Identifying long-term health risks associated with environmental chemical incidents.

In recent years, there has been a notable surge in environmental incidents, including wildfires and chemical releases. Responses to such events have primarily focused on addressing acute and immediate impacts. However, potential long-term health risks have been overlooked. Our proposed framework first advocates for the holistic identification of contaminants, prioritizing persistent organic contaminants determined through both knowledge-based and non-targeted and targeted analysis. We suggest integrating environmental monitoring and modeling approaches to assess the extent and composition of contamination caused by these chemicals. To facilitate swift assessments, we advocate the development of streamlined chemical analysis techniques and dedicated technologies for in situ monitoring of persistent organic chemicals. In addition, we provide an overview of both traditional and state-of-the-art approaches to risk assessment and introduce a three-tier risk assessment framework for evaluating the long-term health risks associated with environmental incidents. We emphasize the importance of in situ soil remediation and coordinated recovery efforts, including effective communication, evacuation, and cleaning plans for affected spaces, which are pivotal for facilitating recovery from environmental incidents. This comprehensive approach fortifies preparedness and recovery strategies, providing a robust framework for managing future environmental crises.

Mortality and cancer incidence in a population exposed to TCDD after the Seveso, Italy, accident (1976-2013).

OBJECTIVES: The Seveso accident (1976) caused the contamination with 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) in an area north of Milan, Italy. We report the results of the update of mortality and cancer incidence in the exposed population through 2013. METHODS: The study cohort includes subjects living in three contaminated zones with decreasing TCDD soil concentrations (zone A, B and R) and in a surrounding uncontaminated territory (reference). Poisson models stratified/adjusted for gender, age and period were fitted to calculate rate ratios (RRs) and 95% CIs. RESULTS: In zone A in males, we found elevated mortality from circulatory diseases in the first decade after the accident (17 deaths, RR 2.00, 95% CI 1.24 to 3.23). In females, mortality from diabetes mellitus was increased, with a positive trend across zones. Incidence of soft tissue sarcoma was increased in males in zone R in the first decade (6 cases, RR 2.62, 95% CI 1.01 to 6.83). In females in zone B, there was an excess of non-Hodgkin's lymphoma after 30 years (6 cases, RR 2.87, 95% CI 1.14 to 7.23). Multiple myeloma was increased in the second decade in females in zone B (4 cases, RR 5.09, 95% CI 1.82 to 14.2) and in males in zone R (11 cases, RR 2.15, 95% CI 1.08 to 4.26). In males in zone R, there was a leukaemia excess after 30 years (23 cases, RR 2.02, 95% CI 1.04 to 3.93). CONCLUSIONS: Although with different patterns across gender, zone and time, we confirmed previous results of increased cardiovascular diseases, diabetes, soft tissue sarcoma, and lymphatic and haematopoietic cancers.

A Method to Extract Causality for Safety Events in Chemical Accidents from Fault Trees and Accident Reports.

Chemical event evolutionary graph (CEEG) is an effective tool to perform safety analysis, early warning, and emergency disposal for chemical accidents. However, it is a complicated work to find causality among events in a CEEG. This paper presents a method to accurately extract event causality by using a neural network and structural analysis. First, we identify the events and their component elements from fault trees by natural language processing technology. Then, causality in accident events is divided into explicit causality and implicit causality. Explicit causality is obtained by analyzing the hierarchical structure relations of event nodes and the semantics of component logic gates in fault trees. By integrating internal structural features of events and semantic features of event sentences, we extract implicit causality by utilizing a bidirectional gated recurrent unit (BiGRU) neural network. An algorithm, named CEFTAR, is presented to extract causality for safety events in chemical accidents from fault trees and accident reports. Compared with the existing methods, experimental results show that our method has a higher accuracy and recall rate in extracting causality.

National Toxic Substances Incidents Program - Nine States, 2010-2014.

