Four Transport Incubators. 30 Patients in NICU.

How do you evacuate all the infants safely?

A recent fire at Children’s Hospital Los Angeles Main Campus forced the temporary evacuation of about 200 people.

Fortunately, in this instance, no one was injured, and normal operations were soon restored. But the possibility of incidents like this keep many healthcare professionals up at night.

How would your facility handle the evacuation of many neonatal and infant patients with the available transport incubators and ambulances that are usually available? 

How would you decide which patients are transported in the incubators? What do you do with the remaining patients? 

How long would it take to transport thirty infant patients (and their mothers), in the ambulances that would be available? 

Now many regional healthcare coalitions are preparing for these types of situations with two emergency medical transport solutions.

The Baby Pod 20 is a lightweight infant transport device that can be strapped to a seat or stretcher that provides four layers of protection to an infant.  Built with the same materials and engineering as a Formula 1® racing car, it can withstand am accident with 20Gs of force in four directions. It can easily be carried by one person, is significantly less expensive and also requires less storage space than an incubator.

The AmbuBus Conversion Kit can be used to convert any available school or metro bus into a multi-patient transport vehicle that can accommodate between 12 and 24 patients on stretchers. By having one or more buses permanently equipped with the AmbuBus frames, you can safely transport large numbers of patients without depleting the pool of ambulances needed for those that are critically ill.

Together, they are a complete emergency neonatal and infant multiple patient transport solution.

The AmbuBus can also be used in a wide variety of other situations such as mass casualty transport, responder rehab, and victim sleeping quarters. The AmbuBus frames can also be set up free-standing for hospital surge or quarantine situations.

Both the AmbuBus and the Baby Pod 20 are available from First Line Technology.

For more information on the Baby Pod 20, please click here.

For More information on the AmbuBus, please click here.


Will There Be Another Active Shooter Incident in the Next 64 Days?

If we can’t stop mass shootings, we need to respond better.

Active shooter incidents in recent history have shown that communities everywhere must be better prepared to respond to mass casualty events.

Studies indicate that the rate at which public mass shootings occur has tripled since 2011. Between 1982 and 2011, a mass shooting occurred roughly once every 200 days. However, between 2011 and 2014, that rate has accelerated greatly with at least one mass shooting occurring every 64 days in the United States¹.

No community can ever be fully prepared for large scale incidents, but every community should undertake an objective and comprehensive review of their existing mass casualty plans.

These types of incidents can easily overwhelm the essential personnel and resources needed to manage the response. Even with frequent planning, drills, and exercises, first responders and first receivers struggle to adapt when faced with mass numbers of casualties, and limited medical triage, transport, and treatment resources.

Public health professionals, emergency managers, emergency medical service directors, police and fire chiefs, are constantly looking to identify “choke points” that could reduce their ability to handle mass casualties.

One of the most frequently cited choke points is the lack of adequate medical transport capacity.

Most ambulances carry one or two patients. With current budget constraints, most EMS units only have enough ambulances and EMTs to respond to daily 911 calls and a small reserve.

When a large-scale incident occurs, even with the support of private ambulance providers, patients may have long wait times before they can be taken to a trauma center.

One solution would be for each community to buy a Medical Ambulance Bus (MAB) that is equipped at an Advanced Life-Saving Level that can handle critically wounded patients.

However, an ALS equipped MAB can cost between $500,000 to $1,000,000. As the pool of available grant dollars has declined, purchasing a MAB is beyond the reach of many communities.

However, there is an affordable alternative.

The AmbuBus Conversion Kit developed by First Line Technology can be used to convert any available school or transit bus into a multi-patient transport vehicle for up to 12 supine patients in about two hours with no power tools.

Many communities acquire an end-of-service school or transit bus as a donation or for a nominal price.

The Basic Life-Saving (BLS) level AmbuBus Kit contains two frames which typically each hold 12 patients leaving an open center aisle. Together with 12 stretchers, pillows, and a purpose-built ramp for loading, an AmbuCarrier wheeled patient transport device, the BLS kit costs approximately $36,000.

First Line Technology offers a full range of accessories including a wheelchair package, portable electric power, multi-patient vital signs monitoring system, and a mass casualty oxygen system to enable the community to expand the capabilities of their AmbuBus.

Most communities permanently install the AmbuBus kit in one or more vehicles for no-notice incidents like active shooters. They then store additional AmbuBus kits for events like hurricanes where there is some advance notice.

