November Roundtable: Mass Decon

September 11,2001, has changed the fire service profoundly, not only in the United States but also around the world. New words (or words that were seldom used before), procedures, tools, and policies have been developed and implemented. Ten years ago, how many departments had a policy in place that gave assignments and implemented activities and activations if we went to a “threat level red”? I’m not sure the fire service knew what “threat level red’ was 10 years ago. 

That single murderous act brought on an onslaught of new terms and acronyms (or at least new to the fire service). Mass decon is one of those terms and procedures brought to the forefront after September 11.
 
To be sure, we in the fire service have had decon for some time prior to 2001. I can remember being assigned to the city’s only hazmat unit in 1981.  We had level A suits and practiced decon on ourselves and our tools. After, 2001, we took that practice to a whole new level. We had thought of deconning mass numbers of victims in a large hazmat incident,  but it was all in-house. After 2001, hospitals, local emergency disaster planning agencies, the military, and law enforcement agencies began to see the need for procedures to conduct mass decontamination of responders and civilians. In Toledo, this became a major undertaking in the early 2000s. Every area hospital wanted to practice mass decon to provide treatment of “subjected” victims while protecting their facility from contamination. We held drills upon drills with pack-up procedures and contingencies. 
 
Like anything else, however, if a learned task is not repeated and practiced, it is soon forgotten, and other priorities and budget requirements have made training in decon less of a priority.– JOHN “SKIP” COLEMAN retired as assistant chief from the Toledo (OH) Department of Fire and Rescue. He is a technical editor of Fire Engineering; a member of the FDIC Educational Advisory Board; and author of Incident Management for the Street-Smart Fire Officer (Fire Engineering, 1997), Managing Major Fires (Fire Engineering, 2000), and Incident Management for the Street-Smart Fire Officer, Second Edition (Fire Engineering, 2008).

 

Question: Do you practice mass decon only within your department, or do you practice with hospitals and transport units? Do you believe mass decon is worth the effort?

 
Thomas Dunne, deputy chief,
Fire Department of New York
Response: New York City is both a terrorist target and one of the most densely populated areas in the country. Mass decon is more than a concept for us; it is a potential reality. In fact, the FDNY has proactively established and positioned decon task forces for incidents ranging from significant United Nations meetings to major events in Yankee Stadium.
 
EMS is a branch within the FDNY; it serves as an intermediary with city hospitals. In addition, some of our EMS personnel are specifically trained in hazmat operations. These individuals are qualified to work in chemical protective clothing, operate in the hot zone if necessary, and treat civilians after they are decontaminated.
 
We have conducted a number of large-scale drills that allowed fire units an opportunity to practice tactics involved in setting up and operating a decontamination corridor. These exercises have also included the EMS functions of triaging, treating, and transporting civilians, sometimes with people playing the “role” of victims.
 
Any mass decon event will no doubt be a complex, extended operation requiring a great deal of coordination among a number of agencies. Given the challenges presented, any effort to rehearse procedures and improve communication between fire and medical personnel is a very productive use of our drill time.
 
Gary Seidel, chief,
Hillsboro (OR) Fire Department
Response: We do have mass decon capabilities. On initial receipt of our mass decontamination equipment, we underwent intensive training so all personnel were familiar with the equipment, its setup and its use. In addition, we did familiarization training with law enforcement, public works, local hospitals, and our regional hazardous materials team. We attempt to conduct our mass decon training on an annual basis. In 2007, Oregon hosted one of the TOPOFF venues in Portland; one of the simulations had a multiagency mass decon component.
 
We have in place two procedures for mass decon; one using tents and decon units. For the second, we use our fire engine and truck companies, which in most cases will be our initial response to a mass decon need.
 
Mass decon training is worth the effort because it builds a better understanding of each other’s capabilities, demonstrates the need to work in a collaborative effort, and makes us better prepared if there is a need for mass decon.
 
Bob Metzger, chief,
Golden Gate (FL) Fire District
Response: We participate in hazmat incidents as part of a larger response from multiple agencies within Collier County, Florida. Depending on the nature and location of the incident, we may provide technician response or support, or both. Support will include establishing and staffing decon. Large-scale training exercises are conducted at least once a year with the agencies likely to be involved, including the transport agencies and local hospitals. The Collier County Fire Chiefs Association’s Training Committee generally coordinates these exercises. Locally, each participating agency is expected to train more frequently.
 
