Protecting Emergency Responders: Lessons Learned From Terrorist Attacks

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ProtectingEmergency RespondersLessons
LearnedFrom Terrorist Attacks
Conference on Personal Protective
Technologies New York City, December
2001 Sponsored by CDC/NIOSH Organized by RAND
Science Technology Policy Institute
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Today's Focus

• About the NIOSH/RAND Conference
• Characteristics of the Responses
• Lessons Learned
• Responder Recommendations
• Concluding Observations

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The Conference

• Purpose
• Document first-hand views on the protection of
  emergency workers in terrorist attack response
• PPE performance, availability, and use
• Training
• Hazard assessment and communication
• Goals
• Understand the post-attack environment
• Identify hazards and protection needs
• Provide input to PPE research agenda
• Improve safety PPE education and training

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ConferenceFormat
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Response Characteristics
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Response CharacteristicsLarge Scale Events

• Large physical area
• Multiple simultaneous incidents (9/11)
• Many responding agencies
• Acquisition and management of back-up supplies
  impeded by air shutdown
• Communications systems overloaded
• 1000s of anthrax calls
• Resources unavailable or used ineffectively

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Response CharacteristicsLong-Duration Campaigns

• Equipment is designed for short intervals
• Air bottles last for up to 30 minutes
• Respirator cartridges clogged
• Batteries need recharging
• Turnout gear heavy, hot, uncomfortable
• Extended wear caused blisters fatigue
• Disposable garments tear
• Responder productivity diminished
• Responders modified or abandoned PPE

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Response CharacteristicsMulti-Threat Events

• Large scale conventional hazards
• Intense fire, falling debris, structure collapse
• Responders faced many additional risks
• Jet fuel, rubble, dust, body parts/fluids,
  hazardous materials
• Unknowns associated with terrorism
• Secondary explosives/attacks
• Nuclear, biological, chemical agents
• Risks exacerbated by stress and fatigue

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Response CharacteristicsNew Roles, New
Responders

• Firefighters were engaged in non-traditional
  tasks
• Trades workers thrown onto the front-lines
• Equipment operators, iron-workers, sanitation,
  food service
• Large numbers of off-duty personnel and citizen
  volunteers were on-scene
• Few agencies and personnel were sufficiently
  prepared for anthrax
• The disaster sites were crime scenes and entailed
  extensive law enforcement activity
• PPE supply and training for law enforcement very
  limited

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Personal Protection Lessons
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Personal Protection LessonsPPE Performance

• PPE worked as designed but fell short in
  multi-threat, extended campaigns
• Respiratory protection
• Full-face respirators hindered vision,
  communications
• SCBA air supply too short
• Inadequate information on anthrax protection
• Garments
• Turnout gear not adequate for rubble confined
  spaces
• BDUs do not provide thermal protection
• Hazmat suits not durable
• Gloves not abrasion resistant, flexible, and
  bio-proof
• Not sized for female responders
• Eye protection ineffective against dust

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Personal Protection LessonsPPE Availability

• Supply
• Shortages were most critical in first few days
• Logistics challenges delayed shipments and
  on-site distribution
• Supplementary gear often not interoperable
• Later in responses, surplus equipment became a
  problem
• Anthrax calls led to shortages of disposable gear
• Maintenance
• Garments not cleaned and dried regularly
• Limited on-site capability to fill air bottles,
  recharge batteries
• Availability varied by organization
• FEMA/USAR task forces well-equipped
• Law enforcement/postal inspectors poorly-equipped

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Personal Protection LessonsInformation and
Training

• Risk assessment and communication was criticized
• Initial sampling limited in scope
• Monitoring technology inadequate
• Poor coordination of monitoring
• Inadequate communications to front-line
  responders
• Inconsistent PPE standards among agencies
  contributed to misunderstandings
• Anthrax response protocols were developed ad hoc
• Limited PPE training was available for
  non-traditional responders and volunteers

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Personal Protection LessonsSite Management

• Scene control is critical for worker safety
• Hard perimeter keeps out the untrained/unequipped
• Entry points are a key PPE enforcement
  opportunity
• Scene control facilitates personnel
  accountability
• Unified command facilitates PPE enforcement
• Coordination of different agency policies
• Uniform enforcement of PPE policy
• Consistent hazard information dissemination
• Incident definition is a difficult issue
• Managing PPE use in the transition from rescue to
  recovery phases is critical

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Responder Recommendations
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Responder RecommendationsEquipment Issues

• Enhance PPE performance
• Comfort and operability for long-duration
• Multi-hazard capability
• Biological threats
• Consider PPE as an ensemble
• Improve PPE availability
• Outfit all responders appropriately
• Promote PPE standardization and interoperability

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Responder RecommendationsInformation and
Training

• Develop advanced monitoring and information
  management technologies
• Coordinate hazard assessment and communication
  among responding services
• Implement standard PPE usage regulations across
  services
• Integrate PPE and response training into standard
  operating procedures
• Improve on-site training
• For use of non-standard gear
• For non-emergency personnel

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Responder RecommendationsManagement Matters

• Define incident command structure rapidly
• Establish scene control quickly
• Assign responsibility for PPE enforcement
• Develop logistics for sustained responses
• Include suppliers, transportation providers
• Stock more PPE caches
• Develop site management guidelines
• Conduct multi-jurisdictional exercises to build
  experience and relationships among agencies

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Concluding Observations

• Responders believe they lack the necessary
  personal protection information, training, and
  equipment for major disaster responses
• Strategies for effectively providing needed
  equipment must be explored
• RD and technology transfer could provide ways to
  address the problems and trade-offs identified
• PPE must provide appropriate balance between
  responder safety and mission effectiveness
• Having effective personal protection policies and
  practices are as important as effective equipment

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Further Information

• RAND Science Technology
• 1200 South Hayes St.
• Arlington, VA 22202
• 703-413-1100, x5521
• contact-st_at_rand.org
• Access the entire report online
• www.rand.org/publications/CF/CF176/