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Large-scale incident safety for first responders

Emergency management and response have changed since 9/11

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For first responders, the 9/11 terrorist attacks were a mind-numbingly unique and devastating event.

“It was hard to prepare for something of that magnitude. It was such a large call,” said Patrick J. Morrison, assistant to the general president for occupational health, safety and medicine at the International Association of Fire Fighters. “It was a trying time.”

On that Tuesday morning in 2001, nearly 3,000 people died during the attacks in New York City, Pennsylvania and Washington, D.C. Of them, 343 were New York City firefighters and 23 were officers with the New York City Police Department. Many first responders who assisted in rescue and recovery efforts are feeling, or have felt, the effects – hundreds have died and thousands are suffering from related cancers, illnesses and injuries.

Training and preparation

The enormity of 9/11 has shaped the way first responders plan and train for future large-scale incidents, as well as how they protect themselves.

“I would definitely say first responders are safer,” said Jeffery W. Carroll, assistant chief of the Metropolitan Police Department in Washington, D.C., and manager of the department’s Homeland Security Bureau. “Since 9/11, there’s been a tremendous advancement in overall emergency management and emergency response.

“The more you plan and the more you train, the better your response will be when an unplanned event occurs.”

Joseph Schmider, state EMS director for the Texas Department of State Health Services, has participated in numerous training events since his career began in the 1970s.

“Before, you did it just within your own company,” he said. “You never depended on anyone else. We had drills and practices, but after 9/11, that made it real.”

During a recent training session in the Dallas area, Schmider said hundreds of first responders were in attendance. “We can’t do it by ourselves,” Schmider said. “We need to be able to work with everybody.”

Carroll credits the widespread adoption of the National Incident Management System – launched in 2003 by the Department of Homeland Security – with providing guidance to all levels of government, nongovernment organizations and the private sector on working together before, during and after incidents.

“When we have these large-scale incidents that occur, we can all [follow] the same structure, know what our responsibilities are and speak the same language,” he said. “That’s been very beneficial.”

With active shooter incidents on the rise nationwide, Carrol said interagency training and cooperation has proved beneficial, as well.

“NIMS provides a consistent, flexible and adjustable national framework where government and private entities at all levels can work together to manage domestic incidents, regardless of their size, location or complexity,” said Lizzie Litzow, press secretary at the Federal Emergency Management Agency.

Chemical exposures

According to the Centers for Disease Control and Prevention, hundreds of cancers are listed on the World Trade Center Health Program’s list of covered conditions – a stark reminder of the dangers many first responders encounter just by arriving on a scene.

Respirators can provide first responders protection from exposures to mold after a hurricane or flood, debris from wildfires, and illicit drugs. However, Angela Weber, coordinator 
of the Disaster Science Responder Research Program at NIOSH, said they have little to no benefit when worn improperly or are not available during a large-scale event.

In May, IAFF announced the launch of the National Fire Operations Reporting System Exposure Tracker mobile app. It will allow first responders to create personal diaries for logging exposures and incident details in a private, encrypted and secure online environment. This data will be used by researchers, according to IAFF, to help improve the understanding of toxic exposures and develop new treatments and protocols for work-related diseases.

How researchers can help first responders

No matter the scale, disasters can take a toll on first responders’ mental and physical health.

NIOSH is working to use research to benefit this workforce during and after future events.

“We’re doing the research NIOSH has always done, but we’re trying to strategically improve on how fast it’s done,” said Angela Weber, coordinator of the agency’s Disaster Science Responder Research Program. “We need a rapid [institutional review board] protocol. We need to rapidly share results.”

The goal is to respond quickly to disasters and keep first responders safer with up-to-date information as an event unfolds. Research results also will help long term when responding to future incidents.

Weber said one example of the program’s work is the possibility of equipping first responders with direct-reading instruments to gather data on exposures they encounter during a disaster. Specifically, the program would have these tools available when exposures “are the most highly concentrated, most complex, most unknown,” Weber said. “We think this is going to address multiple types of disasters. We’re focusing on chemical ones first. We’re excited to see where this leads.”

Along with their use in chemical incidents, these instruments could be helpful in monitoring mold levels after hurricanes or floods and air quality during and after wildfires.

Weber is the only full-time employee involved with the program, which is within the NIOSH Emergency Preparedness and Response Office. She has help, however, from a 10-person steering committee throughout various disciplines at the Centers for Disease Control and Prevention. The committee was formed eight months after a 2014 stakeholder meeting outlined the issues and needs of disaster science research.

“We are looking to conduct research on topics that may include the impact of a novel exposure, unexpected or severe health effects, the effectiveness of a proposed intervention, mental health/resilience issues, and disease outcomes with latency periods,” NIOSH Director John Howard said in a recent interview with Safety+Health.

Looking out for one another

In 2001, Morrison was working for the Fairfax County (VA) Fire and Rescue Department. He spent two-and-a-half months in New York City after the attacks, assisting the FDNY with its counseling services unit.

Morrison and fellow firefighters went to fire stations to listen to colleagues, provide behavioral health support and continually check in on first responders to ensure they weren’t turning to alcohol or other substances.

“The FDNY really changed the paradigm to peer support,” he said.

The counseling services team wanted to offer first responders assistance, so it enlisted retired firefighters, chaplains and trained clinicians.

“It gave us an opportunity to look at what were some of the qualities why some firefighters were doing better than others,” Morrison said.

For some, it involved having a peer, spouse or friend they could talk to during the most difficult emotional times.

IAFF has developed a national peer support training program and, in 2017, opened the IAFF Center for Excellence for Behavioral Health Treatment and Recovery in Upper Marlboro, MD. The facility, for IAFF members, has treated more than 800 firefighters from across the country for post-traumatic stress disorder, substance abuse and/or mental health conditions. Morrison and IAFF staff members visit the facility every two weeks.

“The biggest reward you can have in life is when a firefighter comes up and says, ‘Thank you for saving my life,’” Morrison said.

Schmider, who was working in Pennsylvania in 2001, arrived at ground zero a week after the attacks – when “the pile was still smoking” – to help with family assistance. He is acutely aware of the demands on a first responder’s health and family, and he regularly drives home a safety message with EMS colleagues.

“Whenever I speak to a group,” he said, “I always end with, ‘Take care of your patient. Take care of your partner. Take care of yourself. And, most importantly, take care of the people who are taking care of you.’”

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