Unplanned Contamination Considerations for First Responders
By Jeremy Urukew, Hazmat Specialist with the FEMA Urban Search and Rescue system
The Hazmat/CBRNE response system is quite robust in the United States. There is a plethora of federal, state, and local response assets that are equipped to handle anything from saddle tank ruptures to chemical agent attacks. I have had the pleasure of serving in varying capacities within this intricate network. When you signal a Hazmat response, you can bet that the resources needed to resolve the issue are coming from somewhere.
Having said that, I passionately believe that there is hesitation in the initiation of a hazmat response. We have seen exposed and contaminated responders that go without post exposure decontamination or medical screening due to the fear of initiating a hazmat response. In the current world of response to clandestine laboratories or unknown powder substances, responders often find themselves in situations where possible or probable contamination has happened and yet a suitable decontamination procedures are not initiated.
Looking at the recent increase of synthetic opioid responses, several law enforcement officials have found themselves in the forefront of work in contaminated environments. This contamination can lead to opioid exposure when left unrecognized and untreated. Looking back into the responses that we have all made, think about the calls where a hazardous material response team was initiated, responded, yet the problem was either self-correcting or did not warrant the allocated response. As first responders, we are conditioned to deal with the problems that we encounter in the most efficient way possible. This most often results in an expeditious resolution to the incident. Because of this, it is rare that a hazmat response is initiated to what we deem “simple” response with complicating factors.
If you look at the typical motor vehicle accident, what are your hazmat hazards? Release of brake fluid, transmission fluid, hydrocarbons? Though we have relocated the mitigation of these calls to absorbent and sweeping, is there any other risk to our responders? I’m not suggesting we make all motor vehicle collisions a Type 1 hazmat response, but what is your operational plan when a firefighter, paramedic, or police officer gets these chemicals on their clothes or skin? It is hard for people to put things into a box and begin the decision tree for contamination reduction or decontamination unless it is in their frame of reference. We have started bad habits that differentiate hazmat responses from nuisance and routine responses. This delineation leaves some hazardous grey area with decision making for the initiation of a Hazmat team response.
A paramedic crew is unlikely to call for a hazmat response when they have entered a home to treat a patient where they find paraphernalia suggesting drug storage, sales, and use. If we find a patient with suspected opioid overdose in this home, we treat them. We do not treat the patient as though they could be contaminated. We do not wrap them up to contain any possible contamination. We also do not don the appropriate PPE to mitigate hazards from possible opioid manufacturing hazards. In over 20 years of working in EMS/Fire, it has taken a pandemic to get first responders to wear gowns and masks on calls. Prior to this, the PPE kits on fire apparatus were often pillaged, plundered, or dry rotted from a lack of use. We have a culture of the Superman mentality here we believe that we are impervious to things that we cannot see. If it is not glowing green, and leaking from a barrel, there is no way that it can be a hazmat, right?
The paradigm shift to increase awareness will hinge on two criteria. 1. Training. 2. Modular response processes. With training, we need to incorporate a better awareness of the problems that we cannot see. Of course, our hazmat awareness curriculum is great for learning how to identify a DOT-406 carrying a petroleum product on the highway. We need to increase the awareness training to be more centric on the prevalence of clandestine and illicit substances in our responses. It is difficult to recognize a potential or obvious threat If you are not informed of the possibility of its existence.
In the ever-changing world where responders are expected to be surgeons, constitutional attorneys, and mechanical engineers, we have already placed so much into the training regimens to support our various missions, that much of it has become white noise. Though chemistry has not changed much in the last 20 years, the threats to first responders have. There should be federal agency oversight to develop and implement training programs that are applicable and mandatory to each discipline of emergency response.
Modular response processes. What does that even mean? We employ the ICS system on a routine basis. One of the most beautiful things with that system is that it is adaptable to the size and complexity of the incident. Hazmat should shift to the same mentality. Currently we draw a proverbial line in the sand as to whether we are going to call an incident a hazmat or not. If we do call it a hazmat response, get out the trailers, the trucks, and DECON corridor. Once we pull the rip cord on that delineation, we know exactly what to do. The problem therein lies, that we either roll out the entire hazmat production, or we do not do anything.
Making hazardous materials decontamination more applicable to smaller responses would enable the system to begin its adaptation to modular decontamination systems. Every response vehicle should carry with it a case that contains Tyvek suits, gloves, respiratory protection, and various PPE. In addition, there should be cleaning wipes, (even RSDL), towels, and soaps for cleaning. In the absence of a water- based decontamination corridor, responders should feel empowered to recognize that may be contaminated and to isolate themselves.
Using the contamination reduction kit, responders could lay out a plastic drape, doff their duty clothes, clean themselves with wipes, and redress into a Tyvek suit. This is a concept that makes most DECON officers sweat at the mere mention of it. I realize that it may be less than optimal, but we have made the land of decontamination off limits to anyone but hazmat responders. We should be empowering all our first responders to recognize the probability of contamination (chemical, biological, etc.) and to execute a hasty decontamination of that hazard.
Without the proper awareness and equipment, this is not possible. I can equate it to new equipment implementation. A large EMS service in Charlotte, NC purchased CoTCCC approved tourniquets for their service. They placed them on each ambulance to give paramedics another avenue for rapid bleeding control. Prior to the tourniquets being put into service, there was no recorded use of them. Once they became known of their presence, the paramedics were using them on a myriad of bleeding control cases. Some of these cases were reviewed and deemed not to need that excessive treatment. As time went on, the prevalence of tourniquet placement decreased but was still higher than the pre- deployment placement numbers of zero.
I conclusion, if you do not give responders the tools and the training to increase their situational awareness, we cannot expect them to do so. I am hopeful for a change in the first responder community that promotes the early recognition of smaller hazards and the concomitant use of contamination reduction kits following unplanned exposures.
Jeremy Urekew is a Hazmat Specialist with the FEMA Urban Search and Rescue system as well as a practicing paramedic. He primarily works as a subject matter expert in WMD, teaching for the Department of Homeland Security. He has been a fireman and paramedic for almost 20 years with several different agencies in Louisville, KY. He resides in Charlotte, NC now, and is the Director of Training for Special Operations Aid and Rescue, a training company that provides tactical medical/rescue training and defense contracting. He maintains his parmaedic certifcation through working at a level 1 trauma center and a high volume EMS agency part-time.