Responder

Responders evaluate incident-specific conditions to determine an optimal combination of response options, i.e., the set of response options which are most likely to result in a net environmental benefit.

From: Oil Spill Science and Technology (Second Edition), 2017

Related terms:

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Semiconductor

Amplifier

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Where Emergency Management and Disaster Behavioral Health Meet

Nancy Dragani, ... Nancy Dragani, in Integrating Emergency Management and Disaster Behavioral Health, 2017

DBH in the Recovery Phase

The line between response and recovery is often quite fine and crossed very early in the disaster response. For DBH, an effective response leads immediately into recovery from the traumatic effects of the disaster and optimally reduces the need for long-term psychological care. When attention is paid to the likelihood of long-term consequences of disaster, individuals who have been most severely exposed should receive priority of care.

DBH responders should remain on the scene of a disaster even after the immediate response has been concluded. For example, in October 2015, there was a building in Brooklyn that exploded, killing two and injuring more than a dozen residents (Crook, 2015). The New York Fire Department responded quickly, and the Greater New York chapter of the American Red Cross arrived on the scene to provide mobile canteen support (hot and cold beverages and snacks), disaster mental health, and disaster spiritual care DSC. The DMH and DSC responders remained at the scene for 50 h while the firefighters continued to look through the rubble for another victim (Ryan, 2015). All other emergency responders had left, but because of the nature of the incident, both spiritual and emotional support was still needed in order to assist the survivors in their efforts to begin their recovery.

DBH Myth 5: The only function of DBH practitioners is to recommend self-care or suggest that the responder is not fit to handle the situation and should leave. For responders who want to continue working on the disaster, it is dangerous to talk to a DBH specialist.

In addition, DBH experts in the EOC can provide support to the emergency manager and the other leadership in the EOC. During the long days (and often nights as well), a colleague who is charged with monitoring stress levels while being active in the response can intervene to prevent and mediate conflict, offer another perspective, provide distraction from the high-stress environment, or simply provide comfort. If the DBH expert is in the EOC from the beginning of the response, trust is developed that allows supportive interactions to occur in a natural, spontaneous manner without threat to the emergency manager's sense of integrity and competence.

The DBH expert in the EOC can also prevent a slowdown or poor decision-making due to an emotional crisis by offering guidance on managing the environment and the response. When needed, a DBH staff member will provide much-needed support to other EM personnel in order to allow the continuation of vital work. The intention is to minimize a need to release anyone from duty throughout the response.

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ROLE OF ADHERENT CELLS IN THE INDUCTION OF CYTOTOXIC T LYMPHOCYTES: PROMOTION, SUPPRESSION, AND ANTIGEN PRESENTATION

Gustavo Cudkowicz, ... William W. Freimuth, in Natural and Induced Cell-Mediated Cytotoxicity, 1979

DEPRESSIVE EFFECTS OF ADHERENT CELL REMOVAL ON THE INDUCTION OF F1 ANTIPARENT CTL

Responder and stimulator splenocytes were either pretreated with carbonyl iron particles and magnetism or filtered through Sephadex G-10 columns to remove phagocytic and other adherent cells. There is no doubt that both procedures removed conventional macrophages since the frequency of cells ingesting latex particles decreased from ∼7 to <1%. There is evidence, however, that the carbonyl iron procedure also removes nonphagocytic adherent cells (23) and that both procedures remove nonviable and broken cells (unpublished observations). As to the competence for F1 antiparent CML of the depleted populations, results of two representative experiments are shown in Table 1. Treatment of the responder or stimulator population alone consistently resulted in the development of reduced albeit substantial cytotoxicity, but treatment of both populations entirely prevented the generation of CTL. The carbonyl iron procedure was somewhat inferior to Sephadex G-10 filtration, mainly because the effectiveness of adherent cell removal was more batch-dependent for carbonyl iron (Lymphocyte Separator Reagent, Technicon Instrument Co., Tarrytown, New York) than for Sephadex G-10. No attempts were made in these experiments to remove extensively adherent cells by repeated exposures to carbonyl iron or serial fìltrations through Sephadex G-10. In fact, mixed allogeneic cultures of treated splenocytes were often not as incompetent as F1-parent cultures, an indication that enough adherent cells were left behind to support allogeneic CML, the less demanding response with regard to accessory cells.

