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Chapter 6
Metropolis, USA: Progress, Pitfalls in Front-line Readiness
Amy E. Smithson
Ask public safety officers, rescuers, health care providers, and city emergency managers what their
challenges would be in the aftermath of a chemical terrorist attack and at a staccato pace they start
ticking problems off on their fingers. Absence of awareness and standard operating procedures in 911 call
centers. Disinterest among the police, who are insufficiently equipped and trained and therefore likely to
rush into trouble. Difficulty in decontaminating large numbers of casualties rapidly. Lack of chemical
antidotes, not to mention uncertainty about the protocols to administer them. Far too few hospitals ready to
handle a major onrush of panicked, possibly contaminated casualties. Inadequate chemical casualty care
training among medical professionals, not just in the emergency departments but throughout the hospitals.
Deficiencies in communication systems likely to be overwhelmed and therefore contribute to a confused
response. They run out of fingers before they reach the challenges of recovery in the days and months after
such an attack. The list of worries deviates slightly from city to city, and although they have made headway
in some areas, even cities that have benefitted from assistance under the federal government's unconventional
terrorism preparedness programs can identify gaps in their planning and capabilities to deal with a large-scale
chemical incident.
When these same individuals are asked to assess their level of readiness before and after receiving
aid via one or more of the preparedness training and equipment programs, the answers also vary from city
to city as well as among response disciplines. For example, in cities where the local government chipped
in financial support for adequate manpower to enhance response plans and propagate the training, the ratings
tended to be higher. Also, the training and equipment programs centered around firefighters and hazardous
materials (hazmat) personnel, who generally gave higher ratings. Even within the firefighting ranks,
however, some gave low assessments after the federal assistance. One fire chief said that "the training done
to date has scared the first responders so much that they will stand back and watch people die."1 As a whole,
the appraisals of health care providers tended to be lower, since much less of the federal planning, training,
1 Continued the chief, "They don't feel equipped either with the training or gear to tackle the situation." Interview with
author: Chief, County Fire Department (9 September 1999). Also on this point: Hazmat Coordinator/Instructor (8 September
2000); Police Lieutenant (23 March 1999). Note also that one battalion fire chief lowered his city's chemical and biological
preparedness rating three and two points, respectively, after the training, saying that he thought they were prepared before but
now saw the magnitude of the problem differently. Interview with author: Battalion Fire Chief, Special Operations (25 May
2000).
202 Ataxia: The Chemical and Biological Terrorist Threat and the US Response
and equipment assistance reached the medical sector. Of the preparedness of health care givers, a local
official simply noted, "We've got problems no matter where we look."2
The responders' assessments were subjective, since they were working without a definition of what
constitutes "preparedness." While some local officials felt qualified to appraise only their own organization's
status, others had a broader view of activities city-wide and therefore felt comfortable rating their city as a
whole. Although the ratings in figure 6.1 are something of a potpourri, the intent of the survey was not to
obtain a discipline-specific measure of preparedness. Rather, the purpose was to gain a sense of whether the
federal programs were making a difference locally and how far along the path to readiness various local
officials believed their cities to be. The proposed rating scale was from one to ten, with one being the least
prepared and ten the most. For the "before" ratings, several local officials rewrote the scale. Five specified
that their city ranked a zero and one a negative five prior to the federal aid programs. Overall, the local self-
ratings certainly marked improvement, with the "before" ratings averaging 3.1 and the "after" score rising
to 5.9. The mean improvement was 2.8. Eventually, almost all local officials ended up commenting on the
unescapable, however. The level of preparedness in the months immediately following the federal programs
might not be there in the years ahead unless training is institutionalized, equipment maintained, and seldom-
used skills are drilled.3
Working from interviews with front-line personnel, the first half of this chapter describes what would
unfold in a large US city stricken by a terrorist attack involving a chemical agent. The latter half provides
a similar description for a likely response to a bioterrorist attack. This text can function at several levels.
First, congressional, federal, and local officials can gain insight into where the front line is having difficulty
with response capabilities, serving as a guidepost so that the appropriate adjustments to federal and local
efforts can be made to address these gaps. Second, local emergency response officials may find a number
of ideas that have been employed in other locations that would improve their plans and strategies. Finally,
the following pages can provide lay readers and the media a reasonable understanding of the significant
challenges facing on-scene rescuers and health care providers who would attempt to help their fellow citizens
after this type of disaster.
2 Interview with author: Paramedic/Emergency Planner, Public Health Department (4 February 1999). Also, "Heaven
forbid something happens tomorrow, we're definitely not ready." Interview with author: Registered Nurse/Hospital Disaster
Coordinator (4 February 1999). Similar remarks were made by a physician from a city that viewed preparedness as being much
better than elsewhere. Interview with author: Physician, Hospital Department of Emergency Medicine (24 March 1999).
3 Conveying this point of view: "Sure, the feds gave us a bunch of equipment, but that does not mean we're ready now
or that we'll be ready in the future." Interview with author: Special Projects Program Manager, Department of Public Health (5
February 1999).
Chapter 6 Metropolis, USA: Progress, Pitfalls in Front-line Readiness 203
Figure 6.1: Local Officials Assess Their Preparedness for a Large-Scale Chemical Terrorist Event*
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Before After
*Not all local officials interviewed for this report were asked to rate themselves and some who were asked declined to do so. The survey
includes the appraisals of responders from twenty-two cities, although interviews were conducted with over thirty cities. Some responders
were from cities that at the time of the interview had received only the Domestic Preparedness Program training, and others were from
cities also enrolled in the Metropolitan Medical Response System program. Some cities had received equipment grants from the Justice
Department, others had not.
Sources: Interviews with author: General Manager, Emergency Department (22 September 2000); EMS Chief, Emergency Services Department (21
September 2000); Director, County Emergency Management (21 September 2000); Physician/University Hospital Department of Emergency Medicine (20
September 2000). Physician, Director of Health, Public Health Department (20 September 2000); Director, Emergency Management Division, County
Department of Public Safety (19 September 2000); Director, Office of Emergency Preparedness (19 September 2000); Police Lieutenant, Tactical Support
Office (18 September 2000); Hazmat Coordinator/Instructor (8 September 2000); Fire EMS statistician (30 August 2000); Emergency Planner, Hospital
Health Maintenance Organization (15 August 2000); Police Lieutenant (8 July 2000); Medical Toxicologist/Poison Control Center Director (13 June 2000);
Physician, Hospital Division of Emergency Medicine (31 May 2000); Deputy Director, Office of Emergency Management (26 May 2000); Battalion Fire
Chief, Special Operations (25 May 2000); Director, Emergency Services Department (18 May 2000); Emergency Management Specialist, Office of
Emergency Management (9 May 2000); Police Sergeant (9 May 2000); MMRS Coordinator, Fire Department (9 May 2000); Registered Nurse/Emergency
Planner, Public Health Department (7 April 2000); Registered Nurse/Chief, EMS Division, State Department of Public Health (3 February 2000); Deputy
Coordinator, Fire Emergency Preparedness and Disaster Services (3 February 2000); Detective/Bomb Squad (19 January 2000); Project Manager,
Emergency Management Planning (27 July 1999); Director of Hospital EMS and Disaster Medicine (19 April 1999); Fire Commander (19 April 1999);
Toxicologist, Poison Control Center (9 March 1999); Emergency Planner, Office of Emergency Management (8 March 1999); District Fire Chief, EMS
Division (2 March 2000); Police Captain/Firing Range Director (5 February 1999); Emergency Response Planner, Office of Emergency Management (5
February 1999); Captain/Assistant Emergency Management Coordinator (5 January 2000); Battalion Fire Chief (17 November 1999); Battalion Fire
Chief/Emergency Services Administrator (15 November 1999); Battalion Fire Chief (15 November 1999); Associate Hospital Administrator/Registered
Nurse (13 November 1999); EMS Superintendent-in-Chief (24 March 1999); Physician, Hospital Department of Emergency Medicine (24 March 1999);
Police Commander, Special Operations Division (23 March 1999); Assistant Director, Office of Emergency Management (23 March 1999); Deputy Fire
Chief (23 March 1999); Police Captain, Special Operations Division (23 March 1999); Lieutenant/Hazmat Commander (10 March 1999);
Physician/Associate Director, Hospital Department of Emergency Medicine (9 March 1999); Paramedic Operations Supervisor (9 March 1999); Fire
Captain, HazMat Unit (9 February 1999); Emergency Preparedness Director, Office of Emergency Services (9 February 1999); Battalion Fire Chief (9
February 1999); Fire Battalion Chief/Hazmat Specialist (8 February 1999); Police Lieutenant (8 February 1999); Battalion Fire Chief/EMS Supervisor (8
February 1999); Police Captain, Special Operations Division (8 February 1999); Special Projects Program Manager, Department of Public Health (5
February 1999); Fire Lieutenant (5 February 1999); Paramedic/Emergency Planner, Public Health Department (4 February 1999); Director, Office of
Emergency Services (4 February 1999) Registered Nurse/Hospital Disaster Coordinator (4 February 1999).
204 Ataxia: The Chemical and Biological Terrorist Threat and the US Response
BUILDING BLOCKS FOR RESPONDING TO TERRORIST INCIDENTS
No matter how well-equipped and trained the emergency rescuers in a community are, the
effectiveness of the different responding agencies, separately and together, would be degraded if they do not
have agreed upon disaster response plans. In a great many cities, a flexible, "all-hazards" plan already exists
that, with situational adjustments, can apply to this kind of disaster.4 So, communities need not start from
scratch, because they already have mechanisms in place (e.g., state emergency response plans, hospital mass
casualty plans) that can serve as a planning platform. Many metropolitan areas created a terrorism
subcommittee within an existing planning group to assess local risks and capabilities to handle the
extraordinary circumstances that a chemical or biological terrorist event would create. The end product was
an annex to existing multi-disaster plans and a prioritization of needed response improvements.5
One entity that might be assigned the task of unconventional terrorism response planning is the Local
Emergency Planning Commission, which is responsible for formulating a community's disaster response plan
for hazmat incidents that must be drilled annually.6 In important respects, a chemical terrorist attack would
be an amplified hazmat incident. Commission members are already well-versed in local hazmat response
capabilities, not to mention the number, location, and nature of hazmat sites in the area. Substances that pose
a danger to human health and the environment can be found in abundance in US cities.7 Since terrorists
4 Howard Levitin, "Preparing for Terrorism: What Every Manager Needs to Know," Public Management 80, no. 12
(December 1998): 78.
5 One county accomplished this planning, tailored training, and exercising for first responders under a $65,000 grant
from state government. Their capability assessment covered ability to identify the agent involved, control access to the site,
predict plume and downwind effects, maintain secure communications, protect first responders, alert response entities, gather
intelligence, evacuate the public or shelter them in place, decontaminate victims, care for large numbers of casualties, and
communicate necessary information to the public. Interviews with author: Director, County Emergency Management (21
September 2000); Deputy Director, Office of Emergency Management (2 March 2000). On the utility of building from existing
plans, interviews with author: Director, Emergency Management Division, County Department of Public Safety (19 September
2000); Battalion Fire Chief, Special Operations (25 May 2000); MMRS Coordinator, Fire Department (9 May 2000); Police
Captain (10 August 1999); Physician, Hospital Division of Emergency Medicine (6 August 1999); Project Manager, Emergency
Management Planning, Office of Emergency Management (27 July 1999).
6 Passed by Congress on 17 October 1986, the 1986 Superfund Amendment Reauthorization Act mandated that state
governments appoint members to these commissions, including state and local government officials, representatives from police
and fire departments, environmental, public health, transportation and civil defense agencies, hospitals, community groups, and
the media. Each commission's primary responsibility is the development and maintenance of an emergency response plan for
potential chemical accidents that is specific to local conditions. Since the original legislation did not provide funds for the
commissions, resources to sustain their activities are borne at the local level, which means that commissions are much more
active in some areas than in others. See Public Law 99-499, Title 3. Under section 302 of Title 3, chemical companies and other
industries that consume, handle, store, or process hazardous substances are required to submit data to these panels annually on
the amount of hazmat chemical(s) on sites and where they are located. Also, Occupational Safety and Health Administration
(OSHA) regulation 1910.120 requires employers to set up a health and safety plan dealing specifically with hazmat emergencies,
including the training of personnel, establishment of fire brigades, and designation of escape routes.
