Terrorists may use weapons of mass destruction (WMD) or other methods to cause death, injuries and devastation. Attacks may be large in scale, and response to those attacks long in duration and complex in terms of range of hazards presented.
CHANGING ROLES
The definition and fundamental roles of the first responder, already working in high-risk occupations, has changed forever in the wake of recent terrorist attacks. First responders in New York City who responded to the terrorist attack on the World Trade Center (WTC) were thrust into new roles for which they may not have been properly prepared or properly equipped, and soon discovered that their personal protection equipment (PPE) was inadequate for the sustained campaign of response that unfolded. The initial, urgent phase persisted for several days and then transitioned into a sustained campaign of constant work that lasted several months. Well-trained and equipped firefighters responding in bunker gear and self-contained breathing apparatus (SCBA) found that their equipment, designed for firefighting operations that typically last less than one hour, proved too cumbersome for extended use. Their response was limited by both the weight of the systems and the short lengths of time (about 15-30 minutes) for which they can be used at high levels of exertion before their air bottles must be refilled. The time needed to safely enter and exit the hazardous location further reduced that supply. The level and scale of the destruction and the area involved reduced opportunities for primary reconnaissance and rescue and hazards monitoring.
Emergency responders fulfilled various tasks in and around different hazards that varied within the inner and outer perimeters of the disaster site. Often wearing heavy protective garments and labouring without breaks or equipment changes in high-heat environments, many worked until their stamina was so taxed that they collapsed from exhaustion.
INSUFFICIENT EQUIPMENT
The scale of the WTC site, the duration and the staggering range of hazards faced required that many emergency responders take on tasks for which they were insufficiently equipped and trained. Many PPE ensembles and training practices were not designed to protect first responders from such a range of hazards, or were not supplied in sufficient quantity at the attack site to meet the scale of the problem.
Of all the PPE equipment used at the WTC site, the respiratory protection equipment posed the most significant problem. Emergency medical personnel were on the scene, performing rescue operations. The emergency medical technicians (EMT) who were treating casualties were not initially wearing PPE because it was not part of their standard equipment; they soon found themselves working in air choked with fine particles, human remains, hazardous materials (anhydrous ammonia, Freon, battery acids), and in an environment at risk from potential secondary devices or a follow-on attack. Construction workers were also deployed very early after the attacks and placed in hazardous environments to move rubble and debris.
Many protective respirators proved to be so uncomfortable that extended wear during demanding physical labour became a serious problem, causing many users to use them only sporadically or to discard them. Lens fogging in masks was also a very common complaint. Many responders, due to a lack of information on the hazards present, were unsure if their respirators were even providing adequate protection. There was a perception that marginally effective PPE was hindering their ability to do their jobs. It was perceived that a trade-off existed between the amount of protection provided, and the extent to which PPE is light enough, practical enough and wearable enough to allow responders to do their jobs. While concerned about having adequate protection, many were even more concerned about equipment hindering them from accomplishing their rescue and recovery missions in a sustained campaign.
Powered air-purifying respirator (PAPR) systems were identified as desirable at the WTC site. PAPRs provide a bridge between negative-pressure masks and SCBA in chemical, biological, radiological and nuclear (CBRN) response, and are also described as lightweight motor blowers (LWMB); compact air supply units (CASU); or compact air supply systems (CASS). They are used for NBC/CBRN respiratory protection in conjunction with various NBC/CBRN protective masks, suits and protective devices.
FIRST AND FOREMOST
Protecting the health and safety of first responders is of primary concern for all emergency service organisations and poses a unique challenge. Ensuring an adequate level of PPE for long-term response to terrorist attacks using weapons of mass destruction (WMD) or conventional weapons will require PPE ensembles that combine comfort with appropriate protection.
Many military PPE products, with established CBRN testing, are now available to first responders. In recent testing conducted by the US Army, a military PPE ensemble – including SafetyTech International C420 (type-classified military PAPR), the US Military M40 Protective Mask and the JSLIST suit (the chemical protective over garment qualified by the US Department of Defence for all military services) – achieved a protection factor (PF) of 50,000 (or 50,000 times better than no protection and five times the PF provided by the better protective full face masks). All three products are presently available, internationally, in both military models and first responder variants.
The cooling effect of constant filtered airflow into the face piece provides a high degree of comfort, greatly reduces pulmonary stress, preserves strength and mental acuity, and helps ensure mission success by extending operational endurance and facilitating heavier work performance even after extended user wear times in humid, heated and highly stressful missions – than would be possible or practical using negative-pressure respirators alone. The airflow also prevents fogging in the face piece. Since the WTC attack, tens of thousands of PAPR systems have been purchased by the US first responder community.
DECONTAMINATION
Victims of a terrorist CBRN attack should be decontaminated prior to transfer into a hospital to avoid secondary contamination of responders, transport and medical staff. The US National Guard Bureau selected NIOSH-approved C420 PAPR units for their CERFP (mass decontamination) teams in 2004 because of the environment in which they had to operate. The use of SCBA, or rebreathers, was deemed likely to exhaust decontamination team members. They would require a significant recovery period prior to resuming work. The lighter PAPR, however, system would not exhaust the wearer, would improve comfort and would allow more missions to be conducted; it would also facilitate ease of entry into confined spaces to quickly extract victims or recover bodies. A system with a US NIOSH-approval was also required.
When Singapore purchased CASU/PAPR systems for their first responders, they selected the latest CASU/PAPR variant on the market. The unit features a double safety chamber (DSC) for use in hazardous missions. The DSC versions are equipped with a secondary rubber bladder within the blower housing and provide added protection should the outer housing be compromised during military action or violent impact. The blower housing was recently live-agent tested and shown to easily exceed the permeation resistance requirements of the NIOSH CBRN standard for SCBA.
The CASU C420 is equipped with two filter ports for standard filter canister RD 40x1/7" (Stanag 4155/EN 148-1). The blower outlet has a male RD 40x1/7" for the connection hose. The hose assembly fits all masks designed to utilise the RD 40x1/7" (Stanag 4155/EN 148-1) filter canister and is compatible with their protective facemasks and ensured a significant increase in the PF of their PPE ensemble. Comparable levels of protection for all responders should be provided, and the logistical decontamination teams should be equipped with PAPR units to remain effective. Other responders, particularly those involved with heavy labour, can benefit by using PAPRs instead of (or in addition to) negative-pressure respirators. Such equipment could be used in normal activities as well as terrorist attacks.
RE-EVALUATION
Equipment and methods used to protect first responders in the line of duty are being re-evaluated, internationally, in light of the dramatically increased threat levels posed by terrorists utilising WMD.
Establishing guidelines for appropriate PPE ensembles for long-duration disaster responses and recognising the logistical and decontamination issues associated with large numbers of responses in a short period of time will result in a more disciplined and effective response. Any PPE plan designed for large and extended responses can greatly benefit by the inclusion of PAPR-based ensembles.