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Disclosure

I do not have an affiliation (financial or otherwise) with any commercial organization that may have a direct or indirect connection to the content of my presentation.

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Objectives: Review CBRN Risk Assessment Discuss importance of planning for

Personnel Safety Explore the readiness of Canadian

EMS providers – Survey

“Accidental” emergencies Major Industry Small business Agriculture Transportation

Terrorist attacks• WTC bombing (biologic agent) 1993

•Tokyo Sarin gas release 1995• Edmonton – pipe bombs with chemical agent 1998

Risk = Probability x Impact

Risk = Probability x Impact

Probability?Highly likelyLikelyPossibleUnlikely

Impact?Marginal SeriousCritical Catastrophi

c

Myth:

“Canaries are inevitable”

There is a shockingly passive attitude towards First Responder safety.

We can AND MUST benefit and learn from other people’s issues, lessons, and experiences.

Some lessons are too expensive to be learned twice.

Public Safety agencies must identify risks to First Responders and protect them

CBRN awareness and surveillance must occur at the beginning: 911 operators, paramedics, security, emergency triage

Emergency Triage or 911 Awareness Pattern recognition Multiple patients with similar patterns of

symptoms: Seizing, vomiting (nerve agents) Shortness of breath (asphyxiants) Unconscious (carbon monoxide, opioids) Screaming in pain (blister agents)

HeroUnexpected eventNo trainingNo preplanningNo equipmentNo backupOnce in a lifetimeHigh mortality

ProfessionalPredictableTrainedPreplannedEquippedBackupMultiple

exposuresLow mortality

HeroEvent =

emergency

Professional Emergency =

eventExpecting that people with “rise to the occasion” and manage in a CBRN event and “save lives” is setting them up to be heroes with a high mortality.

A professional can perform a heroic act, but that shouldn’t be the expectation

What we need to achieve in our response capability to CBRN, emerging infections, and “all-hazard” issues:

Live professionals not dead heroes

AwarenessBasic Level Intermediate LevelAdvanced Level

RecognizeSurviveRespondInterveneRecover

There are three zones:

• Hot zone

• Warm zone

• Cold zone

Assessment of risks is first step in planning

Helps focus efforts and ensures no possibilities are missed

Helps prioritize efforts in preparedness Most likely “risk” in Hamilton is

unrecognized exposure to one or a few patients (small industry, lab, agriculture) with secondary contamination of facility and personnel

Recognition and safety are keyWe don’t have to have “canaries” Heroes vs ProfessionalsPlanning, education and training

ensure personnel are able to act as professionals and keep themselves and subsequently other health care providers safe

Decontamination is the systematic process to remove CBRN material from patients to render them safe to others

Secondary exposure can occuras patients off-gas the CBRN material to surrounding people including EMS providers

Dr. Michelle Welsford co-authors: Dr. Daniel Kollek & Dr. Karen Wanger

Other countries have initiated or finalized plans for pre-hospital emergency response to CBRN events

The readiness of Canadian EMS personnel is unknown

On-line survey of pre-hospital providers in BC and Ontario

Survey addressed the self-reported theoretical and practical CBRN training received

1028 respondents, most were: Male 36-50 years 16-22 years experience Predominantly front-line

personnel

Of the 63% who had received training: 61% had received “hands on” or

practical training 39% had received only theoretical

training

Canadian EMS CBRN preparedness is possible

Live Professionals not Dead Heroes

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