7 One emergency official said that his city had over four hundred facilities working with extremely hazardous
substances and over two thousand regular hazmat facilities. Another said that there were roughly six thousand laboratories in his
city using hazardous materials, as well as several high-level containment laboratories working with dangerous pathogens. Yet a
Chapter 6 Metropolis, USA: Progress, Pitfalls in Front-line Readiness 205
could well view hazmat sites as an attractive target for theft or sabotage, some communities worked through
these planning commissions and public safety authorities to strengthen the security at hazmat facilities.8
Another city identified some two thousand locations of all types that could benefit from a security
consultation and activated an expert team for that purpose.9
Another important step that metropolitan areas can take to facilitate a prompt and organized response
is to prepare contingency plans for major sites. To create such a plan, an emergency response team first
surveys the location, whether it be a sporting arena, office building, civic auditorium, landmark, amusement
or public park, zoo, shopping mall, or transportation center. They identify optimum area(s) at the site for
rescuers to enter swiftly, to set up a command post, to gather, decontaminate, and triage casualties, and to
stage emergency equipment. The best routes to and from to the closest trauma center and other hospitals are
marked. At large indoor facilities, this team also scouts the ventilation system and obtains the telephone
numbers for the site engineer or others who would be able to advise them on its operation. Then, the
emergency responders meet with the managers of the site to discuss the plans and ascertain what logistic
support the facility might make available during an emergency. Some site managers agree to drill the plan.
Some cities drew up contingency plans for their major sites long ago, with natural disasters, fires, or
conventional bombings in mind.10
The domestic preparedness effort prompted other cities to identify their high-risk facilities and map
out contingency plans. Aside from major public gathering places, some cities have taken extra precautions
third recalled over three hundred such facilities within city boundaries, including over 125 extremely hazardous substance sites.
Interviews with author: Deputy Director, Office of Emergency Management (26 May 2000); Fire Chief (15 May 2000); Deputy
Coordinator, Fire Emergency Preparedness and Disaster Services (3 February 2000).
8 Interviews with author: MMRS Coordinator, Fire Department (9 May 2000); EMS System Analyst/Paramedic, State
Department of Health and Social Services (25 January 2000); Lieutenant/Hazmat Commander (10 March 1999). OSHA
regulation 1910.120, which governs emergency response plans at hazmat facilities, stipulates that a facility's plans address "site
security and control," but this matter receives neither emphasis nor exposition within the text of the regulation. Matters such as
the height of security fences, creation of patrols, and other measures to prevent or restrict access are left to the judgment of the
facility operator.
9 The local Federal Bureau of Investigation (FBI) office in this city has organized a small team of fire, bomb, and
special weapons and tactics specialists. In addition to the factors considered for an emergency response contingency plan, this
team looks at a site's security patrol patterns and incident response plans. Afterwards, the team makes verbal recommendations
to site security and managerial personnel on how to harden the facility against intruders. Within a five-month period, this team
completed almost ninety consultations. Interview with author: FBI Special Agent (3 February 2000).
10 City officials are confident that these plans would serve well in an unconventional terrorist attack. Interviews with
author: Director, County Emergency Management (21 September 2000); Battalion Fire Chief/Special Operations Officer (25
May 2000); Emergency Management Specialist, Office of Emergency Management (9 May 2000); MMRS Coordinator, Fire
Department (9 May 2000); District Fire Chief, EMS Division (2 March 2000); Deputy Fire Coordinator, Emergency
Preparedness and Disaster Services (3 February 2000); Battalion Fire Chief, (19 January 2000); Lieutenant/Hazmat Operations,
Fire Department, (27 July 1999); Fire Chief (6 April 1999); Deputy Fire Chief (23 March 1999); Emergency Preparedness
Director, Office of Emergency Services (9 February 1999).
206 Ataxia: The Chemical and Biological Terrorist Threat and the US Response
with other high-risk sites (e.g., government buildings, Planned Parenthood clinics).11 These sites
disproportionately receive threats of all types. As noted in chapter 2, the incidents involving chemical and
biological substances were mostly non-credible threats, but some have resulted in minor injuries from
materials like butyric acid.12
LOCAL BLUEPRINTS FOR RESPONDING TO A
CHEMICAL TERRORIST ATTACK
Getting A Smart Start
When a noxious substance is in the air, it often creates victims and panic. Emergency responders
increasingly understand that after a chemical terrorist attack they would encounter chaos and could
themselves be overcome by toxic fumes. Since 911 calls often bring police to the scene moments before
firefighters, police have been nicknamed the "blue canaries." This label is a macabre reference to the fact
that soldiers and miners used to carry the caged yellow birds to detect the presence of poison gases. The
number of first responders injured would depend largely upon any warning they might get en route and their
training and awareness of the consequences of chemical agent exposure.13
Time and again, the importance of how 911 call receivers and dispatchers handle their duties has
been demonstrated. Emergency call receivers ascertain the scope of an emergency and whether its cause is
readily understood (e.g., gunshot, explosion), and, accordingly, forewarn rescuers when extra caution should
be used. The alertness of 911 call receivers and dispatchers to the signals of a toxic event would therefore
11 Cities applying for a Justice Department equipment grant are required to conduct an analysis of all of their high-risk
sites. In addition to preparing contingency plans for these sites, one city sent the terrorism awareness tapes to all of the sites on
its list. Interviews with author: Battalion Fire Chief, Special Operations (25 May 2000); Fire Commander (19 April 1999).
12 On the preponderance of hoaxes, see the end of chapter 2. Also, Paul de Armond, "Right Wing Terrorism and
Weapons of Mass Destruction: Motives, Strategies and Movements," in Hype or Reality? The "New Terrorism" and Mass
Casualty Attacks, ed. Brad Roberts (Alexandria, Va.: Chemical and Biological Arms Control Institute, 2000); T. Trent Gegax and
Mark Hosenball, "The New Bomb Threat," Newsweek, 22 March 1999, 36; Jason Pate, Center for Nonproliferation Studies,
Monterey Institute for International Studies, "Anthrax Hoaxes in the United States," forthcoming 2001.
13 Police are not the only first responders likely to rush in and be injured in such circumstances. One city conducted a
no-notice, mass casualty drill fifteen years ago mocking the release of an organophosphate chemical. Exercise officials ruled the
first fire engine and EMS companies to arrive "dead" of exposure to the hazardous material. Interview with author:
Physician/Associate Director, Hospital Department of Emergency Medicine (9 March 1999). Theoretically, firefighters are better
equipped and trained to cope with this situation since they have self-contained breathing apparatus. However, firefighters also
took considerable "casualties" in a drill mocking the release of sarin in New York City's subway system in June 1995. The
author has reviewed the videotape of this exercise, conducted at the station located at East 14th Street and 1st Avenue. Interviews
with author: former EMS Supervisor/Paramedic (12 July 2000); Project Manager, Emergency Management Planning, Office of
Emergency Management (27 July 1999). In the 20 March 1995 sarin attack in Tokyo, roughly 10 percent of the first responders
were injured, although none seriously. For more detail, see chapter 3.
Chapter 6 Metropolis, USA: Progress, Pitfalls in Front-line Readiness 207
be a crucial factor in limiting injuries among the first rescuers.14 One veteran firefighter described the 911
dispatcher as "the most important person there is in an unconventional terrorist event" because that person's
quick thinking could save the lives of victims and responders alike.15 Nonetheless, the domestic preparedness
training touched lightly on the role of the 911 centers.16 Figure 6.2 diagrams one city's 911 protocol.
Should a caller report numerous choking, seizing victims, a properly trained 911 dispatcher would
advise the police, fire, and Emergency Medical Service (EMS) units directed to the site of a possible toxic
hazard. Next, the dispatcher would follow standard operating procedures, proceeding down a call list to roll
out other units that may be required, particularly the hazmat team.17 In other words, 911 operators could get
a response off to a smart start. For the time being, however, in many cities rescuers could arrive at an
incident scene with minimal warning and information because 911 staffs have not consistently received
tailored training or standard operating procedures.18
14 The rule of thumb is that one or two people down may be suffering heart attacks or seizures, but any time there are
multiple casualties on the ground for unclear reasons, an unknown gas present may be present. Interviews with author: Deputy
Director, Office of Emergency Management (27 July 1999); Police Commander and Police Captain, Special Operations Division
(23 March 1999); Battalion Fire Chief (8 February 1999). One state has drafted a pocket guide that is aboard all of its first
response units and enumerates the steps to be taken in such circumstances. Interview with author: Captain, State Highway Patrol
(22 April 1999).
15 Interview with author: Fire Captain/Assistant Emergency Management Coordinator (5 January 2000). Seconding the
importance of well-trained dispatchers: Director, Emergency Management Division, County Department of Public Safety (19
September 2000).
16 The manual's broad instructions are that the operators and dispatchers need to recognize verbal descriptions of an
attack and unusual trends, know what questions to ask, alert the appropriate responders, and provide them with safety guidance.
"Responder Actions," in Domestic Preparedness Training: Responder Awareness Course, Instructor Guide, Booz Allen &
Hamilton Inc., Science Applications International Corporation, EAI Inc., and Disaster Planning International, Inc. (1998), 30.
17 Given the prevalence of toxic hoaxes over the past couple of years, 911 staff should also have standard operational
procedures for toxic threats. One city dispatches a police car and supervisor to the scene, notifying the fire department and FBI
of the situation. If the initial responders locate a device, the bomb squad is called, the on-scene command is turned over to the
hazmat chief, and the fire chief is informed of the situation. Interviews with author: Police Commander and Police Captain,
Special Operations Division (23 March 1999). When an untrained dispatcher at one 911 center took a call about the receipt of a
letter supposedly containing anthrax, both the dispatcher and the supervisor gave the call a routine priority. The responding
police officer, also untrained and unfamiliar with anthrax, became a "victim." Afterwards, emergency officials concluded that
everyone in the response chain needed awareness training, standardized notifications, appropriate response assets identified
beforehand, and clearly delineated agency responsibilities. Interview with author: Fire Chief (6 April 1999). When an anthrax
hoax letter ended up in Phoenix, the rescuers' response terrified the victims, cost the company involved $43,000 in lost
productivity, and ran the city $40,000 for police, fire, and laboratory testing. Kerry Fehr-Snyder, "It Was a Day I Will Never
Forget," Arizona Republic, 15 February 2000. The problem of "overresponding" is also discussed in chapter 2, footnote 181.
18 As noted in chapter 5, just under half of the respondents answered negative when asked if their 911 personnel had
been trained. Moreover, such training does not ensure that 911 operators will handle this type of incident well. In one city, just
a week after 911 dispatchers and their supervisors received awareness training, a caller reported over a dozen casualties and an
unknown gas in a shipping mall, but the 911 dispatcher did not call the hazmat unit or warn responding paramedics of the
possible presence of a toxic substance. Interview with author: Paramedic Operations Supervisor (9 March 1999).
Figure 6.2: Example 911 Protocol for a Mass Casualty Incident Involving Hazardous Materials
CALL TAKER RESPONSIBILITIES KEY QUESTIONS TO ASK CALLER
* Ask series of specific questions about the nature of the incident -What type of facility is involved?
* Instruct caller to: -How many people are involved?
-leave product where it is to prevent further contamination -What are their signs and symptoms?
-evacuate immediate area -What type of substance is involved (e.g., gas, liquid)?
* Dispatch a first alarm plus hazmat response, going to a tactical channel -Where in the structure is the substance?
and forwarding details from caller and advising of possible nuclear, -Was anything unusual seen happening?
biological, chemical/mass casualty incident -What are the surroundings?
-Are any odd packages, containers, or bottles in the area?
-What do they look like?
-Are there any pools of liquid or powder on the ground?
-Are there any clouds or fog?
-Was there an abnormal smell? What did it smell like?
FIRST ALARM HAZMAT REQUIREMENTS -Was anyone using a spray device?
* 2 pumpers -Is there a fire or was there an explosion?
* 1 ladder -Was the caller exposed to the substance?
* 2 rescues -Are there any dead animals, birds, or insects?
* All hazmat -Where can rescuers meet the caller?
* 2 battalion chiefs
* Decontamination assistance from other units
* Activate mutual aid hazmat team
CHIEF DISPATCHER RESPONSIBILITIES
* Activate MMST and request personnel to respond or contact dispatch
* Make appropriate fire department notifications
* Contact fire department public information officer for media alert
* Advise ambulance service of incident and potential resource needs
* Notify Red Cross and/or Salvation Army
* Arrange for food and shelter for victims and emergency workers
DISPATCH OPERATIONAL ADJUSTMENTS
* Isolate tactical channel
* Clear additional channels for use IF EMERGENCY OPERATIONS CENTER
* Activate call for all staff chiefs to respond for support ACTIVATED
* Call out additional dispatch staff * Assign callback supervisor and a dispatcher to
* Prepare for emergency operations center activation emergency operations center
* Provide personnel for dedicated customer service coverage * Once operational, transfer tactical radio operations
* Request additional public information assistance to emergency operations center to free up
* Bring in additional communications staff to maintain regional dispatch for other calls
coverage, activate emergency deployment procedures, and * Bring in additional dispatch support as needed
possibly call back field personnel
Source: City Fire Department, Dispatch and Deployment Procedures Protocol (June 1999).