Mass decon training is absolutely worth the effort, provided the emphasis is establishing it early. Although many victims of a large-scale exposure may have already fled the scene to seek aid on their own, there are still likely to be many who have not. They will need the professional expertise of basic care. In the process of providing this, useful information can be provided to the hospitals about the nature of the incident and its impact on those being treated at the scene. 
 
Bobby Shelton, firefighter,
Cincinnati (OH) Fire Department
Response: Our city has three mass decon tractor-trailers that were purchased with federal funds. These units are strategically placed throughout the city in case of a weapons of mass destruction (WMD) or a large-scale hazmat incident. The fire stations that house these units regularly drill on setting up all components of the units, and we have had large-scale drills using the mass decon units to test our readiness and their effectiveness. I have mixed feelings about mass decon.
 
Several years ago, there was an explosion at a chemical plant in Cincinnati. Many of the injured that could have been decontaminated self-evacuated or were driven to area hospitals by police or good Samaritans. No decon was performed. In the WMD scenario, I see the exact same thing happening, but I would much rather have the units and underuse them than not have them and be overwhelmed in case of the “big one.” At present we do not hold regular practice sessions or drills with area hospitals. Since we do our own EMS transport, all companies in the fire department are aware of the mass decon trailers and their uses and how things are “supposed” to be done. But again, you never really know until the unthinkable happens.
 
Jeffrey Schwering, captain,    
Crestwood (MO) Department of Fire services
Response: Mass decon is part of my department’s training. Crestwood is one of five departments, along with the St. Louis County Hazmat Team, responsible for staffing and operating the mass decon tents and trailer.
 
Although training is always an issue at times, all three platoons have quarterly training on mass decon. We have been assigned for standby at several events across the city and county. With mutual aid, we could be assigned almost anywhere in the area.
 
Mass decon is worth the effort. In today’s world. firefighters again must step up to meet another challenge that has been placed squarely on our shoulders. I’m not a big hazardous materials guy, but we owe the civilians the best protection we can give.
 
Gregory Noll, program manager,
South Central (PA) Regional Task Force,
Lancaster, PA
Response: Based on current threats and risks, we believe that mass decon is a necessary response capability. Given incident timelines, mass decon is a First Responder-Operations level skill and should be capable of being delivered without the support of a hazardous materials response team (HMRT). 
 
Within our eight-county regional task force, we have approximately 40 companies (includes career, combination, and volunteer) trained and equipped to deliver mass decon services as a decon company or as part of a decon strike team, working with one of our five regional HMRTs. Through our regional Hospital & Healthcare Subcommittee, we have also adopted a standardized Hospital Emergency Response Team curriculum for all 16 regional hospitals to facilitate standardized training and response procedures. The majority of our decon companies have conducted functional or field exercises with HMRTs and their local hospitals.
 

Jason Hoevelmann, deputy chief,
Sullivan (MO) Fire Protection District
Response: We do not have the capabilities for mass decon. Regional hazmat teams are called to respond to major events. We can do emergency decon, if needed, for a very small number of victims, but we are limited in personal protective equipment (PPE), depending on the product.
 
Warren Parker, lieutenant,
Fort Lauderdale (FL) Fire Rescue
Response: As a member of the Fort Lauderdale Fire Rescue Hazardous Materials team, I practice mass decon annually at a minimum. Usually, this is just a dry run to refresh our members in the procedure. The local hospitals also practice mass decon annually for their personnel; we participate with them whenever possible. Since our department is an advanced life support department with its own EMS system, we have not included private ambulances in the past.
 
At the peak of the “white powder” calls, we were part of a large-scale multiagency mass decon drill that included civilians and took place at the United States Post Office. Because of the proximity of the Boca Raton anthrax incident and numerous threats around the country, the Post Office wanted to take extra precautions by placing its employees within a large-scale simulated mass decon incident. The simulation was a success not just with the Post Office but also with our department and the surrounding hazmat teams that participated.
 
Mass decon is important. Just as we practice high-rise procedures and rapid intervention drills, we need to practice simulated mass decon. Of course, no one hopes that we will have to put this exercise into practice, but if the need arises, all of the effort we put forth will pay off as we exceed our community’s expectations.  
 
