Work Package 5: Provision of a training manual

Public Health Response to Chemical Incident Emergencies Toolkit (CIE Toolkit)

Agreement Number 2007205

Deliverable D2 Report, June 2011

Work Package 5: Provision of supporting material for a training manual dealing with chemical incidence preparedness and health

INTERNAL REPORT FOR THE EC

Mark Griffiths, Project Manager (Health Protection Agency, UK)

Raquel Duarte-Davidson, Project Leader, (Health Protection Agency, UK)

This study was partly funded by the European Commission, Agreement Number 2007205

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ABSTRACT

This document is for public health professionals who wish to learn more about processes dealing with major chemical incidents. This is a collation of material dealing with different aspects of a major chemical incident to include planning, preparedness, and response to an incident. This information will be put on the CIE toolkit password protected website (http://cietoolkit.fs-server.com/), together with other supporting material to address specific needs within Member States and to assist public health professionals to conduct a chemical incident management training course. This document contains generic material as well as further supporting documents developed throughout the duration of this project. The material will incorporate areas that are specific to the planning, preparedness, response and recovery phases for use by public health professionals to address specific training needs and thereby strengthen their capabilities for dealing with the immediate aftermath of an acute chemical incident, including accidental and deliberate releases.

http://cietoolkit.fs-server.com/

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CONTENTS

1 Introduction 1

2 Role of public health professionals in planning and response to health threats 3

2.1 Ten Essential Services for Public Health 3

3 The chronological phases of integrated chemical incident public health management 12

4 Constructing emergency chemical plans: locally and regionally 16 4.1 Introduction 16 4.2 Fixed site facilities 16 4.3 Development of a chemical incident response plan 17 4.4 Contents of a chemical incident emergency response plan 19 4.5 Review the plan 22

5 Identifying unique factors in a chemical incident: covert release 32 5.1 Clues that may indicate a cluster of unusual illness which may have a deliberate explanation 32 5.2 Obstacles to identifying a covert chemical release: 33

6 Evacuation versus Shelter-in-Place 36 6.1 Taking decisions about evacuation during a chemical incident 36 6.2 What sheltering in place means 36 6.3 How to know if you need to evacuate 38

7 Cordoning hot, warm and cold zones 42 7.1 Zones 42 7.2 Scene management 44 7.3 Occupiers response to an incident 47 7.4 Command, control and coordination 49

8 Timely alerting and notification 51 8.1 Public Information before an incident 51 8.2 Public information after an incident 53 8.3 Notifying emergency responders and other organisations 54

9 Preparedness, post disaster health care and general welfare support 56

10 Environmental public health tracking and surveillance 59 10.1 What is it? 59 10.2 Why do it? 59 10.3 How to do it? 60 10.4 Who does it? 61 10.5 When to do it? 62

11 Environmental sampling and monitoring 69 11.1 Gathering information about the incident 71 11.2 Performing the sampling 75 11.3 Sampling strategies 76 11.4 Sampling sites following a fire: 77 11.5 Site Sampling 78 11.6 Common principles of land sampling 79 11.7 Checklist of sampling equipment: 86

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11.8 Routine Sampling 88

12 Remediation and Restoration after a Chemical Incident 92

APPENDIX A 95

Constructing emergency chemical plans 95 A1 Chemical Incident Action Card 95

APPENDIX B 98

Constructing Emergency Chemical Plans 98 B1 Public Health Service Response Factsheet 98

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1 INTRODUCTION

In the event of a major chemical incident or emergency, it is vital that public health professionals across Europe are aware of their own and others roles and responsibilities when responding. In order for public health professionals to be effective in fulfilling their roles, adequate training must be provided. A chemical incident will typically be of a relatively short duration, although the effects may be experienced over a wide area and for a prolonged period of time. There is the distinct possibility that any such event will involve the contamination of food, land and/or water supplies resulting in a chronic incident. An effective public health response will thus involve assessing the likely impact of exposure to the chemicals on the health of first responders and exposed people; the provision of evidence-based advice on appropriate measures to be taken so as to minimize the health effects in relation to both mortality and morbidity is required. The public health response will also include methods and advice on conducting follow up exposure studies and implementing remediation measures. Public health response plans require significant development to ensure that adequate numbers of public health and environmental health professionals are trained to respond to an acute chemical incident at local, regional and national levels. Consistency in the training and responsibilities of public health professionals internationally is also important to enable response to trans-boundary incidents and to improve international communication and cooperation amongst those responding to chemical incidents.

The primary objective of this document is to provide supporting material to address specific training needs within Member States and to assist public health professionals to conduct a chemical incident management training course. This document contains generic material as well as further supporting documents developed throughout the duration of this project. The material will incorporate areas that are specific to the planning, preparedness, response and recovery phases for use by public health professionals to address specific training needs and thereby strengthen their capabilities for dealing with the immediate aftermath of a major chemical incident, including chemical terrorist threats.

This can be downloaded from the following address: http://cietoolkit.fs-server.com/

1.1 Development of content for the training manual

This work package addresses many of the core modules and subject matter considered to be of importance when developing and constructing a training package for public health professionals responding to major chemical incidents. The aims are to:

1. Provide details of training material dealing with chemical incidents which are relevant to public health professionals and that covers issues related to emergency preparedness, planning, response and recovery.

2. Identify and outline the relevant subject matter to be included in training modules for public health professionals.

A training programme structure addressing public health issues in the event of a chemical incident has been prepared. It is expected that public health professionals who receive this training will gain enough knowledge to be able to deal with events during a chemical

http://cietoolkit.fs-server.com/

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emergency and also gain an understanding of the key issues that need to be considered in the immediate and longer term. The content for the manual appears in the following sections.

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2 ROLE OF PUBLIC HEALTH PROFESSIONALS IN PLANNING AND RESPONSE TO HEALTH THREATS

The role of public health officials begins long before there is any evidence of a chemical incident. An effective Public Health Office or Agency should regularly undertake analyses of population health levels and of environmental contaminants in order to have baseline registers against which deviations can be noted. Such preparedness actions can also be useful to define where deficiencies in the public health response lie. The information contained in this section will discuss these issues in more detail as a top-ten list of public health duties. These criteria may be used for assessing the emergency planning and preparedness programme in general, and can thereafter be used to tailor public health training accordingly. It must be recognized, however, that few local or regional governments/authorities will have the need or capability to address all these issues and meet all these criteria to the fullest extent. Resource limitations, different responsibilities and expectations, along with the results of the hazards analysis (i.e. the susceptibility or vulnerability of a geographical area to a hazardous materials release) will strongly influence the necessary degree of planning and preparedness. Where deficiencies are identified within an agencys ability to respond as it is expected to, advance planning can help to identify where shortcomings can be addressed, resources can be shared and memorandums of understanding and mutual aid agreements established with other organisations.

2.1 Ten Essential Services for Public Health

To respond effectively to health threats, public health offices should have the capacity, to a greater or lesser extent, for:

1. Monitoring health

2. Diagnosing and investigating health issues

3. Private and public education for health threats

4. Mobilising resources and partnerships

5. Policy development

6. Regulation

7. Coordination and communication

8. Training

9. Evaluation

10. Research

Many of the activities in each of these ten themes overlap, and this is evident from the content of the emergency plan that ideally underpins these criteria. Further information on each of these criteria is presented below, and for more detailed material, the interested reader is directed to the chapter on constructing emergency chemical plans in the training manual, as well as other chapters, as relevant.

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2.1.1 Monitoring health Each country should have a public health agency(ies) that monitor the public health status to rapidly detect and identify an event due to hazardous chemical agents (e.g., community health profile before an event, vital statistics, and baseline health status of the community).

