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                                all  W
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                                       arryy  R

                               Prepared by
                      The Chemical Weapons
                    Improved Response Program

U.S. Army Soldier and  Biological Chemical Command
Aberdeen Proving Ground, MD



The findings in this report are not to be construed as an official Department of the Army
position unless so designated by other authorizing documents.

The use of trade names or manufacturers' names in this report does not constitute an
official endorsement of any commercial product.  This report may not be cited for
purposes of advertisement.



                             Program Director's Message

Subject:  1999 Chemical Weapons Improved Response Program Summary Report

       The purpose of this summary report is to inform members of the first responder and
emergency management communities about the on-going activities, initiatives, and lessons
learned from the Chemical Weapons Improved Response Program (CW IRP).  It is the intent of
this program to relay information to these communities that will result in improved procedures,
organizations, individual personnel knowledge base, and awareness of equipment capabilities
surrounding a weapons of mass destruction (WMD) event.  The information and experience
shared among members of the national response community will hopefully be used as a tool to
better prepare our nation as a whole against the inevitability of the use of chemical agents of
mass destruction on U.S. soil.

       The CW IRP Summary Reports are available via the Domestic Preparedness web page,

                                      James K. Warrington
                                      Program Director
                                      Domestic Preparedness Program


                                         Table of Contents

Part                                                                                   Page

          Program Director's Message
          Table of Contents                                                               ii

I.        Introduction                                                                    1

II.       Major Activities Summary                                                        4
          A.    Baltimore Exercise (BALTEX) VI                                            5
          B.    Health and Safety Tabletop Exercise                                       7
          C.    BALTEX VII                                                                8
          D.    BALTEX VIII                                                               9
          E.    BALTEX IX                                                                10

III.      Functional Working Groups                                                      11
          A.    Law Enforcement Functional Group                                         12
          B.    Emergency Management Functional Group                                    14
          C.    Emergency Response Functional Group                                      16
          D.    Health and Safety Functional Group                                       18

IV.       Technical Study Initiatives                                                    20
          A.    Firefighter Personal Protective Equipment                                21
          B.    Positive Pressure Ventilation                                            23
          C.    Mass Casualty Decontamination                                            25
          D.    Chemical Detectors                                                       28
          E.    Law Enforcement Personal Protective Equipment                            31
          F.    Off-Site Triage, Treatment, and Transportation Center                    33
          G.    List of Technical Studies                                                35

V.        List of Acronyms                                                               36

Table of Contents                                                        1999 Summary Report


                                Part I



Introduction                              1999 Summary Report


          The Domestic Preparedness Program (DPP) was developed to support congressional
legislation passed under Title XIV "Defense Against Weapons of Mass Destruction" of the 1997
National Defense Authorization Act.  The Department of Defense (DoD) was tasked with several
initiatives under this legislation.  These included the execution of a training and exercise
program, establishment of a hotline, and development of a program to improve the civilian
response capability to chemical and biological (C/B) terrorism.  In answer to the latter of these
initiatives, the Improved Response Program (IRP) was developed to identify and improve
systemic deficiencies in the ability of a community to respond to a C/B terrorist incident.
Because there are major differences between the C/B agents and the expected response actions, a
separate program was developed to study each area.  The Chemical Weapons Improved
Response Program (CW IRP) began in July 1997 with a workshop designed to establish the
infrastructure, goals, and objectives of the program.

          The CW IRP developed a series of exercises, entitled Baltimore Exercise (BALTEX), to
present participants with information regarding the potential for terrorist use of chemical warfare
agents (CWAs).  Participants were organized into four functional working groups consisting of
emergency response, law enforcement, health and safety, and emergency management.  Working
through the exercise scenarios, groups developed a list of issues revolving around their response
to a chemical event.  Groups then formed working committees to develop solutions and recom-
mendations for improving the civilian response capability to these issues.

          A summary of the first 18 months of the CW IRP is outlined in the Domestic Prepared-
ness 1997-1998 Summary Report.  This report provides a brief synopsis of the exercises
conducted under the program to assist the participants in developing key issues that pertain to a
response to a chemical weapon(s) of mass destruction (WMD) event.  It further outlines the
functional groups established to identify and address these issues.  Each participant in these
functional groups is critical to the success of the program.  The report also identifies several
technical studies conducted to test and evaluate procedures addressing several of the key issues.
The focus of the program during this period was to conduct a series of exercises designed to help
identify issues within each of the functional groups.

          This 1999 Summary Report represents the major activity of the program for 1999.
BALTEX V, a series of demonstrations based on recommended procedures for emergency
rescue and mass decontamination that were developed in the Emergency Response Functional
Group, concluded 1998.  As the program moved into 1999, more emphasis was placed on the
efforts of the individual functional groups.  Group chairpersons, with the assistance of their
committees, developed their own goals and objectives to seek out recommendations for the key
issues that they identified.  Exercises conducted in 1999 focused on the following two objectives:

          *  Support the efforts of the individual functional groups to resolve key issues.
          *  Share information based on the individual functional group efforts.

Introduction                                                                    1999 Summary Report


          The technical studies briefed in the 1997-1998 Summary Report were completed and are in
the final stages of production.  Several additional technical studies were identified and initiated in
1999.  The status of all the studies is outlined in Part IV of this report.  Additionally, the major
issues and program recommendations from each functional group are currently being prepared as
the CW IRP Playbook.  The technical reports and Playbook provide a comprehensive outline of the
recommendations for responding to a chemical WMD event.  As these reports are finalized, they
are posted to the Domestic Preparedness web page:

Introduction                                                                    1999 Summary Report


                                     Part II

                             Major Activities Summary

Major Activities Summary                                 1999 Summary Report


A.        Baltimore Exercise (BALTEX) VI

Date:  January 20 to 21, 1999
Location:  Essex Community College, Baltimore, MD

1.        Introduction.  BALTEX VI was a time-phased tabletop exercise designed to address the
long-term recovery and remediation issues following a chemical WMD event.  It focused on the
issues a community would face reestablishing normal day-to-day operations, sustainment of  law
enforcement investigations, and long-term patient care.

2.        Background.  Objectives for the exercise were as follows:

          *  Identify and examine the key health and safety contingency planning and execution
             shortfalls that are unique to a WMD incident.

          *  Identify key emergency management planning shortfalls and critical resource
             allocation, prioritization, and consideration issues unique to a WMD incident.

          *  Discuss ways to reconcile requirements for protection of a crime scene and evidence
             with those of rapidly responding to safety needs of the public.

          *  Continue to review interjurisdictional mutual support compacts or agreements
             between the city and the counties in the region.

          BALTEX VI was divided into the following four modules:

          *  Background Information and Warning
          *  Initial Response (Incident to 7 hours post incident)
          *  Follow-On Response (8-36 hours post incident)
          *  Follow-On Response and Restoration (36 hours post incident through day 5)

          A lead facilitator conducted a situation briefing while
supporting facilitators were assigned to each one of the functional
groups to support the group chairpersons.  As with previous
BALTEX exercises, the plenary groups were emergency
management, emergency response, health and safety, and law
enforcement.  Discussion of actions, consequences, and solutions
took place in each of the functional groups after each module.

