Health & Environment
W<
A publication of the Freshwater Foundation
Featuring information from its Health & Environment Network
Volume 5, No. 11 January/February 1992
Special Report:
Emergency Planning
Medical Community
•^fSv.'-'i'>•'">.'• ''. " , - *
... ., ,''•", ~ft: 1-U:^SJ S'cff'Sf S^ll'h'*
When, a .bell sounded at ,1:0.5 pm at't!
?etroleum Company's Houston Chemical Complex on
October.23, 1989, employees knew it wasn't normal.
ijinutes. later, a massiye ^plosion ripped the refinery,
ailing 23 people and seriously injuring many others,
..Dazed and wounded, workers flefiing the shattered
Slant were met by emergency responders. Paramedics set
jbout treating the injured and arranging for their transport
O-hospitals. First responders radioed helicopters and
ambulances for assistance and .nptifiecLhospitals of incom-
; patients. They set up a sign-in area for employees
eaying the plant to determine how many were safe and
I: how many were still inside. They kept in contact with the
| hospitals to check on the accident victims and to make
jlTsure treatment centers weren't being overwhelmed. By
I 6:00 pm, the rescue was nearly complete.
F What made the response to the Phillips emergency
I so effective? The plant, police, fire fighters, medical
i responders, and hospitals were all part of a well-
I rehearsed plan designed specifically for dealing with
J local chemical emergencies. The plan, created and
|~ coordinated by the Pasadena (Texas) Local Emergency
t Planning Committee, was the direct result of federal leg-
j; islation, the Emergency Planning arid Community Right-
to-Know Act of 1986 (EPCRA), commonly known as
Title III of the Superfund Amendments and Reauthor-
ization Act (SARA).
Planning requirements
Under SARA Title III, each state must establish a
chemical emergency planning structure. To aid local
planning, industries, laboratories, hospitals, and other
facilities are required to identify the extremely haz-
ardous substances (EHSs) (above specified quantities)
that they keep on the premises. Title III also requires
facilities to supply state and local planners with informa-
tion about hazardous chemicals in the community.
Because citizens should be aware of chemical hazards in
their community, Title III provides access to information
about these hazards and a process for preparing
responses to the potential emergencies they pose.
The State Emergency Response Commission (SERC)
established by the governor of each state guides chemi-
cal emergency planning. Each SERC comprises a broad
spectrum of organizations, including state agencies
(environmental, emergency management, health, trans-
portation, etc.), environmental and public interest
groups, health professionals, and the media. The SERC,
in turn, designates local planning districts and appoints,
supervises, and coordinates Local Emergency Planning
Editorial Board
Richard H. Adamson, Ph.D.
National Cancer Institute
Henry A. Anderson, M.D.
Wisconsin Division of Health
Ralph Cook, M.D.
Dow Chemical Company
John Doull, M.D., Ph.D.
University of Kansas Medical Center
Vernon N. Houk, M.D.
Centers for Disease Control
Barbara S. Hulka, M.D., M.P.H.
University of North Carolina
Renate Kimbrough, M.D.
Institute for Evaluating Health Risk
John Last, M.D.
University of Ottawa
Robert W. Leader, D.V.M.
Michigan State University
Jack S. Mandel, Ph.D.
University of Minnesota
Raymond R. Neutra, M.D., Dr. P.H.
California Department of Health Services
Victor W. Sidel, M.D.
Albert Einstein College of Medicine
Arthur C. Upton, M.D.
New York University Medical Center
Barbara Scott Murdock
Editor
ONE
-------
By James Makris,
Director,
Chemical Emergency
Preparedness &
Prevention Office,
US EPA
i I) Environmental
Protection Agency (EPA), Sept,
/SSS Chemicals in Your
Community, 2) Environmental
PnMeeitoH Agency (EPA),
February 1991, Successful
Practices in Title llf
Implementation, Office of
Salut Wastf & Emergency
Kefponsf, 3) Meniman, M,
Marsh 1990, Occupational
ItealthG Safety, "Emergency
Mttlical Resjionse Teams React
Sujftly to Phillips Plant
Twgedy," 4) Merrtman, M,
March 1990. Occupational
Health & Safety, "Not a Drill;"
*)) Rational Governors'
Association (NGA), 1990. The
Role (/State Health Agencies
in Chemical Emergency
Management, Centerfor
Policy Kesearcbj 6)
MTQfGCMS, March 1990.
Pilttt SKI fly on Disaster
Preparedness Plans
Resfxtnding to Chemical
Aecitlentii 7) Vntted Nations
Knvtmnment Programme
firWBV. I9S8. APELLtA
Process for Responding to
Technological Accidents,
Industry & Environment
Committees (LEPCs).
The LEPCs develop and maintain emer-
gency response plans, focusing on facilities
that handle EHSs in amounts above specified
thresholds. Because a variety of perspec-
tives is essential to effective emergency plan-
ning, Title III specifies that LEPC members
be drawn from elected state and local offi-
cials, police, fire fighters, public health agen-
cies, schools, environmental groups, hospi-
tals, the media, transportation agencies, and
others. More information on Title III is
available from the EPA's hotline on Title III,
(800) 535-0202.
Role of the health community
Health professionals play a central role
in dealing with chemical emergencies, both
in evaluating chemical risks and in coordi-
nating community medical resources. For
this reason, Title III requires that, under
some circumstances, industries must provide
trade secret information on the properties of
hazardous chemicals to health profession-
als—even when they normally withhold
such information from the LEPC. Health
professionals then use the information, plus
that normally received from industries, to
help the LEPC rank chemical risks in the
community.
Emergency medical technicians and
other first responders, hospitals, and health
departments all contribute to emergency
planning. First responders, such as emer-
gency medical technicians, can help the
LEPC design such crucial steps in initial
response to an emergency as how and
where to set up triage stations, and how to
transport the injured to hospitals.
Hospitals can offer information on treat-
ment capacities and medical resources in the
community. The emergency plan must
clearly identify treatment centers so respon-
ders will know where to send the injured,
who should monitor the transfer of victims,
and where to learn more about chemical
exposure treatment and decontamination.
Hospitals can further provide supplementary
training to police, fire fighters, and
paramedics on such topics as the health
risks of chemical exposures and how to
decontaminate victims.
Hospitals and medical facilities them-
selves may use hazardous chemicals. Thus,
they too may be required to report their
chemical hazards so the LEPC can address
them in the community plan. Hospitals
should also develop their own emergency
response plans so they can coordinate with
emergency responders and evacuate patients
safely if a chemical incident happens in or
near the hospital.
Health departments can point first
responders to available resources, such as
hotlines and computer databases, that pro-
vide information on the hazards and health
effects of specific chemicals. They can noti-
fy the public of chemical risks by distribut-
ing information through schools, physicians'
offices, and other networks traditionally used
to educate the public about health issues.
Other health services, such as the Poison
Information Centers (Poison Control
Centers), have information on the health
effects of chemicals and treatment for chemi-
cal exposures and injuries.
Health departments and hospitals can
also research the health effects of chemicals
and establish treatment protocols to be used
in an emergency. To identify and monitor
chemical risks further, it's also important to
maintain up-to-date information on symp-
toms and illnesses in the community that
may be related to chemical exposures.
Federal & international resources
Chemical emergency planning is most
effective where industry, government, the
medical community, public-interest groups,
and others have established working rela-
tionships and coordinate their responsibili-
ties cooperatively. While the primary bur-
den for preventing chemical accidents falls
on the facility that uses the chemicals, if an
accident occurs, public safety depends on
the successful cooperation of groups in the
LEPC.
In planning, training, and during an
emergency, LEPCs and the SERC can turn to
the federal government for technical assis-
TVS'O
-------
tance, guidance, and information. The
National Contingency Plan, adopted in 1968,
established a federal response structure. The
National Response Team and the Regional
Response Teams coordinate federal
resources at the national and regional levels.
Federal On-Scene Coordinators monitor acci-
dents and manage direct federal actions, and
the National Response Center, which can be
reached at (800) 424-8802, maintains a
national database on chemical releases.
In addition, Congress created the
Agency for Toxic Substances and Disease
Registry (ATSDR), part of the Public Health
Service, to provide training to health profes-
sionals *and gather information on the diag-
nosis and treatment of illnesses and injuries
caused by exposure to hazardous sub-
stances. The Centers for Disease Control
(CDC) sponsor programs on environmental
emergencies and provide leadership and
guidance in responding to public health
emergencies as well as in preventing and
controlling diseases. Both ATSDR or CDC
can be reached 24 hours a day, nationwide,
at (404) 639-0615.
Chemical emergency planning has inter-
national applications as well. A catastrophic
release, like the one in Bhopal, India, that
killed thousands, or the warehouse fire that
contaminated vast stretches of the Rhine
river, ignores political boundaries.
Neighboring countries may coordinate
chemical emergency planning. An example?
Cameron County, Texas, has collaborated
with an LEPC-like organization in nearby
Matamoros, Mexico, to prepare response
communities on both sides of the border for
chemical incidents. The collaboration is part
of a Joint Contingency Plan involving emer-
gency planning for 14 pairs of cities along
the US-Mexican border. And EPA and the
Department of Health and Human Services,
including CDC, are involved in a NATO-
sponsored pilot study on sharing health and
medical information related to emergency
planning and review member countries'
emergency plans.
The United Nations Environment
Programme (UNEP) has developed an inter-
Cbemical emergency planning is most effective where
industry, government, the medical community, public-
interest groups, and others establish working rela-
tionships and coordinate their responsibilities
national emergency planning initiative simi-
lar to Title III. The goal of "Awareness and
Preparedness for Emergencies at the Local
Level" (APELL) is to assist communities
•worldwide in developing emergency plans
and preparing for chemical incidents. EPA is
also working with the World Health
Organization (WHO) on chemical safety
issues, including organizing a meeting on
health and medical aspects of chemical
emergency planning. Through such interna-
tional exchanges, countries can share ideas
and work together to improve emergency
planning efforts.
