CONTENTS. 1. Introduction 1

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1 SUSPECTED CHEMICAL ATTACK IN AN UNDERGROUND TRANSIT SYSTEM FIRE TACTICS AND PROCEDURES EMSC OGP EMERGENGY RESPONSE PLAN ADDENDUM 2 August 30, 2004 CONTENTS SECTION TITLE PAGE 1. Introduction 1 2. General Description of Chemical Agents 1 Nerve Agents... 1 Blister Agents... 1 Blood (Pulmonary) Agents... 2 Choking Agents Initial Incident Recognition and Response 2 Incident Recognition... 2 Initial Incident Response... 2 Radio Code Signal Incident Commander 3 5. First Arriving Units: Protective Measures and Procedures 6 6. Fire Branch: First Arriving Ladder Companies 6 First Arriving Ladder Company Team First Arriving Ladder Company Team First Arriving Ladder Company Chauffer... 7 Second Arriving Ladder Company Tactical Operations... 7 Second Arriving Ladder Company Team Second Arriving Ladder Company Team Second Arriving Ladder Company Chauffer... 8 i

2 August 30, 2004 SECTION TITLE PAGE 7. Fire Branch: First Arriving Engine Companies 8 First Arriving Engine Company... 8 Second and Third Arriving Engines Medical Branch: EMS First Arriving Units 9 First Arriving Ambulances... 9 EMS Officer on Initial Assignment Triage, Treatment, Transport Tracking Haz-Mat Branch: Operations 12 Haz-Mat Company Haz-Mat Battalion Haz-Mat Technician Units (HMTU) Rescue Companies SOC Support Ladder Companies CPC Companies SOC Battalion Safety Operating Battalion Haz-Tac Ambulances Haz-Tac Officer Office of Medical Affairs/OMA Bureau of Fire Investigation Conclusion Related Procedures 16 FDNY Command Guide for Chemical Attack in a Subway Chemical Agent Summary Chart ii

3 1. INTRODUCTION 1.1 This bulletin outlines initial operational procedures for First Responders that arrive at a suspected terrorist attack in a subway as well as procedures for later arriving specialized units Haz-Mat Company 1, Haz-Mat Technician Units (HMTU), SOC Support Ladder Companies, Decon Engines, Chemical Protective Clothing (CPC) Companies, Haz-Tac Ambulances. FDNY is responsible for search and rescue and mitigation to ensure life safety. 1.2 OBJECTIVES OF THE FIRE DEPARTMENT Ensure safety of the public, FD personnel, and all first responders Remove any viable victims trapped in the affected area Identify the materials and any associated hazards Ensure decontamination of exposed civilians Triage, treat and transport any affected persons Mitigate any ongoing chemical release Decontaminate FD personnel and the affected area Assist Law Enforcement to preserve the crime scene Restore scene safety and services before terminating the incident Institute site safety plan 2. GENERAL DESCRIPTION OF CHEMICAL AGENTS There are four types of chemical agents of concern to First Responders: nerve, blister, blood and choking agents. 2.1 Nerve Agents (Organophosphates) A. Examples: Tabun (GA), Sarin (GB), Soman (GD), VX B. Distinctive odor: Fruit C. Outward Signs of Exposure: respiratory distress, convulsions, S-L-U-D-G-E-M: Salivation, Lacrimation (tearing), Urination, Defecation, GI distress, Emesis (vomiting), Muscle Twitching/ Miosis (contraction of pupils) 2.2 Blister Agents (Vesicants) A. Examples: Mustard, Lewisite B. Distinctive odor: Garlic C. Outward Signs of Exposure to Mustards: signs and symptoms do not appear for several hours Skin blistering D. Outward signs of exposure to Lewisite: signs and symptoms appear immediately Severe irritation to eyes, skin and airways, tissue necrosis 1

