EMS Magazine’s Resource Guide: WMD/Terrorism Response

USFA Online Course Helps Prepare EMS Responders for MCIs

The United States Fire Administration (USFA) has launched a new online course designed to assist emergency medical service (EMS) personnel to respond more effectively when faced with a multiple casualty incident (MCI). The new independent study course, EMS Operations at Multi-Casualty Incidents, is a four-hour, Web-based course that addresses preparedness planning; management of the incident; safe and efficient triage, treatment and transportation of patients; and the de-escalation of the response. It is not intended to provide detailed steps in the care of patients.

An MCI can occur as a result of many situations, including a transportation crash, the collapse of a building or bleachers, a civil disturbance, a severe weather event, a hazardous-material release, a terrorist attack and other causes. Since 9/11, EMS responders are keenly aware of the dangers of MCIs and the additional challenges presented by terrorist attacks involving chemical, biological, radiological, nuclear or explosive (CBRNE) agents. The course includes information on safely and effectively dealing with an MCI resulting from a CBRNE agent.

Upon successful completion of this course, participants will be able to describe:

• The characteristics of an MCI.
• The types and indicators of CBRNE incidents.
• The steps for responding to an MCI, including preparedness planning, triage, treatment, transportation and incident demobilization.
• The purpose of triage and how to perform it.
• The purpose of decontamination and the resources required to perform it.
• Specialized medical treatment appropriate for victims of CBRNE incidents.

Located on USFA’s Virtual Campus, the course is available free of charge to emergency management personnel, fire service personnel, first responders, homeland security personnel and the general public. Potential students will be asked to log on. Go to https://training.fema.gov and click Online Training.

For more information on this and other USFA training programs, both online and classroom-based, visit www.usfa.fema.gov.

RAND Study Finds Law Enforcement Agencies Expecting Terrorist Attacks Are Better Prepared

State and local law enforcement agencies that believe they are likely to face terrorist attacks are generally better prepared to respond than agencies less concerned about such attacks, according to a RAND Corporation study titled When Terrorism Hits Home: How Prepared Are State and Local Law Enforcement?, which was issued late last year.

The nonprofit research organization that addresses challenges facing the public and private sectors around the world based its findings on responses to a 2002 survey of officials in 208 state and local law enforcement agencies around the U.S.

The study found that in response to 9/11, state law enforcement agencies and local law enforcement (particularly those in large counties) undertook a number of steps to improve their preparedness for terrorism, including increasing the number of personnel doing emergency response planning; updating response plans (for incidents related to chemical, biological or radiological [CBR] attacks) and, to a lesser degree, mutual aid agreements; and internally reallocating resources or increasing departmental spending to focus on terrorism preparedness. In addition, most state law enforcement agencies and many local agencies (again, especially those within large counties) received guidance from the FBI about what type of information they should collect and pass on about suspected terrorist activities.

The survey found law enforcement agencies in highly populated counties are generally more concerned about terrorist attacks, and so do more to prepare for them than agencies in less-populated counties.

In general, state law enforcement agencies and local law enforcement agencies in large counties were more proactively engaged in terrorism preparedness activities along its different dimensions (planning, training, etc.) than were law enforcement agencies in smaller counties.

In smaller counties, interagency task forces appeared to play a more central role in terms of planning, assessment and training activities.

The RAND survey also found that:

• Law enforcement agencies in populous counties want more training in conducting interagency operations, and tabletop and field exercises; operating in hazardous environments; collecting evidence and using the Incident Command System. They also want more personal protective equipment (PPE) and sensor technology.
• Nearly half of state law enforcement agencies and a third of local law enforcement in large counties want better intelligence information from the federal government about terrorist threats and capabilities. Few law enforcement agencies in small counties want this type of information from federal officials.
• Smaller agencies consider protocols for conducting or evaluating assessments as being their most important support need, as do a third of state law enforcement agencies.

Lois Davis, senior policy researcher and lead author of the RAND study, said, “Our study can help policymakers at the state and federal levels determine what assistance to provide to law enforcement. The survey also provides an important benchmark that can be used by the Department of Homeland Security to assess improvements in preparedness and to better target federal funding.”

To order a copy of the study, or to download it free of charge, go to www.rand.org/publications/MG/MG104/, or call 877/584-8642.

Office of WMD Training and Education Provides On-Site Training to First Responders

For approximately the past year, Albert Einstein Medical Center in Philadelphia has operated an Office of Weapons of Mass Destruction Training and Education to help first responders like firefighters, law enforcement, EMS personnel and other healthcare providers prepare for public health disasters, such as an act of terrorism.

The program, which is funded through a $1.9 million, 2-year grant from the Department of Health and Human Services’ Health Resources and Services Administration (HRSA), is to provide training and education on emergency management in its entirety, with topics ranging from recognition to recovery.

The four-hour class introduces participants to basic types of WMD incidents and response plans for mass casualty incidents, decontamination, and biological and chemical terrorism, says program coordinator Aaron Richman, EMT-P, whose background includes 12 years with the Israel National Police in Israel. As patrol commander in the mid-city area of Jerusalem and a patrol captain in other parts of the city, Richman responded to many terrorist incidents between 1993–2003.