Teamwork is key
Preparing for and preventing chemical
releases requires the dedicated participation
of many groups in a community. Industries
can take steps to prevent chemical releases,
but should one occur, workers must be pre-
pared through drills and exercises to protect
themselves from injury and exposure. People
living near such industries need to be aware
of the risks and to know proper safety re-
sponses if a chemical release should happen.
Minimizing the damage of a chemical
incident requires the coordination of groups
that include emergency medical technicians,
police, fire fighters, hospitals," medical pro-
fessionals, and public health professionals.
But the plan can only be effective when all
are aware of their roles and are prepared to
act as a team. As experience has shown,
only an informed and organized community
can keep a chemical accident from becom-
ing a disaster.
THREE
-------
Commentary
Getting Fingerprints On The Knife
By Albert J. "Bud"
Fekete,
Technological
Hazards
Coordinator,
Louisville &
Jefferson County,
Kentucky, Disaster
& Emergency
Services
In 1985, a hexane leak in Louisville,
Kentucky, caused an explosion that
ripped streets and destroyed houses and
buildings above tivo and a half miles of
sewer lines. The incident prompted the
City of Louisville and surrounding
Jefferson County to adopt an ordinance
that required industiles and facilities to
report their hazardous materials and
develop plans to deal ivith emergencies.
The requirement not only gave Jefferson
County an early start in emergency plan-
ning, but enabled it to become a model
for integrated emergency management.
Jefferson County's health department has
developed haz-mat training for the feder-
al Agency for Toxic Substances and
Disease Registty. Its Local Emergency
Planning Committee (LEPC) includes
members from all 210 reporting facilities,
which means that industry is widely
involved in local emergency planning.
Because of its effective integrated plan-
ning, Lotiisville/feffcrson County was cho-
sen as a test site for the Computer Aided
Management of Emergency Operations
(CAMEO lOsoftivare program. And
today, the county's planning goes beyond
SARA Title III by requiring all facilities
with hazardous materials to develop on-
site and off-site plans. In the following
article, Bud Fekete discusses the strengths
of the integrated approach to emergency
management—BSM.
Emergency management typically
consists of four phases—the Emergency
Response Cycle—carried out by the
agencies responsible for one or more of
the phases—the emergency-response
community.
Mitigation includes any activity that
prevents or reduces the chances for a
disaster, or reduces the damaging effects
of an unavoidable disaster. We can't
stop a tornado or prevent all hazardous
material incidents, but we can reduce
their damaging effects.
Preparedness includes plans or
preparations made to save lives and
property in a disaster. All agencies
involved in the Emergency Response
Cycle must take part in planning their
role. Once plans are in place, a commu-
nity is ready for the Response phase of
the cycle, when plans are put in action
and tested.
In the Recovery phase, activities
return the situation to normal. In this
phase, the incident command may shift
from the action agencies—police, fire, or
emergency medical services—to the
health department or the emergency
management agency.
Each agency has its expertise
Why adopt an integrated response?
Because no single agency has the exper-
tise to handle all phases of response
effectively. The fire department may be
the most qualified to handle patching,
plugging, and diking, but isn't expert in
monitoring test wells or supervising the
removal of contaminated soil. The
police—not the fire department—know
best how to handle traffic control. The
health department, not the fire or police
chief, has trained professionals with a
statuary requirement to protect public
health. Each agency should be part of a
unified command structure that makes
decisions based on the best information
available from all players.
If only one agency carries the whole
haz-mat response load, •weaknesses in
that agency can hinder the entire delivery
system. But if we take advantage of each
agency's expertise, we get the best there
is in the community, instead of pinning
success on one superagency.
In an era of shrinking budgets, inte-
grated planning avoids unnecessary
duplication. Every agency doesn't need
a fully equipped hot-zone entry team.
Instead, planners can look at each agen-
cy's mission and identify the resources
they need versus the ones they control.
They can set up mutual-aid agreements
with the private sector as well as with
other emergency-response agencies.
SARA Title HI has caused communities to
identify their resources for haz-mat
response. Because a great deal of spe-
cialized equipment is available in the pri-
vate sector, industry must be part of an
integrated response—not just for equip-
ment, but for expertise in handling emer-
gencies in their facilities and products.
In an integrated approach, the
Incident Commander (1C) can use each
agency's strengths and offset its weak-
nesses with strengths from other agen-
cies. A Unified Command Structure
allows the 1C to make intelligent deci-
sions after receiving advice from all key
agencies. Another advantage—in an era
of increased liability, it's important for
many agencies and experts to share
responsibility in planning for and han-
dling chemical emergencies. It means
that if the 1C has to appear in court, he
will have many people's fingerprints on
the knife.
A few disadvantages
Like everything else, an integrated
system has some disadvantages. Because
the system is only as strong as its •weak-
est agency, planners must identify an
agency's weaknesses early and take steps
to train its staff or shift part of its respon-
sibility to a stronger agency.
Integrated planning also takes
longer, since all agencies in the four
phases of the Emergency Response Cycle
must participate. But if they help create
it, they will support it. A few people
can't simply develop the plan in some
Ivory Tower: the plan must be a child of
p_.
Th» Htttth 4 Environment Digest* (ISSN 0893-6242) Is published at Freshwater Foundation at Spring HliF Center, 725 County Rd 6, Wayzata, MN 55391. The Digest is a monthly
tiofl Of tha Freshwater Foundation, a public nonprofit foundation whose mission is to help keep water usable for human consumption, industry, and recreation. The Foundation supports
ty'oJ research and educational programs dealing wffh'fre'sliwaterresources. The Freshwater Foundation's.ao'dress is: Spring Hill Center, 725 County Rd 6, Wayzata, MN 55391; (612)
_ Th» Digest dfaws on the expertise of a network of representatives in 22 schools of public healih, 50 state health departments, and over 75 research institutions, government agencies, state
I nuMc tmtth Msociatfons, and medical societies. Start-up funds were provided by a grant from the Bush Foundation.
c- Subscriptions to the Digest; government/public sector, $90; private sector, $115; internatiohaf, $130 (outside the U.S., Canada, and Mexico). Special rates are available for orders _of two or
§~inon Second class postage paid at Wayzata, MN and additional entry, POSTMASTER: Send address changes to: The Health & Environment Digest, Spring Hill Center, 725 County Rd 6,
-Way/aia.MN 55391; (612)449-0092, "
Copyright 6 (992, Freshwater Foundation.
i
FOUR
-------
the street—because that's where it has to
work, in the street at three o'clock in the
morning.
Finally, an integrated system
requires the coordination of a large num-
ber of agencies, people, and personali-
ties. Planners must be able to blend all
the players and may have to do some
"engineering" to get people to work
together. Because there is no room for
freelancing during a haz-mat, each agen-
cy must understand its role. Everyone
must support the 1C.
What are the rewards?
In Louisville and Jefferson County,
Kentucky, we wanted a plan that would
bring all parts of the emergency-response
community together. We've found that
this integrated approach works well, and
provides the community with the best
combination of personnel and equipment
during haz-mat incidents. When each
agency can focus on what it does best,
the 1C can draw on the best the commu-
nity has to offer.
Natural Disasters
by Eric K. Noji,
MD, MPH,
Center/or
Environmental
Health & Injury
Control, CDC
Earthquakes, hurricanes, floods,
tsunamis, fire, tornadoes, and extreme
temperatures have claimed some 3 mil-
lion lives worldwide in the past 20 years,
affected the lives of at least 800 million
more, and caused property damages
exceeding $23 billion. And, as more and
more people settle on flood plains and in
seismic- and hurricane-prone areas,
catastrophic disasters with millions of
casualties become more likely.
- To respond effectively to such emer-
gencies, we need to know what relief
supplies, equipment, and personnel are
appropriate to specific natural disasters.
Past emergency health decisions have
often been based on insufficient, even
false information. The result was inap-
propriate aid, wasted resources, and
countereffective health measures.
Examples? After the 1976 Guatemalan
earthquake, foreign donors sent 100 tons
of unsorted medicines to the country.
Ninety percent were expired, already
opened, or labeled in foreign languages.
Other times, relief efforts have sent
mobile hospitals and teams of specialized
surgeons, when sanitary engineers might
have been more appropriate.
Natural Disasters and
Emergency Planning
To determine what relief is needed,
it's essential to have better epidemiologic
knowledge of the causes of death,
injuries, and illnesses caused by specific
natural disasters.
Floods
Floods account for roughly half of
all natural disasters and a similar propor-
tion of deaths. Fast-flowing water carry-
ing debris, boulders, and fallen trees is
the primary cause of injury and death. In
the US, many who have died in flash
floods were in automobiles. The primary
cause of death is drowning, followed by
trauma and hypothermia.
Among survivors, most injuries are
minor, such as lacerations, skin rashes,
and ulcers. Cuts are often contaminated,
and primary wound closure should be
done with caution. Snakebites may
result as rising waters drive snakes to
higher ground. If flood waters break oil
or gasoline storage tanks and the oil film
ignites, fires may cause many casualties.
From a public health perspective,
floods may disrupt water purification and
sewage disposal, cause toxic waste sites
to overflow, and dislodge chemicals
stored above ground, thus exposing peo-
ple to toxic biological and chemical
agents. Flood victims may be vulnerable
to waterborne diseases, at risk of vector-
borne disease from enhanced vector-
breeding conditions, and exposed to res-
piratory infection in crowded temporary
shelters.
Nevertheless, mass vaccination pro-
grams usually serve only to divert
resources from other more important
tasks. The most effective approach is
epidemiologic surveillance to quickly
identify and address increased communi-
cable disease risk in flood-stricken areas.
Cyclones & Tornados
Cyclones, hurricanes, and typhoons
are usually accompanied by heavy rains
and flooding. Nine out of 10 hurricane
fatalities are caused by drownings associ-
ated with coastal storm surges. Causes of
death and injury include drowning, col-
lapse of houses from wind and water,
penetrating wounds from broken glass or
wood, blunt trauma from floating debris
or from entrapment in mud slides that
may accompany floods, and electrocu-
tion during post-disaster cleanup. In the
1970 Bangladesh cyclone, many survivors
suffered from "cyclone syndrome,"
severely abraded chest, arms, and thighs,
incurred by holding to trees as they were
buffeted by fast-moving water. Those
too young, too old, and too weak to hold
onto trees •were lost in the storm.
