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A Dash of Danger

Responding to a call for a suspicious powder found at a magazine headquarters in New York City, members of the hazmat team from the North Shore-Long Island Jewish Health System’s Center for Emergency Medical Services (CEMS)—dressed in protective gear and armed with medical equipment—were ready to identify the substance and, if necessary, decontaminate the site. Fortunately, what the team found was not a deadly biological agent but a tasty blend of onion, black pepper, parsley, garlic, and other spices, also known as Mrs. Dash.

EMERGENCY MANAGEMENT Coordinator Pat Pogan says that such findings are so typical that the team has a running joke about what the spice of the week will be. As Pogan explains, hoaxes are often carried out using common substances like spices. He stresses, however, that his team must always be prepared for the worst.

For example, in a recent case the hazmat team identified approximately 46 different chemicals in the back of a man’s van. Some of the chemicals, such as hexamine, could be used in combination to make explosives. Because the chemicals were identified as potential threats, police were able to detain the man. On further investigation of his home, several guns and homemade hand grenades were found.

The CEMS, a part of the 15-hospital North Shore-Long Island Jewish Health System, is the largest hospital-based ambulance service in the New York metropolitan area and one of the largest in the United States. It serves New York City as well as Nassau and Suffolk counties. Its 350 emergency response personnel and 45 hazmat technicians operate more than 40 response units a day, and the ambulance fleet transports over 48,000 patients annually.

The hazmat team’s operations offer an instructive model for other metropolitan areas. The key aspects of its operations include the operations center and communication network, the advanced detection equipment, and the intensive staff training.

Origins. The hospital first began discussing the need for a hazardous-response team after the Tokyo nerve gas incident in 1995, but funds were tight and the risk was not perceived as high. Therefore, before 9-11, the teams were small and had a limited amount of protection and detection equipment. Hazmat technicians were included in some ambulances, but a designated hazmat vehicle and sophisticated hazardous-response procedures were not yet in place.

September 11 and the subsequent closing of a prominent New York hospital after the 2001 anthrax attacks prompted hospital administrators to reevaluate the importance of their hazmat response capabilities. Management increased funding to the program, and hazmat vehicles and portable hazmat equipment, including decontamination and identification products, were purchased.

Operations center. The CEMS operations center is located away from the hospitals it services. According to Pogan, this is ideal because “if an attack happens at a hospital, our emergency operations center is a freestanding building away from the danger.”

The center is equipped with police and fire scanners and several TVs displaying local weather, local traffic, and local and national news. Emergency medical technicians (EMTs) and paramedics who are trained in emergency medical dispatch procedures staff the facility around the clock.

Staff monitor what is going on and are able to identify potential problems and anticipate a call to dispatch ambulances or hazmat vehicles. That approach helps them respond more quickly to the approximately 850 calls they get daily.

Response is also aided by a GPS system that allows them to track the whereabouts of all their ambulances. Each ambulance is color coded and is displayed on a large screen located in the ambulance center. The screen allows the dispatchers to track the ambulance’s speed and location.

When a call is received, dispatchers are able to locate and notify the closest unit, significantly reducing response time. The system also maintains a log of each ambulance route, which management can review.

In addition to monitoring for emergency situations needing ambulance assistance, communication center employees are trained to listen for police and emergency scanner reports of suspicious events such as people having difficulty breathing in an underground subway station. If a potentially hazardous material is suspected, the hazmat team will be dispatched in addition to the ambulances. Pogan says this quick response is often critical when dealing with situations where potentially hazardous materials could be present.

For example, the emergency response team heard police discussing reports of a gas explosion in a building in the city. The communication center was able to identify the problem quickly and dispatch the ambulance and hazardous materials units right away, simultaneously letting the trauma teams in the hospital know to expect burn or asphyxiated victims.

As a manager, Pogan also receives emergency notifications on his pager from the Breaking News Network, an emergency notification service used by the hospital. The pager displays any minor fire or crime in the city that may require unusual rescues or a hazardous-materials team.

Pogan says he receives more than 75 pages each day. Although the communication center is often aware of the situation broadcast to Pogan’s pager, the pager acts as a redundant notification tool and Pogan frequently calls the center to make sure they are aware of the situation.

In addition, each member of the CEMS is issued a pager that is used to relay information from the dispatch center to the field. These pagers, however, are not part of the Breaking News Network. They serve as a backup form of communication that can be used if the unit’s cell phone and radios aren’t working.

The CEMS operations center also serves as an early-warning monitoring system for the hospital itself. If a threat is detected in the vicinity of one of the hospitals, a hazmat team can be dispatched to mitigate the risk and decontaminate anyone who was exposed.

“Our goal is that no one who is contaminated with hazardous materials gets into the hospital,” Pogan says. After decontamination, if the person is still in need of treatment they will be taken to the hospital. Pogan says the decontamination is done off-site to prevent the spread of potentially dangerous materials to non-exposed individuals inside the hospital.

Detection. Determining what the contaminant is and isolating the affected area are the first steps in the decontamination process. Properly identifying a substance is critical because different substances require different levels of response. When a hazmat team is called to a site, the team generally establishes temporary decontamination and identification areas. Each hazmat unit is equipped with inflatable structures that are small enough to fit inside the trunk of a car; they can be fully inflated in a matter of minutes.

Chemical agents. The CEMS hazmat team first tests the suspicious solid, liquid, or powder with Hazmat ID from Smiths Detection to identify whether the substance has chemical properties. (This equipment only identifies chemical properties; it cannot identify specific biological agents, although it can determine whether a biological agent is present. If it is, the team will test with another device that can identify specific biological agents. That is discussed later).

