Mass casualty incidents in rural areas pose unique challenges.
In September of 2019, a tour bus carrying 30 Chinese nationals traveling to Bryce Canyon National Park rolled over and crashed into a guard rail. Four people died and at least twelve other people with injuries that ranged from serious to critical.
Mass casualty incidents caused by bus crashes in rural areas often lead to more fatalities than similar crashes in urban areas.
“A National Highway Traffic Safety Administration (NHTSA) study published in 2005 found that nearly 60 percent of fatal crashes occurred on rural roads, despite the fact that rural roads incur only 39 percent of the total vehicle miles traveled and less than 20 percent of the US population lives in rural areas. The frequency of fatal crashes involving large buses, often referred to as motorcoaches, was documented through the NHTSA Fatal Accident Reporting System (FARS) as occurring an average of 137 times a year during the period from 2000 to 2007, with less than 25 percent of these occurring in rural areas. Despite comprising less than a quarter of those fatal crashes, the rural incidents accounted for 56 percent of the fatalities and 72 percent of the non-fatally injured victims.”
(NASEMSO Rural Highway Mass Casualty Guidelines, November 2011)
There are a multitude of factors contributing to the disparity in casualty figures between rural and urban area bus crashes. EMS system subject matter experts assert that rural areas of the United States suffer from a lack of adequate prehospital response capacity.
In many rural areas, few ambulances are available to respond at any given time due to limited funding and qualified staffing. Ambulances may have to travel many miles to reach the scene over difficult terrain and in bad weather.
Open reaching the scene, there are not enough qualified EMTs and doctors to handle triage and immediate care for all the victims. With not enough ambulances available, patients may be waiting by the side of the road for extended periods of time.
While grant funds to rural areas such as the Supporting and Improving Rural EMS Needs (SIREN) Act are available, the funding levels are inadequate for most jurisdictions to purchase, equip, and staff a turnkey, custom-build Medical Ambulance Bus (MAB) to serve as a mobile treatment center. These special purpose vehicles can cost between $500,000 and $1,000,000.
Some rural communities have begun to adopt innovative solutions to improve their prehospital triage, treatment, and transport capabilities.
Utilizing a surplus school or metro bus, and a bus stretcher conversion kit like the AmbuBus developed by First Line Technology, they can deploy a multiple patient transport vehicle at the Basic Lifesaving (BLS) level that can accommodate 12 supine patients for under $50,000.
With additional grant funding in subsequent years or financial assistance from regional coalition partners, they can upgrade the AmbuBus to Advanced Lifesaving (ALS) level complete with power, heating and air-conditioning, wireless multiple patient vital signs monitoring, oxygen flows, and other capabilities.
First Line Technology can also supply customized and pre-filled Multiple Casualty Incident Blocks. MCI Blocks are a modular storage, transport, and deployment system that are color-coded to triage standards for easy identification.
With an ALS equipped AmbuBus and easy to deploy MCI Blocks, rural EMS units can greatly improve their response to mass casualty incidents.
Fore more information on the AmbuBus, click here.
To see the original article on the Bryce Canyon bus crash, click here.
Use an AmbuBus as an on-site shelter for victims and responders.
Smoke and flames begin to rise from a multi-story apartment building. The smoke alarms blare and the building’s sprinkler system begins to shower everyone and everything in it with cold water.
Terrified tenants run outside into the freezing cold waiting for the fire department to arrive. There’s no place open nearby where they can find shelter.
The first responders on the scene know they must get the victims out of the cold before hypothermia sets in. They call to the dispatcher and ask to have one or more of the regional AmbuBuses deployed as quickly as possible.
The first AmbuBus arrives within half an hour. Responders help the most at-risk individuals onto the bus. The warmth from the bus’s heater is welcome relief to the victims.
Some of the victims are suffering from smoke inhalation so the EMTs place them on the AmbuStretchers and provide oxygen through the Mass Casualty Oxygen System (MCOS) and monitor them with the Multiple Patient Monitoring System (MPMS)
Other patients have medical devices that require electricity, so they plug them into the installed AmbuPower system which is a noise and smoke-free generator replacement.
