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Safety at major incidents, part 2
By David Bates
Lessons learned and best practices in managing the risks posed by large-scale incidents.
part 2 of 2
Safety at major incidents, Part 1
Protecting emergency personnel at large-scale, multi-agency or multi-jurisdictional emergency incidents requires a flexible plan and command structure that can respond to health and safety risks as they arise.
Most emergency response managers would agree that there's no single solution or game plan for ensuring workers' safety during disaster response, because the risks that first responders face are as varied as the incidents they respond to.
In the 9/11 attacks on the World Trade Center, for example, emergency responders faced a toxic mix of dust, as well as potential collapse of nearby structures, huge mounds of jagged steel and concrete debris, and intense heat from underground fires that melted the soles of some workers' boots.
In the aftermath of last year's hurricanes that devastated the Gulf Coast, emergency workers faced the obvious flood waters as well as the not-so-obvious chemicals, sewage, petroleum products, pesticides and other contaminants that laced those waters.
No one is immune
The wide variety of hazards means that even highly trained and equipped responders to an emergency event can fall victim to occupational illness or injuries.
"Ours were scrapes, falls and puncture wounds from all the nails," says Asst. Chief Greg West of the Los Angeles Fire Department, whose fema-sponsored urban search and rescue team traveled to Mississippi last year in the aftermath of Hurricane Katrina. "We've got the steel-toed boots, and the nails came through the sides of the boots as we were sliding and falling down. We had to go kind of slow."
For some emergency responders, the greatest occupational risk during an incident may be from other people.
The Santa Clara County (Calif.) Public Health Department, for example, has worked out a plan with local police agencies to protect public health workers who would be tasked with delivering pharmaceuticals and medical supplies during a biological incident, says county public health officer Marty Fenstersheib.
"The big deal is with the security, because if you have a limited number of anything that people want, and they assume that is what they need to protect their lives and those of their families, they're going to want it," he says. "If people see our workers, they may converge on our workers because they may think you have a vaccine. We've talked to law enforcement about protecting our workers from people who demand they be given anything."
Part of the security plan calls for the health department to provide law enforcement officers with antibiotics, vaccines and other pharmaceutical products necessary to protect themselves and their families during such an incident.
"You basically have to give them [law enforcement partners] incentive. And the incentive is training and the promise that, ‘If you come to provide security, you will get prophylaxis, too, as well as your family,'" says Fenstersheib.
Issues in the aftermath
Beyond the immediate rescue phase, occupational dangers to emergency workers sometimes lurk well into the recovery and restoration phase, which can last weeks or even months.
"Particularly in Florida, there's a huge issue with generators," says Teresa A. Scott, public works director for the City of Gainesville, Fla. "During restoration of services, if those generators are hooked up improperly, the power could reverse and go back up the line and kill the workers."
Scott says public works personnel in her city often face safety challenges in their vital, but often unheralded, role of helping utility crews restore energy and water services in the aftermath of hurricanes and other large-scale disasters.
"A lot of times we work closely with the utilities, what you might consider the lifeline, and restoring that lifeline is a public works function," she says. "What we do is actually put together a team of people to go out and clear roads, do damage assessment. We help the power utility go out and clear roadways so they can go out and restore power."
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"They see the job's not finished, and they don't want to quit," she says. "They just want to go and go and go."
Though exhaustion may take a toll on emergency personnel, the damage may not be evident until weeks or months after the incident.
"It's not just at the time. For the first responders, it's actually the period after that's worst," declares James Young, M.D., a former Ontario commissioner of emergency management and currently a special advisor to Canada's Public Safety and Emergency Preparedness Ministry.
"Afterward, you'll see a very high absentee rate. You'll see people get sick. People will talk about being depressed after an incident. You'll see the characteristic signs of marital breakdown," he says. "People have used up their stores and their energies. They will talk about their fatigue. Sometimes in these things, you don't deal with these things until afterward."