Chapter 6 Metropolis, USA: Progress, Pitfalls in Front-line Readiness 209
Beginning to Wrest Order From Chaos
As the closest rescue units arrive on the scene, responders might observe important signs of a toxic
threat, such as dead birds and other small animals, not just choking people. To avoid becoming victims
themselves, the initial rescuers may decide that their best course of action would be to withdraw and call for
units properly equipped to operate in a toxic environment. Circumstances would dictate whether front-line
units could and should attempt rescue operations.
Once the general nature of the emergency is recognized, the senior fire or hazmat officer on the scene
would probably assume command responsibility until all victims who can be rescued are saved. The incident
commander would bear the burden of making a series of critical decisions in rapid-fire succession.19 This
individual's first priority would be to figure out how to keep things from getting worse, so he must quickly
size up the situation, taking into consideration the type of venue and estimating how many people were
harmed.20 As a matter of priority, he would request the city's hazmat squad, of which there are some six
hundred across the country.21 If a city had a Metropolitan Medical Response System (MMRS) team, this unit
and any inventory of personal protective gear and specialized detection, decontamination, and rescue
equipment would also be called to the scene, along with bomb and special weapons and tactics (SWAT)
teams.22 In the interim, the incident commander would begin examining the bare-bones options of how to
rescue victims. Initial rescue decisions would be driven by the number of moving, viable victims and how
quickly additional personnel and special equipment could get there, among other factors. Within minutes,
responding agencies would establish command posts. Ideally, a unified incident command post collocating
personnel from all responding agencies would form, a safe distance upwind and, if possible, uphill from the
"hot zone," where the toxic hazard might persist.23 As assorted rescuers arrive, the incident commander
19 An incident commander can use one of several decision management systems in this regard, including DECIDE, the
8-Step Process©, GEDAPER©, and HAZMAT Strategic Goals. These managerial tools are summarized in Chris Hawley,
Hazardous Materials Response & Operations (Albany, NY: Delmar, Thomson Learning, 2000), 124.
20 Interviews with author: Hazmat Coordinator/Instructor (8 September 2000); MMRS Coordinator, Fire Department (9
May 2000); Fire Captain/Assistant Emergency Management Coordinator (5 January 2000); Battalion Fire Chief/Emergency
Services Administrator (15 November 1999); Police Commander and Police Captain, Special Operations Division (23 March
1999).
21 General Accounting Office, Combating Terrorism: Use of National Guard Response Teams Is Unclear
GAO/NSIAD-99-110 (Washington, DC: US General Accounting Office, May 1999), 2.
22 Interviews with author: Battalion Fire Chief, Special Operations (25 May 2000); District Fire Chief, EMS Division
(2 March 2000); Fire Captain/Assistant Emergency Management Coordinator (5 January 2000); Deputy Director, Office of
Emergency Management (27 July 1999); Police Commander and Police Captain, Special Operations Division (23 March 1999).
23 Interviews with author: Hazmat Coordinator/Instructor (8 September 2000); MMRS Coordinator, Fire Department (9
May 2000); Fire Captain/Assistant Emergency Management Coordinator (5 January 2000); Battalion Fire Chief/Emergency
Services Administrator (15 November 1999); Police Commander and Police Captain, Special Operations Division (23 March
1999). The bombing of the Murrah Building in Oklahoma City occurred at 9:02am. The shift commander of the fire department
began setting up a command post between 9:05 and 9:08am, a block away from the incident site. Also at 9:08am, emergency
210 Ataxia: The Chemical and Biological Terrorist Threat and the US Response
would ask them to accomplish several tasks simultaneously or in quick succession, as the following
paragraphs describe. After such an attack, these tasks would be very difficult even for well-equipped and
drilled responders.
Hazard Assessment
To identify and assess the concentration of the toxic substance, the incident commander would insert
a small reconnaissance team. Circumstances would determine whether firefighters outfitted in maximum
protective gear-level A-or in self-contained breathing apparatus (SCBA) and taped-down bunker gear
should take on this task.24 The team would activate detectors and take a quick look around, observing the
victims' symptoms and behavior, before withdrawing to brief the incident commander so that an appropriate
response plan could be devised.25
Ideally, this team would be equipped with a combination of detectors to provide a general
characterization of the hazardous threat within moments.26 As noted in chapter 5, some emergency
responders were not confident that they purchased the best detection equipment. Some cities would employ
medical services was establishing a command post on the same street, a block away from the fire command post. Police ordered
their mobile command post to the scene at 9:19am, with the vehicle arriving at the fire command post at 9:31am. Alfred P.
Murrah Federal Building Bombing April 19, 1995: Final Report, The City of Oklahoma City (Stillwater, Okla: Fire Protection
Publications, Oklahoma State University, 1996), 3656.
24 Defense Department-sponsored tests show that turnout gear and SCBA will provide sufficient protection to enter the
hot zone for a time ranging from two to thirty minutes. If an unknown nerve agent or suspected mustard gas is present, taped
down turnout gear with SCBA will protect the wearer for two to three minutes. For this type of insertion, firefighters would use
duct tape to secure their bunker gear at several different places to reduce the possibility of skin exposure to agent. Guidelines for
Mass Casualty Decontamination During a Terrorist Chemical Agent Incident (Aberdeen, Md.: US Army Soldier and Biological
Chemical Command, January 2000), 710.
25A reconnaissance team is not likely to confront any suspected terrorists that remain at the site or to rescue victims
since it could consist of as few as two individuals. Interviews with author: Hazmat Coordinator/Instructor (8 September 2000);
Battalion Fire Chief, Special Operations (25 May 2000); MMRS Coordinator, Fire Department (9 May 2000); Deputy
Coordinator, Fire Emergency Preparedness and Disaster Services (3 February 2000); Police Detective/Bomb Squad member (19
January 2000); Fire Captain/Assistant Emergency Management Coordinator (5 January 2000); Battalion Fire Chief/Emergency
Services Administrator (15 November 1999); Battalion Fire Chief (15 November 1999); Police Commander and Police Captain,
Special Operations Division (23 March 1999).
26 Several types of chemical agent sensors could be employed, including the APD-2000 handheld monitor from
Environmental Technologies; the SAW mini-CAD from Microsensor Systems, Inc; the IQ-1000 multi-gas detector from
International Sensor Technology; and detector tubes from Draeger. These detectors are multi-purpose. For example, the SAW
mini-CAD also detects a few industrial chemicals, and the APD-2000 detects pepper spray and mace. Other detectors purchased
through the federal grant programs included the M256 chemical detection kit from Truetech, Inc. and M-8/M-9 chemical
detection papers from Tradeways, Ltd.
Chapter 6 Metropolis, USA: Progress, Pitfalls in Front-line Readiness 211
a robot for this reconnaissance task.27 The goal at this point would be to identify the chemical family
involved so that the level of personal protective gear for rescue operations could be set and guidelines
established for the initial medical treatment of casualties. Exact identification of the agent characteristics,
which is important for criminal prosecution, could be obtained later through laboratory analysis.28
After launching the hot zone assessment, the incident commander would seek other information to
inform his decisions. If available, the incident commander would activate mobile weather analysis and
computerized plume modeling capabilities to aid in setting the perimeters of the hot zone, the warm zone
where decontamination and initial triage would occur, and the cold zone where personnel could presumably
operate without protective gear.29 Based on such information, the incident commander would establish triage
and decontamination areas as well as the transportation corridor(s) for emergency response units.
Throughout rescue operations, he would evaluate progress and adjust plans as necessary.30
Establishing Perimeter Control of the Disaster Scene
Initially, the incident commander would set the exclusion zone conservatively and thus quite widely.
The purpose of a perimeter is to establish firm, complete control of who enters and exits the disaster area.
A first cut at this task could be quickly accomplished with crime scene tape. Refinement of the perimeter
27 A robot can be a time-saving option because people must don protective gear. One city equipped their robot with a
SAW mini-CAD that feeds data back to the command truck. Other cities have opted for the APD-2000 and a video camera.
These robots could also be used to drag victims out of a hot zone. Interviews with author: Fire Captain/Assistant Emergency
Management Coordinator (5 January 2000); Emergency Preparedness Director, Office of Emergency Services (9 February 1999);
Special Projects Program Manager, Department of Public Health (5 February 1999).
28 Interviews with author: Hazmat Coordinator/Instructor (8 September 2000); Firefighter/Hazmat Instructor/Paramedic
(28 June 2000); FBI Special Agent (19 June 2000); FBI Special Agent (16 May 2000); Emergency Preparedness Director, Office
of Emergency Services (9 February 1999); Fire Captain, Hazmat Unit (9 February 1999).
29 In addition to plume projections, some computerized modeling systems can also forecast how many people may have
been injured or killed and how many are likely to be affected by the plume, depending upon the estimated population in the
affected area at different times of the day. Some cities have weather stations atop their hazmat vehicles or at various points
around the metropolitan area. Up-to-the-minute weather data can also be obtained from a variety of other sources, ranging from
the local airport to the National Weather Service. Interviews with author: Deputy Coordinator, Fire Emergency Preparedness and
Disaster Services (3 February 2000); EMS System Analyst/Paramedic, State Department of Health and Social Services (25
January 2000); Police Detective/Bomb Squad member (19 January 2000); Project Manager, Emergency Management Planning,
Office of Emergency Management (27 July 1999); Emergency Preparedness Director, Office of Emergency Services (9 February
1999).
30 Interviews with author: Fire Captain/Assistant Emergency Management Coordinator (5 January 2000); Hazmat
Coordinator/Instructor (8 September 2000); MMRS Coordinator, Fire Department (9 May 2000); Battalion Fire Chief (19
November 1999); Battalion Fire Chief/Emergency Services Administrator (15 November 1999); Police Commander and Police
Captain, Special Operations Division (23 March 1999).
212 Ataxia: The Chemical and Biological Terrorist Threat and the US Response
zones would depend on the type of chemical involved, and better perimeter control could be achieved
gradually with additional personnel and physical barriers.31
Promptly establishing a perimeter is important to hold the number of victims to a minimum and
enable rescuers to do their jobs without undue interference. News crews monitor the emergency
communications frequencies and could quickly get to the scene, sometimes even before key response
squads.32 Continuous, live television broadcasts of the Murrah Building in Oklahoma City began twelve
minutes after the 19 April 1995 bombing.33 Some reporters would view such a disaster as a career-making
story and might be willing to do practically anything to obtain spectacular images or insider interviews for
live reports. The media's behavior could jeopardize their own health and also impede rescue operations in
the early moments critical to victims' survival. Citizens who believe that family members or friends could
be victims would also have to be kept at a safe distance, and responders would need to corral those trying
to flee the scene because exposure to toxic chemicals can cause serious health effects.34
Whether in small accidents or full-fledged disasters, police routinely establish and hold the perimeter
zone. Police are accustomed to acting independently, using basic skills to assess each situation, creating an
operational plan as they go, and calling in more personnel as needed.35 When a toxic substance is the cause
of the disaster, however, police have, with good reason, expressed doubts about their ability to fulfill
perimeter duties. A badge and a gun offer no protection under these circumstances, and most patrol officers
nationwide have little equipment or training to protect them from exposure to hazardous substances.
Depending upon their department's assets and policies, beat cops may lack even riot control masks, which
provide insufficient protection against super toxic chemicals. Therefore, some patrol officers worried about
the exposure risk should the wind shift while they were on perimeter detail. They were wary that police
31 Seattle firefighters demonstrate the crime scene tape perimeter in the instructional video "Weapons of Mass
Destruction and The First Responder." (Washington, DC: Department of Justice, Office of Justice Programs, 2000). During a
disaster, initial chaos and the impulse to rescue victims can delay setting of the perimeter. At 9:28am on 15 April 1995, just over
twenty-five minutes after the bombing of the Murrah Building, Oklahoma City police began to establish crime scene perimeters.
