The Graniteville Disaster Mark T. Arden Chappell Smith and Arden

1. The Graniteville DisasterMark T. Arden Chappell Smith and Arden South Carolina Workers Compensation Educational Association 31st Annual Medical Seminar February 28-March 2,2010 Francis Marion Hotel Charleston S.C.

2. There's a long black train Coming down the line Feeding off the souls that are lost and crying Tails of sin only evil remains Watch out brother for that Long Black Train

3. Facts Concerning the Disaster At approximately 2:39 a.m. on 1/6/05, NS Train 192 was heading north on the NS R-line between August and Columbia. Train 192 consisted of 2 locomotives, 25 loaded cars, and 17 empty cars. Of the 25 loaded cars, 3 contained chlorine. The ninth car, UTLX 900270 contained approximately 90 tons of chlorine.

4. Train 192 rounded a 1-degree curve approaching the Avondale Mills Gregg Plant Lead Switch. Train 192 was traveling approximately 49 m.p.h as it approached the switch. Facts Concerning the Disaster

5. Unbeknownst to the crew of Train 192, the Avondale Mills switch was incorrectly lined for the Avondale Mills industry track. Train 192 entered the Avondale Mills industry spur with no chance to stop prior to colliding with parked Train P22. Car UTLX 900270 was punctured, releasing a poison chlorine gas cloud all around the Gregg Plant area. Facts Concerning the Disaster

6. Damage to the lead locomotives of Train 192 (left) and Train P22 (right).

9. Chlorine Gas

10. Chlorine Gas • Chlorine Gas developed by German chemist Fritz Harbor in 1915 for use as a poison gas in WWI. • Tear gas first was the first recorded gas attack used by the French Army against the German Army in August of 1914. Chlorine gas developed shortly thereafter. • The density of chlorine gas is approximately 2.5 times greater than air, which will cause it to initially remain near the ground in areas with little air movement. • The strong oxidizing effects of chlorine produce corrosive tissue damage. The oxidation of chlorine will penetrate cells and react with cytoplasmic proteins to destroy cell structure.

11. Chlorine Gas • The health effects resulting from most chlorine exposures begin within seconds to minutes. • There is no antidote for chlorine poisoning. • When liquid chlorine is released, it quickly turns into a gas that stays close to the ground and spreads rapidly. • When chlorine gas comes into contact with moist tissues such as the eyes, throat, and lungs, an acid is produced that can damage these tissues. • The gas causes both internal and external blisters on the victim within hours of being exposed to it.

12. World War One French Soldier/ British Casualties

13. Human Costs Casualties From Gas- The Numbers

14. The Fallout • 9 chlorine related deaths; • 554 injured who reported to hospital; • 75 hospital admissions; • 11 in critical care; • Over 5,000 people evacuated.

15. Complexities of the Diagnosisfrom the Graniteville DisasterCase Studies • Pulmonary (reactive airways, restrictive lung disorder, sleep apnea, cough variant asthma- multiple diagnoses of bronchitis) Dyspnea and hypoxia with exertion • Sinus Issues/Skin Rash Issues- recurrent sinusitus-acute bilateral external otitis, hypertropy of inferiror turbinates • Eye problems –ocular injury • Psychiatric Disorders- post traumatic stress disorder, anxiety, major depression, nightmares, flashbacks,

16. Case Study A • Case Study A • Six days admitted in the hospital , 3 in ICU • 64% saturation at the decontamination site, spirometry shows primarily a restrictive pattern with an FEV1 of 3.18 liters or 73% of predicted • Initial complaints – difficulty breathing, severe dyspnea, severe wheezing, burning sensation, dizziness, nausea and vomiting • Diagnosis: Acute lung injury associated with both hypoxemic and hypercapnic respiratory failure • Reactive airways disease secondary to chlorine exposure, obstructive sleep apnea, moderate persistent asthma secondary to chlorine exposure • Subsequent right lower lobe pneumonia with streptococcus pneumoniae • Impairment rating: 30% to each lung and sinus tract • Restrictions: no exposure to airborne dust particles, gases, fumes, extremes in temperatures and molds- No walking distances greater than one block-No freguent lifting more than 10 pounds • Post Traumatic Stress Disorder- persistent symptoms of insomnia • Initial GAF: 45. Last GAF:50.

