What would you do?
…if a dozen dead birds are found near a truck accident site?
…if 20 people complain of tingling in the mouth after eating at a fast-food restaurant?
FEMA have some answers. They have published a new 324-page document discussing key planning factors and considerations for response to and recovery from a chemical incident August 2021).
https://www.fema.gov/sites/default/files/documents/fema_chemical-kpf_060321.pdf
The report shows the potential complexity of responding to a chemical event. Unlike radiological events, chemical events could result in overwhelming numbers of acute casualties, some of which require urgent medical attention with the correct treatments and anti-toxins for the chemical involved – which may not be identified at the start of the event. First responders may be in immediate danger from the contamination themselves, something that is not likely to be true to the same extent for radiological emergencies.
There are broad similarities between the response to a chemical event and to a radiological event (a dangerous substance that can move with air and/or water movements, the need to make decisions with weak information, a complex issue to explain to the public while needing them to urgently take heed of advice, a potentially complex recovery process) but also important differences (rapid onset of medical crisis, wider range of substances to understand).
The FEMA report provides brief details of several chemical accidents, showing the range of events that are included in this class and the complexity of response. It also identifies and discusses the characteristics that are common to chemical accidents which includes the fact that their on-set can be rapid, a quick and effective response is required to save lives, first responders can become exposed, decisions need to be made quickly with a limited understanding of what has occurred, large areas can be affected, communications with the public and between responders is important, medical facilities can be overwhelmed and recovery may take a long time.
It then lists seven Key Planning Factors (KPF), each of which is then given a chapter:
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- “Prime the Pump” Pre-Event Planning;
- Recognize and characterise the Incident;
- Communicate with External Partners and the Public;
- Control the Spread of Contamination;
- Augment Provision of Mass Care and Human Services to Affected Population;
- Augment Provision of Health and Medical Services to Affected Population;
- Augment Essential Services to Achieve Recovery Outcomes.
It justifies pre-planning with the observation that “A large-scale chemical incident with mass casualties is a realistic threat facing both urban and rural communities nationwide. The risk of misuse or accidents involving toxic industrial chemicals (TIC), which are widely stored in large quantities and are routinely transported by rail, waterway, highway, and pipeline, is substantial”. They also believe that a terror attack using chemicals is credible.
Multiagency planning and preparation are required to face this threat and enable a prompt and effective response. A “whole community” concept of operations is suggested.
The report suggests a systematic approach to planning and preparedness with several discrete steps recommended, each of which is explained in detail with lists of suggested consultees, reference documents, check lists and resource requirements.
It stresses the importance of agreeing how decisions will be made suggesting a process whereby stakeholders agree which decisions will need to be made, the minimum information needed to make them and the potential sources for that information. Decision making processes should be established to select among available options for evacuation, shelter-in-place, decontamination and waste management balancing political/social priorities and public health protection against time and cost constraints, and, therefore, should include discussion of reimbursement/ compensation for resources provided and contingencies if resources are damaged, destroyed, etc.
Another important area for discussion is medical resources. The planning process should establish protocols and procedures for the prioritization of medical resources.
There are a range of ways in which a chemical event can become known – this varies from automatic alarms on chemical plant, reports of smells or gas clouds, reports of unexplained illnesses or collapses of people or animals, active monitoring of public spaces and food. The quicker these signs can be picked up the better. The report discusses possible indicators, what they might mean and how best to use them. By considering what signs might be available and what they might mean in advance the planners increase the likelihood that an event can be detected earlier allowing a better response.
The next step is to characterise the release and its extent with the safety of first responders as a high priority. This requires equipment, training and coordination.
There is a nice discussion about atmospheric dispersion and modelling.
The third KPF refers to communication with external partners and the public. It stresses the importance of communication to enable a coordinated response across multiple agencies, jurisdictions and levels of authority and to inform the public providing key information and advice on self-preservation while countering misinformation and misperceptions.