There are over 550 AmbuBuses on the road that are used for mass casualty events, hospital and nursing home evacuations, responder rehab, victim sleeping quarters, and hospital surge situations.

For more information on the AmbuBus and its related accessories, please visit 

You can download a free 24-page brochure with details and pricing for the AmbuBus here


¹ Cohen, Amy P.; Azrael, Deborah; Miller, Matthew (October 15, 2014). ”Rate of mass shootings has tripled since 2011, new research from Harvard shows”. Mother Jones. Retrieved December 13, 2017.


Mass Casualties in Paradise

Everyone dreams of a tropical vacation in Hawaii.

But for the passengers and crew of a recent Air Canada flight, an unexpected trip to Honolulu was not on the itinerary. Severe turbulence inflight caused multiple injuries that required the plane to be diverted to Hawaii.

With a significant number of mass casualties onboard the aircraft; federal, state and county agencies from the airport and surrounding areas responded.

Chief Dean Nakano of the Honolulu Emergency Medical Services explained the incident and how his organization was able to use an AmbuBus in its response effort.

“On July 11, 2019 we got a call that an Air Canada plane was on a non-stop flight to Australia when they hit some turbulence and that there were injuries on the plane. They were about one hour past Honolulu when the turbulence occurred. They turned the plane around and flew to Honolulu so the injured could be treated,” said Chief Nakano.

Initially, there were reports of critically injured people on the flight. It was estimated there were 20 individuals in need of medical attention from a total of 269 passengers and 15 crew members onboard the plane.

The Daniel K. Inouye International Airport falls outside the jurisdiction of Honolulu EMS. Incidents there are the primary the responsibility of Hawaii Crash and Rescue and American Medical Response (AMR). “Usually, if an incident occurs there, Honolulu EMS is asked to assist if needed before sending units. However, when we heard there were at least 20 injured and an unknown amount of critically injured people, we started deploying our resources,” Nakano said.

Honolulu EMS responded with a District Chief, three ambulances, along with the AmbuBus. The Chief of Operations also responded to assist with triage and treatment.

The AmbuBus deployed by Honolulu EMS was donated by the City and County of Honolulu Transportation Services, which operates the bus services for the county. “When we received it, the bus had 600,000 miles on it. They have great mechanics at the Transportation Services Department because the bus is still running four years later.”

Honolulu EMS purchased two AmbuBus kits to refurbish and equip one bus as a multi-patient transport vehicle. Now it’s capable of supporting 12 supine patients, or 24 seated patients.

Chief Dean Nakano. Honolulu EMS

“The AmbuBus is positioned about an hour away from the airport in rush hour traffic. Unfortunately, we have not been able to have a secure parking location for the AmbuBus closer to town,” said Nakano.

“The AmbuBus was rolling at about six o’clock (that) morning, which is peak rush hour traffic in the area. When it arrived at the airport, triage was set-up and we were able to assess the injured. Luckily, there were no critically injured patients, but we saw we had several walking wounded individuals,” said Nakano. In total there was close to three dozen patients.

There was one federal ambulance and four AMR ambulances at the scene, but their crews were tied up with triage, treatment, and transport duties, according to Nakano.

“Some of the patients were transported by the ambulances on the scene and we escorted seven patients onto the AmbuBus, treating and transporting them to the trauma center,” said the Chief of EMS.

“If the AmbuBus had not been available, transporting the patients would mean using 5 or 6 ambulances making multiple trips. That would tie up one third of the total pool of Oahu’s city ambulances. Taking that many ambulances off their regular duties would put a serious strain on our ability to respond to 911 calls,” Nakano added.

Unlike most EMS departments around the country, Honolulu Emergency Medical Services Division is not part of a Fire Department. The Honolulu Emergency Medical Services division is under the Honolulu Emergency Services Department which also includes the Ocean Safety division.

Honolulu EMS is responsible for providing services for the entire island of Oahu. Oahu county has close to 1 million residents and last year approximately 10 million people visited Hawaii.

The Division had approximately 150 paramedics, which includes unit supervisors, district chiefs, and about 80 emergency medical technicians and 25 emergency medical dispatchers. Honolulu EMS has 21 units (two of which are part-time) so when Air Canada experienced its incident last month, they had 19 units on-duty.

In 2018, Honolulu EMS responded to 95,995 911 calls by ambulance and transported more than 56,600 patients to local emergency rooms. Emergency medical dispatchers answered more than 120,000 911 calls.

