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XIII - 1 9th Revision, 6/02) 13.0 EXERCISES AND DRILLS 13.1 General
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13.0 EXERCISES AND DRILLS
13.1 General
Exercises and drills shall be conducted periodically to evaluate the adequacy
of the hazardous materials emergency plan and the skills of the emergency
response personnel. Results of exercises and drills provide a basis for
changes in the response plans, in implementing procedures, and for future
scheduling of training for emergency response personnel. In Pinellas County,
these exercises and drills may be incorporated into existing annual EOC
exercises. The Tampa Bay LEPC was required to conduct a biennial
exercise this fiscal year. Discussion of this exercise appears below.
13.2 Exercises
An exercise is an event that tests the integrated response capability and major
elements within emergency preparedness plans. The emergency preparedness
exercise will simulate an emergency which results in hazardous materials
releases and response by local authorities. Exercises will be conducted
annually and will be evaluated by qualified observers.
For an emergency plan to remain useful, it must be kept up-to-date through
a thorough review of actual responses, simulated exercises, and collection of
new data. As key assumptions and operational concepts in the plan change,
the plan must be amended to reflect new situations.
13.2.1 Full-Scale Exercise
A full-scale exercise is designed to fully demonstrate the emergency
preparedness and response capabilities of appropriate County
agencies and organizations. Mobilization of local emergency
personnel and resources will be demonstrated.
The Tampa Bay LEPC was invited by the City of St. Petersburg to
partner in a Chemical Weapons Full-Scale Exercise (CWFSE) in
conjunction with the Department of Justice (DOJ) Domestic
Preparedness Program (DPP) conducted in St. Petersburg on February
20, 2002. DPP assisted in the development and execution of the
CWFSE through its coordinator, Research Planning, Inc. (RPI).
LEPC Staff participated in exercise planning meetings on October 15,
2001; medical support staff on the morning of January 4, 2002, and
with the full exercise participating staff in the afternoon of January 4,
2002.
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The CWFSE was largely a free-play training exercise. Participant
actions were governed by their respective standard operating
procedures (SOPs), the DPP training and Incident Command
System(ICS)/Unified Command direction and control. The Exercise
Director and Senior Controller monitored the flow of play and made
adjustments, as necessary, to achieve exercise objectives.
The CWFSE was conducted at the Bayfront Arena, located at 300
First Street South (except for hospital participation). St. Petersburg
and the LEPC, in cooperation with DPP, conducted this chemical
terrorism functional exercise. The CWFSE was designed specifically
to focus on actions at the incident site and specified operations and
information centers. These activities included emergency response,
direction and control, triage, treatment and transport, and the
integration of external State and Federal support. The scenario
centered on a simulated chemical terrorist attack at the international
volleyball competition in the arena. The attack triggered a significant
emergency response effort to assist more than 100 casualties.
St. Petersburg has implemented a comprehensive effort to improve
capabilities to respond to terrorist incidents involving Weapons of
Mass Destruction (WMD). Prior to the CWFSE, a number of St.
Petersburg first response personnel participated in training that
addressed emergency activities associated with a WMD terrorism
incident and the "delta" between the hazardous materials (HAZMAT)
incident and the mass casualty crime scene response involving a
WMD. This CWFSE was designed to challenge St. Petersburg's and
other jurisdictions lending mutual aid cadres of first responders with
a volatile, uncertain, complex, and ambiguous operational
environment involving chemical terrorism in the heart of a busy
commercial center. Participants are to be commended on their
professionalism and willingness to assess the continuously refine their
skills. This report documents the strengths and opportunities
identified during the CWFSE.
Scenario Elements
Exercise Scenario
During an international volleyball competition, a device detonates
just inside the north end of the Bayfront Arena. People rush out of
the arena vi the exits at the south end, and past a device disseminating
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the chemical agent lewisite. Some evacuees immediately begin to
experience the effects of lewisite exposure.
Agent
Lewisite is a vesicant that presents both a vapor and liquid hazard.
Eyes, skin, and airways can be damaged by direct contact with the
agent. After being absorbed, lewisite causes an increase in capillary
permeability to produce hypovolemia, shock, and organ damage.
Exposure to lewisite causes immediate pain or irritation, although
lesions require hours to become fully developed. Management of a
lewisite casualty is similar to management of a mustard casualty,
although a specific antidote, British Anti-Lewisite (BAL
[dimercaprol]) will alleviate some effects.
Exercise Methodology
Ambient meteorological data was used for the duration of the exercise
except for the wind, which was simulated to be from due south.
Primary and Secondary Devices
One notational device detonates (simulated by a flash-bang
distraction device) inside the north end of the Bayfront Arena. The
device was hidden inside a backpack, and debris was evident. A
smoke machine simulated the chemical dissemination device near the
south exits.
A secondary device was located outside of the arena in Parking Lot
D, where gross decontamination was initiated. The device was a
thermos inside a marked fire department vehicle. Although this
chemically filled device would have detonated during the response,
it was removed to a remote location to allow the Tampa Police
Department Bomb Squad to exercise their robots and other
equipment.
Exercise Casualties
Volunteers exhibiting various symptomatology simulated the incident
victims. Approximately 100 casualties were located at the incident
site. Other casualties representing walk-in victims were pre-
positioned at selected hospitals. Casualties wore orange cards
identifying key symptoms and vital signs.
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Exercise Participants
More than 300 people participated in the CWFSE. Participating
agencies are listed below
St. Petersburg Fire and Rescue (SPFR)
Hazardous Materials (HAZMAT) Response Team
Public Information Officer (PIO)
St. Petersburg Police Department (SPPD)
Special Events Response Team (SERT)
Explosive Ordnance Disposal (EOD)
Public Information Office
Communications
Criminal Investigation Division
Emergency Medical Services (EMS)
Sunstar Ambulance
American Red Cross - Tampa Bay Chapter
Pinellas County Emergency Communications
Pinellas County Sheriff's Office (PCSO)
Pinellas County Emergency Management Agency (PCEMA)
Pinellas County Medical Examiner
Pinellas County EMS and Fire
Pinellas County HAZMAT Team
Pinellas County Department of Public Affairs
Pinellas County Health Department
Office of the Medical Director/Medical Communications
Office
Tampa Police Department (EOD)
Bayfront Medical Center
St. Anthony's Hospital
All Children's Hospital
Florida Department of Environmental Protection (DEP)
Bureau of Emergency Response
Tampa Bay Local Emergency Planning Committee, District
VIII
Objectives
The goal of the CWFSE was to comprehensively exercise and
evaluate the capability of the St. Petersburg area to respond to an act
of chemical terrorism in a public setting and to integrate mutual-aid
assistance and State/Federal pre-deployed assets. Exercise design
objectives are as follows:
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*
Assess the ability to establish and maintain multiagency and
multijurisdictional communications in response to a WMD
incident.
*
Examine the ability of local response agencies to implement
victim, personnel, equipment, and facility decontamination in
a mass casualty WMD incident.
*
Assess the capability of local response personnel to detect,
identify, monitor, and respond to the effects of a chemical
WMD agent.
*
Evaluate the capability to implement the Incident Command
System in response to a WMD incident and the effective
transition to a Unified Command.
*
Examine the ability to provide effective pre-hospital
emergency medical care in response to a WMD incident.
Assess the community's ability to conduct triage, treatment,
and transport operations.
*
Assess ways to reduce the conflicting requirements for
protection of a crime scene and evidence collection with the
need to perform victim rescue operations.
Several of these objectives were addressed during the CWFSE.
Others did not become areas of concern during the exercise itself,
although officials may have discussed them in depth after the CWFSE
concluded. Immediate feedback on the collective response was
provided during the Controller, Evaluator, and Senior Agency
Officials Debrief held following the exercise. Comments and
impressions from the debriefing are included throughout this
document. Detailed discussion of response issues that concern
numerous agencies follows in the Significant Observations section.
Supplemental comments regarding specific functional areas are
contained in sections as appropriate
Significant Observations
Victim Control/Initial Arrival
Observation.
The initial St. Petersburg Fire and Rescue arriving
engine company and truck stopped a considerable distance from
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Bayfront Arena, performed an assessment of the incident, and
reported their findings to the dispatcher. At the same time, however,
victims seeking help contaminated one of the engine drivers who had
an open window. Other arriving fire department personnel exited
their vehicles without wearing complete Personal Protective
Equipment (PPE)/self-contained breathing apparatus (SCBA)
ensemble and also were at risk for exposure by victims.
Similarly, the St. Petersburg Police Department faced a frantic and
fleeing crowd upon arrival. Officers initially used the public address
(PA) system in their patrol units to give instructions to the crowd, but
victims started to disperse when many first responders left to further
investigate the incident scene. Officers then exited their vehicles in
an attempt to gain control of the crowd. However, officers were
overwhelmed by people seeking medical assistance.
Firefighters attempted to isolate the victims in two areas, Lot D. and
the entrance between lots D and E. Messages given to the crowd
about where to go were largely unheeded, however, because they
could not be heard through the SCBA worn by the police or
firefighters. In addition, it was not clear to several of the victims
where they were supposed to go, since their sense of directions was
impaired by anxiety, pain, or impaired vision; others could not speak
English. As a result, many victims milled around the incident area,
others ran back into the building after the injured, or lay on the
ground hurt without assistance for an extended period of time.
Shortly thereafter, the well trained St. Petersburg Police Department
Special Events Response Team (SERT) arrived and began corralling
the crowd, which was still attempting to flee the area. Initial efforts
appeared ineffective, but once the SPPD officers and the SERT began
working as a team, they were able to contain majority of the crowd
until the SPFR was ready to begin decontamination procedures.
Once a decontamination sector was established, it remained unclear
to victims where to go or what to do. No lines were placed to guide
the victims into the decontamination area. Instead, firefighters had to
guide them to the water curtain providing gross decontamination
(from the two engines and the ladder company) and advise them to
walk through. Once victims went through, they were left standing
around without direction or control until the triage/treatment area was
set up. As a result, many victims stood in the sun off for a long
period of time, while others wandered back into the Hot Zone. In
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addition, hose lines lying across the decontamination path posed a
tripping hazard for victims, especially those victims that may be
having trouble seeing due to the chemical being in their eyes.
Recommendation
. Current police and fire department SOPs for
initial actions at the scene of a HAZMAT/WMD incident should be
reevaluated, especially when balanced against current personal
protective equipment (PPE) capabilities and needs (addressed per
agency in the subsequent appendices). Consideration should be given
to the following:
*
When arriving at a possible HAZMAT, explosion, or
terrorism incident, vehicles should have their windows up,
doors locked, and air conditioner/fan turned off.
*
Personnel exiting their vehicles and encountering a crowd of
personnel should have properly donned their complete PPE
ensemble.
*
A PA system (on the vehicle, hand held, or already located in
the area) with loud volume capability can be used to give
verbal instructions to victims repeatedly.
*
Recorded messages, replayed, can provide instructions for
patients to vacate the area, remove their clothes, sit down,
etc., along with words of reassurance.
*
Hand signals or signs (pre-made or on white boards, etc.) can
also be used to direct victims, especially those who do not
speak English or are deaf.
