Hands-On Training For CBRNE Incidents

Hands-On Training for CBRNE Incidents
Table of Contents Participant Manual
Table of Contents
Participant Manual
Introduction and Overview ..................................................................................................I-1–22
Hands-On Lanes Training Administrative Overview .............................................................1-1–4
Hands-On Lanes Training
Principles of Mass Casualty Response...................................................................... 1A-1–16
Decontamination and SCBA ...................................................................................... 1B-1–32
Scene Survey and Safety .......................................................................................... 1C-1–34
CBRNE Monitoring and PPE Level C ........................................................................ 1D-1–26
COBRATF Briefing ...............................................................................................................2-1–2
COBRATF Practical Exercises ...........................................................................................3-1–48
Conclusion and After Action Review ................................................................................... A-1–4
Appendix A: Glossary and Acronym List ..................................................................... AP-A-1–58
Appendix B: Triage Symptom Cards/Visuals
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Table of Contents Participant Manual
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Introduction and Overview Participant Manual
Introduction and Overview

Duration: .25 Hour
Summary: The instructors provide a course overview to include the administrative matters of
the classroom and facilities. The instructors describe the course goal and general expectations
and outcomes of the course. Participants and staff introduce themselves including professional
background and experience.
Activities: Participants introduce themselves to the class, and the instructor describes the
course goals and the administrative details of the course.
Risk Assessment: Low
Methods of Instruction: Introduction, instructors use facilitated lecture and visuals to
review the course goal, expectations, and class administrative details and reflective questioning
to ensure comprehension. In addition, instructors facilitate introductions of participants.
Instructor-to-Participant Ratio: 1:48
Required Reading: None
Evaluation Strategies: Introduction, instructors informally assess participants, asking
reflective questions such as, “What is the goal of this course?”
Special Instructions: None
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Introduction and Overview

As the nation’s premier all-hazards training center, the CDP offers training to prepare the
nation’s emergency responders to mitigate incidents involving CBRNE hazards, natural
disasters, civil disturbances, and overall emergencies. The CDP offers realistic, scenario-based
training to provide participants with the knowledge and skills necessary for effective and efficient
response.
Purpose
Emergency responders trained at the operations level are part of the initial response to a
potential CBRNE incident. Their purpose is to protect nearby persons, property, or the
environment from the effects of the incident. The Hands-On Training for CBRNE Incidents
course provides participants with the knowledge and skills to perform at the operations level.
Specifically, the Hands-On Training for CBRNE Incidents course prepares participants to
effectively respond to a CBRNE incident involving mass casualties, decontamination
procedures, scene survey and safety, and monitoring for biological, chemical, and radiological
contaminants.
Notes:
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Course Goal
At the conclusion of the Hands-On Training for CBRNE Incidents course, participants will be
able to perform CBRNE-specific response skills in a hazardous environment.
Question: Are there specific tasks and/or skills you would like to learn? If so, what are
they?
Notes:
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Scope of Course
 Principles of Mass Casualty Response

 Decontamination and SCBA
 Scene Survey and Safety
 CBRNE Monitoring and PPE Level C
 COBRATF Practical Exercises
Scope of Course
The Hands-On Training for CBRNE Incidents course is a 2-day, 16-hour course offering
lectures, hands-on training, and team exercises. Participants review information, and practice
skills necessary to effectively respond to a CBRNE incident. Topics for this course include
• Principles of Mass Casualty Response,
• Decontamination and SCBA,
• Scene Survey and Safety,
• CBRNE Monitoring and PPE Level C, and
• COBRATF Practical Exercises.
The Hands-On Training for CBRNE Incidents course culminates with a final exercise in a toxic
agent environment. The exercise integrates the emergency response operations skills and
training learned during the course in a toxic agent environment.
Notes:
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Module # Module Title Time Allocation

DAY ONE Subtotal Total
Introduction and Overview 0.25 hour
Admin 1 Medical Evaluation and Vitals Screening 0.50 hour
Module 1 Hands-On Lanes Training (These lanes are
conducted in a round robin format. The
7.00 hours
actual order followed is determined by
instructors.)
Lane 1A Principles of Mass Casualty Response 1.75 hours
Lane 1B Decontamination and SCBA 1.75 hours
Lane 1C Scene Survey and Safety 1.75 hours
Lane 1D CBRNE Monitoring and PPE Level C 1.75 hours
Admin 2 Lunch (taken after any two lanes in Module 1
0.75 hour
are complete)
Admin 3 Medical Screening 0.25 hour
Module 2 COBRATF Briefing
0.25 hour
Review of Northville Scenario
DAY TWO
Introduction to COBRATF/Safety Briefing 0.75 hour
Admin 4 Vitals Screening 0.25 hour
Module 3 COBRATF Practical Exercises Northville 3.00 hours
Admin 5 Safety Briefing 0.25 hour
Module 3
COBRATF Practical Exercises 3.00 hours
(continued)
Admin 6 Vitals Screening 0.25 hour
Conclusion and After Action Review 0.25 hour
Admin 7 Graduation 0.25 hour
TOTAL CONTACT HOURS 16.00 hours
Notes:
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Prerequisite
 Completion of the AWR-160 Standardized Awareness

Training or another equivalent certified awareness training
program
Prerequisite
To be eligible to attend Hands-On Training for CBRNE Incidents, participants must have
completed the AWR-160 Standardized Awareness Training or another equivalent certified
awareness training program.
Notes:
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Course Objectives
• Explain the course of action for a CBRNE response, including

triage, decontamination, scene survey, and monitoring
operations.
• Perform mass casualty triage, decontamination, and
monitoring operations while wearing the appropriate level of
PPE in response to a CBRNE incident
Course Objectives
At the conclusion of this course, participants will be able to
• Explain the course of action for a CBRNE response, including triage, decontamination,
scene survey, and monitoring operations.
• Perform mass casualty triage, decontamination, and monitoring operations while
wearing the appropriate level of PPE in response to a CBRNE incident.
Notes:
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Participant Requirements
 Participants should be able to

 Don and doff PPE Level C
 Don and doff SCBA
 Lift 40 pounds or more
 Meet the CDP medical criteria (resident training form
[COBRATF 4.18. BB])
Participant Requirements
Participants should be able to
• Don and doff Personal Protective Equipment (PPE) Level C,
• Don and doff Self-Contained Breathing Apparatus (SCBA),
• Lift 40 pounds or more, and
• Meet the CDP medical criteria (resident training form [COBRATF 4.18.BB]).
Continuing Education Units

The CDP awards 1.6 continuing education units for the successful completion of this course.
The CDP has been approved by the International Association for Continuing Education and
Training as an authorized provider of continuing education units. To obtain college credit(s) for
this course, participants must contact their college’s or university’s registrar’s office.
Notes:
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Class Administration
 Classrooms
 Restrooms, break and lunch areas
 Emergency evacuation directions
 “Meet and Greet” session area
 Evening Lecture Series area
 Lanes training areas
Class Administration
Indicate the locations and/or procedures for the following:
• Classrooms,
• Restrooms and break areas,
• Dining area for lunch,
• Emergency evacuation directions,
• “Meet and Greet” session area,
• Evening Lecture Series area, and
• Lanes training areas.
Notes:
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Class Administration (continued)
 Please refrain from use of profanity while at the CDP

 No use of tobacco is allowed except in designated areas
 Please turn off all cell phones during class time
 No text messaging during class
Safety Briefing
CDP’s participant risk reduction includes:
• Onsite paramedics with ambulances,
• Pre- and postexercise vitals screening,
• PPE sanitization,
• Risk analysis conducted, and
• Safety Officer (SO) assigned.
Notes:
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Safety Briefing
CDP’s participant risk reduction includes the following:

 Onsite paramedics with ambulances
 Pre- and postexercise vitals screening
 Cooling vests
 PPE sanitization
 Risk analysis conducted
 Safety Officer (SO) assigned
Safety Briefing (continued)

HAZARD MITIGATION
Tripping (extension cords, training aids,  Secure all cords
working surfaces)  Identify and mark uneven training
surfaces
 Communicate with others
Muscle strains (bending, lifting)  Mannequin—two-person drag, three-
person lift
 Stretch before training
Heat/cold stress-related illnesses  Drink plenty of water before, during,
and after training (heat)
 Cooling vests available
 Use of buddy system
 Dress in layers (cold)
 Heat and Cold Stress Plan to include
modified levels of PPE and/or
training
Notes:
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HAZARD MITIGATION
Irritation to the skin and eyes while utilizing  Place sample containers on tables
M8/M9 paper or M256A1 Kit when sampling
 Wear eye protection (full-face APR)
 Wear butyl gloves (M256A1 Kit)
 Wear nitrile gloves (M8/M9)
Pinch points (mannequins)  Be aware of moving parts on
mannequins
 Do not place hands in joints of
mannequins
Limited visibility (decreased peripheral  Overemphasize the turning of the
vision while wearing an APR) head
 Alert others of hazards in the area
10

HAZARD MITIGATION
Cuts due to mannequin clothing removal,  General awareness of hand
broken ampoules, and SCBAs placement when performing clothing
removal and donning/doffing SCBAs
 Wear prescribed PPE at all times
 Follow M256A1 Kit instructions and
use crushing device as instructed
11
Notes:
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Introduction to Lanes Training
During lanes training, participants are introduced to the

equipment used and actions that occur in the warm zone at a
CBRNE/all-hazards incident. Participants will
 Perform triage and decontamination techniques
 Identify methods of scene survey and safety
 Operate monitoring equipment to measure residual
contamination
12
Introduction to Lanes Training

During lanes training, participants are introduced to the equipment used and actions that occur
in the warm zone at a CBRNE/all-hazards incident. Participants will
• Perform triage and decontamination techniques,
• Identify methods of scene survey and safety, and
• Operate monitoring equipment to measure any residual contamination following
decontamination.
Notes:
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Medical Screening
To dress out, vitals must meet the following criteria:

 Blood pressure < 150/90
 Pulse < 100 per minute
 Respiration < 20 per minute
13
Medical Screening
The CDP Heat and Cold Stress Plan mandate medical monitoring or surveillance for all staff
and participants in training exercises during which PPE is worn. The statistics that are
monitored by the pre-entry medical screening tests are as follows:
• Blood pressure < 150/90,
• Pulse < 100 per minute, and
• Respiration < 20 per minute.
Notes:
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Training Items
Participants are issued the following training items:

 PPE Level C
 Boots
 Cooling vest
 Silver Shield® gloves
 SCBA
 Medical vitals sheet
14
Training Items
The following items will be provided as needed as participants train:
• PPE Level C,
• Boots,
• Cooling vest (as applicable),
• Silver Shield® gloves,
• SCBA, and
• Medical vitals sheet.
Notes:
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General Safety Rules
 Take time to perform each task

 Smoke only in designated areas
 Notify the SO before leaving training area
 Report to SO any injury or illness
 Be careful using scissors; don’t cut gloves
 Follow instructors to safe area during inclement weather
15
Notes:
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Heat Stress
Heat stress indicators

 Heat cramps
 Muscle spasms (especially legs, abdomen)
 Heat exhaustion
 Cool, moist, flushed skin
 Headache, nausea, dizziness, and weakness
 Heat stroke
 Red, hot, dry skin
 Changes in consciousness
16
Heat Stress
Heat stress may occur with the following symptoms:
• Heat cramps may include muscle spasms, which usually start in the legs and abdomen.
• Heat exhaustion is usually indicated by cool, moist, flushed skin; headache; nausea;
dizziness; and weakness.
• Heat stroke symptoms may include red, hot, dry skin and changes in consciousness.
Notes:
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Hand and Arm Signals
CDP signals used during training are

 Attention—Wave one or both arms overhead
 I need help—Exaggerated head patting
 No air—Place hands at the throat (emergency)
 OK—Give “thumbs up” sign
17
Hand and Arm Signals

NOTE: The following hand and arm signals are used by the CDP. They are not intended to
replace any existing jurisdictional protocols. Hand and arm signals may vary from jurisdiction to
jurisdiction. The intent of the CDP is to achieve consistency and promote safety during training.
Notes:
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Emergency Procedures
In an emergency, follow these procedures:

 Stop training
 Follow the instructor’s directions
Anyone can declare “stop training” for safety concerns
18
Emergency Procedures
If “stop training” is called, participants should follow the directions of their instructors. The
instructors will have participants move to a designated area, where instructors will decide the
steps to continue training safely. Anyone, including participants, can declare “stop training” at
any time during the lanes if he or she feels there are safety concerns.
Notes:
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Buddy System
Code of Federal Regulations (C.F.R.) standards regarding the

buddy system
 29 C.F.R. 1910.120(a)(3)—The buddy system organizes
employees into work groups.
 29 C.F.R. 1910.120(q)(3)(v)—The Incident Commander
(IC) limits the number of emergency response personnel;
however, he/she ensures the use of the buddy system by
dividing responders into groups of two or more.
 Participants form buddy teams before lanes training.
19
Buddy System
References for the buddy system are found in Hazardous Waste Operations and Emergency
Response (HAZWOPER), 29 Code of Federal Regulations (C.F.R.) § 1910.120 (2013).
• 29 C.F.R. § 1910.120(a)(3)—Buddy system means a system of organizing employees
into work groups.
• 29 C.F.R. § 1910.120(q)(3)(v)—Incident commander limits the number of emergency
response personnel; however, he/she ensures the use of the buddy system (groups of
two or more).
Notes:
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Overview of Hands-On Lanes
Hands-on lanes training includes

 Principles of Mass Casualty Response
 Decontamination and SCBA
 Scene Survey and Safety
 CBRNE Monitoring and PPE Level C
20
Overview of Hands-On Lanes

Participants take part in four hands-on training lanes, followed by Day Two’s performance-
oriented, hands-on practical exercise at the COBRATF.
Participants engage in a round-robin rotation of hands-on training activities in four unique
training lanes. These lanes are intended to provide participants with an opportunity to use the
skills and knowledge necessary for a safe response to a CBRNE/all-hazards incident. The
lanes, each about 2 hours in duration, are as follows:
• Principles of Mass Casualty Response—Participants practice skills needed to support
mass casualty operations at the scene of a CBRNE MCI. Participants take part in a
scenario-driven practical exercise during which they perform mass casualty response
activities including applying triage methods based on casualties’ signs and symptoms
resulting from a CBRNE incident.
• Decontamination and SCBA—Participants practice the skills necessary to
decontaminate casualties and responders during a CBRNE incident. Participants
discuss the various types of decontamination; explain special considerations associated
with decontamination; and identify the components of PPE Level B and when it is worn.
Participants operate an SCBA. Next, participants view a demonstration of clothing
removal and decontamination and then perform these tasks on nonambulatory
Notes:
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casualties. Participants engage in a discussion of a technical decontamination corridor

and observe role players undergoing decontamination.
• Scene Survey and Safety—Participants identify explosive devices, including basic
device type and design, device construction methods, and the components of
Improvised Explosive Devices (IED) as well as non-IEDs. Participants explain how to
conduct basic searches for devices and practice the skills necessary to recognize
potential hazards and explosive devices. Participants engage in a practical exercise
during which they practice scene survey techniques in searching for explosive devices.
Participants also describe the effects of explosive devices, responder safety during
explosives incidents, and how responders might become a target for terrorists’
secondary devices.
• CBRNE Monitoring and PPE Level C— Participants review information about equipment
capable of monitoring to detect CBRNE hazards and technologies in use throughout the
United States. During the practical exercise, participants perform monitoring by
operating various screening and monitoring equipment while employing PPE Level C.
Notes:
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Module 1: Hands-On Lanes Training Participant Manual
Module 1: Hands-On Lanes Training

Duration: 7.00 Hours
Summary: In the lanes training, participants refine the skills necessary to respond to a
CBRNE incident. Participants apply the appropriate triage method for a CBRNE Mass Casualty
Incident (MCI); perform nonambulatory decontamination; discuss other types of
decontamination, including technical decontamination, required at CBRNE incidents; operate
monitoring equipment to screen for chemical, biological, and radiological material and detect
any contamination following decontamination procedures; and respond to a CBRNE incident
involving possible secondary devices.
Terminal Learning Objective: At the conclusion of this module, participants will be
able to explain the course of action of a CBRNE response, including triage, decontamination,
scene survey, and monitoring operations.
Enabling Learning Objectives:
At the conclusion of this module, participants will be able to
1A-1 Apply triage methods performed during a response to an MCI according to Lerner et
al.’s “Mass Casualty Triage: An Evaluation of the Data and Development of a
Proposed National Guideline.”
1A-2 Triage casualties based on their signs and symptoms resulting from a CBRNE
incident according to information from the Agency for Toxic Substances and Disease
Registry (ATSDR) and relevant medical and military studies.
1A-3 Perform mass casualty response activities within the warm zone of a CBRNE
incident according to Noll, Hildebrand, and Yvorra’s Hazardous Materials: Managing
the Incident.
1B-4 Discuss the types of decontamination consistent with National Fire Protection
Association® (NFPA®) 472, Standard for Competence of Responders to Hazardous
Materials/Weapons of Mass Destruction Incidents, Section 3.3.17.
1B-5 Explain special considerations associated with decontamination in accordance with
Abeel’s Multi-Casualty Mass Decontamination Guidance Document for First
Responders and Oldfield et al.’s Emergency Responder Training Manual for the
Hazardous Materials Technician.
1B-6 Identify the components of Personal Protective Equipment (PPE) Level B according
to Hazardous Waste Operations and Emergency Response (HAZWOPER), 29 Code
of Federal Regulations (C.F.R.) § 1910.120, Appendix B.
1B-7 Operate Self-Contained Breathing Apparatus (SCBA) according to the
manufacturers’ guidance.
1B-8 Perform nonambulatory decontamination consistent with NFPA 472, Section 6.3.
1B-9 Discuss technical decontamination setup and procedures consistent with NFPA 472,
Section 6.4.3.2.
1C-10 Identify types of dissemination devices and their components according to New
Mexico Tech’s Incident Response to Terrorist Bombings.
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1C-11 Explain the Bureau of Alcohol, Tobacco, Firearms, and Explosives’ (ATF) bomb
search technique.
1C-12 Practice proper scene survey techniques according to the ATF’s bomb search
technique.
1C-13 Describe the effects of an explosive device according to New Mexico Tech’s Incident
Response to Terrorist Bombings.
1D-14 Use PPE Level C according to HAZWOPER, 29 C.F.R. § 1910.120.
1D-15 Operate chemical monitoring equipment according to manufacturers’ guidance.
1D-16 Operate biological screening tools according to manufacturers’ guidance.
1D-17 Operate radiological monitoring equipment according to manufacturers’ guidance.
Activity: During Lane 1A, participants review the signs, symptoms, and triage categories for
each type of CBRNE injury. Instructors display different triage cards and/or visuals with
symptoms. Participants identify types of injuries, triage levels, and color-coded medical
requirements for each casualty. Allow approximately 10 minutes for this activity.
Practical Exercises: During Lane 1A, participants don nitrile, Silver Shield®, and butyl
rubber gloves to perform triage operations at an MCI. In this scenario, a bomb blast has
occurred in a restaurant after a soccer game. Some of the casualties show signs of exposure to
a nerve agent. Instructors brief participants about the incident. Participants are informed they
are in the proper level of PPE for entering the area as well as briefed on the findings of the initial
assessment/entry team. Participants enter into the incident area in teams of two or three to
perform triage operations. Allow approximately 1 hour for this exercise.
During Lane 1B, participants operate an SCBA. Participants view a demonstration of the
procedures for casualty clothing removal. Next, participants perform clothing removal
procedures by cutting the clothing off mannequins. Instructors review with participants the
procedures for nonambulatory decontamination of casualties. Participants then perform
nonambulatory decontamination of casualties using mannequins. At the end of the exercise,
participants observe and discuss technical decontamination. Allow approximately 1 hour for this
exercise.
During Lane 1C, participants practice proper scene survey techniques by searching for
explosive devices in separate rooms apart from the classroom. Once participants complete the
initial search, they return to the classroom. Participants take part in the identification of different
types of dissemination devices and their components. Instructors review Improvised Explosive
Device (IED) and non-IED components. After being given this information, participants return to
the rooms separate from the classroom where the instructor explains in more detail the
capabilities and function of the various devices. Allow approximately 1 hour for this exercise.
During Lane 1D, participants identify and operate various monitoring equipment, such as the
Lightweight Chemical Detector (LCD), the M256 Chemical Agent Detector kit, the Powder
Screening Test Kit, and the Ludlum Radiological Survey Meter, in order to become familiar with
them. Participants employ PPE Level C and perform monitoring using the M256 kit. Participants
then doff their PPE Level C. Allow approximately 1 hour for this exercise.
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Methods of Instruction: In Lane 1A, instructors use a facilitated lecture format

supported by presentation visuals to engage participants in discussions triage methods and
CBRNE injuries. Throughout the lane, instructors engage participants in discussions in which
the participants discuss triage methods and signs and symptoms of CBRNE injuries. Instructors
ask reflective questions to challenge participants’ critical thinking skills and reinforce the lane’s
content. Participants perform mass casualty response activities including triaging casualties
based on their signs and symptoms. As participants perform the triage activities, instructors
coach participants as needed on the specific methods of triage. At the conclusion of the lane,
instructors pose objective-based questions, such as “What types of injuries may occur as a
result of a CBRNE incident?” to facilitate discussion and confirm participants’ comprehension of
the lane’s content.
In Lane 1B, instructors use a facilitated lecture format supported by presentation visuals to
engage participants in discussions the types of decontamination, as well as special
considerations associated with decontamination. Using a PPE Level B suit, instructors describe
the components of the suit. Participants are asked to identify the components of PPE Level B.
Throughout the lane training, instructors ask reflective questions to challenge participants’
critical thinking skills and reinforce the lane’s content, such as “How do PPE Levels B and C
differ?” Instructors demonstrate how to operate an SCBA and coach participants as needed as
they operate an SCBA. Instructors also demonstrate nonambulatory clothing removal and
decontamination and coach participants as needed on specific skills, methods, and techniques
as they perform nonambulatory clothing removal and decontamination. At the conclusion of the
lane, instructors pose objective-based questions, such as “What special considerations
associated with decontamination should be identified at the beginning of a response?” to
facilitate discussion and confirm participants’ comprehension of the lane’s content.
In Lane 1C, participants practice surveying, searching, and locating multiple explosive devices
before the beginning of the facilitated lecture. After the initial survey and search of the areas,
participants report to the main classroom. Instructors use a facilitated lecture format supported
by presentation visuals and videos to identify types of dissemination devices, the techniques for
scene survey, and the effects of an explosive device. Following the videos, instructors facilitate
discussion on the effects of the explosive devices viewed by participants. In addition, instructors
engage participants in a discussion of potential response to an explosive device incident based
on a presented scenario. When participants return to search the original areas, instructors
coach participants to ensure that all devices are located and identified. At the conclusion of the
lane, instructors pose objective-based questions, such as “What are the types of dissemination
devices?” to facilitate discussion and confirm participants’ comprehension of the lane’s content.
In Lane 1D, instructors use a facilitated lecture format supported by presentation visuals to
engage participants in discussions PPE Level C and various screening and monitoring
equipment. In addition, instructors demonstrate the specific skills and techniques participants
are required to perform during the lane. During the hands-on practical exercise, instructors
coach participants during the employment of PPE Level C and while operating chemical,
biological, and radiological screening equipment as necessary. When appropriate, instructors
ask questions to challenge participants’ critical thinking skills in the application of skills and
techniques. At the conclusion of the lane, instructors pose objective-based questions, such as
“How difficult was it to use PPE Level C?” to facilitate discussion and confirm participants’
comprehension of the lane’s content.
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Evaluation Strategies: During Lane 1A, instructors use reflective questioning and
observations to informally assess participants’ comprehension of key information. Instructors
also observe and informally assess participants during the practical exercise. In the activity
instructors use triage cards to review and informally assess participants’ level of knowledge of
triage, treatment protocols, and types of CBRNE injuries. In the practical exercise, instructors
informally assess participants as they are categorizing and tagging casualties. Instructors
demonstrate and coach participants as necessary to ensure that participants are applying the
triage methods correctly. In addition, participants use a performance checklist of identified skills
during the training to self-assess.
During Lane 1B, instructors use reflective questioning and observations to informally assess
participants’ comprehension of key information. Instructors also observe and informally assess
participants during the practical exercise. In the practical exercise, instructors specifically
evaluate participants’ ability to discuss and perform decontamination procedures during a
simulated CBRNE incident. Instructors demonstrate skills and tasks and coach participants as
necessary to ensure participants are operating the SCBA and performing decontamination
methods correctly. In addition, participants use a performance checklist of identified skills during
the training to self-assess.
During Lane 1C, instructors use reflective questioning and observations to informally assess
participants’ comprehension of key information. Instructors also observe and informally assess
participants during the practical exercise. During the practical exercise, instructors coach
participants as they practice surveying and searching the areas for explosive devices. As
participants are completing the second survey and search, instructors verify that participants are
practicing proper scene survey techniques. In addition, participants use a performance checklist
of identified skills during the training to self-assess.
During Lane 1D, instructors use reflective questioning and observations to informally assess
participants’ comprehension of key information. During the practical exercise, instructors
observe and informally assess participants’ ability to perform monitoring during a CBRN
incident. As participants are operating the screening equipment, instructors demonstrate skills
as needed to ensure that participants are operating the different pieces of equipment correctly.
In addition, participants use a performance checklist of identified skills during the training to self-
assess.
Special Instructions: In Lane 1A, the practical exercise may be conducted in a darkened
setting to challenge participants during their triage of the casualties. Participants may be issued
a flashlight with their bucket and triage tags to use during this exercise. Per the monitoring
instruction in Lane 1D, this course does not certify or teach technical aspects of monitoring;
those tasks should still be conducted by Hazardous Materials (HAZMAT) technicians or other
certified personnel in local jurisdictions.
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Module 1: Hands-On Lanes Training: Lane 1A Participant Manual
Lane 1A: Principles of Mass Casualty Response

Summary: Participants practice skills needed to support mass casualty operations at the
scene of a CBRNE Mass Causality Incident (MCI). Participants take part in a scenario-driven
practical exercise during which they perform mass casualty response activities including
applying triage methods based on casualties’ signs and symptoms resulting from a CBRNE
incident.
During a response to an MCI, participants will be able to
1A-1 Apply triage methods performed during a response to an MCI according to Lerner et
al.’s “Mass Casualty Triage: An Evaluation of the Data and Development of a
Proposed National Guideline.”
1A-2 Triage casualties based on their signs and symptoms resulting from a CBRNE
incident according to information from the Agency for Toxic Substances and Disease
Registry (ATSDR) and relevant medical and military studies.
1A-3 Perform mass casualty response activities within the warm zone of a CBRNE
incident according to Noll, Hildebrand, and Yvorra’s Hazardous Materials: Managing
the Incident.
Activity: Participants review the signs, symptoms, and triage categories for each type of
CBRNE injury. Instructors display different triage cards and/or visuals with symptoms.
Participants identify types of injuries, triage levels, and color-coded medical requirements for
each casualty. Allow approximately 10 minutes for this activity.
Practical Exercise: Participants don nitrile, Silver Shield®, and butyl rubber gloves to
perform triage operations at an MCI. In this scenario, a bomb blast has occurred in a restaurant
after a soccer game. Some of the casualties show signs of exposure to a nerve agent.
Instructors brief participants about the incident. Participants are informed that they are in the
proper level of Personal Protective Equipment (PPE) for entering the area as well as briefed on
the findings of the initial assessment/entry team. Participants enter into the incident area in
teams of two or three to perform triage operations. Allow approximately 1 hour for this exercise.
Methods of Instruction: Instructors use a facilitated lecture format supported by
presentation visuals to engage participants in discussions concerning triage methods and
CBRNE injuries. Throughout the lane, instructors engage participants in discussions in which
the participants discuss triage methods and signs and symptoms of CBRNE injuries. Instructors
ask reflective questions to challenge participants’ critical thinking skills and reinforce the lane’s
content. Participants perform mass casualty response activities including triaging casualties
based on their signs and symptoms. As participants perform the triage activities, instructors
coach participants as needed on the specific methods of triage. At the conclusion of the lane,
instructors pose objective-based questions, such as “What types of injuries may occur as a
result of a CBRNE incident?” to facilitate discussion and confirm participants’ comprehension of
the lane’s content.
HOT.PM.09.0 1A-1

Evaluation Strategies: Throughout the presentation of the module, instructors use
reflective questioning and observations to informally assess participants’ comprehension of key
information. Instructors also observe and informally assess participants during the practical
exercise. In the activity instructors use triage cards to review and informally assess participants’
level of knowledge of triage, treatment protocols, and types of CBRNE injuries. In the practical
exercise, instructors informally assess participants as they are categorizing and tagging
casualties. Instructors demonstrate and coach participants as necessary to ensure that
participants are applying the triage methods correctly. In addition, participants use a
performance checklist of identified skills during the training to self-assess.
Special Instructions: The practical exercise may be conducted in a darkened setting to
challenge participants during their triage of the casualties. Participants may be issued a
flashlight with their bucket and triage tags to use during this exercise.
HOT.PM.09.0 1A-2
Enabling Learning Objective 1A-1: Apply triage methods performed during a response to
an MCI according to Lerner et al.’s “Mass Casualty Triage: An Evaluation of the Data and
Development of a Proposed National Guideline.”
Triage
Triage is a system used by medical personnel and emergency responders to prioritize care for
casualties and to ensure that limited medical resources can treat the greatest number of
casualties possible.
Notes:
HOT.PM.09.0 1A-3
Triage Color-Code System

The triage color-code system is used to sort casualties based on the severity of the injury.
• Green or minimal—Minimal indicates casualties that are the “walking wounded.” These
casualties can wait on medical assistance if needed.
• Yellow or delayed—Delayed indicates casualties that can wait for care after first aid is
provided.
• Red or immediate—Immediate indicates casualties in critical condition. These casualties
are seriously injured but have a reasonable chance of survival.
• Black or expectant—Expectant indicates casualties that are either deceased or expected
to die due to injuries (Lerner et al., 2008).
Triage Tags
Triage tags allow responders to communicate to others the status of casualties who have been
through the triage process. When completing the triage tags—if time, availability, and
circumstances permit—include the following information:
Notes:
HOT.PM.09.0 1A-4
• Major injuries;
• Status (i.e., Minimal, Delayed, Immediate, or Expectant, if permissible by jurisdiction);
• Vital signs; and
• Casualty identification information.
Triage Techniques
• Move, Assess, Sort, and Send (MASS) triage occurs in the hot zone and is usually done
by Hazardous Materials (HAZMAT) technicians. It is used to determine if casualties are
viable or not.
– Move—All individuals who are physically able are asked to move to a specific
location.
– Assess—Casualties are rapidly assessed based on Respiration, Perfusion/Pulse,
and Mental Status (RPM).
– Sort—Individuals are sorted into the Minimal (Green), Delayed (Yellow), Immediate
(Red), and Expectant (Black) triage categories.
– Send—Casualties are sent (evacuated) safely and promptly to the decontamination
areas (Coule, Schwartz, & Swienton, 2003).
• Simple Triage and Rapid Treatment (START) occurs in the warm zone. The RPM check
is used to assess the casualties. The JumpSTART technique (pediatric triage) is used
with children instead of START triage.
• Secondary triage, or advanced triage, occurs in the cold zone and is performed by
medical personnel.
NOTE: In this course we will use the START technique to triage casualties.
The START triage technique is simple to remember (especially under stress). It does not require
medical expertise but rather a basic knowledge of first aid. The START method recommends
taking less than 30 seconds per person and performing lifesaving measures only. Triage of
casualties should focus on RPM, which includes the following:
• Respiratory status;
– 12–20 respirations per minute—Move to the next step,
Notes:
HOT.PM.09.0 1A-5
– Greater than 30 respirations per minute—Immediate (Red) classification, and

– No respiratory effort—Expectant (Black) classification,
• Perfusion status (i.e., pulse and blood flow);
– Capillary refill less than 2 seconds or a palpable radial pulse—Move to the next step,
– Capillary refill noted to be more than 2 seconds or an absence of radial pulse—
Immediate (Red),
• Mental status;
– Unconscious—Immediate (Red),
– Change in mental status or cannot follow simple commands—Immediate (Red), and
– Normal mental responses—Delayed (Yellow), then move to the next person.
Key Point: Triage of nonambulatory casualties should focus on RPM.

