Appendix 2. Detailed Summary of Breakout Sessions

Transportation

The transportation breakout group concentrated on identifying the specific knowledge requirements of highway and railroad workers. Within this category are many diverse workers, including drivers, loaders/unloaders, vehicle maintenance workers, warehouse workers, truck stop personnel, dispatchers, and security personnel. The railroad personnel specialized in a variety of crafts, including engineers, conductors, car men, track and signal workers, in-plant rail workers, loaders/unloaders, dispatchers, and yardmasters. Participants stressed that in the transportation industry many workers may not have received basic health and safety training.

Pipeline, maritime, and airway workers were generally not considered by the workshop participants, because each group had a specific operating environment and legal/regulatory environment that would affect the knowledge and skill requirements of the workers. For highway and railroad workers, specific knowledge and skills that were identified as desirable by the group included:

• Knowledge Requirements for Transportation Workers:
  
  
  • Familiarity with current Federal laws/policy
    
    
  • Knowledge about chemicals that could be used as weapons of mass destruction (WMD), and general knowledge about chemical toxicity, reactivity, and compatibility
    
    
  • Knowledge of hijacking avoidance
    
    
  • Communication in the event of an emergency
    
    
  • Knowledge of the Emergency Response Guidebook (ERG)
    
    
  • Knowledge of ICS
    
    
  • Skills in First aid/Cardio-Pulmonary Resuscitation (CPR) specific to CBRNE
    
    
  • Awareness of potential targets
    
    
• Skills for Transportation Workers:
  
  
  • Emergency action plan awareness and training
    
    
  • Knowledge of hazard avoidance
    
    
  • Awareness of appropriate initial response (SWIM: Secure area, Warn others away, Isolate, Move upwind)
    
    
  • Knowledge of personal worker limitations (how far to go, or not to go, in CBRNE events)

The participants emphasized that the use of case studies, such as those at the National Transportation Safety Board, could be very helpful in training and creating awareness of past incidents. The participants also suggested a number of specific requirements for different types of workers (below).

• Knowledge Requirements for Highway Workers:
  
  
  • Nuclear/radiological knowledge (suggestion to seek Nuclear Regulatory Commission (NRC) resources and information, as well as from the U.S. Department of Energy (DOE) or the Health Physics Society)
    
    
  • Anti-terrorism, security, and situational awareness (routes, loads, etc.)
    
    
  • Target hardening
    
    
  • Specific training for dispatchers in emergency situations (terrorist acts, CBRNE). Global Positioning Satellite Technology is becoming more prevalent, along with the ability to control or disable a train from a remote location
    
    
• Specific Skills Recommended for Highway Workers:
  
  
  • Management training: basic security training
    
    
  • Need for labor-management cooperation
    
    
  • There is a need for worker input and feedback on training components
    
    
  • Basic awareness of ICS
    
    
  • Knowledge and awareness of training opportunities
    
    
• Specific Skills for Railway Workers:
  
  
  • Awareness of situational terror targets, such as bridges, tunnels, and crossings
    
    
  • Training to resist profiling of public and coworkers (based on activities)
    
    
  • Awareness of signs and symptoms for workers on commuter rail and bus lines (smallpox, anthrax release)
    
    
  • Awareness training for workers at transfer points

Manufacturing

The breakout session on training manufacturing workers for CBRNE weapons discussed a wide range of manufacturing enterprises. The group started with some basic premises: (1) While many workers were focused on biological threats, there was a need to focus on the vulnerability of the particular manufacturing enterprise as well, which in many cases might be chemical or physical hazards, rather than biological. (2) Not all workers have basic health and safety skills, but these are essential for addressing new threats. (3) The risk of chemical hazards in the workplace is always present. (4) Prevention should be emphasized, including facility design, plant access, and other engineering and systems controls. (5) There is a need for guidelines and recommendations to remain up to date, particularly because standards are always moving; and (6) There is a need to “authenticate” training, to ensure that it is effective and that the training results in changes in behavior. The importance of effective communication at all levels of the organization was stressed. Several participants noted the OSHA Process Safety Management standard, particularly in its application to general manufacturing enterprises. It was noted that there is likely to be a need for updated safety equipment, based on the needs assessment and training recommendations. Because manufacturers are using a significant number of temporary employees and contractors, the training of these individuals was raised as a specific concern.

Several additional points were raised in the discussion. The HAZWOPER and Process Safety Management standards are very important parts of worker training for the first and second wave of responders, yet few companies have the Process Safety Management standard in place. The emergency response plan has to be integrated with community emergency plans and other appropriate organizations.

