Thursday, August 13, 2009

Public Health Response to Chemical Incidents

The Rand Corporation recently published a technical report that they prepared for the Department of Health and Human Services (DHHS), Public Health Preparedness and Response to Chemical and Radiological Incidents. The report looks at potential requirements for responses by local public health services to incidents involving the release of chemical or radiological contaminants. The report notes that these releases can come from a number of sources, including: chemical and nuclear plant accidents, train collisions, product tampering, and chemical terrorism” (pg xi). The authors conducted literature reviews, looked at chemical and radiological incident after action reports and conducted interviews with public health professionals from around the country. They identified a number of public health actions that formed key responses to these types of incidents. They then looked at these actions to see which ones are supported by developed, published and well understood ‘practices’. The report identifies four practices that need further development work. They are (pg xii):
“Conduct initial epidemiological investigation; “Provide public information; “Establish a victim registry and monitor long-term health; and “Monitor health conditions at shelters and mass care centers.
Conduct initial epidemiological investigation The report notes that in “the case of a chemical or radiological release that is initially unrecognized or poorly characterized, public health departments will need to use epidemiological techniques to deduce information for understanding the type, time, and/or location of the release” (pg 10). This would be most important where a deliberate release was made covertly, but it could be necessary where there was a non-catastrophic accidental release that was not detected before the medical affects were noted. The problems in this area for chemical releases deal with the initial identification that the medical problems are caused by a chemical exposure and determining which chemical is responsible for the exposure. This may be further complicated by slow on-set symptoms and the similarity of the symptoms to normal disease processes. Provide public information Once a chemical or radiological release event has occurred the public health services may be responsible for risk communication functions, including “providing instructions to individuals about sheltering or evacuating based on where they are located, how to decontaminate, what symptoms to monitor, how to determine whether medical attention is necessary, and potential treatments that may be provided” (pg 10). While actual communications may be handled through the incident command center, it will be input from public health professionals that guide those communications. Establish a victim registry and monitor long-term health Medical care for acute trauma or medical affects of chemical or radiological exposure during the incident is the responsibility of the emergency health care system. The chronic affects of the exposure will be more difficult to manage. This will require the “the creation of a registry about potentially exposed individuals including, for example, contact information, location at time of incident, duration of the exposure at that location, and symptoms” (pg 11). Monitor health conditions at shelters and mass care centers Public health professionals already have a long list of responsibilities for monitoring conditions at evacuation shelters and emergency care centers during any large scale evacuation situation. For chemical and radiological exposure events an additional concern “is monitoring contamination levels at shelters to ensure that they remain safe” (pg 12). This includes meteorologically mediated exposure (normal drift of the contaminant cloud) and contamination inadvertently brought into the shelter by the evacuees. Additionally, exposure symptoms with a lengthy time delay require constant monitoring of the shelter population. CFATS Implications High-risk chemical facilities with toxic release COI have a special responsibility to coordinate in advance of an incident with public health authorities about the chemicals on-site that could have significant off-site affects in the event of a successful chemical attack. Public health officials would then be able to plan for their response to such a terrorist attack. These plans would include:

Identification of symptoms of exposure. This would allow for education of emergency medical technicians and emergency room personnel on the appropriate response required for exposed patients, including initial support and stabilization needs and decontamination requirements.

Provisions for chemical monitoring. This would allow for pre-stocking emergency rooms, ambulances and shelters with appropriate devices for monitoring for chemical contamination of patients and evacuees.

Identification of appropriate treatment options. This would allow for appropriate training of local medical professionals about the most effective diagnostic and treatment options for chemical exposures that result from the successful terrorist attack.

Identification of chronic health affects. This would allow the public health agencies to plan for the establishment of exposure registries and identify what follow-up actions would be necessary.

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