Hazmat Incidents Research Articles

Improving Hazardous Material Incident Preparedness for Emergency Medicine Physician Trainees: A Quality Improvement Project

Introduction:Hazardous materials (HazMat) training is not a requirement for accreditation of US Emergency Medicine (EM) residencies, nor for EM board certification by the American Board of Emergency Medicine (ABEM). However, the US Occupational Safety and Health Administration (OSHA) requires hospitals train all personnel expected to deal with contaminated patients. This QI project aimed to develop an EM physician-specific HazMat course and evaluate the physician comfort level with HazMat personal protective equipment (PPE) donning and doffing, triage, procedural skills, and decontamination.Method:A four-hour “HazMat for Docs” course was designed at a large urban academic trauma center and offered to second-year EM residents. Additionally, we performed a quantitative survey of a cohort of 72 current and recently graduated EM residents (classes 2019-2024), some of whom had taken the course in person. Our primary outcome was to measure improvement in comfort level with essential HazMat tasks after completing the course. Our secondary outcome was to evaluate the current or recently graduated EM physician's overall comfort levels with managing a HazMat incident, as well as HazMat skills and knowledge retention.Results:A total of 53 responses (73.6%) were obtained. 45.3% of the respondents were male and 54.7% female. 37.8% of the respondents were recent EM graduates, with 20.8% PGY-4, 13.2% PGY-3, 15.1% PGY-2, 13.2% PGY-1. 16/53 (30.2%) had prior EMS experience. EM Physicians were most comfortable with donning and doffing PPE (4.92 on a 7-point scale) and least comfortable with decontamination procedures (2.98/7). After completing the HazMat course, EM physicians increased their comfort level with HazMat decontamination procedures by 8.6% and with organizing a multi-disciplinary ED HazMat response by 10.5%.Conclusion:EM Physician comfort levels with HazMat procedures are low. Increased training aimed at improving physician knowledge, preparedness, and comfort level for such events is necessary and can be accomplished through a short course.

Availability and use of medications by prehospital providers trained to manage medical complications of patients in hazardous materials incidents.

Little is known about prehospital availability and use of medications to treat patients from hazardous materials (hazmat) medical emergencies. The aim of this study was to identify the availability and frequency of use of medications for patients in hazmat incidents by paramedics with advanced training to care for these patients. A prospectively validated survey was distributed to United States paramedics with advanced training in the medical management of patients from hazmat incidents who successfully completed a 16-hour Advanced Hazmat Life Support (AHLS) Provider Course from 1999 to 2017. The survey questioned hazmat medication availability, storage, and frequency of use. Hazmat medications were considered to have been used if administered anytime within the past 5 years. For analyses, medications were grouped into those with hazmat indications only and those with multiple indications. The survey email was opened by 911 course participants and 784 of these completed the survey (86.1 percent). Of these 784 respondents, 279 (35.6 percent) reported carrying dedicated hazmat medication kits, ie, tox-boxes, and 505 (64.4 percent) did not carry tox-boxes. For those medications specifically for hazmat use, hydroxocobalamin was most commonly available, either within or not within a dedicated tox-box. Of the 784 respondents, 313 (39.9 percent) reported carrying hydroxocobalamin and 69 (8.8 percent) reported administering it within the past 5 years. For medications with multiple indications, availability and use varied: for example, of the 784 respondents, albuterol was available to 699 (89.2 percent) and used by 572 (73.0 percent), while calcium gluconate was available to 247 (31.5 percent) and used by 80 (10.2 percent) within the last 5 years. Paramedics with advanced training in the medical management of patients in hazmat incidents reported limited availability and use of medications to treat patients in hazmat incidents.

