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Occupational Health Surveillance after the Buncefield Oil Depot Fire, England, December 2005
Final report: March 2007 36574 erpho Data Report.qxd:36574 erpho Data Report.qxd 12/7/07 07:37 Page i
Occupational Health Surveillance after the Buncefield Oil Depot Fire, England, December 2005.
Final report: March 2007
Published by the Eastern Region Public Health Observatory on behalf of the Buncefield Fire Occupational Health Working Group 36574 erpho Data Report.qxd:36574 erpho Data Report.qxd 30/7/07 10:34 Page ii
Buncefield Fire Occupational Health Working Group. Final Report: March 2007
Title: OccupationalHealth Surveillanceafter the Buncefield Oil Depot Fire, England, December 2005. Final report: March 2007
Authors: Buncefield Fire Occupational Health Working Group
Publisher: Eastern Region Public Health Observatory (http://www.erpho.org.uk) on behalf of the Buncefield Fire Occupational Health Working Group
Date of publication: August 2007
ISBN: 1904389 12 0
Electronic copies at URL: http://www.erpho.org.uk Quick Link 16503
Further printed copies from: MarianneQuinn, HPAEast of England Regional Epidemiology Unit, Institute of Public Health, Robinson Way, Cambridge, CB2 0SR. e-mail: [email protected]
Copyright information: Permission is granted to reproduce text and figure 2. Please cite the source as: BuncefieldFire OccupationalHealth Working Group. Occupational Health Surveillance after the BuncefieldOil Depot Fire, England, December 2005. Final report: 2007.Cambridge:erpho; 2007.
Acknowledgements
We thank Dr Marian McEvoy of the Bedfordshire and Hertfordshire Health Protection Unit for her support and advice at the outset of the survey.Wethank Marianne Quinn, Michelle Hardy, Jonathan Richards and Caroline Black for administrative support at the Health Protection Agency East of England Regional Epidemiology Unit. We are also gratefulfor statistical advice from Neville Verlander at the StatisticsUnit, Centre for Infections, Health Protection Agency and to the staff of the occupational health departments and respondents who participated in the survey.Peter Payne from the GIS Team at the Centre for Emergency Preparednessand Response,Health Protection Agency,produced Figure 1. The cover image was providedbyHertfordshire Fire and Rescue Service.
Abbreviations
A&E Accident and Emergency CI confidenceintervals GP general practitioner HPA Health Protection Agency OR odds ratio PCT primary care trust PR prevalenceratio 36574 erpho Data Report v3.qxd:36574 erpho Data Report.qxd 16/8/07 11:50 Page 1
Contents
Contents
Executive summary...... 2 Section 1Introduction...... 4 1.1 Background...... 4 1.2 The Buncefield Fire Occupational Health Working Group ...... 4 1.3 Rationale and Justification for the Register...... 5 1.4 Aims and Objectives...... 5 Section 2Methods...... 6 2.1 Identification of Participating Occupational Health Departments...... 6 2.2 Eligibility Criterion...... 6 2.3 Standardised Occupational Health Assessment of Eligible Individuals ...... 6 2.4 Identification of Occupationally Deployed Workers...... 7 2.5 Exposure Definitions ...... 7 2.6 Health Outcomes...... 8 2.7 Selection of aComparison Population ...... 8 2.8 Analysis...... 10 2.9 Data Handling ...... 11 Section 3Results ...... 12 3.1 Agencies and Individuals Deployed to the Buncefield Site...... 12 3.2 Characteristics of Deployed Individuals ...... 15 3.3 Exposures...... 17 3.4 Use of Healthcare and Occupational Health Services ...... 20 3.5 Health Symptoms...... 21 3.6 Associations Between Risk Factors and Reporting Symptoms...... 25 Section 4Discussion...... 27 4.1 Main Findings...... 27 4.2 Identification of Occupationally Deployed Workers...... 27 4.3 EstimatingExposures...... 28 4.4 Use of Respiratory Protection...... 29 4.5 Health Outcomes...... 30 4.6 Interpretation of Results...... 30 4.7 Operational Issues ...... 31 Section 5Conclusions ...... 33 Section 6Recommendations ...... 34 References...... 35 Appendices...... 37 1. Protocolfor HarmonisedOccupational Health Surveillance Following Deploymenttothe Buncefield Oil Depot Fire, Hemel Hempstead, Hertfordshire, 11 December 2005 ...... 38 2. Guidelines for Occupational Health Departments. Buncefield Fire Occupational Health Register...... 42 3. Register Questionnaire ...... 47 4. Buncefield Occupational Health Invitation Letter ...... 52 5. Occupational Health Participation Form...... 53 6. Invitation letter from the Metropolitan Police ...... 54
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Executive summary
Executive summary
Background and Methods 1. Following the Buncefield Oil Depot fire, which startedon11December 2005 and was extinguished on 14 December 2005, the emergency services in Hertfordshire, Hertfordshire County Council and the Health ProtectionAgency East of England Regional Epidemiology Unit established the Occupational Health Working Group. The Health Protection Agency facilitated the work of the group, the development of an occupational health exposure and illness questionnaire, the establishment of aBuncefield Fire Occupational Health Register database and epidemiological analysis of the data. 2. Individuals were eligible for inclusion in the Register if they were occupationally deployed to or near the BuncefieldOil Depot fire site between 11 December 2005 and 5January 2006. 3. Occupational health departments thatdeployedstaff to the Buncefield fire sitewere identified. 4. The Register questionnaire was distributed by each occupational health department and an anonymous copy of each completed questionnaire was sent the Health Protection Agency East of England Regional Epidemiology Unit for entry into adatabase.
Results 5. Fifty-one organisations deployed staff to the incident site: 35 fire services, 10 public sector organisations, three voluntary organisations, and three private companies. Eight hundred and fifteen of 1834 (44%) eligible individuals from participating organisations completed and returned the study questionnaire. 6. There were 660 individuals deployed during the burn phase (11 to 14 December 2005). Almost three quarters of them were deployed inside the inner safety cordon. Three quarters of respondents reported inhalation of smoke, fumes or particles and 85% smelled smoke and/or chemicals. About two fifths reported using respiratory equipment, of which paper masks were most frequently mentioned. 7. Twenty-six individuals (3%) attendedanAccident and Emergency Department and 12 (1.5%) consulted their general practitioner after the fire. Twenty-two(3%) individuals received an occupational health review.Only 2% (n=18) of individuals took time off sick, 2% (n=15) noted any subsequent ill effects and 4% (n=32) reported feeling anxious about their health. 8. During the burn phase, 41% of 660 individuals reported the occurrence of at least one symptom: irritation to the nose (20%, n=130), throat (26%, n=174) and eye (21%, n=139), coughing(21%, n=138), and headaches(16%, n=105). At least one symptom was reported by 26% of 139 individuals deployed only during the control &clean-up phase (15 December 2005 to 05 January 2006).
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9. As part of aseparate population survey,the generalpublic residentinthe north of Dacorum Primary Care Trust who lived near the Buncefield Oil Depot site but were not under the smoke plume were asked about health symptoms during the four weeks after the explosion. Compared with this group, individuals occupationally deployed during the fire reportedmore eye irritation (prevalence ratio [PR]=2.1, 95% confidence intervals [CI]1.5-3.0), coughing (PR=1.3, 95%CI 1.0- 1.8) and headaches (PR=1.7, 95%CI 1.2-2.5). The prevalence of symptoms reported by individuals deployed only during the control &clean-up phase was not greaterthan residents in the north of Dacorum Primary Care Trust. 10.Multivariablestatistical modelling showed that reportingsymptoms was independently associated withworkinginside the inner cordon during theburnphase (odds ratio[OR]=2.10, 95%CI 1.25-3.53) andwearing amask (OR=2.34, 95%CI 1.66-3.28), afteradjustingfor ageand sex.
Conclusions 11. The proportion of respondents reporting health symptoms was higher during the burn phase than the control &clean-up phase. Compared with the general public, reports of eye irritation, coughing and headaches were more common during the burn phase, but there was no difference between the general public and individuals deployed only during the control &clean- up phase. Few individuals sought health care as aresult of their deployment. 12. The findings from the Occupational Health Register suggest that deployment to the Buncefield fire was not associated with major acute health symptoms.
Recommendations 13. In the absence of major acute health symptoms, repeated follow-up of individuals included in the Buncefield Occupational Health Register is not recommended. 14. During major incidents, responding agencies should have access to appropriate respiratory protection. Standard fire service respiratory equipment may not always be suitable. 15. Personal exposure monitoring of asample of individuals during the early phase of incidents would help assess exposures and potential health impacts. 16. This survey shows the feasibility and usefulness of large-scale harmonised occupational health follow-upafter major incidents in the UK. Similar approaches and mechanisms for their initiation should be considered in the future.
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Section 1: Introduction
Section 1 Introduction
1.1 Background The BuncefieldOil Depot fire started on 11 December 2005. It was the largest fire in Europe since World WarTwo and caused the combustion of 22 storage tanks of diesel, kerosene and aviation fuel. Alarge number of agencies deployed staff to the Buncefield site in response to the fire. Following the incident, the emergency services in Hertfordshire, Hertfordshire County Council and the Health Protection Agency (HPA) East of England Regional Epidemiology Unit identified the need for aharmonised occupational health follow-up across participating agencies. Consequently, an Occupational Health Working Group was established and the HPAEast of England Regional Epidemiology Unit was asked to facilitate the development of aBuncefield Fire Occupational Health Register [see Appendix1:Register Protocol].
1.2 TheBuncefield Fire Occupational Health Working Group The BuncefieldFire Occupational Health Working Group convenedon19December 2005. The group combined expertisefrom the Occupational Health Departments serving Hertfordshire Fire and Rescue, Bedfordshire and Hertfordshire Ambulance and ParamedicService, Hertfordshire County Council and Hertfordshire Constabulary.The remit of group was agreed as to: •provide workers with the opportunity to contribute to astudy of the health impact of deployment to the fire for themselves and fellow workers; •act as guarantors of the harmonised occupational health follow-up; •oversee the establishment of the BuncefieldFire Occupational Health Register; •approve and contribute to analyses, written reports and papers derived from the database; and •adjudicate on ownership and authorship issues related to the Register data.
Membership of the Occupational Health Working Group Oliver Morgan (Co-ordinator), Health Protection Agency,East of England Mark Reacher (Chair), Health Protection Agency,East of England Fraser Kennedy,Hertfordshire Constabulary Steve O’Brian, Hertfordshire Constabulary Paul Lewthwaite, Luton and Dunstable Hospital NHS Trust Robert Lewis, Hertfordshire Fire and Rescue Service Michelle Moore, Hertfordshire Fire and Rescue Service John Osman, Health and Safety Executive Sophie Birch, Hertfordshire County Council Joe Kearney,Dacorum Primary Care Trust
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1.3 Rationale and Justification forthe Register •Itwas judged importanttoseek to measurethe health of individuals deployedtocontrol the fire and its aftermathonaccount of their occupation. •Establishing arecord of individuals deployed following major incidentsiscommon practicefor the Fire and Police Services. •The Buncefield Occupational Health Register provides reassurance through aharmonised assessment of exposures and reported symptoms. •The data collected for the Register would support occupational health departments in their assessment of incident-related health problems among responders. •The Register would provide abaseline health assessment against which any future problems attributed to exposures to the Buncefield fire could be compared. •The Register would be an accurate and comprehensive record of who contributed to the response following the fire, their exposures and their health state, as amatter of public record.
