|Ann. Medit. Burns Club - vol. VIII - n. 3 - September 1995
CHEMICAL SPILLAGE - A PREVENTABLE DISASTER?
Rosenberg L., Shabshin U.
Department of Plastic and
Soroka Medical Center and the Center for Research and Development in Plastic
Ben Gurion University of the Negev, Beer Sheva, Israel
paper considers accidents caused by the spillage of dangerous chemicals and how they could
be prevented, in the light of direct experience gained in Israel and of the findings of
researchers in other parts of the world, as reported in the literature. The procedure
followed in Israel in the event of such accidents is described and general
guidelines are suggested for the stockpiling and transport of these potentially lethal
substances. It is important to be prepared and there must be specific protocols for all
possible forms of chemical poisoning. Hospitals must be well equipped and medical and
paramedical staff properly trained. These accidents can happen anywhere at any time, and
it is stressed that the best protection is prevention.
The need for chemicals in our daily
life and the fast expansion of the human population oblige us to locate chemical plants
near heavily populated areas. The use, transportation and storage of these chemicals pose
the constant threat of a potential spillage disaster. Each chemical substance has its own
environment contamination potentials.
These are defined by a number of criteria:
1. Mass (m).
2. Toxicity - defined by the National Institute for Occupational Safety and Health (NIOSH)
as Immediate Danger to Life and Health (IDLH).' This value relates to the maximum
concentration of the chemical substance in the air that a healthy employee can be exposed
to at least for 30 minutes without any irreversible adverse effects.
3. Volatility - defined by the vapour pressure (VP) of the substance (in mm/hg) at room
The potential environment contamination
(PEC) = m x VP x I/IDLH.
Some chemical plants stockpile compounds with a high poisoning capacity and high PEC,
which means that evacuation has to be completed in less than 30 minutes after spillage
Israel, a small country with a population of 5,000,000, has had several cases of chemical
spillage accidents. To mention the last two: in 1992 a loaded truck full of bromide
skidded on an open road, far away from any urban area. The tank was crushed and the highly
volatile liquid spilled out, creating a gas cloud that spread all over the area. Before
dying, the driver radioed the security service at his chemical company and the police
quickly blocked the road. The cloud of suffocating and corrosive gases dispersed, the
driver being the only casualty. In another chemical factory situated in a huge industrial
zone near a heavily urbanized area there was a chemical spillage caused by the accidental
bursting of a tank. As it was Friday evening the factory and the whole industrial zone
were practically deserted. There was no wind and the only victim was a guard who suffered
moderate injuries and was evacuated to the nearest hospital for successful treatment.
These accidents fortunately caused only a limited number of casualties, but things would
have gone differently if in the first case the truck had crashed in a heavily populated
urban area or if in the second case the industrial zone and the factory had been full of
employees during regular daily working hours. Such accidents may happen any time,
There have been chemical disasters in all parts of the world, e.g. Bhopal, India, in 1984
;3, 4, 5, 6 the Hinton train disaster in Canada in 1986;1 and the Bashkirian train
disaster in the USSR in 1989.1 Thousands of people were killed or injured in these
accidents. Nor do the problems end after acute exposure to the chemical cloud: every year
after the Bhopal disaster at least 15 people exposed to the cloud have died every month.
A number of national and international control organizations have been established for
these toxicological disasters, e.g. CIMAH (Control of Major Accident Hazards, UK), PEC
(Pittsburgh Emergency Poison Center, Pittsburgh, USA) and UNEP (United Nations Environment
Program, UN).9, " However, even with these organizations, is our society ready to
deal with such disasters? Is the medical establishment prepared?
In this paper we will consider the position of the medical establishment and its role in
preparedness for chemical disasters. Our aim is to establish a comprehensive protocol to
guide the various authorities during a chemical disaster.
Materials and methods
In Israel the management of chemical
spillage basically follows the management of chemical warfare activities (i.e. with
mustard gas, sarin, etc. as the contaminants).
On detection of a chemical spillage, the police, security forces and the army take control
of the situation. A control group is established to coordinate all the teams and forces
that may be involved, including communication and the media.
The police are responsible for sealing off the contaminated area and organizing
evacuation, if necessary. Medical and paramedical troops such as NIDA (Red Magen David),
reinforced by well-protected trained rescue teams capable of functioning in contaminated
areas, providing first aid and evacuating casualties, are sent to the scene.
When a spillage accident has been announced, a mobile unit of the Ministry of the
Environment arrives on the site to test and diagnose the nature of the contaminant and to
inform the control group. Information about the contaminant is also provided by one or
more security mobile units of the company involved in the spillage. The country should be
divided into areas, each with its own mobile spillage control unit. The control group
distributes the information to the rest of the forces, including medical staff (field
level and hospitals).
Evacuation should be performed by trained and specially protected teams in order to
prevent spreading of the contaminant.
In the hospitals evacuated patients are treated according to a specific chemical poisoning
protocol which is in two main phases:
1. Cleansing and detoxification
2. Medical treatment
The cleansing and triage posts in the
hospital should if possible be located in an open place (e.g. a parking lot). The posts
should have cleansing facilities (showers, shower stretches, cleansing agents, etc.) and
protected, well-trained personnel. Triage should be performed according to a casualty
scale by well-trained and experienced physicians, protected if necessary.
Treatment posts should be set up in the entrance of the hospital beyond the cleansing
posts. Treatment posts should be divided for different levels of casualty severity, and
treatment must start as soon as possible.
In the front position, besides cleansing and diagnosis of the toxic agent, treatment
should be only supportive, with particular attention for respiratory tract symptoms.
