Responders Today: Getting Personal

When two Norfolk Southern freight trains collided outside of Graniteville, SC, on Jan. 6, 2005, an estimated 60 tons of chlorine gas were released into the air. Nine people died as a result of the accident, another 550 or so sought medical attention and more than 5,400 residents of the city were forced to evacuate their homes.
“It was the first incident since the September 11th attacks on the World Trade Center that the federal government activated its homeland security plan and activated resources,” Lt. Michael Frank, public information officer for the Aiken County Sheriff’s Office, told HSToday. “They mobilized these pods, which consisted of two 18-wheelers full of public safety equipment. They were dispatched here to Aiken [home to Graniteville] and stayed here at the Aiken County Sheriff’s Office. The agencies that were participating in the response could requisition supplies from those trucks.”
Frank, who was on the scene that day with the rest of the responding force, agreed that the availability of personal protective equipment (PPE) provided by the federal government helped to protect first responders from inhaling or absorbing the chlorine gas.
“In the case of the Aiken County Sheriff’s Office, all of our deputies carry personal protective equipment in their vehicles and had them ready when the train derailed,” Frank explained. “The money to buy that equipment became available through the federal government in waves since September 11th. Agencies nationwide have been equipping themselves since then to be able to respond to a similar incident.”
But, he added, “There was PPE on those trucks. Some of that was used to re-supply agencies when they used their equipment up.”
However, an Aiken County report, titled Aiken County Government Action Report: Graniteville Train Wreck, noted that a lack of PPE hindered Aiken County Emergency Medical Services (ACEMS) from aggressively marshalling resources.
“ACEMS access was restricted after first entry due to lack of PPE availability…“ according to the report.
While US federal agencies are reporting progress in providing PPE to local responders, particularly medical personnel, other independent reports have questioned local jurisdictions’ level of preparedness and access to medical PPE.
Pandemic flu protection
In the case of a pandemic flu outbreak, what people wear may have as great an impact on their vulnerability to sickness as their location. Responding medical personnel would require PPE to prevent their contracting the disease and spreading it further.
Last December, the Trust for America’s Health (TFAH), a non-profit public health advocacy organization, published a report titled Ready or Not? Protecting the Public’s Health from Disease, Disasters, and Bioterrorism (http://healthyamericans. org/reports/bioterror06/BioTerrorReport2006.pdf.), that found most US states were critically underprepared to handle the number of patients who would flood their hospitals in the event of a major outbreak.
Among the items the report noted was the lack of access of most state authorities to PPE—such as masks, respirators, gloves and gowns—stashed in the Strategic National Stockpile, the medical supply reserve for national emergencies. Furthermore, the states have to date done little to augment the size of the PPE stockpile in any significant way.
TFAH identified the insufficient amount of PPE as a factor in states’ inability to provide care to a surge of patients in hospitals. The Health Resources and Services Administration (HRSA) at the US Department of Health and Human Services (HHS) identifies PPE as a critical benchmark for the ability to meet surge capacity.
In a fiscal 2007 justification of estimates for appropriations for the National Bioterrorism Hospital Preparedness Program, HHS pointed out that the program helped hospitals prepare for biohazards by providing PPE and related training to hospital staff.
As the document put it: “From FY 2003 through FY 2005, the expanded program scope assisted hospitals and supporting healthcare entities with implementation activities to ensure the safety of the healthcare workforce by allowing for the purchase of personal protective equipment (PPE) and/or well-equipped mobile or fixed decontamination facilities and providing the associated training in the proper use and wear of PPE; by purchasing appropriate and adequate pharmaceutical stockpiles and chemical antidotes; by allowing healthcare personnel to attend competency based training sessions in Hospital Emergency Incident Command Structure (HEICS) and allowing for their participation in local drills and exercises.”
HRSA reported that states have informed the agency that they have improved their ability to respond to outbreaks of Hepatitis A and E. Coli due to the assistance. In addition, the availability of PPE assisted with the chlorine tanker spill that killed nine people in Graniteville, HRSA stressed.
But Laura Segal, TFAH director of public affairs and a co-author of the Ready or Not? report, noted that her organization gave only 15 states and two cities high marks for their ability to provide supplies from the Strategic National Stockpile, where the federal government stores its stock of PPE.
The federal government and the states must decide the levels of shared responsibility required to get PPE into the right hands quickly, she toldHSToday.
“That’s part of the question that needs to be addressed. How much of this is a federal responsibility versus a state responsibility versus a shared responsibility? The federal government, for pandemic flu, has taken it on as a shared responsibility, where they would make a certain amount in the federal supplies available, but then would put it on states to decide whether or not they want to purchase more if it’s available,” she explained.