1.4 Aims and Objectives Aims •Todescribe who was occupationally deployed to the Buncefield Oil Depot fire. •Todescribe their exposuresand any healthsymptoms associatedwith occupational deployment to the Buncefield Oil Depot fire. Objectives •Todescribe exposures with regards to proximity,duration and time of deployment to the site. •Tomeasure self-reported exposure to smoke, fumes and particles. •Todocument use of masks and respiratory equipment. •Todescribe contact with healthcare services as aresult of the fire. •Todescribe self-reported health symptoms.
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Section 2: Methods
Section 2 Methods
2.1 Identification of Participating Occupational Health Departments Occupational health departments were identified throughliaison with public services, Government, professional and commercial networks.Key organisations included: the Fire and Rescue Services; Police Services; Bedfordshire and Hertfordshire Ambulance and Paramedic Service; Hertfordshire Country Council; the Government Office for the East of England; the Office of the Deputy Prime Minister; the Health and Safety Executive; the Ministry of Defence; Three Valleys Water; owners of the Buncefieldsite; and the HPA.
2.2 Eligibility Criterion Individuals were eligible for inclusion in the Register if they met the following criterion: •Aperson occupationally deployed to or near the Buncefield Oil Depot fire site between 11 December 2005 and 5January 2006. This included those directly involved in fighting the fire, and other occupational groups including those providing policing, care of casualties and non-physically injured, environmental sampling, incident investigation, and demolition, construction, engineering or remediation work .
2.3 Standardised Occupational Health Assessment of Eligible Individuals Occupational health departments wrote to eligible individuals asking them to complete,and return to them, the BuncefieldFire Occupational Health Questionnaire [Appendix 3]. Responses to the questionnaire were used by occupational health departments to assist in identifying staff requiring an invitation for incident-related follow-up by an Occupational Health Nurse or Physician. The original completed questionnaires were retained by occupational health departments and anonymised copies sent to the HPAEast of England Regional EpidemiologyUnit for entry into the Register database.
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2.4 Identification of Occupationally Deployed Workers Occupationally deployed workers were identified by each organisation’soccupational health department [Appendices 2, 3, 4and 5]. No directapproach was made to workers by the HPA. Twoagencies,the Metropolitan Police andHertfordshire Fireand Rescue Service, could not directly identify individuals who met the eligibility criterion for deploymenttothe incident (Section2.2). The Metropolitan PoliceOccupational HealthDepartment,therefore, wrote to allofficers deployed as a consequence of the Buncefield fire and asked them to complete and return areply slip to the HPA in apre-paid envelope [Appendix6]. Officerswho returnedthe reply slipand met the eligibility criterion were sentaquestionnairebythe HPAEastofEngland RegionalEpidemiology Unit. HertfordshireFireand RescueService sent aquestionnairetoall staff members, asking them to indicate if they met the eligibilitycriterion and, if so, to complete the questionnaire. Anonymised copies of completed questionnaires were senttothe HPAEast of England RegionalEpidemiology Unit. We calculatedthe response ratefor each agencyasthe percentage of individualsmeeting the eligibilitycriterion who returned acompleted questionnaire. For the Metropolitan Police, because we could not identify how many officers met the eligibility criteria,wecalculatedanestimated responserate as the proportion of eligible individuals who completed reply slipsand who also returned acompleted questionnaire. For Hertfordshire Fire and Rescue Service, we calculated the response rate as all eligible individualswho were sent aquestionnaireand completedit. Individualswho indicatedthey did not attend the firesite were not included in the calculation of response rates.
2.5 Exposure Definitions We used self-reported distance from the fire and time of deployment as proxy measures of exposure, regardless of an individual’sactivity duringdeployment.
Distance fromthe fire was delineatedbysafety cordons established by the Fire Service and individualswere categorised by their closest deployment: •Within the inner cordon (approximately 500m from the fire site) •Inside the outer cordon (about 1000m from the site) •Outside the outer cordon Time of deployment was defined relative to the durationofthe fire: •Burn phase (11 December 2005 to 14 December 2005) •Control &clean-up phase (15 December 2005 to 5January 2006)
Individuals were also asked to complete an exposure diary within the questionnaire. The exposure diary asked respondents to estimate the number of hours they were deployed on each day during two 12-hour periods (00:00 to 12:00 and 12:00 to 24:00) between 11 and 18 December 2005.
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Section 2: Methods
2.6 Health Outcomes For the burn, and control &clean-up, phases separately,weasked individuals to report the presence of fifteen differentsymptoms more than normal: irritation to the nose, throat irritation, eye irritation, sore or itchy skin, skin rash, tingling of lips, coughing, coughingwith sputum or phlegm, tightness or pain in chest, wheezing, shortness of breath,headaches, nausea, vomiting and any other stomach upset. We also asked individuals if they experienced anxiety or concerns about their health after the incident, if they required any time off sick and if they noted any subsequent ill-health effects.
2.7 Selection of aComparison Population We compared increased health symptoms reportedbyoccupationally deployedindividuals with increased symptoms reported during afour-week periodafter the explosionbyresidents living in the northern part of Dacorum Primary CareTrust (PCT). This is an area close to the BuncefieldOil Depot which was at no time under the smoke plume. The comparisonpopulation was selected as part of apopulation survey conductedbythe HPAtoinvestigate local concerns among the general public following the explosionand fire(Ref. 1). The population samples were selected as follows: i .Satelliteimages of the smoke plume were projectedontoamap of Dacorum and Watford and Three Rivers PCTs. Using geographical information sytems software, we plotted a5°segment from the Buncefield fire site with the centreline superimposed on top of the plume boundary (Figure 1). We used asegment rather than aline because of uncertainty about the precise location of the plume boundary. ii.Wedefined two areas: above and below the segment. The area below the segment was covered by the plume and included the southernpart of Dacorum PCT (Dacorum South) and Watford and Three Rivers PCT.The area above the segment was not under the plume and included the northern part of Dacorum PCT (Dacorum North). iii.Weused the PCT computerised database (the Exeter system) to select arandom sample of peoplewho were resident within either PCT and who were also registered with ageneral practitioner (GP). This followed the method used by the NHS Patient Survey Programme (Ref. 2). One thousand residents were sampled from Dacorum North, of whom 413 (41%) returned questionnaires. The questionabout new health symptoms was answered by 365 individuals from Dacorum North.
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Figure 1. Map showing the selectionofthe comparison population
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Section 2: Methods
2.8 Analysis Descriptive epidemiology For each question in the questionnaire we described the frequency and percentage of positive responses. Where questions were not completed by all respondents, we calculated the percentage as the number of positive responses (n) divided by the total number of completed responses (N). For each day during the first week of the response, we calculated the number of individuals deployed and total number of hours at the site. Individuals who stated they had been deployed for more than 12 hours in any 12-hour period were assumed to have been deployed for the maximum 12 hours. We calculated the mean number of hours deployedper person on each day. We calculated the proportion of individuals reporting specific symptoms for those deployed at any time during the burn phase (regardless of whether they were also deployedtothe control &clean- up phase) and those deployedonly to the control &clean-upphase. The numerator was the numberofindividuals reporting aspecific symptom during each phase and the denominator was the number of individuals who were deployed during each phase. We compared the prevalence of symptoms reported during the burn and control &clean-up phases to the prevalence of symptoms reported by the general public resident in Dacorum North during the four weeks after the explosion.Wecalculated prevalenceratios (PRs), 95% confidenceintervals (CIs) and p-values for symptoms that were reported by both groups. Single variable analysis For different risk factors, we calculated the odds ratio (OR), 95% CIs and p-values for reporting symptoms. Symptom reporting (dependent variable)was defined as reporting any of the 15 surveyed symptoms. Potential risk factors (independent variables) were demographic characteristics (age and sex), deployment inside the inner cordon, deployment during the burn phase, wearing amask, smoking cigarettes or tobacco, history of arespiratory conditionand feeling anxious after the fire. Age was divided into four categories (<30, 30-39, 40-49, 50+ years old). Proximity of deploymentwas defined as being inside the inner cordon at any phase. Deployment during the burn phase was defined regardless of proximity.Wearing amask was defined as using any type of mask (fitted or paper mask). History of arespiratory condition was defined as reporting apast history of hay fever,asthma, bronchitis or any other respiratory problem.
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Multivariable analysis We used logistic regression to estimate the OR for reportingsymptoms while adjustingfor multiple risk factors. Risk factors with p<=0.2 in the single variable analysis were included in the logistic regression model. Age and sex were included in the model regardless of statistical significance. We used abackwards stepwise variable selectionapproach whereby variables with p>0.1 were removed, least significant first, until all variables (except for age and sex) had ap- value of about 0.1 or less. Variables that were importantconfounders (i.e. caused a10% or more changeincovariates) were retained regardlessoftheir p-value (Ref.3). We examined all two-way interactions between the remaining variables where p<=0.2 in the multivariable analysis. Interactions with p<=0.05 were considered statistically significant. Apriori we postulated that there wouldbeaninteraction between proximity and time of deployment, with individuals deployed inside the inner cordon during the burn phase most likely to report symptoms.
2.9 Data Handling All data were enteredinto adatabase in EpiData version 3.1. Data entry error was 1% in a sample of 60% of questionnaires checked by double data entry.Statistical analysis was conducted using STATAversion 9.1.
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Section 3: Results
Section 3 Results
3.1 Agencies and Individuals Deployed to the Buncefield Site We identifiedfifty-one organisations that deployedstaff to the incident site (Tables 1and 2). This included 35 fire services, 10 public sector organisations, three voluntaryorganisations, and three private companies. In total, 1949 individuals were eligible for inclusion in the Register.The number of eligible individuals in each organisation ranged from 1to777. One organisation, Hertfordshire Highways, did not participate because they were unable to identify the subcontractors deployed to the site. Another 16 agencies that were invited to participate did not return any questionnaires (Table 2). These organisations accounted for 115 potentially eligible individuals, 6% of the total number of individuals identified. Thirty-four organisations returned completed questionnaires (Table 1). Of the 1949 eligible individuals identified from these organisations, 816 returned completed questionnaires. One completed questionnaire was returned by Thames Water but not received,resulting in atotal of 815 questionnaires entered into the database. The response rate from employees of participating organisations (Table 1) was 815/1834 (44%). The MetropolitanPolice deployed 640 officersasaresult of the fire, although many were tasked withtrafficmanagement along way from the fire site. Completed reply slips were returned by 172 officers(27%), of which 46 were not deployedtothe fire site.Ofthe remaining 126 individuals, 34 returned completedquestionnaires (estimated sample response rate 27%). Hertfordshire Fire and Rescue Service distributed the questionnaire to all 936 staff in their service. One hundred and fifty-nine individuals reported that they did not attend the incident. From the remaining777 individuals, 348 completedquestionnaires (response rate 45%).
