CHEMICAL INCIDENTS The Public Health Response in Wales Huw Brunt

1. CHEMICAL INCIDENTS The Public Health Response in Wales Huw Brunt Consultant in Environmental Health Protection

2. Background • Chemical incident defined as “an acute event in which there is, or could be, exposure of the public to chemical substances which cause, or have the potential to cause, ill health” • Unforeseen event leading to acute exposure of two or more individuals to any chemical substance, resulting in illness or a potentially toxic threat to health • May be accidental or deliberate • Some exceptions, so following are excluded from definition: - occupational exposure with no potential for public health exposure - incidents involving non-ionising radiation - incidents involving drugs and other substances of abuse - single case poisonings

3. Chemical incidents • Ammonium nitrate explosion, Oppau, Germany, 1921 (430-530 deaths) • Cyclohexane release and explosion Flixborough, UK, 1974 (28 deaths, >100 injured) • Dioxin release, Seveso, Italy, 1976 (mass evacuation, large animal kill)

4. Chemical incidents • Methyl Isocyanate tank rupture and release Bhopal, India, 1984 (2,500 deaths, 100,000 injured) • Explosion and fire in ployethylene plant Pasadena, USA, 1989 (23 deaths, >100 injured) • Aluminium sulphate accident Camelford, UK, 1989

5. Chemical incidents • Oil spill from Sea Empress Milford Haven, UK, 1996 • Ammonium nitrate explosion Toulouse, France, 2001 (30 deaths, > 2,000 injured, 600 homes destroyed) • Oil tank overflow explosion Buncefield, UK, 2005 (43 injured, evacuation)

6. Public health response • Chemical incidents can vary in scale and span five response levels • Essential to continually review scale of any chemical incident and associated response action taken • Any incident can increase or decrease in its scale over time • Risk assessments need to be dynamic

7. Part 1: focuses on local arrangements for civil protection, establishing a statutory framework of roles and responsibilities for local responders Part 2: focuses on emergency powers, establishing a modern framework for the use of special legislative measures that might be necessary to deal with the effects of the most serious emergencies. The Civil Contingencies Act 2004 This Act sets the framework for civil protection in the UK.The definition of emergency in the Act focuses on the consequences of emergencies. It defines an emergency as:• an event or situation which threatens serious damage to human welfare;• an event or situation which threatens serious damage to the environment; or• war, or terrorism, which threatens serious damage to security. The Act is separated into two substantive parts:

8. Public health response levels • Response level 1 Small spill 5 litre container of sodium hydroxide leaking at a small industrial site. Incident contained locally by emergency services, no casualties, and unlikely to be any public health implications. • Response level 2 Road traffic accident involving a chemical tanker causes release to atmosphere and/or local watercourse with some exposure/casualties. • Response level 3 (potential major incident) Large fire at industrial site involving five or more fire appliances with potential for large scale damage. Could possibly involve chemicals/cylinders. Incident will have actual or potentially high numbers of casualties/exposure, with actual or potential evacuation. Media interest. • Response level 4 (major incident) Incident involving a fire, explosion, release or spill of chemicals at COMAH site. Incident will have actual or potential mass casualties or mass exposure. Likely to be actual or potential mass evacuation and/or mass shelter and potential for mass decontamination. Likely to be wide-spread public health implications for many HPTs/LHBs and incident on this scale could have cross border issues. • Response level 5 (major incident) An accidental/deliberate release incident such as a release of an organophosphate in a large shopping centre would be catastrophic and have an overwhelming impact upon the NHS community, requiring an immediate response with national management.

9. Management of Emergency Response The management of the emergency response has three levels, which are defined by their differing functions: • Gold - Strategic decision makers and groups at the local level. They establish the tactical and operational framework. • Silver - Tactical level of management to provide overall management of the response • Bronze - Operational level is the level for management on the ground at the incident site or impacted areas.

10. Agency roles and responsibilities EMERGENCY SERVICES • Likely to be first responders at scene of chemical incident • Make scene safe • Identify, treat and transport any casualties • Establish cordons – ‘hot’, ‘warm’, ‘cold’ zones • Notify relevant stakeholder agencies • Undertake initial sampling/monitoring • Decide whether to declare a major incident and establish/communicate incident control arrangements

11. Agency roles and responsibilities NPHS • Plan, prepare for, and respond to, public health/healthcare aspects • Category 1 responder under Civil Contingencies Act • Provide specialist public health information, advice and support • Ongoing liaison with relevant stakeholders • Ensure representation at tactical/strategic management levels • Population health risk and impact assessments • Facilitating NHS agencies in undertaking their own assessments of the likely impact of the incident on their service • Risk communication (public, media and stakeholder agency staff) • Facilitating epidemiological investigations/follow-up, where needed

12. Agency roles and responsibilities HPA • Plan, prepare for, and respond to, public health/healthcare aspect • Category 1 responder under Civil Contingencies Act • Provide specialist advice and support in the following areas: - environmental chemistry and toxicology • - exposure assessment • - risk assessment • - public health mitigation measures: decontamination, sheltering/evacuation • - clinical advice through National Poisons Information Service (NPIS) • - advice and support to SCG through STAC and Air Quality Cells • - advice and support as well as instigation of environmental monitoring • - interpretation of airborne computational modelling • - advice and support regarding biological monitoring • - advice and support for clinical, laboratory and epidemiological follow up • - risk communication

13. Agency roles and responsibilities LOCAL AUTHORITIES • Plan,

14. Agency roles and responsibilities EAW • Prevent/control pollutants that may enter the environment • Provide advice and support on, and regulate, waste disposal around clean-up of larger pollution incidents • Convene, with HPA, an Air Quality Cell in support of major air pollution incidents • Air quality monitoring and modelling during a major air pollution incident. • Monitor pollutants/environmental outcomes following incidents • Pursue enforcement and legal action in accordance with its role as regulator, and ensure remedial action is undertaken

15. Notification of a chemical incident • May be declared where there is contamination, or suspicion of contamination, of the environment which threatens public health • May, or may not, be declared as a major incident • Emergency services notify LA, NPHS, HPA, EAW and others • Collaborative response required

16. NPHS Emergency Response Plan • ……………..

17. NPHS chemical incident response/actions algorithm

18. NPHS chemical incident report form

19. NPHS chemical incident log

20. NPHS chemical incident response actions checklist (immediate response)

21. NPHS chemical incident response actions checklist (medium-term response)

22. NPHS chemical incident response actions checklist (long-term response)

23. CHEMICAL INCIDENTS The Public Health Response in Wales Huw Brunt Consultant in Environmental Health Protection