EMERGENCY SCENARIO # 1: Chemical Spill

Case Description:

A HAZWOPER-trained site supervisor at a designed remediation site receives a call

about an injury and a spill near the environmental laboratory trailer where samples of
biota collected from the site were being processed by formalin fixation for subsequent
chemical contaminant and biological alteration analysis. From what you can gather, a
technician working in the lab reached for a 1 liter bottle of formalin while holding a
specimen and the bottle slipped out of her hand and broke, spilling formalin and
scattering broken glass all over the bench-top and floor. The technician has been cut by
broken glass. A stream of formalin has leaked out of the trailer door, down the entry
steps.

Questions:

1. Identify the hazards present in this situation and the exposure pathways.
 Formalin - lacrimator
 Inhalation
 Absorption – esp. through broken skin of victim
 Ingestion
 Blood/BBP
 Mucous membrane contact
 Percutaneous inoculation – broken glass

2. What are the safety and health risks present in this situation?
 Slip hazard – wet floor
 Chemical exposure – formalin
 BBP exposure – victim’s blood
 Hazard of laceration from broken glass
 Moderate flammability risk

3. What are the possible symptoms or indications of exposure to the hazards

identified?
 Formalin
o Inhalation
 sore throat, coughing, shortness of breath
o Ingestion
 severe abdominal pain, vomiting, diarrhea
o Skin contact
 redness, pain, burns
o Eye contact
 vapors cause redness, irritation, blurred vision
 Blood/BBP
o Hepatitis B and C can lead to irreversible liver damage
o HIV infection can develop into acquired immune deficiency syndrome
(AIDS)
o No immediate symptoms, except those directly related to the injury itself (ex.
laceration) Incubation periods are as follows:
 o Hepatitis B: 60-90 days
o Hepatitis C: up to 9 months
o HIV: around 6 months

4. What resources might be used to gain more information about this hazard?
Chemical hazards:
 Material Safety Data Sheet (MSDS)
 2000 North American Emergency Response Guidebook
 Pocket Guide to Chemical Hazards (NIOSH)
 Dangerous Properties of Hazardous Materials (SAX)
 Merk Index
 Hawleys Condensed Chemical Dictionary

Biological hazards:
 http://www.cdc.gov/nchstp/tb/faqs/qu.htm

 http://www.cdc.gov/nchstp/tb/pubs/mmwrhtml/maj_guide.htm

 http://www.cdc.gov/niosh/homepage.html

 29CFR 1910.1030 OSHA Bloodborne Pathogen Standard

 CDC/NIH Biosafety in Microbiology and Biomedical Laboratories
 AIHA, Biohazards Reference Manual, American Industrial Hygiene Association
Biohazards Committee

5. What actions should be taken to secure the site of the event?

 Establish organizational Incident Command System
o Coordination of facilities, equipment, personnel, and communication
 Incident Commander responsible for Control of Scene
o delineating work zones
o establishing levels of protection
o implementation of decontamination activities
 Restrict public access
 Evacuate Area
 Keep inactive individuals and equipment at a safe distance
 Attend to injured personnel

6. What personal protective measures or equipment would be appropriate?

 Level C
o full-face respirator with formaldehyde organic vapor canister
o chemically resistant gloves, boots, apron or lab coat
 Other equipment
o safety shower/eye wash for injured party
o wet vac

7. What other personnel should be contacted?

 Emergency medical services
 Hazardous Materials Response Teams
8. How should the hazardous material present be handled and disposed?
Formalin:
 Ventilate the area
 Dike area to contain spill
 Absorb with inert material
 Place in DOT approved container for disposal

Blood:
 Follow Standard Precautions
 If spill contains broken glass or other sharp materials, remove and discard using
rigid materials (cardboard, tongs, forceps, etc.)
 Cover with absorbent material and saturate with approved disinfectant (ex: 10%
sodium hypochlorite (bleach) or 70% ethanol (EtOH) solution)
 Allow to sit for 20-30 minutes
 Discard saturated absorbent materials into a biohazard waste container
 Discard all other cleanup materials, including gloves, into the biohazard waste
container
 Don clean gloves
 Disinfect the area with EtOH and allow to air dry

Mixed waste:
 Follow directions for chemical handling, followed by disinfection as per directions for
blood handling

9. How might the area be restored for its original use?

 Ventilate the area
 Flush area with water
 Contain water or conduct hazardous waste determination and dispose down
sanitary sewer.
 After removal of chemical and infectious materials, the room should be
thoroughly evaluated by Biosafety and Chemical Safety personnel to make sure no
residual hazardous materials are present.
 Request evaluation of area from housekeeping and/or facilities to determine if
flooring requires replacement or repair
 A complete and objective review of the event should be performed. This is to
determine if further training and response measures are needed to prevent the
same incident from occurring in the future.