4 2.3 Blood (Pulmonary) Agents A. Examples: hydrogen cyanide, cyanogen chloride B. Distinctive odor: burnt almonds C. Outward signs of exposure: victims gasping for air, convulsions 2.4 Choking Agents A. Examples: chlorine, ammonia, phosgene B. Distinctive odor: chlorine or grass C. Outward signs of exposure: victims gasping for air, eye irritation 3. INITIAL INCIDENT RECOGNITION AND RESPONSE 3.1 Incident Recognition Indicators of people or animals adversely affected by the release: civilians displaying similar signs and symptoms such as pulmonary distress, cardiac distress and/or skin lesions or numerous fatalities with no apparent cause of injury or trauma Other Outward Warning Signs A. Presence of suspicious spray devices or cylinders B. Unusual odors C. Presence of suspicious powders, gels, liquids D. Mists or vapor clouds 3.2 Initial Incident Response Upon notification of a chemical release in a subway adversely affecting people or several people overcome, the following units will be dispatched to the scene: 3 Engine Companies 1 BLS Ambulance 2 Ladder Companies 1 EMS Conditions Officer 1 Battalion Chief 1 Haz-Tac Ambulance 1 Haz-Tac Conditions Officer 1 SOC Support Ladder Company 1 Rescue Company Haz-Mat Company 1 1 Squad Company Haz-Mat Battalion 3.3 Radio Code Signal Verification of a chemical release at a subway shall cause the transmission of signal with the appropriate Code. 2

5 4. INCIDENT COMMANDER 4.1 Establish Incident Command 4.2 Ensure Initial Scene Safety Use available PPE and SCBA Minimize the number of firefighters entering the subway Be aware of secondary devices and multiple release points Protection from a secondary device is a top priority before establishing a command post and staging areas. The Incident Commander shall request that law enforcement search selected locations and provide force protection. A common tactic in the placement and timing of a secondary device is to draw a large crowd and then detonate the device to inflict additional harm. The Incident Commander should limit personnel and apparatus from entering forward positions until adjacent areas are adequately searched and cleared Be aware of the flammable or explosive potential of the chemical agent. If possible, use intrinsically safe equipment Be aware of a multi-agent device or release involving explosives, chemicals, biologicals and/or radiologicals Operate upwind of chemical release Ensure members avoid contact with puddles, liquids, vapors, mists, etc Request fire marshals and other law enforcement to assist in site control, access and security 4.3 Establish the Following Control Zones and Facilities: Exclusion Zone Contamination Reduction Zone (CRZ) A. Safe Refuge Area (SRA) Safe Refuge Areas are positioned in the Contamination Reduction Zone outside the Hotline to evaluate the need for decontamination of those evacuating the Exclusion Zone. B. Decontamination Areas 3

6 4.3.3 Support Zone A. Incident Command Post (ICP) The Incident Command Post should be located in the Support Zone outside the subway entrance, away from ventilation gratings and upwind of the incident. B. Staging Area C. Casualty Collection Points (CCP) 4.4 Perform Hazard Analysis Evidence of Release Physical State of Chemical A. Liquid B. Gas/Vapor C. Solid Location of victims and rescuers Number of people exposed or contaminated 4.5 Initiate Operations for a Chemical Attack in a Subway Define the operational area A. All subway exits/access that serve the effected station B. All subway emergency exits surrounding the effected area Isolate the area and control site access, including: Restricting train traffic Restricting pedestrian traffic Blocking vehicular traffic Restricting access/egress to surrounding building entrances/exits Determine Train and Station Status A. Ensure evacuation of station and trains B. Prevent all unaffected trains from entering or passing the affected/contaminated station C. Unaffected trains between stations should be moved to an uncontaminated station without entering the contaminated area D. Shut off HVAC system to prevent the spread of contaminants E. Cover sidewalk gratings with tarps, sheets of plastic, rugs, etc. 4

7 F. Control/limit ventilation of surrounding properties (i.e. shut down air intakes) G. Shut down HVAC system of all trains in the vicinity of the contaminated area to prevent air intake of contaminants. Note: If the chemical release occurs on a train between stations, the MTA will continue the train to the closest station and keep the train HVAC system on while in transit to dilute the contaminant in the railcar. The receiving station shall be evacuated prior to arrival of the contaminated train. The train will be evacuated upon arrival at the station and victims will proceed to mass decontamination areas. All other trains should be prevented from entering or passing the now contaminated station Strategic Operations A. Defensive Mode Members are NOT to enter a subway where visible persons are unresponsive. B. Evacuation If civilians are self-evacuating, members shall assist evacuation using bunker gear and SCBA. 1. Ensure means of egress are enlarged by forcing/removing gates, fences, and other obstructions 2. Direct evacuees to Safe Refuge Area for decontamination assessment; use apparatus PA system, bullhorn, signs, barrier tape C. Rescue Rescue involves non-ambulatory or trapped victims. Members attempting rescue of civilians may require a higher level of protection. Note: Trained personnel wearing appropriate PPE may be required to administer antidote during rescue Initiate Mass Decontamination, if necessary Consult with transit personnel/supervisors/specialists A. Subway ventilation fan activation B. Emergency exits C. Other subway lines affected D. Accountability of transit personnel Attempt to identify the chemical agent (i.e. odor, patient signs and symptoms, containers) Ensure Medical Branch is established to triage, treat and transport victims following decontamination Note: The Incident Commander should ensure crime scene preservation in cooperation with law enforcement. 5