A subsidy policy to managing hazmat risk in railroad transportation network

Hazardous materials (hazmat) shipments are integral to any modern society, and railroad is the primary transportation mode in North America. Given the catastrophic nature of rail hazmat incidents, every effort should be made to mitigate risk. This study investigates a novel risk mitigation tool, i.e., subsidy, to induce railroad operators to take alternate routes that are away from high-risk portions of the network such as population centers. To this end, a bi-level optimization program is developed that captures both the risk perspective of the leader (i.e., government) and the cost concerns of the follower (i.e., railroad operator). Model complexity necessitated the development of a customized solution technique, and the resulting methodology was used to study problem instances generated on the realistic infrastructure of a railroad operator in Midwest United States. Analyses underscore the significance of using subsidy as a risk mitigation tool and in ensuring a fairer distribution of risk, in demonstrating how significant improvement in risk can be achieved by offering modest subsidy, and in defining the threshold level of the subsidy budget beyond which no improvement should be expected.

Hazardous materials and CBRN incidents: Fundamentals of pre-hospital readiness in the State of Qatar

Background: Hazardous Materials and Chemical/Biological/Radiological/Nuclear (HazMat-CBRN) incidents represent a serious threat to the population and the environment. They require a pre-hospital medical response system well equipped and supported with logistics and clinicians with appropriate knowledge and skills to prevent exposure and mitigate risks. Our aim is to determine if the Hamad Medical Corporation Ambulance Service (HMCAS) fulfils the pre-hospital readiness requirements for such incidents. Methods: This cross-sectional study was performed in HMCAS. An online survey assessed staff behaviour and knowledge in relation to HazMat-CBRN incidents. Responses were obtained on health risks and pre-hospital medical management of related threats in Qatar. Based on the results, a training module “HazMat Incident Management” was prepared with pre-/post-activity assessments. The results were explored using a multivariate linear regression and non-parametric Wilcoxon test for paired samples. Specialized Emergency Management (SEM) staff opinion about this training was assessed through an online survey. Both surveys’ validity and reliability tests were conducted. Ishikawa cause and effects diagram was built for the identification of the factors leading to a pre-hospital successful response to HazMat-CBRN incidents. Results: HMCAS has the proper logistics and plans to manage potential HazMat-CBRN incidents. The knowledge survey demonstrated that the pre-hospital medical staff information about this topic needs reinforcement. The multivariate linear regression and non-parametric Wilcoxon test demonstrated that this was obtained thanks to the implemented training module. The course satisfaction survey showed not only a big interest in this activity but also staff recommended more related topics. Earlier-RSDAT (Recognition, Safety, Decontamination, Antidot, Transport) is a tool proposed as a response acronym to build a successful risk-based response for HazMat CBRN incidents in pre-hospital setting. Conclusion: HMCAS fulfills the readiness requirements for safe and effective response to potential HazMat-CBRN incidents in Qatar. The RSDAT response matrix might help in mitigating pre-hospital response risks.

Designing emergency response network for rail hazmat shipments under uncertainties: Optimization model and case study

Railroad is one of the primary transportation modes for hazardous materials (hazmat) shipments in North America. Designing an emergency response network capable of providing commensurate response is one of the primary levers to contain (or mitigate) the adverse consequences from rail hazmat incidents. To this end, we propose a two-stage stochastic programming model to determine the location of response facilities and equipment packages to be stockpiled therein. Several publicly available reports were consulted to estimate the different model parameters, which in turn facilitated the analyses of the case study on a realistic railroad network in Ontario (Canada). Our study suggests that the strategic emergency response network design decision made only on the basis of empirical data would undermine the effectiveness of the resulting network. We also explore several underlying trade-offs in our model, evaluate the incremental benefit of establishing (and stockpiling) additional response facilities. Furthermore, our analyses highlight that the mean coverage can be improved by redistributing the equipment in the network, purchasing equipment with higher containment capacity, and making use of a disutility multiplier factor.

Fuzzy bi-objective model for hazardous materials routing and scheduling under demand and service time uncertainty

We develop a fuzzy-based bi-objective optimisation model for hazardous materials (hazmat) vehicle routing and scheduling problem with time windows. The task is to find optimal links and routes to maintain a balance between safe and fast distribution of hazmats between origins and destinations through a transport network. We consider unknown probabilities for hazmat incidents along with a game-theoretic demon approach in a link-based model. Using the Nash game theory approach, an integrated routing and scheduling hazmat shipment problem is formulated. Since the formulated problem is a bi-objective model with travel time and population risk objectives, we also propose a solution method based on a hybrid Monte-Carlo simulation and fuzzy goal programming to obtain the set of Pareto optimal solutions. Computational results of a carefully crafted numerical example are also provided to illustrate the effectiveness of the developed mathematical model and the solution method in obtaining Pareto-optimal solutions.