NOTE: Be sensitive to casualties who may not be able to follow simple commands:
• Individuals with special needs (i.e., mentally or cognitively impaired),
• Individuals who are deaf or have a severe hearing deficit, or
• Individuals with a language barrier (Bledsoe et al., 2006).
Notes:
HOT.PM.09.0 1A-6
Enabling Learning Objective 1A-2: Triage casualties based on their signs and symptoms
resulting from a CBRNE incident according to information from the ATSDR and relevant
medical and military studies.
Signs of CBRNE Injuries

To assess the status of patients while performing triage, responders must have knowledge of
signs of injuries resulting from a CBRNE incident. At a CBRNE scene, responders will
encounter injuries that are different from those at a more conventional MCI, such as a train
accident. Knowing the signs and symptoms of exposure to CBRNE hazards will assist in the
triage and treatment process.
Nerve Agents
Nerve agents are among the deadliest of chemical agents. The G- and V-series nerve agents
produce rapid symptom onset following exposure.
• Individuals who are able to walk and talk and indicate that breathing and circulation are
intact—Tag as Minimal (Green).
Notes:
HOT.PM.09.0 1A-7
• Individuals whose initial symptoms are improving (i.e., recovering from prehospital
antidote therapy)—Tag as Delayed (Yellow).
• Individuals who are unconscious or in convulsions (i.e., two or more bodily systems are
involved)—Tag as Immediate (Red).
• Individuals who are not breathing (i.e., for longer than 5 minutes), or have no pulse or
blood pressure—Tag as Expectant (Black).
Symptoms of Exposure
The acronyms SLUDGEM and DUMBELS are used to describe the symptoms found in an
individual suffering from nerve agent poisoning. These agents can be inhaled, ingested, or
absorbed through the skin and eyes (Adams & Miller, 2004).
SLUDGEM DUMBELS
Salivation Diarrhea
Lacrimation Urination
Urination Miosis
Defecation Bronchoconstriction
Gastric Distress Emesis
Emesis Lacrimation
Miosis Salivation
Notes:
HOT.PM.09.0 1A-8
Nerve Agent Antidote

The Antidote Treatment—Nerve Agent, Auto-Injector (ATNAA) is a prefilled auto-injector that
delivers atropine and pralidoxime chloride in one intramuscular injection. After the use of the
ATNAA, a bloodborne pathogen potentially exists in the needles; therefore, to prevent the
spreading of diseases, the devices should be disposed of as hazardous waste.
NOTE: The ATNAA is also known as the DuoDote and may be used as such in individual
jurisdictions. The ATNAA is the military designation and is in place at the Chemical, Ordnance,
Biological, and Radiological Training Facility (COBRATF) as a nerve agent antidote. The
trainers used in this training are the DuoDote trainers.
Blood Agents
Blood agents affect bodily functions by preventing blood cells from using oxygen. Due to the
speed at which blood agents act, as well as the limited availability of antidote treatments and
aggressive oxygen therapy, convulsions may occur after 30 seconds, respiration may cease
after 3–5 minutes, and death could follow within 6–10 minutes.
• Individuals with lower-dose exposure have mild headaches, nausea and vomiting,
hyperventilation, and dizziness. The removal of these individuals from the contaminated
Notes:
HOT.PM.09.0 1A-9
area is crucial to prevent further exposure and deterioration. These casualties are
classified in the Delayed (Yellow) category.
• Severe exposure, indicated by convulsions and sudden loss of consciousness, requires
rapid intervention and falls within the Immediate (Red) category.
• Individuals exhibiting apnea (cessation of breathing) in the absence of sufficient
resources to provide respiratory support are classified as Expectant (Black; Agency for
Toxic Substances and Disease Registry [ATSDR], 2010a; Baskin & Brewer, 1997).
Choking Agents
Choking agents attack lung tissue. Exposure to choking agents causes severe, uncontrollable
coughing, gagging, and tightness in the chest. This can be followed by lung tissue damage and
pulmonary edema. Severe exposure causes a casualty to literally drown in his or her own body
fluids.
• Individuals with no presenting symptoms are classified in the Minimal (Green) category
but should be detained for observation until they can be transported to a hospital for at
least a 24-hour observation period. Complications may be delayed up to 48 hours after
exposure.
• Individuals developing symptoms such as discomfort, abnormal respiratory sounds in the
chest, cough, nausea, or vomiting should be classified as Delayed (Yellow), as long as
their vital signs remain stable for 4 hours following exposure.
• Casualties showing severe respiratory distress or unstable vital signs are categorized as
Immediate (Red).
• Individuals are classified as Expectant (Black) when immediate treatment is not available
and they develop severe respiratory distress within 4 hours of exposure (ATSDR,
2010b).
Blister Agents/Vesicants
Blister agents/vesicants fall within three major families—Mustard (H), phosgene oxime (CX),
and lewisite (L). Most individuals exposed to blister agents are triaged within the Delayed
(Yellow) category.
Signs and symptoms of mustard agents include erythema (redness) and blisters on the skin;
irritation, conjunctivitis, corneal opacity, and damage to the eyes; mild upper respiratory signs to
Notes:
HOT.PM.09.0 1A-10
marked airway damage; and gastrointestinal effects. Medical management includes

decontamination immediately after exposure, as this is the only way to prevent damage.
Supportive care is given to the individual because there is no specific therapy.
For maximum benefit, decontamination for blister agents should be initiated within two minutes
following exposure. Blistering reactions for nitrogen mustard and other blister agents, with the
exception of lewisite, are delayed.
• Casualties with liquid agent burns on less than 2% of their Body Surface Area (BSA) are
Minimal (Green).
• Casualties with liquid agent burns covering 5–50% of their BSA or with eye involvement
are classified as Delayed (Yellow).
• Casualties with moderate to severe pulmonary signs and symptoms have an Immediate
(Red) classification.
• Casualties with liquid agent burns on greater than 50% of their BSA or with no
detectable respiration or pulse have an Expectant (Black) classification (Kenar &
Eryilmaz, 2009).
Radiological Exposure
Radiological exposure casualties may include those exposed to radiation from transport
vehicles, radiation leakage from power plants, and/or Radiological Dispersal Devices (RDD).
Injuries could occur from an explosion, thermal radiation, or ionizing radiation.
• Minimal (Green) casualties are those with burns on less than 10% of their BSA but not
those involving critical areas or those who have received short-term body-ionizing
radiation doses of 100–150 rad.
• Delayed (Yellow) casualties include those with traumatic injuries that are not life-
threatening, such as simple fractures or second- and third-degree burns that involve less
than 25% of their BSA.
• Individuals requiring Immediate (Red) attention are those with traumatic injuries such as
crushing extremity wounds, incomplete amputations, severe burns of the face and upper
respiratory tract, and difficulty breathing.
• Expectant (Black) casualties have severe burns on greater than 25% of their BSA,
critical injuries to the respiratory or nervous system, or have received lethal doses of
Notes:
HOT.PM.09.0 1A-11
total body radiation as indicated by a combination of clinical signs such as a high fever,
disorientation, bloody diarrhea, or vomiting (U.S. Department of Health and Human
Services, Radiation Emergency Medical Management, 2010).
Bomb-Blast Injuries
• Some bombing casualties may be able to walk and talk, are otherwise alert and oriented,
and have intact hearing. These persons are triaged as Minimal (Green).
• Individuals experiencing a decrease in or loss of hearing may have suffered trauma from
the blast. Place these individuals in the Immediate (Red) category.
Activity: Using triage symptom cards and/or visuals, instructors have participants identify
type of injury and triage category for each casualty. Allow approximately 10 minutes for this
activity.
Notes:
HOT.PM.09.0 1A-12
Enabling Learning Objective 1A-3: Perform mass casualty response activities within the
warm zone of a CBRNE incident according to Noll et al.’s Hazardous Materials: Managing
the Incident.
Mass Casualty Response Exercise

This practical exercise provides participants with the opportunity to perform CBRNE response
skills acquired during the lanes training. These response skills, employed collectively, revolve
around an MCI scenario.
NOTE: Participants should be mindful of safety issues related to their response to an MCI (e.g.,
heat exhaustion when in PPE, needle safety with DuoDote employment, and the dangers of
CBRNE agents themselves).
Scenario: A bomb blast has occurred in a restaurant after a soccer game. There are 50 or
more casualties present with multiple injuries. Some of the casualties are showing signs of
exposure to a nerve agent. Participants don nitrile, Silver Shield, and butyl rubber gloves and
then enter into the incident area in teams of two or three to perform triage operations.
Participants perform triage on all casualties present. Participants will spend approximately 1
minute per casualty to assess injuries.
During the triage exercise, participants should consider the following questions:
• During an MCI, what might make it more difficult to decide how to designate casualties in
the color-code system?
• Given less than 1 minute per casualty, how difficult is it to make an informed decision?
• How does the limited time constraint of initial triage affect color-code decisions?
• How do the color codes change during further triage and treatment?
• What special conditions automatically determine a color-code designation?
Notes:
HOT.PM.09.0 1A-13
Conclusion/Hotwash
 What were the most difficult tasks during the exercise?

 What did you learn from the exercise?
 How will you apply these lessons learned to your job?
 What questions do you have about the exercise?
 How would you improve this exercise?
Notes:
HOT.PM.09.0 1A-14
Conclusion
Triage prioritizes care for casualties and ensures that limited medical resources can treat the
greatest number of casualties possible. The triage color-code system is used to sort casualties
based on the severity of the injury. The MASS triage system used in the hot zone enables the
responder to remove the injured to the decontamination area and to transport them later to
receive the appropriate medical care. Simple triage begins in the warm zone, where
decontamination begins. To properly triage, it is imperative for responders to be cognizant of
signs, symptoms, and treatment protocols for casualties with different CBRNE injuries.
Notes:
HOT.PM.09.0 1A-15
References
NOTE: The websites listed below were used in the development of this course. Due to the
variability of content on the Internet, the time that such sites remain viable is unknown.
Adams, B., & Miller, L. (Eds.). (2004). Hazardous materials for first responders (3rd ed.).
Stillwell, OK: Board of Regents, Oklahoma State University.
Agency for Toxic Substances and Disease Registry. (2010a, March 1). Medical management
guidelines for hydrogen cyanide. Retrieved from
http://www.atsdr.cdc.gov/MMG/MMG.asp?id=1073&tid=19
Agency for Toxic Substances and Disease Registry. (2010b, September 1). Medical
management guidelines for phosgene oxime. Retrieved from
http://www.atsdr.cdc.gov/MMG/MMG.asp?id=1010&tid=213
Baskin, S. I., & Brewer, T. G. (1997). Cyanide poisoning. In Brigadier General R. Zajtchuk (Ed.
In Chief), Medical aspects of chemical and biological warfare (pp. 271–286). Retrieved from
http://www.bordeninstitute.army.mil/published_volumes/chemBio/chembio.html
Bledsoe, B. E., Porter, R. S., & Cherry, R. A. (2006). Essentials of paramedic care (2nd ed.).
Upper Saddle River, NJ: Prentice Hall.
Coule, P. L., Schwartz, R. B., & Swienton, R. E. (Eds.). (2003). Advanced disaster life support
manual. Chicago: American Medical Association Press.
Kenar, L., & Eryilmaz, M. (2009, September). Evaluations on triage applications for chemical
casualties in chemically contaminated area. Journal of Academic Emergency Medicine, 8,
9–13. doi: 10.4170/JAEM.2009.84755
Lerner, E. B., Schwartz, R. B., Coule, P. L., Weinstein, E. S., Cone, D. C., Hunt, R. C., et al.
(2008, September). Mass casualty triage: An evaluation of the data and development of a
proposed national guideline. Disaster Medicine and Public Health Preparedness. 2(S1),
S25–S34.
Noll, G. G., Hildebrand, M. S., & Yvorra, J. G. (2005). Hazardous materials: Managing the
incident (3rd ed.). Chester, MD: Red Hat Publishing.
U.S. Department of Health and Human Services, Radiation Emergency Medical Management.
(2010, August 7). Triage guidelines. Retrieved from http://www.remm.nlm.gov/radtriage.htm
HOT.IG.09.0 1A-16
Module 1: Hands-On Lanes Training: Lane 1B Participant Manual
Lane 1B: Decontamination and SCBA

Summary: Participants practice the skills necessary to decontaminate casualties and
responders during a CBRNE incident. Participants discuss the various types of
decontamination, explain special considerations associated with decontamination, and identify
the components of Personal Protective Equipment (PPE) Level B and when it is worn.
Participants operate a Self-Contained Breathing Apparatus (SCBA). Next, participants view a
demonstration of clothing removal and decontamination and then perform these tasks on
nonambulatory casualties. Participants engage in a discussion of a technical decontamination
corridor and observe role players undergoing decontamination.
Given a decontamination situation, participants will be able to
1B-4 Discuss the types of decontamination consistent with National Fire Protection
Association® (NFPA®) 472, Standard for Competence of Responders to Hazardous
Materials/Weapons of Mass Destruction Incidents, Section 3.3.17.
1B-5 Explain special considerations associated with decontamination in accordance with
Abeel’s Multi-Casualty Mass Decontamination Guidance Document for First
Responders and Oldfield et al.’s Emergency Responder Training Manual for the
Hazardous Materials Technician.
1B-6 Identify the components of PPE Level B according to Hazardous Waste Operations
and Emergency Response (HAZWOPER), 29 Code of Federal Regulations (C.F.R.)
§ 1910.120.
1B-7 Operate SCBA in accordance with manufacturers’ guidance.
1B-8 Perform nonambulatory decontamination consistent with NFPA 472, Section 6.3.
1B-9 Discuss technical decontamination setup and procedures consistent with NFPA 472,
Section 6.4.3.2.
Practical Exercise: Participants operate an SCBA. Participants view a demonstration of
the procedures for casualty clothing removal. Next, participants perform clothing removal
procedures by cutting the clothing off mannequins. Instructors review with participants the
procedures for nonambulatory decontamination of casualties. Participants then perform
nonambulatory decontamination of casualties using mannequins. At the end of the exercise,
participants observe and discuss technical decontamination. Allow approximately 1 hour for this
exercise.
presentation visuals to engage participants in discussions concerning the types of
decontamination, as well as special considerations associated with decontamination. Using a
PPE Level B suit, instructors describe the components of the suit. Participants are asked to
identify the components of PPE Level B. Throughout the lane training, instructors ask reflective
questions to challenge participants’ critical thinking skills and reinforce the lane’s content, such
as “How do PPE Levels B and C differ?” Instructors demonstrate how to operate an SCBA and
HOT.PM.09.0 1B-1
coach participants as needed as they operate an SCBA. Instructors also demonstrate

nonambulatory clothing removal and decontamination and coach participants as needed on
specific skills, methods, and techniques as they perform nonambulatory clothing removal and
decontamination. At the conclusion of the lane, instructors pose objective-based questions,
such as “What special considerations associated with decontamination should be identified at
the beginning of a response?” to facilitate discussion and confirm participants’ comprehension
of the lane’s content.
exercise. In the practical exercise, instructors specifically evaluate participants’ ability to discuss
and perform decontamination procedures during a simulated CBRNE incident. Instructors
demonstrate skills and tasks and coach participants as necessary to ensure participants are
operating the SCBA and performing decontamination methods correctly. In addition, participants
use a performance checklist of identified skills during the training to self-assess.
HOT.PM.09.0 1B-2
Notes:
HOT.PM.09.0 1B-3
Enabling Learning Objective 1B-4: Discuss the types of decontamination consistent with
NFPA 472, Section 3.3.17.
Reasons for Decontamination

During a CBRNE or all-hazards response, the primary goal is to protect life. Decontamination is
necessary to prevent the harmful health effects and spread of contaminants. According to the
U.S. Army Edgewood Chemical Biological Center (2009), there are three primary reasons for
decontaminating casualties:
• To remove the agent from skin and clothing,
• To protect emergency responders and medical personnel from cross contamination, and
• To prevent the spread of contamination.
Notes:
HOT.PM.09.0 1B-4
Types of Decontamination
There are three types of decontamination:
• Mass,
• Technical, and
• Emergency (National Fire Protection Association [NFPA], 2013).
Mass Decontamination
Mass decontamination is the “physical process of reducing or removing surface contaminants
from large numbers of victims in potentially life-threatening situations in the fastest time
possible” (NFPA, 2013, p. 472-8). In mass decontamination, copious amounts of water or soap
and water are used to remove contaminants. This type of decontamination is used for large
numbers of people, either ambulatory or nonambulatory.
Ambulatory Decontamination
Individuals are processed through decontamination by triage status. In the gross
decontamination phase, responders direct individuals to the appropriate decontamination lane
Notes:
HOT.PM.09.0 1B-5
and have them remove all clothing. During removal, the clothing should not touch the
individual’s face. Clothing should be bagged, labeled with the individual’s name, and placed into
a sealed container. Once the clothing is removed, the individual should shower with a large
quantity of soapy water (U.S. Army Edgewood Chemical Biological Center, 2009).
After washing and rinsing thoroughly, the individual should move to the monitoring area where
they are monitored to ensure that decontamination is complete. If any residual contamination is
found, the individual should return to the secondary decontamination phase to repeat the
decontamination process (U.S. Army Edgewood Chemical Biological Center, 2009).
Nonambulatory Decontamination
The decontamination process for nonambulatory individuals requires more time and is more
labor-intensive because they cannot assist in the process. Responders should remove the
individual’s clothing from head to toe, and front to back, while keeping clothing away from the
individual’s face to prevent inhalation of the contaminant (Adams & Miller, 2004; Noll,
Hildebrand, & Yvorra, 2005).
NOTE: Any casualty who requires immediate medical treatment must go through both the gross
decontamination phase and the secondary decontamination phase before being treated (Noll et
al., 2005).
Notes:
HOT.PM.09.0 1B-6
Nonambulatory individuals should be decontaminated using soap and warm water (or
appropriate decontaminant based on local protocols). Responders should concentrate on
cleaning all of the individual’s body. Dressings and bandages must be removed as well as any
clothing or personal items that may still be on the individual. All medical treatment items—
including bandages, backboard and collar, and ventilation equipment—must be decontaminated
or replaced with clean materials before the patient can be transported (Adams & Miller, 2004).
Following the secondary decontamination phase, individuals should have no contamination on
their bodies. Removal of contaminants can be verified with monitoring equipment. If an
individual remains contaminated after undergoing decontamination, he or she will need to
repeat the decontamination process.
Technical Decontamination
Technical decontamination is the “planned and systematic process of reducing contamination to
a level that is As Low As Reasonably Achievable (ALARA)” (NFPA, 2013, p. 472-8). Technical
decontamination is a multistep process during which stations are established to methodically
and thoroughly clean responders, their equipment, and their vehicles (Noll et al., 2005).
Notes:
HOT.PM.09.0 1B-7
Emergency Decontamination
According to NFPA 472, emergency decontamination is the “physical process of immediately
reducing contamination of individuals in potentially life-threatening situations with or without the
formal establishment of a decontamination corridor” (NFPA, 2013, p. 472-8). Often, there is no
PPE or specialized equipment used. The most crucial point is to clean the contaminated
individual as soon as possible (Noll et al., 2005).
Notes:
HOT.PM.09.0 1B-8
Responder Safety
The decontamination team is established to coordinate all decontamination operations for the
incident. Responders on the decontamination line should be trained to at least the operations
level (HAZWOPER, 29 C.F.R. § 1910.120, 2013; Noll et al., 2005).
The safety of responders is of foremost importance. All responders with the potential to
encounter contaminated individuals or material during decontamination operations performed
within the warm zone must wear protective clothing and respiratory protection equal to or one
level below the level of protection used in the hot zone (Oldfield et al., 2005). Some other safety
considerations for the decontamination area include the following:
• Responders should use caution when touching anything within the decontamination
area. During doffing, an assistant removes the protective clothing from the responder.
The assistant should take special care not to touch the responder’s skin or inner
clothing. Responders should not allow casualties to touch them.
• Decontamination stations should protect physical safety. All tripping hazards should be
eliminated. Responders should use caution when using tools (e.g., shears when cutting
clothing).
Notes:
HOT.PM.09.0 1B-9
• Decontamination team members should remain at the station to which they are
assigned. Contamination can be spread simply by walking down the decontamination
line.
• Decontamination team members should be equipped with the appropriate PPE
ensembles.
• Containment of all contaminated materials is necessary for proper disposal.
• Decontamination team members are the last to go through the decontamination process.
The team must go through an orderly process of cleaning and doffing PPE (Oldfield et
al., 2005).
Notes:
HOT.PM.09.0 1B-10
Enabling Learning Objective 1B-5: Explain special considerations associated with

decontamination in accordance with Abeel’s Multi-Casualty Mass Decontamination Guidance
Document for First Responders and Oldfield et al.’s Emergency Responder Training Manual
for the Hazardous Materials Technician.
Special Considerations Associated with Decontamination

Many concerns arise during and following decontamination. Several special considerations
associated with decontamination include environmental issues, modesty issues, animals,
equipment, special needs populations, and cold weather.
Environmental Issues
During emergency, mass, and technical decontaminations, the first priority is to ensure that all
casualties who were contaminated are decontaminated. The second priority should be to
contain runoff so that it does not contaminate the environment even further.
Notes:
HOT.PM.09.0 1B-11
Modesty Issues
As part of decontamination, individuals may have to disrobe. Modesty issues need to be
addressed in order to protect the individuals from the full view of the public and possibly the
media (Abeel, 2006).
Animals
Responders should be aware of applicable statutes within their jurisdictions pertaining to how
decontamination of animals in a mass casualty incident should be addressed. Responders will
come into contact with three categories of domestic animals: working animals, service animals,
and companion animals (i.e., household pets). Each of these categories of animals has specific
rights under law.
Equipment
Equipment and tools are the last items to be decontaminated. Responders should consult the
user’s guide, supplied by the manufacturers of the equipment, to properly decontaminate
equipment. Certain tools (e.g., those with wooden handles) may absorb contaminants that
cannot be removed and as a result should be disposed of as hazardous waste (Oldfield et al.,
2005).
Special Needs Populations
Responders may encounter a variety of special needs populations in a decontamination
situation. Considerations for cultural differences and language barriers should be addressed
prior to an incident. Casualties may be blind, deaf, illiterate, non-English speakers, or have
some cognitive impairment. In order to communicate the need for decontamination,
posters/flyers should focus on the subject of decontamination in a simple and understandable
way. To address the community’s needs, the posters/flyers should include illustrations, written in
the languages spoken in the community, and be available in Braille (Abeel, 2006).
Cold Weather
Decontamination in cold weather can be performed; however, there are additional challenges.
Although the temperature is cold, the outdoors is the most practical location for
decontamination. When determining the appropriate location for decontamination in cold
weather, responders should consider the temperature and the wind chill factor.
Notes:
HOT.PM.09.0 1B-12
Responders should be aware of cold weather hazards. If an individual is wet, there is a higher
probability for cold shock and hypothermia. Because cold weather affects the young and the
elderly more intensely, responders should consider giving these two groups priority in these
situations (U.S. Army Edgewood Chemical Biological Center, 2009).
NOTE: Cold weather presents more of a concern for the casualties undergoing
decontamination. Hot weather is more of a concern for the responders in PPE.
Enabling Learning Objective 1B-6: Identify the components of PPE Level B according to
HAZWOPER, 29 C.F.R. § 1910.120, Appendix B.
PPE Level B
PPE Level B has the highest level of respiratory protection but a lower level of skin protection
than PPE Level A. PPE Level B can be used in both the hot zone and the warm zone.
The PPE Level B ensemble provides splash protection, but the wearer is not completely
encapsulated. Air is supplied by a positive-pressure, full-facepiece SCBA or a National Institute
for Occupational Safety and Health (NIOSH)-approved Supplied-Air Respirator (SAR) with
Notes:
HOT.PM.09.0 1B-13
escape SCBA. PPE Level B protection is appropriate in the warm zone, where individuals and
their clothing are possibly contaminated with a chemical that could evaporate or be absorbed
through the skin. While the suit provides protection against liquid chemicals, it is not vapor-
resistant.
Suit Components
The following items comprise the ensemble components for PPE Level B according to
HAZWOPER, 29 C.F.R. § 1910.120, Appendix B:
• SCBA―Positive-pressure, full-facepiece SCBA, or positive-pressure SAR with escape
SCBA (NIOSH-approved);
• Hooded chemical-resistant clothing (overalls and long-sleeved jacket, coveralls, one-
piece or two-piece chemical-splash suit, disposable chemical-resistant overalls);
• Coveralls (as needed);
• Outer chemical-resistant gloves;
• Inner chemical-resistant gloves;
• Chemical-resistant boots with a steel toe and shank;
• Outer chemical-resistant boot covers (disposable; as needed);
• Hard hat (as needed); and
• Face shield (as needed; 2013).
NOTE: Cooling vests may be used as needed (NFPA, 2013).
Notes:
HOT.PM.09.0 1B-14
PPE Considerations During Decontamination

PPE used during decontamination should be the appropriate level of protection required for the
hazard or one level below the level required for the hot zone. If the agent is unknown, PPE
Level B is the minimum level of protection required until the agent is identified.
If there are any malfunctions while wearing PPE Level B during decontamination—such as low
air in the SCBA or a tear in the protective gloves or the suit—a signal should be given and the
responder should immediately seek help. Keep contamination avoidance in mind when
rectifying this situation. Hydration before donning and after doffing PPE is also critical for
responder safety in the decontamination corridor. A number of other potential physical and
psychological limitations are associated with PPE, including impaired vision and mobility,
encapsulation issues, and impaired communication.
NOTE: When wearing inner and outer gloves, placing an additional pair of nitrile or vinyl gloves
over the outer butyl gloves may provide better fit and dexterity.
Notes:
HOT.PM.09.0 1B-15
Enabling Learning Objective 1B-7: Operate SCBA in accordance with manufacturers’

guidance.
SCBA Operations
This exercise allows participants to practice operational checks on the SCBA and donning and
doffing the SCBA.
NOTE: The procedures listed are for the Scott Air-Pak® system used in the hands-on training
modules; procedures for other systems could vary. Review the manufacturer’s instructions for
system checks and functioning for the system type used.
Operational Checks on SCBA

Due to the critical functions of the SCBA, perform a complete and thorough operational check
before each mission, and as recommended by the manufacturer.
NOTE: Remove any large earrings prior to donning the facepiece. The facepiece and SCBA are
sanitized following NIOSH and OSHA standards.
1. Check the facepiece for defects.
– Inspect the netting for any tears or fraying.
– Inspect the adjustment straps on each side of the netting.
– Rotate the facepiece to inspect it for cracks or bad scratches.
– Inspect the docking port to ensure that it is not broken and is free from debris.
– Rotate the netting over the facepiece.
– Inspect the rubber seal for any cracks and to ensure that it is free from debris.
2. Practice donning the facepiece.
– Place the chin in the chin cup and lift the facepiece to the face.
– Pull the netting over the head.
– Tighten the bottom straps of the facepiece by pulling toward the back of the head.
– Tighten the top straps by pulling toward the back of the head.
Notes:
HOT.PM.09.0 1B-16
– To ensure a proper fit, place the flat part of the hand over the docking port and
inhale. Hold for 3–4 seconds. If there are no leaks, the participant has a proper fit.
– If air leaks, adjust the straps. If air still leaks, the participant may need a different
facepiece.
3. Practice doffing the facepiece.
– Loosen the bottom straps by pulling the metal tab at the side of the facepiece.
– Remove the facepiece by lifting over the head and placing the facepiece onto the
empty side of the case.
4. Inspect the air pack.
– Remove the black Velcro® strap.
– Spread out the shoulder and waist straps.
– On the right shoulder strap, inspect the remote gauge to ensure that it is on empty. If
it is showing a reading, this means that the pack has pressure on it that must be
relieved before doing any further inspection.
– Place the remote gauge back to the right to inspect again later for proper function.
– The regulator is on the left shoulder strap. Have participants hold the regulators up
with the black donning switch up and the name facing the instructor.
– Depress the donning switch and listen for a click. If it does not click, the regulator is
in reset mode. The regulator must be in reset to continue with the inspection.
– Test the regulator. Place mouth to the open side of the regulator and suck in. There
should be a pop. If not, depress the donning switch and try again. If there is still no
pop, do not use the pack—the regulator is not working properly.
– If the pop is heard, depress the switch and reset the regulator.
– Move the small black tab (on the right side) back and forth to ensure that the spring
is working properly. This is the locking mechanism that will secure the regulator to
the facepiece.
– On the left side is a large, red knob that is the emergency bypass valve or purge
valve. The high ridge should be up, pointing toward the ceiling; this is the off position.
Notes:
HOT.PM.09.0 1B-17
– Rotate the knob 180 degrees to ensure that the valve will move freely. This valve is
to bypass the regulator should it malfunction. This bypass does not regulate the high
pressure from the cylinder; so, if it is turned on, it will empty the cylinder in a very
short time.
– Hold the waistband and stand the pack on the round end of the cylinder. From this
position, read the two-sided gauge. Make sure that it reads between 35 and 40
pounds (measures in hundreds of psi) of pressure; if it is below 35 psi, replace the
pack.
– Check the tightness of the connection of the high-pressure line to the tank. The knob
is on the left.
– Turn the large black knob on the right side toward the participant; this turns the
cylinder on. There should be a vibrating sound. If a vibrating sound is not heard, do
not use the pack—this is one of the low-pressure alarms. This pack has two separate
alarms. When the alarm sounds, it means there is only 10% of the air left in the tank.
The first alarm is a bell on the shoulder strap. The second is the vibration of the
regulator. There are two alarm systems to ensure that, if working in a noisy
environment and the bell cannot be heard, the vibration of the regulator can still be
felt on the face.
– Place the pack back into the case and inspect the remote gauge on the right
shoulder. It should read the same as the tank gauge; if it does not, replace the pack.
Donning the SCBA

NOTE: This is one method of donning SCBA; other local protocols may vary.
1. Don the air pack.
– With the straps still spread out, grasp the pack by the support members on each
side.
– Bending at the knees and waist, lift the pack up and over the head, keeping elbows
tucked in. This allows the arms to line up with the shoulder straps.
– Ease the pack down the back until the shoulder straps rest on the shoulders.
– Holding the adjustment straps on the shoulders, pull them down and stand up at the
same time.
Notes:
HOT.PM.09.0 1B-18
– While standing, connect the waist straps and adjust to fit by pulling the straps at the
waist. The weight of the pack should be on the lower back.
2. Don the facepiece.
– Perform a seal check on the facepiece.
– Install the regulator to the facepiece.
o With the regulator in hand, turn it so that the red knob is facing up.
o Place the regulator up to the facepiece and rotate it to the left until the lock clicks.
The regulator should go to the positive-pressure mode when inhaling.
o Once in place, take a breath. This will activate the regulator, and one can breathe
normally.
NOTE: If wearing contacts, the participant should close the eyes when taking the first breath of
air.
Doffing the SCBA

NOTE: This is one method of doffing SCBA; other local protocols may vary.
1. Remove the regulator.
– Pull the locking mechanism on the right side of the regulator forward and hold.
– Depress the donning switch.
– While still holding the locking mechanism, rotate the regulator to the right until the
red knob is up. The regulator will release from the facepiece.
2. Doff the facepiece.
– Remove the facepiece by flipping the harness strap keepers to loosen the straps.
– Pull the facepiece down, out, and over the head with a backward motion of the hand.
– Check to make certain that the straps fully extend. Place the facepiece in the case.
3. Remove the pack.
– Pull back the D rings located at the waist strap to release the belt. When the belt is
loose, unfasten the belt.
Notes:
HOT.PM.09.0 1B-19
– Bending at the knees and waist, pull the D rings on the shoulder straps forward.
While still in this position, hold the shoulder straps and stand up.
– Depending on whether one is right- or left-handed, remove one arm from the strap,
grasp the other strap, and swing the air pack off (to the dominant side) like a jacket.
– Place the air pack back into the case the same way it came out, with the round end
of the cylinder at the feet.
4. Shut down the air pack.
– Stand the cylinder on its round end.
– Rotate the large black knob clockwise while pressing in on it—this shuts the pack off.
Ensure that the remote gauge has returned to zero.
– Lay the pack into the case the same way it came out, and pick up the regulator.
Rotate the red knob. (This relieves the pressure on the pack.)
5. Store the air packs.
– Place the shoulder straps to the center of the pack.
– Place the regulator under the waist strap.
– Place the waist strap in the center of the pack.
– Reattach the strap.
– Close the case.
– Make sure to lock the case before picking it up.
Notes:
HOT.PM.09.0 1B-20
Self-Contained Breathing Apparatus (SCBA)
SCBA
http://www.cdc.gov/niosh/nas/ppt/QUADCharts09/Images/ZFYJ2_FY09_QC.jpg
Notes:
HOT.PM.09.0 1B-21
Enabling Learning Objective 1B-8: Perform nonambulatory decontamination consistent

with NFPA 472, Section 6.3.
Nonambulatory Decontamination
Site Setup
A clothing removal area should be established in the warm zone (within the boundaries of the
decontamination corridor). Equipment required for clothing removal will include
• A rolled tarp (or other improvised solution) for control of runoff and containment of waste;
• Buckets containing decontaminant;
• Shears to cut through the individuals’ clothing and personal items—multiple pairs of
shears in each bucket;
• Sponges to decontaminate the individuals—sponges in each bucket; and
• Rescue devices on hand or improvised to transport the individuals.
Nonambulatory Casualty Clothing Removal Procedures
The nonambulatory casualty clothing removal procedures are one way of performing clothing
removal during Center for Domestic Preparedness (CDP) exercises. It is recommended that
participants consult their jurisdictions’ local protocols and procedures for nonambulatory
casualty clothing removal.
It is also recommended that the shears and gloves be rinsed with a decontamination solution
before coming into contact with the casualty. It is recommended that the shears be dipped in the
solution before each cut.
1. Remove clothing nearest the airway first to prevent or eliminate respiratory hazards.
2. Remove the shirt by cutting up the front of the shirt or blouse to the neck area.
3. Cut the sleeves up to the neck area.
4. Peel the shirt down and away from the casualty and use the inside of the shirt as a
barrier for the casualty. This action removes decontamination from the casualty’s airway.
If present, remove the bra at this time.
Notes:
HOT.PM.09.0 1B-22
5. Remove pants starting at the cuff. A cut is made upward from the bottom of both legs to
the waist. Peel the pants down and away from the casualty and use the inside of the
pants as a barrier for the casualty. Remove underwear.
6. Use local protocol in removing shoes, boots, etc.
7. Remove the socks by gently pulling up on the toe of the sock. (If the sock does not pull
off, use the shears to cut a small hole in the toe of the sock, and cut up the sock. Lay the
sock in the SKED® away from the casualty. The socks will be tagged and bagged with
the clothes.)
NOTE: Nonambulatory casualties will not be able to assist in the decontamination process.
Notes:
HOT.PM.09.0 1B-23
Nonambulatory Casualty Clothing Removal Procedures
Courtesy of CDP
Notes:
HOT.PM.09.0 1B-24
Preservation of Property
Preservation of property is essential during an incident because the site may be a crime scene
and the property could be essential to a potential case’s investigation and prosecution.
Equipment Preparation
In preparation for the preservation of property operations, responders should ensure that they
have the following items prepackaged into emergency modesty cover/belongings kits:
• 35-gallon, 0.04-ml-thick polyethylene bag;
• Large zippered plastic bag for personal effects;
• Disposable Tyvek suits for temporary clothing; and
• Information card indicating what was collected from the patients, their names, and
addresses.
Preservation of Property Procedures
The following are the steps to follow to preserve property after clothing removal:
1. Use a large trash bag over a gloved hand to gather and pick up clothing.
2. Gently remove the air from the bag.
3. Twist the bag and use a twist tie to tie off the bag.
4. Fold the twisted part over and tie it again using a twist tie, creating a vapor barrier. This
is known as a gooseneck knot and can function as a handle.
5. The bag is then placed into a second bag.
6. The contaminated strip (triage tag) or information card is placed into the second bag.
7. The air is removed from the second bag, and it is tied off with a gooseneck knot as well.
8. The bags are then placed into an overpack drum.
As in triage, all valuables should be tagged and bagged properly for identification. A part of the
triage tag will go into the bag for identification. Valuables should go through decontamination
and then be returned to the rightful owners if possible. Local protocols will establish chain-of-
custody procedures.
Notes:
HOT.PM.09.0 1B-25
Decontamination of Nonambulatory Casualties

Proper decontamination procedures are crucial to reducing contaminants on a person to an
acceptable level and preventing the spread of contamination during an incident.
The procedures to perform decontamination of nonambulatory casualties for this exercise are as
follows:
1. Decontaminate and rinse the casualty.
a. Using sponges from the rinse bucket, rinse the casualty’s face from the centerline
downward (with clear water). Avoid applying excessive amounts of water to the face.
b. Using sponges and a soap-and-water solution, wash the casualty from neck to toe.
Use a side-to-side, “over and down” pattern and wash from top to bottom.
c. Roll the casualty onto his or her side, decontaminate the back, and rinse from head
to toe. The backboard should be wiped down at this time.
d. Decontaminate and rinse the casualty’s down side.
e. Rinse the casualty’s face using sponges from the rinse buckets.
2. Monitor for contaminants prior to transport to the cold zone.
3. Transport the casualty to the cold zone.
Double-bag and secure personal items. Procedures for collecting personal items will vary
according to local protocol. Identification information should be completed and will accompany
the personal items.
Notes:
HOT.PM.09.0 1B-26
Enabling Learning Objective 1B-9: Discuss technical decontamination setup and

procedures consistent with NFPA 472, Section 6.4.3.2.
Technical Decontamination
The steps to perform technical decontamination are as follows:
1. A contaminated responder emerges from the hot zone using the buddy system.
2. The contaminated responder approaches the control point between the hot zone and the
warm zone. Before crossing the control point, the responder drops any contaminated
waste in the contaminated waste receptacle.
3. As the contaminated responder crosses the first control point and enters the warm zone,
he or she places any equipment in the equipment holding area.
4. Contaminant samples should be brought through decontamination with the responder.
After decontaminating the outside of the container, decontamination personnel should
put samples, if any, in overpack containers and complete the chain-of-custody form. If
evidence is not properly packaged, it may lose its evidentiary value during the
decontamination process.
5. A station attendant will meet the responder to determine if the responder’s PPE has
been compromised or if the responder is showing any signs or symptoms of a chemical
exposure. The hands of the responder should be washed before entering the first
station.
6. The contaminated responder enters the gross decontamination phase of the
decontamination process. The first scrubber will turn his or her brush sideways to assist
the responder entering the gross decontamination phase. The responder will step in
sideways to eliminate any type of tripping hazard. The responder raises arms and opens
legs to enable a thorough application of a decontaminant. It is critical that
decontamination personnel conduct a light scrubbing or swiping with decontaminant,
while the responder is under streaming water, to ensure removal of a majority of the
contamination. They should work from the top of the responder downward.
Decontamination personnel should pay specific attention to creases and folds in the
responder’s PPE.
Notes:
HOT.PM.09.0 1B-27
7. The responder lifts one boot at a time to have the bottom brushed. Decontamination
personnel use a brush to assist the responder while the boots are being decontaminated
to tap on the bottom of the boot to signal when they are finished. The responder steps
out of the pool. (He or she should not allow clean boots to go back into the contaminated
area.)
8. The responder steps into the second pool, the disinfecting station. The responder is
sprayed with a neutralizing agent or soap-and-water solution. He or she is then scrubbed
and rinsed thoroughly with a handheld wand. Boots should be cleaned again as in the
previous step.
9. The responder then steps out after the feet are thoroughly cleaned to the next area,
where appropriate monitoring devices are used to ensure that the contaminant has been
removed. If the contaminant is still present, he or she should repeat the previous step.
10. The critical task at this station is ensuring that the doffing procedure ensures
contamination avoidance.
11. Decontamination is now complete.
NOTE: Throughout the process, supervisors and personnel conducting technical
decontamination should place emphasis on the neutralization of contaminants, as opposed to
the emphasis on speed. Additionally, personnel should practice sound procedures to eliminate
cross contamination.
Notes:
HOT.PM.09.0 1B-28
Conclusion/Hotwash