8 5. FIRST ARRIVING UNITS: PROTECTIVE MEASURES AND PROCEDURES Initial strategic and tactical operations at a chemical release in a subway will be incident driven. If responders are overrun by evacuating civilians, initial actions may only involve assisting in the evacuation and decontamination of victims. However, if conditions are such that responders can perform a hazard assessment of the area, the First Arriving Ladder Company may proceed into the area after analyzing the risks associated with entry. The risks to responders must not outweigh the benefits of entry. 5.1 Avoid contact with any suspected agent. If possible, stay out of any spills, clouds, or fumes, and avoid physical contact with contaminated victims. 5.2 If a dispersal device is still operational, the first alarm units shall make no attempt to stop the device. Responders shall immediately retreat and proceed directly to Gross Decontamination. Bunker gear is not satisfactory protection against the concentrations of agents that will be present around a still operating dispersal device. 5.3 Members operating in bunker gear should not proceed in the Exclusion Zone any further than the farthest live victim when performing hazard assessment or rescue of ambulatory victims. 5.4 The officer must monitor on-air time of members in order to ensure decontamination is completed before the air supply is depleted. 5.5 Immediate actions onsite should include checking for secondary devices and monitoring radiation levels. Alarm activation and radiation levels shall be immediately reported to the Incident Commander. 6. FIRE BRANCH: FIRST ARRIVING LADDER COMPANIES 6.1 First Arriving Ladder Company Team 1: Evacuation and Hazard Assessment The First Arriving Ladder Company will form a team consisting of two firefighters supervised by the officer for victim evacuation and initial hazard assessment. Members are NOT to enter a subway where visible persons are unresponsive. If members come across an area with no responsive victims, indicating an immediate life threat to responders, they should transmit such information to the incident commander and retreat immediately to be decontaminated. Specialized units in proper PPE and metering devices should then be assigned to that area for assessment PPE of Hazard Assessment Team A. Don SCBA and facepiece B. Cover all exposed skin (i.e. hood in place, with earflaps down and coat collars up) C. For additional protection, don examination gloves under firefighting gloves 6

9 6.1.2 Initial Hazard Assessment A. If live victims can be seen or heard, the entry team shall make a rapid assessment of the area, using a route that does not impede the victims evacuation. B. If possible, identify the source and nature of the problem. C. Relay hazard assessment to the Incident Commander First Arriving Ladder Company Tactical Operations A. Direct victims to the Safe Refuge Area (SRA). B. Facilitate civilian evacuation by removal of barriers. If necessary, force open any gates or turnstiles to speed evacuation and allow later CPC equipped members to gain access. C. Mark the route for CPC Entry/Rescue Teams with search ropes. 6.2 First Arriving Ladder Company Team 2: Back-Up In addition to directing evacuation, two of the remaining members will be designated the Back-Up Team for First Arriving Ladder Company Team 1 and will establish a communications relay to the Incident Commander until relieved by the first arriving CPC equipped unit. 6.3 First Arriving Ladder Company Chauffeur The first arriving ladder chauffer will be responsible for apparatus placement, coordinating with other responding units to ensure controlled access to the site The first arriving ladder chauffer will assist in the establishment of the communications relay. 6.4 Second Arriving Ladder Company Tactical Operations The Second Arriving Ladder Company is responsible for the following: Coordinate and limit site access, remaining outside the Exclusion Zone Establish initial Contamination Reduction Zone using barrier tape or utility rope Establish Contamination Reduction Corridor Direct ambulatory victims from the SRA to the Emergency Gross Decontamination Area, if necessary Bring a Stokes Stretcher/SKED if available with a length of utility rope to drag non-ambulatory victims to the Gross Decontamination Area, if necessary 7