The section discusses how communications can support a coordinated response, how to inform the public, how to provide time-critical messaging, strategies for effective communications, and best practice (the latter being a useful checklist of 13 elements).
Controlling the spread of contamination (KPF 4) may save lives and will protect the environment. Depending on the nature of the incident, controlling the spread of contamination may involve environmental containment and/or remediation efforts; decontamination of people, goods, or property; and interventions such as evacuations and food recalls. A lot of important decisions may be needed, and considerable expertise and resource bought to bear.
The support of the affected population (Augment provision of mass care and human services to affected population) (KPF-5) provides life-sustaining and human services to disaster- affected populations, including feeding operations, emergency first aid, distribution of emergency items, and family reunification. Additional resources and services may need to be mobilized to support individuals with disabilities, limited mobility, limited English proficiency, children, household pets, and service and assistance animals. Mass evacuations result in a varied group requiring a range of support services.
The basic objective for Emergency Mass Care is to provide for basic survival needs including food, water, emergency supplies, and a safe, sanitary, and secure environment but hopefully it would go beyond that and cater for other needs, reducing the potential for psychological harm.
The report discusses the support that sheltered and evacuated populations might have and the multi-agency strategies that might be considered to prepare to meet these needs, the facilities that may be required to manage evacuations, provide respite, assistance and shelter.
KPF 6 is concerned with augmenting the provision of health and medical services to the affected population. A chemical event could result in a rapid build-up of casualties requiring specialist assistance, including determination of the active agent, the appropriate medical care and the steps required to protect the responders and medical facilities from contamination.
The report discusses medical treatment for chemical casualties which may require that the symptoms presented are treated while the active agent is unknown i.e. provision of oxygen to those exposed to a lung irritant.
The report mentions “CHEMPACKS” which are containers of nerve agent antidotes placed in safe locations around the country (the USA). I do not know if this system is replicated in the UK. The report recognises limitations to this system.
The Tokyo nerve agent attack in March 1995 was serious – 12 people died, 54 were severely injured, and around 980 were mildly to moderately affected. However, most of the 5000-seeking help, many of them with psychogenic symptoms, were understandably worried that they might have been exposed. This demonstrates the value of rapid information dissemination via the media in reassuring the public. It also shows the importance of effective triage at receiving centres in ensuring that medical resources are reserved for those who really have been exposed.
The final KPF is “augment essential services to achieve recovery outcomes”. This section suggests that recovery begins during the planning and response phases. It divides the recovery into three overlapping stages: short term (days), intermediate (weeks – months) and long term (months – years).
Activities and resources needed to attain recovery outcomes will vary depending on the scenario, context, and location of the chemical incident as well as the incident’s impacts on the local infrastructure, economy, and workforce.
The overall objectives of recovery plans and prioritizations are to restore critical services as quickly as possible to limit cascading effects, and to return the affected community to a sense of normality.
After discussing each of the KPFs the report discusses federal preparedness, response and recovery, outlining the four escalating tiers of federal response. These are (1) an on-scene coordinator assessing the situation and watching the response (2) escalation to invoke the National Oil and Hazardous Substances Pollution Contingency Plan (3) a request to the Department of Homeland Security for coordination capabilities and additional federal agency support (4) a Presidential Disaster Declaration under the Stafford Act. These are discussed in turn with examples.
The report provides links to a wide range of additional information and both planning and response tools. Appendices provide a wealth of information including an overview of nine common toxidromes (syndromes caused by exposure to dangerous levels of toxins), a review of US chemical incident policy, legislation and regulation and chemical planning and notification requirements for responsible parties, environmental containment and remediation options, a flow chart showing how medical attention can be targeted and coordinated.
This is a detailed document covering a wide range of material. For a person with responsibility for planning for, or responding to, a chemical incident in the US it is probably a must read. For people with similar responsibilities elsewhere it is a recommended read – read it and compare your level of readiness with that described.