          The exercise focused on the response and recovery over a 5-day period following a
chemical terrorist incident.  It led the participants through the initial incident, the immediate
emergency response, the detonation of a secondary device, and the transportation of victims to
tertiary facilities, concluding with remediation activities.

          The second day of BALTEX VI began with a presentation by Mr. Ray Blakeney from the
State of Oklahoma Medical Examiner's (ME's) Office.  Mr. Blakeney discussed the recovery

Major Activities Summary                                                        1999 Summary Report


and extrication of the deceased from the Alfred P. Murrah Federal Building following the
bombing on April 19, 1995.  Mr. Blakeney gave a very informative and highly emotional
presentation that focused on the key issues involved in processing and identifying the deceased,
caring for the emotional needs of loved ones, and the psychological support given to the ME's

           The afternoon of Day 2 began with a presentation by Mr. Paul Marmen of the Oklahoma
Emergency Medical Services Children Resource Center.  Mr. Marmen addressed the issues
related to the children involved in the Oklahoma City bombing.  He discussed what happened to
the children who had survived and those who died in the explosion.  Additionally, he addressed
the issues surrounding children who are witnesses to, or victims of, a disaster.

           BALTEX VI concluded with Soldier and Biological Chemical Command (SBCCOM)
giving an update on the ongoing technical efforts of the CW IRP.  A survey was handed out to
gather information on the needs for chemical detectors.  The information from this survey will be
used to select the most appropriate, commercially available detectors for testing live chemical

Major Activities Summary                                                       1999 Summary Report


B.        Health and Safety Tabletop Exercise (HSTTX)

Date:  April 29, 1999
Location:  Dr. Samuel L. Banks Professional Development Center, Baltimore, MD

1.        Introduction.  HSTTX was the first exercise to address specific issues from within one
of the program's functional groups.  The Health and Safety Functional Group developed HSTTX
to facilitate in-depth examination of the medical consequences of a WMD event.  HSTTX was
conducted as a time-phased tabletop exercise.

2.        Background.  Key objectives of HSTTX were the following:

          *  Identify the key requirement(s) for establishing, staffing, and operating an Off-Site
             Triage, Treatment, and Transportation Center (OST3C).

          *  Identify the roles of local police and fire departments in support of health/medical
             facilities and operations.

          *  Discuss ways to improve short- and long-term patient tracking procedures.

          *  Identify procedures  for coordination and conduct of critical  incident stress manage-
             ment (CISM) support for the affected population of the city.

          HSTTX was divided into the following four modules:

          *  Background and Initial Response
          *  Immediate Medical Care
          *  Follow-On Care
          *  Long-Term Care and Recovery

          A lead facilitator conducted a situation briefing with discussion of actions, consequences,
and solutions taking place after each module.

          HSTTX focused on the roles, activities, and coordination facing medical care providers,
mental health professionals, hospitals, and the health department following a chemical WMD
attack.  The activities and coordination of the community necessary to support the health and
medical communities was incorporated into the exercise.  The exercise was pivotal in gaining the
private medical community's support for the program.

          Administrative, emergency department (ED), and infectious control representatives from
the 14 area hospitals supported the exercise.  Dr. Peter Bielenson, Baltimore City Health Com-
missioner, attended the exercise and emphasized the importance of planning and preparation of
all health community agencies for the consequences of a chemical WMD incident.

Major Activities Summary                                                       1999 Summary Report


C.        BALTEX VII

Date:  May 18 to 19, 1999
Location:  Conference Center, Aberdeen Proving Ground (Edgewood Area), MD

1.        Introduction.  BALTEX VII consisted of a series of presentations by program repre-
sentatives designed to inform members of the ongoing efforts of each of the functional groups

2.        Background.  BALTEX VII presentations were designed to bring program participants
up to date on the issues that each of the functional groups had been addressing over the past year.
Each functional group presentation consisted of a mission overview, group composition, and
identification of the issues that each was currently studying.

          Functional group chairpersons focused their presentations
on the efforts of their group over the past year as well as the major
activities planned through the year 2000.

          SBCCOM representatives, supporting each of the
program's technical initiatives, gave a presentation outlining the
current status of each study.  Presentations were given on the
following areas:

          *  Firefighter personal protective equipment (PPE)
          *  Positive pressure ventilation (PPV)
          *  Mass casualty decontamination
          *  Chemical detectors
          *  Law enforcement and Emergency Medical Services (EMS) PPE

          Day 2 of the exercise included a presentation given by Supervisory Special Agent
Carl J. Jensen III of the Federal Bureau of Investigation's (FBI's) Behavioral Science Unit.
Mr. Jensen gave an informative briefing entitled "Psychology of the Terrorist" outlining an in-
depth analysis of the individuals associated with extremist groups and their most likely
motivation for using a WMD.

Major Activities Summary                                                     1999 Summary Report



Date:  October 29, 1999
Location:  Harbor Hospital, Baltimore, MD

1.        Introduction.  BALTEX VIII was a near-real time emergency response tabletop exercise
designed to validate information and procedures developed by the Emergency Response
Functional Group.

2.        Background.  The Emergency Response Functional Group developed the exercise to
introduce new participants to the innovative procedures and recommendations that resulted from
a series of emergency response technical studies.  The studies that BALTEX VIII focused on are
the following:

          *  Firefighter PPE
          *  Mass casualty decontamination
          *  PPV
          *  Law enforcement and EMS PPE

          The exercise was divided into the following three sections based on timed response to a
chemical WMD incident:

          *  First 10 minutes of response
          *  10 to 60 minutes
          *  60 to 180 minutes

          Exercise participants consisted of firefighters, EMS technicians, and law enforcement
representatives who were not part of the ongoing CW IRP program.  Participants included large
and small jurisdictions throughout Maryland with additional representation from Washington, DC;
Philadelphia, PA; and the state of Delaware.

          Members of the Emergency Response Functional Group
facilitated each table, consisting of firefighters from mixed
jurisdictions supported by one EMS and one law enforcement
representative.  Exercise messages were provided to participant
tables in a realistic time-phased sequence representative of the
information flow that an Incident Commander (IC) would
expect to deal with in an actual incident.

          The Emergency Response Functional Group identified 12 elements of response that an IC
is responsible for in a chemical incident.  Participants were asked to address these elements
throughout the exercise.

Major Activities Summary                                                    1999 Summary Report


E.        BALTEX IX

Date:  November 17, 1999
Location:  Gateway Building, Columbia, MD

1.        Introduction.  BALTEX IX provided the forum for both a series of presentations by
functional groups and a brief exercise covering a chemical attack on the city subway.  This
exercise focused on the challenges facing the emergency responders due to the incident being
carried out in an underground, enclosed facility.  Functional group representatives presented
overviews of the major developments and future plans for their group.

2.        Background.  Program presentations focused on the following areas:

          *  Conduct of the Emergency Responder Chemical Exercise (BALTEX VIII).

          *  Status of the development of the Incident Planning and Management Tools (IPMT)
             software project being orchestrated through the Emergency Management Functional

          *  Progress and planning schedule of the CW IRP program awareness videos.