In the past 50 years, tornadoes have
led to more than 9000 deaths. The lead-
ing causes of death are craniocerebral
trauma and crushing wounds of the chest
and trunk. But, in both tornadoes and
cyclones, fractures, lacerations, and other
soft-tissue injuries are common. Because
the wounds may contain highly contami-
nated material such as soil, they should
be flushed with saline and primary clo-
sure avoided.
Volcanoes
In the past 400 years, volcanic erup-
tions have claimed more than 266,000
lives, with fatalities in about 5 percent of
FIVE
-------
all eruptions.
Life-threatening health effects
include: suffocation from inhalation of
airborne ash, scalding by superheated
steam, and surges of lethal gas.
I'yroclastic flows—currents of hot gases
and particles that flow down the slopes
of a volcano—are particularly lethal.
Mudflows or labors—flowing masses of
volcanic debris mixed with water—
account for at least 10 percent of all vol-
cano-related deaths. The sudden release
of toxic volcanic gases from deep crater
lakes can cause effects that range from
death to pulmonary edema, irritant con-
junctivitis, joint pain, muscle weakness,
and blistered skin
A volcanic eruption like the recent
Mt. Pinaftibo eruption in the Philippines
can also generate tremendous quantities
of ash, collapsing buildings and causing
severe trauma to the occupants. Ash can
irritate the eyes, mucous membranes, and
respiratory system. Upper airway irrita-
tion, cough, and bronchospasm are com-
mon, as well as exacerbated chronic lung
diseases. Heavy ashfall may cause
severe tracheal injury, pulmonary edema,
and bronchial obstruction, leading to
death from acute pulmonary injury or
suffocation. Primary closure of wounds
contaminated by mud and volcanic mate-
rial am result in gangrene, osteomyelitis,
compartment syndrome*, and sepsis.
Most deaths stem from immediate
suffocation and, to a lesser extent, burns
or blunt trauma. Advanced cardiac and
trauma life-support would probably be
too late to save asphyxiated victims.
Because patients with respiratory symp-
toms may well develop acute respiratory
distress syndrome, it's advisable to admit
them to intensive care.
Earthquakes
In the past 20 years, earthquakes
have caused more than a million deaths
and injuries worldwide. Death and
injury result primarily from the collapse
of buildings that were inadequately
designed for earthquake resistance. In
major earthquakes, death can be instanta-
neous, as from severe crushing injuries of
the head or chest, hemorrhage, or
drowning from earthquake-induced tidal
waves (tsunamis); rapid (within minutes
or hours), as from asphyxia, hypovolemic
shock, or exposure (hypothermia); or
delayed for days, as from dehydration,
hypothermia, hyperthermia, crush syn-
drome, and postoperative sepsis.
Most people requiring medical assis-
tance will have minor cuts, bruises, and
simple fractures. Infected wounds and
gangrene were major problems after the
1988 Armenian earthquake. Patients
trapped by rubble for hours or days may
also develop compartment syndrome,
requiring fasciotomy or amputation.
Such patients may also have significant
rhabdomyolysis** and should be watched
closely for symptoms of crush syndrome,
such as hypovolemic shock, hyper-
kalemia, renal failure, and fatal cardiac
arrhythmias.
Rapid response in searching col-
lapsed buildings to rescue trapped vic-
tims is critical. A survey of 3619 sur-
vivors of the 1980 Italian earthquake
shows that 93 percent of those who were
trapped and survived were extricated in
the first 24 hours. The study concluded
that 25 to 50 percent of the victims who
died slowly could have been saved if
they'd had immediate lifesaving first aid.
Thus, to reduce earthquake mortality sig-
nificantly, rescuers should focus on
appropriate search and rescue within the
first two days.
Finally, an earthquake may damage
nuclear power stations, hospitals with
dangerous biological products, hydrocar-
bon storage areas, and hazardous chemi-
cal plants.
Epidemics
While natural disasters rarely result
in outbreaks of infectious diseases, they
may increase the potential for disease
transmission. The most frequent increas-
es in communicable disease are caused
by fecal contamination of water and by
respiratory spread (e.g., measles).
Unburied bodies, particularly if death
resulted from trauma, are unlikely to
cause outbreaks of diseases such as
typhoid, cholera, or plague, though they
may transmit gastroenteritis or food poi-
soning if they contaminate water.
Demands for mass burial or cremation
aren't justified on public health grounds.
For more, see: Noji, 1991. Critical
Care Clinics 7(2): 271-91.
'compartment syndrome: Constriction of_a nerve or
tendon.
"rhabdomyolysis: Acute, sometimes fatal disease
characterized by destruction of skeletal muscle.
Chemical Emergencies
Chemical Spill—USSR!
By Harry L. Allen, PhD, & Harry K.
Compton, Environmental Response Team,
Office of Solid Waste and Emergency
Response, US EPA
In November 1990, a tank-filling
accident at a plastics plant in
Novopolotsk, Byelorussia, USSR, spilled
several thousand gallons—an estimated
30 tons of acetocyanohydrin (ACNH)—
on the ground. Misinformation and mis-
handling of this seemingly minor incident
led to the discharge of toxic quantities of
acetone and cyanide into tributaries to .
Latvia's chief inland waterway, the
Daugava River. The Daugava supplies
drinking water to the cities of Daugavpils
(126,700 people) and Riga (915,000 peo-
ple), supports about 30 percent of
Latvia's fishing industry, and is a signifi-
cant tributary to the Baltic Sea.
Plant officials in Novopolotsk appear
to have been told that the spill could be
treated with lime and flushed away with
water. The hydrolyzed ACNH would then
disappear rapidly, posing no risk to
human health or the environment.
Unfortunately, while ACNH does
hydrolyze rapidly in the presence of
alkali, the products of the reaction, ace-
tone and cyanide, may persist for days
under alkaline conditions. What's more,
travel time down the river from the spill
is only about 2.8 days to Daugavpils and
nine days to Riga. Under these condi-
tions, it's ill-advised to treat such a spill
with lime unless it's also possible to con-
tain it on-site until the cyanide dissipates.
Furthermore, whether because of the
technical misinformation or for some
other reason, Latvian authorities and
other downstream users of the river were
SIX
-------
not notified.
The result was that an imminent
public health threat existed for approxi-
mately two days before anyone came to
grips with or even realized the problem.
A massive fish kill sighted near the
Latvian border was the first clue that
something was amiss. Large fish died
outright, while smaller fish first leapt
wildly from the water, became anes-
thetized, and then died or slowly recov-
ered from stupor as the slug of cyanide-
and acetone-contaminated water passed
through. These classic symptoms of
anoxia in fish reflect cyanide's mecha-
nism, which is to inhibit the cellular
transport of oxygen.
The fish kill eventually reached an
estimated 300 tons. At this point, Latvian
authorities made urgent inquiries to
Byelorussian and Soviet authorities about
the threat to water supply systems and
declared a public health emergency.
Although there are significant
municipal and industrial waste problems
in the Baltic Republics, there seems to be
little training in handling chemical emer-
gencies. In other countries' experiences,
a centralized governmental structure
makes it difficult to deal with emergen-
cies effectively and quickly. The
National Contingency Plan (NCP) of the
US, for example, establishes an experi-
enced federal On-Scene Coordinator as
the delegated incident manager. This
person is supported by a Regional
Response Team of representatives of
affected state and federal agencies.
Interestingly, the Latvians, because of the
difficulty of communicating through a
central authority, developed an ad-hoc
structure similar to the US model.
Under the direction of the Ministry
of Health, the response management
committee dealt with the emergency as
though it were a major crisis. Latvian sci-
entists and managers stayed on top of
the developing scenario, tracking spill
movements and managing spill informa-
tion as well as they could with the tools
at hand. They monitored the Daugava
River and water supplies hourly, with a
laboratory system coordinated among
different state and educational agencies
with laboratory capability.
But there were problems: a lack of
information, a lack of clear lines of com-
munication, and steady attrition of
response personnel from fatigue. The
public was calm, but the situation •was
deteriorating. The Latvians knew they
needed help.
In the US, a special provision of the
NCP offers on-scene technical assistance
at environmental emergencies through the
Environmental Response Team (ERT).
Realizing their need for special assistance
in analysis and field monitoring, environ-
mental criteria development and valida-
tion, information on the fate and effects of
the toxic substances, and spill response
management, the Latvians sought aid from
the US EPA. Under the provisions of a
bilateral agreement with the USSR, the
EPA sent a special team, including two
members of the ERT, to Riga.
The EPA team arrived two weeks
after the spill to find near-panic concern
about public health and fish toxicity.
Information had filtered out from various
sources that ACNH was much more toxic
than officials admitted, and cyanide levels
near Riga were rising. Riga had been on
emergency water rationing for over a
week, and water pressure was dangerous-
ly low. The lack of water curtailed day-
to-day activities, with an economic impact
estimated at 25 million rubles per day.
The effect of the arrival of the US
team was electric. It created a nucleus
around which diverse groups involved in
the spill coalesced. Team members
•worked directly •with spill managers and
scientists for about a week, reviewing
information and sharing expertise on all
aspects of spill response, from sampling
and analysis, data presentation, and
water treatment to general spill manage-
ment and legislation. Finally, the team
provided what the Latvians needed
most—assurance that they were handling
the situation correctly.
As one US official wrote later, "A US
Team...played a key role in assessing the
problem and in calming the public. One
result is that the Latvians—and perhaps
others in this country—have an enhanced
understanding of the need to establish
. systems to work in crisis situations.
Another is that, for a small expenditure,
the US was able to make a highly positive
impression on both the people of Latvia
and much of the Soviet leadership..."
Team leaders included Jim Makris,
Director, EPA, Office of Chemical
Emergency Preparedness and Prevention;
Doug Kuehl, Chemist, Environmental
Research Lab, Duluth, MN; Harry L.
