Dr Shantakumari Rajan

Faculty of Health Sciences

UiTM Puncak Alam
shanta@uitm.edu.my

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Toxic Tragedies and Their Impact on Society

 Chemical incidents
 Planning and preparedness
 Historical cases
 Preventable tragedies

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Chemical incidents
Types of chemical incident

A chemical incident has been defined as “an unexpected

uncontrolled release of a chemical from its containment”.

A public-health chemical incident has been defined as

“where two or more members of the public are exposed
(or threatened to be exposed) to a chemical” .
(World Health Organization, 1999).

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 In the majority of cases, this is an acute release, where the
exposure dose is rising or is likely to rise rapidly.
 When the release is chronic, the exposure and dose do not
rise quickly and public-health measures do not have to be
taken so rapidly, though the public-health concern may
emerge suddenly.

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 Chemical incidents affect people in a number of ways,
including:
1) the effects of explosion;
2) the effects of fire;
3) the toxic effects of the chemicals.

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 Toxic effects of chemicals
 Chemicals enter the body through the skin, eyes, lungs or
digestive tract.
 The rate of absorption via these paths is different for
different chemicals, and is also affected by the
concentration of the chemical in contact with the body (the
concentration may change over time), the length of time
that the chemical is in contact with the body, the air
temperature, humidity and the person’s age.

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 Within the body itself, the effect depends upon the actual
toxicity of the chemical and on the biologically effective
dose (i.e. the quantity of chemical taken into the target
tissue).
 The way the dose is accumulated in the target tissue can
make a difference to its impact.
 Even if the exposure is short, the peak level might be high
enough to cause toxic effects.

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 When the exposure is prolonged and the dose rate low, it
may be the total cumulative dose that causes toxicity.
 Effects can be local (e.g. burning or blistering of the skin,
eyes or respiratory tract) or systemic, and the pattern may
be influenced by age, gender, immune state, concomitant
exposures and general fitness.

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 Some effects (e.g. eye and respiratory irritation or central
nervous system depression) can occur within minutes or
hours of the exposure.
 Other effects (e.g. congenital malformations or cancers)
may take months or years to appear.
 In addition to loss of life, the major consequences of
chemical disasters include impact on livestock, flora/fauna,
the environment (air, soil, water) and losses to industry

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 Public-health effects of chemicals
1. Stress and anxiety
 The occurrence of major chemical incidents has shaped the
way members of the public perceive exposure to chemical
substances.
 Such incidents are fear-inducing because they have the
potential to cause large numbers of deaths and illness and
because they raise questions about the fragility of
technologies over which the public may have little or no
control.

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2. Deaths and illness
 Large incidents cause considerable numbers of deaths (e.g.
the explosion at Bhopal, India in 1984).
 However, there are many more less-serious incidents which
cumulatively have a large health impact.
 These chemical incidents remain unreported unless a
specifically designed and targeted reporting system is in
place.

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3. Societal and economic costs
 Significant economic costs relate to livelihoods and
investments
 Costs related to closures of health care facilities, schools or
factories
 Costs related to litigation and compensation

 Costs related to helping affected communities recover

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 Risk Reduction: Planning and Preparedness

 As with responses to all types of disaster, careful planning

and thorough preparedness are prerequisites for an
effective response to a chemical incident.
 At the national level, government needs to set up
procedures and organizations to ensure that the public
health management of any chemical incident is effective
and comprehensive.
 A national plan should be circulated and discussed widely
until agreement has been reached.

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 At the local level, public-health authorities need to identify
situations where chemical incidents could occur, and assess
the likely health risks to exposed people, property and the
environment.
 The public-health sector needs to be fully involved in the
planning and preparedness process, including emergency
plan development and implementation.
 Many organizations will be involved in the planning and
response phases of chemical incident management.

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 MALAYSIA?
Who’s in charge?
Responsible?

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 Disaster Management in Malaysia

 Disaster management in Malaysia is currently

run by the National Disaster Management
Agency (NADMA).
 NADMA was officially established 1 October 2015 under the
Prime Minister’s Department replacing the National
Security Council (NSC) as the focal point in disaster
management.
 The disaster management organization structure continues
under three levels: federal, state, and district.

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 Preparedness Response

Disaster
Management
Cycle
Prevention and
Recovery
Mitigation

 Disaster Management and Relief Committee (DMRC) was

formed to carry out the responsibilities in the formation of
various aspects of the 4 stages of the disaster management
cycle
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 The main function of the DMRC are:
 Formulate national policies and strategies
regarding the alertness and preparation of
various agencies with regard to handling disasters. (The
DMRC’s State and District levels implement these
polices.)
 Ensure sound coordination of agencies involved in
handling disasters and identifying tools of principle.