Outer perimeter control was secured at 11:20am. Final Report of the Alfred P. Murrah Federal Building Bombing, 3667. Some
chemical agents (e.g., mustard, soman, VX, tabun) can persist in the contaminated area for days under temperate conditions,
while others (e.g., phosgene, hydrogen cyanide) will dissipate within a few minutes. Frederick Sidell, Ernest Takafuji, David
Franz, eds., Medical Aspects of Chemical and Biological Warfare: Warfare, Weaponry and the Casualty (Washington, DC: US
Army, Office of the Surgeon General, 1997), 13942, 198200. Also, interviews with author: Fire Chief (15 May 2000);
Battalion Fire Chief (15 November 1999); Deputy Director, Office of Emergency Management (27 July 1999).
32 For instance, one city's SWAT and bomb units responded to a 911 call reporting a possible school shooting incident
to find eight television news cameras already at the school. Interview with author: Police Detective/Bomb Squad member (19
January 2000).
33 Final Report of the Alfred P. Murrah Federal Building Bombing, 366.
34 Interviews with author: Police Lieutenant, Tactical Support Office (18 September 2000); District Fire Chief, EMS
Division (2 March 2000); Battalion Fire Chief (15 November 1999).
35 Interview with author: Police Detective/Bomb Squad member (19 January 2000).
Chapter 6 Metropolis, USA: Progress, Pitfalls in Front-line Readiness 213
supervisors confronting this novel situation could bobble instructions to line officers. Also, some officers
predicted that off-duty police beeped to report as reinforcements might ignore the page if they knew poison
gas had been released.36
Some perimeter strategies have been devised to take regular patrol officers out of harm's way.
Instead of police, some cities plan to assign hazmat and fire crews to establish scene control initially.37
Other cities have found a viable way for police to assume their normal perimeter control duties in these
circumstances without incurring the expense of training and equipping patrol officers for level A
operations. This approach is described in box 6.1. If special police units were deployed on the warm
zone perimeter, regular officers could be stationed at the cold zone perimeter positions-those upwind
and crosswind of the hot zone-where they would be unlikely to encounter concentrations of toxic material
Box 6.1: Assigning Special Police Units the Perimeter Control Mission
Instead of relying on regular uniformed officers, SWAT and special operations police can be
posted on the perimeter in the event of a terrorist attack using chemical agents. These special units
are accustomed to taxing missions, so some cities have trained and equipped them with level B
protective gear to hold the warm zone perimeter.1 In a variant of this approach, another police
department has prepared a trio of officers and a sergeant in each of its districts to report to the scene
immediately, appropriately equipped and trained to operate in the warm zone. This concept spreads
the requisite resources throughout the city to enable a quick, if modest, response. Special operations
police, also level B trained, will augment the early deployment teams to flesh out perimeter control
capabilities.2
NOTES
1. Interviews with author: Deputy Director, Office of Emergency Management (26 May 2000); Deputy Coordinator, Fire
Emergency Preparedness and Disaster Services (3 February 2000); Police Captain/Firing Range Director (5 February 1999).
In an adaptation of this approach, one city is recruiting 130 volunteers from its patrol officers to serve as a standing unit for
perimeter duty in level B protective gear. Interviews with author: Police Detective/Bomb Squad member (19 January 2000).
Another city is also thinking about outfitting and training its transportation police to level B so that they can assist with the
perimeter. Interview with author: Deputy Coordinator, Fire Emergency Preparedness and Disaster Services (3 February
2000).
2. Interviews with author: Police Commander and Police Captain, Special Operations Division (23 March 1999).
36 This attitude and aptitude may change in cities that train their police force well and procure protective gear for
officers. Not all departments distribute riot control masks for patrol units. Even in departments that do, officers interviewed said
that several years often pass in which beat cops do not use these masks. Interviews with author: Battalion Fire Chief, Special
Operations (25 May 2000); Director, Emergency Services Department (18 May 2000); EMS System Analyst/Paramedic, State
Department of Health and Social Services (25 January 2000); Police Detective/Bomb Squad member (19 January 2000);
Emergency Preparedness Director, Office of Emergency Services (9 February 1999); Police Lieutenant and Police Captain,
Special Operations Division (8 February 1999); Police Captain/Firing Range Director (5 February 1999).
37 Interviews with author: Fire Chief (15 May 2000); Battalion Fire Chief (15 November 1999); Deputy Director,
Office of Emergency Management (27 July 1999).
214 Ataxia: The Chemical and Biological Terrorist Threat and the US Response
sufficient to cause injury.38
Some police departments have begun to issue patrol officers a reasonable amount of respiratory
protection so that they would be able to go about various cold zone duties with confidence. For example,
the incident commander might ask police to escort special equipment trailers to the area and to bust open
transportation corridors so that rescue vehicles could get to and from the disaster scene.39 Regular patrol
officers are a challenge to equip because they are notoriously tough on their gear, and police departments
are reluctant to train line personnel to use complicated respirators when so many other certifications must
be met.40 Therefore, whatever gear a department chooses needs to be robust, low maintenance, very easy to
use, and suited to the task to be performed. If patrol officers are to be stationed considerable distances away
from the hot zone, then the officers could be outfitted with a high-performance riot control agent mask that
has canisters to filter extremely toxic industrial and even warfare chemicals (e.g., the MSA Millenium
Chemical-Biological and Advantage 1000 masks). This gear choice is multipurpose, but cities were also
weighing other options.41 To provide additional manpower, one city had arranged for area "mini-cops,"
namely the transit police and those who guard empty buildings, to hold the perimeter once the disaster scene
38 Interviews with author: Project Manager, Emergency Management Planning, Office of Emergency Management (27
July 1999); Police Lieutenant (23 March 1999); Emergency Preparedness Director, Office of Emergency Services (9 February
1999); Police Lieutenant and Police Captain, Special Operations Division (8 February 1999); Police Captain/Firing Range
Director (5 February 1999).
39 Note that getting equipment trailers to the scene in a timely fashion is such a concern in one city that their equipment
trailer has been palletized and sling-wrapped. Special arrangements have been made for it to be brought in by helicopter.
Interview with author: Paramedic (12 May 2000). On this police role, comments were also made by: Medical
Toxicologist/Poison Control Center Director (13 June 2000); District Fire Chief, EMS Division, (2 March 2000); Police
Detective/Bomb Squad member (19 January 2000); Project Manager, Emergency Management Planning, Office of Emergency
Management (27 July 1999).
40 Interviewees observed that police habitually toss seldom-used items in the trunks of their patrol cars where they
bounce around, ignored, until the moment they are needed. Interviews with author: Detective/Bomb Squad (19 January 2000);
Fire Captain/Assistant Emergency Management Coordinator (5 January 2000); Police Lieutenant (8 February 1999); Police
Captain, Special Operations Division (8 February 1999). See also the discussion of the new certification point in chapter 5.
41 The Millennium Chemical-Biological Mask is designed for extended periods of wear, equipped with a speaking
diaphragm and drinking tube. In addition to being effective against biological agents, the mask has been tested both by the
manufacturer and independent laboratories, is certified by the National Institute on Occupational Safety and Health for protection
against chloroacetophenone, chlorobenzylidene, P-100 particulate efficiency level and particulates, and meets the chemical
weapon agent protection requirements of the Chemical Agent Safety and Health Policy Action Committee. The canister contains
a high-efficiency particulate air filter and a carbon bed to absorb gases and liquid vapors. The military version of the mask is the
MCU-2/P. The manufacturer's list price for a single mask kit is $297, and the cost to those meeting federal Government Services
Administration qualifications is $167.50. The Advantage® is a less expensive version of the Millennium mask. "Advantage®
1000 CBA-RCA and Millennium Gas Masks," MSA Data Sheet 05-00-03 (Pittsburgh, Pa.: MSA, August 1999). Whereas self-
contained breathing apparatus is imperative for those working inside or in close proximity to the warm zone, some cities are
considering escape-only masks or positive pressure hoods, options that do not require fit tests or annual certification. This type
of gear may be appropriate in situations when the respiratory threat is minimal. Air purifying respirators, which do require a fit
test, are another equipment choice. Some police departments are also putting a couple of Tyvek suits in the trunks of patrol cars.
Interviews with author: Police Lieutenant, Tactical Support Office (18 September 2000); Hazmat Coordinator/Instructor (8
September 2000); Hazmat Trainer/Firefighter/Paramedic (2 August 2000); Paramedic (12 May 2000); Sergeant, Fire Department
(9 May 2000); Fire Captain/Assistant Emergency Management Coordinator (5 January 2000).
Chapter 6 Metropolis, USA: Progress, Pitfalls in Front-line Readiness 215
had been mostly cleared.42 Physical barriers, such as sawhorses or chained-link fencing, could also reinforce
the perimeter.43
One of the dilemmas that police anticipate after a chemical terrorist attack is sheer, utter panic, with
some attempting to bolt the scene and others to aid the wounded. Police officers expressed uncertainty about
the appropriate level of force to be used to hold the perimeter. Although anyone in regular clothes who
entered the contaminated zone could be harmed, police presumed that they would not be authorized to use
physical force. Rather, police guessed they would be told to use verbal orders and psychological persuasion
to try to maintain order. Perhaps, they would be asked to help fire crews hose people down both to
decontaminate them and to discourage them from leaving the area.44 In some jurisdictions, law enforcement
officers have standing authority to use non-lethal force to maintain order during riots or other difficult
circumstances.45 Elsewhere, police departments had yet to clarify use of force policies for exigent situations
involving large numbers of terrified, confused, and desperate people.
Other Law Enforcement Missions
In addition to perimeter control, police would be asked to attend to the security of the rescuers.
SWAT teams would be on the lookout for snipers and other signs that terrorists might still be at the scene.
Given the need for SWAT teams to have tactical and tactile agility to operate in a potentially hostile
environment, cities were making different decisions about what level of personal protective clothing these
42 Deploying mini-cops, who have a certain amount of academy training and are licensed by their local law enforcement
authority, can free up police officers to answer regular 911 calls. Interviews with author: Police Commander and Police Captain,
Special Operations Division (23 March 1999).
43 Just over three hours after the Oklahoma City bombing on 19 April 1995, chained-link fencing was brought to the
scene for more effective perimeter control. By 4:30 on the afternoon of the bombing, personnel from the Oklahoma City Police,
County Sheriff's Office, and Departments of Military Personnel and Public Safety had met to establish around-the-clock staffing
rotations for an eighteen-square-block area around the Murrah building. After Action Report: Alfred P. Murrah Federal Building
Bombing (Oklahoma City, Okla.: Oklahoma Department of Civil Emergency Management, n.d.), 15.
44 For instance, those trying to depart might be told where they should gather to be decontaminated, receive medical
assistance, and be reunited with their companions. Giving people the information they want can have a calming effect,
convincing people that they will get the help they desire by remaining at the scene. Also, should police and fire crews promptly
begin to hose down the victims, the water pressure should be low and caution exercised if the temperature is cold. Interviews
with author: Director, Emergency Management Division, County Department of Public Safety (19 September 2000); Police
Lieutenant, Tactical Support Office (18 September 2000); Hazmat Coordinator/Instructor (8 September 2000); District Fire
Chief, EMS Division (2 March 2000); Police Detective/Bomb Squad member (19 January 2000); Fire Captain/Assistant
Emergency Management Coordinator (5 January 2000); Project Manager, Emergency Management Planning, Office of
Emergency Management (27 July 1999); Police Captain/Firing Range Director (5 February 1999).
45 During one city's chemical functional exercise, local police officers shocked some by firing non-lethal weapons at
those trying to breach their perimeter. Interview with author: Fire Captain/Assistant Emergency Management Coordinator (5
January 2000).
216 Ataxia: The Chemical and Biological Terrorist Threat and the US Response
teams would wear in a contaminated setting.46 The incident commander would also probably order the bomb
squad to search for other toxic or explosive boobytraps.47 Terrorists have been known to plant additional
bombs to injure the initial responders and cause further havoc.48 Such tactics can have a demoralizing effect
on the rescuers and reduce the public's confidence in the government's ability to handle such situations if
additional people are injured. Until SWAT and bomb squads declare the scene free of such hazards, the
incident commander would try to minimize the number of rescuers involved.
Dealing with the second device issue under the pressure of a disaster rescue is easier said than done.