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Table 1. Organisations that returned completed questionnaires to the Buncefield Occupational Health Register
Organisation Eligible Questionnaires Response rate (%) individuals completed Fire and Rescue Services Humberside55(100) Derbyshire1010(100) Cumbria 11(100) London Fire Scientific Advisors 33(100) Hampshire 43 39 (91) Warwickshire1311(85) Northamptonshire 65(83) Staffordshire 15 12 (80) Norfolk 22 16 (73) Leicestershire 75(71) Oxfordshire 32(67) West Midlands 32(67) Bedfordshire 72 44 (61) Hertfordshire 777 348 (45) Suffolk 42(50) Devon 42(50) Buckinghamshire 85 43 (49) West Berkshire 23 11 (48) Somerset 24 11 (46) London 74 15 (20) Other Public Sector Hertfordshire County Council 44(100) Defence Science and Technology Laboratory 44(100) Ministry of Defence 66(100) Health and Safety Executive/Laboratory 12 12 (100) Health and Safety Laboratory 88(100) Health Protection Agency 15 15 (100) Hertfordshire Police 319 91 (29) Environment Agency 20 9(45) Metropolitan Police 126 *36(27) Bedfordshire and Hertfordshire Ambulance and Paramedic Service 57 14 (25) Private Sector Thames Water 11** (100) Total UK 29 9(31) Voluntary Sector British Red Cross 27 15 (56) Salvation Army 15 5(33) Total 1834 815 (44)
*Estimated from 126 individuals identified as eligible ** Questionnaire sent but not received by the Register team
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Section 3: Results
Table 2. Organisations that did not return questionnaires to the Occupational Health Register
Organisation Eligible Questionnaires Response rate (%) individuals completed Fire and Rescue Services Nottinghamshire 15 0(0) Fire Service TrainingCollege 00(0) Dorset 60(0) Kent 80(0) Surrey 80(0) Shropshire 50(0) Cambridgeshire 40(0) Cheshire 40(0) Cornwall 30(0) Hereford and Worcester 20(0) North Yorkshire 20(0) Lincolnshire 20(0) South Wales 20(0) Gloucestershire 00(0) Mid and West Wales 10(0) Private Sector Hertfordshire Highways Unknown –– Voluntary Sector WRVS 53 0(0) Total 115 00
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3.2 Characteristics of Deployed Individuals Almost three quarters of respondents were deployed by aFire and Rescue Service (Table 3). Fifteen percent of respondents were from aPolice Force (the Metropolitan Police or Hertfordshire Police). Other organisations accounted for arelatively smaller number of respondents. Most of the questionnaire respondents were men (Table 4). Few respondents were younger than 20 years or older than 49 years.
Table 3. Type of organisations that respondents were deployed by
Organisation type Frequency (%) Fire and Rescue Service 591 (72.5) Police Force 125 (15.3) Health and Safety Executive 20 (2.5) Ambulance Service 14 (1.7) Ministry of Defence 10 (1.2) Health Protection Agency 10 (1.2) Local Authority 4(0.5) Other 40 (4.9) Not recorded 1(0.1) Total 815 (100)
Table 4. Age and sex of questionnaire respondents
Age group Men Women Total n(%) n(%) n(%) <20 5(1) 0(0) 5(1) 20-29 133 (19) 21 (34) 154 (20) 30-39 246 (35) 18 (30) 264 (34) 40-49 264 (37) 8(13) 272 (35) 50-59 62 (9) 7(11) 69 (9) 60+ 3(0.4) 7(11) 10 (1) All 713 (100) 61 (100) 774 (100)
Note: 41 individuals with incomplete information: 7missing age, 20 missing sex and 14 missing both.
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Section 3: Results
Seventeen percent of questionnaire respondents were current smokers at the time of the fire (Table 5). Almost one third reported arespiratory condition(n=260), of which hay fever was the most common (28%), followed by asthma (8%) and bronchitis(4%).
Table 5. History of smoking and previous respiratory conditions
Completed Answered (%) reponses (N) Yes(n) Smoking History Current smoker 795 134 (17) Any respiratorycondition 815 260 (32) Hay fever 755 208 (28) Asthma 724 59 (8) Bronchitis712 31 (4) Other 708 10 (1)
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3.3 Exposures Table 6summarises the phase during which individuals were deployed. Almost half were deployed during both phases. About one third were deployedduring the burn phase only. Seventeenpercentwere deployed to the control &clean-upphase only.
Table 6. Deployment of individuals during different phases of incident response
Incident phase Dates n% Burn and control &clean-up phases 11/12/05 to 05/01/06 386 (47) Burn phase only 11/12/05 to 14/12/05 274 (34) Control &clean-up phase only 15/12/05 to 05/01/06 139 (17) No information available –16(2) Total 815 (100)
Of the 660 individuals deployed during the burn phase, almost three quarters were inside the inner cordon at some time during their deployment, 57% inside the outer cordon and 41% outside the outer cordon (Table 7). There were 139 individuals deployedduring the control &clean-up phase, the majority of whom were inside either the inner or outer cordon.
Table 7. Site and phase of deployment of individualstothe Buncefield site
11 to 14/12/05 15/12/05 to 05/01/06 Burn phase Control &clean-up phase [N=660] [N=139] n(%) n(%) Inside inner cordon 485 (73) 101 (73) Inside outer cordon 374 (57) 93 (67) Outside outer cordon 270 (41) 58 (42)
Notes: Individuals were deployed to multiple sites and phases and will be counted more than once. Informationabout phase of deployment not availablefor 16 individuals.
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Section 3: Results
Almost three quartersofrespondents reported inhalation of smoke, fumes or particles and 86% smelledsmoke and/or chemicals (Table8). About two fifthsreported using respiratory equipment,of which paper masks were mostfrequently mentioned.Few individuals reported usingarespirator or fittedmask,while 44% of respondents who reported usingamask did notspecify whattype they used.
Table 8. Reported exposures to smoke and chemicals, and use of respiratory equipment
Completed Answered (%) responses (N) Yes(n) Exposures Inhaled smoke, fumes or particles 796 585 (73) Smell smoke and/or chemicals 791 677 (86) Used respiratory equipment 795 309 (39) Paper mask 309 170 (56) Respirator/fitted mask 309 3(1) Not specified 309 136 (44)
Of 815 respondents, 705 (87%) completedthe exposure diary for the period of Sunday 11 December 2005 to Sunday 18 December 2005. Twohundred and eighty-six individuals reported being deployed to the Buncefield site on the first day of the fire (Table 9). The largest number (n=356) were deployed on Monday 12 December 2005. The number of respondents deployed subsequently declined each day until Sunday 18 December 2005 (Figure 2). Thirty-one percent were deployed on just one day,aquarter for two days,and 15% for three and four days each. About 7% were deployed for five to eight days.
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Table 9. Number of individuals and hours deployed to the Buncefield fire, Sunday 11 December 2005 to Sunday 18 December 2005
Burn phase Control &clean-up phase Sun 11 Mon 12 Tue13Wed 14 Thu 15 Fri 16 Sat 17 Sun 18 Firemen deployed 206 292 221 229 180 155 105 99 Other staff deployed 80 64 68 52 48 28 16 10 (% Firemen) 72 82 76 81 79 85 87 91 Total 286 356 289 281 228 183 121 109
Number of hours deployed 1994.7 2910.3 2249.9 2020.6 1610.8 1174.8 782.5 653.4 Mean hours per person deployed 7.0 8.2 7.8 7.2 7.1 6.4 6.5 6.0
The total number of hours deployedshows asimilar patterntothe number of individuals deployed, reaching apeak on Monday 12 December 2005 and then declining (Figure 2). The mean number of hours of deployment per person was also highest on Monday 12 December 2005 with a mean of 8.2 hours per person. This decreased to 6.0 hours on Sunday 18 December 2005.
Figure 2. Trend in number of individuals deployed and hours of deployment to the Buncefield fire, Sunday 11 December 2005 to Sunday 18 December 2005
400 3,000
2,500 300 2,000 deployed deployed
200 1,500 hours of individuals
of 1,000
100 number tal
Number 500 To
0 0
/12/05 3/12/05 4/12/05 11 12/12/05 15/12/05 16/12/05 17/12/05 18/12/05 e1 d1 Fri Sat Sun Mon Tu We Thu Sun
Individuals deployed in burn phase Individuals deployed in control & clean-up phase Total number of hours deployed
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Section 3: Results
3.4 Use of Healthcare and Occupational Health Services Twenty-six individuals (3%) reported attending an Accident and Emergency (A&E) Department (Table 10). Twowent to Watford Hospital,17toHemel Hempstead Hospital and seven did not specifywhere. Most of the individuals attended A&E following managerial advice or instruction (n=23) and three went because they felt unwell. Twelve (2%) individuals consulted their GP,two of whom had also attended A&E. An occupational health review was conducted with 22 individuals (3%), two of whom also attendedA&E and seven who consultedtheir GP.
Table 10. Reported healthcare use by individuals deployed to the Buncefield fire
Completed Answered (%) reponses (N) Yes(n) Healthcare Attendance at A&E 798 26 (3) Managerial advice or instruction 26 23 (88) Feeling unwell 26 3(12) Consulted their GP 789 12 (2) Occupational Health Received an Occupational Health Review 650 22 (3)
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3.5 Health Symptoms During the burn phase, 41% of 660 individuals deployed reportedatleast one new symptom (Table 11). The most frequently reportedsymptoms were: irritation to the nose (20%), throat (26%) and eye (21%), coughing (21%), and headaches (16%). One hundred and thirty-nine individuals were deployed during the control &clean-up phase only,ofwhom 26% reported symptoms. The most commonly reported symptomswere similar to those in the burn phase.