"Anybody who's being honest will say that, after an incident, everyone will feel some effect," says Young, who helped manage the operation to identify the remains of 229 people who died in the September 1998 crash of Swissair Flight 111 off the coast of Nova Scotia. "I take a big holiday after a big incident. I have no trouble focusing in the middle of a big emergency, but afterward, am I as focused as I was? No, I'm not for several months."
Starting day to day
Protecting emergency responders from occupational hazards at a large-scale disaster requires that safety management be considered before as well as during the incident.
Fenstersheib emphasizes that pre-incident planning is crucial to the Santa Clara County Public Health Department, which must be prepared to distribute drugs to first responders and their families at the outset of a biological incident.
"We already have our plan in place. You can't do it after the incident begins. The logistics alone will stop you from doing it," he says. "Because of the cost of living here, there are a lot of workers who live far away. So the logistics of getting them here and protecting their families when they live in another state is difficult. It's a challenge."
Scott says Gainesville's risk management office works with city personnel throughout the year, not just during an emergency incident, to create safety awareness among emergency responders. "The number of injuries that we've had compared to the risk we faced has been pretty small," she says. "We have a risk management office and they have a safety program and we have them out to do training. Doing those things year round is pretty important."
"We've actually instituted a safety incentive program where they take classes and have a low injury rate on the job," she continues. "It's reduced workman comp injuries. The safety award for the department under that program was $5,000. They gave $5,000 to the department for any equipment that they chose to purchase."
Another important step for ensuring the safety of emergency workers is providing appropriate training, says Scott, especially for public works personnel, for whom incident response may not be a daily work activity.
"We've looked at getting some of our personnel trained to at least recognize the threats and what they need to do to protect themselves, know what kind of materials present a risk and how we can actually assist in hazmat situations and ensure that we're protecting not only their safety but also the environment from the impact of the cleanup," she says. "We're in the process of getting them trained in the various ics and nims systems."
Stop and think first
And beyond knowing how to recognize hazards, another element in safety training is also crucial.
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That "Act now, think later" tendency certainly isn't limited to public works employees, says Capt. John Anderson, homeland security liaison for the Houston Police Department. He says his department has worked to train its police force to do a rapid risk assessment when arriving at a major incident scene.
"In the past, we've been trained to run in and help people," Anderson says. "We're trying to rethink that. When we show up on the scene and it looks like a wmd event, or a chemical has been released, we want them to stand back and observe until the proper resources get to the scene, to get information before they rush into a scene. We observe the wind direction, any smoke plumes, what kind of injuries people are suffering. We talk to witnesses who are there, mainly to do a lot of preliminary observations before rushing into a scene."
In an age of international terrorism, pausing at the outset of an incident to assess risk is a very prudent approach, says Young. "We've seen worldwide that when you see the beginning of an event, that's not the whole event. When you get the first plane into the World Trade Center, the first bomb in Bali, that's not the whole event. That leads to training and planning on where you set up proper perimeters."
Putting time on your side
Young also suggests that disaster safety awareness training has to be parceled out in varying doses to different groups of emergency responders, depending on their level of expertise.
"You can't train all people for all things. The biggest thing a first responder has to recognize is when they've got a big thing, and then call for help," says Young. "The approach that tends to work best is when you triage: You train people to a certain level, then you train a level beyond that, and then you train the highly sophisticated groups. That's where you get the biggest bang for your buck."
Good safety training also means having the discipline to wait for properly trained and equipped emergency response units to arrive and enter the incident site.
"You've got to know when to back away. If you've got a CBRN incident … but you don't have any protective equipment, it's not going to do anyone any good to rush into it. People have to think before they act, to make sure it's the right thing to do," says Young. "And you have to assume there will be further events. In so many of these, the first bomb is not the only bomb: The whole idea is to suck people in, and then detonate the next device."
"All of that is the first line of occupational health. The second line starts when something happens, when the rescue phase is on," he says.
Young says incident managers must implement first responder safety management at the outset of any rescue phase.
"It's very important to pay attention early on to the safety issues," he says. "If the rescue phase becomes too long, the risk to the people that are rescuing grows and people aren't paying as much attention to their own safety as they should. You risk people getting trapped. You risk the emotional burnout. You really do have to, early on, be sensitive to the safety of people who are doing the work."
