Tue, 10 May 2011|
This video from the Firefighters Support Foundation deals with the process of committing suicide by mix chemicals together, which can imperil firefighters and EMTs responding to these incidents. Presented by August Vernon.
[BLANK_AUDIO] [BLANK_AUDIO] Due to the current and emerging threat of chemical suicides it's important that we share this information to prepare responders to deal with this threat. The chemical suicide is the mixture of readily available household chemicals to produce a dangerous and hazardous material gas. The goal of today's presentation is to provide the responder with some very basic tools and information to help you plan and prepare for this response. Three or four years ago responders in the United States had never heard of chemical assisted suicides. Now is becoming very prevalent as more people become aware of it, it should become a bigger threat for responders. The guidelines and procedures discussed in this presentation should not replace common sense and experience. If the responder is trained to the hazardous materials awareness level. They can manage this incident. It's also impossible to plan for every type of response or situation that can occur out there, and with the current emerging threat of chemical suicides, there is no nationally recognized template, so each jurisdiction and state may need to address that. Also, new best practices, lessons learned, training and information is coming out all the time, so it's important that we update this information. Please remember that the information in today's presentation is for educational purposes only. Each agency should follow its local guidelines and procedures. It may be important that the information you learn today can be applied to even updating, and or creating, a response plan or guideline. To manage these incidents. A rapid, safe, and successful response to one of these incidents does require some planning and preparation. So it is very important for agencies to plan for these incidents and to even run scenarios with this incident. So if they have to run across a real incident, it's not the first time they managed it. Also, the likelihood of one of these incidences is still very low, but it's very important that public safety officials plan and prepare for these incidences as they continue to grow across the United States. Also, it can be anticipated that we may see an increase in these responses. As more and more information becomes readily available, as there's more immediate attention on it and the number of websites devoted to this process increase. Failure to plan for these incidents can lead to responder fatalities and injuries. There have already been several incidents across the United States where first responders were exposed to the toxic substances involved in this process. [SOUND] The purpose of this presentation is to provide situational awareness for all responders, to be able to recognize a threat, pick up on the indicators, and protect themselves and the public. Also, these situations are commonly occurring in vehicles, closets, dorm rooms, laundry rooms, any other enclosed or confined space. So, as responders approach these incidents, they need to be more aware if it is an enclosed space such as a closet or a vehicle. There have already been numerous documented cases within the United States of these incidents occurring. At this time there's not a national data base that can tell us exactly how many, but we can find out there's been at least dozens, up to hundreds of incidents. Across the United States. The method involves mixing two readily household chemicals together to produce a very noxious and dangerous gas. It can be done very inexpensively and very quickly. The gas produced during this reaction is a flammable and toxic gas, and typically it will cause the victim to very quickly go unconscious. And to stop their heart. This method of solute suicide, commonly referred to as detergent suicide is becoming more and more prevalent across the United States. There are several reasons for this. Number one: The instructions to mix these chemicals is readily available on the internet. for anyone that has an interest. Number 2, the chemicals used are very, very cheap and are all readily available at any grocery store or household store. Number 3, it is very, very easy to go through the procedure and mix these products. Any jurisdiction big or small that has not yet seen this incident should still plan and prepare for this response. The process of chemical suicide involves mixing common household, readily available chemicals to create hydrogen sulfide, hydrogen cyanide, chloride, or other gases which can be immediately dangerous to life and health. In a small enclosed location. Now one of the best tools that any responder in fire EMS, law enforcement, Hazmat, emergency management has readily available, is the DOT Emergency Response Guidebook. If the only information you have is what you can see from the scene indicators, you go to Guidebook 111 in the guide, and it'll provide you response procedures. Personal protective equipment, first aid, and other items that can help you in your response. As with any response, responder safety is our number one priority. There is the potential for responders to be exposed during this incident. Typically the persons