PROBLEM/CONDITION: Every year in the United States, thousands of toxic substance incidents harm workers, first responders, and the public with the potential for catastrophic consequences. Surveillance data enable public health and safety professionals to understand the patterns and causes of these incidents, which can improve prevention efforts and preparation for future incidents. PERIOD COVERED: 2010-2014. DESCRIPTION OF SYSTEM: In 2010, the Agency for Toxic Substances and Disease Registry (ATSDR) initiated the National Toxic Substance Incidents Program (NTSIP), and it was retired in 2014. Nine state health departments participated in NTSIP surveillance: California, Louisiana, North Carolina, New York, Missouri, Oregon, Tennessee, Utah, and Wisconsin. The states conducted surveillance on acute toxic substance incidents, defined as an uncontrolled or illegal acute (lasting <72 hours) release of any toxic substance including chemical, biologic, radiologic, and medical materials. Surveillance focused on associated morbidity and mortality and public health actions. This report presents an overview of NTSIP and summarizes incidents and injuries from the nine participating states during 2010-2014. RESULTS: During 2010-2014, participating state health departments reported 22,342 incidents, of which 13,529 (60.6%) met the case definition for acute toxic substance incidents, and included 6,635 injuries among 5,134 injured persons, of whom 190 died. A trend analysis of the three states participating the entire time showed a decrease in the number of incidents with injuries. NTSIP incidents were 1.8 times more likely and injured persons were 10 times more likely to be associated with fixed facilities than transportation. Natural gas, carbon monoxide, ammonia, and chemicals used in illegal methamphetamine production were the most frequent substances in fixed-facility incidents. Sodium and potassium hydroxide, hydrochloric acid, natural gas, and sulfuric acid were the most frequent substances in transportation-related incidents. Carbon monoxide was the most frequent substance in incidents with a large number of injured persons, and chemicals used in illegal methamphetamine production were the most frequent substance in incidents involving decontamination. Incidents most frequently occurred during normal business days (Monday through Friday) and hours (6:00 a.m.-5:59 p.m.) and warmer months (March-August). The transportation and warehousing industry sector had the largest number of incidents (4,476); however, most injured persons were injured in their private residences (1,141) or in the industry sectors of manufacturing (668), educational services (606), and real estate rental and leasing (425). The most frequently injured persons were members of the public (43.6%), including students. Injured first responders, particularly police, frequently were not wearing any chemically protective equipment. Respiratory system problems (23.9%) were the most frequently reported symptoms among injured persons and, in a related finding, volatilization was the most frequent type of release in incidents with injured persons. INTERPRETATION: Industrial and transportation incidents occur frequently and have the potential for catastrophic outcomes. However, exposures to toxic substances occur frequently in other settings. Carbon monoxide, natural gas, and chemicals used in illegal methamphetamine production are commonly found in places where persons live, work, attend school, and recreate and are large contributors to incidents affecting the public. Having active NTSIP state surveillance programs did appear to improve the incidents with morbidity and/or mortality, but these programs have ended. PUBLIC HEALTH ACTION: Archived NTSIP public use data are available to download from the website for analysis. There are also many publications and reports on the website to help understand chemical risks. In addition, jurisdictions might choose to collect surveillance data themselves in a similar manner to what NTSIP states did. Chemical incident surveillance data can be used by public health and safety practitioners, worker representatives, emergency planners, preparedness coordinators, industries, and emergency responders to prepare for and prevent chemical incidents and injuries. As noted by the U.S. Chemical Safety Board, more action needs to be taken to prevent large industrial incidents. Although preventing such incidents might not be in the realm of public health, describing the public health implications and preparing for them is. Another important finding of NTSIP is that industrial incidents are only part of the problem. For example, a large number of persons were injured in a private residence or vehicle (22.2%) and an educational facility (11.8%). Public health professionals must resourcefully target prevention and preparedness to protect vulnerable populations in locations where they might spend time (e.g., schools, daycares, nursing homes, recreational areas, jails, prisons, and hospitals). Reducing the threat of chemical incidents and injuries in the United States will require a concerted effort with a variety of stakeholders including industry and labor, responder groups, policymakers, academia, and citizen advocacy groups.