Allen, PhD, and Harry R. Compton,
Environmental Response Team, Office of
Solid Waste and Emergency Response,
US EPA. For more detail, contact: Harry
Allen, PhD, (908) 321-6740.
Transport Spills May Be Less
Frequent Than Thought
By Joseph M. Posid & Wendy E. Kaye,
PhD, Division of Health Studies, ATSDR
While many national data bases are
designed to obtain information on haz-
ardous substance emergencies, they
often have data on only a small propor-
tion of the emergencies that occur each
year.1 What's more, they offer very little
information about the public health con-
sequences of such events.
To get a better understanding of the
morbidity and mortality associated with
hazardous substance emergencies, the
Agency for Toxic Substances and Disease
Registry (ATSDR) is collaborating with a
number of state health departments to
develop, implement, and evaluate a
state-based Hazardous Substance
Emergency Event Surveillance (HSEES)
system. Because such emergencies are
unlikely to be random, ATSDR officials
believe it should be possible to identify
the risk factors associated with deaths
and injuries from these emergencies.
This, in turn, should make it possible to
reduce, alter, or eliminate the risk factors
and the resulting morbidity.
So far, preliminary HSEES data sug-
gest that hazardous substance emergen-
cies happen far more frequently at fixed
facilities, such as factories, than during
the transport of chemicals from one
place to another.
Five states—Colorado, Iowa, Mich-
igan, New Hampshire, and Wisconsin—
have taken part in HSEES since it began
in January 1990. In January 1992, five
more states—Oregon, New York, North
Carolina, Rhode Island, and Washing-
ton—will begin to collect data.
ATSDR officials hope that HSEES
will both answer some general questions
about the public health effects of haz-
ardous substance emergencies and give
state health departments a better under-
standing of the effect of these emergen-
cies on citizens' health. They further
SEVEN
-------
hope that states can use HSEES results to
identify what chemicals are being releas-
ed within their borders, when and where
the events are most likely to occur, who
is being injured, and why injuries occur.
The knowledge should help state agen-
cies, including health departments, pre-
vent injuries and deaths related to haz-
ardous substance emergencies.
In the HSEES project, state health
departments determine which state agen-
cies will be notified of hazardous sub-
stance events meeting the protocol's case
definition. These agencies may include
departments of natural resources or envi-
ronment, public safety, or emergency
management agencies. Once notified,
the state health departments begin an
investigation using a data collection form
developed at ATSDR. The form contains
more than 80 variables describing haz-
ardous substance events and their mor-
bidity and mortality. The investigation
focuses on: die temporal and spatial
description of the event, the chemicals
involved, and the morbidity and mortality
that resulted. The resulting data are
transferred to ATSDR every three months
for analysis.
Information collected on where and
when the event occurred includes
whether the event took place during
transport of a chemical or at a fixed facil-
ity, such as a manufacturing plant, and
whether the event occurred inside or
outside of a building. It covers the
weather, the time of day, and the day of
the week that the event occurred. It
includes data related to possible expo-
sure, such as how close the emergency
was to residential areas; what the prima-
Table 1
Distribution of injured people within
population group, by type of event,
January 1, 1990-June 30, 1991 (N=766)
Population
Group Fixed Facility Transportation
# % # % # %
Employees
Respondent
General Public
TOTAL
357
129
222
708
94.9
79.6
97.4
92.4
19
33
6
58
5.1
20.4
2.6
7.6
376
162
228
766
49.1
21.1
29.8
100.0
ry use of the nearby land was—whether
industrial, commercial, agricultural, or
residential; how many people live within
one-quarter, one-half, and one mile of
the event; and how many were actually
home when it took place.
An emergency is included in HSEES
if the chemicals released are among the
200 substances identified by ATSDR to
be the most hazardous substances found
at Superfund sites, as published in the
Federal Register,2 or if they include chlo-
rine, sodium hydroxide, or hydrochloric,
nitric, phosphoric, hydrofluoric, acrylic
acid, or any insecticide or herbicide.
Information is collected on the name and
quantity of each chemical released, on
the type of release (spill, vapor, fire,
explosion), and on whether environmen-
tal sampling was conducted.
Information collected on morbidity
and mortality falls into two categories:
The first describes deaths and injuries
that result from the event, including who
Figure 1. Proporli
Fixed Facility and Tran
Jan 1990 •
Apr 1990 •
Jul 1990 •
Oct 1990 •
Jan 1991
Apr 1991 -
on of Events
spoliation by Quarter (Jan. 1, 1990-June 30, 1991)
K- ', -,. 41 15.2
L, _ . _ ...:. -, — ;1) gfi o
'..,,, •',' ill 21.2
ft '"...-*. Jl 15.3
fa - 4-t , -, - . •.• H| 26.1
P^^^^^^^^Wf^^^1' S4'3
0 20 40 60 80 100
Percentage
•• Fixed Facility El Transportation
was injured (employee, responder, or
member of the general public), the num-
ber and severity of injuries, and how far
the injured people were from the event
at the time of injury. The second
describes the steps taken to prevent
deaths and injuries, such as the type of
personal protective equipment that the
casualty used, or the use of decontamina-
tion, evacuation, and in-place sheltering.
By the end of June 1991, 933 events
meeting the case definition had been
entered into the HSEES system.
Preliminary findings suggest that more
than 70 percent of the events meeting
the case definition occurred in fixed facil-
ities, such as factories, warehouses, or
storage depots (Figure 1). Further, more
than 90 percent of all injuries sustained
by employees, first responders, and the
general public resulted from fixed facility
events (Table 1). The number and types
of events seem to vary according to the
time of year. During April, May, and
June, for example, there are more events
involving insecticides, herbicides, and
ammonia. Additional analyses indicate
that incidents involving some chemicals,
such as herbicides or PCBs, are less like-
ly to cause injuries than events involving
such chemicals as insecticides or acids.
These preliminary results must be
tempered by the fact that the states par-
ticipating in the HSEES system aren't rep-
resentative of any region or industry, or
of the US as a whole. Thus, the prelimi-
nary results may not apply to other areas
of the country. To learn whether the pat-
tern will hold in the rest of the nation,
ATSDR intends to expand HSEES to more
states over the next few years.
References: 1) Binder, S, 1989. AmJPubHlth
89:1042-4; 2) Hazardous Substances Priority List,
Toxicological Profiles; Second List. October 20, 1988.
53FR41280.
Assessing The Kuwaiti Oil Fires
During the 1991 Persian Gulf war,
Iraqi forces poured oil into Gulf waters
and systematically ignited hundreds of oil
wells in Kuwait. The magnitude of the
environmental crisis brought an immedi-
ate international response. US and
United Nations technical organizations
developed plans for atmospheric moni-
toring and modelling, environmental
remediation and restoration, oil discharge
response, monitoring health effects, and
offering guidance and training.
EIGHT
-------
When Kuwait was liberated on
February 28, the plans went into action.
The US Interagency Air Assessment Team
travelled to Kuwait and Saudi Arabia to
help government authorities in those
countries. The National Oceanic and
Atmospheric Administration (NOAA), the
Departments of Defense and Energy, the
National Science Foundation (NSF), and
the Environmental Protection Agency
(EPA) analyzed the smoke plumes and
are following their environmental effects.
The US Department of Health and
Human Services worked with the Kuwaiti
Ministry of Public Health to assess the
health effects from exposure to air pollu-
tion from the fires. And the National
Response Team, which represents over
15 government agencies and depart-
ments, provided technical assistance for
addressing the oil spills.
The Kuwaiti Ministry of Health, in
collaboration with CDC, developed a
notification system to alert Kuwaiti resi-
dents to air pollution levels that could
threaten health; developed education
programs for physicians to help them
explain the effects of oil smoke exposure
to their patients; developed programs to
help the public learn how to avoid
excessive exposure to air pollution and
to understand its potential health haz-
ards; instituted a surveillance program in
hospital emergency rooms to track respi-
ratory illness that might be related to the
fires; set up a study of asthmatic patients
at the Kuwait Center for Allergic Diseases
to learn whether the oil smoke affected
their condition; and designed a longitudi-
nal study of^people who were highly
exposed and not exposed to smoke from
the oil fires. The study may enable
investigators to determine long-term
effects from exposure to the fires.
To date, given the magnitude of the
environmental problem, findings are sur-
prisingly encouraging. The last oil fires
were extinguished in November 1991,
sooner than predicted. While they
burned, prevailing winds blew most of
the smoke south over the sparsely inhab-
ited desert between Kuwait and Saudi
Arabia, or east over the Gulf. When
smoke drifted over Kuwait City, Kuwaiti
living patterns helped protect the public:
Because of heat and dust, Kuwaitis tend
to stay indoors and to use air condition-
ing, thus buffering themselves against
polluted outside air. And the extra care
given the patients with asthma may have
had a beneficial effect.
While the data are still being ana-
lyzed, it looks as though the fires are
unlikely to cause a "nuclear winter;" their
environmental damage seems to be con-
fined to the Gulf region. The CO2 emis-
sions are unlikely to have an important
effect on global climate. And, while it
will take some years to learn the medium
and long-range effects of the fires and oil
discharges on human health, the data to
date do not indicate an epidemic of res-
piratory disease.
For more information on health
surveillance, contact: Ruth Etzel, MD, •
PhD, at CDC, (404) 488-4227, or Paul
Seligman, MD, NIOSH, (513) 841-4353-
For a copy of the executive summary,
"Report to Congress: US Gulf Environ-
mental Technical Assistance," contact:
Timothy Titus, EPA, (202) 260-0154.
SARA and Hospital Planning
By Linda Young Landesman, MSW,
DrPH, Albert Einstein College of Medicine
How effective has SARA Title III
been in making hospital and health pro-
fessionals aware of emergency prepared-
ness? Have hospitals changed any of
their procedures for responding to chem-
ical accidents since SARA Title III passed?