Chief Nakano has been with Honolulu EMS since January 4, 1981. He started as an EMT before moving up to a paramedic. He was a unit supervisor for about 12 years and then a District Chief for ten years. He has served as EMS Chief for four years.

Chief Nakano said, “In the four years we have had the AmbuBus, we have used it primarily for training and as standby medical support for large events. For example, we have recently had it deployed during a Bruno Mars concert, the Honolulu Marathon, the Pearl Harbor 75th Commemoration, and the Fourth of July Fireworks show.

We are hoping to have a second bus donated so we will have additional multi-patient transport capacity if we have other large-scale events.”

But of course, they hope to have it but not have to use it.


Click here for more information on the AmbuBus. 


First Line Technology Recognized for Lab-to-Life-Saving Innovations

Fairfax County Economic Development Agency has produced a video profile of First Line Technology. The video showcases several of the innovative disaster response solutions developed by First Line Technology for use by first responders and the military.  

In the interview, Amit Kapoor, President and CEO of First Line Technology, explains how the company works together with world class scientists and developers in federal and academic labs to identify solutions that have the potential to offer significant advantages to first responders. 

Among the products presented in the video are: 

  • The AmbuBus Conversion Kit which can be used to convert any school or transit bus into a multi-patient transport vehicle in about two hours 
  • Dahlgren Decon and FiberTect wipes which are used together as integrated hybrid decontamination process that can completely neutralize hundreds of known and emerging threats 
  • PhaseCore professional grade personal cooling vests and the Immersion Cooling Equipment (ICE) System for preventing heat stroke 

The Army’s Other Enemy: Heat Stress

The Military Learns to Combat Deadly Heat Stress 

As temperatures riseincreasing numbers of soldiers are put at risk of enduring heat stress that can end their careers or even kill them. 

In a recent NBC News report by David Hasemyer of Inside Climate News, the U.S. Army is putting significant effort into understanding the causes of heat stress and treating soldiers that experience its effects. 

The video showcases how Fort Benning Georgia’s Emergency Room is developing new treatments for heat stress, as well as teaming with researchers to identify potential cases on an individual level before a serious health problem occurs. 

Research and treatment of heat stress is necessary, but an essential factor may be overlooked. 

Preventing heat stress is better than treating heat stress.

Recently, several Army bases, both in the United States and overseas are deploying a simple but highly effective heat stress prevention modality. Portable, durable basins of cold water such as the ICE System manufactured by First Line Technology are prepositioned along the route of march or at remote ranges where training occurs during hot weather. 

During training or operational cycles, soldiers immerse their forearms into the cold water and walk in place to circulate their blood. Their cooled blood flows throughout their bodies dropping their core temperature about 1.8F in 3 to 10 minutes. 

The ICE System can accommodate up to six individuals at a time. If a serious case of heat stress occurs, the ICE System can be used to fully immerse an individual up to six feet in height and the basin can hold up to 800 pounds. 

For more information on the ICE System, please visit 

To see the original article visit, 


Mass Casualty Wildfires Could Overwhelm Hospitals and Medical Transport

As reported by Adam Rogers for Wired, the devastating California Camp Fire in 2018 was a wake-up call to emergency managers and public health professionals.

The fire killed at least 85 people and destroyed the local Feather River Hospital. That reduced the available medical treatment facilities needed to treat patients and requiring the evacuation of existing patients.

The article states, “That moment made real a problem that specialists had been warning about for years. “There were four beds immediately available in the entirety of Northern California for a burn patient. Everyone else was going to have to wing it,” says Tina Palmieri, director of the Firefighters Burn Center at UC Davis, which would receive 10 burn victims from the Camp Fire alone.”

The threat of major wildfires has been increasing with both climactic conditions and the encroachment of human beings into areas that were once wilderness.

Regional coalitions of emergency managers, healthcare providers, and EMS services in wildfire prone areas are looking for ways to build flexibility and resiliency into systems that are resource constrained.

One potential solution for both the medical transport and patient surge capacity issues is to stock and deploy temporary medical transport capacity and patient sleeping quarters using systems like the AmbuBus Conversion Kit developed by First Line Technology.

In a wildfire scenario, the AmbuBus can be an invaluable resource in four critical areas of response:

Multi-Patient Transport

The AmbuBus Conversion Kit provides two structural steel frames that can typically accommodate 12 patients on stretchers or backboards. The kits can be installed permanently or temporarily into any available school or metro bus in less than two hours by two people with no power tools.

