I guess by now you’ve heard of the chemical emergency caused by the derailment of a Norfolk Southern train in early February. The Environmental Protection Agency (EPA) reports that the hazardous materials included 115,580 gallons of vinyl chloride in addition to other chemicals.  Shortly afterwards, officials decided to set the vinyl chloride on fire, leading to health hazards for the surrounding community.

It’s been several years since I’ve written about inadvertent chemical spills or even deliberate chemical attacks. In today’s modern world, it’s difficult to avoid exposure to toxic chemicals. Therefore, everyone should have an idea of what to do if contamination occurs.

VINYL CHLORIDE

In the Ohio train wreck, exposure to toxic vinyl chloride put the citizens of East Palestine at risk due to contaminated air and, possibly, the water supply. In the air, vinyl chloride is an irritant.  If water is contaminated, vinyl chloride can enter the air when the water is used for showering, cooking, and clothes washing.

Long-term effects of vinyl chloride exposure may be widespread, involving the nervous system, lungs, the liver, bones, and the entire immune system. Over time, the risk of several types of cancer increases. Damage to the reproductive system of both male and female lab animals has also been reported.

OTHER CHEMICAL AGENTS

The response to a chemical emergency depends on the substance involved. Each agent has a different effect on the human body. The list of dangerous chemical agents is long and includes:

• Acids:  Chemicals that burn or corrode people’s skin, eyes, and mucus membranes (lining of the nose, mouth, throat, and lungs) on contact.
• Blister agents(also called “vesicants”): Chemicals that severely blister the eyes, respiratory tract, and skin on contact.
• Blood agents: Poisons that affect the body by being absorbed into the blood.
• Choking agents: Chemicals that cause irritation or swelling of the respiratory tract.
• Incapacitating agents: Drugs that cause an altered mental state or unconsciousness.
• Long-acting anticoagulants: Poisons that prevent blood from clotting properly, leading to hemorrhage.
• Metals: Agents that consist of metallic poisons.
• Nerve agents: Chemicals that work by preventing the nervous system from working properly.
• Organic solvents: Agents that damage the tissues of living things by dissolving fats and oils.
• Riot control agents: Highly irritating agents sometimes used by law enforcement for crowd control or by individuals for protection (e.g., pepper spray).
• Toxic alcohols: Poisonous alcohols that can damage the heart, kidneys, and nervous system.
• Vomiting agents: Chemicals that cause nausea and vomiting.

USE OF CHEMICALS AS A WEAPON

Chemical weapons are largely prohibited by the Chemical Weapons Convention (CWC), a treaty that outlaws their production and use. Although almost all nations have signed this treaty (North Korea is a notable exception), the risk of chemical attacks by terror organizations still exist.

The deliberate use of lethal chemicals dates back to the first poison-tipped arrow. Historical examples of natural and man-made substances used to cause mass casualties abound: The ancient Greeks, for example, commonly poisoned the water supply of besieged cities and, on occasion, would use sulfur fumes on defending forces. During the French conquest of Algeria in the 1840s, French troops trapped 1,000 Berber tribesmen into a cave and used smoke to kill them.

The invention of tear gas in 1912 came just in time for World War I. From 1914-1918, both sides used chlorine, sulfur mustard, and phosgene. Tens of thousands of artillery shells filled with these substances were employed throughout the duration, causing 1.3 million chemical casualties and close to 100,000 deaths.

(Aside: A young Adolf Hitler was temporarily blinded by a gas attack in 1918.)

Although the League of Nations (an early version of the United Nations) ratified a chemical weapon ban in 1925, Benito Mussolini used mustard gas on Ethiopians during Italy’s invasion in 1935-6. Although not used on the battlefield in World War II, hydrogen cyanide gas (known as Zyklon B) killed millions of civilians during the holocaust.

Later in the twentieth century, incendiary chemicals like napalm and herbicides like Agent Orange caused deaths and long-term ill effects. Several incidents of chemical weapon use in Syria were reported in 2013 and 2017.

WHAT TO DO IN CHEMICAL EMERGENCIES

Chemical accidents or attacks, such as an overturned tanker truck, train  derailment, or a terror event, may render an area dangerous. Common sense dictates evacuation as the wisest course of action. This is not only to prevent physical contact but also to avoid noxious fumes that may be carried by the winds. Given the wide range of chemicals, be sure to seek and rapidly act upon the advice of local emergency departments for the specific event.

