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Center for Public Health Preparedness

Transcriptions

University at Albany Center for Public Health Preparedness

Environmental Health & Disaster Preparedness

Original Satellite Broadcast: 12/13/07

Moderator: Good morning and welcome to The University at Albany Center for Public Health Preparedness Grand Round Series. I'm Kris Smith and I’ll be your moderator today. Before we start, we would like to ask you to please fill out your evaluations on-line. Your feedback is always helpful for the development of our programs and continuing education credits are available after completing the post-test. We’ll be taking your calls later in the hour. The toll-free number is 800-452-0662. You may also send your questions at any time during the program by fax or to the e-mail address you see on your screen. Today’s program is Environmental health and Disaster Preparedness. Our guest today is Anna Marie Bokelmann from the Texas A&M Health Science Center School of Rural Public Health. She began with the Philadelphia Water Department and has since developed training courses for specialists and the general work force. Welcome to the program.

Bokelmann: Nice to be here.

Moderator: Maybe we could start with you running through the objectives of this program.

Bokelmann: The things we want to talk about today is the relationship between people and the environment, how that relationship changes in a disaster situation and how we can provide for some intervention to minimize the impact of the disaster situation on public health.

Moderator: So when we’re talking about environmental health, it’s probably blood to have a clear definition of "environment." What do we mean by "environment?"

Bokelmann: Well, in the broad sense of things, the environment is everything external to the host. Today we’re particularly interested in people as the host. You can see in the graphic here, it can include a whole lot of things beyond what we generally immediately think of, like environmental pollution or occupational exposures. It includes things in our homes, in our food, in our furniture, in our lifestyle. So all those possible sources of chemicals are in our lives.

Moderator: And are all of them—do all of them constitute a risk? How would we define "environmental risk?"

Bokelmann: Well, we like to look at according to the E.P.A. risk pair are dime in which we—paradigm in which we start with health effects and try to trace back and determine whether or not there’s a chemical cause for those health effects or start with the idea of using a chemical and then projecting forward to determine whether or not there’s the possibility of an adverse effect as a result of that chemical use.

Moderator: Anna Marie, there’s some terms on that graphic that people might not be familiar with. Can you give us an example of how to apply this paradigm?

Bokelmann: Yes, if we -- today we’ll focus mainly on chemical exposures, although there are others in the environment, and we use the risk paradigm looking at these types of considerations for each step. So at first when you look at the chemical, you say what chemical it is, how it exists, what its properties are, and does it have the ability to produce an adverse effect. Then we look at the possibility of an emission or a release and where that might come from and where it could possibly go and how much we’re talking about. And then we go to the transport and that tells us how the chemical might be dispersed, whether it would go to air or to water, what happens if it’s hot or cold out, what the atmospheric conditions might do to influence the movement, and also the surface, if you have low areas or valleys and hills, or basements even. The fourth step is looking at who may be exposed to it. And first it always goes to public health, to people, but we also consider environmental, ecological receptors in that category, and what kind of sensitivities they may have, and then the last step is what kind of health outcomes we could find, whether they would be Immediate or long-term, whether they’re associated with cancer or not.

Moderator: So really you’re looking at the degree of hazard, coupled with the likelihood of something bad happening in order to quantify the risk.

Bokelmann: Right, right. And who may be at risk and how we might provide for some intervention to prevent that risk or reduce it.

Moderator: To mitigate the consequences. Talk to us about the environmental specialists who would be involved in responding to an environmental emergency?

Bokelmann: If there were a chemical disaster, a chemical release-- you can see from the graphic here that we would have a lot of federal and state responders, and these people are usually highly trained, have certain areas of expertise; they bring some specialized skill and knowledge to the response.

Moderator: Now, I mean, some of those that you have listed on the graphic I think are obvious, but folks like the Federal Aviation Administration, you wouldn’t think of them as necessarily a responder in environmental emergency.

Bokelmann: Right. Well, that would depend on where it is and what kind of special lied skill we need to solve the problem. They may have resources that other departments don’t have, and so we list anyone we can who has knowledge, skills and resources we could use.

Moderator: What about a local level? Who would be involved in the response?

Bokelmann: The local level is the first responders. They’ll be there at the immediate time of release. So you have the usual law enforcement, police service, ambulance service, fire service.

Moderator: All these folks should be involved in planning for environmental disaster. What are some of the important steps we need to take in preparing for environmental disaster?

Bokelmann: If we can identify what kind of disasters might be likely to occur, we can preplan to make sure we have some sort of response program in place. And then at the time of release, we’ll obviously work through our response plan, and then afterwards, we want to try to restore things back to the way they were before the release took place, and then we also look and determine if the same sort of thing were to happen again how we might be better prepared for that.

Moderator: It almost sounds like you’re characterizing it as a cycle.

Bokelmann: Right. It goes around and around. And this graphic we have from the World Health Organization really shows that well. If we start by looking at the disaster itself, we see there is a response to it, and then once the release has been taken under control, we have relief for any sorts of problems that may have occurred in the community as a result of the release, the recovery, restoring things back to as they were before, and then across the top of the graphic, preparing for the next one, getting our equipment, our trained personnel, all of that sort of stuff, and then how we would indicate that an event has occurred, where our warning system is, and then having another disaster and going through the process again.

Moderator: And hopefully not having as an extent of disaster because of the planning we've been able to do. Can you provide us with an application of the disaster management cycle in an incident?

Bokelmann: Yes, if we look at the chemical incident situation, and we have actually gone through the risk paradigm again, if you look through the bullets, the first one showing we’re trying to see where are the potential sources? Where can we have a release occur? Then secondly, what sorts of chemicals and how might they spread in the even of release. And then third, who is likely to be at risk as a result of the release. And finally, what outcomes would be possible and how are we prepared to treat those outcomes?

Moderator: The vulnerable populations point that you were making, different vulnerable populations for different types of chemicals or environmental risks?

Bokelmann: Well, some people may have pre-existing conditions, may have respiratory problems that would obviously put them at a higher risk if we were having a release of a chemical that causes respiratory response.

Moderator: Any factors due to age? Are children more vulnerable?