TABLE 1. Effect of Adherent Cell Removal from Responder and Stimulator Spleen Cell Populations on the Induction of F1 Antiparent CTL

Percent specific lysis (%)bRemoval of adherent cells fromaB6D2F1αB6 → L5MF-22RespondersStimulatorsCarbonyl iron treatmentSephadex G-10 filtration––46.467.1+–39.236.4–+23.526.7++3.3–0.4

aAliquots of responder and stimulator spleen cells were either exposed to carbonyl iron and magnetism or filtered through Sephadex G-10 columns before culture. + or – indicates whether or not the cocultured cells were so treated.bAliquots of responder and stimulator spleen cells were either exposed to carbonyl iron and magnetism or filtered through Sephadex G-10 columns before culture. + or – indicates whether or not the cocultured cells were so treated.

Removal of accessory cells was rendered more effective by prefiltration of splenocytes through nylon wool columns and selection of the carbonyl iron batch. Depletion of F1 responder cells alone was then sufficient to abrogate antiparent responsiveness, despite the availability in culture of parental adherent cells (Table 2). The double procedure did not affect T-lymphocyte viability since the depleted F1 cells were still capable of responding to nondepleted allogeneic instead of parental stimulators.

TABLE 2. Effect of Adherent Cell Removal from Responder Spleen Cell Populations on the Induction of F1 Antiparent CTL by Nondepleted Stimulators

Percent specific lysis (%)bTreatment of responder cellsaB6D2F1αB6 → L5MF-22B6D2F1αC3H → 6C3HEDNone40.243.9Nylon wool filtration54.246.4Nylon wool filtration plus carbonyl iron treatment2.937.9

aAliquots of responder spleen cells were filtered through nylon wool columns; aliquots of the nonadherent subpopulation were also exposed to carbonyl iron and magnetism.bEqual numbers of responder and irradiated stimulator cells were cocultured for five days. F1 antiparent effectors were assayed on L5MF-22 lymphoma targets (H-2b), and F1 anti-C3H effectors on cells of lymphoma 6C3HED (H-2k).

Removal of adherent cells from splenocytes by two different techniques fully confirmed the data previously obtained with antimacrophage agents. The generation of F1 antiparent CTL is critically dependent on adherent cells of both responder and stimulator origin, presumably sensitive to the in vivo and in vitro toxicity of silica particles and carrageenans. The induction of F1 antiparent CML and of certain other CML responses (e.g., against allogeneic or modified syngeneic cells) differ operationally with regard to at least two important parameters: (i) the extent of dependence on an intact pool of adherent cells (quantitative difference); and (ii) the extent to which the functions of adherent cells of responder and stimulator origin are interchangeable (qualitative difference).

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Controls and Procedures

Ido Dubrawsky, in Eleventh Hour Security+, 2010

FIRST RESPONDERS

The first responder is the first person to arrive at a crime scene, who has the knowledge and skill to deal with the incident. The first responder may be an officer, security personnel, a member of the IT staff or Incident Response Team, or any number of other individuals. The first responder is responsible for:

▪

Identifying the scope of a crime scene: What is affected and where could evidence exist?

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Establishing a perimeter: Protecting the crime scene requires cordoning off the area where evidence resides.

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Preserving volatile evidence: If a source of evidence is on the monitor screen, they should take steps to preserve and document it so it isn't lost.

The first responder shouldn't touch anything that is within the crime scene. Depending on how the crime was committed, traditional forensics may also be used to determine the identity of the person behind the crime. In the course of the investigation, police may collect DNA, fingerprints, hair, fibers, or other physical evidence. In terms of digital evidence, it is important for the first responder not to touch anything or attempt to do anything on the computer(s) as it may alter, damage, or destroy data or other identifying factors. When investigators arrive on the scene, it is important that the first responder provide as much information to them as possible. If the first responder touched anything, it is important that the investigator be notified so that it can be added to a report. Any observations should be mentioned, as this may provide insight into resolving the incident.