Two more AmbuBuses arrive shortly thereafter. The responders use the second AmbuBus to accommodate the rest of the victims. Some of them are in wheelchairs so the EMTs set up the AmbuRamp which simplifies loading them. They lock the wheelchairs in place.
The two AmbuBuses containing victims depart for a local school which will serve as a temporary shelter. Since there are no cots there, the responders quickly remove the AmbuBus frames and stretchers and install them free-standing in the school’s gym.
Since the third AmbuBus is not needed for victim transport or shelter, the responders flip some of the stretchers up so that the firefighters that have been working in the wind and spray from the hoses can get out of the cold and rehab before returning to the fight.
Now ask yourself, how would your department handle this scenario if no AmbuBuses are deployed in your area?
To find out more about the versatile AmbuBus Conversion Kit, download our FREE 24-page brochure or call us at (703) 955-7510.
First Line Technology Assists in Jail Cell Decontamination
As fentanyl and other synthetic opioids continue to spread across the country, correctional facilities are discovering that prisoners are finding ways to hide or acquire these dangerous substances.
Recently, Al Lee of First Line Technology (FLT) received a phone call from Lieutenant Scott Brosis of the Aurora, Illinois Police Department. Correctional officers at the Aurora Police Department Headquarters had discovered that one of the prisoners had a stash of drugs that included heroin, meth, and fentanyl.
Concerned that the fentanyl may have contaminated the cell, they cordoned off the cell. Since they had never had to decontaminate a cell for fentanyl contamination before, they reached out to a private remediation company but were told that the firm did not decon fentanyl.
Lt. Brosis then asked Lt. Charlie Kunkel of the King County Sheriff’s Department if he knew of anyone who could assist them. Lt. Kunkel then referred him to Al Lee of FLT who had demoed our fentanyl decontamination solution there.
As Al spoke with Lt. Brosis, it became clear that since they had never dealt with fentanyl before, that someone should assist them in this first encounter.
Al offered to bring both an Electrostatic Decon Kit (EDK) and a sample of Dahlgren Decon. Al suggested that the Aurora Fire Department HazMat Team meet them at the facility so he could show them how to do the decon.
The next morning, Lt. John Ross and four other members of the Aurora HazMat team met Al and Lt Brosis at the facility. The spectrometer used by Aurora Fire Department was rather limited and could only detect up to 51% of fentanyl.
Fortunately, Al Lee had also brought a Synthetic Opioid Safety (SOS) Kit which contains BTNX Test Strips as well as the correct PPE required for small doses of fentanyl and both FiberTect Wipes and Dahlgren Decon.
Al suggested that they use the test strips to check for the presence of fentanyl. Two members of the HazMat Team donned PPE and entered the cell.
Using the tests strips, they determined that there was no fentanyl in the areas of the cell that where drugs had been found. However, to be safe, they decided to decon the cell.
Al showed them how to mix the Dahlgren Decon solution and dilute it with water for use in the Victory MG200 Electrostatic Sprayer included in the Electrostatic Decon Kit.
They sprayed the entire cell and its contents which only took a few minutes due to the efficiency of the electrostatic sprayer. At that point, they removed their PPE and disposed of everything following their department’s protocols.
“I was pleased to be able to help out,” Al said. “Once you see how easy it is to decon an area with the proper PPE, an electrostatic sprayer, and Dahlgren Decon, fentanyl isn’t a major problem anymore.”
When Water Makes it Worse
Thanks to Bob Wagner from Indiana TF1 for bringing this to our attention at the Indiana Hazmat Conference
Earlier this year the Centers for Disease Control put out guidance to avoid washing raw chicken before cooking. This was met with widespread skepticism, as many families had been washing their chicken for generations as a matter of course.
