Environmental Management of Chemical Incidents

Centre for Environmental Health Engineering
School of Engineering, University of Surrey
Environmental Management
of Chemical Incidents
'A
Improving the Public Health Response
Volume 1
Faith Juliet Lydiard Goodfellow
Portfolio submitted in part fulfilment of the requirements for the degree of

Engineering Doctorate in Environmental Technology (EngD)
September 2001
ProQuest Number: 11010064
All rights reserved
INFORMATION TO ALL USERS

The quality of this reproduction is d e p e n d e n t upon the quality of the copy subm itted.
In the unlikely e v e n t that the a u thor did not send a c o m p le te m anuscript

and there are missing pages, these will be noted. Also, if m aterial had to be rem oved,
a n o te will ind ica te the deletion.
uest
ProQuest 11010064
Published by ProQuest LLC(2018). C opyright of the Dissertation is held by the Author.
All rights reserved.

This work is protected against unauthorized copying under Title 17, United States C o d e
M icroform Edition © ProQuest LLC.
ProQuest LLC.
789 East Eisenhower Parkway
P.O. Box 1346
Ann Arbor, Ml 4 8 1 0 6 - 1346
Abstract
Since 1993, health authorities have had a responsibility for the co-ordination of the
health aspects of response to chemical incidents. The public health team within health
authorities currently takes the lead in complying with this duty. However, the majority
of public health professionals have had minimal training and experience in this area.
The focus of this investigation has therefore been the provision o f management tools to
improve the public health response to chemical incidents, with the aim o f minimising
adverse health and environmental impacts.
A detailed investigation of the current state o f knowledge was conducted, and the
research engineer was involved in the management of 70 chemical incidents resulting in
water pollution, as reported to the Chemical Incident Response Service. A best practice
model for the public health response to chemical incidents was developed, based on
lessons learnt from the management of chemical incidents, involvement in incident
exercises and training days, and relevant literature on chemical incident management.
The model was then used to guide the development o f a chemical incident management
guidance manual providing detailed information and guidance on the issues raised in the
model. A quantitative evaluation method was also devised for assessing the
performance of public health professionals in managing chemical incidents.
Validation testing of the guidance manual was conducted to assess its effectiveness in
improving the public health response to chemical incidents. A group o f 79 public health
professionals took part in the testing, which concluded that the manual was effective in
improving performance in the response to a chemical incident exercise. Statistical
analysis further demonstrated that this improvement would be expected across the
general public health population. The value o f previous training on chemical incident
management was also confirmed. However, previous experience in managing chemical
incidents was not shown to influence performance levels.
© Faith Goodfellow, 2001

Acknowledgements
Firstly, I would like to thank my academic supervisor Dr Sabeha K. Ouki (Centre for
Environmental Health Engineering, University o f Surrey), for her support throughout the
project and for allowing me the freedom to investigate my ideas; and my industrial
supervisor Dr Virginia S.G. Murray (Chemical Incident Response Service), for
providing a stimulating and challenging research environment.
Numerous individuals have provided information and advice on particular aspects o f this
project and I would like to thank the public health doctors and other health professionals
that have been willing to offer feedback on the outputs o f the project, and have taken a
valuable part in ensuring the final output, the chemical incident management guidance
manual, meets the needs of the public health profession. Thanks are also due to the
public health doctors who made it possible for me to take part in and evaluate chemical
incidents in which they were involved, particular thanks are due to Dr Angela Iversen
(East Sussex, Brighton and Hove Health Authority) and Dr John Bailey (Norfolk Health
Authority).
The project has involved close collaboration with several water companies, with Thames
Water pic, United Utilities pic (Water) and Three Valleys Water pic providing
particularly useful inputs. Special thanks are due to Professor Jeni Colboume (Thames
Water pic) for her involvement in the earlier stages o f the project and for enabling me to
benefit from her considerable experience o f the water industry, and also to Tony Evans
(Thames Water pic), Frank White (United Utilities pic), Keith Osborn (United Utilities)
and Helen Clay-Chapman (Three Valleys Water pic). Thank you also to Roger Harman,
Area Emergencies Co-ordinator for the Environment Agency, Ridings Area.
Thank you to all those people who brought the benefits o f their expertise, and
generously donated their valuable time to the development o f the best practice model
and the manual, in particular, Dr Katie Begg (Centre for Environmental Strategy,
University of Surrey), Dr Kaetrin Carnegie-Smith (independent consultant in public
health), Dr Colin Ramsay (Scottish Centre for Infection and Environmental Health), Dr
Rosalind Stanwell-Smith (independent consultant in public health) and Jon Berman
(Greenstreet Berman Ltd). Thank you also to Professor Paul Hunter (School of
Medicine, Health Policy and Practice, University of East Anglia) for commenting on
various stages of the research, and in particular for his invaluable assistance with the
statistical analysis.
Finally, I am indebted to the assistance provided by all my colleagues over the past four
years at the Chemical Incident Response Service, in particular to Fiona Welch and
Emma Eagles whose continual support and encouragement has made it possible for me
to get this far, and to Joan Bennett who has provided emotional and practical assistance
on too many occasions to count. I would also like to thank my husband, Graham, for the
provision of tasty morsels to sustain me through the long hours spent enslaved to my
computer.
Guide to the Portfolio
The portfolio consists of two volumes, the content of each volume is summarised below.
Volume 1
• Contains the main thesis and is therefore the primary document providing evidence
for the areas of innovation and contributions to knowledge that have been achieved
by the doctoral project.
• Also provides supporting information as appendices.
Volume 2
• Contains papers that have been produced, and in most cases published, during the
research period. Summaries of the information in these papers are presented in
Volume 1, where references are also made to the relevant paper for readers requiring
more detailed information on particular aspects of the project.
• Also contains Version 2 of the Chemical Incident Management Guidance Manual,

the main output from the project.
Contents
Volume 1
Executive Summary
1. Introduction 1
1.1 Background to the Sponsor Company 1
1.2 Problem Definition 3
1.2.1 Chemical Incidents 3
1.2.1.1 Definition 4
1.2.1.2 Numbers and types of chemical incidents 5
1.2.1.3 Project scope 7
1.2.2 Role of Public Health Professionals in Managing 7
Chemical Incidents
1.2.3 CIRS Approach to Chemical IncidentManagement 9
1.2.4 Preliminary Research Needs 10
1.3 Aims and Objectives 11
2. Current State of Knowledge in Chemical Incident Management 13

2.1 Water-Related Chemical incidents in the Published Literature 13
2.2Chemical Incident Management Procedures in the 17
Published Literature
2.3 Assessment of the Current State of Knowledge Through a 22
Questionnaire Survey
2.3.1 Survey Methodology 23
2.3.2 Survey Results 24
2.3.2.1 Involvement of public health in managing chemical 24
incidents
2.3.2.2 Types of contamination involved inwater-related 25
chemical incidents
2.3.2.3 Resources used in managing water-related chemical 27
incidents
2.3.2.4 Water resource information 28
2.3.2.5 Private water supplies 29
2.3.2.6 Incident report publication 29
2.4Analysis of the Current State of Knowledge Based on the Survey 30
2.5Conc!usions 32
3. Investigation of the Management of Chemical Incidents 33
3.1 Management and Study of Actual Chemical Incidents 33
3.1.1 Numbers and Types of Water-Related Chemical Incidents 33
3.1.2 Incident Summaries of the Selected Case Studies 40
3.1.2.1 Lindane spill into surface waters 41
3.1.2.2 Drinking water contamination following rehabilitation 42
work
3.1.2.3 Drinking water contamination at a hospital following 43
tank re-lining
3.1.2.4 Permeation of solvents from land through plastic 44
water supply pipes
3.1.2.5 Contamination of drinking water following a diesel 46
spill on a building site
3.1.2.6 Sewage/trade effluent flooding of residential 47
properties
3.1.2.7 Drinking water contamination in four blocks of flats 48
following tank re-lining
3.1.2.8 Backflow incident resulting in drinking water 50
contamination
3.1.2.9 Chemical fire and subsequent flooding leading to 51
surface water and land contamination
3.1.2.10 Secondary chemical contamination of a beach and 51
seawater
3.1.2.11 Long-term leakage of heating oil into soil leading to 53
permeation of plastic water supply pipes
3.1.2.12 Petrol station leak leading to drinking water 55
contamination in a block of flats
3.1.2.13 Spill of engine degreaser permeating plastic water 56
supply pipes
3.1.2.14Bromate contamination of drinking water aquifer 57
3.1.3 Classification of the Case Studies 57
3.1.4 Methodology for Learning from Incidents 59
3.1.5 Summary of Lessons Learnt 60
3.1.5.1 General best practice and problematic issues 60
3.1.5.2 Specific types of incidents identified as problematic 65
3.2Chemical Incident Exercises and Training Sessions 68
3.2.1 Planning and Developing Training Sessions 68
3.2.2 Development of Incident Training Exercises 68
3.2.3 Development of Chemical Incident Management Tools 69
3.2.4 External Exercises 69
3.2.5 General Best Practice and Problematic Issues Identified 70
from Chemical Incident Training and Exercises
3.3 Summary of the Investigation into Chemical Incident Management 76
4. Methodology for Development of Tools to Improve 77
Chemical Incident Management by Public Health Professionals
4.1 Best Practice Model for Public Health Response to Chemical 77
Incidents
4.1.1 Aims and Objectives 77
4.1.2 Initial Development Methodology 78
4.1.3 Expert Consultation 80
4.1.4 Final Development Methodology 84
4.1.5 Application 92
4.2Chemical Incident Management Guidance Manual 93
4.2.2 Development Methodology 94
4.2.3 Expert Consultation 96
4.2.4 Application 97
4.3 Validation Testing of the Chemical Incident Management 97
Guidance Manual
4.3.2 Development of Evaluation Method 97
4.3.2.1 Generic evaluation of performance 97
4.3.2.2 Evaluation of performance in the incident exercise 98
4.3.3 Devising the Incident Exercise 99
4.3.4 Conducting the Incident Exercise Sessions 100
4.4Conclusions 103
5. Results and Statistical Analysis from Validation Testing of 105

the Chemical Incident Management Guidance Manual
5.1 Hypotheses 105
5.2 Summary of Data from the Validation Testing 105
5.2.1 Performance Score 105
5.2.2 Participant Variables 107
5.3 Methodology for Statistical Analysis of the Validation Testing Data 107
5.3.1 Aims of the Statistical Analysis 107
5.3.2 Definition of Variables 108
5.3.3 Selection of Statistical Methods 109
5.4 Results from the Validation Testing of the Manual 110
5.4.1 Comparison of Mean Percentage Scores 110
5.4.2 Statistical Analysis of the Significance of the Difference 121
Between Mean Scores
5.4.3 Aspects of Chemical Incident Management Achieved by 124
the Majority of Participants
5.4.4 Aspects of Chemical Incident Management Not Achieved 125
by the Majority of Participants
5.4.5 Actions Completed Outside the Specified Incident Stage 128
5.4.6 Additional Actions Completed to Those Specified in the 130
Evaluation Method
5.5 Conclusions 131
6. Interpretation and Discussion of the Results from Validation 132
Testing of the Chemical Incident Management Guidance Manual
6.1 Introduction 132
6.2 Interpretation of the Results from the Validation Testing of the 133
Guidance Manual
6.2.1 Comparison of Mean Percentage Scores 133
6.2.2 Statistical Analysis of the Significance of the Difference 135
Between Mean Scores
6.2.3 Specific Aspects of Chemical Incident Management 137
6.2.4 Summary 140
6.3 Comments Received on the Testing Process and Guidance 140
Manual
6.4 Discussion of the Validation Testing Methodology 143
6.4.1 Sample Selection 143
6.4.2 Sample Size 144
6.4.3 Categorisation of Participants 145
6.4.4 Length of Service 146
6.4.5 Training On and Use of the Manual 147
6.4.6 Chemical Incident Exercise 147
6.4.7 Provision of a Written Incident Response 149
6.4.8 Evaluation Method 149
6.5 Implications of the Validation Testing Results and Comments 150
on Further Development and Use of the Guidance Manual
7. Discussion 152
7.1 Specification of the Project Aims and Objectives 152
7.2Collection of Information on Chemical Incident Management 154
7.3 Development of the Chemical Incident Management Tools 155
7.3.1 Introduction 155
7.3.2 Best Practice Model for the Public Health Response to 156
Chemical Incidents
7.3.3 Chemical Incident Management Guidance Manual 158
7.3.4 Evaluation Method and Validation Testing Process 159
7.4 Effectiveness of the Guidance Manual in Improving Management 161
7.5 Further Improvements in the Chemical Incident Management 162
Tools and Validation Testing Method
7.5.1 Best Practice Model for the Public Health Response to 162
Chemical Incidents
7.5.2 Chemical Incident Management Guidance Manual 164
7.5.3 Evaluation Method and Validation Testing Process 165
7.6 Difficulties in Conducting Research into Chemical Incident 166
Management
8. Conclusions and Contributions to Knowledge 168
8.1 Conclusions 168
8.2 Satisfaction of Project Objectives 169
8.3 Achievements and Contributions to Knowledge 171
9. Future Research in Chemical Incident Management 173

9.1 Further Dissemination of Research Outputs 173
9.2 Further Development of the Chemical Incident Management Tools 173
9.3 Further Research in Chemical Incident Management 174
10. References 177
Appendices
Appendix 1 Social Research Methods EngD Module Assignment
Appendix 2 Water Related Chemical Incidents Questionnaire
Appendix 3 Water-Related Chemical Incidents Reported to CIRS
from October 1997 - April 2001
Appendix 4 CIRS Chemical Incident Report Form
Appendix 5 Best Practice Model Consultation Form and Instructions
Appendix 6 Raw Data from Consultation on the Best Practice Model
Appendix 7 Checklist of Actions for Chemical Incident Management -
Version 1
Appendix 8 Table of Contents for Version 1 of the Chemical Incident
Management Manual
Appendix 9 Generic Evaluation Method
Appendix 10 Incident Exercise Specific Evaluation Method
Appendix 11 Incident Exercise Used to Validate the Guidance Manual
Appendix 12 Raw Data from Validation Testing of the Chemical
Incident Management Guidance Manual
Appendix 13 SPSS Output for Results from Validation Testing of the
Chemical Incident Management Guidance Manual
Appendix 14 Checklist of Actions for Chemical Incident Management -
Version 2
Appendix 15 Generic Evaluation Method - Revised
Volume 2
Publications
Paper 1 Identifying Chemical Water Incidents in the Published
Literature
Paper 2 Review of the Literature on Procedures for the
Management of Chemical Incidents
Paper 3 Water-Related Chemical Incidents: A National Survey
Paper 4 A Review of Chemical Contamination of Drinking Water
Resulting from Backflow - Draft version
Paper 5 The Public Health Response to an Incident of Secondary
Chemical Contamination at a UK beach
Paper 6 Permeation of Organic Chemicals through Plastic Water
Supply Pipes - Conference Paper
Paper 7 Permeation of Organic Chemicals through Plastic Water
Supply Pipes - Journal Paper
Paper 8 Contamination of Drinking Water as a Result of Re-lining
of Water Tanks or Pipe
Chemical Incident Management Guidance Manual - Version 2

List of Tables
Table 1.1 Coverage of the Five Chemical Incident Regional Service 3
Provider Units in the UK
Table 2.1 Incident Reports in the Published Literature 14
Table 3.1 Table of the 70 Water-Related Chemical Incidents With 34
Significant Research Engineer Involvement, October 1997
- April 2001
Table 3.2 Selected Case Studies 40
Table 3.3 Classification of the Case Studies 58
Table 4.1 Frequency of Ratings for Each Aspect Within the Model 85
Table 4.2 Relationship Between Modal Rating and Chronological 91
Category
Table 4.3 Number of Actions Specified in the Evaluation Method 98
Table 4.4 Total Number of Public Health Professionals in HAs 100
Contracted to CIRS, Categorised by Job Title
Table 4.5 Number of Chemical Incidents Exercise Participants had 101
Managed
Table 4.6 Number of Chemical Incident Training Days Exercise 101
Participants had Attended
Table 4.7 Number of Exercise Participants Under Each Job Category 101
Table 4.8 Number of Participants in Each Training and Experience 102
Group and Use of the Guidance Manual
Table 5.1 Independent Variables Used in Statistical Analysis 108
Table 5.2 Mean Percentage Scores for All Participants 111
Table 5.3 Mean Percentage Scores for Participants with Experience 112
and Training - Group A
Table 5.4 Mean Percentage Scores for Participants with Experience 112
(But No Training) - Group B
Table 5.5 Mean Percentage Scores for Participants with Training 113
(But Limited Experience) - Group C
Table 5.6 Mean Percentage Scores for Inexperienced and Untrained 114
Participants - Group D
Table 5.7 Summary Mean Percentage Scores Across Experience and
Training Groups
Table 5.8 Percentage Improvement in ‘Total’ and ‘Key’ Scores for
Those Using the Manual
Table 5.9 t-testforthe Independent Variable, Manual
Table 5.10 t-test for the Independent Variable, Experience
Table 5.11 t-test for the Independent Variable, Training
Table 5.12 One-Way Analysis of Variance for the Independent
Variable, Occupation - ‘Total’ Score
Table 5.13 One-Way Analysis of Variance for the Independent
Variable, Occupation - ‘Key’ Score
Table 5.14 Results of Tests of Between-Subject Effects Using the
Generalised Linear Model for ‘Total’ Score - Final Model
Table 5.15 Results of Tests of Between-Subject Effects Using the
Generalised Linear Model for ‘Key’ Score - Final Model
List of Figures
Figure 1.1 Number of Chemical Incidents Reported to CIRS for the 5
Years 1994-2000
Figure 1.2 Chemical Incidents as Categorised by Type for the 6
Year 2000
Figure 2.1 Number of Chemical Incidents 25
Figure 2.2 Proportion of Chemical Incidents that are Water-Related 25
Figure 2.3 Types of Contamination in Water-Related Chemical 26
Incidents
Figure 2.4 Types of Chemicals in Water-Related Chemical Incidents 26
Figure 2.5 Percentage of Respondents Using Particular 27
Organisations
Figure 2.6 Reasons for Not Publishing Incident Reports 30
Figure 3.1 Water-Related Chemical Incidents as Type Documented 39
Figure 5.1 Mean Percentage Scores for Participants With and 117
Without Use of a Manual
Figure 5.2 Mean Percentage Scores for Different Experience/Training 118
Groups
Figure 5.3 Mean Percentage Scores for Different Experience/Training 119
Groups, With and Without Use of the Manual
Glossary
A&E Accident and Emergency
ATSDR Agency for Toxic Substances and Disease Registry
BMJ British Medical Journal
BTEX Benzene, Toluene, Ethylbenzene and Xylene
CCDC Consultant in Communicable Disease Control
CDC Center for Disease Control (US)
CDSC Communicable Disease Surveillance Centre
CIPU Chemical Incident Provider Unit
CIRS Chemical Incident Response Service
CIWEM Chartered Institution o f Water and Environmental Management
COMEAP Committee on the Medical Effects of Air Pollutants
CPHM Consultant in Public Health Medicine
CsCDC Consultants in Communicable Disease Control
CsPHM Consultants in Public Health Medicine
DEFRA Department for Environment, Food and Rural Affairs
DETR Department of the Environment, Transport and the Regions
DH Department of Health
DHA District Health Authority
DPH Director o f Public Health
DTLR Department for Transport, Local Government and the Regions
EA Environment Agency
EHO Environmental Health Officer
EngD Engineering Doctorate
EPSRC Engineering and Physical Sciences Research Council
GIS Geographical Information Systems
GP General Practitioner
HA Health Authority
HEPA Health Emergency Planning Advisor
HSE Health and Safety Executive
IPCS International Programme on Chemical Safety
LA Local Authority
MDPE Medium Density Polyethylene
MTU Medical Toxicology Unit
n sample size
NCEC National Chemical Emergency Centre
NHS National Health Service
NHSE National Health Service Executive
NHSME National Health Service Management Executive
NPIS National Poisons Information Service
OECD Organisation for Economic Co-operation and Development
PAH Polycyclic Aromatic Hydrocarbon
PCV Prescribed Concentration or Value
PH Public Health
PHLS Public Health Laboratory Service
PVC Polyvinyl Chloride
RE Regional Epidemiologist
RSPU Regional Service Provider Unit
SCIEH Scottish Centre for Infection and Environmental Health
SEPA Scottish Environmental Protection Agency
SHO Senior House Officer
SI Statutory Instrument
SpR Specialist Registrar
STP Sewage Treatment Plant
STW Sewage Treatment Works
UNEP United Nations Environment Programme
WHO World Health Organization
WRc Water Research Centre
WTP Water Treatment Plant
WTW Water Treatment Works
Executive Summary
Contents
1. Introduction i
2. Project Summary ii
2.1 Background Information and Problem Definition ii
2.2 Aims and Objectives iv
2.3 Investigation and Learning from the Management v
2.4 Methodology for Development of Tools to Improve vii
Chemical Incident Management
2.5 Results and Interpretation from the Validation Testing viii
of the Chemical Incident Management Guidance Manual
2.6 Conclusions xii
3. The Project in the Context of Environmental Technology xiii
4. Areas of Innovation and Contributions to Knowledge xv
5. Areas of Future Research xvii
6. References xviii
1 Introduction
The overall aim of the University o f Surrey/Brunei University Engineering Doctorate
(EngD) Programme in Environmental Technology, as stated in the course handbook
(University of Surrey/Brunei University, 2000, p.5), is:
“...to create graduate research engineers with the necessary
background knowledge, skills and experiences to understand the
relationship between the environment, technology and business and to
apply this understanding to the development, promotion and execution
of corporate strategy.”
In particular, the objective is for research engineers to:
“have expert knowledge in the field o f environmental technology and
be able to apply techniques that balance social and economic benefit
against resource utilisation and environmental impact.”
For Engineering Doctorate projects, the presentation o f the final thesis is referred to as
the portfolio, which comprises the different strands o f the research project and also
demonstrates the progress of the project throughout the research period. The aim o f this
executive summary is to summarise and bring together the different aspects o f the
project. As stated in the programme regulations detailed in the course handbook
(University of Surrey/Brunei University, 2000), the executive summary should:
(i) set the portfolio contents within the context o f environmental
technology;
(ii) direct the reader to evidence in the portfolio which describes the
innovation(s) and contribution(s) to the knowledge in the field of
environmental technology.
The following sections provide a summary of the project as a whole, discuss the project
in the context of environmental technology, identify the innovations and contributions to
knowledge, and detail possible future areas o f research.
2 Project Summary
2.1 Background Information and Problem Definition
The research project was sponsored by the Chemical Incident Response Service (CIRS).
A chemical incident is considered to potentially encompass any event that involves the
release of a chemical, this could be an uncontrolled release or one resulting from normal
industrial operations, and includes both accidental and deliberate releases. Chemical
incidents include both acute and chronic events and may involve contamination from
natural as well as anthropogenic sources. Since 1993, District Health Authorities
(DHAs) have had a responsibility for the co-ordination of the health aspects o f response
to chemical incidents (NHSME, 1993). The designated individual who fulfils this
responsibility is usually the Consultant in Communicable Disease Control (CCDC), who
will work within the HA as part o f the public health team. CIRS is one o f the five
Chemical Incident Regional Service Provider Units (RSPUs) across the UK. RSPUs
provide information and advice to health authorities (HAs) on public health,
environmental, scientific, toxicological and epidemiological aspects o f chemical
incidents to enable them to meet their responsibilities. CIRS covers six National Health
Service Executive (NHSE) Regions, which encompasses 69 DHAs, with a total
population of 37.9 million (Health Service Journal, 1999). The role o f HAs and CIRS in
managing chemical incidents is specified in more detail in Chapter 1.
Public health professionals have only recently become responsible for managing the
health care aspects of chemical incidents, and the majority have had minimal training
and experience in this area. Therefore, the basis of the original project proposal was to
provide specific guidance to assist them in the management o f chemical incidents. In
addition, a need was identified to broaden the approach of CIRS, from the provision of
advice mainly on the toxicological/medical issues involved in chemical incident
management, to include environmental technology issues.
In order to establish the current state of knowledge in chemical incident management,

and to enable the research needs to be further defined and focused, two literature reviews
and a questionnaire survey were conducted. The findings from these investigations are
presented in Chapter 2. Results from the questionnaire paper were also published as a
journal paper, a copy of which can be found in Volume 2 (Goodfellow et al, 2000a).
The focused research needs identified from the literature reviews and questionnaire
survey were as follows:
1. The published literature yields few accounts of incidents that have occurred in the
past few years. Even those that are reported, show that most research is concentrated
on analysing the actual effect o f the incident, rather than in devising procedures for
managing incidents in such a way as to protect human health and the environment.
2. A review of the literature on procedures for chemical incident management did not
find any generic guidance specifically aimed at the public health management o f the
emergency response to chemical incidents. Only one publication providing general
guidance on chemical incident management aimed at public health professionals was
found and its primary focus was on preparation prior to a chemical incident.
3. The questionnaire survey confirmed that levels o f training and experience in
chemical incident management by public health professionals is variable and
generally quite limited and that the development o f comprehensive guidance for the
public health response to chemical incidents is required.
2.2 Aims and Objectives
The general aims identified at the start o f the project were to:
• Evaluate the management of water-related chemical incidents reported to CIRS to
establish how a chemical incident evolves and what lessons can be learnt from these
events; and
• Develop procedures for managing chemical incidents to improve and provide a
consistent response from public health professionals, with the main focus being the
protection o f the public health.
From the assessment of the current state o f knowledge, and further defining and
focusing of the research needs it was possible to develop more specific project aims,
these were to:
• Specify the criteria of a best practice model for the public health response to
chemical incidents;
• Develop a chemical incident management guidance manual to guide those involved
in managing a chemical incident towards the best practice model;
• Develop a quantitative evaluation method to assess the level o f performance
achieved by public health professionals in managing a chemical incident;
• Assess the performance levels achieved by public health professionals with the use
o f the chemical incident management guidance manual; and
• Modify the guidance manual in response to the evaluation results and consultation
comments and provide recommendations for future improvements in management
tools.
Although the main focus o f the research investigation was on water-related chemical
incidents, the chemical incident management tools that have been developed are
intended to be applicable to all types o f chemical incident.
2.3 Investigation and Learning from the Management of

Chemical Incidents
Personal involvement in managing actual chemical incidents provided the opportunity to

collect information about how incidents are currently managed by public health
professionals and to identify areas for improvement. A total o f 246 water-related
chemical incidents were reported to CIRS during the research period, October 1997 to
April 2001. The research engineer had direct involvement in the management o f
70 incidents. Fourteen incidents were selected for in depth study, these are listed in
Table 1, details are provided in Chapter 3.
Table 1: Selected Case Studies
ACUTE INCIDENTS
Lindane spill into a stream feeding a river used for drinking water abstraction (CIRS,
1997a, Hochuli et al, 1998).
Elevated PAHs in drinking water following public supply pipe rehabilitation (CIRS,
1997b).
Contamination of drinking water in a hospital following re-lining o f water tanks (CIRS,
1998a and Goodfellow et al, 2000b).
Solvent permeation through plastic water supply pipes into drinking water from a spill
onto land (CIRS, 1998c, Goodfellow e/ al, 1999 and Goodfellow e/1al, in press 2001).
Diesel in drinking water supplies from land contamination and pipe damage (CIRS,
1998e and Goodfellow et al, in press 2001).
Sewage/trade effluent flooding of residential properties (CIRS, 1998f and Mac Arthur et
al, 2000).
Drinking water contamination in blocks o f flats following re-lining o f water tanks (CIRS
1999a, Crook and Finn, 1999 and Goodfellow et al, 2000b).
Backflow from a central heating system containing chemical additives into the drinking
water system within a block of flats (CIRS, 2000a).
Chemical fire and subsequent flooding leading to surface water and land contamination.
CHRONIC INCIDENTS
Beach and seawater contamination from an adjacent former gas works site (CIRS, 1998b
and Goodfellow et al, 2001).
Heating oil leak leading to surface water contamination and permeation through plastic
water supply pipes to a small housing estate (CIRS, 1998d, Goodfellow et al, 1999 and
Goodfellow, 2000).
Fuel leak from a petrol station leading to permeation through plastic water supply pipes
to a block of flats (CIRS, 1999b and Goodfellow et al, in press 2001).
Spill of engine degreaser permeating plastic water supply pipes to three properties
(CIRS, 2000b).
Raised levels of bromate in a drinking water aquifer (CIRS, 2000c).
For the fourteen incidents studied in depth by the research engineer, full details o f the
circumstances of the incident were recorded. By comprehensively documenting each
event, it was then possible to analyse the incidents at a later date. This enabled specific
lessons to be identified and included in incident management tools and procedures for
application in future incidents. From the fourteen case studies, and also from
involvement in a range of other incidents requiring less in depth involvement o f the
research engineer, a number of principles o f best practice for the management of
chemical incidents were identified; these are specified in Chapter 3, Section 3.1.5.1.
Two specific types of chemical incident were also identified that seemed to occur on a
reasonably frequent basis and posed a threat to public health, these were:
• Permeation o f organic chemicals through plastic water supply pipes; and
• Contamination o f drinking water from water tank and pipe linings.
The lessons from these particular types of chemical incident are addressed in Chapter 3,
Section 3.1.5.2. An additional aspect o f the investigation was to take part in the
chemical incident management training sessions conducted by CIRS and also in regional
chemical incident exercises. Participation in training and exercises provided an
opportunity both to establish the base line expertise o f public health professionals, and to
ascertain the most effective methods for providing guidance to assist in the improvement
of the public health response to chemical incidents. A summary of the lessons learnt
from this aspect of the investigation is provided in Chapter 3, Section 3.2.5.
2.4 Methodology for Development of Tools to Improve

The primary tool that was developed to improve the management o f chemical incidents
by public health professionals was a best practice model. The model specifies the issues
that need to be considered and the actions that need to be taken in a chemical incident.
The aim is to be able to conduct a risk assessment o f the potential impact o f the incident
on the public health, and to prevent or mitigate any adverse effects. The best practice
model was then used to guide the development o f a chemical incident management
guidance manual. This provides an overview o f the framework behind the public health
response to chemical incidents and detailed information and guidance on the issues
raised in the model. The best practice model was also used to devise a quantitative
evaluation method for use in assessing the performance o f public health professionals in
managing chemical incidents. The information basis o f all three chemical incident
management tools was the lessons learnt from involvement in actual chemical incidents,
training sessions, incident exercises, and relevant literature. In developing the tools,
consultation with experts in the field of chemical incident management was carried out.
The evaluation method was then used in the assessment o f the effectiveness o f the
chemical incident management guidance manual in improving the public health response
to chemical incidents. An exercise scenario was devised to simulate a chemical incident
and a group of 79 public health professionals, from across the six NHSE Regions,
worked through the exercise. Each participant was instructed to provide an individual
written response to the exercise, with only half the participants having access to the
guidance manual. The responses were then assessed using the evaluation method and
performance scores were determined for each o f the participants. The performance of
those with and without use of the manual was compared. The effect on performance of
different levels o f previous experience and training in chemical incident management
was also assessed. The detailed methodology used in developing and validating the
chemical incident management tools is addressed in Chapter 4.
2.5 Results and Interpretation from the Validation Testing of

the Chemical Incident Management Guidance Manual
Detailed results and interpretation of the validation testing of the guidance manual can
be found in Chapters 5 and 6. The measure o f performance used was the percentage of
actions completed, as detailed in the evaluation method, for the specified incident
exercise. A number of ‘key’ actions were specified for each stage o f the exercise, these
were considered to have a higher priority for completion. Therefore, a percentage score
was provided for the ‘total’ actions completed and the ‘key’ actions completed. Some o f
the actions specified in the evaluation method could only be achieved in the exercise by
completing several sub tasks; therefore, in some cases an action may be completely or
partially achieved.
The participants in the exercise sessions were all public health professionals. For each
participant three details were collected:
• Number of chemical incidents that the participant had been involved in managing;
• Number o f CIRS training days (or equivalent) attended; and
• Occupational title.
This information was used to categorise the participants as: experienced and trained;
experienced only; trained only; and inexperienced and untrained.
The calculation o f mean percentage scores showed that within each exercise stage and
experience/training group, the score for those with the manual was greater than for those
without the manual, for both ‘total’ actions and ‘key’ actions. Figure I shows the mean
percentage scores for the ‘total’ actions and ‘key’ actions for the exercise as a whole for
each o f the experience/training groups. Scores for participants with and without use of
the manual are shown separately. No data are included for those with experience only as
this only consisted of three people. The percentage improvement in ‘total’ and ‘key’
scores was calculated for the total group and each of the training and experience groups,
as shown in Table 2. These were determined from comparisons o f scores between
participants with and without use of the manual for the exercise as a whole.
Table 2: Percentage improvement in ‘total ’ and ‘key ’ scores fo r those using the manual
Experience/training group Total/key Improvement in score

actions when using the manual
Total Total 16%
(n=79) Key 16%
Experienced and trained Total 31%
(n=12) Key 27%
Trained Total 16%
(n=28) Key 15%
Inexperienced and untrained Total 12%
(n=36) Key 14%
Statistical analysis o f the performance scores was also conducted to show the
significance of the independent variables: use o f manual; experience; training; and
occupational status. Variables were considered to be significant where the p value was
less than, or equal to, 0.05. Univariable analysis using thet-test and one-way analysis o f
variance showed that:
• The manual was a significant factor in affecting the ‘total’ score and ‘key’ score,
with p values of 0.0007 and 0.0004 respectively.
o the improvement in mean ‘total’ score for those with the manual was 6.4
percentage points, with a 95% confidence interval of 2.8 to 10.1.
o the improvement in mean ‘key’ score for those with the manual was 7.4
percentage points, with a 95% confidence interval 3.4 to 11.3.
• Experience showed some significance in affecting the ‘total’ score, with p=0.0525,
but this is not very strong (i.e. statistical significance at p=0.050 has not been
achieved) and the effect on ‘key’ score was not shown to be significant (p=0.0709).
• The effect of training on ‘total’ score was shown to be significant with p=0.0029, the
improvement in mean ‘total’ score for those with training was 5.7 percentage points,
with a 95% confidence interval o f 2.0 to 9.4. No effect was shown on ‘key’ score
(p=0.1145).
• The occupational status of the participant did not have a significant effect on ‘total’
or ‘key’ scores (p=0.1587 and p=0.5192, respectively).
The statistical analysis therefore also demonstrated an improvement in the response to

the exercise for the public health professionals who used the manual. In addition,
training was shown to be a significant factor. This confirms the importance o f specific
training of public health professionals in the methods and knowledge required to
effectively manage chemical incidents. Experience was not shown to result in an
improvement in performance. Public health doctors are only likely to have experience
in a small number of chemical incidents, so will not acquire the breadth o f knowledge
necessary to prepare them to respond to all types o f chemical incident. In addition,
experience does not provide a structured framework for evaluating and responding to
chemical incidents.
X
Figure 1: Mean Percentage Scores for Different Experience/Training Groups, With and Without Use of the Manual
p 3 A 3 |i p e 3JO D S 3 6 e ) U 3 0 J 3 d
2.6 Conclusions
In conclusion, the research project involved the development o f chemical incident

management tools to improve the public health response to chemical incidents. A best
practice model was devised based on:
• Lessons learnt from the management of chemical incidents throughout the research
period;
• Lessons learnt and comments from incident exercises and training days; and
• Lessons learnt and information extracted from relevant literature on chemical
incident management.
This model was then used to direct the development o f two further management tools:
1. A comprehensive chemical incident management guidance manual for use by public
health professionals during the emergency response to chemical incidents;
2. A quantitative evaluation method to assess the performance o f public health
professionals in responding to a chemical incident.
The evaluation method was used in the validation testing of the guidance manual. The
assessment, conducted on a group o f 79 participants, concluded that the manual was
effective in improving performance in the response to a chemical incident exercise.
Statistical analysis further demonstrated that this improvement would be expected across
the general public health population.
3 The Project in the Context of Environmental
Technology
The term environmental technology encompasses not only technical solutions to
environmental problems, but also improvements in management processes and
techniques to minimise environmental impact. The Engineering Doctorate Programme
in Environmental Technology embraces the concept o f clean technology. Clean
technology is concerned with developing and applying new methods o f approaching
environmental problems in a more holistic manner and considering industrial processes
in their entirety, including whole life resource inputs and environmental impacts. For
example, in the clean technology approach to sulphur dioxide emissions from power
stations, the first action would be to reassess the demand for energy. Once the true
needs were established, the next step would be to determine how this level o f energy
should be provided with maximum efficiency o f production, transmission, and use, and
with minimal environmental impact and use o f non-renewable energy resources. In
contrast, the traditional clean-up or ‘end-of-pipe’ approach would be to install a flue gas
desulphurisation unit to remove the sulphur from the power station emissions.
The focus of this project has been on the improvement of management systems for
responding to incidents of environmental contamination, with the aim being to prevent
future events and to minimise the environmental impact o f those incidents that do occur.
The total environment includes humans, and the majority of environmental regulation is
ultimately aimed at preventing or minimising adverse effects on human health or
damage to the environmental resources on which we depend. An additional
environmental aspect of the project is the need to study the impact o f the chemical
incident on the natural environment. For example, determining the concentrations o f
chemicals in various environmental media, and providing information on the behaviour
o f the chemical in the environment to enable effective methods for removal or
remediation to be identified. In many o f the incidents described, the solution to
preventing any further possibility o f adverse human health effects resulting from
environmental contamination was to remove the contaminant source, thereby enhancing
the quality of the natural environment. Where contamination cannot be removed
through natural degradation, the safe disposal of hazardous materials to licensed and
properly managed waste sites is required.
The objective of the project has been to provide improved tools and procedures to enable
public health professionals to prevent or minimise the impact o f chemical incidents on
the public health. Successful management o f a chemical incident inherently involves the
protection and/or remediation of the natural environment. The ultimate aim o f
improving the management of chemical incidents is to prevent the occurrence of
incidents involving chemical contamination o f the environment; this philosophy is the
basis behind clean technology, which requires the minimisation of environmental
problems at source. The balance to be achieved is between the social and economic
benefits of industrial activities, and the potential health and environmental impact o f
accidents arising from such activities.
Returning to the EngD Programme objective stated in the introduction, the project has
involved the study of the relationship between technology and environmental hazards
and also the business, or organisational, limitations o f managing environmental impacts.
This understanding has led to the development o f management tools to improve National
Health Service (NHS) strategies for responding to chemical incidents. These tools are
specifically intended for use by the public health profession.
4 Areas of Innovation and Contributions to
Knowledge
In order to be eligible for the award o f the degree o f Doctor o f Engineering, candidates
must fulfil the following criterion (University o f Surrey/Brunei University, 2000,
p.Al/5):
Demonstrate evidence o f innovation and a contribution to knowledge
via research into either:
(i) novel understanding o f the environmental consequences of
systems for providing goods or services; or
(ii) novel methods of improving the environmental performance o f
systems for providing or using goods or services thereby
contributing to more sustainable development.
This research project has investigated both the environmental consequences o f chemical
incidents themselves, which occur as the result o f accidents from industries providing
goods and services, and also the management of chemical incidents by health
authorities, which form part of the service industry. The output o f the project has been
the development of methods to improve the management of chemical incidents, thereby
enhancing the environmental performance of the management systems employed by
health authorities in responding to chemical incidents.
The specific contributions to knowledge achieved have been:

• Development of a best practice model for the public health response to chemical
incidents, based on the lessons learnt from the management o f actual chemical
incidents. The best practice model sets out in one document all the issues and
actions required in the response to a chemical incident. This constitutes original
work as no similar model currently exists.
• Development of an evaluation method to quantitatively assess the performance
in responding to chemical incidents. This is a novel tool that could be useful for
XV
both assessing effectiveness o f chemical incident training and in ensuring an
adequate level of competency in those professionals required to manage the health
aspects of environmental hazards.
• Creation of a chemical incident management guidance manual providing a
framework and detailed guidance on: the risk assessment o f the potential impact o f a
chemical incident on the public health; communication with other organisations
involved in the management of chemical incidents and with the public; management
actions to prevent or mitigate adverse health impacts; and documentation of
incidents. The effectiveness o f this manual in improving response o f public health
professionals was also demonstrated. Generic guidance aimed at the emergency
response to chemical incidents by public health professionals is not currently
available and the publication o f this manual will provide a valuable and unique
resource for the public health profession. A copy o f the chemical incident
management guidance manual can be found in Volume 2.
• Dissemination of lessons learnt in the management o f chemical incidents through
conferences and training sessions and the publication of journal papers, including:
> ‘Water-Related Chemical Incidents: A National Survey’ - in the journal
Health and Hygiene (Goodfellow et al 2000a);
> ‘The Public Health Response to an Incident o f Secondary Chemical
Contamination at a UK Beach’ - in the BMJ journal Occupational and
Environmental Medicine (Goodfellow et al, 2001);
> ‘Permeation of Organic Chemicals Through Plastic Water Supply Pipes’ -
accepted for publication in the CIWEM journal Water and Environmental
Management Journal (Goodfellow et al, in press 2001).
Copies of all papers produced during the research period can be found in the
Publications Section in Volume 2.
xvi
5 Areas of Future Research
In Chapter 7, Section 7.5, details of the further possible developments o f the chemical
incident management tools are provided. In Chapter 9, more general areas for further
research are discussed. In summary, with respect to the best practice model, further
consultation both within the public health field and also with other organisations
involved in the management of chemical incidents needs to be conducted, particularly
with regard to the prioritisation of management actions. The coverage o f the chemical
incident management guidance manual needs to be further broadened to encompass all
types of environmental chemical incidents and for application across the UK. Further
consultation is also to be conducted prior to final publication of the manual as part o f a
Stationery Office Book, ‘Environmental Management of Chemical Incidents’. Further
investigation with respect to the evaluation method and validation testing process could
also be conducted. In particular, testing the applicability of the evaluation method in
other types of scenarios and for measuring performance in actual chemical incidents.
Further investigation into the effect of experience on chemical incident management
performance would also be of interest.
For chemical incident management in general, further research is required with respect
to the following issues:
• Further specification of the role o f public health professionals in chemical incident
management.
• Further research to ascertain how well the best practice model reflects actual
management practice and whether any differences are due to inadequacies o f the
model or the response.
• Development of geographical information systems (GIS) as a chemical incident
management tool.
• Further information on the most effective techniques and the frequency and duration
of training required, in order to ensure competency o f those required to manage
chemical incidents.
• Development of improved methods o f chemical incident surveillance and
investigation of causal links between environmental exposures and disease
outcomes.
6 References
Chemical Incident Response Service (1997a) Confidential Chemical Incident Response
Service Incident Report. London: CIRS, June (no.L/97/06/117).
Chemical Incident Response Service (1997b) Confidential Chemical Incident Response
Service Incident Report. London: CIRS, July (no.L/97/07/105).
Service Incident Report. London: CIRS, February (no.L/98/02/057).
Chemical Incident Response Service (1998c) Confidential Chemical Incident Response
Service Incident Report. London: CIRS, June (noL/98/06/122).
Chemical Incident Response Service (1998d) Confidential Chemical Incident Response
Service Incident Report. London: CIRS, July (noL/98/07/123).
Chemical Incident Response Service (1998e) Confidential Chemical Incident Response
Service Incident Report. London: CIRS, October (noL/98/10/132).
Chemical Incident Response Service (1998f) Confidential Chemical Incident Response
Service Incident Report. London: CIRS, November (no.L98/l 1/123).
Service Incident Report. London: CIRS, November (no. L/99/11/010).
Crook, S. and Finn, L. (1999) ‘Inadequate curing o f water tank linings leading to
contamination of drinking water’ Chemical Incident Report, no. 12 April pp.3-4.
Goodfellow, F.; Murray, V; Ouki, S. (1999) ‘Permeation of organic chemicals through
plastic water supply pipes’ Proceedings o f the Engineering Doctorate in Environmental
Technology Annual Conference 1999.
Goodfellow, F. (2000) ‘Longstanding Water and Land Contamination from a Fuel Oil
Leak’ Chemical Incident Report, no. 16 April p.8.
Goodfellow, F; Murray, V; Ouki, S. (2000a) ‘Water-related chemical incidents: a
national survey’ Health and Hygiene, vol.21 iss.2 April pp.58-65.
Goodfellow, F.J.L.; Murray, V.S.G.; Ouki, S.K. (2000b) ‘Contamination of Drinking
Water as a Result of Re-lining of Water Tanks or Pipes’ Proceedings o f the Engineering
Doctorate in Environmental Technology Annual Conference 2000.
Goodfellow, F.J.L.; Murray, V.S.G.; Ouki, S.K.; Iversen, A.; Sparks. A.; Bartlett, T.
(2001) ‘The Public Health Response to an Incident o f Secondary Chemical
Contamination at a UK Beach’ Occupational and Environmental Medicine, vol.58 no.4
pp.232-238.
Goodfellow, F.; Ouki, S.K.; Murray, V. (in press 2001) ‘Permeation o f Organic
Chemicals Through Plastic Water Supply Pipes’ Water and Environmental Management
Journal.
Health Service Journal (1999) Map o f the National Health Service. London: Map
Marketing Ltd.
Hochuli, V.; Wheeler, H.; Oliver, F. (1998) ‘Dead fish saved the day’ European
Association o f Poisons Centres and Clinical Toxicologists XVIII Conference, Zurich,
Switzerland, March 24-28 1998. p. 139.
MacArthur, K.; Gubbins, J.; Premaratne, N.; Caine, C.; Henderson, A.; Euripidou, R.;
Goodfellow, F. (2000) ‘Evacuation from persistent contamination following a sewage
spill’ Chemical Incident Report, no.17 July pp.8-11.
National Health Service Management Executive (1993) Health Service Arrangements
for Dealing with Chemical Incidents. London: NHSME (HSG (93) 38).
University of Surrey and Brunei University (2000) Engineering Doctorate (EngD) in
Environmental Technology Course Handbook - For Research Engineers and
Supervisors - Academic Year 2000-2001.
xix
1 Introduction
The Engineering Doctorate (EngD) Programme in Environmental Technology is
conducted jointly by the University o f Surrey and Brunei University and is largely
funded by the Engineering and Physical Sciences Research Council (EPSRC). Each
research engineer is sponsored by a company who proposes a research project within the
environmental technology theme and provides additional funding. The research
engineers are based at the sponsor company where the research work is conducted.
This introduction provides background information on the sponsor company, the initial
problem definition and research needs, and the aims and objectives o f the project.
Details of further investigation into the problem and assessment o f the research needs
are provided in Chapter 2.
1.1 Background to the Sponsor Company
The sponsor company for the research project was the Chemical Incident Response
Service (CIRS). CIRS was formed as a specialised department at the Medical
Toxicology Unit (MTU), Guy’s and St Thomas’ NHS Hospital Trust. It was developed
from a chemical incident research programme, which was established in 1990, and
became a contracted service in 1995. CIRS is now one of five Chemical Incident
Regional Service Provider Units (RSPUs or CIPUs) across the UK, that provide
information and advice to health authorities (HAs) on public health, environmental,
scientific, toxicological and epidemiological aspects o f chemical incidents. The
historical focus of expertise at CIRS has been on the toxicological and medical issues
related to chemical incidents, due to its development out o f the National Poisons
Information Service (NPIS), also part of MTU. The core professional staff at CIRS
consists of consultant toxicologists, information scientists (with expertise in
toxicological data) and, since 1997, an environmental epidemiologist.
l
HAs have a responsibility for the protection of the public health from environmental
hazards. In a chapter specifically on chemical incidents, the National Health Service
(NHS) Guidance ‘Planning for Major Incidents’, states that HAs must ensure that
satisfactory arrangements are in place for handling the public health and health care
aspects of the response to chemical incidents (NHSE, 1998). The designated individual,
usually the Consultant in Communicable Disease Control (CCDC), must ensure that the
HA has access to the necessary advice and expertise concerning public health hazards
arising from chemical incidents. Each HA is therefore required to have a service level
agreement with a Chemical Incident RSPU for provision o f this advice and expertise.
There are a total of 119 District Health Authorities (DHAs) across England, Scotland,
Wales and Northern Ireland, which are grouped under 11 National Health Service
Executive (NHSE) Regions (the organisation of HAs across the UK will be changing
over the next year, with different arrangements for England, Scotland, Wales and
Northern Ireland). The five Chemical Incident RSPUs are listed in Table 7.7; the NHSE
Regions covered and their total population are specified for each unit (Health Service
Journal, 1999). From the table, it can be seen that CIRS covers 6 NHSE Regions, which
encompasses 69 DHAs, with a total population of 37.9 million, 64% o f the total UK
population.
2
Table 1.1: Coverage o f the Five Chemical Incident Regional Service Provider Units in
the UK
Unit NHSE Regions Population