*
Pike poles held in the horizontal position by firefighters can
be used for crowd control and to decrease the chance of
responder contamination.
In addition, while the exercise gave SPPD officers the opportunity to
experience crowd control while wearing Level C protective suits, in
a real situation a larger crowd could overwhelm officers more quickly
and probably result in the escape of contaminated victims and perhaps
the perpertrator. SPPD officers should continue to train with the
SERT to become more familiar with the SERT's crowd control
measures. Additionally, officers should be more aware of their
surroundings and better utilize resources such as fencing, gates, and
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vehicles as a means of crowd containment during such an incident.
Public address systems should be utilized more than in the initial
phase of the response to direct and help contain victims. SERT
officers recommended joint training, involving SPFR, HAZMAT, and
the bomb squad.
Other factors to consider in initial decontamination and victims
control plans include trying to place supply lines out of the way of the
entrances to the mass and technical decontamination areas and
creating a clear corridor from the Hot zone to the decontamination
area with limited ingress/egress points to permit personnel
accountability. The corridor can be marked with fire line or hazard
tape, and advance consideration should be given as to how the
corridor will be lit at night and associated safety issues addressed.
Followup.
Police and fire departments from all jurisdictions are
reviewing SOPs to ensure that PPE capabilities and needs are more
fully considered. Also, the lessons learned about exposure of
personnel and vehicles arriving at the scene is a subject of special
remedial attention. Personnel have been warned of the dangers
inherent in leaving windows rolled down and vehicle air-conditioning
on when in proximity of possible chemical contamination. Vehicles
already possess PA systems and personnel have been instructed on
the value of using these for crowd control and instructions. The
subject of hand signals as well as use of pike poles for crowd control
are being addressed as well. Since this was the first time the Police
Department has had an opportunity to dress out in Level A suits,
much was learned in the process and additional training is scheduled
to ensure that law enforcement personnel are adequately protected.
Secondary Device Awareness
Observation.
While enroute to the scene, police and fire personnel
communicated over the radio to be alert for secondary devices.
However, once they arrived on scene responders appeared to have
tunnel vision and forgot about the possibility of secondary devices.
A bomb dog was requested, but upon arrival it was only utilized
around the incident command post. Subsequent questions were raised
concerning the safety of the bomb dog if utilized in the Hot/Warm
zones.
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Due to the fact that the operational area was not searched and a
secondary device was not discovered, a simulated secondary device
was detonated. This pre-placed device was near the decontamination
corridor and would have killed or injured numerous first responders.
Recommendation.
Training and real-world incidents in the last
decade both reinforce the principal concern of the potential for the
presence of secondary devices aimed at first responders. The Incident
Commander (IC) and SPPD supervisors should delegate the task in
the early stages of the response operations to search for secondary
devices. Refresher training and future drills should reinforce and
emphasize the importance of checking for secondary devices.
Followup.
The protocols on use of bomb dogs in an around
HAZMAT areas is under review. Refresher training and future drills
will reinforce and emphasize the importance of checking for
secondary explosive devices.
Interagency Communication/Intelligence Exchange
Observation.
Interagency communication or intelligence sharing
was limited and incomplete. On several occasions, witnesses with
vital information pertaining to the incident and a possible perpetrator
approached firefighters and police officers with the information.
(Victims were instructed to be, and were, persistent in their attempts
to provide information to first responders.) However, SPFR and
SPPD responders repeatedly dismissed this information and directed
witnesses back into the crowd of victims awaiting decontamination
or treatment. Responders became so focused on containment of
victims and setting up equipment that they failed to isolate potential
witnesses or convey intelligence information to the command post or
to law enforcement.
In addition, better communication needs to be established with SPPD
detectives conducting interviews of witnesses on scene. On
numerous occasions, detectives were directed to a designated area to
interview potential witnesses, but when detectives attempted to locate
the witnesses, they were nowhere to be found.
Recommendation.
Gathering as much intelligence information as
possible regarding the incident is critical to the response and safety of
first responders. As in most criminal investigations, witnesses
seldom voluntarily come forward or want to get involved, but by
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misdirecting potential witnesses or mixing them back into the crowd,
witnesses may become more reluctant to volunteer their information.
Witnesses could potentially have vital information pertaining to
suspicious persons, secondary devices, and weapons. Procedures
should be in place to immediately identify, isolate, and debrief
victims, witnesses, and first responders for the purpose of gathering
intelligence regarding the incident. Additionally, responders should
convey intelligence information to their proper chain of command.
Followup.
Procedures are in place to immediately identify, isolate,
and debrief victims, etc. During the intensity of initial activities,
these procedures are sometimes overlooked and this subject is one of
special concern to all jurisdictions and will be repeatedly
reemphasized.
Recommendation.
SPFR, HAZMAT, and other responders need to
be more sensitive to the law enforcement aspects of such an incident,
which certainly appeared unnatural and possibly criminal in nature.
In this situation and across American since September 11, 2001, all
responders must be cognizant of their role as collectors of intelligence
that can be passed on to law enforcement. This intelligence is not
only important as it relates to information bout perpetrators, it is also
invaluable to efforts to determine the chemical agent, and as part of
their heightened awareness of the secondary threats to themselves.
Training across all agencies, including hospitals, should emphasize
these criminal/terrorism aspects of the "delta": the danger of
secondary devices and the importance of evidence and intelligence
collection. All responders, even the IC, should remain vigilant at all
times.
Followup.
All awareness and operations HAZMAT courses being
taught in District VIII now include as a special attention section the
discussion of secondary devices as a means for chemical
contamination and the need for careful investigation, to include
aggressive interview and debriefing of witnesses.
Hospital Notification/Communications
Observation.
A pre-alert was given to all of the hospitals by
communications within 20 minutes of the start of the incident. (Some
hospitals received their warning earlier than others.) However, the
preliminary information given - a "mass Casualty Incident (MCI)_
Alert" - was insufficient for most hospitals because it did not include
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a possible victim count, estimated time of arrival for the first victims,
or quick details of what had happened. The absence of this
information made it difficult for hospitals to decide whether to
activate their disaster plan. Similarly, hospitals expressed concern
that they did not receive regular updates about the incident.
In addition, great concern was voiced about he lack of a radio system
that will allow all the hospitals to talk with one another and EMS.
This was especially important during the exercise because the
hospitals made an early identification of the agent involved, but had
no way to communicate the information back to the incident.
Recommendation
. Participants agreed that a pre-alert should ideally
include the following:
*
A short explanation of what happened (e.g., plane crash, bus
accident, HAZMAT spill, etc.)
*
The possible number of victims and severity range (e.g. some
critical, many walking wounded, etc.)
*
Any special patient care needs (e.g., decontamination needed).
*
A forewarning about possible walk-ins.
*
The degree of decontamination being done at the incident site,
if any.
*
The estimated time of arrival for the first victims.
In addition, hospitals agreed that while the hospitals closest to the
incident should be given the earliest warning, each hospital likely to
get patients should be notified as soon as possible. Everyone agreed
regular updates about what was happening at the scent, brief patient
reports once vehicles are enroute, and notification when the last
patient had been transported were important for each hospital to
receive. Some participants noted that several of these communication
issues could be remedied by rejuvenating the hospital emergency alert
radio (HEAR) system. Others suggested there could be a role for the
amateur radio operators to play. There was some interest on
exploring the possible use of computers/MCI bulletin board to
transmit this type of information as an alternative or supplement to
radio and cell phone communication.
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Followup.
While there are active measures underway to investigate
more compatible communications systems, to include rejuvenating
the HEAR system, it was emphasized that in an era of cell phones,
which themselves can be vulnerable to over saturation, the hospitals
can ensure that a hospital liaison is established with the Incident
Commander and/or in the EOC to be a single point of contact for
transmitting most pertinent information.
American Red Cross
Observation.
The Tampa Bay Chapter had a positive experience
participating in the exercise. Red Cross personnel were able to
experience and learn about the multi-faceted aspects of a hazardous
materials response (HAZMAT). The hands-on feeding operation was
an excellent training opportunity for the mix of experienced and
inexperienced personnel that participated. Additionally, crisis
counseling teams were in place to assist families of victims. Some
specific Red Cross objectives included: To consider and discuss
Mass Care HAZMAT response options for feeding both victims and
emergency workers; to practice emergency mobile feeding operations;
to consider and discuss Chapter Public Affairs activities during a
HAZMAT response and the interface with other agencies (Joint
Information Center); to recognize requirements for and discuss
options to provide Disaster Health Service (DHS) support during and
following a HAZMAT response; to recognize requirements for and
discuss options to provide Disaster Mental Health Support (DMHS)
during and following a HAZMAT response.
Recommendation.
It is recommend that the Tampa Bay Chapter be
included early in the development of future exercises. Consideration
should also be given to enhancing the public affairs and mental health
portions of future exercises as these issues will surface early in many
similar situations.
Followup.
The Red Cross was only an auxiliary participant in the
exercise, but a vital one in providing both counseling services to
families of victims who normally show up at accident/incident sites
seeking reassurance; and the provision of meals to workers and
participants. The Red Cross is well skilled in doing the things it is
trained to do and needs little outside support. All jurisdictions have
been briefed on necessity of bringing the Red Cross on board as early
as possible any time an incident occurs and the Red Cross can best
determine the level of effort needed.
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Summary
The CWFSE met its objectives by providing a valuable opportunity
to assess the community's preparedness and by establishing a
roadmap for continuing improvement in the training, equipment, and
readiness of the first response community. Followup exercises
addressing critical components of the overall response should be
pursued with the same vigor demonstrated in the CWFSE. This
CWFSE clearly reflected the challenges facing the community if the
unthinkable - rescuing the victims of a chemical terrorist incident -
were to occur. While the exercise scenario brings into question many
preconceived notions regarding response and preparedness planning,
the city demonstrated that its credentials - its innovative, talented, and
tested first responders - are impressive and provide a firm foundation
on which to build.
A)
Fire/HAZMAT
Gross Decontamination
Observation.
Initial SPFR units quickly determined that immediate
gross decontamination was needed due to the number of victims, the
variety of symptoms, and the level of chaos and panic. However, it
was not until well after additional fire department resources and the
HAZMAT teams arrived that organized efforts to initiate gross
decontamination were started.
The first arriving engine company established gross decontamination
by advancing a 1/34" hand line to the area between lots D and E.
Firefighters used this line to decontaminate the victims who were
already in this area. Those victims that were rinsed, were not washed
thoroughly or uniformly. The other victims corralled in Lot D had to
wait until a more formalized mass decontamination was set up. Had
victims been more hysterical and determined, they could have easily
overwhelmed the perimeter security efforts and left the scent or
forced their way into the gross decontamination area.
Instructions were never given to the ambulatory victims to vacate the
danger area or bring out victims who could not walk. In addition,
instructions to remove clothing were not done until well into the
incident, and then not every victim heard those instructions initially.
No attempts were made, ore were there any supplies (pens, bags, or
ties) available, in the gross decontamination area for collecting,
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securing, and marketing clothing or personnel effects. These issues
persisted in the mass and technical decontamination sectors.
Recommendation.
