BY MICHAEL KENNEDY
If your fire response district includes a higher education institution that conducts biomedical research or a pharmaceutical company, there is a chance one of these facilities does research with select agents. According to the Centers for Disease Control and Prevention (CDC), as of May 2011, there were 384 registered entities in the Federal Select Agent Program, of which 29 percent are academic institutions.1 Select agents include bacteria, viruses, and toxins such as Bacillus anthracis (anthrax), Ebolla virus, and ricin. The CDC defines select agents as “having been determined to have the potential to pose a severe threat to both human and animal health, to plant health, or to animal and plant products.” (1) Although most of the effort regarding select-agent facilities revolves around securing the select agent from unauthorized and nefarious use, there are many noncriminal incidents that may require a fire department response.
Fire departments must preplan responses to select-agent facilities and train with facility staff. Firefighters need a basic knowledge of the type of research it conducts, the select agent it uses, laboratory design features, and key staff members. There must be an established relationship and understanding among firefighters, law enforcement, and researchers about the role each will play during an incident.
The CDC under the U.S. Department of Health and Human Services (HHS) is the lead federal agency that authorizes, regulates, and inspects select-agent facilities. The CDC’s Federal Select Agent Program regulates more than 60 agents.2 (http://1.usa.gov/1aNFNSW) The principle balance the CDC strives to maintain is “increasing the nation’s defenses against the threat of biological weapons and reducing the hurdles that legitimate scientists face as they pursue research on potentially dangerous microbes.”3 The security of select agents is maintained though a multilayered approach that includes the background screening of researchers along with physical security systems. The Federal Bureau of Investigation (FBI) Weapons of Mass Destruction Directorate and the Department of Homeland Security Infrastructure Protection Program (DHS-IPP) assist facilities with their security plans by conducting vulnerability assessments and response plan review.
The HHS has a classification system for research laboratories that goes from one to four; four is the most hazardous.4Biosafety in Microbiological and Biomedical Laboratories (BMBL), Fifth Edition details the specific requirements for each biosafety level. These requirements address topics such as agent type, training, practices, facility design, and decontamination procedures (Table 1).
Select agents are used in laboratories that are designated as Biosafety Level 3 (BSL-3) or Biosafety Level 4 (BSL-4). A chief distinction is that select agents used in a BSL-4 laboratory are “frequently fatal, for which there are no vaccines or treatments, or a related agent with unknown risk of transmission.” (4) Simply put, there are treatment options if you are exposed to a BSL-3 select agent, but there are none for a BSL-4 select agent. Laboratories will also affix an “A” to the beginning of the BSL-3 or BSL-4 designation to indicate that the laboratory also houses research animals—e.g., ABSL-3.
BSL-3 or BSL-4 laboratories and chemical research laboratories differ in that biological laboratories are more likely to involve animal research and cultures, whereas chemical research laboratories are more likely to have greater quantities, varieties, and hazards of chemicals. Remember, not all laboratories are the same; even labs within the same building or complex may contain drastically different hazards.
Characteristic of all BSL-3 and BSL-4 facilities is a ventilation system specifically dedicated to the laboratory space, separate and distinct from the regular building ventilation system. This system creates a negative pressure and includes high-efficiency particulate air filters. If the fire department is called for a “smells and bells” type response and does the normal routine of checking the building’s ventilation units, crews must take extreme caution when interacting with the ventilation equipment that serves the BSL-3 or BSL-4 space. These units will have biohazard warnings and identification because of their filtration systems. Unless it is absolutely necessary, firefighters should not open or manipulate these ventilation units. If there is no active fire, allow the facility manager to contact the normal service technicians. If the unit is involved in fire, disconnect the power and use dry chemical extinguishers if necessary. If firefighters are required to open the ventilation units, full personnel protective equipment (PPE) with self-contained breathing apparatus (SCBA) is mandatory. Consider all firefighters and their PPE contaminated, and prohibit PPE use until it is decontaminated.
Fire departments must work with select-agent facilities to understand the hazards and, more importantly, the safeguards in place at the facility. If the company officer turns around en route to an incident and mentions that the facility the crew is responding to has anthrax or Ebola virus, the firefighters riding backward will have a fair amount of trepidation, which can be mitigated through preplanning and training. The unknowns faced at a residential structural fire far exceed the unknowns at a select-agent facility. One of the largest unknown perils that fire officers will face at a select-agent hazard is their crews’ mental readiness, affected by the perceived threat of contamination.