A case study on oil pollution in Istanbul Strait: Revisiting 1994 Nassia tanker accident by utilising Potential Incident Simulation Control and Evaluation System (PISCES-II) simulation. What would be different in terms of response if Nassia accident happened today?

Turkey, with her two important straits, is geographically in the middle of one of the major transportation routes and will continue to face risks the oil tankers pose in those sensitive areas. This paper revisits the site of an oil tanker accident that occurred at the northern entrance of the Istanbul Strait in 1994. The aim of the study was to simulate the same accident in PISCES-II Simulator to compare the response actions of the time with the present capabilities. Effort is also made to understand how the negative impacts of an oil spill accident can be lessened. Therefore, the study is planned to set to cover two separate response scenarios for the identical oil spill incident, actually simulating the 1994 M/T Nassica accident. The results showed that oil pollution response in places with strong currents like Istanbul Strait needs special care to sea conditions as well as related assets.

Hospital Preparedness Plans for Chemical Incidents and Threats: A Systematic Review.

In a wide range of events, people may be acutely exposured to chemical substances. Particular hospital preparedness plans and vital resources are essential for appropriate health-care measures. The present study aimed to conduct a systematic review to summarize and evaluate the existing evidence on hospital preparedness plans or protocols against chemical incidents and threats. In this aim, through May 15, 2018, 5 electronic databases were searched in MEDLINE (PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar) for the following key words: hospital preparedness, plan, protocol, chemical incident, and chemical threat. The final review included 11 peer-reviewed papers that met inclusion criteria. The systematic review was performed using the Preferred Reporting Items for the Systematic reviews and Meta-Analysis protocol (PRISMA) (www.prisma-statement.org). Finally, of 16,540 selected papers, 11 papers were included in the final analysis. The thematic analyses revealed 11 major categories of chemical incidents and threats planning, such as planning requirements, planning prerequisites, preparation team member (multidisciplinary team), decontamination, personal protective equipment, education and training, job descriptions and roles, communication, database, staff /volunteer organization, as well as planning barriers and challenges for chemical incidents. Most countries have launched hospital preparedness planning against chemical incidents and threat activities, but the preparedness of hospitals is often less than desirable. Many items, such as databases, hospital preparation team members, communications, etc., are still challenging.

Development of Accident Probability Index Using Surrogate Indicators of Chemical Accidents in Chemical Plants.

To reduce damage caused by chemical accidents, it is important to establish a prevention system for chemical accidents. The first step in the prevention of chemical accidents is to screen the high-risk chemical plants. Risk index, one of the screening methods, can indirectly estimate the risk at each chemical plant. For calculating the risk index, the probability of an accident needs to be estimated, which requires complex calculation and confidential data from plants that are difficult to obtain. Therefore, we developed a new index, the accident probability index, to estimate accident probability in chemical plants using readily accessible data. We conducted a literature survey on the existing risk indices and interviewed chemical experts and government chemical managers to select surrogate indicators related to chemical accidents, and four indicators were chosen: hazardous characteristics of chemicals, handling volume, records of accident frequency, and national accident frequency of chemicals. We calculated the accident probability index for 4520 chemical plants, and index value means was 5.324 (95% confidence interval (CI): 3.156, 7.493). An increase by 10 in the index value denoted a 1.06-fold (95% CI: 1.04, 1.08) increase in the odds ratio for actual accident occurrence. The accident frequency of the fourth quartile of the index value was 4.30 times (95% CI: 1.72, 10.75) higher than those of the first quartile.

Characterizing Chemical Terrorism Incidents Collected by the Global Terrorism Database, 1970-2015.