Fuzzy bi-objective model for hazardous materials routing and scheduling under demand and service time uncertainty

We develop a fuzzy-based bi-objective optimisation model for hazardous materials (hazmat) vehicle routing and scheduling problem with time windows. The task is to find optimal links and routes to maintain a balance between safe and fast distribution of hazmats between origins and destinations through a transport network. We consider unknown probabilities for hazmat incidents along with a game-theoretic demon approach in a link-based model. Using the Nash game theory approach, an integrated routing and scheduling hazmat shipment problem is formulated. Since the formulated problem is a bi-objective model with travel time and population risk objectives, we also propose a solution method based on a hybrid Monte-Carlo simulation and fuzzy goal programming to obtain the set of Pareto optimal solutions. Computational results of a carefully crafted numerical example are also provided to illustrate the effectiveness of the developed mathematical model and the solution method in obtaining Pareto-optimal solutions.

Multi-objective hazardous materials routing and scheduling for balancing safety and travel time

This research develops a new multi-objective multi-period optimisation model to find optimal links and routes to maintain a balance between safe and fast distribution of hazmats between origins and destinations through the transport network. The transport network includes multiple origins and destinations along with multiple hazmat classes to better mimic the challenges faced by practitioners. We consider unknown probabilities for hazmat incidents along with a game-theoretic demon approach and formulate a link-based routing and scheduling hazmat shipment problem. The objective functions are defined to minimise both the probability of population exposure affected by hazmat transport risks and the total transportation time in the distribution network. This paper also proposes a solution method based on an integrated Monte Carlo simulation and fuzzy goal programming to obtain Pareto-optimal solutions. A numerical example is provided to evaluate the effectiveness of the developed mathematical model and the solution method in obtaining Pareto-optimal solutions.

Hazardous materials emergency incidents: public health considerations and implications

ObjectiveHazardous materials (HAZMAT) incidents, including the deliberate release of toxic chemicals, can cause a significant drain on resources as well as heightened anxiety in the community. Recent high‐profile incidents, including the 2018 illegal waste storage fire in Victoria, Australia, have highlighted the complexity but also the value of multidisciplinary approaches to HAZMAT events. This brief report examines issues from a public health perspective and reflects on the experience of such events in South Australia. MethodsThe type, location and time of HAZMAT incidents for the period 2001 to 2018 (inclusive) in South Australia were compiled and classified from a database of the state Technical Advice Coordinator. ResultsThe profile of HAZMAT events was diverse, including fires, spills, unknown chemicals, sabotage and suicides. Incidents frequently occurred around transportation corridors and storage facilities. Public health agency involvement was most evident for known or suspected biological agents (toxins) and chemical toxicants with persistent exposures. Conclusion and implications for public healthPublic health agencies are likely to have a greater future role in HAZMAT management as the complexity of incidents increases (e.g. mass casualty events and events involving vulnerable subpopulations). There is a need for a national HAZMAT surveillance database to coordinate agency responses on a national level. A unified approach to risk communication for vulnerable communities is also critical.

