You would have to search far and wide to find a jurisdiction that doesn't need to be concerned about a potential hazmat incident causing large numbers of casualties in their response area. With the vast amounts of common toxic chemicals ever-present in our society, the real possibility exists for an overwhelming event in your jurisdiction.

Consider the Jan. 6, 2005, chlorine incident in Graniteville, S.C., that killed nine people and sent 529 to area hospitals. How about the April 11, 1996, train derailment near Alberton, Mont, that released 130,000 pounds of chlorine? The vapor cloud that traveled across I-90 caused multiple vehicle collisions and forced hundreds of victims to seek medical care.

Hazmat response is nothing new to the fire service, but are you doing a good job? Are you integrating well with other response agencies in compliance with the National Incident Management System? Are you prepared to manage scores or even hundreds of contaminated victims immediately after an accidental or intentional release of chemicals on a highway near you? In an era when even a routine rescue of multiple entrapped victims in a motor-vehicle collision can overtax our response assets, how do we handle the big one?

Before the incident

The biggest mistake emergency service leaders can make is to wait until an incident happens to plan a response. Fire service agencies should be working closely with law enforcement, emergency medical services, and other first responder assets and agencies to maintain a comprehensive matrix of potential threats and hazards in the community. We can't fall short in our planning process by limiting our preplanning activities to fixed facilities. Major transportation routes should be a key part of your community's response plans.

How prepared are your personnel? Adequate training in hazardous materials is an imperative cost of doing business in the fire service today. Deciding to what level your personnel should be trained will vary depending on their responsibility, but the minimum standard for firefighters in most jurisdictions is the operations level of NFPA 472, Professional Competence of Responders to Hazardous Materials Incidents. At a minimum, all responders should maintain NFPA 472 awareness certification. Your personnel must be able to at least identify a hazmat incident so that the appropriate help can be obtained when necessary.

Along with NFPA 472 — compliant training, it's imperative that all responders receive training on ICS and know and understand their roles in the command structure, because the law requires its use for all hazmat incidents. In addition, more progressive agencies have implemented comprehensive roadway safety courses that provide strategies and tactics to reduce the risk to responders while operating at the scene of a roadway incident. These tactics become even more important to responder safety during a hazmat response.

The other critical activity prior to the incident is to ensure your equipment is ready to respond. You also need to have a clear understanding of your limitations based on which tools you have. As a part of your ongoing needs assessment, this information will allow your incident commanders to immediately recognize when to call for help from other agencies or jurisdictions if the incident exceeds your agency's capabilities.

Embrace ICS

The most effective way for your agency to handle “the big one” is to ensure that all of your response personnel embrace and always operate in the ICS mindset. Like all skill sets in emergency services, the effectiveness of ICS will follow the old adage of “training like you fight and fighting like you train.”

To successfully manage a large-scale event, personnel at all levels of the command structure must maintain an ICS approach to all incidents, including the more common, smaller ones. Changing the first responder's operational mindset to incorporate ICS concepts in daily response activities not only will improve management of those day-to-day events, it also will limit the confusion of roles and tasks commonly seen in high-impact incidents.

For ICS to succeed, all responders must have command and control of their own units with adequate internal communications and enhanced multiagency/multidisciplinary interoperability. By using ICS during routine incidents, response groups will be better prepared to communicate more effectively during a large-scale event. History has demonstrated that internal and external communications failures are the most common complication and limitation during large or complex incidents.

It also pays dividends to routinely train with other responder disciplines, such as law enforcement, emergency medical services and public works, to ensure maximum interoperability and interagency communication and cooperation. A hazmat incident can't be mitigated completely or effectively by any single response agency alone; cooperation, even prior to the incident, is a must. Encourage other-discipline training such as Hospital Emergency Incident Command System, Traffic Incident Command System or Law Enforcement Incident Command System. This will afford much greater efficiency during training and response activities.

If all of the first response agencies aren't completely trained and proficient in ICS concepts and practices, then it's reasonable to expect that there will be a lack of unity of command at larger-scale emergencies. It's this lack of unity of command that breeds the conflicting priorities often seen between the fire service and other first responder/receiver disciplines.