Table 11. Percentage of individuals reporting new symptoms following deployment during different phases of the incident
Deployed during Deployed during burn phase control &clean-up [N=660] phase only [N=139] New symptom n(%) n(%)
Irritationtonose 130 (19.7)15(10.8)
Throat irritation 174 (26.4) 17 (12.2)
Eye irritation 139 (21.1) 9(6.5)
Sore or itchy skin 35 (5.3) 3(2.2)
Skin rash 9(1.4) 2(1.4)
Tingling of lips 17 (2.6) 1(0.7)
Coughing 138 (21.0) 11 (7.9)
Coughing with sputum or phlegm 34 (5.2) 2(1.4)
Tightness or pain in the chest 28 (4.2) 4(2.9)
Wheezing 27 (4.1) 3(2.2)
Shortness of breath 13 (2.0) 2(1.4)
Headaches105 (16.0) 20 (14.4)
Nausea 32 (4.9) 5(3.6)
Vomiting 1(0.2) 2(1.4)
Other stomach upset 9(1.4) 2(1.4)
Any symptom 269 (41.0) 36 (25.9)
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Section 3: Results
Among individuals reporting symptoms during the burn phase, about three quarters of individuals reported between one and four symptoms (Table 12). In the control &clean-up phase, individuals rarely reportedmore than three symptoms.
Table 12. Number of individuals reporting one or more new symptoms by incident phase
Number of Burn phase Control &clean-up symptoms phase only n(%) n(%) 169(25) 13 (36) 251(19) 9(25) 344(16) 8(22) 439(14) 2(6) 522(8) 2(6) 619(7) 0(0) 710(4) 0(0) 88(3) 0(0) 92(0.7) 0(0) 10 2(0.7) 1(3) 11 1(0.4) 0(0) 12 1(0.4) 0(0) 13 1(0.4) 0(0) 14 0(0) 0(0) 15 0(0) 1(3) Any symptoms 269 (100) 36 (100)
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Compared with members of the public living in Dacorum North, individuals deployedduring the burn phase weremore likely to report eye irritation (PR=2.1, 95%CI 1.5-3.0), coughing (PR=1.3, 95%CI 1.0-1.8) and headaches (PR=1.7, 95%CI 1.2-2.5) (Table 13), and less likely to report shortness of breath (PR=0.3, 95%CI 0.1-0.5) and vomiting (PR=0.1, 95%CI 0.0-0.4). During the control &clean-up phase no symptoms were reported more frequently than by the general population, while coughing and shortnessofbreath were less frequently reported.
Table 13. Prevalenceofnew symptoms and prevalence ratio for occupationally deployed individuals compared with members of the public in Dacorum North during the four weeks after the explosion.
Dacorum North, Deployed during Deployed during reference population burn phase control &clean-up N=[365] [N=660] phase only [N=139] Prevalence PR 95%CI p-value PR 95%CI p-value
Irritationtonose N/A ––– –––
Throat irritation N/A ––– –––
Eye irritation 9.9 2.1 1.5-3.0 <0.001 0.7 0.3-1.3 0.23
Sore or itchy skin 4.1 1.3 0.7-2.3 0.40 0.5 0.2-1.8 0.29
Skin rash 1.6 0.8 0.3-2.3 0.72 0.9 0.2-4.3 0.87
Tingling of lips N/A ––– –––
Coughing 15.6 1.3 1.0-1.8 0.04 0.5 0.3-0.9 0.024
Coughing with N/A ––– ––– sputum or phlegm
Tightness or pain N/A ––– ––– in the chest
Wheezing* 6.0 0.7 0.4-1.2 0.17 0.4 0.1-1.2 0.074
Shortness of breath 7.1 0.3 0.1-0.5 <0.001 0.2 0.0-0.8 0.013
Headaches 9.3 1.7 1.2-2.5 0.003 1.5 0.9-2.6 0.102
Nausea 4.1 1.2 0.6-2.1 0.6 0.9 0.3-2.4 0.79
Vomiting 2.7 0.1 0.0-0.4 <0.001 0.5 0.1-2.4 0.39
Other stomach upset N/A ––– –––
*The survey in Dacorum North asked about Asthma/Wheezing N/A -Not available PR -Prevalence ratio
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Section 3: Results
After deployment, 4% of respondents reported anxiety or concerns related to the incident (Table 14). Eighteen individuals (2%) took time off sick (range 1–33 days) and 15 (2%) noted subsequent ill effects attributable to the incident: three with eye or throat irritation, three with sleeplessness or stress, two with breathing problems, two with physical injuries, one with flu-like symptoms, and four not specified.
Table 14. Post-incident health concerns
Completed Answered Yes(n) (%) reponses (N) Anxiety or concerns after the incident 780 32 (4) Require any time off sick 779 18 (2) Noted any other ill effects subsequently 770 15 (2)
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3.6 Associations Between Risk Factors and Reporting Symptoms Odds ratios for risk factors are shown in Table 15. The oddsofreporting symptoms decreased slightly among older age groups, but not significantly.There was no evidence that symptom reporting differed betweenmen and women. Individuals were more likely to report symptoms if they were deployed inside the inner cordon, worked during the burn phase or wore amask. Smoking or having ahistory of arespiratory illness was not associated with symptoms. There was weak statistical evidence that individuals who were anxious after the fire were more likely to report symptoms.
Table 15. Single variable analysis of risk factors for self-reported symptoms
Risk factor No symptoms Symptoms OR 95%CI p-value Age (years) <30 88 74 1.00 – 30-39 156 113 0.86 0.58-1.28 40-49 161 119 0.88 0.60-1.30 50+ 59 24 0.48 0.27-0.85 0.074 Sex Male 417 301 1.00 – Female 38 25 0.91 0.54-1.54 0.729 Deployment inside No 156 44 1.00 – inner cordon Yes320 295 3.27 2.26-4.73 <0.001 Working during the No 116 39 1.00 burn phase Yes360 300 2.48 1.67-3.67 <0.001 Used mask No 332 154 1.00 Yes129 180 3.01 2.24-4.04 <0.001 Smoker No 388 273 1.00 Yes74601.15 0.79-1.68 0.46 History of respiratory No 332 223 1.00 condition Yes144 116 1.20 0.89-1.62 0.23 Anxiety after the fire No 434 314 1.00 Yes13192.02 0.98-4.15 0.053
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Section 3: Results
Age, sex, deployment inside the inner cordon, working during the burn phase, using amask, having ahistory of respiratory illness,and anxiety after the fire were entered into amultivariable logistic regression model (Table 16). Age and sex did not improve the model fit (p>0.05) but were retained in the model regardless. Having ahistory of respiratoryillness or anxiety were not statistically significant in the model and were removed. Two-way interactions were explored between deploymentinside the inner cordon, working during the burn phase, and using amask. There was evidence of astatisticalinteraction between deploymentinside the inner cordonand working during the burn phase (p=0.0274). Consideration of the OR and 95% CIs for the interaction term suggest that individuals working inside the inner cordon during the burn phase were twice as likely to report symptoms.
Table 16. Multivariable logistic regression model of risk factors for self-reported symptoms
Risk factor OR 95%CI p-value† Age (years) <30 1.00 30-39 0.99 0.64-1.53 40-49 1.11 0.72-1.71 50+ 0.76 0.41-1.42 0.64 Sex Male 1.00 Female 1.45 0.79-2.63 0.23 Used mask No 1.00 Yes2.33 1.67-3.26 <0.0001 Interaction term: deployment inside inner cordon*deployment during burn phase
Place and time of Outside the inner cordon after burn phase 1.00 exposure Outside the inner cordon during burn phase 0.72 0.33-1.57 Inside the inner cordon after burn phase 1.15 0.51-2.59 Inside the inner cordon during burn phase 2.07 1.24-3.47 0.0274 †p-value for whether the variable or interaction term improves the model fit. Note: Final model based on 742 observations.
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Section 4 Discussion
4.1 Main Findings We found that alarge number of organisations and individuals were involved in the response to the Buncefield fire. Althoughthe majority of occupationally deployedindividuals were from the emergency services, the involvement of individuals from other agencies and organisations, including the private and voluntary sector,was notable. We found that alarge number of individuals includedinthe follow-upwere deployed during the burn phase and many were operational within the inner cordon. About half of the individuals were deployed during multiple phases. During the first week after the explosion, the daily mean number of hours of deployment was longer during the burn phase than after. Inhalation of smoke, fumes or particles was reported by 75%ofrespondentsand 85% had smelled smoke and/or chemicals. Twofifths wore amask at any time duringtheir deployment. Information on thetype of mask was providedby56% of these individuals. The most frequently mentioned typewas apaper mask.Just 3% of respondents attended A&E andthis was largely on managerial advice. Three respondents attended A&E because they feltunwell. Similarly,averysmallnumber of respondents consultedtheir GP.Three percent of individuals receivedareview/check-up by their occupational health department/provider,although this question wasleft blank in 20% of questionnaires. One or more symptoms were reported by 41% of respondents deployedduring the burn phase, with respiratory and eye irritation and headaches being most commonly reported. The proportion of individuals reporting symptoms decreased after the burn-phase and was considerably lower in the control &clean-up phase. Few individuals reported more than four symptoms. After the incident, 4% felt anxious or concerned, 2% reported ill effects and 2% took time off sick. This is consistent with fewer acute-term problems following deployment to the Buncefield incident. We used astatistical model to assess the main risk factors for reporting symptoms. We found that the main predictors of symptom reporting were wearingamask and being deployed inside the inner cordon during the burn phase.
4.2 Identification of Occupationally Deployed Workers To our knowledge this was the first harmonised multi-agency occupational health follow-up survey undertaken following amajor incident in the UK. We identified 51 agencies and organisations that deployed individuals in response to the Buncefield incident. These agenciesare likelytorepresent the majority of individualswho were deployed.However,itispossible that we did not identify all agencies or private sector businessesthat deployed personnel. The majority of individualsthat responded to the questionnaire were deployed during the burn phase. This was anticipated because the fire-fighting phase was the most intense period of the response.
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Section 4: Discussion
The response rate overall to the questionnaire was 44%. Explanations include the logistical challenges for occupationalhealth departments to follow up alarge number of clients and limited interest in, and motivationofstaff for,the survey and its objectives. This is addressedfurther in Section 4.7. Several agencies achieved response rates over 80% and these tended to have a smaller number of individuals deployed.
