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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 exe