Bokelmann: Right, age and children, for a number of reasons: mobility, communication, sensitivity to chemicals. As you age, you know, you don’t respond as well to all sorts of things. You’re more likely to get the flu, more likely to be adversely affected by elements in your environment. And then younger children, just because they don’t have their defense mechanisms built up as well. Those are definitely sensitive receptors, the most obvious. And pregnant women would be in the category, too.

Moderator: I have used "sensitive populations" used in disaster planning and they mean people who can’t easily evacuate, for example people in nursing homes or hospitals, and that has to be identified as well.

Bokelmann: Yes, and that would definitely be identified as a sensitive population.

Moderator: How does our vulnerability drive the preparedness strategy?

Bokelmann: The vulnerability is a combination of two things: the likelihood hood we’ll have a release. If we have a lot of chemical facilities or chemical activity in our area and our ability to respond to a release. You can see that at the bottom of the graphic. If we have very limited capabilities and the high possibility of release, you can tell we would be very vulnerable.

Moderator: Is there a tool we can use to help inform our planning?

Bokelmann: In communities, we use the Vulnerability and Capacity Matrix that you can see here. This helps us to really sort it out according to what kind of sources we may have for problems and then the second row looks at what kind of receptors and then thirdly, the behavior of the receptors, the ability to do what we want them to do and respond accordingly.

Moderator: Talk about the attitude playing a part in vulnerability. Can you give examples?

Bokelmann: In terms of how likely people are to respond to request that they evacuate, whether or not they feel like it’s necessary. If they believe that there’s really a risk that might affect whether or not they adhere to the order or they decide that they’re not going to evacuate. They make a personal choice.

Moderator: If you’re a planner, how do you determine that, though?

Bokelmann: The more we can inform people of the possible consequences-- if you operate under the principle if they know what the hazards are, Then they will do what they can to reduce their own personal risk, and part of that could be to evacuate and In some cases, it may be to just stay where they are. But if they understand the possible outcomes, you have already prepared them for that. When you ask them to respond, they’ll be able to determine that it’s an appropriate thing to do.

Moderator: Now, is there any chance that you’ll get an opposite reaction? That people become so accustomed to the risk that they ignore it?

Bokelmann: That’s something that you definitely want to be thinking about, but again, I believe if they have the information, the details, and you’re not just saying "evacuate because I told you so." You’re saying, "evacuate because these are the circumstances and this is the possible outcome," then they can respond the way you want them to.

Moderator: So you’re going to lead us through an example of a chemical incident. What major questions are we looking to answer?

Bokelmann: There are two. The first thing is what are we going to do? What are the challenges? How are we going to resolve the problem? And then secondly, what are the people going to do? I believe that even the residents of the community, they’re responders, too. Unfortunately, they’re not trained at the level that our emergency responders are, and so they don’t necessarily know what they’re going to do, but they are going to respond one way or another. So we want to try to influence that and that’s what we identify in question number 2.

Moderator: Let’s start with the example of Minot, North Dakota. I know that’s a great study and real-life incident as well.

Bokelmann: A train derailment in the middle of the night. We’re going to look at that and then prepare that to a possible incident in a small town where trains go through any time day or night but often right through the middle of town. And then thirdly how we would use those lessons to prepare the community to respond in the way we want them to.

Moderator: And how large is Minot?

Bokelmann: It’s not very-- well, over 30,000, so it’s a medium-sized area. Our Texas example is going to be a lot smaller than that. But our derailment was in the middle of the night, middle of the winter, anhydrous ammonia, and several railcars. The chemical moved through the area, so the transport medium was the air. The receptors were the residents of the area, and the health effects were immediate. And you will see, too, there were some long-term effects and some even emotional, like post-traumatic stress disorder associated with the accident.

Moderator: You made the point this occurred in the middle of the night. Why does that matter?

Bokelmann: That tells us where the receptors are. They’re home, in bed, the middle of the winter, so the homes are closed up nicely, so the possibility of the chemical infiltrating into their home is less likely than if it was spring and there’s a wind and you’ll have more internal exposure in the homes.

Moderator: How dangerous is the anhydrous ammonia?

Bokelmann: There’s coughing, respiratory response. You know it when you’re being exposed to it.

Moderator: Were people?

Bokelmann: A number of folks went to emergency rooms. There was even a fatality.

Moderator: What about the response? Was there a large-scale response?

Bokelmann: Yes, and this will show the agencies involved. The immediate response is definitely local, but over the long-term, trying to restore the area back to the way it was before, it involved a lot of different agencies and private organizations.

Moderator: A lot of these agencies you would expect to be part of this, but what were some of the organizations that might strike folks as a bit unusual.

Bokelmann: The Air Force. There’s no air force base in that immediate vicinity. A veterinarian, which is kind of a strange character you wouldn’t necessarily assume, would respond to a derailment, but you've got all your bases covered.

Moderator: Right. You made the point earlier it doesn’t just affect human health, and in Minot, North Dakota, there would be farm animals to be taken into consideration as well.

Moderator: Livestock, right.

Bokelmann: One of the partners I think we think about but not always bring into the planning process early enough is the media. I want to take a look at the media coverage of that incident in Minot, North Dakota, and I think we have a video that we can show you right now.

Moderator: Good.

Bokelmann: It was about 1:40 when a peaceful night turned to chaos. Several cars of a Canadian Pacific Railways train jumped the tracks, including an anhydrous ammonia tanker that erupted, sending a deadly cloud over Minot. One man saw a fireball race through his neighborhood and slam into a nearby house. Another managed to get out an hour later.

Bokelmann: My eyes and my throat. It was thick. I couldn’t see the ground outside the cab.

Moderator: Trying to go to the hospital?

Bokelmann: Yes, there were cars all over. I called people and nobody could get through. He went to the hospital. So too did about 150 others. 13 were admitted and 6 are still in intensive care. The hospital has called in extra personnel in areas where they’re needed. We remain on high alert incase we need to do that more.

Moderator: So you brought some friends of yours in or something like that?

Bokelmann: Yeah, they called me up, weren’t doing too good, so I brought them up here.

Moderator: Having shortness of breath?

Bokelmann: Yeah. One of them was coughing really badly and the other one, She’s-- her eyes were burning And stuff, so... Governor John Hoven arrived on the scene before 9 in the morning. After flying over the area of the derailment, we landed at the mall parking lot and met with officials who had been working the disaster all morning long. He saw one car that rolled a long way from the railroad tracks and one resident told us it rolled probably a few hundred feet away before coming to rest in someone’s backyard.

