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

Suicide survivors face grief, questions, challenges

Harvard Women's Health Watch

POSTED AUGUST 12, 2014, 1:21 PM , UPDATED OCTOBER 29, 2015, 8:26 PM – Harvard Women’s Health Watch

The death of Robin Williams, reportedly from depression-related suicide, can seem paradoxical. How can such a funny, lively, and successful person be depressed enough to end his life? Crushing sadness can hide behind humor.

Source: Suicide survivors face grief, questions, challenges

In the United States alone, nearly 40,000 people a year die by suicide. Each of these leaves behind an estimated six or more “suicide survivors” — people who’ve lost someone they care about deeply and are left grieving and struggling to understand.

The grief process is always difficult. But a loss through suicide is like no other, and grieving can be especially complex and traumatic. People coping with this kind of loss often need more support than others, but may get less. Why? Survivors may be reluctant to confide that the death was self-inflicted. And when others know the circumstances of the death, they may feel uncertain about how to offer help.

What makes suicide different

The death of a loved one is never easy to experience, whether it comes without warning or after a long struggle with illness. But several circumstances set death by suicide apart and make the process of bereavement more challenging. For example:

A traumatic aftermath. Death by suicide is sudden, sometimes violent, and usually unexpected. Depending on the situation, survivors may need to deal with the police or handle press inquiries. While still in shock, they may be asked if they want to visit the death scene. Sometimes officials discourage the visit as too upsetting; other times they encourage it. “Either may be the right decision for an individual. But it can add to the trauma if people feel that they don’t have a choice,” says Jack Jordan, Ph.D., clinical psychologist in Wellesley, MA and co-author of After Suicide Loss: Coping with Your Grief.

Recurring thoughts. A suicide survivor may have recurring thoughts of the death and its circumstances, replaying over and over the loved one’s final moments or their last encounter in an effort to understand — or simply because the thoughts won’t stop coming. Some suicide survivors develop post-traumatic stress disorder (PTSD), an anxiety disorder that can become chronic if not treated. In PTSD, the trauma is involuntarily re-lived in intrusive images that can create anxiety and a tendency to avoid anything that might trigger the memory.

Stigma, shame, and isolation. There’s a powerful stigma attached to mental illness (a factor in most suicides). Many religions specifically condemn the act as a sin, so survivors may understandably be reluctant to acknowledge or disclose the circumstances of such a death. Family differences over how to publicly discuss the death can make it difficult even for survivors who want to speak openly to feel comfortable doing so. The decision to keep the suicide a secret from outsiders, children, or selected relatives can lead to isolation, confusion, and shame that may last for years or even generations. In addition, if relatives blame one another — thinking perhaps that particular actions or a failure to act may have contributed to events — that can greatly undermine a family’s ability to provide mutual support.

Mixed emotions. After a homicide, survivors can direct their anger at the perpetrator. In a suicide, the victim is the perpetrator, so there is a bewildering clash of emotions. On one hand, a person who dies by suicide may appear to be a victim of mental illness or intolerable circumstances. On the other hand, the act may seem like an assault on, or rejection of, those left behind. So the feelings of anger, rejection, and abandonment that occur after many deaths are especially intense and difficult to sort out after a suicide.

Need for reason. “What if” questions can arise after any death. What if we’d gone to a doctor sooner? What if we hadn’t let her drive to the basketball game? After a suicide, these questions may be extreme and self-punishing — unrealistically condemning the survivor for failing to predict the death or to successfully intervene. In such circumstances, survivors tend to greatly overestimate their own contributing role — and their ability to affect the outcome.

“Suicide can shatter the things you take for granted about yourself, your relationships, and your world,” says Dr. Jordan. Some survivors conduct a psychological “autopsy,” finding out as much as they can about the circumstances and factors leading to the suicide. This can help develop a narrative that makes sense.

Sometimes a person with a disabling or terminal disease chooses suicide as a way of gaining control or hastening the end. When a suicide can be understood that way, survivors may feel relieved of much of their what-if guilt. “It doesn’t mean someone didn’t love their life,” says Holly Prigerson, Ph.D., professor of psychiatry at Harvard Medical School and Director of Psycho-Oncology Research, Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute.

Support from other survivors

Suicide survivors often find individual counseling (see “Getting professional help”) and suicide support groups to be particularly helpful. There are many general grief support groups, but those focused on suicide appear to be much more valuable.