committing this act, have left some type of warning sign. To advise the public and responders that there is a chemical hazard, but this may not always be the case. For example the sign that you see in the slide, this is an actual crime scene photo from an incident and this is the type of improvised warning label or sign that you may come across. [SOUND] During the initial dispatch, dispatchers and call takers should warn the callers not to approach or enter the vehicle or enclosed locations where unresponsive people may have attempted a chemical suicide. This information, if they find this out, needs to be relayed to responders as quickly as possible. The caller may advise that there are warning signs or labels, or they may not volunteer this information. So again responder situation awareness will be key. The initial call may come at a dispatch ____ as people seeing the warning and hazardous material signs, it may come in as an unresponsive person in the vehicle. Or it may even come in as a welfare check. So any of these incidents can turn into a chemical assisted suicide. The warning signs that the victim's placed on the vehicle or the exterior location, may become removed, may be detached or dislodged, or even blown away in the wind before responders arrive on the scene. So they may not always be our best indicators. The caller may also not advise the dispatch of any type of unusual sites or smells or any other indicators that will be passed on to the dispatchers and the responders. Proper initial questioning may yield some information if the dispatch knows to ask those questions of the callers. [SOUND] The information, if it's discovered, must be shared with responders immediately, before their arrival on scene. The information in this presentation should definitely be shared with telecommunicators and dispatchers because they may be the first chain in that link to warn responders. If you have the indicator that you may have a chemical assisted suicide. It's very important to use proper PPE, personal protective equipment, and SEBA to carefully size up the situation with any unresponsive person in an enclosed space. If that subject appears unresponsive and unconscious, is not responding to you verbally, knocking on the window, these all become indicators that you may have had this incident occur. If you see tape or plastic over the windows, over the vents of the vehicle, again, there could be single or multiple indicators that you have had this incident occur. Our normal response to an unconscious or unresponsive victim in a vehicle is to break open the window, open the door, and immediately extract them from car or check that person out. In these incidences, that's not our best choice, our best avenue of attack. Because you will see some of these warnings and indicators. Number one: You may see suicide notes visible or even posted. You may see one or more posted warning signs, or hazardous material signs. You may see in the interior of the vehicles the buckets, the pails, the pots or coolers that the chemical process was mixed in and it's off gassing into the vehicle. You may see empty containers in or outside of the vehicle. You may also have strong or unusual odor, like rotten eggs. [INAUDIBLE] Once the indicators of a chemically assisted suicide have been given, full fire fighter turnout gear and SEBA should be utilized for initial approach of the vehicle, and our rescue based on your scene size up and on scene indicators. If the first on scene is a law enforcement agency or an EMS agency, it's very critical at this point that there may be the opportunity to rescue the victim, but we've got to call the fire department as soon as possible. If the first aids seen on scene is a law enforcement agency or an EMS agency, it's very important to get the fire department there as soon as possible. With their turnout gear, and the SCBA. Because they can make the quickest initial approach, and possibly rescue that victim. [SOUND] During the initial response, we need to survey the inside and the outside of the vehicle. We're also gonna need to determine the responsiveness of the subject. Are they conscious or unconscious. Do they appear to be breathing? Is their chest rising and falling? Is the subject in conscious, can they open the door, exit the vehicle, and walk or crawl away? And some fresh air. Be careful when treating the patient due to the off gassing that will result of the hydrogen sulfide or the hydrogen cyanide. If the subject is unresponsive, and there appears to be no breathing for 30 seconds to a minute, we need to secure the area, back off, and call for the hazardous material team. The most important thing to remember is we need to follow our local guidelines and procedures. Some of the initial indicators you may find upon arrival on the scene. One, are suicide notes that are posted or visible, and two, you may see multiple hazardous material warning signs that the victim placed on the vehicle. Some of the indicators you may see in the inside of the vehicle include buckets, pails and pots where the product has been mixed in. You may also smell a strange odor, a strong sulfur or, odor on the outside of the vehicle. In some incidents, the victims have been seat belted in to, to prevent them from falling on the horn. You may also see that some of the vents have been covered