Version 0 (January 2017) Emergency Responder Health and Safety Manual

1.2 Instructions for Users

This chapter must be implemented across all EPA regions, OLEM special teams, and Headquarters (HQ). This means that each EPA organization must adopt the minimum Agency requirements and management practices listed in this chapter and produce a customized version of the chapter that is reviewed/updated on an annual basis. Other organizations within EPA are also encouraged to implement this chapter.

To customize the chapter, users must (1) complete Appendix A and (2) insert organization-specific information into the blank spaces (highlighted in yellow) that appear throughout the chapter. If organizations advocate additional policies and procedures, they must document them in Appendix B. Tools have been developed to support this chapter, including a glossary (Appendix C). An implementation checklist is included in the “Forms” section of the manual’s website as a tool to assist each organization in ensuring that they have met the requirements of this chapter.
See the Introduction to this manual for details on customizing and posting an organization’s chemical and biological agent program to the manual’s website. The website also includes tools and resources that will be helpful to users, including downloadable forms, reference documents, and training materials.

2.0 ROLES AND RESPONSIBILITIES

Health and Safety Program Contacts (HSPCs); Removal Managers; Safety, Health, and Environmental Management Program (SHEMP) Managers; On-Scene Coordinators (OSCs); OLEM special teams and directors; and individual emergency responders have roles and responsibilities in implementing the Agency’s emergency response program. Appendix A details the tasks that these key personnel must perform. If an organization wishes to delegate a task to someone other than the default assignment presented in the appendix, users can do so when they customize Appendix A and when they fill in the yellow-highlighted areas that appear throughout the chapter’s text. During an emergency response, an OSC often serves as the Onsite Safety Officer.

3.0 AWARENESS TRAINING

Emergency responders who have the potential to be exposed to chemical or biological agents on the job must receive Chemical and Biological Agent Awareness training. The awareness training may be provided as a standalone course or as part of initial 40-hour HAZWOPER training or annual 8-hour refresher training. The training should address the safety and health elements covered in this chapter and the primary references provided within the chapter. Completed training requirements will be tracked in the agency’s Field Readiness Module (FRM).

4.0 OVERVIEW OF CHEMICAL AND BIOLOGICAL AGENTS

Chemical or biological agents can be released accidentally or deliberately. Releases may be in combination (for instance, an explosion that releases biological agents) or in sequence. Threats from chemical and biological agents may also arise from natural or unintentional events, such as the spread of influenza viruses; naturally occurring anthrax; the release of carbon monoxide in interior spaces; or accidental releases of toxic industrial chemicals that result from hurricanes, floods, or other natural disasters. As noted in the introduction to this chapter, emergency response to an incident involving a chemical or biological agent is similar in many ways to a conventional HAZMAT incident response.

During a significant incident, federal agencies, including EPA, have designated response roles, as defined in the National Response Framework (NRF) (see Text Box 2). The NRF presents the guiding principles that enable all response partners to prepare for and provide a unified national response to disasters. For more detailed information, please visit the NRF’s website.
Numerous agencies and organizations have developed lists of potential chemical and biological agents, and there is a growing body of research on the subject. Discussing each agent in detail is beyond the scope of this chapter. However, emergency responders should familiarize themselves with the sources referenced in this chapter and elsewhere in this manual, in order to develop a basic understanding of the major classes and types of chemical and biological agents and their properties. The following sections address chemical and biological agents that are widely recognized as potential threat agents.


Text Box 2
The National Response Framework
The National Response Framework (NRF) is a guide that details how the nation conducts all-hazards response—from the smallest incident to the largest catastrophe. The NRF establishes a comprehensive, national, all-hazards approach to domestic incident response. The NRF identifies the key response principles, as well as the roles and structures that organize national response. It describes how communities, states, the federal government, and private-sector and nongovernmental partners apply these principles for a coordinated, effective national response. It also describes special circumstances where the federal government exercises a larger role, including incidents where federal interests are involved and catastrophic incidents where a state would require significant support. It lays the groundwork for first responders, decision-makers, and supporting entities to provide a unified national response.
Under the NRF, EPA is responsible for coordinating federal interagency support under Emergency Support Function (ESF) #10, Oil and Hazardous Materials Response. In addition to ESF #10, the NRF Biological Incident Annex outlines the actions, roles, and responsibilities associated with response to a human disease outbreak of known or unknown origin requiring federal assistance.

4.1 Chemical Agents

The National Fire Protection Association (NFPA) 1994 Standard on Protective Ensembles for First Responders to Chemical, Biological, Radiological, and Nuclear (CBRN) Terrorism Incidents defines “chemical terrorism agents” as: “Liquid, solid, gaseous, and vapor chemical warfare agents and toxic industrial chemicals used to inflict lethal or incapacitating casualties, generally on a civilian population as a result of a terrorist attack.” The Centers for Disease Control and Prevention (CDC) has defined 13 categories of chemical agents, as shown in Table 1.