12
Notes:
HOT.PM.09.0 1B-29
Conclusion
Operations-level responders should be aware of the need to establish a decontamination
corridor to provide decontamination for both ambulatory and nonambulatory casualties as well
as technical decontamination for responders. They should know the different types of
decontamination to perform and the different decontamination methods available for use.
Responders should know how to address environmental, modesty, and special needs issues as
necessary. Above all, preserving human life and the safety of the responders should be the
main priorities in any CBRNE incident.
Notes:
HOT.PM.09.0 1B-30
References
Abeel, B. (2006, January). Multi-casualty mass decontamination guidance document for first
responders. Retrieved from http://www.oes.ca.gov/Operational/OESHome.nsf/PDF/Multi-
Casualty%20Mass%20Decontamination%20Guidance%20Document%20for%20First%20R
esponders/$file/MCMD-1-2-06.pdf
Adams, B., & Miller, L. (Eds.). (2004). Hazardous materials for first responders (3rd ed.).
Stillwater, OK: Board of Regents, Oklahoma State University.
Hazardous Waste Operations and Emergency Response, 29 C.F.R. § 1910.120 (2013).
National Fire Protection Association. (2013). NFPA 472, Standard for competence of
responders to hazardous materials/weapons of mass destruction incidents. Quincy, MA:
Author.
Noll, G. G., Hildebrand, M. S., & Yvorra, J. G. (2005). Hazardous materials: Managing the
incident (3rd ed.). Chester, MD: Red Hat Publishing.
Oldfield, K. W., Veasey, D. A., McCormick, L. C., Krayer, T. H., Martin, B. N., Hansen, S., et al.
(2005). Emergency Responder Training Manual for the Hazardous Materials Technician
(2nd ed.). Hoboken, NJ: John Wiley and Sons.
U.S. Army Edgewood Chemical Biological Center. (2009, April). Guidelines for mass casualty
decontamination during a HAZMAT/weapon of mass destruction incident. Volumes I and II.
Retrieved from https://www.rkb.us/contentdetail.cfm?content_id=213275
HOT.IG.121710 1B-31
HOT.IG.09.0 1B-32
Module 1: Hands-On Lanes Training: Lane 1C Instructor Guide
Lane 1C: Scene Survey and Safety

Summary: Participants identify explosive devices, including basic device type and design,
device construction methods, and the components of Improvised Explosive Devices (IED) as
well as non-IEDs. Participants explain how to conduct basic searches for devices and practice
the skills necessary to recognize potential hazards and explosive devices. Participants engage
in a practical exercise during which they practice scene survey techniques in searching for
explosive devices. Participants also describe the effects of explosive devices, responder safety,
and how responders might become a target for terrorists’ secondary devices.
Given a variety of situations, participants will be able to
1C-10 Identify types of dissemination devices and their components according to New
Mexico Tech’s Incident Response to Terrorist Bombings.
1C-11 Explain the Bureau of Alcohol, Tobacco, Firearms, and Explosives’ (ATF) bomb
search technique.
1C-12 Practice proper scene survey techniques according to the ATF’s bomb search
technique.
1C-13 Describe the effects of an explosive device according to New Mexico Tech’s Incident
Response to Terrorist Bombings.
Practical Exercise: Participants practice proper scene survey techniques by searching for
explosive devices in separate rooms apart from the classroom. Once participants complete the
initial search, they return to the classroom. Participants take part in the identification of different
types of dissemination devices and their components. Instructors review IED and non-IED
components. After being given this information, participants return to the rooms separate from
the classroom where the instructor explains in more detail the capabilities and function of the
various devices. Allow approximately 1 hour for this exercise.
Methods of Instruction: Participants practice surveying, searching, and locating
multiple explosive devices before the beginning of the facilitated lecture. After the initial survey
and search of the areas, participants report to the main classroom. Instructors use a facilitated
lecture format supported by presentation visuals and videos to identify types of dissemination
devices, the techniques for scene survey, and the effects of an explosive device. Following the
videos, instructors facilitate discussion on the effects of the explosive devices viewed by
participants. In addition, instructors engage participants in a discussion of potential response to
an explosive device incident based on a presented scenario. When participants return to search
the original areas, instructors coach participants to ensure that all devices are located and
identified. At the conclusion of the lane, instructors pose objective-based questions, such as
“What are the types of dissemination devices?” to facilitate discussion and confirm participants’
HOT.IG.09.0 1C-1

exercise. During the practical exercise, instructors coach participants as they practice surveying
and searching the areas for explosive devices. As participants are completing the second
survey and search, instructors verify that participants are practicing proper scene survey
techniques. In addition, participants use a performance checklist of identified skills during the
training to self-assess.
HOT.IG.09.0 1C-2
Introduction
Responders must gain the knowledge and skills necessary to recognize potential hazards and
explosive devices. Required knowledge includes basic device type and design, facets of
explosive devices, device construction methods, and the components of an IED. Responders
must also know how to conduct basic searches for devices, the general effects of explosive
devices, and when to initiate evacuation.
Notes:
HOT.IG.09.0 1C-3
Enabling Learning Objective 1C-10: Identify types of dissemination devices and their
components according to New Mexico Tech’s Incident Response to Terrorist Bombings.
Types of Dissemination Devices

Breaking devices and bursting/exploding devices are dissemination devices likely to be used in
CBRNE incidents. Terrorists create IEDs using common items. Considering the vast array of
common items that could be modified to use as dissemination devices, it is crucial for
responders to have thorough knowledge of devices and delivery methods to apply in both
detection and response capacities (Blades, 2003).
Breaking Devices
Most effective when used with chemical agents, breaking devices encapsulate the CBRNE
agent and release it when broken (Blades, 2003). The most recognizable breaking device is one
made of glass, such as a Molotov cocktail. Breaking devices were used in the March 1995
Subway Sarin Incident in Tokyo (Blades, 2003; “Sarin Gas Attack on the Tokyo Subway,” n.d.;
Smithson & Levy, 2000).
Notes:
HOT.IG.09.0 1C-4
Notes:
HOT.IG.09.0 1C-5
Bursting/Exploding Devices
Terrorists use bursting/exploding devices more than any other type of dissemination device.
Bursting/exploding devices may use an explosive to break the agent container and disseminate
the CBRNE agent. A bursting/exploding device employs a small charge surrounded by the
agent. A fuse, timer, or another device activates the charge. The IED is the most common
bursting/exploding dissemination device.
Bursting/exploding devices for CBRNE dissemination may be used successfully to cause
damage and fear from the actual explosion. Radiological materials are the most likely of the
CBRNE hazards to be disseminated using explosives, specifically as a Radiological Dispersal
Device (RDD) or dirty bomb.
The use of bursting/exploding devices to disseminate biological or chemical agents is limited, as
the heat and stress created by the explosive dissemination can reduce efficiency of the agent or
render it inactive by destroying the organism or toxin (Blades, 2003).
Notes:
HOT.IG.09.0 1C-6
Types of Explosions
Explosives are substances that produce violent effects through chemical reactions. The most
common explosive effects include a rapid and violent change from a solid or liquid to a gas, high
temperatures, extreme shock, and loud noise. There are three types of explosions—atomic,
mechanical, and chemical.
• An atomic explosion occurs when specific atoms are either split (i.e., fission) or fused
together (i.e., fusion), resulting in a substantial release of energy.
• A mechanical explosion occurs when internal pressure increases to burst a sealed or
partially sealed container (e.g., pipe bomb).
• A chemical explosion occurs upon rapid decomposition of a solid or liquid explosive
chemical mixture or compound into gases. The greater volume of the gaseous state
generates an explosion (Slotnick, 2004).
Notes:
HOT.IG.09.0 1C-7
Components of an IED
An IED may be defined as
“A device placed or fabricated in an improvised manner incorporating destructive, lethal,
noxious, pyrotechnic, or incendiary chemicals and designed to destroy, incapacitate, harass, or
distract. It may incorporate military stores, but it is normally devised from nonmilitary
components” (“Improvised Explosive Device,” 2009, para. 1).
The broad classification of IEDs applies to devices of varying size, functioning method,
container, and delivery method. IEDs may use commercial or military explosives, homemade
explosives, or military ordnance and ordnance components.
Because of the broad range of devices, terminology and acronyms have expanded to denote
delivery methods such as Vehicle-Borne IED (VBIED), Person-Borne IED (PBIED), and Suicide
Bomber IED (SBIED; “Improvised Explosive Device,” 2009; “Military: Improvised Explosive
Devices [IEDs]/Booby Traps,” 2005).
NOTE: In the United States, approximately 80–90% of IEDs are made from low explosives
(“Improvised Explosive Device,” 2009).
Notes:
HOT.IG.09.0 1C-8
IEDs generally consist of five basic components: power source, initiator, explosive, switch, and
container (Marks, 2002; “Military: IEDs/Booby Traps,” 2005).
Power Sources
Most mailed or delivered IEDs require an electric power source to activate an electric initiator.
Frequently used power sources include common commercially available batteries, which can
reliably function as an initiator. An alternative mechanical action, such as a spring under
pressure, can store sufficient energy to activate a nonelectric initiator.
NOTE: The power source for the most common IED, the pipe bomb, is typically a match or
cigarette lighter used to ignite a piece of time fuse or hobby fuse.
Initiators
Initiators transform the energy from the power source into the heat or shock energy that is
required to start the deflagration or detonation of the main charge component. The most
common types of initiators are squibs (electric, pyrotechnic devices that fire the igniter) and
blasting caps. Examples of effective improvised initiators include a flash bulb with an exposed
filament, a percussion primer, or an improvised blasting cap.
Firing Train
Also called detonation or an initiation sequence, the firing train is the sequence of events that
cascade from relatively low levels of energy to cause a chain reaction to initiate the final
explosive material or main charge. Low-explosive trains consist of two steps: 1) A fire or a
spark; and 2) A low-explosive initiation. High-explosive trains can be more complex, consisting
of either a two-step sequence (detonator and main charge) or a three-step sequence (detonator,
booster, and main charge; New Mexico Tech, 2006).
Explosives
Explosive material is the main charge that causes most of the damage from a typical IED. When
a typical IED detonates, the explosive material and other components are not totally consumed
or vaporized. Explosive residue can be identified through laboratory analysis.
Switches
IED switches can be simple or complex in structure, and more than one switch may be used to
create redundancy in the system. Many IEDs incorporate both an arming switch and a firing
switch.
Notes:
HOT.IG.09.0 1C-9
The arming switch is a safety for the person constructing the device and works by keeping the
firing switch and circuitry disconnected from the battery. When the arming switch is closed, the
firing switch is placed into the power circuit; however, the circuit is still open. When the firing
switch activates, the circuit closes, connecting battery power to the initiator (blasting cap) and
detonating the device. Switches are numerous and varied in design and activation methods. An
IED can be constructed so that any approach or action by its intended target or a responder will
result in detonation. Switches for an IED can be disguised to blend innocently with the
environment.
Containers
The final component of an IED is the container. Generally, this component simply holds or seals
the other components of the IED. Size and structural resilience are two of the few limiting
factors to container selection. With such variability, the container may serve as camouflage or a
transport method for the device (Marks, 2002).
Enabling Learning Objective 1C-11: Explain the ATF’s bomb search technique.
Notes:
HOT.IG.09.0 1C-10
ATF Bomb Search Technique

When a bomb threat has been made, a scene survey must occur (if time permits) to make
evacuation determinations. There are different methods of approach, including company search
procedures, the ATF bomb search technique, and local department search procedures. Once
again, responders should follow appropriate existing local protocols.
If there is a bomb threat/suspicious package at a company and the company has set policies
and procedures for responding to such situations, they should include search procedures.
Certain employees will be identified as members of the search team who will conduct the search
of the building or area. The company policy may include a joint search effort with local law
enforcement.
Local departments or agencies also have set protocols. These protocols will account for public
areas and buildings as well as private companies with no policies and procedures. Department
protocol may call for conducting the survey in conjunction with company employees, or it may
call for the use of trained bomb search dogs. Generally, employees must be evacuated from the
property prior to the beginning of a search by responders. If responders are not familiar with the
property, they should be provided with detailed maps and floor plans (Decker, 1999).
Notes:
HOT.IG.09.0 1C-11
This technique is very thorough and professional. The ATF’s bomb search technique is
designed with two fundamental presumptions:
• The searchers are not familiar with the room, its contents, or its unique sounds or smells.
• The searchers have no idea how much access the bomber may have had to the room.
For these reasons, there is a huge advantage to having company employees/resident personnel
participate in the search (Decker, 1999).
Use the following steps when conducting a bomb search:
1. Before beginning the sweep of a room, searchers should always listen to the noises
inside the room. Unusual noises and ticking sounds must be identified immediately.
2. During the sweep of a room, searchers may use electronic or medical stethoscopes on
the walls, furniture, and floors.
3. The room should be searched four times at four separate search elevations:
– First elevation—from floor to waist height;
– Second elevation—from hip height to chin or top of the head;
– Third elevation—from chin or top of the head to the ceiling; and
– Fourth elevation—inside false or suspended ceilings, ceiling mounted fixtures, air
conditioning ducts, sound or speaker systems, electrical wiring, and structural frame
members.
4. The room is typically searched at the first elevation, second elevation, and third elevation
in exactly the same manner.
5. The room is entered by two searchers.
6. The searchers visually split the room in half by agreeing on an imaginary line through the
center of the room.
7. Each searcher is responsible for searching his/her half or his/her side of the imaginary
line.
8. They stand at one end of the room, back to back. The wall is immediately next to the
right shoulder of one searcher. The wall is immediately next to the left shoulder of the
other searcher. The imaginary line runs between their backs and is perpendicular to
them.
Notes:
HOT.IG.09.0 1C-12
9. The searchers walk along the walls, searching at the first elevation.
10. The searchers meet at the opposite end of the room and then walk along the center of
the imaginary line back to the point of beginning.
11. The searchers then make similar symmetric searches around the room until the entire
room has been searched at the first elevation.
12. The searchers then conduct searches of the second and third elevations.
13. The search of the fourth elevation is conducted in any manner that will allow the access,
view, or analysis of the more difficult place to be searched (Decker, 1999).
Scenario: A bomb threat has been called in to ABC Research, Inc. The company conducts
research involving stem cells. Because of the controversial nature of the research, bomb
threats occur at least monthly. The threats are generally hoaxes, and the company conducts
cursory searches while employees continue to work. This time, however, the company
president is more concerned. The caller was more specific about the possible locations of the
explosive and the amount (“It is in a briefcase.”). The caller also stated that it would detonate
within the hour. The caller indicated that the bomb contained sarin and that the location would
allow the sarin to enter the ventilation system. The company president is visibly upset. The
company policy, while somewhat specific regarding bomb threats, does not cover any incident
regarding chemical hazards. What recommendations would you make if you were the
responder to the scene and the company president was asking for advice?
Response to a Suspicious Package

A large number of potentially suspicious letters and packages continue to be reported to
Federal, state, and local law enforcement and emergency response agencies nationwide.
However, not all threats and suspicious packages involve explosives. In the fall of 2001, anthrax
letters sent to news organizations and congressional officials nationally dominated the headlines
(U.S. General Accountability Office, 2003).
When responding to a suspicious package call, a responder must be prepared for anything that
could happen. While scene survey techniques involve searching for an explosive device, there
are additional suggested guidelines specifically for a suspicious package that may contain
biological or chemical hazards.
Notes:
HOT.IG.09.0 1C-13
Local jurisdictions, departments, and agencies may have existing procedures for responding to
suspicious packages. The responder should follow any existing protocols. A joint FBI, U.S.
Department of Homeland Security, U.S. Department of Health and Human Services, and
Centers for Disease Control and Prevention (2004) document, “Guidance on Initial Responses
to a Suspicious Letter/Container With a Potential Biological Threat,” includes the following
suggestions:
• Do not touch, move, or open any suspicious package until Hazardous Materials
(HAZMAT) personnel have an opportunity to assess the risk of the situation.
• Evacuate personnel from the immediate area.
• Treat the scene as a crime scene. Preserve evidence and perform collection only in
conjunction with appropriate law enforcement. Enough suspicious material must be
retained for laboratory analysis and forensic examination of criminal evidence.
• Maintain chain of custody.
• Identify and list the names and contact information for anyone who may have been
exposed to the suspicious substance so that they may be treated as necessary.
Notes:
HOT.IG.09.0 1C-14
Preblast Safety Procedures

In response to a possible explosive incident, safety procedures must be followed. Each
department or organization should have a standard operating procedure for threats involving
explosives before a situation occurs. The following are safety suggestions from Pickett’s (2005)
Explosives Identification Guide:
• Do not transmit two-way radios, radar, or television transmitting devices within 1,000 feet
of a device. This includes the Mobile Data Terminals (MDT) in cellular phones. The
Electromagnetic Radiation (EMR) given off by these devices may detonate the item.
NOTE: Follow local protocol regarding use of communication devices. Use only equipment that
has been tested and is safe for use.
• Notify the proper authorities, depending on the jurisdiction and the situation.
• Clear and control the area as one would during a HAZMAT incident. The size and type
of explosive, terrain, shielding, and other factors will determine the size of the area to be
controlled. Move people away from the item—do not move the item away from people.
Notes:
HOT.IG.09.0 1C-15
• Stage emergency medical services, fire, and police units outside the hazardous area.
Emergency units are of little use if they are destroyed in a blast.
• Do not approach the suspected explosive because it may have motion-sensitive or
acoustic fuses that function once a target is sensed.
• Reduce the potential effects of a blast and flying shrapnel by opening doors and
windows and by placing emergency vehicles in the path of the blast wave to act as a
shield.
• Be aware of possible secondary devices.
Evacuation and Search
As the responder arrives on the scene of a potential explosive incident, decisions about
evacuation and investigation must be made quickly. To make initial evacuation decisions, the
responder must know the following:
• Location of the bomb(s),
• Appearance of the bomb(s),
• Type/size of bomb(s),
• Time of detonation, and
• Type of detonation.
Once evacuation decisions proceed, search decisions must be made regarding who will conduct
the search, how it will be conducted, and which areas must be searched. If a suspicious item is
found, further evacuation decisions must be made (New Mexico Tech, 2006).
Notes:
HOT.IG.09.0 1C-16
Evacuation Considerations
There are many considerations when responsible officials must decide whether or not to
evacuate during an incident. Some of those considerations include the following:
• Cost, including
– Human life,
– Money, and
– Time;
• Safety, including
– Evacuation could move personnel from safety to danger (a VBIED or a sniper),
– Sheltering in place poses danger if a bomb explodes, and
– Evacuation routes must be searched prior to evacuation for devices;
• Stakeholders’ input, including
– Government administrators,
Notes:
HOT.IG.09.0 1C-17
– Senior managers, and

– Business owners (New Mexico Tech, 2006).
NOTE: Responsible officials (e.g., government or elected officials, company management,
responders) make decisions according to local protocol. Those making the decision will take
into account the evacuation issues discussed previously as well as any other issues
surrounding the situation.
Evacuation decisions are directly related to time, distance, and shielding.
Time
The time of detonation is usually unknown, and the length of time required to evacuate is
difficult to estimate. Even if a terrorist provides the time that the explosive will detonate, that
information could be inaccurate. A terrorist may lie to gain more “success” in the attack. In
addition, the fuse, switch, and other bomb components often may not work as planned. Each
situation factors time into the evacuation decision.
Information provided by a terrorist, however flawed, may be used to determine if there is enough
time to evacuate or shelter in place. The less time available for evacuation, the more a
Notes:
HOT.IG.09.0 1C-18
responder must rely on structural protection to minimize injuries. Those in the immediate vicinity
of the suspected device must receive priority evacuation.
Distance
The distance from the device should be determined based on the size and potential power of
the explosive as well as available shielding. If the size and power is unknown, distance
decisions should be based on the worst-case scenario. The responder should assume that the
container has the maximum amount of the strongest explosive. Responders should never
handle a suspected device. People should be moved away from the device, rather than moving
the device away from the people.
Shielding
Shielding with a protective barrier between people and the explosion can be found in many
forms. Multiple layers of shielding are most effective. Vehicles, in particular, provide substantial
shielding, and two fire trucks are better than one. Some materials make better shields than
others. Sheets of plywood do not provide as much protection as a wall of cinder blocks (New
Mexico Tech, 2006).
Notes:
HOT.IG.09.0 1C-19
Postblast Safety Procedures

Following a CBRNE incident, safety, rescue, scene control, and evidence collection must be
addressed and prioritized accordingly.
• Safety—The responder’s first responsibility is the safety of responders and the public.
Every effort must be made to avoid additional casualties and ensure their personal
protection. Responders could rush into a situation and become casualties themselves.
As casualties, they are no longer able to assist in the response effort and may require
additional resources for treatment.
• Rescue—Rescue operations are the next priority in the initial postblast response. Living
casualties must be identified and receive appropriate treatment, either at the scene or at
a hospital. In a large-scale incident, there could be hundreds of deaths and injuries.
Responders should be trained in triage techniques for mass casualties.
• Scene control—Scene control is a critical step in supporting all operations. Traffic flow
must be controlled to allow emergency vehicles access to the site. Responders need
crowd control in order to efficiently and effectively perform rescue functions, provide
treatment, and conduct evacuations. Casualties must be identified and medically
Notes:
HOT.IG.09.0 1C-20
evaluated before they evacuate the area. If CBRNE hazards were present,
decontamination must occur. Witnesses (and possibly the suspects) must be identified
for questioning. Potential evidence must be protected from contamination and theft. All
of these tasks rely on scene control. Curious citizens have to be kept out of harm’s way
and must not prevent responders from doing their jobs.
• Evidence collection—Though evidence collection is not the main priority in the initial
response to an explosive incident, all responders are responsible for evidence
identification and preservation. Responder actions at the scene may be vital to the
recovery of valuable evidence during the actual crime scene investigation. Responders
must be trained to identify potential evidence and preserve that evidence for collection
by investigators (New Mexico Tech, 2006).
Hazards Following an Explosion
 Secondary devices
 Damage to structures and utilities
 CBRNE hazards
 Pathogen-containing bodily fluids
14
Hazards Following an Explosion

The responder must be aware of potential hazards following an explosion. Hazards may include
secondary devices, damage to structures and utilities, CBRNE-specific hazards, or exposure to
pathogen-containing bodily fluids. A safe response requires knowledge regarding the type and
location of potential hazards. Postblast hazards affect response actions, evacuation needs,
Notes:
HOT.IG.09.0 1C-21
triage needs, level of personal protective equipment, downwind hazards, and requests for
additional resources. Potential hazards following an explosion include the following:
• Secondary devices—As in any situation involving terrorism, responders must be
continually aware of the potential for secondary devices and must observe surrounding
areas constantly. Secondary devices could be anywhere, including staging areas,
command posts, triage areas, decontamination corridors, etc. If another suspected
device is observed, responders should notify the Incident Commander and begin
evacuation of the area.
• Damage to structures and utilities—Structures may be compromised following an
explosion. They may be unstable and pose a real threat to responders at the scene.
There are three common types of structural hazards following an incident involving an
explosive device—projected or flying glass, falling fragments, and collapse/fire hazards.
An explosion can also sever natural gas, electric, and other utility lines. Severed utility
lines always present a danger to responders and other individuals in the area. Utilities
should be turned off as soon as possible to prevent further hazards.
• CBRNE hazards—Upon arrival at the scene, responders should monitor for CBRNE
hazards. Conventional explosions can be used to disseminate CBRNE hazards or mask
another method of dissemination. All responders should be alert for signs of a CBRNE
attack during an explosive incident.
• Pathogen-containing bodily fluids—Bodily fluids may contain pathogens that are
dangerous to responders and casualties. This concern increases with suicide bombings.
Terrorists may spread hepatitis and other pathogens through bone fragments hurled into
casualties (New Mexico Tech, 2006).
Enabling Learning Objective 1C-12: Practice proper scene survey techniques according to
the ATF’s bomb search technique.
Practical Exercise
Participants return to the previously searched rooms to locate all devices. Participants should
follow the ATF’s bomb search technique.
Notes:
HOT.IG.09.0 1C-22
Enabling Learning Objective 1C-13: Describe the effects of an explosive device according
to New Mexico Tech’s Incident Response to Terrorist Bombings.
Effects of an Explosion
In the brief instant of a high-explosive detonation, some remarkable events take place—The
shock wave produces pressure up to 500,000 pounds per square inch (psi), the detonation
wave travels as fast as 29,000 feet per second (roughly 20,300 miles per hour), and
temperatures can soar to 8,000 °F (Marks, 2002).
Several different effects can create extensive damage in the area surrounding an explosion:
• The incendiary/thermal effect occurs in the immediate vicinity of the seat of the
explosion. The effect varies depending on the compound used. Low explosives generally
produce longer lasting incendiary thermal effects than high explosives. High explosives
produce higher temperatures but for a shorter time. The incendiary effect is usually seen
as a bright flash or fireball at the moment of detonation.
Notes:
HOT.IG.09.0 1C-23
• The fragmentation effect describes the physical material propelled outward by an

explosion. It consists of IED components, broken pieces of the target, and affected
elements of the surrounding environment. Fragmentation adds to the destructive force of
the explosive device, tearing into materials in its path.
• The shrapnel effect consists of material added to an IED specifically to cause additional
damage. It differs from fragmentation in that shrapnel does not derive from working parts
of the device. It can include nails, marbles, ball bearings, or other materials placed in
and around a device.
• The blast pressure effect is created by the expansion of the detonation gasses, which
can be up to 7,000 times the volume of the original explosive material. This effect and
the expanding gases move in all directions as an expanding bubble. There are two
stages of blast pressure:
– Positive pressure—The positive pressure stage occurs when the blast creates a
shock wave that moves rapidly from the seat of the explosion, pushing the air away
from it and delivering violent force to everything in its path. It is formed at the instant
of detonation, when the blast compresses the surrounding atmosphere and pushes it
outward. The expanding bubble of positive pressure creates a vacuum behind the
shock front, which is the leading edge of the pressure wave.
– Negative pressure—The negative pressure phase occurs when the expanding
positive pressure diminishes to the extent that it is less than atmospheric pressure,
causing a suction effect. It follows immediately after a positive phase but lasts two to
three times longer. Negative pressure has the same force as positive pressure, but
because it results over a longer period it does not have the same destructive effect.
The negative pressure phase is essentially a vacuum or suction phase, thus
accounting for much of the debris found at the seat of the explosion and nearby
(New Mexico Tech, 2006).
• The ground shock (or water shock) effect occurs as the explosive pressure wave moves
through the ground or water. This effect is similar to that of a small earthquake.
Structural damage may result at a distance from the detonation site through ground
movement.
Notes:
HOT.IG.09.0 1C-24
Notes:
HOT.IG.09.0 1C-25
Physical Effects and Injuries from an Explosion

According to Bevelacqua and Stilp (2004), the physical effects of a blast wave are devastating:
When a detonation occurs, the positive pressure moves the wave of pressure from the
detonation point outward in all directions. The initial shock wave is dependent on the
type of explosive, the confinement of the material, and the oxidizers present. This
pressure continues in every direction until the released energy has been equalized.
Depending on the level of explosive order, a pressure wave can reach well above
50,000 pounds per square inch (psi). Think of this wave as a locomotive hauling freight
that strikes objects while moving at 15,000 miles per hour! Atomization and total
disintegration of material, including all biological material, will occur close to the
detonation. (p. 17)
Notes:
HOT.IG.09.0 1C-26
Expected Effects from Explosions

Potential Injury Pressure psi Structural Effects
Loss of balance/rupture of eardrums .5–3 psi Glass shatters; façade failure
Cinderblock shatters; steel structures
Internal organ damage 5–6 psi fail; containers collapse; utility poles
fail
Structural failure of typical
Pressure causes multisystem trauma 15 psi
construction
Lung collapse 30 psi Reinforced construction failure
Fatal injuries 100 psi Structural failure
(Bevelacqua & Stilp, 2004)
Types of Injuries from Blast Effects

According to Bevelacqua and Stilp (2004), in the instance of a blast, if an individual is far
enough away from the detonation to avoid disintegration, then injuries will fall into one of the
following four categories:
Notes:
HOT.IG.09.0 1C-27
• Primary blast injuries—Caused by the initial blast wave and involve hollow organs and
interfaces. The gas-filled organs are compressed and develop a gas-pressure exchange,
causing implosion injury. These injuries have a high mortality rate. The types of injuries
could include blast lung, Tympanic Membrane (TM) rupture, middle-ear damage,
abdominal hemorrhage, rupturing of the eye, and concussion.
• Secondary blast injuries—Caused by fragments of the bomb container or surrounding
materials. These injuries have a high mortality rate. Injuries that may occur include
penetrating ballistic or blunt injuries and eye penetration.
• Tertiary blast injuries—Result when a person is propelled through the air by the force of
a blast and strikes other objects. This type of injury, usually resulting from high-energy
explosions, involves organs that are attached or in close proximity to each other—
abdominal viscera, lungs, nervous system, and skin. These injuries have moderate to
high mortality rates, and survivability depends on the distance from the origin of the
blast. Fractures and traumatic amputations are examples of this type of injury.
• Quaternary blast injuries—Include any other injuries caused by the explosion, such as
exposure to toxic gases, dust, and fire created by the explosion. The best protection
from this type of injury is distance and shielding. Injuries could include burns, breathing
problems, angina, hyperglycemia, and hypertension (Bevelacqua & Stilp, 2004; Fish,
2004).
Secondary Devices
According to the Occupational Safety & Health Administration (OSHA; 2005), “Secondary
explosive devices are bombs placed at the scene of an ongoing emergency response that are
intended to cause casualties among responders” (“General Information,” para. 1). The effects
and injuries of secondary devices are the same as primary devices. However, the intent of
secondary devices placed at the scene of an incident is to explode after the initial blast to cause
more injuries, damage, and fear among responders.
Terrorists often place secondary devices concealed from view or in objects such as vehicles,
flashlights, briefcases, flowerpots, or garbage cans. The most common way to detonate a
secondary device is by using a time delay device. Other means of detonating secondary
devices are radio-controlled devices or cell phone-activated devices (Occupational Safety &
Health Administration [OSHA], 2005).
Notes:
HOT.IG.09.0 1C-28
In the United States, Eric Robert Rudolph has admitted responsibility for several bombings
involving secondary devices, including the January 16, 1997, bombing of Atlanta Northside
Family Planning Services and the February 21, 1997, bombing of the Otherside Lounge in
Atlanta, GA (Federal Bureau of Investigation [FBI], 1998; OSHA, 2005).
Another example of the use of secondary devices within the United States was the April 1999
Columbine High School attack by Eric Harris and Dylan Klebold. Harris and Klebold built and
planted 74 IEDs at the high school and placed homemade explosives in their two vehicles
designed to kill students and teachers as they evacuated the school (Hines, 2007).
Notes:
HOT.IG.09.0 1C-29
Conclusion/Hotwash

22
Notes:
HOT.IG.09.0 1C-30
Conclusion
Among the different types of dissemination devices are breaking devices and bursting/exploding
devices. It is important for responders to be familiar with these types of devices, to recognize
different explosive materials, and to identify the potential effects of an explosion in order to
perform tasks safely and effectively in the field.
Recognizing the components of an IED enables responders to identify the indicators of their
use, even during what seems to be a routine investigation. By understanding the threat of
secondary devices and the application of pre- and postblast response actions, responders can
better protect the public and themselves.
Notes:
HOT.IG.09.0 1C-31
References
Bevelacqua, A., & Stilp, R. (2004). Terrorism handbook for operational responders (2nd ed.).
Albany, NY: Delmar.
Blades, H. B. (2003, July–August). Nuclear, biological, and chemical weapons and improvised
explosive devices: An interview with Paul Errico. The Forensic Examiner. Retrieved from
http://findarticles.com/p/articles/mi_go1613/is_7-8_12/ai_n9090442
Decker, R. R. (1999). Bomb threat: Management and policy. Burlington, MA: Butterworth-
Heinemann.
Federal Bureau of Investigation. (1998, October 14). Eric Rudolph charged in Centennial
Olympic Park bombing [Press release]. Retrieved from
http://www.usdoj.gov/opa/pr/1998/October/477crm.htm
Federal Bureau of Investigation, U.S. Department of Homeland Security, U.S. Department of
Health and Human Services, & Centers for Disease Control and Prevention. (2004,
November 2). Guidance on initial responses to a suspicious letter/container with a potential
biological threat. Retrieved from http://www.bt.cdc.gov/planning/pdf/suspicious-package-
biothreat.pdf
Fish, R. M. (2004). Terrorist bombings: Injury mechanisms and characteristics. In C. H. Wecht,
Forensic aspects of chemical and biological terrorism. Retrieved from Google Book Search
database.
Hines, K. (2007, June 14). Response to bomb threats and suspected explosive devices.
Firehouse.com. Retrieved from http://cms.firehouse.com/web/online/Terrorism-and-Front-
Lines/Response-to-Bomb-Threats-and-Suspected-Explosive-Devices/1$38545
Improvised explosive device. (2009, August 12). DOD dictionary of military terms. Retrieved
from http://www.dtic.mil/doctrine/dod_dictionary/index.html
Marks, M. E. (2002). Emergency responder’s guide to terrorism. Chester, MD: Red Hat
Publishing.
Military: Improvised explosive devices (IEDs)/booby traps. (2005, January 11). Retrieved from
http://www.globalsecurity.org/military/intro/ied.htm
New Mexico Tech. (2006). Incident response to terrorist bombings. Socorro, NM: Author.
Occupational Safety & Health Administration. (2005, February 3). Secondary explosive devices.
Retrieved from http://www.osha.gov/SLTC/emergencypreparedness/guides/secondary.html
Pickett, M. (2005). Explosives identification guide (2nd ed.). Clifton Park, NJ: Thomas Delmar
Learning.
Sarin gas attack on the Tokyo subway. (n.d.). NationMaster.com. Retrieved from
http://www.nationmaster.com/encyclopedia/Sarin-gas-attack-on-the-Tokyo-subway
Slotnick, J. (2004). Explosive forces of improvised explosive devices. Retrieved from
http://www.securitydriver.com/aic/stories/article-114.html
HOT.IG.09.0 1C-32
Smithson, A. E., & Levy, L. A. (2000, October). Ataxia: The chemical and biological terrorism
threat and the U.S. response. (Report No. 35). Retrieved from The Henry L. Stimson Center:
http://www.stimson.org/?SN=CB20020111235
U.S. General Accountability Office. (2003, October). Bioterrorism: Public health response to
anthrax incidents of 2001. (GAO Publication No. GAO-04-152). Washington, DC: Author.
Retrieved from http://www.gao.gov/new.items/d04152.pdf
HOT.IG.09.0 1C-33
HOT.IG.09.0 1C-34
Module 1: Hands-On Lanes Training: Lane 1D Participant Manual
Lane 1D: CBRNE Monitoring and PPE Level C

Summary: Participants review information about equipment capable of monitoring to detect
CBRNE hazards and technologies in use throughout the United States. During the practical
exercise, participants perform monitoring by operating various screening and monitoring
equipment while employing Personal Protective Equipment (PPE) Level C.
1D-14 Use PPE Level C according to Hazardous Waste Operations and Emergency
Response (HAZWOPER), 29 Code of Federal Regulations (C.F.R.) § 1910.120.
1D-15 Operate chemical monitoring equipment according to manufacturers’ guidance.
1D-16 Operate biological screening tools according to manufacturers’ guidance.
1D-17 Operate radiological monitoring equipment according to manufacturers’
guidance.
Practical Exercise: Participants identify or operate various monitoring equipment such as
the Lightweight Chemical Detector (LCD), the M256 Chemical Agent Detector kit, the Powder
Screening Test Kit, and the Ludlum Radiological Survey Meter, in order to become familiar with
them. Participants use PPE Level C and perform monitoring using the M256 kit. Participants
then doff their PPE Level C. Allow approximately 1 hour for this exercise.
presentation visuals to engage participants in discussions concerning PPE Level C and various
screening and monitoring equipment. In addition, instructors demonstrate the specific skills and
techniques participants are required to perform during the lane. During the hands-on practical
exercise, instructors coach participants during the use of PPE Level C and while operating
chemical, biological, and radiological screening equipment. When appropriate, instructors ask
reflective questions to challenge participants’ critical thinking skills in the application of skills and
techniques. At the conclusion of the lane, instructors pose objective-based questions, such as
“How difficult was it to use PPE Level C?” to facilitate discussion and confirm participants’
information. During the practical exercise, instructors observe and informally assess
participants’ ability to perform monitoring during a CBRNE incident. As participants are
operating the screening equipment, instructors demonstrate skills as needed to ensure that
participants are operating the different pieces of equipment correctly. In addition, participants
use a performance checklist of identified skills during the training to self-assess.
HOT.PM.09.0 1D-1
Special Instructions: This course does not certify or teach technical aspects of
monitoring; those tasks should still be conducted by Hazardous Materials (HAZMAT)
technicians or other certified personnel in local jurisdictions.
NOTE: The equipment used during training is a representative sample of the full range of
detection equipment on the market. The Center for Domestic Preparedness (CDP) does not
endorse any equipment incorporated into the training. Many types of equipment are available on
the market for sale to the responder community.
HOT.PM.09.0 1D-2
Objectives
 Use PPE Level C.