          *  Upcoming law enforcement activities, including the following:

             -  Special Weapons and Tactics (SWAT) PPE assessment testing.

             -  Law Enforcement Incident Management Exercise (BALTEX X), scheduled for
                 March 2000.

          *  Health and Safety Functional Group upcoming exercises on the OST3C.

          Dr. Richard Hutchinson of SBCCOM's Biological
Weapons Improved Response Program (BW IRP) provided an
overview of the accomplishments and current efforts of the
program.  Current projects of the BW IRP include a series of
field tests of the components of the Modular Emergency Medi-
cal System (MEMS).  The program is also sponsoring a series
of eight specific projects designed to calibrate the biological
weapons template developed through their workshops.

          Mr. Nelson Fellman, Senior Vice President of Anne Klein & Associates, a national public
relations firm in Philadelphia, concluded BALTEX IX with a presentation entitled "Crisis
Communications Preparedness."  Mr. Fellman's briefing focused on the public relations aspect
of the Legionnaires' disease outbreak in Philadelphia in 1976.

Major Activities Summary                                                      1999 Summary Report


                                  Part III

                         Functional Working Groups

Functional Working Groups                             1999 Summary Report


A.        Law Enforcement Functional Group

Chairperson:  Special Agent James Barry, FBI, Baltimore Office

1.        Mission.  The Law Enforcement Functional Group identifies issues and
proposes recommendations to issues that challenge the effective imple-
mentation of law enforcement activities prior to, at the scene of, and
immediately following the use of chemical WMD.

2.        Background.  Special Agent (SA) Barry is supported by representatives of the law
enforcement community throughout the Baltimore metropolitan area.  Regular attendees include
the Maryland State Police; Baltimore City, Howard, Montgomery, and Prince Georges County
police departments; Washington, DC, and New York City police departments; the Harford
County Sheriffs' Office; and transportation police departments from the state of Maryland.

3.        Projects.  The Law Enforcement Functional Group developed a list of key issues
pertaining to the law enforcement response to a chemical incident.  Through various meetings
and studies, they sought resolutions to these issues, focusing their attention on the role of law
enforcement and officer safety.  These issues and the group's recommendations are outlined in
the CW IRP Playbook.  Several key areas are addressed briefly below:

          *  Law Enforcement Roles.  One of the first issues addressed by the group was the
             roles of law enforcement during a chemical incident response.  This included a joint
             discussion with members of the Emergency Response Functional Group.  The groups
             discussed the normal roles that law enforcement expects to perform, including traffic
             control, perimeter security, and criminal investigation.  In addition, several issues
             requiring officer presence in the contaminated area were raised.  These included
             crowd control in the decontamination zone, security of personal items from decon-
             taminated victims, and security over contaminated law enforcement equipment
             including weapons.

Protective Equipment.  The group agreed that the majority of law enforcement operations
would be conducted in the Warm or Cold Zone.  Basic protection for officers operating in
these areas was recommended to be Level-C protection.  Several styles of Level-C protective
suits were tested by SBCCOM to measure the protection afforded by a variety of price ranges
of ensembles suitable for law enforcement.  These tests were conducted using chemical
simulants and were performed with members of the Maryland State Police during routine
actions that would be expected of officers on the incident scene.  The results of these tests and
comparisons of suits and masks are outlined in the report  Chemical Protective Clothing for
Law Enforcement Patrol Officers and Emergency Medical Services When Responding to
Terrorism with Chemical Weapons.  This report is briefly described in the Technical Study
Initiatives section of this report and can be obtained  online at the following Web site:  Additional concerns surrounding law enforcement PPE include
the ability of departments to meet the mask fit requirements of the Occupational Safety and
Health Administration (OSHA) as well as funding for equipment and maintenance.

Functional Working Groups                                                    1999 Summary Report


Additionally, there are no negative pressure respirators approved by the National Institute for
Occupational Safety and Health (NIOSH) for CWA.
          *  Enhanced Training.  As the Law Enforcement Functional Group defined additional
             roles that departments may need to perform on a chemical incident, it became
             apparent that additional training was needed to enhance officer safety based on these
             duties.  A comprehensive list of training areas by position is included in the CW IRP

          *  SWAT Protective Clothing.  The specialized equipment and tactics used by SWAT
             teams preclude them from wearing the standard ensemble recommended for the patrol
             officer.  SBCCOM and the Maryland State Police Special Tactical Assault Team
             Element (STATE) identified seven types of protective suits for use by SWAT.
             Testing is scheduled to be conducted between February and May 2000 on these
             ensembles.  These tests will not only measure the chemical protective qualities of the
             ensembles during tactical operations but will also be evaluated by the wearers to
             determine compatibility with standard SWAT equipment and tactics.

4.        Ongoing Issues.  The CW IRP is scheduled to conduct a law enforcement-specific
exercise in March 2000 to validate the recommendations of the Law Enforcement Functional
Group.  This exercise will involve participants from 14 state and local departments from
Maryland, the District of Columbia, and New York City.

Functional Working Groups                                                     1999 Summary Report


B.        Emergency Management Functional Group

Chairperson:  Lt. Richard Muth, Baltimore County Office of Emergency Preparedness

1.        Mission.  The Emergency Management Functional Group
addresses issues related to resource coordination and support,
contingency operations planning and execution, logistics coordination
and support, and public relations and information.

2.        Background.  Lt. Muth, an emergency management official
for Baltimore County, is the group chairperson.  Permanent members
include the Baltimore City Emergency Manager, representatives from Maryland Emergency
Management Agency (MEMA), the American Red Cross, and Carroll County and Howard
County emergency management offices.  Other local emergency management office representa-
tives attend when available.  The Department of the Army's Director of Military Support
(DOMS) and the Federal Emergency Management Agency (FEMA) send representatives, as

3.        Projects.  The Emergency Management Functional Group has several key projects
underway that have been the focus of their efforts over the last year.  One of the group's main
objectives has been to produce products that will aid in spreading information in the national
emergency management and responder community about the ideas, recommendations, reports,
and initiatives that have come out of the CW IRP process.  This has been a challenging task and
has yielded the following results:

          *  CW IRP Video Series.  Production is underway for four videos that address the
             lessons learned and recommendations cited in three technical studies.  The subject
             matter for the four videos includes mass casualty decontamination, firefighter
             personal protective equipment (PPE), positive pressure ventilation (PPV), and a
             general CW IRP introduction and overview.  Each video will be 7 to 10 minutes long
             and will be designed as training tapes.  The first tape is scheduled for national release
             in the early summer of 2000.

          *  Chemical Weapons Incident Planning and Management Tool (IPMT).  The IPMT
             is a computer modeling software program that helps a jurisdiction plan for and manage
             a terrorist chemical incident.  The program uses an event modeling technique that
             allows the planner to project the consequences of an incident based on the type of agent
             used, target, method of employment, and selected other factors.  Other parameters for
             the program can be tailored to reflect the capabilities and resources of the specified

          *  Resource Needs Modeling Tool (RNMT).  The RNMT is a software program that
             helps the emergency planner project and plan for materiel and personnel resource
             requirements based on a selected scenario.  The tool integrates local resources with
             those available from mutual-aid agreements of regional, state, and federal levels.

