Guidance for First Responders

Brett A. Burdick
Director, Technological Hazards Division

Sizing Up the Incident

When responding to reports of suspicious powders or packages, decisions regarding the selection of the appropriate Personal Protective Equipment (PPE) and respiratory protection require consideration of two fundamental concerns: threat and required degree of protection (respiratory protection and protective clothing).

Threat involves assessing the circumstances surrounding the incident, the potential target, and the existence of any specific written or verbal threats or warnings. Threat assessment is far from an exact science and considerable discretion needs to be applied. Threat determines the responsibility of law enforcement in consultation with other officials or private sector representatives.

Respiratory Protection involves selection of the appropriate equipment to protect responders from the materials known or assumed to be present that might be inhaled. It depends primarily on the state and toxicity of the materials and whether they have been "weaponized" by the presence of a dissemination device.

Protective Clothing selection also involves the type and state of the materials present and whether those materials present a potential dermal exposure route. Protective clothing is necessary when there is a need to protect responders from skin exposure to the materials known or assumed to be present. Taken together, Respiratory Protection and Protective Clothing constitute the Protective Ensemble required for any given response.

There is no blanket, "one size fits all," approach that is appropriate to all response situations. Incident managers need to perform a good incident size up taking into consideration the incident parameters of environment, materials and container.

Environment includes consideration of whether the incident is indoors or outdoors, the temperature, humidity, wind direction and strength, time of day, terrain, and other factors.

Identifying the Material present includes its physical state (solid, liquid, or gas), form (for example, crystalline versus powder or a slurry), and other considerations. Often the materials are not fully identified, but many potential materials can be ruled out by considering the physical state and form of the substance.

The Container influences how the materials may be leaked or dispersed. For materials to be weaponized, it is important that the container be consistent with the intended use. Even the most toxic material in an unbreached, unstressed container is not a public safety emergency.

Determining the Threat

All incident decisions should be made based upon consideration of the Threat accompanying the presumed biological materials. The determination of threat includes such issues as the target of the materials (for example, an office building versus an open field), where within the target they are found (white powder in the vicinity of a lunch room or coffee pot versus in an envelope addressed to a family planning clinic), and accompanying written or verbal threats or warnings. A suspicious package should always be treated as a bomb and law enforcement should be notified. Threat determinations should be made in consultation among fire, law enforcement, public health and emergency management officials.

Determination of the level of the threat should impact all facets of the response. Threats that are unlikely to be highly credible may best be addressed by a small response proceeding to the scene without lights and sirens. As credibility is increased, the response should be increased commensurately. One important feature of these types of incidents is that we often have sufficient time to make considered decisions. It may be best to have a small group of individuals respond to assess the situation before deciding to commit a full response.

Handling Hoaxes

Terrorism and bioterrorist hoaxes are a law enforcement and a public health matter. In every case, law enforcement officials and public health officials should be involved in determining the threat and need for sampling of the materials. Sampling of these materials for evidence or for public health confirmation must be done under the guidance of law enforcement or public health officials and according to their protocols. Decisions regarding evidentiary issues are the responsibility of law enforcement. Decisions regarding public health impacts and the use of any pharmaceuticals or antibiotics are the responsibility of the health providers.

In the event that law enforcement and health officials determine there is no credibility, the threat component of the response does not exist. At this point, the incident commander needs to determine whether a continued public safety emergency response is appropriate.

Responding to Credible Threats

If law enforcement and public health officials determine that a threat may exist, there are some guidelines available for addressing the incident. One source of credible incident response information is the On-Scene Commander's Guide for Responding to Biological/Chemical Threats, dated November 1, 1999, published by the National Domestic Preparedness Office. This guide provides advice to incident managers as to the selection of PPE and response protocols. The guide is available online at the Michigan State Police Web site:

http://www.msp.state.mi.us/division/emd/terrosm/On-SceneCommanderGuides.pdf

and is included in the VDEM course Public Safety Response to Terrorism -Tactical Considerations.

The Centers for Disease Control and Prevention (CDC) issued a Health Advisory for the general public on October 12, 2001, "How to Handle Anthrax and Other Biological Agent Threats." This Health Advisory is available at the CDC Web page:

http://www.bt.cdc.gov/DocumentsApp/Anthrax/10122001Handle/10122001Handle.asp

This document gives advice to individuals who may have been exposed to a biological agent or the threat of the use of a biological agent.