up. In several incidents the vehicle windows maybe have moisture on them or there may be a green or yellow haze. But again we need to remember to follow our local guidelines and procedures. A chemical assisted suicide becomes an emergency response and a crime scene at the time of its discovery. Any public safety official who discovers a chemically assisted suicide is considered first on the scene. This means that they need to call for proper help, evacuate the immediate area, and set up the zones of control like any other Hazmat incident. Also, again, it is important to remember this is a crime scene and should be treated as such. The first thing we need to do upon arrival on the scene is survey the exterior and the interior of the vehicle. If possible, determine the responsiveness of the subject. Are they conscious or unconscious? Do they appear to be breathing? Do you see the chest rising and falling? Do you see movement from the victim? If the subject is conscious and can open the door and exit the vehicle, have them do that. Have them walk away or crawl away from the vehicle into more fresh air. If you are dealing with a patient or victim,. Be careful when treating this patient due to the off gasing that can occur from their clothing and their breath. This is a result of the chemical exposure they have received. If the subject is unresponsive, and there is no apparent breathing for 30 seconds to a minute, we're going to back off the scene, set up those Hazmat zones, and call for the Hazmat team and Fire Department. But again, we need to follow our local guidelines and procedures. When it comes to determining whether the victim is alive or dead, it's important to look at your own guidelines and procedures. Our suggestion is to look at the victim for 30 seconds to a minute. But some Hazmat SOPs and SOGs may not allow you to stay at that scene long enough. Your SOP or SOG may advise you that the moment you see the buckets and the victim in there and the warning signs that you need to pull away. This is something that each agency needs to consider. On the other hand, some SOPs and SOGs may advise us to immediately rescue the victim no matter the circumstances. So, again, each department should go back and look at this new threat and how it impacts their response guidelines and procedures. Similar to any other hazardous material response, you need to consider wind speed and direction when determining the need to evacuate nearby locations and structures that are near the incident. Also, some incidents will take place in a structure or building. So in a dorm or apartment building you need to consider evacuating that floor of the building or even the entire building depending on the threat. Some of these incidents may occur in a structure or residence, so you need to look for exterior visual signs as you approach the scene. Just like a vehicle, you may have warning signs and Hazmat signs that are posted on the front of the house or the apartment, or in the hallways, or on the doors. These doors may be sealed with tape or towels or some other form or fashion in the interior of the room. Other persons from inside the location may be complaining of difficulty breathing. Or smelling the smell of rotten eggs or other type of unusual odors. Also, responders may be exposed to these smells as they approach the incident. Again, we need to be prepared to evacuate that location or even the entire building or the surrounding area based on the response. If there is the possibility the victim is sleeping, or intoxicated, or some other medical condition, attempt to wake them up with the vehicle address system, bullhorn, siren, or some other means or fashion. If they cannot be awakened at that point, responders should perform a thorough recon. You can either perform a recon from some distance from the vehicle using binoculars, spotting scopes, or even [UNKNOWN] cameras. But do a thorough recon before you would make the initial approach on foot if you see the warning indicators. Some of the signs that have been posted in the past may not easily be detected or even understood by other people, including responders. So, again, don't rely on the victim you all the exact information. Also, signs have been hidden and can be hidden by condensation in the vehicle, frost, snow, or even the vapors that are produced by the reaction can mask those warning labels and signs. Also, reminder, any time you're dealing with a suicidal victim,. And this is what you have in this response. The victim may not be there dead and may be still suicidal so there could be the increased likelihood of violence towards responders. Now, responders are live on the scene. It's very important to interview any citizen or any member of the public who has approached the scene to learn what the saw or smelled. You can even ask them to draw out maybe what they saw in the vehicle and what the signs say. When it comes to smell, a rotten egg smell could indicate hydrogen sulfide. An almond odor is typical of a cyanide compound. But again, as with any hazardous material response, responders should not attempt to identify any hazardous material using their sense of smell. If you can clearly see that there are no chemical containers and mixing containers present anywhere in the enclosed space, those containers could be hidden from view, so that may