Functional Working Groups                                                       1999 Summary Report


             This tool is particularly helpful for planning a time-phased matrix of resource

          *  CW IRP Playbook.  The Playbook offers a synopsis of the unique issues associated
             with a chemical incident and recommendations for their resolution.  The issues are
             addressed by functional area.  Additionally, the Playbook gives insights on future
             issues and projects being addressed by the CW IRP.

4.        Ongoing Issues.  The Emergency Management Functional Group will continue to
address the "tough" issues associated with consequence management of a chemical terrorist
event.  These include public awareness factors, financial and legal ramifications, and planning
considerations for the smooth integration of tiered assets (local to federal) into a disaster
situation.  Additionally, the group will continue to address how best to spread the word about the
program's successes and recommendations on best practices.

Functional Working Groups                                                    1999 Summary Report


C.        Emergency Response Functional Group

Chairperson: Deputy Chief Ted Jarboe, Montgomery County Department of Fire and
                  Rescue Service

1.        Mission.  The Emergency Response Functional Group focuses on
ways to improve the response capabilities of first responders to manage the
consequences of a chemical terrorist event.

2.        Background.  Chief Jarboe has assembled a group of experienced
emergency responders from the firefighting and hazardous materials
(HazMat) community.  Organizations supporting the group's efforts
include Baltimore City, Baltimore, Howard, and Harford Counties;
Washington, DC; and Aberdeen Proving Ground fire departments.

3.        Projects.  Many of the group's top priorities resulted in technical studies and testing
conducted by SBCCOM.  These included determining the effectiveness of turnout gear and self-
contained breathing apparatus (SCBA) to protect firefighters from CWA, mass casualty
decontamination, and use of PPV fans in a chemical response.  The key events surrounding the
Emergency Response Functional Group are outlined below:

          *  Follow-On Firefighter PPE Testing.  These tests were conducted with personnel
             and equipment from the departments supporting the functional group and included
             tests on various styles of turnout gear, including used gear, that were not used in the
             original test (1997).

          *  Emergency Responder Chemical Incident Command Exercise.  In an effort to
             validate the findings of the technical studies, the Emergency Response Functional
             Group conducted a chemical incident management exercise (BALTEX VIII) in
             October 1999 that focused on the emergency response issues facing the IC.
             Representatives attended this exercise from 36 jurisdictions throughout Maryland;
             Washington, DC; Delaware; and Pennsylvania.  Participants included firefighters,
             EMS, and law enforcement.

          *  Supporting Roles of Fire and Law Enforcement.  The group attended a Law
             Enforcement Functional Group meeting to mutually discuss the supporting roles of
             fire and police during a chemical WMD incident scene.  The meeting was key to
             presenting the issues facing both departments and developing an understanding of
             how each side perceived the other's involvement.  The groups parted with a basic
             agreement on needs and support between the two agencies.  These issues are recorded
             in the respective sections of the CW IRP Playbook.

Functional Working Groups                                                      1999 Summary Report


     4.     Ongoing Issues.  The Emergency Response Functional Group continues to focus on
            key elements of response to effectively manage a chemical incident, save lives, and
            provide safe operations for responders.  Three such efforts currently under study
            include the following:

            *  Cold weather decontamination procedures.
            *  Chemical incident management tools for the IC.
            *  Casualty decontamination tracking system.

Functional Working Groups                                                  1999 Summary Report


D.        Health and Safety Functional Group

Chairperson:  Mrs. Irene Lumpkins, Baltimore City Health Department

1.        Mission.  The Health and Safety Functional Group focuses on the issues that impact the
well-being of the community at large and the challenges associated with maximizing the impact
of local and regional public health and medical resources.

2.        Background.  Mrs. Lumpkins draws on the experts from the various medical
organizations from the Baltimore region to support the efforts of the group.  Regular attendees
include members of the Baltimore City Health Department, the Maryland Institute of Emergency
Medical Services System (MIEMSS), the Department of Health and Mental Hygiene, and several
area hospitals.  Additional federal, state, and local health representatives support the group when
discussion addresses their areas of expertise.

3.        Projects.  The group focused their efforts on several key issues facing the medical
community.  Solving these issues required gaining support from the hospital community to
develop a rapid notification system to specify the CWA and treatment protocol, to establish an
off-site treatment center, and to train public health nurses, hospital staff, and crisis intervention
personnel to respond to a chemical weapons incident.

          *  Health and Safety Tabletop Exercise.  The group con-
             ducted a medical tabletop exercise in April 1999 (HSTTX,
             outlined on page 7) to address the key issues identified
             through the CW IRP.  Participants from each of the city's
             hospitals attended, as well as members of the Baltimore
             City Health Department and community agencies that
             would be involved in responding to a chemical terrorist
             incident.  The exercise was pivotal in defining the issues
             facing the medical community as a whole, and in identify-
             ing the shortfalls in existing plans and procedures.  The
             exercise was a catalyst to obtain hospital support for the
             group's efforts and resulted in an agreement to review and
             revise current disaster plans.

          *  Off-Site Triage, Treatment and Transportation Center.  The group agreed that
             there is a need to provide rapid medical care to the non-critical victims and the
             "worried-well" while keeping the emergency departments and hospital facilities open
             for patients requiring more definitive medical care.  To avoid unintentionally
             overwhelming the healthcare system, the functional group developed the concept of
             an OST3C as a temporary, alternative care facility to support the medical response to
             a chemical weapons incident.  This center, using existing facilities such as middle or
             high schools, is designed to provide screening and care for patients not requiring
             immediate transport to a hospital.  This concept is under review and the functional
             group plans to conduct an exercise to validate the functionality of the concept.  The
             functional exercise is scheduled for the summer of 2000.

Functional Working Groups                                                      1999 Summary Report


          *  Contaminated Runoff.  The group undertook extensive efforts to obtain a decision
             from the Environmental Protection Agency (EPA) concerning contaminated water
             runoff.  The EPA responded by citing several references, indicating that a community
             would not be liable for releasing contaminated water runoff when actions to save
             lives and protect the public and responders took place under emergency circum-
             stances (e.g., performing rapid decontamination for a mass number of casualties).  For
             a comprehensive understanding of the EPA's viewpoint, it is necessary to read the
             letter that is included in the CW IRP Playbook.

4.        Ongoing Issues.  The Health and Safety Functional Group plans to continue revising the
OST3C concept by obtaining feedback from a preliminary panel review board, a functional
exercise critique, and an external validation process.  The health department continues to use the
information gained from the CW IRP in its efforts to train hospital providers to respond to a
chemical weapons incident and mental health personnel on crisis intervention for family and
friends of victims.