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 Malaysia’s legal framework on disaster management is
characterized as a Type C system
 a specific law regulating disasters, which focused on
emergency preparedness and response to natural hazards
(rather than disaster risk reduction), some technological
hazards, and have elements of early warning and recovery.
 budgeted annually through the Economic Planning Unit
(EPU) and also at the state and district level.

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 Disaster management in Malaysia operates as a top-down
government mechanism with the National Disaster
Management Agency (NADMA) as the lead government
agency responsible for all types of disaster management.
 NADMA also functions as the Secretariat at the federal level
for disaster management

 The Federal Disaster Management and Relief Committee

(FDMRC) is the federal government lead in managing and
handling national level disasters.
 Level 3 disasters which include complex events covering
a wide area of two or more states.

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 The State Disaster Management and Relief Committee
(SDMRC) manages state level disasters
 Chaired by the State Secretary and handles Level 2
incidents without potential to spread beyond two or
more districts but with potential to cause significant
damage to life and property.
 The District Disaster Management and Relief Committee
(DDMRC) handles district and village level disasters
 Chaired by the District Officer to ensure coordinated
actions, sufficient assets, human resources, and manage
the media.
 The District office is the key implementing agency in
Level 1 disasters
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 Malaysia’s national guidelines on disaster management is
based on Directive No. 20: National Policy and Mechanism
on Disaster Management Relief, which acts as a framework
for disaster relief management.
 The objective of Directive No. 20 is to provide a policy
guideline on disaster management and rescue in
accordance with the level of the disaster.
 It also provides a mechanism for managing roles and
responsibilities of agencies that are involved in combating
disaster.

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 Multidisciplinary public-health working
arrangements
 Establishing a multidisciplinary chemical incident team is
usually the best way of achieving the necessary tasks, in
both the planning and response phases.
 In addition, if the team enhances their skills with training
during the planning phase, the resulting teamwork during
an incident is likely to be greatly improved.
 The geographical area covered by the team needs to be
decided, and a coordinating mechanism should be
established.

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 The chemical incident team may be comprised of staff from
a number of agencies concerned with health, civil defence
and disaster management.
 The team should also draw upon scientific expertise and
should build up good relationships with experts, so that
during an incident, help and assistance are speedily
obtained.

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 Community Risk Assessment
 An assessment of the potential effects of a chemical
incident in the local area
 CRA is a complex process and involves a wide range of
expertise and agencies.
 Assess the risk before an incident occurs

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 It is comprises of four steps:

• identification of hazardous chemical sites, pipelines

1 and transport routes

• the identification of possible incident scenarios

2

• identification of vulnerable populations and

3 environments

• estimation of the health impact & requirements

4

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 A coordinated approach to data requests and collection is
required to produce valid and complete data that meet the
needs of the various agencies and experts involved.
 The public should also be involved. Not only can they
provide local knowledge, but their understanding will
increase and their anxiety will be reduced when findings
are shared.

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 Conducting a CRA develops and strengthens the
relationships between
 the emergency services
 the public health services
 the chemical industry
 the general public

 It also helps to identify training requirements.

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 The identification of hazardous sites in the local
community is an important means of recognizing possible
emergency situations.
 Check the availability of appropriate expertise

 Site emergency plans and evacuation

 Procedures
 Materials

 Decontamination equipment
 Antidotes

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Local incident surveillance and environmental
monitoring.
 For each site identified, the chemicals present (current and
planned) are identified and scenarios of possible releases
are developed for each one.
 For each site and substance, the exposure pathways and
vulnerable zone (the area to which the contaminants might
be transported through air or water) are estimated and
mapped out.

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 This can often be done using computer models - requires a
thorough knowledge of the topography of the area, the
waterways, the reservoirs and the prevailing climate.
 Facilities and structures in and around the vulnerable zone
that provide essential services (e.g. hospitals) and which
could be disabled by an incident should be identified.

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 Areas where contamination would have significant effects,
such as farmland, water bodies used for leisure activities or
wildlife support, and ecologically important sites should be
considered.
 Assessing vulnerability around chemical transport routes
presents greater difficulties, but is extremely important.
 Highly toxic chemicals transported by rail or inland
waterways may pass through densely populated areas.

