2019

The Effect of Chemical Incidents on First Responders:

An Interview with Bruce Evans (MPA, NRP, CFOD, SEMSO), Fire Chief, Upper Pine River Fire Protection District

A massive leak of liquefied chlorine gas created a dangerous cloud over the city of Henderson, NV, in the early morning hours of May 6, 1991. Over 200 people (including firefighters) were examined at a local hospital for respiratory distress caused by inhalation of the chlorine and approximately 30 were admitted for treatment. Approximately 700 individuals were taken to shelters, and between 2,000 and 7,000 individuals were evacuated from the area. ASPR TRACIE interviewed Chief Bruce Evans (who was a firefighter- paramedic at the time of the incident), asking him to share his my first large-scale incident: the experiences and highlight how the PEPCON explosion. PEPCON was Access these U.S. Fire Administration Technical Reports fire and emergency response to a rocket fuel plant that supplied propellant used for the space for more information on these chemical incidents has changed incidents: over the years. shuttle program. This explosion sent a shock wave over the • Fire and Explosions at Rocket Corina Solé Brito, ASPR TRACIE entire Las Vegas Valley, blew out Fuel Plant (CSB): Can you please share windows that were miles away, • Massive Leak of Liquefied your experience in Henderson and created a small, multicolored Chlorine Gas and other related incidents, how mushroom cloud on the south end you think the field has changed of the valley. The Professional since then, and what you think Golfers’ Association (PGA) was the future holds? also in town, so there were satellite or injuries from flying debris were I am fortunate trucks and news trucks present. Bruce Evans (BE): to be expected. The hospital—a to have lived through two major At that time, the rudimentary cell small, critical access hospital at incidents that have culminated in phone network was overwhelmed the time—became overwhelmed U.S. Fire Administration technical very quickly; this was my first with the walking wounded. That reports. When I was 21, I left experience with not being able to was a “chaos event,” and the type Central Iowa to be a paramedic communicate with a supervisor. I that most large departments hadn’t in Las Vegas in 1985. Just a didn’t know what chemicals were in few years later, I was involved in that cloud, or how many fatalities 2019

dealt with. At the time, Henderson an “island” surrounded by the formed almost pure hydrochloric Fire Department did not have residential area of Henderson— acid, which burned right through paramedics as part of their team— was technically in the county’s the pipe. Because it was at an after this incident, they decided to jurisdiction. At first, people were elbow, at a 90-degree angle, you increase their level of care, and only reporting a strong smell of couldn’t get a patch on it. Nearly I was recruited to serve on that chlorine, so members of the first 90 tons of liquid chlorine spilled, fire department. engine company, an ambulance, then aerosolized at more than and a battalion chief vehicle pulled 300 times its volume. Fast forward to 1991, when the up to the gate without their air largest leak of liquefied chlorine in As soon as the Clark County packs on. One of the captains later U.S. history took place, also in the firefighters got out of the firetruck, said he thought it was odd that the Las Vegas suburbs, at the Pioneer they were immersed in and security personnel in the guard Chlor Alkali Company. Late that overcome by a cloud of extremely shack were wearing gas masks. night, we (Henderson Fire) got a high parts per million of chlorine. call to assist some firefighters from Pioneer Chlor Alkali was storing Chlorine is a respiratory irritant Clark County Fire Department liquefied chlorine in tanks, and that can cause non-cardiogenic who were at the company’s gate. after crews had serviced the tanks, pulmonary edema, and when Our two communications centers they had left some water in an it mixes with moisture—either ultimately decided that Clark elbow area of a pipe. When they in your airway or areas where County should respond first, since recharged the tanks, the chlorine the facility—while it was essentially mixed with the water and basically 2019