Jacob Oreshan III, deputy chief,
New York State Fire, Hazardous Materials/
Homeland Security Bureau, Albany, NY
Response: We teach mass decon to career and volunteer firefighters, police, EMS, hospitals, military personnel, and hazmat teams throughout New York State as part of our hazardous materials training curriculum. It is important for responding personnel to understand the basics of mass decon and, more importantly, when to implement it.  Mass decon is a fantastic way for first-due companies to start patient care while operating with minimal staffing. Through the use of mass decon, we can teach responders how to quickly and safely prepare individuals for treatment/transport to health care facilities while at the same time using the START triage system. The psychological effect that mass decon has on the public is also a benefit. We can start making these people “feel better” while an established decon corridor is being implemented, allowing for a more efficient personal decon shower to take place. There are many ways to accomplish mass decon; continual training is a must for success regardless of which method an organization uses.
 
Ray Maloney, safety officer,
Northport (NY) Fire Department

Response: At this time, we do not practice mass decon or technical decon. There is no provision to isolate those patients/victims that are contaminated or contagious, which puts our first responder fire and EMS personnel at risk. We rely on the county or other hazmat teams to provide the decon services. If we transport any patient who cannot be deconned in the field, we will lose the ambulance involved and possibly the first responders. How long do we wait for technical decon, which is required for patients subject to life-threatening trauma? Do we triage and load and go, or what? We are not protecting our assets very well. I would appreciate hearing what other fire departments or EMS organizations are doing in these situations.

 

John T. Fallon, chief,
Penn Wynn Overbrook Hills Fire Company,
Merion Township, PA
Response: Our station is assigned as a “Hospital Decontamination Unit.” We drill at conventional and mass decon techniques at a station level. Although many of the more elaborate mass decon models look great in training, I doubt that large numbers of panicked people would cooperate with most recommended methods. How many terrified people are going to line up in an orderly fashion and walk through a well-defined decon line? We have practiced some simpler methods and feel that we might be able to successfully move large numbers of people through them with a minimum of confusion.
 
Another thing that many of the models in use overlook is that a significant number of contaminated people will already have entered the emergency room by the time any alarm is raised. That places a substantial burden on hospital personnel to isolate their own emergency facility and begin appropriate in-house decontamination methods. Unfortunately, most training programs and exercises ignore the fact that persons in a state of panic frequently act irrationally and even violently and that, unlike emergency service professionals, they do not understand the basic concepts of decontamination. Therefore, even the best organized and planned mass decon effort will be chaotic.
 
I don’t write off mass decon as useless by any means. I believe that properly trained people can forge order from chaos. Constant, realistic training is the key. Although I don’t see that we have reached that ideal: state yet, locally, I fully believe that we will eventually reach a state of readiness that will enable us to perform the best possible mass decon measures in a time of need.
 
Dan Oberste, battalion chief,
Little Rock (AR) Fire Department
Response: Our department has conducted a multiagency mass decon exercise using aerial ladder fog nozzles. Volunteer victims were ushered through this shower before they proceeded through the conventional decon tents.
 
Mass decon has value, but I think that an oversensitivity to modesty prevents most of us from performing the most effective mass decon procedure of removing that grossly contaminated outer layer, the victim’s clothing. In our standard operating procedure (SOP) pertaining to modesty, mass decon consists of flushing with copious water before removing the outer garments. In reality, we are transferring the contaminates through the clothing down to the skin layer. It also makes the runoff a more concentrated solution without decreasing the total amount of that runoff.
 
A more effective procedure would be to remove and containerize the victims’ clothing (especially the outer layer) before they enter the mass decon shower zone. This would allow for disposal of the highly contaminated clothing in barrels instead of washing all the contaminants into a difficult-to-handle liquids catch basin. Perhaps the resultant reduction in the cost of cleanup could justify the purchase of a set of modesty screens, for each gender, large enough to divide the area of mass decon.
 
Would a mass of contaminated civilians comply with instructions to disrobe in the open and dispose of their clothing in this manner? I doubt it. But one would be hard pressed to deny that this would be the preferred method to reduce the health effects of a hazmat exposure.
 
Dale Justice, assistant chief,
Indian River County Fire Rescue,
Vero Beach, FL
Response: We practice within our department and include transport units, as they are a part of Fire/Rescue. We are planning another round of training later this year and hope to include other agencies at their level of interface.
 
Mass decon is absolutely worth the effort. A quick and dirty mass decon can be accomplished with two engines with fog nozzles mounted on them and a supply of garbage bags (avoid the white bags) for victims to don over their undergarments. Removal of outer clothing eliminates only about 95 percent of contaminants that are not water reactive.
 