2.1.2 Diagnosing and investigating health issues Health impacts after a chemical incident may not always be obvious or immediate. However, by monitoring health status, an agency will then be better positioned to diagnose and investigate environmental health problems and health hazards in the community specific to detecting and identifying an emergency event due to a hazardous chemical agent (e.g. effective epidemiologic surveillance systems, laboratory support necessary for determining a chemical event in a time-sensitive manner).

2.1.3 Private and public education An important role for any public health organisation is to inform, educate, and empower people about specific health issues pertaining to a threat or emergency event due to the release of a hazardous agent (e.g., health communication effectiveness in implementing a rapid and effective response). This can be achieved in a number of ways, through the use of the internet, media broadcasting and postal campaigns. This information might refer to procedures that would enable residents to protect themselves before responders can assess the situation and provide advice. It might also contain information on how to practice these procedures. If not already in place, the health department should develop a comprehensive public education programme that covers public health matters of interest to the population. The programme should include readily available information about reasonable risks associated with chemical agents.

The public education programme should be capable of providing health-related educational materials to non-native speaking residents. It also should ensure that published public education materials are regularly reviewed and revised, when necessary. Social stigmatism occurs when people outside an affected community ostracize those residing in a potentially contaminated area (Kasperson and Kasperson, 1996) (for more information, read the Psychosocial Manual as part of the CIE Toolkit). Social stigmatism has occurred after some large-scale accidental chemical events and must be considered as a possible consequence of a chemical incident. Because social stigmatism could hamper recovery efforts and profoundly affect the long-term wellbeing of the affected community, public education aimed at minimizing an events societal impact should be developed.

2.1.4 Mobilising resources and partnerships Mobilizing partnerships to rapidly identify and solve health problems before, during, and after an event requires a knowledge of all key partners involved in responding to an emergency event, including terrorism. These partnerships may function at the operational, tactical and/or strategic level, and there will be interchanges between these levels. It would be important therefore for these partnerships to be established long before any incident occurs, and to identify what the funding sources and resource implications are, should these different agencies need to be jointly mobilised. Resource implications refers to the personnel, training, equipment, facilities, and other sources available for use in responding to hazardous materials emergencies.

2.1.4.1 Partnerships Are the following organizations included in the overall hazardous materials emergency preparedness activities?

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Health organizations (including emergency medicine, mental and public health organizations, national and local/regional government)

First responders (Fire, Police, Ambulance, Military where appropriate)

Health and safety (including occupational safety and health)

Emergency management/response planning

Environmental organizations and agencies

Education system (in general)

Transportation, gas, water, electricity and other utilities and private sectors (third responders)

Others e.g. trade and labour organisations, as appropriate

In order to promote a cohesive and integrated response, each organizations authorities, responsibilities, and capabilities should be determined for pre response (planning and prevention), response (implementing the plan during an incident), and post response (cleanup and restoration) activities. Questions which might need to be asked include:

Has one organization been given the command and control responsibility for each of these three phases of emergency response? Have facilities been identified that are suitable for command centres?

Has a chain of command been established for response control through all levels of operation?

Have trained and equipped incident commanders been identified?

Does the organizational structure provide a mechanism to meet regularly/annually for planning, coordination and scenario exercise training? Are the training activities evaluated to correct shortfalls?

Are the roles, relationships, and coordination procedures between government and nongovernment (private entities) defined and understood by all affected parties? How are they instituted (written, verbal)?

2.1.4.2 Resources Personnel:

Have the number and location of trained personnel available for hazardous materials been determined? Are these personnel located in areas identified in the hazards analysis as:

Heavily populated;

High hazard areas - i.e., numbers of chemical (or other hazardous materials) production facilities in well-defined areas;

Hazardous materials storage, disposal, or treatment facilities and transit routes?

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Are sufficient personnel available to maintain a given level of response capability identified as being required for the area?

Has the availability of special technical expertise (chemists, industrial hygienists, toxicologists, environmental scientists, occupational health physicians, etc.) necessary for response been identified?

Have limitations on the use of above personnel resources been identified?

Do mutual aid agreements exist to facilitate interagency support between organizations?

Is there an individual designated to request outside assistance? Are financial procedures in place to streamline procurements in an emergency, if necessary?

2.1.4.3 Equipment: An important part of the resource requirements is to ensure that response equipment has been identified and made available for a given level of response capability. It would be prudent to itemise this equipment, as well as the date any items were serviced or replaced, and to regularly update lists and make them available to responders and health professionals, as appropriate. This will include: personal protective equipment appropriate to the task (e.g. hotzone entry, perimeter security); first aid and other medical emergency equipment; emergency vehicles available for hazardous materials response; sampling equipment (air, water, soil, sediment, etc.) and other monitoring devices; analytical equipment or facilities available for sample analyses; communications equipment that are compatible between agencies and that will not be affected if systems become overloaded e.g. mobile phone networks.

Whilst some of this equipment will be utilised and supplied by first responders, there may also be a requirement for public health professionals to have access to some of the above items also, and so it would be reasonable to ask if sufficient quantities of each type of equipment are available on a sustained basis, and whether or not it is fit for purpose? Furthermore, it is important to have standardised procedures for using the equipment and performing the analyses.

2.1.4.4 Facilities: Following a chemical incident, a rapid sampling may be initiated. However, there is only ever any value in doing this if facilities such as laboratories capable of performing rapid chemical analyses have been identified. Even before the samples are collected, or equipment used to manage an incident, suitable facilities for storing and cleaning/reconditioning of response and sampling equipment need to be established. Related to this is the issue of identifying locations or facilities for the storage, treatment, recycling, and disposal of wastes resulting from a release e.g. contaminated fire fighting water run off or contaminated soil, vegetation or water samples.

If an event escalates and a toxic plume remains above a densely populated area for a prolonged period of time, have evacuation centres been identified for housing persons who are not able to shelter in place? Also has an emergency operating centre, command centre, or other central location with the necessary communications capabilities been identified in the plan for coordination of emergency response activities?

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2.1.4.5 Casualty management In the rare event that there are mass casualties, protocols will need to be established with the health authority and medical examiners, coroners and pathologists in order to manage the situation and ensure plans are in place to provide decontamination and treatment facilities for persons injured by or exposed to chemicals. Mass casualties may conceivably be the consequence of a deliberate release of a chemical agent. Under such circumstances, procedures should also be established to obtain and mobilise appropriate medical supplies in sufficient quantities to be able to quickly treat a sizeable population. This further highlights the need to establish strong links with the wider medical community and poisons centres.

2.1.5 Policy and planning development Horizon scanning will always be a useful exercise to undertake when developing policies and plans that support community health efforts in preparing for and responding to emergencies due to hazardous chemical agents (e.g. demonstration of practical, realistic, and effective emergency response plans). Once established, these plans will need to be tested and evaluated through training exercises that involve a range of scenarios, including the simultaneous occurrence of multiple emergencies e.g. power outage and flooding.

The emergency plan is a useful means to assess incident preparedness, but any existing plan will need regular evaluation to ensure it adequately addresses the needs of the community for which the plan was developed, as well as to ensure that the organizational structure and notification lists defined in the plan are up to date. This would include a central location or phone number in the plan for initial notification of an incident. As has already been emphasised, the locations and levels of vulnerability of hazardous materials, and hazmat emergency response information should be identified in the plan. Have resource implications and partnerships been fully determined and have these other agencies and private response organizations (e.g. chemical manufacturers, commercial cleanup contractors) been engaged in developing and reviewing the plan? Other considerations include identifying areas of public health concern and sensitive environmental areas. Are there addenda provided with the plan, such as laws and ordinances, statutory responsibilities, evacuation plans, community relations plan, health plan, and resource inventories (personnel, equipment, maps [not restricted to road maps],and mutual aid agreements).