Functional Working Groups                                                     1999 Summary Report


                                         Part IV

                                Technical Study Initiatives

Technical Study Initiatives                                    1999 Summary Report


A.          Firefighter Personal Protective Equipment

      *  "Standard turnout gear with SCBA provides first
          responders with sufficient protection from nerve agent
          vapor hazards inside interior or downwind areas of the
          Hot Zone to allow 30 minutes rescue time for known
          live victims."
      *  "Self-taped turnout gear with SCBA provides sufficient
          protection in an unknown nerve aget environment for a
          3-minute reconnaissance to search for living victims
          (or a 2-minute reconnaissance if HD is suspected)."

1.          Study Objectives.  The primary objective of the firefighter protective clothing assess-
ment (bunker gear testing) was to evaluate the degree of protection against CWAs afforded by
standard firefighter protective gear during a quick rescue.  Testing was conducted with
firefighters wearing SCBA for eye and respiratory protection and bunker gear for skin protection.

2.          Study Overview.  Man-In-Simulant Tests (MIST) vapor tests measure the actual adsorp-
tion of agent simulant (methyl salicylate, [MeS] basically wintergreen oil) into human skin by
using passive samplers located on 17 regions of the body.  The samplers are applied directly to
the firefighter's skin, after which the test subjects dress in standard bunker gear with SCBA.
They are then directed to enter a chamber filled with MeS vapor simulant and perform firefighter
activities for 30 minutes.  Finally, the amount of simulant that is adsorbed into the skin samplers
is measured.

            MIST vapor tests were conducted at SBCCOM in January and February 1998 using new
Polybenzimidizole (PBI) firefighter turnout gear.  Verification MIST vapor tests were conducted
at the Royal Military College (RMC) in Ontario, Canada, during April and May 1998.  RMC
served as an independent test facility to validate the vapor tests at SBCCOM.  Quick-fix testing
was also conducted at SBCCOM to assess improved protection that was offered by turnout gear
using on-site modifications to the turnout gear that could be quickly applied using materials
available to virtually all firefighters.  These quick-fix tests included duct taping the wrist, ankle,
and waist closures (conducted in March 1998) and outfitting the firefighter with two plastic trash
bags in a raincoat type configuration underneath the bunker gear with all closures taped
(conducted in June and July 1998).  Tyvek F suits were tested underneath the gear in July 1998.

            Follow-on turnout gear testing was conducted from April to June
1999.  The purpose of this follow-on MIST was to test other commonly
used turnout gear.  Used PBI gear, new Nomex® gear, and used
Nomex® gear were tested during this follow-on effort.  All turnout gear
tested during this follow-on effort provided protection as good as or
better than the new PBI turnout gear tested during the first phase.

Technical Study Initiatives                                                     1999 Summary Report


3.        Conclusions.  In July 1998, an Incident Command Research Team consisting of  a broad
scientific and operational knowledge base, both with general experts and specialized staff,
including medical doctors with direct knowledge of the physiology and toxicological effects of
chemical agents, emergency responders drawn from government organizations at all levels, and
contract research staff was established to ensure standard firefighter operations and procedures
were included in the final Incident Command report.  Additionally, this team was established to
ensure that data were presented in formats and charts operationally useful to the IC and firefighters.

          The desired result from this MIST and extensive technical analysis of test data was to
identify firefighter protection times while exposed to chemical agent vapors during quick rescues
of living victims.  The two primary results from this study are included in the General Guidelines
above.  The first guideline provides the firefighter protected with standard turnout gear with
SCBA 30 minutes of protection from nerve agent vapor while rescuing living victims inside a
contaminated building. The second guideline is for when the firefighter cannot see or determine
whether there are any living victims inside the contaminated building.  Therefore, this second
guideline assumes a worst-case scenario, where the building is saturated (highest concentration
possible) with chemical agent vapor.  Even during this worst-case situation, the firefighter
protected with self-taped (duct tape) turnout gear with SCBA is provided protection from nerve
agent vapor to conduct a 3-minute reconnaissance.

          Incident Commanders intending on using the guidelines outlined in the firefighter
personal protection report need to review the exposure tables in the report to fully understand the
concerns of possible exposure based on agent and concentration levels.

          Many additional results are provided in the final report for this test effort, entitled
Guidelines for Incident Commander's Use of Firefighter Protective Ensemble (FFPE) with Self-
Contained Breathing Apparatus (SCBA) for Rescue Operations During a Terrorist Chemical
Agent Incident.  These detailed results include increased rescue time (and reconnaissance time)
provided by increasing turnout gear protection with quick-fix modifications such as self-taped
openings, buddy-taped openings, or wearing a Tyvek suit under turnout gear.  Increased
protection times are also provided for situations where the chemical agent is known or detected
and the type of dissemination device is known.  This final report contains comprehensive results
in easy to use charts and graphs.  Please visit our Web site at to
obtain a copy of this final report.

Technical Study Initiatives                                                     1999 Summary Report


B.         Positive Pressure Ventilation

  l The use of PPV fans dramatically decreases the interior
      chemical agent vapor concentration of structures.  For
      example, PPV fans can reduce the vapor concentration
      by  50% to 70%  within  the  first  10  minutes  of  use.
  l PPV significantly increases the first responders'
      protection above and beyond the adequate protection
      provided by standard turnout gear with SCBA when
      rescuing  known  live  victims.
  l Before using PPV, consider the downwind hazard for
      unprotected  people.
  l Bigger fans are better.  Two fans are better than one.
      Tilting  the  fan  improves  performance.
  l Negative Pressure Ventilation (NPV) should be used at
      buildings where people are present in closed rooms at
      other  locations  within  the  building.

1.         Study Objectives.  The purpose of this study was to conduct a series of tests for
measuring the hazard reduction that firefighters or emergency medical personnel can achieve by
rapidly employing expedient measures while entering a building in which a terrorist release of
chemical agent is known or suspected to have occurred.  This testing was conducted to examine
near-term measures with which to protect first responders while minimizing the impact upon the
rescue mission.

2.         Study Overview.  PPV fans have been employed in fighting structural fires for about a
decade.  These fans are carried on fire trucks of most fire departments and are used to purge a
building of smoke, carbon monoxide, and hot gases.  This testing complements the bunker gear
testing by employing PPV fans in a simulated chemical terrorist incident to quickly reduce the
concentration of an agent in a building before fire and rescue personnel enter for rescue
operations.  Rescue personnel will wear SCBA for eye-respiratory protection and bunker gear for
skin protection.  Reducing the vapor concentrations in the building during the rescue operation
will reduce the skin hazard to rescue personnel wearing bunker gear, or possibly increase the
permitted duration of the rescue operation for these quick rescue scenarios.  Phase I of the PPV
testing was conducted in August, September, and December of 1998.  Phase II testing was
conducted during October and November 1998.