For decontamination to be beneficial to victims
of a chemical incident it must be performed within minutes of the
agent exposure to reduce injury to victims and to protect responders
and other victims from cross-contamination. While studies have been
done looking at the advantages of using soaps, detergents, and bleach
in the decontamination process, the only decontamination expected
to be immediately available to the first responders is water. However,
this is sufficient for immediate life saving decontamination efforts in
most cases. Removal of victims clothing is also vital. Clothing
removal, even down to the undergarments, will eliminate the majority
of the product that they have been in contact with. Finally, immediate
decontamination efforts can provide victims with psychological
comfort and prevent them from spreading contamination over greater
areas.
In order to make immediate gross decontamination efforts effective,
the immediate use of multiple, rapidly deployed handlines, pump
panel-mounted nozzles, and deluge guns using broad streams of water
to initiate gross decontamination should be considered ­ especially
when large groups of victims are encountered. In addition,
decontamination efforts will have to be systematic and thorough to
remove persistent agents. All personnel should be familiar with
conducting patient decontamination in a similar, consistent fashion.
Victim clothing and personnel effects should be immediately
removed prior to rinsing and placed in clear plastic bags and
identified, if possible, with victim names or unique numbers that are
also attached to the patient. Commercial vendors have clothing
collection/decontamination kits (soap, washcloth, towel, and tyvek
suit) available that can expedite and improve the clothing collection
and decontamination efforts. An SOP on how to handle these
belongings - evidence in a criminal incident - should be developed in
conjunction with the SPPD and Federal Bureau of Investigation
(FBI).
Finally, even in the gross decontamination process, victims should be
queried by firefighters for information about the event, remaining
number of victims, and possible perpetrators. Information obtained
should be relayed to the Command Post. Decontamination team
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members must remain vigilant to the possibility of a secondary device
or other dangerous weapons being found on victims.
For more information on these and other topics, responders can refer
to the U.S. Army's Soldier and Biological Chemical Command's
(SBCCOM's) "Guidelines for Responding to a Chemical Weapons
Incident," or "Guidelines for Mass Casualty Decontamination During
a Terrorist Chemical Agent Incident." both available at
http://www2.sbccom.rmy.mil/hld/
.
Followup.
While gross decontamination went reasonably smooth,
speed of decontamination is crucial. All jurisdictions have been
reacquainted with SOPs requiring processing of clothing as evidence
and the need to ensure that all supplies which will facilitate this
activity are present.
HAZMAT Sector Set-Up
Observation.
The HAZMAT team arrived on-scene and began to set
up near Gate 4 on Fifth Avenue South. The HAZMAT officer
established the sector very quickly, and command vests were utilized
to designate personnel and positions. The HAZMAT sector officer
then informed the IC of both the sector's location and the sector
command personnel. Due to communications traffic, a runner was
used to coordinate with the IC.
HAZMAT team members began to set up their staging area near Gate
4, and began to suit up and discuss a plan of action. As per
department protocol, team members went through a medical
evaluation prior to donning their Level A ensemble. During their
briefing, the HAZMAT officer advised that technical
decontamination would not be set up separately, but the team would
utilize the technical decontamination area established for the victims.
Recommendation.
Utilizing command vests for clear identification
of the sectors was very good, as was use of runners to overcome
communications difficulties. Identifying the Hot, Warm, and Cold
zones with clearly seen markers should be an immediate priority. All
on-scene personnel should adhere to identified boundaries and utilize
only one ingress/egress point. These boundaries should be readily
seen at night and during bad weather.
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In terms of the HAZMAT team's technical decontamination, once the
team has arrived and has set up a staging area, the HAZMAT officer
should consider a separate technical decontamination process for the
HAZMAT entry team. If the victims are still being decontaminated
while HAZMAT operations are still ongoing, sending the responders
through may cause more dely for the victims, or could interfere with
responder decontamination. The existence of a second
decontamination process can also facilitate decontamination of the
non-ambulatory patients removed by entry teams. In addition, if not
already available, an emergency decontamination procedure for use
when firefighters and HAZMAT team members become exposed or
ill should be familiar to all personnel working in the decontamination
sector.
Followup.
All jurisdictions have been briefed on necessity of
establishment and use of only one entrance and egress into the
established area. The provision of a second technical
decontamination facility for first responders has been placed on the
agenda for discussion of future department needs.
Hot Zone Entry
Observation.
The HAZMAT team tried to make entry but was turned
around by SPPD units guarding the perimeter. Due to the delay in
entry, SCBA bottles ran low and had to be changed. Once
communication was made between SPFR and SPPD to correct the
situation, and bottles were replaced, entry was made to the hazard
zone.
As a result of the above delays, the initial entry occurred about an
hour after the initial dispatch. The entry team entered with an ADP
2000, M8 and M0 paper, Geiger counter, and pH paper. On the initial
entry, the HAZMAT team did not go into the Bayfront Arena itself or
to the site of the detonation, but bout 10 to 15-feet inside the entrance
to get readings. From this vantage point, the entry team noted that
they had victims in the arena, but the entry team advised the
HAZMAT officer that the victims appeared deceased. The entry team
did not do any kind of reconnaissance inside the arena to check the
viability of the victims or to conduct air sampling inside the arena
area. After readings were made, the results were given over the radio,
but due to amount of radio traffic and only one channel for the entire
incident, it was not known if the information made it back to the IC
or HAZMAT officer.
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Much later into the incident, a second entry was made due to a report
of an officer down in the arena. The second entry was made in Level
B with SCBA. A search was done, but due to erroneous information
provided on the location, the victim was not located. (Exercise was
terminated before more information on location was provided.)
Recommendation.
Reconnaissance is an important part of any
HAZMAT response. With recon, a plan of action can be established
for victim rescue, area monitoring, and other information that may be
needed for the response to a WMD event. Reconnaissance can
determine if any victims that are still in the Hot Zone are viable
patients, other readings can be done closer to the initial blast location
or in an enclosed area such as an arena, and a better understanding of
what may have happened can be obtained. As in any HAZMAT
response, caution should always be used when Reconnaissance is
performed, secondary devices or even a perpetrator may be waiting
for response personnel.
Entry teams should carry as much monitoring equipment as possible
so that agent identification can be made on the initial entry. Utilizing
some sort of equipment such as a Stokes Basket to carry the detection
equipment would save time and reduce the amount of entries and
physical exertion required. The sooner agent identification can be
made, the sooner victims will be provided proper treatment. The use
of equipment, such as the Dräger Civil Defense Set (CDS), or other
monitoring devices may have identified the product sooner.
In addition, rapidly placing additional entry teams into service will
greatly improve response to a large-scale chemical incident (although
exercise limitations my have prevented use of additional teams in this
case). While caution should be used when allowing firefighters in
turnout gear and SCBA to enter the Hot Zone when the
agent/chemical is unknown, this is acceptable for victim rescue under
certain conditions. Emergency response personnel should review the
"3/30 rule" whereby firefighters in standard turnout gear with SCBA
can make entry into a suspected chemically contaminated
environment (based on nerve agent vapor) for up to 30 minutes. If
the hazard is unknown, self-taped turnout gear with SCBA can be
used for 3 minutes reconnaissance to search for living victims. Some
limitation apply to these guidelines, and can be found in detail in
SBCCOM's "Guidelines for Incident Commander's Use of
Firefighter Protective Ensemble with Self-contained Breathing
Apparatus for Rescue Operations During a Terrorist Chemical Agent
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I n c i d e n t , " F i n a l R e p o r t , A u g u s t 1 9 9 9 , a t :
http://www2.sbccom.army.mil/hld/ip/reports.htm#cwirp
.
Followup.
Refresher training will stress the necessity for ensuring
that the entire area is reconnoitered by HAZMAT team to ensure no
additional casualties remain in the area that have not been identified
and transported out. The subject of carrying additional equipment
will also be addressed with the view towards a means of being able
to do air monitoring quicker and more accurately.
Mass Decontamination
Observation.
Mass decontamination was set up in Lot D of the
Bayfront Center by two engines side by side and a ladder truck
utilizing its aerial device. Once mass decontamination was set up,
victims in Lot D were sent through, as well as some of the victims
(not all) that were in the area between lots D and E. However, the
victims were line up with regard to priority and then sent one by one
into the shower. There was some confusion as to how long they sere
to stay in the water curtain. Many patients simply ran through the
water. In addition, victims were not walking in contaminated water
because the rinsate was not being contained. (Firefighters also were
cross contaminated for the same reason). At no time was special
attention paid to cleaning open wounds. When questioned, personnel
indicated they had no known protocol specifying a time frame for
rinsing the patients during gross or secondary decontamination.
Victims were asked to remove clothing only after they went through
mass decontamination. While there were no gowns available, there
were towels and blanks passed out to victims who came out of the
decontamination tent.
Recommendation
. Consideration should be given to developing a
mass decontamination system that is capable of doing
decontamination on more people, faster, and with modesty protection.
The use of an aerial-based decontamination shelter concept could be
refined to include:
*
Using four 1 3/4" hose lines laced along the aerial bed so
there could be two wash and two rinse nozzle.
*
Draping colored plastic over the aerial bed before it is
extended 75 to 100-feet and elevated 10 feet off the ground
for modesty protection.
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*
Using two trucks configured in a similar fashion, one for
males and one for females
*
Pumping dish soap into the system using a foam inductor
nozzle submerged in 50-gallon trash cans containing water
and soap.
*
Placing kerosene heaters off center in the middle and ends of
the tent to blow heat into the area if needed.
In addition, while this exercise presented a relatively small number of
victims, more staff will be needed to perform mass decontamination
for larger real-world events.
Followup.
All jurisdictions have undertaken to solve the problems
identified in doing mass decontamination more quickly and more
thoroughly.
Technical Decontamination
Observation.
Technical decontamination for victims was set up
behind the mass decontamination area utilizing a tent for modesty and
cultural considerations. However, the victims were not segregated to
take advantage of these two corridors. Warm water was used initially
in the technical decontamination area, but due to equipment
problems, only cold was available for a period of time. Soap and
water with a 5% bleach solution was used as the decontamination
solution. Blankets were given to those victims after decontamination
procedures were completed who requested them, all were given a
towel.
The secondary decontamination performed, especially for the non-
ambulatory patients, was insufficient to be effective. No brushes or
soap appeared to be in use. In addition, the length of time taken for
decontamination, and the completeness of the effort, was variable.
Patients' backs were often omitted. None of the patients were
observed being scanned or otherwise evaluated to make sure they
were as clean as possible to prevent further contamination. (The non-
ambulatory were first taken through the gross decontamination alley
and then to the tent, where they were placed on a roller system for
washing. The design of the roller system is manpower intensive and
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can be a bottleneck if a particular patient proves difficult to clean and
requires more time).
The HAZMAT team elected not to created a separate technical
decontamination sector, but instead opted to use the same system the
victims utilized.
Recommendation.
A regional decontamination SOP for ambulatory
and non-ambulatory patients should be published and rehearsed by all
of the fire departments, HAZMAT teams, and hospitals in the area.