Firefighters have one significant advantage when responding to a select-agent facility: The principal investigator (lead researcher with a doctorate in the field) will have very strict research protocols for the select agent being used. Firefighters will not face an unknown substance or situation as they normally do at a transportation-based hazardous materials response.
Consider select-agent facilities as a target for criminal or terrorist events. Based on incident size-up and the credibility of the threat, law enforcement operations may take initial priority until hazards and threats are assessed. The CDC and the FBI bind the select-agent facility by stringent reporting protocols for any incident. The local law enforcement agency having primary jurisdiction must have a specified response plan to clear the facility of any active criminal threat prior to the fire department’s engaging in response operations. The responding fire department must have a preplanned response with the local law enforcement agency that clearly delineates each agency’s role under various incident types. This plan must include a default provision in which responding fire apparatus automatically go to a staging area until law enforcement deems the scene secure.
Biological agents are more difficult to detect than chemical agents because no direct-read air monitors that can immediately detect their presence exist. Additionally, the signs and symptoms of biological exposure may take hours or days to manifest. However, the principal investigator and the facility’s staff will know exactly what select agents are present in a BSL-3 or BSL-4 laboratory. Identifying which select agents are in use is a mandatory portion of the research protocol. By knowing the select agents being used, any responders who may have been exposed to a select agent can receive prophylactic medications before the presentation of signs and symptoms.
For nonfire incidents (e.g., a researcher experiencing a medical emergency who is unable to self-extricate), responding firefighters or EMS personnel should refrain from wearing their normal PPE such as bunker gear into the select agent laboratory. The recommended PPE for responders is that which the researchers normally use. One benefit is that this PPE will already be on-site. However, firefighters and EMS personnel must be trained beforehand on the donning, use, and doffing of this PPE. If it is decided that firefighters and EMS personnel will wear an N-95 mask instead of a powered air-purifying respirator (PAPR), then fit testing must be provided. It is recommended that the patient be removed from the laboratory and decontaminated prior to the initiation of medical care. Any patient-care equipment brought into the laboratory must be left in the laboratory or decontaminated prior to being brought out. Advise the receiving hospital of the unique setting from which the patient was transported. The select agent laboratory should have a predesignated receiving hospital/emergency room equipped and protocols to deal with a patient from a select-agent facility.
The likelihood of a fire occurring in a select-agent laboratory is relatively low because the contents of a select-agent laboratory are highly regulated and items within the laboratory need to be able to be disinfected or autoclaved (disinfected using high-pressure steam). Additionally, select-agent labs employ stringent housekeeping rules. However, the consequences of a fire in a select-agent laboratory are significant. Consider all water runoff from a fixed suppression system or fire streams contaminated. A fire in a select-agent laboratory will have major technical decontamination challenges and consequences. Consider all PPE, SCBA, tools, equipment, hoselines, and so forth contaminated. The fire department must work with the facility officials to determine a decontamination plan. Response personnel may need to take a field decontamination shower and change out of their clothing prior to returning to quarters. Medical monitoring is advised for anyone suspected of having been exposed to an agent. The length and type of such monitoring depend on the type of exposure and the agent involved. Numerous variables will need to be discussed depending on the circumstances. Consider the mental perception of “contamination” so that responders do not think they could be exposing their families to a contagion to which they were potentially exposed.
Incidents in a select-agent laboratory are low-frequency/high-consequence events. As with all other fire service responses, preplanning, training, and establishing working relationships with key facility staff prior to an incident will determine a successful outcome. Select-agent research is a critical component of our national defense strategy, and the fire service once again finds itself on the front line of securing our nation’s homeland.
1. Centers for Disease Control and Prevention. CDC Select Agent Program. May 2011.
2. Centers for Disease Control and Prevention (2013). Select Agents and Toxins List. Retrieved on 23 February 2013 from http://www.selectagents.gov/Select%20Agents%20and%20Toxins%20List.html.
3. U.S. Department of Health and Human Services (HHS) and Centers for Disease Control and Prevention (CDC). Incident Response in Select Agent or Toxin Facilities. Atlanta, GA, 2011.
4. U.S. Department of Health and Human Services. Biosafety in Microbiological and Biomedical Laboratories (BMBL) Fifth Edition. December 2009.
● MICHAEL KENNEDY is 19-year veteran of the fire service and chief of the South Lyon (MI) Fire Department. He is a Michigan Fire Fighters Training Council instructor, a Michigan State Police professional emergency manager, and a senior emergency management specialist with the University of Michigan (Ann Arbor). He has a bachelor’s degree in political science from the University of Michigan in Ann Arbor and a master of public administration degree from Eastern Michigan University.
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