           This work was completed by SBCCOM as part of the DPP.  The PPV testing examined
the protection provided to firefighters against CWA by their protective clothing, the firefighter
protective ensemble (bunker gear) with SCBA.  This testing (known as MIST) determined the
physiological protective dosage factor (PPDF) of the bunker gear with SCBA suit ensemble.
The PPDF is determined by wearing the suit inside a chemical vapor environment and measuring
the ratio of vapor concentration outside the suit to the concentration on the inside of the suit (at
several different skin locations).  The ratios from the different skin areas are then weighted
according to the sensitivity of the skin at each region and summarized to determine the overall

Technical Study Initiatives                                                   1999 Summary Report


3.        Conclusions.  The first portion of this testing (Phase I) examined the use of PPV fans
through scientific testing to remove chemical contamination from a typical building structure.
Different sizes and configurations of fans were used in this testing to include the most commonly
used PPV fans (16-inch electric and 20-inch gas) along with some larger fans and series
combinations with multiple fans.  The results of this testing showed that the use of PPV fans can
reduce the concentration significantly in building areas that have been contaminated with CWA.
These concentration reductions occurred during the first 10 minutes of use (this is a key concept
in that it only takes 5 to 10 minutes for a PPV fan to purge the majority of the vapor
contamination from a building).

          The improvement in the ventilation rate of the building (over the natural rate) followed
similar patterns and ranged from 43 times (30-inch gas fan) to 22 times (16-inch electric fans)
the natural ventilation rate.  An evaluation of the effects on shut interior rooms (interior doors
closed) showed that the use of PPV fans drove the tracer gas into closed rooms.  Fans used in the
Negative Pressure Ventilation (NPV) mode (drawing air out of the building instead of pushing it
in) were evaluated and determined to be the preferred method for quick concentration reduction
of CWA when interior rooms with closed doors exist in the building because they did not cause
the gas to be driven into the rooms.

          Protective clothing MIST was performed during the second portion of this testing
(Phase II) to examine the improvement provided through the use of the PPV fans during several
live rescue mission scenarios.  Six operational tests were conducted, each with four firefighters.
One test was conducted without using PPV fans as a baseline.  The remaining tests were
performed using the 21-inch gas fan and the two 16-inch stacked electric fans.  These fan
configurations were selected because they represent the fans most commonly used during
firefighting.  The results of this portion of the testing showed that the Combined PPV and
Bunker Gear PF increased the firefighters' protection tremendously when the PPV fans were

          The final report for this test effort can be obtained online at the following Web site:

Technical Study Initiatives                                                  1999 Summary Report


C.         Mass Casualty Decontamination

      * Expect a 5:1 ratio of unaffected/affected 
      * Decontaminate ASAP.
      * Disrobing is decontamination; top to 
       bottom, the more the better.
      * Water flushing generally is the best mass 
       decontamination method.
      * After known exposure to liquid agent, 
       first responders must self-decontaminate 
       ASAP to avoid serious effects.

1.         Study Objectives.  The purpose of the mass decontamination study was to identify and
propose solutions to the challenge of effectively and efficiently decontaminating victims, both
responder and civilian, of a chemical event.

2.         Study Overview.  The CW IRP formed a Mass Casualty Decontamination Research
Team (MCDRT) to address specific technical and operational issues associated with the
performance of mass casualty decontamination after a terrorist incident involving chemical
WMD.  The research team included a broad scientific and operational knowledge base, both with
general experts and specialized staff, including medical doctors with direct knowledge of the
physiology and toxicological effects of chemical agents, emergency responders drawn from
government organizations at all levels, and contract research staff.

           Although HazMat teams have experience and procedures for decontaminating a small
number of chemical burn victims, the emergency response community has no formal procedures
for decontaminating hundreds of victims.  The study was structured to ensure that the solutions
recommended considered the impacts of cost, readily available resources, and logistic constraints
of local responding organizations and compatibility with current policy and procedures.

3.         Conclusions.  The MCDRT acquired and reviewed information from more than
200 research papers, books, articles, manuals, and Internet sites.  From this effort it was deter-
mined that minimal direct research had been performed in the following areas:

           *  Medical efficacy of specific skin decontamination methods
           *  Decontamination prioritization and medical triage of a large number of CWA casualties
           *  Magnitude and nature of potential casualties after a chemical terrorist event

           For decontamination to be effective and save lives, it must be conducted as soon as
possible.  Therefore, firefighters must use resources that are immediately available to them on

Technical Study Initiatives                                                     1999 Summary Report


the incident scene.  Since large amounts of water are generally available, the following methods
of water-based decontamination were considered:

          *  Water alone.  Flushing or showering, this method uses shear force and dilution to
             physically remove chemical agent from the skin.  Water alone is an excellent
             decontamination solution.

          *  Soap and water.  By adding soap, a marginal improvement in results can be achieved
             by ionic degradation of the chemical agent.  Soap aids in dissolving oily substances
             like mustard agent.  A disadvantage to soap is the need to have a supply of it on hand.

          *  Bleach and water.  Bleach (sodium hypochlorite) and water solutions remove,
             hydrolyze, and neutralize most chemical agents.  However, this approach is not
             recommended in a mass decontamination situation where speed is paramount.

          Decontamination by removing clothes and high volume, low pressure (60 psi
recommended) water is the most expedient and the most practical method for mass casualty
decontamination.  Disrobing and showering meets all the purposes and principles of decontami-
nation.  Victims should remove clothing at least down to their undergarments prior to showering
to eliminate the possibility that agent trapped in their clothes will be forced onto the skin.

          The MCDRT explored several approaches to conducting mass casualty decontamination
using existing fire apparatus and equipment.  The two predominant systems developed are the
Ladder Pipe Decontamination System (LDS) and the Emergency Decontamination Corridor
System (EDCS).  These systems approach decontamination from two variations.  The LDS
provides the capability to decontaminate the greater number of victims at one time but affords no
privacy, while the EDCS provides privacy in the form of covered decontamination lanes but the
rate of processing casualties is slowed.  These systems were demonstrated by various fire
departments supporting the CWIRP during BALTEX exercises.  Explanations of these systems
and diagrams on setting them up are outlined in the mass casualty decontamination report.

          The number of apparent casualties from a chemical agent terrorist incident may exceed
emergency responders' capabilities to effectively rescue, decontaminate, and treat victims,
whether or not they have been exposed to a chemical agent.  Responders, therefore, must
prioritize victims for receiving decontamination, treatment, and medical evacuation, in keeping
with the precept of providing the greatest benefit for the greatest number of people.  The first
step in sorting victims is to segregate them as ambulatory and non-ambulatory.  Casualties in
both categories are further prioritized based on agent signs and symptoms or likelihood of
exposure.  In some circumstances, a severely injured, non-chemically exposed casualty cannot
wait for ideal decontamination; therefore clothing removal may be the only decontamination
performed before the victim is removed.  Additionally, severely intoxicated nerve agent
casualties may require antidote administration and treatment prior to decontamination.  Charts
depicting the prioritization of ambulatory and non-ambulatory triaged casualties with regards to
agent exposure are outlined in the mass casualty decontamination report.

          The MCDRT identified three shortfalls that were not addressed in the initial
decontamination study.  These shortfalls are:

Technical Study Initiatives                                                     1999 Summary Report


             *  Cold weather decontamination procedures to reduce the risk of hypothermia
             *  A lack of information on how long to employ a low-pressure/high-volume flush to
                 provide effective decontamination
             *  A lack of standardized methods to evaluate and optimize decontamination shower
                 facilities for efficacy of skin decontamination

          These shortfalls are being addressed in a follow-on study that will complement the Mass
Casualty Decontamination report.

