Emergency Preparedness and Response

Chemical Emergency Overview

chemical-emergency-prepareThe CDC has a key role in protecting the public’s health in an emergency involving the release of a chemical that could harm people’s health. This page provides information to help people be prepared to protect themselves during and after such an event.

What chemical emergencies are

A chemical emergency occurs when a hazardous chemical has been released and the release has the potential for harming people’s health. Chemical releases can be unintentional, as in the case of an industrial accident, or intentional, as in the case of a terrorist attack.

Where hazardous chemicals come from

Some chemicals that are hazardous have been developed by military organizations for use in warfare. Examples are nerve agents such as sarin and VX, mustards such as sulfur mustards and nitrogen mustards, and choking agents such as phosgene. It might be possible for terrorists to get these chemical warfare agents and use them to harm people.chemical-emergency-warfare-biological-weapons

Many hazardous chemicals are used in industry (for example, chlorine, ammonia, and benzene). Others are found in nature (for example, poisonous plants).

Some could be made from everyday items such as household cleaners. These types of hazardous chemicals also could be obtained and used to harm people, or they could be accidentally released.

Types and categories of hazardous chemicals

Scientists often categorize hazardous chemicals by the type of chemical or by the effects a chemical would have on people exposed to it. The categories/types used by the Centers for Disease Control and Prevention are as follows:

  • Biotoxins—poisons that come from plants or animals
  • Blister agents/vesicants—chemicals that severely blister the eyes, respiratory tract, and skin on contact
  • Blood agents—poisons that affect the body by being absorbed into the blood
  • Caustics (acids)—chemicals that burn or corrode people’s skin, eyes, and mucus membranes (lining of the nose, mouth, throat, and lungs) on contact
  • Choking/lung/pulmonary agents—chemicals that cause severe irritation or swelling of the respiratory tract (lining of the nose and throat, lungs)
  • Incapacitating agents—drugs that make people unable to think clearly or that cause an altered state of consciousness (possibly unconsciousness)
  • Long-acting anticoagulants—poisons that prevent blood from clotting properly, which can lead to uncontrolled bleeding
  • Metals—agents that consist of metallic poisons
  • Nerve agents—highly poisonous chemicals that work by preventing the nervous system from working properly
  • Organic solvents—agents that damage the tissues of living things by dissolving fats and oils
  • Riot control agents/tear gas—highly irritating agents normally used by law enforcement for crowd control or by individuals for protection (for example, mace)
  • Toxic alcohols—poisonous alcohols that can damage the heart, kidneys, and nervous system
  • Vomiting agents—chemicals that cause nausea and vomiting

Hazardous chemicals by name (A-Z list)

If you know the name of a chemical but aren’t sure what category it would be in, you can look for the chemical by name on the A–Z List of Chemical Agents.

Protecting yourself if you don’t know what the chemical is

You could protect yourself during a chemical emergency, even if you didn’t know yet what chemical had been released. For general information on protecting yourself, read this Web site’s fact sheets on evacuation, sheltering in place, and personal cleaning and disposal of contaminated clothing.

Basic information on chemical emergencies

Basic chemical emergency information designed for the public can be found in the general and chemical-specific fact sheets and in the toxicology FAQs on this Web site.

In-depth information on chemical emergencies

Chemical emergency information designed for groups such as first responders, clinicians, laboratorians, and public health practitioners can be found in the case definitions, toxic syndrome descriptions, toxicological profiles, medical management guidelines, emergency response cards, First Responders page, and Laboratory Information page.

For more information…

For more information about chemical emergencies, you can visit the following websites:

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Guide For Crime Scene Biological And Infectious Hazard Clean Up

biohazard-clean-up-remediationProfessional cleaners that deal with trauma clean-up can better market their services by advertising their full compliance with guidelines laid out in the Reference Guide for Trauma and Crime Scene Biological and Infectious Hazard Clean Up. This standard, which can be purchased from the IICRC website, outlines procedures for removing any disease-causing agents that escape into the environment when an individual dies or suffers severe injury.  It also enumerates the many health effects caused by biohazards, necessary equipment professionals require, and the safe transport and disposal of waste materials.


One of the more important points of focus addressed by the standard is that of material and building science
.  Any tissue or bodily fluid is classified as a biohazard per Federal regulations.  Whenever a violent crime occurs within a building, or when a body begins to decompose within its interior, the surrounding building materials become contaminated with a variety of toxic agents.  The Reference Guide for Trauma and Crime Scene Biological and Infectious Hazard Clean Up provides a number of detailed items that cover the removal of these toxins from building materials.  For example, blood stains on the carpet typically soak through the carpet and seep into the flooring beneath.  Effective environmental cleaning not only removes the biohazard from the carpet, but also from its supporting understructure.