The plan should outline key definitions and strategies for performing
gross, secondary and definitive decontamination. The plan should
also address would cleaning, decontaminating of ambulatory and non-
ambulatory patients, and proper handling of children, the elderly and
others with special needs (e.g., blind, hearing impaired patients,
wheelchair-bound victims, and frightened persons). The SOP could
also outline the additional equipment needed in the decontamination
sector, including more soft bristle brushes, sponges, and wipes along
with stands for back-boarded patients. More blankets, towels, gowns,
etc. should be available. The decontamination SOP should include
how often brushes, sponges and soapy water should be exchanged.
To limit their exposure to contaminated rinsate, patients should stand
on elevated platforms and backboard stands should be available in
each area to minimize injury and optimize decontamination. Finally,
containment pools also should be adequate in size to hold back-
boarded patients and Stokes Baskets, while avoiding over spray.
Other features to consider in any decontamination plan include an
amplification system to give repeated instructions (in several
languages) to the victims; the use of multi-lingual graphic signs
hanging on the tent wall that detail the desired patient activity;
handling the deceased and the possibility of decontamination animals,
including police dogs and horses; and, an SOP for the
decontamination of emergency vehicles and other large equipment.
An adequate number of stretchers, SKEDS, or other wheeled vehicles
should be available to move non-ambulatory victims between zones
in order to minimize responder fatigue and injury.
Contingency planning should include the possibility of setting up
multiple patient decontamination sectors in different locations (e.g.,
baseball stadium, convention center, etc.) Lastly, decontamination
efforts should include some qualified person determining when no
further decontamination is needed on patients before exiting the
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decontamination sector. Detection devices and/or best clinical
judgment should be used. If patients have not been thoroughly
cleaned, the treatment and transport sectors need to know so that
appropriate PPE can be donned by personnel in those sectors.
Followup.
SOPs are being revised to include above
recommendations for multiple decontamination stations. Most of the
other recommendations already appear in SOPs and should be an item
of special emphasis on refresher training. The need for thorough soap
and water scrubbing in technical decontamination will be a subject of
additional attention at the next exercise and SOPs will be revised to
address the concerns raised on length of decon and exchanges of
brushes, soap and water.
Exclusionary Zones
Observation.
The Hot Zone was established by the Incident
Commander soon after arrival. However, the area was not clearly
marked until well into the scenario. Minimal efforts appeared to be
made to identify the Hot, Warm, and Cold zone areas. The result was
poor perimeter control and cross contamination. Exclusionary zones
were eventually marked with fire line tape and announced by the
Incident Commander of the radio, but few units appeared to
acknowledge this information.
Recommendation.
The determination, updating, clear delineation,
and notification of the exclusionary zone boundaries is vital in a
HAZMAT incident. Victims and non-essential personnel need to be
prevented from entering the area to prevent further injury. In
addition, defined zones with limited ingress/egress points can
facilitate personnel accountability in this hazardous area.
Followup.
Current SOPs adequately cover items being addressed in
this finding. The necessity of following SOPs will be subject of
refresher training and future pre-exercise briefings to participants.
Runoff
Observation.
Due to the simulation of many runoff control
measures, water used for mass and technical decontamination
collected in and around the decontamination tent and started to flow
towards the triage and treatment area. Decontaminated victims exited
technical decontamination and walked through the runoff, re-
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contaminating themselves and tracking it to other locations such as
the triage area.
Some evaluators noted that simulated runoff control measures were
discussed. For example, personnel utilizing pumps and diking and
damming procedures did attempt/would have attempted runoff
containment. Prior to the pump use, evaluators noted that personnel
were or would have been on-scent to oversee the runoff to the storm
drains and water was contained and tested in another location.
Procedures also call for notification of the State Warning Point and
United States Coast Guard to advise of the potential contamination of
the waterways.
Recommendation.
When setting up the mass and technical
decontamination areas, considerations should be given to the runoff.
Runoff water could have contaminants in it and can contaminate
numerous clean areas. If at all possible, personnel should attempt to
redirect the runoff or attempt to contain it, so it does not affect other
areas of the operations. Requesting additional resources, such as
public works for sand, dirt, or barriers, is an option that can be
forwarded through the chain of command.
Followup.
The subject of runoff will be pursued in meetings with
utilities personnel on the best way for containing water used in gross
and technical decontamination. The amount of water used for a mass
casualty exercise, especially in gross decontamination, poses a
problem of entrapment. It is possible to have pumper trucks used in
the collection of waste could be used if rinsate could be directed to a
single pool area that could be pumped. Recommendations for use of
sand, dirt or other barriers are being addressed as well.
Medical Care in the Decontamination Sector
Observation.
Providing patient care in the decontamination area
was not exercised, so problems that would be encountered with
patients undergoing decontamination were not seen and addressed.
However, had this been a real incident in which neither the gross nor
secondary decontamination areas had emergency medical personnel
(or medical supplies and antidotes) available to assist with medical
care and triage activities, the result would have likely been higher
patient morbidity and mortality. Many of the victims seen during the
exercise would have required medical care during decontamination
to survive. In addition, the special needs of children, the elderly,
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blind, deaf, and wheelchair-bound patients would not have been
easily met by the system that was implemented.
In terms of the exercise, patients were triaged when they exited the
technical decontamination process. However, due to limited staffing,
this activity resulted in a bottleneck at times.
Finally, there appeared to be little communication between the
decontamination and triage/treatment sectors. As a result, the triage
and treatment officers had little insight into volume or acuity before
patients arrived.
Recommendation.
All decontamination corridors should have basic
emergency care equipment and supplies to treat significant numbers
of patients. Suction equipment, dressings, bandages, and oxygen are
particularly important. In addition, paramedic personnel or
specifically trained Emergency Medical Technicians (EMTs) should
be immediately available to render lifesaving medical attention (e.g.
suctioning, bleeding control, etc.) In the decontamination sector if
needed. This should include administration of MARK I kits and
other appropriate antidotes when they become available.
An effort also should be made to keep a count of the number of
patients who are processed during decontamination, and this
information should be reported periodically to the Incident
Commander, treatment officer, and transportation officer. However,
obtaining this information should not delay the provision of medical
care.
Followup.
SOPs will be revised to reflect greater role of EMTs in
the decontamination sector is needed and to ensure that following
decon, those requiring additional triage/treatment prior to
transportation receive necessary care. Patient processing will be
highlighted in all future refresher training to stress the importance of
being to accurately account for patients treated and their disposition
from the decon area.
B
Incident Command
Establishing Incident Command
Observation.
Participants demonstrated a clear knowledge and
understanding of the Incident Command process and utilized in very
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competently from the arrival of the first response vehicle to the
termination of the exercise. The first arriving engine company,
Engine 5, staged remotely from the involved area, assessed the
situation using binoculars, and decided on a course of action which
committed them to enter the field of play. Upon entering the
response area, Engine 5 verbally passed command to the next engine
company, Engine 1. Engine 1 assumed command and requested
police presence. Within two minutes, District Chief 5 arrived and
assumed command from Engine 1.
Once District chief 5 became the Incident Commander, a command
post was established and clearly indicated with a green flashing light
on top of the chief's vehicle. The command post's location also was
announced via radio. Unfortunately, the location of the command
post was too close to the field of play and was quickly overrun by
contaminated victims. The incident commander was not
contaminated, however, and remained in his vehicle, and instructed
the victims with his public address system to move away from the
command post.
Recommendation.
None; within the first few short minutes of the
initial dispatch, command had passed from the first company to the
chief officer, in accordance with accepted practices and agency
standard operating procedures. The smooth transitions of command
indicated that the responders are familiar with the system and practice
it routinely. In addition, had this been a real incident, the command
post would have been located farther away from the scene.
Followup.
This item of ensuring that the Incident Command Post is
established far enough from scene to preclude cross-contamination
will continue to be stressed at training sessions.
Incident Command Operations and Management
Observation.
The SPFR IC managed the entire incident competently
and calmly. At 9:14, a second alarm was struck. Subsequently, a
request was made for the Command Bus, for Emergency Operations
Center (EOC) activation, and the bomb dog. Adequate general staff
positions were created, and operations were conducted under an
Operations Chief. Although a HAZMAT Safety Officer was
appointed, the positions of Liaison Officer or Incident Safety Officer
were not observed, and a Public Information Officer was requested
only after controller prompting. Finally, neither a Logistics section
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9th Revision, 6/02)
nor a Finance section were established, although both would have
been crucial to the management of a real incident.
The SPFR IC made good use of the management tools and job aids
available to him. For example, an extensive organizational chart was
developed and updated throughout the incident; strategic goals and
tactical objectives employed at the incident were developed based on
the SPFR checklist; and a National Fire Academy Emergency
Response to Terrorism Field Operating Guide was used as a
reference. However, no written incident action plan (IAP), prepared
before committing resources to tasks, was observed. Utilization of
this action plan would have identified strategic goals and selected
tactical objectives early in the incident. In addition, such an IAP may
have eliminated the stressed and burdens associated with the
command of an incident of his magnitude. Nevertheless, Incident
Command functioned effectively.
The SPPD IC effectively managed the law enforcement aspects of
command. For example, the important issues of command post safety
were addressed in several ways, most notably by having the area
swept by the bomb dog, and then by assigning members of SPPD to
establish a perimeter and protect it. ;In addition, the SPPD IC
competently addressed overall scene security and perimeter control.
In fact, security was so tightly controlled that responders from mutual
aid agencies had some trouble entering the response area until their
identification could be verified.
Recommendation.
While the Incident Command system is designed
to be flexible and modular, an actual incident similar to this exercise
would almost certainly require the full utilization of both the
command staff and general staff positions, provided there are
personnel available to fill the roles. Maintaining the span of control
is critical to mission success and is relatively easy to accomplish.
Additionally, while the IC made good use of incident management
tools, it is strongly suggested that the behaviors exhibited at this
exercise be supplemented with the development of an incident-
specific Incident Action Plan that clearly states the objectives for the
operational period at hand.
Followup.
Real-world considerations the day of the exercise
precluded designating as many people to the IC for role-playing as
desired. However, all SOPs reflect these positions and they would be
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normally filled. Recurring training will stress preparation of Incident
Action Plan as specified in the SOP.
Communications Difficulties
Observation.
As more units arrived and were placed in service at the
incident, the communications system (two-way radios) began to get
overloaded. The Incident Commander recognized this and requested
additional tactical channels. A suitable number of channels for this
size incident were not available, partly due to the fact that one of the
tactical channels was being used as the exercise controller network.
The impact of the lack of channels had on the command function of
the incident was to be felt for the remainder of the exercise.
The lack of tactical radio frequencies, as mentioned previously,
contributed to certain deficiencies in the operation, which, under real
circumstances, would have critical ramifications. Among the
deficiencies was the inability to effectively communicate that lewisite
was the agent involved in the incident. The actual sequence of events
is unclear, but it appears that one hospital determined the agent to be
lewisite and was unable to communicate this fact back to the incident.
Inexplicably, the HAZMAT sector was aware of the hospital's
identification of lewisite before Incident Command. While
conventional communications means were not used to try to reach the
command post, a dedicated radio channel available to the hospitals
would have provided direct communication to the IC.