          The final report for this test effort can be obtained online at the following Web site:

Technical Study Initiatives                                                 1999 Summary Report


D.        Chemical Detectors

1.        Study Objectives.  Knowledge of the identity and approximate
quantity of chemical agent present at the scene of a chemical terrorist
attack gives the responders information necessary to protect themselves
and to properly manage and investigate the incident.  This study looked
at the needs and uses of CWA detectors by the emergency response
community.  Primary objectives were the following:

          *  Assess the detector requirements of the various components of emergency response.

          *  Determine if detectors available on the commercial markets can meet these

          *  Establish guidelines for detector purchasing decisions by emergency response agencies.

          *  Promote the development of chemical detectors designed specifically for emergency

2.        Study Overview.  A report on the use of detectors by the emergency responder
community has been prepared and is being reviewed for publication on the Domestic Prepared-
ness Web site.

          The following are actions that warrant the use of detectors by local emergency

          *  Fire and Rescue units removing people from contaminated areas.

          *  Hazmat responders doing scene assessment.

          *  Law enforcement agencies conducting criminal investigations.

          *  Emergency medical personnel rendering on-scene first aid to casualties and trans-
             porting them to local hospitals.

          *  Hospital personnel doing follow-up medical care to the casualties at their hospitals.

          Surveys of members of these various responder groups have shown that each of them has
unique detector needs.  Detectors for self-protection, scene assessment, and investigations have
totally different requirements.  Not only is the agent sensitivity and false alarm acceptability
level different, but operational issues such as size, weight, power requirements, training needs,
cost, and compatibility with the responder's normal operating mode are also unique.  What is
suitable for a HazMat responder may be not suitable for a law enforcement officer or an
emergency medical technician, and vice versa.

          Market surveys of detector manufacturers revealed about 80 detectors, for both military
and commercial users and claimed CWA detection capabilities, are being advertised and sold.

Technical Study Initiatives                                                     1999 Summary Report


The surveys characterized the detectors by agent detection level, weight, power requirements,
costs, skill level needed, training needs, start-up time and technology type.  A technical
description of each detector technology and manufacturers' contact information for each detector
is included in the report.

          Chemical agent testing was conducted on selected detectors.  Minimum detection levels
to nerve and mustard agents was determined as was response to interfering compounds, which
are chemicals commonly found in commercial and household environments that potentially give
false alarms.  Reports of this testing have already been published on the Web site, and additional
testing is currently on-going.

          A limited test of several detectors' responses to a smoke-filled environment was also

3.        Conclusions

          *  Many chemical detectors designed for detection of commercial chemicals are not
              sensitive enough to detect CWA at levels to determine what type of PPE is required.

          *  Military chemical detectors are subject to false alarms in domestic response situations
              and have not been designed for use outside of military operations.

          *  There are many detection requirements that no single, existing detector can
              adequately address.  A matrix of detectors is needed, each one a solution to a specific
              responder need.  There are also responder requirements that no detector currently on
              the market can fill.

          *  In addition to chemical detection capability, the selection of chemical detectors is
              dependent on operational needs, equipment budgets, maintenance requirements, and
              training considerations.

          *  First units on the scene of a chemical weapon incident can use colorimetric detector
              tubes used in the industrial hygiene community.  They will detect CWA at concentra-
              tions that are immediately dangerous to life and health (IDLH).  These are glass tubes
              that contain chemicals that change color when agent vapors are pulled through them.
              They are inexpensive, easy to use, and need no maintenance. However, they require
              manual operation and are not continuous chemical monitors.

          *  Specialized units such as HazMat response teams, evidence collectors, and hospitals
              have monitoring needs.  Electrically-operated units capable of continuous operation
              are available.  They sound an audible alarm or give some other indication when an
              agent is detected.  These units range from small, hand-held, battery-operated detectors
              to laboratory instruments that must be operated from AC power lines.  They are much
              more expensive than colorimetric tubes, require maintenance, and need highly trained

Technical Study Initiatives                                                     1999 Summary Report


          Results of chemical agent testing of military and commercially available chemical
detectors showed that some detectors that are used by emergency responders are capable of
detecting military chemicals (e.g., nerve and blister agents at IDLH concentrations).  Other
detectors have been proven incapable of detection at IDLH levels.  Also, many of the detectors
will false alarm to interferents, non-toxic concentrations of other chemicals commonly found in
civilian environments.

          A limited test of several detectors in a smoke filled environment indicated that some
detectors will false alarm to heavy smoke that would be found at a typical residence fire.  This
test was not conducted under controlled, replicable conditions.  The results are indicative of the
need for more testing; they are not a definitive answer to whether any particular detector is useful
under these conditions.

Technical Study Initiatives                                                   1999 Summary Report


E.         Law Enforcement Personal Protective Equipment

1.         Study Objectives.  The objective of this study was to present the results of evaluations of
PPE alternatives so that law enforcement officials will have sufficient information to make
informed decisions about how to equip their departments in response to a chemical terrorist

2.         Study Overview.  Law enforcement activities, during a CW incident, and associated PPE
requirements were split into three general categories based on functions performed and proximity
to the hazard at an attack scene:  perimeter or Cold Zone; tactical team; and bomb squad.  Each
function was assessed differently.  PPE guidance from NIOSH and the EPA was considered.
The Law Enforcement Functional Group recognized that the PPE that was tested would afford
protection to the wearer and recommended that departments equip and train their personnel as
best as possible.

           Similar testing that had been used by the IRP to determine the PPDFs of firefighter
turnout gear in 1998 was used to do the same for the standard police officer's duty uniform as
well as six commercially available chemical protective ensembles.  Test subjects were volunteers
from the Maryland State Police Special Operations Division.  In addition to the suits, volunteers
wore overboots, rubber gloves, and military issue protective masks.  These troopers performed
activities in the chamber at SBCCOM that were representative of scenarios troopers would
encounter in the field on actual operations.

           Troopers also performed weapons firing on standard qualification ranges to assess the
effect that wearing a chemical ensemble, mask, and chemical protective gloves would have on
this vital law enforcement function.  Based on the results, no degradation in weapons proficiency
was discovered.

           To address the issue of use of M17 protective masks departments may have received
from the DoD, the Law Enforcement Functional Group assessed the condition of samples of
these masks from the supply rooms of some departments.  These masks were obtained for use in
riot-control situations and may be well suited for that use.  The assessment quickly showed that
these masks, although obtained free of charge, were not suitable for use in an attack involving
CWA due to improper filters, dry rot of the facepiece and unserviceable parts.

Technical Study Initiatives                                                     1999 Summary Report


          The complete report Chemical Protective Clothing for Law Enforcement Patrol Officers
and Emergency Medical Services When Responding to Terrorism with Chemical Weapons can be
found on the following Web site:

3.        Ongoing Efforts.  Further testing is underway, this time assessing SWAT team
operations.  Maryland State Police Special Operation Division personnel are being outfitted in
other chemical protective suits and are performing typical special team operations in buildings
converted to support the testing.  The chemical suits worn for this testing are different from those
tested before to accommodate the different stresses the SWAT teams put on their equipment.
The results of this assessment are expected to provide law enforcement agencies with sufficient
data to make informed decisions regarding how to equip their special teams.

