Zahava Berkowitz

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 Registrys 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.

The public health consequences from acute chlorine releases, 1993-2000.

Learning ObjectivesContrast acute chlorine events, as assessed in 16 states during the years 1993-2000, with non-chlorine events with regard to the frequency of injury and the need for evacuation and decontamination.Recall whether and how chlorine exposures changed in frequency during the period under review, as well as the seasonal occurrence of events, the most common causes, symptoms of victims, and the use of protective equipment.Identify possible measures that could be taken in attempting to prevent chlorine-related injuries. Chlorine, a commonly used hazardous substance, can be harmful to human health when improperly released. 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 the public health consequences from acute chlorine releases in 16 states during 1993 through 2000. There was an overall decline in the number of chlorine events during the period analyzed; however, chlorine events were more likely to result in events with victims, evacuations, and decontaminations when compared with nonchlorine events (relative risk [RR] = 4.5, 95% confidence interval [CI] = 4.1 to 5.0; [RR] = 4.8, CI 4.3 to 5.3; and [RR] = 2.0, CI 1.7 to 2.4, respectively). Most chlorine victims were employees and members of the general public. The predominant symptoms sustained were respiratory and eye irritation. Equipment failure and human error were the most frequent factors leading to an event. Continuous employee training and preventive equipment maintenance can help prevent chlorine releases from occurring and minimize exposure to the general public.

Acute public health consequences associated with hazardous substances released during transit, 1993-2000.

Massive quantities of hazardous substances are transported each day throughout the United States. While most arrive safely at their destination, uncontrolled releases of substances in transit do occur and have the potential of causing acute public health consequences for those individuals at or near the release. Data from 16 state health departments participating in the Agency for Toxic Substances and Disease Registrys (ATSDR) Hazardous Substances Emergency Events Surveillance (HSEES) system were analyzed to determine the public health consequences that occurred from actual releases in transit. Of the 9392 transportation events analyzed, 9.1% resulted in 2008 victims, including 115 deaths. The population groups injured most often were employees and the general public. The most common injury sustained was respiratory irritation. Evacuations were ordered in 5.5% of events effecting at least 63,686 people. Human error and equipment failure were the most common factors leading to events. These findings underscore the importance of job safety training, community planning, and effective emergency response to prevent adverse public health consequences from occurring or lessen their effect on the public.

The Acute Health Consequences to Children Exposed to Hazardous Substances Used in Illicit Methamphetamine Production, 1996 to 2001

Children who are raised in an environment where illicit methamphetamine production occurs can experience acute health effects from hazardous substances used. Common substances used include anhydrous ammonia, hydrochloric acid, and acetone. Many of these are hazardous upon exposure and can lead to emergency events such as fires, explosions, spills, and toxic emissions. Data from 17 states participating in the Agency for Toxic Substances and Disease Registrys Hazardous Substances Emergency Events Surveillance system were used to analyze the acute health consequences among children exposed to hazardous substances released in association with illicit methamphetamine production during 1996 through 2001. Of the 519 methamphetamine-related emergency events identified where releases occurred, at least 8 known events involved 13 children who were injured. In four of these eight events, lethal substances such as anhydrous ammonia were released. The predominant injuries sustained by these children were respiratory ...

Frequency and Type of Injuries in Responders of Hazardous Substances Emergency Events, 1996 to 1998

This analysis describes the frequency and type of injuries among responders to hazardous materials releases. Data were analyzed from states that participated in the Hazardous Substances Emergency Events Surveillance system maintained by the Agency for Toxic Substances and Disease Registry from 1996 through 1998. A total of 348 responders were injured in 126 (0.7%) of 16,986 reported events. Firefighters and police officers were most often injured. Respiratory irritation and nausea were the most commonly reported injuries, and no injuries resulted in death. Almost half of the responder victims wore firefighter turn-out gear, and about a third had received hazardous materials training. Chemicals frequently released during these events were in the category “other substances not otherwise specified” and “acids.” Training, education, planning, and coordination are needed to effectively respond to hazardous substances emergency events.

Hazardous Substances Releases Causing Fatalities and/or People Transported to Hospitals: Rural/Agricultural vs. Other Areas