 Operate chemical monitoring equipment.
 Operate biological screening tools.
 Operate radiological monitoring equipment.
Notes:
HOT.PM.09.0 1D-3
Enabling Learning Objective 1D-14: Use PPE Level C according to HAZWOPER, 29

C.F.R. § 1910.120.
PPE Level C
The responder conducts a variety of tasks in the warm and cold zones during a CBRNE
incident. PPE is a necessary component for the responder in the warm zone because of the risk
of contamination.
The Incident Commander determines the level of PPE to be worn by the responders.
Responders engaged in monitoring tasks may work in either PPE Level B or C—Again,
depending on direction from the Incident Commander.
Don PPE Level C
Obtain a Tyvek suit, an APR, a pair of gloves and boots, and a roll of chemical-resistant tape
(taping is optional in this training).
NOTE: These Tyvek suits are not approved as a PPE Level C garment. For training purposes,
the CDP has substituted a disposable suit.
Notes:
HOT.PM.09.0 1D-4
1. Sit on a stool or chair and remove footgear.

2. Put on the Tyvek suit and boots (suit goes inside boots).
3. Put on an APR and adjust the straps.
4. Conduct an APR leak seal test:
a. Place hand over the opening on the outlet valve of the facepiece.
b. Exhale strongly one time. Air should escape from the contact area between the sides
of the face, forehead, and the mask.
c. Place hands over the filter canister portal(s).
d. Inhale and hold breath for 5 seconds. Mask should collapse on face and remain
collapsed for the duration of this step.
5. Pull the Tyvek suit hood on.
NOTE: The following steps require assistance from a team member. Use of the chemical-
resistant tape is not mandated by the Occupational Safety and Health Administration (OSHA)
but may be implemented depending on local protocol.
6. Allow team member to tape-seal partner’s suit (as directed by the instructor).
a. Place chemical-resistant tape on both of partner’s suit-boot junctions (center the tape
at the junction).
b. Tear off several 3- to 4-inch pieces of tape. Place chemical tape on partner’s suit-
mask junctions (center the tape at the junction). Do not place tape directly under the
chin.
c. Double one piece of tape (6 inches long) onto itself. Using another piece of tape,
secure the doubled piece under the chin.
d. Place chemical-resistant tape along the zipper of partner’s suit.
7. Put on the inner (nitrile or vinyl) and outer gloves.
8. Place chemical-resistant tape on both of partner’s suit-glove junctions (center the tape at
the junction).
9. Reverse roles and repeat the procedure.
Notes:
HOT.PM.09.0 1D-5
Physical and Mental Stressors Associated with PPE

The responder must always be aware of heat concerns and the various physiological and
psychological factors involved in working in PPE Level C. Knowing the expected work rate, the
physical and mental condition of the responder, the ambient temperature, and other
environmental factors helps to alleviate many problems.
Physical and mental stressors of PPE include
• Required donning time,
• Impaired communication,
• Impaired vision,
• Dexterity issues, and
• Heat concerns.
Notes:
HOT.PM.09.0 1D-6
Air-Purifying Respirator
There are several types of APRs, including half-face or full-face designs. The normal APR used
for PPE Level C emergency operations includes full facepieces or tight-fitting coverings and
filtering systems. The full-facepiece APRs are made of flexible molded rubber, neoprene,
silicone, or other materials.
Responders should identify canisters or cartridges used during emergency operations according
to their use; the canisters or cartridges are marked appropriately with numbers and colored
bands. Use the appropriate canister or cartridge based on the agent that is identified or
suspected.
Notes:
HOT.PM.09.0 1D-7
User Seal Check versus Fit Testing of APR

NOTE: The positive-pressure seal check method follows Respiratory Protection, 29 C.F.R. §
1910.134, Appendix B-1, 1.A. The negative-pressure seal check method follows Respiratory
Protection, 29 C.F.R. § 1910.134, Appendix B-1, 1.B.
A user seal check is not a substitute for a fit test of an APR. According to Respiratory
Protection, 29 C.F.R. § 1910.134(b), a user seal check is “an action conducted by the respirator
user to determine if the respirator is properly seated to the face” (2013). A user seal check must
be conducted every time the respirator is donned.
A fit test, according to Respiratory Protection, 29 C.F.R. § 1910.134(b), is “the use of a protocol
to qualitatively or quantitatively evaluate the fit of a respirator on an individual” (2013).
Qualitative fit testing ensures a thorough seal using test agents to challenge the human senses.
If properly sealed, the responder should not react to the test agents.
A user seal check is conducted by using either the positive-pressure method or the negative-
check method.
Notes:
HOT.PM.09.0 1D-8
Quantitative fit testing is more scientific and produces a numeric measurement of the amount of
leakage into the respirator.
Powered Air-Purifying Respirator

The Powered Air-Purifying Respirator (PAPR) uses a blower to force ambient air through air-
purifying elements in the canister or cartridge and then sends the filtered air through the unit,
the air hose, and into the protective hood or protective mask. There are two types of PAPRs—
Loose-fitting and the tight-fitting.
Loose-fitting PAPRs do not require fit tests. Appropriate canisters/cartridges are attached to the
PAPR unit, which is affixed to a belt worn around the responder’s waist. As with an APR, it is
imperative that the responder uses appropriate canisters or cartridges on the PAPR unit to
ensure his or her safety.
Responders should inspect tight-fitting PAPRs in the same manner as APRs prior to each use.
Additionally, it is important to inspect the PAPR unit, battery, air hose, and hood assembly for
flaws each time prior to use. Also, the responder should conduct a performance check on the
PAPR unit assembly.
Notes:
HOT.PM.09.0 1D-9
Enabling Learning Objective 1D-15: Operate chemical monitoring equipment according to

Chemical Monitoring Equipment

The first sign that an incident involves chemical agents may be casualties’ symptoms,
behaviors, and reactions as well as information provided by the initial responders and
individuals at the incident scene. However, some agents or materials cannot be identified solely
by casualties’ symptoms. Monitoring equipment is used to confirm the type(s) of agents,
location, and concentrations of contamination at an incident scene. This confirmation, in turn,
helps to determine the necessary level of protection, first aid, and decontamination measures.
No single piece of equipment will detect all hazardous materials. Responders must use a
number of items. There are different types of systems, from very simple chemical-reactive
papers (that work in seconds) to very sophisticated laboratory instruments (that can take from
minutes to hours to yield results); simple systems provide broad information while complex
systems provide detailed information.
Notes:
HOT.PM.09.0 1D-10
Additional Safety Measures
Modified M256 Chemical Agent Detector Kit

The M256 Chemical Agent Detector kit is modified for use where toxic agent training is
conducted. The kit is modified by removing the blister test spots and separating the heater
ampoules from the test spot. For training purposes, the modified M256 kit will enable
participants to achieve the chemical monitoring training objective. Only modified M256 kits are
used where toxic agent training is conducted.
Notes:
HOT.PM.09.0 1D-11
Monitoring for Contaminants

This section of the lane demonstrates the difficulty in working in PPE while using the M256
sampler.
M256 Chemical Agent Detector Kit
The M256 Chemical Agent Detector Kit is a miniature chemistry laboratory capable of detecting
the presence of nerve, blood, and blister (including lewisite) vapors within 20 minutes.
Use of the M256 Chemical Agent Detector Kit
Prepare the Kit for Use
1. Read all instruction cards in the kit.
2. Remove one sampler and read the instructions printed on the bag.
3. Remove the sampler from the bag. Discard the sampler if there are broken or missing
ampoules, missing spots, crushed reagent channels, or if the blood agent test spot is
pinkish.
NOTE: Do not expose the sampler to heavy rain or other forms of water; the test results could
be tainted. Do not touch sampler test spots. Dirt and oil from gloves will cause test results to be
tainted.
Test for Toxic Agent Vapors
1. The protective strip should still cover the spots.
2. Pull and discard tab #1 to expose the tablet.
3. Rub the top half of white paper tab #2 on the tablet.
4. Hold the sampler with the arrow up. Using the V-shaped protective device (in lieu of the
heater pads), crush the ampoules in three center pockets #3.
5. Rotate sampler so arrow is down. Force liquid to each spot with the right hand while
pressing protective strip with left hand to ensure wetting of covered spots.
6. With the left thumb over the center of the protective strip, hold the sampler flat and swing
the heater (green ampoules) away from the blister spot.
Notes:
HOT.PM.09.0 1D-12
7. Using the crushing device, crush one heater (green) ampoule #4 and swing the heater
over the spot. Vent the heater vapor away from the user and other personnel.
8. Leave the heater over the spot for 2 minutes, and then swing the heater and protective
strip away from spots.
9. Expose the spots to air, shielding from direct sun, for 10 minutes.
10. Crush the second heater (green) ampoule #4 and swing the heater back over test spot.
Leave in place for 1 minute. Swing the heater away from the test spot.
11. Hold the sampler with arrow down. Crush the two outside ampoules #5 using the
crushing device.
12. Re-rub the bottom half of white paper tab #2 next to the first mark.
13. Immediately look for a difference in color between the two marks.
14. Turn the sampler over to determine safe or dangerous conditions. Wait 3 minutes for
nerve agent results.
a. Blister agents (mustard gas [H] and phosgene oxime [CX]) develop color
immediately after all ampoules are broken.
b. If no color develops, a positive nerve test is indicated.
c. Disregard any blue-green edge around the nerve spot rim.
e. At temperatures below 50 ºF, the nerve spot may take up to 5 minutes to develop
color.
f. At high temperatures, a faint blue color may appear in the blister spot in the absence
of H.
g. Yellow and orange color sometimes occurs on the blood spot when no agent is
present. Pink or blue color must be present for a positive test.
h. Nerve, blood, and blister tests must be read no later than 5 minutes after crushing
the two outside ampoules #5.
15. Report the results and dispose of the sampler properly. Handle the sampler as
HAZMAT.
Notes:
HOT.PM.09.0 1D-13
M8/C8 Chemical Agent Detection Paper

M8/C8 chemical agent detection paper provides the means to perform a quick identification of
liquid nerve and blister agents. The paper changes to a specific color for the presence of G-
series nerve agents, H-series blister agents, and V-series nerve agents. Color codes are
located inside the front cover of the booklet.
Lightweight Chemical Detector

The LCD is a portable, battery-operated instrument designed to detect and identify the vapors of
CWAs and Toxic Industrial Chemicals (TIC). It employs Ion Mobility Spectrometry (IMS)
technology.
Capabilities and Features
The LCD can detect tabun (GA), sarin (GB), soman (GD), VX, sulfur mustard (HD), nitrogen
mustard (HN), lewisite (L), hydrogen cyanide (AC), cyanogen chloride (CK), chlorine (Cl), and
phosgene (CG).
Notes:
HOT.PM.09.0 1D-14
CW Mode—In this mode, the LCD detects the following types of chemical agents:
• Nerve: VX, GA, GB;
• Blister: HD, HN, L;
• Blood: AC, CK; and
• Choking: CG, Cl.
TIC Mode—In this mode, the LCD detects the following chemicals:
• Hydrogen sulphide,
• Hydrogen bromide,
• Hydrogen chloride,
• Hydrogen fluoride,
• Cl, and
• CG.
The LCD is designed to be worn on a belt as an area monitor in either the CWA detection mode
or the TIC detection mode. The instrument can also be used to survey individuals and
equipment through the use of a survey nozzle. Take note that using the survey monitoring mode
depletes the battery life faster than when used in the area monitoring mode. Operators of this
detector should use the confidence sample after turning the instrument on and after changing
operational modes (Smiths Detection, 2006).
Notes:
HOT.PM.09.0 1D-15
Limitations
All LCD alarms should be treated as actual detection of a CWA or TIC. However, several
chemicals may produce a false alarm. According to the manufacturer, the items below may
cause the LCD to give a false alarm:
• Aromatic vapors (e.g., aftershave, perfume, food flavorings, and peppermint);
• Cleaning compounds (e.g., disinfectants and products containing menthol);
• Chlorinated materials;
• Smoke and fumes (including glycol-based training smoke); and
• Some gun oils.
The LCD will not detect TICs and CWAs simultaneously. The device must be set to the desired
detection mode. The LCD is not intrinsically safe due to its corona discharge. If contaminated,
the ammonia-doped sieve must be replaced and should be considered hazardous waste and
disposed of properly (Smiths Detection, 2006).
Notes:
HOT.PM.09.0 1D-16
Photoionization Detectors and Multigas Meters

Responders engaged in initial site assessments, often in confined space environments, rely
heavily upon Photoionization Detectors (PID) and multigas meters, specialized instruments that
provide critical air monitoring data. While the technologies driving PIDs and multigas meters are
quite different, it is important to note that both technologies are designed to analyze a given
volume of air and provide the results to the responder. Standalone multigas meters are
manufactured in multiple configurations, are generally less costly than a PID, and provide basic
atmospheric data, including oxygen level and the presence of combustible gases. Frequently
referred to as four-gas or five-gas monitors, multigas meters can easily be configured to meet
the specific requirements of the end user. PIDs are configured either as standalone instruments
or embedded within the body of a multigas monitor. Comparatively complex in design and
operation, PID technology allows for a rapid response, high accuracy, and high sensitivity (e.g.,
parts per million [ppm] and parts per billion [ppb]) in the detection of Volatile Organic
Compounds (VOC).
Notes:
HOT.PM.09.0 1D-17
Enabling Learning Objective 1D-16: Operate biological screening tools according to

Biological Screening Tools

Biological detection and identification capabilities are less prevalent in comparison with current
chemical or radiological detection capabilities. Current technology offers only a limited selection
of biological detection tools responders can use to identify biological agents in the field. It is
reasonable to assume that a biological agent attack, not discovered until days after the actual
event, may have no first response. Response activity in such cases focuses on healthcare.
Powder Screening Test Kit

If a jurisdiction requires the use of onsite screening methodologies to determine the presence of
a biological agent/pathogen, it may be practical at the outset to use a comparatively basic
technology developed to determine the presence or absence of protein.
Notes:
HOT.PM.09.0 1D-18
The Powder Screening Test Kit rapidly screens suspicious powder samples for the possible
presence of a hazardous biological agent. A positive result indicates the presence of protein. All
living substances, including bacteria and many toxins, contain protein.
It is most important to note that a positive result does not automatically suggest the presence of
a biological agent, and further testing methods are required for a more comprehensive
determination of the nature of the organism. It is imperative that responders properly collect and
transport the suspected agent/pathogen to a laboratory for a definitive determination
(BioCheck™ Powder Screening Test Kit, n.d.).
Lateral Flow Assay Technology
Lateral flow assay technology uses the principles of antibody capture to detect microorganisms
of interest, based on liquid capillary action moving up a chromatographic strip (Lateral Flow
Immunoassays, n.d.).
Advanced Tactical Threat Assessment Kit

Referred to as “Pro Strips,” this assessment kit is a field test that simultaneously screens for the
presence of five harmful biological agents. Unlike other systems, the Pro Strips incorporate
polyclonal antibodies in their test media as opposed to monoclonal. This promotes uniform
Notes:
HOT.PM.09.0 1D-19
coverage of the target area and reduces the possibility of masking (Advanced Tactical Threat
Assessment Kit™, n.d.).
Enabling Learning Objective 1D-17: Operate radiological monitoring equipment according

to manufacturers’ guidance.
Radiological Monitoring Equipment

Ionizing radiation cannot be detected by the five senses. Because ionizing radiation produces
damaging biological effects, responders require equipment to detect, locate, and measure the
intensity of ionizing radiation.
Ludlum Model 2241 Radiological Survey Meter
The Ludlum Model 2241 is a portable, general-purpose survey meter equipped with a Geiger-
Müller probe that is capable of measuring alpha, beta, and gamma radiation. This model
provides counts per minute (cpm) and thousand counts per minute (kcpm) in addition to a
reading in milliroentgen (mR) per hour (“Ludlum Model 2241-4 Survey Meter,” 2006).
Notes:
HOT.PM.09.0 1D-20
nukeALERT 951
http://www.berkeleynucleonics.com/products/model-951.html
nukeALERT 951 Radiation Detection Pager

The nukeALERT 951 is a small, self-contained gamma radiation detector that is used to locate
nuclear materials. It was specifically designed to be easily used by trained security forces and
emergency responders. The nukeALERT 951 pager is easy to operate, waterproof, and shock-
Notes:
HOT.PM.09.0 1D-21
resistant. This tool requires no annual calibration from the manufacturer (Berkeley Nucleonics
Corporation, n.d.).
Doffing of PPE Level C and APR

Doffing will follow established COBRATF procedures.
Notes:
HOT.PM.09.0 1D-22
Notes:
HOT.PM.09.0 1D-23
Conclusion
No single technology can perform every detection task. At least three distinct technologies are
employed to provide the best information at a CRBNE incident site.
The equipment and technologies discussed in this lane are important tools for the responder,
but these tools do not provide a definitive description of the agent. The agent should be
sampled and sent to a qualified laboratory for a definitive assessment.
Notes:
HOT.PM.09.0 1D-24
References
Advanced Tactical Threat Assessment Kit™. (n.d.). Retrieved from
http://www.advnt.org/products/biowarfare/attak/
Berkeley Nucleonics Corporation. (n.d.). Model 951 nukeALERT early warning radiation
detector. Retrieved from http://www.berkeleynucleonics.com/products/model-951.html
BioCheck™ Powder Screening Test Kit. (n.d.). Retrieved from
http://www.biocheckinfo.com/product.htm
Lateral Flow Immunoassays. (n.d.). Retrieved from http://www.rapidmicrobiology.com/test-
methods/Lateral-flow-assay.php
Ludlum Model 2241-4 Survey Meter with Neutron Detector. (2006, March). Retrieved from
http://ludlums.com/images/stories/product_manuals/M2241-4mar06.pdf
Rapid Analyte Measurement Platform™. (n.d.). Retrieved from
http://www.responsebio.com/products_biodefense_ramp_biodetection_system_overview.as
p?menu=3&submenu=1
Respiratory Protection, 29 C.F.R. § 1910.134 (2013).
SMART II™ Ticket. (n.d.). Retrieved from http://www.nhdiag.com/anthrax.shtml
Smiths Detection. (2006). Lightweight chemical detector operator training. Watford, UK: Author.
HOT.IG.09.0 1D-25
HOT.IG.09.0 1D-26
Module 2: COBRATF Briefing Participant Manual
COBRATF Briefing
Chemical, Ordnance, Biological, and Radiological Training Facility (COBRATF) instructors will
deliver the briefing using their approved materials.
Day Two: COBRATF Practical Exercises
On Day Two, participants engage in a rotation of about 8 hours of hands-on training exercises
at the COBRATF. This training incorporates the instruction from the hands-on training received
on Day One into a succession of practical exercises involving a response to a CBRNE/all-
hazards incident. Participants don either PPE Level B or Level C in all exercises. Participants
take part in the outdoor practical exercise—Northville Scenario—followed by the exercise inside
the toxic agent training building at the COBRATF.
COBRATF Overview
The training sessions may consist of multiple shifts to allow participants the opportunity to
participate in all aspects of the training.
Final Exercises
Describe the final exercises that consist of the Northville Scenario and the toxic agent training.
Explain that participants will be evaluated during the Northville portion of the COBRATF
practical exercises.
Following Training
State that following the completion of the COBRATF training, the following occur:
• Lunch is provided,
• Graduation and After Action Review are held,
• Participants are transported to the lodging area, and
• Final blood draw is taken the next morning prior to departure.
Notes:
HOT.PM.09.0 2-1
Module 2: COBRATF Briefing Participant Manual
HOT.PM.09.0 2-2
Module 3: COBRATF Practical Exercises Participant Manual
Module 3: COBRATF Practical Exercises

Summary: Participants engage in two exercises at the Chemical, Ordnance, Biological, and
Radiological Training Facility (COBRATF). These exercises allow the participants individually
and collectively to apply the response skills acquired during this course and/or previous Center
for Domestic Preparedness (CDP) courses. Participants begin training by inspecting Air-
Purifying Respirators (APR). Participants use response skills that include the performance of
mass casualty and decontamination operations and operate monitoring equipment to screen for
Chemical, Biological, Radiological, Nuclear, or Explosive (CBRNE) materials (e.g., sarin, VX,
anthrax [Bacillus anthracis], and ricin). Participants perform donning of Personal Protective
Equipment (PPE) to conduct exercises. Participants conduct the first exercise outside at the
Northville training site and the second exercise inside the toxic agent training building. The
exercise inside the toxic agent environment is beneficial to participants because it allows them
to gain confidence while wearing PPE. This exercise is conducted using several scenario-driven
stations. Prior to beginning and following the practical exercises, participants must meet medical
requirements in order to continue with training. At the conclusion of the module, participants
perform doffing procedures.
Terminal Learning Objective: Given a variety of situations, participants will be able to
perform mass casualty, decontamination, and monitoring operations while wearing the
appropriate level of PPE in response to a CBRNE incident.
3-1 Inspect an APR prior to a response to a CBRNE incident scenario in accordance with
the U.S. Department of the Army and U.S. Department of the Marine Corps’
Operator’s Manual for Chemical-Biological Mask M40A1.
3-2 Don PPE Level B or C in response to a CBRNE incident scenario according to CDP
guidelines outlined in the PPE Level B Procedures, PPE Level C Procedures, and
SCBA Operations handouts.
3-3 Perform triage and clothing removal while wearing PPE Level B or C during a
response to a CBRNE incident scenario according to the U.S. Army, Marine Corps,
Navy, and Air Force’s FM 3-11.21: Multiservice Tactics, Techniques, and Procedures
for Chemical, Biological, Radiological, and Nuclear Consequence Management.
3-4 Perform nonambulatory decontamination while wearing PPE Level B or C during a
response to a CBRNE incident scenario according to the U.S. Army, Marine Corps,
Navy, and Air Force’s FM 3-11.21: Multiservice Tactics, Techniques, and Procedures
for Chemical, Biological, Radiological, and Nuclear Consequence Management.
3-5 Operate monitoring equipment in the warm zone while wearing PPE Level C during a
response to a CBRNE incident scenario according to manufacturers’ guidance.
3-6 Perform technical decontamination while wearing PPE Level C following a response
to a CBRNE incident scenario according to National Fire Protection Association®
(NFPA®) 472 Standard for Competence of Responders to Hazardous
Materials/Weapons of Mass Destruction Incidents.
HOT.PM.09.0 3-1
3-7 Perform doffing procedures for PPE Level C following a response to a CBRNE
incident scenario according to CDP guidelines outlined in the PPE Level C
Procedures and SCBA Operations handouts.
3-8 Use the M256 Chemical Agent Detector kit and M8/C8 paper in monitoring
operations during a response to a CBRNE incident scenario while wearing PPE
Level C in accordance with COBRATF’s established procedures.
3-9 Use the Powder Screening Test Kit, and Pro Strips™ to screen for biological material
during a response to a CBRNE incident scenario while wearing PPE Level C in
accordance with manufacturers’ guidance.
3-10 Conduct a scene size-up while wearing PPE Level C during a response to a CBRNE
incident scenario according to Hazardous Waste Operations and Emergency
Response (HAZWOPER), 29 C.F.R. § 1910.120 (c)(2)–(3).
Activity: During the administrative portion of the training, participants inspect APRs for
potential damage. Instructors review and demonstrate each inspection step. Participants
perform the inspection steps at the same time. Allow approximately 15 minutes for this activity.
Practical Exercises: During the “COBRATF Practical Exercises” module, participants are
divided into groups of approximately the same size. They participate in two separate exercises.
Groups depart in 20-minute increments to begin their required tasks.
During the first exercise, which takes place at the Northville training site, participants take part in
a comprehensive scenario-driven exercise. Participants respond to a simulated tank car
explosion resulting in droplets of caustic materials being strewn about Northville. Due to the
circumstances, participants are required to don PPE Level B in order to respond to the incident.
Participants perform mass triage, perform clothing removal and nonambulatory
decontamination, and monitor simulated agents operating various detection devices such as the
Ludlum 2241, the Lightweight Chemical Detector (LCD), and the Powder Screening Test Kit.
They then leave the simulated contaminated area by performing technical decontamination and
doffing procedures. Allow approximately 3 hours for this exercise.
During the second exercise, which takes place inside the toxic agent training environment,
participants perform testing on actual chemical and biological agents. Participants use the M256
kit, M8/C8 paper, and Pro Strips. Participants follow a sequence of testing inside two separate
chemical rooms and one of two separate biological rooms. Participants then conduct a scene
size-up of a CBRNE incident. Finally, participants leave the actual contaminated area following
proper doffing procedures. Allow approximately 3 hours for this exercise.
Risk Assessment: Moderate
Methods of Instruction: Participants engage in two facilitated, collaborative hands-on
exercises supported by introductory presentation visuals. Under the direction and coaching of
the instructors, in the first exercise participants respond to a CBRNE incident scenario and
demonstrate mass casualty response skills, including performance of triage, nonambulatory
decontamination, and monitoring for contaminants at different stations. At the conclusion of
each station, instructors facilitate a hot wash in which participants discuss lessons learned
during the training.
Participants apply skills acquired in previous training to don PPE Level B to respond to the
CBRNE incident scenario. Midway through the exercise, participants are guided by instructors
HOT.PM.09.0 3-2
to transition from PPE Level B to Level C. Participants doff their PPE Level C at the end of the
first exercise.
For the second exercise, conducted inside in the toxic agent training facility, participants are
guided by instructors to don special Level C PPE approved for use with toxic agents. Under the
direction and coaching of the instructors, participants engage in chemical and biological
screening for contaminants in a live agent environment. After the exercise, participants are
guided by instructors to doff the PPE according to the doffing instructions they are given in their
orientation to the COBRATF.
Instructors coach participants during the performance-based exercises to ensure that they can
properly apply the skills, techniques, and tactics acquired in this course and/or previous
courses. Participants work cooperatively with other participants in teams to complete the
practical exercises.
Evaluation Strategies: Instructors informally assess participants using reflective
questioning and observation, correcting as necessary, during the performance of skills and
tasks that are noncritical. Instructors assess participants on the critical task of donning PPE
Level B prior to participation in the first exercise. A performance checklist is used to evaluate
participants’ demonstration of donning PPE Level B. At the conclusion of the module, the
instructor leads a discussion to review the key points of the content as well as to address any
additional participant questions.
Special Instructions: In the event of inclement weather, which precludes training at the
Northville site, an alternate training regimen (PPE Level C inside the toxic environment) is used.
In the event alternate training is necessary or a participant is unable to don PPE Level B,
participants are required to verbally explain to the instructor the proper procedure for donning
PPE Level B in order to meet the criteria of the critical task.
HOT.PM.09.0 3-3
Notes:
HOT.PM.09.0 3-4
Overview
The chances of a terrorist attack using CBRNE materials on the United States are increasing.
More terrorist groups are producing or stockpiling these materials. In order to minimize the
effects of such an incident, the emergency response community must know how to operate in a
CBRNE-contaminated environment and how to overcome the fear instilled by the use of
chemical weapons. This unique training experience is designed to meet those goals.
Upon arrival at the COBRATF, participants receive a facility safety briefing, medical briefing, an
introduction to the day’s events, and a demonstration of the doffing procedures to be completed
inside the Toxic Agent Training Building. The participants are divided into small groups and
assigned two instructors per group. The lead instructor conducts the APR inspection instruction
with a demonstrator. The other instructors oversee their groups’ inspection of individual APRs,
verifying that each participant has a properly functioning APR. Following the APR inspection
and doffing demonstration, the groups proceed to medical screening and odor threshold (in 20-
minute intervals). Participants complete the medical screening and odor threshold before
entering the training building. The first exercise is conducted at the Northville training site. The
first practical exercise is a scenario-driven exercise focusing on practicing mass casualty,
decontamination and monitoring operations following a response to a CBRNE incident.
Notes:
HOT.PM.09.0 3-5
Participants are evaluated on the critical task of donning PPE Levels B and C and doffing PPE
Level C. (NOTE: Those individuals who for medical reasons cannot dress out in Level B or C
are asked to talk the instructor through how they would don and doff both levels.) Following the
first exercise, participants prepare for toxic agent training. Participants complete another
medical screening, administrative safety briefing, and quantitative fit testing using the
individuals’ inspected APR.
In Practical Exercise Two, participants, under the supervision of the COBRATF staff, enter the
toxic agent training building. Inside the building, participants use the M256 Chemical Agent
Detector kit, M8 paper, Powder Screening Test Kit, and Pro Strips performing testing on actual
chemical and biological agents. Participants engage in mass casualty operations and conduct a
scene size-up while wearing PPE Level C.
Following Practical Exercise Two, participants doff PPE Level C and receive a postexercise
medical screening. In addition, participants engage in a hot wash (or informal After Action
Review [AAR]) of the exercise.
Notes:
HOT.PM.09.0 3-6
Enabling Learning Objective 3-1: Inspect an APR prior to a response to a CBRNE incident
scenario in accordance with the U.S. Department of the Army and U.S. Department of the
Marine Corps’ Operator’s Manual for Chemical-Biological Mask M40A1.
Air-Purifying Respirator
The APR used for training inside the COBRATF is the Army M40A1 chemical-protective mask.
The M40A1 chemical-protective mask is the only approved APR for use at this facility.
APR Inspection
Following the direction of instructors, inspect your APRs for potential damage. As the instructor
reviews and demonstrates each step, perform the following actions:
• Locate the voicemitter.
• Visually inspect the canister for cracks, dents, or holes. Shake the APR and listen for
loose, absorbent particles. Tap the canister lightly onto the palm of the hand to ensure
there are no loose particles inside.
Notes:
HOT.PM.09.0 3-7
• Visually inspect the eye lenses for scratches, cracks, or discoloration that could affect
vision.
• Inspect the outlet valve disk by lifting up the outlet valve cover and visually ensuring the
disk is present and not curled or distorted. Physically rotate the disk to make sure that it
does not stick. Re-seat the outlet valve cover.
• Expose the external drink tube.

