This is the third segment of a four-part series on the National Institute for Occupational Safety and Health (NIOSH) conference, organized and directed by RAND Science and Technology Policy Institute on behalf of NIOSH.1,2 attended by 150 responders to the World Trade Center and the Pentagon on September 11, 2001; the anthrax bioterrorism incidents of Autumn 2001; and the bombing of the Murrah Federal Building in Oklahoma City. The emergency responders –assigned to one of eight panels–took part in guided discussions covering topics such as tasks performed during the initial and sustained phases of the response, hazards encountered, availability and relevance of personal protective equipment, and training and information about the use of protective equipment.
Following are summaries of additional major points covered in the conference and some recommendations proposed by the emergency responders/panelists..
Respiratory Protection Equipment
Respiratory protection was the most widely discussed topic among panel members. There was an acute shortage of respirators early in the WTC response; the shortage was less acute at the Pentagon and in the anthrax episodes.
Airborne hazards-such as airborne particulates, toxic gases, and anthrax spores-were present at the terrorist events, and the respiratory system is considered to be the primary pathway for exposure. The consensus was that several types of respiratory protective devices would most likely be needed at these incidents. SCBA was seen as providing the best protection for fire suppression, but it offers only a short-term supply of fresh air-up to one hour, depending on the bottle. SCBA ensemble is heavy. Lightweight carbon firefighter bottles said to be an improvement. Most teams lack sufficient backup or refill capacity to keep responders supplied.
The SCBA’s heavy weight and limited air supply limited firefighters and special operation personnel working at the Pentagon, as they had to travel long distances to get to the fire zone.
Full-face respirators, panelists said, reduced the field of vision, often fogged up, and were uncomfortable.
Another shortcoming of the respirator systems available at these incidents was the lack of interchangeability. The systems were made by different manufacturers and had different fittings; air tanks and canisters often were not interchangeable.
Responders voiced concern about certification of the available respirators. Many did not have a certification stamp, even though the packaging sometimes indicated it was certified. Responders had some questions about which units should be used.
Since it is difficult to communicate while wearing a respirator, many wearers broke their seals to talk. Of course, being able to communicate, especially in the early stages of a terrorist attack response, is most crucial. The less expensive respirators available at the terrorist-attack sites presented communications problems in the high-noise environments.
Responders to the anthrax incidents did not know whether their respirators offered adequate protection. No respirator at the time was NIOSH certified for protection against anthrax; no established selection criteria existed for respirators for use in responses to anthrax incidents.
With regard to flashlights, communications equipment, and other devices that run on batteries, the panelists said specialized batteries were not readily available and that rechargeable batteries are impractical for extended responses. After the first 12 hours of response, responders’ flashlights became essentially useless. Panelists said rechargeable units are preferable to those with specialized batteries and it would be better if the were able to function on readily available disposable batteries such as D-cells. This would make it possible for the batteries to be cached or obtained through local retail networks.
Among the recommendations panelists made for improving future large-scale responses were the following:
Personal Protective Equipment
- Equipment must be practical enough in design and the demands it places on users to enable responders to do their jobs effectively on a day-to-day basis.
- Cumbersome equipment has the potential negative consequence of the equipment’s interfering with emergency responders’ primary task to the point where responders choose not to use it.
- Equipment that provides an intermediate level of protection against a range of threats but has the weight and flexibility responders need enables responders to operate better in multihazard environments and could more easily be decontaminated at the end of the day.
- Provide more flexibility for organizations to adopt several different levels of PPE (scenario-based PPE) geared toward different hazards.
- Make available easy-to-use compatibility charts to guide responders in the use of different levels of PPE (as is done for hazardous materials).
- Make available to all emergency responders escape hoods with supplied air.
- Provide smaller, thinner gloves that provide thermal protection.
- Develop workable eye protection that protects against particulate matter and does not fog up during physical exertion.
- Develop a lighter helmet that is as effective as the current standard gear. The new version should retain the traditional shape.
- All responders working in the same environment should have access to appropriate protection regardless of their particular role or organizational affiliation.
- Caches should contain a greater quantities of PPE so that local responders and supplemental units could be fully equipped and replenished with new gear as needed. The caches should contain ample supplies of boots, gloves, PAPRs, and lighter-weight clothing such as coveralls. The caches should contain all sizes of garments, gloves, and masks.
- The caches should be positioned and staged in locations that take into account the potential for air transportations shutdowns or other disruptions in the transportation infrastructure.
- The caches should be managed at different levels-local, regional, and national–to ensure that a minimum amount of equipment will be available nearby for immediate access in an emergency; additional stores should be available at the regional and national levels. As an alternative, the incoming FEMA Urban Search and Rescue teams should bring in a supply of equipment for local responders already on the scene, especially in smaller jurisdictions that might not have sufficient supplies on hand.
- Implement regulations that require that PPE procured with federal funds meet certain minimal performance standards. The equipment should be tested and certified to nationally recognized standards.
- Federal grants for PPE should require that recipient organizations outfit all responders with a basic PPE ensemble before spending money on expensive, high-tech equipment.
- Develop an inventory databases for site commanders so they can quickly determine what PPE is available in nearby warehouses and request shipment of the most critical goods. The database could function as a national shopping list for emergency responders. Commanders should have proper information and authority to turn away offers of equipment that would not be useful.
- All federal agencies should acquire and stock identical brands, or at least interoperable equipment. Federal regulations should mandate that equipment purchased by responder organizations meet some standard of interoperability. NIOSH or another agency with jurisdiction should issue binding regulations establishing standard couplings on respirators so cartridges and masks could be used interchangeably. As an alternative, smaller agencies could coordinate PPE acquisitions and logistics with other local and state jurisdictions to ensure interoperability.
- There should be interagency training that prepares responders to don and use PPE and to implement health and safety measures and enforce the use of PPE.
- There should be more PPE training in advance of terrorist incidents-the recommended equipment needed for these types of major responses should be integrated into the standard operating procedures of organizations as much as possible. PPE training should be available for the entire range of responders at a large-scale response site. Construction workers be given federal Hazardous Waste Operation and Response (HAZWOPER) training and certification so they can choose proper respirators and identify hazards.
- The Science and Technology Policy Institute is a federally funded research and development center sponsored by the National Science Foundation and managed by RAND. The institute supports the Office of Science and Technology Policy and other Executive Branch agencies, offices, and councils.
- Brian A. Jackson, D.J. Peterson, James T. Bartis, Tom LaTourrette, Irene Brahmakulam, Ari Houser, Jerry Sollinger are authors of the report (CF-176-OSTP, RAND Science and Technology Policy Institute, 2002). To order hardcopies of this report and other RAND documents, contact Distribution Services at (310) 451-7002, fax: (310) 451-6915, e-mail: firstname.lastname@example.org