Bokelmann: We had one deputy trapped there for 45 minutes, the first responding officer. He was taken to the hospital. He was treated and released. Officials are now working to get to the site of the derailment so they can figure out exactly what went wrong. Jim Olsen, KXMC.

Moderator: We want to thank them for giving us that video because that brought up so many important points that I would like to take a few minutes to discuss. First of all, we saw the gentleman obviously exposed to some amount of it quite a bit after the fact. You could see his eyes were still affected.

Bokelmann: Right.

Moderator: It seems toss me he might have been quite lucky to get away with just that minimal impact.

Bokelmann: Right. He probably was.

Moderator: Um-hmm. Lasting health effects for many people, though, weren’t they?

Bokelmann: Yes. Their tear ducts were affected for long periods of time. There were complaints that lasted months after the release.

Moderator: Um-hmm. I think this also brings the point that we do count on media to be there to alert people when an incident is happening, but when it happens in the middle of the night, especially if local media are all under the same ownership, there can be problems, can’t there be?

Bokelmann: Right. And some are not live during the night; they’re prerecorded and so you don’t get the immediate information. What we saw in the video that was after the fact. The before-the-fact media is very important for us-- or at the time of it, to tell people what they need to do.

Moderator: I think I read something about in this particular incident, they actually tried to reach the radio station to get the warning out, but in fact they couldn’t, and I think they had to go wake somebody up at home. So that’s a lot of time that’s lost.

Bokelmann: It’s something we definitely have to think about in smaller areas that don’t have the same resources that a big city may have.

Moderator: Do you think weather radios would help? I know they use them to alert people in a very localized area when a severe storm is coming through. Perhaps something like that would be helpful.

Bokelmann: Weather-related incidents, we have some advanced warning, so people are tuning in, are paying attention, and are thinking about it. In a railcar derailment, you wouldn’t necessarily be thinking, "oh, here comes the train; there may be a derailment." So I don’t know that people would be paying attention necessarily to that. It’s worth a shot.

Moderator: Would you see it?

Bokelmann: Some things you do. Anhydrous ammonia, you could see in the video it was like a low-lying cloud.

Moderator: Would people know what to do necessarily?

Bokelmann: Only if we prepared them for it. Most react-- if there’s something bad gets away from it. A lot of times that’s the best thing to do, but sometimes it’s better to just stay where you are and let it pass, and that way we don’t have a lot of people out on the roads in the possible pathway of the plume.

Moderator: And I realize this is situational, but if you’re in your house, should you go to the duct tape and plastic solution? How does that work?

Bokelmann: What we’re tried to do when we shelter in place is to prevent any of the chemical from getting into the house. We want to keep it out. So if we have areas where it could come through, doors and windows, vents, we want to try to seal that up as best we can, and that may be using duct tape and plastic.

Moderator: I also saw in the video that one of the responders, it looked like they were wearing an N-95 mask and how effective is that in a chemical release?

Bokelmann: It depends on what they’re trying to accomplish. That was an interview with a woman at the hospital and when you have an irritant like anhydrous ammonia, maybe they were just trying to prevent any kind of germs from getting into the vulnerable area. It doesn’t necessarily prevent inhalation of the chemical, but it could keep them in the hospital, other people who are around from being exposed to germs.

Moderator: Another point we might want to make based on what we learned in the video is that responders themselves can become part of the problem—

Bokelmann: Right. They can be victimized as well.

Moderator: So they need more training as well.

Bokelmann: Um-hmm.

Moderator: Now, let’s go back to the weather conditions the day of that incident if we could.

Bokelmann: It was minus 5 degrees, very cold.

Moderator: What impact did that have? On the anhydrous ammonia?

Bokelmann: The weather conditions can affect how easily it passes through the atmosphere. Certainly if there was wind or anything like that... but the other part is that people are closed up tight wherever they are. You don’t have folks out on the street walking and being potentially exposed. So the weather helped in that situation a lot because folks were in secure shelters at the time.

Moderator: Had it been the middle of the day when people were going out their business—

Bokelmann: In the middle of the spring where all the windows and doors... you would have more people expose to higher levels probably.

Moderator: So to some extent the timing was fortuitous.

Bokelmann: The responders probably wouldn’t have felt that way because they had to all get up and out of bed...

Moderator: What’s the possibility of a railcar accident? How likely is that to happen?

Bokelmann: They’re a slim possibility. They do happen but not very frequently. What makes them exciting is, you know, the quantity of materials that they’re carrying. But they do occur. We don’t want people to leave from the presentation thinking every time the train comes up the track they need to roll up the windows and shelter in place, but we do want people to prepare communities for the notification that a release has occurred and that they know what to do. So me at my house, I know what to do.

Moderator: A siren-- how many towns have this type of mechanism? We rely a lot on television and radio--

Bokelmann: Which we have seen has limitations. Right. And we use police sirens, but If the community doesn’t understand why are the police riding around with their alarms going and sirens running, then it really isn’t as beneficial as it could be.

Moderator: Are there particular signals for a chemical hazardous release or perhaps where they have a standing plant?

 Bokelmann: If you have a fixed facility, there will be alarms that they use, but for railcar or a truck passing through town that rolls over on the highway - there aren’t the same sort of signals.

Moderator: It sounds like we need to work on that.

Bokelmann: It would be good.

Moderator: You were going to give us a hypothetical scenario this time so take us through that.

Bokelmann: I picked a small town in Texas where the trains go right through the middle of town. This is Seminole, Texas. The population is less than 2,000. We have quite a few towns like this in Texas. And the population is made up of, you know, typical rural environment. We have mixed race, lot of school-aged kids. We don’t have any fixed chemical facilities in that town itself. The closest hospital is some distance away.

Moderator: There’s a large Hispanic population. How is that going to enter into the preplanning?

Bokelmann: The communication. We need to make sure they understand what procedures to follow when the evacuation order is given and what procedures to follow if it were shelter in place. We need to be sure they understand what they need to do, so we need to address any language issues.

Moderator: The bilateral indicators-- what about trusted channels because perhaps some of these Individuals aren’t documented so will we take advice from people who might send them back?

