Abstract
On April 25, 2019, a farm tractor towing two 2-ton ammonia tanks on a county road in Lake County, Illinois, experienced a mechanical failure that resulted in the release of anhydrous ammonia, a colorless, pungent, irritating gas that can cause severe respiratory and ocular damage (1). Approximately 80% of anhydrous ammonia produced in the United States is used as a fertilizer in agriculture (1). Eighty-three persons, including first responders, motorists, and neighborhood residents, were evaluated at area hospitals because of exposure to the gas. Two weeks after the release, the Agency for Toxic Substances and Disease Registry (ATSDR) and CDC's National Center for Environmental Health (NCEH) collaborated with the Lake County Health Department and the Illinois Department of Public Health on an investigation using ATSDR's Assessment of Chemical Exposures program to describe the release, review the emergency response, and determine health effects associated with the exposure. First responders, community residents, and hospital personnel reported communication challenges related to the nature of the gas release and effective protective measures. Among the 83 persons evaluated at six area hospitals for effects of the chemical release, 14 (17%) were hospitalized, including eight (10%) who were admitted to the intensive care unit (ICU), seven (8%) of whom required endotracheal intubation and mechanical ventilation; no deaths occurred. In addition, ICU health care providers experienced symptoms of secondary exposure. The National Institute for Occupational Safety and Health's Emergency Responder Health Monitoring and Surveillance Program has specific recommendations and tools to protect responders during all phases of a response (2). Hospitals also need to review institutional policies and procedures for chemical mass casualty events, including decontamination (3). Prompt and correct identification of hazardous material (hazmat) events, and clear communication among responding entities, including on-scene and hospital responders, is important to ensure effective response after a chemical release.
Highlights
Preparation for hazardous materials responses should ensure 1) timely and informative public communication, 2) effective communication among first responders, 3) accurate field information provided to health support personnel, and 4) regular hazmat exercises for all response and support personnel
Responders who initially arrived on scene were unaware it was a hazmat incident
Prompt and correct identification of hazmat events, and clear communication among responding entities, including onscene and hospital responders, is important to ensure effective response after a chemical release
Summary
Ten days after the release, on May 9, 2019, a team from ATSDR and CDC arrived in Illinois to assist the Lake County Health Department and the Illinois Department of Public Health with the Assessment of Chemical Exposures investigation, which uses a toolkit of modifiable surveys to conduct rapid assessments after large-scale toxic substance releases (5) This investigation included the following five components: 1) environmental evaluation of the size of the release; 2) abstraction of medical records to characterize the health effects of the release; 3) a survey of first responders who were in or near the plume; 4) a household survey of persons who lived in the four census blocks adjacent to the release; and 5) a survey of hospital emergency department (ED) personnel who treated patients
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