4.3 Estimating Exposures We defined ameasure of exposure to the fire based on distance and phase of deployment. Distance from the site was defined as deploymentatany time within three cordon-defined areas: inside the inner cordon, inside the outer cordon and outside the outer cordon. The cordons were operationally defined for safety purposesand were chosen for use here because they were easily remembered by respondents. However,the cordons are only an approximate indicationofdistance from the Buncefield site. Furthermore, during the incident the cordon boundaries were not static: the inner cordon especially was moved several times for safety reasons (Ref. 4). We found that 84% of individuals whoreported smoke inhalation were deployed to the inner cordon ( c 2 =89.54, p<0.001), as were 80% of individuals whoreportedsmelling smoke and/or chemicals ( c 2 =65.08, p<0.001). Similarly,wefoundthat that 85% ( c 2 =23.72 ,p<0.001) of individualswho inhaled smoke, fumes or particles and 87% ( c 2 =51.88, p<0.001)who smelled smoke and/or chemicals, were deployed during the burn phase. Although we cannot validateour proxy measureofexposure fromthese findings, they are what one might expect if illness-induced exposures had occurred most intensely duringdeployment to the inner cordon and duringthe burn phase. We combined these two measures of exposure(distance and time of deployment) in a multivariable logistic regression model by fitting an interaction term for the incident phase and distance of deployment. Before the analysis we anticipated that individuals who were deployed inside the inner cordon during the burn phase would have the highest exposures. Our results were consistent with this assumption.Wefound that individualswho worked inside the inner cordon during the burn phase were about twice as likely to report symptoms. Deploymenttoother cordon areas or after the burn phase was not statistically associated with higher symptom reporting. Beyond the relativelysimple assessment of distance and phase of deployment, we sought more detailed information about the duration of deployment by including adiary in the questionnaire. We asked respondents to estimate the number of hours they were deployed in each 12-hour period (00:00-12:00 and 12:00-24:00). The diary covered an eight-day period from Sunday 11December,when the explosionoccurred and fire started, to Sunday 18 December 2005. We chose not to extend the diary until 5January 2006, which was the end of the control &clean-up phase, as we thought that respondents would be less likely to complete such along diary. The completion ratefor the diarywas good,with 86% of respondents providing an estimate of the number of hoursthey were deployed.Wewere therefore abletouse the diary to estimate how many respondentswere deployed on each day and the mean number of hours of their deployment. We conductedasub-analysis of individuals deployed during theburn phase period only, to see whether being deployedfor more hourswas associatedwith greater symptomreporting (i.e.an exposure–response relationship). To do this we used alogistic regression model withthe same risk
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factor variables that were included in the original model [see Section 3.6], but withthe variable “deployed duringthe burnphase” substituted by the number of hours deployed. We foundthat although the number of hours deployed to the Buncefield site was an important variable in the model, there was no clear exposure-response relationship. There wasnosimple relationship between spendingalonger periodoftime in theinnercordon and reporting symptoms. Adefining characteristic of the Buncefield Oil Depot fire was that, due to the heat of the fire and the weather conditions, most of the emissions were dispersed high in the atmosphere (Ref. 5). Airborne atmospheric measurements of the Buncefield fire plume by the Meteorological Office and Natural Environment Research Council showed that the main constituent of the plume was soot (black carbon), with low concentrations of polycyclic aromatic hydrocarbons (Ref. 6). Plume modelling data suggested alow risk of contamination at ground level. Local air quality monitoring at anumber of locations near the site was conducted by the Fire Brigade’sScientific Advisers between 11 and 13 December 2005 (Ref. 7). Sampling was conducted for carbon dioxide, carbon monoxide, sulphur dioxide, hydrocarbons, particulates, volatile organic compounds, hydrogen sulphide, ammonia and hydrogen fluoride. The results did not indicate any significant deterioration in air quality around the site. The Health and Safety Laboratory also conducted local air quality sampling near the Buncefield site over the same period. Samples were analysed for total particulates, volatile organic compounds and polycyclic aromatic hydrocarbons (Ref. 7). The results also indicated that none of the pollutants monitored was above background concentrations. Additionally,the Health and Safety Laboratory assessed occupational exposures using personal monitoring devices worn by 12 workers on 29 December 2005 and 16 workers on 30 December 2005 (about two weeks after the burn phase). Levels of benzene, tolune, xylenes, trimethyl benzenes and hydrocarbons were all lower than Workplace Exposure Limits. The Health and Safety Laboratory considered the level of these chemicals to be within those expected under normal conditions for workers in the petrochemical industry.
4.4 Use of Respiratory Protection We found that only 39% of respondents reported using respiratory equipment.Paper masks were the most frequently mentioned type of respirator.Very few individuals used fitted masks or fire service respiratory equipment. Paper masks are abasic type of air-purifying respirator and tend to have apoor filtrationcapacity and inadequateface-sealing properties (Ref. 8). Individuals who used amask were more likely to be closer to the fire site ( c 2 =36.64, p<0.001), reported inhaling smoke, fumes or chemicals ( c 2 =59.50, p<0.001)and smelling smoke and chemicals ( c 2 =37.17, p<0.001). Given the limited filtration provided by paper masks, using amask may not be a measure of respiratoryprotection. However,itisunclear,even after adjustingfor exposure, why wearing amask remained asignificant risk factorfor reporting symptoms in the final model.
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Section 4: Discussion
4.5 Health Outcomes Our primary health outcome measure was self-reported symptoms. This was recorded in the questionnaire by asking if individuals had experienced one or more of fifteen symptoms during the different phases of the incident. However,the questionnaires were distributed and completed over aperiod of several months after the incident,and this may have affected the accuracy of recall. Questionnaire respondents smoked less and had fewer previousrespiratory conditions than the general public, based on the Health Survey for England (Ref. 9). The proportion of respondents that were smokers was 17%, which is lower than the general public, of whom 24% are smokers (Ref. 10). Eight percent of respondents reportedhaving asthma, although among the general adult population, 13% of men and 16% of womenhave doctor-diagnosed asthma (Ref. 9). In contrast, 28% of individuals reported having hay fever,compared with the national adult prevalence of doctor-diagnosed hay fever of 14% in men and 17% in women (Ref. 9). The percentage of individuals reporting at least one symptomwas 41%during the burn phase. We compared the symptoms among individuals deployedduringthe burn phase and control&clean-up phasewith those of members of the general publicwho wereaskedaboutsimilar symptoms during a four-week period afterthe explosion.The comparison groupwere selected for not beingunder the plume of the fire. During the burn phase, occupationally deployed individuals were more likely to report eye irritation, coughing and headaches. No comparativedata were available from the survey of the general publicfor noseorthroat irritation, which were also frequently reportedbyoccupationallydeployed individuals. Theincrease in symptom reporting was restricted to the burn phaseand individualsdeployed onlyduring the control &clean-up phase did not report more symptomsthan the generalpublic. Only asmall number of individuals sought medicalhelp during or after the incident and few took timeoff sick, reported any ill effects after the fire or felt anxious abouttheir health because of their deployment. One of the aimsofthe Buncefield Fire Occupational HealthRegisterwas to assist occupational health departments to assess anypotentialhealth problems among responders. Of individuals who completed aquestionnaire, 3% receivedanoccupational health review.
4.6 Interpretation of Results Products of combustion are respiratory irritants andcan cause coughing and throat, eye, or skin irritation(Ref.11). The long-termhealth effectsofexposuretooil-fire smoke hasbeenstudied followingthe 1991 Gulf War, when 613 Kuwaiti oil wells were deliberatelyset on fire. During deployment, military personnel commonlyreported eye and respiratory tract complaints andthese weremore frequent among individuals closer to thefires(Ref. 12). However,follow-upstudies have foundnoevidence of long-termhealth problems caused by acute exposure to oil-fire smoke (Refs 13 and 14). Our analysis found that the type of symptoms reportedwas consistent with exposure to products of combustion. Moreover,alarge proportion of respondents also reported smelling and inhaling smoke and chemical fumes. These findings appear to contradict those of local air quality monitoring. No personal monitoring was conducted during the first few days of the incident and so it is difficult to assess how well local air quality monitoring can be considered ameasure of personal exposures. However,studies comparingpersonal and ambient measurements of particulate matterhave shown that ambient measurements underestimate personalexposures, especiallywhen ambient particulate exposuresare low (Ref. 15).
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4.7 OperationalIssues To the authors’ knowledge, this was the first time such alarge collaborative occupational health follow-upsurvey has been undertaken in the UK. Its success reflectsconsiderableinput from all participating occupational health departments. As for all new endeavours,there were some aspects that worked well and others that did not. These should be considered when undertaking similar post-incident surveys in the future. It was agreed that each participating occupational health department should identify eligible individuals, distribute questionnaires, review responses and return an anonymous copy to the HPA East of England Regional Epidemiology Unit for epidemiological analysis. This approach had a number of advantages: •The survey was conducted within existing occupational health services for deployed staff and avoided disruption of these services. •The logisticalburden of contacting alarge number of individuals from many different organisations was divided among all participating agencies.Nosingle agency could have undertaken this exercise without considerable resource implications. •Participation in the Occupational Health Register providedacommon template for the occupational health assessment of staff afterthis major incident. •Byonly receivingananonymous copy of the completed questionnaire, the Occupational Health Register did not store individuals’ identifiable health records, so medical confidentiality was not violated. This may potentially avoid difficulties of holding such data for longer-term follow- up. Some of the disadvantages of the approachwere: •The distribution and review of questionnaires represented significant extra workload for occupational health departments, many of which are not resourced for this type of exercise. The workload was particularly heavy for organisations with alarge number of eligible individuals. •Directing all questionnaires via occupational health departments was not straightforward for agencies that use contractedoccupationalhealth providers. For these agencies, the financial and administrative implications may have been substantial. •Contacting alarge number of occupational health departments and arranging the distribution of paper questionnaires was atime-consuming process. Ideally,such an exercise would have been completedassoon as possibleafter amajor incident. •For future incidents,inclusion of anonymous data in aRegister may cause problems if longer- term or repeated follow-up of individuals is needed.NHS number should be consideredasa unique traceableidentifier that is not agency-specific. Notwithstanding the potential utility of health registers for occupationallyexposed individuals, it is unclear what criteria should be used to decide when to establish aregister.The intensive nature of establishingand maintaininghealth registers means that it would be unrealistic to initiate this activity frequently.However,some useful issues have been identifiedinsetting up the Buncefield Occupational Health Register.
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Section 4: Discussion
•That some agencies had difficulty identifying which members of staff were deployed to the fire site and what activities they undertook, suggests that there is scope to improve the information routinely recorded in occupational health records. •Acollaborative approachrequiresalead agency and certain agenciesmay be more suitable for this task in some circumstances. •There was no budget for the health register and the cost was met by participating organisations. Practically this meant that the Register work was undertaken in addition to normal workloads. This not only created adegree of stress in itself, but it meant that gathering and analysing information took longer.Acontingency fund to be held by one or more lead agencies for asimilar activity in the future should be considered. •Achieving amaximal gain from ahealth register requires good information about both health outcomes and exposures. Ability to recordboth of these factorsshould be part of future decisions on when to establish ahealth register. •Gathering information about health symptoms during the acute phase of the Buncefield fire undoubtedly contributed to occupational health assessment. However,ifrepeatedfollow-up is required following future incidents,orifexposures occur to agents with unknown health outcomes, the distinction between operational work and research may become less clear.
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Section 5 Conclusions
The Buncefield Occupational Health Register was the first large-scale harmonisedoccupational health follow-up after amajor incident in the UK. Alarge number of individuals from many differentagencieswere identified. Most of the respondents were deployedduring the burn phase and had been in the inner cordon. During the fire, around 40% of respondents reported at least one health symptom. The most common symptoms were irritation to the nose, throat and eyes, and headaches. No excess of symptomswas reported by individuals deployed only during the control &clean-up phase. The proportionofrespondents reporting health symptoms decreased after the fire and subsequent to the end of the incident.Few individuals sought health care as a result of the fire. The findingsfrom the Occupational Health Register suggest that deployment to the Buncefield fire was not associated with major acute health symptoms.