Emergency Response

Emergency responders include firefighters, police, emergency medical service (EMS) personnel, and hazardous materials (HazMat) responders. They have applicable standards and guidelines, and there are also numerous training programs available (though not universally). Participants identified the following as specific knowledge and skills that different emergency responders might need in responding to CBRNE events:

• Law Enforcement
  
  
  • Awareness level HazMat /CBRNE training
    
    
  • Hazard recognition
    
    
  • Initiating the Emergency Response system

The knowledge and skills that were identified as unique to particular emergency responders included:

• Law Enforcement Personnel
  
  
  • Isolation, quarantine, lockdown, and crowd control
    
    
  • Transportation corridors
    
    
  • Evidence collection and retention
    
    
• EMS
  
  
  • Patient symptoms
    
    
  • Call patterns
    
    
  • Self protection (PPE use and limitations)
    
    
  • Decontamination
    
    
  • CBRNE treatment protocols
    
    
• Fire Service
  
  
  • Extensive Incident Command System (ICS) training
    
    
    • Defining the chain of command
      
      
  • Hazardous Materials/CBRNE Operations level training
    
    
    • Defensive actions
      
      
  • Monitoring/detection devices
    
    
    • Recognition and identification of different threat agents
      
      
  • Isolation zones and perimeters
    
    
  • Communications
    
    
    • Functional across response and support groups
      
      
  • Refresher training
    
    
    • Need to refresh basic hazardous materials (HazMat) skills, in order to effectively employ CBRNE skills
      
      
• HazMat
  
  
  • Should include all of the competencies from the fire service
    
    
  • Needs to include technician and specialist level skills that combine HazMat and law enforcement techniques
    
    
• Emergency (911) Dispatchers

The last category, emergency dispatchers, was singled out for discussion because of the central role these workers play in coordinating response among various services. This was a common theme sounded by several groups—that workers involved in communication had a particularly important role to play, yet they were not often included in the training for emergency response incidents.

Health Care

The health care session focused primarily on defining health care training needs in hospitals. Even within the hospital setting, there are many different types of workers, in many different settings, whose specific training requirements need to be addressed. The core knowledge and skill requirements for preparedness identified by the participants included:

• General knowledge requirements for health care workers
  
  
  • Knowing both who to notify if a threat is identified and the person responsible for making the notification
    
    
  • Functional role in the health care setting
    
    
  • Role in the Emergency Response System
    
    
  • Awareness of the national and local “mutual aid” groups
    
    
  • Incident command structure
    
    
• General skills required of all health care workers
  
  
  • Computer and internet skills and electronic communications
    
    
  • Skills required for the worker’s functional role
    
    
  • Problem-solving skills

In addition to the general knowledge and skills related to preparedness that are listed above, there are specific knowledge and skills required for different health care workers confronting CBRNE threats:

• Specific knowledge requirements for all health care workers confronting CBRNE threats
  
  
  • Knowledge about the specific CBRNE hazards
    
    
  • Communication to appropriate authorities
    
    
  • The contents of the eight-hour HAZWOPER course
    
    
  • Training on the recognition of post-traumatic stress disorder
    
    
  • Full training for emergency room personnel on CBRNE hazards
    
    
• Specific skill requirements for health care workers responding to CBRNE threats
  
  
  • Cross-training
    
    
  • Experience with pre-planned CBRNE disaster response (exercises)
    
    
  • Integrated training of a “medical reserve corps”
    
    
  • Treatment of post-traumatic stress disorder

Participants emphasized the importance of resolving liability issues around training for CBRNE threats, and the need for rehearsal of disaster plans, and training on decontamination. The opportunities for learning from international partners were also stressed, and there was discussion of the need for multilingual training of this particular workforce. Finally, participants stressed that a culture change in hospitals is required; because emergency response is local, there is a need to train and empower workers at the lowest level of the hospital, and to have the leaders of health care institutions appreciate the importance and the need for training. Some participants noted that, in the drive for quality in health care, this could be a major issue, and that there would be a need for evaluation and practice following the training activities.

Skilled Support Personnel

The skilled support breakout group identified a number of critical issues, in addition to the specific knowledge and skill requirements for skilled support workers: (1) Is there a role for certification or licensure of skilled support workers? and (2) Who should do the training, and should there be licensure of trainers? A number of participants felt strongly that workers must have specific training before commencing work, and that they must be certified to do their job if the potential exists for them to be exposed to hazards. Others felt that this is essentially impossible under the current lack of mandatory, enforceable, certified training standards across jurisdictions. This same thought was echoed across the concept of emergency response/rescue (with site-specific instructions) and long term response (where only contractors with appropriate qualifications are employed for this phase). The question raised was: at what point in the response is it appropriate for OSHA or another regulatory body to enforce standards? There was agreement that enforcement of training requirements on the site was necessary.

