Chemtrina: Direct Hits, Near Misses, and Opportunities for Prevention

Connecticut Nursing News, Jun-Aug 2006 by Sattler, Barbara

The aftermath of Katrina has brought to the nation's attention several critical issues. In addition to the plight of the poor and forgotten, two other interrelated problems were highlighted. First, despite huge sums of money having been spent on homeland security, we were clearly not prepared for a "mass casualties" event; second, the stores of toxic chemicals in our industries, in local commerce, in homes, and generally in our communities, clearly pose a significant risk even during natural disasters. Health care providers throughout the south were caught without a planned response to both the quantity and quality of health-related events following Katrina.

Long before Katrina there was general consensus that a really big storm could become a "wet one of mass destruction" in New Orleans. Similarly, there has been general agreement about the cracks in the public infrastructure and its ability to withstand a really big storm. The vulnerability of both the levee and the public health infrastructure became quickly evident in the face of Katrina's ravages. There are lessons to be learned from the tragic events immediately following our 9/11 experience regarding the vulnerability of recovery and clean-up workers. Equally importantly, there is the opportunity to rebuild the coastal South in a way that we would never have imagined possible. And there is a role for nurses in all of the above.

Chemical Emergency Preparedness

Homeland security efforts arose out of the horrific events of 9/11. But long before 9/11, in 1986, Congress recognized that the toxic chemicals in our communities could pose a great risk and created the Emergency Planning and Community Right-to-Know Act (EPCRA). There were several important components to this law. It established communities' "right to know" about the hazardous chemicals in their midst-the chemicals being emitted into the air and water and the chemicals being stored on industrial properties. A list of 600 of the most troubling chemicals must now be reported and made available to the public. This information is known as the Toxic Release Inventory and is available via a user friendly website: www.scorecard.org where you can retrieve geographically-specific information by zip code, as well as information about the potential health effects of the chemicals. Nurses can access this information to better understand the environmental health threats posed by the hazardous chemicals in their communities.

EPCRA also mandated that every state have an emergency response plan for chemical emergencies-leaks, spills, fires, or transportation emergencies. These plans should include contingencies for the interface between people within the community, industries, emergency response personnel (police, fire, and hazardous materials people), and hospital staff. The emergency response plans should be written by the Local Emergency Planning Committees (LEPCs) that every city/county should have. These LEPCs are perfect forums for nurses to learn about the potential chemical dangers in their own communities. But also, who could be better at participating in a plan to protect grammar school children from a dangerous accidental air emission than then the school nurse? Who better to develop a plan for decontaminating patients with chemical burns than an emergency room nurse? And who better to be involved in developing an effective warning system and evacuation plan for the community residents than a community/public health nurse?

Worst Case Scenarios

In 1990, Congress once again asked industry for information about their potentially risky chemicals. When the Clean Air Act was reauthorized in 1990, a new amendment required that companies speculate about the worst possible event that might occur with the chemicals in their plant. Further, they were required to create a plan, to address the projected catastrophic events. These documents are called Risk Management Plans. Congress originally intended for these documents to be publicly available, but the current administration has virtually eliminated access to them. This information is essential when planning for emergencies, and nurses should be insisting on wider access to this critical public health information.

Emergency Response and Clean-up Work

Over a decade ago, the Occupational Safety and Health Administration (OSHA) promulgated the Hazardous Waste Operations and Emergency Response Standard to protect a range of people from toxic chemical exposures. This standard has resulted in years of healthier and safer hazardous waste work in the U.S. Nevertheless, the clean-up crews that immediately descended upon both Ground Zero (the World Trade Center site) and New Orleans were largely unprotected. In the case of 9/11, incredulity about the events clouded our health and safety judgment.

We have since learned that many of the 9/11 clean-up workers are experiencing serious long-term respiratory illnesses. While the 9/11 exposures were primarily chemical; the post-Katrina exposures are chemical and biological-bacterial, fungal, and parasitic.