The impact of fire and rescue service first responders on participant behaviour during chemical, biological, radiological and nuclear (CBRN)/Hazmat incidents

PurposeDecontamination following chemical, biological, radiological and nuclear (CBRN)/Hazmat incidents is a critical activity carried out in order to mitigate and contain the risk posed by any hazardous materials involved. Human behaviour plays a crucial role in such incidents, as casualties will have little understanding of the situation they find themselves in, leading to uncertainty in what actions to take. This will result in very difficult circumstances within which first responders must operate. However, the importance of human behaviour appears to be a fundamental element being missed in the preparation, training and planning assumptions being made by emergency services and planners in preparation for these events.Design/methodology/approachThis paper looks to understand the scope of this omission by reviewing relevant literature on the subject and engaging with Fire and Rescue Service personnel and managers in the UK. This study utilised semi-structured interviews with 10 Fire and Rescue Service Mass Decontamination Operatives, four Fire and Rescue Service Hazardous Material Advisers and three Fire and Rescue Service Strategic Officers participating. These interviews were then analysed using a thematic framework to identified key themes from the research which were then validated using two independent researchers to provide an inter-rater reliability measure. Finally, a follow-up validation questionnaire was also developed to test the validity of the themes identified and this was completed by another with 36 Fire and Rescue Service Mass Decontamination Operatives.FindingsBoth the literature review and interviews undertaken with emergency responders and mangers demonstrated the crucial importance of accounting for behavioural aspects in these situations especially in regards to the likely levels of compliance to be expected by responders and the potential problem of casualties not remaining at the scene of an incident to undergo decontamination.Originality/valueThis research identifies a number of key themes so far not recognized through any other research and in doing so offers insights into potential flaws in the UK Fire and Rescue Service response planning for CBRN/Hazmat incidents requiring mass decontamination. It is intended that this research will inform further study into the areas identified in order to ensure gaps in planning, training and strategies for mass decontamination operations can be more fully informed and if required allow for a more effective response.

Risk communication infrastructure and community resilience: does involvement in planning build cross-sector planning and response networks?

ABSTRACTThe community resilience needed for effective disaster response and recovery depends in part on robust cross-sector, interorganizational networks, but differences among networked stakeholders can make building community resilience difficult. Local emergency planning committees (LEPCs) may help by acting as risk communication infrastructure. LEPCs help conduct emergency chemical hazards planning and support the public's right-to-know about those hazards. Focusing on an LEPC situated in a major U.S. petrochemical corridor, this study surveyed LEPC stakeholders (N = 171) to investigate their perceptions of a hypothetical hazardous materials (HazMat) incident and their planning and response networks, comparing differences among agency and non-agency stakeholders. Respondents reported being part of robust planning and response networks, indicative of capacity for community resilience. Stakeholders' involvement in planning efforts was associated with their perceptions of the HazMat incident and their networks. This study provides evidence for the efficacy and limits of the LEPC as risk communication infrastructure.

Decontamination and Management of Contaminated Hair following a CBRN or HazMat Incident.

This in vitro study evaluated the “triple protocol” of dry decontamination, the ladder pipe system (a method for gross decontamination), and technical decontamination for the decontamination of hair following chemical contamination. First, we assessed the efficacy of the 3 protocols, alone or in combination, on excised porcine skin and human hair contaminated with either methyl salicylate (MS), phorate (PHR), sodium fluoroacetate (SFA), or potassium cyanide (KCN). A second experiment investigated the residual hair contamination following decontamination with the triple protocol at different intervals postexposure. In a third experiment, hair decontaminated after exposure to MS or PHR was evaluated for off-gassing. Though skin decontamination was highly effective, a substantial proportion (20%–40%) of the lipophilic compounds (MS and PHR) remained within the hair. The more water-soluble contaminants (SFA and KCN) tended to form much smaller reservoirs within the hair. Interestingly, substantial off-gassing of MS, a medium volatility chemical, was detectable from triple-decontaminated hair up to 5 days postexposure. Overall, the decontamination strategies investigated were effective for the decontamination of skin, but less so for hair. These findings highlight the importance of contaminated hair serving as a source of potential secondary contamination by contact or inhalation. Therefore, consideration should be given to the removal of contaminated hair following exposure to toxic chemicals.

Skin Absorption of Ethylene Oxide Gas Following Exposures Relevant to HAZMAT Incidents.