Additionally, the heavy use of the incident frequency often caused
messages to be lost or delayed, thereby necessitating repeating and
compounding the problem. Serious miscommunication about the
location of the Bomb Squad, its liaison to the command post, and the
suspected locations of numerous secondary devices resulted due to
communications overload or confusion. Of even more concern,
significant confusion resulted when the whereabouts of a rescue team
in the Hot Zone could not be determined. In a real operation, this
situation would pose a serious threat and could cause an otherwise
successful operation to deteriorate rapidly.
Recommendation.
Communications problems should be addressed
soon; those enumerated for the IC also existed for HAZMAT and
other sectors. The establishment of more tactical channels and the
development of an interagency communication plan that provides for
information to go to and from the incident site will alleviate the
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problems encountered during this exercise. While the lack of
channels was an exercise artificiality, the lack of information
delivered to and from the hospitals and the various response sectors
are procedural issues that merit review.
Followup.
Agree that this is a serious problem and will receive
special emphasis at all additional training sessions. Also to be
addressed will the increase in available tactical channels.
Unified Command Operations
Observation.
At 9:23, an SPPD lieutenant arrived at the command
post. After communicating with police dispatch and presumably
other police department units for approximately 10 minutes, the
lieutenant exited his vehicle and positioned himself outside o the IC's
command vehicle. From this position he conversed with the SPFR IC
through the vehicle's open window. If it unclear whether o not he
was aware or was told that the exterior of the command vehicle had
been contaminated, but at this point in the incident, without having
atmospheric monitoring done in the command post area, there is a
high likelihood that the SPPD lieutenant was operating in the Hot or
Warm zone. (Participants noted that had the playing area been larger,
the command post would have been farther away and this would not
have been an issue. However, as they were forced to be in the
contaminated zones, some notification probably should have
occurred). Notwithstanding this, the conversation and interaction
between SPFR and SPPD signaled the initial establishment of a
Unified Command (UC).
Unified Command manifests itself in both form and function, and to
the credit of the members of the response community, a true unified
command was evident in both. Strategic concepts were shared and
functional needs were expressed between the SPPD and SPFR ICS.
Each IC was able to direct resources available to him towards the
agreed upon strategy. Dialogue between SPPD and SPFR was
continuous throughout the incident.
As the incident progressed, HAZMAT joined the UC and became an
integral part of the command post. Also included in the command
post, not necessarily as decision makers but as valuable informational
resources, were members of the Bayfront Canter management team.
This small collection of individuals comprised the Unified Command
team and functioned cohesively for the duration of the incident. They
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maintained their positions in the command post area and were able to
communicate with each other on a face-to-face basis.
Had this been an actual incident, the UC's composition would have
been significantly larger. Representatives from other major
participating organizations surely would have had a role in the
command process. Absent from the UC at this exercise were
representatives from some significant exercise participants, notably
members from Pinellas County Health, the FBI and local, private, or
county EMS. It is unclear as to why these entities die not enjoy fuller
participation in the exercise of inclusion into the Unified Command
Post since they were represented on-scene.
Impediments to a fully effective UC were mor formative than
functional. Most noticeable was the lack of utilization of a command
vehicle that could accommodate all the members of the UC team.
This is unfortunate because one was available and on site, and the use
of such a vehicle to keep the command team assembled and under one
roof contributes to the success of the mission by removing the team
from the distractions of the field of play. The UC's close proximity
to the incident was an issue at this incident as evidenced not only by
the contamination of the district chief's vehicle early in the incident,
but also when the secondary device detonated. By this time, the UC
was operating to close to the operational area.
Recommendation.
Unified Command functioned well and the
participants seemed to be familiar and comfortable working within it.
However, UC participation by all major response and support
agencies should be considered and encouraged by the lead agencies.
An initial effort that would have alleviated some problems
encountered during the incident is the strategic placement of the
command post. While it may have been a result of the limitations of
the configuration of the area of play, the command post was located
too close to the field of play and too close to the Warm Zone. In
addition, it was placed next to an unknown vehicle, and bomb sweeps
were not made until later. From the onset, the close proximity of the
command post to the field of play caused numerous problems, most
notably the contamination of the command vehicle upon its arrival,
and the close exposure to the effects of the secondary device
detonation. Under real circumstances, there was high likelihood that
the command post would have suffered considerable harm from this
blast.
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Finally, the use of a dedicated command vehicle that can house the
members of the UC and provide a comfortable environment remote
from the center of activity will allow the UC members to concentrate
on the strategic decisions they were deliberating over and decrease the
chance of distraction. St. Petersburg should continue to practice the
Unified Command function with regularly scheduled WMD
exercises.
Followup.
Current SOPs reflect the proper staffing of the UC and
location of the of the command post. This finding will form basis of
additional emphasis on following procedures, especially in regard to
placement of vehicles and potential for danger due to secondary
contamination, secondary explosions, etc. A dedicated command
vehicle to house members of the UC and provide remote access from
center of activity will be designated in future. All jurisdictions do
practice UC functions and will continue to do so.
C
Law Enforcement and Bomb Squad
Initial Response
Observation.
Based on information provided by police
communications, the SPPD patrol supervisor recognized the potential
of a hazardous situation prior to his arrival at the Bayfront Arena.
The SPPD supervisor also recognized the need for additional
personnel and requested activation of the SERT. However, initial
notifications and requests for SPPD detectives, the FBI and the
Bureau of Alcohol, Tobacco and Firearms (BATF) were delayed.
The SPPD supervisor and initial responding officers quickly
established an outer perimeter an appropriate distance from the arena.
Due to exercise artificialities, response units were moved closer to the
arena property. Officers set up an inner perimeter within the
parameters of the exercise area. While the resources maintained the
perimeters adequately, the initial perimeter was established prior to
delineation of Hot, Warm, or Cold zones by SPFR.
Recommendation.
Before rushing into an unknown situation,
responders should slow down, assess the situation, and request
adequate resources. The SPPD did an excellent job recognizing the
hazardous situation, setting up an outer perimeter, and donning the
appropriate level of PPE before proceeding to the scene. However,
SPPD should communicate of coordinate sooner with SPFR/IC prior
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to establishing inner and outer perimeters so that hazardous and
exclusion zones can be considered.
Additionally, initial notification of specialized units, mutual aid, and
Federal agencies needs to be made sooner to prevent delays in
deployment. To assist in planning efforts, law enforcement planners
should review the SBCCOM Chemical Weapons Improving
Response Program (CHIRP) publication: "Guidelines for
Responding to a Chemical Weapons Incident." This resource guide
can be found at:
http://www2.sbccom.army.mil/hld/ip/reports.htm#chirp.
Followup.
Closer coordination for establishing inner and outer
perimeters will be highlighted for future exercises and for real
emergencies. The request for mutual aid support will also be
reviewed in the SOPs for proper and rapid implementation.
Crime Scene Preservation/Investigation
Observation.
The initial SPPD officers on-scene were so
overwhelmed with controlling victims attempting to flee the scene
that crime scene preservation was an afterthought. There was no
demarcation of the crime scene, no protection of the crime scene, or
any investigative activity such as photographing and/or videotaping
the scene or collecting and documenting the personal property
removed from victims.
Recommendation.
While lack of crime scene investigation may
have been an exercise artificiality, due to the limited number of local
or Federal officers available and in part, because crime scene
investigation was not a selected objective, the initial steps in the
preservation of evidence and the scene are the responsibility of local
law enforcement.
Once life safety is no longer a priority, crime scene preservation
becomes the main concern. In a WMD incident, every response
element becomes part of the crime scene. ;Interviews, clothing debris,
and other evidentiary and preservation issues would be the focus of
law enforcement investigations. Eventually, all personnel who were
at the site, including victims, should be interviewed. Boundaries need
to be identified, established, protected, and secured. The crime scene
should be marked off with crime scene tape to delineate the area.
Law enforcement officers should then be posted to prevent
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unnecessary entry. Crime scene logs are essential in the
documentation of response personnel entering and exiting the crime
scene area. Documentation of all persons entering the crime scene is
essential to preserve the integrity of the scene.
For additional resource information on crime scene investigation refer
to the U.S. Department of Justice, Office of Justice Programs,
National Institute of Justice publications: "Crime Scene Investigation:
Au Guide for Law Enforcement," and "A Guide for Explosion of
Bombing Scene Investigation," at
http://www.ncjrs.org.
Followup.
Agree that the crime scene preservation measures detailed
in the SOPs were not carefully followed, so great was the interest in
treating and processing victims through the health system. The
necessity of rapid demarcation of the crime scene to include not only
tape but in some cases, security personnel at critical access points will
continue to be stressed in future exercises.
Victim/Witness Interview Process
Observation.
SPPD detectives responded to the scene and to area
hospitals to conduct victim/witness interviews. The detectives did an
excellent job identifying and debriefing victims; however the
interview location and procedures were inadequate to conduct
appropriate interviews. For example, some victims were not
interviewed, and numerous first responders entered the area while
interviews were being conducted. In addition, there was no
victim/witness control or tracking, and therefore it was difficult to
discern which victims had or had not been interviewed.
Recommendation.
As victims exit decontamination and prior to
transport to the hospitals, when medically possible, each should be
interviewed, identified, photographed, and fingerprinted. This
interview setting should be established away from response
operations or off-site. Furthermore, if the interview site has to be
located near the operations area, the site needs to be distinguished
with controlled ingress/egress. To prevent duplication of interviews
by detectives at the hospitals, a victim tracking system needs to be
implemented.
Followup.
SOPs will be reviewed to ensure that victim processing
is accomplished without duplication and redundancy. The process of
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crime scene/victim interview will be emphasized for all future
exercises to preclude the loss of valuable evidence.
Personal Protective Equipment
Observation.
SPPD should be commended for being one of the first
law enforcement agencies in the region to don Level C protective
suits and air purifying respirators (AIRS) during a CWFSE. Although
this was the first time officers had worn the suits in real world
conditions, numerous lessons were learned including:
C
Openings around the neck and writs areas need to be taped
closed
C
Latex gloves are inadequate for chemical agent environment
C
Equipment worn on gun belts and insufficient footwear
caused tears in the suits
C
AIRS and masks hinder communications.
Recommendation.
SPPD should acquire additional PPE accessories
to complete the Level C suit ensembles. Responders should also
receive training in the proper use of the Level C PPE to have a better
understanding of the capabilities and limitations of the suits.
Followup.
This was the first time the SPPD participated in PPE to
this extent and it was an excellent learning event for the reasons
stated above. Funds for purchase of PPE for the Police Department
are limited and the Level C suits used during this event were provided
by the LEPC for the SPPD. Future training with the police
department will include those items not available during the exercise
along with the protocols for proper donning and securing of PPE by
department personnel.
Radio Equipment
Observation.
SERT officers realized quickly that radio
communications are very difficult while wearing Level C protective
suits and AIRS. Some officers were seen removing their masks in a
contaminated area in order to communicate. Officers were able to
circumvent the problem by holding the speaker-microphones of their
portable radios next to their throats when they talked, using hand
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signals, or relying on face-to-fact dialogue to communicate with each
other.
Recommendation
. SERT officers recommended the acquisition of
a communication system to wear under their masks so they can
communicate with each other. SPPD may want to explore a variety
of speaker-microphones such as an ear microphone. Worn in the ear,
such a system transmits car canal vibrations into microphone signals.