Most communities that utilize the AmbuBus install at least one permanently so that it can be rapidly deployed to evacuate hospitals, nursing homes, or at-risk homebound patients from the disaster area.

They also stock additional AmbuBus kits that can be temporarily installed for additional transport capacity when the danger of a wildfire is imminent.

Hospital Surge Capacity

The AmbuBus kit can be set-up free-standing in a hospital corridor or cafeteria. Less critical patients can be accommodated here which will free up hospital beds for seriously burned or ill patients.

Victim Sleeping Quarters

Major wildfires can destroy hundreds of homes. Additional AmbuBus kits can be installed in schools or tents as temporary sleeping quarters for victims until more permanent accommodations can be found.

Responder Rehab

When not needed for patient transport, an AmbuBus-equipped vehicle can be dispatched to the fire staging area providing a place to rest and rehab or on-scene sleeping quarters.

For more information on the AmbuBus Conversion Kit, click here.

To read the original Wired article, “Hospitals Aren’t Ready for a Mass Casualty Wildfire”, click here.


Baby Pod 20 included in NASEMSO database of Pediatric Transport Products for Ground Ambulances

The National Association of State Emergency Medical Services (EMS) Officials has just released the Pediatric Transport Products for Ground Ambulances, Version 2.

The document is a resource for EMS providers to determine existing options for securing infants and children who are transported by ambulance.

Over 1 million pediatric patients are transported by ambulances nationwide each year. There are an estimated 5,000 ambulance-involved crashes annually, with 10% involving infants or children. 

The Centers for Disease Control and Prevention (CDC) has noted that ambulances are 2.5 times more likely to be involved in a crash than an automobile. While ambulances are generally well equipped to secure adult patients, many are lacking proper devices to secure their youngest patients whose varying sizes make the challenge even greater.

A recent study found that of 200 ambulances observed carrying 206 pediatric patients, more than half of the patients were lying on the stretcher, and 11% were unrestrained. Additionally, 27% of observed pediatric patients were unrestrained on the bench seat, 10% were on the lap of a parent or EMS provider, and 13 different types of medical equipment were minimally secured or not secured at all. 

Why is there such a diversity of ways that infants are transported in ambulances? There are multiple factors, including:

Lack of Standards Increases Risk

There are no established guidelines for infant patient transport, only recommended best practices. This puts each EMS organization and ambulance provider in the position of deciding how they will handle infant patient transport.

Insufficient Funding

Up to now, the preferred method of infant patient transport required both a transport incubator and a dedicated ambulance that could accommodate it.

A transport incubator can cost between $50,000 and $80,000, while an ambulance to carry it could cost $300,000 or more. Many EMS organizations and ambulance providers cannot fund this level of investment.

Risk to the Infant Transport Crew

One factor that is widely overlooked is that a transport incubator during an ambulance accident can break free and injure or kill the infant transport crew. Some ambulance providers refuse to transport infant patients for fear of liability issues.

Separating the Child from the Mother

Many ambulances are designed to carry one patient. If the cot is being used to transport the infant, the mother may have to be transported in another ambulance. This not only ties up two ambulances- mothers sometimes refuse to leave the child during transport.

Infant Transport is Time Consuming

When infant patient transport using an incubator is required, the process disrupts the normal operations of both the ambulance provider and the involved hospital staff.

Typically, the ambulance crew must go to the location where the travel incubator is stored. They may have to remove seating and storage from the vehicle. They then must load and secure the incubator, which may weigh 250 pounds or more. They drive to the sending hospital, unload the incubator, and take it to the pediatric unit.

The hospital team prepares the infant for transport and loads the child in the incubator. The transport team then loads and secures the incubator and drives to the receiving hospital. The unload the incubator, take it to the pediatric unit, and the hospital team unloads the child.

The ambulance crew then must load the incubator, drive it to the storage facility, unload it, and reinstall the seats and storage.

The Baby Pod 20 – Born from Tragedy

After a series of deadly infant transport accidents, an engineer became obsessed with solving the problem.

While watching a Formula 1® race one day, he saw a car hit the barriers at over 200 miles per hour. Seeing the driver walk away from a crash that destroyed the car around him, he realized there was a better way;

Replace the heavy incubator with a smaller, lighter, infant transport device. Less weight equals less mass, less inertia, and less danger to the patient and ambulance crew. 

He approached one of the world’s leading manufacturers of Formula 1® racing cars. They quickly saw the need for a safer infant transport device and put their expertise, time, and talent to work.

Thus, the Baby Pod was born.