Ethylene oxide (EO) is a reactive gas used by numerous industries and medical facilities as a sterilant, a fumigant, and as a chemical intermediate in chemical manufacturing. Due to its common use, EO has been involved in a number of leaks and explosive incidents/accidents requiring HAZMAT response. However, the extent of skin absorption under short-term HAZMAT conditions has not been directly assessed. Such data would assist decision making by first responders regarding skin decontamination in EO HAZMAT incidents. An in vitro test protocol with human skin was used for EO exposures at 800 ppm and 3000 ppm. No evidence of dermal penetration was seen for 800 ppm EO during a 30-min challenge. For 3000 ppm, EO penetration was observed after 20 min and was greater under higher temperature/humidity conditions. Fabric (heavy cotton) on skin enhanced penetration 5-fold compared with naked skin. Off gassing from exposed fabric was rapid. The results show dermal uptake of EO vapour from exposure at 3000 ppm is small but clothing may contribute to further dermal absorption/penetration over time. For exposed, but asymptomatic, persons in EO HAZMAT incidents first responders should remove bulky clothing to prevent potential skin damage and further uptake.

Strategies to Optimize Performance of Healthcare Workers in Hazmat Incidents

Strategies to Optimize Performance of Healthcare Workers in Hazmat Incidents

Variability in Heat Strain in Fully Encapsulated Impermeable Suits in Different Climates and at Different Work Loads.

A major concern for responders to hazardous materials (HazMat) incidents is the heat strain that is caused by fully encapsulated impermeable (NFPA 1991) suits. In a research project, funded by the US Department of Defense, the thermal strain experienced when wearing these suits was studied. Forty human subjects between the ages of 25 and 50 participated in a protocol approved by the local ethical committee. Six different fully encapsulated impermeable HazMat suits were evaluated in three climates: moderate (24°C, 50% RH, 20°C WBGT), warm-wet (32°C, 60% RH, 30°C WBGT), and hot-dry (45°C, 20% RH, 37°C WBGT, 200 W m-2 radiant load) and at three walking speeds: 2.5, 4, and 5.5 km h-1. The medium speed, 4 km h-1, was tested in all three climates and the other two walking speeds were only tested in the moderate climate. Prior to the test a submaximal exercise test in normal clothing was performed to determine a relationship between heart rate and oxygen consumption (pretest). In total, 163 exposures were measured. Tolerance time ranged from as low as 20 min in the hot-dry condition to 60 min (the maximum) in the moderate climate, especially common at the lowest walking speed. Between the six difference suits limited differences were found, a two-layered aluminized suit exhibited significant shorter tolerance times in the moderate climate, but no other major significant differences were found for the other climates or workloads. An important characteristic of the overall dataset is the large variability between the subjects. Although the average responses seem suitable to be predicted, the variability in the warmer strain conditions ranged from 20 min up to 60 min. The work load in these encapsulated impermeable suits was also significantly higher than working in normal clothing and higher than predicted by the Pandolf equation. Heart rate showed a very strong correlation to body core temperature and was in many cases the limiting factor. Setting the heart rate maximum at 80% of predicted individual maximum (age based) would have prevented 95% of the cases with excessive heat strain. Monitoring of heart rate under operational conditions would further allow individually optimize working times and help in preventing exertional heat stroke.

A comprehensive modeling framework for hazmat network design, hazmat response team location, and equity of risk

This paper considers a bi-level hazmat transportation network design problem in which hazmat shipments have to be transported over a road network between specified origin-destination points. The bi-level framework involves a regulatory authority and hazmat carriers. The control variables for the regulatory authority are locations of hazmat response teams and which additional links to include for hazmat travel. The regulatory authority (upper level) aims to minimize the maximum transport risk incurred by a transportation zone, which is related to risk equity. Our measure of risk incorporates the average response time to the hazmat incidents. Hazmat carriers (lower level) seek to minimize their travel cost. Using optimality conditions, we reformulate the non-linear bi-level model as a single-level mixed integer linear program, which is computationally tractable for medium size problems using a commercial solver. For large size problems, we propose a greedy heuristic approach, which we empirically demonstrate to find good solutions with reasonable computational effort. We also seek a robust solution to capture stochastic characteristics of the model. Experimental results are based on popular test networks from the Sioux Falls and Albany areas.