During one city's full chemical drill, the responders got so caught up in the rescue that they forgot to look
for the dummy secondary device.49 In the second hour of the rescue at the Murrah Building in Oklahoma
City, at least two bomb scares forced rescuers to retreat, the incident command post to be relocated, and
rescue operations to be suspended until the "all clear" was given.50 To enable faster, more effective searches,
bomb squads and hazmat teams in several cities have begun cross-training, and some have begun routinely
deploying together on calls to improve operational efficiency.51
Next, police would also be mindful that while lifesaving efforts take precedence over criminal
investigation, preservation of evidence is of key importance. Particularly once decontamination of victims
begins, key pieces of evidence could be compromised or lost entirely. Depending upon local capabilities,
the incident commander might instruct the bomb squad or another unit trained in toxic evidence collection
46 One city is putting its SWAT team in level A after tests that showed that they could still hit targets in a slightly larger
area than they would in their regular gear. Interview with author: Paramedic (12 May 2000). In 1997, another police department
put its SWAT team in level As and found that they were unable to fire their guns with sufficient precision. Therefore, they
concluded that their SWAT team would use level Bs and SCBA. Interview with author: Lieutenant/Hazmat Commander (10
March 1999). Also on level Bs for SWAT teams: Police Lieutenant, Tactical Support Office (18 September 2000); Hazmat
Instructor/Firefighter/Paramedic (2 August 2000); Deputy Director, Office of Emergency Management (26 May 2000); Project
Manager, Emergency Management Planning, Office of Emergency Management (27 July 1999).
47 Interviews with author: Police Lieutenant, Tactical Support Office (18 September 2000); Hazmat
Coordinator/Instructor (8 September 2000); Deputy Director, Office of Emergency Management (26 May 2000); Battalion Fire
Chief, Special Operations (25 May 2000); Paramedic (12 May 2000); District Fire Chief, EMS Division (2 March 2000); Deputy
Coordinator, Fire Emergency Preparedness and Disaster Services (3 February 2000); Battalion Fire Chief (15 November 1999);
Physician/EMS Medical Director (13 November 1999).
48 Alan Sverdlik, "Blasts Rock Atlanta Abortion Clinic; At Least 7 People Slightly Injured in Explosions 45 Minutes
Apart," Washington Post, 17 January 1997.
49 Interview with author: General Manager, Emergency Department (22 September 2000); Physician, Hospital
Emergency Department (11 May 1999).
50 While bomb squads combed the site, rescue efforts were suspended from 10:28am to 11:22am. After Action Report:
Alfred P. Murrah Federal Building Bombing, 2, 14; Final Report of the Alfred P. Murrah Federal Building Bombing, 3678.
51 Interviews with author: Police Lieutenant, Tactical Support Office (18 September 2000); Paramedic (12 May 2000);
Battalion Fire Chief (15 November 1999); Chief of Response Division, State Department of Civil Emergency Management (13
April 1999); Police Lieutenant (23 March 1999); Police Commander and Police Captain, Special Operations Division (23 March
1999); Paramedic/Emergency Planner, Public Health Department (4 February 1999).
Chapter 6 Metropolis, USA: Progress, Pitfalls in Front-line Readiness 217
to protect or gather evidence using equipment especially designed for toxic crime scenes.52 The skills of
toxic evidence collection are unfamiliar to many metropolitan police departments. Successful prosecution
of the perpetrators would depend upon proper collection and analysis of samples and other evidence, as well
as strict observance of chain-of-custody rules for that material. Police would also want to get contact
information for victims and witnesses to facilitate interviews. As soon as is practicable, the incident
commander would notify the nearest Federal Bureau of Investigation (FBI) office of the circumstances. The
FBI would dispatch evidence collection personnel who can operate in a hot zone.53 At the conclusion of
rescue operations, site command would transition to law enforcement authorities.
A final chore that would draw upon police resources relates to whether the situation merited the
sheltering-in-place or rapid evacuation of some citizens. If a significant toxic cloud were present, police
would be directed to ask people in the immediate downwind area to remain indoors until the hazard had
passed or dissipated.54 Further downwind from the disaster scene, citizens might be evacuated. Most cities
and all states have evacuation plans, but their gaping defects have surfaced when these plans were activated.
For example, when Hurricane Floyd struck the southern coastal states in mid-September 1999, governors in
Florida, Georgia, and South Carolina ordered the evacuation of coastal regions. Routes inland turned into
parking lots, and for some the traffic jams lasted up to seventeen hours.55 Experience has shown that just
52 Isolating and collecting contaminated evidence requires special procedures and equipment that not all local police
departments have. SWAT and explosive ordnance disposal (EOD) teams are being trained in some cities to undertake this task.
Interview with author: Director, County Emergency Management (21 September 2000); Police Lieutenant, Tactical Support
Office (18 September 2000); FBI official (1 August 2000); Battalion Fire Chief/Special Operations Officer (25 May 2000); FBI
Special Agent (16 May 2000). Barrier Products, LLC began fabricating special contaminated evidence kits after the collective
suicides of Heaven's Gate cult members in March 1997. The kits, called Portable BioSeal Facility Systems, include a roll of
polyaluminum foil-Tyvek laminate wrapping material, that when welded shut with a heated unit forms a sealed containment
package around contaminated items, fully isolating any associated hazardous gases or liquids. For further information, see the
Barrier Products website at: http://www.bioseal.com.
53 As chapter 4 describes, the FBI's Hazardous Materials Research Unit is trained and equipped specifically for this
task. Some FBI field offices are also acquiring the capability to perform evidence collection in a contaminated area. FBI
personnel in one city trained local firefighters to collect evidence in a contaminated zone. Interview with author: Battalion Fire
Chief, Special Operations (25 May 2000).
54 Sheltering-in-place involves shutting off air handling systems, closing all windows and doors, and tuning to local
emergency or news outlets for official notifications of when it is safe to go outside. Hawley, Hazardous Materials Response &
Operations, 1302. Coordinator/Instructor (8 September 2000).
55 Hurricane Floyd was by no means the only time that citizens have cursed the evacuation more heartily than the
original misfortune. The evacuation orders put some two million Floridians, 500,000 Georgians, and 800,000 South Carolinians
on the road at roughly the same time. Authorities eventually recognized that they could relieve some of the congestion by
turning two-way highways into one-way highways headed inland. Bruce Henderson, Scott Dodd, and David Perlmutt, "Millions
on Run From Fierce Floyd," Charlotte Observer, 15 September 1999; Schuyler Kropf, "Evacuation Traffic Jam Sparks Anger in
S. Carolina," Reuters, 15 September 1999; Alan Judd, "Highways Clogged, Hotel Rooms Scarce," Atlanta Journal- Constitution,
15 September 1999; Lynne Langley, Arlie Porter, and Robert Behre, "Lowcountry Lies in Path of Hurricane," Charleston Post
and Courier, 15 September 1999.
218 Ataxia: The Chemical and Biological Terrorist Threat and the US Response
having a plan on paper is a far cry from having an effective evacuation plan.56 By all indications, police
would have difficulty organizing and implementing a large-area evacuation on short notice.
Rescue Operations
The crux of a disaster scene is rescue operations. The incident commander's natural choice for hot
zone rescuers would be a city's hazmat squad, but, as needed, some cities reported plans to insert SWAT and
EMS personnel to help extricate victims.57 Should the hazard assessment mandate level A suits, rescuers
noted that putting on this gear consumes time. A widely held misperception about a regulatory requirement
for a pre-insertion medical check-up exacerbated rescuers' worries about this time lag. This
misunderstanding was so pervasive that even very experienced firefighters made impassioned pleas that it
be waived if lives were at stake.58 To set the record straight, Occupational Safety and Health Administration
(OSHA) regulations do not stipulate pre-entry health monitoring (e.g., blood pressure), but they do specify
medical check-ups at other times and good safety practice would always incorporate an exam as personnel
exit the hot zone.59 For those still concerned about running afoul of OSHA regulations, box 6.2 describes
a pragmatic time-saver to speed rescues in level A gear.
Given the urgency of administering antidotes to victims exposed to poison gas, several experienced
rescuers strongly advocated the use of snatch-and-grab tactics to extricate victims with the utmost haste.60
56 Interview with author: Police Lieutenant, Tactical Support Office (18 September 2000); Police Lieutenant (23 March
1999).
57 Some cities are sending hazmat squads only into the hot zone. Interviews with author: Director, Emergency Services
Department (18 May 2000); Fire Chief (15 May 2000); Emergency Management Specialist, Office of Emergency Management (9
May 2000). Other cities will also send in EMS personnel to help with the rescue. Interviews with author: Police Lieutenant,
Tactical Support Office (18 September 2000); Police Detective/Bomb Squad member (19 January 2000); Physician/EMS
Medical Director (13 November 1999). On deploying SWAT team members for hot zone rescue: Paramedic (12 May 2000);
Project Manager, Emergency Management Planning, Office of Emergency Management (27 July 1999).
58 With regard to foregoing the level A medical exam, they argued, no one expects police on patrol to stop and put on
eye protection and ear plugs before they fire their gun, even though they are required to do so at the firing range. Interviews with
author: Chief, County Fire Department (9 September 1999); Battalion Fire Chief (9 February 1999); Fire Captain, Hazmat Unit
(9 February 1999).
59 OSHA Regulation 1910.134 specifies that hazmat personnel receive an annual physical, or, at the discretion of the
physician, a biannual checkup. In addition, regulations also require that EMS personnel be standing by for medical assistance
during a hot zone entry. Checkups are required in the event of a chemical exposure injury or an exposure to a chemical above the
permissible exposure limit. Hawley, Hazardous Materials Response & Operations, 10.
60 Interviews with author: Battalion Fire Chief (9 February 1999); Fire Captain, Hazmat Unit (9 February 1999). One
county has put four high-level protection suits on each fire truck so that front-line personnel can perform snatch-and-grab.
Interview with author: Chief, County Fire Department (9 September 1999).
Chapter 6 Metropolis, USA: Progress, Pitfalls in Front-line Readiness 219
Box 6.2: Cutting Down on Dress-out Time for Level A Gear
One city's fire department has instituted a policy that can measurably reduce the level A
dress-out time, requiring hazmat personnel to undergo baseline medical checks at the beginning of
every shift. Bypassing blood pressure and other vital sign checks at the scene can cut the suit up time
in half. This city's hazmat squad also conducts daily checks of its specialized detectors, which helps
personnel with equipment familiarization. The hazmat squad is also responsible for routinely
checking the gear on the city's MMRS equipment trailer.1
NOTES
1. Harkening again to the widespread misinterpretation of the regulations on this matter, the veteran firefighter who described
this policy expressed concern that foregoing the field medical exam could lead to an OSHA violation, but that penalty was
deemed acceptable if lives could be saved. Interview with author: Battalion Fire Chief (15 November 1999). Chris Hawley,
Hazardous Materials Response & Operations (Albany, NY: Delmar, Thomson Learning, 2000), 11.
As one battalion chief put it, "If there is a lot to be gained, we'll risk a lot."61 Should the reconnaissance data
reveal a less severe hazard, the incident commander could insert firefighters in SCBA and taped-down bunker
gear into the hot zone to rescue known live victims.62 The risk to snatch-and-grab rescuers could be further
reduced by aiming water hoses with fog nozzles to clear away the ambient hazard. Dousing the rescuers and
victims as they exit the hot zone would also jumpstart decontamination of the victims.63 If the attack
occurred indoors, the vapor hazard could be significantly decreased for victims and rescuers alike by
positioning fans in doorways.64
Decontamination Operations
Decontamination of people exposed to hazardous substances is a multi-step process.65 The layman's
impression is that decontamination significantly affects the survival of victims, but in truth its main purpose
is to protect the health and safety of on-scene rescuers and hospital personnel who are not typically in
61 Interview with author: Battalion Fire Chief, Special Operations (25 May 2000).
62 If nerve agent vapor is present, rescuers in standard turnout gear with SCBA can enter a contaminated building or the
downwind area of a hot zone for thirty minutes. See also, footnote 24. 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 (Aberdeen, Md.: US Army Soldier and Biological Chemical Command, August 1999), 1017.
63 Interviews with author: Deputy Director, Office of Emergency Management (26 May 2000); Fire Captain, Hazmat
Unit (9 February 1999).
64 For example, the concentration of an agent indoors can be reduced by fifty to seventy percent within ten minutes.
Specific instructions on the positioning and size of fans, as well as when to use positive or negative pressure fans, are provided in
The Use of Positive Pressure Ventilation (PPV) Fans to Reduce the Hazards of Entering Chemically Contaminated Buildings:
Summary Report (Aberdeen, Md.: US Army Soldier and Biological Chemical Command, October 1999).
65 The four types of decontamination are emergency, gross, formal, and fine. For a tutorial on the distinctions and how-
to's, see Hawley, Hazardous Materials Response & Operations, 14657.
220 Ataxia: The Chemical and Biological Terrorist Threat and the US Response
protective gear.66 Cities began adopting tactics to get the job done with all possible speed using front-line
fire equipment, and their commonsense approach passed Defense Department-sponsored tests in 1999.
