Hazardous Materials Events Research Articles

Exploring wearable technology use and importance of health monitoring in the hazardous occupations of first responders and professional drivers.

Hazardous materials (HAZMAT) pose risks to the health and safety of professionals involved with transportation and emergency responses. Two distinct occupational groups that encounter HAZMAT events are first responders and professional drivers. Wearable technology is a tool that can assist with monitoring the health of professionals involved in HAZMAT events. The aim of this study was to compare and evaluate the perceptions of first responders and professional drivers on wearable technology and attitudes toward health monitoring. A survey was administered to first responders (n = 112) and professional drivers (n = 218). Statistical approaches included bivariate analysis, latent class analysis, logistic regression analysis, and path analysis for the variables of interest. There were significant differences between the groups in perceptions of the benefits of monitoring certain health indicators. Professional drivers were more likely to have a history of wearable technology use compared with first responders (odds ratio [OR] = 10.1; 95% CI, 4.42-22.9), reported greater exposure to HAZMAT (OR = 4.32; 95% CI, 2.24-8.32), and were more willing to have their health data monitored by someone other than themselves (OR = 9.27; 95% CI, 3.67-23.4). A multinomial regression model revealed that occupation was not a significant predictor of class preference for acceptance of monitoring specific health indicators. Occupation appeared to be important but further analysis uncovered that characteristics of individuals within the occupations were more salient to the use of wearable technology. HAZMAT exposure, someone else monitoring health data, and experience with wearable technology use were found to be important factors for perceptions about benefits of health monitoring with wearable technology.

Are trauma surgeons prepared? A survey of trauma surgeons’ disaster preparedness before and during the COVID-19 pandemic

ObjectiveUS trauma centers (TCs) must remain prepared for mass casualty incidents (MCIs). However, trauma surgeons may lack formal MCI training. The recent COVID-19 pandemic drove multiple patient surges, overloaded Emergency...

Anhydrous Ammonia Chemical Release - Lake County, Illinois, April 2019.

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.

A Hazardous Materials Educational Curriculum Improves Pediatric Emergency Department Staff Skills.

Emergency department (ED) providers require competency in responding to hazardous materials (HAZMAT) events. The optimal strategies to teach HAZMAT response principles to ED providers and to ensure skill retention are not known. Our aim was to design, implement, and evaluate a multifaceted, interprofessional educational curriculum for pediatric ED staff to improve their skills, knowledge, and confidence in responding to a HAZMAT event. In this longitudinal cohort study, we created and assessed a 3-hour educational curriculum comprised of didactics, skills stations, a tabletop exercise, and a simulated multivictim disaster. Learning objectives included critical aspects of pediatric HAZMAT incident response with an emphasis on donning personal protective equipment (PPE). The primary outcome was the number of HAZMAT PPE donning steps correctly completed within 10 minutes at pre- and postcurriculum assessments measured using a 32-item checklist. Secondary outcomes included skill retention at 3 months, change in knowledge assessed using multiple-choice questions, and change in participant confidence. Eighty-one of 84 participants (96%) completed the entire curriculum. Compared to the precurriculum assessment, participants completed more donning steps correctly after the intervention (mean increase = 58%, 95% confidence interval [CI] = 48%-70%). Relative to the baseline, more steps were also correctly completed at 3 months (mean increase = 49%, 95% CI = 38%-61%). Performance on multiple-choice knowledge questions and confidence in skills also significantly increased from the pre- to postcurriculum assessments. A newly developed HAZMAT educational curriculum improved skills-based performance, knowledge, and confidence in PPE and decontamination skills. Brief, multifaceted educational interventions for ED staff can effectively develop sustainable skills needed for uncommon emergency events.