covered
Chemical Hazard Management and West Midlands 5.3 million
Research Centre at the Institute o f Public
and Environmental Health, University of
Birmingham
Chemical Incident Management Support Northern Ireland 4.6 million
Unit at the College of Medicine, Wales
Therapeutics and Toxicology Centre,
University of Wales
Chemical Incident Response Service at the Eastern 37.9 million
Medical Toxicology Unit, Guy’s and St London
Thomas’ NHS Hospital Trust North West
South East
South West
Trent
Chemical Incident Service at the Northern and Yorkshire 6.4 million
Department of Environmental and
Occupational Medicine, The Medical
School, University of Newcastle
Scottish Centre for Infection and Scotland 5.1 million
Environmental Health
1.2 Problem Definition
The following section outlines the initial definition o f the research problem and a
definition of a chemical incident is provided and the type of incident covered by the
project is specified. The role of public health professionals and CIRS in responding to
chemical incidents is discussed, and the research needs, as identified at the time the
project was proposed, are detailed.
1.2.1 Chemical Incidents
In general terms, a chemical incident is considered to be any event that involves the
release of a chemical. This could be an uncontrolled release or one resulting from
normal industrial operations, and includes both accidental and deliberate releases.
Biological contamination is not considered to be a chemical incident, except in the case
3
where a biological agent releases chemical substances. Radioactive substances are also
not included, unless the substance poses a toxic as well as a radiation risk.
1.2.1.1 Definition
CIRS uses the definition of a chemical incident as specified by Hill and O'Sullivan, who
undertook a survey in 1991 of the arrangements for the identification and investigation
of incidents of acute exposure to the public to toxic substances (Hill and O’Sullivan,
1992). For the purpose of the survey, an incident was defined as:
“An unforeseen event involving any non-radioactive substance resulting in
potential toxic risk to public health or leading to exposure o f two or more
individuals resulting in illness or potential illness ”
or
“Two or more individuals suffering from a similar illness, which might be
due to such an event”
CIRS is concerned with chemical incidents that pose an actual or potential hazard to the
public health. Therefore, an individual exposure is not included within their definition
and occupational hazards are also not investigated unless there is the possibility o f the
general population becoming exposed.
Chemical incidents include both acute and chronic events. For example, a spill into a
watercourse causing only short-term contamination, or contamination o f water supplies
over a long time period due to leaching o f chemicals from the pipe material or lining. In
addition, chemical incidents involving contamination from natural sources are also
included, for example raised levels o f manganese in private drinking water supplies due
to the local geology.
4
1.2.1.2 Numbers and types o f chemical incidents
All chemical incidents reported to CIRS are recorded on a computer database. Incidents
categorised as:
Air • Medicine
CS gas • Spill
Explosion • Suspicious
Fire • Transport
Food/drink • Waste
Land • Water
Leak • Other
Malicious • Not known
Additional fields allow the specification of whether there has been a release to air, water,
water supply or land. Figures 1.1 and 1.2 show, the total number of incidents reported
to CIRS in the years 1994 to 2000, and the percentage of the 913 incidents for the year
2000 as categorised by type, respectively.
Figure 1.1: Number o f Chemical Incidents Reported to CIRSfo r the Years 1994-2000
600
1994 1995 1996 1997 1998 1999 2000
5
Figure 1.2: Chemical Incidents as Categorised by Type for the Year 2000 (n=913)
VO
1.2.1.3 Project scope
The type of chemical incidents included in the scope o f study o f the project was
restricted to water-related chemical incidents. Although there is a water category within
the CIRS database, incidents studied were not restricted to this type as incidents
categorised as other types, in particular spill and leak, could also result in the
contamination of water. The subset o f water-related chemical incidents from all the
chemical incidents reported to CIRS therefore included all incidents that resulted in the
chemical contamination of surface waters, ground waters, marine waters and drinking
water supplies. The majority of the incidents studied in depth were restricted further to
those affecting surface waters or drinking water supplies.
1.2.2 Role of Public Health Professionals in Managing Chemical Incidents
In recent years, public health doctors have taken on a much greater role in the
investigation of environmental hazards that impact on the health o f the general
population, including the management o f both acute and chronic chemical incidents.
The current system, which requires public health doctors within HAs to manage
chemical incidents, has only been in place since the Health Service Guidelines were
produced in 1993 (DH et al, 1993 and NHSME, 1993). The guidelines for the
‘Arrangements to deal with health aspects of chemical contamination incidents’ state
that (NHSME, 1993):
• The responsibility for the co-ordination of the health aspects o f response to chemical
accidents lies with the DHAs;
• Regional and District Health Authorities should ensure that they have adequate
arrangements in place for handling health aspects o f accidents involving actual or
potential chemical contamination of air, soil, water and food; and
• Each DHA should designate an appropriate individual to be responsible for ensuring
that the DHA has access to the necessary advice and expertise concerning public
health hazards arising from chemical contamination and to prepare appropriate plans
to respond to these.
7
The specific responsibilities of the DHA include (NHSME, 1993):
• The protection of the health of, and provision of health care to, those who have been
or may be exposed to a chemical hazard;
• Co-ordinating the NHS response to the accident with other agencies, including those
involved in the collection of non-biological, i.e. environmental, samples for analysis
(in particular local authority environmental health officers);
• Promptly advising the local authority (LA), and as appropriate the emergency
services, on the measures to limit or prevent further exposure o f the public to the
hazard;
• In consultation with Accident and Emergency (A&E) consultants, other clinicians
and the ambulance service, determining what measures are required within the health
service to assist and treat those who have or may have been exposed;
• Ensuring that members of the health professions (including general practitioners,
health visitors and other members o f the primary health care team) are given
adequate information about the accident and the health consequences;
• In the light of available exposure data, the results o f biological and non-biological
sampling and epidemiological findings, and with appropriate specialist advice,
evaluating the risk to the health o f the public; and
• In consultation with the LA and other agencies involved in the accident, issuing any
necessary public statements about the medical care of people who have or may have
been exposed to a hazard, how to avoid or minimise exposure, and providing
information on the probable effects of exposure including reassurance where no or
minimal risk exists.
However, despite the requirement for HAs and public health professionals to manage the
health aspects of chemical incidents, their experience and training is variable and largely
quite limited. The 1991 survey by Hill and O'Sullivan into the identification and
investigation of chemical incidents, found that few public health doctors have been
trained in managing such events or have access to the resources required for
8
identification and investigation of chemical incidents and the mitigation or prevention of
adverse health effects in humans (Hill and O’Sullivan, 1992). Bakhshi (1997) reported
that, whereas the emergency services have learnt to cope efficiently and effectively with
acute incidents, there is a gap in public health preparedness for the provision o f a
continuing assessment of the impact on the exposed community as a result o f a chemical
accident and the resulting action to preserve the health of the community. Bakhshi
(1997) also found that familiarity with knowledge of environmental hazards, related
clinical features, and technical laboratory procedures, is no longer central to the training
and expertise of public health practitioners.
1.2.3 CIRS Approach to Chemical Incident Management
CIRS provides advice and expertise to public health professionals in those HAs with
which it has service level agreements. Advice may also be provided to other health
responders, in particular A&E hospital departments and the Ambulance Service. The
management of a chemical incident requires a multi-agency response and CIRS will
often collaborate with other organisations involved in the management, for example,
Local Authority Environmental Health, Police, Fire Service, Environment Agency (EA),
and water companies.
CIRS may become aware of a chemical incident through the emergency services, A&E
hospitals, NHS Direct, Environmental Health or directly from the industry or company
involved, in which case they will alert the public health doctor in the relevant HA within
30 minutes. Alternatively, the public health doctor within the HA may contact CIRS
directly for advice with respect to an incident o f which they are already aware.
The aim o f CIRS in managing a chemical incident is to assist the public health doctor to
assess the potential impact of the chemical incident on the public health and to take
appropriate action to prevent or minimise any adverse effects on the health o f the
population in their HA area. The specific objectives are to:
• Assist in identifying the chemical hazard and determine the toxic risk;
9
• Provide the relevant medical toxicology information on the chemical or chemicals
involved;
• Advise on personal decontamination, medical treatment, biological sampling and
health follow-up;
• Advise and assist with epidemiological investigations, incident documentation and
surveillance; and
• Assist with the provision and interpretation of environmental information and carry
out site visits where appropriate.
As the incident develops CIRS will assist in monitoring and recording any changes in
the situation and updating hazard and risk assessment information.
1.2.4 Preliminary Research Needs
Prior to the commencement of the project, two general research needs were identified
with respect to the public health and CIRS response to chemical incidents:
1. The advice offered by CIRS in responding to chemical incidents has historically
been of a toxicological/medical nature. In order to cover the breadth o f issues
involved in chemical incident management, CIRS sought to expand its knowledge
base through environmental technology research projects. Therefore, in 1997, two
Engineering Doctorate in Environmental Technology projects were started focusing
on air and water-related chemical incidents. In 1998, an additional project was
initiated to study land-related incidents.
2. HAs and their public health professionals have only been responsible for managing
the health care aspects of environmental hazards, including chemical incidents, since
such a duty was placed on them in the NHS Guidelines in 1993 (DH et al, 1993 and
NHSME, 1993). The majority of public health professionals have minimal training
and experience in this area and would greatly benefit from the provision o f specific
guidance to assist them in the management o f chemical incidents.
10
1.3 Aims and Objectives
From the research needs identified in the previous section, the aim at the start o f the
project was specified as being to develop procedures for the management o f chemical
incidents. Chemical incident response and management is a multi-disciplinary operation
involving public health professionals in HAs, A&E hospitals, primary care groups,
emergency services, Environmental Health Officers (EHOs) in local authorities (LAs),
the Environment Agency, toxicologists, and, in the case o f water related incidents, water
companies. Additional specialists are also often involved, for example, environmental
consultants, the Water Research Centre (WRc), the National Chemical Emergency
Centre (NCEC), Health and Safety Executive (HSE), and the Meteorological Office.
The aim of this research was to provide procedures for chemical incident management
primarily aimed at UK HAs, but that would also be applicable to other organisations in
the UK and internationally. The focus of the procedures for managing chemical
incidents is the protection of the public health.
The output from the project was therefore planned to be a guidance manual for use by
public health professionals in the emergency response to chemical incidents, in order to
assist in the mitigation and prevention of the impact on human health. In addition to
developing the current toxicological response, a supplementary aim o f the project was to
introduce an environmental technology perspective into the process o f chemical incident
management within the public health field.
The main objectives identified at the start o f the project were therefore to:
• Evaluate the management of water-related chemical incidents reported to CIRS and
events; and
protection o f the public health.
11
From the assessment of the current state o f knowledge and further defining and focusing
of the research needs, as will be described in Chapter 2, it was possible to develop more
specific project aims. Therefore, the aim of the project was refined to be the
development of a best practice model for the public health response to chemical
incidents. This model would then be used to direct the development o f guidance
materials to assist those involved in the management o f chemical incidents to meet the
best practice criteria. A quantitative evaluation method would also be devised to assess
the public health response to chemical incidents. This would enable the effectiveness o f
the chemical incident management guidance manual to be assessed.
The specific objectives were detailed as:

chemical incidents;
• Develop a chemical incident management guidance manual to direct those involved
• Develop a quantitative evaluation method to assess the level o f performance
of the chemical incident management guidance manual; and
comments, and provide recommendations for future improvements in the
management tools.
12
2 Current State of Knowledge in Chemical Incident
Management
An extensive literature search has been undertaken to enable the current state of
knowledge in the field to be determined. In order to gather the necessary information,
two literature reviews were conducted, one searching specifically for reports of water-
related chemical incidents and a second identifying any existing procedures on the
management of chemical incidents. The results of the findings, which enabled the most
important research needs to be identified, are reported in Sections 2.1 and 2.2.
In addition, in order to establish the current state o f knowledge in chemical incident

management, a questionnaire survey was developed to determine the current levels of
training and experience of the lead doctors in managing chemical incidents within health
authorities (HAs), usually Consultants in Communicable Disease Control (CsCDC).
The level of resources they had access to, and particular areas requiring investigation
were also identified. The results of the survey are reported on in Section 2.3.
2.7 Water-Related Chemical Incidents in the Published

Literature
At the start of the research project, a comprehensive literature search of English

language journal reports looking specifically at water-related chemical incidents in
Britain was conducted for the period 1994-1997. A full literature review paper was
published in the Chemical Incident Report (CIRS in-house newsletter), and can be found
as Paper 1 in the Publications Section in Volume 2 (Oliver and Holmes, 1998). For the
purposes of the review, only incidents affecting water, either as the primary or secondary
media of contamination, were considered. Only chemical incidents, as opposed to
microbiological contamination, were included; both drinking water and natural waters
were considered, but not swimming pools, or similar artificial environments. An
incident was defined as an event where a chemical in water had been found to be
13
elevated, or suspected to be elevated, above UK drinking water guideline levels and had
the potential to cause adverse health effects. Within this definition, both acute and
chronic incidents were included. With respect to those exposed, only the threat to the
public was considered, occupational or individual exposures were not included.
The results from the searches are shown in Table 2.1. A total o f only eight acute and
chronic incidents were identified from the literature search. Table 2.1 also shows that
there were two categories of papers; those that primarily focused on the reported
symptoms and health effects, and those that actually documented how the incident
occurred and how it was managed.
Table 2.1: Incident Reports in the Published Literature
Health Effects Management of the Incident

An epidemiological study after a water Thetford plastics fire: the role of a preventive
contamination incident near Worcester (Fowle medical team in chemical incidents (Baxter, et
et al, 1996) al, 1995)
Incidence of childhood diabetes mellitus in Sheep dip chemicals and water pollution
Yorkshire is associated with nitrate in (Virtue and Clayton, 1997)
drinking water (Parslow et al, 1997)
Copper in drinking water - an investigation Containing run-off at Allied Colloids (Anon,
into possible health effects (Fewtrell et al, 1995)
1996)
The legend of Camelford: Medical The Environmental Impact o f a Chemical
consequences of a water pollution accident Spill from a Timber-Treatment Works on a
(David and Wessely, 1995) Lowland River System (Dowson et al, 1996)
The four papers focusing on the health effects cover two acute and two chronic
incidents.
• In April 1994, an acute incident occurred involving a major river pollution event
with the chemical 2 ethyl 5,5 dimethyl 1,3 dioxane and 2 ethyl 4 methyl 1,3
dioxolane, which led to a considerable increase in the number o f complaints from the
public concerning an unusual taste and odour in the drinking water in Worcester city
(Fowle et al, 1996).
• A follow-up report was identified regarding health effects, and the general public
response as a consequence of the infamous incident water incident that occurred in
14
Camelford on 6 July 1988 (David and Wessely, 1995). The incident involved the
inadvertent deposition of 20 tonnes o f aluminium sulphate into the wrong storage
reservoir, which resulted in a massive aluminium load in the domestic water supply
of 12 000 residents and 8 000 holiday visitors in the district o f Lowermoor, north
Cornwall.
The two papers on chronic incidents dealt with the possible health effects related to long
term exposure to nitrate and copper in drinking water supplies, and in particular, the
association with childhood diabetes and liver disease (Parslow et al, 1997 and Fewtrell
et al, 1996).
The second category o f papers were more relevant to the research project as they
provided more information regarding incident management responses and their
environmental consequences, with some offering lessons learnt that could be applied to
future events. Papers were identified detailing the response to three acute inciderts, as
summarised below:
• On 11 October 1991 in Thetford, there was an incident involving a fire that
consumed 1000 tonnes of plastic, mainly PVC, over 72 hours and resulted in the
emission of a large smoke plume threatening the health o f both local residents and
emergency workers (Baxter, et al, 1995). The incident also threatened secondary
contamination of water from contaminated fire water entering rivers or storm drains.
The paper focuses specifically on the role of a medical team in the emergency
management of a major polyvinyl chloride fire in an urban area.
• Blocked site drains and pumping systems, as the consequence o f a chemical fire at
an Allied Colloids chemical production plant in South Bradford on 21 July 1992,
resulted in the existing drains and effluent treatment facilities being unable to
contain much of the fire-fighting run-off waters (Anon, 1995). This caused a
significant quantity of polluting material to be released off-site and eventually into
the local river system, leading to a major fish kill as far downstream as 30 miles.
15
• A major timber preservative spillage in March 1990 resulted from a fire at a timber
yard (Dowson et al, 1996). Substantial quantities o f tributyltin and lindane (y-
hexachlorocyclohexane) were released into the River Bourne, with contamination
extending 80 km into the Thames estuary causing extensive fish mortality and virtual
eradication o f the invertebrate population in the immediate vicinity o f the spill. In
addition, three drinking water intakes were closed for a period o f 5-7 days as a
precautionary measure.
Another paper identified a chronic problem of pollution o f watercourses by

organophosphate sheep dip (Virtue and Clayton, 1997). The paper describes the
approach used by the Tweed River Purification Board in 1990-1991 to meet their
objective of reducing the numbers and significance o f water pollution incidents caused
by sheep dipping.
The number of incidents identified through the literature search takes on more
significance when compared to the number of incidents reported to CIRS. From the
analysis of the database compiled by CIRS on reported incidents, from 1997 alone, at
least 31 reports were identified o f chemical incidents that actually, or potentially,
affected water and resulted in a threat to human health. Due to the categorisation o f the
incidents within the database, it was difficult to identify cases where water had been
polluted through secondary contamination, for example via fire water runoff, therefore
this is a conservative estimate of the number o f incidents reported. The comparison o f
the number of incidents reported to CIRS with those described in the published literature
clearly indicates a significant disparity. The opportunities for learning from past events
are greatly reduced without dissemination to the wider professional community through
publication. Valuable information on lessons learnt from the management o f chemical
incidents could be passed on through publication. This would be o f particular benefit to
public health professionals, who may only be called upon to respond to incidents on an
infrequent basis. Consequently, they would benefit from being able to keep up to date
16
with the types of hazards that exist, current practice in responding to incidents, and the
shortfalls identified from the management o f past events.
2.2 Chemical Incident Management Procedures in the

Published Literature
The aim of this literature review was to identify any procedures currently available to
assist in the management of chemical incidents. The particular focus was on the
management o f chemical incidents and environmental hazards by public health doctors
in order to minimise the adverse impact on the public health. This covers a wider remit
than just the medical management o f casualties, which is considered to be largely the
responsibility of hospital accident and emergency clinicians.
A systematic and comprehensive literature search o f a range of electronic databases, and

also internet searches, were undertaken covering the period of 1985 up to January 2001.
In addition to the materials identified from these searches, publications not necessarily in
the public domain, for example internal publications from public bodies or commercial
organisations, were collated throughout the research period. A detailed version o f the
literature review has been prepared as a separate paper and can be found as Paper 2 in
the Publications Section in Volume 2. A summary o f the findings is provided below.
Results from the literature search identified various publications on particular aspects o f
chemical incident management and related issues, including:
• Site specific technical management - a number of papers were found detailing
specific emergency procedures at industrial sites. The Center for Chemical Process
Safety, part of the American Institute o f Chemical Engineers provides guidelines on
the prevention, preparedness, response and recovery stages o f on-site emergencies
within the process industry in particular (Center for Chemical Process Safety, 1995).
The American Institute of Chemical Engineers have also produced a document with
guidelines that aim to establish a basis for successful feedback through investigation
17
of process incidents to determine the many causes and to implement changes which
will prevent recurrence (American Institute o f Chemical Engineers, 1992).
• Medical management of casualties - several references were identified that
specifically covered the medical management o f casualties from chemical accidents,
for example, assessing level of injury, initial treatment, and management o f large
numbers of casualties (Hall, 1995 and Murray, 1990). Another source o f
information on the medical management o f casualties from acute chemical exposures
is provided by the US Agency for Toxic Substances and Disease Registry (ATSDR,
1992). These guidelines were developed to aid emergency department physicians
and other emergency healthcare professionals who manage acute exposure resulting
from chemical incidents. Twenty-seven chemical-specific medical management
protocols are provided with information on the medical treatment o f exposed
patients, how to avoid contamination or injury to medical staff and decontamination
techniques.
• Computer based expert systems for emergency management of chemical
incidents - several computer based expert systems or models exist which aim to aid
the emergency response to chemical incidents (Chang et al, 1988, Mendoza et al,
1989, Finch and Lees, 1997 and Gheorghe and Vamanu, 1999). The use o f a
simulation-based decision support tool for management o f chemical incidents and
the application o f a three-dimensional numerical model in emergency response
management is also reported in the literature (Morin et al, 1999 and Yamada, 1993).
• Collation of information during an emergency - management systems, including
computer based tools, have been developed for use in emergency management in
general and also specifically for chemical incidents, in order to collect and collate
the large array of information from such events (Comfort, 1985, Ernst, 1985,
Gordon, 1988, Marker, 1988 and May hew, 1988).
• Procedures for the management of chemical incidents - only a limited number o f
publications were identified that dealt with general procedures or issues related to
the management of chemical incidents. The Organisation for Economic Co
operation and Development (OECD), the International Programme on Chemical
18
Safety (IPCS), the United Nations Environment Programme (UNEP) and World
Health Organization (WHO) jointly produced a book in 1994 on the ‘Health aspects
o f chemical accidents: Guidance on chemical accident awareness, preparedness and
response for health professionals and emergency responders’ (OECD et al, 1994).
The main subject matter is preparedness, with some specific response information
relating to managing the health impact o f a chemical accident. In 1999, IPCS
produced a book on public health and chemical incidents aimed at policy makers
(IPCS, 1999). It is not designed for use as a tool in the emergency response to
chemical incidents. However, it does identify various aspects o f the public health
management of chemical incidents and in particular, covers issues to be considered
when planning the resources required for incident response. WHO have also
produced a book for an international audience on rapid health assessment protocols
for emergencies. This focuses mainly on large-scale emergencies involving
infectious diseases or natural disaster. However, there is also a short chapter on
chemical emergencies that introduces the issues to consider in a preliminary
assessment of a chemical incident (WHO, 1999). CIRS has also been involved in a
number of publications aimed at providing guidance to those involved in the
emergency response to chemical incidents. In 1995, a toolkit for handling chemical
incidents for trainees in public health was produced (Schonfield et al, 1995). This
document was further developed and revised, and published as the first in a series of
books on chemical incident management produced by CIRS and published by The
Stationery Office (Irwin et al, 1999). This book, which is targeted to public health
physicians, looks at the role of the public health department o f a health authority in a
chemical incident in some detail, however, the focus is largely on preparedness,
rather than actual management actions. Another book, aimed at accident and
emergency clinicians and their role in chemical incident management, also forms
part of this series (Fisher et al, 1999). This book is focused on the hospital role and
medical management of patients in a chemical incident. In 1997, the Environmental
Health and Emergency Planning Services o f Bedfordshire and Hertfordshire Local
Authorities produced a practical guide for Environmental Health Officers (EHOs)
providing information and advice to support the attending officer at an incident
19
involving chemicals (Environmental Health and Emergency Planning Services of
Bedfordshire and Hertfordshire Local Authorities, 1997). The toolkit was intended
to be a practical working document for EHOs providing guidelines and information.
This toolkit has recently been further developed and extensively revised, and
published as part the CIRS series on chemical incident management (Fairman et al,
2001). The NHS Management Executive provides some guidance on the health
aspects o f chemical incident management (DH et al, 1993 and NHSME, 1993).
However, these guidelines largely focus on specifying the role o f public health
doctors and others in dealing with chemical incidents, and also on resource planning
for the management of chemical incidents, rather than detailing the specific issues
and actions involved in managing an incident. NHS guidance has also recently been
provided covering all types o f major incidents, a chapter is included referring
specifically to chemical incidents (NHSE, 1998). The focus o f this guidance is on
emergency planning and defining roles and responsibilities. Some guidance is
provided on particular aspects of response to incidents, for example, basing with the
media, decontamination and personal protective equipment, and long-term health
investigations. The Home Office has also produced more general guidance for all
types of disaster; this document deals with large-scale disasters in general, with only
minimal reference to chemical incidents (Home Office, 1997). However, several
emergency management issues are raised that are applicable to the management o f
major chemical incidents. Finally, the Health and Safety Laboratory have produced
a manual for use when sampling for human exposure following a chemical incident
(White et al, 1999). The focus is clearly on biological sampling following an
incident, and information is provided on establishing the sampling protocol, sample
collection, transport and analysis. However, more general advice is also provided on
collecting information in a chemical incident and defining the scale o f an incident.
• Specific aspects of chemical incident management - other references deal with
specific aspects of chemical incident management, which may be useful to public
health doctors. For example, the Department o f Health has produced a publication
specifically providing guidance to the NHS on managing the health consequences of
a deliberate release of a chemical or biological agent (DH and NHSE, 2000). In
20
addition, the former Department o f the Environment, Transport and the Regions
(DETR) recently published guidance on environmental sampling after a chemical
incident (DETR, 2000). The Committee on the Medical Effects o f Air Pollutants
(COMEAP) has also produced some good practice guidelines for investigating the
health impact of local industrial emissions (DH, 2000). This guidance is largely
aimed at long-term chronic problems from chemical point source emissions, and
focuses on air pollution. However, some general guidance for the management of
chemical incidents can be gained from the document. WHO has also produced draft
guidelines for the investigation o f diseases o f chemical aetiology and follow-up of
exposed subjects, this is just one aspect o f chemical incident management, but
important issues are raised in relation to their management (WHO, 2000). Guidance
on investigation of disease clusters has been produced by the US Center for Disease
Control (CDC, 1990) and the UK Leukaemia Research Fund (Arrundale et al, 1997).
A paper from the Birmingham Communicable Disease Unit also provides a
framework of epidemiological principles that underlie chemical incident surveillance
(Bakhshi, 1997).
• Management of water-related incidents - information related specifically to the
management of water-related incidents has also been collected. Some water
companies have developed written procedures for the management o f chemical
incidents affecting water supplies, for example North West Water (United Utilities)
(1996). Thames Water (1999) also provides guidance for all types of events affecting
drinking water and this includes chemical contamination incidents. Three chemical
incidents of particular note that resulted in the contamination o f drinking water
supplies have occurred in recent years, namely: phenol pollution o f the River Dee in
1984 (Welsh Water and North West Water, 1984), aluminium contamination o f the
water supply at Camelford in 1988 (Lowermoor Health Advisory Group, 1989); and
pollution of the River Severn with 2EDD (2-ethyl-5,5-dimethyl-l-3-dioxane) and
2EMD (2-ethyl-4-methyl-l,3-dioxolane) in 1994 (Ives et al, 1994). These incidents
were thoroughly investigated and comprehensive reports were produced. Lessons
can be learnt from these incident investigations and general recommendations with
respect to chemical incident management were made.
21
In conclusion, the review of the literature on procedures for the management o f chemical
incidents found that the only generic guidance specifically aimed at the public health
management of chemical incidents is the book published by CIRS on ‘Chemical Incident
Management for Public Health Physicians’ (Irwin et al, 1999). Although this book is
aimed at public health doctors in particular, and details aspects o f chemical incident
management, it primarily focuses on the preparation prior to a chemical incident, rather
than providing easy to follow procedures for the emergency response stage o f chemical
incident management. It also does not address many o f the wider issues involved in the
investigation of environmental hazards, and does not cover many o f the specific
problems encountered in water-related chemical incidents in particular.
In addition, two publications by WHO et al were identified through the review o f the
literature that are of particular relevance:
• Health aspects of chemical accidents: Guidance on chemical accident awareness,
preparedness and response for health professionals and emergency responders
(OECD et al, 1994); and
• Public Health and Chemical Incidents - Guidance for National and Regional Policy
Makers in the Public/Environmental Health Roles (IPCS, 1999).
However, these books are aimed more at emergency planning and policy-making rather
than guidance to be followed in the actual emergency response to an incident.
2.3 Assessment of the Current State o f Knowledge Through a

Questionnaire Survey
In the first year of the research project, a nationwide survey was conducted on the
management o f chemical incidents within HAs, concentrating on water-related chemical
incidents in particular. The overall aim o f the survey was to focus the research project to
particularly relevant and important aspects o f water-related chemical incidents. The
objectives o f the survey were to assess:
22
• The actual number and type of water-related chemical incidents that are managed
within HAs; and
• The resources held and used by public health professionals.
2.3.1 Survey Methodology
The survey was conducted by devising a postal questionnaire aimed at collecting the
necessary information to assess how public health doctors currently manage water-
related chemical incidents. A summary of survey techniques was completed as part o f
an assignment for an EngD module, which also includes a detailed description of the
methodology used in this survey. A copy of the report can be found in Appendix 1. The
questionnaire was devised in May 1998, piloted in June, and a final version distributed
at the beginning of July (a copy o f the questionnaire can be found in Appendix 2). The
majority of replies were received by September, and analysis was carried out in October
and November, with a preliminary report produced in November 1998.
The definition of a chemical incident used for the survey was:

An unforeseen event leading to exposure o f two or more individuals to any
non-radioactive substance resulting in illness or a potentially toxic threat to health
Further qualification was provided of which incidents were covered by the definition.
Water incidents involving both primary and/or secondary contamination (including fire
water run-off) of any water medium (drinking water, surface water, ground water,
recreational waters) were included; in addition, both acute and chronic incidents were
specified.
Initially, 77 questionnaires were distributed at the beginning o f July 1998, to CsCDC, or

equivalent positions, at all the HAs in England who held service level agreements with
CIRS. At the time of the survey, this encompassed 73 HAs across England. A second
distribution of questionnaires to Scotland was carried out with the agreement o f the
Scottish Centre for Infection and Environmental Health (SCIEH). Fifteen questionnaires
were distributed in November 1998 to Consultants in Public Health Medicine (CsPHM),
or equivalent positions, at the Scottish Health Boards.
23
2.3.2 Survey Results
From the initial 77 questionnaires sent to HAs in England, 65 were returned completed,
a response rate of 84% . In Scotland, 10 o f the 15 questionnaires were returned
completed, a response rate o f 67% . However, it should be noted that questionnaires
were not received from the areas of Greater Glasgow and Lanarkshire, which account
for 21% of the population in Scotland (Health Service Journal, 1999).
2.3.2.1 Involvement o f public health in managing chemical incidents
CsCDC and CsPHM were asked if they considered non-infectious environmental

hazards, and specifically chemical incidents related to water to be included in their work
responsibilities. All the respondents agreed that this was the case. However, there was a
wide range in the extent of experience in managing chemical incidents amongst public
health doctors. Level of experience was determined from length o f time working as
CCDC/CPHM, background educational and professional training, and how many actual
chemical incidents individuals had managed. The vast majority, 69% , of respondents
had educational and/or professional experience in public health. Alternative training
backgrounds included microbiology, general practice and clinical positions, with a small
number of individuals having trained as epidemiologists, engineers and researchers.
The responses indicated that 88% of the respondents had dealt with some sort of
chemical incident. A breakdown o f how many incidents have been managed by public
health doctors is shown in Figure 2.1. The proportions of these incidents that were
stated to be water-related are illustrated in Figure 2.2.
24
Figure 2.1: Number o f Chemical Incidents (n—75)
n zero incidents
□ 1-4 incidents
□ 5-10 incidents
B >10 incidents
Figure 2.2: Proportion o f Chemical Incidents that are Water-Related (n=66)
□0
□ <25%
□ 25-50%
■ 50-75%
□ >75%
2.3.2.2 Types o f contamination involved in water-related chemical incidents
Overall, 61% of the total 75 respondents had been involved in a water-related chemical
incident. Classification of the water incidents by contamination category showed that
the most frequent scenario by far was drinking w ater contam ination (« 70%),
followed by chemical spills and contamination of recreational waters (~ 30% each), as
shown in Figure 2.3.
25
Figure 2.3: Types o f Contamination in Water-Related Chemical Incidents (n = 46)
p ercen tage of resp ond en ts
10 20 30 40 50 60 70 80
drinking water contam ination
chemical spills
recreational water contam ination
water distribution pipes
agricultural runoff
contam ination within water treatm ent plant
marine pollution
fires
permitted industrial discharges
Figure 2.4 illustrates the specific chemicals encountered in these incidents. The top six
most frequently occurring chemicals were: lead, algal toxins, nitrates, pesticides,
hydrocarbons and iron.
Figure 2.4: Types o f Chemicals in Water-Related Chemical Incidents (n = 46)
p ercen ta g e of resp on d en ts
5 10 15 20 25 30 35 40 45 50
4
algal toxins
nitrates
pesticides
hydrocarbo ns
fluoride
manganese
aluminium
benzene
mercury
solvents
copper
PAH s
ammonia
26
2.3.2.3 Resources used in managing water-related chemical incidents
A number of resources are available to support CsCDC/CsPHM in managing chemical

incidents. One of the survey aims was to identify how well these resources are utilised.
Figure 2.5 illustrates the percentage of respondents who used a particular organisation as
a resource when managing a water-related chemical incident.
Figure 2.5: Percentage o f Respondents Using Particular Organisations (n = 46)
p ercen tage of resp ond en ts
0 10 20 30 40 50 60 70
CIRS
' " .. .................. . "" " : .....................
NPIS (London)
1
local water com pany
I I I ! T
local environmental health 1- ■ ' ' ■ ' .■- - 1 : ■/ ■ 1 .•
Environm ent Agency/SEPA
Health and Safety Executive ■ ■ ■

Water Research Centre m
SCIEH tfi mmBananas ■ 1
Fire Service
NPIS (Edinburgh)
National Focus wmm\
Key:
CIRS = Chemical Incident R esp o n se Service
NPIS = National P oison s Information Service
SEPA = Scottish Environmental Protection A gency
SCIEH = Scottish Centre for Infection and Environmental Health
National F ocu s = UK centre for surveillance of acute chem ical incidents
The most widely used resources were both CIRS and the National Poisons Information
Service (NPIS) in London, and local water companies. In Scotland, the most widely
used resource was SCIEH. Local EHOs also play an important role in the management
of water-related chemical incidents. In terms of particular personal contacts when
managing a water-related chemical incident, the main resource is EHOs, with 70% of
the respondents collaborating with their EHO. Half of the respondents consulted with
their regional epidemiologist (or SCIEH in Scotland), and 43% with CsCDC/CsPHM in
other HAs.
27
2.3.2.4 Water resource information
When dealing with water-related chemical incidents, specific information may be

required, which water companies or local authorities (LAs) will hold. The vast majority
o f respondents, 95% , were able to name the water companies that serve their HA area.
With respect to the involvement o f water companies with the HAs, 95% of respondents
stated that their emergency plans included collaboration with relevant water companies,
and 92% hold meetings between the HA and local water companies at least once a year.
An impressive 81% of respondents stated that their local water companies informed
them about incidents of chemical contamination, with 61% stating that they were
informed about all incidents. The type o f information supplied by the water companies
included: chemical identification; incident details; information on action being taken by
the water company; analytical results; estimates of population exposed; and maps o f the
affected areas.
A number of questions were asked about information held by HAs on water resources,
and action taken in an incident. Only 28% o f respondents said that if environmental
samples were being supplied they would obtain duplicate samples, provided by someone
independent to the water company. When asked about locations o f drinking water
abstraction points within HA areas, 11% o f respondents knew the locations o f all
abstraction points, and 13% knew some locations. However, in addition to those that
actually held this information within their HA, 52% knew where to get access to the
information if necessary.
Water resources are also used for recreational purposes. Polluted recreational waters can
lead to chemical exposure and a threat to the public health. When asked about whether
they knew which water resources in their HA area were used for recreational purposes,
16% of respondents stated that they knew all the water resources used for recreational
uses in their area, and an additional 64% knew some of them.
28
2.3.2.5 Private water supplies
Private water supplies can present different problems to those affecting public water
supplies, and responsibilities for remedial action when water quality does not meet
legislative limits are more problematic. Three quarters of respondents stated that they
have private water supplies in their area.
O f those respondents with private water supplies in their areas, 32% were aware of
chemical problems associated with them. The chemicals most often stated as causing
problems were: nitrate, iron, manganese and pesticides. It is a requirement o f the
Private Water Supplies Regulations (SI 1991, No.2790) that private water supplies are
routinely monitored for biological and chemical water quality. LAs are responsible for
this monitoring and will hold any results. Only 11% o f respondents with private water
supplies in their areas stated that they routinely received analytical results from the LA,
however, another 48% were informed when drinking water quality standards were not
met.
2.3.2.6 Incident report publication
In order to establish the reasons behind the lack of publication, and also the level of
interest in more incident reports being published, the survey included questions about
publication of chemical incident case reports. More than half (59%) responded that the
publication of more water-related chemical incident reports would be useful, 15%
thought it would not. Figure 2.6 illustrates some of the reasons stated for not publishing
incident reports.
29
Figure 2.6: Reasons fo r Not Publishing Incident Reports (n-75)
p ercen tage of resp on d en ts
70
lack of time
only a minor incident
no obvious journal to
publish in
confidentiality is s u e s
possibility of legal action
The most frequently stated reason is the lack of time to prepare papers for publication.
The fact that the incident is only considered to be a minor event is another frequently
stated reason.
2.4 Analysis of the Current State of Knowledge Based on the

Survey
The survey confirmed that public health professionals are aware of their responsibilities
with regard to the management of chemical incidents, but identified a broad range of
experience, in terms of the length of time working as CCDC/CPHM, background
educational and professional training, and the actual management of chemical incidents.
Chemical Incident Regional Service Provider Units (RSPUs) and NPIS can provide
significant support in managing the health aspects of chemical incidents, but
CsCDC/CsPHM should have a core knowledge base themselves. A pressing need was
identified by the survey for the production of more comprehensive guidance that can be
used by those managing chemical incidents.
30
One of the survey aims was to identify how well the resources available to assist public
health doctors in managing chemical incidents are utilised. The results revealed that
greater use could be made of the wide range o f resources available. With respect to
water-related incidents, key providers are RSPUs, EHOs, water company personnel,
Environment Agency (EA) personnel, and experienced people within HAs. The survey
also identified a lack of access to important water resource information, which is
imperative for an effective response to water-related chemical incidents. Important
information includes location of: water abstraction points; private water supplies;
permitted wastewater discharges; and recreational waters. Even if the CCDC/CPHM
does not directly possess such water resource information, they should be able to access
the information and have close communication with representatives from local water
companies and LAs. Further evidence for a need to establish good working
relationships between HAs and water companies was demonstrated by the identification
that drinking water contamination was the most frequently reported water-related
chemical incident.
Finally, there is a need for greater dissemination of the lessons learnt from managing
chemical incidents. An effective method o f communicating these lessons is through the
dissemination of information by proper record and publication o f the detailed incident.
The survey identified some of the possible reasons for the lack o f publication o f incident
reports.
The results of the questionnaire survey were published as a paper in the journal Health
and Hygiene, a copy of which can be found as Paper 3 in the Publications Section in
Volume 2 (Goodfellow et al, 2000a).
31
2.5 Conclusions
The literature reviews and questionnaire survey provided further information on the
research needs with respect to the public health response to chemical incidents, as
summarised below:
1. The literature review of water-related chemical incidents conducted at the start of the
project identified a gap in terms of research in the area o f chemical incident
response, particularly from the public health point o f view. The published literature
yields few accounts of incidents that have occurred in the past few years. Even those
that are reported, show that most research is concentrated on analysing the actual
effect of the incident, rather than in devising procedures for managing incidents in
such a way as to protect human health and the environment.
2. A review of the literature on procedures for chemical incident management did not
find any generic guidance specifically aimed at the public health management o f the
emergency response to chemical incidents. Only one publication providing general
guidance on chemical incident management aimed at public health professionals was
found, and its primary focus was on preparation prior to a chemical incident.
3. The questionnaire survey confirmed that levels o f training and experience in
chemical incident management by public health professionals is variable and
generally quite limited, and that the development o f comprehensive guidance for the
public health response to chemical incidents is required.
This additional information combined with the original project specification identifies a
clear need for the development of guidance to assist public health professionals in
responding to chemical incidents. Procedures are required to allow a more effective and
co-ordinated response to be provided in a timely manner in the event o f a chemical
incident, in order to protect both public health and the environment. Currently, such
procedures covering the broad scope o f chemical incident management do not exist.
32
3 Investigation of the Management of Chemical
Incidents
In order to form the basis for developing improved procedures for the public health
management of chemical incidents, the first stage o f the research project was a direct
and personal involvement in managing actual chemical incidents as they were reported
to CIRS. The aim was to collect information about how incidents are currently managed
by public health professionals and to identify areas for improvement. Involvement in
the management of actual water-related chemical incidents is reported in Section 3.1.
An additional aspect of the investigation was to take part in the chemical incident
management training sessions, as conducted by CIRS, and in regional chemical incident
exercises. Participation in training and exercises provided an opportunity both to
establish the base line expertise of public health professionals, and to ascertain the most
effective methods for providing guidance to assist in the improvement o f the public
health response to chemical incidents. This aspect o f the project is discussed in Section
3.2.
3.1 Management and Study of Actual Chemical Incidents
3.1.1 Numbers and Types of Water-Related Chemical Incidents
An analysis of the CIRS database to select all incidents involving primary or secondary
contamination of water identified 246 water-related chemical incidents that have been
reported to CIRS since the start of the project in October 1997 up until April 2001. A
detailed table of these incidents is presented in Appendix 3. The research engineer had
direct involvement in the management o f the 70 incidents illustrated in Table 3.1. In
addition, two incidents that occurred in the few months prior to the start o f the project
were also investigated. These were an incident involving ele\ated polycyclic aromatic
hydrocarbons (PAHs) in drinking water following rehabilitation o f public supply pipes,
and a spill of the pesticide lindane into a stream feeding a river used for drinking water
abstraction.
33
Table 3.1: Table o f the 70 Water-Related Chemical Incidents With Significant Research
Engineer Involvement, October 1997—April 2001
CIRS Release to
Release to
Reference Date o f Cl Type Circumstances water Chemical
water
Number supply
L/97/11/016 07/11/97 Water Lead pipes in home NA NA Lead
L/98/02/055 24/02/98 Water Concern about nitrate in drinking water N Y Nitrates
L/98/02/057 28/02/98 Leak Cold water tanks in hospital were drained N Y Acetone
for resin application, vapour tainted water Styrene
L/98/02/084 01/08/97 Water Concern that chemicals from an old gas Y N Cyanide
works are seeping onto a beach and PAH
subsequently contaminating water Ammonia
Phenol
L/98/03/102 28/02/98 Water High levels in water supply Y Y Manganese
L/98/04/024 27/04/98 Water Concern about the health implications of N Y Iron
levels of chemicals in drinking water in severa

Potassium
farmhouses and cottages
L/98/04/127 Water Concern about raised water levels and Y Y Iron
links with Parkinsons disease Manganese
Nitrates
Arsenic
L/98/05/032 01/01/01 Leak Lead battery factories have contaminated Y Y

irrigation water with lead; water goes to salad and Lead
crop vegetables
L/98/05/094 20/05/98 Spill Truck spilt contents into lake Y Y Sodium cyanide
L/98/06/005 01/01/96 Leak Contaminated stream running out of Y U Phenols
Colliery Degreasing agent
Cyanide
L/98/06/122 11/05/98 Water Chemical seeped through land and through water U Y
Trichloroethane
supply pipes and contaminated water
L/98/07/032 30/06/98 Food & Concern over levels in water used to wash N Y
Sulphate magnesium
Drink vegetables
L/98/07/094 24/07/98 Leak Accidental spill into river Cyanide
L/98/07/123 Leak Fuel oil tank broke several years previously Y Y

substance contaminated water supply through Kerosene
pipes
L/98/08/104 04/08/98 Water Request for information about high levels o U U

Nitrates
nitrates in drinking water supplies
L/98/09/035 11/09/98 Water Concerns about contamination of drinking N Y Cadmium
water supplies Chromium
Lead
Mercury
34
CIRS Release to
Release to
water
Number supply
L/98/09/060 22/09/98 Water Levels in spa 0.2, as opposed to 0.1. Members of U U

Nitrates
public can get water from spa
L/98/10/119 28/10/98 Water Pesticide leak into private water supply on a U Y

Atrazine
holiday caravan park
L798/10/132 27/10/98 Water Contaminated water supply U Y Diesel
L/98/11/029 12/11/98 Land Chemicals penetrated land and affected N Y Xylene

drinking water supplies 1-methyl-4-tert-
butylbenzene
L/98/11/056 30/10/98 Water Family has long standing health problems, U U Cadmium
concern about water quality Mercury
L/98/11/115 30/11/98 Water Raised levels in drinking water Y Y Nitrates
L/98/11/123 26/11/98 Leak Sewage overflowed from pumping N N Sewage
stations and into residential street. Butoxyethanol

Effluent later found to contain industrial Cyanide
compounds. Residents evacuated from their
Toluene
homes and remediation work is to be carried out
L/98/12/074 24/12/98 Water Elevated levels found in private drinking water Y Y

Nitrates
supply
L/98/12/076 30/12/98 Spill Petrol found to be in sewage drains; strong smell U U

Petrol
found in houses
L/99/01/035 15/01/99 Water Customers reported discoloration of drinking water U Y

Iron
to local water company
L/99/02/014 09/02/99 Routine check of private water supply detected Y Y Sulphates
raised levels of chemicals Magnesium
L/99/02/067 18/02/99 Spill Water tanks contaminated by fibre glass resins N Y Hydroxy methyl
and curing agents pentane
MEK
Fibre glass
L/99/02/077 24/02/99 Water Water supply contaminated with styrene U Y Styrene
L/99/04/013 01/04/99 Leak Water company has become aware of a Petrol U (J

leak of unleaded Petrol from a garage which they Petrol
think has contaminated a borehole/groundwater
L/99/04/052 19/04/99 Water Spill of Kerosene into private well Y Y Kerosene
L/99/04/058 22/04/99 Water Rerouting of water supplies to 80 households, Y Y

sampling of samples detected high levels of Coal Coal tar
tar in the water
L/99/04/073 01/04/99 Info. High levels of Copper detected in water supply at U Y

Copper
a hospital
35
CIRS Release to
Release to
water
Number supply
L/99/04/074 22/04/99 lA/ater Complaints of bad taste in the water from U Y Xylene
residential water supply Benzene
L/99/04/093 27/04/99 Land Football pitch size site, not normally available to N U
public discovered by accident noticed drainage
Cyanide
problems due to illegally connected pipes from site
to sewer pipe.
L/99/05/026 Other Stream next to old leather works is Y U Trichloroethylene
contaminated with chemicals. (Has been going on

Perchlorethylene
for several years)
L/99/06/030 24/06/99 Water Pt is 70 yr old pharmacist with colitis who claims N U

his water supply is contaminated with lead. EHOs Lead
contacted public health.
L/99/06/108 16/06/99 Malicious Terrorist threat to public water supply N U Paraquat
L/99/07/050 19/07/99 Water EHO found high levels of nitrates in a private U Y

Nitrates
water supply.
L/99/07/077 01/07/99 Water Water was initially noticed to be blue in the N Y

hospital. CCDC requested info, on copper toxicity.
Blue water was especially noticeable on a Monday Copper
and a measurement of 14ppm was recorded.
Typical results ranged from 3-6 micro-g/L
L/99/07/121 26/07/99 Spill Kerosene oil spill from a damaged tank caused N N
Kerosene
land contamination on a private property.
L/99/08/069 23/08/99 Water Contamination of water supply by lead. N Y Lead

L/99/09/002 02/09/99 Water Raised levels of manganese detected in water N Y
Manganese
supply.
L/99/09/031 01/09/99 Water A private water supply that supplies a primary U Y

school has high levels of naturally occurring Fluoride
fluoride.
L/99/09/107 Water Contaminated water supply in a residential area N Y

due to contaminated pipes. Hydrocarbons
L/99/11/010 05/11/99 Water Water contaminated in a block of flats with U Y Petrol
chemicals. Benzene
Toluene
L/99/12/035 Leak Fuel oil contaminated residential water supply of 3 N Y

Oil
cottages.
L/00/01/090 13/01/00 Spill A resident reported an incident at his property N N

involving spillage of hydraulic oil from a broker
Hydraulic oil
tank. The oil covered his garden and pathway anc
has now made its way into the house.
36
CIRS Release to
Release to
water
Number supply
L/00/01/093 Land Hexachlorobutadiene found in peoples homes U U

Hexachlorobutadiene
build on the edge of a chemical dump.
L/00/02/077 02/02/00 Water Tenants in a block of flats, noticed that U Y Caustic soda
their drinking water was pink. Sodium bicarbonate
Sodium hypochlorite
L/00/02/082 01/08/99 Leak Leak from the petrol station migrated through soil Y Y
Petrol
into houses.
L/00/03/005 02/03/00 Water Routine sampling of a private water supply, U Y

Herbicide
identified herbicide present in water.
L/00/03/029 Spill Canning factory own water supply caused an N Y

unknown quantity of bromine to enter into mains Bromine
water supply.
L/00/03/096 25/02/00 Water A shutdown for repairs caused flow N Y Iron
changes which resulted in disturbance of main Manganese
sediments causing discoloration. Aluminium
L/00/04/005 14/04/00 Water Pump failure at the water works caused N Y Iron
iron deposits in the mains to be distributed.