10. What medical surveillance and post exposure follow-up might be appropriate
for the persons involved in this event?
 EYES: Hold eyes open and flush immediately with large amounts of water, hold
eyes open.
 INHALATION: Remove the victim to fresh air. If breathing has stopped, give
medical attention.
 SKIN: Flush areas with plenty of water. Address the laceration using
standard first aid.
 INGESTION: Have victim drink large quantities of water, milk or activated
charcoal to absorb the formalin. Do not induce vomiting.
 Info to share with ER
 Chemical name of substance involved
 State of material (solid, liquid, gas)
 Quantities involved
 Number of victims
 Signs or symptoms
 Nature of exposure (inhalation, dermal, etc.)
 Length of exposure.

11. What considerations should be included or enforced in the facility exposure

or emergency control plan to aid in preventing such an event? Specifically
address any engineering controls that might be used in the future.
 Possible procurement of break proof bottles
 Possible use of secondary containment devices for transport
 Ensure proper placement of chemicals to minimize risk
o Move to lower shelf
o Storage closer to use area
 Use formalin within chemical fume hood

12. What regulation(s) are applicable in this situation?

 29 CFR 1910.120 Hazardous waste operations and emergency response
 29 CFR 1910.132-1910.138 Personal Protective Equipment
 29 CFR 1910.1200 Hazard Communication
 CFR 264 . Hazardous Waste
 29 CFR 1910.1030 - OSHA Bloodborne Pathogens Standard
 OSHA Act of 1970 - General Duty Clause

13. What insurance considerations might be present in this scenario?

 Document any work prior to the insurance adjustor being present?
 Environmental impairment exclusion?

14. What regulatory agent notifications might be necessary?

 Local, state, and federal notification requirements ... (reportable quantities; “fat-
cat” – fatality/catastrophe)?

15. What other communications should be considered and how might they be
accomplished?
 Executive leadership; public affairs; advisory boards; media; legal affairs; etc...

Useful references

RTECS: Registry of Toxic Effects of Chemical Substances, Vol. I-III. National

Institute of Occupational Safety and Health (NIOSH), Department of Health and
Human Services. Washington D.C. GPO. 1989.

Casarett and Doull's Toxicology: The Basic Science of Poisons, 5th Edition. Doull,
John, et al. New York. Macmillan Publishing Co., Inc. 1996.
Patty's Industrial Hygiene and Toxicology, Vol. II: Toxicology, 4th Revised Edition.
Clayton, George D. and Florence E., Editors. New York. John Wiley & Sons. 1994.
EMERGENCY SCENARIO # 2: Radiological Spill

It has reached the press that a local university is doing research for the military on new
types of weapons to be used in the fight on terrorism. During a public demonstration
against this work, a small dirty bomb (radiological dispersal device) is detonated in the
middle of the demonstration crowd on the university campus. Emergency response was
immediate and a haz-mat team was dispatched to the bomb-site to evaluate the damage
and control the scene. You are the HAZWOPER site supervisor. The local hospital is
inundated with ambulances and over 100 “walk-ins”-including people at the
demonstration and many working or living in the vicinity of the campus. These “patients”
are coming into the hospital through at least 8 different entrances and wandering
through the building looking for help.

Questions:

1. Identify the hazards present in this situation and the exposure pathways.
Hazards
 Radiation contamination
 Impacts from explosion, over pressurization
 Debris from explosion such as BBP and debris
 Uncontrolled crowd
 Panic / mass hysteria

Exposure pathways
 Inhalation, ingestion, absorption, injection of dust from contaminated persons or
objects
 Bleeding and open wounds
 With unknown radionuclide and activity, being near the radiation may or may not be
a potentially significant source of exposure; radiation exposure in this way is
minimized with limiting time, increasing distance, and/or adding appropriate
shielding

2. What are the safety and health risks present in this situation?
 Possible Acute Radiation Syndrome (ARS) if activity large enough, if smaller
amount, long term increased risk of cancer?
 Bodily injury from explosion/shrapnel
 Riot
 Unnecessary spread of radiation contamination to others such as hospital staff,
hospital surroundings, and those not directly affected by the event (patients)
 Slips, trips, and falls
 After initial exposure, long term biological effects could be a concern, i.e., cancer
induction, etc.