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Section 6: Recommendations
Section 6 Recommendations
•Individuals who were deployed to the Buncefield fire can be reassured that no evidence of significant health problems in the short term has been identified among responders. •Inthe absence of major acute health symptoms, repeated follow-upofindividuals included in the Buncefield Occupational Health Register is not recommended. •Personal exposure monitoring of asample of individuals during the early phase of future incidents would be helpful for assessing exposures and potential health impacts. •All responding agencies and organisations should have access to appropriate respiratory protection. For Fire and Rescue Services, standardfire service respiratory equipmentmay not always be suitable. •Responsible agencies should give early consideration to providing follow-up of individuals occupationally deployed to major incidents. Where multiple agencies are involved, aharmonised approach shouldbeconsidered with co-ordination by acentral agency.Acontingency fund should be available for such multi-agency responses. •Greater use of Internet-based questionnaires could reduce administrative workload and speed up information gathering. However,this must be balanced against potential access difficulties for some individuals. •For future registers, inclusion of non-agency specificpersonal identifiers (such as NHS number) should be considered to facilitate repeated or long-term follow-up, if required.
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Buncefield Fire Occupational Health Working Group. Final Report: March 2007
References
1. Palmer SR, GallacherJ,O’Connell S, Morgan O, Leonardi G, Page L, et al. Appendix 3. Buncefield Follow-up Population Survey.The Public Health Impactofthe Buncefield Oil Depot Fire. Available at: http://www.hpa.org.uk/publications/2006/buncefield/appendix3.pdf: Health Protection Agency; 2006. 2. Healthcare Commission. Primary care trust survey of patients 2005. Available at: http://wwwhealthcarecommissionorguk/nationalfindings/surveys/patientsurveys/nhspatientsurvey2 005/pctsurvey2005cfm. 3. Woodward M. Epidemiology.Study Design and Data Analysis. New York: Chapman &Hall/CRC; 1999. 4. Hertfordshire Fire and Rescue Service. Buncefield. Hertfordshire Fire and Rescue Service’s Review of the Fire Response.Norwich: The StationeryOffice; 2006. 5. Committee on the Medical Effects of Air Pollutants (COMEAP). Statementonthe 2005 Buncefield fire. Available at: http://www.advisorybodies.doh.gov.uk/comeap/statementsreports/dec05buncefieldfire.pdf; 2006. 6. Department for environment food and rural affairs. Initial review of air quality aspects of the Buncefield Oil Depot Explosion. Crown Copyright; 2006. Available at: http://www.defra.gov.uk/environment/airquality/publications/buncefield/buncefield-report.pdf 7. Murray V, Mohan R, Aus C, Wilson J. Atmospheric Modellingand Monitoring. The Public Health Impact of the Buncefield Oil Depot Fire. Health Protection Agency; 2006. Available at: http://www.hpa.org.uk/publications/2006/buncefield/appendix4.pdf 8. Urie R. Personal Protection and Hazardous Materials. In: Sullivan J, Krieger G, editors. Clinical Environmental Health and Toxic Exposures. 2nd ed. New York: Lippincott Williams &Wilkins; 2001. 9. Department of Health. 2001 Health Survey for England.London: The Stationery Office; 2003. 10.Goddard E. General Household Survey 2005. Smoking and drinking among adults, 2005. London: Office for National Statistics; 2006. 11.Harrison H, Elkabir D. Products of Combustion: Health Protection Agency; 2002. 12.PetruccelliBP, Goldenbaum M, Scott B, Lachiver R, Kanjarpane D, Elliott E, et al. Health effects of the1991 Kuwaitoil fires: asurvey of US army troops. JOccup EnvironMed. 1999Jun;41(6):433-9. 13.Kelsall HL, Sim MR, Forbes AB, McKenzie DP,Glass DC, Ikin JF,etal. Respiratoryhealth status of Australianveterans of the 1991 Gulf Warand the effects of exposure to oil fire smokeand dust storms. Thorax. 2004 Oct;59(10):897-903.
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References
14.Lange JL, Schwartz DA, Doebbeling BN, Heller JM, Thorne PS. Exposurestothe Kuwait oil fires and theirassociation with asthma and bronchitis among gulf war veterans. Environ Health Perspect. 2002 Nov;110(11):1141-6. 15.Nieuwenhuijsen M. Personal exposuremonitoring. In: Nieuwenhuijsen M, editor.Exposure assessment in occupational and environmental epidemiology.Oxford: Oxford UniversityPress; 2003.
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Appendices
1. Protocolfor HarmonisedOccupational Health Surveillance Following Deploymenttothe BuncefieldOil Depot Fire, Hemel Hempstead, Hertfordshire, 11 December 2005 2. Guidelines for Occupational Health Departments. Buncefield Fire Occupational Health Register 3. Register Questionnaire 4. Buncefield Occupational Health Invitation Letter 5. Occupational Health Participation Form 6. Invitation letter from the Metropolitan Police
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Appendices
Appendix1
Occupational HealthRegistryfollowing theBuncefieldOil Depot Fire
Protocol forHarmonisedOccupationalHealthSurveillance Following Deployment to theBuncefield OilDepot Fire, HemelHempstead, Hertfordshire 11 December2005
PreparedbyMarkReacher &Oliver Morgan on behalf of the Buncefield Fire Occupational Health WorkingGroup Revised: 14 February 2006
1.0 INTRODUCTION
TheBuncefieldOil Depot Fire started on 11 December 2005. Alargenumberof individualsweredeployedtothe site of the fire, including fire fighters fromservices throughout England, police, health services,Dacorum County Council andothers.
OccupationalHealth Departments andthe Health Protection Agency have identifiedthe need forcollection of data on exposureand health statesofpersonnel deployedin response to the BuncefieldOil Depot Fire.Itwas proposedtoestablishanoccupational health registry.
1.1The BuncefieldFireOccupational HealthWorking Group
Thefirst meeting of the BuncefieldFireOccupationalHealth Working Group took place on Monday19December 2005 at the offices of the HertfordshireHealth Protection Unit, Welwyn Garden City. Thegroup pulledtogetherthe expertise of the OccupationalHealth Departments serving the fire andrescueservices,ambulanceservices,County Council andpolicedepartments in Hertfordshire, whose staff hasled the response to the fire.A second meeting washeldon5January 2006 at the OccupationalHealth Department of the HertfordshireFireand RescueServices,Longfield, Hitchin.
Theremit of group wasagreedas:
“Toconsiderharmonising data collection of individuals’ accesstooccupational heathdepartments andNHS providers because of the Buncefield fire,including the developmentofastandard data collection questionnaire anddataentryinto a confidentialregisteroperated in accordance with best practise,for data storage andretrieval of confidentialinformation.”
1.2Justification andRationale " Although the assessmentfor individuals occupationally exposedatthe Buncefield fire wasthatthe risk to health wasverylow, it is important to systematically collect information fromindividualsfromall responding organisations to confirmthere has been no residual health impact. " Establishing an occupationalhealth registerfollowing major incidents is normal practicefor the Fire andpoliceservices. " TheBuncefieldOccupationalHealth Registrywill provide reassurance to individuals andtheir employerbyconductingathorough assessmentofexposures andreported symptoms. " Thedatacollected forthe Registrywill help OccupationalHealth Departments assess anypotentialhealth problems among responders andprovide an opportunity foran occupationalhealth reviewwhere appropriate. " This Registrywill provide abaseline health assessmentagainstwhichany future problems attributedtoexposures to the Buncefieldfirecan be compared. " TheRegistrywill be an accurate andcomprehensive record of whocontributed to the response following the fire, their exposures andtheir health as amatterofpublic record.
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Occupational HealthRegistryfollowing theBuncefieldOil Depot Fire
1.3Decision to Harmonise Occupational HealthAssessments Related to theIncident
TheWorking Group considered thatoccupationalhealth assessments should be harmonised. This will permitmeaningful epidemiological interpretation of occupational exposureand health data,whichwill be of value to employees,the general public, industryand policymakers.
2.0METHODS
2.1Inclusion criteria
Individuals will be includedonto theRegisteriftheyfulfilthe inclusion criteria:
Aperson who was occupationally deployed to or near theBuncefield OilDepot Fire site between 11th December 2005 and 05th January 2006.
Additional notes on the inclusion criteria: Consequences of the fire include care of casualtiesonsite,care of the non-physically injured by health andsocialservices,policing, environmentalsampling, demolition, construction andengineering andworkonremediation of the site andassociated environment.
2.2Identification of Occupational HealthDepartments ServingEmployees Exposedto the BuncefieldFire, theFireSiteorthe Consequencesofthe Fire
OccupationalHealth Departments thatare likely to have staff meeting the inclusion criteriafor aindividuals occupationally exposedtothe Buncefield Fire will be identified through liaison with public services,government, professionaland commercial networks. Keyorganisations include the fire, policeand ambulanceservices forHertfordshire, the DacorumLocal Authority, the Government Office forthe East of England,the Office of the Deputy Prime Minister, the Health andSafetyExecutive,the MinistryofDefence, ThreeValleys Water, owners of the Fire siteand the Health Protection Agency Chemical Hazardsand Poisons Division.
Departments will be written to, to invite themtoparticipate in harmonisedpost BuncefieldOccupationalHealth Surveillance.
Thenames of departments approached andparticipating will held in adatabaseholding the name of theorganisation, the contact person withinthe organisation, date approached, whetherstaff meeting the inclusion criteriaare known to thatdepartment, consent by the OccupationalHealth Department to participate in harmonisedpost Buncefield OccupationalHealth Surveillance.
2.3 Identification of Occupationally ExposedWorkers
Occupationally exposedworkers will be identifiedthrough the OccupationalHealth Department whichserves their organisation of employment. No direct approach will be madetoworkers otherthanthrough OccupationalHealth Departments.
Thesurveywill, therefore,beundertaken at twolevels-levelone being the Occupational Health Departmentand leveltwo beingthe individuals whoare served by that department.
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Appendix1
Occupational HealthRegistryfollowing theBuncefieldOil Depot Fire
2.4StandardisedPost BuncefieldOccupational HealthAssessment of Individual Workers
Staff identifiedashaving been deployedtothe Buncefieldfireorasaconsequenceofthe fire between 11th December 2005 and05 th January 2006, will be writtentobytheir OccupationalHealth Department asking themtocompleteand returnthe BuncefieldFire OccupationalHealth Questionnaire.
Based on the responsestothe questionnaire, the OccupationalHealth Department will invite individuals judgedtohavehad an illness or injuryassociatedwith the deployment to the fire or itsconsequences,toattend the OccupationalHealth Departmentfor apost Buncefieldhealth evaluation. This will be conducted by an OccupationalHealth physicianornurse.