Resulted in discoloration of water and health Manganese
effects in customers.
L/00/05/009 05/05/00 Water Person that lives in an army camp was told to stop U Y
drinking the water. 62-3mg/l alcohol & benzenes Petrol
found.
L/00/05/010 Water Water company received 20 complaints. Thought U Y

to be contaminated with bitumen lined tanks or Unknown
PAHs.
L/00/05/090 Water Private water supply persistently fails U Y Iron
PCVs Aluminium
Trihalomethanes
L/00/06/057 Water Petrochemicals found in domestic water N Y Toluene
supply of 3 families. Benzene
Ethylbenzene
Xylene
L/00/06/061 Water Raised levels of bromate found in a domestic Y Y

Bromate
aquifer.
L/00/07/048 Water Hydrocarbons contamination of a private N Y Hydrocarbons
water supply. Oil
L/00/07/079 Water Xylene found in water system of hospital. U Y Xylene
L/00/09/067 10/08/00 Air Diesel spill in a basement caused fumes to N Y

Diesel
contaminate domestic water supply.
37
CIRS Release to
Release to
Reference Date of Cl Type Circumstances water Chemical
water
Number supply
L/00/10/069 30/10/00 Fire Fire at a chemical recycling plant. Y Y Hydrocarbons
Acid (unknown)
Smoke
Products of
combustion
Chlorinated phenols
L/00/12/071 Water Elevated levels of nitrates found in 18 homes. U U

Nitrates
L/01/01/029 01/08/00 Water Copper in drinking water. U U Copper
L/01/02/093 01/09/00 Water Elevated levels of chemicals in drinking U U Zinc
water. Copper
L/01/02/120 Water Elevated levels of contaminants found in drinking U Y

Arsenic
water.
Fluoride
Sodium oxide
L/01/03/081 Water Rural farmsteads private water supply U Y Aluminium
found to have excess levels of chemicals. Nitrates
L/01/03/085 Water Chemical in water mains. U Y

Pentachlorophenol
Y - release to water or water supply U - unknown

N - no release to water or water supply N A - information not available
It is clear from Table 3.1 that not all incidents were categorised as water incidents under
the type category. As a result, Figure 3.1 was developed to illustrate the incidents as
documented by type, for the total 246 water-related chemical incidents identified.
Relevant incidents can also be identified in the database through the release to water and
release to water supply fields. However, out of the incidents not categorised as water,
42% did not have a ‘Y ’ in the release to water or water supply fields. For this reason the
identification of water-related chemical incidents from the database required the
examination of each record and in some cases reference to the paper incident file to
determine whether it should be included.
38
Figure 3.1: Water-Related Chemical Incidents as Type Documented (n=246)
Food/drink Other Not know n

1% Fire 2% 3%
Malicious
formation
Waste
Water
59%
39
3.1.2 Incident Summaries of the Selected Case Studies
Out of the 70 incidents identified as forming part of the investigation, a limited number
were selected for more in depth study, these are listed in Table 3.2. Fourteen case
studies were selected on the basis of the level o f involvement by the research engineer in
the incident management and on the availability of detailed information about the
incident. In addition, the aim was to cover a range o f incident types over the period of
investigation. Details of the acute incident involving a chemical fire and subsequent
flooding cannot be provided, as there is currently an embargo on any publication of
information regarding the incident, due to ongoing legal proceedings.
Table 3.2: Selected Case Studies
ACUTE INCIDENTS
Lindane spill into a stream feeding a river used for drinking water abstraction (CIRS,
1997a, Hochuli et al, 1998).
Elevated PAHs in drinking water following public supply pipe rehabilitation (CIRS,
1997b).
Contamination of drinking water in a hospital following re-lining of water tanks (CIRS,
1998a and Goodfellow et al, 2000b).
Solvent permeation through plastic water supply pipes into drinking water from a spill
onto land (CIRS, 1998c, Goodfellow et al, 1999 and Goodfellow et al, in press 2001).
Diesel in drinking water supplies from land contamination and pipe damage (CIRS,
1998e and Goodfellow et al, in press 2001).
Sewage/trade effluent flooding of residential properties (CIRS, 1998f and MacArthur et
al, 2000).
Drinking water contamination in blocks o f flats following re-lining of water tanks (CIRS
1999a, Crook and Finn, 1999 and Goodfellow et al, 2000b).
Backflow from a central heating system containing chemical additives into the drinking
water system within a block of flats (CIRS, 2000a).
Chemical fire and subsequent flooding leading to surface water and land contamination.
40
CHRONIC INCIDENTS
Beach and seawater contamination from an adjacent former gas works site (CIRS, 1998b
and Goodfellow et al, 2001).
Heating oil leak leading to surface water contamination and permeation through plastic
water supply pipes to a small housing estate (CIRS, 1998d, Goodfellow et al, 1999 and
Goodfellow, 2000).
Fuel leak from a petrol station leading to permeation through plastic water supply pipes
to a block of flats (CIRS, 1999b and Goodfellow et al, in press 2001).
Spill of engine degreaser permeating plastic water supply pipes to three properties
(CIRS, 2000b).
Raised levels of bromate in a drinking water aquifer (CIRS, 2000c).
The following sections provide summaries for each o f the case studies.
3.1.2.1 Lindane spill into surface waters (CIRS, 1997a, Hochuli et al, 1998)
In June 1997, a small fish kill in a village pond was reported to the Environment Agency
(EA). The pond was used as a recreational resource by the local population, and was
also fed by a stream that drained into a river used for drinking water abstraction. The
EA conducted an initial investigation at the pond and the dead fish were found to have
heavy parasitic infection. There were no visible signs of pollution and it was concluded
that the fish deaths were due to parasites.
On the following day, further fish deaths were reported and a full biological
investigation was ordered for the next day. It was then discovered that there was no sign
of invertebrate life in the stream feeding the pond. During the investigation, a 20 kg
chemical drum was found 300 metres upstream o f the pond and white sediments were
found on the streambed. The drum was removed from the stream and further
investigations revealed five more drums in a very dilapidated and unsecured shed on
agricultural land adjacent to the stream. The shed was heavily contaminated with a
white powder and the surrounding area was used by children for play.
41
The local water company was advised o f the incident and water abstraction from the
river ceased. Intense sampling of the pond, stream, river and drinking water supply was
conducted, and a thorough clean up o f the area was instigated. Four days after the initial
report of the incident, the laboratory results showed lindane concentrations in the
original pond sample at such high levels that the analytical instrumentation had been
damaged. At this stage, the local authority (LA) environmental health department
erected warning signs around the pond and also contacted the local public health
department.
Calculations were made to estimate the likely maximum concentration that would have
been present at the drinking water intake. Further analysis showed heavy contamination
o f the stream and pond and lower lindane concentrations at the drinking water
abstraction point. The drinking water abstraction was re-opened after several days to
avert supply shortages, once concentrations had been stabilised below the analytical
limit of detection. The area is known for heavy pesticide use, routine lindane
monitoring is undertaken and additional water treatment processes are used to remove
pesticides. Therefore, the threat to drinking water supplies was thought to be limited.
Press releases and a leaflet were issued to the local population and attempts were made
to trace a Cub Scout group who had been ‘pond dipping’ in the area at the beginning of
the incident. The general population reported no adverse health effects, but some o f the
EA officers involved in the clean up reported various minor health symptoms.
3.1.2.2 Drinking water contamination follow ing rehabilitation work (CIRS, 1997b)
This incident occurred following routine pipe rehabilitation work in a small village, in
July 1997. The problem was identified by customer complaints to a local water
company about interrupted supplies and poor water quality. Realisation that there was a
widespread problem was delayed due to the fact that the water company personnel were
dealing with individual complaints independently and therefore the common cause was
not immediately established. Further problems regarding recognition o f the scale o f the
42
incident were encountered as initially it was thought that only 50 properties were
affected when the total number was in fact 240.
Analysis of drinking water samples identified contamination with metal particulates and
PAHs. The source of contamination was pipe sediments that had been dislodged during
maintenance work; coal tar had been used in the past for lining the affected pipes. The
highest PAH results were reported to be well below health related guidelines for short
term exposure, but exceeded standards for aesthetic quality. Customers were advised of
the problem by letter and supplied with bottled water. It was assumed that customers in
the affected area would not consume the contaminated drinking water due to its
unpleasant appearance and smell. However, an elderly lady used the contaminated
water to prepare a hot drink, which she then consumed, causing her to vomit. The local
public health department were not informed about the incident until the day after the
water company received the initial customer complaints.
3.1.2.3 Drinking water contamination at a hospital following tank re-lining (CIRS,

1998a and Goodfellow et al, 2000b)
In February 1998, nurses at a large hospital noticed a strong smell from the tap water.
No symptoms had been reported after drinking the water but there were some complaints
of headaches following showering. Recent maintenance on water storage tanks in the
hospital had involved draining a large divided cold-water tank and applying a resin on
one side. Vapours passing from one side o f the tank to the other caused contamination
of water in the remaining full part o f the tank. The resin contained a mixture o f acetone
and styrene with a peroxide catalyst. Analysis o f water samples found levels o f styrene
up to 552.3 pg/1. The World Health Organization (WHO) drinking water quality
guideline for styrene is 20 pg/1 (WHO, 1996).
Health checks were carried out on staff and patients and an incident group was set up
within the hospital. The tanks and water system were flushed through and bottled water
was used for drinking whilst levels were reduced. The incident raised enough interest
for the local media, including television, to become involved.
43
3.1.2.4 Permeation o f solvents fro m land through plastic water supply pipes (CIRS,
1998c, Goodfellow et al, 1999 and Goodfellow e? al, in press 2001)
This incident occurred in May 1998 on an industrial estate comprising of several units
conducting various activities. One o f the companies carried out metal degreasing
involving the use of solvent tanks. Just outside the industrial estate were a small number
of residential properties. An iron public water supply pipe owned by the local water
company supplied the industrial estate, but private plastic supply pipes branched off the
main pipe to the individual units.
A consumer at one of the industrial units notified the local water company that the
drinking water had a strong smell and was too unpleasant to drink. The local
Environmental Health Officer (EHO) investigated the area, including the nearby
industrial unit using solvents, and identified a ‘solventy’ smell from soil in a trench
being dug by private contractors replacing the plastic water pipe. Chemical cans were
found in the area around the trench. The cause o f the incident was identified to be a
recent localised acute spill of solvents just above a water supply pipe. There was some
evidence that a spill had occurred when a 40-gallon drum o f solvent was dropped and
split.
The affected supply pipe branch was initially thought to supply just two of the industrial
units, but further investigations identified a pipe continuing on to four additional
industrial units, and a residential road with four houses. At a later date, it was found that
a separate plastic pipe running through the contaminated soil also supplied an additional
single house. Eleven adult residents were thought to be residing in the affected homes.
Both the water company and the local authority (LA) environmental health department
took water samples at a number of locations, which were found to be contaminated with
1.1.1 trichloroethane and trichloroethene. There is no UK drinking water standard for
1.1.1 trichloroethane, however a provisional World Health Organization (WHO)
drinking water guideline value has been set at 2000 pg/1, the highest recorded level from
44
the sampling was 945 pg/1 (WHO, 1996). For trichloroethene, the UK drinking water
standard is 30 pg/1 (Croner, 1996), and the provisional WHO drinking water guideline
value is 70 pg/1 (WHO, 1996). Many of the sample results exceeded these standards
with the highest reported concentration being 1435.7 mg/1. Contamination was not
found in water samples from the main pipe or samples from other pipes branching off it.
On discovering that the pipe continued from the industrial estate to the residential street,
the water company advised affected householders not to drink the water or use it for
cooking. Water was initially still used for washing and toilet flushing, but people were
later advised not to use it for showering, due to the possibility o f inhalation of solvent
fumes from the hot and agitated water. Bottled water for drinking was supplied by the
local water company. One of the affected industrial units that was thought to be a
bakery was actually used as a warehouse; baking products were delivered in sealed bags
prior to distribution. None of the industrial units on the estate were found to be using
water for food or drink production.
No adverse health effects were reported to the local public health doctor; however, a
questionnaire survey of the residents in the potentially affected area was carried out.
Residents were asked about tap water consumption over the relevant time period and
current health symptoms that may have been related to solvent exposure. Blood tests
were offered to the residents, although the half-life o f these solvents within the body
would mean that raised levels were unlikely to be detected in blood or urine samples.
Blood test results showed that most of the parameters were within normal limits. Some
abnormalities were detected but it was not thought that these were linked to the solvent
exposure.
Replacement plastic coated copper piping was provided from the public supply pipe to
the two initially affected industrial units. In the short term, the additional industrial units
were then supplied through an overland plastic pipe from the iron pipe. This pipe re
joined the original underground plastic pipe several metres from the area o f confirmed
45
land contamination, and continued on to the residential area, where copper water pipes
already supplied the individual houses. By mid July 1998, the residential area was
provided with a new plastic coated copper pipe that had been re-directed away from the
contaminated area. The local water company laid the new supply pipe, which was paid
for at cost by the LA. Subsequent water samples from the new pipes were clear, as were
taste and odour samples.
3.1.2.5 Contamination o f drinking water following a diesel spill on a building site

(CIRS, 1998e and G oodfellow ^ al, in press 2001)
This incident took place in October 1998 on a new housing estate that was under
construction. The majority of the area was still an active building site, but some
properties were already occupied. The trench for the water pipe was excavated and
backfilled by the site developer, with the local water company laying the main water
supply pipe and installing a pipe surround.
Following a burst on a polyvinyl chloride (PVC) public water supply pipe supplying 20
properties, two customers living on the housing estate complained o f taste and odour in
the drinking water that was described as ‘turpentine’ or ‘petrol-like’. Samples of
drinking water collected from the complainants’ houses showed contamination with
diesel. Initial samples showed diesel concentrations o f 100 pg/1. The UK drinking
water standard for total hydrocarbons is 10 pg/1, and 0.2 pg/1 for total PAHs [sum of
fluoranthene, benzo-3,4-fluoranthene, benzo-ll,12-fluoranthene benzo-3,4-pyrene,
benzo-l,12-perylene and indeno(l,2,3-cd)pyrene] (Croner, 1996). The initial diesel
concentration of 100 pg/1 exceeded the standard, and although subsequent analysis
showed reduced levels of diesel, several PAH results were above the UK standard.
Diesel spills had occurred in the area o f the burst pipe which it was thought had been
caused due to a combination of inadequate backfilling, high stresses on the pipe created
by heavy plant crossing above the pipe, and diesel attack leading to the damage o f the
pipe. The ingress of diesel most likely occurred during the repair work, when the pipe
would have been exposed to ground water contaminated with diesel.
46
After the initial water analysis identified diesel contamination, potentially affected
customers were advised not to use water for drinking, food preparation and cooking, and
bottled water was provided. The water pipe was isolated and a temporary overland
connection was put in place to supply the affected customers. Water quality in the
temporary overland pipe was also tested and found to be normal. Prior to installing the
new public supply pipe it was recommended that the area should be remediated to
remove all potentially contaminated material. The plastic pipes were to be replaced with
galvanised steel for large pipes and plastic coated copper service pipes to the houses.
3.1.2.6Sewage/trade effluent flooding o f residential properties (CIRS, 1998f and

MacArthur et al, 2000)
In November 1998, there was an overflow o f sewage in a residential area following a

pumping station failure. The sewage contained a large proportion of trade effluent from
several industrial facilities nearby and consequently there was a huge array o f chemicals
in the sewage discharge. The discharge collected in a low-lying area o f a residential
street and sewage flooded into several houses. After the initial clean up there were still
remaining concerns about chemical contamination of foundations and floorboards and
underlying soil, as well as furnishings and other property within the houses. There was
also atmospheric contamination from the volatilisation o f the chemicals.
The local water company released information on the chemicals that were consented for
discharge and considerable analysis was undertaken of the effluent, soil, air, and nearby
river to identify the chemicals involved and their concentrations. The multiple
chemicals involved made the toxicological assessment very complex due to the possible
interactions and synergy between the chemicals.
The residents from the affected houses were evacuated to hotels in the area and a very
lengthy decontamination and remediation programme began. Some personal property
such as clothing was cleaned and returned to residents but most contaminated property
was replaced. There were difficulties in getting access to some o f the houses as
47
householders wanted to be present when the clean up staff went into their homes.
However, there were concerns about the resulting increase in personal exposure o f the
residents if they were present. There were also difficulties in establishing the levels of
remediation required and its certification. Remediation consisted of decontamination or
disposal of furnishing and belongings, removal o f contaminated soil, floorboards and
brickwork, and venting of houses.
A health questionnaire was distributed to affected residents and those involved in the
clean-up operation. A General Practitioner (GP) was made available for consultation at
the hotels to which the residents had been evacuated. Public health also informed the
local accident and emergency (A&E) hospital and GP practices of the incident and asked
to be informed of any associated cases. Health effects were reported in clean up
workers, which were investigated by the relevant occupational health departments.
3.1.2.7 D rinking water contamination in fo u r blocks o ffla ts following tank re-lining

(CIRS 1999a, Crook and Finn, 1999 and Goodfellow et al, 2000b)
This incident occurred in February 1999, as a result of re-lining o f water storage tanks in
four blocks o f 10 storey local authority flats. The water supply to the blocks o f flats was
from the public water supply via three cold-water storage tanks, which fed all the
drinking, bathing and toilet facilities. There was no direct connection to the public
supply pipe. Renovation work had been carried out on the tanks over the previous 3-4
weeks. This involved stripping out all the old bitumen linings and relining the tanks
with a fibreglass gel containing curing chemicals. The product was approved by the
Water Research Centre (WRc) for use in potable supplies. Two of the three tanks had
been treated and put back into service when the incident was identified.
The incident began on a Monday when three residents from one o f the blocks o f flats
reported to the LA that their domestic water supply had a strange smell and taste, an
orange colour, and visible scum on the surface. Two o f these residents also complained
of feeling unwell with nausea, vomiting, abdominal pain and a burning sensation in the
mouth. By late evening, as a result o f further enquiries, environmental health and
48
housing staff had posted notices advising residents not to drink the water and the local
water company provided alternative water supplies from bowsers.
The LA distributed a health questionnaire in the early stages o f the incident in which
around 12 residents reported symptoms including dry throat, funny taste, 'hangover'
feeling, abdominal pain and diarrhoea. Only one resident had sought medical advice and
none had been admitted to hospital. On the Tuesday, EHOs and housing officials
continued their investigations, which included arranging for water samples to be tested
and informing residents of events, but it was not until Wednesday evening that CIRS
was advised of the incident and early Thursday afternoon before the HA was notified. A
meeting was immediately arranged between the Consultant in Public Health Medicine
(CPHM) and staff from environmental health and housing. Subsequently, an incident
control group with representatives from the HA, CIRS, environmental health and the
local water company was established. A major chemical incident was declared on the
grounds that a large number of people were affected and there was significant media
interest.
Once the HA became involved a second questionnaire was administered on health

problems and water consumption to all residents o f all four block o f flats. The local GPs
were informed of the incident and asked to notify public health o f any related cases. The
water supply was cut off to the flats to prevent further use and alternative bathing and
laundry facilities were provided. Vulnerable residents were identified and provided with
alternative accommodation and an explanatory letter was provided to all residents from
the housing department. A press statement was also issued and an information aid
advice centre with a help-line was set up at the local community centre.
Samples were taken from all four blocks o f flats and analysis identified high levels o f
styrene and xylene in particular, however, a detailed breakdown of results was not made
available to health professionals, and health advice was therefore based on incomplete
analytical information. A wide range o f styrene levels were reported (0.4 pg/1 to 650
49
ja.g/1) and xylene levels were reported to be between 20.9 pg/1 and 160.3 pg/1. WHO
drinking water quality guidelines for styrene and xylene are 20 pg/1 and 500 pg/1
respectively (WHO, 1996).
Arrangements were made for urine sampling o f all residents living in the block, together
with blood sampling for those residents who had originally complained of symptoms.
Sixteen samples of blood were taken from symptomatic people at the first block o f flats
and no indicator compounds were detected on testing. Urine samples were obtained
from 310 residents as a precautionary measure, a total of 43 urine samples were tested
and no indicator compounds were detected. Individual letters were sent advising those
residents whose specimens had been tested o f their results.
The contamination problem was resolved by making alternative connections to the

public water supply to all four blocks o f flats. The water piping systems were flushed
and tested, then declared free from hydrocarbons.
3.1.2.8 Backflow incident resulting in drinking water contamination (CIRS, 2000a)
In February 2000, an LA environmental health department became aware o f a drinking

water quality problem in part of a Housing Trust estate. The local water company had
been carrying out repairs in the area after a burst public supply pipe, and there had been
complaints about ‘grit’ present in water. The local water company had been
investigating these complaints and discovered pink water in one o f the flats and
contacted the local environmental health department. An EHO and a housing officer
from the estate visited the flat and confirmed the water was pink and took samples. The
EHO and housing officer knocked on doors at the flats near to the affected flat to try and
establish the extent of contamination. A total o f 36 flats were thought to be possibly
affected and 8 were identified as definitely having a problem. There was no indication
that any further blocks were affected. Bottled water was delivered by environmental
health to the affected flats on the same evening, with written information explaining the
problem. Residents were advised not to drink tap water but use bottled water or the
standpipe that had also been provided.
50
Investigation of the contamination concluded that the most likely cause was a cross
connection between the central heating and drinking water systems leading to
contamination of the drinking water with heating water containing an added chemical
corrosion inhibitor. The work on the burst pipe may have caused a drop in water
pressure causing water to be siphoned from the central heating system into the drinking
water system at the cross connection point, probably a hot and cold water appliance such
as a washing machine, shower, or combi-boiler, where pre-heated heating water had
been used to supply the device. Maintenance staff tried to get access to the flats to
identify and remove the cross connection, but they were unable to establish the precise
cause. Water quality returned to normal and public water supplies were reinstated.
A comprehensive literature review o f past backflow incidents resulting in chemical

contamination of drinking water, backflow prevention practice and legislation, and
current engineering theory on backflow has been completed. A copy can be found in
draft form as Paper 4 in the Publications Section in Volume 2.
3.1.2.9 Chemical fire and subsequent flooding leading to surface water and land
contamination
Details cannot be provided, as there is currently an embargo on any publication of

information regarding the incident, due to ongoing legal proceedings.
3.1.2.10 Secondary chemical contamination o f a beach and seawater (CIRS, 1998b

and Goodfellow et al, 2001)
This incident occurred at a beach on the south coast of England. The land immediately
behind the beach was the site of a former gasworks. The beach was used as a naturist
beach, and for line fishing and offshore commercial fishing for crab and lobster. The
problem first came to the attention o f the LA in April 1997, when a local resident
reported that there were reduced numbers o f bait for fishing on the beach. The
fisherman also noticed a sulphurous smell and visible signs of oil whilst digging for bait.
The information was passed on to the EA, who carried out initial sampling o f sediment
51
and seawater at the beach. Visual observation o f the area showed the existence o f
patches of oily film on the sea, a phenolic smell in the area, and sightings of pieces of
“prussian blue” (ferric ferrocyanide). An LA investigation was initiated, including
preliminary sampling.
In August 1997, a meeting was held between the port authority, two LAs, and EA,
following which the EA took sediment, seawater and seepage water (water runoff from
the beach) samples, and conducted a biological survey. A report was produced by the
EA in January 1998, which concluded that the beach was affected by pollution and the
most likely source was the former gasworks. A very high concentration of PAHs (75
550 mg/kg) was reported in one sediment sample, and also a high concentration of
cyanide (1 g/1) in seepage water. When the EA report became available, the LA
immediately alerted the HA of the potential risk to public health and the two HAs
covering the area of concern became involved in the investigation. At this stage a
detailed environmental investigation o f the beach including sediment, seepage and
seawater sampling was conducted, the results of which were used to determine whether
there was risk to public health and if the beach should be closed to public access.
Contaminants identified included ammonia, benzo(a)pyrene, phenol, cyanide, arsenic,
manganese, and iron. Analytical results were compared with contaminated land and
drinking water standards. It was concluded that the beach was contaminated, but at the
concentrations found it was decided that the contamination did not pose a risk to the
health o f the beach users and no action was taken to close the beach. The high
concentrations of PAHs and cyanide found in the initial analyses were not repeated. No
complaints of adverse health effects associated with the beach had been reported.
Although closure of the beach was not necessary, a long-term routine monitoring
programme was established to ensure that contaminant concentrations remained low,
and to provide early warnings of any potentially hazardous changes. Also, it was
suggested that effects on the food chain should be investigated. Mussels, crabs and
lobsters were sampled from the beach and surrounding area and raised levels o f PAHs
were found in mussels. Signs were erected on an adjacent beach where the
52
contaminated mussels were found, to warn the public against collecting mussels for
consumption.
Further details of this incident and its management were published in the journal
Occupational and Environmental Medicine and a copy of the paper can be found as
Paper 5 in the Publications Section in Volume 2 (Goodfellow et al, 2001).
3.1.2.11 Long-term leakage o f heating oil into soil leading to permeation o f plastic
water supply pipes (CIRS, 1998d, Goodfellow et al, 1999 and Goodfellow,
2000)
The incident occurred on a small private estate of 17 houses, re-developed from a former
stable block four years before this incident occurred. The houses were situated within a
private estate of a stately home with adjacent lake and gardens. The housing estate had
an oil tank that supplied all 17 houses; each house had a fuel oil meter. At the time of
construction the builder laid 17 separate plastic water supply pipes to each house from
the main iron water pipe, which ran past the estate.
The problem with oil contamination first arose about two years prior to any drinking
water contamination. At this time it was found that the estate lake was contaminated
with oil. The source was traced back to surface drains from the housing development.
The meters for the domestic heating oil (light paraffin oil) supply to the lesidences had
corroded, and two meters were found to be leaking, visible oil was seen below ground
level. The piping from the fuel tank located behind the development was made o f a
suitable resilient material and ran to the edge o f the development. Howe\er, the
subsequent piping and meters were found to be unsuitable for an outside location. The
meters and the piping were replaced with those manufactured from suitable material.
The old meters were removed, but the old piping was left in the ground, although it was
believed that it had been drained o f any remaining oil and then sealed. The oil supply
and meters had been replaced approximately a year before the reports of drinking water
contamination, and since the replacement o f the pipes and meters no further
contamination of the lake had been observed.
53
In July 1998, following a complaint to the local water company regarding taste and
odour problems in drinking water, the public health doctor contacted CIRS. The water
company took samples from drinking water when the complaint was reported.
Subsequent samples were also taken after an overland supply had been connected. In
addition, soil samples were taken from the soil around the excavated areas where the
connections were made between the overland pipe and the household piping. The
environmental health department o f the district council did not take any samples. No
sample results were made available to CIRS.
No adverse health effects were associated with the incident. Consumption o f the water
ceased once the problem had been reported to the water company and alternative
supplies were provided. Some residents resumed consumption o f tap water after the
installation of the overland supply. The soil around the old meters was considered to be
the most likely source o f contamination. Although only two meters had originally been
found to be obviously leaking, it was possible that leakage may have occurred at other
houses. Any oil contamination at the site of the oil meters would also have been close to
the water supply pipe as it entered the house and therefore contaminated soil might have
been surrounding the water pipes at these points.
A site visit was organised with the participation of the local HA, LA environmental
health, representatives from the site owners and management agency, a residents’
committee representative, and CIRS. Investigation o f the excavated areas outside the
affected houses confirmed a very strong oily/turpentine smell.
Initially, the water supply was cut off and bowsers and a standpipe for drinking water
were provided. The water company then installed an overland pipe directly from the
public water supply and the pipes were flushed through until no further smell was
noticed. The use of plastic coated copper pipes was recommended for new water supply
pipes to the houses, or alternatively, a ductile steel main pipe with copper connections to
each house.
54
The initial lake contamination occurred approximately two years prior to this reported
problem, and concerns were raised about the possibility of long-term exposure. The
inhabitants may have been exposed to low-level oil concentrations, below taste and
odour thresholds, over a long period of time.
Although it was thought that this incident had been resolved in the summer of 1998, in
July 1999, renewed concerns of taste and odour in drinking water in two houses were
reported. Upon investigation, it was found that the connections from the water pipe
outside the house to the internal plumbing were still plastic and that continued
contamination of the soil had resulted in permeation o f oil through the plastic
connectors. These connectors were subsequently replaced and there was also extensive
removal of contaminated soil beneath some houses. A questionnaire survey of the
residents was conducted in order to obtain further information on taste/odour problems
with drinking water, the length of time over which there was a problem, the amount o f
water consumed, and any associated health effects. Residents reported some adverse
health effects.
3.1.2.12 Petrol station leak leading to drinking water contamination in a block o f flats
(CIRS, 1999b and Goodfellow et al, in press 2001)
This incident was initially investigated in April 1999 when, following a petrochemical
company’s audit of its petrol stations, a particular site was found to be losing petrol and
a leak was found in the pipe leading from the tank to the pumps. The local water
company became involved because they were concerned about the threat o f pollution to
a drinking water borehole near the petrol station. However, no contamination was
detected at the borehole.
At the end of October 1999, a taste complaint was received by the local water company
from a resident in a block of flats opposite the petrol station. Due to the knowledge that
there had been a petrol leak from the filling station, water analyses were carried out for
benzene, toluene, ethylbenzene and xylenes (BTEX). On investigation o f the water
55
supply pipes, it was found that a plastic service connection branched off the cast iron
pipe to supply the flats. On excavation it was found that the soil was ‘oil’ saturated and
had a strong smell. To prevent any further contamination, the plastic pipe was replaced
with a metal one and other pipes in the area were also checked and found to be of metal
construction. Water sampling was carried out at the flats and also at some other nearby
properties. Raised levels o f hydrocarbons were found in tap water in the flats and were
above the UK drinking water standards for total hydrocarbons (10 pg/1) (Croner, 1996).
Residents at the flats were advised not to use the water for drinking and cooking until
the levels were reduced to a satisfactory standard following pipe replacement. No health
effects were reported.
3.1.2.13 Spill o f engine degreaser permeating plastic water supply pipes (CIRS, 2000b)
A spill of an engine degreaser at a residential property resulted in permeation of organic

chemicals through plastic water supply pipes leading to drinking water contamination in
three houses. The problem was first noticed in early May 2000, but CIRS were only
informed in June. On investigation, the soil in the area did not appear visually
contaminated but there were taste and odour problems with drinking water. Sampling
and analysis identified toluene, benzene, ethylbenzene and xylene. Unfortunately, only
semi-quantitative data was made available. The EA was also involved in the investigation
and soil analysis was conducted.
A questionnaire was sent to the affected houses to determine how much water had been
consumed and note any adverse health effects. Residents included children and bottle fed
infants. Symptoms reported in the questionnaire survey included, bleeding gums, dry
skin, headaches and nausea. A letter was sent to the residents from the public health
doctor after a survey. The letter addressed the concerns of the residents and provided
reassurance that on the basis of the low level o f exposure and short time scale o f the event
long-term health effects were not expected. In the long-term, the plastic pipes were
replaced with copper ones.
56
3.1.2.14 Bromate contamination o f drinking water aquifer (CIRS, 2000c)
In June 2000, bromate was found in raw water from an aquifer used for drinking water.
The local water company had conducted a survey o f its drinking water sources and
included the analysis for bromate due to the fact that new legislation on drinking water
quality will include a bromate standard for the first time in 2003. The aquifer had not
previously been tested for bromate so the timescale o f contamination was undetermined.
In addition, the water was mostly mixed with water from other sources prior to its
supply to consumers, so it was difficult to estimate the likely concentrations that would
have been in supply. Also, it was not possible to determine the period o f exposure. It
was found that private boreholes from the aquifer were also contaminated. Mapping
was conducted to identify the extent o f groundwater contamination and the boreholes
affected.
A joint press release was issued from the HA and local water company to advise
consumers of the problem and a health surveillance study was initiated to monitor for
excess cancers associated with bromate exposure in the area affected. There was an
extensive investigation for the possible source of contamination of the aquifer and the
most likely source was thought to be a contaminated land site some distance away from
the point of abstraction. This site had been redeveloped for housing but there had
previously been a chemical works situated on the site using bromate and other
chemicals.
3.1.3 Classification of the Case Studies
Table 3.3 classifies the fourteen incidents studied in detail on the basis of:
• Acute or chronic effects;
• Type of water actually or potentially affected - drinking, surface, ground or marine;
• Drinking water contamination caused by permeation of organic chemicals through
plastic water supply pipe; and
• Drinking water contamination caused by re-lining o f tanks.
57
Table 3.3: Classification of the Case Studies
Incident Acute Chronic Drinking Surface Ground Marine Permeation Re-lining

water water water water
s
1. Lindane spill
S
2. PAHs from pipe repairs
S
S S S
s
3. Drinking water
contamination from tank
re-lining in a hospital
S
4. Solvent spill
S S
s s
s
5. Diesel in drinking water
S
S
6. Sewage/trade effluent
discharge
S
s
7. Drinking water
contamination from tank
re-lining in blocks of flats
s
8. Backflow causing
drinking water
contamination
S
S
9. Flooding following a
chemical fire
S
S
10. Beach and seawater
contamination
S
%
11. Heating oil leak
S
s s
s
12. Petrol station leak
S S S
%
13. Engine degreaser spill
S
S S
s
14. Aquifer contamination
OO
3.1.4 Methodology for Learning from Incidents
In order to be able to extract information from the management o f chemical incidents to

assist in devising procedures to improve future management, proper documentation of
the incidents being investigated is required. When reported to CIRS, brief summary
details are recorded on an incident form, a copy o f which can be found in Appendix 4.
The information documented on this form is likely to be limited to whatever can be
provided by the person making the initial request for advice. As the incident develops,
additional information may be recorded on continuation sheets. It is unlikely that
complete chronological logging of telephone calls, information received and provided,
and decisions made will be carried out. Involvement of CIRS in the incident may
include attending site visits or incident team meetings, and it is not usual procedure for
these to be comprehensively documented. When the incident is over, it is unlikely that a
post incident report summarising the incident and identifying lessons learnt will be
provided to or prepared by CIRS. Occasionally, the HA or other organisation will
prepare a post incident report which is made available to CIRS, and incidents are
sometimes documented as articles for inclusion in the Chemical Incident Report (an in-
house newsletter of CIRS, produced quarterly and distributed to all HAs with service
level agreements with CIRS and to other interested parties).
Due to the very limited amount o f information routinely documented on the

management of incidents, it was impossible to analyse past incidents. Therefore, the
research engineer was directly involved in the investigation o f incidents, as described in
Section 3.1.2. Full details of the circumstances o f the incidents studied were recorded
and any available sampling and analysis results were kept and in most cases summary
tables were provided for easier interpretation. Minutes were recorded for any incident
meetings attended and site visit reports were completed where applicable. By
comprehensively documenting the incidents, it was then possible to perform an analysis
at a later date and to identify any specific lessons that could be learnt and would be
applicable to the management of future incidents. Some o f these incidents were fully
reported with the lessons learnt identified, and published in the Chemical Incident
59
Report, in external journals and at conferences, or presented as a part o f CIRS training
days.
3.1.5 Summary of Lessons Learnt
A number of principles of best practice for the management o f chemical incidents were
identified, as well as common problematic issues, as specified in Section 3.1.5.1. Two
specific types of chemical incident were also identified that seemed to occur on a
reasonably frequent basis; lessons from these are addressed in Section 3.1.5.2.
3.1.5.1 General best practice and problematic issues
The incident management process is divided into three major aspects: risk assessment,
communication and required management actions.
Risk assessment of the potential health impact on the population

• Identification of the chemical, exposure duration, and information on any reported
concentrations in relevant environmental media are vital to assessing the possible
impact on the health o f the population.
• It is useful to identify the most likely source o f contamination as this will assist in
directing any sampling and analysis.
• Knowledge about the industry involved may help to identify chemicals;
alternatively, if the chemical is known but the source location has not been
identified, information on the types of industry using the chemical may assist in
finding the source of contamination.
• In the case of land contamination, past site investigation reports may be available
identifying chemicals present.
• The pathway or route of exposure must be identified; toxicity may be dependent on
whether there is inhalation, ingestion or dermal exposure.
• Determining the toxicological effects of multiple chemicals can be particularly
difficult, chemicals may react in the environment to produce secondary products and
there may be enhanced toxicity from exposure to combinations o f particular
chemicals.
60
• The total population definitely, probably and possibly exposed should be identified
as soon and as accurately as possible, populations may be residential, work^elated
or visitors.
• Standards and guidelines, for example, for drinking water or air quality or
contaminated land, can be useful for comparison with environmental concentrations
present. Care should be taken to ensure that units are comparable and the basis of
the standard is understood. For example, occupational standards are aimed at adults
in good health with exposure over a working lifetime. Standards may have to be
adapted to take into consideration particularly susceptible populations.
Communication
• Chemical incident management involves a multi-agency response and there are a
number o f routes by which the public health doctor may be alerted to an incident.
• Early public health involvement is essential where there is a threat or potential threat
to human health, in order for timely health investigations to be carried out. In many
of the chemical incidents included in the study, public health doctors were not
informed of the incident at the early stages. Development o f working relationships
on a local basis between organisations involved in chemical incident management is
needed to ensure all relevant organisations are made aware o f incidents.
• Communication between organisations during an incident is also important, public
health doctors require regular inputs of new information on how the incident is
developing in order to review risk assessments and action strategies.
• In many incidents, close collaboration is best achieved by setting up a formal
incident control group, ideally with members located together near the incident
scene. Incident control team members should have the necessary expertise and
authority to make decisions.
• Due to the multi-agency nature o f chemical incident management, it is important that
the chain of command is determined in the early stages o f an incident and that all
those involved are aware of each others roles, responsibilities and resource
limitations.
61
• Responsibility for conducting and financing environmental sampling and analysis
seems to be a particularly contentious issue and needs to be discussed in the early
stages of the incident.
• The methods of communication between organisations should be made as simple as
possible; there should be a limited number of contact persons within each
organisation to avoid duplication o f effort and confusion.
• Media management is an important aspect o f chemical incident management, where
a number of organisations are involved it is essential that a consistent joint message
is presented to the media.
• The public should be kept well informed about the hazard and action being taken by
the organisations involved and also any action they should be taking to protect
themselves.
• All health advice issued to the public should come from the HA or a jointly issued
statement with HA agreement.
• There may be difficulties in alerting and advising particular sections o f the
population, for example, the elderly, disabled, or ethnic minorities.
Action to prevent or minimise harm

• The area of contamination should be adequately secured to prevent public access.
• Careful consideration should be given to the option of evacuation, in many cases a
more appropriate response is to shelter. If evacuation is required, people need to
take medications with them, and GP attendance may be required.
• In order to prevent further exposure, action should be taken to remove the
contamination source and/or pathway.
• Remediation should be undertaken to established standards, if samples are required
to establish exposure levels these need to be taken prior to clean up.
• Any contaminated victims should be decontaminated at the earliest possible
opportunity, ideally before transport to hospital, in order to minimise spread o f
contamination and exposure of additional people.
62
• Those responding to, or involved in, the clean up o f an incident should be provided
with adequate personal protection equipment and decontamination facilities.
• Vulnerable populations should be identified and alerted, for example, dialysis
patients, the elderly, and young children, especially bottle fed infants.
• Distribution of health questionnaires can be useful in identifying the population
exposed, duration o f exposure and associated health effects. A health questionnaire
survey should be designed by public health professionals with epidemiological
experience.
• When people have been exposed for a number o f years, it may be possible to
determine health impacts on the population from analysis o f cancer register data,
hospital admissions or other health statistics.
• Where level of exposure is not already known, it may be necessary to take
environmental and/or biological samples.
• Biological sampling should be considered if confirmation of exposure is necessary
and possible. It may be appropriate where treatments are available, particularly if
they are based on exposure levels. Where there is no treatment available or if no
meaningful parameter can be measured, biological sampling has little or no value.
• There may only be a short time frame in which it is possible to take blood and urine
samples if the chemical has a short biological half-life.
• Problems may be encountered in linking abnormal biological test results to a specific
exposure; patients are likely to have experienced a lifetime exposure to many
chemicals.
• Several aspects should be determined in conducting a sampling programme:
o what is the aim of programme;
o what is being sampled, air, water, soil, blood, urine;
o who is going to take the samples and conduct the analysis;
o where or who should samples be taken from;
o when should samples be taken; and
o what are the required sampling, sample preservation and analytical
techniques.
63
• Precautions should be taken when collecting, storing and analysing both biological
and environmental samples to ensure they are not contaminated, for example by
containers or lids.
• Repeat environmental samples should be taken in order to identify peaks and troughs
in concentrations.
• Duplicate samples should be obtained, particularly where those taking samples may
be culpable, for example, in drinking water contamination.
Documentation
• Proper documentation of incidents is necessary, particularly where there has been
controversy or there is the possibility of litigation.
• Accurate logs need to be maintained o f events, telephone calls, and decisions made
with justifications and details on the information basis.
• Registers should be compiled of the exposed population and in some cases it may be
appropriate to tag patient notes to track long-term health outcomes from an incident.
• Publication of incidents is useful in passing on lessons learnt and drawing attention
to common problems.
Issues related to drinking water

• Water companies conduct routine sampling of drinking water quality and may have
immediate access to relevant analytical results in the event of contamination.
• In the event of drinking water contamination incident, early provision o f alternative
water supplies is required.
• If a ‘do not use’ notice is placed on public drinking water supplies, consideration
should be given to the conditions at which the notice can be lifted.
• When issuing ‘do not use’ notices for water supplies, careful consideration should be
given in specifying which uses are affected.
• Drinking water may be used for hot and cold drinks, jug water filters, food
preparation, cooking, drinking water for pets, bathing, showering, clothes washing.
In most cases it will still be safe to use water for toilet flushing.
64
• Boiling water is not a satisfactory treatment for chemically contaminated water. It is
not safe to assume that exposure will have been eliminated or reduced if only boiled
water has been consumed, particularly as some chemicals have boiling points above
that of water. In addition, there may be a risk of inhalation exposure if vaporisation of
the chemical occurs.
• Public water supplies may also be used for other uses that could present a hazard, for
example, crop irrigation, drinking by farm animals, food and drink processing or
manufacturing, pharmaceutical products, swimming pools.
• In some cases it may be necessary to cut off water supplies to prevent use and
consumption.
• When the water supply is resumed tanks and pipes should be flushed to remove any
residual contamination and final sampling and analysis should be undertaken to
ensure supplies are safe to drink.
• If contamination has occurred within customers’ premises, including the supply pipe
linking the property to the water company pipe, responsibility lies with the property
owner.
3.1.5.2 Specific types o f incidents identified as problematic
From the study of a large range of water-related chemical incidents, attention was drawn
to two particular types of incident that seemed to occur reasonably frequently and pose a
threat to public health.
Permeation of organic chemicals through plastic water supply pipes

Throughout the investigation period, several incidents involving contamination of
drinking water supplies as a result o f permeation o f organic chemicals from surrounding
soil were reported. Five of these incidents are documented in Section 3.1.2. The issues
surrounding this problem were presented at the EngD Annual Conference in 1999, and a
paper has been accepted for publication in the Water and Environmental Management
Journal. Copies of these papers can be found in the Publications Section in Volume 2 as
Papers 6 and 7, where more details are provided on the number and circumstances o f the
incidents reported to CIRS and the nature of permeation (Goodfellow et al, 1999 and
65
Goodfellow et al, in press 2001). The lessons learnt with respect to this specific type of
incident are detailed below:
• Some organic chemicals are able to permeate medium density polyethylene (MDPE)
without causing physical damage to the pipe. PVC pipes may be attacked by organic
chemicals creating a weakness in the pipe which may cause its fracture;
• Permeation should be considered as a possible cause o f drinking water
contamination, particularly where organic chemicals are involved and land
contamination is suspected;
• The cases of permeation reported to CIRS were identified through taste and odour
problems in drinking water. Many of the chemicals involved in this type o f incident
have low taste and odour thresholds and are therefore quite easily detected in
drinking water. Some chemicals will not be detected by taste and/or odour or may
still be of health concern at levels below taste and odour thresholds;
• The chemicals involved in this type of incident have the potential to lead to both
acute and chronic adverse health effects;
• The initial response to this type o f incident should be to stop consumption o f the
contaminated water supply and possibly the use of water for washing. Alternative
temporary supplies of water should then be provided and in some cases an overland
pipe can be installed bypassing the area o f soil contamination;
• The solution to preventing future contamination o f water supplies is to replace
plastic pipes with plastic coated copper for small pipes or steel for larger pipes;
• Where possible, remediation o f the land contamination source should also be
conducted;
• These incidents raise the issue o f how building contractors and water companies
should identify land that may be vulnerable to organic contamination and where the
use of unprotected plastic pipes for drinking water supplies is therefore unsuitable.
Such sites may include land contaminated from historic land uses or those
susceptible to acute spills of organic chemicals, in particular petrol filling stations
and other fuel depots.
66
Contamination of drinking water from water tank and pipe linings
Another category of incidents identified and studied, involved the contamination of
drinking water supplies following re-lining o f pipes or water storage tanks, usually with
styrene-based resins. Two instances o f this type o f incident are summarised in Section
3.1.2, further examples are provided in the paper presented at the EngD Annual
Conference in 2000, a copy of which can be found as Paper 8 in the Publications Section
in Volume 2 (Goodfellow et al, 2000b). The lessons learnt regarding this type of
incident are listed below:
• Water tank and pipe linings should be considered as a possible cause o f drinking
water contamination, particularly where it is known that recent maintenance work
has been conducted. If the likely source of contamination is known, the type of
chemical involved can then be determined and chemical analysis is simplified;
• This type of incident has the potential to cause adverse health effects and many of
the cases reported to CIRS have involved associated reports o f symptoms in
consumers;
• As with other incidents of chemical contamination of water, it is important to collect
information on water consumption and use and health effects over the period of
concern;
• Sample collection and analysis is another important aspect common to most
chemical incidents. In this case, samples should be collected o f drinking water from
the tanks and/or public water supply pipes, at taps and at other distribution points;
• Biological sampling can be used to confirm exposure. Styrene is often one o f the
contaminants in this type of incident. Styrene or its metabolites can be measured in
blood and urine provided that sampling is undertaken shortly after exposure. As
always, it is important that any samples are collected in appropriate containers with
no other source of contamination.
With respect to precautions that should be taken when re-lining tanks or pipes, it would
appear that in some instances poor curing techniques and/or early refilling can cause
contamination of drinking water from otherwise safe lining products. WRc had
67
approved the types of chemicals used in the incidents reported to CIRS for use in potable
supplies. However, there would appear to be issues around competency of application
by contractors employed to carry out this type o f work. It is clearly important that a
recognised, well-respected company is used and that instructions on use are closely
followed.
3.2 Chemical Incident Exercises and Training Sessions
3.2.1 Planning and Developing Training Sessions
In addition to the involvement in the management o f actual chemical incidents as

reported to CIRS, the project also included the planning and development o f training
sessions, primarily aimed at public health professionals, but also others involved in the
management o f chemical incidents.
Over the research period, fifteen CIRS training days were attended. Involvement has
included presentation of results from the research project, facilitation o f incident training
exercises, and discussion with delegates about the most effective methods o f providing
guidance to public health professionals to improve performance in responding to
chemical incidents. Two additional training days were organised by the research
engineer, focusing specifically on water-related chemical incidents and associated
issues. As part of these training days comprehensive documentation was provided
including early versions of chemical incident management tools and also copies of
papers and reports produced during the research period.
3.2.2 Development of Incident Training Exercises
During the training sessions, incident exercises devised from real incident scenarios are
used to promote discussion and to provide delegates with the opportunity o f exploring
issues involved in the management o f chemical incidents. These exercise sessions
provided valuable input to the project on particularly problematic areas o f chemical
68
The exercises were devised in order to highlight general issues in the management of
chemical incidents and also specific issues related to particular types of incidents, for
example drinking water contamination. Four exercises based on water-related chemical
incidents were devised by the research engineer. Groups o f delegates and presenters at
training sessions worked through the exercises together, which were presented on a
stage-by-stage basis with new information being provided at each stage as the incident
develops. The aim being for the group to discuss the role of public health professionals
in managing the incident described and to assess the impact of the incident on the public
health and identify the actions to be taken.
3.2.3 Development of Chemical Incident Management Tools
Involvement in the development o f training sessions allowed chemical incident

management tools developed during the research period to be tested on public health
professionals and others involved in responding to chemical incidents. This enabled the
tools to be further refined in light o f the feedback and comments received during the
training sessions. This aspect is commented on in Chapter 4 where the methodology for
developing chemical incident management tools is discussed. Guidance manuals on the
management of chemical incidents were provided as part of the training days organised
by the research engineer on water-related chemical incidents.
3.2.4 External Exercises
During the research period the research engineer also took part in exercises organised by
external organisations to test the multi-agency response to chemical incidents, including
the role of public health professionals, these included:
• Joint drinking water incident training exercise organised by Severn Trent Water with
North Derbyshire HA and the two LA environmental health departments, October
1997;
69
• Multi-agency chemical incident simulation exercise organised by South Essex HA,
and attended by representatives from the HA, LA, police, ambulance, EA, June
1998;
• National multi agency drinking water contamination incident exercise, ‘Boadicea’,
October 1998;
• Chemical incident exercise based on a specific industrial site, May 2000;
• Training exercise organised by Yorkshire Water aimed at coordination and response
o f different company departments, May 2000;
• Multi-agency waterborne diseases seminar organised by Berkshire HA, May 2000;
• Multi-agency incident exercise, based on contamination o f a drinking water supply
reservoir following a road traffic accident, organised by East Kent HA, June 2000;
• Incident exercise involving a chemical fire and subsequent contamination o f a river
used for drinking water abstraction, held in Southampton, June 2000.
3.2.5 General Best Practice and Problematic Issues Identified from

Chemical Incident Training and Exercises
This section summarises the general best practice issues and particularly problematic
areas in the management of chemical incidents as identified from the participation in
training sessions and exercises. There is a degree of overlap with those issues identified
from the management of actual incidents, as specified in Section 3.1.5.1. The incident
management process is divided into three aspects: risk assessment, communication and
required management actions.
Risk assessment of the potential health impact on the population

• Identification o f chemical/s involved is of obvious importance, there may be
multiple chemicals and more chemicals may come to light as the incident develops.
• Information is required about the properties o f the chemicals involved, including
environment persistence and degradation, reactivity with other chemicals and
measures for control.
70
• Taste and odour properties can be useful in identifying chemicals and predicting
levels of exposure. However, taste and odour thresholds should not be taken to
indicate levels of toxicity and may differ significantly between individuals and be
dependent on length of exposure.
• The contamination source needs to be identified and also the pathways and routes of
exposure.
• Predictions of the number of people affected and potentially affected is required as
part of the risk assessment process.
• Modelling can be used to assess the area o f contamination. A ‘Chemet’ can be
requested by the Fire or Police Service from the Meteorological Office, which
provides an estimate of the plume area in atmospheric incidents, based on current
wind direction.
• Ordnance Survey maps or Geographical Information Systems (GIS) can be used to
plot cases of exposure or adverse health effects.
• The actual amount of the chemical that the population is exposed to that is likely to
be biologically absorbed needs to be estimated.
Communication
• Collaboration and communication between all the organisations involved is
essential.
• Setting up an incident control team from the start o f the event will make a
collaborative approach easier.
• In establishing an incident team, the membership needs to be considered and also
terms of reference and the tasks and responsibilities assigned to each o f the
organisations represented on the team.
• In larger incidents, a dedicated incident room may be required, equipped with
sufficient telephone lines. The designation o f staff, back-up staff and relief staff will
be necessary. Administrative as well as operational staff will be required.
• Each organisation involved may have its own incident team and also provide a
representative for a multi-agency incident control team.
71
• Liaison with relevant occupational health departments who will be responsible for
the workers of an industrial facility and also for emergency and clean up responders
is important. Occupational health may have biological monitoring results o f workers
that will be useful in predicting the likely impact on the general population. There
may be difficulties in determining the limits of responsibility for occupational and
public health.
• If contamination of agricultural land or farm animals is possible, the Department for
Environment, Food and Rural Affairs (DEFRA) should be alerted.
• The public should be made aware o f the area affected, in order to minimise anxiety
in the unexposed population.
• A help-line may be necessary to provide information to the public; NHS Direct may
be able to provide this service. Telephone operators should all be provided with a
briefing providing information that can be released.
• There should be at least one person to undertake a full time public relations/media
role.
Action to prevent or minimise harm

• The area of contamination should be secured to prevent public access and the
chemical contained or removed if possible.
• Evacuation may be appropriate but is a complex issue and full discussion between all
parties involved is required before action is taken.
• If evacuation is required, ensure the safety o f the evacuation route and destination,
e.g. people should not have to pass through a smoke plume to reach the evacuation
centre.
• Decide from the outset what criteria have to exist for any protective measures to be
removed and for the area to be declared free of contamination.
• There should be early identification and alert o f particularly vulnerable populations.
• In the event of river contamination, downstream abstractors should be alerted, for
example agricultural users and manufacturers. Water resources may also be used for
72
recreational uses such as swimming, fishing or water sports which could lead to
exposure.
• The Health and Safety Executive (HSE) may be able to take action to close down
dangerous operations or ensure action is taken to prevent a recurrence of the
incident.
• The ambulance service and A&Es should be provided with information on the
chemical in order to assist with treatment o f any victims.
• Inform A&Es, GPs, dentists and opticians to look out for the specified symptoms.
• There should be careful management of contaminated victims to avoid secondary
contamination of ambulance and medical staff, hospitals and patients.
• Wherever possible, victims should be decontaminated before leaving the site o f the
incident.
• People involved in response, taking samples, and clean up should be supplied with
personal protective equipment and access to decontamination facilities.
• Environmental sampling may help to establish levels o f exposure; the location and
frequency of samples need to be carefully considered.
• Repeat environmental sampling should be conducted to ensure that concentrations
are not fluctuating.
• Need to establish how long it will take for analysis to be carried out and have a list
o f accredited laboratories. Laboratories undertaking analysis should also be
independent.
• Biological sampling is only worthwhile if it is likely to provide useful information, if
the chemicals have a short biological half-life samples need to be taken soon after
exposure.
• When taking biological samples a control sample may be required to assess the
parameters in a non-exposed individual.
• Determine a precise case definition based on symptoms reported.
• Consider possible long-term impacts on health and ensure adequate healthcare
provision.
73
Documentation
• A log should be kept of the names and addresses o f those exposed and affected.
• Shortfalls in the logging of information and events are commonly identified in the
management of chemical incidents.
Issues related to drinking water

• In some areas, separate companies may be responsible for water supply and
sewerage; representatives from both companies may be necessary on any incident
response team.
• The public health implications of closing water abstraction points, water or sewage
treatment facilities or cutting off water supplies to homes should be considered.
• The water company or EA may be able to predict the time of travel o f contamination
in rivers to reach a drinking water abstraction point to assist in assessments o f
whether drinking water is likely to have been contaminated and how long water
abstractions should be closed.
• Early provision of alternative water supplies is required in the event o f drinking
water contamination.
• A ‘do not use’ notice can be communicated to consumers by a personal letter/leaflet
drop, radio broadcasts, or in some cases loud hailers in the street.
• Possible uses of water include drinking, food preparation and cooking, washing
dishes, bathing or showering, laundry, watering crops and plants, feeding pets or
livestock, swimming pools.
• The start of the contamination and the date and time o f issuing a ‘do not use’ notice
should be recorded in order to estimate exposure duration.
• The possibility of people not taking advice and still using the contaminated water
should be considered.
• It may be possible to isolate the particular part o f the water supply network that is
contaminated and to continue supply in the remainder of the network area.
74
• In providing alternative water supplies, bottled water may be supplied for drinking,
or small bowsers or water tanks. It may be possible to provide alternative large
supplies for critical users.
• Water from bowsers is likely to require boiling before it is safe to drink,
contamination often occurs from unclean tanks and dispensing equipment.
• If bowser water supplies are being used, consideration most be given to people who
are not mobile and will require deliveries o f water direct to their home.
• Vandalism of bowsers and tanks on the streets may be a problem.
• In water contamination events the potential impact on food manufacturers and
producers should be considered, EHOs may already have contacts for their area. It
may be necessary to withdraw food containing or prepared using contaminated
water.
• The fire service may need to know about contaminated water supplies or even more
importantly if water supplies have been cut off.
• Other water users that may need to be alerted are dentists, pharmacists and opticians.
• Water from different sources may be blended before being distributed to consumers,
which may make identification o f the source o f drinking water contamination more
difficult.
• It may be possible to install temporary water treatment facilities, for example
activated carbon filters to remove particular chemicals.
• All supply pipes, internal plumbing, tanks, etc. should be flushed through to remove
residual contamination.
• Residents on water meters may be reluctant to flush their water systems.
• The flushing of water pipes may involve spilling water out over streets, it may be
possible for water to be contained or flushed directly to foul sewers. If water is
collecting in public areas there is a risk o f children playing in contaminated water.
Flushing to surface water drains or direct to watercourse may require a discharge
consent from the EA.
• Extensive flushing may result in the contaminant being drawn through previously
uncontaminated areas.
75
3.3 Summary of the Investigation into Chemical Incident
Management
The previous two sections of this chapter have detailed the information inputs to the
project. These have enabled the research engineer to establish the current state of
knowledge amongst public health professionals in the management o f chemical
incidents and also to identify areas of best practice and issues that seem to be
particularly problematic. Over the research period, there have been 246 water^elated
chemical incidents, 70 of which have involved significant management involvement by
the research engineer. Fourteen have been studied and documented in depth.
Involvement in the management o f actual chemical incidents provided the main source
o f information for developing an understanding o f the issues involved in the
management of chemical incidents and identifying areas o f best practice and those in
need of improvement. Participation in CIRS training sessions and, in particular, the
development and facilitation of incident training exercises added to the knowledge base
on how chemical incidents are currently managed. It also provided the opportunity to
obtain feedback on what resources would be useful to public health professionals to
assist them in improving their response to chemical incidents.
The next chapter demonstrates how the knowledge gained from the study o f chemical
incident management has been applied to developing methods for improving the public
health response to chemical incidents.
76
4 Methodology for Development of Tools to Improve
Chemical Incident Management by Public Health
Professionals
This chapter describes the methodology used for developing the chemical incident
management tools as detailed in the specific objectives laid out in Section 1.3, namely:
• A best practice model for the public health response to chemical incidents;
• A chemical incident management guidance manual to enable public health
professionals to meet the best practice criteria; and
• An evaluation method in order to be able to assess level of performance in managing
chemical incidents.
The final aspect of developing the tools was to devise a method for testing the
effectiveness of the guidance manual. This involved comparing the management
performance, in a simulated chemical incident, o f a group of public health professionals
using the manual, with another group with no manual.
4.1 Best Practice Model for Public Health Response to

Chemical Incidents
4.1.1 Aims and Objectives
A best practice model was developed detailing the public health response to chemical
incidents. The purpose of the model is to specify the general issues that need to be
considered for the successful management of a chemical incident, with the aim o f
preventing or minimising damage to human health and the environment. The primary
target audience for the model is the public health profession.
The model is intended to cover all types of chemical incident and to identify all
possible issues that may need to be considered during the management o f a chemical
incident. For a specific incident, action will not necessarily be required with respect to
77
all the issues raised in the model. The primary focus o f the model is on minor chemical
incidents, rather than incidents at the catastrophic or disaster level, as these are
incredibly rare events and have already received greater attention in the published
literature, for example, the Home Office publication ‘Dealing with Disaster’ (Home
Office, 1997). The majority of chemical incidents managed by public health doctors are
relatively small scale.
Previous authors have identified four stages o f emergency management, for all types of
incident (Home Office, 1997):
1. prevention
2. preparedness
3. response
4. recovery
The aim of the best practice model is to focus on the response and recovery stages of
incident management; however, some aspects of the recovery stage should allow for
improved prevention and preparedness for future chemical incidents. In addition, the
provision of a best practice model prior to an incident allows for improved preparedness
and may result in preventing the occurrence of some negative aspects o f a chemical
incident.
The specific objectives of the best practice model are therefore:

• Identification of all the issues/actions that should form part o f the public health
response to chemical incidents;
• Inclusion of all types of chemical incidents;
• Focus on the more frequently occurring minor incidents; and
• Focus on the response and recovery stages o f incident management.
4.1.2 Initial Development Methodology
The initial stage of development of the best practice model was to compile a first draft of
the model from personal experience o f chemical incident management throughout the
research period. Three sources of information were used:
78
• Lessons learnt from the management of chemical incidents throughout the research
period (as detailed in Section 3.1);
• Lessons learnt and comments from incident exercises and training days (as detailed
in Section 3.2); and
incident management (as detailed in Section 2.2).
As specified in the previous section, the focus o f the best practice model is on the
response and recovery stages of incident management. The approach used to develop
the model was first to identify the key areas o f the public health response to chemical
incidents, as listed below, and then to detail the issues that need to be considered under
each of these headings:
• Identification of the chemical(s);
• Identification of the contaminant source;
• Determination of movement of the contaminant;
• Identification of exposure pathway;
• Identification of the actual/potentially exposed population;
• Identification of level of exposure;
• Contact with relevant response organisations;
• Actions already taken by other relevant organisations;
• Incident control team formation;
• Acute health assessment (including biological monitoring);
• Actions to minimise human exposure;
• Actions to mitigate environmental harm and migration o f contaminant;
• Environmental monitoring;
• Communications with the public and media;
• Remediation action (during the incident);
• Incident status and stand down;
• Long term health monitoring (post acute incident);
• Long term environmental monitoring (post acute incident);
79
• Environmental remediation (post acute incident); and
• Incident documentation (throughout incident).
The purpose of the model is to provide a comprehensive specification o f the issues

involved in the public health response to chemical incidents, but not to provide a
detailed description of exactly how to handle each aspect o f the management. For
example, the model introduces the issue o f conducting human biological sampling, but
does not provide details on when or how a human biological sampling programme
should be instigated. It is the purpose o f the chemical incident management guidance
manual, which will be discussed in Section 4.2, to cover the details o f each aspect of
management highlighted in the model.
After compilation of the first draft o f the best practice model, the project supervisors and
the permanent and seconded staff at CIRS reviewed the model. After incorporation of
comments from this initial peer review the model was then revised and distributed for
consultation with a number of experts in chemical incident management, as detailed in
the next section. A copy of the model used for consultation can be found in Appendix 5.
4.1.3 Expert Consultation
The aim of the consultation process was to incorporate expert comments into the best
practice model and also to assign a level o f priority to the issues specified in the model,
in terms of how early in the management process each issue needs to be considered. The
experts who took part in the consultation process were from both the public health field
and other organisations involved in chemical incident management.
For the purposes of the expert consultation the model was divided into four stages.
1. The first stage covered the initial identification that there had been a chemical
incident that posed a threat to public health and establishing the basic facts
surrounding the incident, this stage was referred to as identification.
2. The second stage was the preliminary investigation, which involved identifying all
the aspects of the incident, with a particular focus on the resulting public health
80
impact. This stage involved some overlap with stage one, with information being
updated and expanded. This stage also encompassed the identification of the
agencies already involved in the management o f the incident and the actions that had
been taken.
3. The third stage defined the management actions to be taken by public health
professionals. The aim was to determine the actions that need to be taken in order to
prevent or minimise any adverse health impact o f a chemical incident. These actions
formed the emergency response. In this stage there was still a need to ensure that the
facts of the incident had been correctly established and that any changes in
circumstances had been noted.
4. The fourth and final stage was the post incident review, this was expected to take
place after the emergency response at a point when all actions had been taken to
stabilise the situation and there would be time for reflection on how the incident was
managed. Proper review and documentation o f an incident enables lessons to be
learnt on how to manage future similar incidents more successfully, or how to avoid
a recurrence of the situation.
A document was prepared to allow experts involved in the consultation process to

provide a rating for each of the issues/actions specified, to comment on what was
included in the model, to specify any additional issues that should be included, and to
provide any further comments on the structure o f the model or more general comments
about the development o f the best practice model. Participants were provided with
instructions that reminded them that the aim was to identify generic issues covering all
types of chemical incident and that the purpose behind the model was to prevent or
minimise any adverse public health impact of a chemical incident. A copy o f the
document used for consultation on the model can be found in Appendix 5.
Participants in the consultation process were asked to provide a rating for each
issue/action in terms of its importance in being considered/conducted at the immediate
response stage or later in the management process. The aim o f the rating exercise was to
identify which issues should be considered in the initial emergency response period,
81
within the first few hours of being alerted to the incident. Although the format of the
model used in the consultation process divided the issues covered into stages, within
each stage the issues or actions were considered to have varying levels of importance in
terms of whether they should be conducted immediately or form part of the extended
management process. The rating scale used was 1 to 5, on the basis of how important it
is that each of the stated issues/actions are considered/conducted in the initial emergency
response period, where:
1 = essential action for initial emergency response in the first few hours
2 = action required in early hours of the incident, within the first 24 hours
3 = action is part of the management process in the first few days of the incident
4 = action forms part of the extended management process, within 1-2 weeks
5 = action can be delayed until the follow-up stage, after the initial management
The higher the rating assigned, the longer the timescale available in which to carry out
the specified action. It was identified that it may be difficult for those specifying ratings
to use the timescales provided in the event o f a chronic incident. The instructions
provided with the model stated that if the rating provided would depend on whether the
incident was acute or chronic, then it should be assumed that the model is for application
in acute chemical incidents. The instructions also stressed that the aim was to provide
ratings that would be applicable to most types of incidents, and that the primary focus of
the model was on the more frequently occurring minor chemical incidents, rather than
the rare events at a catastrophic or disaster level.
Although the model provided in the consultation process had been divided into four
stages, it was not expected that the issues/actions included in the stages would
necessarily follow in chronological order. The stages were intended to allow the actions
to be classified in terms of their purpose, i.e. to identify that an incident has taken place,
to ascertain the details of the incident, to take action to manage the effects o f the incident
and to review the management process, not the order in which they should be carried
out. However, the classification of the stages did imply that the majority o f the actions
in stage one (identification) would be most likely to fall within the initial emergency
response (i.e. rating of 1), and those in stage four (post incident review) would not be
82
expected to form part of the emergency response (i.e. rating of 5). Issues and actions in
the investigation and management stages were more likely to cover the range o f possible
ratings. Those taking part in the consultation were requested to carefully consider the
priority of each issue/action across all the stages and rate accordingly, and not to assume
that they had already been placed in chronological order. It should be noted that an
element of bias might have inadvertently been introduced by classifying the actions
within these stages. Participants may have been inclined to feel that as they worked
through the model the ratings they were providing would move from 1 to 5. However,
the results show that the full range o f ratings was used throughout the model.
A copy of the model and instructions provided for the consultation process can be found
in Appendix 5. Forms were sent out by post or email to 42 experts. A total of 16
completed forms were returned by post or email and 10 additional face-to-face
interviews were conducted. The interviews provided the opportunity to assess any
difficulties participants were experiencing in providing the ratings and to conduct more
detailed discussions about any issues raised whilst working through the model. Ratings
and comments were received from a total o f 26 experts from several organisations. The
range o f work areas and job titles of the experts who provided comments are detailed
below:
• Public health
o Health Emergency Planning Advisors
o Director of Chester Public Health Laboratory Service
o Consultant/Regional Epidemiologists
o Public Health Consultant
o Senior Medical Officer, Environmental Chemicals Unit, Department o f
Health
• Environmental health
o Principal Environmental Health Officers
o Environmental Health Advisor to a Chemical Incident Regional Service
Provider Unit (RSPU)
83
o Lecturer in Environmental Health
• Environment Agency
o Area Emergencies Coordinator
• Water industry
o Scientific Services Manager
o Public Health Managers
o Quality and Environmental Assurance Manager
o Head of Drinking Water Regulation
• Fire Service
o Assistant Divisional Officers
o Fire Station Officers (Hazardous Materials)
• Others
o Emergency Planning Lecturer
o Senior Scientist, Department o f Health
o Toxicologist for a Chemical Incident RSPU
o Chemical pathologist at the National Focus
4.1.4 Final Development Methodology
The comments and ratings obtained from the consultation process were compiled in a
Microsoft Excel® spreadsheet. The detailed table o f ratings provided through the
consultation process can be found in Appendix 6. Where people had rated an
issue/action as, for example, between 1 and 2, a rating o f 1.5 was allocated. In some
cases participants felt that an action would be ongoing throughout the management
process and provided a range of ratings, for example 1-3, in this example the earliest
point at which the action would be started was allocated, which in this case would be 1.
The final rating allocated to a specific issue/action was determined by the modal rating
as calculated from the ratings provided by all the participants (i.e. the most frequently
chosen rating). In a few cases, an action may have been rated, for example 2 by the
same number of participants that rated it 3. In this case, if out o f the other ratings
provided more people rated the action as 1 than rated it 4, then the 2 rating would be
84
selected. Table 4.1 is a summary table o f the frequency with which each rating was
specified for each issue/action in the model.
Table 4.1: Frequency o f Ratings fo r Each Aspect Within the Model
Aspect Frequency of each rating Mode

1 2 3 4 5
STAGE ONE
record incident details 26
record 24 hour contact names and numbers 20 4 1 1
start logs 24 2 1
name, unique number, constituents 25 1 1
identify manufacturer of product involved 21 4 1 1
common uses of the chemical/product 9 12 4 2
physical properties 20 5 1
taste/odour properties 20 5 1 1
basic human toxicology 24 2 1
synergistic or antagonistic effects 17 7 2 1
current geographical location of contamination source 24 3 1

direction of movement of the contaminant 22 4 1
identify nearby vulnerable locations 24 2 1
try to establish the pathway/route of exposure 16 10 1
number of people already exposed 21 6 1
total potentially exposed population 14 12 1 1
nearby populations that may become exposed 12 12 2 1
ascertain if any health effects are reported 21 5
amount of the contaminant released 22 4 1
concentration of the contaminant in relevant media 18 6 2 1

time period of exposure 19 6 1 1
decide on incident status 25 1
85
1 2 3 4 5
STAGE TW O
continue to record incident details 15 8 1 1 1
keep current 24 hour contact names and numbers 14 9 1 1 1
complete logs for incoming and outgoing calls and actions
9 14 2 1 2
taken
ensure all chemicals involved have been correctly
identified and relevant details on properties and toxicity 12 11 2 2 2
are determined
confirm location of contamination source 10 13 2 1 2
where location of source is in doubt consider use ol
4 14 6 2 2
modelling to predict possible sources
identify all environmental media affected 14 10 3 1
determine current weather conditions 23 3 1
predictions of future weather conditions 14 10 2 1
confirm direction of movement of the contaminant 14 8 4 1
when direction of movement of contaminant is in doubt 4 14 8 2
consider use of modelling to predict possible areas at risk
confirm nearby vulnerable locations 16 9 1 1
confirm the pathway/route o f exposure between source o;
9 14 4 2
contamination and human receptors
confirm number of people already exposed or possibly
11 13 1 1 2
exposed to the contamination
where possible obtain names and addresses, include
3 11 10 1 2
visitors to the area
confirm type of health effects reported and number o:
4 13 7 1 2
people affected
mark cases reported on a map or in GIS 5 10 10 1 2
confirm additional nearby populations that may become 3 13 9 1 2
exposed
identify and alert particularly vulnerable populations 8 15 2 2
confirm amount of the contaminant released 11 10 7 2
86
1 2 3 4 5
confirm concentrations of the contaminant in relevant

8 11 5 1 2
media and at various locations and times
ensure most up-to-date analysis results have been received 4 12 10 1 2
estimate time period of exposure, differentiating between 4 10 12 1 3
various populations if exposed for different time periods
alert health organisations 20 6 1 1
alert emergency services 21 4 1 1
alert local authority - environmental health 19 5 1 1
alert local authority 15 12 1
alert water companies 16 7 1 1
alert enforcement agencies 16 9 2 1
alert government departments 10 13 2 1 2
alert occupational health professionals 11 11 3 2
alert environmental specialists, consultancies 5 13 6 1 2
identify contact personnel and record 24 hour contact
12 9 6 1
details
detail actions taken by other organisations involved 9 11 8 2
confirm current incident status 14 12 1
assess whether the severity of the incident is likely tc
12 13 1 1
escalate
87
1 2 3 4 5
STAGE THREE
continue to record incident details 14 8 1 2 1
keep current 24 hour contact names/numbers 12 8 3 2 1
complete logs for incoming and outgoing calls and actions
14 7 2 2 1
taken
consider forming an incident control team 16 9 1 1 1
identify incident control team members 12 9 2 1 1
find appropriate location for incident room 13 10 1 1 1
ensure necessary facilities are available 12 10 1 1 1
ensure contact numbers for the incident control team are
13 9 2 1 1
provided to other relevant parties
determine frequency of meetings 10 9 3 2 1
record of health effects 4 10 7 3 2
patient identification 1 10 10 3 3
record patient details 3 9 10 2 3
compile register of exposed public 7 12 4 3
compile register of exposed emergency responders 4 6 9 4 3
ensure patients/exposed population are adequately
11 9 2 2 1
decontaminated
ensure appropriate medical treatment is available for patients 12 9 2 1 1 1
toxicological evaluation of exposure data to determine
8 8 6 2 2
possible and most likely impacts on health
determine a precise case definition 1 13 8 1 1 2
determine whether there are other possible causes o f il
2 7 9 5 3
health
consider conducting biological monitoring o f patients anc
1 8 6 7 1 2
the exposed population
consider distributing a health questionnaire 2 6 8 5 3 3
alert affected general population and those potentially
16 9 2 1
affected if movement of contaminant is expected
88
1 2 3 4 5
provision of appropriate advice to prevent/minimise

19 7 1 1
exposure
arrange for provision of alternative water supplies 7 19 1
alert other water users 15 8 5 1
ensure personnel do not become contaminated themselves,

16 8 2 1
provide PPE and decontamination facilities
ensure relevant environmental organisations have been
15 10 2 1
informed
ensure actions are being taken to remove or contain the
11 10 4 1
source of contamination
protect vulnerable locations 16 8 3 1
determine if any routine results from environmental
8 10 7 1 2
sampling are already available
establish what environmental samples need to be taken 6 12 7 2
identify laboratory for analysis 9 11 5 2
agree financing, establish timescales for reporting o f results 4 8 10 3 3
initiate sampling, ensuring samples are collected and stored
9 11 5 1 2
appropriately
ensure samples are sent for analysis, ensure appropriate
analytical techniques are used and quality control procedures
4 10 7 1 2
are adequate
establish method for interpreting data, define limits oJ
detection, limitations from sampling procedure, accuracy o1 ' 4 5 11 2 1 3
analytical method, relevant standards for comparison,
including taste and odour
conduct any repeat sampling and analysis to confirm results
3 5 6 9 4
or to detect changes in concentrations
ensure awareness of the public and relevant organisations o;
13 12 2 1
the situation, including residents groups
define population ‘at risk’ to avoid unnecessary concerr
12 12 2 1/2
from unaffected individuals
provide clear and consistent information on the nature of the
10 12 4 2
hazard and the level of risk
ensure affected populations understand what actions the>
15 11 1 1
need to take
provision of press releases to alert the public 12 11 3 2
89
1 2 3 4 5
provision of press releases with follow-up information or

5 9 10 2 2
how the incident is being managed
consider setting up a telephone help-line for enquiries from
10 12 4 2
the public
removal and disposal of the chemical(s), or removal oi
2 18 4 1 2
exposure pathway
decontamination of property 1 8 9 7 3
prior determination of criteria for incident closure 4 11 10 1 2
ongoing assessment of progress towards specified criteria 2 9 10 3 1 3

recognition of when to close the incident 2 6 11 5 3
ensure all organisations involved in the management o f the
3 5 10 5 1 3
incident and the public are informed the incident is over
STAGE FOUR
summary of the incident 7 9 10 5
lessons learned regarding management of the incident 1 9 16 5
changes in procedures 1 6 19 5
identification of preventative action 1 8 17 5
identify specific actions to be taken and a named person 4 7 15 5
provision of information for official reports 1 7 18 5
continued treatment of casualties with long term health
i 1 9 13 5
effects
consider tagging of individual patient notes i 3 7 11 5
follow-up epidemiological studies 2 5 17 5
consider the necessity for long term monitoring o f the
1 8 16 5
affected environment/media if remediation is not possible
ensure remediation at site of contamination is complete anc
2 6 15 5
meets required standards
where possible take steps to prevent recurrence o f the
i 2 6 15 5
situation
where remediation is not possible and a significant risk tc
health remains, consider permanent re-housing of people ir 2 5 16 5
the area affected
follow-up information to reassure the public 1 1 10 15 5
90
Four chronological categories of incident response were specified for the final model.
These were:
1. First few hours;
2. Within 24 hours;
3. Remainder of management; and
4. Post incident.
The issues/actions specified in the first version o f the best practice model were placed in
each of the four categories based on the modal rating determined from the responses
provided through the consultation process. Table 4.2 summarises the relationship
between the modal ratings and these four categories.
Table 4.2: Relationship between Modal Rating and Chronological Category
Modal rating Chronological category

1 First few hours
2 Within 24 hours
3 Remainder o f management
5 Post incident
Only one action had a modal rating o f 4, this was put in the ‘remainder o f management’
category. The wording of some issues/actions was changed in response to comments
received from the consultation process and a few additional issues were added to the
model.
The ratings provided were also used to assist in dividing each o f the four categories into
‘key’ actions and ‘remaining’ actions. ‘Key’ actions are those considered to be the most
important, i.e. it is essential they form part of the response. ‘Remaining’ actions are o f
less importance. The basis of this classification varied for each category. For category
one (first few hours), if the vast majority o f the participants rated the action as 1, this
was classified as a ‘key’ action. For category two (within 24 hours), if the vast majority
of the participants rated the action as 2, or if the modal rating was 2 but a large number
91
o f participants rated the action as 1, this was classified as a ‘key’ action. For category
three (remainder of the management), if the vast majority o f the participants rated the
action as 3, or if the modal rating was 3 but a large number o f participants rated the
action as 2, this was classified as a ‘key’ action. ‘Key’ actions for the post incident
category were selected on the basis o f personal experience. A degree o f judgement was
used in classifying the ‘key’ actions and also the focus o f ‘key’ actions was on the public
health role.
4.1.5 Application
The final best practice model was developed from the initial model as a result o f the
comments and ratings provided in the consultation process. The model has been
presented as a summary checklist for use in the public health response to chemical
incidents. The issues/actions to be considered are specified for each of the four
chronological categories: first few hours; within 24 hours; remainder of management;
and post incident. The three main aspects o f the public health response to chemical
incidents have been identified as: risk assessment o f potential adverse impact on public
health; communication with other organisations and the public; and action to
prevent/mitigate adverse impact (these will be discussed in Section 4.2). The checklist
was used in the chemical incident management guidance manual, which is described in
Section 4.2, a copy of Version 1 of the checklist can be found in Appendix 7.
The same issues/actions and their associated chronological categories were used as the
basis of the evaluation method for assessing the level of performance o f public health
professionals in managing chemical incidents. The division between ‘key’ actions and
‘remaining’ actions was also used. The development of the evaluation method is
described in detail in Section 4.3.
92
4.2 Chemical incident Management Guidance Manual
The aim of the chemical incident management guidance manual is to provide an

9
operational resource primarily for use in the public health response to chemical
incidents, and therefore with the target audience being public health professionals. As
determined from the review of literature on procedures for the management o f chemical
incidents, there is no generic guidance currently available that is specifically aimed at
the public health management o f the emergency response to chemical incidents (see
Section 2.2). The few publications that were identified either focused on specific
aspects o f chemical incident management or dealt with planning and preparation prior to
an incident. The chemical incident management guidance manual therefore aims to
fulfil the need to provide public health professionals with the necessary resources to
satisfy their responsibilities in managing the health aspects of chemical incidents.
As chemical incident management is a multi-agency process, it is expected that much of

the guidance provided will also be useful to other organisations involved in the response
to chemical incidents. In addition, the manual will help to clarify the role that public
health professionals and other organisations can be expected to take in the management
of an incident.
As the aim is for the manual to be used as an operational tool during the actual
emergency response to a chemical incident, the format is focused on concise checklists
and summary diagrams for quick reference, rather than detailed text. References are
made to any relevant publications covering particular aspects in greater detail, which
could be followed up by the user if required.
93
The specific objectives o f the chemical incident management guidance manual are
therefore:
• Provision of a resource for public health professionals in the management of
chemical incidents;
• Focus on the emergency response (rather than planning and preparation); and
• Provision of a concise operational tool (rather than a lengthy reference text).
4.2.2 Development Methodology
Throughout the research period, tools were developed to assist public health
professionals in responding to chemical incidents. As described in previous sections,
information on best practice was collated from involvement in management o f actual
chemical incidents and exercises and also from relevant literature.
One of the resources developed throughout the research period was the detailed checklist
concerned with water-related chemical incidents. The first version was produced in
April 1998. This was extensively revised and updated in April 2000. Both versions
were published in the Chemical Incident Report (the CIRS in-house newsletter} and
were distributed to public health doctors as a part o f CIRS training days and also in the
event of a water-related chemical incident. Feedback was obtained on the use o f the
checklist and used for further revisions. A summary table o f standards for drinking
water quality was also compiled at the beginning of the project as this was soon found to
be a very useful resource. Other resources were developed for inclusion in the
documentation provided at CIRS training days, which focused on the management of
water-related chemical incidents specifically. These were:
• Roles and responsibilities of organisations involved in water-related chemical
incidents;
• Guide to using drinking water quality standards;
• Issues involved in environmental monitoring;
• Guide to presenting and interpreting environmental analyses; and
• Questionnaire for use in a drinking water contamination incident;
94
The introduction to the guidance manual identifies the primary objectives of the public
health response to chemical incidents. These are specified as:
1. To conduct a risk assessment to determine the potential adverse impact of the
incident on the health of the local population;
2. To communicate with other organisations involved in the management o f the
incident and with the public; and
3. To take action to prevent or minimise the adverse public health impact of the
incident.
These three objectives provided the focus for the provision of resources to be included in
the guidance manual. In addition, the development o f the best practice model, as
described in Section 4.1, identified all the issues and actions that form part o f the public
health response to chemical incidents and, where appropriate, guidance was developed
to provide more detailed information on these aspects. The guidance materials produced
in the manual were divided into four types: briefings (more detailed background
information); checklists; flowcharts (diagrams); and forms. In addition, there was some
introductory material at the start of the manual discussing the general framework o f the
public health response to chemical incidents and providing details on the information
contained within the manual.
After compilation of the initial draft, the chemical incident guidance manual was
reviewed by the project supervisors and the permanent and seconded staff at CIRS.
Comments from this initial peer review were incorporated into Version 1 o f the chemical
incident management guidance manual. This version of the manual was used in the
validation testing, as described in Section 4.3. Version 1 o f the chemical incident
guidance manual focused on issues that are common to all types o f chemical incidents
and some issues that are specific to water-related chemical incidents. Resources for
issues related specifically to air or land-related incidents were not included at this stage
as these were being developed by other research engineers as part o f complementary
research projects. The table of contents for Version 1 o f the manual can be found in
Appendix 8, the individual guidance materials are fundamentally the same as in
95
Version 2, but are presented in a different order. A full copy of Version 2 of the manual
can be found in Volume 2.
4.2.3 Expert Consultation
As part of the validation testing of the manual (described in Section 4.3), Version 1 of
the chemical incident management guidance manual was distributed to 82 public health
professionals, including Consultants in Communicable Disease Control (CsCDC),
Consultants in Public Health Medicine (CsPHM), public health specialist registrars
(SpRs), and public health nurses. Feedback was obtained during the validation testing
process and an evaluation and comment form was also included in each o f the manuals.
A few weeks was allowed for those with the manual to have time to work through it and,
if possible, to use it in an actual incident, then follow up letters were sent to all 82
participants in the exercise sessions to request feedback on the content and use o f the
manual. Completed forms were received from 18 participants.
A total of 10 copies of the manual were also distributed to people who had been
consulted with respect to the best practice model, this included representatives from
public health, environmental health and the water industry. In addition, detailed
discussions were conducted with Dr Kaetrin Camegie-Smith, an independent consultant
in public health medicine and public health advisor to the Emergency Planning College.
The comments received from both the participants in the validation testing and from
consultation with experts in chemical incident management have been incorporated into
Version 2 of the manual. The main changes between Versions 1 and 2 were:
• To improve the presentation of the manual in general and also the specific resources
in order to make the manual easier to use;
• To detail more specifically the lead agency for each aspect of chemical incident
management; and
• To provide more detailed explanations of the general application o f the manual and
the specific purpose of each guidance resource.
The comments received regarding the manual are detailed in Section 6.3 and the changes
made to the manual following the validation testing are specified in Section 6.5.
96
4.2.4 Application
As described in the aims and objectives in Section 4.2.1 the application of the chemical
incident management guidance manual is for use as an operational resource for the
public health response to chemical incidents. The aim is to provide information and
guidance that will result in an improvement in the management o f chemical incidents by
public health professionals.
Further development and consultation on the manual will have to be conducted before
the contents are incorporated into a book on ‘Environmental Management o f Chemical
Incidents’ to be published by the Stationery Office (see Section 7.5.2).
4.3 Validation Testing o f the Chemical Incident Management

Guidance Manual
The aim of the validation testing process was to conduct a quantitative assessment o f the
effectiveness of the chemical incident management guidance manual in improving the
management of chemical incidents by public health professionals. In order to be able to
assess the effectiveness o f the manual, the following objectives had to be achieved:
• Development of a method for evaluating the performance o f public health
professionals in managing a chemical incident; and
• Production of an incident exercise in order to provide a realistic and consistent
situation in which to the test the manual.
4.3.2 Development of Evaluation Method
4.3.2.1 Generic evaluation o f performance
The basis of the evaluation method was the final output from the development o f the
best practice model. The same issues/actions and their associated chronological
categories were specified and, in addition, the ‘key’ actions were identified. The aim is
97
to assess the number of actions that have been achieved in the response to a chemical
incident. Table 4.3 details the total number o f actions that have been specified in the
evaluation method for each stage o f the response. The ‘key’ actions are those
considered to be the most important actions for completion. These are also stated for
each stage.
Table 4.3: Number o f Actions Specified in the Evaluation Method
Stage Number of ‘total’ Number of ‘key’ actions

actions specified specified
1. First few hours 57 30
2. Within 24 hours 46 24
3. Remainder of management 18 10
4. Post incident 15 5
Total incident 136 69
By assessing the response to a particular incident with regard to whether the specified
actions were achieved, a percentage score for ‘total’ actions and ‘key’ actions can be
provided for each stage and the incident as a whole. This provides a method of
assessing performance that can then be used as the basis for comparing the performance
of different people, for example, those with access to the guidance manual and those
without. A detailed copy of the generic evaluation method can be found in Appendix 9.
4.3.2.2 Evaluation o f performance in the incident exercise
To assess the effectiveness of the guidance manual, an exercise scenario was devised as
described in Section 4.3.3. The generic evaluation method was adapted for use in the
exercise by specifying exactly how each action would be achieved in the context o f the
exercise. For some actions to be entirely complete several aspects needed to be
included. Therefore, in assessing the performance in the exercise, if the participant had
included all these aspects in their response then they would have completely achieved
that action. However, if only some of the aspects had been included then the action
would only be partially achieved.
98
In conducting the evaluation o f the exercise responses, the actions achieved within the
specified stages of the incident response were recorded. In addition, the actions that were
being achieved in stages other than that in which they were specified were also
documented. This included actions being achieved too early, for example, stage two
actions being completed in stage one, and actions that were being identified too late. In
some cases, issues were highlighted in the responses that had not been included in the
evaluation method these were also documented. A copy o f the exercise specific
evaluation method can be found in Appendix 10. Further details concerning the
evaluation of responses are presented in Chapter 5.
4.3.3 Devising the Incident Exercise
The aim of the incident exercise in this case was to devise an incident scenario that
would test the effectiveness of the guidance manual using the evaluation method
developed, as described in the previous section. A scenario involving contamination o f
drinking water was selected in order that all resources available in the manual could be
fully exploited and tested. The general scenario in the exercise was based on one
particular incident from the experience of the research engineer with additional aspects
added in order to cover the majority of the aspects in the evaluation method. The
exercise was divided into stages to simulate the development o f the incident scenario
over a few days, these stages matched the categories used in the evaluation method: first
few hours; within 24 hours; remainder o f management; and post incident. The time for
completing each stage of the incident exercise was specified as 25 minutes for stage one,
20 minutes for stage two, 25 minutes for stage three, and 10 minutes for the post
incident stage.
In addition to devising the exercise itself, recording sheets were also developed in order
to collect the responses to the incident exercise in a coherent and consistent manner.
The information recorded by the participants had to allow for subsequent evaluation of
which issues and actions had been considered and achieved in responding to the incident
exercise. Forms were provided for each o f the stages one to three, with sections for:
99
issues to be considered; actions/decisions to take; people to contact; further information
required; resources required; and miscellaneous. For the post incident stage the form
was divided into documentation required and actions required.
The exercise was piloted on the permanent and seconded staff at CIRS to verily that the
timings for completing each stage o f the incident were achievable and that the recording
sheets allowed enough information to be documented to conduct the evaluation. A copy
of the exercise used in the validation testing can be found in Appendix 11.
4.3.4 Conducting the Incident Exercise Sessions
Before conducting the incident exercise sessions, the first stage was to ascertain how
many people within the health authorities (HAs) might be required to be involved in the
management of chemical incidents. All 73 o f the HAs, with service level agreements
with CIRS at the time, were contacted to establish the number o f people that were
included on the 24-hour public health department on-call rotas. Potentially, anyone on
these rotas may be required to manage a chemical incident. Table 4.4 summarises the
total number of people by job title for the 73 HAs.
Table 4.4: Total Number o f Public Health Professionals in HAs Contracted to CIRS,
Categorised by Job Title
Job title Consultant in Public Health Consultant in Director o f Public Other
Public Health Specialist Communicable Public Health Health
Medicine Registrar Disease Control (DPH) Nurse
(CPHM) (PH SpR) (CCDC)
N um ber
217 173 87 51 40 17
(total = 585)
It was proposed that an exercise and training session would be held within each o f the
six National Health Service Executive (NHSE) Regions covered by CIRS. Dates and
locations were organised within each region and the CCDC was contacted at each HA to
request participants for the sessions. A total o f 82 public health professionals attended
the exercise and training sessions, with 79 people fully completing the exercise.
Information was collected on the job title o f each participant, the number o f chemical
incidents they had been involved in, and the number o f CIRS training days or other
100
chemical incident training sessions each had attended. Tables 4.5, 4 .6 and 4.7 show the
spread of experience and training o f the 79 participants in the exercise sessions and also
their job titles.
Table 4.5: Number o f Chemical Incidents Exercise Participants had Managed (n=79)
N um ber o f
incidents 0 1 2 3 4 5 6 7 8 10+
m anaged
N um ber o f
44 10 4 3 3 2 2 1 1 9
participants
Table 4.6: Number o f Chemical Incident Training Days Exercise Participants had
Attended (n=79)
N um ber of
training
0 1 2 3 4 5
days
attended
N um ber of
40 19 5 5 3 7
participants
Table 4.7: Number o f Exercise Participants Under Each Job Category (n~79)
Job title Public Consultant in Public Consultant Public Public
Health Communicable Health in Public Health Health
Specialist Disease Nurse Health Senior Assistant
Registrar Control Medicine House
(PH SpR) (CCDC) (CPHM) Officer (PH
SHO)
N um ber o f
30 19 12 4 3 2
participants
Job title Public Emergency Lecturer Medical Public Deputy

Health Planning Officer Health Director o f
Advisor Officer Scientist Public
Health
N um ber o f 2 2 2 1 1 1
participants
The participants were categorised into four groups of: experienced and trained;
experienced only; trained only; and inexperienced and untrained. Experience was
defined as having being involved in five or more chemical incidents and trained as
101
having attended at least one CIRS training day (or equivalent). At each regional session,
approximately half the group were provided with a guidance manual for use during the
exercise and the remaining people had no resources to assist them with the response to
the exercise. A short introduction to the content and use of the manual was provided to
the majority of the participants who used the manual (with the exception o f nine people).
This was provided at the start o f the day and therefore most o f the people who were
selected to use the manual were those who were able to get to the training venue at the
earlier time. Any remaining manuals were allocated on a first come first served basis.
In addition, the aim was for those with and without the manual to be spread across the
training and experience categories. Table 4.8 shows the number of participants in each
of the four categories and also how many from each category used the manual during the
exercise.
Table 4.8: Number o f Participants in Each Training and Experience Group and Use o f
the Guidance Manual
Category Total number of Number with the Number without

participants manual the manual
Experienced and
12 6 6
trained
Experienced only 3 1 2
Trained only 28 13 15
Inexperienced and
36 19 17
untrained
Total 79 39 40
At each session the same set of instructions was presented to the participants explaining
the aims of the exercise, how the responses were going to be evaluated, and how their
responses should be recorded. It was stressed that participants needed to write down
everything they would consider, actions and decisions they would take, people they
would contact and information and resources required in responding to the incident. The
need to prioritise actions was also specified. Participants were explicitly requested not
to discuss the incident with each other.
102
Each participant completed the exercise on an individual basis with responses being
recorded on the sheets provided. As explained in the previous section the exercise was
divided into four stages, these were:
• First few hours;
• Within 24 hours;
• Remainder o f the management; and
• Post incident.
Participants recorded their written response to each incident stage based on the
information provided. New information was provided at each stage to show how the
incident was developing. The same amount o f time was allocated for completion o f
each stage at all 6 exercise sessions, as specified in Sectbn 4.3.3.
4.4 Conclusions
A best practice model for the public health response to chemical incidents was
developed from:
• The lessons learnt through the actual management o f chemical incidents;
• Involvement in chemical incident exercises and training sessions; and
• Relevant literature.
Consultation with a range of experts in chemical incident management was carried out
during the development of the model.
The model was then used to direct the development o f a chemical incident management
guidance manual to be used in the emergency response to a chemical incident. The three
broad issues covered by the manual are:
• Conducting a risk assessment to determine the potential adverse impact o f an
incident on the health o f the population;
• Communicating with other organisations involved in the management o f an incident
and with the public; and
• Actions to be taken to prevent or minimise any adverse impact on the public health.
103
The best practice model was also used as the basis for a quantitative evaluation method
for assessing the performance o f public health professionals in responding to a chemical
incident. An incident exercise scenario and incident specific evaluation method were
also developed to use in the validation testing o f the guidance manual. The following
chapter presents the results from this validation testing.
104
5 Results and Statistical Analysis from Validation
Testing of the Chemical Incident Management
Guidance Manual
5.1 Hypotheses
The main aim of the validation testing o f the chemical incident management guidance
manual was to determine whether its use improves the level of performance in chemical
incident management by public health professionals. The null hypothesis is therefore:
• There is no difference in the performance o f public health professionals with and
without the use of the guidance manual in managing a chemical incident.
In addition, the effects o f training and experience were to be investigated, in particular:

• Is the use of the guidance manual o f greater benefit to public health professionals
with no previous experience and training in chemical incidents compared to those
with previous experience and/or training?
• Irrespective of the use of the guidance manual, do public health professionals with
experience and/or training in chemical management achieve a higher level o f
performance than those without?
5.2 Summary of Data from the Validation Testing
5.2.1 Performance Score
As explained in Section 4.3, the method for testing the effectiveness o f the guidance
manual was to evaluate the performance o f a group o f public health professionals by
asking them to provide a written response to a chemical incident exercise (i.e. a
simulated chemical incident). Performance was evaluated using the evaluation method
described in Section 4.3.2, which specifies the actions that should be completed during a
chemical incident. Using this method, assessment o f the written responses allowed a
105
score to be derived showing the percentage o f the total number o f required actions that
had been successfully achieved. The measure of performance was therefore the
percentage of actions completed for the specified incident exercise.
As the exercise was split into stages one to three and a post incident stage, percentage
scores could also be calculated for each of these stages. In addition, a number o f ‘key’
actions had been specified for each stage o f the exercise, which were selected as having
higher priority for completion. Therefore, for each stage, a percentage score could be
provided for the ‘total’ actions completed and the ‘key’ actions completed. Finally,
some of the actions specified in the generic evaluation method could only be achieved in
the exercise by completing several sub tasks. For example, alerting relevant emergency
services for this particular exercise would involve alerting the ambulance, fire and police
services. Therefore the action would only be completely achieved if all three o f the
services had been alerted. In some cases, an action may be completely or partially
achieved.
To summarise, for each participant the total percentage score can be subdivided as
detailed below:
Completely
achieved
Total
actions
Stage one Partially
achieved
Total Stage two
percentage
score Stage three
Post incident Completely
achieved
Key
actions
Partially
achieved
106
5.2.2 Participant Variables
The participants in the validation testing were all public health professionals. For each
participant three details were collected:
• Number of chemical incidents that the participant had been involved in managing;
• Number of CIRS training days (or equivalent) attended; and
• Occupational title.
The subdivision of the total group o f 79 participants is described in Section 4.3.4 in

Tables 4.5, 4.6 and 4. 7. This information was used to categorise the participants as:
• Experienced and trained;
• Experienced only;
• Trained only; and
• Inexperienced and untrained
The number of participants in each group is shown in Table 4.8 in Section 4.3.4. The
table also shows how many participants in each group used the manual in the exercise.
The majority of the 39 participants using the manual also received introductory training
on the content and use of the manual, only nine participants did not receive this training.
5.3 Methodology for Statistical Analysis o f the Validation

Testing Data
5.3.1 Aims of the Statistical Analysis
The aim of the statistical analysis o f the results from the validation testing was to
identify if any of the following variables had a significant influence on the performance
of the participants in the incident exercise:
• Use of manual;
• Previous experience in managing chemical incidents;
• Previous training on management of chemical incidents; and
• Occupational status.
107
5.3.2 Definition of Variables
Two dependent variables were used in the analysis; labels used are specified in brackets:
• Overall score for ‘total’ actions (over_tot); and
• Overall score for ‘key’ actions (over_key).
The more tests conducted, the greater the probability that an untrue significance will be
encountered. In order to avoid this inherent problem in multiple testing, only the overall
‘total’ and ‘key’ scores were used. The separate scores for the individual stages o f the
incident were not separately analysed and no distinction was made between partially and
completely achieved actions. The overall score was the combined total of partially and
completely achieved actions.
The four independent variables were defined as detailed in Table 5.1, which also
specifies the number of participants falling under each definition.
Table 5.1: Independent Variables Used in Statistical Analysis
Independent Definition Label Number of

variable participants
Manual Use of manual manual_l 39
No manual manual_0 40
Experienced Experienced - involved in managing at least experien_l 35
one chemical incident
Inexperienced - no previous involvement in experien_0 44
managing chemical incidents
Trained Trained - attended at least one chemical trained_l 39
incident training day.
Untrained - not attended any chemical trained_0 40
incident training days.
Occupation Consultant - CCDC, CPHM, DPH, senior consultant 25
lecturer
Medic - SpR, SHO, clinical lecturer, med 35
medical officer
Nurse - public health nurse nurse 12
Other - non medical public health roles other 7
108
CCDC = Consultant in Communicable Disease Control
CPHM = Consultant in Public Health Medicine
DPH = Director of Public Health
SpR = Specialist Registrar
SHO = Senior House Officer
5.3.3 Selection of Statistical Methods
Consultation on the selection and use of statistical methods and output interpretation was
obtained from Professor Paul Hunter, Professor of Health Protection, School of
Medicine, Health Policy and Practice, University o f East Anglia. The software package
used to analyse the data was SPSS for Windows® (Release 10.0.7, 1/6/2000). Two types
of analysis were used to assess the significance of the four independent variables,
univariable and multivariable analysis.
The aim of the univariable analysis was to assess the independent variables in isolation
to identify if any of them had a significant effect on the overall ‘total’ and ‘key’ scores
for the exercise. A p value of 0.05 was used to establish significance. The t-test was
used to determine if there was a significant difference in the mean performance scores
between different groups o f participants. The unpaired t-test was conducted on the
manual, experience and training variables, which are binary. The hypothesis that each
group had equal variance was tested by the F-test. The results for a two-sided test were
used due to the possibility that any o f the variables could cause an increase or decrease
in the performance score. For the occupation variable, one-way analysis of variance was
used to assess the effect on overall ‘total’ and ‘key’ scores. This variable is divided into
four categories; therefore the t-test cannot be used.
Multivariable analysis was then conducted using the generalised linear model. The
model was run initially with all four independent variables. If any variable gave a p
value >0.2, the least significant variable was removed and the model re-run. This step
was then repeated until all variables in the model gave a p value o f <0.2.
109
5.4 Resuits from the Vaiidation Testing of the Manuai
5.4.1 Comparison of Mean Percentage Scores
The scores shown are all calculated from the mean average across the specified group of
participants and are given as percentages. The complete set o f scores achieved for each
participant can be found in the tables in Appendix 12. Tables 5.2, 5.3, 5.4, 5.5 and 5.6
show the mean percentage scores calculated for the following groups o f participants:
• those without a manual;
• those with a manual who received introductory training on its use;
• those with a manual who did not receive any introductory training; and
• all those with a manual, irrespective o f whether they received training.
Mean percentage scores are shown for each stage of the incident exercise and also the
combined total score for the complete exercise. The mean scores are given for the
‘total’ actions and the ‘key’ actions (i.e. the most important actions). In addition, the
percentage of actions completely and partially achieved are provided with a combined
total.
Tables 5.2, 5.3, 5.4, 5.5 and 5.6 show the mean percentage scores for each o f the groups
of participants as specified by level o f training and experience. For this section,
‘experienced’ is defined as those who have been involved in the management o f five or
more chemical incidents and ‘trained’ as those who have attended at least one CIRS
training day (or equivalent). Table 5.2 illustrates the mean scores for the total group,
Table 5.3 for those with experience and training (group A), Table 5.4 for those with
experience but no formal training (group B), Table 5.5 for those with training but limited
experience (group C), and Table 5.6 for those who are inexperienced and untrained
(group D). It should be noted that group B, those with experience but no formal
training, only consisted of three participants and there were no participants with
experience but no training who received the manual without the introductory training on
its use.
110
Table 5.2: Mean Percentage Scores for All Participants (n=79)
% Actions achieved
Exercise Comptletely Partially Comibined
M anual Stage achieved achi eved toifal
Total Key Total Key Total Key
Total 26.7 31.0 12.5 14.8 39.2 45.8
No manual Stage 1 21.5 23.3 20.0 23.1 41.5 46.3
(n=40) Stage 2 23.0 28.8 10.4 14.3 33.5 43.2
Stage 3 35.7 43.4 3.8 0.5 39.4 43.9
Post incident 47.1 68.3 0.4 0.0 47.5 68.3
Total 33.6 39.2 11.3 13.5 44.9 52.7
Manual and Stage 1 26.5 30.0 18.8 22.2 45.3 52.2
training Stage 2 29.8 39.3 8.8 12.0 38.6 51.3
(n=30) Stage 3 43.5 49.7 3.1 0.0 46.7 49.7
Post incident 60.5 78.9 0.0 0.0 60.5 78.9
Total 34.8 38.1 13.2 16.6 48.1 54.7
Manual Stage 1 27.7 29.1 21.4 25.2 49.1 54.3
(n=9) Stage 2 31.2 39.6 11.7 16.9 42.8 56.5
Stage 3 51.2 49.5 2.5 0.0 53.7 49.5
Post incident 53.0 63.0 0.0 0.0 53.0 63.0
Total 33.9 38.9 11.8 14.2 45.6 53.2
Combined Stage 1 26.8 29.8 19.4 22.9 46.2 52.7
manual Stage 2 30.1 39.4 9.4 13.2 39.6 52.5
(n=39) Stage 3 45.3 49.7 3.0 0.0 48.3 49.7
Post incident 58.8 75.2 0.0 0.0 58.8 75.2
111
Table 5.3: Mean Percentage Scores for Participants with Experience and Training -
Group A (n=12)
% Actions achieved
Exercise Comp letely Part ially Comlnned
M anual Stage achi eved achi eved tot al
Total 26.3 29.4 12.3 14.8 38.5 44.2
No manual Stage 1 20.8 23.7 19.8 23.1 40.6 46.8
(n=6) Stage 2 22.0 23.2 10.6 14.5 32.5 37.7
Stage 3 38.9 47.0 2.8 0.0 41.7 47.0
Post incident 44.9 61.1 0.0 0.0 44.9 61.1
Total 39.7 41.3 12.3 14.3 52.0 55.6
Manual and Stage 1 33.3 32.1 20.1 24.4 53.5 56.4
training Stage 2 38.2 46.4 8.9 11.6 47.2 58.0
(n=3) Stage 3 40.7 39.4 5.6 0.0 46.3 39.4
Post incident 69.2 88.9 0.0 0.0 69.2 88.9
Total 33.6 36.0 15.2 20.6 48.8 56.6
Manual Stage 1 23.9 25.6 23.3 32.1 47.2 57.7
(n=3) Stage 2 30.1 34.8 14.6 20.3 44.7 55.1
Stage 3 51.9 51.5 3.7 0.0 55.6 51.5
Post incident 59.0 77.8 0.0 0.0 59.0 77.8
Total 36.7 38.6 13.7 17.5 50.4 56.1
Combined Stage 1 28.6 28.8 21.7 28.2 50.3 57.1
manual Stage 2 34.1 40.6 11.8 15.9 45.9 56.5
(n=6) Stage 3 46.3 45.5 4.6 0.0 50.9 45.5
Post incident 64.1 83.3 0.0 0.0 64.1 83.3
Table 5.4: Mean Percentage Scores fo r Participants with Experience (But No Training)
—Group B (n=3)
% Actions achieved
Exercise Comp letely Part ially Comlbined
M anual Stage achi eved achi eved toifal
Total 22.0 27.0 15.2 20.6 37.2 '47.6
No manual Stage 1 19.8 21.2 22.6 28.8 42.5 50.0
(n=2) Stage 2 14.6 19.6 14.6 23.9 29.3 43.5
Stage 3 33.3 45.5 5.6 0.0 38.9 45.5
Post incident 38.5 66.7 0.0 0.0 38.5 66.7
Total 36.8 47.6 12.0 14.3 48.8 61.9
Manual and Stage 1 28.3 34.6 24.5 26.9 52.8 61.5
training Stage 2 34.1 47.8 4.9 8.7 39.0 56.5
(n=l) Stage 3 55.6 72.7 0.0 0.0 55.6 72.7
Post incident 53.8 66.7 0.0 0.0 53.8 66.7
112
Table 5.5: Mean Percentage Scores for Participants with Training (But Limited
Experience) - Group C (n=28)
% Actions achieved
Exercise Compdetely Part ially Comlbined
M anual Stage achi eved achieved toifal
Total 29.5 34.7 12.7 13.4 42.3 48.1
No manual Stage 1 24.9 27.9 21.1 21.0 46.0 49.0
(n=15) Stage 2 27.2 33.3 9.8 13.0 36.9 46.4
Stage 3 35.9 44.8 3.7 0.0 39.6 44.8
Post incident 47.2 66.7 0.5 0.0 47.7 66.7
Total 36.2 40.6 11.6 13.7 47.8 54.3
Manual and Stage 1 27.5 30.8 20.0 23.5 47.5 54.2
training Stage 2 35.6 43.0 8.0 10.9 43.7 53.9
(n=10) Stage 3 43.3 49.1 3.3 0.0 46.7 49.1
Post incident 63.8 76.7 0.0 0.0 63.8 76.7
Total 40.0 42.9 13.9 16.4 53.9 59.3
Manual Stage 1 28.9 26.9 23.3 25.6 52.2 52.6
(n=3) Stage 2 37.4 49.3 10.6 15.9 48.0 65.2
Stage 3 64.8 63.6 3.7 0.0 68.5 63.6
Post incident 59.0 55.6 0.0 0.0 59.0 55.6
Total 37.1 41.1 12.1 14.3 49.2 55.4
Combined Stage 1 27.9 29.9 20.8 24.0 48.6 53.8
manual Stage 2 36.0 44.5 8.6 12.0 44.7 56.5
(n=13) Stage 3 48.3 52.4 3.4 0.0 51.7 52.4
Post incident 62.7 71.8 0.0 0.0 62.7 71.8
113
Table 5.6: Mean Percentage Scores for Inexperienced and Untrained Participants -
Group D (n=36)
% Actions achieved
Exercise Comp letely Part ially Comlbined
M anual Stage achi eved achieved toifal
Total 24.9 28.7 12.0 15.4 36.9 44.1
No manual Stage 1 18.9 19.2 18.9 24.2 37.7 43.4
(n=17) Stage 2 20.8 27.9 10.5 14.3 31.3 42.2
Stage 3 34.6 40.6 3.9 1.1 38.6 41.7
Post incident 48.9 72.5 0.5 0.0 49.3 72.5
Total 30.6 37.3 10.9 13.3 41.5 50.6
Manual and Stage 1 24.5 28.8 17.5 20.7 42.0 49.5
training Stage 2 24.4 35.1 9.5 13.0 33.8 48.1
(n=16) Stage 3 43.4 50.6 2.8 0.0 46.2 50.6
Post incident 57.2 79.2 0.0 0.0 57.2 79.2
Total 30.9 35.4 10.7 12.7 41.6 48.1
Manual Stage 1 30.2 34.6 17.6 17.9 47.8 52.6
(n=3) Stage 2 26.0 34.8 9.8 14.5 35.8 49.3
Stage 3 37.0 33.3 0.0 0.0 37.0 33.3
Post incident 41.0 55.6 0.0 0.0 41.0 55.6
Total 30.7 37.0 10.9 13.2 41.5 50.2
Combined Stage 1 25.4 29.8 17.5 20.2 42.9 50.0
manual Stage 2 24.6 35.0 9.5 13.3 34.1 48.3
(n=19) Stage 3 42.4 47.8 2.3 0.0 44.7 47.8
Post incident 54.7 75.4 0.0 0.0 54.7 75.4
The above results are summarised further in Table 5.7, which illustrates mean
percentage ‘total’ and ‘key’ scores for those with and without the manual for the
experience and training groups A, C and D and the total group. The mean scores for
group B have not been shown in this table due to the fact that this group only consisted
of three individuals. The scores for those with the manual have not been subdivided to
show those with and without the introductory training on the manual, as only nine o f the
39 participants with the manual did not receive the training.
114
Table 5.7: Summary Mean Percentage Scores Across Experience and Training Groups
ro
'W
'M
Cl
C/5
fS
C/5
C/5
hr
C5
Post incident
fir
hr
Q>
Experience/ Total exercise
C«
Use of
1—1
<L»
training group m anual % of % of % of % of % of % of % of % of % of % of
total key total key total key total key total key
actions actions actions actions actions actions actions actions actions actions
Total group No manual 39 46 42 46 33 43 39 44 48 68
!
(n=79) (n=40)
O
ro
ti-
in
VO
Manual 53 46 53 48 50 59 75
! (n=39)
VO
Experienced No manual 1 39 44 47 33 38 42 47 45
and trained (n=6) 1 m
Tl-
(n = 12) Manual 50 56 50 57 46 57 64 ! 83
(n=6) ! I W I I B iH lI
ZV
Ov
VO 67
Trained only No manual I 48 46 i
37 *■3- 1
40 45 48
(n=28) (n= 13)
in
ro
ZL
O'.
VO
Manual 49 55 54 57 52 52
(n=15)
m
m
m
oo
<N
CN
Inexperienced No manual 37 39 49 73
and untrained (n=19)
m
r->
(n=36) 42 50 50 34 48 45 48 55
£ S
a II
C '—
03 £?-
From the individual scores for each participant it can be calculated that the total mean
percentage scores for the whole exercise across the entire group of 79 participants are:
• ‘total’ actions = 42.4%
• ‘key’ actions = 49.4%
From Table 5.7 it can be seen that:

• Within each exercise stage and experience/training group, the mean percentage score
for those with the manual is greater than it is for those without a manual for both
‘total’ actions and ‘key’ actions (with the exception of the ‘key’ actions score for the
experienced and trained group in stage 3 o f the exercise).
• Within each experience/training group,andlooking separately at those with and
without the manual, themean percentage score for‘key’ actions is higherthan the
mean percentage score for ‘total’ actions for all stages of the exercise (with the
exceptions of those with a manual in the experienced and trained group in stage 3 o f
the exercise and those with a manual in the trained group in stage 3 o f the exercise).
These trends can also be seen in Figure 5.1, which illustrates the mean percentage scores
for those with and without a manual. The ‘total’ actions and ‘key’ actions for each stage
of the exercise and for the total exercise are given, and the division between actions that
are completely and partially achieved can also be observed.
116
|enuei/\|
>
lenueuj on
CD
£
lenueiAl
£
lenueiu on
|enue|/\|
ft
c
lenueiu on 0
■g
o
Figure 5.1: Mean Percentage Scores for Participants With and Without Use of a Manual
|enue|/\|
"ro £
□ Partially ach ieved

£
lenueiu on
lenueiAl
>>
lenueiu on CO
0
B Completely achieved
CD
ienue|/M w
"co
£
lenueiu on
|enue|/\|
Key
lenueiu on
Stage 2
lenueiAl
CD
7TTT
£
lenueiu on
lenueiAl
le n u e w o n
lenueiAl co
le n u e iu o n
paAOjipe ojoos aBeiuaojad

From Table 5.7, there do not seem to be any clear trends between the three groups of
experience/training. Scores are generally, but not exclusively lower for those in the
inexperienced and untrained group than both the experienced and trained and the trained
only groups. Comparisons of scores between the experienced and trained and the
trained only groups do not seem to show any consistent differences. Figure 5.2 shows
the mean percentage scores for the ‘total’ actions and ‘key’ actions for the exercise as a
whole for each of the experience/training groups. Scores for participants with and
without use of the manual are combined to show the effect of training and experience
irrespective of the effect of using the manual. Figure 5.3 shows the same results but
with the scores separated for those with and without use of the manual.
Figure 5.2: Mean Percentage Scores fo r Different Experience/Training Groups
6 0 .0 ,--------------------------------------------------------------------------------------------------------------------------------------------------------------
50.0 5 . .-------------- = 3
"O
a>
© 4 0 .0
Total group A - Experienced and C - Trained only D - No training or

Trained exp erien ce
g Completely ach ieved □ Partially ach ieved
118
Figure 5.3: Mean Percentage Scores for Different Experience/Training Groups, With and Without Use of the Manual
CD
^
o
o
o
o
CO
o
o
CM
paAajipe ajoos aBejuaojad

The summary graphs in Figures 5.2 and 5.3 show that the scores for the inexperienced
and untrained group are lower than both the experienced and trained group and the
trained only group. Comparison of scores between the experienced and trained and the
trained only groups seem to show slightly lower ‘key’ and ‘total’ scores for the
experienced and trained group when the scores of those with and without the manual are
combined. However, looking at the separated scores, for those without the manual, both
the ‘key’ and ‘total’ scores o f those with training only are higher than for the
experienced and trained group, but for those with the manual, there is the opposite
effect.
From comparison of scores between participants with and without use of the manual for
the exercise as a whole, the percentage improvement in ‘total’ and ‘key’ scores can be
calculated for the total group and each o f the training and experience groups, as shown
in Table 5.8.
Table 5.8: Percentage Improvement in ‘Total’ and ‘K ey’ Scores for Those Using the
Manual
Experience/training group Total/key Improvement in score

actions when using the manual
Total Total 16%
(n=79) Key 16%
Experienced and trained Total 31%
(n=12) Key 27%
Trained only Total 16%
(n=28) Key 15%
Inexperienced and untrained Total 12%
(n=36) Key 14%
For the total group, the percentage improvement in both ‘total’ and ‘key’ scores is 16%.
The percentage improvement in score is greatest for the experienced and trained group,
with a 31% increase in ‘total’ score and a 27% increase in ‘key’ score. The percentage
improvement in scores for the trained group are lower at 16% for ‘total’ score and 15%
for ‘key’ score and for the inexperienced and untrained group are even lower at 12% for
‘total’ score and 14% for ‘key’ score.
120
5.4.2 Statistical Analysis of the Significance of the Difference Between
Mean Scores
As described in Section 5.3, the data collected from the incident exercise was assessed
using univariable and multivariable analysis. Analysis was conducted for the overall
scores for ‘total’ actions and ‘key’ actions and the significance o f each o f the four
independent variables, use of manual, experience, training and occupational status was
assessed. The detailed SPSS data output can be found in Appendix 13.
Tables 5.9, 5.10 and 5.11 show the results of the unpaired t test assuming equal
variances, for ‘total’ score and ‘key’ score for the three binary independent variables,
use o f manual, experience and training. Tables 5.12 and 5.13 show the results o f the
one-way analysis of variance for occupation.
Table 5.9: t-test for the Independent Variable, Manual
Param eter Total actions Key actions

Mean score with manual 45.6 53.2
Mean score without manual 39.2 45.8
Difference in means +6.4 +7.4
95% confidence interval for
+2.8 to +10.1 +3.4 t o +11.3
difference between means
degrees of freedom 77 77
t 3.52 3.68
two sided p 0.0007 0.0004
Table 5.10: t-testfo r the Independent Variable, Experience
P aram eter Total actions Key actions

Mean score with experience 44.5 51.6
Mean score without experience 40.7 47.7
0 to +7.7 -0.3 to +8.2
t 1.97 1.83
two sided p 0.0525 0.0709
121
Table 5.11: t-test for the Independent Variable, Training
Parameter Total actions Key actions

Mean score with training 45.2 51.1
Mean score without training 39.5 47.7
be
+2.0 to +9.4
+
■
p
o
t 3.07 1.60
two sided p 0.0029 0.1145
Table 5.12: One-Way Analysis o f Variance for the Independent Variable, Occupation—
‘Total ’ Score
F (variance p for Type of Mean total 95% confidence interval

ratio) for occupation occupation score
occupation
Consultant 44.8 41.1 to 48.5
1.78 Medic 43.3 39.9 to 46.7
0.1587
Nurse 40.0 35.3 to 44.8
Other 38.6 32.8 to 44.5
Table 5.13: One-Way Analysis o f Variance for the Independent Variable, Occupation —
‘Key ’ Score
F (variance p for Type of Mean key 95% confidence interval

ratio) for occupation occupation score
occupation
Consultant 49.0 45.3 to 52.7
Medic 51.8 48.6 to 55.0
0.76 0.5192
Nurse 46.5 41.4 to 51.5
Other 47.6 40.9 to 54.3
In summary, the results of the univariable analysis show:

• The manual is a significant factor in affecting the ‘total’ score and ‘key’ score, with
p values o f 0.0007 and 0.0004 respectively. The improvement in mean ‘total’ score
for those with the manual is 6.4 percentage points, with a 95% confidence interval of
2.8 to 10.1. The improvement in mean ‘key’ score for those with the manual is 7.4
percentage points, with a 95% confidence interval of 3.4 to 11.3.
122
• Experience shows some significance in affecting the ‘total’ score, wifn p=0.0525,
but this is not very strong (i.e. statistical significance at p=0.050 has not been
achieved) and the effect on ‘key’ score is not shown to be significant (p=0.0709).
• The effect of training on ‘total’ score is shown to be significant with p=0.0029 but
no effect is shown on ‘key’ score (p=0.1145). The improvement in mean ‘total’
score for those with training is 5.7 percentage points, with a 95% confidence interval
of 2.0 to 9.4.
• The occupational status of the participant does not appear to have a significant effect
on ‘total’ or ‘key’ scores (p=0.1587 and p=0.5192, respectively).
Table 5.14 shows the results of the generalised linear model for the overall ‘total’ score.
The results of the final model are shown, variables with p>0.2 in the initial analyses
were eliminated.
Table 5.14: Results o f Tests o f Between-Subject Effects Using the Generalised Linear
Model for ‘Total ’ Score —Final Model
Parameter Regression Significance 95% Confidence Interval

coefficient Lower Bound Upper Bound
Intercept 49.8 0.000 46.4 53.1
Manual 6.7 0.000 3.3 10.1
Experienced 2.5 0.168 -1.1 6.1
Trained 5.3 0.004 1.8 8.8
Table 5.15 shows the results of the generalised linear model for the overall ‘key’ score.
The results of the final model are shown, variables with p>0.2 in the initial analyses
were eliminated.
123
Table 5.15: Results o f Tests o f Between-Subject Effects Using the Generalised Linear
Model for ‘Key ’ Score —Final Model
Parameter Regression Significance 95% Confidence Interval

coefficient Lower Bound Upper Bound
Intercept 56.4 0.000 52.6 60.3
Manual 7.5 0.000 3.6 11.4
Experience 3.3 0.114 -0.8 7.3
Trained 2.8 0.168 -1.2 6.9
In summary, the results of the multivariable analysis show:

• For ‘total’ score, use of the manual has the most significant effect (p=0.000);
• For ‘total’ score, training also has a significant effect (p=0.004);
• Experience is not shown to have a significant effect on ‘total’ score.
• For ‘key’ score, use of the manual again has the most significant effect (p=0.000);
• Neither experience nor training has been shown to affect the ‘key’ score.
5.4.3 Aspects of Chemical Incident Management Achieved by the Majority

of Participants
Analysis was conducted over the total group o f participants to identify which aspects o f
the response to the incident exercise were particularly well achieved, various aspects
were identified as being achieved by at least 75% o f the participants in the relevant
stages.
Stage 1 - first few hours

• Estimations of the population actually and potentially exposed.
• Identification of all environmental media affected.
• Determination of current weather conditions.
• Consideration of direction of movement o f the contaminant.
• Alerting relevant health organisations.
• Alerting emergency services.
• Alerting local authority environmental health department.
124
Stage 2 - within 24 hours
• Confirmation of number of people actually or potentially exposed.
• Confirmation of pathway/route o f exposure between source o f contamination and
human receptors.
• Confirmation of contaminant concentrations in the relevant media and attainment of
most up-to-date analytical results.
• Provision of press releases to alert the public and reassure those not affected.
Stage 3 - remainder of management

• Confirmation of population within current area o f contamination.
• Ensuring all people with health effects have been identified through the various
agencies.
• Confirmation of contaminant concentrations in relevant environmental media.
• Requesting any necessary repeat sampling and analysis to confirm results or detect
changes in concentration.
• Provision of press releases with follow-up information on how the incident is being
managed.
Post incident
• Writing a summary of the incident.
• Identifying the lessons learnt from the management o f the incident.
• Recognition of possible long-term health effects in those exposed.
• Ensuring preventative action is taken to avoid any further problems at the particular
site.
5.4.4 Aspects of Chemical Incident Management Not Achieved by the

Majority of Participants
Analysis was conducted over the total group o f participants to identify which aspects o f
the response to the incident exercise were particularly poorly achieved, various aspects
125
were identified as not being achieved by at least 75% o f the participants in the relevant
stages.
Stage 1 - first few hours

• Identification of taste/odour and visual properties of the chemicals involved.
• Identification of any synergistic or antagonistic effects of multiple chemicals.
• Contact with the manager at the incident site with regard to the chemicals used and
those likely to be involved in the incident - some participants identified this at stages
2 and 3.
• Identification of the type of contaminant source.
• Ensuring that symptoms are consistent with the toxicology of the chemical involved
- several participants identified this in stage 3.
• Recognition of whether the incident had been declared a ‘major incident’ by any of
the agencies involved.
• Assessment of whether the severity o f the incident is likely to escalate.
• Use of health authority (HA) emergency plan.
• Alerting other relevant department o f the local authority, e.g. emergency planning.
• Ensuring an incident room is available for incident control team meetings - some
participants identified this at stage 2.
• Ensure contact numbers for the team are provided to operational staff not in the
incident room.
• Scheduling of incident control team meetings.
• Documentation of incident details - some participants identified this at the post
incident stage.
• Recording o f contact names and numbers o f organisations involved - a few
participants identified this at the post incident stage.
• Logging calls and actions/decision taken - several participants identified this at the
post incident stage.
126
Stage 2 - within 24 hours
• Identification of other chemicals used in the process involved in the incident.
• Confirmation of location of the incident.
• Use of a map or geographical information system to map reports of health effects.
• Determining a specific case definition - a few participants identified this at stage 3
• Confirmation of the amount o f contaminant released.
• Considering the use of modelling to predict direction o f movement o f the
contaminant and possible areas at risk.
• Determining availability of any routine environmental sampling results, e.g.
regulatory drinking water analysis.
• Ensuring an appropriate analytical laboratory is identified for environmental samples
and that samples are collected, stored and analysed appropriately with adequate
quality control procedures.
• Confirmation of current incident status.
• Continued assessment of whether the severity of the incident is likely to escalate.
• Determination of criteria for incident closure - several participants identified this at
stage 3.
• Alerting relevant occupational health professionals.
• Alerting environmental specialists for clean-up and remediation.
• Confirmation that vulnerable populations had been identified and alerted - a few
participants identified this at stage 3.
• Recording incident details.
• Keeping a current list of contact numbers for organisations involved.
• Keeping logs of calls and actions/decisions taken.
• Recording minutes and agreed actions of incident control meetings - several
participants identified this at the post incident stage.
• Recording details o f actions taken by other organisations.
• Recording details of health effects and exposure.
• Obtaining names and addresses of the exposed population.
127
Stage 3 - remainder of management
• Establishing methods for interpreting environmental analytical data, identifying
relevant standards for comparison.
• Assessment of progress towards specified criteria for incident closure.
• Ensuring that all the organisations involved in the management and the public have
been informed when the incident is over.
• Keeping patient records and contact details - some participants identified this at the
post incident stage.
• Compiling a register of the exposed population, public and emergency responders.
Post incident
• Consideration o f the possibility o f tagging patient notes o f those exposed to identify
any future health problems that may be related to the exposure.
• Identification of specific actions to be taken as a result o f the incident to prevent
future incidents and improved response, with a named person responsible for
completion.
5.4.5 Actions Completed Outside the Specified Incident Stage
Some of the participants completed actions in stages earlier that those in which they
were specified. In this case they were carried forward and included in the score for the
relevant stage of the response. The actions that were completed early by quite a few of
the participants included:
• Provision of press releases to alert the public and reassure those not affected.
• Considering conducting biological monitoring of patients and the exposed
population to identify level of exposure and adverse health effects.
• Estimation of the time period o f exposure, differentiating between various
populations if exposed for different time periods.
• Agreement of financing and establishing timescales for reporting o f results where
additional samples have been requested.
128
® Considering distributing a health questionnaire to identify level o f exposure and
adverse health effects.
• Ensuring continued treatment o f casualties with long-term health effects.
• Where remediation is not possible and a significant risk to health remains,
considering permanent re-housing of people in the area affected.
• Considering the necessity for long term monitoring of the affected
environment/media if remediation is not possible.
• Considering conducting a follow-up epidemiological study (monitoring of relevant
health data).
• Ensuring remediation at site of contamination is complete and meets required
standards.
• Identifying preventative action to avoid the occurrence o f similar incidents.
• Writing up a summary of the incident.
• Identifying and documenting the lessons learned regarding management of the
incident.
Some of the participants completed actions in stages after the one in which they were
specified. Completion of actions later than required was not included in the score.
However, in Section 5.4.4 for those aspects that were badly achieved, indication has
been given if these particular aspects were identified at a later stage in the incident.
In addition to those actions highlighted in Section 5.4.4, the following actions were also
completed late by quite a few of the participants:
• Identification of physical and chemical properties o f the chemical involved.
• Finding out if any health effects have been reported to any agency.
• Alerting local authority environmental health department.
• Alerting local water companies, both water supply and sewage, where relevant.
• Alerting relevant enforcement agencies, e.g. Health and Safety Executive or
Environment Agency.
• Considering forming an incident control team.
129
® Ensuring necessary facilities are available in the incident room, e.g. telephones,
administrative support.
• Identifying vulnerable populations within current or potential area o f exposure.
• Conducting a toxicological evaluation o f exposure data to determine possible and
most likely impacts on health.
• Confirming that alternative water supplies have been provided where regular
supplies cannot be used.
• Considering conducting biological monitoring of patients and the exposed
population to identify level of exposure and adverse health effects.
• Confirming action has been taken to remove and dispose of the chemical(s), or to
remove the exposure pathway.
5.4.6 Additional Actions Completed to Those Specified in the Evaluation

Method
A few additional actions were identified from the exerciseresponses that had not been
specifically included in the evaluation method for theexercise,these arespecified
below:
• Alerting the HA press officer.
• Alerting the HA Director of Public Health and Chief Executive.
• Alerting the Health Emergency Planning Advisor (HEPA).
• Alerting the Regional Epidemiologist (RE).
• Contacting veterinary surgeons in the local area.
• Preventing access to the incident area.
• Stopping production of potentially contaminated soft drinks and recalling any
contaminated product.
• Obtaining maps of the water supply network and private water supplies.
• Conducting a site visit.
• Holding a public meeting.
• Compiling a report on media and communications handling during the incident.
• Assessing training needs of public health professionals as a result o f the incident.
130
• Identifying other sites where similar industrial operations take place.
• Identifying sites where use of plastic pipes may be problematic.
5.5 Conclusions
Validation testing of the guidance manual was conducted in order to assess its
effectiveness in improving the public health response to chemical incidents. The mean
percentage scores illustrate an improvement in scores for those participants using the
manual. Statistical analysis also confirms the significance o f the manual in improving
response. Statistical analysis also illustrated that previous training in chemical incident
management improved the ‘total’ score o f participants. However, it was not shown to
improve ‘key’ scores. Experience in managing chemical incidents was not demonstrated
to result in an improvement in response. The aspects o f chemical incident management
that were well and poorly achieved have also been identified.
In the following chapter an interpretation of the results is provided, the validity o f the
testing methodology is discussed, and the implications for further testing and
development o f the manual are identified.
131
6 Interpretation and Discussion of the Results from
Validation Testing of the Chemical Incident
Management Guidance Manual
6.1 Introduction
The aim o f the validation testing was to evaluate the effectiveness o f the chemical
incident management guidance manual in improving the public health response to
chemical incidents. A group of 79 public health professionals from six National Health
Service Executive (NHSE) Regions provided written responses to a chemical incident
exercise. These responses were evaluated to derive a performance score for each
participant. Performance scores were then compared between those with and without
the guidance manual and comparisons were also made between participants with and
without previous experience and training in chemical incident management.
The null hypothesis to be tested, as stated in Section 5.1, was therefore:

• There is no difference in the performance o f public health professionals with and
without the use of guidance manual in managing a chemical incident.
The additional questions to investigate were:

• Is the use of the guidance manual o f greater benefit to public health professionals
with no previous experience and training in chemical incidents compared to those
with previous experience and/or training?
• Irrespective of the use of the guidance manual, do public health professionals with
experience and/or training in chemical management achieve a higher level of
performance than those without?
132
The following sections provide discussion on:
• Interpretation of the results from the validation testing;
• Specific areas of the best practice model that were well or poorly achieved;
• Qualitative comments from participants on the testing process and the manual;
• Reliability of the validation testing methodology; and
• Implications of the testing results on the further development and use o f the
guidance manual.
6.2 Interpretation of the Results from the Validation Testing of

the Guidance Manual
6.2.1 Comparison of Mean Percentage Scores
The overall mean percentage score for the total group for the exercise as a whole was
found to be 42% for ‘total’ actions and 49% for ‘key’ actions. These results are
disappointingly low and provide further evidence that public health professionals who
are required to manage the health aspects o f chemical incidents may not have the
experience and training to respond effectively. Not only does this result indicate that
more efforts are required in order to ensure that relevant training is made available to
public health professionals, but it also supports the need for Chemical Incident Regional
Service Provider Units (RSPUs). RSPUs can provide the specialised information and
expertise, with respect to responding to chemical incidents, in their advice to health
authorities (HAs), and can assist in ensuring that incidents are managed effectively. In
general, there was greater achievement o f the ‘key’ actions (those with highest priority
for completion) than ‘total’ actions. The participants seemed to be able to identify and
complete these most important actions more successfully than those o f lower
importance.
Comparisons of scores for participants with and without use o f the chemical incident
management guidance manual show an improvement in the mean percentage score for
those with the manual for both ‘total’ and ‘key’ actions and across all stages o f the
133
incident exercise. Improvement in performance by using the manual was also
demonstrated across the different groups of experience and training. The manual has
therefore been shown to consistently improve the scores in the incident exercise for the
participants included in the testing process. The percentage improvement in score for
those using the manual was found to be 16% for both ‘total’ and ‘key’ actions for the
incident exercise as a whole. The percentage improvement in score varied between the
experience and training groups, with the experienced and trained group having the
greatest improvement, 31% for ‘total’ score and 27% for ‘key’ score. The trained only
group showed an improvement o f 16% for ‘total’ score and 15% for ‘key’ score, and the
inexperienced and untrained group a 12% improvement for ‘total’ score and 14%
improvement for ‘key’ score. This is contrary to the hypothesis that ‘the use of the
guidance manual will be of greater benefit to those with no previous experience and
training in chemical incidents’. In retrospect, it would seem more logical that those
participants who already have a framework in which to set the manual would find it
easier to apply it to a particular exercise. With no previous experience or training in
chemical incidents, it may be difficult to know how to use the information provided in
the manual.
The effect of training and experience on actual performance scores was more difficult to
assess. Those with no training and little or no experience definitely had lower scores in
general, compared to those with training and/or experience. This confirms the value of
gaining specific expertise in chemical incident management in order to improve
response to incidents. The effect of training versus experience was not clear from the
mean percentage scores, there seemed to be some indication that those with training but
no experience actually scored better than those who had experience in addition to
training. Only three of the participants had experience in managing chemical incidents
but no training. The lack of clarity on the effect o f experience on the individual scores
seems to be inconsistent compared with the finding that a greater percentage
improvement in score when using the manual was achieved by those with experience
and training, as compared to those with training only. From Figure 5.3 in Chapter 5, it
can be seen that part of the greater percentage improvement in score by the experienced
134
and trained groups is brought about by a higher performance by those with the manual
compared to the trained only group. In addition, those with experience and training
without the manual had lower scores that the trained only group. As discussed later in
Section 6.4.2, the sample sizes used in determining the percentage improvements were
not very large. Further discussion on the effect of training and experience on
performance can be found in the next section.
6.2.2 Statistical Analysis of the Significance of the Difference Between

Mean Scores
The univariable analysis, using t-tests and analysis o f variance, and the multivariable
analysis, using the generalised linear model, again showed that the use o f the manual
resulted in an improved performance, for both ‘total’ and ‘key’ actions. The p values
from the two-sided t-test for the effect o f the manual were 0.0007 for ‘total’ score and
0.0004 for ‘key’ score. The improvement in mean ‘total’ score for those with the
manual was 6.4 percentage points, with a 95% confidence interval o f 2.8 to 10.1. The
improvement in mean ‘key’ score for those with the manual was 7.4 percentage points,
with a 95% confidence interval of 3.4 to 11.3. The generalised linear model showed the
p value for the manual to be 0.000 for ‘total’ and ‘key’ scores. The statistical analysis
therefore confirms the importance o f the manual in improving the performance o f the
participants in the incident exercise, thereby disproving the null hypothesis that there
would be no difference in performance for those with and without the manual.
The t-test did not show that experience had a significant effect on performance.
However, training was shown to be a significant factor with a p value of 0.0029 for
‘total’ score, but had no significant effect on ‘key’ score. For ‘totd’ score, the effect o f
training was an improvement in mean ‘total’ score of 5.7 percentage points, with a 95%
confidence interval of 2.0 to 9.4. In the generalised linear model, experience was again
shown to be insignificant, however, training was shown to be a significant factor in
improving ‘total’ score (p=0.004) but not for ‘key’ score. For the statistical analysis
‘experienced’ was defined as anyone who had been involved in at least one chemical
incident. The knowledge and expertise gained from involvement in only one incident
135
would not be expected to have a large effect on the future performance o f the individual,
as the response required would differ significantly depending on the exact nature o f the
incident in question. For the groups used in comparing the mean performance scores,
‘experienced’ was defined as being involved in five or more incidents, as this was
intended to ensure participants would have had some breadth o f experience. However,
only 15 of the 79 participants had this level o f experience and with this small sample it is
difficult to show any clear trends. In conclusion, although experience appears not to
improve the performance o f individuals in managing an incident, this is most likely to be
due to the fact that the majority o f public health professionals will only have the
opportunity to be involved with very few numbers o f incidents.
Training was shown to have a positive effect on improving the ‘total’ score o f the
participants. This result could be due to the fact that specific CIRS training on chemical
incident management would include providing a general framework for managing an
incident that would not be gained through experience alone. Also, training would
involve the dissemination of lessons learnt by CIRS through involvement in hundreds of
incidents a year, i.e. a much larger information base than could be achieved by an
individual public health professional.
A possible reason for why training is only shown to improve ‘total’ score and not ‘key’
score could be that ‘key’ actions are more obvious and could be identified using general
common sense and do not require specific training. However, in order to be able to
cover all the issues involved in the management o f a chemical incident, the benefit of
training to identify the less obvious issues is more apparent. As identified earlier, the
‘key’ scores were found to be higher than the ‘total’ scores, which seems to reinforce the
hypothesis that these actions are more obvious, even to the untrained. Another possible
reason could be that the training provided does not emphasise the priorities of the
different aspects of chemical incident management. This could result in those with
training having an improved overall performance, but not being better at identifying and
completing the high priority actions. Alternatively, by providing training covering all
possible issues involved in chemical incident management, it may result in participants
136
being concerned with ensuring their response is as complete as possible instead of
making sure they have completed the most important actions first.
In the statistical analysis, the effect o f occupational status was also assessed, but was not
shown to be significant. This would seem to imply that status as consultant, registrar,
nurse or other occupation is not important, compared to the benefit achieved from using
the manual or from having training in chemical incident management.
6.2.3 Specific Aspects of Chemical Incident Management
In Section 5.4.3 the aspects of incident management, as specified in the evaluation

method, that were particularly well achieved were identified. The areas of chemical
incident response that were achieved by at least 75% o f participants were:
• Identifying the population exposed and potentially at risk and those with actual
health effects;
• Obtaining analytical results with the concentrations o f the chemical in relevant
environmental media and ensuring repeat samples are taken to monitor for any
changes;
• Determining current weather conditions and assessing likely direction o f movement
o f the contaminant;
• Determining the possible pathways/routes o f exposure between the source of
contamination and the population;
• Alerting health organisations, the emergency services and environmental health;
• Provision o f press releases to alert and inform the public;
• Recognition of the possible requirement for long-term follow-up o f those exposed;
• Ensuring preventative action is taken to avoid future problems from the company
responsible for releasing the chemical; and
• Writing a post-incident report and identifying lessons learnt from the management o f
the incident.
137
In Section 5.4.4 the aspects of incident management, as specified in the evaluation
method, that were particularly badly achieved were identified. The areas o f chemical
incident response that were achieved by 25% or less o f participants included:
• Identifying the taste/odour and visual properties of the chemical and any possible
synergistic or antagonistic effects o f multiple chemicals;
• Confirming details about the location o f the incident and the industry involved and
contacting someone at the site;
• Confirming the amount o f the chemical involved and identifying other possible
chemicals involved in the incident;
• Use of the health authority emergency plan;
• Alerting other relevant local authority departments;
• Organising an incident room and contact numbers for those in the room, scheduling
of incident meetings, and recording minutes and agreed actions;
• Confirming any particularly vulnerable populations in the area;
• Considering the use of modelling to predict movement o f the chemical;
• Requesting results of any routine sampling that may be available, particularly for
drinking water;
• Ensuring that appropriate laboratories are used for sampling and analysis with
adequate quality control procedures, and determining methods o f interpreting the
results from analyses;
• Considering the current status of the incident and possible escalation o f the problem
and reassessment of status throughout the incident, specifying criteria for closure and
assessing progress towards these;
• Documenting any incident, contact, and patient details, logs o f calls/actions, etc.
during the actual incident. Documentation was largely only mentioned at the post
incident stage; and
• Compilation of registers of the exposed public and responders with contact details.
In Section 5.4.5 actions completed at stages other than those specified by the evaluation
method were identified. O f those that were completed consistently early, the majority
138
were post incident actions that had been considered in the last stage o f the management.
However, this was most likely to be due to the fact that the participants seemed to be
unaware that they would have a separate opportunity to write down their post incident
actions. Actions that were consistently completed late were also identified, o f particular
note were:
• Identifying the physical and chemical properties o f the contaminant - it is important
these are established as soon as possible as they will influence how the chemical
behaves in the environment and therefore the risk to the population. However, in
many circumstances details of properties may not be available immediately.
• Conducting a toxicological evaluation o f exposure data to determine possible and
most likely impact on health - ideally this should also be completed as soon as
possible, in order to assess the risk to the population. However, toxicological data
may not be immediately available, particularly if specific chemical details are
unknown.
• Considering forming an incident control team - if appropriate, this should be
convened as soon as possible to ensure a co-ordinated multi-agency response.
• Confirming action has been taken to remove and dispose of the chemical or exposure
pathway - although the actual clean up would not be the responsibility o f the health
authority, this is an essential part of the response in order to ensure that there is no
continuing exposure of the population.
• Considering conducting biological monitoring - if biological monitoring is to be
conducted it is likely that samples will have to be taken as soon as possible after
exposure, as the chemicals may have a short biological half-life.
Finally, a few additional actions were identified from the responses to the exercise that
had not been specified in the evaluation method. These were incorporated into the
revised best practice model and evaluation method, as discussed in Section 7.5.
139
6.2.4 Summary
With respect to the original hypotheses, the validation testing has shown that from the
performance scores derived from those taking part in the testing process:
• The chemical incident management guidance manual developed from the research
project significantly improves the level o f performance o f public health professionals
in responding to a chemical incident.
• The use of the manual is o f greater benefit to those with training and/or experience in
chemical incident management, compared to those without, contrary to the
hypothesis.
• Training is a significant factor in improving the level of performance for ‘total’
actions, but not for ‘key’ actions. However, experience was not found to be
significant.
6.3 Comments Received on the Testing Process and

Guidance Manual
Some comments were received during the exercise and training sessions concerning the
exercise and the guidance manual. Additional comments were also added to the
evaluation forms completed for each of the six training sessions. Positive comments
were received about the exercise scenario and how realistic it was, some minor
comments were made on missing details within the scenario. Some participants felt it
was helpful to complete the exercise individually, in order to find out the limits of their
knowledge and expertise. However, several participants felt that acting alone was
unrealistic and that group exercises are more beneficial. Participants also commented
that, in reality, managing an incident would come in addition to conducting routine work
activities. With regard to the manual itself, general comments were made that the
manual approach was helpful and the content seemed very useful. It was felt that
training on how to use the manual was necessary to enable its full benefit to be attained.
The main problem with the manual was the layout and ‘sign posting’ to different
resources within the manual. Another general comment was that the manual, covered
140
areas of incident management that are not within the responsibilities of the public health
function.
A comment form was attached to the front o f each guidance manual and participants
were asked to return the completed form when they had had an opportunity to look
through the manual in more detail and to use it during an actual incident. Unfortunately,
over the period of several weeks, only 18 comment forms were returned completed. The
results from the following specific questions asked were:
• Do you find the manual approach useful?
o y e s-1 0 0 %
• How easy did you find it to use the manual? - on a scale of l(very difficult) to 5
(very easy)
o 3.75 (75%)
• How easy do the contents page and summary diagrams make it to find the required
guidance note? - on a scale of l(very difficult) to 5 (very easy)
o 3.70(74%)
• Did the checklist of actions for chemical incident management provide a useful
summary of issues and actions? - on a scale of l(not useful) to 5 (very useful)
o 4.40(89%)
Qualitative comments were provided about each aspect of the manual and the manual in
general these are specified below:
• Briefings:
o informative and comprehensive
o useful
o clear and easy to follow
o information needs to be ‘localised’ and kept up to date
o content does not reflect the role o f public health doctors, some aspects
fall within the remit of other agencies
141
o more detail required on levels o f command and what specifically they
involve
• Checklists
o useful
o comprehensive
o content needs to reflect the role o f the Consultant in Communicable
Disease Control (CCDC)
o format could be improved, need to reduce density o f text to make them
easier to go through quickly
o need provision to record completed items during an incident
• Flowcharts/diagrams
o clear and easy to use
o some do not flow very well
• Forms
o very useful
o need more space to complete details
o some need to be tailored to local needs
o need to be available electronically
General comments included:

• Manual is a good resource/tool;
• Excellent overview of the issues;
• Practical and useful;
• Detailed and comprehensive;
• Need to provide more instructions on how to use the manual and a detailed contents
list and better indexing for easier location of relevant material; and
• Could organise manual by topic, rather than type o f guidance.
Copies of the manual were also sent to some of the people who took part in the expert
consultation for the best practice model. A limited number o f comments were returned.
142
Most o f the comments were with respect to the presentation o f the manual, rather than
the specific content, and the need for clearer specification o f the purpose o f each
resource and the limits of the public health role. Detailed discussions on the content and
presentation of the manual were conducted with Dr Kaetrin Camegie-Smith,
independent consultant in public health medicine and public health advisor to the
Emergency Planning College.
6.4 Discussion of the Validation Testing Methodology
6.4.1 Sample Selection
The results obtained indicate the performance of a particular group of public health
professionals in responding to a specific incident exercise. The provision o f confidence
levels enables predictions to be made about the probable range o f the improvement in
score resulting from use of the manual, or previous chemical incident training, that
would be achieved across the population of public health professionals as a whole. The
sample of public health professionals used in the testing exercise was biased towards the
untrained and inexperienced. This could be due to the fact that attendance o f the
exercise and training sessions was considered to be o f more value to those with no
previous training or experience. The total population o f public health professionals that
may be required to cover the management of chemical incidents as part o f an on-call rota
is also likely to largely consist of people who have no or little previous training or
experience in chemical incidents. The number of chemical incidents handled by each
health authority is relatively low and CIRS training events are only attended by a
fraction of the total possible number o f public health professionals. Invariably, only
those who take the HA lead in responding to chemical incidents attend these training
events.
The sample group was self-selected; the exercise and training sessions were advertised
to all public health staff in health authorities, largely through the CsCDC. Individuals
then attended the sessions on a voluntary basis. A possible area o f bias is that only
143
public health professionals from HAs with service level agreements with CIRS were
asked to take part in the exercise sessions. The general experience and training of public
health professionals would not be any different for the remaining HAs in England, but
specific training on chemical incident management may vary between Chemical Incident
RSPUs.
The selection of those using the manual was largely related to those who were able to
arrive at the session early enough to receive preliminary training on the use of the
manual. A few participants received the manual without the introductory training; these
manuals were allocated on a first-come-first-served basis. Venues were chosen within
each of the six NHSE Regions on the basis o f availability of a suitable room and with
the aim of having a reasonably central location for participants to travel to. In addition,
in allocating the manual to the participants, the aim was to ensure that manuals were
used by participants across the range o f experience and training. This was largely
achieved by default, but some selection of participants with appropriate
experience/training was required for the last two training sessions to ensure an adequate
balance.
In summary, it is considered that the sample o f public health professionals taking part
was representative and that although allocation o f the manual was not random, there
would appear to be no reason why the method used would have created any bias in the
results. The most likely cause o f any distortion in performance scores o f the
participants, compared to the general population o f public health professionals, is
considered to be the fact that the participants all volunteered to take part and therefore
are likely to have had a greater interest in chemical incident management.
6.4.2 Sample Size
The total sample size for the validation testing exercises was 79 participants, 39 o f these
used the manual. These samples sizes are considered to be large enough for the results
to be applicable to the total population. With respect to the sample sizes for the different
groups of experience and training used in comparing the mean percentage scores, the
144
inexperienced and untrained group consisted o f 36 participants and the trained only
group of 28 participants, which again are acceptable sample sizes. However, the
experienced only group consisted o f just three participants and the experienced and
trained group of 12 participants. Due to these small sample sizes, the inferences drawn
about the effect of experience and training on performance, and particularly about
experience may be less robust. Percentage improvements in scores achieved by those
with and without the manual were calculated for the different experience and training
groups, this would involve even smaller sample sizes.
In the statistical analysis, each participant was given separate ‘experienced’ and ‘trained’
designations and the effect of experience and training on the performance scores was
assessed separately. ‘Experienced’ was defined as being involved in one or more
chemical incident and included 35 o f the participants. ‘Trained’ was defined as being
involved in at least one training day and included 39 participants. These sample sizes
therefore allow for more confidence in the results from the statistical analysis.
6.4.3 Categorisation of Participants
The experience and training categorisations are an area of potential bias within the
process of interpreting the results. A definition o f what could be considered
‘experienced’ is debateable. For the comparison o f mean performance scores, the
groups of experienced and trained; experienced only; trained only; and inexperienced
and untrained were allocated by defining those with past involvement in five or more
chemical incidents as ‘experienced’ and those who had attended at least one CIRS
training day as ‘trained’. Attendance o f the CIRS training day on ‘how to respond to
chemical incidents’ is considered to be the basic requirement for those taking the HA
lead in responding to chemical incidents. A definition of experience is more difficult to
justify and a limit o f five incidents was selected as providing some breadth o f experience
o f different types o f events without restricting the size o f the sample too much. For the
statistical analysis, the significance o f any experience (i.e. involvement in at least one
chemical incident) was assessed; this provided a more equal division of the group and
145
gave clear definition between experienced and not experienced rather than between
degrees of experience.
As the positive effect of training was determined from the results, the use o f attendance
at only one training day would seem to have been vindicated. A possible cause o f the
unclear interpretation of the effect of experience is thought to have been the definition of
‘experienced’ used. If a cut off point had been used at a higher level o f experience, for
example involvement in 10 or more chemical incidents, a clearer result may have been
achieved. However, only nine participants had this level of experience, and this small a
sample would not have provided conclusive results.
The provision of information by the participants on their previous experience and

training may also have introduced an element o f bias as participants could have used
different definitions. Participants were asked to specify the number o f chemical
incidents they had had significant involvement in. This could have been interpreted
differently depending on how much involvement participants considered to be
‘significant’ and there may have been confusion over what constituted a chemical
incident. However, the majority of public health professionals seem to be aware o f the
definition of an incident used by CIRS. Another factor is the reliance on participants to
accurately remember the number of incidents they have been involved in, which may
have occurred infrequently over a long time period. Participants were asked specifically
how many CIRS training days they had attended, but were also asked to provide any
additional details of relevant experience or training which was taken into account when
deciding whether participants were ‘trained’. Some confusion may have arisen if
participants had only included CIRS training obtained in London and not regionally
based training which has also been provided.
6.4.4 Length of Service
An additional factor affecting performance, which was not accounted for in the analysis,
is the length of service o f the participant. Someone who has worked as a public health
professional for several years may be able to apply general public health principles to
146
the management of chemical incidents more successfully without any specific training
and experience in this area. Statistical analysis was conducted to assess the effect of
occupational status on performance. It would be expected that there would be some
association between length of service and whether the participant was a consultant or
specialist registrar. Occupational status was not shown to have a significant effect on
performance, and therefore, length of service would also not be expected to improve
performance.
6.4.5 Training On and Use of the Manual
It was initially planned that introductory training on the manual would be provided to
half the group using the manual and the rest would use the manual without any prior
knowledge on its content or intended application. However, due to the complication o f
adding another variable to the analysis, and also participant’s reluctance to use the
manual without any introduction, the majority (30) of the 39 participants using the
manual did receive training. This meant it was not really possible to assess the effect of
training. The group of nine participants with the manual but no training were also not
spread across the experience and training groups in the same proportions as those who
did receive specific training. The comments received from the participants verified that
the success of the manual would partially depend on specific training being provided on
its use. In addition, it was not possible to assess how often the participants did actually
refer to the manual. From personal observations some participants did appear to use the
manual more than others.
6.4.6 Chemical Incident Exercise
Applicability of the results from the testing process to chemical incident management in
general would depend on the incident scenario devised. The aim was clearly to simulate
the events and the corresponding response that would occur in the management o f an
actual incident. The incident exercise was based on actual chemical incidents and
participants commented on the scenario being realistic. It is possible that performance
may vary depending on the type of incident and the specific details.
147
Differences in response between the exercise and an actual incident may also occur due
to the fact that the exercise was conducted in isolation to any other work activities. It
would be expected that distractions by other tasks would result in a further reduction in
effectiveness of the response. Set time periods were used for completion o f each stage
of the exercise by the participants, and were kept the same for all six training sessions.
The majority of participants seemed to have adequate time to complete their responses.
Comments received from the participants confirmed that the timings allowed fa* the
exercise were appropriate.
Another factor that may have affected the applicability of the exercise results, compared
to the management of an actual incident, was that the exercise was completed on an
individual basis in order that participant specific performance scores could be obtained.
Several comments were received from participants that suggested that working on their
own was unrealistic and would prevent them from discussing their response with
colleagues within the health authority. As part of a multi-agency response they would
also be collaborating with other organisations and obtaining advice and information
directly from them. Although working in groups on the exercise may have been more
realistic, it would have been difficult to evaluate the response. In addition, public health
professionals, particularly those working on-call, may have to conduct some o f their
response on an individual basis and it was considered that evaluation o f individual
competencies was useful.
Care was taken to ensure that the instructions provided to the participants were the same
for each of the six exercise sessions, and the same information was provided to those
with the manual in each case. The only information about the incident available to the
participants was that which had been stated on the exercise scenario.
During the actual conduction of the incident exercise, biases may have occurred due to
participants conferring during the exercise and at breaks between stages. Participants
were encouraged not to discuss the incident until it was completed but it was not
possible to completely enforce this.
148
6.4.7 Provision of a Written incident Response
The requirement to provide written details on how the incident would be responded to
may have led to inconsistencies between the response provided for the exercise and that
which would occur in an actual incident. Writing a response in a specified time frame
and with no other distractions may have resulted in an ‘ideal’ response being provided,
which may not reflect what actually happens in practice. It was necessary for a written
response to be documented in order to provide a record that could be subsequently
evaluated.
Although the need to record everything that would be included in the response was
impressed upon the participants at the start o f the exercise, it is possible that some
aspects that were seen as obvious were not recorded. In addition, information provided
to the participants as part of the exercise scenario may not have been documented again
as part of the response. The area o f incident management that is most likely to have
suffered from the method used to record the response is documentation. Participants
may have easily forgotten to write down that they would be recording their actions and
incident details, even if they would do so in an actual incident.
Finally, the section headings on the forms provided to the participants, may have guided
them to a particular response. However, the same forms were used for all the exercise
sessions and only general headings were provided, with the aim o f giving the
participants somewhere to start and to make it easier to find information when assessing
the responses.
6.4.8 Evaluation Method
The evaluation method was based on the best practice model, which was devised from
extensive experience in the management of chemical incidents and from consultation
with experts in the field of chemical incident management. Development of the best
practice model and evaluation method is described in detail in Chapter 4.
149
The evaluation method for the incident exercise specified the required response in detail,
ensuring that responses would be consistently assessed. In evaluating the responses a
positive bias was adhered to, and partially completed actions were included which would
result in a generous score being assigned.
The categorisation of the actions within the evaluation method as ‘key’ and ‘total’ was
aimed at separating actions that must be completed, from those that could be excluded
without causing as much detriment on the overall management o f the incident. The
‘key’ actions were also selected to focus on the public health role, so actions that would
be very important as part of the total response, but are primarily the role o f another
agency were not specified as ‘key’.
6.4 Implications of the Validation Testing Results and

Comments on Further Development and Use o f the
Guidance Manual
In summary, the implications of the validation testing with respect to the further
development of the chemical incident guidance manual itself were:
• Two additional resources were required, a more detailed introduction on the
application of the manual, and a glossary o f terms.
• From the expert comments, and in particular, consultation with Dr Kaetrin Camegie-
Smith (an independent consultant in public health medicine and public health advisor
to the Emergency Planning College), some minor changes were required to the
content o f some of the guidance materials within the manual.
• The format o f the individual resources needed to be clearer with an introductory
paragraph for some materials, followed by more succinct information for quick
reference during an incident.
• The order of the resources needed to be revised to make it easier to work through
them during an incident.
150
® There needed to be clearer demarcation o f the public health role in managing a
chemical incident.
The above changes were incorporated into the manual after the validation testing.
Version 2 of the manual is reproduced at the back o f Volume 2 after the Publications
Section.
Further testing of the effectiveness o f the manual and the independent effect of
experience in chemical incident management could be conducted. A study
encompassing more CsCDC who are likely to have greater experience in managing
previous chemical incidents may provide more conclusive evidence on whether
experience affects level of performance and the degree o f experience required before a
positive effect is attained. It would also be useful to present various resources in
different formats and/or colours and test their relative effectiveness. This would enable
the best presentation method to be determined. Further testing o f the manual in real
incident situations would also provide more information on its practical application. The
benefits of using the manual may be cumulative over time as familiarity o f using the
manual is gained. It would be interesting to repeat performance evaluations on the same
set of individuals over time, although, obviously the level o f experience and training is
also likely to increase over the same period.
Finally, the validation testing also confirmed the value o f chemical incident management
training in general and its beneficial impact on performance. Areas that are particularly
poorly achieved in responding to chemical incidents were identified from the
evaluations. Training could be targeted to these areas and also on the prioritisation of
actions during an incident. It would be advised that in providing the manual to public
health professionals, specific training should also be made available on how it should be
applied in an actual incident.
151
7 Discussion
7.1 Specification of the Project Aims and Objectives
At the commencement of the project, it had already been identified that there was a gap
in the knowledge base of CIRS and public health professionals in managing chemical
incidents. The focus of the advice provided by CIRS was toxicological/medical and a
need was identified to broaden the management process of chemical incidents. In 1993,
clear responsibilities, with respect to the management of the health aspects of
environmental hazards and chemical incidents specifically, were designated to health
authorities (HAs) in National Health Service (NHS) Guidelines (DH et al, 1993 and
NHSME, 1993). These were further strengthened by later NHS Executive guidance on
planning for major incidents (NHSE, 1998). These responsibilities were delegated to
public health departments within HAs, and in particular to Consultants in
Communicable Disease Control (CsCDC). However, there is a lack of training and
experience of public health professionals in the management of chemical incidents.
Further evidence for the need to investigate and document the management of chemical
incidents, and specifically to provide guidance for public health professionals, was
identified through two literature reviews and a questionnaire survey. A review of water-
related chemical incidents in the published literature found only eight reports of
incidents in Britain between 1994 and 1997, indicating that there is incomplete learning
and dissemination of lessons from the management of chemical incidents. A review of
chemical incident management procedures found no generic guidance for the emergency
response to chemical incidents aimed at public health professionals. A questionnaire
survey aimed at Consultants in Communicable Disease Control or Public Health
Medicine (CsCDC/CsPHM) found a varied and generally limited level of training and
experience in chemical incident management and identified a need for chemical incident
management tools and procedures.
152
For public health doctors, the management o f chemical incidents is only a small part of
their work responsibilities. The need to be involved in the management o f a chemical
incident is infrequent, and the background training o f public health professionals has
very little input on the management of this type of event. The nature o f a chemical
incident is such that it could occur out o f normal office hours, so responsibility for
responding forms part of the on-call public health rota within HAs. The designated lead
person for managing the health aspects of environmental hazards within each health
authority will have had the opportunity for specialist training and may have had a few
experiences of involvement in the management o f chemical incidents. However, this is
not necessarily the person who will be required to provide the first response to a
chemical incident. A source of expert guidance in both the process and the specific
details o f managing a chemical incident is therefore required for public health
professionals who may be required to provide a response without any, or at best with
minimal, previous training or experience in this specific area. It will not always be
possible for the appropriate Chemical Incident Regional Service Provider Unit (RSPU)
to guide the public health doctor through every detail o f their response to an incident,
therefore, the provision of guidance materials to provide the necessary knowledge base
is required.
The aim of the research project was to draw lessons from the management o f chemical
incidents and any relevant literature, and to use this information to devise a best practice
model for the public health response to chemical incidents. The subsequent objectives
were:
• To develop a chemical incident management guidance manual with specific
information and tools to direct public health professionals to meeting the criteria set
out in the best practice model;
• To develop a quantitative evaluation method to assess the performance o f public
health professionals in managing a chemical incident; and
153
• To assess the effectiveness of the chemical incident management manual (using the
above evaluation method) in improving the management of chemical incidents by
public health professionals.
7.2 Collection of Information on Chemical Incident

