2013 Kentucky Trauma and Emergency Medicine Symposium

• Jointly Sponsored by;

Sampson and Goliath

Hazardous Materials Releases in Natural Disasters

We Will NEVER Forget!!!!

Financial Disclosure• I, Les Fryman, have no relevant financial or nonfinancial

relationships in the products or services described, reviewed, evaluated or compared in this presentation.

Objectives• Brief history of natural disasters in Kentucky.• Most prevalent natural disasters in recent

history.• What are the most prevailing chemicals

released in natural disasters.• Hospital preparation for these events• Hospital operations for those contaminated

patients.

How About Some Data

• Natural Hazards were the cause of approximately 16,600 Hazardous Materials Releases reported by the NRC between 1990 and 2008.

• That is 3% of all Hazardous Materials Releases that were reported.

• Rain induced were the most at 26%• Hurricanes – 20%• Winds, Storms and other weather related

phenomenon account for another 25%

Disasters

• A single natural hazard event may effect a large area and many industries• The response to the natural disaster itself may

divert resources that otherwise would be available.

• Source of data from the NRC’s Incident Reporting Information System. (IRIS)

• Natural Disasters make up 75% of FEMA declared disasters.

History of Natural Disasters

• Where does Kentucky rank in the nation as far as declared natural disasters?• #8

• Since 1953 there have been:• 56 Disaster Declarations• 4 Emergency Declarations• 6 Fire Management Assistance

Declarations

Most Prevalent Disasters in Kentucky

• Severe Storms, Straight-Line Winds, Severe Winds, etc…

• Since 1957 – 43 Major Disaster Declarations

• From 1950-2010 – • 2,071 extreme wind

events• 26 Considered Strong

Wind Events

Zeus

Wind Storm Damage

Kentucky Severe Storm Vulnerability Score

Kentucky Hail Vulnerability Score

Most Prevalent Disasters in Kentucky

• Floods, Rockslides, and Mudslides• Since 1957 – Mentioned

in 39 Natural Disaster Declarations.

• From 1950-2010• 604 Extreme Flooding

Events• 0 Extreme Landslides

Poseidon

Flood and Landslide Damage

Kentucky Flood Vulnerability Score

Kentucky Landslide Vulnerability Score

Most Prevalent Disasters in Kentucky

• Tornadoes:• Since 1957 listed in 20

Major Disaster Declarations

• Tornado Index: • Kentucky – 136.89• U.S - 136.45

Aeolus

Tornado Damage

Kentucky Tornado Vulnerability Table

Most Prevalent Disasters in Kentucky

• Winter Storms or Snow:• Since 1957, listed in 7

Major Disaster Declarations

• 1950-2010 – • 7 Extreme Ice Storms• 25 Extreme Winter

Storms• 16 Extreme Heavy

Snow Events• 22 Extreme Winter

Weather Events

Boreas

Winter Storm Damage

Kentucky Winter Storm Vulnerability Table

Most Prevalent Disasters in Kentucky

• Fires:• Since 1957, listed in 6

Fire Management Assistance Declarations.

• 1950-2010 – • 1 Extreme Wildfire

Event• 24 Extreme heat

Events

Hephaestus

Wildfire Damage

Kentucky Wildfire Vulnerability Table

Number of Releases Associated with Various Natural Phenomena

Most Prevalent Hazardous Materials Released In Natural Disasters

Chemical Process IDLH % in Spills

Nitrogen Oxide Flare Stack Emissions

20ppm 13

Benzene Flare Stack Emissions

500ppm 8

PCB’s Dielectric and coolant fluids

0.5ppb in drinking water

5

Sulfur Dioxide Byproduct or Sulfuric Acid Production

100ppm 5

Hydrogen Sulfide

Sewer GasBreakdown of

organic material

10ppm 4

Ammonia, Anhydrous

Refrigeration systems at

storage tanks

300ppm 4

Quantity of Materials Released

• Range from drops to millions of liters. • Most spills are less than 400 liters spilled• Other spills were well over 40,000 liters. • Total volume from 1990-2008 = 29 million liters

spilled

Volume of petroleum released by Natechs, 1990-2008

Hospital Preparedness• Golden Rule with Preparedness:

• IF YOU FAIL TO PREPARE……THEN PREPARE TO FAIL!!!!