• Recommended Knowledge/Skill Requirements for Supervisors/Foremen/Stewards:
  
  
  • A minimum of the OSHA 10-hour course in terms of basic skills
    
    
  • HAZWOPER, PPE (especially respiratory protection), hazard communication, and decontamination procedures
    
    
  • ICS
    
    
  • Local/community emergency plans
    
    
  • Critical incident stress—a response to events
    
    
  • Emergency preparedness: site security, what skills or equipment may be needed, and where to get them
    
    
  • CBRNE awareness and risk communication. Supervisors should be able to communicate risk to workers
    
    
  • Personal health protection—not just regarding CBRNE agents, but other factors that could be dangerous, such as heat stress

It was suggested that training should include a description of the consequences of failure to adhere to proper procedures, perhaps through case histories. The need for refresher training was stressed, as was the need for site-specific training as soon as workers arrived on-site. The need for multilingual training was also stressed.

• Recommended Requirements for Skilled Support Workers:
  
  
  • OSHA 10-hour course
    
    
  • Respiratory protection and PPE training and fit-testing
    
    
  • ICS
    
    
  • Critical incident stress awareness/management
    
    
  • Decontamination
    
    
  • Personal health protection
    
    
  • Site-specific training can come later

Participants also noted that, although computer-based instruction for the non-hands-on (knowledge) component of the work was suitable, it was not sufficient for the hands-on (skills) component of the workers’ activities.

Decontamination/Remediation

The decontamination/remediation group focused on workers who would be involved in decontamination or remediation of sites that had been exposed to biological, chemical, radiological, nuclear, or other weapons of mass destruction. It is important to note that all of the decontamination/remediation activities would be covered under the HAZWOPER standard, as mentioned earlier in this report. It was the goal of the group to go beyond the general requirements of the HAZWOPER standard to consider additional skills or knowledge that might be required of specific trades in specific circumstances. The group also discussed issues related to credentialing, a topic that has also been addressed in reports by the National Clearinghouse for Worker Safety and Health Training (see footnote 10). The group spent considerable time defining different categories of workers and exposures, and was able to draw some general conclusions about the types of training that would be involved for the workers. A large number of different personnel were considered likely to become involved, at some level, in remediation activities, including: line workers, supervisors, project managers, health and safety personnel, security, union representatives, medical/emergency response, transportation workers and employers, regulatory agencies, owners, public relations workers, insurers, volunteer agencies, engineers, and vendors.

• Knowledge Requirements for Remediation/Clean-Up Workers:
  
  
  • Transportation/disposal handling
    
    
  • Security at the remediation site
    
    
  • Familiarity with technology and equipment used in remediation activities
    
    
  • Regulations/best information/best management practices for remediation and safety
    
    
  • Stop-work knowledge
    
    
• Skills Applicable to Remediation/Clean-Up Workers:
  
  
  • How to recognize and prevent cold/heat stress
    
    
  • Decontamination practices—equipment/supplies, site, and workers
    
    
  • Remediation methods
    
    
  • Waste handling
    
    
  • Engineering controls
    
    
  • Evidence collection
    
    
  • Practicing chain of command—stop work
    
    
  • Monitoring—health, environment, and safety

Participants emphasized the need to address certain critical issues, including: training and pre-qualification of workers who would be eligible to go on-site; liability; and the “fear factor” present in dealing with contaminated sites. They also discussed the importance of daily safety briefings and regular safety inspections.

• Specific knowledge and skills for workers involved in chemical remediation (remediation of sites exposed to chemical weapons):
  
  
  • Process safety management (PSM)—reactive hazards
    
    
  • Compatibility
    
    
  • Remediation techniques
    
    
  • Hazard communication
    
    
  • Specialized personal protection equipment
    
    
  • Structural integrity changes
    
    
  • Specialized environmental monitoring equipment
    
    
    • Long-term medical monitoring
• Specific knowledge and skills for workers involved in sites contaminated by radiation:
  
  
  • Monitoring—specific
    
    
  • Different PPE—based on dose “as low as reasonably achievable” (ALARA)
    
    
  • Remediation practices for heating, ventilation, and air conditioning equipment
    
    
  • Use of robotics
    
    
  • Broad area of remediation—indoor vs. outdoors
    
    
  • Knowing if there are pre-qualifying doses for workers who have previous exposures and how much prior exposure should be allowed before they are unable to work on a decontamination project
    
    
  • Disposal/transportation
    
    
  • Long-term security issues
    
    
  • Specific decontamination procedures
    
    
• Specific knowledge and skills for workers involved in sites contaminated by biological agents:
  
  
  • Infectious vs. non-infectious agents
    
    
  • Lack of knowledge of agents
    
    
  • Vaccines/antibiotics
    
    
  • Long-term monitoring/diagnoses
    
    
  • Pre-qualification—medical—eliminating the work force
    
    
  • Hazards of remediation

The critical issue raised by the breakout session participants for this area concerned training and pre-qualification of workers who might be called upon to respond in the event of a CBRNE event. Questions included the following: (1) Is there a need for comprehensive training requirements across groups of workers at the remediation stage? (2) Who provides the training? (3) Who develops the substantive content of the training? A related question involving the medical pre-qualification requirements of trainers was discussed but was not explored in depth by the group.