“As a result of my experience in Israel, we do a lot of things hands-on,” says Richman. “We do less talking and more physical training with the Level C suits on, doing hands-on skills related to the particular attendee. If it’s paramedics, we have them doing intubations wearing the suits to see how they operate within them. It’s actually a confidence-building tool, since the next time they wear them, they’re more comfortable because they’ve worn the suits before.”

Until now, classes have been free, thanks to the DHHS/HRSA grant. According to Richman, they’re now waiting to see if the grant will be renewed, or if they’ll have to start charging for the course.

“Attendees can earn four continuing education credits, which are approved by the Pennsylvania Department of Health,” says Richman. “We’re also an accrediting facility for nurses, who are usually mandated by their facilities to show up, and physicians get Grand Rounds CMEs, which is important, because we aren’t just teaching them about medications or signs and symptoms—we’re teaching them about the overall threat that’s out there and how to operate under those circumstances.

“The whole training takes 4 hours,” Richman adds. “We do about 45 minutes of a PowerPoint overview, then get right into skills, which includes putting on and taking off the Level C suit, using the buddy system, using the Mark 1 antidote kits for chemical exposure and doing intubation with the suit on. We actually build each course specifically for the audience, so if I have a roomful of doctors or nurses, they’ll be doing different skills than if we have paramedics.”

Although this particular program is unique to the state of Pennsylvania, agencies in other parts of the country have developed their own training programs, using grant money from the same source. Richman welcomes questions about the Albert Einstein Medical Center’s program. He can be reached at 215/951-8195 or RichmanA@einstein.edu.

AHRQ Offers Guidance for Mass Prophylaxis Efforts

Sometimes, you’re fortunate enough to know in advance of a biological threat and have the opportunity to counteract it. Each year, for example, influenza makes its rounds at around the same time, in a fairly predictable way. Flu vaccines, therefore, are rolled out (in most years) in advance to protect those wishing to receive them. In some circumstances, that’s even true with an intentional terrorist bio-attack. When an as-yet-unknown perpetrator started mailing out anthrax in late 2001, public-health folks began dispensing the Cipro in a pre-emptive strike to protect those at high risk of exposure.

Both of these cases highlight the challenge of prophylactically treating large numbers of people in the face of a biological threat. For public-health personnel, it’s a high-stakes mission with a lot of aspects to consider.

A new publication from the Agency for Healthcare Research and Quality (AHRQ) may assist in this important job. Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness, prepared by a team of health professionals in Cornell University’s Department of Public Health, aims to guide authorities through the process of delivering prophylactic protection to large numbers of citizens.

“Since the 9/11 and anthrax attacks of 2001, we, as a country, have pumped about $15 billion into public-health systems, with much of that going to improve our ability to protect the population against biological threats,” says the document’s lead author, Nathaniel Hupert, MD, MPH, an assistant professor of public health and medicine at Cornell’s Weill Medical College. “But despite that tremendous amount of money, there was no basic document describing, both to planners and to the public at large, what the whole enterprise of community-wide antibiotic drug dispensing or vaccinations would consist of. This money went out with a requirement that states and localities create mass-prophylaxis models, but no guidance came with it. So this is an attempt to provide that guidance.

“It’s for people who are new to the process, or interested in it. It says, ‘This is the process by which a community comes up with a mass prophylaxis plan, these are the people who need to be at the table, and these are some of the issues that need to be considered.’”

The document, which complements the Strategic National Stockpile Guidebook offered by the Centers for Disease Control and Prevention (CDC), is broken down into four sections:

I. Overview of Mass Prophylaxis—An overview of the five components of a mass-prophylaxis outbreak response (surveillance, stockpiling, distribution, dispensing and follow-up).

II. Fundamentals of Dispensing/ Vaccination Clinic Design and

III. Examples of Antibiotic Dispensing and Vaccination Clinic Plans—These sections describe a network of specially designated Dispensing/Vaccination Centers (DVCs) that communities would use to treat their citizens, as well as sample plans to be used in conjunction with a separate customizable computer planning model, the Bioterrorism and Epidemic Outbreak Response Model (BERM), developed to supplement the guide.

IV. Clinic Management/Command Structure—This section describes the implementation of a comprehensive operational structure for clinics, based on the National Incident Management System (NIMS).

The key concept to the response framework outlined in Community-Based Mass Prophylaxis is the DVC. The document describes what each DVC needs in terms of supplies and stockpiles, staff, protocols, flow plans, support services and transportation, and further discusses aspects such as location, security, storage and communications.

The operations of each DVC are broken down into core functions (e.g., triage, medical evaluation, transportation assistance, the distribution and collection of vaccinees’ information) and support functions (like inventory/resupply, directing traffic, data entry, translation services, facilities maintenance, etc.).

Guidance is also provided, via the BERM, for determining how many DVCs will be needed in a particular community, how many patients each can accommodate and what kind of staffing will be needed to support them.

“It’s linked to a computer model we created that helps with calculating things like the number of people and sites needed to cover a community,” says Hupert. “What we were trying to do was give people the types of tools to really come up with an evidence base and a locality-specific plan.”

Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness is available from AHRQ (www.ahrq.gov; publication #04-0044) and can be downloaded at no charge from www.ahrq.gov/research/cbmprophyl/cbmpro.htm.