A Descriptive Analysis of Prehospital Response to Hazardous Materials Events

Little is known about the overall frequency of hazardous materials (HazMat) events in the United States and the nature of prehospital care for those exposed. The purpose of the current study was to perform a descriptive analysis of Emergency Medical Services (EMS) activations reported to a national EMS database. Analysis of the 2012 National EMS Information System (NEMSIS) Public Release Research Data Set v.2.2.1, containing EMS emergency response data submitted by 41 states, was conducted. Mandatory data elements E0207 (Type of Response Delay), E0208 (Type of Scene Delay), and E0209 (Type of Transport Delay) contained specific codes for HazMat events and were used to identify specific EMS activation records for subsequent analysis. Overlapping data elements were identified and combined in order to prevent duplicate entries. Descriptive analyses were generated from the NEMSIS Research Data Set. A total of 17,479,328 EMS activations were reported, of which 2,527 unique activations involved HazMat response. Mass-casualty incident was coded for 5.6% of activations. The most common level of prehospital care present on scene was Basic Life Support (BLS; 51.1%); 2.1% required aggressive Advanced Life Support (ALS) response. The most common locations for HazMat activations were homes (36.2%), streets or highways (26.3%), and health care facilities (11.6%). The primary symptoms observed by EMS personnel were pain (29.6%), breathing problems (12.2%), and change in responsiveness (9.6%). Two percent of HazMat activations involved cardiac arrest, with 21.7% occurring after EMS arrival. Delays in patient care included response delay, scene delay, and transport delay. Hazardous materials events are rare causes of EMS activation in the United States. The majority occur in non-industrial venues and involve two or fewer patients. Scene time frequently is delayed due to multiple barriers. Cardiac arrest is rare but occurred after EMS arrival in one-fifth of patients.

Hazardous Material Events in Schools and How the Regional Poison Control Center Can Help

Hazardous Material Events in Schools and How the Regional Poison Control Center Can Help

Secondary Contamination of Medical Personnel, Equipment, and Facilities Resulting From Hazardous Materials Events, 2003–2006

When not managed properly, a hazardous material event can quickly extend beyond the boundaries of the initial release, creating the potential for secondary contamination of medical personnel, equipment, and facilities. Secondary contamination generally occurs when primary victims are not decontaminated or are inadequately decontaminated before receiving medical attention. This article examines the secondary contamination events reported to the Agency for Toxic Substances and Disease Registry (ATSDR) and offers suggestions for preventing such events. Data from the ATSDR Hazardous Substances Emergency Events Surveillance system were used to conduct a retrospective analysis of hazardous material events occurring in 17 states during 2003 through 2006 involving secondary contamination of medical personnel, equipment, and facilities. Fifteen (0.05%) Hazardous Substances Emergency Events Surveillance events were identified in which secondary contamination occurred. At least 17 medical personnel were injured as a result of secondary contamination while they were treating contaminated victims. Of the medical personnel injured, 12 were emergency medical technicians and 5 were hospital personnel. Respiratory irritation was the most common injury sustained. Adequate preplanning and drills, proper decontamination procedures, good field-to-hospital communication, appropriate use of personal protective equipment, and effective training can help prevent injuries of medical personnel and contamination of transport vehicles and medical facilities.

Poison Centers as Information Resources for Volunteer EMS in a Suspected Chemical Exposure

In the early part of chemical terrorism or hazardous materials events, protective actions and patient care require empirical decisions because reliable and accurate information may not be readily available. It has become increasingly important to identify reliable information resources that are the most likely to be accessed for information during these events. We sought to identify information resources that volunteer Emergency Medical Services (EMS) providers would use during a suspected chemical exposure. Survey questionnaires were completed by 116 of 151 (76.8%) suburban and rural EMS providers. In the past 12 months, most participants used medical journals and textbooks (59.5%), internet sites (57.8%), and poison centers (55.2%) as information resources. For two hypothetical scenarios involving chemical exposures, poison centers were most frequently chosen as likely contacts for information regarding the identity of the agent (case 1: 52.6%, case 2: 48.3%), treatment (74.1%, 64.7%, respectively), and antidote (59.5%, 49.1%, respectively). Fire department hazardous materials team tied with poison centers as the highest for chemical agent in the second scenario (48.3%) and was ranked highest both for decontamination (75.0%, 64.7%, respectively) and personal protection (56.9%, 45.7%, respectively). Poison centers were selected as the best resource for timely information (70.7%), availability (69.0%), and ease of contact (72.4%), and second highest for knowledge of chemical agents (44.0%), after CHEMTREC (56.9%). Finally, poison centers and CHEMTREC received the highest overall ratings (28.4% and 26.7%, respectively). Poison centers are viewed as an important information resource by EMS providers and may be the most commonly sought resource for various information needs during a suspected chemical exposure.

