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

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4.3 Secondary Attacks

Emergency responders must be alert to the threat posed by secondary attacks. Secondary attacks are designed to cause casualties and inflict injury and panic on those responding to the initial incident. For example, they may involve explosive devices placed at the scene of an ongoing emergency response and detonated after response personnel arrive. OSHA’s Safety and Health Guide provides guidance on the nature of secondary explosive devices and their potential health and safety effects.

Text Box 4
BioWatch: Early Warning System for Biological Agents
BioWatch is designed to detect the intentional release of select aerosolized biological agents. Operating nationwide, BioWatch uses a coordinated team of field, laboratory, and response personnel from city, state, and federal organizations. The team is responsible for installing the BioWatch sampling units (air samplers equipped with special filters), collecting and analyzing samples, reporting results, and responding to alerts. The BioWatch sampling units are positioned around the country using special site selection modeling programs.
BioWatch is one of many systems used to make public health decisions. In combination with corroborative information, BioWatch results could trigger emergency response activities. DHS provides funding and oversight. The key partners and their roles are as follows:
City, county, and state stakeholders operate the BioWatch system.

CDC oversees the Laboratory Response Network and acts as the liaison with state and local health departments.

In some regions, EPA leads field operations and serves as the primary contact for state and local environmental monitoring agencies.

The Department of Energy’s national laboratories, Los Alamos and Lawrence Livermore, provide technical oversight for field and laboratory operations, including development of new technologies.

The Federal Bureau of Investigation leads criminal investigations.
In the event of confirmed biological agent detection, DHS is poised to dispatch federal response assets to support the public health infrastructure of an impacted area, including:
The Strategic National Stockpile, a reserve of large quantities of medicine and medical supplies.

The National Disaster Medical System, composed of teams of health professionals to be deployed to support local health care delivery systems, including public health officials.


This section covers program elements that specifically address the safety and health of emergency responders who will participate in chemical and biological incident response. It supplements the safety and health program elements described elsewhere in this manual.

5.1 Medical Surveillance

EPA OSCs will have ready access to a medical professional in the event of a suspected chemical or biological release. During onsite emergency response activities, a Medical Monitor2 must closely observe and monitor emergency responders for signs of acute exposures as well as other safety or health problems (such as heat stress). Nerve agent antidote kits (e.g., Mark I) may be administered immediately upon exposure of a nerve agent. Medical Monitors can use the sample Onsite Medical Monitoring Tracking Form provided in the “Forms” section of the manual’s website to document vital signs and potential exposures. In the event that a worker is potentially exposed to a chemical or biological agent (e.g., PPE is breached or the worker develops symptoms), appropriate medical attention must be sought and the SHEMP Manager and Removal Manager must be notified. Also, the Medical Monitor, working with the Onsite Safety Officer (or another designated person), must contact and share potential exposure information with the health care provider (i.e., either a physician at a health care facility where an employee is being transported or an employee’s personal physician) so that the health care provider can determine whether special tests (e.g., acetylcholinesterase) are required and develop and implement agent- and site-specific protective measures, such as the administration of vaccines and prophylactic antibiotics. Follow up medical treatment and monitoring will be performed as determined by the SHEMP manager and the health care provider to address any possible chronic or latent health effects.

Depending on the individual responder’s activities and potential exposure to a chemical or biological agent, the following medical considerations may apply:
Immunizations—Section 4.1 and Table 4, Vaccination Recommendations for EPA’s Emergency Responders, in the manual’s Medical Surveillance Program chapter provide general guidance on recommended immunizations. For general guidance on immunizations for selected CDC Category A agents, see Table 3 in Section 5.3.2 below. For example, as stated in that table, all EPA emergency responders involved in a smallpox cleanup effort must be immunized before deploying to the field.

Chemoprophylaxis (antibiotics)—Section 4.2 and Text Box 4 of the manual’s Medical Surveillance Program chapter provide general recommendations on antibiotics. Also, general information on recommended chemoprophylaxis measures for selected CDC Category A biological agents is presented in Table 3 in Section 5.3.2 below.3

Procedures for administering nerve agent antidotes—Section 4.3 of the manual’s Medical Surveillance Program chapter provides general guidance on access to and use of nerve agent antidote kits. (Also see OSWER Directive 9200.51 on the storage, training, use, and disposal of Mark 1 Kits.)

5.2 Hazard Evaluation

EPA’s emergency responders must perform a hazard evaluation before entering an incident site. Level B is the minimum level of protection to be used for initial site entry or during the early phases of a response where site conditions have not been fully characterized (Chapter 6.9.3 of the Standard Operating Safety Guides). Where site conditions have been fully characterized following the early phases of a response, sampling must be conducted to determine the necessary exposure controls and type of PPE to be used. Sampling is also conducted during field operations to reassess site hazards as additional information on site hazards becomes available and job tasks become better defined. The manual’s Respiratory Protection Program chapter and PPE Program chapter provide detailed guidance on conducting hazard evaluations at response sites. For example, Appendix E of the Respiratory Protection Program chapter presents a Site/Task Specific Hazard Evaluation Form and a list of items to consider when performing an evaluation for respiratory protection. Additionally, Appendix E of the PPE Program chapter presents a sample Site Hazard Assessment and Certification Form that lists items to consider when selecting PPE. The information provided in this appendix is designed to assist emergency responders in obtaining and organizing information during the hazard evaluation process.

The Onsite Safety Officer (or another designated person) should work with experts from EPA and other agencies to determine the appropriate sampling or monitoring method(s) for the site-specific chemical or biological hazards. In cooperation with other onsite and/or knowledgeable personnel, EPA emergency responders are responsible for obtaining details regarding hazardous contaminants, work areas, work activities, and other related information that is needed to assess site-specific hazards.
The following guide contains information for selecting biological agent detection equipment: National Institute of Justice. 2001. An Introduction to Biological Agent Detection Equipment for Emergency First Responders. NIJ Guide 101–00. Washington D.C.: National Institute of Justice, Office of Science and Technology.

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