Employment Standards for Australian Urban Firefighters: Part 4: Physical Aptitude Tests and Standards.

Firefighter physical aptitude tests were administered to unskilled subjects and operational firefighters to evaluate the impact that testing bias associated with gender, age, activity-specific skills, or task familiarity may have upon establishing performance thresholds. These tests were administered in sequence, simulating hazmat incidents, ventilation fan carriage (stairs), motor-vehicle rescues, bushfire incidents, fire attacks, and a firefighter rescue. Participants included two unskilled samples (N = 14 and 22) and 143 firefighters. Firefighter performance was not significantly different from the unskilled subjects. Participants from both genders passed the test, with scores unrelated to performance skill or age; however, familiarization significantly improved performance when the test was repeated. These outcomes confirmed this test to be gender-, age-, and skill-neutral. Familiarization effects could be removed through performing a single, pre-selection trial of the test battery.

Probabilistic Hazardous Materials Contamination Model for a Municipal Water Source

In 1997 conditional probability was used to assess the frequency of contamination of the Truckee River by hazardous material (hazmat) released during a rail or highway accident. A Great Basin stream originating at Lake Tahoe, Calif., and terminating at Pyramid Lake, Nev., the Truckee River is the principal water source for the Reno–Sparks (Nev.) metropolitan region. The 1997 probabilistic assessment was based on sparse to nonexistent data for accident frequency and other factors. Assumptions made during the 1997 study were reassessed in 2007 using a significantly more comprehensive database for rail and highway accidents and hazmat incidents. The 2007 assessment confirmed that estimates of hazmat contamination probability (likelihood) were reasonable and even low. Consequently, the operational plan to be implemented, should a hazmat contamination occur, relies on estimates of arrival times coupled with the ability to shut down water treatment plants and rely on groundwater resources during such an emergency.

Chlorine and hydrogen cyanide gas interactions with human skin: In vitro studies to inform skin permeation and decontamination in HAZMAT incidents

Accidental or intentional toxic gas releases may result in significant public health and psychological consequences. Management of exposed individuals during HAZMAT incidents should be risk-based and supported by a suitable scientific evidence base. There appear to be large evidence gaps in relation to dermal absorption of gases, as well as management advice for potentially exposed individuals. Chlorine and hydrogen cyanide are two common HAZMAT gases and this paper addresses the need for experimental data tailored to HAZMAT scenarios and first responders. In addition to time variations of gas concentration, the modifying effects of clothing, temperature, and oil-based sunscreen on epidermal absorption and penetration are assessed. Results for chlorine show little penetration up to 500ppm but with small enhancing effects due to heavy cotton and oil-based sunscreen. Hydrogen cyanide up to 800ppm shows minor penetration consistent with previous studies, with little variability in the presence of sunscreen and clothing. Practical guidelines to support the decision-making of emergency responders with regard to personal decontamination have been derived.

Risk analysis system for the transport of hazardous materials

IntroductionIn this paper, a literature study on risk analysis systems for the transport of hazardous materials was conducted. ResultsThe insights that resulted from this literature review have led to the development of a refined approach to map the risk of hazmat transport in Flanders based on historical accident data. The proposed framework allows setting up an overall risk map for hazmat transport by different transport modes. Additionally, a methodology to calculate a local accident risk, which takes local infrastructure parameters and accident data into account, is being introduced. In the presented framework one of the general principles is that the risk of a catastrophic hazmat incident can be divided into two parts, which can both be validated on the basis of accident data: (a) the calculation of the general probability of the occurrence of an accident based on international accident data of transport of hazardous materials – this is the basis for the global risk map, and (b) the calculation of the local probability of the occurrence of an accident based on accident data and infrastructure parameters of the complete available freight transport in Flanders – this is the basis for the local risk map. The ratio between these two results in a locality parameter, which represents the local specific circumstances that can lead to an accident. ConclusionsThis evaluation framework makes it possible to estimate the risks of hazmat transport along a specific route for transport by road, rail, inland navigation and even pipelines.