Bokelmann: The recommendation would be to go to church leaders, community leaders, to the people they would take information from as important and hit them right where they’re going to get the most benefit.

Moderator: Okay. So here’s where the bad stuff starts to happen. Say we have a chemical disaster in this typical town. What happens?

Bokelmann: In the middle of the town, the middle of the day, where is everyone and how are we going to get the word to everyone? So the first responders will arrive and they will identify the area that needs to be isolated and then they will make some sort of effort to try to move people out of that area. So if we have chlorine leak, the initial isolation area is 800 feet in all directions. That could involve the school; that could involve businesses, homes, and a variety of facilities.

Moderator: I’m not really good, I guess, with trying to figure out how big 800 feet is. Can you give us an example of what that would encompass? Is that like a football field?

Bokelmann: Yes, no bigger than that, in all directions from the source of the spill.

Moderator: So it could have a pretty good impact then.

Bokelmann: Yes.

Moderator: All right. Six blocks or so?

Bokelmann: All right. (Laughing)

Moderator: A block in downtown New York may be different from a block in Seminole, Texas. It’s kind of hard to say.

Bokelmann: That’s right. In your communications, you have to be explicit and use the same term of reference, the whole national management command using the same terminology. Good point. You said this could happen almost anywhere, what could happen in this town.

Moderator: Right. What happened in North Dakota can happen anyplace there’s a train and a train track. It could happen in the day. It could happen in the night. It doesn’t matter. They don’t happen very often, but they’re not planned, so any time.

Moderator: So we need to plan.

Bokelmann: That would be good.

Moderator: Is there a guidebook that can help us to do that?

Bokelmann: Well, the guidebook that we’re showing here, this is what the emergency responders generally use. This is the guidance for the initial response and this is where they’re going to find out how much of an area needs to be isolated, needs to be evacuated.

Moderator: And is this template or-- are you able to adapt it to your own situation?

Bokelmann: Yes. If you can identify the chemical or identify its identification code or see the placard or even if you can’t see anything but the transport container, there is guidance in what to do, and it would tell us how large of an area needs to be cleared out.

Moderator: All right. Well, I want to remind our viewers that we will be ready to take your calls in just a few minutes. What’s the first step?

Bokelmann: We need to know what’s being released. We need to know what the chemical is and how it may move. One of the resources used very often is the NYOSH Pocket Guide for Chemical Hazards, and we show here the image of it for the chlorine and some of the important properties that would be looked at from this document include the gas relative density-- or relative gas density. That will tell us if the gas is going to stay low to the ground or will float away. Here we can see it’s greater than 1, and that means it’s going to stay low to the ground. Another interesting property is the solubility, so if we have humidity or rain, we can tell whether or not the chemical will dissolve into that precipitation and caught problems that way, too. It will knock it out of the air but then cause a surface contamination problem.

Moderator: As an aside, my husband was a career fire department captain, and he carried that guide book in his car and as we were traveling along, we'd see a placard on a chemical tanker and he'd have me look it up. Sometimes it’s more information than you actually want, but it would tell you how it would expand with weather conditions and those are helpful things to know if you’re planning. So that’s step one.

Bokelmann: We say how is it being released and how much do we have and is it a small release or catastrophic container failure where all the contents will come out at one time? Also the timing of release: day or night, with the atmospheric conditions generally different. Summer or winter, and that has to do with atmospheric conditions, temperature, and people being out on the street.

Moderator: Before you talked about exposure pathways and you talked about the way chemicals move, so how is movement different from the pathway?

Bokelmann: The pathway is air, water, soil, and the movement is, you know, obviously how it transports through that medium. And so when we’re talking about the third step in the paradigm, the transport, we need to know, is it spilling to the surface? Is it being released to the air? What the atmospheric conditions are that may influence the direction that it’s going to go or how large of a plume is likely to occur, and then the topography. If it’s heavier than air, it would accumulate in low areas, also basements and subsurface structures.

Moderator: Are many chemicals heavier than air?

Bokelmann: When in doubt, assume it is because that means you’ll be overprotective, assuming it’s staying right here with you. And most-- lots are. Certainly if they come out of liquid and evaporate, the evaporated vapor is generally heavier than air.

Moderator: There’s a principle known as anchor anything a cycle social response to a disaster and that’s when people in highly stressful situations, they anchor their behaviors to things that have worked for them in the past and many people are accustomed to a severe windstorm or tornado warning to take shelter in their basements, so if they heard a chemical exposure had occurred, they might go to their basements if they didn’t know better.

Bokelmann: Right, and that would be a potentially bad thing to do.

Moderator: So we need to focus on the advanced education, and the communities that have fixed facility are probably already doing that.

Bokelmann: At least more so than others, yeah.

Moderator: And this could happen anywhere. That’s important to know. So what’s the next step?

Bokelmann: Receptors. Who is likely to be exposed? And here we’re going to consider age and language and mobility and health status and all those things that are important considering their sensitivity and also how we’re going to move them out of this space. Another thing that we haven’t really brought up is pets, animals, and livestock. In rural communities, that’s important. We have to consider how those would be affected by the response and how we might transport them out of the response area.

Moderator: That might be one of the attitudes or behaviors that you’re talking about. If your livelihood depends on your livestock, you’re going to go out of the house and try to protect them.

Bokelmann: And you may be reluctant to leave them.

Moderator: Actually, we’ll be doing a program on that in February. We’ll discuss that a bit further. So you've got your receptors.

Bokelmann: So then it’s what could possibly happen, what health effects? This is important for health care providers as well as the individual population so they can say "I’m experiencing this. It’s probably a result of the exposure." I need to go get care. Or some of the care may be you could take care of yourself; you would wait until you got to the point where you need professional care. So when you note the chemicals, you say, "Okay, these are the possible health effects, and that focuses on who might be a sensitive receptor.

Moderator: Chlorine gas, what are those effects?

Bokelmann: Eye, nose, respiratory responses, irritation, difficulty breathing, tearing, those sorts of things.

Moderator: Is there a temperature component to that, if University exposed to it and it’s extremely cold?

Bokelmann: If you’re at the point of release. It comes out of the container at a very cold temperature so if you’re very close to it, you can get frostbite. Hopefully the residents wouldn’t be close enough, but a responder could.

