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EMS Corner
Rule #1: Contain the incident
If the treatments and decon procedures appear straight forward and uncomplicated, what happened in East St. Louis?
Volume 23, No. 6

Hazardous materials incidents represent a challenge even under the most ideal of circumstances. Even with the best preplanning, the best training, the best equipment, the best personnel, the best of the best of everything, things can still go drastically sour in a matter of seconds. When emergency workers do everything right, it can still go badly. If the general public or the plant workers fail from the start, the emergency crews end up so far "behind the eight ball" that it is amazing sometimes that anyone comes out alive. That is apparently what happened recently in East St. Louis, IL. The citizens of the area have some very cool-headed professionals to thank for their calm response and quick thinking.

The first consideration and the number one rule in any hazardous materials incident is contain the incident! If patients are contaminated, dying and needing medical attention, the second rule is see rule number one! This cannot be stressed enough. Regardless if there are dead, dying or contaminated individuals within that incident, the first and only initial consideration is to prevent spreading that incident. Anyone inside that hot zone is considered a casualty until the incident is contained, appropriately protected personnel can enter the hot zone to facilitate removal of victims, the victims are decontaminated and the victims are moved to appropriate medical facilities. When it comes to the initial management, it is important for all EMS personnel to know that they must not rush into a hazmat incident, scoop up patients and run for the nearest medical facility. Though this is preaching to the choir and this is not what happened in East St. Louis, these basic concepts can never be stressed enough to everyone. For what did happen, see Page 6.

An incident at a packaging and repackaging facility in East St. Louis started a regional panic that involved multiple hospital facilities, local fire departments and the FBI, all because plant procedures may not have been followed. Workers handling a drum of nitroaniline (more on this substance later) reportedly dropped the container, the lid came off and some powder spilled. Evidently this was not seen as a problem by plant workers as they cleaned up the spill, disposed of the chemical in a trash dumpster (not an EPA-approved method, but that is not the focus here), showered onsite and went home. They did not notify local authorities of the spill. 1

Some hours later patients started to arrive at various hospitals via private automobiles. They complained of various symptoms consistent with nitroaniline poisoning. Nitroaniline is a dry chemical, typically yellow in color, that is relatively stable in most environments. Used in the chemical industry as an intermediary in the plastics industry and in some dye preparations, it is considered a hazardous chemical and comes with a plethora of handling and disposal requirements.

Exposure to nitroaniline causes symptoms similar to that of carbon monoxide (CO) poisoning and the mechanism is also similar. It causes methemoglobinemia, which causes the hemoglobin on the red blood cells to lose their ability to carry oxygen. This ultimately causes hypoxia. The patients end up with similar signs and symptoms to CO poisoning with some noted exceptions. When inhaled, cyanosis may occur (as opposed to the "cherry red" color associated with CO poisoning) and, as oxygen deficiency increases, patients may experience headache, weakness, irritability, drowsiness, shortness of breath and unconsciousness. If ingested, nitroaniline will cause related gastrointestinal complaints of nausea and vomiting, along with the effects associated with inhalation. The chemical may be absorbed through the skin, with some possible irritative effects as well, leading to the related systemic effects discussed previously. Treatments are relatively simple. With inhalation, the patient is moved to a clean atmosphere and administered oxygen. Ingestion calls for inducing vomiting. Since some MSDS conflict and some state just to induce vomiting, the standard falls to medical control for ingestion cases. Surface exposures (skin, eyes, etc.) call for the removal of contaminated clothing and washing affected areas with soap and water. Flush the eyes for at least 15 minutes. 2

So, if the treatments and decon procedures appear straight forward and uncomplicated, what happened in East St. Louis? There was questionable logic applied at the plant location and a lack of appropriate notification about the spill to the local emergency providers. Plus the general public had no idea how to handle a hazardous material contamination, which is not their fault. What happened after the fact can only be attributed to general ignorance of the public. Actions of emergency workers post incident appear consistent with standard operational procedures when faced with an unknown. The emergency response workers should get kudos for their handling of this incident. Criticism for shutting down facilities and locking down hospitals should fall on deaf ears. When faced with a large, unidentified problem in hazmat, remember rule number one: contain the incident. If no one has said it, "Well done, guys!"


    news/entries/2008/09/02/nitroaniline-spill/3232 (BROKEN LINK)


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