Terrorism seems to be the buzzword in the fire service, and this is as it should be. We think of the World Trade Center incidents of 9/11 and in 1993. We think of Oklahoma City. As Americans we are prime targets of many extremist groups.
When we think of weapons of mass destruction, we categorize them as nuclear, chemical or biological agents. Studies and current information have shown the nuclear threat is not as pressing as the other two, and considering the others, chemical and biological, the latter is truly the worst of all. I say this because it would take a week or more before we would even know an event has happened.
If you consider the incubation periods of most diseases, all usually take between three and 10 days to show up in any recognizable form. Even then, most appear as the common cold or flu. If a biological event occurs during flu season, most victims would be dismissed as being flu patients. When otherwise normally healthy individuals start to die, and the victims are tracked to a general area, the alarm may or may not be sounded, and even then only by extremely astute health care professionals.
Actually, what would happen is EMS crews would notice trends in illnesses, then report that to their supervisors and medical directors. This in turn would be discussed with other medical directors and health departments, and an investigation would be initiated. Depending on what agent or pathogen has been released will dictate the procedures followed.
As of late, it appears as though the biological agent du jour is smallpox. The World Health Organization (WHO) declared in 1982 that smallpox was eradicated from the face of the earth. This, of course, is a nice thought, but further evidence has shown this is not the case. If you have read the book Biohazard by Dr. Ken Alebek, who was the director of the "Biopreparat," the Soviet Union's biological weapons production division, he mentions the sobering fact that tons of smallpox was manufactured, and in some experiments combined with other pox viruses, like chicken pox and cow pox, in order to make them even more virulent, and resistant to conventional treatments. The Soviet Union is defunct, but the pathogens are still around. If you consider the economic state of Russia and the states of the former Soviet Union, and combine them with the greed, desperation and ruthlessness of some countries, the combination is deadly.
Let us consider smallpox, and a release in this country. Most American baby boomers received smallpox vaccinations in the 1950s. That immunity is non-existent today. No one has been vaccinated since 1982. Because the WHO declared the smallpox virus eradicated, there is a minimal amount of vaccine on hand. The sad thing is that the federal government has declared that all first responders should be vaccinated first. There is not enough vaccine on hand to even start this project.
Recently, Region 7 in Florida conducted a smallpox tabletop exercise, and indeed it was a learning experience. Health care providers in all arenas were present from Miami-Dade, Broward, Monroe and Palm Beach counties. The bottom line from the exercise is this: if our first responders are not vaccinated very soon, we could potentially have a crisis on our hands. Even when people are vaccinated against smallpox, it takes between seven and 12 days before the immunity is effective. After the terrorist releases the agent is not the time to be vaccinated.
The exercise involved the entire southeastern portion of the state, an area of more than 3,000 square miles. In the scenario, the "disease" eventually showed up as far north as Tallahassee. The "death count" was conservatively estimated at around 400 people, and many thousands of people were "infected."
If a smallpox release happens, those personnel who are not vaccinated - which are the majority of firefighters and EMS workers - would be exposed immediately, and they should be considered contaminated and potentially infected. According to the health department physicians who were present, the infected people should be quarantined for a minimum of 17 days after exposure. This means after the first response to contaminated patients, these firefighters, EMS workers, police officers and hospital workers would be out of the picture for further responses to any other patients. This would destroy most EMS systems and inundate hospitals in the opening moments of an event. The now presumably contaminated first responders would be a danger to the public and to their families. They would in most cases be unable see their families for three weeks. They would not be able to do their jobs as EMS workers. They would become part of the problem immediately.
Every day, we see something in a newspaper or a magazine or on TV about the threat of smallpox and other biological agents. What disturbs me is that we appear to recognize our vulnerabilities, yet I sense no urgency on the part of government is addressing these issues. I can't be the only one who feels complete frustration and sees the importance of addressing this loaded issue in a timely manner.
We as fire chiefs and fire and EMS services should make our voices heard. Directors of fire and EMS departments, health departments and the CEOs of hospitals should implore their congressmen and senators to immediately set in motion a program of mass vaccinations, at the least for first responder and hospital personnel.
Fire and police chiefs should speak to the international associations of fire and police chiefs to lobby for such a program. Union heads and the International Association of Fire Fighters (IAFF) should make their voices heard. If we are to do the job we are entrusted to do, give us the tools we need and do it now. THE CLOCK IS TICKING.
Chief Concerns is a forum addressing issues of interest to chief fire officers. Opinions expressed are those of the writer. We invite all volunteer and career chief fire officers to share their concerns, experiences and views in this column. Please submit articles to Chief Concerns, Firehouse Magazine, 445 Broad Hollow Road, Melville, NY 11747.
Chief Michael J. Essex is special operations officer for the Emergency Response Division of City of Miami Fire-Rescue. The division includes the technical rescue, hazardous materials and dive rescue teams. Essex also is the department's SWAT-Medic commander.