However, the CDC had very good reasoning – washing raw chicken can aerosolize harmful bacteria such as Salmonella and spread it across the counters, dishes, and utensils in your kitchen. Even a single tiny airborne water droplet can contain thousands of disease –causing bacteria.
Anyone who has sprayed a fire hose or pressure washer has seen and felt the mist that comes up and is familiar with aerosolization.
Aerosolization is the process of converting a solid or liquid substance into particles that are small and light enough to be carried on the air. Unlike vaporization the substances do not change their physical state to gas, however an aerosol made up of tiny liquid or solid particles can present some of the same challenges to the HAZMAT responder as a gaseous vapor. Aerosols can require different selection of PPE suits and respiratory protection, extensions of minimum safe standoff distances, and changes to where and how decontamination is conducted.
Just like spreading tiny bacteria laden water droplets from raw chicken, decontamination by using traditional methods that rely on spraying water can greatly increase the chances of spreading contamination. In fact, using the wrong kind of decontamination can turn a stable or contained solid or liquid hazard into a far more dangerous airborne threat.
New guidance from the US Department of Health and Human Services recommends using a dry absorbent wipe as the first step to safely remove bulk contamination. Besides being faster and easier to implement, dry gross decon is just as effective as water while posing a much lower risk of cross contamination. For responders in PPE, a low volume solution like Dahlgren Decon can then be applied to neutralize most chemical threats.
Enhanced using an electrostatic sprayer, Dahlgren Decon is applied as a very low volume, low pressure mist that attaches to the contaminant and prevents aerosolization. The application process is more like painting with an airbrush to evenly coat and contain the contamination, versus blasting it off with a pressure washer with all the previously mentioned risks of cross-contamination. The neutralized material can then be safely rinsed or wiped off as a final clean-up step prior to PPE removal.
First Line Technology products represent the state-of-the-art in decontamination technology and First Line Utilization Academy was created to advance tactics, techniques, and procedures for decontamination. To learn more about courses which teach safer, faster, and more effective Hybrid Decontamination techniques contact firstname.lastname@example.org or visit https://www.firstlinetech.com/flua/
October 2, 2019
Media Release: IMMEDIATE RELEASE
First Line Technology Brings Expansion to Stafford
Stafford, VA—First Line Technology, of Chantilly, is expanding its operations to Stafford. First Line, established in 2003, manufactures disaster preparedness, emergency response equipment and products for military and first responders.
First Line will purchase an office and manufacturing/warehouse facility on 487 Lendall Lane in Stafford County. The company sought out several sites in the region before identifying the Stafford site. The County and Stafford Economic Development Authority will assist in the expansion with an incentive agreement equal to a 50% rebate of the tax revenue generated by the company’s new business property investment over a five year period. In return, the company is committed to creating and maintaining at least 19 new jobs in Stafford.
“We are eager to encourage these types of businesses to expand and invest in Stafford,” said John Holden, Director of Economic Development and Tourism.
First Line has transferred and developed new products. Its newest product is a life-saving decontamination technology for warfighters and first responders nationwide. The U.S. Navy signed an exclusive license agreement with First Line in 2016 to permit the manufacture of the technology developed at Dahlgren.
“First Line is an excellent addition to Stafford’s business community. A growing business developing several lines of products for military, first responders, and civilian capabilities aligns with our ‘target industries’ platform perfectly,” said Board Chairman Gary Snellings. “It is wonderful to see First Line Technology choosing Stafford to expand their business,” stated Supervisor Tom Coen, George Washington District. “We recognize the need to protect our military and first responders, and are proud to be the location of a technology transfer agreement with Naval Base Dahlgren. We look forward to their continued expansion in Stafford County.”
First Line Technology is a minority-owned small business that develops and commercializes technology that defends the public from hazardous threats for U.S. and international first responders and military personnel.
“This property is perfect for us as it accommodates our needs for office space, our training capability, and the production and assembly of our products,” stated Amit Kapoor, President of First Line. “We’re excited about the continued growth of the company, and to partner with Stafford County to keep this success in Virginia. Fredericksburg Regional Alliance (FRA) was extremely helpful throughout the site Page | 2 selection process. Several facilities matched our needs, and we determined the Stafford location fit our current and long-term plans perfectly. It provides a place to showcase our corporate capabilities and space to grow additional product lines.”