Overturning conventional wisdom about the need for bleach or soap decontamination solutions, studies show
that it would probably be most expedient and effective to use water alone. Taking time to dilute a bleach
solution properly or to add soap could delay the onset of decontamination and cause additional medical
problems.67 The overriding factor in decontamination is to begin as soon as possible.
Weather conditions permitting, firefighters would probably start gross decontamination of the
victims using fog nozzles as soon as hoses were hooked to hydrants. Ladder trucks could raise boom nozzles
to create large area, high-volume, low-pressure outdoor showers or engines could be arranged side-by-side
to set up decontamination corridors. Firefighters would adjust configurations of front-line equipment
according to the number of victims. Well-drilled crews could set up an impromptu decontamination corridor
in fifteen minutes or less. Although the requirements vary depending on the agent used, the initial goal
would be to get victims to shower thoroughly for at least two to three minutes.68 Ideally, victims would be
separated into different holding areas, prioritizing those with more serious exposure symptoms for
decontamination first.69 Firefighters-often dual-trained as emergency medical technicians (EMTs)-could
66 According to a physician who has treated hundreds of chemical agent casualties, not a single one of whom was
decontaminated, the most dangerous exposure risk-vapor-evaporates as the victim moves to the medical treatment area. "By
the time the casualty hits a medical response station, you are not going to do the casualty one bit of good by decontaminating the
casualty's skin. After thirty minutes, that agent is in the skin; mustard is in the skin. The nerve agent has either killed the
casualty, or else there has not been enough on the skin to do any harm." Dr. Fred Sidell, "Chemical Agents: Overview," in
Proceedings of the Seminar of Responding to the Consequences of Chemical and Biological Terrorism, Office of Emergency
Preparedness (Washington, DC: US Department of Health and Human Services, Public Health Service, 11-14 July 1995), page
1-73. See also, page 1-71.
67 Use of bleach solutions is also not advisable for victims with abdominal, thoracic, or neural wounds. Care must also
be taken to avoid areas near the victims' eyes and mucous membranes. Employment of soapy solutions if a blister agent has been
released could also increase the damage such agents can cause. Guidelines for Mass Casualty Decontamination, 56. To mix a
decontamination solution quickly, one city has decided have its firemen dump a product called Pool Shock-stackable,
unbreakable packages of chlorine-into its pumper trucks en route to the incident scene. This simple approach, in the words of
those who described it, obviates the need for measurement and therefore is "fireman proof." Another fast approach that avoids
measurement is to buy bleach in quarts rather than in bulk. Interviews with author: Police Lieutenant (23 March 1999);
Emergency Preparedness Director, Office of Emergency Services (9 February 1999); Battalion Fire Chief (8 February 1999).
68 Interviews with author: Fire EMS Statistician (30 August 2000); Deputy Director, Office of Emergency Management
(26 May 2000); Battalion Fire Chief, Special Operations (25 May 2000); Director, Emergency Services Department (18 May
2000); Fire Chief (15 May 2000); Paramedic (12 May 2000); MMRS Coordinator, Fire Department (9 May 2000); Emergency
Management Specialist, Office of Emergency Management (9 May 2000); District Fire Chief, EMS Division (2 March 2000);
Battalion Fire Chief, (19 January 2000); Fire Captain/Assistant Emergency Management Coordinator (5 January 2000).
Instructions for positioning trucks and ladders for decontamination can be found in Guidelines for Mass Casualty
Decontamination, 713; Hawley, Hazardous Materials Response & Operations, 14855.
69 At first, victims can be separated into ambulatory and non-ambulatory categories. Those who have liquid agent on
their skin or clothing, were closest to the source of the agent, reported exposure to vapor or aerosol, or have serious clinical
symptoms would receive first priority for decontamination. Next, ambulatory cases could be further separated into those
moderately showing the characteristic signs of exposure, who would be the second in priority for decontamination. Also in this
category would be individuals who suffered other conventional injuries. Finally, those who were farthest away from the source
of the agent and have no outward exposure symptoms could wait until last for decontamination. This final group should be
Chapter 6 Metropolis, USA: Progress, Pitfalls in Front-line Readiness 221
perform initial triage by observing the victims and trying to distinguish between individuals who were more
frightened by the situation than in genuine need of decontamination.
Optimally, rescuers would begin the decontamination process by instructing victims to disrobe. Even
those in physical distress might object to taking off their clothes in public, so rescuers would have to explain
clearly that taking off one's outer clothing can remove roughly 80 percent of the contamination hazard.70
Separate showers for men and women would help preserve victims' privacy. Failure to erect barriers that
shield victims from prying eyes can result in harsh criticism from the media, the public, and even those
rescued.71
Plans often call for impromptu front-line fire truck and engine set-ups to be augmented with a
second, formal stage of more careful showering and scrubbing of residual contaminants from the victims,
using bleach or soap solutions, as appropriate. Some cities have trailers filled with commercially available
field decontamination systems and so-called tent cities.72 Other cities may bring in a dedicated
decontamination truck or bus, which is a more expensive option that some first responders view with
cynicism.73 To cut set-up time down to about eight minutes, one rescue team pre-packed its tents, using
periodically checked for the onset of clinical symptoms that might indicate they should receive a higher decontamination priority.
Guidelines for Mass Casualty Decontamination, 145.
70 Undressing also reduces the chances that showering could transfer the agent from the clothing to the skin. Clothing
should be taken off from head to toe. If use of a biological agent is suspected, victims should be doused before they remove their
clothing. Guidelines for Mass Casualty Decontamination, 6.
71 On 24 April 1997, the nationwide print and electronic media splashed images of the Washington, DC fire
department's efforts to decontaminate individuals that they thought had been exposed to anthrax. As it turned out, the container
placed in front of the B'nai B'rith headquarters in the capital city was part of a hoax. The only things exposed were the victims,
thirty whom were stripped to their undergarments for decontamination within full view of media cameras. A further 109 people
from this building were quarantined, and two blocks of the city were cordoned off from traffic. The city's emergency response
community, which had previously been described as a model of preparedness, was harshly criticized afterwards. For a dissection
of this response, see Jessica Stern, Fire Department Response to Biological Threat at B'nai B'rith Headquarters, US Fire
Administration Technical Report Series, report 114 (Washington, DC: Federal Emergency Management Agency, 1997). See
also, Michael Powell and Allan Lengel, "Chemical Alert Traps Workers in Buildings," Washington Post, 25 April 1997; Sari
Horwitz, " FBI Sends Alert to Jewish Groups," Washington Post, 26 April 1997; "Defense Department Establishes DC Anti-
terrorism Unit," Armed Forces Newswire, 13 January 1997.
72 The contents of these trailers vary from city to city, depending upon prevailing weather conditions, resources, and the
city's decontamination plan. They may contain tents, hoses, decontamination solutions, scrub brushes, personal protective gear,
backpack tanks and decontamination sprayers, plastic storage bags, pools to catch contaminated water, heaters and propane tanks
to heat the water, towels, and temporary or disposable clothing for the victims. Interviews with author: Paramedic (12 May
2000); Emergency Management Specialist, Office of Emergency Management (9 May 2000); MMRS Coordinator, Fire
Department (9 May 2000); District Fire Chief, EMS Division (2 March 2000); Deputy Director, Office of Emergency
Management (27 July 1999); Emergency Preparedness Director, Office of Emergency Services (9 February 1999).
73 One city spent $80,000 to install shower heads and other features (e.g., hydraulic lift for wheelchair patients) on a
delivery truck. This truck can decontaminate over twenty people at a time, with tents stored aboard to expand its capacity. Funds
for this vehicle came from a state law requiring private facilities to pay for hazmat services. The truck is to be deployed to all
hazmat incidents. Interview with author: Fire Chief (15 May 2000). Other locations have also invested in mass decontamination
trucks. Interview with author: Chief, County Fire Department (9 September 1999). More than one individual expressed the view
222 Ataxia: The Chemical and Biological Terrorist Threat and the US Response
velcro to secure pools and hoses at the appropriate places inside the tents, which inflate with the push of an
air button.74 Some cities were also hoping to save time by stationing their decontamination trailer(s) with
their hazmat team(s); others situated these trailers at strategic area locations.75 As they exit the
decontamination process, victims would be given Tyvek suits, spare clothing, or even garbage bags to wear.76
Depending on the size of a tent city and rescuers' training, dozens of people could be herded through
decontamination lines simultaneously.77
Decontamination operations, which are labor intensive and exhaustive, would soon deplete a city's
supply of trained responders. Hours would be required to decontaminate hundreds of people. To provide
a ready supply of reinforcements, fire departments have designated engine companies to serve as hazmat and
decontamination squads, equipping and training them to level A and level B operations, respectively.78 Some
cities were also spreading training and equipment to neighboring municipal areas, so that their mutual aid
partners could help. In one metropolitan area, each jurisdiction was asked to offer one fire house to serve
as a decontamination squad on all shifts. Between $1,300 and $1,500 worth of equipment can outfit a fire
that these fancy decontamination rigs will soon be seen as dinosaurs because the front-line fire engine set-up is much more
expedient and tent cities much less expensive. Moreover, these trucks may be unable to make it to the scene in time to be of
much use. Interviews with author: Hazmat Instructor/Firefighter/Paramedic (2 August 2000); Paramedic (12 May 2000);
Physician, Hospital Department of Emergency Medicine (24 March 1999).
74 All that remains is to hook the water hoses to outside lines. Interview with author: Hazmat Specialist/Instructor (9
February 1999).
75 Interviews with the author: Deputy Director, Office of Emergency Management (27 July 1999); Emergency
Preparedness Director, Office of Emergency Services (9 February 1999).
76 Interview with author: Battalion Fire Chief (8 February 1999). Industrial trash bags come two thousand per roll and
could provide slight modesty and thermal protection for victims. Interview with author: Police Lieutenant (23 March 1999).
Another rescuer thought that asking the victims to wear garbage bags-a cheap and easy option-would rob them of their dignity
and also show that city emergency personnel were less than well prepared to handle the situation. Interview with author: Fire
Captain, EMS Division (27 July 1999).
77 Victims can be moved quickly through decontamination lines if the attending personnel are well trained. For
example, the 100-person National Medical Response Team in Winston-Salem, North Carolina, practices regularly and can
decontaminate twenty non-ambulatory and two hundred ambulatory people per hour. Interview with author: Physician/National
Medical Response Team member (11 May 1999). In one city's decontamination drill, however, it took three hours to process
twenty people with an indoor shower. Interview with author: Deputy Fire Chief (23 March 1999). Other cities concerned about
how long it would take them to set up decontamination lines gave some thought to busing victims to car washes and water
amusement parks, but discarded the idea. Interviews with author: Emergency Management Specialist, Office of Emergency
Management (9 May 2000); Registered Nurse/Emergency Planner, Public Health Department (7 April 2000).
78 Interviews with author: Hazmat Coordinator/Instructor (8 September 2000); Fire EMS Statistician (30 August 2000);
Deputy Director, Office of Emergency Management (26 May 2000); Battalion Fire Chief/Special Operations Officer (25 May
2000); Director, Emergency Services Department (18 May 2000); EMS Specialist/Paramedic (12 May 2000); MMRS
Coordinator, Fire Department (9 May 2000); Deputy Coordinator, Fire Emergency Preparedness and Disaster Services (3
February 2000); Fire Captain/Assistant Emergency Management Coordinator (5 January 2000); Battalion Fire Chief (17
November 1999); Battalion Fire Chief (15 November 1999); Fire Captain, EMS Division (27 July 1999); Lieutenant/Hazmat
Commander (10 March 1999); Fire Lieutenant and Fire Captain (5 February 1999).
Chapter 6 Metropolis, USA: Progress, Pitfalls in Front-line Readiness 223
house to function in a backup decontamination capacity.79 The incident commander would probably request
such assets via the emergency operations center described in box 6.3. Another pool of local backups possibly
available to an incident commander would be the hazmat teams from private industry sites.80 Unless the
attack was of truly astronomical proportions, local rescuers do not anticipate calling upon rescuers from
outside the region because they could not arrive within sufficient time and some of the federal teams would,
quite frankly, be more trouble than they were worth. Local concerns about being bombarded by outside aid
teams are discussed in box 6.4.