10 6.5 Second Arriving Ladder Company Team 1: Evacuation to Gross Decon Direct ambulatory victims from the SRA to the Gross Decontamination Area, if necessary Assist non-ambulatory victims to the Gross Decontamination Area using the Stokes stretcher, if necessary 6.6 Second Arriving Ladder Company - Team 2: Site Access Control Define initial Exclusion Zone with RED Haz-Mat barrier tape Establish Contamination Reduction Zone Establish Contamination Reduction Corridor 6.7 Second Arriving Ladder Company Chauffeur Positions apparatus out of the hazard area and as a barrier for site access control as ordered Coordinates apparatus placement with other responding units Establishes physical barriers to area using apparatus, barrier tape, traffic cones or traffic signs Assist Team 1 and Team 2 as necessary 7. FIRE BRANCH: FIRST ARRIVING ENGINE COMPANIES 7.1 First Arriving Engine Company Stage the apparatus and equipment upwind and away from any potential sources of contamination such as subway entrances and sidewalk gratings, but near enough to begin Gross Decontamination of contaminated victims. When staging apparatus, position near the location of the access/egress point(s) of First Arriving Ladder Company performing assessment Locate a working hydrant and connect to it, establishing a positive water supply Don appropriate PPE Remain outside the subway system unless ordered by the IC Provide Emergency Gross Decontamination for ambulatory victims in accordance with decontamination procedures. 8

11 7.1.6 Direct persons who have been decontaminated to Casualty Collection Points (CCPs) staffed by EMS for triage, treatment and transport Provide estimate of number of victims to Incident Commander Inform Second Arriving Ladder Company and Incident Commander if victims collapse on their way from the subway exit to the Gross Decontamination Area. 7.2 Second and Third Arriving Engines Given the number of remote entrances many stations have, the second, third and even fourth engines may operate independently, each at their own entrance, to ensure that decontamination facilities are available quickly at these locations The Engine Companies should be prepared to perform CFR-D duties as needed. 8. MEDICAL BRANCH: EMS FIRST ARRIVING UNITS 8.1 First Arriving Ambulances Establish contact with the Incident Commander Transmit to dispatcher incident type, number of patients, signs and symptoms observed, best access into incident and request for additional resources Operate upwind of chemical release in the Support Zone Don available PPE as necessary A. Helmet B. Safety coat C. Exam gloves D. Work gloves E. N95 respirator F. Goggles/Eye Protection Note: The N95 respirator and goggles are not sufficient PPE for chemical vapors. In the event of deteriorating environmental conditions, which requires immediate escape, don the APR mask/hood and leave the hazardous environment Establish a staging area for incoming resources Perform Simple Triage and Rapid Treatment (START) on decontaminated patients A. Black tag Deceased B. Red tag Immediate C. Yellow tag Delayed D. Green tag Minor 9

12 8.1.7 Utilize Casualty Collection Points (CCP) in the Support Zone until adequate resources are able to remove patients from the scene to designated hospitals 8.2 EMS Officer on Initial Assignment Report to Incident Commander Assume command of the Medical Branch Establish Groups, Sectors, etc. to participate in the Incident Command System, as necessary Evaluate scene safety/security Ensure all EMS members are utilizing proper PPE and that all non Haz-Tac members are operating in the Support Zone Coordinate best access and staging area for incoming EMS units Identify or evaluate triage and treatment strategy Garner information regarding: A. Type of event B. Number of patients C. Signs and symptoms of patients D. Identification of hazardous material Communicate directly with OMA On-Call Medical Director to confirm request and issuance of a Class Order, if necessary. Evaluate need for and request deployment of: CHEMPACK(s) - a stockpile of chemical/nerve agent antidote Controlled substances from the Weapons of Mass Destruction Controlled Substances Depot(s) Note: A Class Order is authorization for the use of a specific treatment or antidote kit. The Class Order is issued by a FDNY OMA Medical Director who is on scene, or is relayed by a FDNY OMA Medical Director through On-line Medical Control or FDNY Emergency Medical Dispatch Special call additional resources as needed. A. Mobile Emergency Response Vehicles (MERV) B. Logistical Support Units (LSU) C. Advanced Life Support Units (ALS) D. Basic Life Support Units (BLS) E. Haz-Tac Resources (HTA/HT Conditions/HT Bat) 10