Moderator: Or the train crew definitely as well. How would you protect the public from the potentially adverse effects of a disaster of this nature?

Bokelmann: Well, we rely on two avenues for that, one being evacuate, and we now evacuate, move out of the hazardous area. The other is shelter-in-place. That’s stay put in a secure area so you don’t have an exposure. And the area that would possibly-- in this chlorine release that we would be talking about, we would want to protect a pile and a half down wind, depending on how stable the wind direction and speed are, that may expand to a very wide area and include half the town. So we’re trying to look at communicating with all these people and tell them to stay put or to leave and by what route we want them to leave so they don’t interfere with the response actions of the emergency responders.

Moderator: Anna Marie, probably a good component of our audience today comprises public health professionals. What role would public health play in-- in an incident of this nature?

Bokelmann: Preparedness, getting people ready, making sure they understand what they need to do, and in the support, They’re not going to be in the middle of the response but on The periphery providing for support, shelters, if we’re evacuating people, food, water, you know, those sorts of things.

Moderator: Perhaps remediation in terms of emission pathways and long-term health effects. You talked about what people need to do to plan for themselves and we touched on It earlier that duct tape and plastic. When it came out in a list of preparedness items, I think the Department of Homeland Security. Actually, they made fun in the media but is there a place for duct tape and plastic and what do people need to think about?

Bokelmann: Anyplace contaminants can enter the home. If you have a broken window or a door that doesn’t seal very well. If you have outside air coming in through the ventilation ducts, those are things you would want to cover up and prevent from coming out.

Moderator: If you’re getting cold drafts in the winter, you know you have a situation where it could be getting in.

Bokelmann: Yeah.

Moderator: But obviously people have to be careful that they don’t totally seal themselves off from air for a long time.

Bokelmann: Shelter-in-place doesn’t work if we need you to stay put for a week. It’s for a day or two at the most. Otherwise, we have to move you from the area. So it would be an immediate response, until the plume passed or the leak was stopped and we didn’t have the same atmospheric concentrations of the chemical that would produce adverse effects.

Moderator: Are there other things that would be helpful?

Bokelmann: Food, water, medications, some communication device so you can hear instructions, those sorts of things.

Moderator: Is a chemical like chlorine gas corrosive to the point that it could affect telephone lines and wires for electricity?

Bokelmann: Oh, you’re asking me to go outside my knowledge area. I'm not sure that--

Moderator: The reason I ask is because in a couple of instances where I had read about chlorine gas leaks, I see they had interference in telephone communications.

Bokelmann: The other thing with telephone communications is that everybody wants to make a call and so you jam up all of the resources, especially cell phone use. If you have a land line, you have a better chance of making a call that’s successful than a cell phone.

Moderator: I want to remind everybody that the University at Albany Center for Public Health Preparedness does have an on-line course for personal preparedness, and it’s well worth your time because there are so many things that we don’t think about, and in an emergency, it’s too late to start thinking about it then. So definitely check out our web site and take advantage of that course. Let’s talk about not just the individual but the community as a whole. How do we prepare the community?

Bokelmann: Education, training, providing for resources. If you have people that don’t have the financial ability to have the disaster kit that they need to have at home, providing for that. So we have to identify who it is that exists in our community, what their education levels are, what they understand, what language they speak, and where they may be at the time of a release and talk about dealing with school children at school versus school children at home. There’s going to be different approaches to that.

Moderator: Would drills and exercises be a good approach?

Bokelmann: Absolutely, absolutely. And making sure there’s some oversight, someone in charge to be sure that everything is taken care of.

Moderator: Who would be the incident commander in a chemical emergency or would it be situational?

Bokelmann: It is. If it’s a railcar, definitely the railroad would want a role in incident command but generally you find law enforcement, fire service, state agency, federal agency, depending on the size of the incident. And in a joint command or unified command structure rather than one person in charge.

Moderator: I don’t know how much we have touched on the health care system as an important partner, but certainly for the consequence of management, that’s got to be taken into consideration.

Bokelmann: That’s where everybody wants to go. We’re going to the hospital. We feel sick; we want to go. So the more we prepare folks for when they can do that and when they can just treat at home or if it’s not serious enough to go to the hospital, we can alleviate some of the traffic jam that might occur in the emergency room

Moderator: But people do show up at the hospital after being exposed to a chemical. We have to think about decontamination.

Bokelmann: Absolutely, what it’s going to do to the hospital facilities.

Moderator: And whether it could play an effect or-- there’s so much to think about. That’s why we have to plan in advance. What’s the difference in planning for an event of this magnitude in an urban setting versus a rural locale?

Bokelmann: In an urban setting, you have lots of resources. In a rural setting, most resources will have to be brought in and may have to travel considerable distances, so there will be some time lapse between when the event takes place and when we see some type of control of it. And in that time, that’s the important time where we deal with the residents and what we’re going to do about them. That has to be taken care of immediately. That’s why the point of my presentation today is to focus on that and focus on the residents, because we’ll all respond. Everybody will have a response. It’s just whether or not we’re going to respond properly.

Moderator: All right. Rural areas, large geographically, but population wise, not so large.

Bokelmann: Right, spread out.

Moderator: And is that easier or harder to plan for?

Bokelmann: Well, you know, it’s a little-- it’s probably just as difficult. In an urban area, you have quantity. You have so many people you have to deal with that it’s a huge burden. In rural, you don’t have at many people but they’re scattered all over, so it’s tricky to communicate with people and get the job done.

Moderator: Are there common characteristics or what are the demographics we should think about?

Bokelmann: Lots of them have train tracks right through the middle of town. They don’t quite have the resource to have full-time, trained emergency responders right there in their facilities-- in their neighborhoods. There may be challenges with respect to moving people, mobility, and also with resources. So they present their own challenges. I'm not saying that it’s easier or harder than in an urban setting; it’s just different.

Moderator: Take us through how you would implement the plan. You talked about essentially two options: you’re going to take the people to safety, move them to safety, or keep them as safe as possible at home. Evacuate versus shelter-in-place. How do you implement either of these?

Bokelmann: The emergency responders, the first on the scene, they will determine which way we want to go, either evacuate or shelter-in-place. The important thing is that that message get to everyone, and so we preplan to figure out how we’re going to share that message, and if our first approach, our first effort-- television, radio, if that’s not effect, what will we do second to that. The other thing is to make sure that people know what to do if they’re asked to evacuate and know what to do if they’re asked to shelter in place.

