In dangerous environments, Lohrenz said, leaders must be able to decide what is most important about the work at specific times. She recommends a process she calls “prepare, perform, prevail,” which involves setting clear objectives, rules, and expectations, assigning accountability, and planning to debrief.  “Risk management and operating safely is everything” to fighter pilots, she said. “We take the time to brief our team [so that] everybody knows what success is going to look like. [And] after every single flight, we debrief.” Lohrenz challenged attendees to use what they learn at the conference to influence their organizations and broader communities. “The only way any of this is going to make a difference is if you take action,” she said. “If you can simply do one thing every day that either puts a pit in your stomach or a lump in your throat, I promise you will inspire and empower everyone around you to step up and start owning their role as a fearless leader as well.” FOURTH-GENERATION NERVE AGENTS On March 4, 2018, in Salisbury, England, Sergei Skirpal and his daughter Yulia were found slumped on a park bench, vomiting and suffering from seizures. An investigation eventually uncovered that operatives working for the Russian government had sprayed a doorknob at Sergei’s house with a fourth-generation nerve agent, or FGA. The attack was an act of retribution against Sergei Skirpal, a Russian double agent. Following the incident, the White House National Security Council convened a working group to develop resources for emergency responders in case a similar exposure occurs in the U.S. At AIHce EXP 2019, two industrial hygienists involved with the working group, John Koerner of the Department of Health and Human Services and Jennifer Hornsby-Myers of NIOSH, shared what they had learned about FGAs. Koerner explained that FGAs are distinct from highly volatile chemical warfare agents such as sarin and low-volatility agents such as VX. FGAs are more persistent, and detection is problematic. Hornsby-Myers emphasized that a failure to detect FGA doesn’t mean it isn’t present. In cases where signs and symptoms suggest the presence of FGA but instruments don’t detect it, “go with signs and symptoms,” she said. Both presenters highlighted the need for emergency responders to follow proper protocols when responding to incidents with unknown chemical hazards, such as wearing appropriate PPE.  The resources developed by the National Security Council working group include a summary of the events in Salisbury written for emergency responders, medical management guidelines for FGAs, and an FGA reference guide that resembles a safety data sheet. The resources can be accessed online. IH AND THE OPIOID CRISIS At a session on May 20, Peter B. Harnett, chair of AIHA’s Opioids Responder Working Group, discussed the group’s initial focus on the health and safety of first responders to opioid-related incidents. Working group members have participated in outreach and training efforts, responded to a NIOSH request for input on a fentanyl wipe procedure, and developed an opioid response card template for first responders. The template was adapted by the New York City Police Department, and now more than 50,000 police officers and staff have access to the information, Hartnett said. Working group member Jonathan Rosen spoke next about the National Institute for Environmental Health Sciences training program for workers with potential for occupational exposure to fentanyl and other opioids. The program teaches workers the signs and symptoms of exposure, control measures, and methods for decontamination and cleanup. Rosen noted that organizations should tailor the training to their own policies, procedures, and personal protective equipment. One challenge for police and responders is that they often don’t know how much drug material is present until they arrive at the scene. After arrival, it would be difficult for responders to change their level of protection, Rosen explained. Rosen noted that science organizations have advised that incidental skin contact with dry opioid products is not likely to cause overdoses, but NIOSH has not had the opportunity to do real-time monitoring. None of the agency’s health hazard evaluations have been able to determine exactly how people were exposed. Rosen also highlighted the need to encourage workers with opioid addiction to access treatment. “If people have a substance abuse problem in the workplace, we want them to feel comfortable coming forward,” he stressed.