Theoriginalofthe Questionnairewill be retainedbythe OccupationalHealth department forits ownpurposeswithin theindividualOccupationalHealth record.
2.5Confidentialityand Entry of theOccupational HealthQuestionnaireDataInto the Register
Thecopy of the Questionnairesenttothe registrywill not include the individual’sname, addressorthe name andaddressofthe individual’sGeneral Practitioner. Theunique personalidentifiers to be reportedtothe registryare theOccupationalHealth Department record numberand the patient’sNHS number,ifavailable.These unique identifiers,date of birth andsex will permit identification of duplicateOccupationalHealth records.
2.6Recording EmployeeConsent to RecordsBeing Enteredinto theBuncefield Occupational HealthDatabase
Areturnwill be madebythe participating OccupationalHealth Department of thenumber of individuals identifiedasmeeting theinclusion criteria, the numberwho consentedand the numberwho declined/failedtocomplete the questionnaire.
2.7Transmission of Completed Post BuncefieldOccupational Exposure andHealth Questionnaires
Acopy of the completedquestionnaires will be sent by post to BFR, Health Protection Agency East of England RegionalEpidemiology Unit, Institute of Public Health, University Forvie Site,Robinson Way, Cambridge CB2 2SR.
2.8Establishment of aDatabaseofIndividuals Occupationally Exposedtothe BuncefieldFireorits Consequences
Thequestionnaires will be entered into asecure password protected database held at the Health Protection Agency East of England RegionalEpidemiology Unit. This database is held on asecure local area computernetwork andisfullybacked up. TheUnit is experienced in maintainingconfidentialdatabases andisasecure environmentand complieswith RegionalHealth Protection Agency StandardsofProtection of Confidential Information.
2. 9The ContinuedRole of theBuncefieldFireOccupationalHealthWorking Group
TheWorking group will act as guarantorsofthe harmonisedpost Buncefield OccupationalHealth Surveillance. This will entail overseeing the establishmentofthe BuncefieldFireOccupationalHealth database,guiding, approving andcontributing to
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Occupational HealthRegistryfollowing theBuncefieldOil Depot Fire
analyses, writtenreports andpapers derivedfromthe database andadjudicating on ownership andauthorshipissuesrelated to the surveillanceand database.
Thegroup will be the point of approach andapprovalfor agencies andindividuals seeking accesstoanalyses fromthe database,ordownloads elements of the database.
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Appendix 2
Buncefield Fire Occupational Health Registry
Guidelinesfor Occupational Health Departments
Forany queries,contact Oliver Morgan
1.0INTRODUCTION
Thank youfor agreeing to participateinthe Buncefield Fire OccupationalHealth Registry. This documenthas been writtenasaguidefor participatingOccupational HealthDepartments. It will answer your questions about whyweare making aregistry, what youhavetodoand whoelseisinvolved.
1.1Why make a Registry? " Althoughthe assessment forindividuals occupationally exposed at the Buncefield fire wasthatthe risktohealth wasvery low,itisimportantto systematically collectinformation from individuals from allresponding organisations to confirmthere has been no residualhealthimpact.
" Establishing an occupationalhealthregister following majorincidents is normal practice forthe Fire andpoliceservices.
" TheBuncefield Occupational Health Registrywillprovidereassuranceto individuals andtheir employer by conducting athoroughassessment of exposures andreported symptoms.
" Thedatacollectedfor theRegistrywillhelp OccupationalHealthDepartments assess any potential healthproblemsamong responders andprovidean opportunityfor an occupationalhealthreviewwhere appropriate.
" This Registrywill provideabaseline healthassessment againstwhich any future problems attributed to exposures to theBuncefield fire canbecompared.
" TheRegistrywillbeanaccurate and comprehensiverecord of whocontributed to theresponsefollowingthe fire,theirexposures and their health as amatter of public record.
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Appendix 2
Buncefield Fire Occupational Health Registry Guidelines
1.2Who is involved TheRegistryisbeing overseenbythe Buncefield Fire Occupational HealthWorking Group (OHWG). TheOHWG consists of Occupational Healthprofessionals from all the main emergencyservices andother organisations that responded to thefire. Afull list of theOHWG members is provided in Section 4.0.
Theday-to-day management of theRegistryisbeingundertakenbythe Health Protection Agency’sEastofEngland Epidemiological Unit.The RegistryCo-ordinatoris Oliver Morgan.All queries from Occupational HealthDepartmentsshould be directedtoOliver Morgan.
2.0OVERVIEW OF PROCEDURES
A. Occupational HealthDepartmentsidentifyall individuals within their organisationwho respondedtothe Buncefieldfire.
B. Occupational HealthDepartmentssendout astandardquestionnaire developed by theOHWG.The questionnairerequireseachindividualto complete aseries of questions abouttheir exposures andhealthsymptoms.
C. Individuals returntheir completed questionnairetotheir Occupational Health Department.Amember of staff within theDepartment completes asmall section on thequestionnaire aboutthe individual, makesacopy of the questionnaire andthensends thecopy to theRegistryCo-ordinator.
D. TheOccupational HealthDepartment reviewseachindividual’s responsetothe questionnaire andifdeemednecessary,can recall that individualfor afurther occupational healthreview. This is at thediscretion of eachOccupational HealthDepartment.
E. TheOHWG will analyse thedataand writeareporttobedistributed to all participatingOccupational HealthDepartments.
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Appendix2
Buncefield Fire Occupational Health Registry Guidelines
3.0PROCEDURES FOROCCUPATIONAL HEALTH DEPARTMENTS
3.1Confidentiality, data protection procedures TheRegistrydatabasewill not contain ANYidentifiabledata(individual’s name, address or details of theirGeneralPractitioner). No information recordedonthe questionnaire will allowthe identificationofindividuals by theRegistryCo-ordinator or anybodyelse. Only theparticipating OccupationalHealthDepartment will be abletoidentifythe individual viathe unique OccupationalHealthDepartment record number. OccupationalHealth Departmentsare askedtoparticipateonavoluntarybasis.
3.2Accessing thematerials All materials provided in this packcan alsobedownloaded of adedicated webpageheld at http://www.erpho.org.uk/viewResource.aspx?id=13732.[You canalsoenter 13732intothe “QuickLinks” searchbox on themainpagewww.erpho.org.uk.Furthercopies mayalso be obtained by contacting theRegistryCo-ordinator.
3.3Identifying eligible individuals EachOccupationalHealthDepartment is askedtoidentifythe relevant individuals.An individualiseligible forthe Registryifthey meet thefollowing definition:
Aperson whowas occupationally deployed to or nearthe Buncefield Oil Depot Fire site between 11th December 2005 and05thJanuary 2006.
" When your department hasidentifiedall eligibleindividuals,pleasecompletethe short OccupationalHealthDepartment participationforminAnnex 3. Theinformation collectedusing theformwill allow us to know whichdepartmentshaveagreedto participateand howmany individuals have been identified. " We recommend that youprint alistofall individuals andcross their namesoff once youhavereceived acompleted questionnaire and/orconsentform.
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3.4Printing andposting lettersand questionnaires Youwill need four itemsfor themail-out:
A. Aletterofinvitation(Annex1) B. ThestandardRegistryquestionnaire(Annex2) C. Astamped return envelope with theaddressofyourdepartment
" Atemplatefor theletterofinvitationhas been provided in Annex1.Pleasefeelfree to change thetextorwriteyourown.You canalsoprint this on your own organisation’s headed letterpaper. " ThestandardRegistryquestionnaire is attached in Annex 2. It is five pages long and canbeprinted eitherdouble sidedorsingle sided. Pleaseensurethat all sheets have beenstapled together. IMPORTANT:For allOccupationalHealth Departments otherthenthe Fire Service of PoliceService, ensure theindividual’s occupationalhealthnumberhas been addedtothe firstbox on page 1before putting thequestionnaire in theenvelope. " Finally,you need to includeastamped A5 size return envelope with theaddressof your Department.
3.5Receipt of completedquestionnaire and/or consentforms " When youreceivethe questionnaire crossthat individual offyourlist. " Complete thefirstbox on Page 1ofthe questionnaire.Thisrequires the Occupational HealthDepartment to indicatewhetherthe individualhas received an occupational healthreviewand theindividual’s dateofbirthand gender. " Make acopyofthe questionnaire andsendittothe Registryco-ordinator usingthe following addressand Freepostnumber. BFR HealthProtection Agency EastofEngland Regional Epidemiology Unit Institute of Public Health, UniversityForvie Site Robinson Way, Cambridge CB22SR " Storeacopy of thequestionnaireinthe individual’sfile. " Checkquestion 15.Ifthe individualhas indicated,pleasesendacopyofthe questionnaire to their GP.
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Appendix2
Buncefield Fire Occupational Health Registry Guidelines
3.6Review questionnairesand arrange follow-upassessments Occupational HealthDepartmentscan review theresponses to thequestionnaireand if they feel necessary,recallanindividualfor an occupationalhealthreview. This is not mandatoryand is at theOccupational HealthDepartment’s discretion .Ifanindividual has been recalledfor areview, pleaseensurethat youhaveticked“yes” in thebox on thefirstpageofthe questionnaire.
3.7Non-response to thequestionnaire " If an individual has been sent aquestionnaireand does not respond, asecond questionnaire will be sent outtwo weeksafterthe firstquestionnaire. " If there is no response to thesecondquestionnaire,athird andfinal copy will be sent to theindividual 2weeksafterthe second copy. " If there is no responseafterthe thirdquestionnaire, theindividual will be recorded as anon-responder.
3.8Enteringthe data into adatabase Occupational HealthDepartmentsdonot need to do anydataentry.All of this will be donebythe Health Protection Agency under thesupervisionofthe RegistryCo- ordinator.
3.9Accesstothe data,analysis, andreporting results All participatingOccupationalHealthdepartmentswill have access to all of thedataat any time.Acopy of thecompletedatabasewillbesenttoeachdepartment on completion of thework.The analysisofthe data and finalreportwillbeproducedbythe OHWG anddistributed to allparticipatingorganisations.
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Appendix 3
BUNCEFIELD OILSTORAGEDEPOT FIRE –Occupational Health Questionnaire(February 2006)
TO BE COMPLETEDBYTHE OCCUPATIONAL HEALTH DEPARTMENT OccupationalHealthDepartmentUnique Identificationnumber: Occupationalhealth staffmemberreviewing this questionnaire ………………………………………………… (Name) ……………………………………………………… NHS Number:………..……………………… (Date)………………………………………………………. HAS THIS INDIVIDUAL RECEIVED AN OCCUPATIONAL HEALTH REVIEW Name of OccupationalHealthDepartment: FOLLOWING THEFIRE? ………………………………………………. YES NO
ALLREMAINING QUESTIONSTOBECOMPLETEDBYTHE INDIVIDUAL
DATEOFBIRTH:………………… MALE /FEMALE (pleasecircleasappropriate) WhichOrganisationwereyou working forduringthe Buncefield Fire,orinrelationtothe site of thefire?