BACKGROUND: The Global Terrorism Database (GTD) is an open-source database on terrorist incidents around the world since 1970, and it is maintained by the National Consortium for the Study of Terrorism and Responses to Terrorism (START; College Park, Maryland USA), a US Department of Homeland Security Center of Excellence. The consortium reviews media reports to determine if an event meets eligibility to be categorized as a terrorism incident for entry into the database. OBJECTIVE: The objective of this study was to characterize chemical terrorism incidents reported to the GTD and understand more about the kinds of chemical agents used, the associated morbidity and mortality, the geography of incidents, and the intended targets. METHODS: Chemical terrorism incidents from 1970 through 2015 were analyzed by chemical agent category, injury and fatality, geographic region, and target. RESULTS: During the study period, 156,772 terrorism incidents were reported to the GTD, of which 292 (0.19%) met the inclusion criteria for analysis as a chemical terrorism incident. The reported chemical agent categories were: unknown chemical (30.5%); corrosives (23.3%); tear gas/mace (12.3%); unspecified gas (11.6%); cyanide (8.2%); pesticides (5.5%); metals (6.5%); and nerve gas (2.1%). On average, chemical terrorism incidents resulted in 51 injuries (mean range across agents: 2.5-1,622.0) and seven deaths (mean range across agents: 0.0-224.3) per incident. Nerve gas incidents (2.1%) had the highest mean number of injuries (n = 1,622) and fatalities (n = 224) per incident. The highest number of chemical terrorism incidents occurred in South Asia (29.5%), Western Europe (16.8%), and Middle East/North Africa (13.0%). The most common targets were private citizens (19.5%), of which groups of women (22.8%) were often the specific target. Incidents targeting educational institutions often specifically targeted female students or teachers (58.1%). CONCLUSIONS: Chemical terrorism incidents rarely occur; however, the use of certain chemical terrorism agents, for example nerve gas, can cause large mass-causality events that can kill or injure thousands with a single use. Certain regions of the world had higher frequency of chemical terrorism events overall, and also varied in their frequencies of the specific chemical terrorism agent used. Data suggest that morbidity and mortality vary by chemical category and by region. Results may be helpful in developing and optimizing regional chemical terrorism preparedness activities.

Occupational exposure and poisoning by chemical products in the Federal District.

OBJECTIVE: to describe case of occupational exposure to chemical products. METHOD: descriptive retrospective study using record data of 382 workers assisted in the Outpatient Care for Occupational Toxicology of the Reference Center of Workers' Health of the Federal District, between 2009 and 2013. RESULTS: From the total, 66.7% were men, 55.2% had up to 9 years of activity and 81% did not use personal protective equipment (PPE). Nearly 60% were farmers and environmental surveillance agents, exposed to pesticides (63%), of which 40% were organophosphorus insecticides. The majority (68%) presented butyrylcholinesterase activity decreased, mostly farmers (85.9%); 57.3% of workers were considered poisoned - 61.6% by pesticides and 37.9% by industrial chemicals -, and away from work for at least 10 days. CONCLUSION: The profile was male workers, from 30 to 39 years, which not used PPE, indicating the need for prevention together with them to prevent poisonings.

Occupational exposure and poisoning by chemical products in the Federal District / Exposición e intoxicación ocupacional a productos químicos en el Distrito Federal / Exposição e intoxicação ocupacional a produtos químicos no Distrito Federal

ABSTRACT Objective: to describe case of occupational exposure to chemical products. Method: descriptive retrospective study using record data of 382 workers assisted in the Outpatient Care for Occupational Toxicology of the Reference Center of Workers' Health of the Federal District, between 2009 and 2013. Results: From the total, 66.7% were men, 55.2% had up to 9 years of activity and 81% did not use personal protective equipment (PPE). Nearly 60% were farmers and environmental surveillance agents, exposed to pesticides (63%), of which 40% were organophosphorus insecticides. The majority (68%) presented butyrylcholinesterase activity decreased, mostly farmers (85.9%); 57.3% of workers were considered poisoned - 61.6% by pesticides and 37.9% by industrial chemicals -, and away from work for at least 10 days. Conclusion: The profile was male workers, from 30 to 39 years, which not used PPE, indicating the need for prevention together with them to prevent poisonings.