He says incident managers should strive to have emergency personnel work shorter, rather than longer days and to ensure the proper number of responders are working on site.
"Don't have too many people, don't have too few," he says. "Don't work them too long, work them shorter hours. As quickly as you can, you get into shorter workdays, and you spread the work around. You watch to see who's not managing the emotion of it all."
And Young warns that, "You can send too many people into a situation, just as you can send too few. If there are too many people and not enough work, that's where you get into trouble."
"We had times with Swissair, because we were doing the recovery at sea, there were times we received lots of remains. There were other days where we received very little," he says. "When we realized there was very little, we would send people off and say, ‘Don't stay here bearing the frustration.'"
Scene access control
Another important factor that can enhance first responder safety, in a number of ways, is establishing a perimeter and controlling access to the incident scene early in the response operation.
"It's critical," LAFD's West says of access control. "We look to law enforcement to enforce perimeter control. I hate to see volunteers converge on the incident, get themselves in trouble and then get themselves hurt. We don't want to bring more victims in. It only dilutes our efforts."
Houston's Anderson agrees. "Our job is to set up perimeters, hot zones and cold zones. Basically, that's what law enforcement is about in an incident like this, controlling the scene. That's what we're trained to do."
He says Houston has a pool of more than 600 officers who have received Special Response Group training and can be deployed to control access to large-scale incidents.
"If we had a disaster, these guys would be the first to respond to the scene. They receive quarterly training in the use of ppe, tear gas, crowd control," he explains. "This was actually formed back in the early '90s when the Republican Convention was in town, because we had so many protests. It's evolved into a WMD force over the last five or six years."
Decon and quarantine
Incident commanders may find access control handy not only for keeping people out of an incident site, but also for preventing individuals from leaving until they've undergone decontamination.
In California's Santa Clara County, the public health department is the enforcer on matters of disaster incident decon, says Fenstersheib, who explains that his agency has the legal authority to order the detention of any individual who refuses to undergo decon at an emergency incident site.
"I have a standing order for hazmat people in the field to detain people who refuse to go through decontamination," says Fenstersheib. "I wrote a standing order which gives them the authority to detain somebody while they're figuring out what it is and while they're looking for me."
Fenstersheib says his agency has been working with state legislators to extend the enforcement authority to public health agencies throughout the state. The provision is one of several fixes to state health and safety codes that are now working its way through the statehouse in Sacramento, he says.
Anderson says the hpd plays the role of decon enforcer at disaster incidents in Houston. "The fire department is pretty much in charge of decontamination. Our job is pretty much to control the crowd and get people to go through the decontamination. We want to control people who are going away as well as arriving at the incident scene."
Perimeters and access control can also help incident commanders safeguard other emergency workers and the general public by enforcing a quarantine when necessary, says Anderson, whose agency helped provide security last fall at Houston's Astrodome where 20,000 to 30,000 people arrived to escape the devastation of Hurricane Katrina.
"In the State of Texas, the local health authority can request a quarantine order through the courts which would restrict peoples' movements in an area," he explains. "Once a quarantine has been issued, if a person decides to leave, he can actually be arrested for attempting to leave a quarantine area."
Anderson says about 200 Katrina survivors suffering various contagious illnesses were moved to the former Astro Arena, a smaller sports facility, to isolate them and prevent their illnesses from spreading to other Katrina refugees or to emergency responders.
Access control and credentialing of hurricane victims also was important to preventing scammers from entering the Astrodome and obtaining disaster assistance and other benefits for which they weren't eligible, Anderson says.
"We issued survivors wristbands to identify them as survivors," he explains. "We had our own people, sometimes homeless, in Houston trying to sneak into the system to get assistance."
Spontaneous volunteers
Finally, good perimeter controls can also help incident commanders control the flow of volunteers who often show up at disaster scenes to offer their assistance.
Although spontaneous volunteers can be a valuable resource in some rescue operations, in many cases unskilled volunteers can become a liability to their own safety, the safety of professional first responders working around them and the well-being of those they're trying to rescue.
