EMS Weapons of Mass Destruction Pilot Program

It happened like this: I’d just finished spending three days at the New Mexico Institute of Technology, attending a class called Incident Response to Terrorist Bombings (it was an extremely cool class, basically watching the staff blow stuff up). I had some time to kill, so I stopped by the school library to check my e-mail. And there it was, a mysterious missive from our regional WMD coordinator, Larry Johnson, looking for “qualified paramedics” to volunteer for an unspecified FEMA drill at the Center for Domestic Preparedness (CDP).

Now, I had attended Incident Command for WMD, including hands-on training with live agents, at the CDP last January, so the thought of returning to northern Alabama, along with the general mystery surrounding the e-mail, intrigued me. I signed up immediately.

I arrived in Atlanta on July 21 and boarded the bus for Anniston. It was a balmy 97ºF, with approximately 90% humidity. During the 90-minute journey to Anniston, we drove through two thunderstorms.

Upon arriving, we checked in at the training center—still no information forthcoming about why we were there. Other members of the class who were assembled in the lounge similarly knew nothing.

A little about the Center for Domestic Preparedness: It is located at Fort McClellan, a deactivated military base in Anniston, AL. It is home to the Cobra training facility, the only live agent (nerve gas) training facility in the U.S. Located about 10 miles down the road is the Anniston Army Depot, site of one of the largest stockpiles of nerve agents in the continental U.S.

The Center has been in existence since 1997, first under the Department of Justice (DOJ) and now under the Department of Homeland Security (DHS). It is tasked with training first responders at the technician and management levels in responding to chemical WMDs.

As we assembled in the classroom the next day, I looked around at my 19 fellow participants. They were all the kind of “high speed, low drag” persons you would expect to find volunteering for an unknown exercise like this. The 20 of us, all paramedics, pretty well represented a cross-section of services in the U.S.: public (police, fire, third service), hospital-based and private. The only unifying characteristics were that we had all been here before, and none of us had any idea what we were in for now.

The revelation came in the form of our first speaker. He stated we had been chosen to be the evaluators—read guinea pigs—for a new WMD course designed especially for advanced providers. In addition, we would be performing a drill in conjunction with a FEMA hospital leadership course that was taking place at Noble Medical Center, a few blocks down the road.

A little more history: When Fort McClellan closed, the base hospital was taken over by FEMA and set up to provide hospital personnel real-world training in dealing with WMDs. Prior to the formation of the Department of Homeland Security, the DOJ and FEMA had never worked together in any training capacity. Therefore, this would be the first of what is hoped to be many combined exercises designed to educate both hospital and prehospital healthcare providers on their respective roles in a WMD event.

The first day was spent reviewing WMDs, triage and treatment, with an emphasis on ALS skills such as placing ET tubes and IV lines while dressed in Level C attire. In addition, the concept of definitive decon prior to movement into the hospital was introduced and practiced. We then went over to Noble and were introduced to our hospital counterparts.

That night, the weather announcer on the local news said the temperature in Anniston the next day was going to be in the high 90s, with a heat index of 115. She was right.

We assembled the next morning, our instructors becoming increasingly nervous as the temperature continued to rise. There was talk of canceling the drill. The class argued loudly that we could manage our end with safety officers and cooling vests under our protective suits. Ultimately, a compromise was reached: We would wear Tyvex outside in triage and treatment, with our air-purifying respirators and full Level C suits on the decon line at the hospital.

The first five of our personnel manned the initial triage point, where patients were brought after gross decon. There, the patients were further triaged, medical care was given, and the patients were moved on to transport.

Our second five prepared the patients for transport, ably assisted by the Anniston EMS units stationed at the drill. The patients were then transported by ambulance to Noble, where they were met by our third quintet.

At Noble, the patients received definitive decontamination, with ETTs, IVs and splints exchanged and the patients being deconned as much as possible. The patients were then brought into the ED, where our fourth group of five observed the hospital staff in action.

Through effective safety monitoring, appropriate hydration and the use of cooling vests under our suits, none of our personnel suffered any heat-related problems. The difficulties associated with adequate hydration and Level C suits were, however, roundly discussed.

All things considered, this was an excellent drill. Hopefully, it will be a precursor to many other interagency training courses and exercises.

For more information on this and other training opportunities at the Center for Domestic Preparedness, call 866/213-9553, or visit www.cdptraining.com.