“Just the Flu”

Scene

Attack One responds to a busy local foundry on a summer afternoon for a person “ill at work.” The crew is greeted by a supervisor at a large garage door, but is told the worker has been moved to the front offices. They walk through the plant area, noting several large, open garage doors and oversize racks of auto parts and paper packing materials.

Reminder to self: Let fire inspectors know about the fire load conditions in this building and the flammable packing materials.

In the office, the crew finds a worker vomiting and complaining of unusual fatigue. He has not been ill recently, and no one else in his household is ill. He ate lunch today, and has had plenty of fluids due to the warm weather. He has a mild headache, but no chest pain or other symptoms. He does not feel warm to the touch. He states that he feels too ill to drive home and requests removal to a nearby hospital.

As he’s being prepared for this, another worker enters the office, complaining of a headache and nausea and requesting to go home. A plant supervisor says, “Boy, three people with the flu in one day!” Your math skills have always been pretty good—was another person ill today?

“Yes, another worker was ill early in the afternoon,” you’re told. He was taken to the plant’s preferred occupational health clinic. In fact, he called just a few minutes ago to advise the supervisors that he “just had the flu” and was going home.

This changes your assessment. Your first thoughts are about toxic exposures, but the guard says, “Doors have been open all day, and we’ve had no material spills.”

This is not reassuring, and the crew requests a hazardous-materials response.

The patient is evaluated. No other injuries are found. His treatment includes oxygen by cannula, intravenous fluids and prochlorperazine, and placement in a position of comfort to prevent worsening the nausea. He is transported to the ED.

When the hazmat crew arrives, they initiate operations in the office area. They review the material safety data sheets for substances used at the company, and initiate a survey of the foundry work area. No material spills are evident, although closed solvent bins are scattered throughout the area. The ill workers happened to be in the same work area: between large overhead garage doors open for the entire day. There are no unusual odors or activity in the area. But as the crew finishes its surveillance, another worker in the area approaches them and says he’s feeling ill. He is taken to the office area, where the Attack One crew finds he has the same symptoms as the other ill workers. The hazmat crew takes their monitoring equipment into the work area and immediately finds the the carbon monoxide level to be significantly elevated. That information is relayed to the EMS providers in the front office. In light of this discovery, the patients are administered 100% oxygen, as well as IV fluids and antiemetic medication.

The hazmat crew begins working to identify the source of the CO and the extent of its spread. The machinery working in the area is all mechanical, but nearby workers (who are being evacuated) say a forklift had been working in the area for most of the afternoon. It is now working another area of the foundry. The initial work area shows a pocket of high carbon monoxide readings, while nearby areas are clear. When the crew follows the forklift to its current area, the readings rise again, especially around the vehicle’s exhaust. The forklift operator has gone for the day, but the floor supervisor says this propane-powered tool has recently been repaired.

The forklift is moved outside, and large fans are used to clear the air in the foundry before the workers are allowed to return.

Incident Management