Mechanisms of and Facility Types Involved in Hazardous Materials Incidents Stephen N. Kales,1'2'3 Gerry N. Polyhronopoulos, Michael J. Castro,4 Rose H. Goldman,7 2'3 David C. Christiani3'5'6 1The Cambridge Hospital, Cambridge, MA 02139 USA; 2Harvard Medical School, Boston, MA 02115 USA; 3Harvard School of Public Health, Department of Environmental Health (Occupational Health Program), Boston, MA 02115 USA; 4Newton Fire Department and Metrofire Haz-Mat Team, Newton, MA 02159 USA; 5Pulmonary/Critical Care Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02115 USA; 6Center for Occupational and Environmental Medicine, Massachusetts Respiratory Hospital, Braintree, MA 02184 USA The purpose of this study was to systemaically investigate hazardous material (hazmat) releases and determine the mechanisms of these accidents, and the industries/activities and chemicals involved. We analyzed responses by Massachusetts' six district haz t teams fiom their inception through May 1996. nformation from incident reports was exraced onto standard coding sheets. The majority of hazatdous matea incidents were caused by spils, leaks, or esca of hazardous materials (76%) and ocurred at fixed facilities (80%). Tramportation-elated- accidents account- ed for 20% of incidents. Eleven percent of hazardous materials were at schools or health care facilities. PetroWsum-deriv t fuels were involved in over half of traportation-relate acci- dents, and these accounted for the majority of petroleum fuel releases. Chlorine derivatives were invohKed in 18% of all accidents and were aociated with a wide variety of faclity ypes and activ- ities. In condusion, te ic study of hazardous materials indnts allows the identcation of preventable causes of thiese incidents. Key wordn chemical accidents, chlorine, environmental exposure, ethylene oxide, hazardous substances, hospitals, petoleum, public healh. Environ Healh Penpea 105:998-1001 (1997). /rtpllehis.niehs. nihgpv The EPA has defined a hazardous material as any substance that "may present severe health hazards to humans following short- term exposure during a chemical accident or other emergency" (1). A hazardous mate- rials (hazmat) incident may potentially occur at any point in the manufacture, stor- age, transport, sale, usage, or disposal of a substance (2). Approximately 60,000 chem- icals are manufactured and used in the United States, and about 2,000 of these have been defined as hazardous by the Department of Transportation (DOT) (2). Examples such as the methyl isocyanate release in Bhopal, India; the explosion involv- ing dioxin in Seveso, Italy; the Chernobyl nuclear accident in the former Soviet Union (3); and the recent Tokyo, Japan, subway sarin attack (4) have emphasized that haz- ardous materials releases may cause substantial human morbidity and mortality. Many reviews (5-1J) have addressed the need for emergency community and medical prepared- ness to minimize the adverse consequences of such incidents, and many communities have formed local emergency planning committees (LEPCs) and hazardous materials teams to cope with accidents. Yet, there has been little discussion in the literature directed at the pri- mary prevention of such incidents. We previously studied the first 88 haz- mat responses by Massachusetts' six district hazmat firefighter teams, from their incep- tion through February 1994 (11). In this paper, we report on all 165 hazmat responses by the same teams, from their inception through May 1996, focusing on the causes of these accidents, the facility types involved, and the chemicals associated with specific facilities or activities. Methods The Metrofire Hazmat Team (formed in June 1990) is made up of selected firefight- ers from 24 fire departments in the greater Boston suburban area and responds to haz- mat incidents within an area of 43 commu- nities. Likewise, the other five Massachusetts district teams are made up of firefighters from various local departments in the fol- lowing regions: Natick (formed in May 1991), Lowell (November 1990), Bourne (November 1990), Chicopee (May 1991), and Pittsfield (September 1991). A hazardous materials incident includ- ed any situation, incident, or accident to which one of the regional teams respond- ed. Copies of incident reports were obtained directly from the Metrofire Hazmat Team. The other five district teams submit summaries of all of their incident responses to the Hazmat Tech, a newsletter for Hazmat technicians co-pub- lished by one of the authors (M.J.C.). Information from each report was then extracted onto a standard coding sheet for each incident. This information included the local fire department and hazmat team responding to the incident; the site and type of facility involved; the chemicals or agents encountered at the episode; the mechanisms causing the release; and civil- ian, firefighter, and hazmat technician injuries. Spills were defined to include any spill, leak, or other escape of hazardous material not resulting from fire or explo- sion. "No release of hazardous material" included those incidents where no spill, fire, or explosion occurred, such as responses to intact containers. Injuries were defined