Management
In order to be able to extract information from the management of chemical incidents to

assist in devising procedures to improve future management, proper documentation is
required o f the incidents being investigated. Normal incident documentation at CIRS is
not sufficient to conduct a detailed investigation o f past incidents. Direct involvement
of the research engineer in the examination o f the incidents described in Section 3.1.2
allowed full details of the circumstances o f the incident to be recorded. By
comprehensively documenting these incidents it was then possible to analyse them at a
later date to identify any specific lessons that could be learnt from the incident that
would be applicable to future incidents and could be included in incident management
guidance materials.
The investigations detailed in Sections 3.1 and 3.2 provided the main information inputs
to the project. This enabled the research engineer to establish the current state o f
knowledge amongst public health professionals in the management o f chemical
incidents, and also to identify areas o f best practice and issues that seem to be
particularly problematic. Over the research period, there were 246 water-related
chemical incidents. The research engineer had direct involvement in the management of
70 incidents; fourteen have been studied and documented in depth. In Section 3.1.5.1, a
number of principles of best practice derived from the management of actual incidents
are specified. Two specific types o f chemical incident were also identified that seemed
to occur on a reasonably frequent basis; lessons from these are addressed in Section
3.1.5.2. The incidents studied as part o f the research project were primarily taken from
those reported to CIRS and therefore locations were largely restricted to the area covered
by HAs with service level agreements with CIRS. Participation in CIRS training
154
sessions, and in particular in the development and facilitation o f incident training
exercises, added to the knowledge base of how chemical incidents are currently
managed. They also provided the opportunity to obtain feedback on what resources
would be useful to public health professionals to assist them in improving their response
to chemical incidents. Lessons learnt from the training and exercise aspects o f the
project are described in Section 3.2.5.
The lessons learnt as identified from the involvement in chemical incidents and incident
exercises combined with the information obtained from relevant publications on aspects
of chemical incident management, enabled the development o f chemical incident
management tools, as described in the next section.
7.3 Development o f the Chemical Incident Management Tools
7.3.1 Introduction
Leading on from the objectives of the project, the chemical incident management tools
developed were:
• A best practice model for the public health response to chemical incidents;
• A chemical incident management guidance manual providing detailed guidance to
enable public health professionals to meet the criteria set out in the best practice
model; and
• A quantitative evaluation method to allow the performance of public health
professionals in managing a chemical incident to be assessed.
In addition, the effectiveness of the chemical incident management manual in improving

the management of chemical incidents by public health professionals was tested. This
was achieved by using the evaluation method, as specified above, to assign performance
scores to the responses provided by a group of public health professionals to a chemical
incident exercise. The performance o f those who used the manual was then compared
with those that did not.
155
As described in Section 7.2, the main information input for the development o f the
chemical incident management tools was the involvement in the management of
chemical incidents and exercises. The focus o f this involvement was on water-related
chemical incidents, and generally those affecting drinking water or surface waters.
However, in developing the chemical incident management tools a broader approach
was taken. The best practice model and associated evaluation method are intended to
cover all types of chemical incident, the guidance manual currently covers issues that are
common to all types of chemical incidents and also some issues that are specific to
water-related chemical incidents. However, the final version of the manual will cover
all types of chemical incident as discussed in Section 7.5.2. The main focus of the
chemical incident exercise used in the validation testing process for the guidance manual
was drinking water contamination. However, the aim of the exercise was to cover as
much of the evaluation method as possible, and secondary air and land contamination
aspects were also included in the scenario.
7.3.2 Best Practice Model for the Public Health Response to Chemical
Incidents
The methodology for developing the best practice model is explained in detail in Section
4.1, the aim of this section is to discuss any possible sources o f bias or error associated
with the methodology and any consequent limitations to the model.
All the issues and actions incorporated into the best practice model were determined
from involvement in actual chemical incidents and also from relevant literature. As
discussed above, the focus of the involvement in chemical incidents was on water-
related chemical incidents, and therefore there could possibly be difficulties associated
with air or land contamination issues not being addressed. This potential problem was
tackled by consulting the wider literature on management of all types o f chemical
incident, and by conducting consultation with experts across the field o f chemical
incident management. In addition, many o f the incidents studied that resulted in water
pollution, also affected other environmental media, particularly land. Also, by being
156
based at CIRS, the research engineer was able to experience exposure to other types of
incidents and in some cases was directly involved in their management. Two further
research engineers have specifically covered the investigation of air and land-related
incidents.
After identifying the issues for inclusion in the best practice model, a group o f experts in
chemical incident management from the public health field and also other organisations
involved in responding to chemical incidents were consulted. They were asked to rate
the issues in order to identify which should be included in the initial emergency response
period, within the first few hours o f being alerted. As identified in Section 4.1.3, the
format of the model for the consultation process may have resulted in directing those
providing ratings to give a rating of 1 to the issues at the beginning of the model and 5 to
those at the end, rather than obtaining an unbiased opinion of the rating. In addition,
although comments and ratings were received from 26 experts across a range of
organisations, ideally a larger group should have been surveyed and also some key
responders were not included in the consultation, most notably, the ambulance and
police services and accident and emergency hospital departments.
The final best practice model, with the issues and actions categorised into chronological
stages, was devised as a result of the ratings provided from the consultation process.
However, the ratings from public health specialists and other organisations were
combined. If there had been a larger group o f experts it may have been useful to
separately analyse the ratings provided by the different organisations. In particular, as
the model is aimed at the public health response, by incorporating the ratings o f the
other organisations the final model may not truly reflect the priorities of public health
professionals, although those involved in the consultation process were specifically
instructed to consider the public health angle. In addition, the consultation only
involved one stage, time permitting, it would have been useful to have sent out the
model again after categorising the issues/actions and to obtain a consensus on whether
issues had been categorised appropriately.
157
With respect to the scope o f the best practice model, it is intended to cover all types of
chemical incident, although the primary aim is to cover minor incidents. It is felt that a
major disaster or catastrophic incident would have significantly different priorities and
involve different management processes. However, it may be argued that it would be
more useful to have one model that applies to all levels o f incident. The timescales used
for the chronological categories are more applicable to acute incidents. Again, it may be
preferable to develop a completely generic model. However, even in a chronic incident,
the issues involved are likely to be similar, particularly where chronic contamination has
led to acute health effects or there is a public and/or media reaction that requires a rapid
response.
7.3.3 Chemical Incident Management Guidance Manual
The methodology for developing the guidance manual is described in Section 4.2. In
summary, the aim o f the manual was to provide more detailed information in order to
guide public health professionals towards meeting the criteria specified in the best
practice model. The information basis for the guidance materials devised for inclusion
in the manual was again the involvement in actual chemical incidents and also published
literature on aspects of chemical incident management. As described in the previous
section, the majority of the research engineer experience was in water-related chemical
incidents, but the aim of Version 1 of the guidance manual was to cover issues that are
common to all types of chemical incident, as well as some issues that are specific to
water-related chemical incidents. As the manual currently stands (Version 2) there is
still a water bias due to the nature of the research investigation on which it is based.
However, the final version of the manual will cover all types o f chemical incident as
discussed in Section 7.5.2. Additional materials, as devised by the researchers
investigating air and land-related chemical incidents and by other staff and students at
CIRS, were not included in the manual used in the validation testing. This was because
the aim o f the validation testing was to assess the effectiveness o f tools developed
specifically from this research project.
158
Some consultation was conducted on Version 1 of the manual and changes were
incorporated into Version 2. As described in Section 6.5, these changes focused on the
format and order o f the materials. Some comments were received from those people
who took part in the exercise sessions and also from a few of the experts who
commented on the best practice model. Specific feedback on the content and ease o f use
o f the manual was rather limited, although the general impression was that the manual
was very useful.
Attempts were made to investigate previous research in the area of devising operational
procedures and also on the format and presentation of management tools. Informal
discussions were conducted with Professor Neville Moray, Professor of Applied
Cognitive Psychology (Department of Psychology, University of Surrey), Andrew
Brazier of Human Reliability Associates (an international consulting company
specialising in improving human performance and minimising human error in industry)
and Jonathan Berman of Greenstreet Berman (a strategic risk management consultancy).
A copy of Version 2 of the manual can be found at the back of Volume 2 following the
Publications Section.
7.3.4 Evaluation Method and Validation Testing Process
The generic evaluation method was devised directly from the best practice model, using
the same issues/actions and chronological categories. In addition, a number o f ‘key’
actions were identified, which were those actions that are considered essential for the
successful management of a chemical incident. The designation o f ‘key’ actions was
based on the ratings provided during the consultation on the best practice model, the
rating process used is described in Section 4.1.4. Those who took part in the
consultation process were not, however, explicitly asked what are the most essential
actions; the importance o f actions was inferred by the consistency o f ratings. In
addition, the designation of ‘key’ actions would be dependent on the target responder;
the essential public health actions will clearly differ from the essential actions for the
fire service, for example. Therefore it may have been preferable to focus on the
159
comments and ratings provided by the public health experts in assigning the ‘key’
actions.
By providing a tailored evaluation method for the specific exercise used in the validation
testing process, it is believed that consistent assessment of the response was achieved.
Although the generic evaluation method provides general guidance to assess
performance, it would be necessary to explicitly state the appropriate details for a
specific incident if consistent evaluation o f several people was required. The main area
o f difficulty in using the evaluation method was deciding how to score for actions that
were completed outside the stages specified. For example, a stage one action being
completed, but not until stage three of the response. For the validation testing o f the
manual, participants were given marks for actions completed early but not for those
completed late. Actions completed outside the stages specified were also documented
and these are reported on in Section 5.4.
As described in Section 6.4.6, care was taken to ensure that each o f the six exercise
sessions in the validation testing o f the manual were conducted in the same way. The
possible areas of bias and error in the validation testing method used are covered in
detail in Section 6.4. In summary, care was taken to ensure the sample was
representative of the population and o f an adequate size, and that a realistic incident
scenario was devised so that the performance scores would be applicable to the
management of a real incident. It may have been more accurate to compare performance
with and without the manual for the same participants. However, this would have
required a second scenario, which would create difficulties in making sure that the two
scenarios were comparable and required the same type o f response.
160
7.4 Effectiveness of the Guidance Manuai in Improving
Management of Chemical Incidents
Chapter 6 provides detailed interpretation and discussion of the results from the
validation testing of the guidance manual. The overall conclusion is that the manual did
improve performance for the group tested and statistical analysis indicates that an
improvement would also be seen in the population as a whole. Although the
improvement in performance relates to a specific incident exercise, it is expected that the
manual would also be shown to be effective in improving response in ‘real’ chemical
incidents and for a range of scenarios. In addition, the validation testing also identified
that training in chemical incident management improves overall performance (although
not for the ‘key’ actions). The effect o f previous experience was not found to be
conclusive.
Another point of particular note from the validation testing, is that the performance
scores achieved were generally low, although slightly higher scores were achieved for
‘key’ actions, which are considered to be the most important part of the response. The
low levels of achievement in the exercise sessions seem to further confirm the lack of
knowledge and expertise in the management o f chemical incidents by public health
professionals. This strengthens the need for the expert information and skills provided
to HAs through the Chemical Incident RSPUs, and also the value o f specialised training
and the provision of guidance materials. Evaluation o f the responses to the exercise
enabled the identification of aspects o f chemical incident management that were
particularly poorly achieved,, which will assist in directing training programmes. More
information on prioritisation of actions during an incident would also seem to be
required.
161
7.5 Further improvements in the Chemical Incident
Management Tools and Validation Testing Method
From the results and comments obtained during the exercise sessions, further
developments and improvements that could be made to the chemical incident
management tools and the validation testing method can be suggested, as detailed in the
following sections.
7.5.1 Best Practice Model for the Public Health Response to Chemical
Incidents
Some minor changes were made to the best practice model as a consequence o f the
comments received from the exercise sessions and also in light o f the responses provided
to the exercise. The revised checklist of actions for chemical incident management is
included as Appendix 14. The main changes are:
• An introduction to the purpose and application of the checklist with a list of
abbreviations.
• Division of the actions into three categories to enable communication issues to be
listed separately.
• Addition of a column to state the lead agency for each action.
• Promotion of initial contact with the media to stage one o f the response.
• Promotion of the estimation of the time period of exposure from stage three to stage
two.
• Addition of extra actions:
o ‘ensure population are prevented from accessing the incident site’
o ‘consider conducting a site visit’
o ‘consider alerting volunteer organisations’
o ‘consider holding a public meeting’
o ‘identify similar hazards in the area’
• Also, due to changes in the layout o f the manual, the references in the checklist to
further guidance materials have been updated.
162
The key area for future development of the best practice model is the need to conduct
further consultation, both within the public health field and also with other organisations
involved in the management of chemical incidents. In particular, further work is
required on assigning ‘key’ actions in the model as used in the evaluation method for the
validation testing. These ‘key’ actions should focus on the public health role
specifically, rather than actions that form part of the public health considerations but are
primarily the responsibility of another organisation. For each time period used in the
model, the ‘key’ actions should be identified. This would be best achieved by
consulting with public health professionals with experience in managing chemical
incidents and determining the consensus of opinion. As well as sending out the model to
collect individual opinions, it would also be useful to conduct group discussions. It may
also be possible to further prioritise the actions in each time period, effectively,
providing a checklist in the order that actions should be completed. However, this
would require considerably more work and it is likely to be difficult to obtain a
consensus.
One of the main criticisms o f the best practice model from the exercise sessions and the
expert consultation was that public health professionals are not necessarily the lead
agency for all the issues/actions included in the model. It was felt that there was a
crossover with other people’s responsibilities and there could be duplication o f effort
where actions are outside public health responders’ responsibilities. HA staff need to
have an awareness of the actions taken by other organisations in an incident, however,
they should not be trying to conduct the entire response independently. To clarify which
actions are primarily the role of public health professionals and those that have another
lead agency, a column has been added to the best practice model specifying the lead
agency for each issue/action raised. Further consultation would be useful in respect to
this aspect of the model in order to ensure clarification o f the roles of each responding
organisations.
163
7.5.2 Chemical incident Management Guidance Manua!
As already discussed, some changes were made to the manual subsequent to the exercise
sessions; these are detailed in Section 6.5. The main changes made were to the format,
separation of background information from operational tools, provision of further
guidance on how the manual should be used, and specification o f the responsibilities of
each organisation. Further development o f the manual is required and will be carried out
prior to its inclusion as part of a book to be published by the Stationery Office on
‘Environmental Management of Chemical Incidents’. The final version will have a
broader coverage and the current bias towards water-related chemical incidents will be
removed as guidance materials devised as part of complementary research projects and
also by permanent and seconded to CIRS are added. In particular, the following
additional resources have been developed by other researchers: a public health
evacuation checklist and public information leaflet, detailed information on public health
surveillance, specific checklists on land contamination incidents and non-domestic fires,
and a site visit report form. Before the final publication o f the manual, further
consultation is also required because only a small number of experts were able to return
comments within the timescale of this project. There was also a low level of response
with respect to the comment forms returned by participants in the exercise sessions.
From the validation testing of the manual, it was concluded that specific training on the
application of the manual is useful and it is recommended that it should be offered.
Various comments were received at the exercise sessions on the most useful format of
presenting the manual. Some felt that a loose-leaf binder would be best so that extra
information can be added. However, the danger is that the manual will become
incomplete as pages are removed and not returned. The use o f ‘spiral binding’ was also
suggested to facilitate photocopying of forms and key checklists. Availability o f the
information in an electronic format, either as a CD-ROM or via the web was also
considered to be very useful. Access to a restricted website will be easier to update than
a book or a CD-ROM and will enable users to print off additional copies of materials. A
paper version o f the book is considered to be important as access to the internet may not
164
always be possible in an incident, for example, if the person is on-call or if there are
electricity supply disruptions.
Further development of the manual is also required to make it applicable across the UK
in general. At the moment it is more applicable to HAs in England and, in particular, to
those with service level agreements with CIRS. The difficulty in making a UK-wide
publication is that there may be local differences in response and the manual needs to be
flexible enough to accommodate these differences. The manual should also fit into
procedures already used within HAs, for example general incident emergency plans
and/or chemical specific plans. Public health departments are experienced in managing
outbreaks of communicable diseases and ideally, a similar framework should be adopted
for chemical incident management. A generic incident/outbreak plan was produced a
few years ago by the Communicable Disease Surveillance Centre (CDSC) at the Public
Health Laboratory Service (PHLS) and is currently being revised. The incorporation of
chemical incidents within this plan should be considered.
Although the manual was found to be effective in improving response to the chemical
incident exercise provided, it would be interesting to measure the effect on performance
in managing actual incidents. If performance was monitored over time it may be
possible to assess if there is an increased improvement with continued use o f the manual.
7.5.3 Evaluation Method and Validation Testing Process
The evaluation method is derived directly from the best practice model. Therefore the
minor changes and additions required for the best practice model after the validation
testing, as mentioned in Section 7.5.1 are also applicable to the evaluation method. A
copy of the revised generic evaluation method is provided in Appendix 15. The exercise
itself may also benefit from the addition o f more information on the scenario, if it is to
be used again.
The evaluation method worked well for the validation testing but it should also be tested
for its applicability in other types o f scenarios and also for measuring performance in an
165
actual incident. One of the main comments o f the validation testing process was that
completing the exercise on an individual basis was unrealistic. The evaluation method
could be used as it stands for assessing group performance, but this would really only be
useful if it was applied to a group o f people that would actually be working together in
an incident.
To improve the validity o f the results there should be random selection o f the
participants and also random assignment o f the manual. In interpreting the results there
were some difficulties with respect to the categorisation of participants by experience
and training. The impact of different definitions could be investigated, but a bigger
group would be required, and in a particular a wider range of experiences.
If further degrees o f prioritisation were added to the best practice model, as described in
Section 7.5.1, then a more complex evaluation method could be devised where the
completion of particular actions are weighted depending on their importance.
7.6 Difficulties in Conducting Research into Chemical Incident

Management
This final section aims to identify some o f the difficulties in conducting research into
chemical incident management. The first problem is the breadth o f the subject and
difficulties in selecting a discrete aspect for detailed research. In providing guidance for
chemical incident management there is a conflict between providing generic guidance
and providing sufficient detail to cover all types of chemical incident. It may be easier
to provide comprehensive guidance by looking at a specific type o f incident. However,
provision of information then becomes unwieldy as different guidance is provided for
further types. Practitioners would prefer to use one source o f information rather than
having to decide which guidance they should adhere to.
As raised in the previous sections, public health professionals seem to be confused about
their role in the management of chemical incidents and this is not likely to improve in
166
the near future as the changes to NHS structures are brought in. Even where public
health professionals are aware of their specific remit, they seem unwilling to accept the
multi-disciplinary nature of chemical incident management and the need to have some
awareness of the other aspects involved, in order that they can effectively manage their
response.
During the project, a need was identified for providing assistance to public health
professionals to enable them to meet their responsibilities. Specific requests were also
received for the development of management tools. However, due to the fact that
chemical incident management is only a small part o f the overall job of the public health
doctor, it was difficult to obtain comments on what areas o f research would be of
particular use, and constructive feedback on guidance materials developed during the
project and how they could be improved to be o f greater assistance.
Another area of complication, with respect to chemical incident management in the UK,
is the current existence of five Chemical Incident RSPUs covering different
geographical areas and advising different HAs. The approach used in the management
of chemical incidents varies between units and can result in inconsistencies in advice
provided to HAs. Inconsistencies in advice are particularly problematic in incidents
involving cross-regional contamination. In addition, in some areas, the local authorities
and health authority are obtaining their advice from different RSPUs. There also seems
to be a lack of co-ordination regarding research and development in chemical incident
management between the units.
Finally, the dissemination of results and information from investigations into chemical
incidents is made difficult by the lack of a dedicated peer reviewed journal. Although
there are several public health journals, chemical incident management is not a major
aspect of public health medicine and papers on chemical incident management do not fit
comfortably within the normal subject area o f public health journals. Also, the lessons
learnt need to be disseminated to all those involved in chemical incident management,
not just to public health professionals.
167
8 Conclusions and Contributions to Knowledge
8.1 Conclusions
The review of the current state of knowledge in chemical incident management, which
involved two literature reviews and a questionnaire survey, concluded that:
• The published literature yields few accounts of water-related chemical incidents that
have occurred in the past few years. Even those that are reported, show that most
research is concentrated on analysing the actual effect of the incident, rather than in
devising procedures for managing incidents in such a way as to protect human health
and the environment.
• No generic guidance is currently available specifically aimed at the public health
management of the emergency response to chemical incidents. From the review of
the published literature, only one publication providing general guidance on
chemical incident management aimed at public health professionals was found and
its primary focus was on preparation prior to a chemical incident.
• Levels of training and experience in chemical incident management by public health
professionals are variable and generally quite limited and the development of
comprehensive guidance for the public health response to chemical incidents is
required.
The research project involved the development of chemical incident management tools
to improve the public health response to chemical incidents. A best practice model was
devised based on:
• Lessons learnt from the management o f chemical incidents throughout the research
period;
• Lessons learnt and comments from incident exercises and training days; and
168
This model was then used to direct the development of two further management tools:
1. A comprehensive chemical incident management guidance manual for use by public
health professionals during the emergency response to chemical incidents;
2. A quantitative evaluation method to assess the performance o f public health
professionals in responding to a chemical incident.
The evaluation method was used in the validation testing o f the guidance manual. The
assessment, conducted on a group o f 79 participants, concluded that the manual was
effective in improving performance in the response to a chemical incident exercise.
Statistical analysis further demonstrated that this improvement would be expected across
the general public health population.
8.2 Satisfaction of Project Objectives
The overall objectives, as identified prior to the commencement o f the project, were to:
• Evaluate the management of water-related chemical incidents reported to CIRS and
events; and
protection of the public health.
The general aim of investigating water-related chemical incidents has clearly been
achieved, with significant involvement in 70 incidents over the research period. These
incidents have also been comprehensively documented and lessons learnt identified, as
detailed in Section 3.1. The involvement of the research engineer in the management of
chemical incidents at CIRS has focused on providing an environmental technology input
to supplement the toxicological approach already developed. In managing water-related
chemical incidents, the focus has been on environmental management, this has
specifically involved advising on environmental monitoring and data interpretation,
interpretation of water quality standards, and advice on water and wastewater treatment.
169
The research engineer has also assisted in improving liaison between water utilities and
health authorities, including attending incident team meetings.
From the assessment of the current state o f knowledge and further defining and focusing
of the research needs, it was possible to develop more specific project objectives. These
were:
chemical incidents;
• Develop a chemical incident management guidance manual to direct those involved
• Develop a quantitative evaluation method to assess the level of performance
of the chemical incident management guidance manual; and
comments, and provide recommendations for future improvements in the
management tools.
Chapter 4 describes the methodology in developing the best practice model and
chemical incident management guidance manual, and also the process for validation
testing of the manual, including devising an evaluation method to measure the
performance of public health professionals in managing chemical incidents. Chapters 5
and 6 provide the results and interpretation of the results of the validation testing which
demonstrate that the manual successfully improved the response to a chemical incident
exercise. Chapter 6 also provides comments on the modifications made to the manual as
a result of the testing process and from consultation comm aits. In Chapter 7, further
developments of the manual are discussed.
170
8.3 Achievements and Contributions to Knowledge
The investigation of the environmental management o f chemical incidents, and the

public health response in particular, has resulted in comprehensive documentation of
several incidents and also the lessons that can be learnt from the management o f actual
incidents and from chemical incident training and exercises. The analysis of these
lessons has resulted in the production o f a best practice model for the public health
response to chemical incidents, which has been used to develop a chemical incident
management guidance manual and a method for evaluating the performance of public
health professionals in responding to a chemical incident. Subsequent validation testing
of the guidance manual by a group of public health professionals, with a range of
previous experience and training, demonstrated a significant improvement in
performance in responding to a chemical incident exercise when using the manual.
The specific contributions to knowledge achieved have been:

• Development of a best practice model for the public health response to chemical
incidents, based on the lessons learnt from the management of actual chemical
incidents. The best practice model sets out in one document all the issues and
actions required in the response to a chemical incident. This constitutes original
work as no similar model currently exists.
• Development of an evaluation method to quantitatively assess the performance
in responding to chemical incidents. This is a novel tool that could be useful for
both assessing effectiveness o f chemical incident training and in ensuring an
adequate level of competency in those professionals required to manage the health
aspects of environmental hazards.
• Creation of a chemical incident management guidance manual providing a
framework and detailed guidance on: the risk assessment o f the potential impact of a
chemical incident on the public health; communication with other organisations
involved in the management o f chemical incidents and with the public; management
actions to prevent or mitigate the adverse health impacts; and documentation of
incidents. The effectiveness o f this manual in improving response o f public health
171
professionals was also demonstrated. Generic guidance aimed at the emergency
response to chemical incidents by public health professionals is not currently
available and the publication o f this manual will provide a valuable and unique
resource for the public health profession. A copy o f the guidance manual can be
found in Volume 2.
• Dissemination of lessons learnt in the management o f chemical incidents through
conferences and training sessions and also the publication o f journal papers,
including:
> ‘Water-Related Chemical Incidents: A National Survey’ - in the journal
Health and Hygiene (Goodfellow et al 2000a);
> ‘The Public Health Response to an Incident o f Secondary Chemical
Contamination at a UK Beach’ - in the BMJ journal Occupational and
Environmental Medicine (Goodfellow et al, 2001);
> ‘Permeation o f Organic Chemicals Through Plastic Water Supply Pipes’ -
accepted for publication in the CIWEM journal Water and Environmental
Management Journal (Goodfellow et al, in press 2001).
Copies of all papers produced during the research period can be found in the
Publications Section in Volume 2.
172
9. Future research in Chemical Incident Management
9.1 Further Dissemination o f Research Outputs
In addition to the publications detailed in Chapter 8, further papers are to be submitted

for publication:
1. A paper on the results of the validation testing o f the chemical incident guidance
manual is planned for a peer-reviewed public health medicine journal. This will also
include the outcome of the literature review o f existing chemical incident
management procedures for public health.
2. An additional paper is planned for an emergency planning journal, detailing the
evaluation method for the assessment o f performance in the management o f
chemical incidents
Following further consultation and revision o f the chemical incident management

guidance manual, the final version will be published by the Stationery Office as part o f a
book on ‘Environmental Management of Chemical Incidents’.
9.2 Further Development of the Chemical Incident

Management Tools
A detailed discussion on the further development o f the chemical incident management

tools that have been devised as part o f this project is provided in Section 7.5, a summary
of the issues raised is provided below.
Best practice model

• There is a need to conduct further consultation on the actions to be included in the
best practice model, in particular, the designation o f ‘key’ actions. Further
consultation should include both the public health field and also other organisations
involved in the management of chemical incidents.
173
• Further clarification is required of which actions are primarily within the role of
public health professionals and o f the roles o f the other responding organisations.
Chemical incident management guidance manual

• Broadening the coverage of the manual to include all types o f environmental
chemical incidents and for application across the UK is required.
• Further consultation needs to be conducted prior to final publication of the manual as
part of a Stationery Office Book ‘Environmental Management o f Chemical
Incidents’
Evaluation method and validation testing process

• Testing the applicability of the evaluation method in other types of scenarios and
also for measuring performance in an actual incident is needed.
• If further validation testing of the manual was conducted it should follow more
extensive training and familiarisation with the manual.
• Further investigation into the effect o f experience on performance in managing
chemical incidents should be conducted.
9.3 Further Research in Chemical Incident Management
Areas where further research would be particularly useful for the continued development
and improvement of chemical incident management by public health professionals
include:
• Detailed specification of the role o f public health professionals in chemical incident
management. Despite NHS guidance this still seems to be unclear and with the
reorganisation of health authorities across the UK, roles may change. Due to the
multi-agency response to chemical incidents, clarification o f roles is important.
However, it is also difficult, as public health professionals may need to be aware of
what other organisations are doing and collaborate with them without taking over
their role.
174
• Further research should be conducted to ascertain how well the best practice model
reflects actual management practice and whether any differences are due to
inadequacies of the model or the response. The problem with developing a best
practice model is that an unachievable standard may be set based on a theoretical
response.
• The development of geographical information systems (GIS) as a chemical incident
management tool. GIS could be used for a number of applications, for example:
o To identify vulnerable populations or environmental locations;
o To provide maps to indicate areas and populations at risk based on the
output from plume modelling;
o To improve surveillance by assisting with the assessment o f the
geographical spread o f particular types o f incident, and by mapping
locations of hazardous sites, particularly those near population centres.
• Further research into the provision of training would also be extremely useful. The
results from the validation testing show the importance o f training, but more detailed
information is required on the most effective techniques and the frequency and
duration of training required in order to ensure competency o f those required to
manage chemical incidents. Some information was gained from the validation
testing on areas of management that are particularly poorly understood, but further
specification of these areas would enable more directed training programmes to be
developed.
• Improved methods for chemical incident surveillance are also required, in particular:
o Valuable information on environmental exposures is gathered through the
Chemical Incident RSPUs that could be used to a much greater extert to
provide evidence for causal links between particular exposures and
disease outcomes. For this to be successful, more long-term follow-up of
chemical exposure victims would be required, which would entail
substantial associated financial burdens,
o The methods for collecting data for surveillance require further
development. At CIRS, although a wealth o f data are collected during an
175
incident, due to the unsystematic manner in which it is recorded, the full
value of the lessons learnt cannot be achieved,
o By improving surveillance o f chemical incidents, it would be easier to
identity common types and causes of chemical incidents, which may
allow for prevention strategies to be employed.
It should be noted that the Department of Health has contracted national surveillance
of chemical incidents to the ‘National Focus’.
176
10. References
American Institute o f Chemical Engineers (1992) Guidelines fo r investigating chemical
process incidents. New York: American Institute o f Chemical Engineers.
Anon (1995) ‘Containing run-off at Allied Colloids’ Fire Prevention, no.279 May
pp.15-17.
Arrundale, J.; Bain, M.; Botting, B. (1997) Handbook and guide to the investigation o f
clusters o f diseases. London: Leukaemia Research Fund.
ATSDR (1992) Medical management guidelines for acute chemical exposures. Atlanta:
US Department of Human Services, Public Health Service, Agency for Toxic Substance
and Disease Registry, http://aepo-xdv-www.epo.cdc.gov/wonder/prevguid/
p0000016/p0000016.asp [accessed 18 Oct 2000].
Bakhshi, S.S. (1997) ‘Framework of epidemiological principles underlying chemical
incidents surveillance plans and training implications for public health practitioners’
Journal o f Public Health Medicine, vol. 19 iss.3 pp.333-340.
Baxter, P.J.; Heap, B.J.; Rowland, M.G.M.; Murray V.S.G. (1995) ‘Thetford plastics
fire, October 1991: the role of a preventive medical team in chemical incidents’
Occupational and Environmental Medicine, vol.52 no. 10 pp.694-698.
Center for Chemical Process Safety (1995) Guidelines for technical planning for on-site
emergencies. New York: American Institute of Chemical Engineers.
Center for Disease Control (1990) Guidance on cluster investigation. Atlanta: CDC.
Chang, E.; Sidebottom, G.; Masrani, R. (1988) ‘HERMES: Heuristic emergency
response management expert system (chemical spills)’ Chemical Spills, 5th Annual
Technical Seminar, Montreal, Que. (Canada), 9-11 Feb 1988.
Service Incident Report. London: CIRS, July (no.L/97/07/105).
Chemical Incident Response Service (1998d) Confidential Chemical Incident Response
Service Incident Report. London: CIRS, July (noL/98/07/123).
Chemical Incident Response Service (1998e) Confidential Chemical Incident Response
Service Incident Report. London: CIRS, October (noL/98/10/132).
177
Chemical Incident Response Service (1998f) Confidential Chemical Incident Response
Service Incident Report. London: CIRS, November (no.L98/l 1/123).
Service Incident Report. London: CIRS, November (no. L/99/11/010).
Service Incident Report. London: CIRS, June (noJL/00/06/057).
Comfort, L.K. (1985) ‘Information search processes in emergency management
Computer simulation as a means of improving decision-making capacity’ 1985 SCS
Multiconference, San Diego, CA (USA), 24-26 Jan 1985.
Croner (1996) Substances hazardous to the environment. Kingston, Surrey: Croner
Publications Ltd. June.
Crook, S. and Finn, L. (1999) ‘Inadequate curing o f water tank linings leading to
contamination o f drinking water’ Chemical Incident Report, no. 12 April pp.3-4.
David, A.S. and Wessely, S.C. (1995) ‘The legend of Camelford: Medical consequences
of a water pollution accident’ Journal o f Psychosomatic Research, vol.39 no.l pp. 1-9.
Department of Health (2000) Good practice guidelines for investigating the health
impact o f local industrial emissions. London: Department o f Health.
Department of Health, Department of the Environment and National Health Service
Management Executive (1993) Public health: Responsibilities o f the National Health
Service and the roles o f others. London: DoH, DoE, NHSME (HSG(93)56).
Department of Health and NHS Executive (2000) Deliberate release o f biological and
chemical agents: Guidance to help plan the health service response. London:
Department of Health. Restricted document.
Department of the Environment Transport and Regions (2000) Environmental sampling
after a chemical incident. London: DETR.
Dowson, P; Scrimshaw, M.D.; Nasir, J.M.; Bubb, J.N.; Lester, J.N. (1996) ‘The
Environmental Impact of a Chemical Spill from a Timber Treatment Works on a
Lowland River System’ Journal o f Chartered Institute o f Water and Environmental
Management, no. 10 August pp.235-244.
Environmental Health and Emergency Planning Services o f Bedfordshire and
Hertfordshire Local Authorities (1997) Local authority environmental health toolkit for
handling chemical incidents.
178
Ernst, W.D. (1985) ‘Managing the chemical emergency-the need for information
logistics’ Emergency ’85 - 3. Int. Congress and Exhibition fo r Emergency, Disaster
Preparedness and Relief Washington, DC (USA), 21-24 May 1985.
Fairman, R.; Murray, V.; Kirkwood, A.; Saunders, P. (2001) Chemical incident
management for local authority environmental health practitioners. London: The
Stationery Office.
Fewtrell, L; Kay, D; Jones, F; Baker, A; Mowat, A. (1996) ‘Copper in drinking water -
an investigation into possible health effects’ Public Health, vol.110 no.3 pp.175-177.
Finch, D.J. and Lees, P.F. (1997) ‘A hybrid knowledge-based system for chemical
incident management’ Expert Systems with Applications, vol. 12 no.3 pp.349-361.
Fisher, J.; Morgan-Jones, D.; Murray, V.; Davies, G. (1999) Chemical incident
management for accident and emergency clinicians. London: The Stationery Office.
Fowle, S.E.; Constantine, C.E.; Fone, D.; McCloskey, B. (1996) ‘An epidemiological
study after a water contamination incident near Worcester, England in April 1994’
Journal o f Epidemiology and Community Health, vol.50 no.l pp. 18-23.
Gheorghe, A.V. and Vamanu, D.V. (1999) ‘Integrated Decision Support Systems for
Emergency Preparedness and Management’ Contingency, Emergency, Crisis, and
Disaster Management: Defining the Agenda for the Third Millennium, Delft
(Netherlands), 7-11 Jun 1999.
Goodfellow, F.; Murray, V; Ouki, S. (1999) ‘Permeation of organic chemicals through
plastic water supply pipes’ Proceedings o f the Engineering Doctorate in Environmental
Technology Annual Conference 1999.
Goodfellow, F. (2000) ‘Longstanding Water and Land Contamination from a Fuel Oil
Leak’ Chemical Incident Report, no. 16 April p.8.
Goodfellow, F; Murray, V; Ouki, S. (2000a) ‘Water-related chemical incidents: a
national survey’ Health and Hygiene, vol.21 iss.2 April pp.58-65.
Goodfellow, F.J.L.; Murray, V.S.G.; Ouki, S.K. (2000b) ‘Contamination o f Drinking
Water as a Result of Re-lining of Water Tanks or Pipes’ Proceedings o f the Engineering
Doctorate in Environmental Technology Annual Conference 2000.
Goodfellow, F.J.L.; Murray, V.S.G.; Ouki, S.K.; Iversen, A.; Sparks. A.; Bartlett, T.
(2001) ‘The Public Health Response to an Incident of Secondary Chemical
Contamination at a UK Beach’ Occupational and Environmental Medicine, vol.58 no.4
pp.232-238.
Goodfellow, F.; Ouki, S.K.; Murray, V. (in press 2001) ‘Permeation o f Organic
Chemicals Through Plastic Water Supply Pipes’ Water and Environmental Management
Journal.
Gordon, S. (1988) ‘Hazardous materials information management-planning for
emergency response’ Hazardous Material Spills Conference, Chicago, IL (USA), 16-19
May 1988.
179
Hall, S.K. (1995) ‘Management of chemical disaster victims’ J Toxicol Clin vol.33 no.6
pp.609-616.
Health Service Journal (1999) Map o f the National Health Service. London: Map
Marketing Ltd.
Hill, P. and O'Sullivan, D. (1992) Survey o f arrangements fo r identification &
investigation o f incidents o f acute exposure to the public to toxic substances. London:
NHS Management Executive.
Home Office (1997) Dealing with disaster. 3rd ed. Liverpool: Brodie Publishing
Limited.
Hochuli, V.; Wheeler, H.; Oliver, F. (1998) ‘Dead fish saved the day’ European
Association o f Poisons Centres and Clinical Toxicologists XVIII Conference, Zurich,
Switzerland, March 24-28 1998. p. 139.
International Programme on Chemical Safety (IPCS) (1999) Public health and chemical
incidents - guidance for national and regional policy makers in the
public/environmental health roles. Cardiff: WHO Collaborating Centre for an
International Clearing House for Major Chemical Incidents.
Irwin, D.J.; Crombie, D.T.; Murray, V. (1999^Chemical incident management for public
health physicians. London: The Stationery Office.
Ives, K.J.; Hammerton, D.; Packham R. F. (1994) The River Severn pollution incident o f
April 1994 and its impact on public water supplies. Severn Trent Water Ltd.
Lowermoor Health Advisory Group (1989) Water pollution at Lowermoor North
Cornwall. Report o f the Lowermoor incident health advisory group. Chairman - Prof.
Dame Barbara Clayton. July.
Mac Arthur, K.; Gubbins, J.; Premaratne, N.; Caine, C.; Henderson, A.; Euripidou, R.;
Goodfellow, F. (2000) ‘Evacuation from persistent contamination following a sewage
spill’ Chemical Incident Report, no. 17 July pp.8-11.
Marker, T. (1988) ‘Overview of information management requirements for emergency
preparedness’ Hazardous Material Spills Conference, Chicago, IL (USA), 16-19 May
1988.
Mayhew, J. (1988) ‘CHEMTREC: Strategies for emergency communications and
information management’ Hazardous Material Spills Conference, Chicago, IL (USA),
16-19 May 1988.
Mendoza, M.; Masrani, R.; Sutherland, L.; Sidebottom, G.; Chang, E.; Clark, D. (1989)
‘HERMES: An expert system for emergency response management’ 6. Technical
Seminar on Chemical Spills, Calgary, Alta. (Canada), 5-6 Jun 1989.
Morin, M.; Axelsson, M.; Rejnus, L.; Jenvald, J. (1999) ‘Simulation-based decision
support for management of chemical incidents’ 13th European Simulation
Multiconference (ESM 99) 1-4 June 1999 —Modelling and simulation: a tool for the
next millennium, vol.l pp.585-590.
180
Murray, V. (ed) (1990) Major chemical disasters - Medical aspects o f management.
London: Royal Society of Medicine, International Congress and Symposium Series
(no. 155).
National Health Service Executive (1998) ‘Chemical Incidents’. In: National Health
Service Executive (1998) Planning for major incidents - The NHS guidance. London:
NHS Executive, pp.97-118.
National Health Service Management Executive (1993) Health service arrangements for
dealing with chemical incidents. London: NHSME (HSG (93) 38).
North West Water (1996) Managing incidents o f gross chemical contamination o f
drinking water supplies - QP41. Warrington: North West Water.
Oliver, F. and Holmes, E. (1998) ‘Identifying Chemical Water Incidents in the Published
Literature’ Chemical Incident Report, no.8 April pp.2-9.
Organisation for Economic Co-operation and Development (OECD); International
Programme on Chemical Safety (IPCS); United Nations Environment Programme
(UNEP); World Health Organization (WHO) (1994) Health aspects o f chemical
accidents: Guidance on chemical accident awareness, preparedness and response for
health professionals and emergency responders. Paris: OECD (OECD Environment
Monograph N o.81, UNEP IE/PAC Technical Report No. 19).
Parslow, R.C.; McKinney, P.A.; Law, G.R.; Staines, A.; Williams, R.; Bodansky, H.J.
(1997) ‘Incidence of childhood diabetes mellitus in Yorkshire, northern England, is
associated with nitrate in drinking water: an ecological analysis’ Diabetologia. vol.40
no.5 pp.550-556.
Schonfield, S.; Cummins, A.; Murray, V. (1995) Toolkit for handling chemical incidents
for trainees in public health medicine - acute incidents 1st ed. London: Medical
Toxicology Unit.
Thames Water (1999) Event management arrangements - Drinking water procedure.
Reading: Thames Water.
University of Surrey and Brunei University (2000) Engineering Doctorate (EngD) in
Environmental Technology course handbook - fo r research engineers and supervisors -
academic year 2000-2001.
Virtue, W.A. and Clayton, J.W. (1997) ‘Sheep dip chemicals and water pollution’ The
Science o f the Total Environment, no. 194/195 pp.207-217.
Welsh Water and North West Water (1984) Joint report on the pollution incident
affecting the River Dee and water supplies —January 1984.
White, M.; Watterson, J.; Jones, K.; Foster, J.; Thomas, D.; Bowen, H. (1999 ^Sampling
for human exposure monitoring following a chemical incident. Sheffield: Health and
Safety Laboratory.
World Health Organization (1996) Guidelines for drinking-water quality, vol. 2, 2nd ed.
Geneva: WHO.
181
World Health Organization (1999) Rapid health assessment protocols for emergencies.
Geneva: WHO.
World Health Organization (2000) Draft guidelines for the investigation o f diseases o f
chemical aetiology andfollow-up o f exposed subjects. Geneva: WHO.
Yamada, T. (1993) ‘Application o f three-dimensional numerical models to emergency
response management’ 86th Air & Waste Management Association Annual Meeting and
Exhibition, Denver, CO (USA), 13-18 Jun 1993.
182
Appendix 1
Faith Oliver
1st year Research Engineer
19 May 1998
Social Research Methods

Engineering Doctorate Module - Course-work Assignment
Contents
1. Introduction 1
2. Background 1
3. Research Question 2
4. Research Method 3
4.1 Techniques available 3
4.2 Selected technique 5
5. Errors 6
6. Sampling 7
7. Outline of the research 7
8. Timetable 9
9. Costs 9
10. References 10
1. Introduction
This assignment takes the form o f a proposal for a small scale social research study related to my
industrial placement. The initial sections comprise o f a description o f the background to the
proposal with an explanation o f why the research is necessary, and a statement o f the research
question. The bulk o f the assignment consists o f a description o f the social research methods
available, and the rationale for the method selected for this research, with a discussion o f the
advantages and disadvantages involved in the use o f different methods. Sections five and six
contain a short discussion of potential sources o f error and brief details on the sampling procedure
to be used in the proposed research. The final sections outline the stages o f the research, with a
timetable, and a summary of the costs involved.
2. Background
The sponsoring organisation for my Engineering Doctorate is the Medical Toxicology Unit
(MTU), at New Cross, London, which is part o f the Guy’s and St Thomas’ Hospital Trust. The
MTU was established to provide information to medical practitioners on the toxicology in man o f
chemical and pharmaceutical products, and advise on the diagnosis and treatment o f those
poisoned.
The Unit has a number of specialised sections, including the area where I am employed, which is
the Chemical Incident Response Service (CIRS). The CIRS developed from the basic toxicology
service in response to increasing reports o f exposure to toxic substances as a result o f ‘chemical
1
incidents’. The CIRS is funded by contracts with 73 Health Authorities across the country, and
also by several Environmental Health departments.
My Engineering Doctorate research project involves researching the management o f chemical

incidents that have resulted in water pollution. As explained, the majority o f funding for the CIRS
is currently provided by Health Authorities. Part o f the responsibilities o f the Public Health
Departments, within Health Authorities, is to minimise the impact on public health o f chemical
incidents. Such incidents may be acute, for example a fire at an industrial plant, or chronic, such
as the long term exposure o f the public to lead in drinking water, and could involve any one o f a
large number of chemicals currently used in industrial, agricultural or domestic situations.
The current scope o f the project is very wide, covering all chemical incidents that affect water,
and in order for the project to reach the required standard for a doctorate degree it will have to be
focused on particular chemicals and water events. For this reason I propose to carry out a piece o f
social research involving the “customers” o f the CIRS, in order to find out what particular
problems occur more frequently, or are especially severe. In addition to the research satisfying
this need to identify areas of particular concern on which to focus my project, it will also help to
identify areas for future research. I also aim to find out how public health professionals already
respond to chemical incidents involving water, and especially what collaboration exists between
water companies and health authorities, and whether the CIRS is providing the appropriate
assistance. This information will help the CIRS to gain a better understanding o f the process
public health professionals use in managing chemical incidents, and will highlight any problems
with communication between the different organisations involved in incident response. The CIRS
will then be able to target its efforts for providing assistance to health authorities in responding to
chemical incidents.
Searches on the Sociofile CD-ROM revealed no previous research in this area. As public health
have only recently been given the obligation by the Department o f Health to respond to chemical
incidents, it is unlikely that any previous social research has been done. A study has been carried
out for the CIRS by Jarlath Hynes (1997) regarding the management o f land contamination
incidents. Although the issues of land and water contamination are quite different, this study will
help in the general design o f research that aims to obtain information from those involved in
incident response, including public health departments.
3. Research Question
The initial aim o f the research is to gather information to answer the question:
What chemicals and situations occur most often in water related chemical
incidents?
However, social research is different from mere data collection, as discussed by Gilbert (1993), it
has to be concerned with understanding, not just description. There are two approaches to a social
research study, deduction and induction. In deduction theorising comes before research, research
then functions to produce empirical evidence to test or refute theories. Conversely with induction,
research comes before theory and the aim is to generate theoretical propositions on social life
from collected data (May, 1993). The research proposed here aims to gather data first, in order to
obtain the information to generate theories on the factors affecting incident management
behaviour, i.e. it will follow the induction process. Theories may be developed that explain the
2
distribution o f different types o f incidents. The initial research question is not a theory statement
to be tested by the research, but provides a focus for the data collection process.
Theories must be capable o f being tested, or falsified. For the purposes o f research a theory will
be broken down into theoretical propositions or testable hypotheses. As concepts often cannot be
measured directly they need to be operationalised, for this purpose indicators are derived, which
are a way o f linking concepts to observable facts. Indicators must be both valid, i.e. accurately
measuring the concept; and reliable, i.e. consistent from one measurement to the next
(Bumingham, 1998; Gilbert, 1993).
This research proposal does not involve testing a theory, but the research question still contains a
number o f subjective concepts which need to be defined more rigorously as part o f the initial
research design.
4. Research Method
This section will consist o f a very brief general introduction to the research methods available to
social researchers, with comments on their applicability to this research. This is followed by a
more detailed discussion o f the more appropriate methods, and their advantages and
disadvantages, and finally a statement o f the selected research method to be used.
4.1 Techniques available
The major techniques used in social research are listed in May (1993) as:
• questionnaires;
• interviewing;
• participant observation;
• documentary research;
• secondary analysis;
• comparative research.
Survey methods are not listed as a discrete technique, this is because as defined by Paul Lavrakas
(1993, p i):
Survey methods are a collection o f techniques fo r which the most typical purpose is to
provide precise estimates (i.e. measures that are stable with relatively low variance) o f the
prevalence o f some variable o f interest.
Questionnaires are a method o f conducting surveys. Quantitative and factual information can be
obtained using closed questions. Qualitative data can also be collected through the use o f open
questions (Newell, 1993). The design o f questionnaires is pivotal, for the quality o f the data
produced depends upon their design (May, 1993). A questionnaire with largely closed questions
will be the most effective way o f collecting the data for this study, administering questionnaires
will be discussed further in the next section.
Interviews can take a number o f forms (May, 1993):

• structured interview - standardised, associated with survey research;
3
• semi-structured - questions specified, but interviewer may probe beyond answers for
clarification and elaboration;
• focused interview - open-ended, qualitative, aims to challenge preconceptions o f the
researcher, also referred to as informal, unstandardised, or unstructured interviews.
For this research unstructured interviewing would be very time consuming, but a structured
survey interview could be used as a method o f administering a questionnaire. More detailed
unstructured interviews in the format o f a group discussion, or focus group scenario, would be
helpful in the initial stages o f the research to aid in designing the questionnaire and ensuring
appropriate phraseology is used, and that all possible options are included for answers to closed
questions.
Participant observation or ethnography involves listening, observation and experience. It is about

engaging in a social scene, experiencing and seeking to understand and explain it. It does not
involve developing ideas and testing them. In participant observation no firm assumptions are
made about what is important (May, 1993). This is not a suitable method for gathering the
information required for this research as it is not possible to spend time with a group o f public
health consultants who deal with chemical incidents, as they all work in different health
authorities. It would take a great deal o f time to shadow every consultant individually, or even a
selection o f consultants, and the majority o f their time is not spent on dealing with chemical
incidents.
Documentary research comprises o f using content analysis, involving quantitative or qualitative

techniques, to analyse documentary sources. Sources o f documentary research include:
• historical documents: laws; statutes; people’s accounts o f incidents or periods in which they
were involved.
• mass media.
• novels and plays.
• maps.
• drawings.
• biographies, diaries, oral histories.
• photographs (May, 1993).
As there are very few reports on chemical incidents, particularly their handling by public health,
this method is not appropriate for this research.
Secondary analysis involves devising ways o f testing hypotheses against data originally collected
for other purposes (May, 1993). It includes any further analysis o f an existing dataset which
presents interpretation, conclusions, or knowledge, additional to, or different from, those
presented in the first report. Data available includes both government data and academic sources
(Procter, 1993). Information on demographic characteristics o f the population, their opinions and
lifestyles from official statistics is considerable. Possible useful sources as suggested by May
(1993) are: the 10-year census; criminal statistics; the family expenditure survey; register o f
births and deaths; General Household Survey (GHS); and British Social Attitudes Survey
(BSAS). A drawback with secondary analysis is that the appropriate data may not have been
collected, also it is important that the researcher understands how the data were constructed,
before carrying out secondary studies (May, 1993). Again this method would not be appropriate
for the proposed research because the data available for secondary analysis will not cover the area
to be investigated.
4
Comparative research is a pluralist approach to methods and theories centred mainly, but not
exclusively, around the theme o f comparing countries under the umbrella term ‘cross national’
study. It involves studying the ways in which different cultures and societies organise their social
and political affairs and everyday life in order to enhance insight into our own lives (May, 1993).
Comparative research would make an interesting follow up study to this research to find out
about the differences in incident response in different countries.
4.2 Selected technique
The most appropriate method for carrying out the proposed research, which involves collecting
factual and attitudinal data, has been selected as a questionnaire survey. Even deciding on this
method there are still a number o f different techniques that can be used to conduct a survey, these
are: mail questionnaires (self completion), telephone survey, or face-to-face interviews (May
1993). The following sections deal with some o f the issues involved in each o f these techniques.
Mail - Self completion surveys are efficient in time and money, and a large sample can be
covered relatively quickly and cheaply. Also people can take time to think about answers and
there is no problem o f interviewer bias. However, questions must be clear and unambiguous as
the researcher has no control over interpretation, also there can be no probing. In addition, there is
no control over who answers the questionnaire, and response rates are also typically low (May,
1993). In addition, a drawback o f using self-administered questionnaires is the reliance on a self
selected sample. Although the sample may be systematically determined, only those respondents
personally motivated to complete and return the questionnaire will be heard from. Consequently,
such samples often do not meet criterion o f representativeness (Frey and Oishi, 1995).
Telephone - A major advantage to telephone surveying is its cost efficiency. They are typically
more expensive than mail surveys, but the potential advantages for reducing total survey error
often outweigh this disadvantage. Another major advantage is speed at which data can be
gathered, and thus processed. In a week or less, one can gather survey data via the telephone that
might take a month or more using in-person interviews. An even longer period could be
anticipated using a mail survey, with the necessity o f follow-up mailings to increase typically low
response rates. Disadvantages may include limitations on complexity and length o f the interview
(Lavrakas, 1993). Also a result obtained in many experimental comparisons o f face-to-face and
telephone interviewing is that a lower level o f co-operation is obtained on the telephone (Groves,
1990).
Face-to-face - Interviews may be chosen in preference to self-administered questionnaires,

because clarification and probes can be used most effectively in the in-person mode. If direct
observation is required, obviously in-person interviewing will be necessary. However, the
interviewer may affect the way a respondent answers a question, negative effects may be reduced
on the telephone because o f the lack o f visual cues. Both telephone and in-person interviews
suffer from socially desirable response, but it is more prominent with in-person. Practical issues
that may preclude the use o f in-person as opposed to telephone interviewing are: funds;
personnel; time; and facilities (Frey and Oishi, 1995).
In making the final selection o f the research method to be used it is important that practical
constraints are considered as well as methodology. After consideration o f the above research
methods and their pros and cons, as well as the practical issues, I have decided to use a
5
questionnaire survey to collect the information. As commented by Lavrakas (1993, p7) there has
recently been significant growth in use o f multiple frame or mixed mode surveys. He also adds
that telephone surveys and other modes o f surveying should not be viewed as if they were in
competition with each other, for example, telephoning can be used to encourage compliance to
mail surveys, or to screen for rare groups who are then interviewed in-person.
In view o f this I intend to carry out initial unstructured discussions in groups as part o f the
questionnaire design process. A pilot questionnaire will also be tested out on a limited sample.
The final questionnaire will be initially administered by post for self completion. The time
required to conduct each interview precludes the completion o f all questionnaires via telephone
interview, but as I require a good response rate, and the response period is limited, non
responders will be followed up with the offer o f a telephone interview, or if appropriate sending
out another postal questionnaire. If necessary an in-person interview could be offered for a small
number o f respondents.
5. Errors
This section contains a brief discussion o f the sources o f error in surveys in particular, and their
significance in this research. As detailed in Lavrakas (1993), there are four potential sources o f
imprecision and bias, which together constitute ‘total survey error’. The most commonly
considered error is sampling error, but non sampling errors also occur, as detailed below.
Sampling error - a function o f the heterogeneity o f what is being measured, the size o f the
sample, and the size of the population. This source o f imprecision in a survey is associated with
the fact that only a sample of all elements in a population is studied, rather than a census in which
all elements would be studied. As explained in the following sampling section, this will not be
significant in this research as the population under study will effectively constitute a census.
Coverage error - do all elements in the population have at least some probability o f being
sampled, e.g. in a telephone survey, those without a telephone and the homeless have zero
probability o f being sampled. If the people you cannot reach are different from those you can
reach in a way that is relevant to the survey objectives, your results will be biased (Frey and
Oishi, 1995). As the population defined in this research are those that have contracts with the
CIRS, then all the elements are defined and can be contacted by mail or telephone.
Non-response error - elements that are sampled but for which no data are gathered
systematically, may differ from those sampled o f which data are gathered. If data gathered are not
correlated with whether or not a given type o f person responded, then error due to non response
would not exist. It is hoped that non-responders will be kept to the bare minimum in this study,
also as the main focus is improving the service provided by the CIRS, by seeking the opinions o f
contract holders, then if there is no response then this would seem to indicate that the contract
holder is satisfied with the current service. Also, as non-responders will be contacted by
telephone following an initial mail out, there should be no problem o f non response due to the
intended respondent not receiving a questionnaire. Regarding response rates, no particular rate is
accepted as standard, but Frey and Oishi (1995, p30) state that for telephone interviews if rates o f
70%-80% are achieved, one can feel comfortable with analyses based on the data.
6
Measurement error - not all data that are recorded on a survey questionnaire are accurate
measures o f the phenomenon o f interest. These errors may be due to errors associated with the
questionnaire, the interviewers, the respondents and/or the mode via which this data are gathered.
One o f the most effective ways o f minimising measurement errors will be to carry out a
comprehensive pilot study. With regard to measurement error in telephone interviews (as
compared to in-person), it has been documented that the quantity o f response is reduced on open
questions (Groves 1978; Sykes and Collins 1988), this is often attributed to the faster pace o f
telephone interviews.
6. Sampling
A sample is a portion or subset o f the population the surveyor is interested in interviewing and is
drawn when it is impractical to survey everyone in the population. Researching a sample can
yield more accurate results than using the complete population. For instance, in survey research,
if fewer people are studied, more resources can be spent on each interview, permitting better
quality interviewers, more supervision and better coders (Arber, 1993a).
Most surveys of sub-populations use some kind o f population list or sampling frame, from which
to draw a sample o f potential respondents (Frey and Oishi, 1995, p. 14). A number o f methods can
be used to select the sample (May, 1993). The two broad types are probability (which requires a
random sample selection) and purposive. Non-probability, or purposive sampling methods
include quota sampling and snowball sampling. Random methods o f selection include:
simple random sampling - where each element has equal chance o f being selected;
systematic sampling - if the population number is known every nth case can be selected;
stratified random sample - first a particular group is identified, then each group is sampled;
cluster or multi-stage sample - a cluster is selected, then a sub-sample within it.
For this research study it is intended that one questionnaire will be sent to each o f the health
authorities. Usually there is only one person with the main responsibility o f dealing with chemical
incidents within each health authority, which is the Consultant in Communicable Disease Control
(CCDC). Some further investigation is required before sending out the questionnaires to
determine the most appropriate person to send the questionnaires to. In effect the questionnaire
will be forming a census, as opposed to a survey, as the whole sampling population will be sent a
questionnaire, and I will endeavour to ensure that a questionnaire is completed by every
contracted health authority. In this case the population is small enough for a census to be
practical, and also it is too heterogeneous to be able to generalise accurately from a selected
sample. Only health authorities (as opposed to local authorities and other incident response
bodies) will be included in this study as the differences between the groups will probably
necessitate a different questionnaire for each, and the health authorities are the largest customer
group.
7. Outline of the research
The main stages in the research process (Bumingham, 1998) are:

• research design;
• sampling and access;
• design o f research instrument/negotiating access;
7
• data collection;
• coding;
• data interpretation and writing up.
The research method chosen is to send out a questionnaire, o f largely closed or semi-structured
questions. The process of collecting information through questionnaires can be spilt up into a
number o f stages.
Administrative plan - the very first stage is to comprehensively plan the research study and to
create a flow chart o f major tasks in sequence, with the most important properly designated and
singled out.
Compile the sample: before even designing a questionnaire the sample they are to be sent to
should be determined. Section six above details the sampling strategy for this study.
Devise draft questionnaire: a large portion o f the work will be devising the questionnaire, and it
is important to take sufficient time and care over this stage as the value and validity o f the results
will be greatly influenced by the quality o f questionnaire. It is important that the questionnaire is
clear and questions appropriately worded. As part o f this stage I expect to consult with a selection
of CCDCs to ensure that the correct terminology is used, and to make sure that the right
categories are identified for particular questions, and that the wording o f questions is
understandable to those with a public health background, as opposed to science or engineering. It
is important that any technical terms used, including the term incident, are clearly defined in
order to get a consistent response. In devising the questionnaire the analysis stage should also be
accounted for, the coding system should be devised as part o f compiling the questionnaire, and a
codebook should be put together. A covering letter also needs to be devised introducing the
research, establishing legitimacy of the work, and highlighting the benefits o f completion.
Approval for the research can be obtained from the Public Health Medicine Environment Group,
which adds prestige to the work.
Piloting the questionnaire: before sending out the questionnaire to the full sample, the final
draft will be tested on a smaller sample, probably aiming at about 10% o f the total population.
The aim will be to test the questionnaire at a range o f locations throughout the UK as the
chemicals and types o f incident situation are likely to vary across the country, depending on local
conditions such as geology and topology, and also industrial and agricultural activities. In sending
out a questionnaire it will be possible to identify categories that should be included within
questions, particularly where tick lists are provided, in order to include as many options as
possible. The pilot stage will also highlight if there are any problems with comprehending the
questions and ensuring that the answers you expected to receive are being provided. The
completed pilot questionnaires will also be analysed to ensure that the coding system is working
correctly.
Develop final questionnaire: after receiving feedback from the pilot questionnaire, changes will
be incorporated to ensure that the questions are correctly worded to achieve the answers required,
and that the final analysis of the questionnaires will run smoothly.
Distribute questionnaires: The final questionnaire will be printed and initially one questionnaire
will be sent to a named individual at each o f the 73 contracted health authorities. A 3 week period
will be stated for completion of the questionnaire. After 2 weeks non responders will be contacted
by telephone and offered a telephone interview, or a second copy o f the questionnaire will be sent
out where necessary. A reminder letter will be sent after the 3 weeks has elapsed to those who
have still not responded. W ith respect to the telephone follow-ups a call sheet should be devised
(see Lavrakas 1993), and the questions most likely to be asked by respondents should have
prepared standardised responses, these are sometimes referred to as called “fallback statements”
(Frey and Oishi, 1995).
Collating and analysing data: as soon as the completed questionnaires start to be returned the
answers will be collated and analysed, using the coding system devised in the initial stage. The
data will be converted to a computer readable form and analysis will most likely be carried out
using the Microsoft Excel spreadsheet package.
Presenting data and preparing reports: when all the completed questionnaires have been
received and the information extracted and analysed, the final results will be presented in a clear
understandable way, probably using graphical representation. It has been held that the most
important part of a research project is not collecting data, but publishing it in a form which will
transmit the research results to interested parties (Arber, 1993b).
8. Timetable
As the information to be gathered from this survey is fundamental to the development o f my

Engineering Doctorate project, and I need to be able to focus my research as soon as possible, this
piece of social research is already underway. An additional practical constraint is that from mid
July to September it is likely that a large number o f CCDCs will not be available and response
rates are likely to be very low.
First stage, 11/5/98 - 5/6/98: put together the sample, initial group discussions and devising draft
questionnaire.
Second stage, 8/6/98 - 3/7/98: pilot questionnaire, refining questionnaire into final format.
Third stage, 6/7/98 - 31/7/98: distribution o f initial questionnaire, followed by follow-up

questionnaires and telephone interviews where necessary.
Fourth stage - bring together the data, collate, analyse and put in a format that can be easily
understood. This stage will start as soon as questionnaires start to be returned, from mid July. The
aim is to complete the final report by the end o f August.
9. Costs
This is not expected to be a hugely expensive research project, the main items that will incur cost
are: postage;
telephone calls;
stationery;
printing questionnaires and letters;
production and dissemination o f final report.
9
Seventy three questionnaires will have to be sent initially and a significant number are likely to
be sent out for a second time. Some questionnaires will be completed by telephone interview and
the costs for repeat telephone calls to those who fail to respond must be included in cost
estimations.
10. References
Arber, Sara (1993b). ‘Designing samples’ in Gilbert, N. (ed) Researching Social Life. London:
Sage.
Arber, Sara (1993b). ‘The research process’ in Gilbert, N. (ed) Researching Social Life. London:
Sage.
Bumingham, Kate (1998). ‘Getting started: developing a research question’ in Introduction to

Social Research Methods. Lecture notes for the Engineering Doctorate Year 1 module.
Frey, James H. and Oishi, Sabine Mertens. (1995) How to conduct interviews by telephone and in
person. The Survey Kit TSK4. California: Sage.
Gilbert, Nigel (1993). ‘Research, theory and method’ in Gilbert, N. (ed) Researching Social Life.
London: Sage.
Groves, R.M. (1978). On the mode o f administering a questionnaire and response to open-ended
items. Soc. Sci. Res. 7:257-71; cited in Groves, R.M. (1990). ‘Theories and Methods o f
Telephone Surveys’ Annual Review o f Sociology vol. 16 pp.221-40.
Groves, R.M. (1990). ‘Theories and Methods o f Telephone Surveys’ Annual Review o f Sociology
vol. 16 pp.221-40.
Hynes, Jarlath C. (1997). Contaminated Land: Aspects ofToxicological Risk Assessment and Risk
Management. A dissertation submitted to the University o f Surrey.
Lavrakas, Paul J. (1993) Telephone Survey Methods - Sampling, Selection, and Supervision. 2nd
edition. Applied Social Research Methods Series - volume 7. Newbury Park, California: Sage.
May, Tim (1993). Social Research - Issues, Methods and Process. Buckingham: Open University
Press.
Newell, Rosemarie (1993). ‘Questionnaires’ in Gilbert, N (ed) Researching Social Life. London:
Sage.
Procter, Michael (1993). ‘Analysing other researchers’ data’ in Gilbert, N (ed) Researching
Social Life. London: Sage.
Sykes, W, Collins, M. (1988). Effects of mode o f interview: experiments in the UK, pp 301-20;
cited in Groves, R.M. (1990). ‘Theories and Methods o f Telephone Surveys’ Annual Review o f
Sociology vol. 16pp.221-40.
10
Appendix 2
Water related chemical incidents questionnaire Questionnaire no:
Water Related Chemical Incidents Questionnaire
This survey w ill focus only on WATER related CHEMICAL INCIDENTS. Please do not include information
concerning other media (such as air or land), or m icrobiological or any other infectious hazards.
When answering the questions please bear in mind the CIRS definition o f an incident:
An unforeseen event leading to exposure o f two or more individuals to any
non-radioactive substance resulting in illness or a potentially toxic threat to health
Water incidents include those involving both primary or secondary contamination (including fire water run-off) o f any
water medium (drinking water, surface water, ground water, recreational waters). Both acute and chronic incidents
should be included.
Please answer the follow ing short questionnaire as instructed, if possible avoid using ‘not sure’ options. Feel free to add
any additional comments on the last page.
Section 1 -person al details
Please check and complete any missing details below
1. Name:
2. Position:
3. Health Authority:
4. Address:
5. Contact telephone number:_______________________________________

6. How long have you been employed in your current position?_______
7. Please state your educational and previous professional background:
(e.g. clinical, public health, m icrobiology)
Section 2 - chem ical incident m anagem ent
1. D o you consider that non-infectious environmental hazards, and specifically chem ical incidents related to water, are
included in your work responsibilities? (please tick)
I I Y es □ No UZ1 N ot sure
2. a) Approximately how many chemical incidents in total, acute and chronic, have you been involved in managing,
over the last five years (or since you have been in your current position)? (please tick)
□ none - go to Section 3, page 3
□ 1 -4
□ 5-10
| | greater than 10 (please state number) ______________
b) O f these, what percentage would you consider to be water related, involving either primary or secondary
contamination (including fire water run-off) o f any water medium (drinking water, surface water, groundwater,
recreational waters)? (please tick)
| | zero - go to Section 3, page 3
□ less than 25%
| | between 25 and 50%
| | between 50 and 75%
| | greater than 75%
Chemical Incident Response Service Page 1 o f 7

3. When managing w ater related chem ical incidents, whicho f the follow ing resources have you used as sources
o f information or advice? (tick all appropriate options)
L O C A L / R E G IO N A L O R G A N ISA T IO N S
P oisons C entres 1 1 Belfast □ Birmingham
□ Cardiff □ Dublin
1 1 Edinburgh □ Leeds
1 1 London □ N ew castle
C hem ical In cident R esponse Providers
1 I CCI, Birmingham □ CIMSU, Cardiff
1 1 CIRS, London □ New castle
1 1 SCIEH, Glasgow
O thers 1 1 Fire Service □ Environmental Health at district council
1 1 local water company
1 1 others (please list)
N A T IO N A L O R G A N ISA T IO N S
I I Environment A gency □ National Chemical Emergency Centre, A EA , Culham
I I National Focus □ Water Research Centre, Medmenham
I I Health and Safety Executive I I other (please lis t) ______________________________
PE R SO N A L C O N T A C T S
local/regional □ Regional Epidem iologist
□ Environmental Health Officers
□ County Scientific Officer
□ Environment A gency Personnel
□ others (please list)
national □ CCDCs in other Health Authorities
□ others (please list)
L ITER A TU R E SO U R C ES
I I WHO drinking water quality guidelines
□ Croner's manual o f Substances Hazardous to the Environment
I I computer based CD-ROM and internet searches
□ others (please list) ________________________________________
4. O f the incidents that you have managed, which types o f situations occur m ost frequently? (tick all appropriate
1 1 Drinking water contamination options)
1 1 Recreational water contamination 1 1 Fires, including water runoff
1 1 Water distribution pipes 1 1 Contamination within water treatment plant
1 1 Permitted industrial discharges 1 1 Agricultural runoff
1 1 Transport 1 1 Marine pollution
1 1 Chemical spills 1 1 other (please list)
5. In connection with W ATER ONLY, have you been involved in incidents, or had enquiries, concerning any o f the
follow ing chemicals? (tick all appropriate options)
1 1 Aluminium □ Arsenic
1 1 Cadmium n Copper
1 1 Iron □ Lead
1 1 Manganese n Mercury
1 1 Zinc □ Amm onia
1 1 Asbestos □ Cyanide
1 1 Fluoride □ Nitrate
1 1 Pesticides □ Polyaromatic hydrocarbons (PAHs)
1 1 Benzene □ Other hydrocarbons (including oil, petrol and diesel)
1 1 A lgal toxins □ Solvents
1 1 others (please list)

Section 3 - W ater Supply
This section o f water supply is split into questions specifically about water companies, follow ed by questions on:
private water supplies; effluents and sewage; and recreational use.
Water companies
1. Which water companies are within your health authority? (tick all appropriate options)
□ Anglian Water pic □ Bournemouth and W est Hampshire Water pic
□ Bristol Water Holdings pic □ Cambridge Water pic
□ Essex and Suffolk Water □ Folkestone and D over Water Services Ltd
□ Hartlepool Water pic □ Mid Kent Water pic
□ Mid Southern Water pic □ North Surrey Water Ltd
□ Northumbrian Water Ltd □ North W est Water
□ Portsmouth Water pic □ Severn Trent pic
□ South East Water Ltd □ Southern Water
□ South Staffordshire Water pic □ South W est Water pic
□ Sutton and East Surrey Water pic □ Thames Water pic
□ Three V alleys Water pic □ Tendring Hundred Water Services Ltd
□ W elsh Water □ W essex Water
□ Wrexham Water pic □ Yorkshire Water
Scotland
□ East o f Scotland Water Authority □ North o f Scotland Water Authority
□ West o f Scotland Water Authority
2. D o your em ergency plans include collaboration with the relevant water companies in the event o f an incident
affecting water? (please tick)
I I Y es □ No d ] N ot sure
3. Are meetings held between your health authority and the local water companies at least once a year? (please tick)
I I Yes No N ot sure
4. a) D o your local water companies inform you about incidents o f chem ical contamination? (please tick)
I I Y es, always □ Y es, som etim es No I I N ot sure
b) In the event o f an incident what information do they supply? (tick all appropriate options)
□ time o f incident □ location o f incident
I I type o f chem ical sample results with levels o f contaminant
I I population exposed □ details on what action they are taking to remedy the situation
□ maps □ not sure
□ other (please lis t) _______________________________________________________________
c) I f environmental samples are being provided, do you obtain independent duplicate samples provided by
someone other than the water company? (please tick)
I I Y es, always □ Y es, som etim es □ No
5. a) With respect to locations o f the drinking water abstraction points in your health authority, do you.
(please tick)
I I know the locations o f all abstraction points
I I know locations o f som e abstraction points
I I have access to information on abstraction points if necessary
I I have no information on abstraction points
I I not sure
b) If locations are known, do you have maps, either paper or digital, showing these?
I I Y es □ No [^ | N ot sure

Private water supplies

6. a) Are there any private water supplies in your area? (please tick)
I I Y es □ No □ ] N ot sure
b) I f yes, approximately how m any are there?

□ 0 -9
□ 10-49
□ 50-100
I I greater than 100 (please state number) ______________
I I not sure
7. Are you aware o f any chem ical problems associated with these? (please tick)
I 1 Y es □ No [□ N ot sure
If yes please state the nature o f these problems. _______________________________________________
8. D o you receive details o f the monitoring o f chemical water quality from any private supplies? (please tick)
I I Routinely [□ If there is a chem ical problem
I I No □ N ot sure
I f yes, w ho do you receive this information from? {please state)
If you only receive information if there is a potential health problem, what is the trigger for you being informed?
Effluents and sewage

9. D o you know the locations o f permitted discharges in your health authority area? (please tick)
I I Y es, all o f them □ Y es, som e o f them
I I No □ N ot sure
10. Have hazard characterisation studies been carried out for the discharges in your health authority area?
(please tick)
I 1 Y es □ No [□ N ot sure
11. What sewage sludge disposal techniques are used in your health authority area? (please tick)
I I Landfill □ Incineration □ ) Disposal at sea
I I Application to agricultural land !□ N ot sure
□ others (please sta te) ______________________________________ _____________________________
Recreational use
12. D o you know which water resources in your health authority area are used for recreational purposes?
(please tick)
1 1 Y es, all o f them 1 1 Y es, som e o f them
□ No 1 1 N ot sure
13. What types o f recreational waters do you have in your health authority area? (tick all appropriate options)
1 1 estuarine 1 1 coastal
1 1 rivers 1 1 lakes
1 1 artificial lakes n water storage reservoirs
1 1 canals 1 1 not sure
I 1 others (vlease state)
14. What are the recreational waters in your areas used for? (tick all appropriate options)
1 1 swimming 1 1 fishing
1 1 non-contact water sports, e.g. sailing 1 1 contact water sports, e.g. canoeing, wind-surfing
1 1 not sure 1 1 others (please state)

S ection 4 - E valuation o f the C IR S
1. a) Have you used CIRS when managing chem ical incidents? (please tick)
I I Y es □ No
b) I f no, please indicate reasons w hy not. (please state)
2. H ow w ould you rate the usefulness o f the current response from CIRS?
(please rank in order of usefulness, with 1 being most useful)
I I chemical information sheets □ analytical resources
□ site visits □ telephone advice
I I provision o f legislative standards on particular chemicals
□ other (please state) ___________________________________________________
3. What additional information w ould be o f particular help to you in the event o f a water related chemical incident?
4. a) Have you attended one o f the CIRS training days for chemical incident response? (please tick)
□ Y es - answer question b) | | N o - answer question c)
b) i) If yes, w ould you agree with the statement:

“the training day was o f significant benefit in improving m y skills in responding to chemical incidents"
(please ring the most appropriate option)
strongly agree 1 2 3 4 5 strongly disagree,
ii) D o you have any suggestions for improvements with respect to training days?
c) If no, w hy have you not attended a CIRS training day? (tick all appropriate options)
□ lack o f time □ did not know training courses were provided
□ too far to travel □ no places available
n other (please state) _________________________________________________________________
Section 5 - Future Research
1. Which journals do you read? (tick all appropriate options)

I I Chemical Incident Report (CIRS)
□ Chemical Incident (Centre for Chemical Incidents)
□ Focus on Chemical Incidents (National Focus)
I I Communicable D isease Control and Public Health (PHLS and SCIEH)
I I Occupational and Environmental M edicine (BMJ)
I I Journal o f Public Health M edicine
I I N ew England Journal o f M edicine
I I British M edical Journal
I I Lancet
□ Others (please sta te) ______________________________________________
2. Would you find the publication o f more water related chemical incident reports helpful? (please tick)
I I Y es \Z3 No 1 I N ot sure

3. What, in your opinion, are the obstacles to publishing incident reports? (tick all appropriate options)
□ N o obvious journal to publish in
I I Lack o f time
I I Confidentiality issues
I I Only a minor incident
□ Others (please sta te) ____________________________________________________________
4. Which o f the research areas below would you be interested in receiving information about?
(tick all appropriate options)
P articular chem icals
I I Nitrates in drinking water □ ] Chlorine products from drinking water disinfection
I I O ff shore oil spills [□ On-shore oil spills
I I A lgal toxins |~ ] Pesticides
I I Oestrogen m im icking chemicals I I others (please lis t) ______________________________
Incident scenarios
□ Contamination o f recreational waters
I I Tidal areas and pollutant dispersal
□ Private water supplies and contamination problems
I I Transport related water contamination incidents
I I D iffuse pollution from agricultural activities, including pesticides, nitrates, phosphates
I I Sew age sludge on agricultural land and potential chemical contamination o f water sources
□ Chemical leachates from landfill sites, m ines and other contaminated land sites
W ater distribution and treatm ent

I I Polyaromatic hydrocarbons from water mains linings
□ Water recycling and the use o f grey water
I I Lead pipes and lead solder
□ Water distribution pipes through contaminated land
I I Chemical treatment o f water supplies to reduce plum bosolvency
I I Identification o f chemicals used in the treatment o f water and provision o f toxicological information
Incident m anagem ent

I I Compilation o f organisations involved in incident management, their roles and the services they
provide
I I Expanding collaborations between public health and other organisations to aid incident management
I I Investigation o f incident response procedures used internationally
I I A geographical information system (GIS) which w ill allow easy identification o f vulnerable sites
follow ing a water incident
I I Dispersion m odelling used in conjunction with GIS to show the probable extent o f contamination from a
water incident, and changes over time
I I Manual o f com m on sources o f contamination e.g. gas works sites, and the typical contaminants that
are found
I I Compilation o f available water standards and their m eanings and context
□ Risk assessment and characterisation o f hazards from industrial discharges
H ealth effects
I I Lead and pregnancy, investigation o f exposure to lead in drinking water and lead in babies
I I Epidem iological studies related to point sources o f pollution
5. Are there any other topics related to chemical contamination o f water that are o f particular interest to you?

6. a) A s part o f a toolkit for responding to water related chemical incidents, which specific outputs w ould be useful?
(tick all appropriate options)
I I CD-ROM
I I dispersion m odelling
I I geographical information system s (GIS)
I I others (please lis t) ________________________________________________________________
b) D oes your health authority already use or expect to purchase a GIS system in the near future? (please tick)
□ Y es, please state which package____________________________________________________
I I No N ot sure
c) D oes your health authority already use the computer statistical package SPSS (please tick)
I I Y es No I I N ot sure
d) W ould your health authority have funds available to implement such outputs as a GIS system or computer
m odelling package?
I I Y es No I I N ot sure
If you w ould like to make any additional suggestions about water related chem ical incidents, or have any comments
about the questionnaire, please use the space provided below.
H&cuik you f a (fowt tim e and coefaenatioti itt comfetetirtfy t&ie queatiowtaine
Appendix 3
Water-Reiated Chemical Incidents Reported to CIRS from
October 1997 - April 2001
CIRS Release to
Release to
water
Number supply
L/97/10/030 13/10/97 nformation Tanker heading for the coast in a force 5 gale, NA NA Coal tar naphtha
turned back by two tugs
L/97/10/109 01/10/97 Water High levels found in water NA NA Cadmium oxide
L/97/11/005 03/11/97 Water Contaminated water supply to industrial unit NA NA Xylene
L/97/11/014 07/11/97 Water Contaminated water supply NA NA NaOH
L/97/11/016 07/11/97 Water Lead pipes in home NA NA Lead
L/97/11/027 17/11/97 Water Several hundred gallons spilled into a river NA NA Grenadine
L/97/11/030 21/11/97 Water Found in drinking water supplies, 4 times NA NA

Barium
permitted level
L/97/11/050 13/11/97 Water Suspected toxic levels in water supply (200 NA NA

Aluminium
mcg/L)
L/97/11/074 17/11/97 Land PhD students testing air and water levels found NA NA
Mercury
high concentrations of mercury
L/97/11/109 28/11/97 Water Elevated levels in drinking water in surgery, 4 NA NA

Copper
times legal limit
L/97/11/110 26/11/97 Spill Spill at work of 200-300 litres NA NA Wood preservative
L/97/11/117 24/11/97 Water Possible over chlorination of water NA NA Chlorinated water
L/97/11/137 27/11/97 Spill Spilt at timber yard NA NA Timber treating

substance
L/97/12/042 10/12/97 Information Deliberately contaminated water supply NA NA Hydrocarbons
Ammonium phosphate
L/97/12/047 09/12/97 Malicious Added to water supply and individuals bathed in NA NA Methylated spirits
it White spirit
L/97/12/049 10/12/97 Waste Suspected spill into water supply NA NA Diesel
Polyaromatic
hydrocarbons
L/97/12/050 16/12/97 Water Concern about water contamination on river and NA NA Polyaromatic
effect on river users hydrocarbons
L/98/02/055 24/02/98 W ater Concern about nitrate in drinking w ater N Y Nitrates
L/98/02/057 28/02/98 Leak Cold w ater tanks in hospital were drained N Y Acetone
for resin application, vapour tainted w ater Styrene
L/98/02/084 01/08/97 W ater Concern that chemicals from an old gas Y N Cyanide
works are seeping onto a beach and PAH
subsequently contam inating w ater Am m onia
Phenol
L/98/03/003 01/12/97 Water High lead levels in water N Y Lead

CIRS Release to
Release to
water
Number supply
L/98/03/010 03/03/98 Not Known Fish kill in canal-unknown source of chemical Y N Unknown chemical
L/98/03/061 03/03/98 Not Known Barrels of chemicals washed up on beach, Y N
Aniline
confusion as to their contents. Potential PH risk.
L/98/03/102 28/02/98 W ater High levels in w ater supply Y Y Manganese

L/98/04/024 27/04/98 W ater Concern about the health implications of N Y Iron
levels o f chemicals in drinking w ater in several

Potassium
farmhouses and cottages
L/98/04/089 26/04/98 Spill 10 gallons of petrol washed down drain; Y N
Petrol
complaints of odour from occupants of houses
L/98/04/127 W ater Concern about raised w ater levels and Y Y Iron
links with Parkinsons disease Manganese
Nitrates
Arsenic
L/98/05/030 01/01/98 Leak 2 Hospitals supplied by same bore hole that has Y Y
Atrazine
found to have raised levels of chemical
U98/05/032 01/01/01 Leak Lead battery factories have contaminated Y Y
irrigation w ater w ith lead; w ater goes to salac Lead
and crop vegetables
L/98/05/078 19/05/98 Water Raised levels found in water supply, concern over Y Y
Potassium solution
levels
U98/05/094 20/05/98 Spill Truck spilt contents into lake Y Y Sodium cyanide
L/98/05/119 18/05/98 Leak Fuel pipe broke in soil resulting in approximately U U
Kerosene
500-900 litres of kerosene being absorbed
U98/06/005 01/01/96 Leak Contaminated stream running out of Y u Phenols
Colliery Degreasing agent
Cyanide
L/98/06/018 29/05/98 Water Water accidentally contaminated with chemica N Y
Monoethylene glycol
after plumbing mix up
U 9 8/06/122 11/05/98 W ater Chemical seeped through land and through U Y
Trichloroethane
w ater supply pipes and contaminated water
L/98/07/031 09/07/98 Leak Concern about potential petrol leak from petro u U
Petrol
station into residential water supply
L/98/07/032 30/06/98 Food & Concern over levels in w ater used to wash N Y
Sulphate m agnesium
Drink vegetables
L/98/07/041 02/07/98 Leak Water came in contact with piece of treated wood U Y Copper
after plumber/builder carried out repairs Chromium
Arsenic
CIRS Release to
Release to
Reference Date of Cl Type Circumstances w ater Chemical
water
Number supply
1798/07/055 16/07/98 Malicious Threat of contamination at reservoir, found by U Y Aluminium
police on internet Magnesium
Magnesium sulphide
L798/07/059 28/07/98 Water Epoxy resin used for road works contaminated N Y Styrene
water supply Epoxy resin
L798/07/094 24/07/98 Leak Accidental spill into river Cyanide
L798/07/123 Leak Fuel oil tank broke several years previously, Y Y
substance contam inated w ater supply through Kerosene
pipes
L798/08/014 31/07/98 Water Spill of cyanide in water Y U Cyanide
L798/08/019 10/08/98 Water Patient drank water from domestic supply that Y Y
Chlorine
appeared to be contaminated
L798/08/042 12/08/98 Air Two people exposed to hydrogen sulphide at Y Y
Hydrogen sulphide
sewage works
L/98/08/088 27/08/98 Leak 200I leaked down street drain U N Ethyl mercaptan
L798/08/092 28/08/98 Water Cyanide found in stream after fish kill observed. Y U
Cyanide
L798/08/104 04/08/98 W ater Request for information about high levels o U U

Nitrates
nitrates in drinking w ater supplies
L798/09/004 01/09/98 Spill Ammonia spilt by dry cleaning company- Y Y

Ammonia
contaminated water supply and swimming pools
L798/09/035 11/09/98 W ater Concerns about contam ination of drinking N Y Cadm ium
water supplies Chromium
Lead
Mercury
L798/09/060 22/09/98 W ater Levels in spa 0.2, as opposed to 0.1. Members U U
Nitrates
of public can get w ater from spa
L798/09/074 03/09/98 Leak Leak of fuel reported on 3/9/98 but extent of U U Kerosene
pollution not realised until EA had sampled on

Diesel
24/9
L798/10/021 30/09/98 Water Increased levels found in stream Y u Cyanide
L/98/10/048 15/10/98 Spill Possible phenol contamination of stream near U u
Phenol
electronics workshop
L798/10/060 14/10/98 Water Excess chlorine detected in drinking water for N Y
Chlorine
several months
L/98/10/068 20/10/98 Water Household tap water contaminated with iron and N Y Iron
Manganese Manganese
L/98/10/075 Food & Lead found in water supply U Y

Lead
Drink
CIRS Release to
Release to
water
Number supply
L/98/10/088 19/09/98 Leak Accidentally entered hot water supply instead of N Y

Fernox
heating system
L/98/10/119 28/10/98 Water Pesticide leak into private w ater supply on a U Y

Atrazine
holiday caravan park
L/98/10/132 27/10/98 Water Contaminated w ater supply U Y Diesel
L/98/10/139 31/10/98 Water Contaminated water supply u Y Chlorine
L/98/10/142 10/10/98 Water Squirrel killed with substance fell into domestic N Y
Pesticide
water supply
L/98/11/029 12/11/98 Land Chemicals penetrated land and affected N Y Xylene
drinking w ater supplies 1-methyl-4-tert-

butylbenzene
L/98/11/056 30/10/98 W ater Family has long standing health problems, U U Cadmium
concern about w ater quality Mercury
L/98/11/066 21/11/98 Water Contaminated water supply Y Y Heating oil
Monoethylene glycol
L/98/11/093 23/11/98 Water Entered water supply N N Hydrogen peroxide
L/98/11/111 27/11/98 Spill Mussels affected by oil spill. Y N Acrylonitrile
L/98/11/115 30/11/98 W ater Raised levels in drinking water Y Y Nitrates
L/98/11/123 26/11/98 Leak Sewage overflowed from pumping N N Sewage
stations and into residential street. Butoxyethanol
Effluent later found to contain industrial Cyanide
compounds. Residents evacuated from their

homes and remediation work is to be carried Toluene
out
L/98/12/001 02/12/98 Information Concern about raised levels of chemical in private U Y

Atrazine
water supply
L/98/12/003 02/12/98 Waste Open canister found on beach, collected by N N

Phosphine
Surfers Against Sewage
L/98/12/018 18/12/98 Water Water supply contaminated with fibre glass at N Y

university students had been washing, bathing Fibre glass
and drinking with it
L/98/12/073 23/12/98 Water Elevated levels found in drinking water supplies Y Y Nitrates
L/98/12/074 24/12/98 W ater Elevated levels found in private drinking water Y Y

Nitrates
supply
L/98/12/076 30/12/98 Spill Petrol found to be in sewage drains; strong U U

Petrol
smell found in houses
L/99/01/035 15/01/99 W ater Customers reported discoloration of drinking U Y

Iron
water to local w ater company
L/99/01/059 28/01/99 Water Benzene contaminated water being drunk by Y Y

Benzene
several members of the public
CIRS Release to
Release to
water
Number supply
L/99/01/064 26/01/99 Water Illegal connection between cooling water and Y Y Glutaraldehyde
mains supply leading to deposit of chemicals Sodium nitrate
L/99/01/068 28/01/99 Water Accidental ingestion of contaminated water with U Y

Lead
ead by family
L/99/01/080 21/01/99 Water Exposure to Cadmium in water Y Y Cadmium
L/99/01/084 12/01/99 Water Water coming out of town fountain has turned U N Potassium
purple permanganate
L/99/02/008 04/02/99 Water Routine sampling of private spring by EHO Y U

Atrazine
showed high levels of Atrazine
U99/02/014 09/02/99 Routine check of private water supply detected Y Y Sulphates
raised levels of chemicals Magnesium
L/99/02/044 05/02/99 Water Drinking water in infertility unit contaminated with N Y

Unknown chemical
chemical
L/99/02/067 18/02/99 Spill Water tanks contaminated by fibre glass resins N Y Hydroxy methyl
and curing agents pentane
MEK
Fibre glass
L/99/02/077 24/02/99 Water Water supply contaminated with styrene U Y Styrene
L/99/02/106 23/02/99 Water Concerned about levels of chemicals in tap water U Y

Chloromethylsilane
L/99/03/006 02/03/99 Other High samples of chemical detected in private u Y

Diuron
water supply
L/99/03/038 05/03/99 Water Water post treatment in office block contaminated N Y

Copper
with Copper
L/99/03/044 23/03/99 Water Motel had its water system serviced and engineer N Y
Methyl chloroform
noticed a problem with the water
Diesel
L/99/04/013 01/04/99 Leak Water company has become aware of a Petrol U U

leak of unleaded Petrol from a garage which
Petrol
they think has contaminated a
borehole/groundwater
L/99/04/052 19/04/99 Water Spill of Kerosene into private well Y Y Kerosene
L/99/04/058 22/04/99 Water Rerouting of water supplies to 80 households, Y Y

sampling of samples detected high levels of Coal tar
Coal tar in the water
L/99/04/073 01/04/99 Info. High levels of Copper detected in water supply U Y

Copper
at a hospital
L/99/04/074 22/04/99 Water Complaints of bad taste in the water from U Y Xylene
residential water supply Benzene
CIRS Release to
Release to
Reference Date o f Cl Type Circumstances w ater Chemical
water
Num ber supply
L/99/04/093 27/04/99 Land Football pitch size site, not normally available N U
to public discovered by accident noticec
Cyanide
drainage problems due to illegally connectec
pipes from site to sewer pipe.
L/99/05/025 22/05/99 Water Raised iron levels detected in water supply N Y Iron
L/99/05/026 Other Stream next to old leather w orks is Y U Trichloroethylene
contaminated with chemicals. (Has been going

Perchlorethylene
on fo r several years)
L/99/05/033 16/05/99 Spill Plastic drum on back of tractor with a new Y N

Pyrethroid
chemical spilt into water source.
L/99/05/053 Land CCDC reported deposit found in water U U Tin
Zinc
L/99/05/081 26/05/99 Water Chlorine dioxide in their water supply exposed via N Y
Chlorine dioxide
skin and eyes
L/99/06/010 06/06/99 Water 50L Ferric acid and 80L print screening solution N Y Ferric chloride
spilt into a drainage system in an industrial unit. Print screening

solution
L/99/06/030 24/06/99 W ater Pt is 70 yr old pharm acist with colitis whc N U

claims his w ater supply is contam inated with Lead
lead. EHOs contacted public health.
L/99/06/052 15/06/99 Water Unknown chemical in water caused oral/bucca N Y

health effects including swelling, blistering and
Unknown
nausea. Water had bad taste/odour after relining
work done to water pipes.
L/99/06/108 16/06/99 Malicious Terrorist threat to public w ater supply N U Paraquat
L/99/06/114 28/06/99 Water Fibre glass found in home water supply. N Y Fibre glass
L/99/07/008 07/02/99 Water Accidental ingestion of contaminated water supply U Y

Oil
by a lady.
L/99/07/031 07/09/99 Water Water contaminated by Diuron, which was used to Y U

Diuron
treat water.
L/99/07/050 19/07/99 W ater EHO found high levels of nitrates in a private U Y

Nitrates
w ater supply.
L/99/07/077 01/07/99 W ater W ater was initially noticed to be blue in the N Y

hospital. CCDC requested info, on coppei
toxicity. Blue w ater was especially noticeable
Copper
on a Monday and a measurement o f 14ppir
was recorded. Typical results ranged from 3-6
micro-g/L
L/99/07/081 31/07/99 Water 77mg/L benzene & petrol found in residential N Y Benzene
water supply of 4-5 houses. Petrol
L/99/07/084 27/07/99 Water Cyclohexane

CIRS FRelease to
FRelease to
Reference [)a te o fC I 1type (Circumstances V vater CChemical
Vvater
Num ber J supply
U99/07/121 26/07/99!Spill kerosene oil spill from a damaged tank causec N N

kerosene
and contam ination on a private property.
L/99/08/005 03/08/99 A/ater .ady concerned about her lead pipes changed N Y .ead
o copper used for her water supply. Hopper
L/99/08/020 16/08/99 \A/ater 3urst water main petrol in drain. U U Detrol
L/99/08/045 A/ater
19/08/99 N Raised levels in drinking water. N Y Hopper
L/99/08/058 16/08/99 A/ater Accidental ingestion of contaminated water with N U

Lead
ead.
L/99/08/061 16/08/99 A/ater Water contaminated with chemicals. U Y Benzene
U99/08/069 23/08/99 Water Contamination o f w ater supply by lead. N Y Lead
U99/09/002 02/09/99 Water Raised levels o f manganese detected in watei N Y

Manganese
supply.
L/99/09/029 10/09/99 Water Water company detected chemicals present in U U

Unknown
water.
U99/09/031 01/09/99 W ater A private w ater supply that supplies a primary u Y

school has high levels of naturally occurrinc Fluoride
fluoride.
L/99/09/066 10/09/99 Water MCPB found in water supply @ 0.134 mg/l - PH Y Y

MCPB
concerned that water co. says not dangerous.
L/99/09/073 08/09/99 Water Pathlab found nitrates in the drinking water. GP U Y

Nitrates
concerned for pregnant patient.
L/99/09/075 20/09/99 Water Water company found high levels of polyaromatic U Y Polyaromatic
hydrocarbons, creosote, benzofuran, di- hydrocarbons
benzofuran, anthracene, dibenzophthiophine &

Creosote
quiniline following complaints by residents.
L/99/09/090 25/09/99 Water Water company detected hydrocarbons and N Y Kerosene
kerosene in a private water supply. Hydrocarbons
L/99/09/099 Water Anti-fouling boat paint somehow (deliberately?) U Y Paint
contaminated a water supply. Xylene
Copper
Ethylbenzene
L/99/09/104 30/09/9S Water Water supply contaminated by heating oI N Y

Heating oil
(320ug/l)
L/99/09/107 Water Contaminated w ater supply in a residentia N Y

Hydrocarbons
area, due to contaminated pipes.
L/99/11/010 05/11/95 W ater W ater contaminated in a block o f flats with U Y Petrol
chemicals. Benzene
Toluene
L/99/11/035 12/11/9 9 Spill Spill of diesel a week ago, land contaminate!1 N N

Diesel
under block of flats. Residents evacuated.
CIRS Release to
Release to
Reference Date o f Cl typ e Circumstances water Chemical
water
Number supply
L/99/11/054 17/11/99 i/Vater ngestion of contaminated water, where there is U U

Bleach
thought to be some sort of water contamination.
L/99/11/090 Spill Water contaminated with above chems. U U Petrol
Benzene
Toluene
L/99/11/106 Spill Fuel oil kerosene / petrol spilt in a residential N Y Petrol
well. Kerosene
L/99/12/022 16/12/99 Water Contamination of water supply with chemicals. N Y Iron
Copper
Zinc
L/99/12/029 19/12/99 Water Accidental ingestion of Chlorine from U Y

Chlorine
contaminated water supply.
L/99/12/032 Water Contaminated water supply caused illness. N Y Chlorine
L/99/12/035 Leak Fuel oil contam inated residential w ater supply N Y

Oil
of 3 cottages.
L/99/12/036 Leak 45 Gallon pyrene drum found spilled on the side of U N

Pyrene
a road in a gully
L/99/12/075 11/12/99 Air Trying to stop water leak. N Y Nitrates
L/99/12/089 24/12/99 Spill 0.5 tonne fuel bunker oil spill in harbour. Washed Y N
Oil
up into gardens & harbour wall.
L/99/12/092 16/11/99 Water Raised levels of heavy metals found in drinking N Y Iron
water Copper
Zinc
L/00/01/018 19/01/00 Water Water authority detected high chloride Y Y

contamination, and did further sampling to detect
1,3 Dichloro 5,5
source. Some patients have complained of feeling
Dimethyl Hydantoin
unwell, and would like to know if the contaminated
water is the cause.
L/00/01/024 28/01/00 Water Leak of chemical. N N Formic acid
L/00/01/090 13/01/00 Spill A resident reported an incident at his property N N

involving spillage of hydraulic oil from £
broken tank. The oil covered his garden anc Hydraulic oil
pathway and has now made its way into th(
house.
U00/01/093 Land Hexachlorobutadiene found in peoples home U U

Hexachlorobutadiene
build on the edge o f a chemical dump.
L/00/02/011 03/02/0C Water Domestic water supply contaminated with lead (26 N Y
Lead
houses).
CIRS Release to
Release to
water
Num ber supply
L/00/02/051 23/12/99 Leak Over Christmas 1000 lites of kerosene leaked U U

from a fuel tank. Fuel has now leaked into the
Kerosene
neighbour’s garden and they have reported funny
smells/headaches, they also have a private well.
L/00/02/071 03/02/00 Water Raised lead levels detected during water sampling U Y
Lead
on a council estate.
L/00/02/075 29/02/00 Land 20 damaged drums found on steel works site. Y U Xylene
Toluene
L/00/02/077 02/02/00 W ater Tenants in a block o f flats, noticed that U Y Caustic soda
their drinking w ater was pink. Sodium bicarbonate
Sodium hypochlorite
L/00/02/082 01/08/99 Leak Leak from the petrol station migrated through Y Y
Petrol
soil into houses.
L/00/03/004 02/03/00 Spill 30,000 litres of "slurry" spilt into a river. Health Y N
authority have been assured that there is no risk
to Public Health and the water companies have Unknown
been notified that there is no risk to domestic
water supply.
L/00/03/005 02/03/00 W ater Routine sam pling o f a private w ater supply U Y

Herbicide
identified herbicide present in water.
L/00/03/029 Spill Canning factory own w ater supply caused ar N Y

unknown quantity o f bromine to enter int< I Bromine
mains w ater supply.
L/00/03/034 Water Insecticide dieldrin (0.099 mg/l) found in private N Y

Dieldrin
drinking water supply following routine sampling.
L/00/03/096 25/02/00 W ater A shutdown fo r repairs caused flow N Y Iron
changes which resulted in disturbance o f main Manganese
sediments causing discoloration. Aluminium
L/00/03/115 28/03/00 Spill Elevated level of this pesticide found in private N Y

Dieldrin
water supply (0.099 mg/l).
L/00/03/122 23/03/00 Spill 8000I spill of aviation turbine fuel from a pipeline N U
Aviation fuel
that runs through a residential area.
L/00/03/123 Other Family living in a rural area suffering unexplained U U Unknown
health effects. Formaldehyde
L/00/04/003 Water Water contamination by a former Lead Smelting Y N

Lead
Factory.
L/00/04/004 Land CCDC concerned that leachate (from a reclaimed N Y

landfill) collecting in a golf course culvert may Unknown
contaminate water or golfers.
CIRS Release to
Release to
water
Number supply
L/00/04/005 14/04/00 W ater Pump failure at the w ate rw o rks caused N Y Iron
iron deposits in the mains to be distributed

Resulted in discoloration o f w ater and health Manganese
effects in customers.
L/00/04/009 03/04/00 Water Maritime & Coastguard agency reported container Y N Cresol
lost overboard containing drums with these
Epichlorhydrin
chemicals.
L/00/04/018 Leak Petrol spill. U U Petrol

L/00/04/070 05/04/00 Leak 8000I of petrol leaked from underground storage U U
into sewers. People evacuated by environmental Petrol
health.
L/00/04/071 31/03/00 Water Office block's water contaminated with corrosion N Y

Corrosion Inhibitors
inhibitor.
L/00/04/077 30/04/00 Fire Fire in a factory warehouse. U U Unknown
White spirit
Aniline
Naphthalene
U00/05/009 05/05/00 W ater Person that lives in an arm y cam p was told tc U Y
stop drinking the water. 62-3mg/l alcohol & Petrol
benzenes found.
L/00/05/010 Water W ater company received 20 com plaints u Y
Thought to be contam inated with bitumer Unknown
lined tanks or PAHs.
L/00/05/071 05/05/00 Water Water standing in a bitumen lined water main N Y PAH
was allowed to enter the distribution system in
Naphthalene
error.
L/00/05/079 Water Elevated levels (0.7 ppm) found in private water U Y

Diuron
supply.
L/00/05/088 25/04/00 Water Elevated levels of benzene & xylene found in N Y Bitumen
water supply after the water tower had be relined
PAH
with bitumen.
U00/05/090 W ater Private w ater supply persistently fails U Y Iron

PCVs Alum inium
Trihalom ethanes
L/00/05/095 Water Raised levels of pesticide found in private water u Y
Pesticide
supply.
L/00/05/096 Not Known Raised nitrate levels found in private water supply u Y
Nitrates
to a food processing site.
L/00/06/013 08/06/00 Water Water supply contaminated. N Y Iron
L/00/06/034 15/06/00 Water Hydrochloric acid used to clean a water tank N U

Hydrochloric acid
contaminated water.
CIRS Release to
Release to
Reference Date of Cl Type Circumstances w ater Chemical
water
Number supply
L/00/06/046 23/06/00 Water Solvents contamination in water. U U Solvents
L/00/06/051 Water Yellow water in house. U U Unknown
L/00/06/057 W ater Petrochem icals found in dom estic w ater N Y Toluene

supply o f 3 families. Benzene
Ethylbenzene
Xylene
U00/06/061 W ater Raised levels o f bromate found in a domestic Y Y
Bromate
aquifer.
L/00/06/080 Waste Elevated levels of lindane found in a river. Y N Lindane
L/00/06/083 Water Benzene & tetrachloroethylene found in water Y U Benzene

stream going through basement of a house. Tetrachloroethylene
L/00/06/094 Land Sampling by water utility found elevated level of N U

Lead
lead contamination.
L/00/07/011 07/08/00 Spill Spill of 25 litre drum of acetone. 15 litres into Y N

Acetone
Thames
L/00/07/039 22/07/00 Water Scouts water supply in a 20-30 gallon tub was N Y
Kerosene
contaminated.
L/00/07/048 W ater Hydrocarbons contamination of a private N Y Hydrocarbons
w ater supply. Oil

L/00/07/079 W ater Xylene found in w ater system o f hospital. U Y Xylene
L/00/07/080 19/07/00 Fire Large fire in an industrial estate. Also resulted in Y U Smoke
water contamination & fish kill. Fall out of
Pesticide
chromium carbonate also occurred.
L/00/07/089 Other Chemical recycling works went into liquidation U N Phenol
and left the cleanup to the site owners. Mercury
Solvents
L/00/08/016 18/07/00 Spill Lindane contamination of a reservoir. U Y Lindane

L/00/08/020 07/11/00 Spill Organophosphates spilt in river - Massive fish kill. Y U Fungicide
Organophosphates
Formaldehyde
L/00/08/064 Water Elevated levels Manganese found in water supply. U Y
Manganese
L/00/08/074 Leak Former pesticide factory thought to have Y Y

Lindane
contaminated drinking water supplies with lindane.
L/00/08/083 Spill Chemical spill into river. Large fish kill. Y U Squalene
Palmatic oil
Butanoic oil
L/00/09/009 04/09/00 Spill 1000L of 3 chemicals spilt into a surface drain. Y N Aromatic
hydrocarbons
Acetone
CIRS Release to
Release to
w ater
Number supply
L/00/09/016 Water Hydrocarbons found in water. U U Hydrocarbons
L/00/09/027 Water Raised levels of Manganese found in water U Y
Manganese
supply.
L/00/09/061 02/09/00 Malicious Vandals poured barrels of these chemicals down a Y U Aromatic
surface drain. hydrocarbons
N,N-
dimethylacetamide
Solvents
U00/09/067 10/08/00 Air Diesel spill in a basem ent caused fum es to N Y
Diesel
contam inate domestic w ater supply.
L/00/09/068 Not Known Unknown chemical contamination of water supply. U U

Unknown
L/00/10/033 Water Evidence of hydrocarbon contamination of water Y U

following the floods in South East England. Hydrocarbons
L/00/10/041 Waste Elevated levels of Aluminium found in local water U u

Aluminium
supply.
L/00/10/051 Spill 80 Gallons latex spilt. Y N Latex

U 00/10/069 30/10/00 Fire Fire at a chemical recycling plant. Y Y Hydrocarbons
Acid (unknown)
Sm oke
Products of
com bustion
Chlorinated phenols
L/00/10/082 Water Raised levels of iron found in a domestic water U Y

Iron
supply.
L/00/11/006 03/11/00 Water Transport tanker sunk off an island with full cargo N N
Styrene
of chemicals still on board.
L/00/11/028 Water Private water supply contamination. U U Unknown

L/00/11/030 Water Lead thought to be in water supply. U U Lead
L/00/11/062 Not Known Mercury found in water supply. U U
Mercury
L/00/11/078 21/11/00 Food & Bottled water contaminated with sewage sludge Y U
Sewage
Drink (product recall).
L/00/11/087 Water Water very hard on factory site. U U Magnesium
Calcium
L/00/11/090 Water Elevated levels of iron found in drinking water of a U U
Iron
boarding school.
L/00/11/098 Water Elevated levels of Nitrates found in peoples Y U

Nitrates
homes following flooding.
CIRS Release to
Release to
w ater
Number supply
L/00/11/107 30/10/00 Waste Elevated levels of Iron and Manganese found in U Y
Iron
drinking water.
Manganese
L/00/12/015 Land Dioxins in floodwater contaminated homes. Y N Dioxins
L/00/12/047 Land Heavy rain on chrome dump is leaching out the Y N
Chrome
metal.
L/00/12/053 Leak Boat leaking Petrochemical. Y N Petrochemical

L/00/12/056 Water Flood water is passing though a MSW landfill and Y N
Unknown
then entering residential homes.
L/00/12/057 Water Elevated levels of chemicals found in flood water. Y N

Ammonia
Unknown
L/00/12/068 Water Contaminants present in floodwater potentially Y U Sewage
entering peoples homes. Unknown
Diesel
L/00/12/071 Water Elevated levels o f nitrates found in 18 homes. U U
Nitrates
L/00/12/072 Water Elevated levels of Copper found in a private watei U u

Copper
supply.
L/00/12/073 Spill Kerosene spill in residential area. u u Kerosene

L/00/12/074 Water Elevated levels of Uranium found in drinking u Y
Uranium
water.
L/01/01/029 01/08/00 W ater Copper in drinking water. u U Copper

L/01/01/054 Spill Spill into a water course. Y N Resins solution
L/01/01/073 Waste Elevated levels found in drinking water. U Y Arsenic
L/01/02/029 05/02/01 Water Water contamination following pipes treated. N Y Unknown
L/01/02/039 Waste Copper in drinking water. U Y Copper

L/01/02/067 Information Elevated levels of aluminium in water. U U Aluminium
L/01/02/073 Waste Chemicals released in small water tank. U Y Unknown
L/01/02/083 Water Relining of water tanks released chemicals to Y Y Styrene
drinking water. Epoxy acrylates
L/01/02/092 Water Elevated concentration of Nitrates in ground water Y U
Nitrates
following heavy rains.
L/01/02/093 01/09/00 W ater Elevated levels of chem icals in drinking U U Zinc
water. Copper
L/01/02/099 Air Odours from a landfill flooded site. Y N Mercaptan

L/01/02/107 Water Raised levels of Ammonium nitrate found in U Y
Ammonium nitrate
drinking water.
L/01/02/115 Information Concerns about radon in soil penetrating water N N

Radioactive material
supplies.
CIRS Release to
Release to
water
Number supply
L/01/02/120 W ater Elevated levels of contam inants found ir U Y
Arsenic
drinking water.
Fluoride
Sodium oxide
L/01/02/121 Waste Elevated levels of contaminant found in private U Y Sodium oxide
water supply. Fluoride
L/01/03/081 W ater Rural farm steads private w ater supply u Y Aluminium
found to have excess levels o f chemicals. Nitrates

L/01/03/084 01/01/01 Water Iron oxide slug released following pipe works. u Y Iron
L/01/03/085 W ater Chemical in w ater mains. u Y
Pentachlorophenol
L/01/03/089 01/04/99 Leak Repeated petrol leaks from a petrol station. u U Petrol
L/01/04/054 27/04/01 Not Known Damaged ship at a harbour. Leaking chemicals. Sodium Chlorite
High population density in area surrounding.
Hexafluorosilic acid
Incident to Gold Command.
Y - release to water or water supply U - unknown

N - no release to water or water supply N A - information not available
N.B. The incidents highlighted in bold have had direct input to their management from
the research engineer.
Appendix 4
CONFIDENTIAL
To be completed by 2nd tier
CIRS R e f : ........................................................... In c id e n t n a m e .................................................................