you might be sweating, like your and bleached their shirts, turning listened to the radio, waiting for armpits or groin—it turns into them pink where the zippers were. someone to gain control over the hydrochloric acid and burns what It is extremely warm in those scene. About an hour later, we it comes in contact with. When we suits, and you essentially create heard that there was a strong arrived (wearing our air packs), your own humidity when you wear incident commander in place, we rescued eight people; as a one. The gas reacted with the making good decisions, so we firefighter-paramedic at the time, sweat in their armpits and groin returned to the scene. Overall, I remember very vividly seeing the areas, burning any skin that had we sent about 45 firefighters to battalion chief coughing up blood. perspiration on it. We had to strip the hospital. Everyone had mucus running out them down and perform a field Once the sun came up and the of their eyes and noses, and their decontamination (i.e., rinse them heat dissipated the chlorine, you eyes were burning. We tried to with the fire hose) and transport could see this massive, green decontaminate them as quickly them to the hospital. cloud sitting over most of the as possible and get them to the We came back to the command (evacuated) community. Within hospital for treatment. post a second time, and I learned a couple of days, all of the trees We returned to the command another lesson. The plant official, were completely defoliated. post, and this is when I learned a the expert on chlorine, arrived Once the incident was deemed specific lesson. A command officer and told us we were too close complete, the crews that performed showed up and started making to the spill and instructed us to most of the rescues reported to some questionable decisions move further away. I remember the hospital to be checked out. that ultimately lead to the injury listening to him advise the incident We realized the chlorine had of more firefighters. The officer commander, who replied, “Well, off-gassed from patients and some chose to send a few firefighters chlorine is heavier than air; it of the firefighting equipment and into the facility in a pickup truck to should travel downhill and we actually pitted the stainless steel in try to put a patch on the leaking should be safe here.” About 20 the back of our ambulances. container. The two members from minutes later, the cloud was so Even though we wore our air the HAZMAT team were allowed to large that it overtook the command packs while we treated patients don Level B protection suits (Tyvek post and we had to evacuate in the ambulances, we all got a and an air pack). In this day and and very hastily move to another fairly significant dose of chlorine. age, I would never let anyone go staging area. Just 10 minutes The hospital that we went to into a situation like that without a later, the cloud grew even larger had a TOMES database and Level A suit. and overtook us again. We they also called Poison Control, rescued four more firefighters When these two firefighters explaining that they were treating who had been overcome by the returned about 15 minutes later, firefighters who had inhaled fumes, and once again, the scene jumped out of the truck, and chlorine gas. At that time, the became chaotic. started stripping off their clothes, TOMES database and the I remember seeing how the At that point, I decided to take the Poison Control operator told the chlorine had penetrated through four injured firefighters to another physicians to nebulize bicarbonate. their Tyvek suits. Most firefighters hospital farther away from the We all sat in the emergency room wear a navy blue t-shirt and navy primary access hospital that we (ER) with nebulizers, inhaling blue pants. The chlorine had normally use. After we dropped bicarbonate solutions. seeped through the Tyvek suits them off, we sat in our truck and 2019

unnecessarily putting people at risk. In 1994, the National Fire Academy began offering a new class called “Advanced Life Support Response to Hazardous Materials Incidents.” Instructors taught one week of organic and inorganic chemistry followed by another week of toxicology. I took the inaugural course and I’ve been on the instructor cadre for this class for 20 years. This was not the correct treatment for future work. Based on these plan. Simple chemistry shows that results, and to reduce the pending Subsequently, I had a long when you mix an acid in a base, it fines (levied based on a NIOSH conversation with the director of is going to give off heat, creating investigation into prior training, the local Poison Control center, an exothermic reaction. So as we equipment provided, and other and we agreed they would look into inhaled that nebulizer bicarbonate related factors), the International their protocols and update them based on the directions given Association of Firefighters sent a based on this experience. Now to the ER doctors by the Poison team in from Phoenix and trained they know to use normal saline to Control center, we all wound everyone in the department dilute and stabilize the chlorine. up with low-level respiratory up to the HAZMAT operations CSB: You said your health burns. Most of us ended up with level under the NFPA Standards effects lasted 7-8 years. Can reactive airway disease, and 472 and 473, and covered how you share more about the health it was probably seven or eight to operate in a Level A suit effects for other firefighters who years before I could get my lung and perform decontamination. responded to this incident? capacity up to where I could Additional research on our part stop using an inhaler. One of my found that the treatment protocol BE: A lot of people who were colleagues who had an underlying in the TOMES database used by injured were lucky enough to be asthma condition was off work for the Poison Control operator at moved into administrative and almost two years, in a worker’s the time was based on one study training positions. Ultimately, compensation situation, while conducted on only eight patients. everyone returned to work. The trying to get his lung capacity to Based on the lessons we have battalion chief I mentioned earlier the point where he could wear an learned from other incidents over who was in non-cardiogenic air pack again. the years and the advancement of pulmonary edema returned HAZMAT medicine, the guidance for about six months and then The National Institute for has changed significantly. retired. After nearly two years, Occupational Safety and Health the firefighter-paramedic who had (NIOSH) and the Occupational After that incident, I wanted to an underlying asthma condition Safety and Health Administration have the knowledge to be able to returned to work and was able to (OSHA) later came in and politely refuse an order or point finish his career. highlighted the errors that were out to an incident commander made and made recommendations that their instructions might be 2019