17. Treatment • Pulmonolgist: reactive airways disease ongoing visits-medicine regimine includes Advair 250/50 and as needed does of albuterol. • Psychiatrist: Counseling and Effexor,Trazadone, Clonidine, Seroquel and Wellbutrin

18. Case Study A Clothing

19. Case Study B • One day ICU- Six Days Hospitalized • Initial complaints-Dyspnea with exertion; • documented hypoxia; tachycardia with simple activities; insomnia, ocular injury; reactive airways disease with restrictive appearing spirometry; obstructive sleep apnea; recurrent sinusitus, cough varient asthma; multiple issues of bronchitus;Impotence • Initial FVC 51% of predicted, FEV1 53% of predicted. • 4 months later- FVC 52% of predicted, FEV1 53% predicted • Low lung volumes- off medication patient respiratory function is in the severe range. • Pulmonary Function Tests reveal severe airflow limitation with noted bronchodialator response, severe airway resistance, significantly reduced diffusion capacity. • Diagnosis- Severe occupational-induced asthma with a reactive airways syndrome physiology;severe bilateral external otitis, chronic sinusitis, hypertrophy of inferior turbinates: PTSD, Major depression • Impairment- 70% to both lungs as well as airway sinus tract • Restrictions- Limited standing,lifting,bending or strenuous activity: Avoid exposure to airborne dust particles, inicluding gases,fumes,extremes of temperature and humidity, - lung capacity restricts him to sedentary duties-Modified sedentary FCE.

20. Treatment • Pulmonologist-”It is expected that the patient will suffer from recurrent bronchitis,pneumonia and other lung infections in the future.” Ongoing hospitalizations,treatment and medicine regimine. • ENT- visits for chronic sinusitus • Psychiatrist- ongoing counseling and medicine/treatment. • Obesity and onset of weight gain due to use of oral steroids combined with inactivity.

21. Psychiatric Issues • Multitude of DSM IV diagnosis • Most prevelant – Post Traumatic Stress Disorder • Unusual triggering factors- smells/crowds hospitals, sirens verses trains • Common complaints involve sleep variations, anxiety, cautious and on edge demeanor, irritability, fearfulness, hypervigilance, avoidance/anxiety related to social situations, nightmares, flashbacks, and intrusive recollections of the traumatic event

22. Conclusion and Lessons Learned • Same exposure-varied diagnosis • Five different presentations can be from the same type of exposure • The need for different medical specialist leads often to a time lapse prior to acurate diagnosis. It does not mean the patient is a poor historian or exagerating his symptoms. • Minor exposures harder to assess/diagnose and even harder to treat. • Effects of the exposure are lifelong and there is no cure.

23. Emergency Response Issues: What Went Wrong in Graniteville (Stephen Brittle) • 1. Emergency responders from the local volunteer fire department responded to the train crash and subsequent chlorine release without first donning personal protective gear. This severely hampered and compromised their response. Some wound up with blisters on their lungs. This volunteer fire department had HAZMAT training and equipment due to the proximity if the Savannah River Nuclear Site. One would think that the scenario of a train derailment involving hazardous materials such as chlorine would have been part of their training, as well as something the Aiken County LEPC would have contemplated and prepared for in preparing and updating its EPCRA Section 303 emergency plan. Neither law enforcement personnel nor emergency responders seemed trained/drilled/prepared for this scenario. • 2. Civilians were mostly on their own when it came to evacuating. There were true accounts of heroism and good Samaritans. Workers at the Avondale Mills plant worked together to make sure they got away. Some trying to flee had difficulty starting their cars and trucks as the chlorine worked with the humidity in the air on ignitions. Cell phones also did not always work for the same reason. • 3.The community had a rare resource, an emergency telephone ring-down system, but it was not activated for hours after the incident, then told people to shelter-in-place at first, when it should have told many to evacuate. Later, it was used to tell people to evacuate. • 4.The railroad did not make the call to the National Response Center required by CERCLA 103 until over an hour and fifteen minutes after the release of chlorine. [According to the NRC report, the incident occurred on 06-JAN-05 at 02:40 local time. *Report taken by: MST3 CREWS at 03:58 on 06-JAN-05] It is unknown what effect this had on the actual response, or if the delay exacerbated the emergency response issues, but the system set up by federal law was not properly utilized. CERCLA requires an immediate phone call. Under the EPA penalty policy, penalties begin after a 15-minute delay, and the maximum penalty is assessed after one hour. The notifications from the NRC to the various state and federal emergency response agencies came after at least a fifteen-minute delay.

