Protecting Emergency Responders: Lessons Learned From Terrorist Attacks

1. ProtectingEmergency Responders:Lessons LearnedFrom Terrorist Attacks

2. Today's Focus About the NIOSH/RAND Conference Characteristics of the Responses Lessons Learned Responder Recommendations Concluding Observations

3. 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

4. ConferenceFormat

5. Response Characteristics

6. Response Characteristics:Large 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

7. Response Characteristics:Long-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

8. Response Characteristics:Multi-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

9. Response Characteristics:New 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

10. Personal Protection Lessons

11. Personal Protection Lessons:PPE 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

12. Personal Protection Lessons:PPE 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

13. Personal Protection Lessons:Information 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

14. Personal Protection Lessons:Site 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

15. Responder Recommendations

16. Responder Recommendations:Equipment 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

17. Responder Recommendations:Information 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

18. Responder Recommendations:Management 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

19. 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 R&D 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

20. Further Information RAND Science & Technology 1200 South Hayes St. Arlington, VA 22202 703-413-1100, x5521 contact-st@rand.org Access the entire report online: www.rand.org/publications/CF/CF176/