontamination? This is a difficult decision to make. “Decontamination by removing clothes and flushing or showering with water is the most expedient and the most practical method for mass-casualty decontamination.”2 However, having people without their clothes on creates privacy concerns and may draw media attention. How long can you wait to make that decision?
If everyone is walking and no one has suffered a seizure, a clothed gross decontamination (“… rapid use of water, with or without soap, for decontamination … the process should never be delayed to add soap or any other additive”) (2) may suffice until additional help arrives and a formal corridor can be established. However, keep the affected people isolated until they have been properly decontaminated.
On the other hand, if any of the victims are seizing or have lost bowel control, you probably will not meet with too much resistance if you ask them to disrobe for decontamination. You will have to find some type of shelter and clothing for them.
In a pinch, a roll of heavy trash can liners can serve as field expedient “gowns” until the cases of chemical splash clothing (Level B suits) arrive, and a garage one house upwind can serve as a shelter and will enable you to keep contaminants from spreading over a huge area.
Once you take a deep breath, act. The symptoms the victims are exhibiting might be the result of exposure to a harassing agent such as mace or pepper spray or to a nerve agent—the bad stuff. The contaminant may also be an industrial chemical such as chlorine or calcium hypochlorite (HTH) used to chlorinate swimming pools.
Begin gross decontamination. Find a patch of grass you can sacrifice, and start flushing everyone off. Your primary concern here is life safety, which may dictate that you not take the time to set up containment areas for the contaminated wastewater. Someone’s front lawn or driveway may not be the ideal containment area, but the earth can be excavated later as hazardous waste if environmental agencies feel it is necessary.
Accomplishing decontamination with the typical three-person company can be tricky. Have one firefighter pull a 13/4-inch hoseline with a fog nozzle and “flood” the contaminated individuals with high-volume, low-pressure water to minimize the possibility of driving contaminants into mucous membranes, abrading skin, or causing other injuries. The pressure created by placing the apparatus into “Pump” should be sufficient.
While the firefighter is conducting decon, the engineer/driver should locate a positive water source and cap storm drains close to the decon area (pull the grate with a pry bar, lay a tarp over the hole, and replace the grate to pin the tarp in place). You, as the officer, should establish a shelter area where the victims can stay until additional help arrives. You and your crew, while wearing full turnout gear and SCBA, should handle all these tasks. You should be adequately protected as long as you do not touch anyone who may be contaminated. Stay uphill and upwind to minimize your exposure.
When the additional responders arrive, have them stage until they are properly equipped and prepared. If possible, they should wear at least a Level B ensemble with taped seams, gloves, and boots. This will increase their chemical resistance and reduce the quantity of expensive turnout gear that may have to be thrown away.
Keep the area isolated, and have companies with WMD monitoring capability3 examine the affected individuals; if they are wearing the appropriate personal protective equipment, check the area in which the exposure occurred. Keep in mind that you and your crew will have to be decontaminated before doffing your gear and going to a refuge area. Therefore, keep track of your air supply so that you will have enough to get you through the decon process.
By thinking about the first five minutes of responses like these in advance and practicing your plan with your crews, you will be prepared to handle incidents involving chemicals until help arrives. After you have thought about the basics involved in accomplishing this evolution on a warm, sunny day, consider how you would change the evolution if it took place in 12°F (below-zero) temperatures or if the incident site were a home improvement supply store and 30 people were exhibiting symptoms of chemical exposure on your arrival.
The first goal is to have all members go home healthy at the end of the shift; the second is to help the civilians who have been exposed. By planning and practicing, and using the five-step incident management process as a guide, you can accomplish these goals.
Endnotes
1. The Illinois Fire Service Institute teaches the five-step process for incidents involving hazardous materials and terrorism.
2. Guidelines for Mass Casualty Decontamination During a Terrorist Chemical Agent Incident, U.S. Army Soldier and Biological Chemical Command (SBCCOM).
3. Do you have M8/M9 tape on your apparatus? It is paper tape that indicates the presence of a chemical warfare agent in liquid form. You can use it to swab an affected individual or check the water runoff for decon-tamination. M8 and M9 are military designations for the tape.
CHRISTOPHER BRENNAN is a firefighter with the Darien-Woodridge (IL) Fire Protection District and a field staff member of the Illinois Fire Service Institute’s hazardous-materials program.