Hazmat ID is a portable FT-IR spectrometer, which is used to analyze the chemical agents to determine their specific makeup. This portable device, also used by law enforcement, can identify over 6,000 chemicals by comparing the unique chemical fingerprint to its onboard database.

If the substance is not one of the 6,000, the hazmat team sends the chemical fingerprint via wireless transfer to Smiths Detection, which compares the substance to its library of over 30,000 substances. If Smiths is unable to identify the substance, it sends the image to a spectroscopy expert who analyzes the information.

Pogan says that both the Smiths identification and expert identification have been extremely quick to respond. Members of the hazmat team can expect an answer in less than 45 minutes.

Recently, while members of the hazmat team were participating in a drill with the Nassau county emergency responders, a live call came in that the village hall in the county had received a threatening letter with powder included.The hazmat team was asked to assist.

The team immediately established a secure identification station outside the building, using their inflatable structures. They were given a sample of the powder and ran it through the detection equipment.

When the substance was analyzed against the initial 6,000, it came back as a combination of elements including grass and spores. Unhappy with the inconclusive result, Pogan sent the chemical fingerprint to Smiths for positive identification. The Smiths analysis, provided to Pogan in 20 minutes, revealed that the sample contained a high amount of carbohydrates, which is indicative of a spice and not a harmful chemical.

Pogan says the Smiths database includes several thousand white powders that are often used to spoof an anthrax attack, helping his team detect a hoax. The chemical library is so specific that it can differentiate between Gold Bond Medicated Powder and Dr. Scholl’s.

Biological agents. For detection of biological agents, the hazmat team uses Bio-seeq, also from Smiths, which is a hand-held thermocycler capable of detecting both bacterial and viral pathogens. In addition, the battery-operated unit uses polymerase chain reaction (PCR) technology to detect DNA. If the hazmat team suspects a biological agent, a small sample is placed on the machine, and Pogan says the substance is typically identified within 20 minutes.

Gas and airborne agents. The hazmat team has an additional system, the APD 2000, which simultaneously detects nerve and blister agents, recognizes pepper spray and mace, and identifies hazardous compounds in the air. The portable, hand-held system can also detect radiation.

Pogan says the system was used by the hazmat team when there was a report of choking and difficulty breathing in a subway tunnel. The team was not able to find any physical substance, such as a white powder, to test using the hazmat ID or Bio-Seeq. But using the APD 2000, Pogan’s team was able to identify trace amounts of pepper spray in the air.

Decontamination. If exposure to a chemical, biological, or airborne agent occurs, the team is equipped with portable decontamination units that can be set up outside a contaminated site. Decontamination procedures vary for each substance.

In some cases, the appropriate response may be to saturate the substance with water, which would mean having the people potentially in contact with it shower in the decontamination unit. In other cases, the team may isolate potentially exposed persons until they can be taken to a medical facility with an isolation room for treatment.

Advance planning. The hazmat team plans ahead when it is designated as the standby response unit for a public event. It considers how it will deal with a possible contamination situation at that specific facility.

For example, the team was selected to provide emergency medical and hazmat protection for the 2004 U.S. Open Golf Tournament held at the Shinnecock Hills Golf Club in South Hampton, New York. The tournament hosted more than 45,000 spectators. Before the event began, members of the hazmat team worked with the garden and landscape staff to survey the best places for mass decontamination.

They worked with the head of landscaping to make sure they knew where to hook up the hose and tap into the sprinkler system for the entire golf course. “If something did happen—a mass release of a chemical—we could actually turn on the sprinklers on the entire golf course and tell everyone to move into the sprinklers to wash off any hazardous substance,” explains Pogan.

Training. Each member of the hazmat team is trained to what Pogan calls “the operations level.” The training is done in house and consists of 16 hours of intensive instruction on how to identify hazardous substances, how to respond to the substances, and how to decontaminate those exposed.

Operations-level training also teaches the hazmat responder how to use the various detection equipment and how to properly use the protective gear such as Tyvec suits and breathing apparatuses used by members of the team during substance identification and decontamination.

Select members also receive tech-level training at the Center for Domestic Preparedness in Alabama. The center, funded by the Department of Homeland Security, is the only federally chartered facility for weapons of mass destruction training and is available free to state and local responders.

Currently 10 members of the hazmat team have received the Center for Domestic Preparedness training, which consists of 40 hours of instruction that includes an exercise in which they are required to neutralize a live biological or chemical agent, such as sarin.

Students wear full protective gear during the exercise and are required to take a full physical before entering the facility. After completion of the training, they are tested for possible exposure.

Pogan says it is important that all hazmat team members constantly refresh and sharpen their skills. Therefore, members of the team are required to attend eight additional hours of federal government hazmat training each year.

Members of the hazmat team are also recruited to train members of the community. They have, for example, trained the 340 members of the Nassau County Health Department staff. The training was conducted in small classes of no more than 20 students, and each course lasted a total of 16 hours. Completing the training for all 340 members of the health department staff took a little over a year, and it included a review of symptoms and a brief history of chemical and biological agents.

Eileen Scanlon, biological terrorism coordinator for the department, says the training offered by the team was comprehensive and helpful. “They are a wonderful asset,” she says. Although the Health Department has not had any live situations that required knowledge of biological or chemical agents, Scanlon says members of her staff are often asked to participate in tabletop drills with police and Pogan’s hazmat team.

Pogan says the hospital system is constantly looking for public grants to expand the hazmat team’s equipment and training. In addition, he anticipates that management will continue to provide resources and will eventually train all members of the hospital staff in the identification of and response to chemical and biological agents.

Emergency response is a team effort, Pogan says, and he and his team are eager to share their knowledge and expertise with the community. The more that members of the community know about how to respond, the more likely it will be that an incident can be quickly countered and the impact on people and the environment contained.

Marta Roberts is staff editor at Security Management.