“Mostly, the personal protective gear that we are talking about are things like masks and gloves and gowns,” she added. “Those items are part of the Strategic National Stockpile, which is the cache of vaccines, anti-virals and medical equipment that the federal government maintains. They maintain it in 12 different locations around the country and keep it accessible for an emergency so that they could fly it to a state when it is needed.”
Experts predict that up to 25 percent of the US population (which totals more than 300 million people) could become sick in an outbreak of avian flu. As of Nov. 13, HHS had announced that the Strategic National Stockpile contained 73.1 million respirator masks, with an additional 31.8 million on order. The stockpile also contained 37.4 million surgical masks, with more on order. HHS indicated that it also had face shields, gloves and gowns, but did not indicate their numbers.
As of press time, the World Health Organization had reported that 258 people worldwide have become infected with the latest strain of H5N1 avian influenza, killing about 60 percent of those infected.
Implementation plan
The White House reports that the federal government is doing pretty well in executing the National Strategy for Pandemic Influenza Implementation Plan (http://www.whitehouse.gov/ homeland/nspi_implementation.pdf), which includes targets for PPE preparation and instruction in federal hospitals. The Bush administration met a six-month deadline for the implementation of 92 percent of items in the plan, Frances Townsend, White House homeland security adviser, told reporters at a Dec. 18 press conference in Washington, DC.
Townsend highlighted items that had been completed in the national strategy, such as those in Chapter 6: Protecting Human Health. The completion of items in this section indicate that all hospitals and health facilities funded by HHS, the Department of Defense (DoD) and the Department of Veterans Affairs (VA) have developed, tested and prepared implementation of infection control campaigns. Specifically, Supplement 4 of the HHS Pandemic Influenza Plan (available at www.hhs.gov/pandemicflu/plan/sup4.html) instructs healthcare personnel on managing infected patients and preventing the spread of infections to medical workers. HHS has published Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Health Care Settings during an influenza pandemic to educate medical personnel on the proper use of PPE.
DHS plans to host a national forum sometime in February to review interim guidelines and adopt a planning model for best practices in dealing with pandemic flu.
DoD and VA additionally have developed and disseminated educational materials in coordination with HHS to update communication materials concerning PPE.
According to a Dec. 18 summary of progress released at the HHS website for pandemic flu information, www.pandemicflu.gov: “We have developed pandemic influenza educational materials that are tailored to our personnel and our patients. These materials are aligned with messages of other agencies and we have worked together with other agencies to produce some materials. Specific topics include general information on pandemic influenza, how to protect oneself and one’s family from respiratory illnesses, how to wash hands and control coughing and sneezing, how to correctly put on and take off protective equipment, and how to care for someone who is sick with influenza.”
VA and DoD have both published PPE guidance at two other websites —www.publichealth.va.gov/infectionDontPassItOn and deploymenthealthlibrary.fhp.osd.mil, respectively.
Townsend acknowledged that the national strategy fulfilled only the needs of federal facilities, but that states could benefit by following the federal government’s example. She also called upon the private sector to help out with preparedness resources.
“As we saw on 9/11 and during Katrina, the private sector will play a critical role in the response to any large-scale event,” Townsend said. “The private sector recognizes this, and I’m happy to say that they have stepped up to the challenge. Businesses have made it clear that they want to put plans in place to ensure continuity during a pandemic. In return, we are committed to ensuring that the private sector is included in our planning efforts at the federal level and that we provide guidance to state and local authorities on how they can do the same at the community level.”
Analysis
HHS may have the lead in maintaining the National Strategic Stockpile and assisting with PPE through programs like the National Bioterrorism Hospital Preparedness Program, but DHS also has responsibilities for ensuring that the right PPE gets into the hands of first responders who need it—largely through its grants programs.
As a result, DHS and other agencies of the US government have been wrestling with setting standards for that equipment and—as important—providing responders with the funds to purchase and use it.
In 2007, responders should have more access to those funds than at any previous time since the homeland security grant program was established.
Fiscal 2007 grant guidance from DHS indicates that state and local governments can use most of the available Homeland Security Grant Program funds to purchase PPE. DHS has cleared funds under the State Homeland Security Program, the Urban Area Security Initiative, Law Enforcement Terrorism Prevention Program and the Metropolitan Medical Response System (but not the Citizen Corps Program) for purchasing personal protective equipment.
In addition, state and local governments can use funds under transit and rail Infrastructure Protection Programs to purchase protective gear, as can grant recipients under the System Assessment and Validation for Emergency Responders  program and the Commercial Equipment Direct Assistance Program.