• Inspect the head harness for loss of elasticity, cuts, tears, or fraying. Extend metal tabs
out approximately 1 inch at all six points.
• Rotate the head harness to the front of the APR.
• Locate the air deflector.
Notes:
HOT.PM.09.0 3-8
• Visually inspect the facepiece and nose cup for any foreign objects (e.g., dirt, grime, lint).
Notes:
HOT.PM.09.0 3-9
• Visually inspect the nose cup valve disks to ensure that they are present and not curled
or distorted. Physically rotate the disks to ensure they do not stick.
Notes:
HOT.PM.09.0 3-10
Fitting Procedures for the APR

For the following activities, the instructor verbally guides and demonstrates each step.
Participants are paired with another participant (buddy) when performing the following:
• Remove all hairpins, hair knots, buns, or braids that interfere with the fit of the APR.
• Adjust the head harness straps to approximately 1 inch from the clip-buckle assembly.
• Open the APR by placing the thumbs under the head harness. Place the chin in the chin
cup. Slip the harness over the head while pulling the APR up against the face. Place two
fingers on the voicemitter.
• The buddy ensures the head harness pad is located on the crown of the head and the
eyes are generally centered in the eye lenses. Ensure the tab on the head harness is not
under the pad.
• The buddy adjusts the straps using the ABC method (Above–forehead, Below–cheek,
and Center–temple straps). Ensure that the buddy maintains one hand on the head
harness during adjustment.
Notes:
HOT.PM.09.0 3-11
• Place two fingers on the voicemitter. The buddy adjusts the A–forehead and B–cheek
straps first. Ensure that the buddy maintains one hand on the head harness during
adjustment.
• Remove the fingers from the APR. The APR should remain in place. If the APR slips
down, re-place two fingers on the voicemitter while the buddy readjusts the A–forehead
and B–cheek straps until the APR remains in place.
• When the A–forehead and B–cheek straps have been adjusted, remove the two fingers
from the voicemitter to check APR tightness. Then, re-place two fingers against the
voicemitter while the buddy adjusts the two C-temple straps.
• Have the demonstrator clear and seal the APR by placing the palm of the hand against
the outlet valve covering and blowing out forcefully. Remove the hand from the outlet
valve and cover the air inlet of the canister, breathe in, and hold for 5–10 seconds. The
APR should collapse and remain collapsed against the face.
• If the respirator leaks, the APR should be readjusted or replaced.
Notes:
HOT.PM.09.0 3-12
Checking the APR Fit

When checking for a proper fit of the APR, verify the following:
• The edge of the APR comes up on the forehead, but not into the hairline
• C–temple straps and B–cheek straps do not cut into the ears
• Head harness straps are flat and in a straight line
• Eyes are generally centered in the lenses of the APR
• The skin in front of the ears is not wrinkled from the straps being too tight
After completion of the fit check, only the bottom two straps should be loosened to remove the
APR.
Notes:
HOT.PM.09.0 3-13
Doffing Demonstration
After completion of APR inspection/fitting, a doffing demonstration is given by the COBRATF
staff.
Doffing Procedures
Doffing follows the established COBRATF procedures.
• Instructors demonstrate/simulate the individual tasks.
• Instructors demonstrate/simulate the partnered/buddy tasks.
Orientation Round Robin

At this time, instructors divide participants into their assigned groups/teams to complete the
orientation activities, which include a medical screening and the odor threshold screening.
Separate into instructor-led groups and conduct the orientation activities to include medical
screening and the odor threshold screening. Below is the agenda for each group.
• Team A
– Group 1—Medical screening, odor threshold screening, locker room dressing
procedures, PPE Level B donning, and Northville scenario.
– Group 2—Odor threshold screening, medical screening, locker room dressing
procedures, PPE Level B donning, and Northville scenario. (Group 3 can perform
odor threshold screening along with Group 2 to preclude delaying Group 1 at the
odor threshold screening station.)
• Team B
– Group 4—Medical screening, odor threshold screening, locker room dressing
Notes:
HOT.PM.09.0 3-14

procedures, PPE Level B donning, and Northville scenario. (Group 6 can perform
odor threshold screening along with Group 5 to preclude delaying Group 4 at the
odor threshold screening station.)
Notes:
HOT.PM.09.0 3-15
Introduction of the Northville Scenario

The city of Northville terrorist activity command center has raised the terrorist threat level in the
city of Northville due to recent activities of the Universal Advisory (UA) terrorist group. The
Northville Daily News has published several articles exposing the extremist views of the UA.
The local Simpson’s Chemical supply operates several chemical containment sites throughout
the country. One of Simpson’s largest containment facilities are situated adjacent to the
Northville Shopping area. The UA has vowed to take action on all chemical production and
storage facilities with the United States. UA has been linked to the destruction of several of
Simpson’s trucks in the last several months. Several large tanks of chemicals are due in by rail
this morning. The railroad tracks leading to the facilities run around the shops and local school
area.
At approximately 6:30 am, Train 0704 is heading west along track four when suddenly there is a
loud explosion and it appears to be raining out of nowhere. Individuals sitting outside begin to
scream loudly from pain. The liquid is a caustic material causing their skin to burn and blister.
The train was to stop at Simpson’s Chemical Supply and offload several types of Toxic
Industrial Chemicals (TIC), one being a caustic soda solution.
Notes:
HOT.PM.09.0 3-16
Shortly after the explosions at the scene of the wreckage, a Radiological Dispersal Device
(RDD) containing an unknown quantity of Cesium-137 explodes about 100 feet west of the train
spraying a fine white power near the Northville Flower Shop.
By 7:30 am, several response teams have arrived and the Incident Commander (IC) begins
developing and Incident Action Plan (IAP).
The Northville IC has organized its resources and has selected responders to participate in the
following four areas of responsibility following the initial response of the Bomb Technician and
Hazardous Material Technicians:
• Mass casualty operations,
• Decontamination,
• Scene survey and safety, and
• Monitoring in the warm zone for radiological materials and chemical and biological
agents.
These areas of responsibility will be in continuous operations until the incident is stabilized.
Notes:
HOT.PM.09.0 3-17
Practical Exercise One—Northville Exercise

Participants take part in this exercise outdoors at the Northville training site, which is adjacent to
the toxic agent training facility. Participants don PPE Level B and report to the warm zone at the
incident site in Northville. The immediate tasks for participants relate to mass casualty
operations, decontamination operations, and monitoring activities.
This exercise has five stations. Each station takes approximately 15–20 minutes. Time
constraints preclude all participants from engaging in all stations. Station One is the dress out
station where the participants are issued PPE, receive the Northville Scenario brief and are
required to don PPE Level B. The group is divided into two teams and assigned tasks with
Team A having the task of Station Two (Mass Casualty Response) and Team B having the task
of Station Three (Nonambulatory Decontamination). After going on air, participants proceed to
Station Two. At Station Two, participants perform triage and cutout while wearing PPE Level B.
At Station Three, participants are required to perform nonambulatory decontamination while
wearing PPE Level B. After Station Three, participants gather in a waiting area to receive a
briefing. Participants are informed that the Incident Commander has downgraded the protective
posture of PPE Level B to PPE Level C. The COBRATF staff assists the participants with
assuming the downgrade. When properly dressed in PPE Level C, they proceed to Station Four,
Monitoring. At Station Four, participants are issued monitoring equipment, which they operate
throughout the warm zone. If time permits, instructors demonstrate the RAMP for participants
during this time. Participants are prompted with questions to ensure that they understand the
monitoring process and equipment being used. Following monitoring, participants proceed to
Station Five, Technical Decontamination.
Enabling Learning Objective 3-2: Don PPE Level B or C in response to a CBRNE incident
scenario according to CDP guidelines outlined in the PPE Level B Procedures, PPE Level C
Procedures, and SCBA Operations handouts.
Station One—Dress Out

• The instructor issues Team A its mission assignment (i.e., Nonambulatory
Decontamination).
• The instructor issues Team B its mission assignment (i.e., Mass Casualty Response and
Clothing Removal).
Notes:
HOT.IG.09.0 3-18
• The instructor directs participants to initiate PPE Level B dress out to include pre-
operation equipment checks. Participants conduct dress-out procedures following the
performance checklist.
Read the following script.
“Responders have arrived at the incident site in Northville. Terrorist involvement is
suspected, though unsubstantiated. The Incident Command realizes that a caustic
material is threatening the shopping and school area north of the train wreck. It is
approximately 6:30 a.m. on an average workday. Hazardous Materials (HAZMAT)
technicians have entered the hot zone and have initiated rescue activities. They have
brought casualties to a Casualty Collection Point (CCP), and that is where responders
will take over operations.”
Enabling Learning Objective 3-3: Perform triage and clothing removal while wearing PPE
Level B or C during a response to a CBRNE incident scenario according to the U.S. Army,
Marine Corps, Navy, and Air Force’s FM 3-11.21: Multiservice Tactics, Techniques, and
Procedures for Chemical, Biological, Radiological, and Nuclear Consequence Management.
Station Two—Mass Casualty Response

Having donned PPE Level B, participants assume operations at Station Two, which is located
approximately 10 feet from the hot–warm zone demarcation line. No fewer than six participants
are present and operational at Station Two.
Participants engaged in extrication operations do not enter the hot zone but assist HAZMAT
technicians with extrication duties at the hot-warm zone demarcation line. At this time,
participants receive a nonambulatory casualty from the HAZMAT technicians and transport the
casualty to the CCP using an extrication device (e.g., SKED, Red SLED, or backboard).
Participants at Station Two perform Simple Triage and Rapid Treatment (START) procedures,
use the Triage Tag System, and transport casualties to the decontamination corridor control
line.
The use of an SCBA requires that participants’ mass casualty mission be terminated 20 minutes
after going on air. After 20 minutes, ensure that participants doff the SCBAs and are provided
the opportunity to hydrate and rest. Prepare these participants for donning PPE Level C when
they move to Station Four.
Notes:
HOT.IG.09.0 3-19
Prepare for the next group of participants in PPE Level B. This group assumes mass casualty
operations.
The Team B (COBRATF) instructor leads the team to the mass casualty response and clothing
removal area. The instructor provides a mission brief to participants.
Participants perform the following actions/operations at this station:
• Assume extrication operations at the hot–warm zone demarcation line, ensuring that
nonambulatory casualties are transported to the CCP for triage and tagging.
• Conduct mass casualty operations in the warm zone while wearing PPE Level B.
• Perform START operations, using the Triage Tag System.
• Using two participants and an extrication device, drag a nonambulatory casualty from
the CCP through the mass decontamination corridor to the clothing removal station, and
position the person on the ground. Be careful not to cross the control line.
• Using a three-person lift, place the SKED with a casualty on an elevated platform and
conduct casualty clothing removal procedures.
• Using a three-person lift, move the casualty forward to a waiting nonambulatory
decontamination team.
Notes:
HOT.IG.09.0 3-20
Enabling Learning Objective 3-4: Perform nonambulatory decontamination while wearing

PPE Level B or C during a response to a CBRNE incident scenario according to the U.S.
Army, Marine Corps, Navy, and Air Force’s FM 3-11.21: Multiservice Tactics, Techniques,
and Procedures for Chemical, Biological, Radiological, and Nuclear Consequence
Management.
Station Three—Nonambulatory Decontamination

Gross decontamination for technical decontamination operations is performed at the beginning
of the operational line. For example, the technical decontamination line supports gross
operations as the initial step in decontaminating participants.
The removal of nonambulatory individuals’ clothing suffices as gross decontamination. For
training purposes, arrange for some nonambulatory casualties to cause the monitoring
equipment to sound an alert following decontamination. Participants should have these
individuals return to the nonambulatory decontamination line for secondary decontamination.
Participants performing decontamination operations work in PPE Level B. The exercise
coordinator has nonambulatory individuals brought to the decontamination corridor. Mannequins
are available to simulate nonambulatory casualties.
Monitor participants’ air supply. Use of an SCBA requires the participants’ decontamination
mission be terminated approximately 20 minutes from going on air. After 20 minutes, ensure
that participants performing decontamination operations are taken off air, hydrated, and rested.
Prepare these participants for donning PPE Level C, at which point they conduct monitoring
operations.
Prepare for the next group of participants in PPE Level B. This group assumes nonambulatory
decontamination operations.
The Team A instructor (COBRATF) leads his or her team to the nonambulatory decontamination
area. Participants conduct the Station Three activities on air for 20 minutes.
Inform participants of the following:
• Mass decontamination operations for ambulatory casualties are simulated.
• A secondary decontamination operation for nonambulatory casualties may be
necessary.
Notes:
HOT.IG.09.0 3-21
• Gross decontamination for nonambulatory casualties is accomplished through the

removal of the individuals’ clothing and personal items.
• At least three participants should be adjacent to the nonambulatory decontamination
operations line and tasked to collect a casualty from CCP personnel after clothing
removal.
• The casualty is decontaminated using soap and water.
• The casualty can be monitored for contaminants at another station following the
decontamination process.
Gross decontamination for nonambulatory casualties is accomplished through the removal of
the individuals’ clothing. Casualties are monitored for residual contamination, and a secondary
decontamination operation is conducted if necessary.
Participants are directed by instructors to the appropriate decontamination corridor, ensuring
that an adequate number of participants are present to run operations.
Enabling Learning Objective 3-5: Operate monitoring equipment in the warm zone while
wearing PPE Level C during a response to a CBRNE incident scenario according to
Station Four—Monitoring
Participants who complete decontamination and mass casualty operations are directed to
proceed to Station Four (monitoring). Ensure that participants arriving at Station Four are rested
and hydrated. Ensure that they have doffed their SCBAs and are prepared to don PPE Level C
prior to conducting monitoring operations.
Participants engaged in monitoring (Station Four) operate throughout the warm zone.
Ensure the placement of participants at the hot–warm zone (Station Two) demarcation line
where individuals are entering the warm zone. Instruct participants to operate monitoring
equipment to monitor casualties with M8 Paper and the Ludlum 2241 survey meter. Ensure that
the Ludlum 2241 survey meter is equipped with a pancake probe used for alpha and beta
detection.
Groups are divided into three teams to conduct CBRNE monitoring operations. Team A goes to
Station Three (Nonambulatory Decontamination), where participants operate the Ludlum 2241,
Notes:
HOT.IG.09.0 3-22
M8 Paper, and the LCD. Team B goes to Station Two (PMCR), where participants use the
Ludlum 2241, M8 Paper, and Powder Screening Test Kit. Team C may consist of one or two
participants from each team, A and B. Team C goes with an instructor to use the M256 kit (if
necessary, participants operating the M256A1 sampler can do so with Team A or Team B).
Participants report to Station Four following their respective missions at Station Two and Station
Three. After reporting to Station Four, participants may be directed by the instructor to monitor
for contaminants anywhere in the warm zone.
At Station Four, participants conduct monitoring operations in the warm zone while wearing PPE
Level C.
Enabling Learning Objective 3-6: Perform technical decontamination while wearing PPE
Level C following a response to a CBRNE incident scenario according to NFPA 472,
Standard for Competence of Responders to Hazardous Materials/Weapons of Mass
Destruction Incidents.
Enabling Learning Objective 3-7: Perform doffing procedures for PPE Level C following a
response to a CBRNE incident scenario according to CDP guidelines outlined in the PPE
Level C Procedures and SCBA Operations handouts.
Station Five—Technical Decontamination

Participants report to Station Five following their mission at Station Four. Participants perform
decontamination on participants who are leaving the hot zone.
At this station, remember the following details:
• Gross decontamination for technical decontamination operations is conducted at the
beginning of the technical decontamination corridor.
• The technical decontamination area is segregated from the mass decontamination
operation.
• Two station attendants (participants) are positioned at the gross decontamination pool.
– One of the attendants assesses participants as they come to the decontamination
line.
Notes:
HOT.IG.09.0 3-23
Module 3: COBRATF Practical Exercises Instructor Guide
– Participants enter and exit the decontamination shower/pool using the stability
devices provided.
– One of the attendants scrubs participants from head to foot.
• Two station attendants (participants) are positioned at the technical/secondary
decontamination pool (apply decontamination solution). At this second pool, one of the
attendants
– Applies decontamination solution (allowing sufficient contact time).
– Scrubs participants with long-handled brushes from head to foot, paying close
attention to the hands, knees, and bottom of the feet (using downward strokes).
– Rinses participants from head to foot. Have participants exit the pool after rinsing the
bottom of each foot, ensuring that the participant uses the stability devices provided.
• Instructors assist with removing the PPE from the participants if necessary.
Upon completion of the practical exercise at the Northville training site, all groups return to the
locker room of the training building to dress out for toxic agent training and to conduct a glove
check. After dress out and glove-check procedures are completed, all groups return to the
administrative building for the following:
• Postexercise vitals screening,
• Administrative safety briefing, and
• PortaCount procedures.
Notes:
HOT.IG.09.0 3-24
Safety Rules
The safety of participants and staff is of the utmost importance. In order to ensure everyone’s
safety, it is important that participants comply with the following while training at the COBRATF:
• Do not lean against training aids or misuse training materials.
• Do not kneel on floors.
• Do not disturb another participant’s locker in the locker room.
• Do not run, shove, or play around.
Notes:
HOT.IG.09.0 3-25
• Do not remove APR until told to do so during doffing procedures.

• Be mindful of hands and feet.
NOTE: Be mindful of hands and feet when entering or exiting through any door in the training
building. The gasket-sealed doors are heavy and swing closed forcefully; therefore, ensure
hands and feet are clear when they are closing. In addition, there is a ledge present at each
doorway that participants should be aware of when walking through any door in the toxic agent
training area. Be sure to step over the ledge to prevent falling and possibly compromising the
APR or protective posture.
• Use two fingers on the voicemitter.
NOTE: Apply two fingers using slight inward pressure to the voicemitter of the APR to prevent
breaking the seal anytime someone is touching the APR or hood, or when the participant
coughs, sneezes, or laughs.
• Always use the buddy system. If there is a problem with the participant or his or her
buddy, an instructor should be notified immediately.
Notes:
HOT.IG.09.0 3-26
Ensuring the safety of participants while working in potentially hazardous environments is

extremely important. While training at the COBRATF, participants should be aware of the
potential signs and symptoms of environmental stress and nerve agent poisoning that either
they or their peers could experience. If any of the following signs and symptoms is experienced
or exhibited, participants should notify their instructor as soon as possible. During training, the
instructors are continually monitoring participants for these signs and symptoms.
Cold Injuries
General cold injury signs and symptoms include the following:
• Pain or loss of feeling in any part of the body,
• Mild confusion or difficulty performing tasks,
• Redness of skin in light-skinned persons and grayish coloring in dark-skinned persons,
and
• Mild shivering.
Notes:
HOT.IG.09.0 3-27
Heat Injuries
Heat injuries can be divided into three categories, ranging from mild to more severe: heat
cramps, heat exhaustion, and heat stroke.
Heat Cramps
General heat cramp signs and symptoms include the following:
• Muscle cramps in the arms, legs, or abdomen;
• Excessive sweating; and
• Thirst.
Notes:
HOT.IG.09.0 3-28
Heat Exhaustion
General heat exhaustion signs and symptoms include the following:
• Sweating, accompanied by pale, moist, cool skin;
• Weakness or dizziness;
• Loss of appetite;
• Headache;
• Heat cramps;
• Nausea;
• Urge to defecate;
• Chills;
• Rapid breathing;
Notes:
HOT.IG.09.0 3-29
• Tingling of hands and/or feet; and

• Confusion.
Heat Stroke
General heat stroke signs and symptoms, which indicate a true medical emergency, include the
following:
• Headache;
• Dizziness;
• Confusion;
• Nausea;
• Hot, dry skin;
• Seizures;
• Loss of consciousness; and
• Lack of pulse.
Notes:
HOT.IG.09.0 3-30
Signs and Symptoms of Intoxication Due to Nerve Agent Exposure

• Vapor Exposure
– Mild/Moderate Intoxication
– Severe Intoxication
• Liquid Exposure
– Mild/Moderate Intoxication
– Severe Intoxication
Notes:
HOT.IG.09.0 3-31
Signs and Symptoms of Mild/Moderate Intoxication Due to Vapor

Exposure
• Lacrimation—Tearing;
• Miosis—Pinpointing of pupils and dimness of vision;
• Rhinorrhea—Unexplained runny nose;
• Salivation—Excessive flow of saliva, drooling;
• Unexplained sudden headache;
• Coughing; and
• Dyspnea—Tightness in the chest or difficulty breathing.
Notes:
HOT.IG.09.0 3-32
Signs and Symptoms of Severe Intoxication Due to Vapor Exposure

Severe nerve agent vapor exposure signs and symptoms include all mild and moderate
exposure signs and symptoms, plus the following:
• Severe miosis—Pinpointing of pupils and dimness of vision, red eyes with tearing;
• Vomiting;
• Involuntary urination/defecation;
• Respiratory arrest (i.e., not breathing);
• Seizures/convulsions;
• Strange, confused behavior; and
• Sudden loss of consciousness.
Notes:
HOT.IG.09.0 3-33
Signs and Symptoms of Mild/Moderate Intoxication Due to Liquid

Exposure
• Muscle twitching at site of exposure,
• Nausea,
• Abdominal cramps,
• Tachycardia followed by bradycardia—Heartbeat over 100 bpm followed by heartbeat
under 60 bpm,
• Rhinorrhea—Unexplained runny nose,
• Salivation—Sudden drooling, and
• Dyspnea—Tightness in the chest or difficulty breathing.
Notes:
HOT.IG.09.0 3-34
Signs and Symptoms of Severe Intoxication Due to Liquid Exposure

Severe nerve agent liquid exposure signs and symptoms include all mild and moderate
exposure signs and symptoms, plus the following:
• Severe muscular twitching and general weakness;
• Sudden loss of consciousness;
• Strange, confused behavior;
• Respiratory arrest (i.e., not breathing);
• Seizures/convulsions;
• Involuntary urination/defecation; and
• Vomiting.
Notes:
HOT.IG.09.0 3-35
First Aid for Nerve Agent Poisoning

First aid for nerve agent poisoning is a nerve-agent antidote. Each training room contains
adequate supplies of nerve-agent antidote. Only the COBRATF staff administers a nerve-agent
antidote if it is needed. Instructors use the DuoDote
Notes:
HOT.IG.09.0 3-36
Emergencies
Participants should be aware of the following emergencies:
• Injury—Report any injury to an instructor.
• Agent contamination—The instructor takes appropriate actions if there is suspected
nerve agent contamination.
• PPE compromise—The instructor should be notified of any possible compromise of
PPE. All attempts are made to correct the compromise and continue training. Otherwise,
the participant doffs out of PPE and his or her training ends.
• Complications with contact lenses or optical inserts—Notify the instructor of any
problems with contact lenses. If the participant is able to continue training with contacts,
he or she is permitted to do so.
Notes:
HOT.IG.09.0 3-37
Key Points
Participants should also remember the following key points:
• Contamination avoidance—As with any chemical agent scenario (actual or training), the
number one rule is contamination avoidance.
• Use of ATNAA—Only COBRATF or medical personnel administers the ATNAA to a
nerve agent casualty.
• Poor communications—If a participant cannot hear or understand an instructor while
wearing the APR, he or she should raise his or her hand and the instructor will repeat
instructions.
• Lifting mannequins—When lifting mannequins, participants should use proper lifting
techniques and be mindful of the pinch points in the joints of the mannequins.
NOTE: When lifting mannequins, a minimum of three people is needed to lift. Two people are
required to drag.
Notes:
HOT.IG.09.0 3-38
Training Bay Safety Features

• Handrail
• Cameras
• Kill buckets
• Decontamination/rinse bucket
• ATNAA
• Intercom
• If anything is dropped on the floor, staff will pick it up
Notes:
HOT.IG.09.0 3-39
Quantitative Fit Testing of the APR

The quantitative fit testing of the APR is conducted in the PortaCount area. Each exercise
(except the grimace) takes 60 seconds, and there should be no talking unless directed to do so
during the exercises. Participants engage in the following exercises:
• Normal breathing—In a normal standing position, the participant breathes normally.
• Deep breathing—The participant takes long, deep, slow breaths.
• Head side to side—The participant breathes normally while turning his or her head from
left to right. The participant should turn far enough to feel tension on the hood. He or she
should take care not to touch the APR canister to his or her shoulder.
• Head up and down—The participant breathes normally while slowly alternating from
looking up at the top of the door to looking down to the bottom of the door. He or she
should take care not to hit the APR canister on his or her chest.
• Count backward from 100—While breathing normally, the participant slowly counts
backward from 100.
Notes:
HOT.IG.09.0 3-40
• Grimace—The participant forms a small smile and/or frown. This is a 15-second

exercise.
• Bend over—The participant takes one step back and bends forward slightly at the waist
while keeping his or her eyes on the computer screen. He or she should breathe
normally; after about 10 seconds, stand erect, wait for 10 seconds, and repeat this
exercise for 60 seconds.
• Normal breathing—In a normal standing position, the participant breathes normally.
Notes:
HOT.IG.09.0 3-41
Practical Exercise Two—Toxic Agent Training

Prior to entering the toxic agent environment for Practical Exercise Two, participants engage in
the following actions when prompted by the COBRATF staff:
• Move to the training building—When authorized by the COBRATF staff, instructors
escort their respective groups to the training building.
• Enter the training building—Instructors notify Safety Control of the number of participants
and staff members entering the building. Participants, under the supervision of the
instructors, check the pockets of the LANX™ suits to determine if any unauthorized
items have been left in the pockets from prior use. Instructors inform Safety Control
when the pocket check has been completed.
• Receive an APR check procedures briefing—Instructors review the APR check
procedures discussed in the classroom prior to entering the air lock.
• Enter the air lock—Participants must remember to step up and over door thresholds.
• Enter the APR check chamber—Conduct an APR check according to COBRATF
established procedures. Upon completion of the APR check, each group’s instructor
leads participants into the service gallery.
• Enter the service gallery—Upon entering the service gallery, instructors and participants
don identification apparel. Instructors secure radios.
Conduct Toxic Agent Training
Task 1: Chemical Detection
Participants are required to enter two rooms. A chemical agent is introduced into the rooms. The
participants use the M256 kit and M8/C8 paper to determine the agent present. Instructors
demonstrate other monitoring devices.
Task 2: Biological Detection
Participants are required to enter one of two rooms. Biological agents are introduced into the
rooms. The participants use the Pro Strips to screen for biological agents. Time permitting,
instructors may demonstrate other devices, such as the RAMP. Instructors explain that the
RAMP is normally used in the warm zone or cold area. The sample would be collected by a
HAZMAT technician and transported for presumptive identification.
Notes:
HOT.IG.09.0 3-42
Task 3: Casualty Search and Rescue/Scene Size-Up

Participants enter a room where they conduct a search, triage, and rescue of viable casualties.
Once the viable casualties are processed and at the room entryway, the instructor discusses
scene size-up and reporting procedures. Participants conduct a scene size-up of the CBRNE
incident site.
Enabling Learning Objective 3-8: Use the M256 Chemical Agent Detector kit and M8/C8
paper in monitoring operations during a response to a CBRNE incident scenario while
wearing PPE Level C in accordance with COBRATF’s established procedures.
Enabling Learning Objective 3-9: Use the Powder Screening Test Kit, and Pro Strips to
screen for biological material during a response to a CBRNE incident scenario while wearing
PPE Level C in accordance with manufacturers’ guidance.
Tasks #1 and 2: Monitoring Exercises for Contamination

Safety
Review the following safety considerations for training inside the toxic agent training
environment:
• Identification apparel—Instructors, staff, and participants don identification apparel upon
entry to the service gallery. Instructors don instructor vests, and participants don team
color-coded identification devices.
• Gasket-sealed doors—Participants should not attempt to stop any door while it is
closing; they must keep hands and feet away from the doorjamb at all times. Instructors
or staff members open and close all doors.
• Threshold—Participants should step up and over all door thresholds (when encountered)
to prevent slipping and possibly compromising PPE. Participants should use handrails (if
available), which are found inside the training bays to the left of the shuffle pit, for
additional safety.
• M8/C8 paper—Participants should use proper monitoring techniques.
• Powder Screening Test Kit—Participants should use proper sampling techniques.
Notes:
HOT.IG.09.0 3-43
• Pro Strips (live)—Participants should use proper sampling techniques.

• Kill buckets—Instructors identify the location of the kill buckets and how to dispose of
contaminated items properly.
• Decontamination and rinse buckets—Instructors identify decontamination and rinse
buckets in training bays and demonstrate their proper use.
• Exit doors/cameras—Instructors review safety and emergency procedures.
• Modified M256 Chemical Agent Detector kit—Participants should construct the crushing
device as taught during cold lanes training. The instructor guides the group through all
the steps of how to use the M256 sampler.
• ATNAA Auto-Injector—The ATNAA is located in all of the bays. The ATNAA is
administered by COBRATF staff only.
• Drains—Participants should limit walking on covered grates located in the service gallery
and training bays.
• Extrication device operations—Instructors ensure that all participants on the extrication
teams have been cleared by the medical personnel for lifting and pulling. Participants
should avoid potential pinch points on the extrication device.
• Mannequins—When lifting mannequins, participants should be aware of pinch points
located at the joints that can cause injury or compromise PPE. Participants should use
proper lifting techniques at all times.
• Contamination avoidance—Participants should not lean on or against anything inside the
COBRATF, nor should they kneel on the floors.
• Body position—Participants should not straddle or bend over the mannequins. If bending
is necessary, participants should bend near the mannequin, not over the mannequin.
• Dropped items—Participants should not pick up dropped items but should notify an
instructor who will pick up the item.
• Safety/emergencies—In the event of an emergency, participants should follow the
directions of the instructor.
• Agent neutralization—Instructors will neutralize agent. Instructors should discuss
movements and locations during the neutralization operation.
Notes:
HOT.IG.09.0 3-44
Enabling Learning Objective 3-10: Conduct a scene size-up while wearing PPE Level C
during a response to a CBRNE incident scenario according to HAZWOPER, 29 C.F.R. §
1910.120 (c)(2)–(3).
Task # 3: Casualty Search and Rescue Using Extrication Device; Scene Size-up
Overview
Participants search, triage, rescue, and extricate viable casualties. Once the viable casualties
are processed and at the bay entryway, the instructor discusses scene size-up and reporting
procedures. Participants conduct a scene size-up of the CBRNE incident site.
Safety
Review the following safety procedures for training in the COBRATF:
• Contamination avoidance—Participants should lean neither on nor against anything
inside the hot zone, nor should they kneel on the floors.
• Gasket-sealed doors—Participants should not attempt to stop any door while it is
closing; keep hands and feet away from the doorjamb at all times. Instructors or staff
members open and close all doors.
• Off-limit areas—Instructors identify those areas that are off limits to participants (e.g., the
truck).
• Threshold—Participants should step up and over all thresholds encountered to prevent
slipping and possible compromise of PPE, using handrails (if available) for additional
safety.
• Body position—Participants should not straddle or bend over the mannequins during the
clothing removal process. If bending is necessary, participants should bend beside the
mannequin, not over the mannequin.
• Extrication device operations—Instructors should ensure that all participants on the
extrication teams have been cleared by the medical personnel for lifting and pulling.
Participants should avoid pinch points on extrication device.
• Mannequins—When lifting mannequins, participants should be aware of pinch points
located at the joints that can cause injury or compromise PPE and should use proper
lifting techniques at all times.
Notes:
HOT.IG.09.0 3-45
• Decontamination and rinse buckets—Instructors identify decontamination and rinse

buckets in the training bays and demonstrate their proper use.
Reflective Questions
Possible questions to ask during the scene size-up include the following:
• How many viable casualties did you see?
• How many nonviable casualties?
• Were there any explosive devices?
• What about the barrels? Were there any markings? Should there be markings?
• Is there any technology that can assist you in determining what happened?
Doffing Procedures
After completion of toxic agent training, participants proceed to the doffing area with their
group’s instructors. Participants are guided through the procedures in a lock-step manner to
ensure safety.
Follow established COBRATF’s doffing procedures.
Upon completion of the doffing process, participants decontaminate and rinse their gloves and
move to the yellow line for instructions from the support personnel. Once the participant has
cleared the wall, he/she must place both hands together, pinch and pull his/her gloves, and
move forward to the instructor at the glove removal bin for assistance. Once the gloves have
been removed, participants must stay clear of all other participants coming across the wall. Also
participants should be reminded not to touch their APRs with their bare hands.
After showering and dressing, participants return to the administrative building for the
postmedical screening and AAR.
Notes:
HOT.IG.09.0 3-46
References
NOTE: The following were used in the development of this course. Due to the variability of
content on the Internet, the time that the referenced websites remain viable is unknown.
Center for Domestic Preparedness, Chemical, Ordnance, Biological, and Radiological Training
Facility. (2009, December 1). M256A1 detector kit. In Standard Operating Procedure.
Anniston, AL: Author.
Center for Domestic Preparedness, Chemical, Ordnance, Biological, and Radiological Training
Facility. (2004, January 21). M8 detector paper. In Standard Operating Procedure. Anniston,
AL: Author.
National Fire Protection Association. (2013). NFPA 472, Standard for competence of
responders to hazardous materials/weapons of mass destruction incidents. Quincy, MA:
Author.
U.S. Army, Marine Corps, Navy, and Air Force. (2008, April 1). FM 3-11.21: Multiservice tactics,
techniques, and procedures for chemical, biological, radiological, and nuclear consequence
management. Retrieved from http://www.fas.org/irp/doddir/army/fm3-11-21.pdf
U.S. Department of the Army and U.S. Department of the Marine Corps. (2007). Operator’s
manual for chemical-biological mask M40A1. Washington, DC: Author.
HOT.IG.121710 2-47
HOT.IG.09.0 3-48
Conclusion and After Action Review Participant Manual
Conclusion and After Action Review

Duration: 0.25 Hour
Summary: After Action Review (AAR) occurs at the conclusion of each day’s training.
Participants engage in an AAR in which they discuss the strengths and areas for improvement
of the training provided by the Center for Domestic Preparedness (CDP). Participants review
lessons learned and describe the applicability of the training to their local jurisdictions.
Activities: Participants return to the classroom to engage in an AAR. Participants describe
course components and exercise experiences. Participants explain specific lessons learned
during the hands-on training and describe how they plan to apply the lessons learned in the
performance of their duties. The discussion allows for participants to gain additional ideas
regarding possible implementation within their local jurisdiction from their peers and instructional
staff.
Methods of Instruction: Instructors use facilitated lecture and visuals to lead a
discussion of the strengths and areas for improvement of the training provided by the CDP.
Additionally, the instructor uses reflective questioning to encourage participants to explain
improvements in their personal knowledge, skills, and abilities and describe the possible
application of such upon their return to their local jurisdiction.
Evaluation Strategy: The instructor informally assesses participants through involvement
within the AAR.
HOT.PM.09.0 A-1
Notes:
HOT.PM.09.0 A-2
After Action Review

Participants engage in an AAR of the course to discuss the strongest, weakest, and most useful
elements of the training course. Participants review lessons learned and the applicability of the
training for their local jurisdictions. Instructors lead a discussion in which participants are
encouraged to convey which lessons were most effective and offer suggestions for
improvement.
Questions: Based on the training, answer the following questions:

• What were the strongest elements of the training course?
• What are the areas of improvement for the training course?
• What were the portions of the classroom work (prior to the exercise) that were most
useful?
• What were the most useful elements of the exercises?
• How can the CDP improve the overall training experience?
• Are there any suggestions to improve the subject matter?
• Are there any suggestions to improve the scope or level of the training for the target
audience?
• What are the lessons learned from this course that will be most helpful to apply within
the participants’ own jurisdictions?
• What new skills have the participants developed as a result of this training?
• What skills or abilities have the participants improved or strengthened as a result of this
training?
• What pieces of equipment have the participants had an opportunity to use that are not
available in their home jurisdictions?
• In what ways can participants apply knowledge and skills gained during training to their
local jurisdictions?
Notes:
HOT.PM.09.0 A-3
End-of-Course Assessments
The end-of-course assessments provide information to the CDP to improve the quality of the
training. Please complete the forms and return to any of the course instructors.
Training Offered by the CDP

Further information concerning the available resident, nonresident, and indirect courses of the
CDP may be found at https://cdp.dhs.gov/.
Notes:
HOT.PM.09.0 A-4
Appendix A: Glossary and Acronym List Participant Manual
Glossary
Some of the terms listed may not be applied in this training course; however, they may be
relevant in preparing for or responding to a CBRNE incident. They are included in this glossary
as an informational resource.
Action Plan (See Incident Action Plan.)
Acute Radiation A person exposed to radiation will develop ARS only if the radiation
Syndrome (ARS) dose was high, penetrating (e.g., x-rays or gamma rays),
encompassed most or all of the body, and was received in a short
period of time. Clinical severity of the four subsyndromes of ARS
(hematopoietic, cutaneous, gastrointestinal, and neurovascular) will
vary with dose and host factors (e.g., young or old age,
immunosuppression, and medical co-morbidity-—especially
extensive trauma and burns). Also known as Radiation Sickness.
Adulticide The treatment for the eradication of adult mosquitoes using

chemicals, “adulticides” specific for mosquito control.
Advanced Life Support Definitive emergency medical care that includes defibrillation,
airway management, and the use of drugs and medications.
Agency A division of government with a specific function or a

nongovernmental organization (e.g., private contractor, business)
that offers a particular kind of assistance. In the Incident Command
System (ICS), agencies are defined as jurisdictional (i.e., having
statutory responsibility for incident mitigation) or assisting and/or
cooperating (i.e., providing resources and/or assistance). (See
Assisting Agency, Cooperating Agency, and Multiagency.)
Agency Administrator The official responsible for administering policy for an agency or
(or Executive) jurisdiction. An Agency Administrator/Executive (or other public
official with jurisdictional responsibility for the incident) usually
makes the decision to establish an Area Command.
Agency Dispatch The agency or jurisdictional facility from which resources are
allocated to incidents.
Agency Representative A person assigned by a primary, assisting, or cooperating Federal,

state, tribal, or local government agency, or nongovernmental or
private organization, that has been delegated authority to make
decisions affecting that agency's or organization's participation in
incident management activities following appropriate consultation
with the leadership of that agency.
HOT.PM.09.0 AP-A-1
Air Sampling The collection of samples of air to measure the radioactivity or to

detect the presence of radioactive material, particulate matter, or
chemical pollutants in the air.
Airborne Radioactivity A room or area in which radioactive materials exist in