The Baby Pod 20 is safer, more affordable, and more efficient than travel incubators.

The Baby Pod 20 was designed to overcome all the disadvantages of a transport incubator.


The Baby Pod 20 is designed and built with the same materials as a Formula 1® racing car. Altogether, there are four distinct layers of protection for the child:

  1. The outer shell of Baby Pod 20 is constructed of carbon fiber, which is a strong, yet lightweight and durable material. It acts as a rigid cocoon to protect the infant from flying debris.
  2. The Baby Pod 20’s internal shock absorbent foam is constructed of polyurethane foam with a PUNL® removeable cover, which remains breathable, yet is impervious to liquids and solutions. The foam interior surrounds the infant’s head, feet, and sides during transport and is designed to help protect the infant in the event of impact.
  3. The vacuum mattress is manufactured from a soft foil and is filled with flame-retardant polystyrene beads. Removal of the air from the vacuum mattress via the attached valve allows secure positioning of the baby within the Baby Pod 20. It also reduces discomfort caused by road vibration as well as dampens traffic noise.
  4. Maintaining the infant’s core body temperature during transport is critical. That is why up to now, transport incubators were necessary. The Baby Pod 20 incorporates the Transwarmer™ Infant Transport Mattress which is designed to provide radiant heat and additional shock absorption to the infant during transport. Unlike an incubator, the Transwarmer™ Infant Transport Mattress does not require electricity to maintain the infant’s core temperature.

In addition to these four layers of protection, the Baby Pod 20 incorporates additional state of the art safety innovations to protect the infant. With all these features the Baby Pod 20 can withstand 20Gs of force in four directions and up to 10Gs vertically or inverted making it the safest infant transport device available.


A typical transport incubator costs around $60,000 and requires a dedicated vehicle that can cost up to $360,000. You can buy seven Baby Pod 20 Infant Transport Devices for the cost of one incubator.


Typical time to transport an infant using an incubator in a dedicated incubator ambulance is between 7 and 8 hours. Typical time to transport an infant using a Baby Pod 20 in any ambulance or aircraft is 3 to 4 hours.

With all these advantages over travel incubators, it is easy to see why EMS organizations, ambulance providers and hospitals are beginning to adopt the Baby Pod 20 as their primary infant patient transport device.

NASEMSO plans comprehensive crash testing

NASEMSO created the Pediatric Transport Products for Ground Ambulances resource to minimize the confusion by allowing the EMS industry to compare the products available.

Inclusion of a product in the Pediatric Transport Products for Ground Ambulances resource does not imply that it has been deemed “safe” or is endorsed by NASEMSO. Unfortunately, there are no minimum safety criteria to be included in the product list, because such criteria have not been developed.

Unlike child carseats used in automobiles, which must meet rigorous safety standards developed by the U.S. Department of Transportation, there are no such requirements for child transport devices used in ambulances. Further, industry experts agree the testing criteria for child seats designed for automobiles do not apply to the patient compartment of an ambulance.

NASEMSO hopes to fill this gap by organizing and leading a comprehensive crash testing project to determine pass/fail criteria for these pediatric transport products. The project will be a collaborative effort involving national EMS organizations, manufacturers of the equipment (who will donate their devices for the crash testing research), safety engineers, and pediatric experts. The crash testing research is expected to be a five-year effort before the criteria are developed and standards are published. In the interim, NASEMSO urges EMS providers to utilize devices specifically designed for child transport in ambulances.

The Pediatric Transport Products for Ground Ambulances, V2 is available here.


WATCH: Manatee County Florida Deploys an AmbuBus

See Manatee County EMS District Chief Jason Evans Present the Multi-Patient Transport Vehicle

Manatee County Florida has deployed an AmbuBus Conversion Kit in a metro bus frame to serve as a multiple-patient transport vehicle. The bus can accommodate 17 passengers in a single trip. 

In a recent television newscast, Manatee County EMS District Chief Jason Evans explained their plans for using the AmbuBus for mass casualty incidents, medical evacuations, major sporting events, and other scenarios. 


For more information on using the AmbuBus for mass casualty response call (703) 955-7510 or email 



Tornadoes, Hurricanes, Floods, or Wildfires? Which Will You Face?

2019 Could be a challenging year for emergency managers.

If current conditions continue, 2019 may be one of the worst years for natural disasters in America.  

From January through May, we have already seen 611 tornadoes that have caused at least 38 fatalities and left hundreds homeless. This figure includes a record 13 straight days with at least 8 tornadoes reported. 