Technical Study Initiatives                                                    1999 Summary Report


F.        Off-Site Triage, Treatment, and Transportation Center (OST3C)

1.        Study Objectives.  The primary objective of an OST3C is to operate as an ancillary
medical facility that is set up to care for the mass number of "walking wounded" and "worried
well" casualties that results from a chemical weapon terrorist attack.  The OST3C is a temporary
site that supplements the existing healthcare infrastructure and can be duplicated to prevent
facility over-crowding.

2.        Study Overview.  The CW IRP Health and Safety Functional Group identified many
issues that will challenge a health department's ability to respond to a chemical WMD attack.
The overall purpose of identifying issues was to generate solutions, qualify those solutions, and
create a template response plan for other cities to utilize.  The sarin attack on the Tokyo subway
resulted in more than 5,000 people seeking medical treatment, only 20 percent of which needed
tertiary care.  The Health and Safety Functional Group established the OST3C as an alternative
care facility designed to keep medical treatment facilities from being overwhelmed by the large
numbers of non-critical and non-exposed patients expected to seek care.

          Members from the local health department, area hospitals, animal control, SBCCOM, and
private disaster consultants developed the initial format for the concept.  The draft concept was
formally written (winter 1999) and is scheduled to undergo a series of reviews and evaluations
throughout the year 2000.

          The basic concept of the OST3C is to provide medical screening and care for non-critical
patients from a chemical WMD incident.  This care includes the following:

          *  Secondary decontamination for patients transported from the incident scene.

          *  Thorough decontamination for self-referring patients.

          *  Initial entry into the medical care system for patients not processed at the scene.

          *  Medical care for non-critical patients.

          *  Transportation to medical care facilities for patients exceeding the scope of care at the

          *  Mental health counseling and briefing for the victims and families.

          Developing the OST3C requires evaluating the concept from the perspective of those who
would put the center into operation as well as staff the center.  The Health and Safety Functional
Group selected a 30-member panel to review the concept, based on the types of individuals
needed to operate the center.

          This review (March 2000) will present the concept of the OST3C, specify how it fits into
a city's response to a chemical weapon terrorist attack, and evaluate patient flow through the
center.  A computer-generated scenario will simulate the patient flow through the center.  At

Technical Study Initiatives                                                      1999 Summary Report


each station, the staffing requirements, the station function, and the required supplies will be

          The goal of the Panel Review is to theoretically work out flaws in the overall concept
before proceeding to staff training and a functional exercise.

          A training day for OST3C staff (spring 2000) will brief personnel of their duties and
responsibilities in the OST3C.  These personnel will then staff the OST3C during the functional
exercise (summer 2000).

          The fourth step in the concept design is to put the OST3C into operation via a functional
exercise.  Standing up an OST3C will help agencies identify areas that need to be revised,
identify staffing or station changes necessary to help maintain a constant flow of patients, help
address concerns that may not have been previously introduced, and serve as a practice drill for
the local health department staff.

          Once the OST3C plan is revised, an external panel review is scheduled for summer 2000.
The purpose of this panel is to present the concept to individuals who have not heard of the
OST3C but understand chemical terrorism in general.  The group's feedback will serve as a
reality check in evaluating a city's overall ability to operate an OST3C.

          Pending this last review and SBCCOM approval, the OST3C plan will be released for
distribution on the Domestic Preparedness Web page as one facet of a city's improved response
plan to mitigate chemical terrorist attacks.

Technical Study Initiatives                                                   1999 Summary Report


The CWIRP technical studies are documented in individual reports by SBCCOM.
Downloadable copies of these reports are being placed on the domestic preparedness website as
they are finalized.  The website for Domestic Preparedness is

Technical studies

          Guidelines for Incident Commander's Use of Firefighter Protective Ensemble (FFPPE)
with Self-Contained Breathing Apparatus (SCBA) for Rescue Operations During a Terrorist
Chemical Agent Incident.  Final Report dated August 1999.

          Guidelines for Mass Casualty Decontamination During a Terrorist Chemical Agent
Incident.  Final Report dated January 2000.

          Use of Positive Pressure Ventilation (PPV) Fans To Reduce the Hazards of Entering
Chemically Contaminated Buildings.  Final Report dated October 1999.

          Personal Protective Equipment for Use by Law Enforcement Officers at a Terrorist
Incident Involving Chemical Warfare Agents.  Final Report dated November 1999.

          Guidelines for Establishing an Off-Site Triage, Treatment and Transportation Center
(OST3C) for Managing Casualties from a Terrorist Chemical Agent Incident.  Draft Report,

Technical Study Initiatives                                                1999 Summary Report


                              Part V

                      List of Acronyms


List of Acronyms                          1999 Summary Report


BALTEX               Baltimore Exercise
BRHA                 Body Region Hazard Analysis
BW IRP               Biological Weapons Improved Response Program

C/B                  Chemical and Biological
CISM                 Critical Incident Stress Management
CWA                  Chemical Warfare Agent
CW IRP               Chemical Weapons Improved Response Program

DoD                  Department of Defense
DOMS                 Department of Military Support
DPP                  Domestic Preparedness Program

ED                   Emergency Department
EDCS                 Emergency Decontamination Corridor System
EMS                  Emergency Medical Services
EPA                  Environmental Protection Agency

FBI                  Federal Bureau of Investigation
FEMA                 Federal Emergency Management Agency

HazMat               Hazardous Materials
HSTTX                Health and Safety Tabletop Exercise

IC                   Incident Commander
IDLH                 Immediately Dangerous to Life and Health
IMPT                 Incident Management and Planning Tool
IRP                  Improved Response Program

LDS                  Ladder Pipe Decontamination System

MCDRT                Mass Casualty Decontamination Research Team
ME                   Medical Examiner
MEMA                 Maryland Emergency Management Agency
MEMS                 Modular Emergency Medical System
MeS                  Methyl Salicylate
MIEMSS               Maryland Institute of Emergency Medical Services System
MIST                 Man-In-Simulant Tests

NIOSH                National Institute for Occupational Safety and Health
NPV                  Negative Pressure Ventilation

OSHA                 Occupational Safety and Health Administration
OST3C                Off-Site Triage, Treatment, and Transportation Center

List of Acronyms                                                              1999 Summary Report


PBI                  Polybenzimidizole
PPDF                 Physiological Protective Dosage Factor
PPE                  Personal Protective Equipment
PPV                  Positive Pressure Ventilation

RMC                  Royal Military College
RNMT                 Resource Needs Modeling Tool
ROI                  Rate of Improvement
RVI                  Rate of Ventilation Improvement

SA                   Special Agent
SBCCOM               U.S. Army Soldier and Biological Chemical Command
SCBA                 Self-Contained Breathing Apparatus
STATE                Special Tactical Assault Team Element
SWAT                 Special Weapons and Tactics

WMD                  Weapons of  Mass Destruction

List of Acronyms                                                     1999 Summary Report