Area concentrations in excess of Derived Air Concentrations (DAC)
specified in Appendix B of 10 Code of Federal Regulations (C.F.R.)
§ 835.2 to § 20.1001–20.2401, or to such a degree that an
individual present in the area without respiratory protective
equipment could exceed, during the hours an individual is present
in a week, an intake of 0.6% of the Annual Limit on Intake (ALI) or
12 DAC-hours.
Air Operations Branch The person who ensures the safe and efficient use of aviation
Director resources and oversees the management of the air support and air
tactical groups.
Allocated Resources Resources dispatched at the incident.
Altered Standard of A shift to providing care and allocating scarce equipment, supplies,
Care and personnel in a way that saves the largest number of lives in
contrast to the traditional focus on saving individuals.
Annual Limit on Intake The derived limit for the amount of radioactive material taken into
(ALI) the body of an adult worker by inhalation or ingestion in a year.
Antibody A large Y-shaped protein used by the immune system to identify

and neutralize foreign objects like bacteria and viruses. Each
antibody recognizes a specific antigen unique to its target. This is
because at the two tips of its “Y,” it has structures akin to locks.
Every lock only has one key, in this case, its own antigen. When
the key is inserted into the lock, the antibody activates, tagging or
neutralizing its target.
Antigen A substance that causes the production of antibodies in the body.
Antigenic Drift A minor change of an antigen on the surface of a pathogenic

micro-organism.
Antigenic Shift An abrupt, major change in the antigenicity of a virus believed to

result from a recombination of genes.
HOT.PM.09.0 AP-A-2
Area Command An organization established to oversee the management of

multiple incidents that are each being handled by a separate
Incident Command System (ICS) organization or to oversee the
management of a very large or evolving incident that has multiple
Incident Management Teams engaged. An Agency Administrator or
Executive or other public official with jurisdictional responsibility for
the incident usually makes the decision to establish an Area
Command. An Area Command is activated only if necessary,
depending on the complexity of the incident and incident
management span-of-control considerations.
Area of Refuge An area within the hot/warm zone boundaries where exposed or
contaminated personnel are protected from further contact and/or
exposure.
As Low As Reasonably Means making every reasonable effort to maintain exposures to

Achievable (ALARA) ionizing radiation as far below the dose limits as practical,
consistent with the purpose for which the licensed activity is
undertaken, taking into account the state of technology, the
economics of improvements in relation to state of technology, the
economics of improvements in relation to benefits to the public
health and safety, and other societal and socioeconomic
considerations, and in relation to utilization of nuclear energy and
licensed materials in the public interest.
Assigned Resources Resources checked in and assigned work tasks at an incident.
Assignments Tasks given to resources to perform within a given operational

period, based upon the tactical objectives in the Incident Action
Plan (IAP).
Assistant Title for subordinates of principal Command Staff positions. The

title indicates a level of technical capability, qualifications, and
responsibility subordinate to the primary positions. Assistants may
also be assigned to Unit Leaders.
Assisting Agency An agency or organization providing personnel, services, or other

resources to the agency with direct responsibility for incident
management.
Attack Rate A ratio applied to specific population as observed for a specific time
period, such as a pandemic. The ratio compares the total number
of sick individuals in a group to the total number of sick and well
persons in the group. Primary Attack Rate refers to individuals who
acquire disease from an exposure. Secondary Attack Rate, used to
measure exposure in subgroups (household, schools, etc.), refers
to individuals who acquire disease from an exposure to a primary
case.
HOT.PM.09.0 AP-A-3
Avian Influenza Respiratory illness that occurs amongst wild birds and poultry; it is
caused by Type A influenza virus. Occasionally, some strains of
this virus may infect humans.
Backflow The process of reversing the normal flow of water in a pipe through
siphon or pressure.
Base 1—The location at which primary logistics functions for an incident

are coordinated and administered. There is only one Base per
incident (Incident name or other designator will be added to the
term Base). The Incident Command Post (ICP) may be collocated
with the Base.
2—A liquid or solid with a pH higher than 7.
Basic Life Support A specific level of prehospital medical care provided by trained
(BLS) responders, including emergency medical technicians, in the
absence of advanced medical care, including emergency
cardiopulmonary resuscitation, control of bleeding, treatment of
shock, acidosis and poisoning stabilization of injuries and wounds,
and basic first aid.
Becquerel (Bq) A unit, in the International System of Units (SI), of measurement of

radioactivity equal to one disintegration per second.
Biohazard Any pathogenic vector, agent or disease with the capability to

transmit illness, disease to any other living organism.
Biohazard Bag A container for materials that have been exposed to blood or other
biological fluids and have the potential to be contaminated with
hepatitis, AIDS, or other viruses.
Biological 1—Of or relating to biology or to life and living processes.

2—Used in or produced by applied biology.
Biological Agent Living agents used to threaten human life (e.g., anthrax, smallpox,
or any infectious disease).
Biological Fluids Fluids that have human or animal origin, most commonly
encountered at crime scenes (e.g., blood, mucus, perspiration,
saliva, semen, vaginal fluid, and urine).
Biological Warfare Warfare involving the use of living organisms (as disease germs) or
their toxic products as weapons; also: warfare involving the use of
herbicides.
HOT.PM.09.0 AP-A-4
Biosecurity Embodies all the cumulative measures that can or should be taken
to keep disease (e.g., viruses, bacteria, fungi, protozoa, parasites)
from a farm and to prevent the transmission of disease by humans,
insects, rodents, and wild birds and/or animals within an infected
farm to neighboring farms.
Blepharospasm Spasm of the orbicular muscle of the eyelid.
Blister Agents Substances that cause blistering of the skin. Exposure is through
liquid or vapor contact with any exposed tissue (e.g., eyes, skin,
and lungs). Examples are mustard (H), distilled mustard (HD),
nitrogen mustard (HN), and lewisite (L); also known as vesicants.
Blood Agents Substances that injure a person by interfering with cellular

respiration (the exchange of oxygen and carbon dioxide between
blood and tissues). Examples are hydrogen cyanide (AC) and
cyanogen chloride (CK).
Bloodborne Pathogen Infectious, disease-causing micro-organisms that may be found or

transported in biological fluids.
Body Surface Area In physiology and medicine, the Body Surface Area is the
(BSA) measured or calculated surface of a human body.
Branch The organizational level having functional or geographic

responsibility for major parts of incident operations. The Branch
level is organizationally between Section and Division/Group in the
Operations Section, and between Section and Units in the Logistic
Section. Branches are identified by the use of Roman numerals or
by functional name (e.g., Medical and Security).
Cache A predetermined complement of tools, equipment, and/or supplies

stored in a designated location, available for incident use.
Camp A geographic site, within the general incident area, separate from
the incident Base, equipped and staffed to provide food, water, and
sleeping and sanitary facilities to incident personnel.
Capabilities and Needs Designed to provide operational capability information and guide
Assessment the identification of program needs. This assessment is to be
conducted for each identified jurisdiction.
HOT.PM.09.0 AP-A-5
Capability Credible information exists that a specific Potential Threat Element

(PTE) possesses the requisite training, skills, financial means, and
access to resources necessary to develop, produce, or acquire a
particular type of CBRNE in a quantity and/or potency sufficient to
produce mass casualties, combined with information substantiating
the PTE’s ability to safely store, test, and deliver the same. All
these factors must be met before a group or individual can be
justified as possessing the requisite capability necessary to
implement a CBRNE attack.
Case Fatality Rate The ratio or the number of deaths caused by a specified disease to
the number of diagnosed cases of that disease.
Case File The collection of documents comprising information concerning a

particular investigation. (This collection may be kept in case
jackets, file folders, ring binders, boxes, file drawers, file cabinets,
or rooms. Subfiles are often used within case files to segregate and
group interviews, media coverage, laboratory requests and reports,
evidence documentation, photographs, videotapes, audiotapes,
and other documents.)
Casualty Collection Serves as a location near the incident site that provides areas to
Point (CCP) triage, treat, and transport the injured in a Mass Casualty Incident
(MCI).
Causative Organism Organism resulting in a disease.
Chain of Command The orderly line of authority within the ranks of the incident
management organization.
Chain of Custody A process used to maintain and document the chronological history
of the evidence. Documents should include name or initials of the
individual collecting the evidence, each person or entity
subsequently having custody of it, dates the items were collected
or transferred, agency and case number, person’s or suspect’s
name, and a brief description of the item.
Check-In The process through which resources first report to an incident. All
responders, regardless of agency affiliation, must report in to
receive an assignment in accordance with the procedures
established by the Incident Commander (IC).
Chemical A substance obtained by a chemical process or used for producing

a chemical effect.
Chemical Agent A compound that may cause bodily harm if touched, ingested,
inhaled, or ignited. These compounds may be encountered at a
clandestine laboratory, or through a homemade bomb or tankard
leakage (e.g., ether, alcohol, nitroglycerin, ammonium sulfate, red
phosphorus, cleaning supplies, gasoline, or unlabeled chemicals).
HOT.PM.09.0 AP-A-6
Chemical The use of chemicals that react with specific types of evidence
Enhancement (e.g., blood, semen, lead, and fingerprints) in order to aid in the
detection and/or documentation of evidence that may be difficult to
see.
Chemical Warfare Tactical warfare using incendiary mixtures, smokes, or irritant,

burning, poisonous, or asphyxiating gases.
Chemical Weapon A weapon used in chemical warfare.
Chemoluminescence Emission of light as a result of a chemical reaction.
Chiefs The Incident Command System (ICS) title for individuals

responsible for command of functional sections: Operations,
Planning, Logistics, and Finance/Administration.
Chloropicrin (PS) A heavy, colorless, insoluble liquid compound that causes tears
and vomiting; used as a pesticide and as tear gas.
Claudication Limping or lameness in a body part characterized by localized

weakness, pain and tension.
Choking Agents Substances that cause physical injury to the lungs. Exposure is
through inhalation. Death results from lack of oxygen. An example
of a choking agent is phosgene (CG).
Cistern A receptacle for the collection, holding and storing of water.
Clean and The process of removing biological and/or chemical contaminants

Disinfecting/Sanitize from tools and/or equipment (e.g., using a mixture of 10:1
household water and bleach).
Clear Text The use of plain English in radio communications transmissions.

No 10-Codes or agency-specific codes are used when using Clear
Text.
Cohesion 1—The act or state of sticking together tightly; especially: unity.

2—Union between similar plant parts or organs.
3—Molecular attraction by which the particles of a body are united
throughout the mass.
Cold Zone Area where the command post and support functions that are
necessary to control the incident are located. Also referred to as
the clean zone, green zone, or support zone.
Coliform The colon-aerogenes group or the Escherichia coli species of

gram-negative enteric bacilli microorganisms, which comprises
most of the intestinal flora in humans and other animals. Presence
of coliforms is used as a standard indication of water pollution with
fecal matter.
HOT.PM.09.0 AP-A-7
Collect/Collection The process of detecting, documenting, or retaining physical

evidence.
Collection Sewer Any gravity flow pipelines, force mains, effluent supply lines, and
appliances appurtenant thereto, used for conducting wastes from
building drains to a treatment system or to a ground absorption
sewage treatment and disposal system.
Command Post (See Incident Command Post.)
Command Staff The staff who report directly to the Incident Commander, including
the Public Information Officer, Safety Officer, Liaison Officer, and
other positions as required. They may have an assistant or
assistants, as needed.
Committed Dose According to the Nuclear Regulatory Commission (NRC), the dose
Equivalent (CDE) to some specific organ or tissue that is received from an intake of
radioactive material by an individual during the 50-year period
following the intake.
Committed Effective The committed dose equivalent for a given organ multiplied by a
Dose Equivalent weighting factor.
(CEDE)
Common (Seasonal) Influenza that occurs commonly from year to year.

Flu
Common Name A common name is a name in general use within a community; it is

often contrasted with a scientific name. Each agent has a scientific
name based on its composition and formula.
Communications Unit An organizational unit in the Logistics Section responsible for

providing communication services at an incident. A
Communications Unit may also be a facility (e.g., a trailer or a
mobile van) used to provide the major part of an Incident
Communications Center.
Compacts Formal working agreements among agencies to obtain mutual aid.
Compensation The functional unit within the Finance/Administration Section

Unit/Claims Unit responsible for financial concerns resulting from property damage,
injuries, or fatalities at the incident.
Complex Two or more individual incidents located in the same general area,
which are assigned to a single Incident Commander (IC) or to
Unified Command (UC).
HOT.PM.09.0 AP-A-8
Comprehensive An integrated approach to the management of emergency

Emergency programs and activities for all four emergency phases (mitigation,
Management (CEM) preparedness, response and recovery) for all types of disasters
and for all levels of government and the private sector.
Consumable Medical Items used in the treatment of patients that must be replaced
Supplies because they are disposable and usually for one-time use;
examples of this are latex gloves, paper gowns, needles, syringes,
and tongue depressors.
Contagion An infectious disease that can be transmitted from person to

person.
Contamination The presence of an infectious agent on a body surface; also on or

in clothes, bedding, toys, surgical instruments, dressings, or other
inanimate articles or substances including water, milk, and food, or
that infectious agent itself.
Contamination Area Any area, accessible to individuals, where removable surface

contamination levels exceed or are likely to exceed the removable
surface contamination values specified in Appendix D of 10 Code
of Federal Regulations (C.F.R.) § 835, but do not exceed 100 times
those values.
Contamination This area separates the contaminated area from the clean area
Reduction Zone and acts as a buffer to reduce contamination of the clean area.
Also known as the warm zone.
Continuity of Designed to establish policy and guidance to ensure the mission

Operations (COOP) essential functions and to direct the relocation of personnel and
Plan resources to an alternate facility.
Control/Blank Sample Material of a known source that presumably was uncontaminated

during the commission of the crime.
The CANA uses an auto-injector to administer Diazepam. Use of

Convulsant Antidote for
Diazepam is for actively seizing patients; therefore, it is not
Nerve Agent (CANA)
intended for self-administration. Diazepam is used to control
muscle spasms and convulsions and to relieve feelings of anxiety
experienced during recovery from exposure.
Cooperating Agency An agency supplying assistance other than direct operational or

support functions or resources to the incident management effort.
HOT.PM.09.0 AP-A-9
Coordination The process of systematically analyzing a situation, developing

relevant information, and informing appropriate command authority
of viable alternatives for selection of the most effective combination
of available resources to meet specific objectives. The coordination
process (which can be either intra- or interagency) does not involve
dispatch actions. However, personnel responsible for coordination
may perform command or dispatch functions within the limits
established by specific agency delegations, procedures, legal
authority, etc.
Coordination Center Any facility that is used for the coordination, agency, or
jurisdictional resources in support of one or more incidents.
Cost Sharing Agreements between agencies or jurisdictions to share designated

Agreements costs related to incidents. Cost Sharing Agreements are normally
written, but may also be oral between authorized agency and
jurisdictional representatives at the incident.
Cost Unit The functional unit within the Finance/Administration Section

responsible for tracking costs, analyzing cost data, making cost
estimates, and recommending cost-saving measures.
Crew (See Single Resource.)
Cross Connect A physical connection that allows wastewater to mix with potable
water.
Cross-Contamination The unwanted transfer of material between two or more sources of

physical evidence.
Curie (Ci) A measure of how many radioactive atoms are disintegrating per
unit time. Equal to 37 billion disintegrations per second.
Critical Incidence The management of certain characteristic symptoms following a

Stress Management psychologically distressing event which is outside the range of
(CISM) normal experience.
Cytokine Dysregulation Cytokines are soluble hormone-like proteins used by cells of the
immune system to coordinate their actions. In dysregulation, the
interactions become reversed, or tangled. Cytokine dysregulation
may be involved in some virulent influenza infections.
Derived Air The product of the concentration of radioactive material in air and
Concentrations (DAC) - the time of exposure to that radionuclide, in hours.
Hour
Decontamination To rid of contamination (such as radioactive material).
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Decontamination An exit passageway at the edge of the hot zone into an area where
Corridor decontamination is performed. The exit passage at the end of the
decontamination corridor, or warm zone, passes into the cold zone.
Definitive (See Technical Decontamination.)

Decontamination
Deflagrate To burn or cause to burn with great heat and intense light.
Delegation of Authority A statement provided to the Incident Commander (IC) by the

Agency Executive delegating authority and assigning responsibility.
The Delegation of Authority can include objectives, priorities,
expectations, constraints, and other considerations or guidelines as
needed. Many agencies require a written Delegation of Authority to
be given to ICs prior to their assuming command or larger
incidents.
Demobilization Unit The functional unit within the Planning Section responsible for
assuring orderly, safe, and efficient demobilization of incident
resources.
Deputy (Chief) A fully qualified individual who, in the absence of a superior, could
be delegated the authority to manage a functional operation or
perform a specific task. In some cases, a Deputy could act as relief
for a supervisor and therefore must be fully qualified in the position.
Deputies can be assigned to the Incident Commander (IC),
General Staff, and Branch Directors.
Derived Air The concentration of a given radionuclide in air, which, if breathed

Concentrations (DAC) by the reference man for a working year of 2,000 hours under
conditions of light work (inhalation rate 1.2 m3 of air per hour),
results in an intake of one Annual Limited on Intake (ALI).
Derived Intervention The concentration derived from the intervention level of dose at
Level (DIL) which introduction of protective measures should be considered.
Derived Response The DRL is the calculated exposure rate that will produce a dose
Levels (DRL) equal to the applicable Relocation’s Protective Action Guide.
Detonate To explode violently.
Device A contrivance or an invention serving a particular purpose,

especially a machine used to perform one or more relatively simple
tasks. Also a technique or means, a plan, or scheme, especially a
malign one.
Disaster A natural, unintentional incident that significantly disrupts the

Environment of Care (EC).
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Diphosgene (DP) Diphosgene (Trichloromethyl chloroformate, ClCO2CCl3) is a

chemical originally developed for chemical warfare, a few months
after the first use of phosgene. At room temperature it is a stable,
colorless liquid with a vapor pressure of 10 mmHg at 20° C. It
decomposes to phosgene around 300° C.
Director The Incident Command System (ICS) title for individuals

responsible for supervision of a Branch.
Disaster Medical A team that assist in providing care for ill or injured individuals at
Assistance Team the location of a disaster or emergency. Functions as part of the
(DMAT) National Disaster Medical System (NDMS).
Disaster Mortuary A DMORT is a volunteer group of medical and forensic personnel,

Operational Response usually from the same geographic region, that has formed a
Team (DMORT), response team under the guidance of the National Disaster
National Disaster Medical System (NDMS; or state or local auspices), and whose
Medical System personnel have specific training/skills in victim identification,
(NDMS) mortuary services, and forensic pathology and anthropology
methods. Usually includes a mix of medical examiners, coroners,
pathologists, forensic anthropologists, medical records technicians,
fingerprint technicians, forensic odentologists, dental assistants,
radiologists, funeral directors, mental health professionals, and
support personnel. DMORTs are mission tailored on an ad-hoc
basis, and usually deploy only with personnel and equipment
specifically required for current mission.
Disinfection A process that eliminates many or all pathogenic microorganisms,

except bacterial spores, on inanimate objects. Disinfectants are the
agents used to accomplish this process.
Dispatch The implementation of a command decision to move a resource or

resources from one place to another.
Dispatch Center A facility from which resources are assigned to an incident.
Dispensing/Vaccination The principal operational unit of the dispensing functions of a

Center (DVC) community-wide disease outbreak response. A DVC is a single
dispensing site that can be free standing or located in a pre-
existing building. A DVC may also be called a Point of Dispensing
(POD).
Division The organizational level having responsibility for operations within

a defined geographic area. Divisions are established when the
number of resources exceeds the manageable span of control of
the Section Chief. (See Group.)
Division Boundaries Division boundaries are used to divide an incident into geographic
areas of operation.
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Documentation Written notes, audio/videotapes, printed forms, sketches and/or

photographs that form a detailed record of the scene, evidence
recovered, and actions taken during the search of the crime scene.
Documentation Unit The functional unit within the Planning Section responsible for
collecting, recording, and safeguarding all documents relevant to
the incident.
Domestic The state of being prepared, especially military readiness for

Preparedness combat.
Domestic Terrorism The unlawful or threatened use of force or violence by a group or

individual based and operating entirely within the United States
and/or Puerto Rico, without foreign direction, and whose acts are
directed at elements of the U.S. government and/or its population,
in the furtherance of political or social goals.
Domestic Use Any item, including food or drink, intended

for the sole purpose of human use or
consumption.
DuoDote™ The DuoDote Auto-Injector is a single, prefilled, dual-chambered

auto-injector that is filled with two separate chemical nerve agent
antidotes; the outer cylinder with 2.1 mg of atropine and the inner
with 600 mg of pralidoxime chloride (2-PAM chloride). The
DuoDote treats symptoms of chemical nerve agent poisonings and
toxic levels of common organophosphate insecticides. It is a
replacement for the Mark 1™/Nerve Agent Antidote Kit (NAAK). The
DuoDote will phase out the Mark 1, which was in production until
the end of August 2007 and has a shelf life of approximately 5
years.
Durable Medical Items used in the treatment of patients that can be used many
Supplies times; examples include stethoscopes, x-ray machines, blood
pressure cuffs, and ventilators.
Effluent The liquid discharge of a septic tank or other sewage treatment

device.
Elimination Sample A sample of a known source taken from a person who had lawful
access to the scene to be used for comparison with evidence of the
same type.
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Emergency The physical process of immediately reducing contamination of

Decontamination individuals in potentially life-threatening situations with or without
the formal establishment of a decontamination corridor. Procedures
taken for the rapid reduction of agent from the individual. This can
occur at any time during the incident, or when an emergency arises
from the response process (e.g., responder runs out of supplied air
during the decontamination process).
Emergency The individual within each political subdivision that has the
Management coordination responsibility for jurisdictional emergency
Coordinator/Director management.
Emergency Medical A specially trained medical technician certified to provide basic

Technician (EMT) emergency services (e.g., cardiopulmonary resuscitation [CPR])
before and during transportation to a hospital.
To facilitate a preplanned strategy for protective actions during an

Emergency Planning
emergency, there are two EPZs around each nuclear power plant.
Zones (EPZ)
The exact size and shape of each EPZ is a result of detailed
planning which includes consideration of the specific conditions at
each site, unique geographical features of the area, and
demographic information. This preplanned strategy for an EPZ
provides a substantial basis to support activity beyond the planning
zone in the extremely unlikely event it would be needed. The two
EPZs are described as follows:
• Plume Exposure Pathway—The plume exposure pathway EPZ
has a radius of about 10 miles from the reactor site.
Predetermined protective action plans are in place for this EPZ
and are designed to avoid or reduce dose from potential
exposure of radioactive materials. These actions include
sheltering, evacuation, and the use of potassium iodide where
appropriate.
• Ingestion Exposure Pathway—The ingestion exposure
pathway EPZ has a radius of about 50 miles from the reactor
site. Predetermined protective action plans are in place for this
EPZ and are designed to avoid or reduce dose from potential
ingestion of radioactive materials. These actions include a ban
of contaminated food and water.
Emergency Support A plan to provide a coordination mechanism to assess the

Function (ESF) consequences of a disaster and to coordinate the long-term
recovery.
Enabling Learning Measures an element of the Terminal Learning Objective (TLO).

Objective (ELO)
Endemic Common diseases that occur at a constant but relatively high rate
in the population.
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Environmental Health The protection of individuals against environmental factors that

may adversely impact human health or the ecological balances
essential to long-term human health and environmental quality,
whether in the natural or man-made environment. It is also a
profession within the public health field.
Environmental Health An individual with special training/education in environmental

Professional health enabling them to perform regulatory roles related to
environmental health protection. These individuals are commonly
referred to as Environmental Health Specialists (EHS) or
Sanitarians.
Epidemic A disease that appears as new cases in a given human population,

during a given period, at a rate that substantially exceeds what is
“expected,” based on recent experience (the number of new cases
in the population during a specified period of time is called the
“incidence rate”).
Eschar A slough of tissue produced by a thermal burn, corrosive, or

gangrene.
Euthanasia The practice of ending the life of an individual or an animal who is

suffering from a terminal disease or a chronically painful condition
in a painless or minimally painful way either by lethal injection, drug
overdose, or by the withdrawal of medical support.
Event A planned, nonemergency activity. Incident Command System

(ICS) can be used as the management system for a wide range of
events (e.g., parades, concerns, or sporting events).
Exclusion Zone The area where the actual incident occurred and contamination
exists. All individuals entering the Exclusion Zone must wear the
prescribed levels of Personal Protective Equipment (PPE) and be
decontaminated before leaving. Also known as the hot zone.
Extrication To free or remove from an entanglement or difficulty. Rescue from

the hot zone.
Facilities Unit Functional unit within the Support Branch of the Logistics Section
that provides fixed facilities for the incident. These facilities may
include the Incident Base, feeding areas, sleeping areas, sanitary
facilities, etc.
Fatality Surge Peaks in the number of dead caused by the dramatic increases of
mortality during an outbreak, or “wave,” is often referred to as
fatality surge; typically, during influenza pandemics the most
serious surge in fatalities and illness occurred in the second wave.
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Field Operations Guide Durable pocket or desk guides that contain essential information
(FOG) required to perform specific assignments or functions.
Finance/ Administration The Section responsible for all incident costs and financial
Section considerations. Includes the Time Unit, Procurement Unit,
Compensation/Claims Unit, and Cost Unit.
First Responder Those individuals who in the early stages of an incident are
responsible for the protection and preservation of life, property,
evidence, and the environment, including emergency response
providers as defined in Section 2 of the Homeland Security Act of
2002 (6 United States Code [U.S.C.] § 101), as well as emergency
management, public health, clinical care, public works, and other
skilled support personnel (such as equipment operators) that
provide immediate support services during prevention, response,
and recovery operations.
Flood Plain Areas subject to frequent flooding means those areas inundated at
designated frequencies including alluvial soils and areas subject to
tidal or storm overwash.
Fluorescence Light emitted by sources other than a hot, incandescent body, in

which light of a visible color is emitted from a substance under
stimulation or excitation by light or other forms of electromagnetic
radiation or by certain other means. The light is given off only while
the stimulation continues.
Food Unit Functional unit within the Service Branch of the Logistics Section
responsible for providing meals for incident personnel.
Fomites Inanimate objects or substances capable of transmitting infectious

organisms from one individual to another.
Frisk Process of monitoring personnel for contamination. Frisking can be

performed with hand-held survey instruments or automated
monitoring devices.
Function The five major activities in the Incident Command System (ICS):
Command, Operations, Planning, Logistics, and
Finance/Administration. A sixth function, Intelligence/Investigations,
may be established, if required, to meet incident management
needs. The term function is also used when describing the activity
involved (e.g., the planning function).
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Events that involve actual or imminent substantial core damage or

General Emergency
melting of reactor fuel with the potential for loss of containment
(GE)
integrity are in progress or have occurred. Radioactive releases
can be expected to exceed the limits set forth by the U.S.
Environmental Protection Agency (EPA) for more than the
immediate site area.
General Staff A group of incident management personnel organized according to

function and reporting to the Incident Commander (IC). The
General Staff normally consists of the Operations Section Chief,
Planning Section Chief, Logistics Section Chief, and
Finance/Administration Section Chief. An Intelligence/Investigations
Chief may be established, if required, to meet incident management
needs.
Genetic Drift The ability of a virus to mutate naturally; the term is used in
population genetics to refer to the statistical drift over time of allele
frequencies in a finite population due to random sampling effects in
the formation of successive generations.
Genetic Shift Occurs when the genetic material of a virus is fragmented and a
cell is infected by two different but related viruses. The virus
progeny can inherit fragments coming from both parent viruses
(genetic reassortment). Influenza virus genome consists of eight
RNA molecules. If a cell is simultaneously infected by a human and
an avian virus, a combination of their RNA molecules in a progeny
virus may result in a progeny virus with novel properties. This is
also referred to as an antigenic shift, which may lead to a
pandemic.
Gray The SI unit "Gray" has replaced the older "rad" designation. (1 Gy =
1 joule/kilogram = 100 rad). Gray can be used for any type of
radiation (e.g., alpha, beta, neutron, gamma), but it does not
describe the biological effects of different radiations. Biological
effects of radiation are measured in units of "Sievert" (or the older
designation "rem"). Sievert is calculated as follows: Gray multiplied
by the "radiation weighting factor" (also known as the "quality
factor") associated with a specific type of radiation.
Gross Decontamination The initial phase of the decontamination process during which the
amount of surface contaminant is significantly reduced.
Ground Support Unit Functional unit within the Support Branch of the Logistics Section
responsible for the fueling, maintaining, and repairing of vehicles,
and the transportation of personnel and supplies.
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Group An organizational subdivision established to divide the incident

management structure into functional areas of operation. Groups
are composed of resources assembled to perform a special
function not necessarily within a single geographic division. (See
Division.)
Harborage The general term to designate shelter or refuge for animal species
other than human.
Hazardous Waste A waste that poses substantial or potential threats to public health
or the environment and generally exhibits one or more of these
characteristics: carcinogenic, ignitable, oxidant, corrosive, toxic,
radioactive, explosive. It has the potential to: cause, or significantly
contribute to an increase in mortality (death) or an increase in
serious irreversible, or incapacitating reversible illness; or pose a
substantial, present or potential, hazard to human health or the
environment when improperly treated, stored, transported, or
disposed of, or otherwise managed.
Health Department Any county, district, or other health department authorized to be

organized under laws or statutes within a given state or territory.
Helibase The main location for parking, fueling, maintenance, and loading of
helicopters operating in support of an incident. It is usually located
at or near the Incident Base.
Helipad Any designated location where a helicopter can safely take off and
load. Some helipads may be used for loading of supplies,
equipment, or personnel.
Hemagglutinin An antigenic glycoprotein found on the surface of the influenza

viruses (as well as many bacteria and other viruses). It is
responsible for binding the virus to the cell that is being infected.
High Contamination Any area, accessible to individuals, where removable

Area contamination levels exceed or are likely to exceed 100 times the
removable contamination values specified in Appendix D of 10
Code of Federal Regulations (C.F.R.) § 835.
High Radiation Area An area, accessible to individuals, in which radiation levels from
radiation sources external to the body could result in an individual
receiving a dose equivalent in excess of 100 mrem in 1 hour, 30 cm
(1 foot), but less than 500 rad in 1 hour 1 meter (3 feet 3 inches)
from the source or from any surface that the radiation penetrates.
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Hospice Care Treats the terminally ill person rather than the disease. Emphasizes
quality rather than length of life. Provides family-centered care 24
hours a day and 7 days a week involving the patient and family in
making decisions. Care can be given in the patient’s home, a
hospital, nursing home, or at a private hospice facility. Most hospice
care given in the home has a family member serving as the main
caregiver.
Hospital Incident A National Incident Management System (NIMS)-compliant system

Command System for hospitals to use during any type and level of incident. Based on
(HICS) NIMS Incident Command System (ICS), response is led by an
Incident Commander (IC) and the Command Staff. HICS provides
for Operations, Logistics, Finance/Administrative, and Planning
Sections.
Hostile Action-Based An act toward a Nuclear Power Plant or its personnel that includes
Action (HAB) the use of violent force to destroy equipment, take hostages, and/or
intimidate the licensee to achieve an end.100
Hot Zone The area immediately surrounding a CBRNE/all-hazards incident

which extends far enough to prevent adverse effects from released
CBRNE to personnel outside the zone. Also referred to as the
exclusion zone, red zone, or restricted zone.
Hypovolemia Abnormally decreased volume of circulating fluid or plasma in the

body.
Improvised Explosive A device placed or fabricated in an improvised manner

Device (IED) incorporating destructive, lethal, noxious, pyrotechnic, or incendiary
chemicals and designed to destroy, incapacitate, harass, or
distract. It may incorporate military stores, but it is normally devised
from nonmilitary components.
Improvised Nuclear Illicit nuclear weapons bought, stolen, or otherwise originating from a
Device (IND) nuclear state, or a weapon fabricated by a terrorist group from illegally
obtained fissile nuclear weapons material that produces a nuclear
explosion. It produces same physical and medical effects as a nuclear
weapon explosion.73
Incident Action Plan An oral or written plan containing general objectives reflecting the
(IAP) overall strategy for managing an incident. It may include the
identification of operational resources and assignments. It may also
include attachments that provide direction and important
information for management of the incident during one or more
operational periods.
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Incident Base (See Base.)
Incident Command The location at which the primary command functions are executed.
Post (ICP) The ICP may be collocated with the Incident Base or other incident
facilities.
Incident Command A standardized onscene emergency management concept

System (ICS) specifically designed to allow its user(s) to adopt an integrated
organizational structure equal to the complexity and demands of
single or multiple incidents, without being hindered by jurisdictional
boundaries.
Incident Commander The individual responsible for all incident activities, including the
(IC) development of strategies and tactics and the ordering and release
of resources. The IC has overall authority and responsibility for
conducting incident operations and is responsible for the
management of all incident operations at the incident site.
Incident The location of the Communications Unit and the Message Center.
Communication Center
Incident Management An Incident Commander (IC) and the appropriate Command and
Team (IMT) General Staff personnel assigned to an incident. The level of
training and experience of the IMT members, coupled with the
identified formal response requirements and responsibilities of the
IMT, are factors in determining “type” or level, of IMT.
Incident Objectives Statements of guidance and direction needed to select appropriate

strategies and the tactical direction of resources. Incident
Objectives are based on realistic expectations of what can be
accomplished when all allocated resources have been effectively
deployed. Incident Objectives must be achievable and measurable,
yet flexible enough to allow strategic and tactical alternatives.
Incident Support Includes any off-incident support provided to an incident. Examples

Organization would be agency dispatch centers, airports, or mobilization centers.
Incubation Period The length of time from exposure to a pathogen to development of

signs of disease.
Infectious Disease A disease caused by a living organism or other pathogen, including

a fungus, bacteria, parasite, protozoan, virus, or prion. An infectious
disease may, or may not, be transmissible from person to person,
animal to person, or insect to person.
Influenza Illness caused by the influenza virus.
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Information Collection The capture of information based on a reasonable suspicion of

criminal involvement for use in developing criminal cases,
identifying crime trends and protecting the community by means of
intervention, apprehension, and/or target hardening.
Ingestion Exposure The principal exposure from this pathway would be from ingestion of
Pathway contaminated water or foods such as milk or fresh vegetables. The time of
potential exposure could range in length from hours to months.
Intelligence The pursuit of information based on leads and evidence associated

with a particularly defined criminal act to identify and apprehend
criminal offenders for prosecution in a criminal trial.
Intelligence Cycle The ongoing process that seeks continuous input so that every new
piece of information which meets the standards of rigor can be
added to the evidentiary picture.
Initial Action The actions taken by resources that are the first to arrive at an
incident.
Initial Response Resources initially committed to an incident.
Integrated Emergency A system developed in the early 1980s that is an all-hazards