For 2019, NOAA’s Climate Prediction Center is predicting a likely range of 9 to 15 named storms (winds of 39 mph or higher), of which 4 to 8 could become hurricanes (winds of 74 mph or higher), including 2 to 4 major hurricanes (category 3, 4, or 5; with winds of 111 mph or higher). 

Vast areas of the United States are at risk of flooding this spring, even as Nebraska and other Midwestern states are already reeling from record-breaking late-winter floods. Some 13 million people could be exposed to major flooding, making this a “potentially unprecedented” flood season, said Edward Clark, director of NOAA’s National Water Center. 

While much of the country should have fewer wildfires in 2019, the West Coast of the U.S. could see many significant wildfires according to the National Interagency Fire Center. 

Future events like those mentioned above may require the evacuation of patients in hospitals and nursing homes as well as home-bound, at-risk citizens.  

If your community suddenly must deal with a large-scale disaster, will you have enough multiple-patient transport capacity to manage both large numbers of casualties and patient evacuations? 

What emergency planners need is a scalable, affordable, and flexible approach to multi-patient transport. 

One option that is being used by many communities is to convert existing transportation assets on a permanent, or as needed basis to handle mass casualty situations. 

By leveraging surplus or end of service school or metro buses, using a conversion kit such as the AmbuBus from First Line Technology, a community can have a vehicle that can transport up to 18 non-critical patients for well under $50,000. 

The organization can often borrow the vehicles for temporary use or buy them for a nominal amount from the school or transportation district. They then purchase one or more AmbuBus conversion kits which cost between $25,000 to $50,000. Once assembled, which takes two people about two hours, the converted AmbuBus can carry up to 12 non-critical patients, two or more EMTs, and medical supplies. 

By having at least one AmbuBus kit permanently installed the community has a multi-patient transport vehicle (MPTV) that can handle mass casualty incidents that have no prior warning. 

They can then purchase additional kits that are unassembled and stored in wooden pallets. These can be stacked up in any available warehouse and used to temporarily convert additional buses for events such as hurricanes. 

Since the installation of the kits does not require any holes to be drilled, the structural integrity of the vehicle is preserved, and it can be returned to regular service after the event.                                                           

For more information, download the free white paper, “A Scalable Approach to Mass Casualty Transport” at 


Are Electrostatic Sprayers the Right Choice for Personnel Decon?

New EPA report evaluates the effectiveness of electrostatic sprayers

The use of electrostatic sprayers has been a matter of serious debate across the HazMat community. However, with the release of a recent EPA report, the evidence is growing that electrostatic sprayers have significant operational and financial advantages.

The report titled, “Evaluation of Electrostatic Sprayers for use in a Personnel Decontamination Line Protocol for Biological Contamination Incident Response Operations” presents the results of rigorous tests of electrostatic sprayers versus electric backpack sprayers.

A previous EPA study “Report on the 2015 U.S. Environmental Protection Agency (EPA) International Decontamination Research and Development Conference.” (USEPA 2015b) shows that compared to traditional sprayer systems, an electrostatic spray technology is more efficient, reduces waste, and delivers a more uniform distribution of liquids over uneven surfaces. The current study explores the use of electrostatic sprayers as an alternative to the sprayers currently used in a decontamination line setting. Specifically, this study compares the performance of an electrostatic sprayer with a traditional electric backpack sprayer by evaluating the efficacy of each sprayer in removing or inactivating spores of Bacillus atrophaeus var. globigii (Bg), a surrogate for Bacillus anthracis, from different types of PPE materials.

The new report expands on those findings and highlights the operational advantages provided by electrostatic sprayers in personnel decontamination protocols. Among these advantages are:

  • Less chance of cross contamination
  • Less liquid used
  • Less contaminated runoff
  • Lower logistical requirements
  • Less cost to cover

HazMat teams that utilize electrostatic sprayers can reduce the amount of liquid needed to effectively decontaminate biological contamination which reduces risk of cross contamination as well as contaminated runoff.

The results of the tests showed that the quantity of liquid waste generated by the electrostatic sprayer was almost 75 times less than by the backpack sprayer.

Although the spray duration of the electrostatic sprayer was three times longer than the traditional backpack sprayer, the liquid waste from the electrostatic sprayer rarely contained viable spores, and the waste stream volume was significantly reduced.

Therefore, the disadvantage of increased decontamination line spraying time may be outweighed by the significant advantages in waste reduction and the decreased risk of personnel cross-contamination and spread of contamination beyond the impacted site.