Certain tools are required for biohazard removal.  Special equipment, such as protective gear, must also be worn by the removal personnel in order to protect them from the hazardous materials they are using.  It benefits any organization specializing in this type of work to follow the recommended equipment list found in the standard.  Tools that can be reused, along with equipment that is by nature disposable, is clearly defined.  Containers for various types of waste, along with chemicals that help sanitize the environment after cleaning is complete, are also covered in the standard.

The Reference Guide for Trauma and Crime Scene Biological and Infectious Hazard Clean Up also talks about the various health effects associated with different types of incidents.  Diseases such as the Flu, including Type A and H1N1, HIV/AIDS, Type A and B Hepatitis, TB, Cholera, and Salmonella are all diseases that can be transmitted from bodily fluids.  These fluids escape into the environment any time a body decomposes, whether a person commits suicide, is murdered, or suffers some type of tragic, accidental death.

Other aspects of the biohazard removal industry are also covered in the Reference Guide for Trauma and Crime Scene Biological and Infectious Hazard Clean Up.  General safety and health precautions are addressed in the standard.  Administrative procedures that pertain to the execution of various cleanup jobs are also enumerated.  Guidelines for inspection are covered, along with information on when and how to demolish structures that are simply too hazardous to remain standing.  Content removal, transportation, and disposal of contaminants are also covered in the material.

Professionals interested in purchasing the Reference Guide for Trauma and Crime Scene Biological and Infectious Hazard Clean Up can do so online at the IICRC website.  This site also contains information on continuing education, professional certification, and marketing materials that registrants and certified firms can use to solicit their services to their respective communities.

 

Written By: The Institute of Inspection, Cleaning and Restoration Certification (IICRC)

Back to main topic: Certifications & Brochures

Viral Hepatitis

hepatitis

Young Persons Who Inject Prescription Opioids and Heroin

The recent explosive increase in the misuse of prescription opioids and heroin in this country has sparked growing public recognition and concern. And deservedly so. The hepatitis B virus (HBV) and hepatitis C virus (HCV) are among the numerous health threats facing people who misuse opioids, particularly those who inject these drugs. These blood-borne viral infections have reached epidemic proportions in most states. Persons who become infected with HBV and HCV are at increased risk for other diseases transmitted through contact with blood, such as HIV.

How Viral Hepatitis is Spread Among Persons Who Inject Drugs

The hepatitis B and hepatitis C viruses are very infectious. People who have direct contact with surfaces, equipment, or objects contaminated with infected blood, even in amounts too small to see, can become infected. Hepatitis B can survive outside of the body for at least 1 week, and hepatitis C can survive on equipment and surfaces for up to 3 weeks.

People who inject drugs can get hepatitis B or hepatitis C from:

  • Sharing needles or reusing needles and syringes
  • Sharing drug preparation equipment such as cookers, cottons, water, ties, and alcohol swabs
  • Reusing personal-care items (e.g., razors, nail clippers, and toothbrushes) from someone infected with HBV or HCV
  • Sexual contact (particularly for HBV infection)

Hepatitis C Among Persons Who Inject Drugs (PWID)

Cases of HCV have been increasing for several years among PWID. The Centers for Disease Control and Prevention (CDC) has investigated and reported outbreaks and alarming increases in disease trends in collaboration with state and local health departments.