Additionally, a bone microphone which is worn on the top of he head
or behind the ear and which transmits vibration signals is sometimes
appropriate. Finally, a throat microphone is worn on the throat and
transmits vibration signals.
Followup.
This equipment is on the list of needed assets. In the
meantime, special emphasis will be given to use of hand signals and
other non-verbal communications.
Police Communication Center
Observation.
The SPPD Communications Center did an
extraordinary job of communicating information, requesting
resources, and notifying and dispatching units, considering the
atypical circumstances in which they were working. Initial officers
on scene helped paint a clear picture of events occurring on scene,
and SPPD communications quickly provided detailed scene
information to responding police units, which enabled them to assess
the situation and take appropriate protective measures before arrival
on-scene. A detailed log of all response activities was maintained
with the assistance of a computer-aided dispatch (CAD) system.
Some first responders reported having difficulty communicating on
the same radio frequency. SPPD employs an 800 MHZ trunked
system with allocated talk groups to a particular radio frequency. In
an incident of this magnitude, communications overload is
foreseeable, even though additional radio frequencies would be
available in normal situations.
Recommendation.
The information that communication operators
obtain from victims, witnesses, or first arriving officers - and the
promptness in communicating this information to field units - can
minimize the risks to first responders. SPPD should continue to build
a strong WMD-response system based on lessons learned and through
regular refresher training for support staff on chemical agent
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recognition. Communication operators must obtain as much
information as possible regarding the incident, including the number
of victims, signs and symptoms, secondary explosions, suspect
description, etc., in order to provide first responders with sufficient
information to effectively evaluated the situation prior ro arrival.
To assist communication operators with communication overload,
non-essential radio traffic should be kept to a minimum and all radio
transmissions should be clear and precise. Furthermore, all requests
for resources should be coordinated and requested by one focal point.
Followup.
Communications is the weakest link in all exercises and
recognized for special emphasis. This will be continue to be included
in future exercise objectives to ensure that radio discipline in the
exercise is practiced to include elimination fo non-essential traffic
and need to more precise communication of information. SOPs all
currently stress these items, but they remain some of the most
difficult to implement under stress.
Volunteer Agency Integration
Observation.
A number of actors portraying family members and
friends relentlessly attempted to gain entry into the scene. Fire and
police personnel positioned around the perimeter repeatedly turned
the actors away. However, the responders did not provide any
information to the actors/family members, nor did they direct them to
a specific location where they could obtain this information. The
actors subsequently had to request the location of the American Red
Cross.
Recommendation.
In a mass casualty event of this nature, it would
not be unrealistic for family, friends, co-workers, and volunteers to
come to the scene attempting to locate family and friends or to offer
assistance. The American Red Cross and Salvation Army provide a
variety of services that can be beneficial to the management of an
Mass Casualty Incident (MCI); e.g., life-sustaining needs, food
services, mental health counseling, family support, victim tracking,
and multilingual interpreters. Response agencies and their personnel
should become more familiar with the support services provided by
volunteer agencies. In addition, local SOPs should address the
integration of volunteer agencies and the support services that they
provide during an MCI event.
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Followup.
While SOPs do address the multitude of volunteer
services and their functions, SOPs will be reviewed to ensure that
more information is related to relatives of victims as soon as possible
following an incident.
Bomb Squad Response and Integration
Observation.
There was a delay in dispatching the Tampa Bomb
Squad to the incident, which resulted in the controller prompting a
request for the team. When the Bomb Squad did arrive, a
representative was detained for approximately one hour before being
allowed access to the Incident Command Post. Other Bomb Squad
arrival and set-up activities proceed as usual some distance from the
ICP and decontamination areas.
Recommendation.
With an incident of this type - an initial
explosion and the possibility of terrorism- the early notification and
integration of the Tampa Bomb Squad is vital. At a minimum, visual
sweeps of the Incident Command Post and staging areas can and
should be completed by the Bomb Squad, before operations continue
in order to ensure the safety of all responding personnel and to
minimize the potential for additional casualties. The Bomb Squad is
one of the most effective tools the Incident Commander has to ensure
a safe incident scene and access to them is critical early on in the
incident. While the maintenance of a secure perimeter is also vital,
and commendable in this exercise, procedures to recognize and
provide access for additional resources, including the Bomb Squad,
need to be refined and exercised.
Followup.
SOPs dealing with bomb squad requests and integration
will be reviewed to ensure that there are no bottlenecks in future
responses.
Tampa Bomb Squad PPE
Observation.
Tampa Bomb Squad technicians were outfitted in
Level B chemical protective suits under their Med-eng SRS-5
Explosive Disposal Suits. Together, this PPE allowed them to
operate in a possibly contaminated environment while still providing
blast protection. Technicians operated multiple robots, so personnel
dressed in Level B PPE were primarily a reserve asset, in case access
to the device could not be achieved remotely.
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Recommendation.
Commendably, the Tampa Bomb Squad is
currently trained to the HAZMAT Technician/WMD level. They are
self-sufficient with their own PPE, thereby making them self-
sufficient with only decontamination support needed. In addition, the
team's highly skilled use of multiple robots provides enhanced
protection for Bomb Squad members.
Followup.
Concur. This has been a successful phase of Bomb Squad
training and will continue.
Device Neutralization
Observation.
Upon identification of a possible secondary device, the
Tampa Bomb Squad performed reconnaissance of the area using
binoculars and robots. Once the device was located, a plan was
formulated to have two Bomb Squad technicians ready in Level
B/SRS-5 suits while remote examination of the device was done
using three robots. Based on a visual assessment of the device, the
team used a "blind shot" render-safe procedure (RSP) using a Pan
Disruptor.
Disruption techniques removed one of the power supplies without
rupturing the container holding the chemical agent. However, a
secondary power supply under the device remained intact and may
have been able to detonate the device.
HAZMAT was not with the Bomb Squad to assist in chemical
monitoring while they were operating near the device.
Recommendation.
Although the Tampa Bomb Squad is trained in
HAZMAT, they need to coordinate with HAZMAT during incidents
that may be WMD in nature. The Bomb Squad can gather important
information from the HAZMAT Sector to aid in possible agent
identification for secondary devices. In return, the HAZMAT team
can provide chemical monitoring, additional equipment or research,
or a foam spray in case any chemicals are released during bomb
Squad operations. To enhance this relationship, HAZMAT team
members could be integrated into training exercises.
Followup.
Special emphasis to the integration of Bomb Squad and
HAZMAT team members in training will be made to reduce
possibility of contamination at a secondary explosion site.
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D
Emergency Medical Services
Triage/Treatment Sector Location
Observation.
EMS responders arrived and began to set up the triage,
treatment, and transport areas. The triage sector was established very
close to the Warm Zone and the decontamination area. The area was
not swept for secondary devices, and it became contaminated due to
the runoff from decontamination. In addition, because the EMS
personnel wore no PPE, in a real incident many of them would have
become contaminated when patients whose degree of
decontamination was unknown began to arrive from the
decontamination sector.
Recommendation.
The triage and treatment sectors should be
located a safe distance from the decontamination sector in an area that
is large, and preferably protected from the environment and the press
and media.
EMS personnel need to have immediate access at an minimum Level
C attire to wear in the triage and treatment sectors and during
transport if needed. Consideration should be given to having
treatment and transportation sector personnel wear PPE initially, until
it is certain that the victims no longer present a contamination risk.
In order to protect EMS responders, Incident Command must ensure
that the EMS sectors are notified what degree of decontamination is
being performed, and identification of the agent so that appropriate
safety actions can be taken by all EMS personnel.
Followup.
Refresher training for EMS personnel will continue to
emphasize use of PPE. However, it is assumed that patients are
decontaminated properly prior to triage and transport and to assume
otherwise could pose undue delay in transporting patients to the
hospital.
Triage Process
Observation.
A triage officer stationed at a choke point assessed
patients as they entered the treatment sector. The triage sector
became overcrowded several times by patients waiting transfer to the
treatment sector. This resulted in safety hazards and difficulty in
managing the patient's problems.
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In terms of assessment, the simple Triage and Rapid Treatment
(START) system appeared to be used to determine each patient's
priority. This system, while well-designed for normal trauma, is not
ideal for chemical agents, particularly those with possible latent
effects that can only be avoided by rapid decontamination and
medical care. Once assessed, triage tags were used to reelect patient
priority. The degree of medical information, such as injuries found
or treatment given, recorded on the tag was variable. However, the
tag is not designed for HAZMAT incidents and hence specific
information on decontamination and treatment was often not
recorded.
Recommendation.
A chemical/biological/HAZMAT-oriented triage
system should be established or adapted from current plans and taught
to all area responders, including the fire department and hospital
personnel.
Followup.
This item will receive high priority for review and
development for future operations.
Patient Treatment
Observation.
Due to exercise staffing, there were not enough EMS
personnel to tend to the patients, and this slowed the provision of
care. In addition, patients were organized by category, but each
treatment area became quickly crowded and patients were not
optimally organized. For example, it was difficult to determine where
each priority was located. Patients were often laid out too close to
one another and not in a similar alignment.
The treatment sector did not receive notice that the suspected agent
was lewisite until late into the exercise, and not all EMS personnel
received the notification. It is unclear what research was then done
on lewisite once the agent was identified. Several EMS personnel did
not recognize the patient's signs and symptoms as a vesicant agent,
nor were many of them familiar with lewisite. There were HAZMAT
trained medical personnel on scene who were familiar with the agent,
but they were limited in number.
Recommendation.
The treatment area should be organized by
patient category with each patient carefully placed so that complete
access is achieved and patients are laid out in similar rows. The
treatment sector/medical care priority areas should be plainly marked
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with colored tarps or other easily seen identifiers. This will be
especially important when mutual aid responders or additional
personnel arrive on-scene.
All EMTs and paramedics in the region should have the same training
on HAZMAT/WMD disaster response plans, triage/treatment
practices, and have similar drug inventories on transport vehicles.
The treatment protocols should reflect approved antidote for use for
WMD agents. Firefighters and EMS personnel should be familiar
with approved drugs and dosages for treating adult and pediatric
patients and themselves. In addition, consideration should be given
to attaching antidotes and portable needle disposal systems on the
SCBA and Powered Air Purifying Respirators (PAPR) systems of
responders working in both the decontamination and treatment
sectors. Then, if not already devised, a method for quickly indicating
when an antidote has been given could be developed for use in the
decontamination and treatment sectors.
Followup.
These recommendations are excellent but may require
change in SOPs which may have telescoping effect on other
operations. They will be taken under advisement, especially those
relating to the stockage of additional inventories on EMS vehicles.
Medical Supplies
Observation.
Due to exercise simulation, only limited attempts were
made to utilize medical equipment and supplies on patients. The
mass casualty vehicle was on-scene, but no attempts to use its
contents were noted, nor were any of the transport vehicles stripped
of unneeded medical supplies and equipment and placed in a central
location. This may have prevented an appreciation of the significant
treatment and re-supply issues that personnel will confront in a real
situation. For example, the on-hand antidote cache would be
inadequate to treat even a small number of patients. Participants
reported that MARK I kits were on-scene, but they were only for use
by the HAZMAT team in an emergency. Minimal efforts were made
by the treatment officer to request the needed items from Incident
Command, perhaps due to the simulated nature of events. Those
requests that did go to the command post appeared to go unanswered.