Triage and Initial Medical Treatment
The goal of triage and on-scene medical care is to stabilize patients before transport so that definitive
treatment can be given in a more controlled hospital setting. During triage, EMS crews, aided in these
circumstances by hazmat crews and firefighters, would quickly evaluate the condition of patients and
prioritize those with the most severe injuries as the first to receive attention. Color-coded tags would indicate
a person's condition and treatment priority.81
79 Inexpensive versions of much of the requisite equipment can readily be found at hardware stores. Interviews with
author: Director, County Emergency Management (21 September 2000); Hazmat Instructor/Firefighter/Paramedic (2 August
2000); Battalion Fire Chief, Special Operations (25 May 2000); Deputy Coordinator, Fire Emergency Preparedness and Disaster
Services (3 February 2000); Deputy Director, Office of Emergency Management (27 July 1999); Fire Chief (13 April 1999);
Assistant Director, Office of Emergency Management (23 March 1999); Police Lieutenant (23 March 1999); Deputy Fire Chief
(23 March 1999); Emergency Planner (8 March 1999); Fire Lieutenant and Fire Captain (5 February 1999).
80 Interviews with author: Director, Emergency Management Division, County Department of Public Safety (19
September 2000); Battalion Fire Chief, Special Operations (25 May 2000); EMS Licensing Agent, State Department of Public
Safety (27 January 2000); EMS System Analyst/Paramedic, State Department of Health and Social Services (25 January 2000);
Deputy Fire Chief (23 March 1999).
81 EMS crews employ a number of triage systems, such as Simple Triage and Rapid Treatment/Transport, to prioritize
patients. One city plans to affix a numbered, waterproof Tyvek wrist band to victims in order to indicate level of problem. The
same number would identify bags that contain victims' clothing and personal items. Interview with author: Fire Chief (14 June
1999).
224 Ataxia: The Chemical and Biological Terrorist Threat and the US Response
Box 6.3: Emergency Operations Center Coordination of Local, Regional Assets
Once it is understood that an event of significant proportions has taken place, designated
officials from all of the responding agencies would be paged to a city's emergency operations center
to help coordinate the disaster response. This center-the civilian equivalent of a war room-would
be open around the clock until normalcy was restored. Aside from public safety and health
agencies, the public works department, which can supply a great deal of logistical assistance to the
incident commander, and public utility companies (e.g., electric, gas, telephone) would be
represented. Volunteer organizations, such as the Red Cross, often have permanent seats at the
table. Emergency operations centers normally have extensive communications capabilities to enable
them to interact simultaneously with a great number of organizations throughout a high-demand
period. Ideally, regional, state, and federal organizations would send representatives to this center if
they became involved in the response.1 State emergency officials may open their own command
center as well.
As soon as the emergency operations center opened, the incident commander at the scene of
a chemical terrorist attack would begin to funnel requests for resources through the center,
delegating the notifications, logistics, and coordination of incoming response units. For instance,
should the incident commander ask for extra help to contain the runoff from the decontamination
lines and buses to transport patients to the hospitals, the public works and environmental safety
departments would deliver crews, and the city might pull regular transit buses or activate contracts
with private transport companies. Anticipating a response of some duration, city managers might
ask one of the volunteer organizations to provide water and food for the rescuers on scene, as well
as for the hospital staffs. The emergency operations center would also organize humanitarian
assistance for victims (e.g., food, clothing, shelter). The emergency operations center would help
coordinate any evacuation that might be needed, or in the case of a biological attack, quarantine
activities. In these types of disasters, special attention would have to be given to mental health care
services not only for the victims but for the community at large.2 Another major function of the
emergency operations center is to provide information to the public and the media about the disaster
and the city's response to it. (continued, next page)
To supervise triage and initial medical care, MMRS teams include physicians and sometimes medical
toxicologists.82 Rapid administration of antidotes would be key to patient survival,83 but precision and
advanced medical expertise is required. Experience has repeatedly shown that serious consequences can
result when the wrong type or quantity of antidote is used. For example, the incorrect amount of dicobalt
vegetate given to individuals thought to have been poisoned by cyanide caused them to exhibit cobalt
82 Some cities are paging other toxicologists to the receiving hospitals, as well as to the city emergency operations
center. Interviews with author: Fire EMS Statistician (30 August 2000); Physician/Director of Hospital Disaster EMS (27 July
1999); Toxicologist, Poison Control Center (9 March 1999).
83 Sidell, Takafuji, and Franz, eds, Medical Aspects of Chemical and Biological Warfare, 32931; Richard J. Brennan,
Joseph F. Waeckerle, Trueman W. Sharp, and Scott R. Lillibridge, "Chemical Warfare Agents: Emergency Medical and
Emergency Public Health Issues," Annals of Emergency Medicine 34, no. 2 (August 1999): 201.
Chapter 6 Metropolis, USA: Progress, Pitfalls in Front-line Readiness 225
Box 6.3: Emergency Operations Center (continued)
City response agencies would first bring all of their own assets to bear, but as soon as officials
recognized that the disaster would outstrip their capacities, mutual aid agreements with neighboring
municipalities would be activated. The terms of fire mutual aid agreements differ from area to area,
sometimes involving hazmat as well as fire crews. In some locations, police and EMS also have
mutual aid agreements, in other cases not. Some cities also have standing aid arrangements with the
hazmat crews employed by private chemical companies.3 A couple of cities also reported cooperative
arrangements with local military bases that would enable them to tap into supplies, equipment, and
manpower.4 These regional assets were always described as essential components of success in
responding to a major disaster, in part because of the quick deployment time their proximity allowed
and in part because of prior responses that engendered high confidence that experienced, collegial
support would be provided.
NOTES
1. During a chemical terrorism drill in November 1997, one city challenged its major public utility company to maintain
service throughout the emergency, which led company officials to recognize the need to train and equip a team to operate in
warm zone conditions. Interview with author: Project Manager, Emergency Management Planning, Office of Emergency
Management (27 July 1999). Also on emergency operations center functions: Director, Emergency Services Department (18
May 2000); Division Chief, State Department of Emergency Management (3 May 2000); District Fire Chief, EMS Division
(2 March 2000); Project Manager, Emergency Management Planning (27 July 1999); Emergency Preparedness Director,
Office of Emergency Services (9 February 1999); Director, Office of Emergency Services (4 February 1999).
2. If a large number of fatalities were involved, the emergency operations center would help coordinate mortuary services and
grief counseling. Interviews with author: Director, Emergency Services Department (18 May 2000); District Fire Chief, EMS
Division (2 March 2000); Project Manager, Emergency Management Planning, Office of Emergency Management (27 July
1999); Emergency Preparedness Director, Office of Emergency Services (9 February 1999). For background on emergency
management practices as they apply to terrorism, see William L. Waugh, Jr., Terrorism and Emergency Management: Policy
and Administration (New York: Marcel Dekker, Inc., 1990).
3. Interviews with author: Fire EMS Statistician (30 August 2000); Project Manager, Emergency Management Planning,
Office of Emergency Management (27 July 1999); Chief of Response Division, State Department of Civil Emergency
Management (13 April 1999); Lieutenant/Hazmat Commander (10 March 1999); Special Projects Program Manager,
Department of Public Health (5 February 1999).
4. Interviews with author: Battalion Fire Chief/Special Operations Officer (25 May 2000); Director, Emergency Services
Department (18 May 2000).
poisoning. Also, when too much atropine is administered to patients suffering from nerve agent or
organophosphate exposure, they have to be put on respirators.84 While EMS crews have standardized
procedures for many types of injuries, such as immobilizing those with possible spinal cord damage, a
consensus is still forming as to the best practices for the field care of people exposed to super toxic
chemicals. The lack of pre-hospital treatment protocols has caused no end of frustration and confusion
locally. A case in point was the significant controversy over civilian use of the Mark 1 kits, which were
84 Timothy C. Marrs, "National Consequence Management Concepts and Plans for Chemical and Biological Incident
Response," in Proceedings of the Seminar of Responding to the Consequences of Chemical and Biological Terrorism, page
314. An atropine overdose patient may need to be on a respirator for several days. From 18 to 28 February 1991, Iraq bombed
Israel with thirty-nine Scud missiles, and many thought they were armed with chemical agents. In the vicinity of Tel Aviv, 230
overdoses of atropine occurred during this timeframe. Guidelines for Mass Casualty Decontamination, 37, note 10.
226 Ataxia: The Chemical and Biological Terrorist Threat and the US Response
designed by the military for battlefield use to counteract severe nerve agent poisoning. Absent guidelines,
cities were adopting different policies.85
Emergency response personnel expressed differing philosophies about when to initiate medical
treatment of victims, depending in no small part upon whether their EMS squads were trained and equipped
to operate in the warm zone. According to one approach, EMS personnel in regular work clothing would
attend to victims after they were fully decontaminated.86 A second approach would be more aggressive, with
EMS personnel in protective garb, partnering with hazmat specialists in the contaminated area. Some cities
would even call upon their EMS staffs to help with rescue operations; others would assign their paramedics
and EMTs to conduct preliminary triage, begin medical treatment before decontamination if warranted, and
assist and evaluate the medical status of victims throughout the decontamination process. Figure 6.3 portrays
this forward triage approach as it pertains to nerve agent casualties. Patients would then move to the formal
triage area for additional medical treatment, as appropriate, and priority staging to ambulances.87 The
advantage to forward triage is that medical intervention occurs as soon as possible, all the more important
85 Mark 1s contain a pair of auto-injectors with atropine and pralidoxime chloride, or 2-PAM. The doses in these
injectors are pre-measured for physically fit soldiers, but children, the elderly, and pregnant women could be felled in a terrorist
attack. Some cities are therefore reserving Mark 1s solely for their affected first responders, who are more likely to match the
military weight and fitness profile. Some cities bought vials of atropine so that doses can be adjusted for civilians. Interviews
with author: Police Sergeant (2 April 1999); Emergency Preparedness Director, Office of Emergency Services (9 February 1999).
Others, however, developed pre-hospital protocols for the Mark 1s. In some jurisdictions, only paramedics are authorized to use
these kits; in others, EMTs are authorized as well. As to worries about whether the kits are appropriate for civilians, one
responder observed that if victims are exhibiting symptoms, the fine tuning of treatment could be done by physicians, if the EMS
crews could keep them alive. Interviews with author: EMS Chief, Emergency Services Department (21 September 2000);
Deputy Director, Office of Emergency Management (26 May 2000); Battalion Fire Chief, Special Operations (25 May 2000);
Director, Emergency Services Department (18 May 2000); Paramedic (12 May 2000); MMRS Coordinator, Fire Department (9
May 2000); Registered Nurse/Emergency Planner, Public Health Department (7 April 2000); Fire Captain/Assistant Emergency
Management Coordinator (5 January 2000); Physician/Associate Medical Director, Fire EMS Division (27 July 1999). On
having developed pre-hospital protocols for several chemical agents: Fire EMS Statistician (30 August 2000).
86 In some instances, this approach is being used out of choice, as EMS supervisors see no reason to have their
personnel operate in a contaminated environment. In other cities, stationing EMS crews only in the cold zone is a necessity,
because cities have not yet been able to outfit and train their EMS personnel to operate in protective gear. Interviews with
author: Director, County Emergency Management (21 September 2000); Hazmat Coordinator/Instructor (8 September 2000);
Director, Emergency Services Department (18 May 2000); Fire Chief (15 May 2000); Paramedic (12 May 2000); MMRS
Coordinator, Fire Department (9 May 2000); Emergency Management Specialist, Office of Emergency Management (9 May
2000); District Fire Chief, EMS Division (2 March 2000); Registered Nurse/Chief, EMS Division, State Department of Public
Health (3 February 2000); Battalion Fire Chief (19 January 2000); Battalion Fire Chief/Emergency Services Administrator (15
November 1999); Paramedic Operations Supervisor, Paramedic Division (9 March 1999).
87 Several cities plan to employ forward triage. Interviews with author: EMS Chief, Emergency Services Department
(21 September 2000); Deputy Director, Office of Emergency Management (26 May 2000); Battalion Fire Chief, Special
Operations (25 May 2000); Registered Nurse/Emergency Planner, Public Health Department (7 April 2000); Deputy
Coordinator, Fire Emergency Preparedness and Disaster Services (3 February 2000); Fire Captain/Assistant Emergency
Management Coordinator (5 January 2000); Physician/EMS Medical Director (13 November 1999); Fire Captain, EMS Division
(27 July 1999); Fire Chief (14 June 1999). A Defense Department report cautions that non-ambulatory patients showing
significant signs of exposure should be the only ones to receive medical treatment prior to decontamination. In cases of nerve
agent exposure, Mark 1 kits can be administered in the hot zone, after which victims should be quickly removed from the
contaminated area. Guidelines for Mass Casualty Decontamination, 21.