“Some people also find it helpful to be in a group with a similar kinship relationship, so parents are talking to other parents. On the other hand, it can be helpful for parents to be in a group where they hear from people who have lost a sibling — they may learn more about what it’s like for their other children,” says Dr. Jordan.

Some support groups are facilitated by mental health professionals; others by laypersons. “If you go and feel comfortable and safe — [feel] that you can open up and won’t be judged — that’s more important than whether the group is led by a professional or a layperson,” says Dr. Prigerson. Lay leaders of support groups are often themselves suicide survivors; many are trained by the American Foundation for Suicide Prevention.

For those who don’t have access to a group or feel uncomfortable meeting in person, Internet support groups are a growing resource. In a study comparing parents who made use of the Internet and those who used in-person groups, the Web users liked the unlimited time and 24-hour availability of Internet support. Survivors who were depressed or felt stigmatized by the suicide were more likely to gain help from Internet support services.

You can join a support group at any time: soon after the death, when you feel ready to be social, or even long after the suicide if you feel you could use support, perhaps around a holiday or an anniversary of the death.

Getting professional help

Suicide survivors are more likely than other bereaved people to seek the help of a mental health professional. Look for a skilled therapist who is experienced in working with grief after suicide. The therapist can support you in many ways, including these:

  • helping you make sense of the death and better understand any psychiatric problems the deceased may have had
  • treating you, if you’re experiencing PTSD
  • exploring unfinished issues in your relationship with the deceased
  • aiding you in coping with divergent reactions among family members
  • offering support and understanding as you go through your unique grieving process.

A friend in need

Knowing what to say or how to help someone after a death is always difficult, but don’t let fear of saying or doing the wrong thing keep you from reaching out to a suicide survivor. Just as you might after any other death, express your concern, pitch in with practical tasks, and listen to whatever the person wants to tell you. Here are some special considerations:

Stay close. Families often feel stigmatized and cut off after a suicide. If you avoid contact because you don’t know what to say or do, family members may feel blamed and isolated. Ignore your doubts and make contact. Survivors learn to forgive awkward behaviors or clumsy statements, as long as your support and compassion are evident.

Avoid hollow reassurance. It’s not comforting to hear well-meant assurances that “things will get better” or “at least he’s no longer suffering.” Instead, the bereaved may feel that you don’t want to acknowledge or hear them express their pain and grief.

Don’t ask for an explanation. Survivors often feel as though they’re being grilled: Was there a note? Did you suspect anything? The survivor may be searching for answers, but your role for the foreseeable future is simply to be supportive and listen to what they have to say about the person, the death, and their feelings.

Remember his or her life. Suicide isn’t the most important thing about the person who died. Share memories and stories; use the person’s name (“Remember when Brian taught my daughter how to ride a two-wheeler?”). If suicide has come at the end of a long struggle with mental or physical illness, be aware that the family may want to recognize the ongoing illness as the true cause of death.

Acknowledge uncertainty. Survivors are not all alike. Even if you are a suicide survivor yourself, don’t assume that another person’s feelings and needs will be the same as yours. It’s fine to say you can’t imagine what this is like or how to help. Follow the survivor’s lead when broaching sensitive topics: “Would you like to talk about what happened?” (Ask only if you’re willing to listen to the details.) Even a survivor who doesn’t want to talk will appreciate that you asked.

Help with the practical things. Offer to run errands, provide rides to appointments, or watch over children. Ask if you can help with chores such as watering the garden, walking the dog, or putting away groceries. The survivor may want you to sit quietly, or perhaps pray, with him or her. Ask directly, “What can I do to help?”

Be there for the long haul. Dr. Jordan calls our culture’s standard approach to grief the “flu model”: grief is unpleasant but is relatively short-lived. After a stay at home, the bereaved person will jump back into life. Unfortunately, that means that once survivors are back at work and able to smile or socialize again, they quickly get the message that they shouldn’t talk about their continuing grief. Even if a survivor isn’t bringing up the subject, you can ask how she or he is coping with the death and be ready to listen (or respect a wish not to talk about it). Be patient and willing to hear the same stories or concerns repeatedly. Acknowledging emotional days such as a birthday or anniversary of the death — by calling or sending a card, for example — demonstrates your support and ongoing appreciation of the loss.

Helpful resources for suicide survivors are available at from the American Foundation for Suicide Prevention and the American Association of Suicidology.

(An earlier version of this article appeared in the July 2009 Harvard Women’s Health Watch.)

 

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

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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