13 Oversee medical care of patients Ensure hospitals are notified via Emergency Medical Dispatch (EMD) Ensure patients are decontaminated prior to being treated and transported. Redirect contaminated patients to the Decontamination Area. 8.3 Triage, Treatment, Transport Haz-Tac members may triage and treat contaminated patients After Gross and Technical Decontamination, patients will be triaged and treated by EMS personnel at the Casualty Collection Point(s) in the Support Zone Specific antidote treatments given to relieve, counteract or reverse the effects of poisons or drugs may be given following issuance of a Class Order. A. For Nerve Agents: Regional Emergency Medical Advisory Committee (REMAC) Protocol 400, Weapons of Mass Destruction (WMD) Nerve Agent Exposure Protocol B. For Cyanide: OMA Directive A/CFR-D Manual Chapter 6, Medical Management of Cyanide All exposed patients must be transported to a healthcare facility due to possible delay of onset of symptoms from exposure to certain chemicals The worried-well are ambulatory persons who are exhibiting no signs or symptoms of exposure, but are requesting treatment either due to fear or the delayed effects of some chemical agents. These people may have been somewhere in the vicinity of the event or they may have actually received an exposure. These worried-well should be directed to a designated area where they can be properly assessed and, if appropriate, interviewed by law enforcement and healthcare personnel. The number of worried-well is likely to be several times the number of persons actually affected. 8.4 Tracking All patients triaged, treated and/or transported must be tracked by EMS. Information regarding patient count and types of injuries should be relayed to the Incident Commander through the Medical Branch Director/Group Supervisor. 11

14 9. HAZ-MAT BRANCH: OPERATIONS The First HMTU Company Officer to arrive should be assigned as the Haz-Mat Branch Director/Group Supervisor and operate in that position until relieved by the Haz-Mat Company 1 Officer or the Haz-Mat Battalion Chief. 9.1 Haz-Mat Company Upon arrival, the Haz-Mat Company 1 Officer will assume the role of Haz-Mat Branch Director until relieved by the Haz-Mat Battalion Chief Haz-Mat Company 1 will verify initial monitoring results obtained by the First Arriving HMTU The specialists from HMC1 will initiate an entry whose objectives include: Advanced air monitoring Identification Containment Neutralization Mitigation Determine appropriate level of PPE for responder operations 9.2 Haz-Mat Battalion A. Bunker gear vs. Chemical Protective Clothing B. SCBA vs. APR or PAPR The Haz-Mat Battalion Chief will operate as the Haz-Mat Branch Director upon arrival. The Haz-Mat Battalion Chief and firefighter will don the appropriate level of PPE and report to the Incident Commander. After being briefed, the Haz-Mat Battalion Chief should supervise Haz-Mat operations and provide progress reports to the IC Upon arrival of the SOC Battalion Chief, the Haz-Mat Battalion Chief should take on a more strategic advisory role to the IC, assuming the role of Technical Advisor to the IC. The Haz-Mat Battalion Chief should consider remaining at the ICP and coordinate the response of the various CPC units. 9.3 Haz-Mat Technician Units (HMTU) Assist in air monitoring to identify safe zones including adjusting the perimeter of the Exclusion Zone and the location of the SRA based on meter readings Assist in rescue of ambulatory and non-ambulatory victims. 12