Chapter 6 Metropolis, USA: Progress, Pitfalls in Front-line Readiness 227
Box 6.4: Local Worries About Help From Outside the Region
In contrast to the confidence that city officials expressed about regional rescue assets stepping
in to help them after an unconventional terrorist attack, virtually every local official interviewed had
major reservations about the ability of federal and even state assets to arrive in sufficient time to impact
the outcome of a chemical terrorist attack response. They were also seriously concerned whether the
federal government could quickly deliver enough medical manpower to help after a biological attack.
Whereas rescuers can recover victims days after earthquakes and tornadoes, the lifesaving window of
opportunity for a chemical attack is much, much briefer. The locals repeatedly pointed out the
difference between the deployment times promised for these teams and reality. Several interviewees,
veterans of Urban Search and Rescue task forces and Disaster Medical Assistance Teams, knew full
well the delays in deploying these teams. None of the specialized federal or state teams, they said,
would have lifesaving applicability after a chemical terrorist attack unless they were pre-deployed. To
say the least, interviewees were vexed about the funds "wasted" on creating new federal and state teams
and money frittered away on enhancing other federal teams for rescue missions they cannot achieve.
Conversely, they worried that insufficient funding and use of the civilian medical response system
meant that the medical cavalry might not come through when they were needed most.1
Far and away the most criticized of the newcomers were the National Guard's Weapons of
Mass Destruction Civil Support Teams, at first known as the RAID (Rapid Assessment and Initial
Detection) teams. The National Guard can be called out by a state governor, but can also be
federalized. The locals viewed the resources being poured into the RAID teams as nothing short of
scandalous, characterizing this effort as a job employment program. Locals that saw RAID squads in
action rated them as bulldozing amateurs. To illustrate the point, a RAID team pushed aside local
rescuers in the Portsmouth segment of the mid-May 2000 Topoff drill, where a terrorist attack with the
chemical agent mustard was simulated. Yet, this particular team lacked the technical expertise to
understand the minimal hazard posed by mustard on a chilly, forty-nine degree day.2 Incident
commanders want to be able to rely on the help that arrives, not worry about deficiencies in training and
experience that could hinder or jeopardize their own personnel. RAID teams would not accrue
invaluable mission experience until a unconventional attack occurs, and trials by fire are a recipe for
failure. Similar concerns were voiced about other federal squads that rarely see real action, but in
particular, local responders heaped ridicule on the RAID teams: "They're helping me?" scoffed one fire
chief.3 To a person, however, the local officials welcomed the Guard in its traditional support role. The
locals anticipate asking the National Guard to help only with cots, water supplies, law enforcement
support, and other logistical matters.4
City emergency managers and responders expressed a great deal of apprehension that just as
they were beginning to get a handle on the disaster, they would be bombarded with incoming federal
teams. Although local officials had heard federal authorities state that no help would be sent unless
requested, each dismissed such claims because they had seen the federal teams shove vigorously to
participate in mere exercises, much less in a real event. The locals noted that the officers and
bureaucrats who created these teams would deploy to justify their existence. Once on the ground, local
authorities expected the pushing to continue. With a mixture of chagrin and amusement, they related
tales of federal squads scrapping with each other for tasks, brandishing every conceivable kind of
gizmo. Federal protestations to the contrary, locals have also experienced outside teams telling them
what to do in their own city, despite their utter lack of knowledge of local capabilities and
circumstances. Local rescuers therefore predicted that the state and federal teams would jam them up so
completely that they could hardly function, creating another disaster of sorts.5 Only half facetiously,
one city emergency manager stated that once the disaster scene was cleared, his first order of business
would be to station police at the city boundaries, guns pointed outward, to keep all of these "helpers"
from overrunning the city hours later.6 (continued, next page)
228 Ataxia: The Chemical and Biological Terrorist Threat and the US Response
Box 6.4: Local Worries (continued)
The locals were not alone in this forecast: One senior federal bureaucrat described how the sky
would be "black with the incoming aircraft filled with helpers."7 The locals worried that once the
federal teams arrived they would have to expend more time and energy managing the federal assets than
the crisis at hand. Instead of weaving into the local emergency operations center, multiple federal
command posts would be established. To keep tabs on what these so-called helpers were doing, local
officials would have to send representatives to the federal command posts, an additional drain on
already depleted city emergency response personnel.8 While they were extremely skeptical that federal
teams would be disciplined enough not to barge in after a chemical disaster, local officials hoped that
outside teams would at least stage at the nearest military base. With the exception of FBI personnel,
who would be pursuing the criminal investigation, the only non-local expertise the city officials could
truly foresee needing in the short term was in area decontamination, if their regular contractors refused
to take the assignment. In other words, locals fully expect to ask that these state and federal squads to
return home without any ever seeing the disaster scene. If a biological attack took place, however, they
simply hope against hope that a federal medical aid system never tested in such a crucible would be able
to get significant medical assets there in time.9
NOTES
1. Interviews with author: General Manager, Emergency Department (22 September 2000); Hazmat Coordinator/Instructor (8
September 2000); Fire EMS Statistician (30 August 2000); Medical Toxicologist/Poison Control Center Director (13 June
2000); Deputy Director, Office of Emergency Management (26 May 2000); Battalion Fire Chief/Special Operations Officer (25
May 2000); Director, Emergency Services Department (18 May 2000); Division Chief, State Department of Emergency
Management (3 May 2000); Detective/Bomb Squad (19 January 2000); Battalion Fire Chief (19 January 2000); Chief, County
Fire Department (9 September 1999); Project Manager, Emergency Management Planning (27 July 1999); Director of Hospital
EMS and Disaster Medicine (19 April 1999); Fire Commander (19 April 1999); EMS Superintendent-in-Chief (24 March
1999); Police Lieutenant (23 March 1999); Assistant Director, Office of Emergency Management (23 March 1999); Paramedic
Operations Supervisor (9 March 1999); Lieutenant/Hazmat Commander (10 March 1999); Fire Captain, Hazmat Unit (9
February 1999); Battalion Fire Chief (9 February 1999); Emergency Preparedness Director, Office of Emergency Services (9
February 1999); Fire Lieutenant (5 February 1999); Police Captain/Firing Range Director (5 February 1999); Registered
Nurse/Hospital Disaster Coordinator (4 February 1999); Paramedic/Emergency Planner, Public Health Department (4 February
1999); Director, Office of Emergency Services (4 February 1999). Often, the delay is not in the team reporting to the airport,
but in getting them and their equipment aboard commercial flights.
2. Interviews with author: Hazmat Coordinator/Instructor (8 September 2000); former EMS Supervisor/Paramedic (12 July
2000). Another National Guard team was so unfamiliar with its equipment that in another drill several hours passed before they
were ready to enter the contaminated zone. Then, the Guard team tried to give the city responders directions about possible
plume repercussions, but they lacked the knowledge of how the chemical plume would effect the area depending upon the
population at different times of day. Interview with author: Detective/Bomb Squad member (19 January 2000); Battalion Fire
Chief (19 January 2000).
3. Emphasis reflects the incredulous tone of the comment. Interview with author: Chief, County Fire Department (9 September
1999). Similar reactions to the RAID teams were given by: Hazmat Coordinator/Instructor (8 September 2000); former EMS
Supervisor/Paramedic (12 July 2000); Firefighter/Hazmat Instructor/Paramedic (28 June 2000); Battalion Chief (19 January
2000); Fire Commander (19 April 1999); Hazmat Materials Specialist (19 April 1999); Director of Hospital EMS and Disaster
Medicine (19 April 1999); Lieutenant/Hazmat Commander (10 March 1999); Lieutenant/Hazmat Commander (10 March
1999); Emergency Planner, Office of Emergency Management (8 March 1999). Similar tales and views were expressed by:
Fire EMS Statistician (30 August 2000); EMS Supervisor (20 May 1999); Deputy Director, Office of Emergency Management
(26 May 2000); Division Chief, State Disaster Medical Services Division (15 February 2000); Detective/Bomb Squad member
(19 January 2000); Battalion Fire Chief (15 November 1999); Battalion Fire Chief/Emergency Services Administrator (15
November 1999); Project Manager, Emergency Management Planning (27 July 1999); Police Lieutenant (23 March 1999);
Fire Captain, Hazmat Unit (9 February 1999); Battalion Fire Chief (9 February 1999); Emergency Preparedness Director,
Office of Emergency Services (9 February 1999); Director, Office of Emergency Services (4 February 1999). For yet another
negative review of the RAID teams, see General Accounting Office, Use of National Guard Response Teams Is Unclear.
4. Ibid. (continued, next page)
Chapter 6 Metropolis, USA: Progress, Pitfalls in Front-line Readiness 229
Box 6.4: Local Worries (continued)
5. "Everybody and their brother wants to go to the scene to justify their response capability or some little whiz-bang toy that
they have developed and want to use." Interview with author: Director of Hospital EMS/Disaster Medicine (19 April 1999).
Two officials described federal teams arriving in their city with price tags still on their gear, then coming close to a fist-fight
over which team would get to analyze a sample that common sense told the locals was innocuous. Interviews with author:
Lieutenant/Hazmat Commander (10 March 1999); Emergency Planner, Office of Emergency Management (8 March 1999).
Other tales of this nature were recalled by: General Manager, Emergency Department (22 September 2000); Hazmat
Coordinator/Instructor (8 September 2000); Fire EMS Statistician (30 August 2000); former EMS Supervisor/Paramedic (12
July 2000); Deputy Director, Office of Emergency Management (26 May 2000); EMS Supervisor (20 May 1999); Division
Chief, State Disaster Medical Services Division (15 February 2000); Detective/Bomb Squad member (19 January 2000);
Battalion Fire Chief (15 November 1999); Battalion Fire Chief/Emergency Services Administrator (15 November 1999);
Project Manager, Emergency Management Planning (27 July 1999); Police Lieutenant (23 March 1999); Fire Captain,
Hazmat Unit (9 February 1999); Battalion Fire Chief (9 February 1999); Director, Office of Emergency Services (4 February
1999). On how squabbles between local, federal, and state officials can cost lives, Osterholm and Schwartz, Living Terrors,
179.
6. Interview with author: Director, Office of Emergency Services (2 April 1999).
7. Interview with author: Senior official, Health and Human Services (HHS) Department (6 May 2000).
8. "The federal government doesn't understand the concept of a unified command." Director, Office of Emergency Services
(2 April 1999). Acknowledging the problem of multiple federal command posts, Senior official, HHS Department (6 May
2000). Also on the headache of interacting with the various federal commands, Chief of Response Division, State
Department of Civil Emergency Management (13 April 1999); Police Lieutenant (23 March 1999).
9. Federal assets were staged in this manner after the Oklahoma City bombing and in natural disasters, such as Hurricanes
Opal and George. Many teams were sent home without being pulled into service. Interview with author: Director of Hospital
EMS and Disaster Medicine (19 April 1999). Cities often have companies on contract to clean up sites after a hazmat
incident, but more than one city reported being unable to locate a contractor willing to take on this type of a job. Expecting to
ask for decontamination assistance: Director, Emergency Management Division, County Department of Public Safety (19
September 2000); District Fire Chief, EMS Division (2 March 2000); Battalion Fire Chief (17 November 1999); Emergency
Manager, Office of Emergency Management (17 May 1999); Fire Commander (19 April 1999); Chief, County Fire
Department (9 September 1999). On worries about the timeliness and quantity of federal medical aid: Registered
Nurse/Chief, EMS Division, State Department of Public Health (3 February 2000); Director of Hospital EMS and Disaster
Medicine (19 April 1999); Police Lieutenant (23 March 1999); EMS Superintendent-in-Chief (24 March 1999); Physician,
Hospital Department of Emergency Medicine (24 March 1999); former State Epidemiologist (18 August 2000); Physician,
Division of Disease Control, Public Health Department (8 August 2000); Fire EMS Statistician (30 August 2000);
Emergency Preparedness Director, Office of Emergency Services (9 February 1999); Senior CDC Official (29 August 2000);
Registered Nurse/Hospital Disaster Coordinator (4 February 1999).
because chemical agents can kill within minutes and decontamination can be a slow process. According to
one source, decontamination could delay medical intervention by twelve to twenty-five minutes.88 However,
this forward triage approach requires EMS crews to don protective clothing, unfamiliar territory for many.
A study with twenty paramedics, summarized in table 6.1, shows that EMS personnel can still perform
procedures that demand dexterity in this gear, albeit not as quickly.
88 S. Dyer et al., "Efficiency of Civilian Paramedics at Perfo