Transportation Sector

The transportation industry is highly integrated and highly interdependent. However, there are many small and independent operators in some transportation modes, which can be a challenge when thinking about worker safety training. In addition, there are many government agencies that regulate or influence the industry. This panel dealt primarily with surface transportation, although all modes were discussed to some extent. Panelists noted that the transportation system incorporates a wide variety of jobs. The system transports a large quantity of hazardous materials on a constant basis. The U.S. Department of Transportation (DOT) has general training requirements for transportation workers, including⁵ :

• Familiarity with the general provisions.
  
  
• Ability to recognize and identify hazardous materials.
  
  
• Knowledge of specific requirements for the transport of hazardous materials.
  
  
• Specific functions performed by the employee during normal and abnormal operating conditions.
  
  
• Familiarity with emergency response information such as the Emergency Response Guide (ERG).
  
  
• Ability to perform self protection safety measures.
  
  
• Understanding of accident prevention methods and procedures.

While much attention has been focused on the vulnerability of the transportation infrastructure, the vehicles, and the cargo, panelists emphasized that less attention has been focused on the need to train vehicle operators or those who support the industry.

Manufacturing Sector

The panel discussing the manufacturing sector workers noted that many manufacturing companies are now looking at new threats and their potential risk. Panelists emphasized the need to apply basic principles of public health and prevention to the problem, including the hierarchy of controls, which specifies that preventive strategies, such as substitution of less dangerous products, use of engineering controls, or isolation of hazardous processes, are preferable to measures such as personal protective equipment (PPE). Some industries (such as the chemical industry) have been interested in this issue for years and have developed relatively sophisticated plans, while other companies are just beginning to address the problem.

It was noted that existing standards have already influenced the planning in this area. Applicable standards include the HAZWOPER, Egress and Evacuation, and Process Safety Management standards⁶. The need for real-world drills was emphasized by the panel. The panelists stressed the need to err on the side of safety, by following basic public health principles of preparedness and prevention. The threat assessment should include all threats, including chemical, biological, radiological, nuclear, and high explosives (CBRNE). In assessing the threats to an individual company, among the most significant are those manufacturing facilities with chemical storage.

Pre-event planning should include consideration of the root causes of the problems and potential corrections and prevention measures. The hierarchy of controls applies to new threats, as much as to traditional hazards. Thus, the design of industrial processes, including redundancy of controls, needs to be considered. Detailed emergency response plans, which include knowledge, skills, and constant practice, should also be prepared. In making plans for emergency response, some employees such as the local emergency responders or volunteer fire fighters, may have dual responsibilities. Panelists also mentioned that health care providers who treat workers who are potentially exposed to CBRNE agents should have a heightened index of suspicion and should not wait for “proof” of exposure.

It was also noted that OSHA has some existing training requirements for emergency response planning:

• 29 CFR 1910.38 Employee emergency plans
  
  
  • (a)(5) Training
    
    
• 29 CFR 1910.120(q) Emergency response to hazardous substance releases
  
  
  • (6) Training
    
    
• 29CFR 1910.1200 Hazard Communication
  
  
  • (h) “Employee information and training”
• 29 CFR 1910.1450 Occupational exposure to hazardous chemicals in laboratories
  
  
  • (f) Information and training

The National Fire Protection Association (NFPA) also has training requirements in NFPA 1600, Disaster/Emergency Management and Business Continuity Programs, and a number of other resources. Other organizations have also prepared plans and guidance on emergency response, chemical process safety, and emergency management⁷.

Health Care Sector

The health care panel addressed several critical issues in training health care workers who may need to respond to CBRNE events and treat those affected by CBRNE weapons. One critical issue of immediate importance is the smallpox vaccination. The panel addressed some issues related to training and vaccination, particularly towards the communication related to the risks of vaccination. Using smallpox as an example of an airborne pathogen, one panelist posed the possibility of developing a standard for airborne pathogens analogous to the OSHA bloodborne pathogens standard (29 CFR 1910.1030).

Training the health care workforce is complicated, in part, because it is a large, diverse workforce with many different professions and types of workers. Research at the Columbia University Mailman School of Public Health Center for Public Health Preparedness has focused on the training needs of health care workers. Pilot studies suggest that training is effective, but that the availability of health care workers in an emergency may be influenced by many external factors including the availability of childcare and/or eldercare, personal health problems, or concerns about compensation.