  • In 2011, the Massachusetts Department of Health and CDC investigated an epidemic of HCV among adolescents and young adults who were primarily injecting prescription opioids and heroin. In this outbreak, HCV was transmitted through sharing of drug-injection equipment. A report was published in the Morbidity and Mortality Weekly Report (MMWR) describing the HCV epidemic.  The investigation of these cases revealed that HCV was spread from sharing equipment to inject drugs, and that HCV infected persons were mostly injecting prescription opioids or heroin.
  • In 2012, an investigation by the Wisconsin Division of Public Health and CDC attributed rising numbers of HCV infections in the state to increasing use of injected prescription opioid drugs and heroin. CDC found that these infections were caused by different strains of the virus, suggesting the patients were infected through separate, unrelated networks of HCV transmission and that additional cases likely remained undetected.
  • In 2014, the national analysis of HCV surveillance data from 2006-2012 revealed an emerging epidemic of HCV infection, primarily among young persons living in small towns and rural areas. Indeed the number of new HCV infections was found to be rising in at least 30 states, with largest increases in nonurban counties east of the Mississippi River, particularly in Appalachian states.
  • In 2014, a CDC analysis of surveillance data revealed that approximately 30,000 new cases of hepatitis C (referred to as “acute” cases) occurred in 2013, representing a nationwide increase of more than 150% from 2010 to 2013; 28 states reported increases.
  • In 2015, HIV spread quickly among PWID in Scott County, Indiana; almost all persons who became infected with HIV had first been infected with HCV. This outbreak was unique, in that networks of HCV transmission within the community were identified using Global Hepatitis Outbreak and Surveillance Technology (GHOST), technology that enables identification of viruses with similar genetic make-up.
  • In 2015, CDC released a report on the increase in new cases of hepatitis C infection in the Appalachian region associated with injection drug use, often among people who first began drug use with prescription opioids. The article, Increases In Hepatitis C Virus Infection Related To Injection Drug Use Among Persons Aged <30 years, reported an estimated 364% increase in new hepatitis C infections during 2006-2012 among persons aged ≤30 years in four Appalachian states (i.e., Kentucky, Tennessee, Virginia, and West Virginia).

Hepatitis B Among PWID

  • According to CDC estimates, approximately 20,000 new cases of hepatitis B occurred in 2013, representing the first increase in acute cases of hepatitis B since 1990.
  • In 2016, CDC released a report on the increases in new cases of hepatitis B in the Appalachian region.  The report, Increases in Acute Hepatitis B Virus Infections — Kentucky, Tennessee, and West Virginia, 2006–2013, describes a 114% increase in acute hepatitis B from 2006-2013 in three states — Kentucky, Tennessee, and West Virginia; increases primarily occurred after 2009.

Highlights of CDC’s Response to the Epidemic of Viral Hepatitis Associated with Opioid Injection

CDC’s Division of Viral Hepatitis (DVH) is providing the programmatic foundation and leadership for the prevention and control of HBV and HCV infections among PWID. DVH works to improve hepatitis B and hepatitis C prevention by identifying communities at high risk for these infections and increasing testing and linkage to care among persons who inject drugs. Specifically, DVH

  • funds hepatitis coordinators in 48 states and 4 cities who direct local prevention efforts to best meet the needs  of each community;
  • helps communities assess their risks for HBV and HCV transmission, investigate the spread of infection, and prepare a public health response to stop transmission;
  • improves public health surveillance and other sources of critical information to help communities better detect HBV and HCV infected persons and guide delivery of prevention services;
  • studies patterns of HCV transmission, investigates behaviors that increase risk for HCV, and  identifies prevention services (e.g., testing, care, and treatment) that are most effective in stopping disease transmission;
  • trains state/local public health staff in how to guide the delivery of HCV and HBV prevention services in their communities;
  • collaborates with partners to provide technical assistance to prevention programs to identify practices that are most likely to lead to the detection, care, and treatment of viral hepatitis in PWID; and
  • uses a web-based system known as Global Hepatitis Outbreak and Surveillance Technology (GHOST) to improve investigation of HCV infection at the community level.  GHOST allows investigators to determine whether patients are infected with the same strain of HCV, helping uncover patterns and networks of transmission. CDC plans to apply this modern molecular surveillance tool in a growing number of states through a web-based platform that will facilitate effective collaboration and communication across the public health system.

CDC is Committed to Preventing Viral Hepatitis Among PWID

CDC’s DVH recognizes that only through improved prevention (e.g., vaccination, testing, and linkage to viral hepatitis care and treatment) can liver-related morbidity and mortality be prevented in the United States and that PWID are in urgent need for improved access to these services. Although hepatitis B vaccination is over 90% effective in preventing HBV infection, many adults with risks (including PWID) have not been vaccinated. A combination of syringe services programs and drug treatment can reduce transmission of HCV by more than 80% among PWID. The U.S. Department of Health and Human Services (HHS) has released new guidance[PDF – 22 pages] for state, local, tribal, and territorial health departments that will allow them to request to use federal funds to support syringe services programs. CDC models show that the addition of HCV testing and treatment can increase prevention effectiveness even further.

DVH works closely with CDC colleagues in the Division of HIV/AIDS and the Division of Injury Prevention. Partners outside of CDC include the National Institute on Drug Abuse, state and local health departments, and a variety of non-governmental organizations. Partnerships are essential in marshaling the resources to stop transmission of HBV, HCV, and HIV, and the increases in injection drug use.