con- servatively to include any injury, exposure, symptomatic individual, and/or anyone transported to a health care facility. The original incident database contained information on all incidents from the teams' inceptions through February 1994 (11). It has subsequently been updated to include all incidents through May 1996. A detailed dis- cussion of the types of injuries and the haz- ardous substances involved is presented else- where (12). Results During the study period, the six district hazmat teams responded to a total of 165 incidents. Table 1 shows the frequency of various causes of hazardous materials inci- dents and the number and percentage of these incidents resulting in injury. The vast majority of responses involved spills, leaks, or other escapes of hazardous materials. For three (2%) of the accidents, information on causes was unavailable. The totals exceed 100% because more than one cause was responsible for some of the accidents. The proportion of incidents resulting in injury was highest for explosions, but was similar for other causes of accidents (fires, spills, and motor vehicle accidents), either alone or in most combinations. Explosion- associated injuries included inhalation expo- Address correspondence to S.N. Kales, Occupational Medicine, Department of Medicine, The Cambridge Hospital, 1493 Cambridge Street, Cambridge, MA 02139 USA. S.N.K. is supported by grant KO1 OH00156-01 from the National Institute for Occupational Safety and Health of the Centers for Disease Control and Prevention. RH.G. is supported in part by NIH grant IK07ES00266. D.C.C. is supported by NIH grants ES00002 and ES05947. The authors would like to thank the members of Massachusetts District Hazardous Materials Response Teams; James D. Weed, Director of the Commonwealth of Massachusetts Hazardous Materials Response Program; and Dianne Plantamura, Karl Kelsey, Howard Hu, Thomas Gassert, Charles Sweet, and Darvid Artzeronian for their continuing support of this research. Received 21 January 1997; accepted 27 May 1997. Volume 105, Number 9, September 1997 * Environmental Health Perspectives 998 Articles - Hazardous materials incidents sures, explosion-related trauma, and chemi- cal burns. Injuries sustained during vehicu- lar accidents, with or without spills, were primarily due to the vehicular accidents and not to hazardous materials. Over 70% of injuries sustained during fires were due to inhalation exposures. Most spill-associated injuries were chemically associated: most fre- quently, inhalation; followed by dermal exposures; while trauma due to motor vehi- cle accidents occurred in five incidents. Table 2 describes the facility type or activity at which hazardous materials acci- dents occurred. The majority of hazardous materials incidents occurred at fixed facili- ties; transportation-related incidents accounted for 31 of 157 (20%) incidents. When considering individual facility types, transportation-related incidents were the most common, followed by accidents occurring at industrial, commercial, health care, and residential sites. For 8 (5%) of the incidents, information on the facility type or location of the incidents was unavailable. There were several specific locations involved in accidents more than once. There were two incidents at a company involved in the cleanup and transportation of waste; both of these incidents involved lead, and one each involved sulfuric acid and silver metal. A trucking terminal had two incidents involving spills. There were two incidents at a police headquarters due to a faulty heating system that filled the building with carbon monoxide on 2 con- secutive days. There were two incidents at one chemical company involving fires and a mixture of materials, including neoprene, a synthetic rubber compound. Finally, there were two incidents at a university, both occurring in laboratories during experiments, which resulted in fires. Table 3 displays the hazardous materials that were observed frequently in incidents at specific facility or activity types. Oil was involved in almost half of transportation- related incidents, and transportation-related incidents accounted for 15 of 22 (68%) accidents involving oil. Chlorine derivatives and gasoline were also observed in multiple transportation-related accidents. The majority of hazardous materials acci- dents at hospitals involved ethylene oxide. Similarly, of the seven incidents involving ethylene oxide, five (71%) occurred at hospi- tals. Freon, which is mixed with ethylene oxide in gas canisters for use in sterilization, was involved in three of eight incidents at hospitals and in three of five (60%) incidents involving ethylene oxide. Eight hazardous materials incidents occurred at schools. Chlorine derivatives were involved in half of these, and metals/metal- loids were involved in another 25%. Metals/metalloids were also observed repeat- edly at chemical companies and other indus- trial sites and twice in waste-related accidents. There were several facility types that were very strongly associated with specific haz- ardous materials. Cyanide was found in three of four incidents at electroplating operations, while three of five accidents involving