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Baseline health assessment
 To measure the impact of a chemical release on health, it is
necessary to know the background levels of illness in the
community before the release.
 In most countries, health data are only available at
population levels greater than that likely to be affected by a
chemical incident.
 This can make it more difficult to identify any changes in
the health of the affected population.

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 To overcome this difficulty, routine data should be collected
from populations around the chemical sites.
 This can be expensive, but should be considered for very
high-risk sites.
 If routine data are not available to produce a baseline
measure, a one-off survey may be considered.

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Baseline environmental assessment

 Air, water, soil, sediment and food in the vicinity of chemical

plants should be sampled and tested for the full range of
chemicals (or their by-products) being manufactured, used
or stored.
 Priority areas may need to be selected from the CRA and
targeted.
 It may be helpful to carry out a complete environmental
assessment, to predict the levels of environmental
contamination from a variety of likely release scenarios.

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Liaison with the local community
 The people who live and work in the area that could be
affected by a chemical release should not only be informed
about the plans for a chemical incident, but should also be
involved in drawing them up.
 Community members who help with these preparations
must represent their local community.
 Large public meetings is the most common and familiar
way of initiating face-to-face discussions with the public,
though it is often one of the least effective ways to institute
a dialogue.

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Public warning systems
 Once an incident has occurred, there is a need for robust
warning systems for informing the public of the incident
and of any protective measures they should take.
 This can be very effective and is appropriate for high-
priority areas, though the public need training and
updating in the process.
 Site visits can help the community to understand the
measures taken by the industry to protect the workers and
the public.

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Public-health plans for chemical incidents
 In most countries, there is a general plan covering major
incidents and disasters, and the roles of the emergency
services in chemical incidents.
 There are usually also major incident plans in hospitals that
cover most types of incidents.
 However, public-health plans to deal with chemical
incidents are usually non-existent or poorly developed.

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 The public-health chemical incident plan needs to take
account of four different scenarios:
1) a release from a fixed site: this will usually be a
registered hazardous site;
2) a detected release of a known chemical from a non-
fixed site such as a road tanker (which may not be
clearly labelled as carrying hazardous material);
3) a detected release of an unknown chemical: typically,
this will occur in releases from sites not on the
hazardous site inventory, or with unknown
combustion products from a chemical fire;
4) a silent release, where the release is unknown or
suspected from other routes.
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Conducting exercises and training
 Training and education play an important part in
preparedness for, and response to, chemical incidents.
 The emergency services, other relevant health professions,
local chemical plants, etc. need to train their personnel to
properly manage occurrences that might grow to become
chemical incidents, as well as chemicals incidents
themselves, to understand the responsibilities of other
professionals, and to minimize the risks to the workers and
members of the public.

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 It is important that all those with specific responsibilities in
a chemical emergency response should receive joint
theoretical and practical training in the use and
implementation of jointly agreed emergency response
plans.
 This will enable them to become familiar with taking part in
a broad cooperative effort to respond to a chemical
incident.
 Core training for the response team is an important
mechanism for the various agencies’ staff to get a good
understanding of their own and others’ needs.

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Chemical Leakage Disaster Simulation Training –
Accident between a Bus and a Tanker

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The bus
passengers
queuing up for
a shower to
remove traces
of chemicals
from their
bodies during
the simulation
exercise.

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 Emergency response team members attending to victims
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 Public-health elements that should be included in the
core training are:
 risk and exposure assessment
 epidemiology and toxicology
 emergency actions and procedures to reduce risk to
responders and the public
 the use of protective equipment
 shelter and protective measures and procedures
 biological and environmental sampling
 risk communication techniques

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 Dealing with chemical incidents
 In any chemical incident, there are essential steps to take as
part of the chemical incident plan.
1. Alerting the health-care services
 Public-health/environmental-health professionals are in a
good position to assess the extent of the casualties and to
alert and activate local and more distant health-care
facilities.
 This will involve providing accident and emergency
departments with information about the nature of the
chemical(s) and any precautions to be taken, and
information about secondary contamination and how to
decontaminate casualties, staff and equipment.
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2. Best outcome assessment/estimate
 Once a chemical incident has occurred, there are a number
of courses of action or management options that can be
taken at different points in the sequence of events.
 A management option can be any choice available to the
emergency responders
→ extinguish a fire or let it burn out
→ use which chemical dispersant following an oil spill
→ evacuate people from an affected area or recommend
sheltering.