Crime scene technicians are individuals who have been trained in computer forensics and have the knowledge, skills, and tools necessary to process a crime scene. The technician is responsible for preserving evidence, and will make great efforts to do so. Evidence is further packaged to reduce the risk of damage, such as from ESD or jostling during transport. Once transported, the evidence is then stored under lock and key to prevent tampering, until such time that it can be properly examined and analyzed.

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Applications to Improve the Assistance of First Aiders in Outdoor Scenarios

Enrique Gonzalez, ... David Munoz-Rodriguez, in Intelligent Data Sensing and Processing for Health and Well-Being Applications, 2018

10.3.1 Prehospital Assistance Personnel

Personnel participating in a prehospital assistance scenario must have adequate training for the attendance of emergency situations. Classifications and protocols are previously established regarding prehospital caregiver capabilities and training. Some of the most representative are first responder, basic, and advanced prehospital trauma care [9]. Each of the classifications play different roles and their collaboration forms the backbone of the emergency medical system to safeguard injured patients' lives.

10.3.1.1 First responders

First responders are people with basic knowledge of what to do in emergencies. First responders are usually present or nearby when an accident occurs, and they must follow these tasks: assess the scene, call for help, assess the victim, provide choking support, provide breathing support, immobilize the victim, provide cardiopulmonary resuscitation if needed, drag the patient to a safe place, and stop any bleeding. At this level individuals are equipped only with basic supplies such as bandages, gloves, immobilizers, etc.

10.3.1.2 Basic prehospital trauma care

These individuals are formally prepared and have a consistent background in patient transportation, scene management, rescue, and stabilization. Based on their knowledge and training, they should be able to evaluate injured or ill patients to decide whether they really need to be transported to a specialized medical center or can be treated at the scene. The scope of practice of these providers includes extrication and rescue, immobilization, and the administration of oxygen. Ambulance services customarily use personnel trained at this level.

10.3.1.3 Advanced prehospital trauma care

These people are commonly physicians or paramedics sufficiently prepared through specialized courses of thousands of hours for emergency assistance. They must have theoretical and practical training which lets them face serious emergency cases in crisis situations. This level of prehospital assistance is not often found worldwide; first-world countries commonly have this level. Within the capabilities available at this level are: endotracheal intubation, needle decompression of a pneumothorax, cricothyroidotomy, and sutures in tissues [9].

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Robotics in endoscopic transnasal skull base surgery: Literature review and personal experience

Alba Madoglio, ... Francesco Doglietto, in Control Systems Design of Bio-Robotics and Bio-mechatronics with Advanced Applications, 2020

2.4 Survey on endoscope holders

Paraskevopoulos et al. (2016, 2018) recently performed a survey among neurosurgeons regarding the use of endoscopic holders.

The results of the survey underlined that most neurosurgeons prefer not to use an endoscope holder and those who responded that they use an EH, mainly use a holder for ventricular rather than skull base procedures. Furthermore, most surgeons regularly work with a cosurgeon.

The responders stressed the positive and negative features of endoscope holders:

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Positive features: stability, number of joints, maneuverability, safety;

–

Negative features: raw movements, limited degrees of freedom as compared to free hand, downward drift, lack of flexibility, iatrogenic injury, expensive, too bulky.

The same group conducted a second, wider, and more specific survey (Paraskevopoulos et al., 2018) after the pilot one; in particular, they tried to differentiate between different uses of EHs, such as intraventricular versus skull base, specific procedures, and pitfalls. In this second study, the authors reported pitfalls of endoscope holders in different applications.

Pitfalls that were reported and were specific to skull base surgery included:

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Cleaning difficulties: maintaining a clear vision is of paramount importance in surgery; when the endoscope is introduced in the nose, even minor bleeding might impair visualization and lead to the need of lens cleaning. This is usually achieved with commercially available cleaning systems that flush saline solution on the lens; when this is not enough, the endoscope might have to be removed from the nose to be cleaned;

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Need to incorporate the limitations of the holder into the operative planning.

