1. CCBRN IDENTIFYING AND DEALING WITH CCBRN INCIDENTS

2. Introduction The purpose of this lecture is to help us as fire fighters in identifying and dealing with CBRN incidents.

3. “The 1,2,3 SCENE SAFETY RULE” Step 1One casualty: approach using normal procedures. Step 2Two casualties: approach with caution, report arrival and give * CHALETS Assessment. Step 3Three casualties: do not go to the scene but to a perimeter RVP and wait further instructions.

5. Immediate action Remain calm Protect yourself before going to the aid of others Put on PPE DO NOT go to the aid of casualties without PPE, await specialist help. Move back to cold zone and send initial CBRN report.

6. ARRIVAL AT THE INCIDENT Dead or dying animals, Unexplained multiple casualties suffering serious illnesses, Nausea, disorientation, difficulty in breathing or convulsions and Definite casualty patterns or no logical explanation for the amount of casualties. If confronted with an incident there are a number of generic triggers that may indicate an attack:

7. First responder objectives Secure the area Identify hot, warm and cold zones Initial identification of agent released Casualty rescue – decontamination – triage – treatment – evacuation Media and crowd control Avoid secondary contamination Protect evidence and scene of crime Beware of the threat form secondary devices

9. CHALET assessment CASULATIES – approximate number: dead, injured and uninjured HAZARDS- Present and potential ACCESS & EGRESS – best access routes for emergency vehicles LOCATION – exact location of incident EMERGENCY SERVICES – present and required TYPE OF INCIDENT – brief details

10. Other factors to be aware of include the presence of: Unusual liquid, spray or vapour Droplets, pools of liquid or any oily film on the ground Clouds, fog or mist not related to the weather conditions. What are the weather conditions e.g. wind speed/direction. What is the direction of any plume

11. The officer in charge should also consider the possibility of: A secondary attack The isolation of radio signals Ensuring that radio transmissions are isolated or kept to a minimum Ensure appropriate Personal protective equipment is worn Evacuate and isolate casualties within the inner cordon Prepare for Mass Decontamination Varying the position of appliances where there has been previous attendances to the premises

12. CBRN report information Time History of incident – witness statements or observations Type of release – chem / bio etc Location of release site ( nearest 10 meters) Positive CB indicators Weather conditions Wind direction Wind speed Plume information RVP / ICP location Recommended safe route to RVP / ICP Recommended mass decon area CHALET casualty report

13. The officer in charge should also lookout for any casualties suffering the ‘DUMBELS’ effect. Diarrhoea, Urination, Miosis or pin point pupils, Bronchospasm or wheezing, Emesis or vomiting, Lacrimation or, Salivation.

14. Suspicious devices or packages which may contain any  Unexplained wiring or tubing.  Compressed air cylinders with tubing.  Liquid containers  Aerosols  Timers and batteries Unexplained munitions, ball bearings or metal fillings.

15. Chemical agent indicators

16. Biological agent indicator

17. Radiological / nuclear

18. If the hazard cannot be identified through the normal means for example with the assistance of the Emergency Response Guidebook or the Chemdata system then alternative methods should be sort.

19. Hazard Identification An Indicator Matrix has been developed to assist in identifying the agent. The Indicator Matrix is based on data provided by the Defense Protective Service at the Pentagon. It is designed to give the best approximation of the agent used but it is not to be considered definitive until confirmed by a hazardous materials officer or suitably qualified medical personnel.

20. To use the matrix simply put a check in each row in which the indicator is present. Grey boxes signify indicators that are not applicable to a given agent. At the bottom of each page total the number of check marks in each column then total all the marks from each page. The column with the highest percentage of indicators should be considered the agent most likely present.

21. AGENT INDICATOR MATRIX ABCDE Appearance Prostration Twitching Convulsions Coma Bleeding from mouth Couching Sneezing Vomiting Fasciculation’s Skin Cyanosis Grey area of dead skin Pain, irritation Clammy Sweating, localised or generalised Eyes Small pupils Normal, large pupils Involuntary closing Tearing Burning, irritation Headache, pain around the eye Dim vision Blurred vision Burning pain in the eyes Redness Respiratory Coughing Runny nose Tight chest (short of breath) Burning, irritation in nose Cardiovascular Slow heart rate Fast heart Digestive System Defecation Nausea TOTAL Grey Boxes = Not Applicable AGENTS INDICATOR MATRIX A = Nerve agents B = Blister agents C = Cyanide D = Pulmonary agent E = Riot control agent 12 3 6 0 4 ************************ ****** ************ ********

22. More detailed information on the Agent Indicator Matrix and the effects and treatment of the agents mentioned can be found in Jane’s Chem-Bio Handbook

23. Mass Decontamination At any of these incidents Mass Decontamination of the public may be required

24. The Fire Service in partnership with the Department of Health has accepted responsibility for the management of public mass decontamination, in the event of a radiological, biological or chemical attack, which is beyond the capabilities of the Ambulance Service alone.

25. Fire & Rescue Services and Brigades, Ambulance Services, Police Forces, Emergency Planning Units and the Environmental Agency. To enable the Fire Service and other agencies to respond effectively to any large-scale terrorist attack where mass decontamination is required, a local Memorandum of understanding has been produced and agreed upon by various organisations in the area, these include;

26. THE “WARM ZONE” This indicates the area where there is a low risk of exposure to the hazardous material, or there is a possibility of cross contamination from the casualty or equipment. It is still necessary for personnel to be appropriately protected in this area. To ensure successful Mass Decontamination, strict controlled areas need to be established. Within these controlled areas the implementation of zones and cordons is paramount to its success: THE “COLD ZONE” Indicates a sanitised area that is provided to allow for other emergency personnel and their advisors to work unhindered at an incident The wind direction should be taken into account with the decontamination area and Command & Control vehicles positioned upwind. THE “HOT ZONE” This indicates the area where personnel are likely to come into direct contact with the hazardous materials. Personnel will wear full protective clothing. i.e. Gas Tight Suits, Breathing Apparatus etc.

27. Decontamination methods Wherever possible the Senior Ambulance Officer present should be consulted as to the best methods of decontamination available. 80% of the contaminant is removed if the casualty removes their outer clothing. The remaining 20% can be removed by washing the exposed skin. If time and numbers permit decontamination using buckets of warm soapy water and sponges should be used.

28. The appropriate decontamination agent is water and detergent. It is recommended that a mixture of 0.5% detergent in water is used which is approximately 50ccs of detergent in a standard bucket of water. This will usually be applied using a rinse/wipe/rinse method. If however the numbers or circumstances are such that the rinse/wipe/rinse procedure is not appropriate, then consideration should be given to the introduction of sprays from hose reels or showers.

29. One method of providing mass decontamination showers is to erect a gantry using short extension ladders formed into an ‘A’ frame and toped with roof ladders to provide the horizontal securing for hosereels that supply the water spray for decontamination

30. Both Fire and Ambulance Services will set up their own decontamination showers as normal, to run alongside Mass decontamination modules. In addition to Fire Service equipment other emergency services and agencies have their own equipment.

31. The end