Using electrostatic sprayers, HazMat teams can cover and decontaminate larger surface areas with less liquid reducing the amount of decontamination solution that must be procured and stored

Additionally, liquid waste generated from a biological decontamination line may be costly to dispose of and will likely cause difficulty in finding a disposal facility willing to accept the liquid waste.

Download a copy of the full EPA report here.

Also, download the free White Paper, The True Cost of Decontamination here.


Evacuation of At-Risk Population


Why are communities still struggling to evacuate at-risk citizens during an emergency?  

In virtually every disaster, a disproportionate number of casualties are the elderly, disabled, or home-bound also referred to as socially vulnerable populations. 

For example, in the Camp Fire incident in California most of the 86 people who died in the fire were senior citizens. Of the 69 bodies that have been positively identified, 53 were over the age of 65. This age group accounted for 77 percent of the fatalities. 

In Hurricane Katrina 49 percent of the victims were 75 years old and older. 

In Superstorm Sandy, 49 of the 106 deaths were 65 or older. 

Ever since Hurricane Katrina, emergency managers, public health professionals, and emergency medical services directors have devoted significant attention to this problem, but many communities and regions still are not able to ensure the timely evacuation of all at-risk individuals. 

There are many reasons for the lack of progress in solving this problem, but the most obvious is that most communities simply do not have enough patient transport capacity. Their existing ambulance pool is quickly depleted trying to cover the surge in injured during an emergency as well as the evacuation of hospitals, nursing homes, and home-bound individuals in a major event. 

Typically, emergency managers have relied on mutual aid agreements with other jurisdictions or contracts with private ambulance providers to supplement their patient transport capacity. 

However, with massive events like Hurricane Katrina, Hurricane Matthew, and Superstorm Sandy, the ambulance assets they were counting on were overburdened trying to handle casualties in their own communities. 

One approach has been to buy an Advanced Life-Saving (ALS) equipped Medical Ambulance Bus (MAB). But an ALS level MAB costs between $500,000 and $1Million dollars. Most communities cannot secure enough grant funding to procure a MAB. 

A Better Approach 

What emergency planners need is a scalable, affordable, and flexible approach to multi-patient transport. 

One option that is being used by many communities is to convert existing transportation assets on a permanent, or as needed basis to handle mass casualty situations. 

By leveraging surplus or end of service school or metro buses, using a conversion kit such as the AmbuBus from First Line Technology, a community can have a vehicle that can transport up to 18 non-critical patients for well under $50,000. 

The organization can often borrow the vehicles for temporary use or buy them for a nominal amount from the school or transportation district. They then purchase one or more AmbuBus conversion kits which cost between $25,000 to $50,000. Once assembled, which takes two people about two hours, the converted AmbuBus can carry up to 18 non-critical patients, two or more EMTs, and medical supplies. 

By having at least one AmbuBus kit permanently installed the community has a multi-patient transport vehicle (MPTV) that can handle mass casualty incidents that have no prior warning. 

They can then purchase additional kits that are unassembled and stored in wooden pallets. These can be stacked up in any available warehouse and used to temporarily convert additional buses for events such as hurricanes. 

Since the installation of the kits does not require any holes to be drilled, the structural integrity of the vehicle is preserved, and it can be returned to regular service after the event.                                                           

For more information, download the free white paper, “A Scalable Approach to Mass Casualty Transport” here


Are You at Risk from Secondary Exposure to Fentanyl?

Are You at Risk from Secondary Exposure to Fentanyl?

Simplified Fentanyl Response Saves Lives and Money

INCIDENT: Officer Exposed During Fatal Overdose Response

LOCATION: Wareham, Massachusetts


Fentanyl is changing the rules of the game for all first responders. There’s no such thing as an easy call anymore. 

Chief Ray Goodwin of the Onset Fire Department in Wareham, Massachusetts can attest to that. A recent incident there resulted in one patient dying, and a police officer hospitalized during the responseIt could have been much worse. 

More responders could have suffered accidental Fentanyl overdose by contact with residual Fentanyl that was on their equipment without realizing it was there. 

According to Chief Goodwin, “Sadly, we have been responding to Heroin overdoses for over 4 decades. In the past few years, we’ve had a significant increase in overdoses. We’ve been encountering Fentanyl in Heroin for quite some time before it was officially recognized.  