2.1.6 Regulation Public health agencies have a statutory objective to protect public health and consumers' other interests. These regulations may be directed by European (EU) legislation. However, excessive or unclear regulations can place a burden on business, the public and third sectors1

1 The third sector refers to the range of organisations that are neither public sector nor private sector. It includes voluntary and community organisations (registered charities and other organisations such as associations, self-help groups and community groups), social enterprises, mutuals and co-operatives.

and so hinder effective delivery of the intended benefits. To a greater or lesser extent, public health officials will be able to enforce laws and regulations that protect health and ensure safety, especially in case of an emergency or threat resulting from releases or spills, and having the authority to direct the public response (e.g. enforcement of sanitary codes; establishment of statutory regulations for environmental permitting; REACH regulations). The following criteria may be used to assess the existing legal authorities for response actions following a chemical incident:

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Do clear legal authorities exist to establish a comprehensive hazardous materials response mechanism (national, regional, and local laws, ordinances and policies)?

Do these authorities delegate command and control responsibilities between the different organizations within the same level of government (horizontal), or provide coordination procedures to be followed? When dealing with outside agencies (vertical)?

Do they specify what agency(ies) has (have) overall responsibility for directing or coordinating a hazardous materials response?

Do they specify what agency(ies) has (have) responsibility for providing assistance or support for hazardous materials response and what comprises that assistance or support?

Have the agency(ies) with authority to order evacuation of the community been identified?

Have any limitations in the legal authorities been identified?

2.1.7 Coordination and communication It is vital to be able to rapidly and effectively communicate with responders and the public, and to link people to needed personal health services in the course of an incident. However, maintaining the flow of information within agencies, with partners and to the wider public is extremely challenging under emergency conditions. Procedures should be established for coordination of information during a response and it should be made clear which organization(s) has been designated to coordinate communications activities, including speaking with the media. Part of an emergency plan exercise would be to test the system that has been identified to carry out public information/community relations activities e.g. does a communications system/ method exist to disseminate information to responders and affected public in a clear and consistent way? Does this network have provisions for informing the public about what hazards to expect, what precautions to take to avoid exposure or manage illness, and whether evacuation is required? For those involved in the response, a number of questions can be asked:

Is there a communication link with an Emergency Alert System (EAS) that is available 24 hours per day?

Have alternate systems/methods of communications been identified for use if the primary method fails?

Does a mechanism exist to keep telephone rosters up-to-date?

Is a system available to provide responders with rapid and up to date information on the hazards of chemicals involved in an incident?

Is this information available on a 24-hour basis? Is it available in computer software? Are there personnel available 24 hours with operational familiarity to access the information?

Have doctors and Accident and Emergency departments been advised on the identification, diagnosis and management of suspected cases; how to protect their own

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staff and other patients and how to notify the relevant public health agency of numbers of casualties?

Does the initial notification system have a standardized checklist of information that is collected for each incident?

Has a central clearinghouse for hazardous materials information been established with access by the public and private sector? Can it be operated as an information centre during an incident?

Effective information management to build situational awareness will be central to managing an incident. The development of a Common Recognised Information Picture (CRIP) requires prior preparation in order to be able to manage, transmit or assess the relevance and accuracy of high volumes of information from multiple sources. Emergency responders will have differing perspectives and objectives by the nature of their roles that they provide. Thus, public health officials will serve as focal points and they need to consolidate the information provided by different agencies. An awareness that perspectives of the incident can be incorrect and mistakes can occur under pressure, it is vital to ensure an integrated approach between agencies by regularly consulting, agreeing and deciding on key issues. Having done so it will be easier to issue instructions, policies and guidance to which emergency response partners are likely to conform to.

2.1.8 Training The purpose of training is to assure a competent and trained public health-care workforce for rapid response e.g., education and training for all public health-care providers in effective response to an emergency event or threat. As part of the emergency planning, the training requirements for the public health officials in a region can be examined, along with the facilities that will provide such training. The nature and content of the training is likely to vary, but consideration should be given to whether:

The organizational structure provides training and cross training for or between organizations in the response mechanism and if one agency has been designated to coordinate this training?

The organized training programme is available for all response personnel at a level consistent with their duties and responsibilities?

Training standards or criteria have been established for a given level of response capability? Is any certification provided upon completion of the training?

A system exists for evaluating the effectiveness of training?

The training programme provides refresher courses or some other method to ensure that personnel remain up-to-date in their level of expertise?

2.1.9 Evaluation Part of the evaluation process will be a risk assessment and/or hazards analysis. This includes the procedures for determining the susceptibility or vulnerability of a geographical area to a hazardous materials release, for identifying potential sources of a hazardous materials release from fixed facilities that manufacture, process, use, store, or dispose of

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materials that are generally considered hazardous when released into the environment. This also includes an analysis of the potential or probable hazard of transporting hazardous materials through a particular area.

A hazards analysis is generally considered to consist of identification of potential hazards, determination of the vulnerability of an area as a result of the existing hazards, and an assessment of the risk of a hazardous materials release or spill.

The following criteria may assist in assessing a hazards analysis:

Has a hazards analysis been completed for the area? If one exists, when was it last updated?

Does the hazards analysis include the location, quantity, and types of hazardous materials that are manufactured, processed, used, disposed, or stored within the appropriate area?

Was it done in accordance with community right-to-know laws?

Does it include the routes by which the hazardous materials are transported?

Have areas of public health concern been identified?

Have sensitive populations and environmental areas been identified?

Have historical data on spill incidents been collected and evaluated?

Have the levels of vulnerability and probable locations of hazardous materials incidents been identified?

Are environmentally sensitive areas and population centres considered in analyzing the hazards of the transportation routes and fixed facilities?

2.1.10 Research Whilst research funding becomes increasingly difficult to secure, and time for such activity can be scanty, participating in research for new insights and innovative solutions to health problems resulting from exposure to hazardous agents should not be neglected. This can be facilitated through links with academic institutions, and capacity for epidemiologic and economic analyses should be considered an important part of public health.

Whilst there are many sound reasons for public health professionals to work closely with first responders, it should be noted that the priorities of both groups will not always overlap. Principally, the common objectives for responders (some of which are common objectives for public health professionals also) are:

saving and protecting human life;

relieving suffering;

containing the emergency limiting its escalation or spread and mitigating its impacts;

providing the public and businesses with warnings, advice and information;

protecting the health and safety of responding personnel; safeguarding the environment;

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as far as reasonably practicable, protecting property;

maintaining or restoring critical activities;

maintaining normal services at an appropriate level;

promoting and facilitating self-help in affected communities;

facilitating investigations and inquiries (e.g. by preserving the scene and effective records management);

facilitating the recovery of the community (including the humanitarian assistance, economic, infrastructure and environmental impacts);

evaluating the response and recovery effort; and

identifying and taking action to implement lessons identified.

References

Kasperson RE, Kasperson JX. The social amplification and attenuation of risk. An Acad Pol Soc Sci 1996;545:95-105.

