Interview with Mr. David DiGregorio, Director, Hazardous Materials Emergency Response Division, Massachusetts Department of Fire Services, USA

First of all, thank you for taking the time to do this interview despite your hectic schedule. Firstly, could you please introduce yourself and the MA Department of Fire Services to our readers?

David DiGregorio, Director of Hazardous Materials Emergency Response for the Massachusetts Department of Fire Services. The Hazardous Materials Emergency Response division (HazMat) coordinates six regional HazMat teams which are strategically located to be able to respond anywhere in the state in less than 1 hour. The teams support local fire departments with technical information, expertise, and specialized equipment. The program was originally created to respond to industrial or transportation incidents like a tanker truck rollover or a manufacturing incident involving chemicals. Other capabilities that the teams have acquired over nearly 30 years is the ability to respond to clandestine laboratories, mercury spills and any other hazardous materials incident involving chemical, biological, radiological or nuclear response needs.

Fourth Generation nerve agents, although low volatility, are highly persistent. Do you believe that these agents are given enough attention within the field, i.e., are they perceived as a serious/emerging threat that should be prioritized?

I believe that more and more attention was given to fourth generation agents since the incident in Salisbury, UK involving the Skripals and the unfortunate death of Dawn Sturgess. Recently, the poisoning of Alexei Navalny has reignited the interest in these agents for those in the CBRN realm. The fact that there are two documented cases of the use of these substances as weapons against personnel indicates that there must be an effort to learn as much as we can about them as well as how to detect, identify and mitigate such occurrences should they occur.

Fortunately, this has been reflected in the efforts made by scientists and manufacturers of the many technologies that hazardous materials technicians use in the field to detect and identify these substances. As many are aware, the characteristics of low volatility and high persistence were purposeful when creating Fourth Generation Agents to avoid detection and cause increased morbidity and mortality. Until recently, there was little that could be used in the field to achieve early results that would be useful for medical providers caring for patients impacted by an incident involving these products. Vendors of several technologies have and are working to build their libraries in order to increase the possibility of early detection. Do you feel that the current crisis/risk communication messages (in CBRN incidents) are well received by the general public (or does the general public still lack knowledge on how to act in a CBRN incident)?

I think the general public may have heard the term “Novichok” on the news or on social media but like many news stories, something new takes its place and it is forgotten. With regard to CBRN incidents in general, most members of the public remain blissfully ignorant on the topic. This is not a slight on anyone. With the 24-hour news cycle and so many “threats” being spoken about, I believe that the public is on overload. What should they be worried about? Is it Covid, gun violence, international unrest, flesh-eating bacteria, etc.? There is so much sensationalism in the media today that the average citizen may gain a cursory awareness of some of these reports but does not have the time nor the inclination to delve further into them. That is why it is incumbent on those of us in the first responder community to be ready to respond, knowing that we generally have a public with a limited knowledge base on how to react in such situations. Communication is key throughout a CBRN incident.

The main challenges associated with these agents are toxicity, detection, persistence, and the potential for delayed onset symptoms. What are the current guidelines and resources to aid first responders in preparing and responding to a potential fourth-generation agent attack/incident?

Towards the end of 2018, I was fortunate enough to be involved in a multi-agency effort to review several guideline documents for first responders and medical personnel prior to their release in January 2019. These documents range from a one-page Safety Awareness for First On-Scene Responders to a Reference Guide for hazardous materials technicians and a Medical Management Guidelines document for EMS and healthcare personnel. These documents were widely distributed to first responders and medical personnel. Since that time, several articles and presentations have been noted in various publications and venues, as more details emerge from the incidents previously mentioned. Despite the consensus from medical experts that fentanyl overdose from incident skin contact is a medical impossibility, emergency responder’s perceptions of the risk associated with brief exposure to fentanyl vary. How does the current training and education address this topic?

In Massachusetts, the hazmat teams became acutely aware of the fentanyl issue towards the end of 2016 and beyond. The word was getting out about fentanyl and its analogues and much of the information on its effects was exaggerated, particularly regarding its dermal impact. Frankly, fentanyl was the Boogeyman. Since that time, we have made a concerted effort to educate first responders (law enforcement, fire and EMS) on the true science behind these products and how they should be handled in the field. We conducted several agency-specific and multi-agency training events to dispel some of the unwarranted fear with PBAs while stressing the need for proper PPE and response protocols to keep the responders and the general public safe.

At one point, the hazmat teams in MA were responding to so many suspicious powder calls that they accounted for approximately one-third of all of our calls. Since that time, first responders have become more educated and thus, more comfortable responding to some of the more uncomplicated calls without calling the hazmat teams. We have seen a precipitous drop in these calls. This is not to say that hazmat has stopped responding to fentanyl calls; we are now responding to calls involving larger amounts of product or instances where product is not contained, whether in a home or public establishment, a vehicle or a potential manufacturing lab. Hazmat response teams need quick, confident answers in the event of a (CBRN) attack/incident to minimize casualties and to be able to contain the spread of possible contamination. What are the current detection and identification capabilities/tools available for Hazmat emergency response teams, as first responders must be equipped with tools/equipment that can easily adapt to volatile, novel threats? Honestly, there are many. We are fortunate enough here in Massachusetts to have a well-funded program, allowing us to purchase and train on some of the best field detection and identification technology that there is to offer. From colorimetrics, to Fourier-Transform Infrared (FTIR) spectrometry, to Raman spectroscopy, to High-pressure Mass Spectrometry and Gas Chromatograph Mass Spectrometry, each have a place in hazmat response. The goal is to know what that place is. As in medicine, all the tests and labs in the world will not diagnose a patient without having an educated, savvy clinician knowing what to do with the results of these tests. Furthermore, they must know which tests are pertinent for the situation that they are facing.