15 9.4 Rescue Companies Assist in rescue of non-ambulatory victims If non-ambulatory victim removal is initiated, provide the Incident Commander and/or Haz-Mat Branch Director with: A. An estimate of the number of removals necessary and their location. B. If bunker gear equipped personnel can be staged closer to victims and a victim relay from CPC equipped units to bunker gear equipped units is feasible, this should be initiated Determine non-ambulatory victims responsiveness and potential for survival using Noxious Stimulus Triage (NST)*. A. If the victim responds to voice or touch, the victim is likely to survive and should be removed from the area immediately. B. If the victim only responds to painful stimulus, survival may be possible, but requires immediate advanced medical treatment. The availability of such advanced treatment will influence victim survival. In a mass casualty setting, the large number of victims may require that rescue efforts focus on saving those victims with a better chance of survival. C. If the victim does not respond to painful stimulus, the CPC equipped members should leave the victim in place and proceed to the next victim. This victim will most likely not survive even if he/she receives the most advanced treatment available. D. Deceased victims should be left in place until the criminal investigation is completed, unless movement of such victims is necessary to rescue additional victims or to mitigate further hazards. *Note: Any CPC Level trained member or above may perform Noxious Stimulus Triage. 9.5 SOC Support Ladder Companies Report to the Incident Commander for a briefing of hazard assessment activities, limitations and PPE Begin immediate monitoring activities using instruments to support visual assessments of the First and Second Arriving Ladder Companies. Initial monitoring activities may be done in firefighting PPE to confirm appropriate zone establishment and safety of operating members. Don appropriate PPE based on the results of the monitoring. 13

16 9.5.3 If assigned as a component of the Mass Decon Task Force (MDTF): 9.6 CPC Companies A. Ensure various decontamination stations (i.e. ambulatory, non-ambulatory and responder) are established and adequately staffed. B. Assist in victim assessment and victim transition from the SRA to the appropriate decontamination station Establish a CPC FAST Unit for entry teams as directed by the Haz-Mat Branch Director Assist in rescue of victims. 9.7 SOC Battalion The SOC Battalion Chief may oversee the operation of personnel operating in the Exclusion Zone, and shall be prepared to operate in the appropriate level of PPE including Level A, to directly supervise operations in the Exclusion Zone. 9.8 Safety Operating Battalion Safety Operating Battalion oversees the overall safety within the incident control zones and monitors the control and mitigation activities of Haz-Mat personnel for compliance with standard operating procedures Upon arrival, the Safety Operating Battalion will report to the Incident Commander Duties may include: Evaluate control zones and access control points Ensure Staging Area and Operations Post are located in a safe environment Verify wind direction Monitor time/duration of incident Determine best response patterns for incoming units Oversee decontamination area Ensure that personnel are monitored for entry and exit time Ensure decontamination is completed before air supply is depleted 9.9 Haz-Tac Ambulances Conduct medical management of exposed civilians and responders prior to and during decontamination operations Conduct medical monitoring of entry team members. 14

17 9.10 Haz-Tac Officer Upon arrival, check-in with the Medical Branch Director, then report to the Haz-Mat Branch Director to coordinate Haz-Tac Operations Notify the Medical Branch Director for additional Haz-Tac resources as necessary Directly supervise all Haz-Tac operations on the scene of Haz-Mat assignments including triage/treatment, medical monitoring and decontamination procedures Oversee medical management for all victims of potential or actual hazardous materials exposure prior to and during decontamination operations Report updated information to the on-scene Medical Branch Director. 10. OFFICE OF MEDICAL AFFAIRS (OMA) 10.1 The On-Call Medical Director shall be special called as needed As a technical specialist, the Medical Director will assist the Medical Branch Director in the implementation of the Medical Branch operations. The On-Call Medical Director will be the highest medical authority on-scene providing medical control Responsibilities include: Issuance of a Class Order, as needed Act as the direct physician-to-physician contact with area hospitals Assist the Medical Branch Director in the management of patient care and in the determination of final patient destination. 11. BUREAU OF FIRE INVESTIGATION 11.1 Control access to the site 11.2 Provide force protection 11.3 Investigate suspicious and incendiary fires 11.4 Preserve evidence 11.5 Cooperate with law enforcement (FBI, NYPD, PANYNJ) 15 Rev. 09/01/14