Additional CDC Resources:

Stay Informed

  • @cdchep  has the latest information on viral hepatitis.
  • Email updates are available from CDC’s Division of Viral Hepatitis.

Bloodstain Precautions

Vernon J. Geberth, M.S., M.P.S. author of the textbook, Practical Homicide Investigation: Tactics, Procedures, and Forensic Techniques, FOURTH EDITION, 2006.

UNIVERSAL PRECAUTIONS TO TAKE SERIOUSLY
blood-crime-scene-clean-upInvestigators and crime scene technicians need to be cognizant of the potential dangers in handling blood and other biological fluids in the crime scene. The presence of airborne pathogens and other biohazards such as AIDS, hepatitis and hepatitis B, meningitis and even tuberculosis create a potential risk. Investigators should adhere to the following procedures at any crime scene where blood or body fluids are encountered.

The CSI should wear approved disposable gloves while in the crime scene and remain aware that blood and other body fluids may carry diseases. Consider wearing a disposable mask while in crime scenes where airborne communicable diseases such as meningitis or tuberculosis might exist. Wear eye protective and disposable infectious disease gown to protect clothing when exposed to large amounts of blood or other body fluids.

After the investigation is complete, dispose of gloves, masks, and gowns contaminated by blood or body fluids in a biohazard bag and wash hands thoroughly with an antiseptic hand rinse. Before returning to the station, wash hands again with water and a bacterial liquid hand wash, i.e., Bacti-Stat. Restrict the number of investigators on the scene who may come in contact with the scene of the potential infection exposure. Advise any investigators on the scene who may come in contact with the scene of the potential infection exposure.

Decontaminate all equipment used prior to your return to the station. Change clothing contaminated with blood or other body fluids immediately and decontaminate. Dispose of contaminated supplies as recommended in this protocol. Skin provides a very effective barrier for the prevention of infectious diseases. Wash all contact areas as soon as possible after exposure to help prevent contamination. Wounds such as cuts, sores, and breaks in the skin, regardless of the size, provide an entrance for infection into the body and should be properly bandaged. Report all significant exposures to blood or other body fluids within 24 hours of exposure.

References

Bevel, T and Gardner R., Bloodstain Pattern Analysis with an Introduction to Crime Scene
Reconstruction, 2nd Ed
, Boca Raton, FL: CRC Press, LLC Inc., 2002
Gardner, Ross M. Practical Crime Scene Processing and Investigation. Boca Raton, Florida:
CRC Press, LLC Inc., 2004.
James, Stuart et. al. Principles of Bloodstain Pattern Analysis Theory and Practice, Boca Raton,
FL: Taylor & Francis CRC Press, 2005.

Eight Things to Do After a Loved One Passes Away

When faced with an ‘unattended death’

February 26, 2011 – By ANTHONY GAYNOR Staff Writer
unattended death med tech blog
Image Source: Pulptastic

When a loved one passes away unexpectedly and alone, family members may be forced to wait before the body is released to a funeral home. West Virginia law states certain deaths must be reported to medical examiners before they can be released for services.

Law enforcement officials refer to the deaths as “unattended deaths,” and certain activities must be concluded before the family can begin funeral services.

The code states when any person dies from “violence, or by apparent suicide, or suddenly when in apparent good health, or when unattended by a physician, or when an inmate of a public institution, or from some disease which might constitute a threat to public health, or in any suspicious, unusual or unnatural manner,” the chief medical examiner, county medical examiner or county coroner must be notified by a physician in attendance or by law enforcement if a physician is not present, or by the funeral director or any other person present.

“We secure everything and get in touch with the county coroner,” Randolph County Sheriff Jack Roy said. “They direct us to what they need us to.”

Roy said anytime there is an unattended death, the police will photograph the scene and prepare for an investigation in case it is needed. Roy said many different circumstances can be considered an unattended death.

“If the person lives alone or has not been seen in a while,” he said. “There is no set amount of time, it just depends on the circumstances.”

Roy said if two people are in a home and they are separated for a long period of time, it can be considered an unattended death.

Roy said the body cannot be released until the county coroner makes a determination.

Randolph County Coroner Scott Shomo said each case is different and if an autopsy is needed it can take “a while” before the body is released.

“If it is a true natural death, it can be released,” he said. “If it’s an elderly person, the medical examiner’s office doesn’t even get involved and the body will be released to a funeral home. All unexplained children’s deaths are sent to the medical examiner.”

Natural Disaster Emergency Response

Written By: US Environmental Protection Agency

Natural-Disasters-01

Call 911 if you are in immediate danger and need emergency help.

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