Selecting the Proper PPE

When incident managers complete their incident size up — including assessment of the environment, the material, the container and the threat — and determine that action is appropriate, they may select the appropriate protective ensemble to respond effectively, efficiently and safely. The CDC has issued a document, "Interim Recommendation for Firefighters and Other First Responders for the Selection and Use of Protective Clothing and Respirators Against Biological Agents." This document can be found on their Web site at:

http://www.bt.cdc.gov/DocumentsApp/Anthrax/Protective/10242001Protect.asp

The CDC provides this guidance in an attempt to provide maximum protection for responders absent any additional information regarding the environment, materials or containers present. As such it should be used as a "fall back" position for PPE selection rather than a first choice document. The CDC document recommends the following protective ensembles:

The primary concern regarding route of exposure for these materials is for exposure by inhalation. The current data suggest that positive pressure Self-Contained Breathing Apparatus (SCBA) in use by most fire departments in the country will provide responders with respiratory protection against biological exposures associated with a suspected act of terrorism.

The Level A protective ensemble employs a fully-encapsulating, gas tight suit with SCBA or other supplied air. These are the so-called "moon suits" we see at some hazardous materials incidents. The CDC recommends the use of a Level A protective ensemble when the type of airborne agent is totally unknown, where the method of dissemination is totally unknown, or where the dissemination is active and ongoing.

VDEM notes this scenario is extremely unlikely and has not been experienced during the current rash of incidents. We do not recommend the use of Level A ensembles unless there is a compelling reason to do so. Level A requires a full Hazardous Materials Team response. If incident managers believe such a response is appropriate, you should initiate this by using Virginia's existing hazardous materials response system and call the Virginia Emergency Operations Center at (804) 674-2400.

The Level B protective ensemble employs SCBA with protective clothing designed to provide splash protection against liquid chemicals. The CDC recommends the use of a Level B protective ensemble whenever the suspected biological materials have been aerosolized (disseminated into the air as a fine particle mist), when the aerosol is no longer being generated, and where there may be a splash hazard.

VDEM notes that the use of a Level B ensemble is more than adequate for the response to any of the incidents we have seen so far. Structural firefighting gear and SCBA provide the same respiratory protection as Level B and, since there are no chemical splash hazards present, should provide adequate protection. There are, however, concerns regarding the use of bunker gear as protection at a biological incident (see below).

The Level C protective ensemble employs an air-purifying respirator (APR) or a powered air-purifying respirator (PAPR) and protective clothing to guard against skin exposure. The CDC recommends the use of a Level C protective ensemble when there was poor dissemination of the biological materials that did not result in a high concentration of airborne particles or where the dissemination was by way of a letter or package that can easily be bagged.

VDEM notes this is the most common scenario we have seen to date. A Level C response is fully protective for nearly all bioterrorism responses.

At an absolute minimum, VDEM recommends the responder wear disposable gloves (latex or nitrile) and coveralls (fabric or Tyvek) to prevent soiling duty uniforms (fabric coveralls, if used, should be laundered after each use). If the incident size up concludes that a biological material may be present, it is important to upgrade to the appropriate level of respiratory protection.

Selection of the appropriate protective ensemble needs to be made in consideration of the incident as a whole, not just the potential of the presence of what may be biological materials. It is also important to note that providing responders with respiratory protection of any type carries with it the need for OSHA compliance. Incident managers should be aware of the requirements of OSHA's respiratory protection standard.

The CDC does not recommend the use of firefighter turnout gear as PPE in biological incidents. The reason for this is not that bunker gear fails to provide adequate protection but that it may become damaged if decontaminated with bleach solutions.

Decontamination

The CDC document also gives guidance on how best to bag the item and to handle the materials, although the need for evidence security needs to be considered. Any responder who contacts these materials should be decontaminated. Recommended decontamination procedures involve careful suit removal and disposal and washing of hands and face with soap and water. Equipment that has been contaminated can be decontaminated with a 10 percent bleach solution (1 part household bleach added to 9 parts water).

The area where the materials were released may be decontaminated as well. The decision to perform environmental decontamination should be based upon confirmation of the presence of a pathogen and upon the threat assessment, but a precautionary decontamination may be desirable. The spreading of powders can be controlled by wetting them prior to cleanup. Some organizations are recommending that the suspicious powders be sprayed with the same 10 percent bleach solution, left alone for 15 minutes to kill any organisms present, and then swept up. Be sure that any required evidentiary or public health samples are obtained before wetting or applying bleach to the suspicious powders.

Also, we need to be aware that we do not become so focused on anthrax that we miss other potential hazards. Just because something is not anthrax does not mean it is safe. Good incident size up and threat assessment can help determine the presence of other potential hazards as well.

If you need information or assistance at the scene of a suspicious powder incident, please feel free to call the Virginia Emergency Operations Center at (804) 674-2400. The EOC will put you in contact with a VDEM Hazardous Materials Officer (HMO). The HMO will be able to give you specific technical assistance in handling any potential terrorist incident.