Human error and time of occurrence in hazardous material events in mining and manufacturing

Human error has played a role in several large-scale hazardous materials events. To assess how human error and time of occurrence may have contributed to acute chemical releases, data from the Hazardous Substances Emergency Events Surveillance (HSEES) system for 1996–2003 were analyzed. Analyses were restricted to events in mining or manufacturing where human error was a contributing factor. The temporal distribution of releases was also evaluated to determine if the night shift impacted releases due to human error. Human error-related events in mining and manufacturing resulted in almost four times as many events with victims and almost three times as many events with evacuations compared with events in these industries where human error was not a contributing factor (10.3% versus 2.7% and 11.8% versus 4.5%, respectively). Time of occurrence of events attributable to human error in mining and manufacturing showed a widespread distribution for number of events, events with victims and evacuations, and hospitalizations and deaths, without apparent increased occurrence during the night shift. Utilizing human factor engineering in both front-end ergonomic design and retrospective incident investigation provides one potential systematic approach that may help minimize human error in workplace-related acute chemical releases and their resulting injuries.

Morbidity and mortality from hazardous materials events in the personal services industry, 1993-2001: A follow-up report from the Hazardous Substances Emergency Events Surveillance (HSEES) system

An estimated 8% of acute hazardous materials (HazMat) events that occur annually in the United States involve victims. Little information is available in the literature pinpointing which industries are associated with these acute events. Data from the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance (HSEES) system were analyzed to determine which industry categories had the highest proportion of events with victims. These data were collected from 17 state health departments that participated in the HSEES system from 1993 through 2001. During 1993 through 2001, 53,142 HazMat events occurred, of which 51,989 involved actual releases. Of these events with actual releases, 4,324 (8.3%) involved victims. Of the 14 major industrial categories analyzed, personal services-with 1,311 total events, including 468 with victims-had the highest major industrial category proportion of events with victims (35.7%). This high proportion of events with victims was associated mainly with the following three personal services subcategories: private households; laundry, cleaning, and garment services; and hotels and motels. Most of the victims injured in personal services events involved members of the general public. The most frequently reported symptom was respiratory irritation. The causal factors leading to most releases were operator error, followed by deliberate/illegal damage. Targeting the personal services industries with appropriate prevention strategies may be an effective way to help begin reducing the high proportion of events with victims in this category.

Counting Crises: US Hospital Evacuations, 1971–1999

To investigate the relative distribution of hazards causing hospital evacuations, thereby to provide rudimentary risk information for hospital disaster planning. Cases of hospital evacuations were retrieved from newspaper and publication databases and classified according to hazard type, proximate and original cause, duration, and casualties. Both partial and full evacuations were included. The total number of evacuation incidents for all hazards were compared to the total number of hospital incidents for the one hazard, fire, for which national data is available. There were 275 reported evacuation incidents from 1971-1999, with an annual average of 21 in the 1990s, the period for which databases were more reliable. The most, 33, were recorded in 1994, the year of the Northridge Earthquake. Of all incidents, 63 (23%) were attributable primarily to internal fire, followed by internal hazardous materials (HazMat) events (18%), hurricane (14%), human threat (13%), earthquake (9%), external fire (6%), flood (6%), utility failure (5%), and external HazMat (4%). More than 50% of the hospital evacuations occurred because of hazards originating in the hospital facility itself or from human intruders. While natural disasters were not the preponderant causes of evacuations, they caused severe problems when multiple hospitals in the same urban area were incapacitated simultaneously. Clearly, as hospitals are vulnerable to many hazards, mitigation investments should be assessed not in terms of single-hazard risk-cost-benefit analysis, but in terms of capacity to mitigate multiple hazards. In view of the many qualifications and limitations of the dataset used here, but value of such data for disaster planning, hospitals should be asked to submit standardized incident reports to permit national data gathering on major disruptions.

Surveillance of hazardous materials events in 17 states, 1993-2001: a report from the Hazardous Substances Emergency Events Surveillance (HSEES) system.