Additionally, mass decon may provide some peace of mind for the victims (many of whom are in fact in the “worried well” group), preserve a victim’s modesty, and having some type of decon prior to transport or emergency department arrival gives all involved a measure of safety and security during a highly emotional, rapidly evolving incident. Any reduction of “off-gassing” is worth the effort if it can prevent the shutdown of a transport unit or, more importantly, an emergency department because of cross-contamination. Mass decon does not work in all cases, but it provides a high return on investment for the communities and departments that use it when appropriate.
 
Christopher Feder, senior firefighter,
PennWynne-Overbrook Hills Fire Company,
Lower Merion, PA
Response: In my station, I am the hazardous materials and rescue coordinator and have been training our people for years in technical decontamination for our hospital response. We have been funded and trained to support hospital decon in a hazmat/WMD incident. It was not until recently that I realized that some of our training was focused too much on technical operations. In an incident, our most likely immediate response would be setting up a mass decon corridor with our engine and quint. We may not have time to set up for technical decon, especially if hundreds of people are involved. My department borders Philadelphia, and there is a good possibility that people may get in their cars and drive themselves to that hospital simply because they live outside the city. They do not know any better or just want to get out of the incident area. If we are setting up for a hazmat team, then maybe a mass decon would not be the best course of action. However, for a hundred or so people who are possibility contaminated and scared,  mass decon is the way to go. I believe that mass decon has a place in the service and should be something that everyone including (nonhazmat personnel) should be trained in doing. Mass decon is simple, quick, and more effective than doing nothing.
 
Eric Smith, captain,
Westland (MI) Fire Department
Response: We are trained to the Operations level, which allows decontamination but no offensive action with regard to handling the product. Our department has spent very little time training, specifically on mass decon, but we have had some reading assignments on this specific topic for our personnel over the years.  We train beyond the eight-hour minimum refresher annually but have not set up any practical drills on mass decon beyond the company level. We are part of a 21-community Mutual Aid Association that provides a hazmat team that is also a regional response team in Michigan. This team, which can be called at any time, has two mass-decon tents that can be operational in about one to two hours from the time of call unless they are prepositioned for a special event and placed on standby.
 
Whether mass decon is worth the effort depends on the chemical or product involved. In some cases, mass decon, if done quickly, may make a major difference in saving lives or the quality of life.
 
As with all incidents, the priorities remain the same; mass decon can be an important part of the tasks that help us meet these goals. Removing gross contaminates may reduce direct injuries and the dose received by the victim. It will protect responders and emergency care providers from potential injury by cross-contamination
 
Mark Wendelsdorf, chief,
Caldwell (ID) Fire & Rescue
Response: I believe mass decon training is very important and must be practiced with all responders. In July 2005 we had 30-plus farm workers with a chemical exposure from a field in which they had been working earlier that day. All patients were symptomatic; two were in critical condition.  Within the first 30 minutes of the first units being on-scene, we had a mass decon unit set up—three tents with two lines: undress, shower, and redress. Patients were triaged and awaiting transportation but were no longer symptomatic.
 
Seven hospitals were notified, so they could protect themselves from walk-in patients. The county sheriff, state police and the State Department of Agriculture were working to identify the field and chemical(s) involved. Three fire departments responded for staffing; the regional hazmat team was on-scene, Public Health was working on notifications and coordinating the press information. The news media showed up expecting to find mass chaos; they found an organized and orderly response to the incident, which led to minimal coverage. The many drills and exercises, done together, allowed this real-life event to come off without a hitch.
 
This type of a response is a team response and necessitates that all members of the team practice together. It would do no good for the quarterback to practice all by himself until game day.
 
Michael Schlags, captain/hazmat WMD specialist,
Santa Barbara County (CA) Fire Department
Response: There is an expectation on the part of the public that something will be done in a WMD event and the potential exposure to nuclear-biological-chemical agents. Not to do so opens up a can of worms in regard to public expectations and liability for your jurisdiction.
 
Basic hazmat training has taught us that by simply removing the clothing and rinsing off, most of the contaminants can be removed or at least diluted to a point where they will not present as much of a hazard. More susceptible individuals such as small children, the elderly, or immune system-compromised individuals should always be concerns when it comes to decon.
 
Setting up an elevated master stream to provide mass decon is a valuable tool for many reasons. First, it can be set up under 10 minutes, providing a focus point for victims. When the loud speakers advise victims to walk to the elevated master stream, a couple of things happen. Triage starts to take place with those able to walk and identifies the ambulatory patients. Those left are either dead, nonambulatory, or care givers who refuse to leave their family member or friend. Putting the elevated master stream in service will buy you time to set up other mass decon components.
 