To assess the situation in New York
State, I undertook a study in fall 1989 in
cooperation with the New York chapter
of the American College of Emergency
Physicians, and mailed a survey about
chemical accidents to emergency depart-
ment directors of acute-care hospitals
across the state. The survey, which drew
a response from 174 hospitals (a 73 per-
cent response rate), was the first to
assess whether SARA Title III or any
environmental legislation has had any
effect on the allocation of health
resources and staffing in response to
environmental emergencies.
The research, which built on a 1986
survey by the Office of the New York
Attorney General, looked at changes in
the number of hospitals that had devel-
oped disaster plans for responding to
chemical accidents; and measured varia-
tion in their preparation for chemical
emergencies. More important, the inves-
tigation helped define characteristics of
the hospitals, the professionals, and the
implementation of the legislation in the
better-prepared hospitals.
The study protocol defined two
components that contribute to a hospi-
tal's ability to respond to chemical acci-
dents. The first is the organizational
preparation made by the hospital (staff
training, emergency response plan, etc.).
The second involves modifications or
designations made within the facility
(designated decontamination room, prop-
er equipment, ability to test blood, etc.).
Interestingly, SARA had different
effects on each component. Involvement
in an LEPC was a good predictor that the
organizational elements were in place,
that, for example, the emergency depart-
ment had developed' a response plan or
undertaken staff training to address a
chemical emergency, but did not predict
whether the facility itself had been modi-
fied to handle the emergency. Results
also indicated that if emergency depart-
ment directors were aware of and
involved in implementing SARA, both the
organization and the facility were more
likely to be prepared. While involve-
ment in an LEPC alone was related to
organizational preparedness, awareness
of and participation in the implementa-
tion of SARA within the hospital made it
even more likely that the hospital was
prepared.
In 1989, significantly more of the
responding hospitals—56 percent—had
disaster plans for response to chemical
accidents than in 1986, when only 26
percent had such plans. The study fur-
ther grouped hospitals according to the
number of accidents that had occurred
between 1983 and 1989 in the counties
where they were located. The number
of hospitals that had plans for response
to a chemical accident had increased 30
percent, both in the group with few acci-
dents (less than 80) and the group with
many (81-221).
But having a special disaster plan
did not necessarily mean that the hospi-
tals were better prepared. On a 13-item
scale measuring the hospital's organiza-
tional preparedness, the 1989 study
found a significant, but less dramatic
improvement over 1986. Despite this
change, the hospitals in the state still
rank in the bottom third of this scale in
1989. Thus, while the state's emergency
NINE
-------
departments are better prepared than
they were before SARA Title III, their
preparation is far from ideal.
Several characteristics were related
to the organization's overall prepared-
ness. First, Emergency Department
directors were asked to rank the respon-
sibilities, such as staffing, quality assur-
ance, or issuing reimbursement for care,
that they faced in providing care in their
department every day. The better-pre-
pared hospitals were those in which the
Emergency Department director gave a
higher o%'erall ranking to this group of
activities. In addition, the more recently
the hospital had treated patients exposed
to toxins and the better the staff knew
what procedures the hospital should fol-
low in a chemical accident, the more
likely the hospital was to be organized to
deal with a chemical emergency.
But responses on three items in the
questionnaire indicated whether a hospi-
lal was less prepared for a chemical
emergency. If the director believed that
only some centers should treat patients
exposed to chemicals, that preparation
was more of an administrative task than
a medical one, and that being prepared
only meant more paperwork, then the
hospital was less prepared.
Characteristics of the professionals
who answered the questionnaire also pre-
dicted how well the hospital was pre-
pared. Mere, the longer someone had
been director, and whether he or she had
attended continuing education programs
about hazardous materials were signifi-
cant predictors of good preparation. One
might surmise that long-term directors
had been able to establish a routine that
allowed them time to plan for chemical
emergencies, an area that otherwise
would not command high priority.
One finding was alarming. The
study divided the hospitals into three
groups: those that had plans in 1986,
those that had developed plans by 1989,
and those that had no plans. A compari-
son of the number of accidents that had
occurred in the locations for each group
showed that, in 1989, those hospitals with
no plans for chemical emergency
response were also located in the coun-
ties with the highest number of accidents.
The directors answered eight ques-
tions about their professional role in
preparing for chemical emergencies. The
group indicated that it was the role of the
director to: be involved in local planning
(and not send a designee); participate in
developing the community plan; know
whom to contact in event of a chemical
accident; conduct disaster drills to pre-
pare for chemical accidents; maintain a
file of Material Safety Data Sheets. The
group, on the average, disagreed that
they should get involved only if there
were an accident.
Because this study found a direct
relationship between physicians' partici-
pation in continuing education about
hazardous materials and improved hospi-
tal preparation, physician training in this
area should be expanded. Further, there
is evidence that when health profession-
als take part in community planning for
environmental emergencies, their associ-
ated hospitals are better prepared. For
this reason, we should encourage
increased involvement of health profes-
sionals in such planning.
Preparing A Hospital
Emergency Room
By Anne Le Sher, MD, and Jay
Feldstein, DO, FACEP, Medical Center of
Delaware, Dept. of Emergency Medicine
Each day, tons of hazardous materi-
als are transported on roads and rail-
roads. While spills are few compared to
spills from fixed facilities, the shipments
still offer a major source of potential haz-
ardous materials incidents, even in com-
munities with no chemical industry.
Because of this, every hospital emer-
gency department must be prepared to
treat contaminated patients. While few
can build a decontamination unit, still,
with careful preparation and minimum
capital outlay, most departments can treat
these patients and protect themselves
and the community. Here are some
guidelines:
The first step for any emergency
department director is to become aware
of the resources already in the communi-
ty. By being an active member of the
LEPC and Emergency Medical Services
(EMS) systems, you can learn which
groups are already trained in decontami-
nation and •what equipment is available.
Contact your local industries to learn
about their on-site EMS and fire depart-
ments and establish a relationship with
community EMS and Fire Departments.
The next step is to learn everything
possible about the emergency depart-
ment: How does the ventilation system
work? Where is every outside door and
hose connection? What kind of wastewa-
ter disposal system is there?
Work with the hospital's mainte-
nance, engineering,, and fire and safety
departments. Walk out potential routes
for contaminated patients to become
aware of areas and equipment that can
be exposed to contamination. Obtain
blueprints of the facility and study them
carefully.
Explore educational resources and
have someone in the department attend
a training course. There are texts avail-
able, most dealing with pre-hospital care.
Prepare a list of useful "hot-line" num-
bers, such as CHEMTREC. If you have
the resources, obtain computer-based
software systems that review identifica-
tion, decontamination, and treatment
after hazardous material exposure.
Your plans will need to address two
categories of patients: the walking
wounded and the severely traumatized.
For either, the best management is to
decontaminate the patient as much as
possible on-site. This contains the agent,
and dramatically reduces the number of
people who could be exposed.
The walking wounded are patients
exposed to a hazardous material but who
exhibit only mild symptoms and haven't
suffered trauma. Preliminary decontami-
nation of these patients can take place
outside the emergency department, using
a garden hose, shower nozzle, plastic
kiddie wading pool, and screens. In
severe weather, you can decontaminate
the patient in a garage or other protected
area.
These patients can remove their own
clothing, shower, wash their hair, and
under their nails. At the hospital, wash-
ing should be prolonged and repeated
three times. We can't emphasize enough
how important it is to use quantities of
water and have the patients shower for at
least half an hour.
Patients can then dress in hospital
issue and be processed in the usual way.
Their clothing—including shoes—should
be placed in plastic bags, sealed, and
placed in another plastic bag that is
sealed and labeled -with name, date, con-
taminating agent, and site. If the agent is
unknown, indicate this. One difficulty is
TEN
-------
that wastewater can't simply be washed
into the sewer system, but must be con-
tained for proper disposal. The hospi-
tal's Public Safety department should deal
with the wastewater and contaminated
clothing.
Much more complex is the care and
decontamination of a seriously affected
and or traumatized victim. It's critical to
have the patient's clothing cut away and
left at the site of exposure. In most
cases, this simple procedure can elimi-
nate 70-80 percent of secondary contami-
nation.
In planning for treatment of severely
contaminated victims, it's important to
consider how patients will arrive in the
department, what path they will travel to
the treatment area, and which room
they'll be treated in. Ideally, they should
be transferred to a clean stretcher out-
side, brought through a separate
entrance, and taken directly to the treat-
ment room. Their path will need to be
covered with wide heavy-gauge plastic
taped to the floor.
The treatment room will be one in
which the ventilation system can be iso-
lated. Simply shutting down the ventila-
tion will increase the risk to people car-
ing for the victim. The room must have
doors that can be shut, and empty or
closed storage units. The walls and floor
must be covered with precut plastic
sheeting. All supplies in the room should
be disposable. Equipment used with
these patients must be decontaminated
and may be out of service for days.
Supplies to be stockpiled in the
decontamination room include: plastic
sheeting and duct tape to secure it, a gar-
den hose, shower nozzles, blankets,
green soap and dish detergent, dispos-
able nail files, and preferably, a decon-
tamination stretcher that allows you to
wash the patient's skin and hair and con-
trol the wastewater. If you use a stan-
dard stretcher, you'll need some way,
such as floor drains or containment
dikes, to control the wastewater.
You will also need personal protec-
tive equipment (PPE) for your staff.
Because the teratologic effects of many
of these compounds are not known,
pregnant staff members should not par-
ticipate. Have staff put on scrub suits,
remove jewelry and leather objects, and
wear some protective garment over the
scrubs, such as a Tyvek or Saranex cov-
erall or at least an OR gown with water-
proof sleeves and front. Disposable plas-
tic aprons add more protection. Shoes
should be covered with high-top surgical
shoe covers and taped to the pant legs.
Staff should wear two pairs of milled sur-
gical gloves and change them immediate-
ly if they develop holes. Hair must be
covered with a coverall hood or some
other water-resistant head cover. The
eyes should be protected with glasses
with side shields or goggles.
Using respirators requires education,
frequent testing, and practice. They must
be fitted to the individual and, unless
they are SCBA type, may only provide a
false sense of security. If the contami-
nant is in a powder or dust, a canister fil-
ter respirator may offer reasonable pro-
tection, but the type of canister must be
specific for the agent.