FRA President Curry Roberts remarked, “Our hope is that First Line is literally the first of many businesses in the region that will open to develop Dahlgren’s military products for civilian use.”
For additional information and other work provided by First Line Technology, LLC, please visit www.firstlinetech.com or call 703.955.7510.
Read the original release here.
Dorian’s winds take damage to a whole new level.
Hurricane Dorian smashed into the Bahamas with sustained winds of 185 mph and gusts of 220 mph.
In an article by Jim McKay on Government Technology’s Emergency Management website, Jared Moskowitz, director of the Florida Division of Emergency Management was quoted as saying, “Whatever the building code is in the state of Florida — and we have the best building code in the country — it was not built for Hurricane Dorian.”
Nor are Florida’s standards designed for two 2017 storms. Hurricane Irma achieved 180 mph wind speeds, and Hurricane Maria touched 175 mph.
If these wind levels continue in future hurricanes, much of the effort that communities have spent into disaster resilience and response will be ineffective in protecting lives and limiting damage.
Among the challenge’s planners face will be the decision to evacuate hospitals, nursing homes, and at-risk homebound patients instead of having them shelter in place.
But with storms the size of Dorian, Katrina, and superstorm Sandy, the pool of available ambulances would be insufficient to handle the increased patient transport requirements. Mutual aid agreements would not provide much help as other communities will be attempting their own evacuations.
Many communities in areas where hurricanes and severe storms are prevalent have already added one or more AmbuBus Conversion Kits to their disaster response capabilities.
By permanently installing an AmbuBus Conversion Kit into an available school or metro bus, they have a ready-to-roll vehicle that can transport between 12 and 24 supine patients or a mix of supine and wheelchair bound individuals.
Many of these communities stock additional AmbuBus Conversion Kits and temporarily install them in vehicles when there is advance warning of an impending storm.
An AmbuBus has another critical advantage over ambulances in floods and hurricanes. A standard school bus has much higher clearance than an ambulance and can drive through a higher level of standing water than an ambulance.
For more information on the AmbuBus or to download a brochure with complete information on configuration, pricing, installation, and operation click here.
Hospitals evacuate patients as fire approaches.
The ongoing series of wildfires in California continue to expand at a frightening pace. Driven by winds that often exceed 85 miles per hour, officials ordered evacuations in large areas of Sonoma County.
As originally reported in The Mercury News, officials at Sutter Santa Rosa Regional Hospital and the Kaiser Permanente Hospital in Santa Rosa evacuated over 200 patients including eight babies from Neonatal Intensive Care Units.
In situations like these, officials often have to choose between attempting to shelter in place or transporting many patients in buses with only bench seating. due to a lack of available ambulances
Shelter in place poses the least risk to patients but if danger from the fire or prolonged outages make that tactic untenable, evacuations become the only option.
Many communities in the rural areas that are at most risk of woodland fires do not have access to multiple-patient transport vehicles (MPTV) and must shuttle a limited number of ambulances or worse, use school or metro buses that are not equipped to handle supine patients or wheelchairs.
To give emergency managers a cost-efficient solution to this problem. First Line Technology developed the AmbuBus Conversion Kit that can transform any available school or metro bus into a twelve to twenty-four patient transport vehicle in less than two hours with no power tools required.
The AmbuBus can be permanently installed for immediate response or temporarily installed when fire risk conditions suggest they may be needed.
The AmbuBus can be equipped with power, air conditioning, multi-patient monitoring systems and multi-patient oxygen to reduce the strain on patients’ health.
Read the original article here.
Part A is 10,000x more effective than Dawn dish soap.