Just the psychological benefits alone can justify providing emergency decon to the masses. The only problem in regard to decon a large number of people is modesty protection. We understand that people need to disrobe completely. How do you it while providing some degree of privacy? Simple answer: Trash bag decon. Take a 55-gallon black trash bag with no ties. Fold it in half and in the middle, cut out a half-circle the size of your fist. When you fold it back out, you will have a hole in the bottom of the bag where it is sealed shut. Slip the trash bag over the patient’s head. This will enable the patient to remove his clothing while ensuring privacy. If you have the time to make up these units, consider placing a strip of duct tape on both sides of the cutout hole (where the head slips through) to protect the heat-sealed seam on the bottom of the bag.
 
Two bags will be needed for each patient going through this process. The first bag is a small self-lock bag for valuables; the second bag is for the contaminated clothing and shoes. Disaster triage tags now come with tear-off bar-coded strips that enable you to identify the “evidence.” You never know who’s a bad guy and who’s a terrorist. Anyone going through the USA Homeland Security COBRA training learned the importance of this. Having the means to control a large number of victims, provide mass decontamination, and handle and categorize the removed clothing may be key factors in the incident.
 
Yousef Ghadanfari, fire prevention engineer,
Kuwait National Petroleum Company-HSE
Response: Many challenges arise when conducting mass decon, including   difficulty in controlling people coming and going in all directions. Do we have the authority to detain persons we might see as contaminant carriers? I believe it is worth the effort to conduct mass decon and to use it only when you have the opportunity to do it; otherwise, it is impossible to contain masses of people in one or two locations and tell them that they will be decontaminated. More effort should be put into educating the community on the importance of mass decon, which will take a lot of time especially in communities with cultural diversity.
 
Nathan Barrington, chief,
Kingston (RI) Fire District
Response: Mass decon is a vital and important skill for the fire service. The technology to deliver increasingly sophisticated methods for dispersing radiation, biological, and other injury-causing devices does not seem to be going away, nor are the zealots who wish to harm people to make a case. The fire service cannot run, cannot wish someone else was responding, and cannot ignore the fact that it could happen in any community any day.  When people are injured and contaminated by some material; your community will expect you to have the competence to handle the call. The normal rules of hazmat will need to be adjusted to the situation, and people who have been exposed or think they have been exposed are going to be looking for help quickly. That help most likely will start with the first-due engine company, EMS, or law enforcement unit. 
 
We have run a mass-victim decon unit as part of Rhode Island’s overall strategy for homeland security for the past 10 years. As one of seven teams deployable, as needed, in conjunction with a hazmat team, we train with local hospitals at least annually. Members, comprised of personnel from three agencies, are trained to the operations level-plus and are specialized in decon training. Our team has had several minor callouts and was deployed with several Rhode Island teams to New Orleans as part of the Federal Emergency Management Agency (FEMA) plan.
 
The team and process are of value in a major terrorist or other incident resulting in the release of materials causing exposure to many people. The foundation of this operation–and, in my opinion, any decon operation–are the actions of the first-due companies: initiating effective scene size-up, perimeter control, and deploying basic decon techniques using the engine company to begin gross victim decon using equipment found on most pumpers, aerial devices to set up corridors, and establishing contamination zones. 
 
These are admittedly rare and unusual calls; the skill set and equipment acquired are transferable to other operations such as fires involving toxic materials on fire personnel, gear, and equipment. With an emphasis on radiation contamination and monitoring fire, personnel are exposed to training beyond fire suppression. These teams are capable of supporting a hospital emergency department during an incident; in a major incident, teams are deployed to affected hospitals.
 
In our situation, the teams are regionalized and collaboratively managed by a stakeholder group of hazmat and decon team providers through the auspices of the Rhode Island Emergency Management Agency. This stakeholder group meets monthly and is comprised of career and volunteer fire departments, state agencies, and National Guard assets. Team equipment is standardized; training requirements and schedules are coordinated for consistency. The model allows for overlap and interoperability among teams. The teams function as a support for any major event to a community local incident commander such as Tall Ships Newport. As with any operation, proper preplanning, training, and the actions of first-due companies will steer the outcome and minimize the impact or statement by effectively providing mass decon.
 