RESUMEN Objetivo: describir casos de exposición ocupacional a productos químicos. Método: estudio retrospectivo descriptivo utilizando datos del prontuario de 382 trabajadores atendidos en el Ambulatorio de Toxicología Ocupacional del Centro de Referencia en Salud del Trabajador del Distrito Federal entre 2009 y 2013. Resultados: El 66,7% eran hombres, el 55,2% tenía hasta 9 años de actividad y el 81% no usaba el equipo de protección individual (EPI). Casi el 60% eran agricultores y agentes de vigilancia ambiental, expuestos a agrotóxicos (63%), de los cuales 40% insecticidas organofosforados. La mayoría (68%) presentó actividad de butirilcolinesterasa disminuida, principalmente agricultores (85,9%); el 57,3% de los trabajadores fueron considerados intoxicados, 61,6% por agrotóxicos y 37,9% por productos químicos industriales, y alejados del trabajo por lo menos 10 días. Conclusión: El perfil de los trabajadores atendidos fue de hombres, predominantemente de 30 a 39 años, que no utilizaban el EPI, indicando la necesidad de acciones de prevención junto a esa población para evitar la ocurrencia de intoxicaciones.

RESUMO Objetivo: descrever casos de exposição ocupacional a produtos químicos. Método: estudo retrospectivo descritivo utilizando dados do prontuário de 382 trabalhadores atendidos no Ambulatório de Toxicologia Ocupacional do Centro de Referência em Saúde do Trabalhador do Distrito Federal, entre 2009 e 2013. Resultados: 66,7% eram homens, 55,2% tinham até 9 anos de atividade e 81% não usavam equipamento de proteção individual (EPI). Quase 60% eram agricultores e agentes de vigilância ambiental, expostos a agrotóxicos (63%), dos quais 40% inseticidas organofosforados. A maioria (68%) apresentou atividade de butirilcolinesterase diminuída, principalmente agricultores (85,9%); 57,3% dos trabalhadores foram considerados intoxicados, 61,6% por agrotóxicos e 37,9% por produtos químicos industriais, e afastados do trabalho por pelo menos 10 dias. Conclusão: O perfil dos trabalhadores atendidos foi de homens, predominantemente de 30 a 39 anos, que não utilizavam EPI, indicando a necessidade de ações de prevenção junto a essa população para evitar a ocorrência de intoxicações.

Multiple Patients With Burn Injury Induced by a Chemical Explosion Managed by Physician-Staffed Helicopters.

On December 1, 2017, the Fuji factory of Arakawa Chemical Industries exploded. Dust that formed as a byproduct from the crushing and packing process of the resin for ink exploded at the facility. The Fuji City Fire Department requested the dispatch of 2 physician-staffed helicopters (known as a doctor helicopter [DH] in Japan). The first party of emergency services established a headquarters and first-aid station. However, this area was feared to be at risk of a second explosion. Physicians performed re-triage for all 11 burned patients. Three severely injured patients were transported to emergency medical service centers either by ground ambulance or the DH without undergoing any decontamination. The physician who escorted the patient by ground ambulance complained of a headache. One of the severely injured patients was treated at a local hospital and then transported to an emergency medical service center after undergoing decontamination and intubation. Fortunately, all patients who were transported to medical facilities obtained a survival outcome. Chemical, biological, radiological, nuclear, and explosive incidents are rare but can be fatal for responders to these types of disaster. Therefore, all who work in these settings should be prepared and trained adequately to ensure that they have the knowledge and skill to both manage patients and protect themselves from harm. (Disaster Med Public Health Preparedness. 2019;13:799-805).

UK's initial operational response and specialist operational response to CBRN and HazMat incidents: a primer on decontamination protocols for healthcare professionals.

The UK is currently in the process of implementing a modified response to chemical, biological, radiological and nuclear and hazardous material incidents that combines an initial operational response with a revision of the existing specialist operational response for ambulant casualties. The process is based on scientific evidence and focuses on the needs of casualties rather than the availability of specialist resources such as personal protective equipment, detection and monitoring instruments and bespoke showering (mass casualty decontamination) facilities. Two main features of the revised process are: (1) the introduction of an emergency disrobe and dry decontamination step prior to the arrival of specialist resources and (2) a revised protocol for mass casualty (wet) decontamination that has the potential to double the throughput of casualties and improve the removal of contaminants from the skin surface. Optimised methods for performing dry and wet decontamination are presented that may be of relevance to hospitals, as well as first responders at the scene of a chemical incident.