The diversity of the health care system is such that there are both core and specific training competencies for health care workers. Public health agencies, for example, must continue to deliver essential services even while they may be responding to an emergency. Dr. Kristine Gebbie of the Columbia University School of Nursing described the training needs of the public health workforce. These needs include: communication systems; emergency management or command systems; specific technical knowledge; and mental health skills. Core competencies for emergency preparedness for public health workers have been promulgated by the Centers for Disease Control and Prevention (CDC) (See Figure 5). Newer competencies, based largely on the core competencies, are being developed for specific types of emergencies (e.g., bioterrorism events) and specific types of workers (e.g., administrators, clinicians, laboratory workers, public information officers, technical and support staff, etc.) across all phases of an event⁸. Competencies in additional areas, such as informatics and legal issues, also need attention and are in development.

Emergency Response Personnel

First responders include fire fighters, emergency medical technicians (EMTs) and paramedics, and police. Based on the focus groups, first responders expect they will be at risk in any future events involving CBRNE weapons. This has led to some changes in risk perception, as well as a recognized need for more and improved equipment and training for hazard detection, health surveillance, communications, personnel tracking, and personal protective equipment (PPE). In addition, having immediate digital references available in the field will improve hazard recognition and threat management. There is a need to augment basic skills training, particularly with respect to hazardous materials and CBRNE weapons, personal scene safety, risk management, and cross-training with federal responders and skilled support personnel. All new recruits identified as first responders should be trained to the operations level. There is a new increased focus on detection, protection, and decontamination.

The first responder community has long been aware that, in any event involving CBRNE weapons, they will (by definition) be the first on scene and are among those with the greatest potential for exposure. Panelists noted that the training for CBRNE threats had much overlap with existing training for management of hazardous materials incidents. Some of the elements of this training include:

• Maintaining personal safety at the scene.
  
  
• Assuring that all recruits receive training.
  
  
• Improving access of first responders to “real-time” expertise and detection equipment.
  
  
• Improving coordination of emergency responders with other responders, support personnel, and clean-up personnel.

Challenges at the state and local level for emergency responders include new threats, more requirements for planning and meeting, as well as the increase in the core mission of the fire service and first responders. First responder health and safety is still the priority, and basic training needs should address these issues. The hazardous materials-level training that should be provided to every first responder includes: (1) use and limitations of personal protective equipment (PPE) (especially respiratory protection); (2) vaccination against bloodborne pathogens; (3) communications; (4) command structure; and (5) basic operations. Partnerships are key in developing effective training, especially given the magnitude of the need and the limited resources.

Skilled Support Personnel

Skilled support personnel are those workers temporarily on a site for specific purposes, defined in the HAZWOPER standard⁹. Although skilled support personnel are thought of as temporary workers, in the case of the World Trade Center and Pentagon, they remained on-site for many months. With these factors in mind, their estimates of exposure potential need to be considered carefully.

Training for skilled support personnel has been recognized as a critical issue in the wake of the events of September 11, 2001. Among the issues that affect training for skilled support personnel are:

• Construction procedures are defined by contracts, and in these events there were no established contracts and no planning for the project.
  
  
• The strict structure governing contractors, supervisors, and workers was absent, compared with normal construction operations.
  
  
• There was both formal and informal training, with less formal training at the outset, followed by more formal training after several months.

What kind of training is needed, based on the lessons from September 11, 2001 and afterwards? First, an identification of the hazards and the exposed population is basic and critical. Second, supervisors need to know the capabilities of their workers, and they need to do as much advanced training as possible. Issues such as confined space training, fall protection, night operations, HAZWOPER, and respirator training need to be incorporated into the basic training plans of the contractors, employers, and unions. Pre-incident and post-incident training should also be considered. A recent report by the National Clearinghouse for Worker Safety and Health Training highlights the importance of supplementing HAZWOPER training for skilled support workers, with more specific training that depends on whether the training is occurring pre-event or post-event.

Post-Emergency Response Clean-Up Operations

The challenges of post-emergency response clean-up operations were discussed in a number of other conference panels, although they were not the subject of a separate panel. As noted earlier: at the WTC, there was no clear delineation between the emergency response and the post-emergency response cleanup. The HAZWOPER standard currently distinguishes between these phases, although in large-scale disasters the line between the two may often be blurred. The challenges of post-emergency clean-up operations, which could involve decontamination of biological or radioactive materials, involve: (1) clearly defining when a site (or portion thereof) or response has moved from the emergency response to the clean-up phase; and (2) deciding what level of training is appropriate for those involved in clean-up as opposed to emergency response. These issues have been thoroughly discussed in several recent reports.^2,10 Clean-up operations (decontamination and remediation) frequently involve exposures, not only to the original hazards, but to an entirely new set of potential hazards. These hazards include: chemicals used in neutralization; combustion by-products; mold growth, as a result of water; and physical hazards associated with demolition can all be classified as potential hazards.