Elsevier

Resuscitation

Volume 42, Issue 2, October 1999, Pages 133-140
Resuscitation

An integrated response to chemical incidents — the UK perspective

https://doi.org/10.1016/S0300-9572(99)00112-4Get rights and content

Introduction

Globally, intense concern about the dangers of chemicals for humanity and the natural environment was expressed at the United Nations Conference on the Human Environment in Stockholm, Sweden, in 1972. The World Health Assembly in 1977 also identified the need for international action leading to the International Programme on Chemical Safety (IPCS) by the World Health Organisation (WHO), the United Nations Environment Programme (UNEP) and the International Labour Organisation (ILO). As a result the Organisation for Economic Co-operation and Development (OECD), an international organisation grouping 24 industrialised countries, published in 1992 a guidance document entitled ‘Guiding Principles for Chemical Accident Prevention, Preparedness and Response’. This document sets out guidance for public authorities, industry, labour and others related to all aspects of accident prevention, preparedness and response with respect to fixed installations that manufacture, handle and store hazardous substances.

Four international organisations subsequently collaborated in a Workshop on Health Aspects of Chemical Incidents held on 13–16 April 1993 at Utrecht, the Netherlands. Approximately 100 professionals from more than 25 countries, including 11 OECD member countries, participated and contributed to the guidance documents on health aspects of chemical incidents published from Paris in 1994 [1].

Despite the above initiatives the level of awareness and preparedness to deal with chemical accidents varies enormously in the UK. Emergency planning is particularly deficient in areas where there are no chemical industries, as it is generally believed that the risk of a chemical incident is negligible.

Section snippets

Risks in the UK

Many millions of tonnes of chemicals are manufactured in the UK chemical industry each year. This involves high temperature and/or high pressure processes. Almost half of the UK chemical production is sold overseas and much of the production is not used at the site of production. It is estimated that 80 million tonnes of chemicals are moved around the UK each year [2]. Over 2000 are considered to be toxic in their own right. A tanker carrying chemicals passes through Cleveland, UK, every 2 min.

National guidance

The guidelines for health service arrangements for dealing with chemical incidents published in 1990 [3], relied heavily on the district health authorities to formulate plans for provision of health care and protection of health in the event of a chemical incident. The advice given in the document emphasised that emergency plans for the most potentially hazardous industrial sites must be prepared in accordance with the Control of Industrial Major Accident Hazard Regulations (CIMAH) [4].

Civil and defence liaison

Organisation of chemical incident response is usually within the remit of response to a disaster of various kinds. In several countries close cooperation between civil and military services is established for coping. Such liaison took place in the UK during the Gulf War (1991).

All staff of Emergency Departments and acute hospitals designated to receive Gulf War victims, were updated on chemical warfare and the medical management of casualties covering nerve agents, mustard gas, hewisite,

Towards a co-ordinated emergency response

Recognising the need for multidisciplinary approach, the UK Ambulance Service Association (ASA) commissioned a Chemical Incident Procedures Subcommittee chaired by one of the authors (RW) in June 1995. Representation was made by the fire services through The Chief and Assistant Chief Fire Officers Association (CACFOA), the Chemical Industries Association, the Health Emergency Planning Officers and 2 Accident & Emergency Medicine Consultants representing the specialty Fig. 2, Fig. 3, Fig. 4.

As

Personal protection

Whilst it is recognised that complete protection against chemicals is unlikely to be feasible in a patient handling environment, the provision of items of personal protective equipment to staff attending chemical incidents is essential. The levels of equipment recommended were chosen for the particular roles and tasks staff would undertake [6], [7], [9].

Identification of chemical(s)

First responders to a chemical accident need to know right away the chemical(s) involved, the associated hazards and first aid measures. Much basic information on chemical hazards can generally be found on safety data sheets and transport emergency cards. Such sheets have existed for many years in a wide variety format, with a broad range of data quality and quantity. The IPCS and European Community produce ICSCs or International Chemical Safety Cards [2].

The European Chemical Industry Council

Chemical incident management at scene

Efficient and effective management of victims of a chemical incident depends upon the co-ordinated response between the emergency services, the acute hospital response team, the poison information centre, public health physicians and the local authorities concerned. Management of the scene consists of triage, decontamination, treatment and evacuation.

Ambulance–hospital interface

From the receiving hospitals view point, advanced warning with comprehensive details of the incident are keys to success. A pneumonic ‘When ETHANE’ is one method of reporting recommended for use by emergency services (Appendix 6). In addition detailed toxicological information related to the chemical will be required to offer definitive care to the victims and also to protect the hospital and it's staff. Currently there are two sources for this information.

Chem data is accessed by the fire

Risk management

As chemical incidents pose a range of hazards and risks to the emergency services, hospital staff and the community, it is recommended that a risk assessment is carried out in one’s own geographical location [9]. Only then, education, training and provision of facilities for managing a chemical incident can be planned to minimise the potential human suffering and damage.

The authors reside and work on Teesside (previously Cleveland County), situated on the north east coast of UK. This area is

Joint training and education

Joint training and education are essential ingredients in producing a multidisciplinary team functioning optimally under stressful circumstances. Training must include communication exercises, small scale (hospital and emergency service) response exercises and full scale simulations involving industry, health professionals, emergency services and others with responsibilities in the area, such as civil defence services and military authorities. The experience on Teesside indicates that it is

National focus-emergency planning co-ordination unit

The National Focus was established at the University of Wales Institute, Cardiff, on 1 February 1997, to provide a national, centralised unit to co-ordinate work or response to chemical incidents, and surveillance of possible health effects attributed to exposure to chemicals in the environment. Recognising that a significant amount of work had already been undertaken, the National Focus nominated members of Chemical Incidents Procedures Working Group on to its technical advisory board. The

Incident reporting

As lessons can be learnt from every incident, it is important that every agency complies with the requirements and sends information to the ASA and National Focus of any chemical incident in their own areas in a standardised format [9]. This initiative has resulted in a pilot phase of the National Public Health surveillance of chemical incidents from which preliminary data is currently available from the National Focus.

Summary

Although chemical emergencies on a massive scale like in Bhopal, India, in 1984 and the Sarin incident, Tokyo, in 1995, are fortunately rare occurrences, less serious incidents occur from time to time which require a sufficient level of preparedness. A successful response requires a consistent, well co-ordinated seamless response from different agencies, starting with the fire services, emergency medical services and hospitals, extending to the regional offices of the NHS Executive and the

Acknowledgements

I am indebted to Miss D. Watson and Mrs P. Coulthard for their kind assistance in preparing the manuscript.

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