Matt Stuart, firefighter/medic,
Ft. Thomas (KY) Fire Department
Response: It is good to be able to provide mass decon. However, one must remember it is only as good as your personnel. Yearly training on decon is a must.  Most of the personnel involved in mass decon are not hazmat technicians or members of a hazmat team. They are firefighters from engine and truck companies. So you can see that training is a must. Decon training is not just setting up some hoselines and washing people. It assumes an understanding of why it is being done and how to properly decontaminate someone so the contaminants are not spread. Proper decon could save someone’s life. In our region, we have several mass decon trailers that can respond and be set up rapidly while using a skeleton crew. Our local hospitals have decon rooms and large decon tents that can be set up prior to patient arrival at the emergency room. Fire departments everywhere should practice interdepartmental training with all entities that may be involved with a large-scale incident
 
Joseph Repar, battalion chief,
Central Kitsap (WA) Fire and Rescue
Response: Back in the late ‘80s while working for a private ambulance company, I responded to a chlorine exposure at a city pool. The chlorine pumps had failed and had overpumped the chlorine during a swim break. Not having experience in decon, let alone hazmat, I triaged and transported more than 30 people to the two local hospitals. I was raked over the coals for not deconning everyone. I had the ability with the showers at the pool. Never again would I not decon numerous victims if there was any question of exposure.
 
John Jackson, county fire coordinator,
Westchester County (NY) Department of Emergency Services.
Response: The concern I have is with runoff from a mass decon operation. It was the standard that the Environmental Protection Agency was not concerned with the runoff because of the dilution factor of this type of decon. Is that still the case, or has its position changed?
 
Monte Keady, division chief training/EMS,
Klamath County (OR) Fire District No. 1
Response: Mass decon (done the way we do it) is a simple and elegant drill where two engines face opposite directions to create a corridor and flow water generating a beautiful spray for participants to walk through. Yet if the need for mass decon occurs, it will be messy and fraught with complications. To be effective, this drill must include objectives that address the following: Where do the victims’ valuables go? How do I get the right car keys/wallet/cell phone back to the right victim? Do on-scene personnel notify the closest hospital for possible self-transported contaminated victims? What level of PPE should the firefighters be in as they enter the hot zone and direct the victims through the corridor? What about the contaminated victim who goes around the corridor contaminating responders? Where will the runoff go? The answers to these questions must be determined before an emergency.       Consider the following: some triage tags for mass casualty incidents, tear-off tags to go in self-locking baggies with victims’ valuables. No ticket/no valuables. Dry decon using garbage bags for wearing and depositing clothes, and moist towelettes to clean exposed skin. Consider that if the person is walking, he is “worried well,” not sick. Practice all of the drill, not just the simple portion.
 
Paul Stewart, division chief,
Central Kitsap (WA) Fire & Rescue
Response: Mass decon is well worth the effort. The potential to contaminate other first responders or critical infrastructure, such as hospitals, is too great not to have a comprehensive decontamination policy or program in place and exercise the procedure on a regular basis. Our field decon efforts are complemented with further decon at our main receiving hospital prior to the patient’s getting into the facility. While the best decon processes in the world may not get all of the contaminants off the patient, we will make every effort to get the patients as clean as possible before introducing them to an environment where the potential to contaminate the general public is great. Our plan is to provide, at a minimum, a gross field decon prior to anyone’s transport to a facility. If there is time to set up a formal decon at the scene, that will also be set up. Once a patient is transported to a hospital, he will again be decontaminated. We’ve practiced this process in conjunction with our receiving facilities. Fortunately, we haven’t had the need to perform a mass decon, but we are prepared. Like everything else we do, we need to keep practicing to make sure we do it right when the time comes to perform at a real incident.
 
Steven Joyce, medical director,
Salt Lake City (UT) Fire Department
Response: I think the concept of mass decon may be a figment of our imaginations. We have to distinguish between exposed and contaminated: one, the other, or both are possible. The Centers for Disease Control and Prevention’s Agency for Toxic Substances Disease Registry and many other sources state that wet decon is not necessary if the victim is exposed to gases or vapors only. Gases or vapors are the most likely contaminants to affect large numbers of people in terrorist or hazmat incidents. It is hard to imagine a scenario wherein many victims are contaminated with solids or liquids. Dry decon (clothing removal) should be adequate in most mass vapor/gas exposure incidents, as it would’ve been in the Tokyo sarin attacks. By all means, let’s be prepared to wet decon 20 or 30 victims, but not thousands. Also, the concept of “gross decontamination” does not seem to apply to hazmat victims. Running a fully clothed victim under a high-volume, low-pressure spray is unlikely to remove contaminants and may just wash them into the clothing and onto the skin. If you don’t buy that, try taking a shower with your clothes on and see how clean you feel afterwards.
 