Nelson, C., Lurie, N., and Wasserman, J Assessing Public Health Emergency Preparedness: Concepts, Tools, and Challenges. Annu. Rev. Public Health 2007. 28:118

Williams, J., Walter, D. and Challen K. Preparedness of emergency departments in northwest England for managing chemical incidents: a structured interview survey. BMC Emergency Medicine 2007, 7:20

http://www.epa.gov/emergencies/docs/chem/cleanNRT10_12_distiller_complete.pdf

http://www.cabinetoffice.gov.uk/media/238642/err-guidance-120809.pdf

World Health Organization (WHO). Manual for the public health management of chemical incidents, 2009. ISBN 978 92 4 159814 9. Available from http://www.who.int/environmental_health_emergencies/publications/FINAL-PHM-Chemical-Incidents_web.pdf

The public health response to biological and chemical terrorism: interim planning guidance for state public health officials. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2001)

http://www.epa.gov/emergencies/docs/chem/cleanNRT10_12_distiller_complete.pdfhttp://www.cabinetoffice.gov.uk/media/238642/err-guidance-120809.pdf

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3 THE CHRONOLOGICAL PHASES OF INTEGRATED CHEMICAL INCIDENT PUBLIC HEALTH MANAGEMENT

A chemical incident, as defined by the World Health Organizations (WHO) International Programme on Chemical Safety (IPCS) is an uncontrolled release of a chemical from its containment that either threatens to, or does, expose people to a chemical hazard. Such an incident could occur accidentally, e.g. a chemical spill or deliberately, e.g. the use of sarin on a public transport system. Annually, within any European country, it is expected that there will be hundreds to thousands of chemical incidents involving the exposure, or potential exposure of tens of thousands of people. Many of these incidents are usually obvious, and they will be further manifest in many people being advised to evacuate or shelter-in-place, by being displaced behind a cordoned cold zone, or in some other form of community disruption. In limiting the adverse health impacts to both humans and the environment, a coordinated response is clearly required, which begins even before an incident occurs during the preparedness and planning phase, in order to prevent a chemical incident in the first instance. This is followed up by the subsequent phases of detection of a chemical release and alerting of emergency responders, stakeholders and the affected community. The alert that is issued precipitates a response that typically lasts from a few hours to, in rare instances, several weeks. This resultant action is designed to reduce chemical release or environmental burden and isolate and remove the contaminant. Following on from the response is the recovery phase, which may take several years to complete and can include remediation of contaminated land and an incident investigation and audit.

Phase 1: instituting preventative (to include risk identification and risk assessment) and preparedness measures, including training and exercises

Phase 2: developing detection and alert systems

Phase 3: Response: initial notification and risk assessment

Information gathering, verification, assessment and dissemination

Phase 3b: Response to the incident acute phase

Developing a strategic approach with clearly defined aims and objectives

Phase 4: Clean up and Recovery

Phase 5: Closure

Prevention occurs at National, regional, local and organisational levels, and entails taking all technical and organisational steps necessary in order to prevent an incident occurring in the first instance, or to limit its impact (direct, indirect and interdependent consequences) and the risk it poses to the community, should it occur. Where relevant, a full risk assessment should be conducted for the hazards present and the risk of occurrence, as well as the mitigating infrastructures in operation. Relevant stakeholders can simultaneously be identified and logged so that they can be contacted in an emergency. This preparation will help to limit the time taken during an incident to locate equipment, coordinate the actions of the various stakeholders, establish links between agencies and emergency services, establish a response plan and gather general information about the

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chemical pollutant(s) and the facility responsible for the incident. Equally, the incident response system should be designed so that the roles, responsibilities and competencies are assigned to trained and exercised personnel. As part of the preventive phase, it is also important to anticipate future risks through horizon scanning exercises.

Preparedness for a chemical event will involve developing detection and alert systems. In many cases, a chemical incident will be of such a nature, e.g. fire, explosion or transport accident that it will be evident that chemicals are involved or that there are risks to human health and the environment. However, for the silent releases which risk going undetected for extended periods of time, effective, regular and routine surveillance will serve to alert relevant personnel to an incident. Such surveillance can be in the form of inspections of materials and infrastructures and sampling of media.

The response to a chemical incident will involve several stages. From a public health perspective, it is vital to obtain accurate and verified information before assessing its meaning and disseminating it through appropriate channels. This will provide clarity when developing the strategic aims and priorities and should be clearly communicated between the various emergency response agencies and public health authorities and category 2 responders (e.g. utilities and transport companies and other government agencies) in order to inform multi-agency planning frameworks. There will necessarily be a periodic risk assessment of the potential for harm to public health.

The initial response stage to a chemical incident will include a risk assessment. This can be a difficult task and subsequent decisions in the management of the incident may rest upon this assessment. For the public health practitioner a key question is whether or not the incident poses a risk in any way to the health of the surrounding population. The Chemical Response Checklist and Factsheet can help with this assessment (Appendix A). If there is a public health remit, then the response will need to consider the engagement and management of the public health team dealing with the incident; the public health advice that is to be issued and liaison with other agencies.

It is vital to capture as much accurate information about the incident, as is possible, in order to make the correct assessment of the situation and to determine whether there is good reason for public health involvement. Clearly, it is essential to know what the nature of the incident and chemical involved is i.e. tyre fire, ammonia spill, chlorine leak, road transport accident, etc. Also, when did it happen and where; who are involved and any information as to how it may have happened? Once this has been established, it is possible to drill down into more detail i.e. quantity and composition of chemical released, who has been exposed, what are their symptoms and are there any vulnerable groups facing exposure? What are the prevailing weather conditions and which agencies are involved resulting in which mitigating measures? Armed with this knowledge, it will then be possible to make an assessment of the number of public health officials that should be involved and a rota of their involvement. It may also be possible to determine resource requirements against their availability, and whether or not an inter-agency strategic approach and operation centre should be established. There are several references that will give toxicological information about the chemical in question that may help to determine the potential severity of the incident, and the subsequent public health involvement e.g. the HPAs Chemicals Compendium (www.hpa.org.uk/chemicals) Toxbase (www.toxbase.org) the Agency for Toxic Substances and Disease Registry (www.atsdr.cdc.gov) or WISER (http://wiser.nlm.nih.gov/).

http://www.hpa.org.uk/chemicalshttp://www.toxbase.org/http://www.atsdr.cdc.gov/http://wiser.nlm.nih.gov/

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In some instances the complaint may be more based on community suspicions being raised due to a perceived increase in an unusual disease or level of a disease. Under such circumstances, it is natural to want to find an explanation and attention will often turn to an environmental source, along with the gathering of evidence of a wider disease cluster. Before a broad investigation is initiated, an initial investigation into the plausibility of the claims would be made e.g. is there a possible source-pathway-receptor relationship? Is there any sampling data to suggest that regulations or guideline levels have been exceeded? Do the symptoms match the symptoms understood to be caused by the alleged chemical contaminant? To help with this process of exposure verification, it is important to establish the number, characteristics, distribution, and timing of complaints. A retrospective analysis will be the subject of methodological difficulties, such as recall bias and lack of exposure assessment values, but where a relationship between disease and exposure is suspected, it is appropriate to investigate the matter further.

In the event of an acute chemical incident, it is important to have good communication between the emergency services (the first responders) and local authority environmental health departments, public health departments, local accident and emergency hospitals, and other agencies. Consideration will be given to forming an incident control team composed of members from key organizations with responsibility for developing the strategy and tactics for an emergency response to improve communication between the various agencies involved in the management of a chemical incident. This will lead to a better understanding of the needs and resources of other organisations; will promote the pooling of information and resources and lead to shared decision making.

This should be a well rehearsed procedure where necessary facilities and logistical support (rooms, telephones, and administrative support) can be readily put into operation. Contingency planning would also require alternative facilities to be available in instances where the preferred choice is too close to the incident under investigation. The ongoing objective is to manage the incident by confirming and improving information about the chemicals, their movement in the environment, population exposures, health risks, and to ensure effective liaison between agencies.

Depending on the nature of the hazard, it may be appropriate to contact water companies to enforce mitigation measures to protect critical water sources. If the drinking water supply is contaminated or at risk of contamination, actions would be needed to alert the public not to drink tap water, or to boil it before drinking it. Alternative sources may be needed (e.g. bowsers, bottled water distributions). Contact will also be established with the chemical incident response provider, government departments and agencies for the environment, health and water (whenever appropriate), transport offices and relevant health and safety organisations. Other alerts may also be needed, e.g. to food manufacturers that use water from sources at risk of contamination.

Those affected and populations at risk need to be alerted if movement/dispersal of the chemical is expected, and advice given about protection measures (e.g. stay indoors, shut windows, don't drink or dont use water) or to evacuate vulnerable populations if circumstances demand. The provision of a helpline number may help to ease public anxiety, as will effectively liaising with the press. Immediate protection and mitigation measures may include evacuation, decontamination of exposed persons and treatment for the injured (see the Chemical Response Factsheet and section on evacuation versus sheltering).

