1 Chemical Threats Dwight Flammia, Ph.D. State Public Health Toxicologist Virginia Department of Health

2 Chemical Release Where? Fixed facility Transportation Public places Home How? Accidental Intentional When? Anytime

3 Bhopal, India Chemical Release 1984: 40 metric tons of methyl isocyanate released injuring 100,000 and killing 3,000 U.S. Congress passed Emergency Community Right to Know Act

4 Survey of Chemical Releases Polychlorinated biphenyls ANHYDROUS AMMONIA SULFURIC ACID CHLORINE Hydrochloric acid Benzene Sodium Hydroxide VINYL CHLORIDE Mercury Petroleum products Sodium hydroxide SULFURIC ACID ANHYDROUS AMMONIA CHLORINE VINYL CHLORIDE Adipic acid Ammonium nitrate Top Chemical Accidents Top Hazardous Materials Shipped by Rail

5 Ammonia Corrosive colorless gas with an intense irritating odor Used as a fertilizer and as a refrigerant Toxic effects restricted to site of contact (i.e., skin, eyes, respiratory tract, mouth, and digestive tract) Exposure can occur quickly and result in numerous injuries

6 Ammonia Exposure Scenarios Edinburg, VA Ammonia leak at poultry processing plant 12 homes evacuated 1 person treated for chest pain and difficulty breathing

7 Chlorine Greenish yellow gas, heavier than air, with a suffocating pungent odor Widely used chemical Respiratory system and eyes are principal targets of exposure to chlorine

8 Chlorine Exposure Scenarios Train derailment in SC: 2:40am 60 tons of chlorine released 597 people sought medical attention 9 deaths Train derailment in Florida Chlorine gas cloud covers highway 88 injuries 8 deaths

9 Sulfuric Acid Clear, colorless, oily corrosive liquid Most widely used chemical in the United States Corrosive and destroys any tissue it comes in contact with Fumes - extremely irritating to the respiratory system, eyes

10 Sulfuric Acid Exposure Scenarios Train derailment in TN Sulfuric acid fumes 3000 feet in the air People living within 1.3 miles evacuated 24 people treated and released Major complaints: respiratory distress, eye irritation 2005 Acid release in UT Sulfuric acid mixture released 8,000 persons downwind evacuated One person (0.25 miles away) treated for respiratory irritation

11 Vinyl Chloride Colorless gas - burns easily and has ethereal odor Used primarily in the manufacturing of polyvinyl chloride Breathing vinyl chloride can result in dizziness, sleepiness, headaches Known carcinogen

12 Vinyl Chloride Exposure Scenarios Train derailment in NJ Vinyl chloride leaked into waterway 18 people at a marine terminal reported breathing problems 0.5 mile radius evacuated Train derailment in Germany 268 people treated as outpatients 28 people admitted to hospital Symptoms: headache, nausea, respiratory and eye irritation Vinyl chloride in ground water reached 73 mg/L

13 Tetrachloroethylene Organic solvent, liquid at room temperature, easily evaporates, has a sharp sweet odor Breaks down in the environment producing other harmful chemicals Used to dry clean clothes and as a metal degreaser Skin irritant; intoxicating effects similar to ethanol if inhaled; anticipated to be a carcinogen

14 Tetrachloroethylene Exposure Scenarios Groundwater Indoor air Private wells

15 VDH State Chemical Emergency Epidemiologic Response Plan Basics of chemical agents Public health planning and preparation Public health response during event phase Public health response during recovery phase Reporting form and contact information

16 Office of Epidemiology under Incident Command System (ICS) Structure Surveillance Investigation Information data collection, dissemination, report preparation define exposed population, interview exposed persons, collect and tract specimens, assess treatment effectiveness provide scientific knowledge, develop information for dissemination, respond to request for information

17 Identifying a Chemical Release Emergency response Fixed facility Transportation accident Surveillance Syndromic data from hospitals/ERs Laboratory records Mortality records Environmental sampling data

18 Indicators of a Chemical Exposure Rapid onset of breathing problems, eye irritation, nausea Failure of a common disease to respond to usual therapy Higher morbidity or mortality than expected Unusual - clustering of patients; age distribution in illness or death; illness in a population; pattern of death or illness among plants and/or animals; odors or discoloration in the environment

19 Initial Notification Health District Local emergency management Local law enforcement VDH Central Office Division of Environmental Epidemiology (DEE) Toxicology/health assessments and waterborne Division of Surveillance and Investigation (DSI) Enhanced surveillance support

20 Initial Notification DSI and DEE State Epidemiologist Division of Consolidated Laboratory Services VDH Offices and Divisions Office of Drinking Water (if waterworks impacted) Office of Environmental Health Services (if private wells or shellfish impacted) Office of Emergency Preparedness State Epidemiologist Commissioner of Health Centers for Disease Control and Prevention

21 Local Health Department Provide background and define release Maintain contact with first responders and provide event updates Respond to citizens and media Collect samples to be analyzed Follow-up with community (not necessarily just hospitalized) Make sure everyone has access to doctors and medicine Coordinating with Red Cross displaced individuals Emotional trauma Identify local government needs

22 VDH Central Office Role Identifying public health impacts posed by agents Coordinating sample collection and testing Coordinating with state and federal agencies Monitoring during and after release Responding and coordinating w/state and federal agencies Toxicological support Recommending actions for reducing ongoing exposure Determining when it is safe to return

23 Sample Collection DSI and DEE can coordinate sample collection and analysis between DCLS, OEHS, HAZMAT, DEQ, federal agencies, and local health departments Determine samples to be collected sample kits sampling methods storage and shipment requirement any chain of custody reporting requirement

24 Recovery and Post Event Phase Revisit site to ensure preventive actions in place Monitor health of responders and exposed individuals Determine cleanup and re-entry safe levels Evaluate need for additional environmental sampling Help community deal with loss Community access to shelter, food, water, medicine, clothing

25 Information Gathering and Dissemination Public information officer Need to be able to tell community and media What happened What we know What they can do (what we are doing) Establish Talking points Message maps Fact sheets

26 Contacts Business hoursAfter hours Division of Environmental Epidemiology (804) (804) / (866) Division of Surveillance and Investigation (804) (804) / (866) Office of Emergency Preparedness (804) ; local, regional and state contacts: Dwight Flammia Public Health Toxicologist Office: (804) BB: (804)