BY TIMOTHY P. HENNESSEY
In December 2001, the Depart-ment of Defense, under direction of the President, ordered that all military personnel and emergency essential civilian personnel participate in the smallpox vaccination program. The result of this order had far-reaching effects on a part of the American fire service that is not widely publicized.
A large number of U.S. military installations across the country and the world are staffed with civilian firefighters. While most are directly employed by the Department of Defense, some are civilian defense contractors. Although the order to be vaccinated was not mandatory for some of these firefighters, they were able to receive the vaccine if they so chose.
The Eskan Village military base, in Riyadh, Saudi Arabia, is staffed by civilian contractor firefighters. Eskan Village is a U.S. Army and Joint Task Force South West Asia installation. It is home to a variety of different branches of the Armed Forces and is tasked with command and coordination of air defense artillery for Saudi Arabia and Kuwait.
Because of the world situation and the history of terrorist attacks in this country, a number of our firefighters chose to receive the smallpox vaccination when it was made available. To date, we are well through the process. We did, however, encounter some challenges.
The shot itself was the easiest part of the vaccination process. Members who received it said it was a bit more painful than an initial mosquito bite but not as bad as a tattoo needle. A majority of our members had not been inoculated for smallpox previously and, therefore, received the minimal number of punctures. Members who had been previously vaccinated for smallpox were punctured as many as 15 times, compared with two or three times for first-time vaccinees.
OCCURRENCE OF SIDE EFFECTS
Everyone who received the shot experienced some type of side effect. The most common effects reported were cold- and flu-like symptoms. Two of our members experienced a minor swelling of the nodes under the arm. Members lost no time from work, and they could still engage in physical activities such as sports and exercise.
SITE CARE
We used a 4- 2 4-inch gauze pad secured by medical tape. Members specifically assigned to patient-care duties placed an additional dressing over the pad as an added precaution. Dressings were changed every 24 hours at the most or prior to that, based on the time of showering. The site of the dressing, if securely taped, was not affected by wearing turnout gear. Wearing chemical warfare gear also did not affect it. Fire departments that use Special Operations Divisions such as tactical medical personnel or rescue scuba divers may experience more troubles, most likely because of the types of equipment or clothing worn, such as skintight wetsuits.
The major factor in caring for the site and preventing transmission is leaving the site alone. By the first two weeks, an occasional itch developed at the site. Members were fully briefed on the hazards of touching the site. We used our strong will to ignore the irritation, which passed after a short time.
CHANGES AROUND THE STATION
A few of our members were medically exempt from the shot or chose not to take it. Because of the possibility of transmitting vaccinia among our nonvaccinated members, we had to implement some changes.
Sleeping quarters in bunkrooms were reassigned according to who had been vaccinated and who had not been vaccinated. The quarters were labeled, and members were briefed at shift change. The new arrangements were in effect 21 days. Vaccinated members decontaminated their beds every morning with a bleach and water solution. We had investigated purchasing plastic covers for the mattresses, but they were not readily available at our location. All bedding was washed each shift.
Shower rooms were also assigned according to those who had been or had not been vaccinated. After showering, we decontaminated the shower area with a bleach and water solution. Members also took extra care to ensure that they did not brush up against shower walls or shower curtains with the vaccinated arm.
We changed our laundry practices. Instead of sending all laundry to a service, as we usually do, we laundered clothing worn on the upper body such as T-shirts, uniform shirts, and sweatshirts at the fire station. Members brought them to the station in specially designated washing bags, and the items were washed in a designated washer. All other laundry items were sent to the laundry service.
Vaccinated members washed their hands with alcohol-based and antibacterial soaps every time they accidentally came in contact with the vaccination site and after changing the dressing.
THE THREAT
We all know how much the world has changed since 9/11. Based on your confidence in the U.S. government, you may have taken much of what Colin Powell said to the United Nations in early February to heart. During that briefing, he outlined the potential for various weapons of mass destruction agents out there that might get into terrorists’ hands. I believe that the initial round of smallpox vaccinations for emergency responders is only the tip of the iceberg. Our department was also vaccinated for anthrax, under the auspices of the Department of Defense. As time goes on and new threats emerge, America’s firefighters are going to be called on. Even though for now, whether to get vaccinated is a personal choice, the day may come when it becomes mandatory. Regardless, members who are physically able should do all they can to protect themselves.
Our fire department successfully completed the smallpox vaccination program. Because of the great pains taken by the health care providers, the Centers for Disease Control and Prevention guidelines, and suggestions from the International Association of Fire Chiefs (IAFC), we had no major developments. If followed, the IAFC guidelines are excellent; they have been tested and found to be sound.
Many of us were faced with the same trepidation as some of our brothers and sisters are currently facing. In retrospect, a lot of the concern was alleviated by all the information made available to us. The end result is that we have one more tool in our toolbox with which to defend ourselves in the new world we face.
TIMOTHY P. HENNESSEY is a member of the Waterford (CT) Fire Department and a registered civil, criminal, and fire investigator with Glenn Investigations in East Lyme, Connecticut. He is a former captain of the Eskan Village Army Base (Riyadh, Saudi Arabia) Fire Emergency Services, which served the U.S. 3rd Army, ARCENT-SA, and was responsible for weapons of mass destruction and haz-mat preparedness and operations.