cyanides were at electroplating facilities. Of the three incidents involving cyanide that occurred at electroplating operations, two (66%) resulted in inhalation injuries. All three incidents that occurred at gas sta- tions involved gasoline [three of seven (43%) accidents involving gasoline oc- curred at gas stations]. In both incidents at water treatment facilities, chlorine was the sole hazardous material involved. Some frequently observed substances were associated with many different types of facilities and activities: chlorine deriva- tives were observed in 30 (18%) incidents involving 15 classes of facilities; ammonia derivatives were associated with 10 facility types in 11 incidents; metals/metalloids were observed at 8 facility types in 12 acci- dents; nitrites/nitrates were associated with 8 facility types in 12 accidents; and sul- fites/sulfates were observed in 7 classes of facilities in 10 incidents. Discussion Spills (including other leaks and escapes) of hazardous materials, either alone or in combi- nation, were the most frequent cause of haz- ardous materials accidents in this study and were involved in 76% of accidents. This is in agreement with our initial study [team incep- tion through February 1994, 88 incidents; (11)], which found spills to be involved in 79% of Massachusetts hazardous materials incidents. Shaw et al. (13) found that leaks or drops from moving vehicles and vehicular accidents were common causes of hazardous Table 1. Frequency of causes of hazardous materi- als incidents and number and percentage of those resulting in injury Number of Number of incidents incidents Incident type a%)8 with injury (%)b Spill 123 (76%) 32(26%) Fire 27 (17%) 9(33%) Vehicular accident 26 (16%) 8 (31%) Vehicular accident and spill 25 (15%) 8 (32%) No release of hazardous material 17 (10%) 4(24%) Explosion 14 (9%) 6(43%) Fire and spill 13 (8%) 2 (15%) Spill and exposion 4(2%) 0 (0%) Totals exceed 100% because more than one cause was responsible for some accidents. aPercent of total incident (n = 165). bPercent of that incident type. materials incidents reported by the California Highway Patrol. The present results support the recommendations derived from these two studies (11,13) that tank and container con- struction, as well as worker education regard- ing the safe loading, handling, and disposal of hazardous materials, are appropriate targets for preventive interventions. Table 2. Facility type and frequency of hazardous materials incidents Facility type Transportation Industrial Commercial Health care Residential School Chemical company Laboratory Environmentalc Recreation Truck terminal Waste related Warehouse Electroplating Office Gas station Dry cleaners Police department Water treatment related Miscellaneous Total Number of Number of incidents incidents (%)8 with injury (%)b 31 (20%) 8 (26%) 19 (12%) 5 (26%) 15 (10%) 7 (47%) 10 (6%) 3 (30%) 9 (6%) 3 (33%) 8 (5%) 1 (12%) 7 (4%) 2 (28%) 7 (4%) 2 (28%) 6(4%) 1 (17%) 6 (4%) 2 (33%) 6 (4%) 1 (17%) 6 (4%) 4 (67%) 5 (3%) 2 (40%) 4 (2%) 2 (50%) 4 (2%) 2 (50%) 3 (2%) 0(0%) 2 (1%) 0 (0%) 2(1%) 0(0%) i 2(1%) 0(0%) 5 (3%) 1 (20%) 157 (100%) 46 (29%) aPercent of total incidents. bPercent of incidents at that facility type. clncludes releases into areas such as parks and rivers. Table 3. Hazardous materials frequentlya found at facility types and activity types during hazardous materials accidents Facility or activity type Transportation (n= 31) Hospital (n=8) School (n= 8) Laboratory (n= 7) Chemical company (n=7) Electroplating (n=4) Gas station (n=3) Hazardous material Oil Chlorine derivative Gasoline Ethylene oxide Freon Chlorine derivative Chlorine derivative Sulfuric acid Metals/metalloids Cyanide Gasoline Other industrial Metals/metalloids (n= 19) Solvents Number of incidents (%)b 15 (48%) es 4 (13%) 3 (10%) 5 (62%) 3 (38%) Bs 4(50%) Bs 4(57%) 3 (43%) 4(57%) 3 (75%) 3 (100%) 4 (21%) 3 (16%) 8Hazardous material was found three or more times at a facility or activity type. bNumber of incidents at that facility type involving the hazardous material and percent of incidents at that facility type with that material. Environmental Health Perspectives * Volume 105, Number 9, September 1997 999 Articles - Kales et al. Petroleum-derived fuels, although they are not usually considered corrosives, should probably be transported in stronger tanks, given that these fuels accounted for over half of the transportation-related accidents in this series. Although most of these spills do not result in chemical exposure injuries, they may cause secondary motor vehicle accidents and present incendiary hazards. Even in the best case scenario, such spills still require deanup and possibly environmental remediation. The frequent involvement of petroleum-derived fuels in hazardous materials accidents war- rants reconsideration of their exclusion from programs such as the Massachusetts Toxic Use Reduction Program and the Agency for Toxic Substances and Disease Registry's (ATSDR) Hazardous Substances Emergency Events Surveillance (HSEES). Releases of hazardous materials at industrial, commerce, warehouse, trans- port, residential, and disposal-related sites confirm that hazardous