 Each of these management options may end up with a

different outcome on the health of the public, the
responders and the environment.
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 Chemical incident response staff, for example, will be
primarily concerned with containing the chemical, while
hospital doctors will be dealing with the casualties, and
neither will be able to view the incident from a distance or
in the long term.
 The function of the chemical incident team is to try to work
out the management option that arrives at the best
outcome for the health of the public and the environment.
 The accuracy with which this can be done depends on the
amount of information and data that arrives from the
incident site, and the amount of time available before a
decision is required.

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3. Information and public warnings—communication
skills
 The public often needs information about:
 the incident;
 measures being taken to contain the release;
 who is currently under threat;
 the health effects of exposure;
 what the public can do to protect themselves;
 when, where and how further information will be made
available.
 All public information must be consistent, and should be
provided by a small number of people with strong
communication skills and training.
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4. Advice on protection
 Proper assessment during the incident can determine
whether individuals or a population are likely to be
exposed, and the possible health effects of short-term, acute
and chronic exposure.
 This assessment may be done by the emergency services
for populations near the incident site, or by the chemical
incident team for more distant populations.

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5. Sheltering or evacuation/removal.
 For the public, usually the most feasible protective measure
is sheltering—i.e. staying in a building, closing all the
windows and doors, and shutting down any ventilation or
airconditioning systems until the chemical (usually in a
cloud) has passed.
 This procedure will usually protect the population for about
2 hours, which is more than enough for the majority of
incidents.

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 Evacuation often involves complex arrangements for
providing transport, shelter, food, water and appropriate
medical care.
 It may also require ensuring the security of the properties
left uninhabited.
 The decision on whether to evacuate people or encourage
them to seek protection by sheltering must be based on a
balance of the risks of the two options, with the primary
consideration being the risk of exposure (both level and
duration).

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 Evacuation may be the better option in one or more of the
following cases:
 the chemicals are widely dispersed and contamination
is extensive;
 toxic chemicals are suspected, but cannot be identified
readily;
 the chemical is highly hazardous;
 the air will be hazardous for a prolonged period.

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 Bhopal (1984)
In the predawn hours of December 3, 1984, a toxic cloud of
methyl isocyanate gas escaped from the Union Carbide
pesticide plant in Bhopal, India, and quickly spread throughout
the city. Vomiting and gasping for air, those who didn’t die in
their sleep poured into unprepared area hospitals or
desperately attempted to outrun the fumes. Dog, bird, cow and
water buffalo corpses reportedly lined the streets.
Investigations later uncovered a slew of safety violations at the
plant, including broken and outdated equipment. Lax
management also played a role; a supervisor, for example,
allegedly broke for tea at the moment of crisis, believing it was
only a water leak. To this day, the site of the plant, now owned
by Dow Chemical Company, remains highly contaminated.
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 Al-Mishraq Plant (2003)
Al-Mishraq is a state run sulfur plant near Mosul, Iraq. In June
2003, it was the site of the largest human-made release
of sulfur dioxide ever recorded when a fire gained control and
burned for about three weeks. Two civilians died and nearly
1,000 people were treated for toxic gas inhalation. The total
mass of the released sulfur dioxide was estimated to
approximately 161,000 tons distributed over seven days,
equivalent to a small volcanic eruption.

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 two deaths

 600,000 tonnes of sulphur dioxide was released in the fire

(hydrogen sulfide also was released)
 $40 million of damage to local crops

 widespread respiratory problems in local residents

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 Deepwater Horizon (2010)

On April 20, 2010, the Deepwater Horizon oil rig, located far
out in the Gulf of Mexico, exploded into flames, killing 11
workers and injuring several others. The rig, owned by
offshore drilling contractor Transocean and under lease to oil
giant BP, then sank two days later, causing a petroleum leak
that would gush out of control for nearly three months.

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 Eleven people killed

 4.2 million barrels of oil escaped

 contaminating at least 43,300 square miles of ocean and

1,300 miles of shoreline
 temporarily decimated the Gulf’s fishing and tourism
industries
 killed thousands of birds, sea turtles and dolphins

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 Samarco Mine Tragedy (2015)
At 3.45pm on 5 November 2015 a huge tailings dam operated
by Brazilian mining company Samarco collapsed and a tidal
wave of 32m to 40m cubic meters of mining waste washed
across the countryside of green valleys, villages and farmland.

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 One week after disaster
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 Twelve people dead

 Killed fish and aquatic life hundreds of kilometres away

 Water for hundreds of thousands of people undrinkable

 600 people were evacuated

 500 people remain homeless

 the mud contains greater than acceptable concentrations

of heavy metals (arsenic, lead & mercury)

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