• First Receiver Programs for Hospitals• JCAHO Recommendation

• It is no longer sufficient to develop disaster plans and dust them off if a threat appears imminent. Rather, a system of preparedness across communities must be in place everyday.

JCAHO Recommendation• JCAHO requires:

• Hazards Vulnerability Analysis• Conduct a Hazard Vulnerability Analysis (HVA)• Required by JCAHO (JCAHO 2002)• Lists possible hazards (tornados to terrorism)• Impact on hospital operations• Actions to minimize likelihood, or mitigate the impact• Rank vulnerability to hazard and prioritize efforts to

reduce vulnerability• That hospitals consider their anticipated roles and coordinate

activities with other emergency response agencies and hospitals within the community.

American College of Healthcare Executives (ACHE)

American College of Healthcare Executives (ACHE)

American College of Healthcare Executives (ACHE)

Hospital Disaster Response Plans• Components of a Hospital Emergency Disaster Plan:

• Objectives of the Emergency Plan/Disaster Plan• Definitions of Roles and Responsibilities• Central operations Center• Community Contacts• Guidelines to Emergency/Disaster Preparedness• Pre-Disaster Planning• Procedures during an emergency event• Recovery plan to resume normal operations• Disaster – Specific Scenarios• Appendix Table

Hospital Disaster Response Plan• Appendices:

• Listing of Approved Shelters• Emergency Preparedness Letter of Understanding• Generic Checklist• Personal Items to bring to work in the event of an

emergency• Communications postings and scripting• Local Contact Information• Materials Management Supplier Disaster Phone

List• Pay Pone Listing/Alternate Phone Locations

Hospital Disaster Response Plan

• Appendices:• Emergency Staffing Pay• Dependent Care• Childcare Plan Enrollment• Staffing During Emergency/Disaster Event Policy• Labor Pool Process• Disaster Preparedness Status Briefing• Red Cross Chapters• Staff Notice/Briefing• Procurement Summary Report

Hospital Disaster Response Plan

• Appendices:• Team briefing Format• Identification of Personnel• Employee Contact Information• Visitor Policy• Local Radio Station Listing• Emergency Plan Staff organization chart• Incident Command Checklist• Emergency Disaster Exemption Form• Communications

Hospital Disaster Response Plan

• Appendices:• Director’s Emergency/Disaster Checklist• Employee Emergency/Disaster Checklist• Post-Impact Assessment Form• Sleep Assignment Form• Employee Emergency/Disaster Preparedness

Handbook (for all employees to have and review)

Initial Operations• IC Announces disaster declaration• IC notifies “Mahogany” Row• IC give readiness briefing• Departments start preparation of their specific areas• Internal Communication plans in operation• Ensure computer/electronic equipment protection

measures• Activate labor pool • Activate child care plan• Prepare and send staffing plans to HR• Dismiss Team “B” for 24 hours if possible

Emergency Department• Initial procedures to get ED ready to accept patients:

• Surge Capacity• Decontamination Procedures set up and in place

“The solution to the pollution is dilution”

Summary• When natural disasters happen, the chance of

hazardous materials releases can hamper a hospitals response

• Emergency Disaster Plans need to be rehearsed and updated at all levels of the organization

• Failing to plan for your organization will ensure your plan will fail when you need it most.

Resources• Sengul, H., Santella, N., Steinberg, L. J. and Cruz, A. M.

(2012), Analysis of hazardous material releases due to natural hazards in the United States. Disasters, 36: 723–743. doi: 10.1111/j.1467-7717.2012.01272.x

• Federal Emergency Management Agency. (2008). Fema Information. Retrieved from http://www.fema.gov.

• Centers for Disease Control and Prevention. (2010). Retrieved from http://www.cdc.gov/

• Centers for Hazards Research and Policy Development, University of Lousiville

• Schneid, Thomas D., and Larry Collins. Disaster Management and Preparedness. Boca Raton, FL: Lewis, 2001. Print

Resources

• Managing Hazardous Materials Incidents. [Atlanta, Ga.]: U.S. Department of Health & Human Services, Public Health Service, Agency for Toxic Substances and Disease Registry, 1994. Print.

• Briggs, Susan M., and Michael Cronin, eds. The ABC's of Disaster Medical Response. N.p.: International Trauma and Disaster Institute, 2005. Print

• American College of Healthcare Executives. Healthcare Executives' Role in Emergency Preparedness. N.p.: ACHE, 2009. Print