Peracetic Acid (PAA) is the main oxidizing agent in Dahlgren Decon that chemically neutralizes toxic chemicals and emerging threats. But there is more chemistry behind the effectiveness of Dahlgren Decon than just PAA. In fact, Part A of Dahlgren Decon, also known as Dahlgren Surface Clean, was specifically formulated by the US Navy to be the most effective decontamination soap available.
A key challenge in decontamination is the removal of oily, viscous, and insoluble materials. These materials do not mix with water and require a huge volume of water and scrubbing to remove through sheer force. The traditional solution was to add a surfactant (soap) to the mix, which lowers the surface tension of water and helps the water and the material to mix. This mixing of soap, water, and contaminant is called an emulsion.
An example of an emulsion is Italian salad dressing. Just like Italian dressing, an emulsion with oily contamination will only stay blended for a short period of time before the oil, water, and any other contaminant begin to separate out. This can occur very rapidly and can lead to a small area of contamination being spread out in a thin layer across the entire surface area of a person or object.
The solution to this problem lies in microemulsions like Part A of Dahlgren Decon. A microemulsion is made using advanced surfactants, which reduce the surface tension of water over 10,000x more than commercial dish or laundry soap.
Multiple types of surfactants with different properties are used so that the microemulsion can accept both oil and water-based contaminants into the same solution, as well as quickly dissolve and trap volatile liquids and powder solids. The microemulsion acts like a liquid sponge, absorbing and holding large amounts of contamination. And most importantly, unlike a standard emulsion, microemulsions are stable and the contamination will stay in solution for an extended period until it can be easily rinsed or wiped away.
The microemulsion surfactant that is Part A of Dahlgren Decon is pH neutral and safe for use on skin.
It was originally developed for removal of some of the toughest challenges like Chemical Warfare Agents. However, it excels at physical removal of a broad range of hazardous materials from a wide variety of surfaces. Uses include washing off oily contamination like petroleum from spills.
Because it works well on both oil and water-based substances it can be used on both types of OC spray and riot control chemicals. It will wet, dissolve and remove fentanyl and its analogues while keeping the pH neutral, which is important to avoid aerosolizing or converting the fentanyl into a more dangerous form. The Part A microemulsion also has use in post-fire decontamination to help remove potentially cancer-causing materials.
New data can improve evacuation planning.
In a recent article by Jim McKay on Government Technology’s Emergency Management website, a new study of traffic patterns in 100 communities identified several factors that have a major impact on evacuation constraint risk.
StreetLight Data conducted the study which looked at 30,000 towns in the United States with populations under 40,000.
According to Laura Schewel, the CEO of StreetLight Data, “We decided to analyze small towns because those are the ones where you get the most horror stories and they have the most bottlenecks and the least amount of resources to deal with it.”
The StreetLight Data team developed an index that focused on a few key factors including:
- How many total routes out of town are there?
- On a typical day, what percentage of people take a certain route, even if other routes are available?
- Total population
When multiple routes are available, most people choose a route out of ease of use or force of habit. Emergency managers must evaluate the likelihood of congestion on those favored routes and not assume there will be an equal traffic load on all the available routes.
The states with the most evacuation-challenged communities are:
1. Florida (20 communities)
2. California (14)
3. Arizona (8)
4. Texas (6)
5. Washington (6)
The results of the study are available for free to government agencies.
Outside of the factors detailed in the study is the need for multiple patient transport capacity for hospital and nursing home evacuation, or picking up at-risk, homebound individuals. Many of the fatalities associated with large scale disasters that require evacuation occur among the elderly and other at-risk populations.
For more information on how the AmbuBus can give you the multiple patient transport capacity needed for these events, click here.
To read the original article on Government Technology’s Emergency Management website, click here.
Are We Handling Fentanyl Decon at the Appropriate Level?
Here are a few things no one discusses when we talk about the fentanyl crisis.
Most communities do not have dedicated, full-time HazMat teams. There aren’t six to twelve guys sitting around in full personal protective gear that only respond to HazMat incidents. They are usually firefighters that are also trained as HazMat Techs. They respond to fires and other routine calls.