The Homeland Security Appropriations Act for Fiscal 2007 directs DHS to make determinations and grant awards quickly in many cases. The Act also directs the Office of Grants & Training to brief the appropriations committees of both the House and Senate on the recipients of formula-based grants, law enforcement terrorism prevention grants and high-density urban area grants at least five full business days in advance of any public announcement of those recipients.
The goal of that directive is most certainly to avoid the embarrassment and outrage voiced by some members of Congress when the office seriously cut the percentage of fiscal 2006 awards to New York City and Washington, DC—the two cities targeted by the terrorist attacks of 9/11.
In all, it has taken time and it will take more time—but the need for PPE and the money forstates and localities to purchase it is now a federal priority and the mechanisms are in motion to provide it to those who need it most. HST

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Acronyms in this article
ACEMS—Aiken County Emergency Medical Services
CEDAP—Commercial Equipment Direct Assistance Program
DHS—Department of Homeland Security
DoD—Department of Defense
HHS—Department of Health and Human Services
HRSA—Health Resources and Services Administration
NFPA—National Fire Protection Association
PPE— Personal protective equipment
SAVER—System Assessment and Validation for Emergency Responders
TFAH—Trust for America’s Health
TSWG—Technical Support Working Group
VA—Department of Veterans Affairs

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Private sector action
Private companies have stepped in when called upon to lend a PPE hand during disasters. Officials in Graniteville, SC, called on the giant chemical company DuPont, Wilmington, Del., to assist with their chlorine tanker spill on Jan. 6, 2005, according to Dale Outhous, global business director for DuPont Personal Protection.
“The activity of coming alongside first responders to help them make decisions as to what PPE should be worn in a real-life situation happens regularly,” Outhous told HSToday. “For example, when there was a huge chlorine spill in South Carolina, they called us, not only because of our PPE but DuPont, being an owner/operator, handles chemical materials, and we had a plant site not too far away. So we could provide emergency response support to that.”
Companies like DuPont also work with the federal government to develop PPE solutions that meet established standards. For example, DHS operates a grant program through the Technical Support Working Group (TSWG). DHS occasionally releases solicitations to industry to inform them of a product proposal under TSWG. Industry then responds with its ideas, and DHS may make grant awards to develop those ideas.
“Last year, we participated in one of them to create a new technology for firefighters that would protect them from weapons of mass destruction and chem-bio hazards while not compromising their fire-resistant bunker gear. That was a good example where they saw from 9/11 that firefighters running around in their bunker gear could be well protected from fire, but not necessarily protected from a chemical attack,” Outhous said.
DuPont executives also sit on National Fire Protection Association (NFPA) committees for fire and chemical protection.
“Those standards-setting bodies are there and we work with them to set appropriate standards. And we work with end users to build technology solutions that meet the standards and the end user needs,” he said. “The Department of Homeland Security has come up with a standard equipment list and an approved equipment list. They make this list available to agencies and departments in order for them to select the appropriate PPE off of those lists, based on the situation that they are facing. That’s how they grant money.”
DuPont’s competitors participate in standards-setting organization, as well, and many of them have built strong relationships with DHS. Once a standard has been adopted, DuPont immediately sets to work to develop products that comply with that standard. DHS doesn’t develop standards and it doesn’t create technologies, Outhous noted, but DuPont works with the department when it spends money to fulfill specific needs.
That technology remains under development at DuPont through a TSWG grant, he added. DuPont also monitors solicitations for new technologies through the Homeland Security Advanced Research Projects Agency and pays close attention to the goals of various agencies like the Federal Emergency Management Agency and the bureau of Customs and Border Protection.
Outhous noted that DuPont continuously works independently, as well, to create new innovations for the benefit of first responders. For example, the company recently developed a protective garment called the Tychem ThermoPro for defending against both chemical splashes and flash fires.
“Law enforcement personnel were going into clandestine chemical labs and they were being confronted with threats of both a chemical nature and fire,” Outhous explained. “There had been no technology in the world that would protect you from a chemical splash or a chem-bio hazard and a flash fire in one technology without compromising one or the other.
“So we developed a new technology called Tychem ThermoPro and, for the first time, a first responder doesn’t have to make that choice,” he stated. “This technology meets NFPA standards for both chemical splash and flash-fire hazards. It allows first responders to have protection from multiple threats. Several cities have adopted it as a technology that they can use on their HAZMAT teams and in law enforcement, as well. The DC Metropolitan Police was one of the first adopters of this technology.”

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