Recommendation.
Plans should be developed, if not already
available, which will not only bring large amounts of medical
equipment, supplies, and pharmaceutical caches to the scene quickly,
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but also will address security, distribution and documentation
requirements. For example, all incoming vehicles should be stripped
of their treatment equipment/supplies and collected by the resource
officer for distribution and use.
Followup.
Plans and SOPs will be reviewed toward the
implementation of this recommendation.
Sector Control
Observation.
The treatment sector officer was not readily
identifiable, and on more than one occasion was noted to be
providing direct patient care. In addition, no one person appeared to
be in charge of each priority area in the treatment sector.
Although the police broadcast a lookout for a possible perpetrator,
EMS was not aware of the information. In addition, EMS personnel
were not seen seeking information from the victims about what
happened.
Another potentially complicating factor was the inability to determine
the clinical certification levels of the patient care providers assigned
to aid the patients. The large number of mutual aid responders,
perhaps unknown to local responders, who would be expected to
respond to the scene would compound this problem.
Persons reported to be clergy, psychiatrists, as well as family
members were seen wandering around the triage and treatment
sectors, but were not challenged for identification.
Recommendation.
In order to control the EMS sector, especially
during a criminal incident or one in which many mutual aid or
unknown personnel may be rendering assistance, sector control and
personnel identification will be vital. All EMS officers should be
easily identifiable by colored vest with their command title. They
should focus on the "big picture" and upon providing leadership for
their respective areas. Similarly, the clinical certification levels of
EMS personnel should be easily seen on their clothing and/or special
identifiers (e.g., blue helmets/vests for EMTs, red for paramedics.
In addition, information about possible perpetrators and other
pertinent incident management information should be given to all
response personnel and the hospitals once it becomes available. EMS
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personnel should also be aware of victim attempts to convey
information to them, and should not simply dismiss what could be
valuable details about secondary devices or suspicious persons. Also,
further consideration should be given on the optimum way police can
conduct patient interviews in the treatment and transportation sectors.
Officers conducting these interviews should have visible
identification Patients, once interviewed, should be identified in some
fashion such as a forehead dot, "INT" on the triage tag. Video taping
victims may be helpful and not disrupt clinical care if done properly.
Finally, because other personnel may arrive on-scene during a large
or extended response operation, the role and responsibilities of the
additional physicians, the Office of the Medical Director (OMD), the
health department, and mental health workers should be included in
the response plan. The OMD should be easily identifiable by vest or
some other appropriate markings. Mental health workers should be
available to assist victims and responders with managing stress
reactions, but like other responders and the health department, should
wear easily seen identification and be able to come across police
lines.
Followup.
SOP review and possible revision will focus on
procedures to ensure patients are properly identified after interview.
The video taping suggestion has merits, but could pose privacy
problems and will be referred to legal authorities for review. All
medical treatment personnel should be identifiable and this item will
also be stressed in follow on training.
Transport Operations
Observation.
A transport officer was appointed early in the incident,
and vehicles were arranged in an orderly fashion in close proximity
to the treatment sector. However, none of the transport crews were
wearing PPE and would have been at risk depending on the
effectiveness of the decontamination effort.
The transport officer used a makeshift log of patient disposition
decisions being made with hospital command. His records reflected
the actual number of victims on the scene who were transported, not
all of the patients treated. Portions of the patient triage tag were
sometimes collected but information completeness varied; names
were not recorded.
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Communication seemed to run smoothly between the transportation
officer/aid and hospital communications. For example, bed
availability was received and considered when making transport
decisions. Certain drill artificialities may have made it easier for the
officer to do his job than had this been a real incident. For example,
assigning multiple mixed priority patients to each transport vehicle
was not necessary, and notational buses were used to assist with
transport.
Finally, due to exercise artificialities, there was no way to thoroughly
evaluate transport sector and hospital communications, which were
not heard consistently. Hospital officials later reported that many
communications were late or not received. When information was
given it lacked sufficient details to be very helpful. (See Appendix
E, Hospitals). In addition, perhaps due to another exercise
simulation, no attempts to report patient names, destination, or
severity to emergency management or to the American Red Cross
were observed during or after the exercise in an attempt to centralize
information for release to the public.
Recommendation.
A patient tracking system involving EMS, the
hospitals, and communications should be established, if not already
available, and rigorously tested. All patients leaving the scene need
to be accurately accounted for, and the record keeping system used
should be able to identify where each patient has been taken and their
priority. This system should be developed in conjunction with the
area hospitals and the American Red Cross so information about
patient location can be provided to families and friends in a timely
manner. As part of this system, the transport officer should retain a
portion of each patient's triage tag, which includes the patient's name
and age as well as hospital transported to, and record this information
on a standardized log sheet designed to allow immediate
determination of the number and severity of patients sent to each
healthcare facility.
As referenced in the Significant Observations, the current hospital
communication plan should be reviewed to assure all metropolitan
area hospitals are given preliminary information about the incident in
a timely fashion. Scene updates, agent identification, and the degree
of decontamination being done, along with patient disposition
information, should be regularly provided in a prompt and efficient
manner.
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Followup.
Current SOPs call for a very detailed patient tracking
system and failure of the system to be fully implemented during this
exercise was a failure to follow all protocols. This will be given
special emphasis during recurring training.
E
Hospitals
Internal Communications
Observation.
Several of the facilities commented they encountered
communication problems of one kind or another. Problems identified
included failure by staff to use the designated disaster hotline to make
staff notifications, overhead pages announcing a disaster code were
not heard in all areas of the facility, an insufficient number of portable
radios and radio channels, portable radio transmission distances were
insufficient to provide needed coverage, and pages were not always
received by key personnel. The importance of having communication
aides for command officers and the use of runners was also reinforced
by this exercise. Discussion also brought out concerns about phone
lines becoming saturated with families looking for loved ones who
may have been injured.
Recommendation.
Just as with communications to the site, each
hospital needs to have a comprehensive internal communications plan
that has built in redundancies and overcomes identified structural
and/or resource limitations.
Followup.
Hospitals have been requested to identify "black-out" or
interference areas that prevent effective communications. Whether
or not building modifications can be made would be referred to
engineering for study. However, knowledge of the "dead
communications" areas should be relayed to personnel operating
radios and other communications equipment.
Hospital Response Plans
Observation.
As noted above, some hospitals were uncertain
whether or not to activate their disaster plans based on initial
information received from the incident site. All of the hospitals
reported they have a disaster plan, but most have not yet written a
HAZMAT/WMD specific plan or annex. However, once response
activities began, each hospital indicated they implemented their
incident management system (IMS) and the exercise provided a
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valuable opportunity to test each hospital's current plan. One hospital
reported they needed more command vests and each facility felt they
needed to provide additional training on the IMS concept to their
personnel. Moreover, none of the hospitals requested the assistance
of the EOC in St. Petersburg or Pinellas county regarding Emergency
Support Function (ESF) #8 (Health and Medical). Several hospital
representatives were not very familiar with how the ESF system is
designed to assist them. There also was confusion as to whether the
city or the county EOC should be called to request assistance.
Recommendation.
Consensus existed that hospital administrators
should be given training on the operation of the EOC and the function
of the Health and Medical ESF, especially as the St. Petersburg
Metropolitan Medical Response System (MMRS) development
proceeds.
In addition, the exercise highlighted not only the need to have a
comprehensive plan, but also the importance of having a standardized
regional response plan for all the hospitals to follow. The benefits of
a standardized approach include common terminology, easier
familiarization for staff that may rotate between facilities, increased
liability protection, and a greater ability to enjoy cost savings by bulk
purchase of PPE and decontamination materials.
Hospital participants also discussed the importance of having a
hospital mutual aid agreement. Although there is an informal
agreement for facilities to assist one another during the emergency
evacuation, there is no agreement covering personnel or equipment
sharing. There was agreement that steps should be taken to develop
a regional hospital institutional plan. This planning should be done
in collaboration with public safety, public health, and emergency
management officials in order to assure a systemic approach can be
put in place. It was also agreed that a comprehensive hospital mutual
aid memorandum of understanding should be developed possible
following a format found in similar agreements in other parts of the
county; e.g. Washington, DC, Northern Virginia, Oklahoma City, etc.
Followup.
Courses specifically geared for hospital administrators
will be developed on the operation of the EOC and the function of the
Health and Medical ESF, especially as the St. Petersburg
Metropolitan Medical Response System (MMRS) development
proceeds, to ensure that senior executives are completely
knowledgeable of these systems. Additionally, the development of
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a standardized regional response plan is integrated with the Pinellas
County Comprehensive Emergency Management Plan (CEMP). The
MMRS will correct these deficiencies as their efforts continue to
integrate healthcare response for the metropolitan region.
Facility Security
Observation.
There was no notification given by Incident Command
of the possible need to "lock down' hospitals, nor was any facility
told of the probable deliberate nature of the incident. Moreover, none
of the hospitals received information about a possible perpetrator, nor
evidence collection instructions. Instead, all of the facilities initiated
lock-down procedures because of their own assessment of the
situation. New technology allowed the procedure to be completed
quickly at one of the hospitals. Those facilities that manually
implemented lock down procedures voices some concern about the
length of time it took to complete the process. Similarly, a few
hospitals indicated their security staffs may be too small to lockdown
their facility by themselves and they would likely request police
assistance.
One hospital expressed concern about how to handle private vehicles
in which contaminated victims arrive. Concerns were also voiced
about how parking lots should be secured, how to safely deal with
large numbers of walk-ins, how to get staff into work through secure
perimeters and how to prevent staff letting family and friends in
through locked doors.
Recommendation.
Hospitals agreed that transmission of any
security-related information/warnings from the scene is viewed by
each hospital as critical to their being able to keep the facility safe and
secure. Regardless, each hospital needs to have a security plan,
which addresses a broad range of issues relative to protecting their
facility. For example, hospitals expecting security assistance need to
work out a plan now with the police on how to request that help and
use it effectively when it arrives. Hospitals also must be prepared to
implement a plan which does not place total dependence on local
police assistance because they may not be immediately available.
Everyone also agreed that hospitals need to be given "lookout"
information as soon as it becomes available, along with any special
evidence collection procedures requested by the police. It is also
important that hospital staff maintain a heightened sense of security
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awareness during and after any MCI incident, especially one
involving a hazardous material or suspected act of terrorism. It is
likely that each hospital will have police investigators sent to them to
interview the victims and assist staff with evidence collection. How
these needs will be coordinated should be considered in future
planning efforts.
Followup.
All hospitals are aware of the need for increased security
capabilities and the events of September 11, 2001 have only
emphasized what could happen. Yet, scarce resources compete with
patient health-care. Nevertheless, hospitals will be working closer in
the future with law enforcement to integrate plans for patient
interview immediately following an MCI incident.
Personnel Protective Equipment
Observation.