Inhalation Injury and Toxic Industrial Chemical Exposure.

Toxic industrial chemicals include chlorine, phosgene, hydrogen sulfide, and ammonia have variable effects on the respiratory tract, and maybe seen alone or in combination, secondary to inhalation injury. Other considerations include the effects of cyanide, carbon monoxide, and fire suppressants. This Clinical Practice Guideline (CPG) will provide the reader with a brief overview of these important topics and general management strategies for each as well as for inhalation injury. Chlorine, phosgene, hydrogen sulfide, and ammonia are either of intermediate or high water solubility leading to immediate reactions with mucous membranes of the face, throat, and lungs and rapid symptoms onset after exposure. The exception to rapid symptom onset is phosgene which may take up to a day to develop severe acute respiratory distress syndrome. Management of these patients includes early airway management, lung-protective ventilator strategies, aggressive pulmonary toilet, and avoidance of volume overload.

Public health risk management case concerning the city of Isfahan according to a hypothetical release of HF from a chemical plant.

Accidents have happened in the chemical industries all over the world with serious consequences for the adjacent heavily populated areas. In this study, the impact of the probable hypothetical event, releasing considerable amounts of hydrogen fluoride (HF) as a strong irritant into the atmosphere over the city of Isfahan from a strategic chemical plant, was simulated by computational fluid dynamics (CFD). In this model, the meteorological parameters were integrated into time and space, and dispersion of the pollutants was estimated based on a probable accidental release of HF. According to the hypothetical results of the simulation model in this study, HF clouds reached Isfahan in 20 min and exposed 80% of the general public to HF concentration in the range of 0-34 ppm. Then, they dissipated 240 min after the time of the incident. Supposing the uniform population density within the proximity of the city of Isfahan with the population of 1.75 million, 5% of the population (87,500 people) could be exposed for a few minutes to a HF concentration as high as 34 ppm. This concentration is higher than a very hazardous concentration described as the Immediate Danger to Life and Health (30 ppm). This hypothetical risk evaluation of environmental exposure to HF with the potential of health risks was very instrumental for the general public of Isfahan in terms of risk management. Similar studies based on probable accidental scenarios along with the application of a simulation model for computation of dispersed pollutants are recommended for risk evaluation and management of cities in the developing countries with a fast pace of urbanization around the industrial sites.

Traits and causes of environmental loss-related chemical accidents in China based on co-word analysis.

Chemical accidents are major causes of environmental losses and have been debated due to the potential threat to human beings and environment. Compared with the single statistical analysis, co-word analysis of chemical accidents illustrates significant traits at various levels and presents data into a visual network. This study utilizes a co-word analysis of the keywords extracted from the Web crawling texts of environmental loss-related chemical accidents and uses the Pearson's correlation coefficient to examine the internal attributes. To visualize the keywords of the accidents, this study carries out a multidimensional scaling analysis applying PROXSCAL and centrality identification. The research results show that an enormous environmental cost is exacted, especially given the expected environmental loss-related chemical accidents with geographical features. Meanwhile, each event often brings more than one environmental impact. Large number of chemical substances are released in the form of solid, liquid, and gas, leading to serious results. Eight clusters that represent the traits of these accidents are formed, including "leakage," "poisoning," "explosion," "pipeline crack," "river pollution," "dust pollution," "emission," and "industrial effluent." "Explosion" and "gas" possess a strong correlation with "poisoning," located at the center of visualization map.

Surveillance of carbon monoxide-related incidents - Implications for prevention of related illnesses and injuries, 2005-2014.