Regarding pitfalls in both intraventricular and skull base surgery:

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Not dynamic with limited maneuverability: limited degrees of freedom as compared to free hand;

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Time consuming and cumbersome: the main issue is usually related to the space that is required by the holder, as this might occupy significant space, usually used by the assistant surgeon; set-up time might be time consuming;

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Difficult to get in the appropriate position: with some systems positioning is not optimal due to the delay in the locking system or due to the absence of minor movements that are needed to obtain an optimal position in confined, small areas;

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Restricted range of motion because of geometry of the holder;

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Shifting of holder or accidental loosening (esp. mechanical arm): scope may slip and may be inadvertently displaced by assistant or surgeon, so scope holder is one more tool to pay attention to during surgery;

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Failure to hold the scope;

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Downward drift: articulated arms can help to prevent fatigue in lengthy cases, but are often prone to drifting downwards during initial positioning, thus making minor adjustments necessary, either in anticipation of this downward drift or after initial positioning.

Although endoscopic holders have a role in cranial neuroendoscopy, their use seems limited and their features are regarded as suboptimal by most neurosurgeons. To overcome the limitations of nonrobotic holders, in the last two decades, modern technology allowed robotic applications to be considered (Paraskevopoulos et al., 2018).

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Research and Training in ABC Structural Systems

Mohiuddin Ali Khan Ph.D., M.Phil., DIC, P.E., in Accelerated Bridge Construction, 2015

3.10.3 List of FHWA initiatives

The FHWA, working with state department of transportation (DOT) officials and stakeholders such as the AASHTO, developed an initial list of initiatives on which they have focused for the past several years. States chose the initiatives they wanted to pursue, and the FWHA provided access to the technical expertise. It appears that some states are more aggressive in adopting initiatives because their circumstances allow it.

Safety Edge: One successful initiative was "Safety Edge." It is a paving process in which the edges of roads in primarily rural areas are compressed at a 30° taper angle rather than left at an unfinished 90°. Research indicates that 90° drop-offs are a factor in about 20% of rural traffic accidents.

EDC (Every Day Counts): Because of the challenging economic environment for infrastructure, state DOTs were pressured to find new ways to deliver projects in less time and for less money, and EDC has been well received. The success of EDC (discussed earlier in Chapters 1 and 3) is due to the collaborative nature of the initiative, combining input from the FHWA and participants such as state DOT officials, trade groups, and private industry stakeholders. The EDC is designed to provide evidence of proven innovations. However, the cautious nature of engineering perhaps delayed the application of the EDC approach. Construction industries, in order to remain in business, often prefer to rely on tested and proven techniques.

FWHA: continues to champion the ABC time savings provided by using prefabricated bridge elements and systems and geosynthetic-reinforced soil. The new initiatives list includes:

Alternative Technical Concepts: States can be presented with innovative ideas that save time and money. Contractors may be allowed to propose alternatives during the design phase, similar to value engineering.

Programmatic Agreements: This is a streamlined approach for environmental requirements that are often repeated on a project-by-project basis. An example is determining what mitigation actions are required when a particular endangered species is affected by rapid construction, and then repeating those actions on any project that impacts the species.

Locally Administered Federal-Aid Projects: This initiative is designed to reduce state oversight, by educating local agencies on the complexities of the processes and requirements of the Federal-Aid Highway Program.

Intersection and Interchange Geometrics: There is a need to explore any safety innovations to reduce possible conflict points between motorists, pedestrians, and bicyclists using the bridge.

High-Friction Surfaces: This safety measure adds a high-friction surface on curves, which account for 25% of fatalities. It does not impact the cost significantly, since curves comprise only about 5% of highway miles in the United States.

Geospatial Data Collaboration: This innovation allows data sharing between stakeholders, by exploring a cloud-based geographic information system platform.

Implementing Quality Environmental Documentation: The size of the National Environmental Policy Act documentation can be reduced to some extent, and innovation can accelerate project delivery.