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Environmental sampling will be conducted for air, water and soil samples, and also of exposed individuals. Such sampling and biomonitoring is important for exposure assessment, epidemiological studies and tracking the dispersal of a chemical, as well as for declaring the end of an incident. After a response and as part of the recovery phase, in some incidents it may be appropriate to consider a health survey of the local population. Checks should also be made to ensure that properties have been adequately decontaminated, and that evidence-based decisions are made as soon as possible about the safety of drinking water and the use of soil for growing food e.g. on allotments. It may be necessary to incorporate remediation measures to make the area suitable for human habitation and use, otherwise resettlement issues will need to be considered. Once the incident is considered over, the public should be informed, and the relevant agencies involved in the response debriefed.

References

Goodfellow F, Eagles E, Welch F, Murray V. The environment and public health. London: The Stationery Office. 2004. ISBN 0 11 322590 3

Irwin DJ, Crombie DT, Murray V. Chemical incident management for public health physicians. London: The Stationery Office. 1999. ISBN: 0 11 322107 X.

World Health Organization (WHO). Manual for the public health management of chemical incidents, 2009. ISBN 978 92 4 159814 9

IPCS 1999, Public Health and Chemical Incidents: Guidance for National and Regional Policy Makers in the Public/Environmental Health Roles

http://www.cabinetoffice.gov.uk/media/238642/err-guidance-120809.pdf

http://www.who.int/ipcs/emergencies/definitions/en/index.html

http://www.cabinetoffice.gov.uk/media/238642/err-guidance-120809.pdfhttp://www.who.int/ipcs/emergencies/definitions/en/index.html

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4 CONSTRUCTING EMERGENCY CHEMICAL PLANS: LOCALLY AND REGIONALLY

4.1 Introduction

Public Health departments should develop preparedness plans to respond effectively to a major chemical release upon a population, whether the release be deliberate or accidental. Whilst explosive devices often produce a larger number of casualties than deliberately released chemical agents, it is possible that such devices can be used to covertly disperse chemical agents to increase the level of harm caused during the consequent emergency response. Non-deliberate chemical incidents can be equally damaging to that posed by a terrorist threat, and may occur at the production, storage, transport, usage or disposal stage of a chemicals life history. Planning guidance will serve to help public health officials determine the roles of their departments in response to a chemical incident, and to foster collaborations with emergency first responders, local authority and other agencies and organisations within the Environmental and Emergency Management System. It should also be noted that the polices first priority is the same as the public health department - protecting lives. Therefore, the actions and responsibilities of law enforcement and the public health system should not conflict. However, law enforcement must secure a possible crime scene and preserve evidence. Therefore, the entire emergency response community must understand the role of law enforcement agencies and coordinate response activities, such as search and rescue, so that the scene is not disturbed, in order to avoid making evidence collection, protection and future prosecutions more difficult.

4.2 Fixed site facilities

Of course, for any chemical incident, preventing its occurrence is preferable to having an effective plan in place to manage the response in the aftermath. Preventive measures can be taken at the industrial level through careful regulation and monitoring. A facilities hazardous materials management plan or equivalent, will provide information both to Fire and Rescue Services and public health practitioners on what chemicals are produced or stored in large quantities, and can be useful in providing guidance on safe handling and what mitigating steps can be taken in the event of a chemical incident. Information regarding a facility inspection procedure by facility staff, and a log of accidental discharges of hazardous materials should also be included in the facility plan.

The environmental permit holder/company plant owner should develop and follow a written inspection procedure for inspecting the facility for malfunctions, deterioration and poor housekeeping practices, which may be causing or may lead to unauthorized discharges of hazardous materials. These inspections must be at a frequency appropriate to the possible deterioration of equipment and facilities, and to the probability of human error and of sufficient frequency to detect problems prior to discharge. An inspection sheet should be created and maintained for review and should include the following elements:

1. dates, times, and location(s) of inspections

2. name of inspector

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3. problems discovered during the inspections

4. date, time, and nature of corrective action(s)

5. counter signature of the designated safety manager for the facility showing the corrective action has been taken

A separate log of unauthorized hazardous material discharges (wastewater or otherwise) should be created and maintained by the applicant. The log should note the:

date, time, location, and reason(s) for the discharge

type of material and quantity released

corrective action taken

whether or not the Fire Department was contacted for emergency assistance

whether or not Environmental Protection or Health Protection agencies were notified of the discharge

4.3 Development of a chemical incident response plan

However, given the inevitability that chemical incidents will happen, in developing chemical emergency plans public health departments can determine their capacities and needs (staff and resources) through relevant hazard assessments, identify other agencies potentially involved in an emergency chemical response and build links with other departments and facility managers to be better positioned to coordinate responses. Emergency response and public health agencies will often have individual plans in place to deal with a number of different situations they are likely to encounter in their region. However, due to the complex nature of chemical incidents, and the wide array of agencies potentially involved in any single incident, coordinated plans may not always exist. By coordinating efforts in the planning stage, duplication of effort and poor use of resources is likely to be prevented. It also assists by making possible a capacity and capability assessment of joint resources and available personnel. Through such an undertaking, an opportunity to liaise, network and forge partnerships is created or strengthened.

The local chemical emergency plans should be used by the responsible agencies to familiarize themselves with the specific information on the sites in their jurisdiction, including information regarding the chemical and physical properties and locations of the hazardous chemicals. If a facility increases the quantities of hazardous materials produced or stored on site, this should be reported in the plan, which should then be reviewed and revised if needed in response to such new information. Having this information in advance will result in a more focused and timely response.

National guidelines which prescribe minimum requirements e.g. threshold chemical quantity amounts can then be used by local planners in the development of realistic scenarios for their training exercises. All parties, including operators of hazardous installations and possible sources of incidents, can be included in this process. Different scenarios can be prepared which would give consideration to a number of factors, such as:

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The type of chemical release e.g. detected, undetected, deliberate, accidental

The media the chemical is released into e.g. soil, water, air

The types of injuries expected e.g. toxic exposure, blast injuries, chemical burns

The chemical source e.g. fixed site, transported, whether the site is regulated and maintains a hazard site inventory

A framework policy should be developed to set minimum requirements for local emergency planning and response activities, but which can be used nationally. Such a plan should address:

detection, alert and scaling up capabilities of local emergency response;

command/control, roles and responsibilities for local emergency planning and response;

national support mechanisms, infrastructure and alerting mechanisms e.g. to evacuate or shelter-in-place;

requirements for operators to comply and liaise with local governments;

training and exercise requirements for key personnel;

planning the capacity of personnel and equipment for dealing with possible chemical incidents.

public crisis communication and health sector communication.

The plan will also be significantly improved if key members of the local community are involved throughout the development process. Through such community outreach, it will serve both to raise awareness of the existence of such plans and the steps to take during an incident, but also provide reassurance and promote compliance should such a plan need to be implemented. A well developed plan will provide a clear and concise framework of actions with binding requirements upon those who will implement it. In addition to implementing national legislation, the chemical incident plan should include procedures to:

Ensure that resources (finances, staff, equipment, infrastructure and training) are available for local networks involved in management of chemical incidents.

Establish a local database of hazardous sites, and/or contribute to a national database if one exists

Coordinate inter-agency relationships and collaborations e.g. on contributing to health and exposure investigations during the incident.

Develop and implement a model of command and control (see the chapter on Command and Control)

Develop procedures to inform the public concerning hazardous installations and to help to ensure that the public understands this information (refer to the section on timely alerting and notification and also the following link:

http://www.direct.gov.uk/en/Governmentcitizensandrights/Dealingwithemergencies/Preparingforemergencies/index.htm)

http://www.direct.gov.uk/en/Governmentcitizensandrights/Dealingwithemergencies/Preparingforemergencies/index.htmhttp://www.direct.gov.uk/en/Governmentcitizensandrights/Dealingwithemergencies/Preparingforemergencies/index.htm

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Conduct or sponsor routine activities such as exercises, and make modifications to the plan on the basis of the exercise evaluation

Ensure that national assistance such as laboratories, antidotes, decontamination equipment and experts will be made available to local responders.