Management System approach that includes direction, control, and coordination for
(IEMS) disasters regardless of their location, size and complexity.
International Terrorism Violent acts or acts dangerous to human life that are a violation of
the criminal laws of the the United States or any state, or that would
be a criminal violation if committed within the jurisdiction of the
United States or any state. These acts appear to be intended to
intimidate or coerce a civilian population, influence the policy of a
government by intimidation or coercion, or affect the conduct of a
government by assassination or kidnapping. International terrorist
acts occur outside the United States or transcend national
boundaries in terms of the means by which they are accomplished,
the persons they appear intended to coerce or intimidate, or the
locale in which they are accomplished.
Iodophor Preparation of iodine in a solution containing a surfactant to allow

suspension of free iodine for use as a sanitizer or disinfectant.
Isodose-rate Line A line on a map, diagram, or overlay joining all points at which the
radiation dose rate at a given time is the same.
Isolation The physical separation and confinement of an individual or groups

of individuals who are infected or reasonably believed to be
infected, on the basis of signs, symptoms, or laboratory analysis,
with a contagious or possibly contagious disease from nonisolated
individuals, to prevent or limit the transmission of the disease.
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Isotope Any of two or more species of atoms of a chemical element with the
same atomic number and nearly identical chemical behavior, but
with differing atomic mass or mass number and different physical
properties.
Joint Information A facility established to coordinate all incident-related public

Center (JIC) information activities. It is the central point of contact for all news
media. Public information officials from all participating agencies
should collocate at the JIC.
JumpSTART Pediatric A rapid triage system with protocols for children 12 months to 8
MCI Triage© years old.
Jurisdiction 1—A range or sphere of authority. Public agencies have jurisdiction

at an incident related to their legal responsibilities and authority.
Jurisdictional authority at an incident can be political or
geographical (e.g., Federal, state, tribal, local boundary lines) or
functional (e.g., law enforcement, public health).
2—The power, right, or authority to interpret and apply the law.
3—a: The authority of a sovereign power to govern or legislate.
b: The power or right to exercise authority: control.
4—The limits or territory within which authority may be exercised.
Jurisdiction Threat An assessment or evaluation of the threat level of each Potential

Assessment Threat Element (PTE) identified in one’s jurisdiction. The threat
level of an existing PTE is determined on the basis of its past
violent history, intentions to commit an act of terrorism, the
capability to carry out an act of terrorism, and any targeting efforts
aimed at achieving the specific terrorist act.
Jurisdictional Agency The agency having jurisdiction and responsibility for a specific
geographical area, or a mandated function.
Key Resources Any publicly or privately controlled resource essential to the

minimal operations of the economy and government.
Landing Zone (See Helipad.)
Liaison Officer A member of the Command Staff responsible for coordinating with
representatives from cooperating and assisting agencies.
Life Safety The joint consideration of both the life and physical well-being of
individuals.
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Lift Station A pump location whose purpose is to move liquids from a given
elevation to a higher elevation.
Logistics Section The section responsible for providing facilities, services, and
materials for the incident.
Lower Explosive Limits The limits beyond which, the vapor and air mixture cannot be
(LEL) ignited.
Lymphadenopathy Disease of the lymph nodes characterized by localized pain,

swelling, and tenderness.
Management By A management approach that involves a five-step process for

Objectives (MBO) achieving the incident goal. The MBO approach includes the
following: establishing overarching incident objectives; developing
strategies based on overarching incident objectives; developing
and issuing assignments, plans, procedures, and protocols;
establishing specific, measurable tactics or tasks for various
incident-management functional activities and directing efforts to
attain them in support of defined strategies; and documenting
results to measure performance and facilitate corrective action.
Managers Individuals within Incident Command System (ICS) organizational

units who are assigned specific managerial responsibilities (e.g.,
Staging Area Manager or Camp Manager).
Mass Casualty Incident An incident in which the number of people overwhelms the
(MCI) available resources. Varies from jurisdiction to jurisdiction.
Mass Decontamination The physical process of reducing or removing surface contaminants

from large numbers of people in potentially life-threatening
situations in the fastest time possible.
Mass Prophylaxis Medical care or measures provided to most or all individuals in an

at-risk population to prevent or protect them from disease.
Medical Hazard Associated with the handling of rough or sharp objects which could
abrade, cut or pierce the skin.
Medical Unit Functional unit within the Service Branch of the Logistics Section
responsible for the development of the Medical Emergency Plan
and for providing emergency medical treatment of incident
personnel.
Memorandum of A formal document that delineates roles and responsibilities in

Agreement (MOA) collaborative partnerships.
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Memorandum of A legal document describing an agreement between parties. It is a

Understanding (MOU) more formal alternative to a gentlemen’s agreement, but less formal
than a contract.
Message Center The Message Center is part of the Incident Communications Center
and is located with or placed adjacent to it. It receives, records, and
routes information about resources reporting to the incident,
resource status, and administrative and tactical traffic.
Metropolitan Medical A system that assists highly populated jurisdictions to develop

Response System plans, conduct training and exercises and acquire pharmaceuticals
(MMRS) and personal protective equipment to achieve the enhanced
capability necessary to respond to a mass casualty event caused
by a terrorist act.
Military Each agent has a symbol; it is not a chemical symbol or formula,

Designation/Symbol but rather a shorthand way of designating the agent.
Mobilization The process and procedures used by all organizations—federal,

state, and local—for activating, assembling, and transporting all
resources that have been requested to respond to or support an
incident.
Mobilization Center An off-incident location at which emergency service personnel and

equipment are temporarily located pending assignment, release, or
reassignment.
Monitoring Well Any well constructed for the primary purpose of obtaining samples
of groundwater or other liquids for examination or testing, or for the
observation or measurement of groundwater levels.
Mortality Rate The number of deaths per unit or group in a given place and time.
Move, Assess, Sort, Sorts individuals into categories quickly to make those in most need
Send (MASS) Triage of treatment the greatest priority. Occurs primarily in the hot zone of
a CBRNE incident.
Mucopurulent An exudate (any fluid or semisolid that has exuded out of a tissue
or its capillaries due to injury or inflammation) containing both
mucus and pus.
Multiagency A center that offers the ability for state, federal and local agencies
Coordination Center to come together in a central location to coordinate the response to
(MACC) emergencies and disasters throughout the state.
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Multiagency A group of administrators or executives, or their appointed

Coordination (MAC) representatives, who are typically authorized to commit agency
Group resources and funds. A MAC Group can provide coordinated
decision making and resource allocation among cooperating
agencies, and may establish the priorities among incidents,
harmonize agency policies, and provide strategic guidance and
direction to support incident management activities. MAC Groups
may also be known as multiagency committees, emergency
management committees, or as otherwise defined by the
Multiagency Coordination System (MACS).
Multiagency A system that provides the architecture to support coordination for

Coordination System incident prioritization, critical resource allocation, communications
(MACS) systems integration, and information coordination. A MACS assists
agencies and organizations responding to an incident. The
elements of a MAC include facilities, equipment, personnel,
procedures, and communications. It is also known as a multiagency
system or multiagency committee. Two of the most commonly used
elements are Emergency Operations Centers and MAC Groups.
Multiagency Incident An incident where one or more agencies assists a jurisdictional

agency or agencies. May be a single or unified command.
Multijurisdiction An incident requiring action from multiple agencies that have a

Incident statutory responsibility for incident mitigation. In Incident Command
System (ICS) these incidents will be managed under Unified
Command (UC).
Multiple Causation of Epidemiological concept specifying that there are combinations of

Disease factors categorized as agent, host, and environmental factors that
collectively determine whether health or disease will prevail within a
population of individuals.
Multiple Scenes Two or more physical locations of evidence associated with a crime
(e.g., in a crime of personal violence, evidence may be found at the
location of the assault and also on the person and clothing of the
individual/assailant, the individual’s/assailant’s vehicle, and
locations the individual/assailant frequents and resides).
Muscarinic Effect Effects imposed on Muscarinic receptors (cholinergic receptors) on

autonomic effector cells, some autonomic ganglion cells and some
central neurons as stimulated by muscarine or
parasympathomimetic drugs and blocked by atropine.
Symptomology typically demonstrated includes excessive
production and excretion of bodily fluids, gastrointestinal distress,
blurred vision, and labored breathing.
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Mutual Aid Agreements Written or oral agreement between and among

and/or Assistance agencies/organizations and/or jurisdictions that provides a
Agreements mechanism to quickly obtain emergency assistance in the form of
personnel, equipment, materials, and other associated services.
The primary objective is to facilitate rapid, short-term deployment of
emergency support prior to, during, and/or after an incident.
Myocarditis Inflammation of the myocardium, or heart muscle.
Myositis Inflammation of the muscle tissue.
Mycotoxins Toxic compounds produced by certain fungi, some of which are

used for medicinal purposes (e.g., muscarine and psilocybin).
National Disaster A federally coordinated system that augments the nation’s medical
Medical System response capability. The overall purpose of the NDMS is to
(NDMS) supplement an integrated national medical response capability for
assisting state and local authorities in dealing with the medical
impacts of major peacetime disasters and to provide support for the
care of casualties evacuated back to the United States from
overseas armed conventional conflicts. The Disaster Medical
Assistance Team (DMAT) is a response team within the NDMS.
National Incident A set of principles that provides a systematic, proactive approach

Management System guiding government agencies at all levels, nongovernmental
(NIMS) organizations, and the private sector to work seamlessly to prevent,
protect against, respond to, recover from, and mitigate the effects
of incidents, regardless of cause, size, location, or complexity, in
order to reduce the loss of life or property and harm to the
environment.
National Infrastructure The NIPP provides the unifying structure for the integration of a
Protection Plan (NIPP) wide range of efforts for the enhanced protection and resiliency of
the nation’s critical infrastructure and key resources (CIKR) into a
single national program.
The National This Division is responsible for Administration and Compliance (i.e.,
Integration Center developing and maintaining a national program for National Incident
(NIC) Incident Management System [NIMS] education and awareness); Standards
Management Systems and Credentialing (i.e., ensuring the adoption of common
Integration (IMSI) standards); Training and Exercise Support (i.e., development of
Division training and exercises); and Publication Management (i.e., naming
and development of publications, review and certification of
publications).
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National Response A comprehensive all-hazards approach to enhance the ability of the

Framework (NRF) United States to manage domestic incidents. The framework
incorporates best practices and procedures from incident
management disciplines and integrates them into a unified
structure. NRF forms the basis of how the federal government
coordinates with state, local, and tribal governments and the private
sector during incidents. The NRF superseded the National
Response Plan (NRP).
Necrotic Dead cellular tissue.
Nerve Agents Substances that interfere with the central nervous system.
Exposure occurs primarily through contact with the fluid (via skin
and eyes) and secondarily through inhalation of the vapor.
Examples are tabun (GA), soman (GD), and VX.
Neuraminidase An antigenic glycoprotein enzyme found on the surface of the

influenza virus.
Nicotinic effect Effects imposed on nicotinic receptors (cholinergic receptors) on

autonomic ganglion cells and motor end-plates of skeletal muscle
as stimulated by nicotine and blocked by high doses of
tubocurarine. Symptomology often includes nausea, vomiting,
diarrhea, stomach pain, sweating, headache, dizziness, difficulty
seeing/hearing, confusion, chest pain, rapid heartbeat, and seizure
activity.
Nitrification Field Also known as the septic drain field, it is the land area in which
nitrification lines are located under the ground surface, usually
designed as beds or trenches.
Nitrification Lines Approved pipe or other approved materials which receive partially
treated sewage effluent for distribution and absorption into the soil
beneath the ground surface.
Nonambulatory Person Person who is unconscious or unable to walk.
Nonporous Container Packaging through which liquids or vapors cannot pass (e.g., glass
jars or metal cans).
Events that indicate potential degradation in the level of safety of the plant are in
Notification of Unusual
progress or have occurred. No release of radioactive material requiring offsite
Event (NOUE)
response or monitoring is expected unless further degradation occurs.
Nuclear 1—Being a weapon whose destructive power derives from an

uncontrolled nuclear reaction;
2—Of, produced by, or involving nuclear weapons;
3—Armed with nuclear weapons;
4—Having or using nuclear energy (e.g., nuclear reactor, nuclear
medicine).
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Occupational Dose According the Nuclear Regulatory Commission (NRC), the dose
received by an individual in the course of employment in which the
individual’s assigned duties involve exposure to radiation or to
radioactive material from licensed and unlicensed sources of
radiation.
Officer The Incident Command System (ICS) title for the personal
responsible for the Command Staff positions of Safety, Liaison, and
Information.
Operational Period The period scheduled for execution of a given set of operation
actions as specified in the Incident Action Plan (IAP). Operational
Periods can be of various lengths, although usually not over 24
hours.
Operations Section The Section responsible for all tactical operations at the incident.
Includes Branches, Divisions and/or Groups, Task Forces, Strike
Teams, Single Resources, and Staging Areas.
Otalgia Pain in the ear.
Otorrhea Discharge from the ear.
Out-of-Service Resources assigned to an incident but unable to respond for

Resources mechanical rest or personnel reasons.
Overhead Personnel Personnel who are assigned to supervisory positions which include
Incident Commander (IC), Command Staff, General Staff,
Directors, Supervisors, and Unit Leaders.
Overpack 1—A package used to contain one or more packages to facilitate

handling and protection of the inner packages.
2—A term used to describe the placement of damaged or leaking
packages in a recovery drum or an overpack.
3—The outer packaging for radioactive materials.
Palliative Care Branch of medicine that manages the holistic needs of dying
patients.
Pancytopenia Abnormal depression in quantity of all cellular blood components.
Pandemic Influenza A widespread epidemic of influenza caused by a highly virulent

strain of the influenza virus.
Pathogenic Any organism capable of causing illness, disease or death in

humans.
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Pathogenicity The ability of a parasite to inflict damage on a host.
Pericarditis Inflammation of the lining around the heart causing chest pain and
accumulation around the heart.
Personal Protective Articles such as disposable gloves, masks, and eye protection that
Equipment (PPE) are utilized to provide a barrier to keep biological or chemical
hazards from contacting the skin, eyes, and mucous membranes
and to avoid contamination of the crime scene; refer to 29 Code of
Federal Regulations (C.F.R.) § 1910 Subpart I.
Planning Meeting A meeting held as needed throughout the duration of an incident to

select specific strategies and tactics for incident control operations
and for service and support planning. In larger incidents, the
planning meeting is a major element in the development of the
Incident Action Plan (IAP).
Planning Section The Incident Command System (ICS) Section responsible for the
collection, evaluation, and dissemination of operational information
related to the incident, and for the preparation and documentation
of the Incident Action Plan (IAP). This Section also maintains
information on the current and forecasted situation and on the
status of resources assigned to the incident.
Point of Dispensing (See Dispensing/Vaccination Center [DVC].)

(POD)
Potable A term usually associated with water, meaning fit for human
consumption.
Potentially Hazardous Foods that require time-temperature control to keep them safe for
Food human consumption and that: contains moisture, water activity,
greater than 0.85; contains protein and/or have are a pH between
4.6 and 7.5. These foods spoil easily and harbor or permit growth
pathogenic microorganisms and/or the production of toxins that can
cause foodborne illness in humans.
Presumptive Test A nonconfirmatory test used to screen for the presence of a

substance.
Prion A disease-causing agent that is not bacterial, fungal, or viral and

contains no genetic material.
Procedure 1—a: A particular way of accomplishing something or of acting;

b: A step in a procedure;
2—a: A series of steps followed in a regular definite order;
b: A series of instructions for a computer that has a name by which
it can be called into action;
3—A traditional or established way of doing things.
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Procurement Unit Functional unit within the Finance/Administration Section

responsible for financial matters involving vendor contract.
Prophylaxis Medical care or measures provided to individuals to prevent or

protect them from disease.
Protective Action Projected dose to an individual in the general population that

Guide (PAG) warrants the implementation of protective action. The U.S. Food
and Drug Administration (FDA) and U.S. Environmental Protection
Agency (EPA) have recommended specific protective action guides
in terms of the level of projected dose that warrants the
implementation of evacuation and sheltering, relocation, and
limiting the use of contaminated food, water, or animal feed.
Protective Action For the ingestion exposure pathway, PAD are actions taken to limit
Decisions (PAD) the radiation dose from ingestion by avoiding or reducing the
contamination that could occur on the surface of, or be incorporated
into, human food and animal feeds.
Public Health The approach to medicine that is concerned with the health of the
community as a whole to fulfill society's interest in assuring
conditions in which people can be healthy.
Public Information A member of the Command Staff responsible for interfacing with
Officer (PIO) the public and media or with other agencies requiring information
directly from the incident. There is only one PIO per incident. The
PIO may have assistants.
Quarantine The physical separation and confinement of an individual or groups

of individuals, who are or may have been exposed to a contagious
or possibly contagious disease, and who do not show signs or
symptoms of a contagious disease, from nonquarantined
individuals, to prevent or limit the transmission of the disease.
Radiation absorbed A measure of absorbed energy from any ionizing radiation

dose (rad ) deposited in any material. Equal to 100 ergs per gram.
Radiation Area An area, accessible to individuals, in which radiation levels could

result in an individual receiving a dose equivalent in excess of
5mrem, but less than 100mrem, in 1 hour, 30cm (1 foot) from the
radiation source or from any surface that the radiation penetrates.
Radio Cache A supply of radios stored in a predetermined location for

assignment to incidents.
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Radioactive 1—Of, caused by, or exhibiting radioactivity;

2—The property possessed by some elements (as uranium) or
isotopes (as carbon-14) of spontaneously emitting energetic
particles (as electrons or alpha particles) by the disintegration of
their atomic nuclei; also: the rays emitted.
Radioactive Material Any area within a controlled area, accessible to individuals, in

Area which items or containers of radioactive material exist and the total
activity of radioactive material exceeds the applicable values in
Appendix E of 10 Code of Federal Regulations (C.F.R.) § 835.
Radiological 1—Of or relating to radiology;

2—Of or relating to nuclear radiation.
Radiological Dispersal A radiological weapon that combines radioactive material with

Device (RDD) conventional explosives; any device that is designed to disperse
radiation or radioactive material, usually for a malevolent purpose.
Radiological FEMA established the REP Program to (1) ensure the health and
Emergency safety of citizens living around commercial nuclear power plants
Preparedness (REP) would be adequately protected in the event of a nuclear power
Program plant accident; and (2) inform and educate the public about
radiological emergency preparedness.
REP Program responsibilities encompass only “offsite” activities,

that is, State, tribal and local government emergency planning and
preparedness activities that take place beyond the nuclear power
plant boundaries. Onsite activities continue to be the responsibility
of the U.S. Nuclear Regulatory Commission (NRC).
Radiological Exposure An RED is a terrorist device intended to expose people to

Device (RED) significant doses of ionizing radiation without their knowledge.
Constructed from partially or fully unshielded radioactive material,
an RED could be hidden from sight in a public place (e.g., under a
subway seat, in a food court, or in a busy hallway), exposing those
who sit or pass close by. If the seal around the source were broken
and the radioactive contents released from the container, the
device could become a radiological dispersal device (RDD),
capable of causing radiological. Also called a hidden sealed source.
Rate of Action/Onset The rate of action or onset time is the period of time that elapses
Time before a person begins to show or feel the symptoms of a particular
agent. With some agents, this time will be just a few seconds, in
other cases it could be minutes to hours. Knowing the onset time is
important because it indicates how much time is left.
Reactive Skin A liquid Chemical Warfare Agent (CWA) decontaminant designed

Decontamination to destroy chemical agents on contact.
Lotion (RSDL)
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Recorders Individuals within Incident Command System (ICS) organizational

units who are responsible for recording information. Recorders may
be found in Planning, Logistics, and Finance/Administration
Sections.
Reinforced Response Those resources requested in addition to the initial response.
Restricted Area An area with access limited by the licensee for the purpose of
protecting individuals against undue risks from exposure to
radiation and radioactive materials.
Reporting Locations Location or facilities where incoming resources can check in at the
incident. (See Check-In.)
Resources Personnel and major items of equipment, supplies, and facilities

available or potentially available for assignment to incident
operations and for which status is maintained. Resources are
described by kind and type and may be used in operational support
or supervisory capacities at an incident or at an Emergency
Operations Center (EOC).
Resources Unit Functional unit within the Planning Section responsible for
recording the status of resources committed to the incident. The
Resources Unit also evaluates resources currently committed to the
incident, and anticipated resource needs.
Rhabdomyolysis Disintegration of striated muscle tissue with excretion of myoglobin

in the urine.
Risk Assessment Includes instruments developed by the FBI and the Centers for
Process Disease Control and Prevention (CDC) to evaluate and integrate
vulnerability, threat, and public health performance and yield a risk
profile.
Note: This definition provides sufficient predicate for the FBI to

initiate an investigation.
Roentgen (R) A unit of gamma or X-ray exposure in air. 1,000 milliRoentgen (mR)
= 1 R.
Roentgen equivalent Standard unit that measures the effects of ionizing radiation on
mammal/man (rem) humans.
Safety Officer (SO) A member of the Command Staff responsible for monitoring and
assessing safety hazards or unsafe situations and for developing
measures for ensuring personnel safety. The SO may have
assistants.
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Sanitary System of A complete system of sewage collection, treatment and disposal,

Sewage Treatment and including approved privies, septic tank systems, connection to public
Disposal or community sewage systems, incinerators, mechanical toilets,
composting toilets, recycling toilets, mechanical aeration systems, or
other such systems.
Sanitizers Substances that reduce the number of microorganisms to a safe

level usually capable of killing 99.999%, known as a 5 log reduction,
of a specific bacterial test population, and to do so within 30
seconds.
Sarin (GB) A human-made chemical warfare agent classified as a nerve agent.

Originally was developed in 1938 in Germany as a pesticide. It is a
clear, colorless, and tasteless liquid that has no odor in its pure form.
It can evaporate into a vapor (gas) and spread into the environment.
Secondary Removal of an agent from a person already processed through

Decontamination mass decontamination that shows continued signs of contamination.
Section The Incident Command System (ICS) organizational level having

responsibility for a major functional area of incident management
(e.g., Operations, Planning, Logistics, Finance/Administration, and
Intelligence/Investigations if established). The Section is
organizationally situated between the Branch and the Incident
Command.
Sector Term used in some applications to describe an organizational level

similar to an Incident Command System (ICS) Division or Group.
Sector is not a part of ICS Terminology.
Segment A geographic area in which a Task Force/Strike Team Leader or

Supervisor of a single resource is assigned authority and
responsibility for the coordination of resources and implementation
of planned tactics. A Segment may be a portion of a Division or an
area inside or outside the perimeter of an incident. Segments are
identified with Arabic numbers.
Self-Contained A supplied-air respirator consisting of an oxygen tank, carrying

Breathing Apparatus assembly, gauge, safety valve, and full facepiece for use when
(SCBA) exposures are unknown or particularly toxic.
Septic Tank A water-tight, covered receptacle designed for primary treatment of

sewage and constructed to: receive the discharge of sewage from a
building; separate settleable and floating solids from the liquid;
digest organic matter by anaerobic bacterial action; store digested
solids through a period of detention; and allow clarified liquids to
discharge for additional treatment and final disposal.
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Septic Tank System A sanitary subsurface or ground absorption sewage system

consisting of a septic tank, subsurface disposal field and sometimes
a repair area for the treatment and disposal of sewage effluent.
Service Branch A branch within the Logistics Section responsible for service
activities at the incident. Includes the Communications, Medical, and
Food Units.
Sewage The liquid and solid human waste and liquid waste generated by
water-using fixtures and appliances, including those associated with
food handling. The term does not include industrial process
wastewater or sewage that is combined with industrial process
wastewater.
Sewer/Public Sewer Wastewater collection and treatment facilities, also known as a

municipal sewer systems, serving the public for the purpose of
rendering wastewater safe enough through primary, secondary and
advanced treatment processes, to be discharged into motile surface
waters.
Shelter A shelter, human shelter, is a place that covers, protects, and

provides safety from any environment detrimental to human
existence or the human condition.
Short Term Exposure A 15-minute Time-Weighted Average (TWA) exposure that is not to
Lime (STEL) be exceeded at any time during a workday even if the 8-hour TWA is
below the Permissible Exposure Limit (PEL).
Sievert (Sv) The International System of Units (SI) unit for radiation dose. 1 rem
= 0.01 Sv.
Simple Triage And A rapid triage system used within the warm zone during mass
Rapid Treatment casualty incidents to determine those individuals that need
(START) immediate care, dead, and those that can have delayed treatment.
Triage per person takes approximately 30 seconds and occurs prior
to decontamination.
Single Resource An individual, a piece of equipment and its personnel complement,

or a crew or team of individuals with an identified work supervisor
that can be used at an incident.
Single-Use Equipment Items that will be used only once (e.g., tweezers, scalpel blades,
droppers).
Site Land or water area where any facility, activity or situation is

physically located, including adjacent or nearby land used in
connection with the facility, activity or situation.
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Events that may result in actual or likely major failures of plant

Site Area Emergency
functions needed to protect the public are in progress or have
(SAE)
occurred. Any releases of radioactive material are not expected to
exceed the limits set forth by the U.S. Environmental Protection
Agency (EPA) except near the site boundary.
Sludge The solid component of wastewater.
Smear A sample made for the purpose of determining the presence of

removable radioactive contamination on a surface. It is done by
wiping, with slight pressure, a piece of soft filter paper over a
representative type of surface area.
Solid Waste A waste type, either solid or semisolid form, which includes
predominantly household waste (domestic waste) with sometimes
the addition of commercial wastes that is usually collected by a
municipality within a given area.
Source Term The types, quantities, and chemical forms of the radionuclides that
encompass the source of potential for exposure to radioactivity.
Span of Control The number of resources for which a supervisor is responsible,

usually expressed as the ratio of supervisors to individuals. (Under
the National Incident Management System [NIMS], an appropriate
span of control is between 1:3 and 1:7, with optimal being 1:5, or
between 1:8 and 1:10 for many large-scale law enforcement
operations.)
Staging Area Temporary location for available resources. A Staging Area can be
any location in which personnel, supplies, and equipment can be
temporarily housed or parked while awaiting operational assignment.
Step-off Pad Transition area between contaminated and non- contaminated areas
that is used to allow exit of personnel and removal of equipment.
Sterilization A process that destroys or eliminates all forms of microbial life and is
carried out by physical or chemical methods.
Strategic Intelligence Provides detailed information on the overview of criminal activity,

groups, and threats.
Strategic National The federal government’s national repository of antibiotics, chemical

Stockpile (SNS) antidotes, life-support medications, intravenous (IV) administration
and airway maintenance supplies, and medical surgical items.
Strike Team Specified combinations of the same kind and type of resources with
common communications and a leader.
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Subsurface Disposal The application of sewage effluent beneath the surface of the
ground by distribution through approved nitrification lines, bed or
other means.
Supervisor The Incident Command System (ICS) title for individuals responsible
for command of Division or Group.
Supply Unit Functional unit within the Support Branch of the Logistics Section
responsible for ordering equipment and supplies required for
incident operations.
Support Resources Nontactical resources under the supervision of Logistics, Planning,

Finance/Administration Sections, or the Command Staff.
Supporting Branch A Branch within the Logistics Section responsible for providing
personnel, equipment and supplies to support incident operations.
Includes the Supply, Facilities, and Ground Support Unit.
Supporting Materials Various attachments that may be included with an Incident Action
Plan (IAP; e.g., communications plan, map, safety plan, traffic plan,
and medical plan).
Surge Capacity A health care system’s ability to rapidly expand beyond normal
services to meet the increased demand for qualified personnel,
medical care, and public health in the event of bioterrorism or other
large-scale public health emergencies or disasters.
Surveillance Close observation of a person, group, or activities.
Tactical Directions Direction given by the Operations Section Chief that includes the
tactics appropriate for the selected strategy, the selection and
assignment of resources, tactics implementation, and the
performance monitoring for each operational period.
Tactical Intelligence Used in either the formulation of an ongoing criminal investigation or

in threat mitigation during a crisis situation.
Team (See Single Resource.)
Team Leader A person that manages a set number of resources of the same kind
and type operating with common communications between them.
Teams (known as Strike Teams or Task Forces) represent known
capability and are highly effective management units. For example,
a fire response may consist of five Type 1 engines and a Strike
Team Leader. The Team Leader is required to have a vehicle with
communication capabilities to communicate with his or her team.
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Team Members Individuals who are called to the scene to assist in investigation or
processing of the scene (e.g., scientific personnel from the crime
laboratory or medical examiner’s office, other forensic specialists,
photographers, mass disaster specialists, experts in the
identification of human remains, arson and explosives investigators,
clandestine drug laboratory investigators, as well as other experts).
Technical The planned and systematic process of reducing contamination to a

Decontamination level that is As Low As Reasonably Achievable (ALARA).
Technical Specialists Personnel with special skills that can be used anywhere within the
Incident Command System (ICS) organization.
Technique 1—The manner in which technical details are treated (as by a writer)
or basic physical movements are used (as by a dancer);
2—Ability to treat such details or use such movements.
Temporary Flight Temporary airspace restrictions for nonemergency aircraft in the

Restriction (TFR) incident area. TFRs are established by the Federal Aviation
Administration (FAA) to ensure aircraft safety and are normally
limited to a 5-nautical-mile radius and 2000 feet in altitude.
Tenesmus Ineffectual and painful straining to void urine or evacuate stool.
Time Unit The functional unit within the Finance/Administration Section

responsible for recording time for incident personnel and hired
equipment.
Time-Weighted The safety threshold limit values, the time-weighted average

Averages (TWA) concentration for a normal 8-hour workday and a 40-hour workweek,
to which nearly all workers may be repeatedly exposed, day after
day, without adverse effect.
Toxicology A science that deals with poisons and their effect and with the
problems involved (as clinical, industrial, or legal).
Toxins Potent poisons produced by a variety of living organisms, including

bacteria, plants, and animals.
Trace Evidence Physical evidence that results from the transfer of small quantities of
materials (e.g., hair, textile fibers, paint chips, glass fragments,
gunshot residue particles).
Transient Evidence Evidence that, by its very nature or the conditions at the scene, will
lose its evidentiary value if not preserved and protected (e.g., blood
in the rain).
Triage The process of sorting injured people into groups based on their
need for medical treatment. Also a system used to allocate a scarce
commodity, especially in an emergency.
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Tympanic Membrane Thin semitransparent ovoid membrane stretching across the ear
canal separating the middle and outer ear. Commonly referred to as
the eardrum.
Type An Incident Command System (ICS) resource classification that

refers to capability. Type 1 is generally considered to be more
capable than Types 2, 3, or 4, respectively, because of size, power,
capacity, or (in the case of Incident Management Teams [IMT])
experience and qualifications.
Unified Area Command A Unified Area Command is established when incidents under an
Area Command are multijurisdictional. (See Area Command.)
Unified Command (UC) An Incident Command System (ICS) application used when more
than one agency has incident jurisdiction or when incidents cross
political jurisdictions. Agencies work together through the designated
members of the UC, often the senior persons from agencies and/or
disciplines participating in the UC, to establish a common set of
objectives and strategies and a single Incident Action Plan (IAP).
Unit The organizational element having functional responsibility for a

specific incident planning, logistics, or finance/administration activity.
Unity of Command The concept by which each person within an organization reports to
only one designated person.
Vector An organism, such as an insect or animal that transmits disease-

carrying germs.
Very High Radiation An area, accessible to individuals, in which radiation levels from
Area radiation sources external to the body could result in an individual
receiving a adsorbed dose in excess of 500 rad in 1 hour, 1 meter (3
feet, 3 inches) from the source or from any surface that the radiation
penetrates.
Vesicants (See Blister Agents.)
Volatile Organic Any organic compound that evaporates readily to the atmosphere.
Compound (VOC)
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Volatility/Persistency Volatility is important because it provides an indication of how rapidly

an agent will evaporate. The more volatile an agent is, the more
rapidly it will evaporate. Evaporation will cause the agent to become
a true gas or vapor and reduce the liquid hazard. Temperature, wind
speed, and humidity at the incident site influence how rapidly an
agent will evaporate.
This evaporation process is also referred to as persistency (the

amount of time an agent will remain a threat in the incident site). A
nonpersistent agent will not remain at the incident site as long as a
persistent agent. Obviously, if an agent is released inside an
enclosed space, weather will not play a role, and the persistency will
normally increase.
Volunteer For purposes of the National Incident Management System (NIMS),

any individual accepted to perform services by the lead agency
(which has authority to accept volunteer services) when the
individual performs services without promise, expectation, or receipt
of compensation for services performed. See 16 United States Code
(U.S.C.) 742f(c) and 29 Code of Federal Regulations (C.F.R.)
553.10
W, X, Y, & Z
Warm Zone Transitional area between hot and cold zone where
decontamination occurs. Also known as the contamination
reduction zone.
Water Table Upper limit of the ground layer wholly saturated with water.
Weapon of Mass A WMD is any device that is designed or intended to cause mass
Destruction (WMD) destruction and/or death (Refer to Title 18 United States Code
[U.S.C.] § 2332a for an in-depth definition.)
Well Any excavation that is cored, bored, drilled, jetted, dug or otherwise
constructed for the purpose of locating, testing, developing, draining
or recharging any groundwater reservoirs or aquifer, or that may
control, divert, or otherwise cause the movement of water from or
into any aquifer.
Well Casing A pipe or tubing constructed of specified materials and having

specified dimensions and weights, that is installed in a borehole,
during or after completion of the borehole, to support the side of the
hole and thereby prevent caving, to allow completion of a well, to
prevent formation material from entering the well, to prevent the loss
of drilling fluids into permeable formations, and to prevent entry of
contamination.
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Well Head The upper, terminal, of the well including adapters, ports, valves,
seals, and other attachments.
Wetland A designated water saturated area on the land surface established

under the provisions of the Coastal Area Management Act or the
Federal Clean Water Act.
Zoonotic A disease of animals, such as rabies or psittacosis, which can be

transmitted to humans.
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Acronym List
A
AAAASF American Association for Accreditation of Ambulatory Surgery Facilities
AAAHC Accreditation Association for Ambulatory Health Care
AAR After Action Review
ABCS Active Bacterial Core Surveillance
Animal Care
AC
Hydrogen Cyanide
ACS Alternate Care Site
ACT Adrenocorticotropic Hormone
AEFI Adverse Effects Following Immunization
AEM Associate Emergency Manager
AHA American Hospital Association
AHRMM Association for Healthcare Resource and Materials Management
AHRQ Agency for Healthcare Research and Quality
AHT Animal Health Technician
AI Avian Influenza
AIA American Institute of Architects
AIIR Airborne Infection Isolation Room
ALA American Library Association
ALARA As Low As Reasonably Achievable
ALI Annual Limited on Intake
ALS Advanced Life Support
AMA American Medical Association
AMC Army Materiel Command
AMS Aerial Measuring System
ANA American Nursing Association
ANG Army National Guard
ANSI American National Standards Institute
AOA American Osteopathic Association
APEC Asia-Pacific Economic Cooperation
HOT.PM.09.0 AP-A-41
APHIS Animal and Plant Health Inspection Service