18 12. CONCLUSION Operations at a chemical attack in a subway should be conducted according to this bulletin and other related Haz-Mat documents. Following the procedures outlined above will allow members to initiate immediate life-saving actions to the affected public, while ensuring the safety of members of the Department. Members will also act to mitigate the hazard and preserve the crime scene for further investigations. 13. RELATED PROCEDURES Protocol For Responses to Assignments Involving Unknown Substances: EMS Command Order Protocol For Patients Exposed to Unknown Substances: OMA Directive Medical Management of Cyanide(Revised): CFR-D Manual Chapter 6/OMA Directive A Issuance of a Class Order: OMA Directive Response to Cyanide Incidents: EMS Operations Order A Chemical Terrorism Preparedness and Response Card: EMS Operations Order CHEMPACKS: EMS Operations Order Controlled Substances at Nerve Agent or Organophosphate Incidents: EMS OGP Supplement B Protocol For Patients Exposed to Unknown Substances: CFR-D Manual Chapter 6/ OMA Directive Hazardous Materials Fire Tactics and Procedures o First Responder General Guidelines o Chemical Protective Clothing (CPC) Units o Decontamination Procedures o Hazardous Materials Technician Units (HMTUs) o Special Operations Command (SOC) Support Ladder Companies o Addendum 1: SOC Support Ladder Company Support Vehicle Equipment Hazardous Materials Response and Management: EMSC OGP Use of the MSA Air Purified Respirator (APR) Millennium Model: EMSC OGP , Supplement 1 Use of the MSA Response Escape Hood: EMSC OGP , Supplement 2 Vehicle Off Service-Decontamination: EMS OGP

19 FDNY COMMAND GUIDE FOR CHEMICAL ATTACK IN A SUBWAY Scene Restriction Confirm appropriate Exclusion Zone based on monitoring devices PPE: Consult with Haz-Mat resources for appropriate level Restrict entry of unprotected, untrained rescuers Restrict vehicular, pedestrian, aircraft traffic Hazard or Risk Analysis Evidence of release (i.e. note, dissemination device, threat, people/animals displaying symptoms of chemical exposure) Physical state of chemical hazard Flammable/combustible environment Multiple release points Potential secondary device Number of exposed/contaminated Location of civilians and rescuers (i.e. downwind versus upwind; away from ventilation gratings) Re-evaluate operational zones Resources Haz-Mat SOC EMS Transit Authority OMA NYPD Mass Decon Task Force Tech Specialist(s) OEM BHS DEP PIO Tactics Develop Strategic Operations: Defensive, Evacuation and/or Rescue Determine train and station status Define operational area (identify subway exists/access) Cover ventilation gratings on sidewalks Direct exposed victims to a Safe Refuge Area Set up Decontamination areas Establish Casualty Collection Points Protect-in-place or evacuate exposures (Consider: Risks, Direction of travel of the agent, Time of impact on population) Coordinate medical operations with Medical Branch Director Preserve crime scene Mitigation and Termination Neutralize hazard Document exposed victims Complete decontamination of scene, civilians, responders, equipment and apparatus Restore critical services 17

20 Chemical Agent Physical Distinguishing Onset Visible Signs Treatment States Characteristics Nerve Liquid, GA: Fruity odor Vapor: S-L-U-D-G-E-M Tabun (GA) Vapor GB: No odor Seconds Salivation Atropine Sarin (GB) GD: Camphor, fruit odor Lacrimation (tearing) 2-PAM Soman (GD) VX: No odor Liquid: Urination VX Min-Hrs Defecation GI distress Emesis (vomiting) Miosis/Muscle twitching Other: respiratory distress, convulsions Blister (Vesicant) Liquid N: Fishy, musty odor Mustard Skin: redness, blisters Mustard: None Mustard VAPOR, S: Garlic, mustard odor Hours Eyes: tearing, swelling Nitrogen mustard SOLID L: Odor of geraniums Resp. tract: runny nose, Lewisite: British Sulfur mustard Color: clear, yellow-brown Lewisite: sneezing, bloody nose, cough, Lewisite Minutes difficulty breathing Blood HCN: Gas Hydrogen Cyanide Odor: burnt almonds Immediate (HCN) CK: Gas, Cyanogen Chloride Liquid (CK) Resp. tract: gasping for air Other: convulsions, unconsciousness Choking Gas, Liquid Phosgene: clear to pale yellow Immediate Skin: redness, blisters None Phosgene color; Odor of musky hay Eyes: watery eyes Chlorine Cl gas: yellow-green color; Resp. tract: coughing, Ammonia Odor of bleach difficulty breathing Amyl nitrite or Sodium nitrite, Sodium thiosulfate OTHER All chemical agents, except hydrogen cyanide are heavier than air Exposure to chemical agents will result in immediate signs and symptoms (seconds to minutes), with the exception of Mustards and Phosgene, which will have delayed effects (hours). 18