At first, we attributed the increased number of overdoses to thinking the supply of heroin we were seeing was purer and not cut as much. Then the intelligence we received from DEA started coming in about the possibility of Fentanyl being mixed with the Heroin. 

I’ve been on the State HazMat Team for about twenty years, so I have experience in decontamination. 

Returning from a recent trip, my Deputy Chief informed me of an incident that had occurred the night before. On a Saturday night, the Department received a report of an overdose and we responded. The police arrived just before us. There was a male patient that was down and repeated doses of Narcan were administered but the patient did not respond.”  

“There was white product all over the table and it was suspected that the patient had been snorting Fentanyl.” 

“During treatment of the patient, one of the police officers on scene started experiencing dizziness, light-headedness, and couldn’t hold himself upright. The patient and the police officer were transported to the hospital and our responders returned to the station. None of the fire department personnel had any symptoms of exposure. 

Because this Fentanyl threat is relatively new, we are currently working on our policies and procedures to address this problem. 

Since there was no SOP guidance, the responders had simply wiped the equipment bag down when they had returned. 

The crew was called out for a fire that morning, so I went to the scene to examine the truck and the equipment. 

Luckily, I had some Fentanyl test strips and some 200ml kits of Dahlgren Decon that I acquired when I attended the DeconTect Awareness Program training that was conducted for the Commonwealth HazMat Team. I gloved up and put on an N95 mask and started swabbing the vehicle compartment and the first-in bag. I got one negative hit on the bottom of the bag but when I tested the other half of the bag I got a positive hit for Fentanyl. 

I told the Deputy to send the vehicle back to the station with just the driver and send the crew back in other vehicles. 

I mixed the Dahlgren Decon from the kits that I had and applied it to the bag. I removed all the soft stuff from the bag and disposed of it properly and then applied the Dahlgren to the hard stuff from the bag as well as the compartment in the vehicle.  

I notified the State HazMat team and they arrived to assess the situation. We tested some of the gear from the people who had been on the scene as well as the two ambulances and fortunately, they came back negative for Fentanyl. 

The HazMat team and my Deputy tested the incident scene and applied Dahlgren to neutralize the remaining Fentanyl residue. They then tested the area after it had been deconned and had no positive hits for Fentanyl. 

We considered the incident mitigated at that point. The station was mitigated, the vehicle and equipment were mitigated, and the ambulances used were clean. We had a positive outcome and there were no secondary exposures due to contamination. 

It was just a lucky chain of events that I had recently taken the training in hybrid decontamination using FiberTect wipes and Dahlgren Decon to neutralize Fentanyl and had the kits on hand to manage the decontamination process.” 

“If we had not had the Dahlgren Decon on hand, I probably would have had to take the vehicles out-of-service and thrown away the bag and all the equipment.” 

“Some people will tell you that you can use soap and water on Fentanyl but you’re really not neutralizing it if you do that. You’re just diluting it and moving it around. Dahlgren Decon changes the Fentanyl’s chemistry and completely neutralizes it. 

Utilizing two of the available Dahlgren Decon kits I was able to decontaminate the vehicle, the equipment bag and hard equipment, and even the incident scene for under $200 in less than two hours. Without those kits, we would have had a vehicle out-of-service for an extended period and had to pay a cleaning company a significant amount of money to do the same work. For the convenience alone, the Dahlgren Decon is priceless. It’s a game-changer for us. 

Since our responders’ safety is the most important thing, if I would have had to toss the equipment away, I would have done it. It’s just the cost of doing business. But this decontamination process means I don’t have to do that to protect them. 

What I want our fellow responders around the country to understand is that we can respond to these types of incidents effectively. With training, education, and practice, as well as good equipment and policies, we can respond effectively and perform the services our public needs us to do.” 

The Onset Fire District is a 5 square mile area located in the Town of Wareham in South-East Massachusetts near the end of the Cape Cod Canal. The town has a year-round population of 8,900 residents which swells to between 20,000 and 30,000 during the summer months. The Onset Fire Department responds to between 1,500 and 2,000 calls per year. 

The Department has 7 full-time members and 65 on-call members. They respond in a combination model where the station is manned 24 hours a day. The Town of Wareham has an advanced life-saving (ALS) ambulance but the area is remote, so the Fire Department usually arrives on-scene before the ambulance. 

The community is very economically diverse with expensive waterfront properties as well as trailer parks. They have a wide-range of customers for their services. 

Editors Note – Do you have a decontamination response story to share with your counterparts in other departments? Let us know. Email us at with a brief description of your experience.