Improving Texas Homeland Security: A Practical Framework for Joint Hospital-Chemical Industry Emergency Planning

Date

2023-10-15

Authors

Mastrangelo, Mike

Journal Title

Journal ISSN

Volume Title

Publisher

Institute for Homeland Security

Abstract

Given the high concentration of petroleum and chemical industry in Texas, a new approach to joint industry/hospital planning for the healthcare response to chemical accidents is needed. The novel aspect of this framework is that it applies the concepts of a chemical risk assessment – and a risk prioritization to readiness - and adds to the risk assessment process the need and availability of medical countermeasures. In treating chemical incidents, it is imperative that the patient get to the right hospital as quickly as possible. The right hospital means that the hospital has conducted joint planning and exercises with the industry. The hospital knows what chemicals are used at the plant, they know how to treat the injuries, and they have the correct medical countermeasures for the chemicals involved. To illustrate the importance of this concept, in a 1986 incident a plant worker was exposed to hydrogen fluoride gas. He was first transported to a nearby nursing home for oxygen. When this was not effective, he was transported to a small community hospital. When they realized they could not care for him he was again transported to a regional hospital that had the ability to treat the patient, but unfortunately too much time had passed, and the patient died shortly after arrival. If taken to the right hospital first, he would have survived. The proposed framework for joint industry/hospital planning will be described and can be used in a practical way for planning, training, and exercise development at any Texas location that includes chemical industry and a nearby hospital. The basic process is: • Conduct an inventory of toxic industrial chemicals in use and do a risk prioritization of those chemicals (based on volume and toxicity) • Determine if specific medical countermeasures (MCM) are required for medical treatment for priority risk chemicals • Model release scenarios to estimate the volume of medical countermeasures that might be needed • Inventory the volume of that MCMs available in the region, if sufficient supplies are not available – work with Industry on contingencies • Conduct joint planning and exercises with industry for occupational exposures and community exposures guided by modeled scenarios The work presented is based on work done with a gasoline refinery in Texas. The plant uses large volumes of Hydrogen Fluoride in their process. Calcium Gluconate is the medical countermeasure needed for treatment, but it had been on the National Pharmaceutical Shortage list and generally is not held by hospitals in large volumes. Joint readiness would benefit workers at the plant that might suffer occupational exposure, but it would also be applicable to a larger release that could affect the fence-line community. An incentive to the Chemical Sector to collaborate with the Healthcare Public Health Sector would be the potential for better healthcare treatment for either occupational or community exposures and therefore the possible mitigation of damage from a release incident. While cross-sector planning and exercises between the 6 Chemical Sector and Healthcare Public Health Sector would make sense, a search for examples provides no specific examples.

Description

Keywords

Healthcare, Chemical, Emergency Management, Homeland Security

Citation

Mastrangelo, M. (2023) Improving Texas Homeland Security: A Practical Framework for Joint Hospital - Chemical Industry Emergency Planning. (Report No. IHS/CR-2023-1019). The Sam Houston State University Institute for Homeland Security. https://doi.org/10.17605/OSF.IO/U4DFR