Gather information

No matter what type of incident we respond to today — medical aid, structure fire or routine public assistance — our overall priorities should always remain life safety, incident stabilization, and preservation of property and the environment. How you achieve these goals, particularly in hazmat incidents, depends on the command officers managing the events.

Even before units arrive at the scene, response activities should be in high gear. Dispatchers and call-takers should be obtaining as much information as possible regarding the location, number of potential victims, and magnitude and type of incident — spill, vapor release or explosion. Responders also must understand that if the event is an intentional act, purposefully misleading information may be given to call-takers and responders in an attempt to cause further havoc.

Hazardous materials can be obvious, such as the cloud and odor of a chlorine leak, or they can be completely unnoticeable, such as radioactive materials. Consequently, emergency call-takers need to gather as much information from callers as possible before relaying the information to the responders via the incident commander.

The ability to respond safely and have a positive impact at the incident depends heavily on the responders' ability to recognize the nature of the incident before it's too late. Responders should pay attention to sensory clues en route to the incident scene that could lead to a higher index of suspicion of the possibility of hazmat involvement.

Billowing smoke or vapor clouds could give responders advanced warning that a hazardous substance may be involved, but it may not be this obvious. The sense of smell is often the first sensory indicator of a problem; however, if you smell something, you're too close and should remove yourself to a safe distance immediately.

Of course, not all hazmat carriers are clearly marked. Delivery trucks routinely carry hazardous materials that can be released if a collision occurs, yet if the quantity falls below the minimum reportable values or if the act is intentional, the vehicle may not be marked at all. Binoculars and basic reference materials, such as the 2004 North American Emergency Response Guidebook, should be used during the initial phase of the incident to ascertain as much information as possible as on-scene operations begin.

As responders approach the scene, it's most important to remain at a safe distance while gathering information and determining the initial hazards. It's still a very real challenge to keep responders from entering a hazardous environment without adequate protection. The hazard must be determined immediately, before other responders enter a chemically contaminated area. Special attention should be paid to the type of container and any damage to it, as well as to the quantity of hazardous material and the container's potential capacity. Personnel also should note any placard or label, along with any other product information, surrounding conditions or potential path of released materials.

Responders should exercise extreme caution when attempting rescue at any hazmat incident scene. No responder should enter a hazardous environment, even to conduct rescues, without proper protective equipment. Additionally, responders should never attempt to wear PPE unless they have had the proper training and have met protective equipment testing requirements. The appropriate initial level of protection will be dictated by the substance and can be found in the Emergency Response Guidebook.

Consider safety

Once the magnitude of the incident is realized, the first priority should be to isolate the hazard area and secure the scene by denying entry and exit to all unauthorized persons. This may include preventing potentially contaminated victims from leaving the scene, which represents one of the greatest challenges during a large-scale, mass-casualty hazmat event.

Once a safe area has been determined, it's critical to initiate command and establish the incident command post. The dispatchers should clearly state this information to all responders to ensure that everyone is operating from the same sheet of music as the incident develops. It's also important to initiate a personnel accountability system as soon as possible.

The command post must be set up with safety as the primary concern. Not only must it be safe from the hazard that initiated the response — upwind, uphill and the like — but careful consideration of the potential for a secondary device must be part of its location selection and security screening. Even if the incident doesn't initially appear to be an intentional act, responders must always be aware that they may be a target of ill-intentioned individuals or groups.

As the command post is being set up and appropriately staffed with only the essential personnel, effective communication must be the priority. Not only must ICS be used, but also a Unified Command System should be considered to manage all of the different groups responding concurrently to the scene. The prompt establishment of unified command can help set common priorities and strategies and better manage these resources from the earliest phase of the event.

Responders should note essential information, such as weather, surrounding land use and topography, site accessibility, drainage, and surrounding potential hazards. This information needs to be included in site mapping and other documentation as the incident develops. The site map also may include information on obstacles, exposures, utilities or other scene features important to response planning.

As these features and elements of the incident are determined, responders and incident commanders should ask themselves:

• What are my immediate priorities?
• What are the response objectives?
• What protective actions, such as shelter in place or evacuation, will be necessary?
• What additional resources will I need to accomplish these objectives?

