Disclosure I do not have an affiliation (financial or otherwise) with any commercial organization that may have a direct or indirect connection to the content of my presentation.

 Objectives:  Review CBRN Risk Assessment  Discuss importance of planning for Personnel Safety  Explore the readiness of Canadian EMS providers – Survey

 “Accidental” emergencies  Major Industry  Small business  Agriculture  Transportation

 Terrorist attacks WTC bombing (biologic agent) 1993 Tokyo Sarin gas release 1995 Edmonton – pipe bombs with chemical agent 1998

Risk = Probability x Impact

Probability? Highly likely Likely Possible Unlikely Impact? Marginal Serious Critical Catastrophic

 Myth: “Canaries are inevitable”

 There is a shockingly passive attitude towards First Responder safety.  We can AND MUST benefit and learn from other people’s issues, lessons, and experiences.  Some lessons are too expensive to be learned twice.

 Public Safety agencies must identify risks to First Responders and protect them  CBRN awareness and surveillance must occur at the beginning: 911 operators, paramedics, security, emergency triage

 Emergency Triage or 911 Awareness  Pattern recognition  Multiple patients with similar patterns of symptoms:  Seizing, vomiting (nerve agents)  Shortness of breath (asphyxiants)  Unconscious (carbon monoxide, opioids)  Screaming in pain (blister agents)

Hero Unexpected event No training No preplanning No equipment No backup Once in a lifetime High mortality Professional Predictable Trained Preplanned Equipped Backup Multiple exposures Low mortality

Hero Event = emergency Professional Emergency = event Expecting that people with “rise to the occasion” and manage in a CBRN event and “save lives” is setting them up to be heroes with a high mortality. A professional can perform a heroic act, but that shouldn’t be the expectation

 What we need to achieve in our response capability to CBRN, emerging infections, and “all-hazard” issues: Live professionals not dead heroes

 Awareness  Basic Level  Intermediate Level  Advanced Level

 Recognize  Survive  Respond  Intervene  Recover

There are three zones: Hot zone Warm zone Cold zone

 Assessment of risks is first step in planning  Helps focus efforts and ensures no possibilities are missed  Helps prioritize efforts in preparedness  Most likely “risk” in Hamilton is unrecognized exposure to one or a few patients (small industry, lab, agriculture) with secondary contamination of facility and personnel

 Recognition and safety are key  We don’t have to have “canaries”  Heroes vs Professionals  Planning, education and training ensure personnel are able to act as professionals and keep themselves and subsequently other health care providers safe

 Decontamination is the systematic process to remove CBRN material from patients to render them safe to others  Secondary exposure can occur as patients off-gas the CBRN material to surrounding people including EMS providers

Dr. Michelle Welsford co-authors: Dr. Daniel Kollek & Dr. Karen Wanger

 Other countries have initiated or finalized plans for pre-hospital emergency response to CBRN events  The readiness of Canadian EMS personnel is unknown

 On-line survey of pre-hospital providers in BC and Ontario  Survey addressed the self-reported theoretical and practical CBRN training received

 1028 respondents, most were:  Male  years  years experience  Predominantly front-line personnel

 Of the 63% who had received training:  61% had received “hands on” or practical training  39% had received only theoretical training

 Canadian EMS CBRN preparedness is possible  Live Professionals not Dead Heroes