3. What are the possible symptoms or indications of exposure to the hazards

identified?
No obvious immediate physiologic responses due to radiation exposure expected,
Delayed symptoms of ARS include but are not limited to:
 vomiting
 erythema
 diarrhea
  headache
Note: time to onset of symptoms depends upon radiation dose rate received

Psychological symptoms:
 confusion
 hysteria

Other physical symptoms due to explosion:

 hearing loss
 cuts
 burns
 eyesight damage
 damaged limbs

4. What resources might be used to gain more information about this hazard?
 Local Emergency Response plan
 Radiation detectors (Geiger counter, ion chamber, etc.)
 Management of Terrorist Events Involving Radioactive Material, NCRP Report 138
 State and national Radiation Safety organizations (NRC, HPS, etc.)
 REAC/TS staff in Oak Ridge, Tennessee
 Basic Radiation Protection Technology, Gollnick
 Local Health Physicist (if they have one)

5. What actions should be taken to secure the site of the event?

 Initiate Incident Command System (ICS)
 Security of entrance and exit pathways
 Crowd control.
 Contact site RSO (if applicable) for assistance
 Assess injuries of any persons involved
 Don protective apparel for assessing contamination and decontamination
procedures and assess the surroundings
 Prevent spreading of contamination

6. What personal protective measures or equipment would be appropriate?

 Level C response gear, including coveralls, gloves, respirator, radiation monitoring
devices, personal and area monitors for triage and decontamination
 Decontamination materials: absorbent papers, plastic for isolation, water, soap and
other cleaning agents
 Maintain log of workers for exposure and contamination follow-up purposes
 Radiation monitoring devices may include, Geiger-Mueller (GM) meters, ion
chambers (IC), sodium iodide (NaI) meters, germanium detectors (GeLi) or portable
device with gamma spectrum capabilities

7. What other personnel should be contacted?

 Emergency management personnel
 Federal authorities such as NRC and DHS
 Local, city, and state authorities
 The University
 Radiation regulatory bodies if personnel exposure exceeds acceptable limits
  Legal representative
 Media liaison
 Possibly REAC/TS staff in Oak Ridge, TN if ARS symptoms identified

8. How should the hazardous material present be handled and disposed?

*Assumption: the isotope was able to be identified
 Don PPE and use appropriate control devices to minimize exposure and
contamination
 Survey the materials for radiation and then bag and tag as appropriate including
clothing and all decon supplies used
 Contaminated items may be properly stored, shielded and held for decay if isotope
has half life less than 300 days
 Post or rope off areas where contamination is not removable until decayed to
background levels
 Follow hospital protocols as well for hazardous material disposal
 Possible shipment to a LLRW site
 Contact the local radiation disposal site for possible assistance

9. How might the area be restored for its original use?

 Calm the pandemonium, educate population
 Ensure total decontamination of all affected areas and persons
 Bring in extra help from inside and outside sources if possible (post-event
counseling)

10. What medical surveillance and post exposure follow-up might be appropriate
for the persons involved in this event?
 Counseling may be offered to alleviate fears or stigmas associated with radiation
 Offer medical examination to anyone who was potentially exposed
 Perform bioassays as needed for responders or patients? (such as thyroid or urine
bioassays)

11. What considerations should be included or enforced in the facility exposure

or emergency control plan to aid in preventing such an event? Specifically
address any engineering controls that might be used in the future.
 Controlled entrance and exit pathways for events such as this
 Designated decon areas if not already designated
 Mass casualty drills (Rad and epidemic)
 Dispel negative stigma about radiation through education

12. What regulation(s) are applicable in this situation?

 OSHA dose limits in 29 CFR 1910
 NRC dose limits and contamination control in 10 CFR 20
 PA DEP-BRP Title 25, Article V of the Penn code, Chapters 219, 236

13. What insurance considerations might be present in this scenario?

 Document any work prior to the insurance adjustor being present?
 Environmental impairment exclusion?

14. What regulatory agent notifications might be necessary?

  Local, state, and federal notification requirements ... (reportable quantities; “fat-
cat” – fatality/catastrophe)?

15. What other communications should be considered and how might they be
accomplished?
 Executive leadership; public affairs; advisory boards; media; legal affairs; etc...

Publications / helpful information:

Berger ME, O’Hare FM Jr, Ricks RC, editors. The Medical Basis for Radiation Accident
Preparedness: The Clinical Care of Victims. REAC/TS Conference on the Medical Basis
for Radiation Accident Preparedness. New York : Parthenon Publishing; 2002.

Gusev IA , Guskova AK , Mettler FA Jr, editors. Medical Management of Radiation

Accidents, 2 nd ed., New York : CRC Press, Inc.; 2001.

Jarrett DG. Medical Management of Radiological Casualties Handbook, 1 st ed.

Bethesda , Maryland : Armed Forces Radiobiology Research Institute (AFRRI); 1999.

LaTorre TE. Primer of Medical Radiobiology, 2 nd ed. Chicago : Year Book Medical
Publishers, Inc.; 1989.

National Council on Radiation Protection and Measurements (NCRP). Management of

Terrorist Events Involving Radioactive Material, NCRP Report No. 138. Bethesda ,
Maryland : NCRP; 2001.

Prasad KN. Handbook of Radiobiology, 2 nd ed. New York : CRC Press, Inc.; 1995

(CDC web site also has an emergency video in preparation for hospitals in particular in
case of such an event).