Chemical, biological, radiological, and nuclear mass casualty medicine: a review of lessons from the Salisbury and Amesbury Novichok nerve agent incidents.

On March 4, 2018, two casualties collapsed on a park bench in Salisbury, Wiltshire, UK. They were later discovered to have been the victims of an attempted murder using the Soviet-era Novichok class of nerve agent. The casualties, along with three further critically ill patients, were cared for in Salisbury District Hospital's Intensive Care Unit. Before the COVID-19 pandemic, the Salisbury and Amesbury incidents were the longest-running major incidents in the history of the UK National Health Service. This narrative review seeks to reflect on the lessons learned from these chemical incidents, with a particular focus on hospital and local organisational responses.

A controlled cross-over study to evaluate the efficacy of improvised dry and wet emergency decontamination protocols for chemical incidents.

The UK Initial Operational Response (IOR) to chemical incidents includes improvised decontamination procedures, which use readily available materials to rapidly reduce risk to potentially exposed persons. A controlled, cross-over human volunteer study was conducted to investigate the effectiveness of improvised dry and wet decontamination procedures on skin, both alone, and in sequence. A simulant contaminant, methyl salicylate (MeS) in vegetable oil with a fluorophore was applied to three locations (shoulder, leg, arm). Participants then received no decontamination (control) or attempted to remove the simulant using one of three improvised protocols (dry decontamination; wet decontamination; combined dry and wet decontamination). Simulant remaining on the skin following decontamination was quantified using both Gas Chromatography Tandem Mass Spectrometry (GC-MSMS) for analysis of MeS and UV imaging to detect fluorophores. Additionally, urine samples were collected for 24 hours following application for analysis of MeS. Significantly less simulant was recovered from skin following each improvised decontamination protocol, compared to the no decontamination control. Further, combined dry and wet decontamination resulted in lower recovery of simulant when compared to either dry or wet decontamination alone. Irrespective of decontamination protocol, significantly more simulant remained on the shoulders compared to either the arms or legs, suggesting that improvised decontamination procedures are less effective for difficult to reach areas of the body. There was no effect of decontamination on excreted MeS in urine over 24 hours. Overall, findings indicate that improvised decontamination is an effective means of rapidly removing contaminants from skin, and combinations of improvised approaches can increase effectiveness in the early stages of decontamination and in the absence of specialist resources at an incident scene. However, the variable control and consistency of improvised decontamination techniques means that further intervention is likely to be needed, particularly for less accessible areas of the body.

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.

Characteristics, Cause, and Severity Analysis for Hazmat Transportation Risk Management.

The accidents caused by hazardous material during road transportation may result in catastrophic losses of lives and economics, as well as damages to the environment. Regarding the deficiencies in the information systems of hazmat transportation accidents, this study conducts a survey of 371 accidents with consequence Levels II to V involving road transportation in China from 2004-2018. The study proposes a comprehensive analysis framework for understanding the overall status associated with key factors of hazmat transportation in terms of characteristics, cause, and severity. By incorporating the adaptive data analysis techniques and tackling uncertainty, the preventative measures can be carried out for supporting safety management in hazmat transportation. Thus, this study firstly analyzed spatial-temporal trends to understand the major characteristics of hazmat transportation accidents. Secondly, it presents a quantitative description of the relation among the hazmat properties, accident characteristics, and the consequences of the accidents using the decision tree approach. Thirdly, an enhanced F-N curve-based analysis method that can describe the relationship between cumulative probability F and number of deaths N, was proposed under the power-law distribution and applied to several practical data sets for severity analysis. It can evaluate accident severity of hazmat material by road transportation while taking into account uncertainty in terms of data sources. Through the introduction of the as low as reasonably practicable (ALARP) principle for determining acceptable and tolerable levels, it is indicated that the F-N curves are above the tolerable line for most hazmat accident scenarios. The findings can provide an empirically supported theoretical basis for the decision-makers to take action to reduce accident frequencies and risks for effective hazmat transportation management.