INTRODUCTION Mass-casualty and hospital preparedness has been analyzed widely. However, information regarding the types of areas where these events occur is limited. Therefore, the characteristics of acute hazardous substances releases resulting in death/multiple-victim events occuring in rural/agricultural areas and in all other areas were studied and compared. METHODS Data reported to the Hazardous Substances Emergency Events Surveillance (HSEES) system from 16 state health departments during 1993-2000 were used to examine factors associated with events with death/multiple victims involving acute release of hazardous substances. A death/multiple-victim event is defined as any event resulting in a death and/or at least five people being transported to a hospital. RESULTS Of a total of 43,133 events, 6661 occurred in rural/agricultural areas. Of these, 107 were death/multiple-victim events with 632 victims, of whom 91 died and 77 were hospitalized. All other areas had 472 death/multiple-victim events with 7981 victims, of whom 116 died and 413 were hospitalized. Death/multiple-victim events in rural/agricultural areas were more likely to be associated with transportation (Proportional Ratio (PR) = 4.1, 95% CI = 3.1-5.4) and fires and/or explosions (PR = 1.4, 95% CI = 0.95-2.0) than were death/multiple-victim events in all other areas. Among transportation-related events in rural/agricultural areas, 19 were associated with air transport--mainly crop dusters--and resulted in 18 deaths. Responders were three times more likely to be injured in rural/agricultural areas. Of responders, volunteer firefighters constituted 52% compared with 6.7% in all other areas. The most frequently released chemicals in rural/agricultural areas were ammonia, chlorine, and pesticides. In all other areas, ammonia, chlorine, hydrochloric acid, carbon monoxide, and 0-chlorobenzylidene malononitrile, a tearing agent often associated with an illegal or unauthorized act, were released most frequently. CONCLUSIONS Findings from this analysis suggest that remedial actions should address safety measures in both transportation and fixed facilities containing acute hazardous substances. These include regular maintenance of equipment, education of workers about the substances used in their facility, rigorous training and licensing of drivers and crop duster operators, and education and training of employees and first responders in the use of protective equipment. These activities may reduce the number of events, casualties, and costs associated with hazardous substance events.

Hazardous substances emergency events in the agriculture industry and related services in four mid-western states.

Learning ObjectivesRecognize the seasonality and farming-related factors connected with uncontrolled release of hazardous substances in the agricultural setting.Recall the commonest agricultural threats and their clinical sequelae.Describe what protective measures presently are in common use, and those that could limit the injurious effects of exposure to hazardous agricultural substances. Analysis of Hazardous Substances Emergency Events Surveillance data reported from 14 participating states between 1993 and 1998 found that acute releases are seasonal. This seasonality was more prevalent in four Midwestern states during April–June and coincided with their planting season, suggesting an association of these releases with the agricultural industry. A more detailed analysis of events related to this industry in these states found that ammonia was the chemical most frequently released, and ammonia related events resulted in a significantly higher number of evacuations than all other events (OR = 10.7, [5.25–22.28]). A logistic regression model to identify risk factors for an event with victims found an increased risk for: (1) events with ammonia during April–June (adjusted OR = 3.57, [2.09–6.09]); (2) events in fixed-facilities during April–June (aOR = 3.74, [2.01–6.95]); and (3) events with multiple substances (aOR = 2.33, [1.05–5.17]). The most common causes for the events were equipment failure and operator error. Resulting injuries were mainly respiratory, ocular and traumatic, and included six deaths. Employing more stringent safety measures and educating employees and the public about the health hazards involved with agricultural chemicals may reduce injuries and help contain costs associated with the releases.

Factors associated with severity of injury resulting from acute releases of hazardous substances in the manufacturing industry.

Data from the Hazardous Substances Emergency Events Surveillance system was used to identify factors associated with the severity of injuries of victims (an ordinal outcome variable) harmed in acute chemical release events in the manufacturing industry. We used proportional odds models to account for the order of severity in the outcome, with the general estimation equation. There were 659 events involving 2826 victims. More severe injuries were associated with explosion (adjusted OR aOR = 6.45), multiple chemicals (aOR = 1.75), multiple chemical categories (aOR = 1.70), the chemical group acids (aOR = 1.6), multiple injuries to an individual (aOR = 1.38–1.56) (ranges represent several models), confinement within a structure in a fixed facility (aOR = 1.76–1.90), and being located in the midwest region (aOR = 1.76–1.90). The summer was less likely than all other seasons to be associated with more severe outcome. The results provide information beneficial for preventive activities.

Hydrofluoric Acid Releases in 17 States and the Acute Health Effects Associated, 1993-2001

Hydrofluoric (HF) acid is 1 of the strongest and most corrosive acids known. Human exposure commonly occurs from occupational releases and can result in severe injuries and death. Data from the Agency for Toxic Substances and Disease Registrys Hazardous Substances Emergency Events Surveillance (HSEES) system were used to conduct a descriptive analysis on the acute health effects of HF acid exposure. Of the total HSEES events (n = 49,106), HF acid releases occurred in 0.3% of events (n = 134). HF acid events were 2 times more likely to involve injuries when compared with other acid events and 3 times more likely when compared with nonacid events. Employees such as those in trucking services, petroleum refining, and chemical manufacturing need to understand the dangers of HF acid and should have the appropriate personal protective equipment available to prevent exposure.