You are now ready for drills. First
do a walk through, then add PPE.
Finally, contaminate a victim with fluo-
rescent but invisible powder and run a
dress rehearsal, complete with bath and
shampoo. A Wood's light will reveal
areas that were missed and secondary
contamination. Integrate this haz-mat
plan with your institution's Disaster Plan
and in the next drill, include one or two
victims who require decontamination.
In the four years we've been at the
Medical Center of Delaware, we have
treated victims from at least ten haz-mat
incidents. The worst involved some 20
victims. It's something you have to be
ready for.
The Whys of Drills & Simulations
In 1987, the Emergency Services for
Sioux City and Woodbury County, Iowa,
ran a full-scale simulation of an air crash.
Some 30 agencies took part, using full
equipment to control simulated flames,
treating participants who had simulated
injuries, hauling victims to hospital emer-
gency rooms.
Two years later—on the same
spot—a DC 10 crashed, killing 112 peo-
ple and injuring 184 others. News of the
accident galvanized the community.
Emergency responders sped to the scene,
this time to put out real fires and treat
real patients. Physicians rounded up
their staffs, closed their offices, and
headed to the hospitals. Over 40 nearby
communities sent emergency equipment.
More than 400 citizens gave blood, while
others phoned in offers of food, blankets,
and housing for the survivors and their
kin.
The response illustrated several key
components of successful emergency
management: first, the need for a •well-
rehearsed disaster plan that forges peo-
ple and agencies from all over the com-
munity into a team; second, the critical
role that simulations can play in emer-
gency planning; third, the importance of
a sense of community in facing down a
disaster.
Sioux City began developing its
emergency management skills nearly 40
years ago. The area has three waterways
with a history of flooding, a major inter-
state that carries 6 million vehicles per
year, and lies within 100 miles of a
Strategic Air Command (SAC) base. It's a
major railroad route, a crossroads for
underground pipelines, and has a full-
service airport. It's hilly—a problem in
severe winter storms, and subject to tor-
nadoes and blizzards.
The population is scattered:
Woodbury County has 98,000 people;
85,000 live in Sioux City. The public
safety system is small: the Sioux City fire
department has seven stations and 112
firemen; one 24-hour-a-day ambulance
service has two units; a third works from
8 to 5. The police force has 110 officers;
only six or seven are on the streets at
any one time. The rescue squad has two
people: one paid, one volunteer. And
the sheriffs department patrols an 877-
square-mile territory. To cover the need,
all small communities have volunteer fire
and ambulance service.
Because the community has limited
resources to respond to catastrophes,
community leaders decided to focus on
planning. The plan involves heads of all
city and county departments, such as
public works, public safety, health, and
fire. When SARA Title III mandated
Local Emergency Planning Committees,
Sioux City planners recruited industry
representatives to their team, until then
the only piece missing in the puzzle.
Sioux City planning is team-oriented
and addresses both hazardous materials
and natural emergencies. A control team
coordinates all efforts. And at least once
each year, the team undertakes a full-
ELEVEN
-------
scale simulation; each month they do a.
tabletop exercise to work through a sce-
nario for a possible disaster. They dis-
cuss such problems as how to handle
live wires on chain link fences, what to
do if nail-studded lumber halts fire
engines after a tornado. All simulations,
which have ranged from a school col-
lapse to a hostage taking, are based on
hazard analyses that identify potential
disasters in the area.
The drills, shaped by Federal
Emergency Management Agency (FEMA)
training, stress an integrated team
approach. The philosophy is to make
exercises into learning experiences:
Post-drill reviews critique the action, not
the team members. Questions focus on
whether planners put together a realistic
scenario, whether the team was well
enough trained, whether it had the
resources to do the job—not whether its
members performed well. Team mem-
bers evaluate the administration of the
drill, not the people who took part.
Finally, the plan takes political geog-
raphy into account. Because Sioux City is
near the Nebraska and South Dakota
borders, the plan provides for cross
boundary training so that the team
approach to emergency management
doesn't stop at the Iowa border.
For more, contact: Gary Brown,
Woodbury County Emergency Services,
(712) 279-6550.
Nuclear Power Emergencies
What kind of planning goes into the
response to an incident at a nuclear
power plant? Plans at the Minnesota
Dept. of Health (MDH) give some indica-
tion of the level of detail needed.
Minnesota has two nuclear power
plants. Planning for response to a nucle-
ar emergency at these plants is coordi-
nated by the Minnesota Dept. of Public
Safely through its Division of Emergency
Management (DEM). The response
includes activities by state and federal
agencies, local governments, local private
organizations, and the power utility. The
plan addresses only incidents serious
enough to pose a hazard to people who
live or work off-site. It doesn't address
minor on-site incidents, transportation
incidents involving radioactive materials,
and incidents involving radioactive mate-
rials at facilities other than nuclear power
TWELVE
plants.
State agencies involved include the
departments of health, transportation,
human services, agriculture, pollution
control, natural resources, education, and
the state patrol. Minnesota and Wiscon-
sin also coordinate their response plans
to address possible accidents at the
power plant near Red Wing, Minnesota.
The Minnesota Dept. of Health's
responsibility is to assess the accident
and make decisions about actions to pro-
tect the public and emergency response
personnel, and to assure the provision of
emergency medical services. Its role is
to provide trained personnel for field
staff operations and the emergency oper-
ations center accident assessment office,
to notify and mobilize MDH emergency
responders, and to provide equipment
and procedures for such emergency
response functions as radiation plume
monitoring and accident dose assess-
ment. An inter-agency agreement with
the DEM funds MDH's emergency
response actions. For fiscal year 1992,
the agreement provided about $300,000
to support MDH activities. DEM and
other agencies have similar agreements.
Under the plan, field teams and the
accident assessment team are mobilized
when the health department receives an
incident notification at the "alert" classifi-
cation. The field teams meet at MDH,
collect equipment and vehicles, receive
their assignments, and drive to the affect-
ed area. The accident assessment team
reports to the state emergency operations
center at the state capitol.
The MDH field program includes
monitoring teams to measure radiation
levels in the environment and to collect
samples. A team captain coordinates
movements, sampling activities of the
monitoring teams, and other field teams.
A mobile radiochemical analysis team
analyzes air samples for radioiodine and
supplies the monitoring teams; other
radionuclides are analyzed in the labora-
tory. County decontamination center
liaisons advise local decontamination
centers on monitoring and decontamina-
tion procedures for field workers, vehi-
cles, and equipment.
The MDH accident assessment team,
mobilized by telephone or through on-
call pagers, reports to the state emergen-
cy operations center. The team coordi-
nator manages MDH accident assessment
and field monitoring activities. An assis-
tant coordinator helps develop recom-
mended protective actions and communi-
cates with the power plant. A dose
assessment analyst performs radiation
dose calculations using computerized
modelling, such as the RASCAL model
provided by the Nuclear Regulatory
Commission, and receives data on poten-
tial and actual radioactive releases from
the reactor. A communications liaison
keeps in touch with local officials, plots
monitoring data, and maintains status
boards. Public information staff explain
MDH public health actions and recom-
mendations to the media, and compose
messages for the emergency broadcast
system, which may advise the public to
take shelter or evacuate.
Other MDH activities include radio-
chemical analyses, emergency medical
services, assessing water and food safety,
and giving guidance to emergency work-
ers on such general issues as sanitation
and safety. The MDH water supply pro-
tection program coordinates with local
water supply utilities and recommends
protective actions. The radiochemical
laboratory analyzes samples collected by
monitoring teams for radionuclide con-
tent. The results are used to guide deci-
sions about protective actions. Finally,
emergency medical services coordinate
the evacuation of hospitals and nursing
homes in the affected areas, and arrange
the transport of patients to host facilities.
For more, contact: Raymond W.
Thron, PhD, PE, Director, Division of
Environmental Health, Minnesota Dept.
of Health, (612) 627-5033.
Addressing Post-disaster Trauma
By Jackie Little, Ouachita Parish
Local Emergency Planning Committee
How do people deal with the mental
pictures of destruction, injury, and death
that accompany disasters?
In spring 1991, Ouachita Parish,
Louisiana, population 142,000, had three
major disasters in ten days: First, a flood
placed over 500 homes under water;
three days later, an explosion at the
Angus Chemical plant left eight people
dead; five days after, another flood left
2500 homes under water for five weeks.
-------
Fortunately, the Parish has a disaster
plan and, thanks to its LEPC, a strong
section of the plan deals specifically with
chemical emergencies. But what we
hadn't planned for was the emotional cri-
sis that disaster precipitates.
While many community groups ded-
icate some portion of their programs to
emotional crisis support, typically for bat-
tered women, rape victims, and child
abuse counseling, disaster response per-
sonnel didn't have the training to deal
with the widespread emotional trauma
facing them—chemical workers' memo-
ries of the explosion; flood victims' stress
of weeks spent in a public shelter or
fighting to keep snakes out of their living
rooms.
To get help in dealing with the psy-
chological traumas, the Parish turned to
the National Organization for Victim
Assistance (NOVA). NOVA responded by
training local personnel in disaster crisis
management, assisting in emotional
debriefings, providing an intense training
session for counselors that focused on
the immediate crisis, and visiting the
stricken communities. They provided
support to citizens desperate to talk
about the horrors they'd survived. They
visited workers who had witnessed and
experienced the explosion.
The experience made officials real-
ize that crisis management planning too
often overlooks the emotional compo-
nent of trauma. Thus, to prepare the
emergency response staff for emotional
counseling for future disasters, the
Ouachita Civil Defense Agency held a
three-day •workshop in November that
brought together NOVA counselors and
personnel from various organizations
with counseling duties. The goal is to
develop a Crisis Counseling Crew to
respond to the emotional needs of citi-
zens in the area.