Chris Houk, captain,
Neosho (MO) Fire Department
Response: Like so many other jobs we encounter in these times, If not us, who else will do it? We cannot risk contaminating vital facilities; apparatus; equipment; and, most importantly, personnel. It can be a difficult and somewhat daunting task in larger cities and at large incidents. Our responsibility is to the people we protect. We aren’t allowed to pick and choose our responsibilities on daily responses; and, certainly, more is expected from us at large responses and under unusual circumstances.
 
Gary Rettig, lieutenant,
Moraine (OH) Fire Department
Response: Our department, as well as mutual-aid departments, trains on mass decon, as does our regional hazmat team, the Dayton Regional Hazardous Materials Response Team. The regional team recognizes that first responders, engine and ladder crews, will handle mass decon. However, for the region to be consistent, we review these procedures as a team so that members can take the information back to their home departments. Fire, EMS, and hospitals are all involved in mass decon procedures and training in the Dayton area. In fact, the hospitals, recognizing a need, have purchased decon trailers to be prepared for those who leave the scene and still need to be decontaminated. As a region, we are constantly reviewing and revising the plans for mass decon and then training on those revisions.
 
Mass decon is beneficial if it can be performed in a timely manner. The only way to achieve that is through constant training. Mass decon involves many logistical issues: modesty considerations, a time frame for moving large groups through decon, and those who leave the scene and transfer the contaminants to other people and buildings. When hospitals are not prepared for mass decon, they run the risk of contaminating a large portion of their hospital and staff, which in turn leaves them unable to perform their mission.       
 
Jody Carter, instructor,
Domestic Preparedness Equipment
Technical Assistance Program
Pine Bluff, AR
Response: Our program provides Department of Homeland Security (DHS)-sponsored training to emergency responders, as outlined in an article I wrote that was published by Fire Engineering in November 2004. Part of our curriculum includes mass-casualty decontamination, with one course aimed toward responders and another at hospitals. We have trained personnel across the nation.
 
Gregg Sieloff, captain,
Lynnwood (WA) Fire Department
Response: We do practice mass decon annually at the operations and technician levels within our department. As part of a regional hazmat response team, we have been provided mass decon systems through the DHS. All of the local hospitals have also been so equipped. As such, we feel compelled to practice with these systems based on a just-in-case philosophy. Is it worth the effort? Probably not. The hospitals have a mass decon setup. Yet, one must wonder how the masses will get to the hospital. If they do, don’t you think the hospital staff will be a little busy? Our operating guidelines require that all persons transported to the hospital who have been deemed contaminated must be decontaminated prior to being accepted at any of these hospitals.
 
It is my belief that the only hope for successful mass decon happens at the Operations level of response. When the first-arriving engines recognize the need, they must take action. We don’t have the luxury of a dedicated hazmat response vehicle.  The delay in our response requires quick action. To achieve this, we use opposing engines with fog stream nozzles to provide a quick and easy mass decon setup. Each of our engines carries enough soap and paper blankets to decon 50 people. This creates a simple system that is easily practiced and definitely worth the effort. 
 
John Stassi, captain,    
Prairieville (LA) Fire Department
Response: It depends. What is the material, where is the incident, what are the abilities of the receiving facilities, what are the resources on-site, etc.?
 
Sue McManus, battalion chief,
Memphis (TN) Fire Department
Response: Our department participates in a mass decon exercise once a year.  It is usually a multiagency exercise involving fire, police, outside EMS providers, and various hospitals. The emergency management agency is the coordinating agency. Usually the involved agencies attend planning meetings for a month or two prior to the drill to establish what type of performance should be measured. This year we had an exercise that involved a WMD scenario. The ability of the plan to move the Chem Pak to the scene was evaluated as well as a mass decon for more than 100 people. Hospitals received all of those “victims” and many others who would have been considered self-evacuating from the scene who had not been deconned. The drill went into the next 24-hour evaluation period, which evaluated the plan to move the Push Pak to the predesignated points of distribution and distribute medications to responders following an “anthrax” confirmation. Several changes in the plan were made during the preplanning sessions as well as after the drill itself. Several hospitals invested in inflatable decon tents after realizing they were underprepared for a large influx of patients requiring decontamination. We also added equipment to further facilitate decon procedures of nonambulatory victims. It was a good exercise for all.
 