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.

Health effect research on Hebei Spirit Oil Spill (HEROS) in Korea: a cohort profile.

PURPOSE: The Hebei Spirit Oil Spill occurred on 7 December 2007 and resulted in the spillage of 12 547 kl of crude oil on the coastline near Taean. Historically, this was the largest oil spill in Korean water. The health effect research on Hebei Spirit Oil Spill (HEROS) is a prospective cohort study that aimed to evaluate the long-term health effects of oil spill exposure on residents in the affected community. PARTICIPANTS: The Taean Environmental Health Center initially enrolled adults, adolescents and children living in Taean in 2009 and 2010. Follow-up surveys of participating adults and children were conducted every other year. By 2017, a total of 9585 adults and 2216 children and adolescents were enrolled. Of these, 294 adults and 102 children and adolescents were included in all subsequent surveys. FINDINGS TO DATE: Children who lived closer to the oil spill site exhibited a lower level of pulmonary function and higher prevalence of allergic rhinitis, than those who lived further away from the oil spill site. Adults who lived in a highly exposed area or participated in clean-up work had higher urine levels of the oxidative stress biomarkers malondialdehyde and 8-hydroxydeoxyguanosine. Changes in haematological parameters during a 3-year period were observed in residents of both sexes in highly exposed areas, in addition to increases in respiratory diseases and mental health problems in female and male participants, respectively. FUTURE PLANS: The findings of this study will better enable policy makers to develop environmental health policies intended to prevent adverse health effects in residents of communities affected by oil spills, as well as policies regarding the management of future oil accidents. The HEROS study will continue to follow participants in future and will be updated to enable an investigation of long-term health effects.

Guideline Implementation: A Safe Environment of Care.

The OR can be a hazardous environment for both patients and personnel. Low lighting, fluid on the floor, combustible and noxious chemicals, multiple pieces of equipment with cords, the fast pace, and numerous distractions are only some of the factors that can lead to an accident or injury. The AORN "Guideline for a safe environment of care" provides guidance to perioperative personnel on identifying hazards and implementing processes to mitigate risks in the perioperative setting. This article elaborates on key takeaways from the guideline, including precautions to reduce the risk of OR fires; occupational injuries associated with slips, trips, and falls; and handling, storing, and using hazardous chemicals. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) Science and the CBRNE Science Medical Operations Science Support Expert (CMOSSE).

A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.

Initial environmental risk assessment of hazardous and noxious substances (HNS) spill accidents to mitigate its damages.

In this study, a system was established to perform an initial environmental risk assessment of hazardous and noxious substances (HNS) spill accidents. Initial environmental risk assessment was performed using exposure and hazard assessments. An integrated hydrodynamic and chemical fate model was used to predict HNS concentrations at harbors, taking into account local environmental conditions. To consider the worst case HNS spill accident, the spill amount of 10,000 tonnages, was used for this study. The results show that highly soluble HNS are fatal to marine organisms during the neap tide. The results were based on a hypothetical worst case HNS spill accident and, not any specific actual HNS spill accident. Nevertheless, the method and system developed in this study, which includes the physical/chemical properties of 158 priority HNS, can be readily used to perform an initial environmental risk assessment for future HNS spill accidents.

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.

Fuzzy Bayesian Network-Bow-Tie Analysis of Gas Leakage during Biomass Gasification.

Biomass gasification technology has been rapidly developed recently. But fire and poisoning accidents caused by gas leakage restrict the development and promotion of biomass gasification. Therefore, probabilistic safety assessment (PSA) is necessary for biomass gasification system. Subsequently, Bayesian network-bow-tie (BN-bow-tie) analysis was proposed by mapping bow-tie analysis into Bayesian network (BN). Causes of gas leakage and the accidents triggered by gas leakage can be obtained by bow-tie analysis, and BN was used to confirm the critical nodes of accidents by introducing corresponding three importance measures. Meanwhile, certain occurrence probability of failure was needed in PSA. In view of the insufficient failure data of biomass gasification, the occurrence probability of failure which cannot be obtained from standard reliability data sources was confirmed by fuzzy methods based on expert judgment. An improved approach considered expert weighting to aggregate fuzzy numbers included triangular and trapezoidal numbers was proposed, and the occurrence probability of failure was obtained. Finally, safety measures were indicated based on the obtained critical nodes. The theoretical occurrence probabilities in one year of gas leakage and the accidents caused by it were reduced to 1/10.3 of the original values by these safety measures.