National Traffic Incident Management Responder Training: This initiative offers a national training program for first responders. FHWA Strategic Highway Research Program 2 (SHRP2), discussed earlier, seeks to reduce the 4.2 billion hours and 2.8 billion gallons of gasoline motorists waste when frequently stuck in traffic on congested highways because of the following:

•

Extreme weather

•

Accidents

•

Disabled vehicles

•

Debris in the road

Market-ready technologies, vendor products, innovative techniques for the use of new construction materials, remote health monitoring, and recent developments in repairs and rehabilitation methods are addressed.

•

Use of such efficient methods will cut down the life-cycle costs and the duration of maintenance.

•

Some of the newer methods have not been fully tested, and precautions may be required in their applications.

•

The latest ideas, ingenuity, and contributions from individual researchers and publications are listed.

•

Recent developments in new materials and prefabricated concrete elements for rapid construction will be discussed.

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Emergency Planning

In Lees' Loss Prevention in the Process Industries (Fourth Edition), 2012

24.13.3.2 Activate and Deploy Resources

In this step, responders analyze the situation, indentify and prioritize requirements, and activate and deploy available resources. Below are the key activities:

•

Activating people and resources: it's important that the resources and people deployed and the activation of supporting incident management structures are directly related to the size, scope, nature, and complexity of the incident.

•

Requesting additional resources: for large scale incidents, additional resources may be requested through mutual aid and assistance agreements with the state or the federal government. It's critical to prioritize and clearly communicate needs so that resources are efficiently matched and mobilized to support operations.

•

Identifying needs and pre-positioning resources: in planning for emergencies, adequate resources should be anticipated and prepared. Resources can be pre-contracted when needed.

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The confluence of intelligent agents and materials to enable protection of humans in extreme and dangerous environments

Shawn M. Walsh, Daniel M. Baechle, in Robotic Systems and Autonomous Platforms, 2019

21.3 Protecting warfighters and first responders

To illustrate such a disruptive approach, a case study is presented here—namely, the use of autonomous robots as an alternative means to augment the protection of human warfighters. The term "disruptive" is used to denote that this is an unconventional approach to a very conventional if not historic and persistent need—namely, the protection of warfighters. The case study unites key aforementioned themes, including the role of materials in robotics, the confluence of otherwise disparate technologies, and redefining tasks by exploiting the intrinsic characteristics and benefits of the robots and other technologies in the context of the task itself. The case study is an evolving concept that begins to create an intelligent cloud of adaptive capability to augment the protection of individual warfighters.

Army soldiers and first responders have several areas in common. They often operate under extreme conditions with evolving or limited information. They require materials, equipment, and information to perform their tasks. One of the requirements of their equipment is to provide protection. In the case of the soldier, protection may include the use of materials to resist bullets, ballistic projectiles, or low speed impact trauma from building debris. A law enforcement officer or a firefighter might need protection against firearms or burning debris, respectively. The conventional approach to such protection falls into two primary areas: (1) the conception and design of protection to be worn on the body, and (2) the development and fabrication of materials to meet the design and performance requirements associated with extreme events like ballistic and blunt impact. Though not comprehensive, these common characteristics can be highlighted as follows:

•

Operate under dangerous, extreme, uncertain conditions

•

Require as much information as possible, but little time to process it

•

Need access to difficult areas and locations that pose threats from potential adversaries or are inherently physically dangerous

•

Require appropriate levels of protection

•

Require tools to augment their ability to identify, stabilize, and resolve dangerous situations

•

Limited by the amount of equipment that can be carried on their person for extended periods of time, and in extreme locations

Conventional approaches to warfighter protection have changed little, in principle, from ancient practices. Contemporary warfighters (such as Army soldiers, Marines, and Special Operations forces), like their ancient warrior counterparts, don equipment on their person as shown in Fig. 21.7. Body-worn armor fortifies warfighter resistance against penetrating and nonpenetrating forces delivered by bullets, ballistic fragments, and blunt impacts. While this principle of "individual" protection worn by the warfighter has remained essentially the same through the ages, both the threats and the strategies by which they are mitigated have changed dramatically. Innovation in body armor, to include helmets, soft and hard torso plate armor, and extremity protection (deltoids, legs, neck, groin, arms) is performed in two primary ways. The first is conceptual design, which addresses challenges such as appropriate area of coverage, comfort, and ergonomic interfacing with other equipment worn or used by the warfighter. The second thrust focuses on developing materials and mechanisms to effectively mitigate both the forces and deformations associated with the sudden and extreme application of ballistic and blunt impact loads. More recently, research has also been initiated to mitigate both free field and fragment-laden blast events (e.g., improvised explosive devices).