Evacuation may involve going to an emergency shelter. If so, notify others of your plan of action and take additional supplies and medications that the municipality may not have in sufficient quantities. Know what their policy is regarding pets. The schools your children attend will have their own plan of action for chemical emergencies; be aware of their disaster protocols.

There are many different chemicals; each might require a specific method to neutralize. To absorb a small spill comprised of inorganic acids and bases, there are commercial neutralizers like FastAct® available. Some sources suggest that a 1:1:1 mixture of unscented kitty litter, sodium bicarbonate (baking soda), and dry sand is good for most chemical spills including solvents, acids and bases. Another option is to absorb certain spills with absorbent pads (or non-flammable pillows to suppress vapors), sand, or vermiculite.

SHELTER IN PLACE?

Some chemical emergencies could make going outdoors risky. Leaving might put you in harm’s way. Sheltering in place is (arguably) a way to get some protection until help arrives. Sheltering in a vehicle, however, is a last resort, as vehicles aren’t airtight enough to protect you from noxious fumes.

If you can’t evacuate the area, choose a room with as few windows and doors as possible. Some gases sink to the floor, so a second-story room is preferable. Notice how different this strategy is from most natural disaster plans, where a basement might be the safest area in the home.

Shut all outside doors and windows as soon as you are aware of the emergency. Locking and taping them will make a better seal against the chemical. Turn off air conditioners, fans, and heaters. Close the fireplace damper, vents, and any place that air can enter from outside.

Go into the designated safe room and shut the door. Turn on the radio and keep a cell phone available. If it is necessary to drink water, drink safely-stored water, not water from the tap. Consider shutting off the valve for your house may help avoid contamination of the existing water in the pipes. If you run out of water, you can drink from the toilet tank (but not from the bowl) or release some from the hot water heater.

DIRECT CHEMICAL CONTACT

Some types of chemical exposure involve direct contact. As many substances (especially in liquid or solid form) can penetrate clothing and be absorbed through the skin, it’s necessary to remove and safely dispose of contaminated clothing. A thorough body wash with soap and water is then needed to both protect the victim and medical personnel. The faster this is accomplished, the more effective the decontamination; once the chemical has contaminated the water supply, showering may spray it onto you.

When taking off chemical-drenched clothing, avoid pulling it over your head. Cut it off instead. When removing clothing from others, make every effort to avoid touching contaminated areas without hand protection (rubber kitchen gloves), tongs, or other methods that avoid contact with skin. Place all “dirty” items in a biohazard bag and seal it.

Eye damage from chemical exposure can be severe. Remove any contact lenses and rinse eyes with clean water for 10-15 minutes. Hold the eyelids away from the eyeball while moving the eye in all directions. Wash eyeglasses with soap and water.

SUPPLIES

With any luck, a chemical emergency will last only a short time. Despite this, your shelter should have the usual basics:

• A good first aid kit
• Flashlights, battery-powered radio, and extra batteries for both
• A means of communication
• Food and bottled water. Store at least 1 gallon of water per person in plastic bottles as well as non-perishable foods with a long storage life.
• Towels and plastic sheeting. You may have to cut sheeting to fit your windows, doors, and vents. Duct tape can be used to form a better seal.

Of course, this is the absolute minimum necessary for a short-term event. Longer-term disasters require much more. In modern times, call 911 or your local poison control center.

MATERIALS NEEDED FOR CHEMICAL SPILLS

Some specialized materials not normally included in medical kits are useful for chemical spills. They include:

• Rubber or other chemically-resistant gloves, aprons, and boots
• Brooms & dustpans
• Safety goggles
• Gas masks(Note: N95 and other respirator masks may provide some protection against certain airborne infections, but are insufficient to protect against most noxious chemicals and gases)
• Plastic spatulas and shovels
• Plastic hazardous material bags
• 5-gallon buckets with lids
• Drum liners
• Baking Soda (sodium bicarbonate)
• Vermiculite

Hopefully, you’ll never be involved in a major chemical emergency, but it’s the responsibility of the survival medic to know about any crisis they may face in times of trouble.

Joe Alton MD

Dr. Alton

Learn more about chemical emergencies, including chemical warfare, in the Book Excellence Award-winning 4^th edition of The Survival Medicine Handbook: The Essential Guide For When Help Is NOT On The Way, available in black and white on Amazon and in color and spiral bound versions at store.doomandbloom.net. And don’t forget to check out our entire line of quality medical kits and individual supplies as well! You’ll be glad you did.