Moderator: We’re ready to take your calls now and we’ll remind you of the toll-free number again: you talked a lot about the need to have some sort of a warning mechanism, be it a siren, be it a good plan for public address, be it weather radios that could wash people of emergencies other than weather-related. Who’s responsible for getting that started? Is it federal responsibility, state, local? How do we go about making this happen?

Bokelmann: The emergency-- when the emergency occurs, the local responders will say, "we need to evacuate." The law enforcement, if you have are large-scale, you may end up with the National Guard. It could be anybody that aids in that process. The signal, though, is whatever is best going to be understood by the population. So that’s something that’s going to be identified on an individual basis.

Moderator: So that probably should be a key component of the local planning?

Bokelmann: Yes, absolutely.

Moderator: And of course testing those signals on a regular basis. I know in the areas around commercial nuclear power plants, they have warning sirens, but they test them regularly, and unfortunately on a number of occasions, some of the sirens tend to not sound.

Bokelmann: Right. They malfunction, as anything can malfunction, so you have that backup plan. And where there are chemical facilities, nuclear facilities, the personnel within the facility train, they drill. They know what to do. They know how to solve their problem. Where the system kind of falls apart is what you want the public to do. Do they know what to do?

Moderator: And do you think the public classifies all chemicals with sort of a broad brush? They are as worried about something that might not be as dangerous as another chemical that is more hazardous?

Bokelmann: I don’t know because it depends on education. You can have chemicals all around you, in your food, in your hair care products, in your-- we know now there’s lead in lipstick, lead paint in your toys, so we’re surrounded. So I don’t know if that desensitizes people to the need to be paying attention or if it increases their sensitivity.

Moderator: You talked about railway accidents, and unfortunately-- you said it was a very small percentage. Do you have that number?

Bokelmann: More than 99.9% of cargo travel on rail makes it to its destination, so it’s very rare, but it’s spectacular when it occurs because you have a large volume. It may be a very hazardous chemical, may be in a remote location. It’s very exciting but very rare. We don’t want people to think every time a train comes down the track they need to get the duct tape and plastic.

Moderator: That’s a good point to make. What percentage of chemicals or just give us a characterization of how much is over the highways?

Bokelmann: Oh, about the same amount. We do travel a lot of gasoline fuel products, which is something we hadn’t mentioned in this discussion. Chlorine is not an explosion hazard, but if you have release of something that could explode, shelter-in-place gets to be more interesting. Not only do you want to seal things up, but where the glass could break into the house, you want to make sure that’s covered, too, so you want to close your shades so if the glass were to break it wouldn’t blow into the house on anybody that’s inside.

Moderator: You have touched on over and over during the last quarter of an hour, three-quarters of an hour, the need for people to be educated, and it would seem that in something as important at this, it would be great to get members of the public involved in drills and exercises. Is anybody doing that or how do we do that?

Bokelmann: I don’t know the extent of that actually occurring. I'm afraid to say. I don’t really think it’s happening very often if at all. It’s a huge undertaking and you have to invest resources to do something like that. But it is important. It’s just like people having fire drills in their own home. How many really do that? But you know it would be a good idea, right?

Moderator: Especially if it’s late at night and the smoke alarm goes off - everybody runs around, “What do I do? What do I do?" There’s a public engagement That’s very much in vogue now And it basically is trying to learn what you don’t know by engaging the public. Has it been used in chemical disaster planning, do you know?

Bokelmann: I don’t know. I know after 9/11, we were Instructed to look at vulnerability and do community risk assessments and vulnerability assessments, Identifying our sensitive areas, our chemical facilities That could be attacked, as well as where schools and nursing homes and sensitive receptors might be, but to the point of drilling individuals in their homes, whether they know what’s to do and let’s pretend we’re having a release and everybody shelter in place and what questions and problems do you have after you tried that drill, I don’t know if that’s occurred.

Moderator: Maybe it wouldn’t have to be something quite to that magnitude, but just finding out people’s attitudes at to how willing they would be, for Instance, to evacuate if you asked them to, or to shelter in place when they know there’s something bad out There.

Bokelmann: Right. That would be important to plan, I would imagine.

Moderator: And we saw in the Katrina situation the variety of attitudes, the people that want to just wait it out and stay with their stuff and stay with their animals, and then the other people that heeded advanced warning and left. So how attached you are to your home, your pets, your life, and how willing you are to be separated from that for who knows how long. So there are a lot of psycho lodge al-- psychological and emotional issues that has to be incorporated into that. And what happens in a drill is not necessarily what happens in real life.

Bokelmann: Right. Because people are reacting from a whole different-- In a fire drill, you leave your stuff. In a fire, you want all your stuff.

Moderator: We’re starting to get some questions. The first one, Anna Marie, is asking you to exemplify the use of the Vulnerability and Capacity Matrix. Could you go through that again for us?

Moderator: Do you want to go back to that slide and see what it looks like? That was-- I don’t know. Can you do that?

Bokelmann: The vulnerability and capacity matrix is what we’re trying to talk about. Basically, it talks about looking at who’s at risk and--

Moderator: It says, "What are your Vulnerabilities?" The first row is talking about physical and material. What is vulnerable? We look at that saying where we have those things that could be problematic and those things that could be sensitive-- sensitive. So we could say where are our chemicals in our area, our neighborhood? And also what are our resources that could be vulnerable, like our water. If we use well water and we have a discharge to the soil that could get into the well water, what would we do? The capacity is looking at alternative sources for water. Do we have that available?

Bokelmann: The social and organizational, the second one down there is who is vulnerable, and that again focuses on our receptors and not limiting to human receptors. It may be ecological. We may have a wetland area, endangered species, livestock, cattle, things like that, and then what our capacities are with respect to modifying that vulnerability or controlling it. And then, finally, is the motivational and attitude. Its convincing people it’s important for them to do what you need them to do, and so that’s looking at receptor behavior. I think that again if people know how things are dangerous for them or how they might hurt them, they’re going to do what they can to minimize their own personal risk. We just need to say, "This is what you need to do to minimize that risk. These are what the risks are." They need to understand these things.