Ensure that national public health information is acquired on a regular basis.

4.4 Contents of a chemical incident emergency response plan

Having identified relevant stakeholders, a preliminary version of the emergency response plan can be drafted. Following discussions with stakeholders, an initial planning meeting can be arranged to discuss the plans and appoint committees and chairs to develop particular aspects of the plan, and the timeframe over which they will be developed. As the role of the person who will chair the overall production of the plan is so important, it would be appropriate to also appoint a co-chair. Final drafts of each section of the plan, as produced by individual committees can be circulated and discussed at an implementation meeting ahead of the final version document being compiled and signed off. This final version would also contain a brief introduction outlining what the plan is designed to cover, and perhaps more importantly, what it does not. Within the plan should be a section detailing the contact details of all the senior officials who are critical to authorising and coordinating their agencies response to a chemical incident. The plan will then need to be distributed and a record kept of all the receiving organisations.

As legislation, local organisations and infrastructures are dynamic processes and change frequently (e.g. REACH Regulations [Registration, Evaluation and Authorization of Chemicals]), the emergency response plan will need periodic review and revision to ensure that it remains current, useful and appropriate. The use of tabletop, command post, and full-scale emergency management field exercises offer the best way, short of emergencies, to determine whether the plan is understood, that it "works," and that it would actually be used in an emergency. Following such an evaluation, a post-exercise review will want to suggest needed revisions, which may include a recommendation for refresher training for existing or new personnel or updating standard operating procedures (SOPs) and their ownership. Key to the success or otherwise of any such emergency plan will lie in how well the details of the plan are communicated to relevant public health and emergency response officials, as well as members of the public for larger scale incidents such as those planned for upper tier COMAH sites.

4.4.1 Objectives The objective of any public health office should be to strengthen capacity. The planning guidance presented here can be tailored to best suit the requirements of individual users by helping to identify where knowledge or capacity gaps may occur, and how to best address these issues, if possible.

In order to prepare their departments effectively, Public Health managers must be capable of the following:

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Identifying the types of events that might occur in their communities i.e. what chemical-related activities take place within their health authority jurisdiction (see the above section on hazard analysis).

Planning emergency activities in advance to ensure a coordinated response to the consequences of credible events.

Building capabilities necessary to respond effectively to the consequences of those events.

Identifying the type or nature of an event when it happens.

Implementing the planned response quickly and efficiently.Recovering from the incident.

In order to coordinate the incident response and subsequent public health activities, it will be useful to know the following:

(1) who will be in charge (lead organization);

(2) what will be the chain of command;

(3) who will activate/operate the emergency operating centre, if required;

(4) who will maintain the on-scene command post and keep it secure;

(5) who will have advisory roles (and what their precise roles are);

(6) who will make the technical recommendations on response actions to the lead agency;

(7) who (if anyone) will have veto power;

(8) who is responsible for requesting assistance from outside the community; and

(9) who is responsible for public information releases?

The plan should identify the lead public health official responsible for assessing the incident in terms of its public health impact. This person will be prepared to provide scenario-specific advice on what public health measures may need to be introduced should the incident grow or decrease in severity.

Following an incident and the clean up response, an investigation follow up report will be produced. It is important therefore, that key response personnel are instructed to maintain an accurate log of their activities. Actual response costs should be documented to facilitate cost recovery. It is also important to identify who is responsible for the post incident investigation to discover quickly the exact circumstances and cause of the release. Such investigations help determine whether response operations were effective, whether the emergency plan should be amended, and what follow-up responder and public training programmes are needed.

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4.4.2 Communication Emergency response planning includes having in place a well defined communications network and strategy to ensure that public health agencies are capable of reliable communications with their own response personnel as well as with all other agencies involved in the emergency response. This is not expected to be comparable to the communications network that the emergency services will have in place, but nevertheless will entail a clearly structured and auditable version controlled system. The communications system should disseminate accurate information to first responders, health-care providers, and decision-makers. This should include having protocols for notifying Emergency Operation Centres (EOCs) in the affected area to facilitate communication and coordination in the event of an incident. It would be useful to have a 24 hour contact list for all critical local and regional public health, medical, law enforcement, and emergency management personnel which can be verified at least monthly and updated whenever changes in personnel occur. Emergency communications must cover internal and external communications. Thus, the plan should identify, preferably by title, the person and alternates authorized to communicate and receive emergency information between the health department, emergency response agencies and other members of the public health community. To maintain the usefulness of this plan, the primary and back-up emergency communications links within the public health community and between the health department and response agencies should be tested two or three times each year.

4.4.3 Notification Authority The plan should identify, by title, the person and alternates responsible for the following:

Interagency notification.

o It is essential that key public health officials be aware of notification and coordination procedures when multiple agencies are involved, at least locally and regionally.

Notification of the news media.

Notification of the public. The plans will:

o Describe the means by which the public will be notified about a public health emergency

o Describe how the notifications will be coordinated with other response agencies, especially if evacuation is the recommended course of action

o Provide for notification of non-native language speaking residents;

o Describe how the notification procedures will be tested at least annually.

These people and their 24-hour contact numbers (e.g., telephone, pager) should be identified in the public health plan, even if those responsible for public notification or media coordination are not public health officials. There also needs to be well established procedures for providing the news media with timely and accurate public information to expedite the release of emergency information in the event of a chemical incident. To prevent the dissemination of inconsistent or conflicting data, one organization or person should be designated to coordinate all public information and speak to the news media (see the Early Response section).

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4.4.4 Special Populations The plan should identify the locations of special population groups. These groups include people in hospitals, prisons and other detention facilities, as well as people in intermediate- and long-term care nursing facilities. Care must be taken to ensure that the emergency public health needs of these and other identified special populations are considered and protected through provisions contained in the plan.

4.4.5 Mental Health Emergency situations place significant stress on both responders and the exposed population. The exposure to hazardous chemicals can lead to psychosocial responses different from, and in some instances greater than other emergency situations. The inability to quantify exposure along with concerns about developing illnesses well into the future result in special feelings of vulnerability and loss of control. The unique mental health concerns caused by a chemical event must be considered during the planning process. The plan should include provisions for identifying and obtaining mental health resources and psychosocial care for those affected by an emergency situation. Special care should be taken to ensure that emergency personnel receive the mental health support they may need, especially when the response personnel or any of their family members are victims of the incident. Research indicates that children and the elderly react differently to disaster-related stress than do average adults (Friedman et al., 1995; Oriel, 1999). These differences should be considered and planned for in the provision of emergency-related mental health services (for further information see the CIE toolkit Psychosocial Manual).

4.4.6 Morbidity and Mortality Study During and after disasters, public health personnel should survey an affected community and document the health and medical effects of the event on the population. Post-incident investigations could evaluate the effect of the chemical agent released, quantity and route of delivery, and the number and severity of casualties. Health departments also could investigate the effectiveness of pre-hospital and hospital responses and outcome effectiveness, and they could examine such secondary issues as shelter-in-place and evacuation-related accidents (for further information see the section on environmental public health tracking).

4.5 Review the plan

No single plan can cover every eventuality, and neither should it attempt to do so. Rather, it should develop a generic multi-hazard emergency operation plan that will provide sufficient detail and latitude to cater for most incidents in a timely and concise manner. It is recommended that the plan be reviewed and updated on a regular basis, either yearly or half yearly, as deemed appropriate within the region. Such a review would want to consider a hazard analysis, noting any new chemical facilities or transport routes, hospital or public building projects. Some countries or organisations e.g. environment agencies, Friends of the Earth, maintain chemical release or toxic chemical inventories as a community right-to-know service, which are themselves periodically updated. It would be useful therefore, to review the plan in the light of any such inventories.