Fire Health andSafetyExecutive Police Ministry of Defence Ambulance Health Protection Agency LocalAuthority Other(specify):
WORK LOCATION DURING DIFFERENT PHASES OF THEFIRE
If YES, pleasetickall appropriate boxes 11 to 14/12/05 15/12/05 to 05/01/06 BURN CONTROL* CLEAN-UP* PHASE*
1. Were you deployedinside theinner cordon?
2. Were youdeployedinside theoutercordon?
Were youdeployedoutside theouter 3. cordon? *Burnphase waswhile thefirewas burning, controlphase wasduringmaintenance of thefoam blanket andclean-upwas during therecoveryand removalofequipment from thesite .
Please describe your roleat, or as aresultof, theBuncefield Depot Fire andgivedetails of your exposure:
………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………….
Thankyou for completing this questionnaire. Pleasereturnthe form to yourOccupationalHealth Department.
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Appendix3
BUNCEFIELD OILSTORAGEDEPOT FIRE –Occupational Health Questionnaire(February 2006)
EXPOSUREDIARY 4. Please record thetimeintervals you were deployedatthe sceneduring theweek following theBuncefield Fire by tickingthe boxesinthe diarybelow andestimatethe hours you were deployedineachinterval. (Leavethe boxes blankfor intervalswhenyou were not deployedatthe sceneofthe fire).
Date 0000 to 1200 hours 1200 to 2400hours
Sun11Dec Numberofhours……. Numberofhours…….
Mon12Dec Numberofhours……. Numberofhours…….
Tues 13 Dec Numberofhours……. Numberofhours…….
Wed14Dec Numberofhours……. Numberofhours…….
Thurs15Dec Numberofhours……. Numberofhours…….
Fri 16 Dec Numberofhours……. Numberofhours…….
Sat 17 Dec Numberofhours……. Numberofhours…….
Sun18Dec Numberofhours……. Numberofhours…….
Thankyou for completing this questionnaire. Pleasereturnthe form to yourOccupationalHealth Department.
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Appendix 3
BUNCEFIELD OILSTORAGEDEPOT FIRE –Occupational Health Questionnaire(February 2006)
EXPOSURE TO SMOKE, FUMESAND PARTICLES 5a.Doyou feel that you inhaledsmoke,fumes or Yes No Comments particles, howeverbriefly?
5b. Didyou smell smoke and/or chemicals?
6. Estimate thetotaltimeinminutes, hours anddays that you were exposed to smoke,fumes or particles (Pleaseremembertoadd up anyintermittent ……………minutes …………..hours ………….days…… exposuresinestimatingthe totaltime)
7a.How near were youtothe smoke or fire, at the closestpoint,however briefintime? …………….feet ………………yards…………….miles
7b. How closewereyou to thesmoke or fire formost of thetime ?(pleasegiveyour best guess) …………….feet ………………yards…………….miles
MASKSAND RESPIRATORYEQUIPMENT 8. Were you wearingamask or anytype of Yes No Comments respiratory protection? If no, go to Q.12
9. Estimate thetotaltimeinminutes, hours anddays that you wore amaskorrespiratory protection? ……………minutes …………..hours ………days….
10. Whattype of mask or respiratory protectiondid you wear?
11. From whom,orwhere,did you obtainit?
CONTACTWITHACCIDENTAND EMERGENCY DEPARTMENTS Yes No Comments 12. Didyou attend hospital/A&E ?
13. If Yes, which A&EUnit? ………………………………..……
14. Why didyou attend A&E? …………………………………….. a. Iwas feelingunwell a
b. Managerial advice or instruction b (If d, pleasespecify thereason): c. Personalwishfor check-up c …………………………………… …………….…………………..…. d. AnotherReason d …………………………………….. Didyou require anytreatment? Yes No (IfYES,pleasegivedetails in Commentssection opposite):
CONTACTWITHGPs
15. Didyou consultyour General Yes No Wouldyou likeacopy of this Practitioner(GP or family doctor) questionnairetobepassedtoyour GP? Yes
Thankyou for completing this questionnaire. Pleasereturnthe form to yourOccupationalHealth Department.
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BUNCEFIELD OILSTORAGEDEPOT FIRE –Occupational Health Questionnaire(February 2006)
SYMPTOMS DURINGORFOLLOWING THEFIRE 16. Didyou have anysymptomsthatyou thought at Yes No If YES, describe: the time might be duetothe effectsofthe Buncefield fire ? 17. Didyou have anysymptomsthatyou now think If YES, describe: might have been due to theeffectsofthe Buncefield fire?
18. Didyou have anyofthe following symptoms more than youwould have hadnormally ?IfYES,tickthe box corresponding to therelevantperiod.
11 to 14/12/05 15/12/05 to 05/01/06 SUBSEQUENTLY BURN CLEAN- CONTROL* PHASE* UP*
AIrritationtonose
BThroatirritation
CEye irritation
DSoreoritchy skin
ESkinrash
FTinglingoflips
GCoughing
HCoughing with sputum or phlegm
ITightness or pain in thechest
JWheezing
KShortness of breath
LHeadaches
MNausea
NVomiting
OOther stomachupset
Thankyou for completing this questionnaire. Pleasereturnthe form to yourOccupationalHealth Department.
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BUNCEFIELD OILSTORAGEDEPOT FIRE –Occupational Health Questionnaire(February 2006)
*Burnphase waswhile thefirewas burning, controlphase wasduringmaintenance of thefoam blanketand clean- up wasduringthe recovery andremoval of equipmentfromthe site Yes No (If Yes,pleasestate what youwere Have youexperienced anxietyorworry AFTER worried about) 19. thefire (remember, only if morethan youwould normally havehad beforethe incident) (IF YES, please statenumberof days) 20. Didyou require anytimeoff sick? ………………………….days (IF YES, please explain) 21. Have you noticed anyother ill effects?
HISTORY OF SMOKING Yes No IF YES,how many cigarettesor 22. Do you smoke? otheramountsoftobacco per day normally 23. Have you cutdown or stoppedsmoking sincethe incident?
24. If Yes, didyou stop or cutdown becauseofhealth concerns relating to theincident?
25. If Yes, pleasegivedetails in theComments sectionopposite
HISTORY OF RESPIRATORYCONDITIONS 26. Do you have anypasthistory of:
Hayfever?
Asthma?
Bronchitis?
27. Any otherrespiratory problem? (IF YES, give details, together with any current treatment)
Please feel free to addany additional comments below(continue overleafifnecessary).
Thankyou for completing this questionnaire. Pleasereturnthe form to yourOccupationalHealth Department.
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Appendix 4
[LOGO]
[DATE]
Dear XXXX
RE:BuncefieldFire OccupationalHealth Questionnaire
Your OccupationalHealthDepartment has identifiedyou as havingbeing deployedin theresponsetothe Buncefield fire in December 2005.
We would liketoinviteyou to completethe attached questionnairethat asks youabout your exposure andhealthsymptomsfollowingthe Buncefield Fire.The questionnaire should nottakemorethan10minutes to complete. Your questionnaire will be reviewed by your Occupational Health Department andstoredinyour file.
We will also send an anonymous copy of your questionnaire to theBuncefield Fire Occupational HealthRegistry. TheRegistryisadatabase containingquestionnaires from many otherindividuals whowere alsodeployed to theBuncefieldfire. The databasewill be completelyanonymous andwillprovideanaccurate picture of exposures andhealthsymptomsamong all thosewho were deployed.Ifyou do notwant an anonymouscopy of your questionnaire sent to theRegistry, pleaseinformyour Occupational HealthDepartment.
If youhaveany queries aboutthe questionnaire, theRegistryorother occupational healthconcern, pleasecontact your OccupationalHealthDepartment.
Yours sincerely
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Appendix 5
Buncefield FireOccupationalHealth Registry
OccupationalHealth Department summary information form
To helpuskeepatrack of theOccupationalHealthDepartments invited to participatein theRegistry, canyou pleaseprovideuswithyourcontactdetails,tell us how many personnel were deployed andwhetheryourorganisation has agreed to participate?
Name of Occupational HealthDepartment:
ContactPerson:
ContactAddress:
ContactTelephone:
Contactemail:
Number of personneldeployed:
Hasyour organisationagreed to participate?
YES NO
PleaseReturn this form to:
BFR HealthProtection Agency EastofEngland Regional Epidemiology Unit Institute of Public Health, UniversityForvie Site Robinson Way, Cambridge CB22SR
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Appendices
Appendix 6: Letter from Metropolitan Police Occupational Health Department to its offices.
Your ref:
Ourref:
Date:
Dear
RE:Buncefield Fire Occupational Health Registry
Iwrote to youinFebruarythisyear, advising youthatyour namehad been addedtothe MPSregistercompiledafter theBuncefieldDepot fire.
This mirrorsaGovernment programme, delegated to the Department of Health and the Health Protection Agency (HPA)tocreateanationalregister for allthoseinvolvedin majorincidents occurring in theUnitedKingdom.
TheHealthProtectionAgency is now inviting youtoparticipate in theBuncefieldFire Occupational Health Follow-up Registry.
TheRegistry, whichisadministered by theHealthProtectionAgency(www.hpa.org.uk), is adatabasecontaininginformation aboutexposures andhealthsymptoms. Many individualsfromdifferent emergency services whowerealsodeployed to the Buncefield fire areproviding information.
If youwould liketoparticipate, the Health Protection Agencywillsendyou an anonymousquestionnaire,which shouldnot takemorethan 10 minutes to complete.
If youdonot want to participatetheywill not contactyou again.
Please indicate in theshort form attached whetheryou wouldliketoparticipate or not andreturnthisletter in thepre-paidenvelopeprovided.
Yourssincerely,
Head of Professionfor Nursing&Counselling
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Buncefield Fire Occupational Health Working Group. Final Report: March 2007
Appendix 6
Buncefield Fire Occupational Health Registry
June 2006
Name:
Housenumber:
Streetaddress 1:
Streetaddress 2:
Town/City:
Post code:
Wouldyou like to participateinthe Buncefield Fire Occupational Health
Registry?Ifyou sayyes,wewillsendyou ashort questionnaire.
YES –Iam happy to participate:
NO –Ido notwant to participate:
Please indicate why:
Iwas toofar away from thefire
Iwas notdeployedfollowing this incident
Ihavenoconcerns
Idon’twanttosharemyinformation
Ireceive toomanyquestionnaires
Please returnthisforminthe pre-paid envelope provided
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www.erpho.org.uk
Final Report of the Buncefield Fire Occupational Health Working Group
Published on their behalf by the Eastern Region Public Health Observatory (erpho)
August 2007
ISBN 1 904389 12 0
Typeset and printed by Piggott Black Bear, Cambridge, UK.