The acronym CBRNE stands for chemical, biological, radiological, nuclear, and explosive – and is used by responders as shorthand for what also are called weapons of mass destruction (WMDs). Because there have been so many CBRNE incidents in Iraq and Afghanistan in recent years the phrase improvised explosive device, or IED, also has become part of the modern American military lexicon. The term “dirty bomb” usually refers to a radiological weapon or device – another very real threat in the age of terrorism – and is now part of the common vocabulary as well. So far, though, the threat posed by an improvised chemical device, or ICD, is not quite so well known.
That could change in the very near future. The destructive potential of an ICD, placed covertly by a terrorist organization, has been recognized by first-responder agencies for over a decade. The ICD threat is not only substantial but also ubiquitous and relatively low in cost. The reason is simple: Like IEDs, ICDs can be made primarily from materials commonly available in most communities throughout the country. Those communities include numerous small towns and literally hundreds of rural hamlets and villages throughout the United States, where chemicals toxic enough to be a significant hazard are usually available for purchase. Other common chemicals, available for over-the-counter purchase at local grocery stores, can also, when mixed properly, produce a toxic cloud of poison gas.
As with IEDs, ICDs can range in size from a small localized device that affects only those in a specific building, or a small room or compartment – e.g., in a subway station or delivery truck – to a rail car-sized attack that could cripple and contaminate a major section of a large city.
EMTs (emergency medical technicians) and their leaders must be much more aware of chemical hazards and threats in the future than they have been in the past. Fortunately, there are five operational principles to follow that can and should be easily remembered: (1) a 10-second scene survey; (2) scene demarcation and control; (3) decontamination; (4) affirmative treatment; and (5) communications across silos.
Close Observation, Common Sense, and Reliable Communications
In the microcosm of the individual ambulance or EMT, the first and best defense against an ICD attack is a combination of close observation and common sense. Every responder should perform a 10-second scene survey – which means, in everyday language, taking a quick look at the scene of an incident, checking for any hazards that might be evident, before the ambulance pulls in to the curb. Any EMS unit that arrives on scene, for example, and sees a number of people on the ground without an obvious cause, should and would be super-cautious. The same principle holds true when responding to a report of an explosion or an unusual smell. These and other common-sense clues should be warning enough to put on the brakes and look before leaping. In short, just a 10-second look should be enough to give the responders the opportunity to personally survive to carry out their mission of saving the lives of the victims of the incident.
Fire and hazmat staff also should quickly establish the edges of the contaminated – i.e., “hot” – area and mark it off (the “scene demarcation and control” task mentioned previously) to prevent accidental exposure after their arrival. Law-enforcement personnel also may assist by maintaining the boundary from the clean (cold) side. The warm zone usually can serve as a buffer between the cold and hot zones in which responders can clean or decontaminate the victims. It also is in this area that EMTs can, if properly trained and equipped, start evaluating patients and providing non-invasive care.
The macrocosm of the EMS system requires that EMTs and other responders – as well as emergency managers and other decision makers – must continue to pursue better detection and treatment options. Being astute enough to pull back from a hazard is acceptable only until backup personnel with appropriate skills and equipment arrive at the scene.
A constant feature of after-action reports – derived from drills and training exercises, as well as from real events – is the need to improve communications. Here there should be not only inter-unit communications connecting unit to unit but also inter-agency and system-wide communications so that, when one agency or jurisdiction is aware of a threat, that same threat also is on the radar of all of the other parties potentially affected.
To briefly summarize: The ICD threat is not only one of the most obvious nightmare scenarios confronting the EMS community today but also, in all likelihood, the one with the greatest growth potential – because the materials needed to make an ICD are readily at hand in the community. Fortunately, most of the resources needed to respond to the ICD threat are locally available as well.
For additional information on ICDs and how to handle them safely, click on any or all of the following sites:
Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.