Paramedics To The Response

Calgary is the largest city in the province of Alberta, Canada. Tourism brochures tout Calgary, which is nestled at the base of the Canadian Rocky Mountains, as part of the "Old West, New West, Real West and Wild West." The annual Calgary Stampede, a 10-day celebration of Western heritage, attracts a half-million visitors. From the EMS perspective, any large gathering of this magnitude is a challenge. But in today's world, with threats of terrorism clouding large events in even the most idyllic communities, comprehensive preparedness is the key to public safety.

     For medical emergencies, Calgary EMS operates as an independent service, with 44 ALS units responding to an average of 100,000 calls per year. According to Glenn Bjolverud, Calgary Emergency Medical Services superintendent, Calgary EMS works closely with the Calgary Fire Department and Police Service. "We have an extremely positive working relationship with our fire hazmat people," Bjolverud says. "We co-respond in a number of areas."

Hazmat IRPs: The New Program Begins
      In 2001, in the shadow of 9/11, Calgary fire, police and EMS first responders were called to "a raft of suspicious white powder calls," Bjolverud says. "We also had the G8 Summit coming up in 2002 that involved all the presidents and prime ministers of the top eight economic countries in the world, so we needed to upgrade our response capability for terrorism or some type of deployed weapons."

     The "Advanced Life Support Response to Hazardous Materials Incidents" course at the National Fire Academy in Emmitsburg, MD, served as the foundation for the pioneering Calgary EMS Hazardous Materials Paramedics (HMP) program, which graduated 20 specially trained and equipped HMPs in 2002. In 2005, the program was re-christened the Incident Response Paramedic (IRP) program, with 16 specially trained and equipped IRPs, four per platoon, on duty. IRPs focus on events involving chemical, biological, radiological, nuclear (CBRN) and explosive devices, as well as industrial and other hazmat calls.

     "Our role within hazmat is not to deal with the hazmat event, but with the casualties of the hazmat event," Bjolverud says, adding that the paramedics also act as a "medical safety net" for Calgary Fire hazmat technicians and other first responders who have to work with high levels of protection. "Initially, we thought our paramedics would be unlikely to enter anything beyond the 'warm zone,'" Bjolverud explains. "While this may be true in an industrial hazmat call, with a terrorist event potentially involving several hundred casualties, paramedics can be integral to the 'hot zone' response as well."

     IRPs receive intensive training, including toxicology, hazmat chemistry, NFPA hazmat awareness and operations, as well as three weeks of CBRN training, antidote, medical countermeasures, MCI and protective equipment training. "For any criminal terrorist event training, we work with the Canadian Emergency Management College in Ottawa and Defense Research and Development Canada (DRDC) for live-agent training at the proving grounds. This is equivalent to Fort Detrick in the United States," Bjolverud says. "We do two weeks of training at the intermediate level and one week of advanced, live agent training."

The Benefits of IRPs
      For day-to-day operations, IRPs respond to hazmat- and toxicology-related incidents, including incidents involving solvent and hydrocarbon abusers, commonly known as "huffers." Bjolverud notes, "These patients off-gas and pose a risk to our people who are transporting them. Our IRPs have a significant database in terms of toxicology and an understanding of how to protect the patients and our personnel. Patients can have product on their hands, faces and mouths, and can release any number of toxic chemicals into the environment. Our preference is to decontaminate patients before we put them into an ambulance, but this is not always possible. But, if we transport someone who is actively off-gassing, we move into higher levels of respiratory protection."

Local, Regional and Federal Response
      Calgary EMS can serve at the regional and federal levels in a major emergency as an Emergency Medical Assistance Task Force (EMAT) through Public Safety Canada, the Canadian counterpart to FEMA. Several specialized vehicles enhance IRP operations, including a 53-foot, Featherlite NASCAR-style trailer, which can support 40 EMS personnel for a 10-day period, independent of any local infrastructure support. This hazmat/CBRN trailer includes "an extensive amount of protective equipment, medical countermeasures and decontamination products," Bjolverud says.

     The Medical Rescue Command (MRC) vehicle, a mobile command post and equipment vehicle built on a five-ton International chassis, carries portable tents and other equipment that can be quickly deployed to manage approximately 100 casualties. Two medical rescue support (MRS) vehicles, based on an F-550 chassis, can deal with up to 60 casualties per unit. This is especially important in the event that triage and casualty collection units need to be set up simultaneously in multiple locations, says Bjolverud.

     "We have been fortunate that there have not been any major terror events in Calgary," he says. "But we have had a number of hazardous materials events involving a significant patient volume, including the release of an organophosphate pesticide at a transport company, where 24-30 patients were assessed for signs and symptoms of poisoning by an organophosphate, which is a precursor to a chemical nerve agent. And an industrial site had some mixing that went south on them, creating a major hazmat event. There were more than 20 casualties, including first responders who got a little too close."

Building Resilience
      The IRP program is "an important part of building a community that is resilient," says Bjolverud. "Communities need to be able to deal with issues independent of federal resources. We work from the 'yo-yo-72' principle: 'You're on your own for 72 hours' before additional resources may become available. And it's important to remember that if a major event happens, it may not be isolated to your municipality. Pandemic is a perfect example. Will the federal government be able to parachute resources into a dozen communities or more that are under siege? Higher levels of protection, awareness and training are part of a resilient, all-hazards response capability."

     All paramedics "need to be trained on a routine basis to handle risk assessment," Bjolverud stresses, "so when they go into an MCI they can quickly assess whether it might be a criminal event." Because no single emergency service has the skill, knowledge and manpower needed to respond to terrorism, he adds, "A multi-service capability is essential. For CBRN, we know we're going in as all-hazards. And if there are patients involved, the Incident Response Paramedics are going to be involved very quickly. Specialized training and skill are part of what has to be in today's world."

Nancy J. Rigg is an author and documentary filmmaker in California who specializes in public safety and emergency preparedness issues. She served as a flood safety education and swiftwater rescue expert with the 2006 FEMA Integrated Water Rescue Working Group, and is an emeritus member of the Higgins & Langley Memorial and Education Fund Board of Directors. In 2003, Rigg was presented with the distinguished Higgins & Langley Lifetime Achievement Award in Swiftwater Rescue.