APHL Agency for Public Health Laboratories
APHT Applied Public Health Team
APR Air-Purifying Respirator
APWA American Public Works Association
AR Army Reserve
ARAC Atmospheric Release Advisory Capability
ARDS Acute Respiratory Distress Syndrome
ARES Amateur Radio Emergency Service
ARG Accident Response Group
ARS Acute Radiation Syndrome
ASAC Assistant Special Agent in Charge
ASAP As Soon As Possible
ASCE American Society of Civil Engineers
ASF African Swine Fever
ASHE American Society for Healthcare Engineering
ASPR Assistant Secretary of Preparedness and Response, Department of
Health and Human Services
ASTHO Association for State and Territorial Health Officials
ASTM American Society for Testing and Materials
ATF Bureau of Alcohol, Tobacco, Firearms, and Explosives
ATSDR Agency for Toxic Substances and Disease Registry
AVIC Area Veterinarian in Charge
AVMA American Veterinary Medical Association
AWA Animal Welfare Act
B
BC/DR Business Continuity/Disaster Recovery
BCI Business Continuity Institute
BCM Business Continuity Management
BCP Business Continuity Plan
BDRP Biological Defense Research Program
BERM Bioterrorism & Epidemic Outbreak Response Model
HOT.PM.09.0 AP-A-42
BHPP Bioterrorism Hospital Preparedness Program

BIA Business Impact Analysis
BIDS Biological Integrated Detection System
BLS Basic Life Support
BNICE Biological, Nuclear, Incendiary, Chemical, Explosive
BP Blood Pressure
BQA Beef Quality Assurance
Bq Becquerel
BRS Biotechnology Regulatory Services
BSE Bovine Spongiform Encephalopathy
BURP Business Unit Resumption Plan
BWA Biological Warfare Agent
BWC Biological Weapons Convention
C
C3 Command, Control, and Coordination
C&D Cleaning and Disinfection
C/B-RRT Chemical Biological Rapid Response Team
CAFO Confined Area Feeding Operation
CAH Critical Access Hospital
CANA Convulsant Antidote for Nerve Agent
Cognitive, Affective, and Psychomotor
CAP
College of American Pathologists
CARF Commission on Accreditation of Rehabilitation Facilities
CBDCOM Chemical Biological Defense Command
CBIRF U.S. Marine Corps Chemical Biological Incident Response Force
Chemical, Biological, Radiological, Environmental Defense Response
CBRED
Teams
CBRNE Chemical, Biological, Radiological, Nuclear, or Explosives
CC Campesino Caballeros
CCID Coordinating Center for Infectious Diseases
CCP Casualty Collection Point
CDC Centers for Disease Control and Prevention
HOT.PM.09.0 AP-A-43
CDE Committed Dose Equivalent

CDP Center for Domestic Preparedness
CDS Civil Defense Set (manufactured by Dräger)
Comprehensive Emergency Management
CEM
Certified Emergency Manager
CEO Chief Executive Officer
CERC Crisis and Emergency Risk Communication
CERCLA Comprehensive Environmental Response, Compensation, and Liability Act
CERT Community Emergency Response Team
CEU Continuing Education Unit
C.F.R. Code of Federal Regulations
CHAP Community Health Accreditation Program
Ci Curies
CIA Central Intelligence Agency
CIKR Critical infrastructure and key resources
CIRG Critical Incident Response Group
CISM Critical Incidence Stress Management
CK Cyanogen Chloride
CMP Crisis Management Plan
CME Continuing Medical Education
CMS Center for Medicare and Medicaid Services
CMT Crisis Management Team
CNA Certified Nursing Assistant
CNP Controlled Negative Pressure
CNS Central Nervous System
COBRATF Chemical, Ordnance, Biological, Radiological Training Facility
COOP Continuity of Operations
CoP Conditions of Participation
COPD Chronic Obstructive Pulmonary Disease
COTPER Coordinating Office for Terrorism Preparedness and Emergency Response
CPM Counts Per Minute
CPR Cardio Pulmonary Resuscitation
HOT.PM.09.0 AP-A-44
CPX Command Post Exercise

CREC Crisis Risk Emergency Communication
CRED Centre for Research on the Epidemiology of Diseases
CRI Cities Readiness Initiative
CRM Comprehensive Resource Management
CS Chlorobenzylidenemalononitrile (Riot Control Agent)
CSD Chemical Support Division
CSI Criticality Safety Index
CSTE Council of State and Territorial Epidemiologists
CWA Chemical Warfare Agent
Counterterrorism
CT
Computed Tomography
CX Phosgene Oxime
D
DAC Derived Air Concentrations
DAN Direct Action Network
DHQP Division of Healthcare Quality Promotion
DHS Department of Homeland Security
DIL Derived Intervention Level
DMAT Disaster Medical Assistance Team
DMORT Disaster Mortuary Operational Response Team
DOC Dispensing Operations Commander
DOD Department of Defense
DOE Department of Energy
DOJ Department of Justice
DOL Department of Labor
DOT Department of Transportation
DP Diphosgene
DPMU Disaster Portable Morgue Units
DRD Direct Read Dosimeter
DRL Derived Response Levels
DUMBELS Diarrhea, Urination, Miosis, Bronchoconstriction/Bronchorrhea, Emesis,
HOT.PM.09.0 AP-A-45
Lacrimation, Salivation
DVC Dispensing/Vaccination Center
DVC ICP Dispensing/Vaccination Center Incident Command Post
E
EAS Emergency Alert System
EC Environment of Care
ECC Emergency Communications Center
ECP Exposure Control Plan
ECS Emergency Care Simulators
ED Emergency Department
EH Environmental Health
EHS Environmental Health Specialist
EI Emotional Intelligence
EIP Emerging Infections Program
EIS Epidemiological Intelligence Service
ELISA Enzyme Linked Immunosorbent Assay
ELO Enabling Learning Objective
EMA Emergency Management Agency
Emergency Management Assistance Compact
EMAC
Emergency Medical Assistance Compact
EMAP Emergency Management Accreditation Program
EMI Emergency Management Institute
EMR Electromagnetic Radiation
EMS Emergency Medical Services
EMSA Emergency Medical Service Authority
EMT Emergency Medical Technician
EMTALA Emergency Medical Treatment and Active Labor Act
END Exotic Newcastle Disease
EOC Emergency Operations Center
EOP Emergency Operations Plan
EPHI Electronic Protected Health Information
EPA Environmental Protection Agency
HOT.PM.09.0 AP-A-46
EPD Electronic Personal Dosimeter

EPZ Emergency Planning Zone
ERG Emergency Response Guidebook
ERP Emergency Response Plan
ERT Evidence Response Teams
ERV Emergency Response Vehicle
Emergency System for Advanced Registration of Volunteer Health
ESAR-VHP
Professional
ESF Emergency Support Function
ETA Emergency Treatment Area
ETI Early Transient Incapacitation
EWID Early Warning Infectious Disease
F
FAA Federal Aviation Administration
FAO Food and Agriculture Organization
FAR Federal Acquisition Regulation
FBI Federal Bureau of Investigation
FCO Federal Coordinating Officer
FD Fire Department
FDA Food and Drug Administration
FEMA Federal Emergency Management Agency
Firefighting Resources of Southern California Organized for Potential
FIRESCOPE
Emergencies
FM Field Manual
FMT Field Monitoring Team
FOG Field Operations Guide
FOIA Freedom of Information Act
FRERP Federal Radiological and Emergency Response Plan
FRMAC Federal Radiological Monitoring and Assessment Center
FTX Functional Training Exercise
HOT.PM.09.0 AP-A-47
GA Tabun (Nerve Agent)

GAO Government Accountability Office
GB Sarin (Nerve Agent)
GBS Guillain-Barré Syndrome
GC Gas Chromatograph
GD Soman (Nerve Agent)
GE General Emergency
GIS Geographic Information System
GPD Gallons per Day
GPM Gallons per Minute
GPO Government Printing Office
H
H Blister Agents (Mustard/Sulfur Mustard)
HACCP Hazard Analysis Critical Control Points
HAM Home Amateur Radio Team
HAN Health Alert Network
HAZMAT Hazardous Materials
HCC Hospital Command Center
HD Distilled Mustard
HEAR Hospital Emergency Administration Radio
HEPA High-Efficiency Particulate Air
Hospital Emergency Response Teams
HERT
Hospital Emergency Response Training
HFAP Healthcare Facilities Accreditation Program
HHS Department of Health and Human Services
HICPAC Healthcare Infection Control Practices Advisory Committee
HICS Hospital Incident Command System
HIPAA Health Insurance Portability and Accountability Act
HIPPA Healthcare Information Patient Privacy Act
HMR Hazardous Materials Regulations
HMRT Hazardous Materials Response Teams
HMRU Hazardous Materials Response Unit
HOT.PM.09.0 AP-A-48
HN Nitrogen Mustard
HPAI Highly Pathogenic Avian Influenza
HPLC High-Performance Liquid Chromatograph
HPP Hospital Preparedness Program
HPS Health Physics Society
HRCQ Highway Route-Controlled Quantity
HRSA Health Resources and Services Administration
HSEEP Homeland Security Exercise and Evaluation Program
HSOC Homeland Security Operations Center
HSPD Homeland Security Presidential Directive
HTH Calcium Hypochlorite
HVA Hazard Vulnerability Assessment
HVAC Heating, Ventilating, and Air Conditioning
I
IACET International Association for Continuing Education & Training
IACP International Association of Chiefs of Police
IAEA International Atomic Energy Agency
IAP Incident Action Plan
IC Incident Commander
ICDDC Interstate Civil Defense and Disaster Compact
ICP Incident Command Post
ICRP International Commission on Radiological Protection
ICS Incident Command System
ICU Intensive Care Unit
IDLH Immediately Dangerous to Life or Health
IED Improvised Explosive Device
IEMS Integrated Emergency Management System
IIMG Interagency Incident Management Group
ILI Influenza-Like Illness
IMH Incident Management Handbook
IMT Incident Management Team
HOT.PM.09.0 AP-A-49
Improvised Nuclear Device

IND
Investigational New Drug
IPG Incident Planning Guide
IPM Integrated Pest Management
IQ Intelligence Quotient
IRCT Incident Response Coordination Team
IRG Incident Response Guide
IS Independent Study
ISO International Standards Organization
J, K
JAMA Journal of American Medical Association
JAS Job Action Sheet
JFO Joint Field Office
JIC Joint Information Center
JIS Joint Information System
JTTF Joint Terrorism Task Force
JTWG Joint Terrorism Working Group
KI Potassium Iodide
L
L Lewisite (Blister Agent)
LD50 Lethal Dose
LDS Ladder-Pipe Decontamination System
LEL Lower Explosive Limits
LEPC Local Emergency Planning Council
LPAI Low Pathogenic Avian Influenza
LPHA Local Public Health Agency
LPHS Local Public Health System
LRN Laboratory Response Network
LSA Low Specific Activity
HOT.PM.09.0 AP-A-50
M256A1 Chemical Agent Detector Kit

M8 Chemical Agent Detector Paper
M9 Chemical Agent Detector Paper
MAC Multiagency Coordination
MACC Multiagency Coordination Center
MACS Multiagency Coordination System
MASS Move, Assess, Sort, Send
MBO Management by Objectives
MCC Medical Coordination Center
MCI Mass Casualty Incident
ME Medical Examiner
MEDCOM U.S. Army Medical Command
MERS Mobile Emergency Response Support
MFI Mass Fatality Incident
MHT Mental Health Team
MSEL Master Scenario Events List
MIL STD Military Standard
MMRS Metropolitan Medical Response System
MMST Metropolitan Medical Strike Team
MO Medical Officer
MOA Memorandum of Agreement
MOU Memorandum of Understanding
MRC Medical Reserve Corps
MRI Magnetic Resonance Imaging
MRSA Methicillin-Resistant Staphylococcus Aureus
MS Mass Spectrometry
MSEHP Model State Emergency Health Powers Act
MSHA Mine Safety and Health Administration
MTPB Maximum Tolerable Period of Disruption
HOT.PM.09.0 AP-A-51
N
NAAK Nerve Agent Antidote Kit
NACCHO National Association for County and City Health Officials
NAEMT National Association of Emergency Medical Technicians
NATO North Atlantic Treaty Organization
NBC Nuclear, Biological, and Chemical
NBHPP National Bioterrorism Hospital Preparedness Program
NCAVC National Center for the Analysis of Violent Crime
NCEH National Center for Environmental Health
NCIRD National Center for Immunization and Respiratory Diseases
NCP National Contingency Plan
National Center for Preparedness, Detection, and Control of Infectious
NCPDCID
Diseases
NCRP National Council on Radiation Protection and Measurement
NDMS National Disaster Medical System
NDPO National Domestic Preparedness Office
NEHA National Environmental Health Association
NEMA National Emergency Management Association
NEPMU New Environmental and Preventive Medicine Units
NEST Nuclear Emergency Support Team
NFPA National Fire Protection Association
NIMS Integration Center
NIC
National Integration Center
National Integration Center Incident Management Systems Integration
NIC IMSI
Division
NIMS National Incident Management System
NIOSH National Institute for Occupational Safety and Health
NIPP National Infrastructure Protection Plan
NMRC Naval Medical Research Center
NMRI U.S. Naval Medical Research Institute
NMRT National Medical Response Team
NNDSS National Notifiable Disease Surveillance System
NNRT National Nurse Response Team
HOT.PM.09.0 AP-A-52
NSSE National Special Security Event

NOAA National Oceanic and Atmospheric Administration
NPG National Preparedness Goal
NPPA National Press Photographers Association
NPRT National Pharmacy Response Team
NRCC National Response Coordination Center
NREVSS National Respiratory and Enteric Virus Surveillance System
NRF National Response Framework
NRC Nuclear Regulatory Council / National Response Center
NSF National Sanitation Foundation
NSPI National Strategy for Pandemic Influenza
NTF Noble Training Facility
NUE Notice of Unusual Event
NUREG Nuclear Regulation
NVOAD National Volunteer Organizations Against Disasters
NVSL National Veterinary Services Laboratory
NVSN New Vaccine Surveillance Network
NWS National Weather Service
O
OCR Office of Civil Rights
ODP Office of Domestic Preparedness
OES Office of Emergency Services
OIC Officer-in-Charge
OIG Office of the Inspector General
OJP Office of Justice Programs
OLMC On-Line Medical Control
OME Office of Medical Examiner
OPEO Office of Preparedness and Emergency Operations
OR Operating Room
ORO Offsite Response Organizations
OSC Onscene Coordinator
HOT.PM.09.0 AP-A-53
OSHA Occupational Safety and Health Administration

OSPHL Oregon State Public Health Laboratory
OSPP OSHA Strategic Partnership Program
P, Q
PAD Protective Action Decisions
PAG Protective Action Guides (Environmental Protection Agency)
PAO Public Affairs Officer
PAHPA Pandemic and All-Hazards Preparedness Act
PAS Passport Accountability System
PAPR Powered Air-Purifying Respirator
PCR Polymerase Chain Reaction
PDA Preliminary Damage Assessment
PDD Presidential Decision Directive
PDK Personal Decontamination Kits
PEL Permissible Exposure Limit
PFO Principle Federal Official
PHF Potentially Hazardous Food
PHI Protected Health Information
PHICS Public Health Incident Command System
PHS Public Health Service
PID Photoionization Detector
PIO Public Information Officer
PIP Pandemic Influenza Plan
PMI Public or Media Inquiry
PMR Progressive Muscular Relaxation
POD Point of Dispensing
POV Personal Owned Vehicles
PPE Personal Protective Equipment
PPV Positive Pressure Ventilation
PRBC Packed Red Blood Cells
PRSA Public Relations Society of America
HOT.PM.09.0 AP-A-54
PS Cholorpicrin
PSA Public Service Announcement
PSCC Public Safety Communications Center
PTE Potential Threat Element
PTSD Post Traumatic Stress Disorder
R
R Roentgen
RACES Radio Amateur Civil Emergency Service
rad Radiation Absorbed Dose
RAM Radiological/Radioactive Material
RAP Radiological Assistance Program
RCA Riot Control Agents
RDD Radiological Dispersal Device
RDECOM Research, Development and Engineering Command
RDF Rapid Deployment Force
REAC/TS Radiation Emergency Assistance Center/Training Site
RED Radiological Exposure Device
rem Roentgen equivalent mammal/man
Rural Health Clinic
RHC
Regional Hospital Coordinator
RLAF Responder Lanes Assessment Form
RPM Respiration, Perfusion/Pulse, and Mental status
RPO Recovery Point Objective
RRCC Region Response Coordination Center
RRIS Rapid Response Information System
RRT Radiological Response Team
RSDL Reactive Skin Decontamination Lotion
RSO Radiological Safety Officers
RSS Receive, Stage, and Store
RST Radiological Strike Team
RT Respiratory Therapist
RTAP Real-Time Analytical Platform
HOT.PM.09.0 AP-A-55
RTF Response Task Force

RTNDA Radio-Television News Directors Association
RTO Recovery Time Objective
RQ Reportable Quantity
S
SAA State Administrative Agency
SAC Special Agent in Charge
SAE Site Area Emergency
SAR Supplied-Air Respirator
SARS Severe Acute Respiratory Syndrome
SC Site Commander
SCBA Self-Contained Breathing Apparatus
SCO State Coordinating Officer
SEL Standardized Equipment List
SI International System of Units
SIOC Strategic Information Operations Center
SLA Service Level Agreement
Salivation, Lacrimation, Urination, Defecation/diarrhea, Gastric Distress,
SLUDGEM
Emesis, Miosis
Single Membrane Antigen Rapid Test Tickets
SMART
Specific, Measurable, Achievable, Realistic, Timely
SME Subject Matter Expert
SNS Strategic National Stockpile
SO Safety Officer
SOCO Single Overriding Communication Objective
SOG Standard Operating Guidelines
SOLER Stand squarely; Open posture; Lean slightly forward; Eye contact; Relax
SOP Standard Operating Procedures
SPJ Society of Professional Journals
SPLC Southern Poverty Law Center
Social Security Administration
SSA
Supervisory Special Agent
STARCC Simple, Timely, Accurate, Relevant, Credible, Consistent
HOT.PM.09.0 AP-A-56
START Simple Triage and Rapid Triage System

STD Sexually Transmitted Disease
STEL Short-Term Exposure Limit
SWAT Special Weapons and Tactics
T
T3 Triage, Treatment, and Transport
TARU Technical Advisory Response Unit
TBI Traumatic Brain Injury
TCS Time/Temperature Control for Safety
TEA Threat Environment Assessment
TECP Totally Encapsulating Chemical Protective
TEDA Triethylene Diamine
TEDE Total Effective Dose Equivalent
TEEP Transportation Emergency Preparedness Program (Department of Energy)
TEU U.S. Army Technical Escort Unit
TIC Toxic Industrial Chemicals
TILT Time in Lieu of Temperature
TM Tympanic Membrane
TOXNET TOXicology Date NETwork
TtT Train the Trainer
TLD Thermoluminescent Dosimeter
TLO Terminal Learning Objective
TSS Toxic Shock Syndrome
TWA Time-Weighted Average
U
UAB University of Alabama at Birmingham
UC Unified Command
UCS Unified Command Structure
UL Underwriter’s Lab
ULV Ultra Low Volume
US&R Urban Search and Rescue
HOT.PM.09.0 AP-A-57
USAMRIID U.S. Army Military Research Institute for Infectious Disease

USDA United States Department of Agriculture
USGS United States Geologic Survey
V
VA Veterans Administration
VAERS Vaccine Adverse Event Reporting System
VBIED Vehicle-Borne Improvised Explosive Device
VHF Viral Hemorrhagic Fevers
VIP Very Important Person
VMAT Veterinary Medical Assistance Team
VMD Volume Median Diameter
VMI Vendor Managed Inventory
VOAD Volunteer Organizations Active in Disasters
VOC Volatile Organic Compounds
W, X, Y, Z
WHO World Health Organization
WCU Wounded Care Unit
WIC Women, Infants, and Children
WISER Wireless Information System for Emergency Responders
WMD Weapon(s) of Mass Destruction
WNV West Nile Virus
WTC World Trade Center
HOT.PM.09.0 AP-A-58
Appendix B: Triage Symptom Cards/Visuals Participant Manual
Appendix B:
Triage Symptom Cards/Visuals
HOT.PM.09.0 AP-B-1
PATIENT:
Baker, Sally
Age: 20 months INJURIES:
Sex: Female • Confused, hysterical and
crying
Pulse: 134 • Amputated left arm
• 2nd degree chem. burns
RR: 36 (hands, face, neck, chest,
B/P:116/94 thighs)
• Responds to verbal stimuli
Cap Refill: > 2 sec
PATIENT:
Brown, Jason
Age: 4 years old INJURIES:
Sex: Male • Confused; does not
follow directions
Pulse: 122 • Gasping, choking
RR: 38 • Short of breath
B/P:134/88 • Pain in right lower leg
Cap Refill: < 2 sec
PATIENT:
Ashley, Tony
Sex: Male • Difficult, labored
breathing
Pulse: 138 • Experiencing chest
RR: 36 pains
B/P:188/104 • Cool, moist to the touch
• Difficulty following
Cap Refill: > 2 sec instructions
PATIENT:
Daniel, Renee
Sex: Female • Right forearm
laceration
Pulse: 86 • Alert, responsive
RR: 16 • Notice a white
B/P:118/66 “glowing” powder on
individual
Cap Refill: < 2 sec
PATIENT:
Causey, Bill
Sex: Male • Broken left ankle
• Short of breath
Pulse: 146
• Singed hair on face
RR: 36 and arms
B/P:174/102 • Alert but anxious
Cap Refill: < 2 sec

PATIENT:
McCain, Jody
Sex: Male • Abdominal pain,
vomiting, diarrhea
Pulse: 126 • Second degree burns
RR: 20 on 65% of body from
neck on back of body
B/P:92/54
• Conscious and
Cap Refill: > 2 sec incoherent
PATIENT:
Thrower, Darci
Sex: Female • Mangled right lower leg
• Burns to hands and
Pulse: 164 feet
RR: 18 • Alert and oriented
B/P:142/86 • Extreme pain
Cap Refill: < 2 sec

PATIENT:
Parker, Robert
Sex: Male • Unable to move arms
or legs
Pulse: 126 • Neck and back pain
RR: 36 • Shortness of breath
B/P:144/92 • Uncooperative
Cap Refill: > 2 sec

PATIENT:
Dobbs, Rebecca
Age: 18 month old INJURIES:
Sex: Female • Right leg lacerations
• Burns to abdomen and
Pulse: 138 legs
RR: 28 • Scared and confused;
B/P: 100/ 52 does not follow
instructions
Cap Refill: > 2 sec
PATIENT:
Brock, Micah
Age: 4 year old INJURIES:
Sex: Male • Gasping, short of
breath
Pulse: 118 • Crying and has dry
RR: 38 raspy cough
B/P: 102/88 • Difficulty swallowing
• Found wandering and
Cap Refill: < 2 sec confused
PATIENT:
Mullen, Amy
Sex: Female • Left arm lacerations
• Burns to upper chest
Pulse: 124 and abdomen
RR: 18 • Oriented
B/P: 146/82
Cap Refill: > 2 sec
PATIENT:
Wood, Brent
Sex: Male • Choking and short of
breath
Pulse: 106 • Right leg pain
RR: 32 • Confused
B/P: 148/102
Cap Refill: > 2 sec
PATIENT:
Boundtree, Pete
Sex: Male • Complains of chest
pain
Pulse: 112 • Severe difficulty
RR: 36 labored breathing
B/P: 142/98 • Difficulty following
instructions
Cap Refill: > 2 sec
PATIENT:
Mullen, Adam
Sex: Male • Left arm lacerations
Pulse: 84 and abdomen
RR: 18 • Oriented
B/P: 128/58
Cap Refill: > 2 sec
PATIENT:
Thompson, April
Sex: Female • Lacerated right arm
with a venous bleed
Pulse: 92 • Exposed skin has a
RR: 16 glossy sheen
B/P: 112/64 • Alert and oriented
Cap Refill: < 2 sec

PATIENT:
Owen, Jerry
Sex: Male • Twisted ankle
• Some shortness of
Pulse: 86 breath
RR: 26 • Singed hair on arms
B/P: 128/54 • Coherent
Cap Refill: < 2 sec

PATIENT:
Roberts, Ryan
Sex: Male • Vomiting and diarrhea
• Second degree burns
Pulse: 106 on 50% of body
RR: 20 • Conscious but
B/P: 102/86 incoherent
Cap Refill: > 2 sec

PATIENT:
Muse, Katie
Sex: Female • Deformed right tibia
• Burns to hands and
Pulse: 122 feet
RR: 18 • Alert and oriented
B/P: 144/86 • Extreme pain
Cap Refill: < 2 sec

PATIENT:
Porter, Mike
Sex: Male • Lower back pain
• Cannot move legs
Pulse: 88
• Shortness of breath
RR: 36 • Confused
B/P: 166/98 • Unwilling to follow
directions
Cap Refill: > 2 sec
PATIENT:
Luallen, Samantha
Sex: Female • Impaired vision
• Unexplained runny
Pulse: 116 nose
RR: 31 • Tightness in chest
B/P: 116/74 • States she smelled
“freshly mown hay” at
Cap Refill: < 2 sec scene
PATIENT:
Smith, Sherri
Sex: Female • Violent tremors
• Vomiting
Pulse: 102
• Slight chest discomfort
RR: 26 • Does not respond to
B/P: 104/92 instructions
Cap Refill: > 2 sec

PATIENT:
Frame, Anna
Sex: Female • Severe facial
lacerations
Pulse: 42 • Chest trauma
RR: apneic • Unresponsive
B/P: 60/42
Cap Refill: > 2 sec
PATIENT:
Brown, Katrina
Sex: Female • Confused but follows
simple commands
Pulse: 86 • Holding bloody left
RR: 20 wrist
B/P: 126/84 • Burns to both forearms
Cap Refill: < 2 sec

PATIENT:
Swafford, Jason
Sex: Male • Coherent
• Nauseated
Pulse: 112
• Difficulty breathing
RR: 28 shallow • Severely angulated leg
B/P: 132/92
Cap Refill: < 2 sec
PATIENT:
Reaves, Charles
Sex: Male • Severe blunt chest
trauma
Pulse: 64 • Disoriented
RR: 28 labored • Shortness of breath
B/P: 102/88
Cap Refill: > 2 sec
PATIENT:
Ivey, Michelle
Sex: Female • Right cheek laceration
• Tongue nearly bitten in
Pulse: 126 two
RR: 20 • Hair and clothing burned
on back side
B/P: 128/86 • Anxious and bleeding
Cap Refill: < 2 sec • Follows simple directions
PATIENT:
Black, Dora
Sex: Female • Chest pain
Pulse: 112
• Soot in nostrils
RR: 20 • Alert but hysterical
B/P: 118/96
Cap Refill: < 2 sec
PATIENT:
Wells, John
Sex: Male • Tightness in chest
• Unexplained runny
Pulse: 98 nose
RR: 31 • Impaired vision
B/P: 146/92 • Confused, disoriented
Cap Refill: > 2 sec

PATIENT:
Shelton, Derek
Sex: Male • Violent tremors
• Vomiting, diarrhea
Pulse: 126
• Glossy look to exposed
RR: 8 skin
B/P: 90/76 • Unresponsive
Cap Refill:< 2 sec

PATIENT:
Farmer, Leah
Sex: Female • Severe eye irritation
• Runny nose
Pulse: 114
• Vomiting
RR: 28 labored • Difficulty breathing
B/P: 80/62 • Anxious and confused
Cap Refill: < 2 sec • Responds slowly to
verbal commands
PATIENT:
Simpson, Scott
Sex: Male • Third degree burns
over 75% of body
Pulse: 136 • Anxious and alert
RR: 28 labored
B/P: 104/62
Cap Refill: > 2 sec
PATIENT:
Young, Allison
Sex: Female • Broken arm with some
discomfort
Pulse: 76 • Soot around nose and
RR: 24 mouth
B/P: 108/54 • Coherent
Cap Refill: < 2 sec

PATIENT:
Ford, Kelly
Age: 2 month old INJURIES:
Sex: Female • Sucking chest wound
• Frothing
Pulse: 116
RR: 22 labored • Unresponsive
B/P: 68/56
Cap Refill: > 2 sec
PATIENT:
Brooks, Michael
Sex: Male • Broken left femur
Pulse: 138
• Anxious
RR: 28 • Somewhat confused
B/P: 146/102
Cap Refill: > 2 sec
PATIENT:
Kaler, Ben
Sex: Male • Tightness of chest with
some associated
Pulse: 106 pressure pain
RR: 31 • Slightly confused
B/P:168/118
Cap Refill: < 2 sec
PATIENT:
Dobbs, Bernice
Sex: Female • Violent tremors
• Unresponsive
Pulse: 144
• Staring into space
RR: 8
B/P:126/88
Cap Refill: > 2 sec
PATIENT:
Noles, Jackie
Age: 13 year old INJURIES:
Sex: Male • Post extrication
• Crushing injury to
Pulse: 44 pelvic and legs (pinned
RR: none under large concrete
slab)
B/P: 86/60
• Unresponsive
Cap Refill: < 2 sec
PATIENT:
Noles, Natalie
Sex: Female • Distraught
• Unable to follow simple
Pulse: 116 instructions
RR: 30
B/P:124/66
Cap Refill: < 2 sec
PATIENT:
Brown, Maggie
Sex: Female • Right forearm fracture
• Singed hair
Pulse: 112
• Covered in soot
RR: 24 • Having difficulty
B/P:128/78 swallowing
• Coherent
Cap Refill: < 2 sec
PATIENT:
Hammonds, Shane
Sex: Female • Impaled object in chest
• Severe difficulty
Pulse: 126 breathing
RR: 32 labored • Alert and oriented
B/P:104/86
Cap Refill: > 2 sec
PATIENT:
McBrayer, Zach
Sex: Male • Lower left leg fracture
• Difficulty breathing with
Pulse: 124 gurgling sounds
RR: 36 shallow • Anxious and somewhat
B/P:106/64 confused
Cap Refill: > 2 sec

PATIENT:
Smith, Susie
Sex: Female • No apparent injuries
• Staring and
Pulse: 102 unresponsive
RR: 24
B/P:98/56
Cap Refill: < 2 sec
PATIENT:
Michaels, Robert
Sex: Male • Impaired vision
• Nauseated
Pulse: 128
• Skin appears swollen
RR: 31 • Difficulty breathing
B/P:144/56 • Disoriented
Cap Refill: < 2 sec • Difficulty following
commands
PATIENT:
Shores, Katie
Sex: Female • Third degree burns
over 95% of body
Pulse: 46 • Unresponsive
RR: 8
B/P:88/52
Cap Refill: > 2 sec
PATIENT:
Applebaum, Pete
Sex: Male • Severe eye pain
Pulse: 108 and face
RR: 28 labored • Painful swallowing and
B/P:146/100 inhalations
Cap Refill: > 2 sec

PATIENT:
Bowers, Janet
Sex: Female • Dry raspy cough
• Anxious
Pulse: 118
• Noticed a pleasant
RR: 28 fresh mown hay smell
B/P:114/70
Cap Refill: < 2 sec
PATIENT:
Drummond, Frances
Sex: Female • Broken right arm
• White powdery
Pulse: 104 substance covering
RR: 24 body
B/P:98/56 • Swollen glossy skin
• Coherent
Cap Refill: < 2 sec
PATIENT:
Joiner, Irene
Sex: Female • Other than bruise on
forehead appears
Pulse: 54 healthy
RR: 16 • Unresponsive
B/P:102/48
Cap Refill: > 2 sec
PATIENT:
Parker, Marcia
Sex: Female • Difficulty breathing
• Irritated nose, throat
Pulse: 122 and lungs
RR: 34 • Anxious
B/P:130/76
Cap Refill: < 2 sec
PATIENT:
Chupp, Heather
Sex: Female • 3 months pregnant
• Nauseated, vomiting
Pulse: 138
• Some difficulty
RR: 20 breathing
B/P:124/86 • Alert but scared for the
baby
Cap Refill: < 2 sec
CBRNE Triage Signs and Symptoms
http://www.bt.cdc.gov/radiation/criphysicianfactsheet.asp
Courtesy of EPA Region 9 Emergency Response Section Introduction to

Ionizing Radiation for First Responders 10/01/07
Photo Courtesy of CDC’s PHIL # 7735

Photo Courtesy of CDC’s PHIL #1934

http://react.wi.gov/scrapbook_view.asp?locid=146&ssid=195&th
isslide=2243
http://react.wi.gov/scrapbook_view.
asp?locid=146&ssid=195&thisslide
=2240
http://www.nema.ne.gov/index_html?pag
e=content/home_news/beacon1003.html
http://www.vdh.state.va.us/OEMS/Training/ResourceCD/Moulage.htm

Hands-On Training For CBRNE Incidents

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Hands-On Training for CBRNE Incidents

Table of Contents Participant Manual

Introduction and Overview

Introduction and Overview

 Principles of Mass Casualty Response

Module # Module Title Time Allocation

 Completion of the AWR-160 Standardized Awareness

• Explain the course of action for a CBRNE response, including

 Participants should be able to

Continuing Education Units

Class Administration (continued)

 Please refrain from use of profanity while at the CDP

CDP’s participant risk reduction includes the following:

Safety Briefing (continued)

Safety Briefing (continued)

Safety Briefing (continued)

Introduction to Lanes Training

During lanes training, participants are introduced to the

Introduction to Lanes Training

To dress out, vitals must meet the following criteria:

Participants are issued the following training items:

General Safety Rules

 Take time to perform each task

Heat stress indicators

Hand and Arm Signals

CDP signals used during training are

Hand and Arm Signals

In an emergency, follow these procedures:

Code of Federal Regulations (C.F.R.) standards regarding the

Overview of Hands-On Lanes

Hands-on lanes training includes

Overview of Hands-On Lanes

casualties. Participants engage in a discussion of a technical decontamination corridor

Module 1: Hands-On Lanes Training

Methods of Instruction: In Lane 1A, instructors use a facilitated lecture format

Lane 1A: Principles of Mass Casualty Response

Instructor-to-Participant Ratio: 2:12

Triage Color-Code System

– Greater than 30 respirations per minute—Immediate (Red) classification, and

Key Point: Triage of nonambulatory casualties should focus on RPM.

Signs of CBRNE Injuries

Nerve Agent Antidote

marked airway damage; and gastrointestinal effects. Medical management includes

Mass Casualty Response Exercise

 What were the most difficult tasks during the exercise?

Lane 1B: Decontamination and SCBA

coach participants as needed as they operate an SCBA. Instructors also demonstrate

Reasons for Decontamination

Enabling Learning Objective 1B-5: Explain special considerations associated with

Special Considerations Associated with Decontamination

PPE Considerations During Decontamination

Enabling Learning Objective 1B-7: Operate SCBA in accordance with manufacturers’

Operational Checks on SCBA

Donning the SCBA

Doffing the SCBA

Self-Contained Breathing Apparatus (SCBA)

Enabling Learning Objective 1B-8: Perform nonambulatory decontamination consistent

Nonambulatory Casualty Clothing Removal Procedures

Decontamination of Nonambulatory Casualties

Enabling Learning Objective 1B-9: Discuss technical decontamination setup and

 What were the most difficult tasks during the exercise?

Lane 1C: Scene Survey and Safety

Required Reading: None