Fig. 21.7. Classical soldier protection paradigm.

From the National Archives, US Army Staff Sgt. Pablo N. Piedra, and US Army NSRDEC, left to right.

Developing effective body armor presents multifold challenges largely due to limits on the ability of the human warfighter to tolerate the cumulative weight of body armor materials. Comfort, thermal, and flexibility issues can also erode body armor tolerance under certain operating conditions or prolonged missions. Warfighter protection is usually described as part of an "iron triangle" which suggests a sensible balance and coupling between lethality, mobility, and survivability [26]. While body armor is an effective enabler for survivability, it can be detrimental to mobility by weighing the warfighter down or impeding his or her movement. The iron triangle highlights that armor is not the only means to increase the probability of warfighter protection and survival; it also suggests enhancing, rather than limiting, mobility can favorably influence survivability as well. Thus, trade-offs are made to strike a holistic balance, and to ensure the warfighter has required levels of protection, mobility, and lethality commensurate with the mission and threat environment.

Conventional body armor has been effective in mitigating the threats it is specifically designed to address. However, contemporary and forecasted concerns continue to emerge that suggest conventional body armor may not sufficiently address all future threats. Threats include, but are not limited to:

•

More effective bullets

•

Increased projectile velocity

•

More effective and lethal weapons

•

Ability to repeatedly deliver multihit accurately

•

Deleterious effects from nonpenetrating ballistic impacts or blasts

•

The potential of lethal robots or robotic launched lethal mechanisms

Predictions of future operating environments and the disruptive advances in lethality made possible by concomitant advances in science and technology provide the impetus to rethink the approach to bolstering and ensuring warfighter survivability. Ancient warfighters generally encountered relatively low velocity projectiles, and simply preventing penetration was sufficient for effective body armor. By contrast, preventing penetration from modern ballistic projectiles in body armor is often a necessary but insufficient requirement to ensure survivability. The forces and deformations generated from nonpenetrating ballistic events can cause serious, if not life-changing or lethal, disturbance to human physiology (e.g., brain tissue, vital organs, muscle, bone).

It could also be argued that kinetic and ballistic-based lethality mechanisms are evolving at a rate that will pose a challenge for conventional body armor materials, designs, and strategies. Advances in the precision and accuracy to deliver disabling and more lethal "effects" have benefitted from innovations in sensing, device design, and munition efficacy. Weaponry to repeatedly deliver threats can easily compromise the multihit (i.e., ability to defeat at least two small arms projectile events) resistance. New devices to overcome the thermodynamic limits of conventional chemical-based propulsion of projectiles, such as electromagnetic (EM) guns, pose potential threats. In short, it can be argued that lethality is rapidly and robustly challenging classic passive armor approaches. Though cognitive and physical conditioning suggests that some humans can tolerate more load (and hence more armor) on their person, average humans may not be evolving or conditioning fast enough to cope effectively with heavier armor solutions.

Aside from manufacturing, robots could also enable entirely new modes of material deployment on the battlefield. Generally, discussion of military robots typically conjures images of surveillance drones such as the large Global Hawk or the small Raven, armed systems such as the Reaper UAS or the TALON SWORDS UGV, and bomb detection/defusing systems such as PackBot. However, recent efforts at the U.S. Army Research Laboratory have demonstrated robots could provide significant advances to warfighter survivability—enabling the capability of robots to deploy materials for protection of dismounted soldiers.