The workshop, designed for emer-
gency medical services and hospital staff,
law enforcement officers, mental health
practitioners, and clergy, covered: the
nature of catastrophe; long-term stress
reaction; death and dying; crisis interven-
tion techniques; post-trauma counseling;
the spiritual dimension of trauma; group
debriefing techniques; coordinating com-
munity crisis response; and stress reac-
tions to caregivers.
NOVA was founded in 1975 by peo-
ple who worked with victims of crime;
today, NOVA has over 3500 agencies and
individuals as members, 12 staff members,
and over 200 volunteer consultants. NOVA's
headquarters are in Washington, DC.
For more on working with NOVA,
contact: Jackie Little, Ouachita Civil
Defense, 413 Natchitoches St., West
Monroe, LA 71291; For more on NOVA
or its crisis team, contact: North
Louisiana Health Center, PO Box 1881,
Monroe, LA 71210.
Cameo Portrait
Today, many emergency response
planners use a computer software pro-
gram called "Computer Aided
Management of Emergency Operations"
(CAMEO). Developed by the National
Oceanic and Atmospheric Administration
(NOAA) and the US EPA, CAMEO is
designed to aid emergency planning and
response to chemical accidents and to
automate SARA Title III compliance
responsibilities.
Available in both DOS and
Macintosh versions, CAMEO is menu-
driven, features a database of over 3300
commonly transported hazardous chemi-
cals, over 60,000 synonyms, identification
numbers, and labelling conventions.
Integrated databases can track and
retrieve data on facilities and their chemi-
cal inventories, chemicals in transit, ship-
ping companies, emergency spill reports,
and response resources. Software for an
air dispersion model, ALOHAtm, allows
planners and incident commanders to
estimate the area and concentration of a
gas plume under various conditions.
MARPLOT1"1 software allows planners to
add data on facilities, gas plumes, evacu-
ation zones, and emergency resources to
1990 census maps of roadways, water-
ways, railroads, and political boundaries.
What advantages does CAMEO offer?
How well does it work in practice? Here
are some answers from the Disaster and
Emergency Services (DBS) of Louisville/
Jefferson County, Kentucky, which was .
chosen by NOAA and the EPA as a test
site for CAMEO II software.
DBS administers the county's emer-
gency response program and manages
the data collected by the LEPC. Those
data, according to DBS technological haz-
ards coordinator Bud Fekete, who
recently reviewed CAMEO in Firehouse
magazine, now cover 557 facilities,
including 206 extremely hazardous sub-
stance (EHS) facilities, 210 non-EHS facil-
ities, and 149 gas stations, plus 599 spe-
cial populations, such as schools, nursing
homes, and medical facilities. The LEPC
uses the data to run vulnerability screen-
ing and develop site-specific scenarios.
CAMEO modelling has been
extremely useful in alerting industrial
facility managers to the size of their vul-
nerability zones, according to Fekete. As
a result, some plants have substituted
non-EHS for EHS chemicals.
DBS has used CAMEO to create a
series of detailed digitized maps of the
city and county. Each facility is linked to
the map, and the link is placed in a spe-
cial computer file. An operator can
access any map within one second. The
maps also pinpoint the locations of
schools, nursing homes, daycare centers,
and medical facilities, thus allowing DBS
ROHMTsfHflFIS ''l,
CAMEO/ALOHA
model of an anhy-
drous ammonia
plume from a
chemical plant.
This model also
calculates out-
door and indoor
air concentra-
tions over time
for buildings
downwind of the
release.
Plot courtesy of
Louisville/Jefferson
County, Kentucky Dept.
of Emergency Services,
_
THIRTEEN
-------
to supply industrial plants with a. list of
special populations in their vulnerability
zones.
In CAMEO's air dispersion modeling
application, ALOHA™, DES made 52
maps for an ALOHA map file. This
allows an on-scene officer to tell the
computer operator that his position is on
a particular page, so the operator can
bring up the same map and scroll to the
right section. Further, the technological
hazards coordinator carries a computer,
printer, and Coastal Climate's
\VeatherPAC---lOO with a radio transmitter
in his response vehicle. During an emer-
gency, the meteorological station can be
driven to the hot zone, where it sends
information directly to the master com-
puter, updating the plume every 30 sec-
onds. ALOHA recalculates the plume,
adjusting for variations in wind speed
and direction, and supplies the incident
commander with on-site weather data.
DES turns CAMEO II into a planning
tool by developing a site-specific sce-
nario and using the vulnerability zone
developed from the scenario as the plan-
ning zone for each facility. The map
shows all special populations, evacuation
routes, transportation routes, and possi-
ble shelters outside the zone. Data for
each facility', including building plans
that show the locations of hazardous
materials, utility shutoffs, private protec-
tion systems, hydrants, and so forth, can
also be accessed easily.
According to Fekete, CAMEO has
allowed the technological hazards coor-
dinator to reinforce the incident com-
mander's work. "Most ICs are delighted
to be handed hard copy of an area map
with the plume drawn on it," said Fekete.
"The text accompanying the map, along
with the chemical-specific information,
gives the 1C a solid foundation upon
which to base decisions."
For more on Louisville/Jefferson
County's experience, contact: Bud
Fekete, DES, (502) 625-3646, or see the
July 1991 Fircboiise magazine. For more
on CAMEO, contact: Lee Feldstein,
National Safety Council, Environmental
Health Center, (202) 293-2270.
Training for HazMat Response
Where can people go for training in
handling chemical incidents? One source
of training is the Hazardous Materials
Incident Response Training Program,
FOURTEEN
developed by the EPA's Emergency
Response Division, Office of Emergency
and Remedial Response (OERR).
Program courses are designed for people
who respond to emergencies or investi-
gate and clean up abandoned hazardous
waste sites. They provide training in
safety and health, and in the technical
operations needed to identify, evaluate,
and control hazardous releases.
One of the 12 environmental courses
offered by the training center is
"Emergency Response to Hazardous
Materials Incidents" (ERTHMI, 165.15),
developed for first responders—firefight-
ers, police officers, and EMS personnel.
During the five-day course, partici-
pants learn to recognize and evaluate a
hazardous materials incident, organize a
response team, protect response person-
nel, identify and use response resources,
implement control measures, practice
decision-making, and protect the public.
Topics include: chemical and physical
properties of hazardous materials; toxi^
cology; recognition and identification of
hazardous materials; direct reading of
instruments; standard operating proce-
dures; personnel protection and safety;
and information sources.
The class emphasizes hands-on
exercises in which participants wear fully
encapsulating suits and chemical-splash
gear and handle equipment. Attendees
take part in two simulations designed to
apply and test the lessons they learn.
After the course, they should be able to:
select appropriate personal protective
equipment; use combustible gas detec-
tors, oxygen meters, and detector tubes
to evaluate hazards; use confinement and
containment techniques to control haz-
ardous material releases; identify the
importance of an incident command sys-
tem for effectively managing a hazardous
materials incident; develop procedures
for decontaminating emergency response
personnel; and use situation evaluation
techniques to develop strategies and
select appropriate tactics for mitigating
hazardous materials incidents.
To make more training available to
first responders, the Emergency Response
Division (ERD) permits other organiza-
tions to present the ERTHMI course. Any
organization that would like to present
the EPA course should have an estab-
lished, recognized training program that
routinely presents courses related to haz-
ardous materials incident response. It
must also have the necessary facilities,
equipment, instructors, support staff, and
other resources.
While the EPA can't provide fund-
ing, ERD will assist organizations in
developing and implementing the cours-
es to ensure that they meet ERD stan-
dards. ERD also provides sponsoring
organizations with copies and updates of
all written material and visual aids, and
with such administrative materials as reg-
istration, student evaluation, and report
forms. ERD or its training contractors
may also be able to offer assistance in
presenting courses.
For more, contact: Bruce Potoka,
ERT Training Program, US EPA, (513)
569-7537.
Resources From ATSDR
A number of resources are available
from the federal Agency for Toxic
Substances and Disease Registry
(ATSDR), a -Health and Human Services
Department agency created by the
Comprehensive Environmental, Response
Compensation, and Liability Act of 1980
(CERLCA). Under CERCLA and the
Superfund Amendments and
Reauthorization Act of 1986, ATSDR's
mission is to prevent or mitigate human
health problems and diminished quality
of life resulting from exposure to haz-
ardous substances in the environment.
ATSDR is also mandated to develop
information and educational programs to
help health professionals evaluate, diag-
nose, treat, and conduct surveillance on
patients exposed to hazardous sub-
stances. The agency further is involved
in emergency response consultation in
hazardous materials incidents.
Medical Management Guidelines for
Acute Chemical Exposures (MMGACE) is
a resource for health professionals who
must effectively decontaminate victims,
communicate with other staff, transport
victims to medical facilities, protect them-
selves and other staff from contamina-
tion, and provide medical treatment to
victims of hazardous substance emergen-
cies. Intended for emergency room
physicians, poison control centers, emer-
gency responders, occupational health
clinics, county health officials, the mili-
tary, and other health professionals who
must respond to acute exposure inci-
dents involving hazardous chemicals,
-------
MMGACE was developed under the guid-
ance of a committee of toxicologists,
occupational and emergency room physi-
cians. It addresses the medical manage-
ment of acute exposure to 25 chemicals
(ranging from ammonia to xylene), man-
agement of unknown exposures, com-
munication, triage, decontamination,
transport, and protective clothing. A ref-
erence section includes information
resources, antidotes, a guide to using
Material Safety Data Sheets, basic toxicol-
ogy, and a glossary. Available in 1992
from ATSDR's Division of Medical
Education, (404) 639-6204.
Emergency Medical Services: A
Planning Guide for the Management of
Contaminated Patients is intended to
help emergency medical services person-
nel plan for hazardous materials inci-
dents. The manual can be used to help
communities assess their capabilities for
handling potential community hazards
and to develop response plans. A com-
panion manual, Hospital Emergency
Department: A Planning Guide for the
Management of Contaminated Patients,
is intended to help emergency depart-
ments prepare for and respond to haz-
ardous materials incidents. It, too, can
be used to assess community hazards
and to develop response plans. It does
not offer information on medical treat-
ment. Available from ATSDR's
Emergency Response and Consultation
Branch, Division of Health Assessment
and Consultation, (404) 639-0616.
