InterAgency Board Offers Opioid-Specific Recommendations for First Responders

The InterAgency Board (IAB) has released a summary of its recommendations for preventing first responder exposures to synthetic opioids, like fentanyl, during emergency operations. To understand the background for these recommendations, we’ll first review the IAB history and mission, as well as some of its recent publications and products. 

New challenges

The 1990s challenged and changed the emergency response landscape across the nation. The 1993 World Trade Center bombing in New York City, the March 1995 sarin incident in Tokyo, and the April 1995 Oklahoma City bombing made it clear that response agencies needed to upgrade their capabilities to match the evolving threats. 

During these years, responders preparing for incidents involving weapons of mass destruction (WMD) largely relied on tools adapted from laboratory or military technologies, and many performed poorly in the civilian environment. Federal defense and law enforcement organizations sought to support their civilian counterparts in the new threat environment, but much of the available equipment was designed for military use in overseas battlefield settings. Equipment developed for civilian emergency response to chemical or biological incidents through grants and other procurement mechanisms often impeded, rather than improved, operational readiness. 

In addition, there were no standards by which to judge technical performance. In incidents requiring mutual aid or federal emergency response, incompatibility of the various agencies complicated equipment operations. After-action reports frequently cited the need for interoperable communications, equipment and supplies. Local emergency responders and their federal partners needed a unified voice to advocate for developing equipment and standards that supported effective, coordinated and integrated responses to complex emergencies. 

Interagency community needs

As such, in 1998, the attorney general sanctioned the creation of an interagency working group comprising officials from various local, state and federal government response organizations. They were asked to develop, maintain and annually update a national standardized equipment list (SEL) for the interagency community, including fire, EMS, hazardous materials and law enforcement, to use in preparing for and responding to WMD and terrorism events.  

Supported by funding from the Departments of Defense and Justice, the 1999 Marshall Convention added National Guard representation to the federal and local emergency response professionals originally convened by the Attorney General. This unique assembly merged the mandate for an SEL with the need to develop performance specifications and standards for the equipment that was designed for use in the civilian response environment. This multi-disciplinary expertise in emergency response and the unique, collaborative working structure has since been known as the InterAgency Board for Equipment Standardization and Interoperability, or IAB.  

IAB today

IAB members come from all levels of government (federal, state, and county or municipal) and include subject-matter experts from operational, technical, support and research organizations. The IAB has established the following six working subgroups, each with a federal and a state or local co-chair: 

1. Equipment
2. Science & Technology
3. Health, Medical & Responder Safety
4. Training & Exercises
5. Standards Coordination
6. Information Management & Communications

The federal members whose agencies are also IAB funding partners make up the Federal Agency Coordinating Committee (FACC). The FACC articulates federal concerns related to emergency response capabilities and provides the funding to operate the IAB. The FACC and other federal members also help leverage ongoing research, development, test and evaluation (RDT&E) efforts when responder requirements are brought to them by consensus of the IAB members. The FACC and the IAB Leadership Team work together to prioritize IAB initiatives and projects, and to coordinate associated efforts within the federal community. The current FACC partners include the following: 

• Department of Defense, Joint Program Executive Office for Chemical and Biological Defense (JPEO-CBD) 
• Department of Defense, Combating Terrorism Technical Support Office (CTTSO), Technical Support Working Group (TSWG) 
• Department of Defense, Homeland Defense and Global Security (HD&GS) 
• Department of Defense, Joint Project Manager Guardian 
• Department of Homeland Security, Office of Health Affairs (OHA), Biowatch Program 
• Department of Homeland Security, Science & Technology Directorate (S&T), Support to the Homeland Security Enterprise and First Responders Group (FRG) 
• Department of Justice, Office of Justice Programs, National Institute of Justice (NIJ) 
• Department of Health & Human Services, National Institute for Occupational Safety and Health (NIOSH), National Personal Protective Technology Laboratory (NPPTL)

Based on direct field experience, IAB members advocate for and assist with developing performance criteria, standards, test protocols, and technical, operating and training requirements for equipment used in all-hazards emergency incident response. The IAB maintains a special emphasis on chemical, biological, radiological, nuclear and explosive (CBRNE) issues and provides subject-matter expertise to inform the development of emergency preparedness and response policy, doctrine and practice. 