materials accidents can occur anywhere along the chain of pro- duction, distribution, storage, usage, and disposal. The vast majority of hazmat responses by Massachusetts district teams were to incidents occurring at fixed facili- ties, while transportation-related accidents made up a significant minority (20%). This is similar to our initial study in which 84% of accidents occurred at fixed facilities (11) and to HSEES data in which 23% of events were transportation-related and 77% were fixed-facility events (14). These studies contrast with data from Binder (15) and Shaw et al. (13), who reported 56% and 89% of hazmat incidents, respectively, to be transportation related. As we have previously noted (11), this marked differ- ence is most likely due to the use of data- bases (California Highway Patrol and DOT) that are likely to be biased toward transportation-related incidents. It is of concern that 11% of responses were to incidents at schools or health care facilities. This is similar to our initial study in which incidents at health care facilities and schools accounted for 15% of all responses (11). These accidents are especial- ly worrisome because of the potential for toxic exposures to more susceptible popula- tions: children and persons with various medical illnesses. School and hospital labo- ratories and hospital sterilization areas using ethylene oxide (EtO) should be targets for increased safety planning, awareness, and training in the safe use of chemicals. Sullivan (16) has suggested that, although the use of EtO as a sterilization agent in the health care industry accounts for less than 5% of EtO production, the poten- tial for EtO exposure is probably greater in the health care industry than in the chemical industry. In this study, 71% of incidents involving EtO occurred at hospitals, while 62% of hospital accidents involved EtO. Although actual EtO exposures may have been small or even negligible during these incidents, the need for improvements in safe- ty and engineering controls is obvious. If successful, such measures could eliminate the majority of hazardous materials accidents at Massachusetts hospitals. The necessity to use hazardous chemi- cals in school laboratories should also be reconsidered. At present, hospitals, univer- sities, and schools are not included in the Commonwealth of Massachusetts Toxic Use Reduction Programs. Their representa- tion in hazardous materials accidents mer- its their consideration for future inclusion in such programs to reduce the use of haz- ardous substances. Chlorine derivatives were involved in 18% of all incidents and were associated with releases from a wide variety of fixed facilities and transportation accidents. The companion study (12) demonstrated that chlorine derivative releases have a high propensity for causing injuries (accounting for 23% of all incidents resulting in injuries). Injuries occurred in 38% of chlo- rine derivative-associated hazmat accidents; therefore, prevention of these accidents should have a very high priority. Several other classes of hazardous mate- rials, in addition to chlorine, were also fre- quently involved in accidents, but were associated with a diversity of facilities and activity types. In these cases, preventive efforts by manufacturers and distributors are needed to reduce releases. Such efforts may include safer containers, greater precautions in transport, and a greater emphasis on edu- cation and safety warnings directed towards industrial, commercial, and retail con- sumers. Kilburn (17) has recently comment- ed on the need for increased regulation of the transportation of hydrochloric acid. Although the sample is relatively small and regional, most of the facility types and chemicals involved could be expected in most areas. Certain industries, natural disas- ters, hazardous waste sites (sites contaminat- ed with or for disposal of hazardous materi- als), transportation routes, and other unique factors may predominate in different geo- graphic areas and thus predispose to certain types of incidents and exposures. Regional data should be useful feedback to LEPCs in determining their prevention and accident contingency plans. Such information may also be useful to toxic use reduction pro- grams in identifying target hazards for vari- ous types of industry and commerce. Specific companies and/or locations that have been involved in more than one hazardous materi- als incident should draw increased attention and preventive efforts from LEPCs. Comparison with our original Massachu- setts series [inception through February 1994, 88 incidents; (11)] demonstrates simi- lar relative frequencies of involvement of var- ious causes, chemicals, and facility types con- sistent with some degree of temporal stability in the pattern of Massachusetts hazmat acci- dents. This temporal stability suggests that hazardous materials accidents are not ran- dom occurrences and that effective preven- tive measures, based on historical data for a specific region, could prevent some future accidents in that same area. REFERENCES 1. Rules and Regulations. Fed Reg 51 (221):41473 (1986). 2. 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