Unmanned vehicles for maritime spill response case study: Exercise Cathach.

This paper deals with two aspects, namely a historical analysis of the use of unmanned vehicles (UAVs ROVs, AUVs) in maritime spill incidents and a detailed description of a multi-agency oil and HNS incident response exercise involving the integration and analysis of unmanned vehicles environmental sensing equipment. The exercise was a first in terms of the level of robotic systems deployed to assist in survey, surveillance and inspection roles for oil spills and harmful and noxious substances.

Comparación de dos métodos de evaluación simplificada del riesgo químico por inhalación en un laboratorio universitario (COSHH Essentials y método basado en el INRS) / A comparison of two simplified methods of exposure risk assesment of inhalation of chemical agents: the COSHH essentials method and the INRS-based method

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Eighteen years of recommendations to prevent industrial chemical incidents: results and lessons learned of the US Chemical Safety Board.

OBJECTIVES: The US Chemical Safety Board (CSB), a federal agency that investigates significant chemical incidents and hazards, is interested in determining the impact of the recommendations resulting from its investigations, and how to better more effective recommendations to prevent chemical incidents. STUDY DESIGN: This is a descriptive study of the US Chemical Safety Board's safety recommendations. METHODS: The CSB coded and analysed its safety recommendations according to potential impact on reducing incidents, implementation status, purpose and recipient type. RESULTS: As of March 31, 2015, the CSB has issued 733 recommendations, 75% (548) of which are closed and 25% (185) of which remain open. For recommendations categorised as having high, medium, and low impact, 38% (78), 76% (160), and 78% (245) were implemented, respectively. CONCLUSIONS: CSB recommendations have led to important and lasting safety changes through regulations, industry guidance and voluntary consensus standards, and individual companies; however, coding recommendations by potential impact do not fully capture the influence of CSB recommendations. While this methodology serves as a preliminary way to determine the effect of recommendations, further data are needed to determine the extent to which these safety changes have reduced the frequency or severity of industrial accidents.

Major accident prevention through applying safety knowledge management approach.

OBJECTIVE: Many scattered resources of knowledge are available to use for chemical accident prevention purposes. The common approach to management process safety, including using databases and referring to the available knowledge has some drawbacks. The main goal of this article was to devise a new emerged knowledge base (KB) for the chemical accident prevention domain. DESIGN: The scattered sources of safety knowledge were identified and scanned. Then, the collected knowledge was formalized through a computerized program. The Protégé software was used to formalize and represent the stored safety knowledge. RESULTS: The domain knowledge retrieved as well as data and information. This optimized approach improved safety and health knowledge management (KM) process and resolved some typical problems in the KM process. CONCLUSION: Upgrading the traditional resources of safety databases into the KBs can improve the interaction between the users and knowledge repository.

Keep Hazmats in Their Containers.

Stocking spill response supplies such as squeegees, absorbents and wipes in areas where hazardous materials are used, handled, and stored allows employees to immediately respond to incidental spills.

[Methodological problems of noninfectious epidemiology and hygiene under chemical pollution of the environment].

In modern conditions the base of the assurance of the safety of human being from harmful factors of environment is the hygienic rationing for the latters. The use of this methodological principle led to the considerable decline in the level of chemical pollution of environment objects. However tens of millions of Russians are exposed to the impact of chemicals above admissible hygienic level. There was noted the high prevalence and mortality rate due to noninfectious diseases of the population. The hygienic science needs to develop and introduce methodology of personification prevention on protection of the person against chemical environmental pollution.