Moderator: I apologize for putting you on the spot, but it’s an important component to reiterate. Thank you for doing that.

Bokelmann: If you put vulnerability and capacity matrix in a search engine, you’ll get to a whole lot of information on what to do with that. but you look at each thing that you’re vulnerable. It’s not just a chemical spill. You can look at the possibility of a tornado, the possibility of an earthquake. You put these together and say, "what could happen and how could we intervene to prevent that from becoming a real serious problem?"

Moderator: So we can look at it exponentially.

Bokelmann: Absolutely.

Moderator: We have a call from Nassau County. Go ahead, caller.

Caller: My question has to do with regarding the immediate notification of the public when an emergency occurs in their community. Could you comment on what the State should do or has done and what leadership role can the state play in making sure that there’s a uniform system for alerting the public to an emergency in their community and perhaps this should consist of using the sirens that are available in all of the communities throughout the State.

Bokelmann: So at the state level, again, that’s guidance and resources. At the individual community level, it’s hard to come up with funding to support any kind of installation of equipment or purchasing of equipment or even training the community. So if we can get that sort of funding resources and expertise from the state level that would be extremely beneficial. But the siren is one idea. In the fires in California not that long ago, they used reverse 911, so everyone got a phone call, and when you have a lot of cell phones, that can really be helpful, so siren is not necessarily the only thing that we can do. Again, the radio, the television, those are things that folks typically turn to for that sort of information, but the state role with the state emergency planning committees and then down to the local emergency L.E.P.C.S., right, the planning, Communities at the local level can help, but the L.E.P.C.S. are areas where we have fixed facilities. If there are facilities in your area, you’re more likely to be prepared for a release. If there aren’t any, there would obviously be less local resources to support that sort of information.

Moderator: But maybe the communities that have fixed resources could be a resource for planning in terms of sharing lessons learned.

Bokelmann: Right. And they do generally have mutual agreements to share their resources and to promote those would be very helpful from the local authority level, to encourage that sort of a relationship.

Moderator: Thank you, Anna Marie. We have a call from Minnesota. Go ahead, caller.

 Caller: Thank you. Anna Marie, you referenced the NYOSH Pocket Guide and talked about the fact that chlorine was heavier than air, but where in the guide does it provide that specific information?

Bokelmann: That’s relative gas density. Sometimes it’s listed as vapor density, and if you look under-- on slide 31 is-- On slide 31, physical Description-- do you see it? Relative gas density 2. -- Something. It’s so small on my slide I can’t read it.

Moderator: I don’t know if everybody has the slides, but they will be available on-line in a few days. Toward the bottom - the physical description section highlighted in blue. If you go below that, the second row; I think it’s the third listing across-- does that say relative gas density? When you go to the NYOSH website, you can put your chemical name in and it will show all this information, but also it has a glossary and it has an introduction that explains how you would use all this information. So it’s really accessible and user-friendly, and we have a link to that guide right on our web site, so our viewers can access that right on-line. Another question, the role of the Emergency Planning Committee, the Citizens Emergency Response Team, Medical Reserve and Red Cross. What role do they play in the planning or response to an Environmental disaster? It would seem to me they would all have different roles in different parts of the cycle.

Bokelmann: Right. And it depends on their expertise and resources, what they bring to the table. When we plan, we say "what do you have to offer and how does that fit with what we need?" And everyone has their role. The Red Cross, Salvation Army, Those are extremely helpful in a situation where we have evacuations. They’re going to provide for the shelters, the support while people are away from their homes, and the other, again, it’s what tools do you have? What equipment, what people, and what resources do you have and how can we combine those things into an effective response?"

Moderator: Maybe turn around your traditional thinking because when I saw the question about the Red Cross, I immediately thought about in terms of consequences management immediately after the response, and then at we’re talking I was thinking about you really drilling into the fact that education is so necessary, the Red Cross does a lot of preparedness education, and they could be a valuable resource in getting the information out of there.

Bokelmann: They have lots of information on the web site about evacuation and shelter in plates and what to do and what to listen for and how to be very efficient about it so you don’t become part of the problem; you’re part of the solution.

Moderator: We have another question that asks for specific strategies for communicating with individuals who have special needs, particularly those who are not fluent in the English language. What are some just common sense steps we can take?

Bokelmann: We need to go to where they get any information, and that maybe their charge. They may have a community group. There are certainly leaders in their community that are bilingual that can effectively communicate with that population. We just need to-- maybe even at the schools and through the school children that information gets to the adults, to the parents.

Moderator: That’s an important point because I read recently that they’re really focusing preparedness messages in school children because they come home, and they actually give them assignments to see what they have in terms of the items you need to be prepared, and they can be very persistent in asking mom and dad what it is they need to do, so that’s really good.

Bokelmann: Right.

Moderator: The other thing, as you were speaking, that occurred to me is how often are community-based organizations Included in part of the planning process?

Bokelmann: It depends on how progressive your local planning committee is. Sometimes we include them and sometimes we don’t necessarily think about them. I'm hoping that’s what this message will be. If the community knows what to do, your life is going to be a while lot easier in resolving your release situation because you won’t have to worry about what everybody is doing; you’ll just be able to focus on stopping the release, minimizing the impact to the environment and restoring the area back to the way it was before. If people are taking care of themselves or are being taken care of and they know what to do.

Moderator: And to have realistic expectations so that individuals don’t expect that they can be rescued while this is taking place and they know they can protect themselves for a short time at least. Otherwise, they may do something that’s counter to their best interests.

Bokelmann: Right. As we have seen in fairly recent disasters. Not chemical disasters, but disasters in general, yes.

Moderator: Let’s talk about your key messages. Could you summarize them for us? What should we take home as a result of our discussion today? What are the most important things to remember?

Bokelmann: Well, to me it’s 'don’t take anything for granted'. Don’t assume people know what to do. And make a real effort to educate the public as to what is expected in an evacuation, what is expected with respect to shelter in place and make sure they understand how to hear that message if, you know,-- if the alarm sounds, You know what to do. That would be the-- you know, if we get that message out today, I think that we have done a great service.

Moderator: And our planners need to be using the E.P.A. risk paradigm?