So, when they get called out for small, street level amounts of fentanyl, they are unavailable if a fire or other incident occurs.
In addition, police, EMTs, and healthcare workers often stop and withdraw if they see anything that MIGHT be fentanyl or another synthetic opioid. They then call the HazMat team and wait for them to respond and handle the detection and decontamination of the substance. That often means they are unable to proceed with treatment or response.
That was fine when encountering fentanyl was a rare occurrence. But now, in much of the country, first responders and receivers are seeing it daily.
To be clear, fentanyl and other synthetic opioids in powder form can easily be aerosolized with deadly consequences.
In a recent incident, eighteen SWAT officers were taken to the hospital after a suspect kicked over a table with fentanyl on it. But most police, EMTs, and healthcare providers know to retreat and call the HazMat team if they encounter anything much larger than a street level quantity of a substance that might be fentanyl.
But the prevalent fear about fentanyl has often meant that HazMat teams are being called out for quantities that could easily be handled by anyone with a little training and the right equipment.
If a small quantity of suspected fentanyl is encountered, the first responder or first receiver has three key concerns that can easily be addressed:
DETECT – Simple, easy to use fentanyl test strips can detect the presence of fentanyl and other synthetic opioids quickly and accurately.
DEFEND – The only protective gear needed to protect against accidental overdose from small amounts of fentanyl are nitrile gloves, a P100 face piece respirator, and safety goggles. They should also have access to Naxalone (Narcan) in case an overdose occurs.
DECON – Much of the substance can be safely removed using a three-part wipe or mitt called FiberTect. Dahlgren Decon, an easy-to-mix and apply decontamination solution is peracetic acid based and completely neutralizes fentanyl in about five minutes.
First Line Technology, the developers of FiberTect and Dahlgren Decon offer both training and all the equipment needed for first responders and healthcare workers to safely detect and decontaminate small quantities of synthetic opioids like fentanyl.
The First Line Utilization Academy offers a wide range of courses which combine both classroom sessions and hands-on experience. These courses include:
- Synthetic Opioid Safety – A four-hour course for First Responders, Correctional Workers, Healthcare Workers
- Tactical DeconTect for Law Enforcement/EMS – A four-hour course on field decontamination of individuals and equipment
- Dry Decon Training – A four-hour course that covers basic awareness of hazardous material threats, contaminant identification, safety precautions, and operational use of Dry Decon to remove up to 95% of the contaminant using FiberTect wipes.
- DeconTect Train-the-Trainer – An eight-hour course for First Responders, Medical Professionals, and Correctional Workers to enable them to effectively train others in their organization in Hybrid Decontamination
For more information or to register for courses, click here.
First Line Technology also offers a wide range of easy-to-use kits that bring together everything responders need for the decontamination of Fentanyl and hundreds of other known and emerging threats. For more information, click here.
Incident highlights need for large-area fentanyl neutralization.
In a recent article by Eric Levenson and Mirna Alsharif on CNN, six staff members at the Chesire Correctional Institute were taken to local hospitals for possible exposure to fentanyl.
If fentanyl becomes aerosolized, it can be easily dispersed over an area by air circulated by fans or air conditioners. This can contaminate large surface areas or cause overdoses.
Correctional facilities are beginning to see these types of incidents occur frequently within cell blocks or common areas.
To reduce the risk of accidental overdose, personnel at jails and prisons should be trained to identify fentanyl and other synthetic opioids and response teams set up to quickly neutralize the threat before it spreads to larger areas.
First Line Utilization Academy (FLUA) offers customized training for law enforcement and correctional facility personnel. FLUA has a Tactical DeconTect for Law Enforcement Class as well as a Synthetic Opioid Safety Class. Details on each program can be found by downloading the FLUA Course Catalog here.
First Line Technology offers a wide range of decontamination kits that scale from an individual responder size to a large team or area decon kit that utilizes an electrostatic sprayer. Details on the decon kits available can be found here.
See the original CNN article here.
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