CSB: Did the event overwhelm hospital administrators understand all of their bases. This is being the healthcare facilities? Was that self-evacuated patients— lost now, when providers are the hospital evacuated? some who may be contaminated being pushed to stick to time- with chemical or weaponized related metrics and make quick BE: This event absolutely materials—can show up at the ER treatment decisions. overwhelmed the small community without any EMS involvement, and hospital located a quarter of a mile CSB: Do you have any final are preparing for these scenarios. from the facility. Not only did we thoughts to share with flood that facility with patients, but CSB: What else “keeps you our readers? it was located downwind from the up at night?” BE: After 9/11, first responders leak. If this were to happen now, BE: There is a human condition, were supposed to be trained to the we would evacuate the hospital, or a protective factor, that makes HAZMAT operations level, because but it remained operational us feel like things can’t ever be the awareness level doesn’t throughout the event. We had that terrible, that terrible incidents include the decontamination piece. done shelter-in-place drills with the like this can’t happen. While we But so many departments still only local schools, where they would don’t want to believe that humans train to the awareness level and shut down their HVAC systems, can cause other humans harm, this is a challenge with private duct tape classroom doors, and I feel like we still must focus on ambulances serving about 40% of put plastic sheeting around the and prepare for the worst case the country. All of our ambulances entrances to the buildings. The scenario. We can learn a lot from at Upper Pine contain one five schools were much more prepared the Israelis who unfortunately have gallon bucket that holds two Tyvek than the hospital was for dealing vast experience in these types of (Level B) suits that can be paired with a chemical leak. I don’t think incidents. EMS providers in Israel with self-contained breathing zoning permits would allow a generally are allowed to take their apparatus to function as Level B chemical facility like that to be vehicles home with them, allowing equipment, an adapter hose, dish built anywhere near a residential them to quickly respond in a soap, and gloves—if responders area today. vehicle that can transport a patient. encounter something in the field, Of course today, hospitals are In the article Health and Medical they can quickly decontaminate. required to go through these types Response to Active Shooter and Chemicals are evolving. Look of drills. And when the hospital Bombing Events, we discuss the at organophosphates, look at was remodeled several years benefit of pre-designed response fentanyl. Bad actors involved ago, they incorporated lessons matrices which are programmed with “street chemistry” are getting learned from the incident and to assign a set of resources to “better” at what they do. Including added outside decontamination specific incidents. the basics of chemical awareness facilities close to the ambulance On a related note, I think one of and response in continuing entrance and built double-door the things we are losing sight of education programs can both systems to enable them to isolate in traditional medicine is the “rule increase responder resilience the ER. The Joint Commission has out.” For a long time, physicians and readiness for the next done a fantastic job encouraging were taught to start by assuming asymmetrical incident. ■ hospital preparedness. With the worst case scenario to cover ASPR’s help and after 9/11,