Thousands of acute hazardous materials (HazMat) releases occur annually throughout the United States. To prevent human exposure and resulting injuries, it is critical to understand the frequency with which these releases occur, the locations involved, the industries associated, and the specific substances being released. HazMat events data from the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance (HSEES) system were analyzed for frequency and locations of occurrence, major industry categories and sub-categories involved, and substances released. The data analyzed were collected from 17 participating state health departments for 1993 through 2001. During 1993 through 2001, 53,142 HazMat events occurred. Of the 17 states analyzed, Texas had the most releases, comprising 38.3% of all HSEES events. Of the 14 major US Census industry categories analyzed, the manufacturing category had the highest percentage of events (48.7%) followed by transportation, communication, and other public utilities (27.5%). Of the 10 states that participated during the entire analysis period, the numbers of events increased 64.3%. Twelve of 14 major industrial categories experienced increases in numbers of events over the analysis period, while public administration and active duty military events decreased. The substances released most frequently overall included ammonia, sulfur dioxide, and sulfuric acid, respectively. The HSEES data appear to reflect an upward trend in the occurrence of hazardous HazMat events. While it is difficult to definitively conclude whether this trend is due to more events actually occurring or from other factors, reviewing historical HazMat data may help communities, government agencies, and industries prevent or better prepare for potential events in the future.

Secondary contamination of ED personnel from hazardous materials events, 1995–2001

Hazardous materials (hazmat) events pose a health threat not only for those individuals in the immediate vicinity of the release (ie, members of the general public, on-site first responders, employees), but also for ED personnel (ie, physicians and nurses) treating the chemically contaminated victims arriving at the hospital. Secondary contamination injuries to ED personnel result when exposed victims enter the ED without being properly decontaminated. Data from the Agency for Toxic Substances and Disease Registry’s Hazardous Substances Emergency Events Surveillance System were used to conduct a retrospective analysis on hazmat events occurring in 16 states from 1995 through 2001 that involved secondary injury to ED personnel. Six events were identified in which 15 ED personnel were secondarily injured while treating contaminated victims. The predominant injuries sustained were respiratory and eye irritation. Proper victim decontamination procedures, good field-to-hospital communication, and appropriate personal protective equipment (PPE) use can help prevent ED personnel injuries and contamination of the ED.

Hazardous materials events: Evaluation of transport to health care facility and evacuation decisions

The study objective was to analyze hazardous materials event and victim factors associated with transportation of victims to a health care facility, and evacuation or shelter-in-place of nearby populations. A retrospective review was conducted on hazardous materials events in Washington State from 1993 to 1997. Bivariate and multiple logistic regression were used to identify risk factors for transportation, evacuation, and shelter-in-place. Over five years, 2,654 victims from 457 events were reported, with 1,859 (70%) transported to a health care facility. Evacuation occurred in 279 (61%) events and shelter-in-place in 14 (3%) events. After excluding 14 deaths, regression analysis indicated that victims with trauma (OR 5.87, 95% CI 1.41-24.5), thermal burns (6.90, 1.15-41.3), dizziness/other CNS symptoms (1.59, 1.00-2.54), and headache (1.54, 1.01-2.35) were most likely to be transported. Chemical releases inside buildings (2.09, 1.06-4.10, compared with transportation events), and involving 3-5 victims (2.86, 1.54-5.31, compared to 1 victim) or > or =6 victims (8.74, 4.01-19.0), were most likely to involve evacuation or shelter-in-place. Events involving sulfuric acid (0.15, 0.05-0.49) and sodium hydroxide (0.19, 0.04-0.94) were least likely to involve evacuation or shelter-in-place. Prehospital decisions to transport victims to a health care facility and evacuate or shelter-in-place nearby populations are associated with event and victim factors. Further research is needed to determine if these factors also predict need for medical care or removal from exposure, and to develop evidence-based prehospital care protocols for hazardous materials exposure victims.

Hazardous materials events: an industrial comparison.

Identifying industries at high risk for hazardous materials releases can facilitate prevention and preparation for such events. A retrospective review by Standard Industrial Classification (SIC) codes was conducted on non-petroleum hazardous materials emergency events from 1993 to 1995 and collected by the Washington State Department of Health in a program supported by the Agency for Toxic Substances and Disease Registry. Annual US Census data were used to determine the number of facilities and employees by SIC code in the state of Washington. SIC codes with the most total events and events per 10,000 employees were ranked and characterized by type of releases. In 3 years, 1269 events were recorded, with 294 involving human victims. Industries with the highest average annual number of events per 10,000 employees were agricultural chemical manufacturing (142); petroleum refining (122); industrial and miscellaneous chemical manufacturing (56); electric light and power (54); and pulp, paper, and paperboard mills (39). Industries with high rates of hazardous materials emergency events should continue to develop methods of preventing these releases.

Hazardous materials events at a New York city trauma center

Hazardous materials events at a New York city trauma center