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In case of attack, follow their lead

Boston center sets training standard

Emergency responders practiced for disaster in protective suits at the DelValle Institute in Mattapan. Emergency responders practiced for disaster in protective suits at the DelValle Institute in Mattapan. (Joanne Rathe/ Globe Staff)
By James F. Smith
Globe Staff / June 15, 2009
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Brookline police Sergeant Robert Disario donned thick blue-green gloves, yellow rubber boots, gas mask, and respirator, and colleagues taped the seams on his chemical-proof plastic suit. Then he waddled around a parking lot in Mattapan, imagining what it would feel like to be rushing to the scene of a terrorist attack somewhere in Greater Boston.

Disario and 31 other officers from Boston-area communities spent three days last week in a course that prepares medical and security personnel for terrorist attacks or other disasters that could result in mass casualties.

It was just one of hundreds of hands-on courses run by Boston's DelValle Institute for Emergency Preparedness, which was set up in 2003 by the city's Emergency Medical Service and the Public Health Commission. The institute may be little known in Boston, but it has won praise from national antiterrorism specialists.

Nearly 13,000 nurses, doctors, police officers, ambulance teams and other emergency personnel have been through DelValle's training courses, in the classroom in downtown Boston and in hands-on learning - mainly at a steel-framed EMS station in Mattapan.

This week, the DelValle Institute will extend its reach internationally when experts from countries targeted by recent mass-casualty terror attacks meet here with their local and national counterparts. At a conference today at the John F. Kennedy Library, specialists from Pakistan, India, Israel, Spain, and Britain will brief Boston emergency specialists and officials from the At lanta-based Centers for Disease Control and Prevention, the primary US government agency responsible for medical responses to emergencies.

And tomorrow, the CDC team will draw on what it learned from the Boston conference to update its main teaching blueprint for emergency systems to respond to terrorism, titled, "In a Moment's Notice: Surge Capacity for Terrorist Bombings."

One of the national experts who helped draft that document in 2006 was Chief Richard Serino, who heads Boston's Emergency Medical Service.

Serino grew up in Dorchester. After high school, while studying at Boston State College (now part of UMass-Boston), he started working as an emergency medical technician and then rose through Boston's EMS ranks.

His hands-on grasp of the work helped him get promoted to superintendent of field operations in 1993 and then chief of EMS in 2000. Last year, he was national EMS chief of the year.

Serino named the DelValle Institute after Manuel DelValle, who was the stepson of Dr. Peter Moyer, former medical director of Boston EMS.

Delvalle was a New York City firefighter who died responding to the 2001 attack at the World Trade Center. The center opened in 2003 and operates on a budget of just under $1 million that comes mainly from federal grants from the CDC and the Department of Homeland Security.

At the Mattapan training center last week, four trainers put the 32 veteran police officers, including a number of detectives, through three days of preparation for using gear needed for protection and for decontamination in a chemical-weapon attack or accident.

Boston Patrolman Jim Davis, who works in the commercial vehicle enforcement unit, advised the officers donning protective masks: "Put your chin in first," "Don't make the tape too tight," and "Keep yourself hydrated."

One goal was to let the trainees touch and smell the gear and get comfortable with it. Police Lieutenant Paul Ivens, a veteran trainer who works in the domestic violence unit and spent 11 years in special operations, told the officers: "Now you know why you can't just watch a video. You have to do it hands-on. You can't absorb it otherwise."

EMS Lieutenant Brian Pomodoro, the lead trainer for the DelValle Institute, has run disaster courses for doctors, emergency technicians, local environmental officials, and police officers since 2004.

"You have to train and train again," Pomodoro said. "In times of stress, you always revert back to what you learned in training."

Firefighters are the principal first-responders to emergencies, he noted, and go through far more intensive training in use of breathing apparatus and avoiding chemical dangers in accidents.

But because other municipal officials could end up playing a role at a disaster scene, the more who understand what's at stake, the better.

The trainees posed practical questions: For example, should they keep their firearm holstered and inside the chemical suit, or keep it outside and ready to use?

The answer: If it's an evidence-gathering mission after an incident, keep it inside; if it's a live crime incident, guns should be at the ready.

"In the event that we have to handle decontamination, now we're on the same page and we know what we're doing," said Disario, the Brookline sergeant, after learning the painstaking steps to remove the gear without touching its surfaces. "There's no guesswork. For cohesion, this is great."

That practical, collaborative spirit also guides the national Centers for Disease Control and Prevention's national policy-making, said Dr. Richard C. Hunt, director of the Division of Injury Response within the CDC Injury Center.

Hunt and several senior CDC colleagues will be in Boston to hear from the international experts about their recent attacks as well as learn from local officials handling day-to-day preparation for possible incidents.

"This conference is about people with real-world experience, who are actually having to respond to these things. That is invaluable to us," said Hunt. "We'll take that real-world experience, and make it part of a document that matches real-world challenges with real-world solutions."

Dr. Paul Biddinger, director of disaster medicine at Massachusetts General Hospital and head of the disaster preparedness center at the Harvard School for Public Health, said Serino has set a national example for collaboration by including in the training and planning all the players involved in a potential disaster, from staff of hospitals, EMS, and in public health to firefighters and police officers.

Serino insists that the training should not be limited to one hospital or police force but should involve people from different areas of expertise and from all of the nine communities that make up the Boston homeland security area: Boston, Brookline, Cambridge, Chelsea, Everett, Quincy, Revere, Somerville, and Winthrop.

"You don't want to be exchanging business cards at the scene of an incident," he said. "We want people to know each other. We need to build relationships."

The terrorism surge document that Hunt's CDC team will update tomorrow and Wednesday drew heavily on the lessons from Madrid's response to its March 2004 train bombings that killed 200 people, wounded more than 2,000, and sent more than 300 patients to one nearby hospital.

Terrorism attacks have escalated and grown more sophisticated since 2004. Biddinger said that as specialists learn from these attacks, they are recognizing the unique effects of terror blast injuries in the lungs, abdomen, and head, and health systems are learning how to move patients quickly and efficiently among hospitals in the critical early minutes after explosive blasts.

The Boston gathering will provide insights on more recent attacks from specialists including Dr. Aparna Deshpande, a surgeon and professsor at a major hospital in Mumbai, site of a brutal terror attack last year, and Rashid Jooma, who has just been named health minister in Pakistan.

"From Madrid to London to Israel to India, we'll start to see patterns that will help us," Serino said. "No one agency can do it alone, and no one city can do it alone."

James F. Smith writes about Boston's global ties. His blog is www.boston.com/worldlyboston. He can be reached at jsmith@globe.com