not be your best indicator that there has been a chemical assisted suicide. So it's very important that on any situation, or any scene that responders maintain their situational awareness. And observe the entire scene to look for any other warning signs or indicators that you may find. If chemical containers are present, attempt to identify the chemicals from their labels, from the container itself, or maybe even receipts laying around that you may find on the scene. All these may help you identify what process was created. Now there's several different reactions that can take place. One reaction may utilize an acid found in many common cleaning compounds and a sulfide that's present in many different paints, insecticides, and shampoo that is utilized, produce hydrogen sulfide. The hydrogen sulfide chemical process is the most common chemical assisted suicide that is taking place right now. The presence of containers of potassium cyanide or any other cyanide compound would indicate a reaction that is producing hydrogen cyanide. Which again, is a very toxic. And dangerous chemical. This is less common than the hydrogen sulfide reaction, as the cyanides are not as easily obtained, but have still been emerging as a threat that you may come across. Air monitoring and detection can be used to determine the presence, or the absence, of hydrogen sulfide, hydrogen cyanide, chloride gas, or any other materials that may be utilized. In a chemically assisted suicide. One option for hazardous material teams is to put small holes to allow a probe to be entered into a vehicle or into a structure, or even into the gap between a door and the floor to put it into a room. Using columetric tubes, Draeger tubes, and other hazardous material monitoring equipment. So that tells us that a properly trained and equipped hazardous material team. Is the best option for these responses. At this point if it's been determined that the patient is deceased, all we need to do is secure the scene and wait for a hazardous material team. Even if this takes an hour or two for a regional team to arrive, that is our best and safest option for the responders. Both hydrogen sulfide and hydrogen cyanide are very flammable. At this time there's been no incidence of fire reported at a chemical assisted suicide scene, but the concentrations may not typically reach the LEL of the lower explosives limit except at very close proximity. To the mixing containers or the pails. So what that means is responders should eliminate ignortion, ignition sources that are near the source. Vapors inside the space should be ventilated to the outside of the vehicle or the structure. Also, if you're beginning the ventilation process. Ensure no one will be endangered by those vapors before using natural or forced ventilation to air out the location. Positive pressure ventilation can be used to reduce vapors inside a residence or structure. It's also very important to remember that the reaction may restart if that bucket is moved. So the bucket removal and identification is an excellent job for that hazardous material team. Whether the incident is a victim rescue or a victim recovery, the clothing should be removed and double bagged due to off gassing. Also responder clothing and personal protective equipment. Should be laundered before being reused. If alive, the victim needs to be immediately stripped and decontaminated on the scene with soap and water before being transported from the scene to a hospital. This can be done very rapidly with the water off of a fire truck if necessary. From an emergency medical response, it is important to remember that these victims can off gas through their breathing during treatment, so emergency medical service responders may need to have proper PPE on, and the hospital may need to initiate its hazmat procedures and decon teams to manage this patient upon their arrival. Responders must initially utilize emergency decon for rescue operations. This would include both the victim and the responders. Once a more detailed plan is put into place, you will need to provide technical decon for the hazmat entry team and those involved in victim removal and recovery. Also, once a victim is removed. The deceased victim will still need to be decontaminated and should be covered by a sheet on the scene, as a deceased victim could even possibly be off gassing. As you can see from the crime scene photo on this slide, again, there is a variety of warning labels and signs that you may be seeing that were printed off and placed on the site to warn responders. On slide 35 there are some nationally recognized references that would be available to you if you need any additional information or references. Also some final notes on the response to a chemical assisted suicide. It's very important that all responders. Utilize the incident command system and build an incident command post so the multiple agencies on scene are working together in a unified command to make the safest and the best possible answers for the incident. It's very, very important to notify EMS and the hospitals of the victim exposure. So that we can avoid contamination of both the ambulance and the hospital. Also, it's very important to establish our normal HAZMAT zones of control. Our hot zone, our warm zone, and our cold zone, for this incident. [BLANK_AUDIO]