24. 5. EPA set up a chlorine monitor at the crash site that maxed out at 1.5 ppm. Although the incident response lasted for several days, a better monitor that would show actual levels of chlorine in the ambient air was not used. It would have served the immediate community of Graniteville, as well as the nearby community and county seat of Aiken, to have had the information and technical data about maximum concentrations of chlorine at the site and a variety of off-site locations. Again, one wonders why the local volunteer fire department did not have this type of monitor, as an incident such as a local train derailment involving chlorine or other HAZMAT would be a foreseeable contingency. • 6. The ALOHA modeling program distributed by EPA (for use by responders and emergency planners in modeling chemical spills) seems to have not worked very well in modeling this particular chlorine spill. The official account available in the press was that only one railcar was breached and leaking, but according to an ALOHA model, it would have been expected to empty rather quickly, certainly within hours. The report later was that much of the chlorine in the breached railcar did not leak into the atmosphere, and eventually was neutralized and off-loaded. There was some confusion about how many of the rail cars of chlorine were breached. Utilizing this ALOHA modeling, responders could have made an educated guess about just how far away adverse effects of the chlorine might have been felt, as well as the infiltration of dwellings. • 7. The head of the local volunteer fire department and designated incident commander was also an employee of the railroad. It is unclear whether this had an effect on the release of information to the press and the public about the incident. I certainly got the impression that the Norfolk Southern Railroad was in control of the command center and the flow of information. All press statements and information seemed to be carefully controlled to minimize embarrassment to the company. Questioning would be cut off whenever the press asked hard questions of the rail company, at least when I was present. I was able to find out the cause of the incident almost immediately upon arrival at Breezy Hill (adjacent to Graniteville) on the morning of the 6th of January. I learned that the rail crew that parked a locomotive and two cars on the side rail by the Avondale Mills facility had not switched the diversion switch back and had gone home hours before the oncoming train with the chlorine railcars arrived. The NTSB announced some of the information

25. 8.As I wandered the incident command center area the day after the crash, I noticed a very distressed young black woman who seemed to be ignored by the various officials and staff present at the area. I asked her and found out that she was trying to locate information about her father, Willie Tyler, and that she had not been able to get any kind of answer from hospitals or anyone. I convinced a sheriff’s deputy to assist her, and she was referred to a Red Cross center some miles away. Later, Willie Tyler was found dead at the Avondale Mills plant. He was the ninth victim. It seems wrong that he was known to be missing and yet no one or official had contacted his family. It also seems wrong that she could not find out this vital information easily. • 9. The area of evacuation was likely not sufficient. I spoke with a woman who lived about 2.5 miles downwind from the rail crash site who had not ever been evacuated by emergency responders. She had heard the crash but thought it was thunder. She awoke the morning of the crash feeling weak, and noticed what she described as “a strange fog” outside. She learned about the disaster on television. When her husband came home later that day, they left their home and went further away to some relatives, but the chlorine fumes came there also, so they went back home. Considering that the potential off-site consequence of a catastrophic release of chlorine from a rail car can be up to 14 miles away, according to EPA, it appears that the emergency response and evacuation should have looked further into the area outside the IDLH (10ppm for Chlorine), and should have conducted air monitoring periodically throughout the areas downwind. This appears to be a common problem going back to the mindset of the emergency response community using ALOHA. The area of IDLH (Immediate Danger to Life and Health) gets much attention, but the levels of chlorine in the ambient air outside an IDLH can still be at harmful levels, certainly with chronic exposure. Even the OSHA standard for workplace exposure is 0.5 ppm, TWA. People outside the designated IDLH should have been warned to avoid exposure and what symptoms might indicate an adverse effect. • 10. Some of the medical community, despite the rail disaster, seems to have ignored the obvious. This aforementioned woman did not go to an emergency room until Sunday the 9th of January, four days after the incident, because she did not get any better. There was no notification to her and others about potential health effects to watch out for. The hospital, unfortunately, diagnosed her with pneumonia and merely gave her antibiotics, which did not help at all. She saw her primary care physician on Tuesday, the 11th of January, who realized her chlorine exposure, and prescribed something to ease the inflammation of her lungs and allow her to breathe easier.

26. 11. It is always helpful when the responsible party steps up to the plate to assist in relieving the problems caused by a chemical accident. However, although Norfolk Southern Railroad set up a relief center to give people checks to cover motel and food expenses, but people had to wait hours to process paperwork and get these checks. It would have been better if this had been expedited with more staffing and resources, and it would have also looked better for the railroad company if it had not put releases for people to sign on these checks. (A court action soon ruled that these releases were invalid.) • 12. It is unbelievable and appalling that the Federal Emergency Management Agency rejected Gov. Mark Sanford's request for federal disaster relief in the wake of the Jan. 6 train accident and chlorine gas spill that killed nine and temporarily displaced thousands in Graniteville. A Feb. 9 letter from FEMA Under Secretary Michael Brown told Sanford the agency didn't think the Graniteville derailment and chemical spill warranted an emergency declaration. • 13. The hazardous materials contents of the railcars traveling through Graniteville or anywhere need not be a mystery. OREIS™ is a software tool that provides emergency responders, emergency planners, on-scene fire, police and EMS responders with vital information for dealing with rescue, response and counter-terrorism operations on or around railroads and highways, including those involving hazardous materials. The software provides responders with real-time information about the chemical contents of railcars and trucks that have been involved in an incident, schematics for passenger railroads and a host of other life and timesaving features for emergency responders. The concept was born in 1995 in Houston, Texas and sprang from a Federal Railroad Administration (FRA) initiative to provide hazardous materials information to emergency responders.

27. http://www.youtube.com/watch?v=ecEmm-ZSKU4