None of the hospitals asked staff to wear PPE during
the exercise. Further discussion revealed that the type and on-hand
quantities of PPE varied between facilities. Each level of PPE was
reviewed and the consensus was a minimum of Level C PPE should
be used by all of the hospitals. Everyone also agreed that a minimum
standard of care should be developed for all area hospitals, which
includes proper PPE to be available, a system for assuring hospitals
are appraised of the proper clothing to wear during an incident,
donning and offing procedures, and the safety procedures to be
followed while wearing the PPE.
There was a brief discussion of what problems should be anticipated
by personnel working in PPE, including inability to work in a suit for
extended periods, impaired vision and dexterity, and difficulty
communicating effectively. The use of magaphones, large
whiteboards, and pre-made signs illustrating what steps patients
should take while undergoing decontamination were suggested as
possible solutions to patients not being able to hear hospital
decontamination personnel.
.
Recommendation.
It was recommended that either mask or hooded
PAPRs be used as the minimum respiratory protection. The potential
extended nature of these types of incidents will require the
availability of large inventories of PPE in various sizes. The benefits
of purchasing individual items versus suit ensemble packs were
discussed, along with the need to have security storage of these
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materials close to where the triage/decontamination sector will be
located.
The importance of performing medical monitoring of personnel
wearing PPE was also pointed out along with completion of medical
surveillance documentation on each responder. Everyone felt a
regional approach should be taken to providing hospitals with needed
HAZMAT training. A regional approach to buying standardized PPE
and decontamination equipment was also discussed and felt to be
worth exploring further.
Followup.
A regional approach has been taken in offering
HAZMAT training to hospitals under the LEPC's Hazardous
Materials Emergency Preparedness (HMEP) grant program. The
acquisition of equipment and supplies will require careful resource
allocation and reprioritization within scarce hospital assets.
Decontamination
Observation.
While no facility actually performed decontamination,
many operational issues were discussed. Some of the items discussed
included the appropriate time for hospital staff to don their PPE,
whether or not hospitals decontaminate patients already
decontaminated at the incident site prior to transport by EMS, and the
most effective decontamination of patients with special needs such as
children, the elderly, persons with sensory impairments, non-
ambulatory patients, and police with weapons with weapons and
ballistic vests. Other topics addressed included what supplies are
needed, the assistance the fire department may be able to provide to
decontamination efforts at the hospital, and how to determine when
the patient is "clean."
None of the hospitals felt they had the capability to decontaminate
large numbers of patients quickly. However, this shortcoming is
being addressed by two of the facilities through reconstruction or use
of portable decontamination systems. Questions were also raised
about how hospital staff and response personnel should be screened
for possible contamination along with any equipment, including
transport vehicles. How to properly contain and dispose of
contaminated water/rinsate was also identified as a major concern.
Questions were raised whether patients will remove their clothes and
shower with people they do not know. The availability of modesty
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and environmental protection was felt to increase the likelihood of
patient complaisance, as will giving consistent, firm and understood
instructions. Also, because of the multinational cultures in the Tampa
Bay area, participants agreed that providing instructions in various
languages would be useful.
In addition, the exercise pointed out he problems associated with
collecting and identifying patient clothing. Because patients will
want the items back, and police may want these personal effects as
evidence, it was agreed that bagging and tagging the items was
imperative. Aside from evidentiary issues, deciding if and when the
materials can be safely returned to the patient will require
consultation with the hospital Safety officer and HAZMAT team
members.
Recommendation.
Because not everyone shared a common
understanding of HAZMAT/decontamination terminology and
procedures, there was agreement that area hospitals need to work
more closely with the fire department/HAZMAT team to develop a
comprehensive mass decontamination plan which addresses incident
scene and hospital decontamination considerations. The plan needs
to address personnel decontamination procedures, rinsate collection
and disposal, along with methods that can be used to clean
contaminated equipment and the facility itself if necessary. The
development of the MMRS was seen as being an important step in
meeting this goal.
Followup.
Additional emphasis will be given to development of
such planning requirements and as indicated above, the MMRS has
undertaken this as one of its goals.
Patient Care and Tracking
Observation.
A wide variety of patient care and tracking issues
arose at the hospitals. For example, although a triage tag was placed
on most transported patients, several hospitals reported that there was
insufficient information on the tags and they sometimes had trouble
reading the writing. Everyone agreed the triage tag is an important
communication and patient care tool, but it must be utilized properly
to be helpful.
Patient care also was complicated by the fact that it took a
considerable period of time before field personnel told them that the
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agent was lewisite. One Emergency Department physician felt the
agent might be lewisite based on the signs and symptoms. However,
no system is in place to communicate this suspicion to Incident
Command.
Even once the agent is determined, hospital personnel indicated that
currently there are no standardized clinical assessment and treatment
protocols, which all hospitals have agreed to follow.
In an incident such as this, participants noted all available hospital
beds will be quickly filled. However, there is not regional or State
hospital mutual aid agreement that can be implemented in a disaster.
How scarce resources; e.g., ventilators, pharmaceuticals, etc, will be
allocated was also seen as a problem to be addressed from a regional
perspective. For example, while there was discussion about Federal
assets such as Disaster Medical Assistance Teams (DMATs) and
Disaster Mortuary Operational Response Teams (DMORTs),
participants were unclear about the utilization and integration of these
assets.
Recommendation.
Additional training for EMS and the hospital
personnel should be given on triage techniques and tag utilization. A
weatherproof tag, which can be used on HAZMAT victims, should be
sought. In addition, there was agreement that information sharing
with Incident Command and EMS needs to work in both directions.
The value of standardization as means of optimizing patient outcome,
minimizing litigation and avoiding public confusion and frustration
were discussed. ;It was suggested that MMRS team could address this
matter as part of the procedures they will be developing. Similarly,
additional planning on how needed equipment and supply items can
be quickly acquired and distributed is needed and could be handled
under MMRS procedures. Annual hospital surveys should be
conducted which will identify the number of available beds,
ventilators, on-hand pharmaceuticals and key personnel and their
telephone numbers.
In addition, there was agreement that a statewide interfacility transfer
plan would be useful and should be explored further. The District of
Columbia has a plan that could be used as a template. Another idea
participants stated that they were developing (to be compliant with
Joint Commission for the Accreditation of Healthcare Organizations
[JCAHO] requirements) is the use of Alternative Care Facilities
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(ACFs). However, concerns were voiced about how already under-
resourced facilities open another clinical site. There was agreement
that emergency management and public health need to develop plans
for opening up off-site ACFs using non-hospital personnel such as
public health nurses, school nurses, and retired nurses for staffing.
Items for particular attention include:
C
Equipment clean up
C
Re-supply
C
Staff rehabilitation
C
Public confidence restoration
C
Risk Management documentation completion, and
C
Publicizing the"above and beyond' contributions of the staff.
Followup.
As recommended additional training for EMS and the
hospital personnel will concentrate on triage techniques and tag
utilization. A weatherproof tag, which can be used on HAZMAT
victims, will be explored. Information sharing with Incident
Command and EMS will also be emphasized in follow on refresher
training and all agree that it needs to work in both directions. The
MMRS is currently exploring most of the recommendations and
already has in the process, several solutions to exercise shortfalls.
The idea of regional response to MCIs is one that will require careful
coordination with all facilities. Hospital ER and safety personnel are
currently being trained at the Operations level which means that they
must don PPE and practice decontamination procedures. This
training has heightened sense of awareness in hospital personnel of
need to be able to decon patients if they have not been done so at the
scene. The greatest challenge comes not from EMS transport of
victims who have undergone decon, but in the patients who did not
go through the system but transported themselves to the hospital for
treatment - in most cases without decontamination. All of these
issues will continue to command top priority.
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13.2.2 Functional Exercise
A functional exercise is designed to demonstrate one or more
functions or capabilities specified in the emergency plan.
Mobilization of local personnel and resources will be limited.
13.2.3 Tabletop Exercise
A tabletop exercise is a simulation in which response activities are
discussed. There is no mobilization of emergency personnel and
resources.
13.2.4 Scheduling and Scenario Development
Within the Tampa Bay LEPC area, exercises will be scheduled jointly
by the facility owner/operators and the location County's emergency
management office. Exercise objectives and the scenarios for the
exercises will be developed and prepared jointly by the facility
owner/operator and the location County's emergency management
office. The next scheduled biennial exercise for the HAZMAT Plan
FY 2001-2002.
Scenarios will be varied from year to year so that all major elements
of the plan and preparedness organizations are tested within a five-
year period.
13.2.5 Critique and Reports
Controllers and observers will fully participate in all exercises. The
controllers and observers will be selected from nonparticipating
County agencies and organizations, neighboring counties, state and
federal agencies. A critique will be conducted after each exercise to
evaluate the capability of participating emergency agencies and
organizations to implement emergency plans and procedures.
Participating agencies will be requested to submit written critique
comments as input for an after-action report on the exercise.
13.3 Drills
A drill is a supervised instruction period aimed at developing, testing, and
monitoring technical skills necessary to perform emergency response
operations. A drill may be a component of an exercise. Each drill will be
evaluated by the coordinator for that particular drill.
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In addition to the required exercise, drills will be conducted at the frequencies
listed below:
13.3.1 Communications Drills
Communications between the facility owners/operators and state and
local governments will be tested as described in Section 5.
Communications with federal emergency response organizations will
be tested quarterly. Communications between the facilities, state, and
local EOCs and on-scene personnel will be tested annually. The test
of communications with on-scene teams will be part of the exercises.
13.3.2 Medical Drills
Medical emergency drills involving a simulated contaminated injury
and participation by appropriate local emergency medical services
will be conducted as part of the exercise.
13.3.3 Chemical Monitoring Drills
Monitoring drills for state and appropriate County hazardous
materials monitors will be conducted as part of the exercise. These
drills will include collection and analysis of sampling media,
provisions for communications, and record keeping.
13.3.4 U.S. Coast Guard Marine Safety Office Tampa Drills
In order to determine the overall effectiveness of each plan, an annual
exercise is coordinated with local and state agencies. In the past year,
these have included a Vessel of Opportunity Skimming System
(VOSS) deployment, PREP Area Exercise, a marine fire fighting
tabletop and field training exercise, marine counterterrorism tabletop
exercise, VOSS deployment and Prep tabletop exercise.
In an effort to mitigate the damage from any possible oil spill within
Tampa Bay, MSO Tampa has begun conducting required
government-initiated unannounced spill response exercises at
facilities within the Port. The exercises are designed to test a vessel
or facility's oil spill response plan. MSO Tampa coordinates its
efforts with the Florida Department of Environmental Protection
(DEP) and sends four to six people to conduct the surprise drill. The
exercise usually starts with a scenario being given to the dockman or
vessel master and is followed until the "spill" is contained and proper
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response plan steps are completed. The timeliness of notifications
and response and the utilization of the response plan to mitigate the
spill are key areas to be evaluated. At the conclusion of the exercise
a debrief is held with response personnel and participants are given
the opportunity to provide comments or ask questions. To date MSO
Tampa has conducted exercises at Chevron Oil Co., Mariani Asphalt
Co., Florida Power & Light at Weedon Island and Marathon Oil Co.
A tabletop PREP drill is planned for late September 2002 involving
SeaRiver, prime transporter for Exxon/Mobil. Scenario will involve
a stranding within Tampa Bay with hazardous materials on board.