Communications

The incident commander must always be apprised, especially during the initial phase of the event, of operational activities and critical conditions so that additional resources can be requested without delay as needed. This is also imperative to ensure that public information can be disseminated quickly. Early notification to first receivers, such as hospitals and other medical facilities, is critical. A significant percentage of victims won't stay at the scene to wait for the arrival of emergency services. These victims who self-transport pose a great risk to the medical facilities, as they have the potential to contaminate an entire hospital emergency department.

Communications are especially important. A hazmat incident may dictate that a civilian population evacuates or shelters in place, and getting this critical information to the public before they're affected by the incident can be very challenging. Remember, it's your responsibility to not only protect the public, but also to keep them informed and updated.

As victims start leaving the immediate scene of the incident, they will take contamination with them wherever they go. To prevent secondary contamination, it's critical to be prepared to conduct a mass decontamination operation if large numbers of casualties are present at the scene. Mass decontamination can be achieved rather simply even before the arrival of specialized hazmat equipment and personnel. It may be as simple as fire personnel with low-pressure hand lines positioned at points of egress.

Clear communication with these victims is essential, as they will most likely be overwhelmed from the incident and difficult to direct. As these patients emerge from the incident, responders must also pay close attention to any signs or symptoms that they may be exhibiting. This information may be critical for the initial treatment of casualties as EMS assets begin care of the victims.

Zones and sectors

As additional resources respond to the scene, personnel at the scene in appropriate PPE should set up contamination control zones:

• Hot Zone/Exclusion Zone

  The area of danger posed from the material as dictated by isolation and protective action distances.

• Warm Zone/Contamination Reduction Zone

  The area where decontamination activities take place.

• Cold Zone

  The “clean” area where the command post, staging and treatment areas are located.

• Security Perimeter

  Set up by law enforcement to ensure responder safety and operational security of the entire event.

Other personnel should then initiate primary triage of the victims. The ideal personnel to conduct triage are Basic Life Support providers because they're less likely to become engaged in treatment of individual patients. Treatment by triage personnel should be limited to positional airway management, severe hemorrhage control and patient positioning for shock.

During the initial triage, all additional responding units should be directed to the staging area so that they may be directed to their assigned location without interfering with the entrance and egress of other operational response vehicles and personnel. After initial triage of all patients, triage personnel are responsible for moving patients, in order of priority, to the decontamination area for decontamination and distribution to the appropriate treatment area.

Using BLS providers for triage allows for Advanced Life Support resources to be used more appropriately in the treatment sector. The treatment sector should be divided into three distinct areas for separating immediate, delayed and walking-wounded patients. As personnel treat the patients in the treatment areas, patients should be re-triaged frequently to ensure they haven't deteriorated or improved. Patients whose conditions have changed to a different triage category should be immediately moved to the appropriate treatment area corresponding to their updated triage category.

The transport sector is responsible for timely transport of patients to appropriate medical facilities based on medical priority. This sector also is responsible for tracking patients and their medical facility destination. The transport officer should maintain the current availability status of area medical facilities so patients are distributed responsibly and no one facility is overwhelmed with patients. Simply put, don't just transfer the disaster from the scene to the hospital.

Hazmat incidents can be overwhelming in the treatment areas as medical providers may be in short supply. Until adequate personnel, supplies and equipment arrive in sufficient quantities, medical providers may be tasked with managing very high provider-to-patient ratios.

The ultimate goal of a mass-casualty hazmat incident is to efficiently triage, decontaminate, treat and transport all of the victims to appropriate medical facilities.

When a hazardous material complicates the event, operational challenges will greatly exceed the capabilities of the initial response resources. To effectively control the incident, it's imperative that the first-arriving units implement ICS immediately. As help arrives, you can accomplish the necessary objectives of protecting responders, rescuing victims, triaging, decontaminating, treating and transporting to appropriate medical facilities.

As fire service leaders, we will bear the burden of ensuring an efficient response at these high-impact incidents. With proper pre-planning, training, incident command and communication, you will have the most success at remaining composed and successfully mitigating the event.

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Brandon W. Graham is currently the WMD program coordinator at the Texas Engineering Extension Service Emergency Services Training Institute in College Station, Texas. His background includes EMS, fire service, law enforcement and special operations in Washington, D.C.