BACKGROUND: Carbon monoxide (CO) is an insidious gas responsible for approximately 21,000 emergency department visits, 2300 hospitalizations, and 500 deaths in the United States annually. We analyzed 10 combined years of data from two Agency for Toxic Substances and Disease Registry acute hazardous substance release surveillance programs to evaluate CO incident-related injuries. METHODS: Seventeen states participated in these programs during 2005-2014. RESULTS: In those 10years, the states identified 1795 CO incidents. Our analysis focused on 897 CO incidents having injured persons. Of the 3414 CO injured people, 61.0% were classified as general public, 27.7% were employees, 7.6% were students, and 2.2% were first responders. More than 78% of CO injured people required hospital or pre-hospital treatment and 4.3% died. The location for most injured people (39.9%) were homes or apartments, followed by educational facilities (10.0%). Educational services had a high number of people injured per incident (16.3%). The three most common sources of CO were heating, ventilation, and air conditioning systems; generators; and motor vehicles. Equipment failure was the primary contributing factor for most CO incidents. CONCLUSIONS: States have used the data to evaluate trends in CO poisoning and develop targeted public health outreach. Surveillance data are useful for setting new policies or supporting existing policy such as making CO poisoning a reportable condition at the state level and requiring CO alarms in all schools and housing. Public health needs to remain vigilant to the sources and causes of CO to help reduce this injury and death.

Medical Response to the Tianjin Explosions: Lessons Learned.

BACKGROUND: On August 12, 2015, a hazardous chemical explosion occurred in the Tianjin Port of China. The explosions resulted in 165 deaths, 8 missing people, injuries to thousands of people. We present the responses of emergency medical services and hospitals to the explosions and summarize the lessons that can be learned. METHODS: This study was a retrospective analysis of the responses of emergency medical services and hospitals to the Tianjin explosions. Data on injuries, outcomes, and patient flow were obtained from the government and the hospitals. RESULTS: A total of 46 ambulances and 143 prehospital care professionals were dispatched to the scene, and 198 wounded were transferred to hospitals by ambulance. More than 4000 wounded casualties surged into hospitals, and 798 wounded were admitted. Both emergency medical services and hospitals were quick and successful in the early stage of the explosions. The strategy of 4 centralizations (4Cs) for medical services management in a mass casualty event was successfully applied. CONCLUSIONS: The risk of accidental events has increased in recent years. We should take advantage of the lessons learned from the explosions and apply these in future disasters. (Disaster Med Public Health Preparedness. 2018; 12: 411-414).

Use and limitations of offsite consequence analysis tools from South Korea and the United States in hydrogen fluoride accidental release.

We investigated the characteristics and limitations in the event of hydrofluoric acid (HF) leakage by comparing and analyzing the offsite consequence analysis (OCA) tools based on the chemical plant operating conditions. We reviewed the tools Korea Offsite Risk Assessment (KORA) from South Korea and Risk Management Plan*Comp (RMP*Comp™) and Areal Location of Hazardous Atmospheres (ALOHA) from the United States. The scenario studied was based on a leak event from a 50% HF aqueous solution storage tank, and the operating conditions taken into consideration were the operating temperature and dike installation conditions. The results from the OCA differed; KORA presented a smaller range of offsite impact than did ALOHA. The offsite impact ranges of KORA and ALOHA increased as the operating temperature and dike installation area increased. However, RMP*Comp differed greatly in its offsite impact range results in the operating temperature range of 25 °C to 30 °C. Moreover, in the alternative scenario, a limitation existed in that the offsite impact range was not changed by the dike installation conditions. The offsite impact range analyzed via KORA and ALOHA reflected the reality of an HF leak accident better than that analyzed via RMP*Comp. Therefore, it is more reasonable to use KORA and ALOHA instead of RMP*Comp in OCA. Moreover, users should realize that ALOHA has a somewhat wider range of offsite impact than KORA does in OCA. The separation distance from the storage tank when installing a dike is effective between 1 and 1.5 m in consideration of securing the minimum workspace for workers. Integr Environ Assess Manag 2018;14:205-211. © 2017 SETAC.