Randall W. Hanifen, lieutenant,
West Chester (OH) Fire-Rescue
Response: Mass decon has received much attention after 9/11. It is worth the effort, as many of the potential terrorist and nonterrorist mass-casualty events involve materials that would cause severe problems after the incident, especially at infrastructures on which we rely daily, such as hospitals. However, much of the emergency services have been falsely led to believe that a tent that sets up in 45 minutes is the solution. Proper training on setting up mass decon in phases is the key to success. Properly placed fog streams is a great first-line attempt. However, as time continues at the incident, more formalized systems that respect the dignity of the victims must be put in place. The largest problem I have noted is the lack of specialized teams to set up these apparatus. The key to success in these infrequent operations is to have personnel in sufficient numbers trained to set up decon apparatus.
 
Vance L. Duncan III, deputy chief,
Erie (PA) Bureau of Fire

Response: In the past, we have conducted mass decon drills as a multicompany operation within our department, and we also have practiced with our local hospitals and ambulance transport units as part of WMD exercises.  During the past four years, our area hospitals have received decon equipment for use on-site at their facilities. This decon equipment is standardized for our five-county region: the Erie Bureau of Fire, the county (Erie County) hazmat team, and each hospital has the same style and brand of tent. These hospitals schedule training on the use of the equipment on a regular basis as well as schedule drills at least once a year. There are many training situations where decon is incorporated into the Erie Bureau of Fire curriculum– to list a few, new firefighter recruit training, hazmat operations 472 and hazmat operations refresher 472 training, WMD gross decon, clandestine meth lab awareness, urban search and rescue (US&R) FEMA WMD enhanced operations, US&R technical search and structural collapse technician, confined space rescue, and structural burn sessions.  Removal of contaminants is the goal for training sessions as well as actual incidents.

Our response to a mass-decon incident would include a minimum of two engine companies, one tower/truck company, a platoon deputy chief, and a deputy chief aide.  The first-arriving engine company would secure a water supply (upwind, upstream, and uphill of the incident) and then deploy a minimum of one 1¾-inch hoseline staffed by at least one firefighter in full PPE (including SCBA). The company officer would direct the affected people (by amplified voice and hand signals) to walk through the wide fog stream from the hoseline. As the second engine company and tower/truck company arrive, a mass-decon corridor may be constructed using side-by-side placement of the engine companies and the overhead deployment of the tower/truck company’s master stream. If this operation is deemed too time consuming, staffing from the second engine company may position additional 1¾-inch hoselines with the first handline, and the tower/truck may set up its master stream to assist with mass decon  The platoon deputy chief and aide would be charged with incident management, accountability, and safety.  Additional resources will be dispatched to the scene or predesignated areas at the request of the incident commander.

 
Mass decon is worth the effort since the main purposes of decon are removal of lethal chemical agent/contaminate from victims to increase their survivability, reduce secondary contamination, protect response and medical personnel, and offer psychological comfort to victims. 
 
Victims must disrobe to their undergarments. At this point, the victim will remove 80 percent of a liquid contaminate and nearly 100 percent of a vapor contaminate. The quicker the contaminants are removed, the better the outcome for the victims. Mass decon removes contaminates from a large number of victims. Patients are triaged, and EMS personnel treat patients according to symptoms, These patients are transported according to triage status. Uninjured or asymptomatic patients are moved to a holding area for further evaluation. The goal is to save as many affected persons as possible.
 
 
Mark Gillan, deputy chief,
Saint John Fire Department,
New Brunswick, Canada
Response: Our department responds to the needs of citizens and industry; both, within the City of Saint John and regionally within our province, in the field of hazardous materials response. Mass decontamination is an area that requires a substantial amount of study and standardization. Each geographical area must have the capacity to begin this process quickly and efficiently while awaiting technical response. The effect of having an inefficient response in this area can result in increased anxiety and suffering among those civilians quarantined or experiencing symptoms from their exposure.
 
With the increased probability of civilian exposure through intentional acts; it is clear that fire service professionals in Canada and the United States must agree on a common approach to mass decontamination, to minimize our society’s vulnerability. To this end, we are working with the Canadian Federal Government: CBRNE Research and Technology Initiative (CRTI) to compile and test current procedures in mass decontamination to create a “Leading Practice” for consideration within the North American Fire Service.
 
Any interested individuals or departments could provide for this work would be greatly appreciated; any practices, procedures or equipment used will be fully referenced within the final summary document. Please contact Mark.gillan@saintjohn.ca.

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