Today, this mission to strengthen CBRNE preparedness and response has become more complex. Incidents routinely cross disciplinary lines and have raised citizens’ expectations of local, state and federal response capabilities. Public safety responses to local incidents have expanded to include emergency management and public health components, with state and federal assets supporting fire, EMS and law enforcement responses. Other assets—such as National Guard Civil Support Teams (CSTs), FBI Technical Hazards Response Unit, U.S. Coast Guard and U.S. Customs and Border Protection resource—are increasingly integrated into local planning and emergency response. Additionally, the nation’s fusion centers routinely share intelligence with local partners. Interagency cooperation across all tiers of response is vital as we work in this common mission space.  

The current membership of the IAB recognizes this interdependency and take an active role in all phases of planning, research and response. The members and subject-matter experts of the IAB work to identify and address issues that will improve this holistic approach to addressing the rapidly evolving needs of all emergency responders. The mission of the IAB is accomplished in the following ways: 

• Emphasizing interoperability, compatibility and standardization
• Fostering a multidisciplinary perspective
• Facilitating effective intergovernmental partnerships
• Being a credible voice of the responder community
• Being proactive
• Sharing field operational experiences and recommending best practices

More complete descriptions of the membership and activities of the IAB are published each year in the Annual Report. 

IAB products for the fire service 

Through the existing subgroups or through special project groups that are assembled to address contemporary threats and issues, the IAB develops various types of products to serve both federal and local response constituencies. For example, every year since its inception, the IAB has updated the annotated SEL, a source of valuable information for those preparing grant applications, especially for fire, rescue and EMS equipment. 

Primarily for its federal partners and private sector stakeholders, the IAB annually publishes a prioritized research and development requirements list. This list is generated from survey input submitted by the full membership, with all response disciplines and mission types represented. The proposed capabilities are outlined in a standardized matrix, along with brief descriptions of the requirements and some critical performance specifications.

The Training & Exercises subgroup regularly develops and publishes Training Triggers that can be adapted and expanded by emergency response organizations to address local threats or important operational concepts. Fire service members may be interested in the August 2017 issue, Training Trigger: Wildland Firefighting/Urban Interface.

Another product particularly relevant to firefighters is Recommended Actions Related to Reducing the Known Risk of Cancer in Fire Fighters. This report includes an extensive literature review with citations of important scientific studies upon which the IAB based its recommendations. 

With regard to prevention of first responder exposure to synthetic opioids, the IAB has published a comprehensive list of recommendations to assist policy and protocol developers at the agency or jurisdictional level. This document—Recommendations on Selection and Use of Personal Protective Equipment and Decontamination Products for First Responders Against Exposure Hazards to Synthetic Opioids, Including Fentanyl and Fentanyl Analogues—was published by the IAB in August 2017, after a review of the literature and by consensus of the IAB’s subject-matter experts, including responders representing fire, EMS, law enforcement and hazardous materials. This process was similar to that used by the IAB in 2014 to develop its PPE recommendations for emergency responders who could potentially be exposed to the Ebola virus. It is organized as a matrix, by exposure threat level and the type of mission the responder must accomplish while in the PPE.  

In sum

The products described here are a very small, fire-service-oriented sample of the resources the IAB has developed to improve the nation’s ability to prepare for and safely respond to the ever-evolving hazards that threaten our communities. Not only do these products enhance the effectiveness and safety of local emergency responses, but they also improve interoperability during large-scale events requiring integration of a federal, multi-agency response. The unique composition and structure of the IAB, combining federal and local responders across all response disciplines, have made these contributions possible.