Hazmat and field detection and identification is no different. A good technician must be aware of Interferences in certain technologies and cross-sensitivities that may skew results. Rarely should one technology lead to a definitive answer. In MA, we have adopted some of the protocols of the Scientific Working Group for the Analysis of Seized Drugs (SWGDRUG). Here, several technologies are considered in analysis and categorized with regard to their effectiveness and sensitivity and specificity. By using these technologies in tandem, confidence in results can be greatly improved.

Lastly, teams purchasing some of the more technical and frankly, expensive technology should consider purchasing a “reach back” contract with the vendor. Often, the vendor will have a 24/7 team of scientists ready to analyze the spectra that the team receives from the instrument in the field. This allows for another set of expert eyes to confirm field results or to look a bit deeper into the spectra presented to them.

What do you consider to be the major challenges within the field in the next five years?

First is to be constantly ready for the next emerging threat. Most knew nothing about FGAs prior to the event in Salisbury. Few considered a worldwide pandemic and the devastating impact globally. Response readiness was immediately seen as a weakness initially but significant work by many has allowed for some comfort level in these areas. Secondly, as as mentioned prior, public overload may result in complacency. There are so many "threats" to the public on the news each night that much of the public tend to drown out or simply ignore the banter. How do public safety officials effectively educate the public on real threats and how to be more prepared with so much noise?

I still believe that the use of pharmaceutical-based agents (PBAs) is a true threat based on ease of acquisition and dissemination and the impact of such an attack. Most of us in the field are dealing with cut product, perhaps 2-5 percent fentanyl with the 95-98 percent being a benign cutting agent. The effects of a purposeful release of pure or near pure fentanyl or other PBAs in a crowd would be devastating to both the public and first responders alike. We do not have enough antidote or medical equipment that could be on hand rapidly enough to save significant lives. An event of this magnitude would result in significant loss of life and could cause a long-term disintegration of trust in first responder capability. How crucial is the role of interagency partnerships within your field?

Interagency cooperation is absolutely crucial. As most will attest to, very few, if any major events, are mitigated by one agency alone. Law enforcement, fire, EMS and healthcare, as well as so many other disciplines play a major role in response but perhaps more importantly, in preparation to respond. Knowing the roles of each responding agency and game planning as to how they will fit into an integrated response is paramount to success. What has been the worst crisis/incident you have responded to?

One of the most challenging responses a few years back was to a chemical processing facility that had experienced a significant explosion, critically injuring several workers. We responded with the Massachusetts State Police Bomb Squad and a multi-team hazmat response. The chemical being used was trimethyl aluminum, used in the production of semiconductors and LED lighting. This liquid spontaneously bursts into flames if exposed to air, and reacts explosively with water. It is believed that a failure in the system exposed the chemical to a water source, demolishing the laboratory.

Once the teams had arrived on scene, an assessment occurred and it was determined that several hundred canisters containing this chemical were buried under significant debris. Some canisters were in questionable condition. Each would have to be retrieved after removing the debris by hand with the hope that doing so would not, in some way, expose them to air or water. This task would be conducted over two days by a joint team made up of the bomb squad and specially trained hazmat techs skilled in explosives and energetic materials. Each member slowly mitigated the scene, dressed in bomb suits and ballistic gear.

A secondary concurrent operation, conducted by the hazmat teams, was to keep traps and canisters in other parts of the facility cooled with dry ice throughout the response. If the canisters warmed below a specific temperature, expansion would occur, risking further explosions. This was a very complex, intricate operation spanning over two days. Fortunately, it was a very successful operation and no one else was injured.

What developments, technological/policy, are you most looking forward to in the upcoming years?

I believe that remote air monitoring, detection and identification and scene assessment via drone technology and robotics will continue to improve for both hazmat and bomb squads. The ability to decrease the number of entries into a dangerous environment by humans by conducting these operations with robots and drones will increase safety at such events significaantly. The human element cannot be replaced; these technologies used as an adjunct to the response, will improve outcomes.

The ability to monitor remotely and “push” these signals, meter readings and photos and audio/video feeds back to a central location in the safe zone to maintain a common operating picture (COP) is becoming a reality. The technology is here today. Agreements and permissions from vendors, allowing this information to be shared through a singular system, is the next wall to break down. Anything else you would like to add?

First, I truly appreciate the opportunity to be interviewed by you. The sharing of information between teams and departments makes us all better. I look forward to receiving feedback. As I said earlier, technology is great and necessary in many calls but should NEVER replace training every technician in your response protocols in order to responding safely and effectively.

Mr. DiGregorio will speak at NCT Virtual Hub - Novichoks and Pharmaceutical Based Agents!

Mr. David DiGregorio currently serves as the director for the Massachusetts Department of Fire Services Hazardous Materials Emergency Response Division after holding the position of deputy director until 2016. He retired from the US Army and Massachusetts Army National Guard after 32 years of service in 2014. Amongst his duty assignments, David served as a non-commissioned and commissioned officer with the 1st Weapons of Mass Destruction-Civil Support Team in the positions of Medical NCO, Physician Assistant and Deputy Commander. Prior to retiring, he held the position of Deputy State Surgeon for the Massachusetts National Guard, earning the Legion of Merit Award, Meritorious Service Medal and several Army Commendation and Army Achievement Medals. He has earned a MS degree in Emergency Management from the Massachusetts Maritime Academy as well as a BS degree and MS degree in Physician Assistant Studies from the University of Nebraska Medical Center. He currently serves on the faculty of the Massachusetts Maritime Academy as a capstone advisor for the graduate level Emergency Management course.