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Integration in Disasters of Different Types, Severity, and Location

James M. Shultz, ... Ronald Sherman, in Integrating Emergency Management and Disaster Behavioral Health, 2017

Integration in an Urban Evacuation: Yonkers Mudslide

In this author's opinion and experience, on March 11, 2015, the rapid response to the Yonkers, New York mudslide illustrates how local government, in this case the City of Yonkers in Westchester County, and the American Red Cross (ARC) of Greater New York, partnered to help residents of two senior citizen high-rise apartment buildings evacuate when a mudslide threatened the structures. The site had been a source of concern for local officials because of known threats. The geology of the area, surrounding development, recent rain, and melted snow had raised awareness of the potential danger.

Both the city of Yonkers and Westchester County, directly north of New York City, are large entities with strong staffing. The American Red Cross of Greater New York, with a large number of volunteer licensed mental health experts with DBH experience, was available on short-notice. The actions of all responding organizations were managed at an onsite Incident Command Post. This is where the integration between EM and DBH staff initially occurred.

In addition, many of the responders from the various organizations had experience with other area emergencies and had worked together in the past. They had also participated in disaster exercises together. They were able to build off their existing relationships and integrate their activities. They were not strangers to each other.

The scene of an incident is not the ideal time for responders to meet face-to-face. There is an underlying need, in whatever jurisdiction, for essential staff to know each other prior to an event. These relationships are an essential part of integrating EM with DBH professionals.

The 109 seniors, some of whom had mobility issues but were largely independent, were evacuated in the afternoon, leaving personal property behind, including medications and clothes. With Yonkers EM and Westchester County officials, a wheelchair accessible reception center was set-up by the ARC while hotel rooms were located. The ARC team of licensed mental health professionals, led by a seasoned ARC mental health expert, provided a compassionate presence to the displaced residents. The Westchester County Commissioner of Health was onsite, writing prescriptions for residents, which were delivered by hand messenger to a nearby pharmacy, filled, and hand-carried back to the reception center.

Within 12 hours, beginning with the mandatory evacuation order, all residents were safely lodged, either in hotels or with family and friends. Throughout the event, the residents were protected from the media. This was accomplished because no responding agency released any names or relocation information. This ensured the survivors' privacy and eliminated the need for anyone to relive or retell their stories of going through something they could neither control nor respond to themselves. Because temporary slope stabilization was not feasible, the residents were eventually permanently relocated to other senior living facilities.

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Acute Inhalational Injury

Yasunori Ichimura, David Baker, in Reference Module in Biomedical Sciences, 2019

Preventing Acute Inhalational Injury

Civil and military emergency medical responders can be protected against acute inhalational injury by the use of filtration respirators (also known as an Anti-Gas Respirator AGR) (Box 6) or closed circuit breathing apparatus (Self Contained Breathing Apparatus or SCBA, used by many fire services around the world).

Box 6

Respiratory protection by a filtration respirator.

Reception and decontamination facilities for toxic trauma casualties at a French hospital designated for the reception of chemical casualties. Access to the hospital is through one specific entrance for contaminated casualties. The emergency physicians are wearing level C protection stored at the hospital with filtration respirators. (Photo courtesy of SAMU de Paris).

The principle of the filtration respirator is that inhaled air enters the mask via a canister filled with activated charcoal which removes toxic gases by chemical adsorption. Different types of canister are available from commercial manufacturers to filter out various TICs. While AGR are effective against a wide range of TIC they have recognized limitations which are:

(1)

Their duration of effectiveness is dependent on the concentration of inhaled TIC or agent. Generally, the higher the concentration the shorter is the effective protection time.

(2)

Filtration canisters in AGR do not remove carbon monoxide which is a major component of the products of combustion. For this reason fire services who are regularly exposed to this hazard use SCBA where inhaled air is provided from compressed external sources in a closed circuit system.

When the concentration of a toxic substance in the atmosphere is known emergency medical personnel wearing filtration respirators can work safely to provide immediate emergency care in a contaminated zone. If the patients are not contaminated with liquid which is providing a vapor hazard they can be evacuated after stabilization to a safe emergency medical clearing station which is situated uphill and upwind of the point of the TIC release or fire and is free from further inhalation hazard.

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