Bokelmann: It’s a good which to think about things. Once you start doing it, you start doing it all the time. You say, "I’m bringing a chemical into my home and am using it to paint the furniture, what are the possible health effects? Do I need to use ventilation? Where’s it going to go? Where are my receptors, my kids, when I’m doing this activity?" It’s something you end up thinking about all the time, small scale to large scale.

Moderator: Are there web sites that can be helpful to planners as we start to think about how best to address this really large challenge?

Bokelmann: Yes. Well, we have listed here the web sites that were used in the presentation. We have the NYOSH Pocket Guide, but we have access to the North American Emergency Response Guidebook. That’s also available on-line, the orange book that we showed a picture of that the first responders will use. Both of those things could be effective tools in their community training session when you’re talking about chemical releases. The Red Cross, an excellent resource for shelter-in-place and information on evacuation, what to bring, what to have in your disaster kit, what to do, you know, all of those important aspects. These are all listed here for you. And there’s many more.

Moderator: One of them being the Centers for Disease Control and Prevention.

Bokelmann: And that’s where the NYOSH Pocket Guide comes from, too.

Moderator: Very good. And the National Transportation Safety Board, especially talking about railcar accidents--

Bokelmann: Right. If you’re in a remote area and you don’t have fixed facilities, you’re mainly planning for transportation-related problems, so those would be useful resources from them, too.

Moderator: You are a wealth of information. I'm sure our viewers want to know how they can contact you if they want further information.

Bokelmann: I can be reached at the Health Science Center at Texas A&M University. That’s the best way to have contact with me.

Moderator: What would you like to see done? You said education. So we have to educate our citizens about the role they need to take. What else?

Bokelmann: Well, I think that’s the main thing. If people know that they have control over their exposure-- their potential risk, they will do-- I trust and believe they will do whatever it takes to minimize their adverse effects. Nobody wants to get hurt, so if they know what’s going on and they can understand and they can believe, then they can do what needs to be done. We spend a lot of time training-- you know, I teach a graduate program. We’re training all kinds of people that will have professional responsibilities, but we don’t go to the, you know, Joe Citizen, and it’s not his job. So why would he know, unless we tell him?

Moderator: But we have to convince him and her that it is their job because--

Bokelmann: It’s in their interests.

Bokelmann: It’s in their interests, and we all need to be responsible to some extent to not be part of the problem. The other thing I wanted to talk about because you had focused on it as well is the plan "b." I remember two years ago there was a train derailment in, I believe it was Graniteville, South Carolina, similar situation to the one you talked about in Minot, North Dakota, except I think the chemical was chlorine gas. Now, interestingly, the volunteer fire house that was the prime response agency was directly in the plume and the volunteers could not get there to get their equipment. I'm not sure what they did, but this would be-- I mean what would you do?

Bokelmann: Sometimes you can’t respond to the point of the release to stop the release. The main thing that we have to do is get to a position where we can wait, and that means give the release enough room to do whatever it is that it’s going to do and wait until we have the resources and capabilities to respond. So its still-- even if you can’t get to the emergency apparatus and go to the scene, we still have to get people out of the way. We still have to move people out of the potential exposure area, and that’s almost always going to happen, so that’s why we need to focus on the things that we have discussed today.

Moderator: And plan "B" of course, we also have to think about having-- well, the fancy term is redundant capacity in notifying people. If the radio station isn’t staffed, the telephone lines are down, if they’re asleep and not able to get an e-mail message--

Bokelmann: Go door to door! (Laughing) We may have to!

Moderator: The electricity is down; you may have to do that.

Bokelmann: Right.

Moderator: These types of man-made, exotic threats tend to have a long-term biologic impact. We did a program last month on psycho/socio-effects. In Minot, there was a lot of long-term psychological impact. Can you talk about how you get people through that?

Bokelmann: It’s similar to post-traumatic stress. Every time the train goes through, they get nervous this is going to be another incident, and no matter how often you tell them it’s a rare event; it’s not likely to happen twice in the same place, whatever caused the initial event has been resolved, the track has been repaired, the problem has been taken care of, they still get that jumpy, anxious, don’t want to live near the tracks concern. And you have to properties through it just like you would any kind of post-traumatic stress.

Moderator: I think some of the advice is to give people things to do to help them feel they are not a helpless victim or the situation is hopeless, so if planners can come up with some concrete suggestions that will make people feel that they do have a role and that they can help themselves, that may assist in getting through this at well.

Bokelmann: Again, it’s the education. It’s the more you know, the less likely you are to put yourself in a position where you’re going to have a problem.

Moderator: And we probably should also mention that we do have that show on the psycho/socio-effects. In that instance it was a radiological emergency, but I can’t imagine chemical is a whole lot different in terms of effect on people, that’s archived on the web site along with all our broadcasts. So we think that’s really important that people take advantage of them. What else should we discuss today?

Bokelmann: I think we have about covered everything that I had prepared for today. Just making sure that people know what to do and they’ll act accordingly. We can expect that folks are going to do what we help them understand that they need to do.

Moderator: So we’re talking about a rare risk, but real and potentially very hazardous in its consequence.

Bokelmann: It’s very exciting, big, frightening, all of those things, and the rareness of it means you don’t practice. It’s not like you can get better at it because it doesn’t happen often enough, hopefully.

Moderator: One last question: funding sources for this training. Where are we going to find the money?

Bokelmann: You tell me! (Laughing) It’s worth it, though. It’s worth an effort to try to find the funding to promote This sort of education so we can minimize the outcome because if we have to have a lot of hurt, injured people, we’re going to have to pay for that, so oh it’s see me now or see me later sort of thing.

Moderator: Exactly. And to some extent we’re talking all hazards because if we have a good system for notifying people about a chemical accident, we have a good system for notifying them about anything that’s going to happen.

Bokelmann: Absolutely.

Moderator: So its money well spent. We just have to find it! Thank you so much for joining us today.

Bokelmann: Thank you.

Moderator: We would like very much that you please fill out your evaluations on-line because your feedback is so important to the developing of our programs. And continuing education credits are available after you complete the post-test. We’ll put you to work a bit. This program will be available via web streaming within a week. See our web site for more details. I'm Kris Smith. We’ll see you next time on the Albany Center for Emergency Preparedness Grand Rounds. Thank you so much. You were very good.

Bokelmann: Thank you. (Music)

 

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