In the middle of the night on Jan. 6, 2005, a freight train collided with a parked train in Graniteville, SC, resulting in immediate derailment and the puncturing of three chlorine tank cars adjacent to the Avondale Textile Mill. In less than two minutes, an estimated 60 tons of liquid chlorine was released into the air, producing a thick cloud of chlorine gas that quickly spread throughout the unincorporated and medically underserved town. The incident resulted in nine immediate deaths, 72 hospitalizations for acute health effects, and some 850 people seeking medical attention.
The incident gave pause to EMS personnel in New Orleans, who later that year endured the unprecedented devastation from Hurricanes Katrina and Rita. Even though no significant chemical spills were reported from those disasters, leaders wanted to be better prepared to respond to chemical incidents, especially in the world’s largest port by tonnage—the lower Mississippi River’s combined six deep-water ports.
Dev D. Jani, chief of planning and preparedness for the Office of Homeland Security & Emergency Preparedness in New Orleans, spearheaded the city’s participation in the Chemical Defense Demonstration Project (CDDP), which followed two scenarios of chemical spills. What would happen if a river barge tank of 2,400 gallons of hydrogen fluoride was breached? How would the 9-1-1 community respond to 19,000 gallons of organophosphate released via railcar on the tourist-laden riverfront?
“The organophosphate nerve agent was picked to test our countermeasures distribution system,” says Jani, noting the Department of Homeland Security’s Office of Health Affairs approved New Orleans as one of only four Phase II CDDPs in 2014. “We definitely have a large burden of common toxic inhalational chemicals. We also wanted to really hone in on our localized commodities flow in the port system.”
Best Practices to Share
Jeffrey M. Elder, MD, FAAEM, director and medical director for New Orleans EMS, discussed lessons learned from both exercises in his 10-minute presentation, “Taking a New Defensive Striving Course in the Crescent City: Enhanced Preparation for Chemical Disasters N’Awlins Style,” at the Gathering of Eagles retreat in February. “We wanted to identify best practices that may be shared with and adaptable to other communities,” he says.
For the chemical spill exercises, dubbed Crescent Shield, more than 150 participants from all levels of government converged at NASA’s Michoud Assembly Facility in New Orleans East to systematically approach issues that would arise in the aftermath of a catastrophic chemical incident. Specifically collaborators honed in on critical decisions post-incident that need to be made in the first half-hour. “We not only looked at the overall landscape of critical decisions; we also looked at the ones that, if discerned, would lead to a cascade of additional answers for detections and recognition,” says Jani.
In both chemical spill exercises, weather conditions were 81ºF, with winds of 6–8 mph from the southeast and 73% humidity. Exercises focused on response via operations, logistics and command control; protective action messaging and public information; tactical communications and interoperability; and medical and public health surge capacity.
“We had many moving parts to consider,” says Elder. “We learned we needed a better picture of the total traffic coming through New Orleans. Port traffic is fairly easy to count, but rail and interstate traffic is more difficult to calculate. For example, the Public Belt (Railroad) owns and operates nearly 100 miles of track (from Lake Pontchartrain to the Mississippi River waterfront). Private carriers may use the Belt’s track and pay for the service or go around it by using the ‘back belt,’ owned by Norfolk Southern. The traffic discussion led to a hazardous-commodities flow study for port and rail that’s in the works now.”
The exercises yielded outcomes such as critical decision support architecture and a concept of operations to complement city and regional crisis management frameworks. More specifically, these tools were created: a robust concept of operations (CONOPS) to complement the city’s hazardous-materials release management plan; decision matrices for use by first responders; EMS protocols and paramedic hazmat training. Also as a result of the project, New Orleans EMS now carries the Cyanokit for cyanide poisoning, and calcium gluconate (for hydrofluoric acid burns, among other uses) is on order, says Elder.
“We looked at both exercises as the eyes and ears for our health systems,” says Elder. “Our focus should be, as we’re getting people decontaminated in an event, to actually treat patients by having the medical knowledge to make the right decisions in the field. As a medical director, I think the biggest thing that keeps me up at night is making sure we have medics who have the training and knowledge and wherewithal to know where to go to get more information when they have to during an event.”