It is advisable to maintain a list of plan holders, based on the original distribution list, plus any new copies that have been made or distributed. As staff retire, relocate and are replaced and telephone numbers change, it will be necessary to ensure that telephone

23

rosters are kept up to date. A periodic request can be sent out to departments/branches showing who is on the distribution list and asking for any additions or corrections. In addition, ask departments and agencies to review sections of the plan defining their responsibilities and actions. Any key change (new emergency phone number, change in equipment availability, location, etc.) should be distributed as soon as it is known. Do not wait for the regular review period to notify plan holders. After a significant number of individual changes, the entire plan should be redistributed to ensure accuracy and completeness.

In order to ensure that the plan is up to date, it is important to test the plan through regularly scheduled exercises (at least annually). This testing should include testing the emergency broadcast messages to the public and debriefing after the exercises whenever gaps in preparedness and response capabilities are identified. One organization should be responsible for coordination of the review and overall stewardship of the updating of the plan. Use of the planning team in this role is recommended, depending on the effort available.

Include a Record of Amendments and Changes sheet in the front section of the plan to help users of the plan stay abreast of all plan modifications. Include a When and Where to Report Changes notice in the plan and a request for holders of the plan to report any changes or suggested revisions to the responsible organization at the appropriate time.

4.5.1 Planning: Incident Information Summary Checklist It is important to develop a format for recording essential information about the incident. The Box below show the essential information that should be contained within an incident checklist (see also the Evacuation versus Shelter-in-Place checklist prepared by the HPA at:

www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/ExpertGuidance/

and the Chemical Release/incident Action Card (Appendix A) and the public health service response factsheet (Appendix B) for more detailed information):

Box Essential information that should be included in a chemical incident checklist

Name of person receiving call

Name and telephone number of on-scene contact

Location

Nearby populations

Nature (e.g., leak, explosion, spill, fire, derailment)

Time of release

Possible health effects/medical emergency information

Number of dead or injured; where dead/injured are taken (e.g. hospital, rest centre)

Estimate of number of people already exposed and nature of exposure

Estimate number of people facing potential exposure

Identify any nearby populations that may become exposed, e.g. if contaminant is airborne

http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/ExpertGuidance/http://www.hpa.org.uk/Topics/EmergencyResponse/ExtremeWeatherEventsAndNaturalDisasters/ExpertGuidance/

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Estimate time period of exposure for population(s)

Rescue accomplished? Rescue needed?

Name of material(s) released; if known

Manifest/shipping invoice/billing label

Chemical Abstracts Service (CAS) Registry number

MSDS available? (MSDS can be found on a number of websites e.g. www.hazard.com)

Shipper/manufacturer identification

Container type (e.g., truck, rail car, pipeline, drum)

Railcar/truck identification details/numbers

Placard/label information

Characteristics of material (e.g., colour, smell, physical effects), only if readily detectable

Present physical state of the material (i.e., gas, liquid, solid)

Total amount of material that may be released

Other hazardous materials in area

Amount and concentration of material released so far/duration of release, environmental persistency and degradation products.

Whether significant amounts of the material appear to be entering the atmosphere, nearby water or storm drains, or soil

Whether the release was in a confined space

Direction, height, colour, odour of any vapour clouds or plumes

Current and forecast weather conditions (temperature, wind direction, speed, precipitation)

Local terrain conditions significant to dispersion

Personnel at the scene

Environmental pathway/route of exposure between source of contamination and human receptors

http://www.hazard.com/

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Checklist of activities when constructing emergency chemical plans

Chemical Incident Management Planning Checklist Basic Emergency Preparedness Planning Checklist Yes No

1. Have you outlined the purpose of the plan?

2. Have you cited appropriate European, national, and local public health authorizing legislation, ordinances, and regulations?

3. Have you outlined any assumptions on which the plan is based?

4. Have you identified specific individuals and alternates authorized to direct the public health emergency response?

5. Have you referenced the major scenarios or scenario categories? 6. Have you referenced existing interagency agreements? 7. Have you explained all abbreviations and defined key or unfamiliar terms? 8. Have you included procedures for maintaining a record of plan distribution and a record-of-receipt form?

9. Does the plan contain the following protocols? a. Protocols for convening police, fire, emergency medical services, local hospitals, public health officials, members of the local emergency planning committee, emergency operations centre, and other relevant parties on a periodic basis to review the content of the plan.

b. Protocols for convening police, fire, EMS, local hospitals, public health officials, members of the local emergency planning committee, EOCs, and other relevant parties as appropriate, on a periodic basis to test the content of the plan through exercise scenarios.

c. Protocol for designating, by title, the public health personnel (and alternates) responsible for staffing the centralized EOC when activated

d. Protocol for coordinating public health responsibilities with law enforcement responsibilities.

e. Protocols for notifying interagency, media, and public of an emergency. f. Protocol for informing the public of population prevention measures which include: hazards to expect, precautions to take, requirements for evacuation or shelter-in-place, including a consideration of special populations.

g. Protocol for mutual aid agreements and interagency coordination. h. Protocol for implementing an emergency epidemiologic investigation for human exposures.

i. Protocol for implementing decontamination, evacuation and mass casualty transportation.

j. Protocol for protecting care-providers and victims from secondary exposures e.g. off-gassing from vomitus. k. Protocol for methods for collecting, handling, decontaminating, transporting, preserving, and storing chemical evidence, including maintaining the chain of custody and referral to public health laboratory

l. Protocol for interviewing potentially contaminated victims.

m. Protocol for critical incident stress counselling for victims or response personnel, including public health and medical professionals.

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Command and Control Yes No 1. Have you designated a location for the Public Health Department emergency operations?

2. Have you designated the public health employees responsible for staffing the Emergency Operations Centre (EOC)?

a. have these staff been fully trained in how to operate an EOC?

3. Have you described the relationship between national, regional and local response efforts and described procedures to coordinate the efforts of the different levels of government and agencies during an emergency?

4. Have you determined under what conditions the plan would be activated?

5. Have you identified local health-care resources (e.g., beds, staffing, ventilators, decontamination tents, vacant hospital buildings)?

6. Have you identified by title, the person and alternates responsible for assessing the public health consequences of the emergency incident?

7. Does the plan identify the locations of special population groups including jails, prisons, and other detention facilities as well as intermediate- and long-term care nursing facilities?

8. Have you developed protocols for dealing with a large number of casualties?

9. Are you aware of the location(s) of identified mass care centres in your region?

10. Have you worked with mass care providers to ensure proper documentation of all emergency and nonemergency medical care occurring at mass care centres?

11. Do you have identified evacuation centres in your region?

10. In the event of a mass evacuation, do you have access to the resources to facilitate such an evacuation e.g. transport, personnel?

Communications Yes No

1. Have you communicated in advance with emergency department directors and hospital administrators in the community to facilitate coordination of emergency activities?

2. Have you explained how information will be disseminated accurately to first responders, the public, health-care providers, EOC staff and decision-makers?

3. Have you identified suitable telecommunication methods, e.g. sufficient radio frequencies; pagers; cell phones etc., to facilitate communication between necessary organizations on a 24-hour emergency basis?

4. Have you described the health departments capability to alert and

27

communicate with its field response units?

5a. Have you developed, distributed and maintained a list of contact information for all critical local or regional public health, medical, law enforcement and emergency management personnel?

5b. Have you developed, distributed and maintained a list of contact information for environmental organisations, relevant government departments, occupational health professionals, environmental specialists/consultants and relevant local volunteer groups

5c.Are these lists updated at least monthly?