"As a rule, somebody just shows up and says, ‘I'm a firefighter from Rochester, N.Y., and I'm here to help,' you should be wary, because you really don't know what they're trained to do," cautions Young. "A better way would be to phone up a fire department or a police agency and say, ‘Can you send me some people?' What you try to do is to bring people in who you know."
"The other problem is, there are usually a shortage of things in that area. There are people who have to be fed, and have to be housed. And there are people who flood an area and get themselves into a lot of trouble," Young continues. "You don't let them on the site. You've got to be careful not to clog the site. If you have too many people, you're really going to slow yourself down."
West uses members of Los Angeles' Community Emergency Response Team to vet volunteers in an orderly way during emergency incidents.
"At nearly all of my incidents, I have a cert manager who voluntarily shows up. What I can do with my cert coordinator is put them in charge of my volunteer management," he says. "They can determine if any of the volunteers are certified" and direct them to appropriate tasks.
In Houston last year, emergency officials had to develop a solution for handling the tens of thousands of volunteers who showed up at the Astrodome over the course of the Katrina survivor relief operation.
"We learned a little bit about volunteers during Katrina," says Anderson. "We had over 60,000 volunteers show up at the Astrodome over several weeks. We had a special entrance they went in through. They were credentialed. They were given a special id to put on their pocket so that anybody would recognize them as an authorized volunteer."
He adds that volunteers who arrived from other, regional police agencies posed a special problem for the Astrodome operation.
"During the Katrina thing, we had a lot of smaller police departments show up to help. Out of their goodness, they just wanted to help," Anderson says. "But in a way, it's a hindrance, number one, because we can't communicate with them when they show up, and number two, we don't have anything specific for them to do."
Cowboys need not apply
Another issue incident commanders must deal with is enforcing safety rules. For a variety of reasons, many emergency responders at the 9/11 attacks on the World Trade Center, for example, had no personal protective equipment, those that did often failed to use it, while others had received no proper training in how to use their safety gear. Many WTC emergency workers opted not to wear cumbersome breathing apparatus, feeling that it interfered with communications or was slowing down their efforts to locate and extricate survivors.
Several professional emergency response managers say safety rules for responding personnel must be established at the outset of an incident and then enforced.
"It's about leadership training and discipline," says West, who touts the Incident Command System as providing enforcement mechanisms. "In your incident action plan, you lay out clear expectations and don't deviate from them and don't allow for violation of the procedures."
"The safety officer has the authority of the incident commander to stop the work," he continues. "And all the firefighters who go there want to work, if you take them off the line or stop the work, you get their attention. The beauty of safety in the Incident Command System is that the safety officer maintains the right to stop any operation at any time with the authority of the incident commander."
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Scott says Gainesville makes safety violations a part of the personnel disciplinary process, if necessary.
"The risk management office will cite employees if they see them doing unsafe acts," she says. "At the same time, they'll send a notice that they saw them doing something safe. They will also note that, recognizing that employee. It works both ways. It's a carrot and a stick."
Similar to Gainesville's risk management office, the Houston Police Department has its own safety unit that would lead the disaster safety enforcement for police officers during a large-scale emergency, says Anderson.
"We have a safety officer. He deals with workers' comp issues on a day-to-day basis. His group tours police stations and looks for unsafe practices," Anderson says. "In a large-scale incident, he would be brought on board to ensure police officers are following safe practices."
Young says incident managers have to make emergency responder safety "a priority from the beginning."
"Even though at ground level they're focused on getting the job done, the management is thinking about, ‘Have we got them dressed properly? Are we watching out for signs of stress in them?'" he says.
"Depending on what the particular risks are, you make it very clear: ‘This is what the risks are, and this is how we're going to go about it.'"
He, too, suggests a firm stance if emergency responders balk at following incident safety rules.
"If I was managing something and we had occupational health and safety concerns, my answer to them would be, ‘Go back home.' Being part of the team means abiding by the rules, for your safety and also for the liability factor. It's not a place to be a cowboy."
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