Antidotes for some well-defined toxic agents (such as 4-damp, amyl nitrite and sodium
thiosulphate for cyanide, BAL or other chelators for arsine, and calcium gluconate for
fluorides) should be kept in a regularly refreshed store. Local hospitals, with their
normal facilities, are the natural and logical centre for the medical care of the victims.
Chemical spillage accidents, unlike wartime incidents, occur without any forewarning. The
number of casualties is often higher than predicted and is determined by the toxic
properties of the chemical substance and the circumstances of the accident.
In many cases, following individual or badly organized evacuation, patients may reach the
hospital even before the medical staff have been informed and specific facilities
prepared. In such cases, the cause of the accident and the number and severity of the
patients are unknown.
For each potential chemical poisoning a specific protocol including toxicology (early and
late) and treatment is prepared. All these protocols are compiled in sets for chemical
These sets of protocols should be supplied to every hospital that may be involved in
chemical disasters (e.g. because of its vicinity to a chemical factory, chemical depot or
All hospitals should obtain a list of chemical substances in general use in their area.
The protocols should be available at all times.
Each hospital should prepare its own trained medical and paramedical staff, with
representatives of all disciplines (i.e. intensive care, plastic surgery, toxicology,
internal and paediatric physicians, etc.).The training of these teams should include
refresher courses and the checking of techniques and equipment, including antidotes. An
emergency communications network system to contact teams in the event of an emergency
should be prepared and practised. There should be reserve personnel for each discipline.
National and international toxicology staff should also be included in this network. The
contaminated zone is defined by a clearly visible perimeter established by the chemical
factory rescue and intervention vehicle (from chemical factory* manuals). A. Chemical
tanker B. Spilled chemicals C. Lights D. Electrical generator E. Wind direction F. Rescue
and intervention vehicle G. Perimeters of the contaminated zone
Chemical spillage can happen at any
moment. Dangerous chemicals are very often stored in the vicinity of populated areas and
when transported they pass along heavily congested routes exposing thousands of people to
In Israel, owing to the threat of chemical
warfare such as in the recent "desert storm" war, a system for treating civilian
chemical victims at field level and in hospital had to be organized and implemented. The
same system could be used for chemical spillage accidents (Fig. 2).
The success of handling accidents and
victims depends basically on:
- decisions taken by the control group
- early detection of the chemical substance
- distribution of clear and effective information and orders
- the ability to detoxify the substance
- the handling of the evacuation of casualties
- the functioning of the medical team at field level and in
- correct use of media and communication systems
The arrival of patients at the hospitals should be
coordinated and the cause of the accident and the number of patients and their severity
Experience from past incidents (such as Bhopal) shows that the number of casualties in the
population at risk will be 25% in the contaminated area, of whom 5% will be dead or badly
injured, 15% will have intermediate injuries and 80% mild injuries.
The most frequent injuries will be in the respiratory tract, mucous membranes and skin.
Respiratory tract symptomatology ranges from mucous membrane irritation to severe chemical
pneumonitis. Eye symptomatology ranges from conjunctival irritation to orbital
oedema, infeclions and even blindness.` Skin symptomatology ranges from mild irritation to
severe chemical bums.
In mild injuries the problem of diagnosis may be much more difficult to resolve as the
symptomatology may be obscure and mixed. Many symptoms can be unspecific, such as
tachycardia, tachypnoea, chest pain, sweating, confusion, ete. All such patients should be
kept under supervision and appropriate adjusted supportive treatment.
Many chemical substances have long-lasting effects. The morbidity and mortality rates
among residents in con~ taminated areas rise significantly, especially with regard to
chronic respiratory, liver and kidney disease. Genetic malformations may occur in the
Because of the complexity of the problem and the lethal risk to large populations, it is
imperative to establish a comprehensive system to tackle chemical spillage.
The different levels of such a system are
- a front control group responsible for coordination of all
matters involved in the incident (i.e. personnel, equipment, cooperation between teams,
gathering and documenting information)
- diagnosis of the chemical agent and its toxic effect
- safe evacuation of the endangered population and civilian
- prevention of expansion of the spillage
- fast and safe transportation of patients to hospital
- comprehensive and well-adjusted medical treatment
- dealing with the media
The levels of hospital facilities are:
- evacuation, cleansing and triage of casualties (as
performed in chemical warfare)
- reinforced task teams and medical staff during the
emergency, all with adequate equipment and personnel
- preparation and implementation of protocols for the medical
staff (chemical substances, exposure, toxic signs and symptoms, antidotes and supportive
- training in various scenarios of chemical spillage
It must be borne in mind that no operative
plan can give full protection to the population. Emergency plans can reduce the number of
casualties and damage in the short and long term. But the best protection is prevention,
which is provided by:
- better and safer management of chemical depots
- better protection for equipment and personnel
- better insulation of chemical substances
- removal of chemical plants and depots from populated areas
- construction of safe by-pass routes for chemical
transportation in populated areas and cities
The vital questions that arise and must be
answered by all concerned are:
Do we have all these set-ups?
Do we have similar or alternative means to handle cases of chemical spillage?
Are we prepared?
RESUME. Les auteurs, à la
lumière de leurs expériences directes en Israël et des observations présentées par
les chercheurs dans les autres pays du monde, considèrent les accidents causés par le
renversement des produits chimiques dangereux et comment les prévenir. Ils décrivent la
procédure suivie en Israël quand ces accidents se produisent et ils proposent des
suggestions pratiques pour ce qui concerne l'emmagasinage et le transport de ces
substances potentiellement mortelles. Il est important d'être préparé et il faut donc
formuler des protocoles spécifiques pour toutes les formes possibles d'intoxication
chimique. Les hôpitaux doivent être bien équipés et le personnel médical et
paramédical très qualifié. Ces accidents peuvent survenir partout et dans tous les
moments, et les auteurs concluent en soulignant que la meilleure protection est la
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