Chemical agents come in many forms and may pose a hazard through multiple exposure routes such as dermal (skin), ocular (eye), inhalation, and ingestion. Within each class of compounds, such as nerve agents, the individual substances have distinct physical properties. They may be dispersed as a liquid, gas, aerosol, or even contaminated dust. The agents also vary in volatility and persistence and can pose different degrees of hazard by inhalation. Therefore, the response effort must be tailored to the unique hazards posed by the agent. A detailed discussion of all potential chemical agents is beyond the scope of this chapter; nerve agents are presented in Text Box 3 as just one example of a chemical agent.
CDC’s Emergency Preparedness and Response website contains detailed information on chemicals recognized as potential threats. Also, the NRT has developed Quick Reference Guides for a range of chemicals, including many on CDC’s list of chemical agents. The Quick Reference Guides are available for downloading at the NRT’s website.
Table 1
CDC’s 13 Categories of Chemical Agents

Agent	Properties	Examples
Biotoxins^a	Poisons from plants or animals	Digitalis, ricin, tetrodotoxin
Blister agents/vesicants	Chemicals that severely blister eyes, skin, and the respiratory tract on contact	Mustards, phosgene oxime, lewisite
Blood agents	Poisons that affect the body through blood absorption	Arsine, carbon monoxide, hydrogen cyanide, cyanogen chloride
Caustics (acids)	Chemicals that burn or corrode skin, eyes, and mucus membranes on contact	Hydrofluoric acid, phosphoric acid, sulfuric acid
Choking/lung/pulmonary agents	Chemicals that cause severe irritation or swelling of the respiratory tract	Ammonia, methyl bromide, phosgene, diphosgene, phosphine, phosphorus (elemental, white, or yellow)
Incapacitating agents	Drugs that make people unable to think clearly or that cause an altered state of consciousness (possibly unconsciousness)	BZ (3-quinuclidinyl benzilate), etorphine, fentanyl
Long-acting anticoagulants (e.g., hemorrhagic agents)	Poisons that prevent blood from clotting properly, resulting in uncontrolled bleeding	Brodifacoum, bromadiolone, super warfarin
Metals	Agents that contain metallic poisons	Arsenic, barium, mercury, thallium
Nerve agents	Highly poisonous chemicals that work by preventing the nervous system from working properly	Sarin (GB), soman (GD), tabun (GA), VX
Organic solvents	Agents that damage living tissues by dissolving fats and oils	Benzene, carbon tetrachloride, toluene, tetrachloroethylene, trichloroethylene
Riot control agents/tear gas	Highly irritating agents normally used by law enforcement for crowd control or by individuals for protection (for example, mace)	Bromobenzylcyanide (CA), chloroacetophenone (CN), chloropicrin (PS), dibenzoxazepine (CR)
Toxic alcohols	Poisonous alcohols that can damage the heart, kidneys, and nervous system	Ethylene glycol, diethylene glycol, methanol
Vomiting agents	Chemicals that cause nausea or vomiting	Adamsite (DM), diphenylchloroarsine (DA), diphenylcyanoarsine (DC)

^a Biotoxins are identified as chemical agents within CDC’s classification system and are therefore listed in Table 1. (Note: CDC lists ricin as both a chemical and biological agent, so ricin is listed in Tables 1 and 2.) Consensus has not been achieved regarding how to classify biotoxins. This chapter follows CDC’s classification system.

Text Box 3
Nerve Agents
Nerve agents are so named because they affect the transmission of nervous system impulses. They are organophosphorus compounds, a group that also includes many pesticides, but they are more potent than pesticides. Considered potential threats because they are stable, easily dispersed, and highly toxic, they can be produced with relatively simple laboratory equipment and techniques. The raw materials are inexpensive, but some are subject to the controls of the Chemical Weapons Convention and the Australia Group Agreement. Commonly known nerve agents include:

• 
  GA (tabun): A low-volatility,^a persistent chemical absorbed by skin contact or inhaled as a gas or aerosol.
  
• 
  GB (sarin): A volatile, non-persistent chemical mainly taken up through inhalation.
  
• 
  GD (soman): A moderately volatile chemical absorbed by skin contact or inhaled.
  
• 
  GF (cyclosarin): A low-volatility persistent chemical absorbed by skin contact or inhaled.
  
• 
  VX: A low-volatility persistent chemical, with a consistency similar to that of motor oil, which can remain on material, equipment, and terrain for long periods. Uptake is mainly through the skin but also through inhalation of the substance as a gas, aerosol, or contaminated dust.
  

^a “Volatility” refers to a substance’s ability to become airborne as a vapor at relatively low temperatures. A highly volatile (non-persistent) substance poses a greater respiratory hazard than a less volatile (persistent) substance.
Source: National Institute of Justice. 2001. Guide for the Selection of Chemical and Biological Decontamination Equipment for Emergency First Responders. NIJ Guide 103–00. Washington, D.C.: National Institute of Justice, Office of Science and Technology.

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