6. Have you identified, by title, the person and alternates authorized to communicate necessary public health information between:

a. the health department and other health agencies and organizations?

b. the news media

c. the public? (These people should be identified and contact telephone numbers included, even if those responsible for public notification or news media coordination are not public health officials.)

7. Have you described the procedures by which the public will be notified of a public health emergency?

8. Have you provided for notification of non-native language speaking residents?

9. Have you described how the public notification procedures will be tested at least annually?

10. Have you described how the public protective action messages will provide the detail necessary to implement the recommended protective actions?

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Telephone Roster

To facilitate the communication process following an incident, it would be useful to maintain an updated list of the following contacts. This list is not considered exhaustive, but merely representative of the types of organisations that could form part of the public health response following an incident that may require a wider response. It should be added to, depending on local and national structures.

Community Assistance

Police . ........................................

Fire ........................................

Emergency Management Agency........................................

Public Health Department........................................

Environmental Protection Agency........................................

Departments of Transportation........................................

Department of Education........................................

Public Works........................................

Water Supply........................................

Sanitation........................................

Port Authority........................................

Transit Authority........................................

Rescue Squad........................................

Ambulance........................................

Hospitals........................................

Coast Guard........................................

Utilities:

Gas........................................

Phone........................................

Electricity........................................

Community Officials:

Mayor........................................

City Manager........................................

County Executive ........................................

Councils/Departments of Government (local/national) ........................................

Army........................................

Bomb disposal........................................

Volunteer Groups

Red Cross........................................

Salvation Army........................................

Church Groups........................................

Response Personnel

Incident Commander........................................

Agency Coordinators........................................

Response Team Members........................................

Industry

Transporters ........................................

Chemical Producers/Consumers ........................................

Spill Cooperatives........................................

Spill Response Teams........................................

Media

Television........................................

Constructing emergency chemical plans: locally and regionally

29

Newspaper........................................

Radio........................................

Public Education and Emergency Public Information Yes No

1. Has the state established a comprehensive and pro-active (as opposed to reactive) public education programme on public health matters of interest to the population as well as the risks associated with chemical agents? If yes;

a. Does the public education programme provide for the education of non-native language speaking residents?

b. Have procedures been established for revising the public education materials annually or whenever significant changes warrant revision?

c. Have procedures been established for providing the news media with ongoing information about public health initiatives and public health-related emergency preparedness efforts?

2. Does a protocol exist for notifying or warning the community of potential hazards resulting from a chemical release? If yes--

a. Does this protocol have provisions for informing the public of what hazards to expect, what precautions to take, and whether evacuation or shelter-in-place is required?

b. Has the protocol been reviewed with members of the news media?

c. Does the public information programme include procedures for releasing emergency information to non-native speaking residents in a timely and effective manner?

Mental Health Yes No

1. Have you developed the capability to identify and obtain mental health resources rapidly in an emergency situation?

2. Are procedures in place for notifying both disaster victims and emergency workers of the availability of mental health services?

3. Have you tailored the mental health counselling to the age of the

30

person seeking mental health services?

Patient Decontamination Yes No

1. Have you identified the agencies responsible for patient decontamination?

2. Have you established protocols for identifying when decontamination will and will not be required?

3. Have you specified the public health communitys role in ensuring that decontamination of potentially contaminated people is both timely and thorough?

4. Have you identified the public health communitys role in training medical personnel to decontaminate ill, disabled or injured people safely before their entry into a hospital setting?

5. Have you established procedures for educating and informing the public of decontamination procedures in the event of a chemical incident?

6. Have you worked with your medical examiner or coroner to develop protocols for evidence preservation and decontamination of bodies for the immediate fatalities of a chemical incident?

References

Friedman S, Alderman E, Pantell R, Saylor C, Sugar M. Psychosocial issues for children and families in disasters. Washington DC: Department of Health and Human Services (U.S.);1995 May. Publication No. (SMA) 95-3022.

Oriol W. Psychosocial issues for older adults in disasters. Washington, DC: Department of Health and Human Services (U.S.);1999. Publication No. ESDRB SMA 99-3323.

Agency for Toxic Substances and Disease Registry. Report of the Expert Panel Workshop on the Psychological Responses to Hazardous Substances. Available on the Web at URL: http://www.atsdr.cdc.gov/HEC/PRHS.

Emergency Preparedness Guidance on Part 1 of the Civil Contingencies Act 2004, its associated Regulations and non-statutory arrangements: HM Government, Crown copyright Ref: 267619/1105/D40

Emergency Response to Terrorism: Incident Management, (http://www/usfa.fema.gov/nfa/tr6m1.htm).

http://www.atsdr.cdc.gov/HEC/PRHS

Constructing emergency chemical plans: locally and regionally

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Expectations and Indicators of Good Practice Set for Category 1 and 2 Responders. The Civil Contingencies Act (2004), its associated Regulations (2005) and guidance, the National Resilience Capabilities Programme, and emergency response and recovery. HM Government Crown copyright, 2009

Hillingdon Health Economy: Major Incident Plan (Hillingdon PCT) April 2006; prepared by Margie Meltzer and Siobhan Clarke

National Risk Register of Civil Emergencies HM Government Crown copyright (2010 edition)

OECD Guiding Principles for Chemical Accident Prevention, Preparedness and Response. Guidance for Industry (including Management and Labour), Public Authorities, Communities, and other Stakeholders (Second edition, 2003)

Public health emergency response guide for state, local, and tribal public health directors, Department of Health And Human Services Centers For Disease Control And Prevention

http://www.bt.cdc.gov./chemical/www.apic.org

www.fema.gov/emi/is195Ist.htm.

http://www.usfa.fema.gov/nfa/tr6e5.htm

www.bt.cdc.gov/protocols.asp

http://www.fema.gov/pte/gaheop.htm

http://www.epa.gov/emergencies/docs/chem/cleanNRT10_12_distiller_complete.pdf

http://www.epa.gov/emergencies/index.htm

http://www.direct.gov.uk/en/Governmentcitizensandrights/Dealingwithemergencies/Preparingforemergencies/index.htm

For some examples of templates and further information on developing local emergency response plans, visit:

Health sector: http://www.bt.cdc.gov/planning/

Water sector: http://www.nj.gov/dep/watersupply/erp_template_10_04.doc,

http://www.doh.wa.gov/ehp/dw/security/331-211_5-13-03_Emergency_Response_Planning_Guide.pdf

Environmental incidents: http://www.dem.ri.gov/topics/erp.htm

http://www.bt.cdc.gov./chemical/http://www.bt.cdc.gov./chemical/http://www.bt.cdc.gov/protocols.asphttp://www.epa.gov/emergencies/docs/chem/cleanNRT10_12_distiller_complete.pdfhttp://www.nj.gov/dep/watersupply/erp_template_10_04.doc

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5 IDENTIFYING UNIQUE FACTORS IN A CHEMICAL INCIDENT: COVERT RELEASE

Whilst the release of chemicals will most frequently be overt in nature, if a covert release occurs, the awareness of health care workers and public health practitioners is essential for early detection and management. Emergency services have staff trained and equipped to deal with CBRN incidents and these should be notified, along with the police, as soon as such an incident is suspected. For public health agencies to facilitate the recognition and response to a covert chemical incident requires health care professionals to report acute poisonings to poison centres, a national health protection agency and/or to a rapid alerting system, such as the rapid alerting system for chemicals (RAS CHEM*

). The public health professionals may then need to act together with toxicologists, the national poisons centre and reference laboratories to confirm whether or not such a chemical incident has occurred.

5.1 Clues that may indicate a cluster of unusual illness which may have a deliberate explanation

Whenever a cluster of unusual illness occurs, the question should always be considered whether the occurrence is the result of deliberate action with malicious intent. There are some general clues (e.g. epidemiologic and clinical syndromes) that a cluster may be the result of deliberate action. For instance, as many agents have similar chemical properties, they will produce a limited numbe