Other useful materials include Case
Studies in Environmental Medicine, self-
instructional educational materials that
guide physicians through the diagnosis,
treatment, and surveillance of people
exposed to hazardous substances. The
15 case studies developed to date have
been, reviewed and approved by such
professional associations as the American
Medical Association and the American
Academy of Pediatrics. A second set of
15 documents is under development.
Available from ATSDR's Division of
Health Education, (404) 639-6204.
Toxicological Profiles offer compre-
hensive information on 225 chemicals
identified at hazardous waste sites. The
profile of each chemical includes techni-
cal information, discussions of informa-
tion gaps on the substance's toxicity and
health effects, and a public health state-
ment that can be used in communicating
with the general public. Available
through the Division of Toxicology and
the National Technical Information
Service (NTIS), (404) 639-6043.
Finally, ATSDR offers 24-hour-a-day
consultation for hazardous materials
emergencies at the Emergency Response
and Consultation number, [(404) 639-
0615], and emergency response training
through the Louisville/Jefferson County
Health Dept. For more information on
training, contact: Emergency Response
and Consultation Branch, Division of
Health Assessment and Consultation,
(404) 639-0616.
Aid From The CDC
The Centers for Disease Control is
the lead US Public Health Service agency
for coordinating and managing overall
health response in major emergencies
and disasters. CDC also investigates the
health effects and medical consequences
of natural and technological disasters.
In a major emergency, CDC alerts
other appropriate federal agencies, con-
sults with state and local agencies on
identifying and finding necessary medical
resources, advises federal, state, and
local officials on emergency response
and worker protection issues, and estab-
lishes public health surveillance. Its
responsibilities include providing techni-
cal and epidemiological assistance to
state and local governments before and
after disasters; documenting and quanti-
fying public health consequences of dis-
asters; using risk factor analysis to identi-
fy potential strategies for preventing or
mitigating public health effects from dis-
asters; developing prevention programs
and contingency plans; developing and
maintaining national systems for acute
environmental hazard surveillance;
assessing health care needs immediately
after a disaster; assessing health risk; and
providing epidemiological and scientific
support to other agencies involved in
disaster planning.
To reach CDC in an emergency, call:
(404) 639-0615.
Information Sources
Here are a few other sources of
training, research, and information on
emergency response.
The Federal Emergency Management
Agency (FEMA) offers training in the
integrated approach to emergency man-
agement. For more, contact: FEMA,
National Emergency Training Center,
Emergency Management Institute, 16825
S. Seaton Ave., Emmetsburg, MD 21727;
(301) 447-1000.
The University of Delaware's Disaster
Research Center (DRC) carries out
research on preparation for, response to,
and recovery from community-wide
emergencies, including natural and tech-
nological disasters. Contact: Disaster
Research Center, University of Delaware,
(302) 451-6618.
Colorado State University's Hazards
Assessment Laboratory facilitates interdis-
ciplinary research on risk communica-
tion, hazard mitigation and management,
and planning and preparation for emer-
gency response. Contact: Hazards
Assessment Laboratory, Colorado State
University, (303) 491-7347.
The Hazard Reduction and Recovery
Center at Texas A&M University studies
hazard mitigation, disaster preparedness,
response, and recovery. Contact: Hazard
Reduction and Recovery Center, College
of Architecture, Texas A&M University,
(409) 845-7813.
The Natural Hazards Research and
Applications Information Center at the
University of Colorado is designed to
strengthen communication among
researchers and individuals, organiza-
tions, and agencies concerned with miti-
gating the effects of natural disasters. Its
principal communications vehicle is the
Natural Hazards Observer, published
bimonthly, free to US subscribers and
$15 to subscribers outside the US.
Contact: Natural Hazards Research and
Applications Information Center, Institute
of Behavioral Science, University of
Colorado, (303) 492-6818.
The 1992 Hazardous Material Spills
Conference, Philadelphia, Pennsylvania,
April 21-24, will cover the latest on emer-
gency response planning. Sponsored by
the National Response Team, the Nation-
al Governors' Association, the Chemical
Manufacturers' Association, and the
American Institute of Chemical Engin-
eers, the conference •will examine how
nations, states, communities, and indus-
tries prepare for hazardous materials inci-
dents. It •will examine the effects of new
legislation and offer samplers of available
training programs. To register, contact:
Sonja Cohen, Technical Resources, Inc.,
FIFTEEN
-------
(301) 231-5250.
The Chemical Manufacturers'
Association offers several public services.
CHB/TKCCXChemical Transportation
Emergency Center) provides support in
hazardous materials transportation emer-
gencies and advice in non-transportation
incidents. Designed for emergency
responders, carriers, and officials, it pro-
vides information on the nature of the
chemical and procedures for handling
spills, and notifies shippers for informa-
tion and follow-up, including on-site
assistance. MEDTREC(Medical Treat-
ment Emergency Communications), still
under development, is designed to
enhance medical emergency response
efforts to get usable information quickly
to emergency- medical and first response
personnel. To reach CHEMTREC and
MEDTREC, call: (800) 424-9300, 24 hours
a day, seven days a week. The number
is for emergency response only.
C/ffil/iYETXChemical Network), pro-
vides emergency response teams from
chemical companies or private contrac-
tors. Designed for chemical producers
who have no emergency response capa-
bility at the site of the spill, CHEMNET
provides a program for responding to
serious hazardous materials transporta-
tion spills. CHEMNET membership is
open to chemical producers or handlers
who are CHEMNET registrants. TRANS-
CAER (Transportation Community
Awareness and Emergency Response)
addresses community concerns about the
transport of hazardous materials, helps
LEPCs identify hazardous materials mov-
ing through the community, offers guid-
ance for evaluating local emergency
response plans, and assists with emer-
gency preparedness training. For more,
call CHEMTREC administration: (202)
887-1152.
The Chemical Referral Center (CRC)
is designed to help the public, trans-
portation workers, and users of chemi-
cals to obtain health and safety informa-
tion on chemicals and chemical products.
Available 9-6 Eastern Time, Monday to
Friday, it refers callers to state, federal, or
industry representatives who can answer
questions about chemicals. The number
is (800) 262-8200 or (202) 887-1315.
Finally, CMA is involved in training
programs. One, being developed by the
Chemical Industry Council of Delaware,
offers emergency room physicians gener-
SIXTEEN
al training in handling chemical emer-
gencies. As part of its MEDTREC initia-
tive, CMA is also working with the
American Association of Poison Control
Centers to develop a training package for
handling medical emergency inquiries
involving industrial chemicals. To be
completed by summer 1992, the training
package will improve poison control
centers' ability to respond to emergencies
involving acute occupational or acciden-
tal exposures to chemicals during their
use, transport, or storage. For more on
these programs, contact: Karen Creedon,
CMA, (202) 887-1387.
As of December 1, 1991, the
Environmental Protection Agency's
Integrated Risk Information System data
base (IRIS) contained 491 chemicals.
This included 336 oral reference dose
(RfD) and 60 inhalation reference con-
centration (RfC) summary sections, and
205 carcinogen assessments, for a total of
601 risk information summaries. In addi-
tion, the system contains summaries of
64 chemical-specific Drinking Water
Health Advisories, 187 US EPA regulatory
action summaries, and complete biblio-
graphic citations for 446 substances.
The December update replaced the
oral RfD summary for silver, which had
been withdrawn, and added inhalation
RfC information summaries for allyl chlo-
ride, 1,2-dichloropropane, and methyl
tert-butyl ether.
The risk information available in
EPA's Integrated Risk Information System
(IRIS) represents EPA-wide consensus
positions on the potential adverse chron-
ic human health effects of approximately
500 substances. IRIS information, on
both non-cancer and cancer effects, is
appropriately used when applied in the
broader context of the risk assessment
process outlined by the National
Academy of Sciences (NAS) in its 1983
publication, "Risk Assessment in the
Federal Government: Managing the
Process." As identified and defined by
NAS, the process consists of four ele-
ments: hazard identification, dose-
response assessment, exposure assess-
ment, and risk characterization. IRIS data
contribute to the first two of these ele-
ments: hazard identification and dose-
response assessment.
While IRIS is a useful risk informa-
tion resource, it doesn't provide situa-
tion-specific information on instances of
exposure. Only when IRIS data are com-
bined with specific exposure information
can they be used for characterizing the
public health risks of a given chemical in
a specific situation. In this context, IRIS
data can aid in reaching a risk manage-
ment decision designed to protect the
public health. IRIS data shouldn't be
construed as representing regulatory
decisions.
For information on accessing IRIS,
call: IRIS User Support at (513) 569-7254
or write: IRIS User Support, ECAO/EPA
(MS-114), 26 West Martin Luther King
Dr., Cincinnati, OH 45268.
Keeping Up With IRIS is a regular
Digest feature, carried with support from
the EPA's Office of Health and Environ-
mental Assessment.
• Conducting Indoor Air Quality
Investigations, Jan 14-16, St. Paul, MN.
Contact: Midwest Ctr for Occup'l Health
& Safety, (612) 221-3992.
• Demonstration Workshop of an
Integrated Emergency Response, Mar 30-
Apr 2, Apr 13-16, May 11-14, Jun 8-11,
Aug 31-Sep 3, Sep 21-24, Louisville, KY.
Contact: Emergency Response & Consul-
tation Branch, ATSDR, (404) 639-0615-
• HazMat Spills Conf, Apr 21-24,
Philadelphia, PA. Contact: Sonja Cohen,
Technical Resources Inc, (301) 231-5250.
• Risk Mgmt in Env 'I Health &
Protection (and Quantitative Risk
Assessment), Jun 9-12, New York, NY.
Contact: NYU Graduate School of Public
Service, (212) 998-7432.
• 5th Annual Nt'l Mtg & Conf of the
Academy of Certified Haz Mat Mgrs, Jun
23-25, Milwaukee, WI. Contact:
Federation of Environmental
Technologists, Inc., (414) 251-8163.
Printed on recycled paper.
------- |