Exercise:.................................................
CHEMICAL INCIDENT RESPONSE SERVICE

MEDICAL TOXICOLOGY UNIT, LONDON
CHEMICAL INCIDENT REPORT FORM
1. NOTIFICATION OF INCIDENT TO CIRS/2nd tier
Date Time
Who Position
Tel No Fax No
Address
Health Aut lority (if known)
2. CIRCUMSTANCES /AGENT(S)/PATIENTS DETAILS
Start date of incident End date of incident
General Text box e.g. site of incident and circumstances
SAMPLES REQUESTED YES NO

Biological YES NO
Environmental YES NO
1
CONFIDENTIAL
Type of incident ✓ Location (address, type or manufacturer etc.)

Air
Explosion
Fire
Food and drink
Land
Leak
Malicious act
Medicines
Spill
Transport accident
Waste
Water
Not known
Other (specify)
Chemical(s) Amount (mls/Its/kgs/tonnes)

1.
2.
3.
4.
5.
3. PATIENT DETAILS
Number exposed
Number affected
Number dead
Any secondary contamination?
Any tertiary contamination?
Name of patients (if known) Date of Birth/Hosp no.

1.
2.
3.
4.
2
CONFIDENTIAL
4. LABORATORY SAMPLES
4a: Samples already taken

Biological Results Antidotes Dispatched
Blood Yes No
Urine Yes No
Other Yes No
Non-Biological
Type (specify)
Suspect matter
Type (specify)
4b: Samples advised by CIRS

Biological Advised Urgent Non-urgent Cost agreed Antidotes Dispatched
Blood Yes No Yes No Yes No Yes No
Urine Yes No Yes No Yes No Yes No
Other Yes No Yes No Yes No Yes No
Non-Biological
Type (specify) Yes No Yes No Yes No
Suspect matter
Type (specify)
3
V
CONFIDENTIAL
5: CONTACT WITH OR NOTIFICATION OF:
Professional/ Name Tel No When Action

Agency (Date/Time)
Public Health
Hospital(s)
Environmental Health
Manufacturer/
Company chemist
Other Poisons Centre
Environment Agency
Water Company
Emergency Services
MAFF
FOCUS
Other (specify)
6. CIRS CHECKLIST AND MONITORING OF INCIDENT RESPONSE
Services Date/Time Who Information source

NPIS contact to medic
Medic recall to initial caller
NPIS/CIRS information
Service Action Additional information

Literature search Frequency?
Site visit requested
Report needed For MTU
For local PH
For DoH
Press inquiry contact MTU
Local PH
DoH
Form completed by
Date: ......................
4
Appendix 5
Faith G oodfellow
14 March 2001
Personal details and experience
N a m e :....................................................................................
Job title :.................................................................................
Work address:..........................................................................................
Telephone n um ber:..............................................................
Email address:.......................................................................
Please briefly describe your current main job responsibilities:
Please also describe any previous jobs that are relevant to chemical incident management:
For approximately how many years has your work involved aspects o f chemical incident
m anagem ent?...................................................
Approximately how many chemical incidents have you been involved in during this time?
Please provide any other information relevant to your experience in the management o f
chemical incidents.
Page 1 o f 18
Faith G oodfellow
14 March 2001
Development of Best Practice Model and

Incorporation of Expert Comment
The aim o f this consultation process is to incorporate comments and opinions into the best
practice model for the public health response to chemical incidents. Comments are being
sought from public health professionals and also additional organisations, agencies or
companies who may form part o f the overall management o f a chemical incident, including
local authority environmental health, Environment Agency, water industry and government. It
is important that a broad range o f expertise is incorporated in the best practice model and your
input is greatly valued.
Application of the best practice model

In providing comments on the best practice model please remember that:
• the aim is to identify generic issues covering all types o f chemical incident; and
• the purpose behind the model is to prevent or minimise the public health impact o f a
chemical incident.
Please also note that the model is not intended for use by responders in an actual incident,
specific guidance is being devised for this purpose. The model is a method o f identifying all
the relevant issues, prior to producing a guidance manual for emergency response.
Comments and opinions

Please provide your comments and opinions on:
• what is already included in the model;
• any additional issues that you think should be included in the model;
• any further comments on the structure o f the model or any more general comments about
the development of the best practice model.
Please also provide a rating for each action in terms o f its importance in being
considered/conducted at the immediate response stage or later in the management process, as
described below.
Rating the actions

The aim o f the rating exercise is to identify which issues should be considered in the initial
emergency response period, within the first few hours o f being alerted to the incident.
Although the model has been split into stages, within each stage the actions will have varying
levels o f importance in terms o f whether they should be conducted immediately or form part
o f the extended management process. Please rate, on a scale o f 1-5, how important you feel it
is that each of the stated actions are considered/conducted in the initial emergency response
period, where:
1 = essential action for initial emergency response in the first few hours
2 = action required in early hours of the incident, within the first 24 hours
3 = action is part of the management process in the first few days of the incident
4 = action forms part of the extended management process, within 1-2 weeks
5 = action can be delayed until the follow-up stage, after the initial management
Page 2 of 18
Faith G oodfellow
14 March 2001
The higher the rating assigned, the longer the timescale available in which to carry out the
specified action. You may find that the rating you would give depends on whether the incident
is acute or chronic, if in doubt, assume the model is for application in acute chemical
incidents, e.g. spills, fires, as opposed to chronic problems, e.g. routine emissions from
industrial facilities or historically contaminated land. Try to provide ratings that would be
applicable to most types o f incidents, even if for a specific incident you might rate an action
differently. The primary focus o f the model is on the more frequently occurring minor
chemical incidents, rather than the rare events at a catastrophic or disaster level.
The stages one to four are not necessarily completed in chronological order, in particular, not
all the actions in the identification stage need to be completed before moving on to the
management stage. For stage one (identification) it is expected that the actions stated in the
model are likely to fall within the initial emergency response (i.e. rating o f 1), and those in
stage four (post incident review) are not expected to be part o f the emergency response (i.e.
rating o f 5), however, please still rate the actions in these stages to confirm their status.
If you have any further questions about the best practice model or would like to discuss your
views in more detail please contact Faith Goodfellow at the Chemical Incident Response
Service.
telephone: 020 7771 5380
email: faith.goodfellow@gstt.sthames.nhs.uk
Page 3 o f 18
Faith G oodfellow
14 March 2001
Comments and Ratings
1. It is advised that you browse through the model first, before assigning ratings
2. Please remember that the aim of the model is to prevent or minimise a public health
impact, when providing ratings this should be the primary consideration
3. The aim is to identify generic actions for all types of incidents, please try to rate on
the basis of most types of incident
4. Please write comments/amendments in the appropriate section or in the space

provided at the end of each stage
5. Where you have provided additional issues/actions to be included in the model please
also provide an associated rating
Stage 1: Identification
initial follow
response up
1 2 3 4 5 Comments
IN C ID E N T D O C U M E N T A T IO N
record incident details
record 24 hour contact names and numbers
of all organisations/agencies involved
start logs for incoming and outgoing calls
and actions taken
Additional suggested actions with ratings
ID E N T IFIC A T IO N O F C H E M IC A L (S)
name, unique number, constituents of a
mixture
identify manufacturer o f product involved
(where constituents/properties are unknown)
common uses of the chemical/product
physical properties
taste/odour properties
basic human toxicology o f the chemicals
synergistic or antagonistic effects of
multiple chemicals
Page 4 o f 18
Faith G oodfellow
14 March 2001
initial follow
response up
1 2 3 4 5 Comments
ID E N T IFIC A T IO N O F C O N T A M IN A T IO N S O U R C E
current geographical location o f
contamination source
D E T E R M IN A T IO N OF M O V E M E N 1 O l ' T I m C O N T A M IN A N T
direction o f movement o f the contaminant
identify nearby vulnerable locations, e.g.
rivers, aquifers, schools, hospitals, nursing
homes
ID E N T IF IC A T IO N OF E X P O S U R E P A T H W A Y
try to establish what the pathway/route o f
exposure between the source of
contamination and the human receptors is
ID E N T IFIC A T IO N OF A C T U A L /P O T E N T IA L L Y E X P O S E D PO P U L A T IO N
number of people already exposed
total potentially exposed population
nearby populations that may become
exposed
ascertain if any health effects are reported
Page 5 o f 18
Faith Goodfellow
14 March 2001
initial follow
response up
1 2 3 4 5
IDENTIFICATION OF LEVEL OF EXPOSURE
amount o f the contaminant released
concentration o f the contaminant in relevant
media
time period of exposure
INCIDENT STATUS
Decide on incident status, i.e. whether to
declare a ‘major incident’ or any other
incident classification
ANY FURTHER COMMENTS OR ADDITIONAL SIJGGES1’ED ACTIONS (with ratings)
Page 6 o f 18
Faith G oodfellow
14 March 2001
Stage 2: Investigation
initial follow
response up
1 2 3 4 5 Comments
INCIDENT DOCUMENTATION
continue to record incident details
keep current 24 hour contact names and
numbers
complete logs for incoming and outgoing
calls and actions taken
IDENTIFICATION OF CHEMICAL(S)
ensure all chemicals involved have been
correctly identified and relevant details on
properties (including environmental
persistency) and toxicity (including
biological uptake) are determined
N.B. there may be multiple chemicals,
reaction products and additional chemicals
added as part of the management, e.g. fire
fighting
IDENTIFICATION OF CONTAMINATION SOURC

confirm location o f contamination source,
with postcode and/or grid reference where
possible
where location o f source is in doubt consider
use of modelling to predict possible sources
Page 7 o f 18
Faith G oodfellow
14 March 2001
initial follow
response up
1 2 3 4 5 Comments
DETERMINATION OF MOVEMENT OF TIIE CONTAMINANT
identify all environmental media affected,
i.e. air, water and land
determine current weather conditions
predictions o f future weather conditions
confirm direction o f movement of the
contaminant and ensure regular updates are
received to monitor for any changes
when direction o f movement o f contaminant
is in doubt consider use of modelling to
predict possible areas at risk
confirm nearby vulnerable locations, e.g.
rivers, aquifers, schools, hospitals, nursing
homes
IDENTIFICATION OF EXPOSURE PATHWAY

confirm the pathway/route o f exposure
between source of contamination and human
receptors, including food contamination
IDENTIFICATION OF ACTUAL/POTENTIALLY EXPOSED OR AFFECTED POPULATION

confirm number o f people already exposed
or possibly exposed to the contamination
where possible obtain names and addresses,
include visitors to the area
confirm type o f health effects reported and
number o f people affected
mark cases reported on a map or in
geographical information system (GIS)
confirm additional nearby populations that
may become exposed
identify and alert particularly vulnerable
populations, for example, through health
visitors, vulnerable patient support groups,
etc.
Page 8 o f 18
Faith G oodfellow
14 March 2001
initial follow
response up
1 2 3 4 5 Comments
IDENTIFICATION OF LEVEL OF EXPOSURE
confirm amount o f the contaminant released
confirm concentrations o f the contaminant in
relevant media and at various locations and
times
ensure most up-to-date analysis results have
been received
estimate time period o f exposure,
differentiating between various populations
if exposed for different time periods
CONTACT WITH RELEVANT RESPONSE ORGANISATIO1ISIS

health organisations - chemical incident
provider unit, neighbouring health
authorities, A&E hospitals, GPs
emergency services - police, ambulance, fire
brigade, Maritime and Coastguard Agency
local authority - environmental health
local authority - emergency planning,
housing, social services
water companies - water supply, sewerage
enforcement agencies - Environment
Agency, Health and Safety Executive, Food
Standards Agency
government - DH, DETR, DWI
occupational health professionals - industry
and emergency response organisations
environmental specialists, consultancies
A d d itio n a l su g g e ste d a c tio n s w ith ra tin g s
Page 9 o f 18
Faith G oodfellow
14 March 2001
initial follow
response up
1 2 3 4 5 Comments
ACTIONS ALREADY TAKEN BY OTHER RELEVANT ORGAN ISATIONS
identify contact personnel and record 24
hour contact details
detail actions taken by other organisations
involved, as identified through contact stage
INCIDENT STATUS
Confirm current incident status, i.e. ‘major
incident’ or any other incident classification
Assess whether the severity o f the incident is
likely to escalate
ANY FURTHER COMMENTS OR ADDITIONAL SIJGGES1 "ED ACTIONS (with ratings)
Page 10 o f 18
Faith G oodfellow
14 March 2001
Stage 3: Management actions
initial follow
response up
1 2 3 4 5 Comments
IN C ID E N T D O C U M E N T A T IO N
continue to record incident details
keep current 24 hour contact names/numbers
complete logs for incoming and outgoing
calls and actions taken
IN C ID E N T C O N T R O L T E A M E O R M A T K T *
consider forming an incident control team
identify incident control team members -
representatives from key organisations
involved in the management with the
necessary seniority and expertise to be able
to take decisions
find appropriate location for incident room
ensure necessary facilities are available -
telephones, administrative support for
provision o f minutes, etc.
ensure contact numbers for the incident
control team are provided to other relevant
parties
determine frequency o f meetings
Page 11 o f 18
Faith G oodfellow
14 March 2001
initial follow
response up
1 2 3 4 5 Com m ents
ACUTE HEALTH ASSESSMENT
full record o f any health effects reported
patient identification - through GPs,
pharmacists, hospitals, reports to
HA/LA/other agencies
record patient details - names and addresses
compile register o f exposed public
compile register o f exposed emergency
responders
ensure patients/exposed population are
adequately decontaminated
ensure appropriate medical treatment is
available for patients
toxicological evaluation o f exposure data to
determine possible and most likely impacts
on health
determine a precise case definition
determine whether there are other possible
causes o f ill health, e.g. viral infections
consider conducting biological monitoring
of patients and the exposed population to
identify level o f exposure and adverse health
effects
consider distributing a health questionnaire
to identify level o f exposure and adverse
health effects
A dditional suggested actions w ith ratings
Page 12 o f 18
Faith Goodfellow
14 March 2001
initial follow
response up
1 2 3 4 5 Comments
ACTIONS TO MINIMISE HUMAN EXPOSIJRE
alert affected general population and those
potentially affected if movement of
contaminant is expected, include vulnerable
populations
provision o f appropriate advice to
prevent/minimise exposure - e.g.
evacuation, sheltering, stop drinking/using
drinking water, find alternative dialysis
facilities
arrange for provision o f alternative water
supplies, where regular supplies cannot be
used
alert other water users, e.g. food
manufacturers, agricultural facilities
ensure personnel directly involved in
tending to potentially contaminated patients
or cleaning up the hazard do not become
contaminated themselves, provide
appropriate personal protective equipment
and decontamination facilities
ACTIONS TO MITIGATE ENVIRONMENTAL HARM AND MIGRATION OF

CONTAMINANT
ensure relevant environmental organisations
have been informed, i.e. Environment
Agency, MCA
ensure actions are being taken to remove or
contain the source o f contamination and that
chemicals or contaminated substances are
appropriately disposed o f
protect vulnerable locations, e.g. drinking
water abstraction points
Page 13 o f 18
Faith Goodfellow
14 March 2001
initial follow
response up
1 2 3 4 5 Com m ents
E N V IR O N M E N T A L M O N IT O R IN G
determine if any routine results from
environmental sampling are already
available
establish what environmental samples need
to be take: media, when, where, who will
take them and what parameters are to be
tested for
identify laboratory for analysis
agree financing, establish timescales for
reporting of results
initiate sampling, ensuring samples are
collected and stored appropriately
ensure samples are sent for analysis, ensure
appropriate analytical techniques are used
and quality control procedures are adequate
establish method for interpreting data, define
limits o f detection, limitations from
sampling procedure, accuracy o f analytical
method, relevant standards for comparison,
including taste and odour
conduct any repeat sampling and analysis to
confirm results or to detect changes in
concentrations
A dditional suggested actions w ith ratings
Page 14 o f 18
Faith G oodfellow
14 March 2001
initial follow
response up
1 2 3 4 5 Comments
COMMUNICATIONS WITH THE PUBLIC AND MEDIA
ensure awareness of the public and relevant
organisations of the situation, including
residents groups
define population ‘at risk’ to avoid
unnecessary concern from unaffected
individuals.
provide clear and consistent information on
the nature o f the hazard and the level o f risk
ensure affected populations understand what
actions they need to take (e.g. stop using
water, leave home, consult GP etc.)
provision o f press releases to alert the public
provision o f press releases with follow-up
information on how the incident is being
managed
consider setting up a telephone help-line for
enquiries from the public
REMEDIATION ACTION
removal and disposal o f the chemical(s), or
removal o f exposure pathway, i.e.
containment
decontamination o f property, including
water pipes
INCIDENT STAND DOWN

prior determination o f criteria for incident
closure
ongoing assessment o f progress towards
specified criteria
recognition o f when to close the incident
ensure all organisations involved in the
management of the incident and the public
are informed that the incident is over
Page 15 o f 18
Faith G oodfellow
14 March 2001
initial follow
response up
1 2 3 4 Comments
5
ANY FURTHER COMMENTS OR ADDITIONAL SUGGESTED ACTIONS (w ith ratings)
Page 16 o f 18
Faith Goodfellow
14 March 2001
Stage 4: Post incident review
initial follow
response up
1 2 3 4 5 Comments
INCIDENT DOCUMENTATION
summary o f the incident
lessons learned regarding management of
the incident - negative and positive
changes in procedures to improve
management o f future incidents
identification o f preventative action to avoid
the occurrence o f similar incidents
identify specific actions to be taken and a
named person responsible for ensuring
completion
provision of information for official reports
to enforcement agencies, e.g. DWI, HSE
LONG TERM HEALTH MONITORING

continued treatment of casualties with long
term health effects
consider tagging o f individual patient notes
follow-up epidemiological studies
(monitoring o f relevant health data e.g.
disease registers, hospital admission
registers)
LONG TERM ENVIRONMENTAL MONITORING

A consider the necessity for long term
monitoring o f the affected
environment/media if remediation is not
possible
Page 17 o f 18
Faith Goodfellow
14 March 2001
initial follow
response up
1 2 3 4 5 Comments
ENVIRONMENTAL REMEDIATION
ensure remediation at site of contamination
is complete and meets required standards
where possible take steps to prevent
recurrence o f the situation
where remediation is not possible and a
significant risk to health remains, consider
permanent re-housing of people in the area
affected
COMMUNICATIONS WITH THE PUBLIC AND MEDIA

follow-up information to reassure the public
that the risk to health has been eliminated
and appropriate actions have been taken to
prevent a similar event
ADDITIONAL SUGGESTED ACTIONS (with ratings)
ADDITIONAL COMMENTS ABOUT THE BEST PRACTICE MODEL IN GENERAL
Page 18 o f 18
Appendix 6
I
R a n g e
in CM CM C O I f ) C O C O CM C O CM CM CM CM CM C O C O CM CM C O C O M" m C O CM C O C O
1 -4
1
1 -4
1 -4
i i i 1 ■ 1
1 -4
- -
1
M o d a l
ra tin g CM CM
CM CM CM - - - -
o
o e g CO T f C O C O h - h - C O CM O ■ *r C D C O 00 C O O )
1 M e a n
p in ^r o CM C D M" m CM o CM CM
o CO O o CM o CM CM O T“ O CO CM ■M; p so C O o p p CO CM p to p
S t P
T— CM T— T— T— T ~ T— T— CM
2
ad T“ T— CO CO - T— x— T— T — ^— T — CM T — CM CM -
- - - CM CM - - - - - CM CM - T— - -
Q
l_ 2 T — CM - CM CM CM CM CM CM CM CM CM
0) > - - CM CM CM - - - - CM
JZ
* -*
o CM CM CM - - E - CM CM CM C O CM CM CM C O
CD -
a
LU - CM T — CM CM - - -
c>
ad T““ CM - - - CM - - T - - CM CM - CM - CM - - - - CM - CO E CO CO CO M" - CM -
o
X T—
© 1— CM CM CM CM CM - - CM CM
k.
U L CD
- in CM CM CM CM CM CM C O C O - M" M" M" M " CM CO CO - CM C O
~3
Ratings provided from the consultation process for the best practice model
Q CM CM CM CM C O T— -
CL - CM CM
£ - - - - - CM - T — CM CM - T — CM - CM CM - T“ T—
0 . - - - - - - - - - - - - -
U .
- CM - - - CM - - T — CM - E - CM - CM CM CM - T— T — - CM CM CM CM CM CM CM CM C O CM
0)
LU
CO 1—
5
o p in in in
—> CM CM CM - CO - CM CM CM V CO C O C O CM C O C O
cm " CM - - - - - - - CO
C o n s u lte e s
o
X CM C M CM - - -
< X
L U ad - E
LL in in p in in
Cd CM CM CM CM CM - CM - - - CM CM CM CM
CM - CM - -
z Q
s■*-» T— T~“ - T“ CM CM V" T“ * T— CM CM - CM T— V “ CM - CM T “ V“ CM CM
CD - E - - - - -
TO
CD Q
X 0 . CM CM CM - CM CM CM CM CM CM CM - CM CM
>
c CO in to
H i <
T“
- CM T — - - C O CM CM - CM r* I T - CM CM CM E CM - - CM - - CM - - CM o- CM T “ CM
2 -
£ CM CM CM CM CM CM T “ - - -
CO
Cd CM CM CM C O T “ - CM CM - - CO - - - CO CO - CM C O
CO CM CM CM
—> CM - CM CM - - -
£
■4-»
CO Cd in E
o o - - - -
X
X CM C O C O C O
CL - - - - CM CM CM CM CM CM CM CM CM CM -
- -
CO
- - - - - - - - - - - - - - - - T— - - - ^ ■ E - - r* CM - T- -
- - -
o
CD CM - CM CM CM CM CM CM CM T — x— CM CM - CM - CM - CM CM - CM -
5 - - - - - - - -
|
CD
CJ p
«*—
3 CO CD 7 3 O
O 73 SZ £ -2 ro c
CD CD a > CO so
X3 CO
SZ CD T3 E so 2 i 3 sz
o CD E i—
CD 3 CD 3 "ro ro E
CD CO
sz
CD
O
O T3
CL CD
c
CO SZ o 8 w 73 ro
X3 73 E
O . X •e > 7 3 C 3) c -2 CD CD 73 c
E
3
CD
> O
E
JO
CO
sz X
CD
CD o a) SZ sz
CO o
CD
r o CD
O SZ
o ro SZ C J
CD o
3
SZ O CD Q . 2 O CD o
SZ o
CD
ro
B P M
3 c '£ *+— 73 CD D ) o O —
SO > 7 3 CD C E CD
73 p o JO c o T3 O 2 CD p CD 3 ro t CD x > a St o -O p
SZ
CO
"E
CD
O W o E o 0) CD
CD
o
o 2
CD
CO c
JO E O > CL
SZ CO sz 4—
=3 o . Q . O
o o 3 O p CD ( 0 CD CO JO CO
c 7SZ 3 co o CO -a o o
sz o
CD 3 "ro SZ CO O CL 3 XI sz 1 1
fro m
Cl) S t sz o SO "5 to 73 o c
E
W 7o3 O
SZ
CD o p
CD o
" >.
X
CD O
Q. >>
CO a
2
E
73 o CO
ro ro ^
> CO
sz .£ = < d ro o ro ro
CO Q . E O " co CO > . CL C
ro C3>
E so s z E p E
o W— CD E s t C SZ ro ro
A sp e c t
sz o CD
o SZ > . to o o SZ 5 TJ T3
CO CD CD
CO
SZ co
CD
3
CD c
7 3 oo E
ro ' « ro ro to
ro >
jd o sz CD C D 'sz o 2 "co
CO
p
2 1 1 c 2 o "c to o
ro O E 2 CD p E o 3 ra O o o 13 Q . ro $
jo
ro
X I r o CD
CD o
C D " oc o CD q 3 Q . O J O CD CD t o C 3 po o
ro E
O _c " c o CL CD " c o E
© o
73 o
c
E
3
3
o M—
o
CD
CD
'• e
CD
Q .
O JO
" x C 'sz
E
CD 3> s z
a)
CD XCD SZ xCD:
o
c p
O
Q. c
o m — X CD
o
"E x : ^ s »4— 8
o
O ^
o
sz
o
5
"c
2
3 o
c
SZ
£
'• e
CD O o CO Q . O
>
s:
Q . >> >% o o CD 7 3 o M" £
o CM E 2 73 o sz 2
3
p
c 3 CD 2 O "co sz CD sz h — o so c ■>
LU Cl) o CD 3 CD Q. Q. c o CD E CD CD J O CO O O 2 “ -a g sz 3 o
Z 73 x : 1 3 SZ
_ D " CO CD
g CO o o CO 1 5 CL 3
CL
x : o c C g 5 S o c .= to .1 ^
ro O
O
3 3 o c M— 73 o z=> zs. = o to ° CD 2
O CJ M " Q . E CD CD J O O O sz 2 E p CD SZ
C CM CD 'sz E C O C T sz SZ t o
O <L> CL p o 2 CD iS O CD to 73
3 w o SZ o
LU cn 3 O "co 7 3 SZ O ) E o £ CD O > < ‘co "c c aj LU CD3 3 f l j CD ™ p ^
P p
O 7 3 73 p
CD E
O O
o
CD
X ) CL X ) ■e 3 CD Q . 7CD CD C
O g f tc = a > E 'E o E
O O tr CD CD o O CD O 3 Q. = J ’■ £ T 3 i+CC 2 " r o
C J O TO E
c E >% ' cd SZ 2 c E P CO O o c CD O C CD i i c sr zo 7o3 c ro 7 3 c
s CD CD CO CD o SZ t roa CO >> 3 2 CD 3 CD CD E o E CD 2 o CD o o £ ro £ o ro ro 2 o
(0 W c “O sz Cl X ! CD O T3 SZ O SZ CO CO o 73 C O o ZtS O CO r o co o 5 E 73 73 Q . o
|
R a n g e
CO CO CO ■M" in ■M" ■M-i C O C Oi •M" M" C O C O C O CM C O C O C? m C O C O CM CO
i i 1 1 1 1
1 -4
x— T—
M o d a l
ra tin g
CM co CM CM CM
eg - CM CM CM CM CM CM CM CO - - - - CM CM CM -
T— CM - - -
O)
CM 03 03 CD i n
1 M e a n
e ^r o O •M" 03 h - M - CM h - ■M- C O CO 0 3 0 3 i n CM C D CO
“X •M ; 1^. CD •M- CM CM CO h - 0 0 <33 CM 0 0 CM CM CM C O ■M; N ; C D r - . 0 3 ■M; in
rLe. cm ' x— CM CM CM CM x— CM CM CM T—
a: CM x— CO CO CO
- E CM - CM CM CO - - - - CM - - E E - - -
a -
CO T“ X— CM C O CM CM - CM M- CM - CM - T— CM CM i n CM CM -
O th e r
> - - - - -
CO CM CM CM CO CM C O CM CM C O CM CO CM - CM CM CM CM CM C O C O C O C O CM CM
0 -
Q CO V m in in
CM CM CM C O CM CM CM C O E CO CO CM CM CM CM CM CM CM CM CM CO
LU CM CM cm ’
|
o
m CM - - - CM E •M- C O CM - CM CO C O CM C O C O CM CM C O ' t CO CO C O C O CM CM
o
JO CM - T“ CM CM CM CM CM CM - - - ^— - -
in
-
in in in
CM T -
h- - CM - T— - -
F ire
0 C O CM CM CM CO CO CO C O CM CM CM CO CO CM CM CM C O CM CM - CM
—)
Q CM - CM CO CM CM CM CM - CM CM - ■*— CM - T— T — CM -
Q. - - - - - - -
I
£ - - CM - CO C O T— V T— CM - CM E CM - C O CM t—
Q . - - - - - - - -
U_
CM C M CM CM CO C O CM C O CM CM CO CO C O V“* T “ CM CM - CM - T" CM CM CM CM CM
a te r
LU CM CM T“ T“ r—
h- - - - CM - CM - CM CM CM CM - CM E - - - - T— - -
W
o C O CM CO CO CO CO - CO CO CO CO CO C O CM CM CM CM CM CM CM CM CM CO CO - x—
—)
o X— X— in LO i n in m m in
CM CM CM CM CM CM CM - - CM CM CM CM CM CM CM CM
X CM CM
|
< X in m
CM CM CO CM T" CM CM CM - CM CO CO CM CM CM
LU X t— - cm "
LL lO in m m in in
CM CM CM CM CM -
X CM - CM CM CM CM CM -
o
CM T“ CM T— CM X— C O C O CM CM CM CM CM CM - CM CM CM CM CM CM CM
H e a lth
0 E - - -
Q CM CM CO CO CO CO CO
X CM CM CM E CO CO CM CM CM CO CO CM CM
Env
m t— T—
CM - - - CM - - - - CM CM - - - - - - CM - CM - - T— -
<
CO T“ CM CM CO CM CM C O CM CM CM CM C O CM - CM - C O CM C O CM C O - CM
s - -
|
CM CM CM CM CM CM CM CM CM CM CM CM CM CM CM C M CM CM CM
CO CO CO CO
CO Tf CO - CM CO CO M- CM - CM C O CM CM CM
X -
CO CM - CM T- CM CM - CM CM - ■M- CM T"
—) - - - - - - CM CM CM - - - CM
H e a lth
X T“ " T-
E - - in - CO - E - - CO - - - CM - - CM - CM -
o - - -
X CO CO CO C O CM c o
X - - - CM CO CO CO CO CO CM -
CO
CM CM CM - CM CM CM - CM CM CM CM CM - T“ CM - - CM - CM - T“ CM CM
-
o
m CM - CO CM C O CM - r* T— x—1
5 - - - - - E E E E E E E E E - -
[
ro ro
X o >, V+—
3 ro - X3 ro E O
o "c 0
° re
3
re
■3a o
o re ro C ro X
O c
T5 ro re re
o O
ro
XI
ro
XI
c
o
>
ro ro 2? c ro
>
>X
ro
■- 2 cz _c ro 0
X E >> ro X D) ^ 0 0
re ro ro ]ro C 5=
ro 3 ro >
a) o re
ro £Z E
3
X X c 2 ro ^
3 c re
3 X ro ro 0
£ s re 73 o X re c
ro ro re c £
£ re XI re
re C ro X ro Er o wcd X re ■
cz ro
■— re ro ro C /) X re 2 X M - 0 X
E ° ro r e oX •a 73
ro ro
ro ro ro CM
0 re X ro ~3 s t= re X 0 X ro 0
ro ^ 3 O X X ro I I c
B P M
re c cz ro re cz re
"E o cz o2
ro
rr oo - > x x
ro ■E
O
o
ro c
ro
7 3 ro
c
C
=5 8 . ro
ro
ro O
O 'cz ro
o re ro
8 ^ X cz X
ro
o _c ro
c 03 . r e
o 2 ro X
ro re
"3 ro 03
X
ro ro ro X 3 3 O
03 re
0 X o l e > ro cz cz X 0 re
fro m
re 2 c re ro X E 0 3 0
_o o ro E § i "E 0 c
c o ro ro - 9 E ro x .2 ro "re 0 >x
° 8 o X ro ro ro ro
ro £ E ro ro ro _ ro c **— ro c x .1 re X
E
A sp e c t
ro ifc >x o o o ro E re" "ro re ro

1 ? XI 3 3 X 3 cz £ 0
Q) 1= ro O X c ro c
O
o re o ro ® ro 0 re cz >
f f c x
o ro ro 0 3 0 re cz > . " E ro
o° ro 0 r o re
X® ro X ro ■E sz "ro ro X X
_c 'r o cz ro 73 re r e ■ > 0 re X
E o "ro ro M— • r Io . S9 c ro c 0 X c " o ro
E
3 Ho o o ro ro -E
ro
X
o o 1 £ o o ro c
r e ro
ro ro ro _ c X
o M— > Z. ° o o sz o •E ro re "ro X X ZtZ
n - 73 X cz a . X 3 ro 1 r o 0 3 ro re ro
c o >x
§ 1 a> a ) ro ro o ro ro o ro "c ^ § 3 re r o > * >. 'cz r o X 0 c ro
X - Q s z 3 r o ,1
.9 <u x ro x i r o
ro o
ro
o
ro .2
'cz r e ro £ ro re 2 X
ro ro . 9 re £ re x 73 8 ^ 03 1 ro ^ ro X c "ro c "c cz ro
8 § ro i s re _ > : ro 7 3 c E o X 0 o ' o o ro cro cz ro 0 0 3 X
cz £ E o o
r o rr oe 73 ro ro o cz E 7 3 —r o >
c x
o E ? cz X X E0 E 0
0 0 (D
o " 3 E E 0 5
E E ro o EE ®r e ,> . E EE rr oo 2 ro 3 0 ro c ro cz ro
^ 1 E re §> 1 8 & X a i ro ro 0 X 0 _w E re £
mr o wc li= o i t : O ? l Id x a : id o c Id
" r o r o " r o "ro
r o r o 3 <D C O
- S o w
cz c
o
o
O M_ o
cz X
X x
r o ,-t; < z o
re o ro ro o
c X
X ro c
o o “ 1 8
• !
w
I
a)
£
E ro E o
0
0 ro cz > 0 0 c
0 > "E "ro " r o cz if) if)
if)O
5 o x o o o o ro 5 > o X E o ro X C 3 o E ro 2 a ) c X ro o 0 5 ® ro
■g X 0
d ro 0 3 0 ro S X 0 co a>
<
LU
Aspect from BPM | Health | Env Health | W ater 1 Fire | Other Mean Modal Range
x
0
0
o
0
X
X
X
!0 d
X
X
X
X
x
M IA I la v
x
>
o
2
x
o
o
o
X
O
dlAI
o
Q
LU
Q
Q
LU
H-
—)
CL
1-
Q.
—>
CO
s
rating rating
CO
CO
—»
CD
U_
ISTAGE THREE 1
-
-
-
-
-
1
T j*
T“
Icontinue to record incident details 1 1-64
-
-
-
-
-
E E
M"
'S t ■sr
<NJ CO
CM CM
CM CM
CM CM
CM CM
T"“ T“
CM CM
CM CM
CO
CO CO
CNJ CM
CM
Ikeep current 24 hour contact names/numbers | 1.80 |
T—
complete logs for incoming and outgoing calls and
-
-
-
-
-
-
V”
M-
1-4
CM
actions taken 1.68
-
CM -
CM -
-
CO -
CM -
-
T
-
in
t—
T— CM
consider forming an incident control team I 1-44
-
-
i
T"
CM CM
■identify incident control team members 1 1-59 I
-
-
-
-
-
LO in
I
CO CO c d
T*“ T“
CM CM CM CM
■find appropriate location for incident room 1 1-52 |
-
-
-
-
E T— E T— -
T— -
in
cd
E
T— CO CM CM
E E E
E E E
CM CM
•M- CM CM CM CM
CM CM CM CM CM
CM CM CM CM CM
CM CM CM CM
CM
CM CM CM
CO CM CM CM CM
CM CM CM CM
|ensure necessary facilities are available | I 1-54 | I 1-4 I
ensure contact numbers for the incident control team
-
-
-
-
-
M-
x—
CM
T—
are provided to other relevant parties 3.5 1.56

-
-
-
f r 'l-
-
in
in
I
cd
E
E
E E
CO CO
CM
CM
00
T— CM
jdetermine frequency of meetings |
-
V
CM
E T— CO
CO
■M-
|record of health effects | | 2.38 | I 1-4 I
co
CD
CO
CO
CM
■M"
Ipatient identification | I 2/3 |
-
-
CM CO
CM CM CM
CM CM CM
|record patient details | I 2.46 |I 2/3 |
CM CO CO c o
O '
CM
M-
M"
|compile register of exposed public | I 2.87 |

CM CM CM CO CO CO -
CO CO CO CO -
E E E E E
CO CO
CO CO
E E
E E E E E
CM CM CM CO CM CO CO
CM CM CO CO CO CO CO
CM CM CO CO CO CO CO
CO CO CO CO CO
■M" ■M" ■M" ■M- O '

CM CO CO CO
•M"
CM CM CM CM
CM CO CM CM CM CO CO
CM CM CM CM CM
CM CM CM CM CM CM CM
CM ■M- CO CO CO CO CO
CO CO CO
CM
CM CM CM CM CM
CM T—
|compile register of exposed emergency responders | I 2.57 I I 1-4 I
ensure patients/exposed population are adequately
-
-
-
-
-
-
E
E
CO
CM
■sr
CM
CM
•M"
CM
CM
CO
CM
CM
CM
CNJ
T—
decontaminated 1.79 1-4
ensure appropriate medical treatment is available for
-
-
-
-
-
-
-
-
-
-
-
m
T*“
E
E
CM
CM
CM
CM
CM
CM
CM
CM
CO
■M-
patients 2.5 1.77
toxicological evaluation of exposure data to determine
-
-
-
-
O
v-
T f
CO
CO
CM
CM
•M-
possible and most likely impacts on health 1-4
-
in | s -i
T— in
I
CNJ c o
E
E E
E E
CM
CO CO
CM CO
CM CM
CM
CM CM
CM
CM
CM CM
CM
CO CO
T— CO
CO CO
CM CM
CO CM
CM
CO CM
CM CM
CM CM
■M-
|determine a precise case definition | I 2.50 |

determine whether there are other possible causes of ill
-
rr
co
E
E
E
CO
CO
CO
CO
CO
CO
CO
CM
CO
CO
CM
CM
CM
CM
CM
■M-
■M-
CNJ
Tfr
1-4
M"
health 2.74
consider conducting biological monitoring of patients
-
in
in
i
E
CM
and the exposed population 2.96 2/3/4

-
in
in
■M- m
i
■M" in
•M- O ’
■M" O ’
•M" O ’
CO
E E
E E
CM CO
CO CO
CO CO
CO CO
CO CO
CM CO
CO CO
■M- CO
CM CM
CM
CO CM
CM CM
CM CM
CM CM
■M- ■M-
|consider distributing a health questionnaire | 1 3.04 1

■M"
alert affected general population and those potentially

-
-
-
-
-
-
-
-
-
-
-
-
-
-
in
cd
CO
CO
x—
CM
CM
CM
CM
CM
CM
CM
CM
affected if movement of contaminant is expected
CO
provision of appropriate advice to prevent/minimise

-
-
-
-
-
-
-
-
-
-
-
-
-
-
in
exposure 1.33
-
-
-
in
T— t—
CM
T— CM
CM
CM
CNJ
|arrange for provision of alternative water supplies | I 1-79 |

-
CM -
CM -
-
-
CM -
CM -
T— CM -
-
in
in
in
T“
CD
CO CO CO
CM CM CO
CM CM CO
CM CM CO
CM CO
X—
CO CO CO
CM CM CM
CM
CM CM CM
CM CM CM
| CM CM
CM CNJ
jalert other water users

T“*
T—T“"
CO
re
o>
c
re
o'
re S’
■oo ■=£
c O)
re
Q)
c
~ so
a:
Q
a:
o
O
a
CL
CO
LU
C
M
o CO
o
x CO
C
M
UL
cc C
M
CO
C
M
C
M
CO
C
M
■M-
CO
CO
w
= re c
2 i5
re
8 “O= 2 ro E 2
ro -2 ro ro
re
1 »
re « •S8 ro 3
d) 0
«>» J=
ro E
ro > ro
o>
of re ro’ c l
ro
■ro
o a)
> o
G 8 E S£ ro c re tj -O •a
ro
0
ro .ro E TJ
0) a> *+—
re re D) Q.
re °
*- "O
o £hr ^W re
CD
E
S "o
-o
j2 re ro o .g
3 -Q
w ro
cr 3
E °-
■B E
re ro ■R ro
re E re
o
a> LU >- —
ro o -o s i-
ro re
cl £
re ro
Q. O CL
<= CL 1 " rCe —
Q)
ro o •ro 3
W ro E5 vi (_J
V) </)
< O q)
!E 0
p ro re 8
a> a> ro >, m
o .E
■■3 -o ro "ft ro CL
0)
d) ,S5 2 ro 3 € ir o ro o S. rore O 0) •-
ro U) •*- re
c os c ro o
£ re «*r .2
cl 0)
re -tz
ro
^CL pQ. ® c tj x: ,-tz c c re *- TJ
C O
re re 2 -5
"o
•g 3 ^Q- -are
w £ 2 o. ro ro "re E r o —
8. J il TD ro o 1 S,
E CL I & o E = o § c 2
ro c l S •£ a . JC c >» w ro i_
w ro re *- o
I I
ro ro
S-sg
o co
I*
ro ■reo
re £ re re re t3 3 c: .52 . 2 re .52 CL C re ro
3 E I f ro 2 1/1 &Q . _PC 3ro ore o E re ro
| re w o ^ E Its o C CL O w re o o 0) «§ E w m
re £ .E w re ro o re "a ro o ■r oe 0o=
0o)
c
RS
cc
"to
•n .E
° «
C
ro e0 5
ro +5
~ «
CD
lO
CO
CO
(0
d)
l.
3
cr O
c
0) 'iZ TO
o O”
•t± c
0c c o
o *=
05 Q)
TO
S TJ "E CL
CL
CL C
TO TO
C TO
CD 0)
x: § I TO <5
E C
D O -Q £
o C
o ?»= O to TO TO
TO CL
SI o TO ° 1 O i_
a. i- ~n _05 X3 Q . TO
CD * - T5
CL <i> O
3 £ O TO 9
TO “ 3
< 03 "to
to TO TO TO O
O. o >, TO TO C T5
3 CL TO 05 P
O E
O 05
rx>
c o "O -E E -o TO'5C
.o T3 TO oTO
P S
•n
TO 05
05 >
TO E in
0 3 C Q. TO
CO Q_ SZ c
CL ] q
0 JE
TO P TOT5 TO T TO
O
“O S I >
O 5) 0Z
5 tC CL
§ JO _Q5
'TO O E TO TO
CO
c E TO ^
o
o
o
vfc
E
o 'Z
C o XTO
J to
05 O tt=
O 05
C
O TO O
O Sfc
05
C CO 5 TO s 5
TO TJ JZ
Q. TO T
Appendix 7
Faith G oodfellow , CIRS DRAFT
14 M ay 2001 Version 1
Checklist of Actions for Chemical Incident Management
ACUTE PHASE
1. First few hours (or as soon as practicable)
Assess potential public health impact
ACTION F urther C om plete N /A

guidance ✓ S
Chemical
Identify name o f chemical (common/trade/scientific), unique number,
constituents o f a mixture
Identify taste/odour and visual properties (e.g.colour)
Identify physical and chemical properties, e.g. physical state, pH,
density, boiling point
Determine basic human toxicology o f the chemicals, including Flowchart 4
availability o f antidotes
Identify any synergistic or antagonistic effects o f multiple chemicals
Identify manufacturer o f product involved (where constituents/properties
are unknown)
Identify any measures for control or mitigation o f impact
Incident source and location
Identify current geographical location o f contamination source
Identify type o f contaminant source (e.g. fixed installation or transport) Flowchart 1
Determine information about the area (e.g. topography, urban/rural)
Population exposure and health effects
Estimate number o f people already exposed and nature o f exposure
Estimate the total potentially exposed population
Identify any nearby populations that may become exposed, for example Flowchart 6
if contaminant is airborne
Estimate the time period o f exposure for the population
Find out if any health effects have been reported to any agency Flowchart 7
Check any symptoms exhibited are consistent with the chemical
identified
Contaminant concentrations and movement
Determine approximate amount o f the contaminant released
Identify all environmental media affected, i.e. air, water and land Flowchart 1
Determine the concentration o f the contaminant in relevant media and Briefing 3
where applicable at various impact points Checklist 7
Determine current weather conditions, e.g. temperature, wind

speed/direction, rainfall
Obtain predictions o f future weather conditions
Consider direction o f movement o f the contaminant (in all relevant
media, e.g. from Chemet for air)
Try to establish what the environmental pathway/route o f exposure Checklist 8
between the source o f contamination and the human receptors is Flowchart 5
Flowchart 7
Incident status
Find out if incident has been declared ‘major’ by any agencies involved
Decide what status to give the incident within the HA
Assess whether the severity o f the incident is likely to escalate
Page 1 o f 6
14 May 2001 Version 1
Action to prevent/mitigate impact or inform others
ACTION F urth er C om plete N /A

guidance ✓ ✓
Refer to pre-prepared emergency plan
Alert other agencies
Alert relevant health organisations, e.g. CIPU, neighbouring health
authorities, health authority regional office, A&E hospitals, GPs
Alert relevant emergency services, e.g. police, ambulance, fire, MCA
Alert local authority environmental health department, where relevant
Alert National Focus, where relevant B riefing 1
Alert other relevant departments o f the local authority, e.g. emergency (Checklist 1)
planning, housing, social services
Alert local water companies - water supply and sewage, where relevant
Alert relevant enforcement agencies, e.g. Environment Agency, Health
and Safety Executive, DWI, Food Standards Agency
Incident control team
Consider forming an incident control team
Identify incident control team members - representatives from key
organisations involved in the management with the necessary seniority
and expertise to be able to take decisions, ensure roles are clear
Briefing 1
Confirm location for incident room with security access and adequate
Checklist 2
parking (should be pre-planned) Checklist 3
Ensure necessary facilities are available - telephones, administrative
support, etc. plus toilets and food/drink (should be pre-planned)
Ensure contact numbers are available for incident control team members
Determine scheduling of meetings
Alert and advise affected population
Identify vulnerable populations within current or potential area of
exposure, e.g. schools, hospitals, nursing homes Checklist 9
Ensure affected population is alerted and those potentially affected if Checklist 10
movement o f contaminant is expected, include vulnerable populations
Ensure appropriate advice is provided to prevent/minimise exposure - (Checklist 1)
e.g. evacuation, sheltering, stop drinking/using drinking water Checklist 8
Ensure affected populations understand what actions they need to take (Checklist 1)
(e.g. stop using water, leave home, consult GP etc.) Checklist 8
Ensure patients/exposed population are being adequately decontaminated Checklist 4

Ensure appropriate medical treatment is available for patients
Ensure personnel directly involved in tending to potentially Checklist 4
contaminated patients or cleaning up the hazard do not become
contaminated themselves by the provision o f appropriate personal
protective equipment and decontamination facilities
Alert other water users, where relevant, e.g. food manufacturers, Checklist 1
agricultural facilities
Prevent/minimise environmental contamination
Identify nearby vulnerable environmental locations that are or could Flowchart 1
become contaminated, e.g. rivers, aquifers, agriculture
Ensure vulnerable environmental locations are protected, e.g. drinking (Briefing 2)
water abstraction points Checklist 1
Ensure actions are being taken to remove/contain source of (Briefing 2)

contamination and chemicals/contaminated substances are disposed o f Checklist 8
Flowchart 5
Page 2 o f 6
2. Within 24 hours (or as soon as practicable)

guidance S ✓
Chemical
Where possible confirm that all chemicals involved have been correctly
identified and relevant details on properties and toxicity are determined
(including environmental persistency and degradation product, biological
uptake)
Flowchart 4
N.B. there may be multiple chemicals, reaction products and additional
chemicals added as part o f the management, e.g. fire fighting
Identify common uses o f the chemical/product, to aid chemical
identification if necessary
Confirm location o f contamination source, with postcode and/or grid
reference where possible
If location of source is in doubt consider use o f modelling to predict
possible sources, there may be variations in results from different models
Confirm number o f people already exposed or possibly exposed to the Flowchart 6
contamination
Confirm additional nearby populations that may become exposed
Conduct a toxicological evaluation o f exposure data to determine Briefing 4
possible and most likely impacts on health Flowchart 7
Confirm type o f health effects reported Flowchart 7

Mark cases reported on a map or in geographical information system
Determine a precise case definition
Confirm amount o f the contaminant released
Confirm direction o f movement o f the contaminant and ensure regular
updates are received to monitor for any changes
If direction of movement o f contaminant is in doubt consider use o f
modelling to predict possible areas at risk, there may be variations in
results from different models
Confirm the pathway/route o f exposure between source o f contamination Checklist 8
and human receptors, including food contamination Flowchart 5
Confirm any contaminant concentrations available in relevant media and

at various locations and times, ensure most up-to-date analysis results
have been received
Determine if any routine results from environmental sampling are
already available
If no or inadequate environmental sampling results are available,
Briefing 3
establish what environmental samples need to be taken: environmental Checklist 7
media, when, where, who will take them and what parameters are to be
tested for
If more environmental sampling is required, ensure an appropriate
laboratory for analysis is identified, ensure the necessary samples are
collected and stored appropriately and appropriate analytical techniques
are used and quality control procedures are adequate
Page 3 o f 6
ACTION Further C om plete N /A

guidance ✓ ✓
Incident status
Confirm current incident status
Determine criteria for incident closure

guidance ✓ ✓
Confirm environmental organisations have been informed, e.g.
Environment Agency, MCA
Alert relevant government departments, e.g. DH, DETR, MAFF Briefing 1
Alert occupational health professionals, where relevant
Alert environmental specialists/consultants, where relevant
Define population ‘at risk’ to avoid concern in unaffected individuals Flowchart 6
Provide press releases to alert the public and reassure those not affected,
ensure consistency across all agencies involved
Confirm that particularly vulnerable populations have been identified
Checklist 9
and alerted Checklist 10
Provide clear and consistent information on the nature o f the hazard and
the level o f risk, prepare Q&As for common queries
Consider setting up a telephone help-line for enquiries from the public
Confirm that alternative water supplies have been provided where Briefing 2
regular supplies cannot be used Checklist 1
Consider conducting biological monitoring of patients and the exposed Checklist 5

population to identify level of exposure and adverse health effects
Confirm nearby vulnerable environmental locations that are or could Flowchart 1
become contaminated, e.g. rivers, aquifers
Confirm action has been taken to remove and dispose o f the chemical(s), Checklist 8
or to remove the exposure pathway, i.e. containment Flowchart 5
Page 4 o f 6
POST-ACUTE PHASE
3. Remainder of management (before incident is declared over)

guidance ✓ ✓
Confirm population within current area of contamination has been Flowchart 6
identified
Estimate time period o f exposure, differentiating between various
populations if exposed for different time periods
Ensure all people with health effects have been identified - through GPs, Flowchart 6
pharmacists, NHS Direct, hospitals, reports to HA/LA/other agencies
Determine whether there are other possible causes o f ill health, e.g. viral Flowchart 7
infections
Confirm current direction o f movement o f the contaminant, if
appropriate
Confirm current concentration o f contaminant in relevant environmental Briefing 3
media Checklist 7
Where additional samples have requested, agree financing and establish Checklist 7
timescales for reporting of results
If not already available, establish method for interpreting environmental Briefing 3
analytical data, define limits o f detection, limitations from sampling Checklist 7
procedure, accuracy of analytical method, relevant standards for

comparison, including taste and odour
Request any necessary repeat sampling and analysis to confirm results or Checklist 7
to detect changes in concentrations
Incident status
Assess progress towards specified criteria for incident closure
Recognition o f when to close the incident
Ensure all organisations involved in the management o f the incident and
the public are informed that the incident is over

guidance ✓
Provide press releases with follow-up information on how the incident is Checklist 9
being managed Checklist 10
Consider distributing a health questionnaire to identify level o f exposure Checklist 6
and adverse health effects
Ensure property has been adequately decontaminated, including where
appropriate, drinking water pipes
Page 5 o f 6
POST-INCIDENT PHASE
4. Post incident (after incident is declared over)
ACTION F urth er C om plete N /A

gu idan ce ✓ ✓
Ensure follow-up information is provided to reassure the public that the Checklist 9
risk to health has been eliminated and appropriate actions have been Checklist 10
taken to prevent a similar event
Ensure continued treatment o f casualties with long term health effects Briefing 5
Where remediation is not possible and a significant risk to health
remains, consider permanent re-housing o f people in the area affected
Consider the necessity for long term monitoring o f the affected Checklist 7
environment/media if remediation is not possible
Consider conducting a follow-up epidemiological study (monitoring o f Briefing 5
relevant health data e.g. disease registers, hospital admission registers)
Consider tagging o f individual patient notes to identify any future health
problems that may be related to the exposure
Ensure remediation at site of contamination is complete and meets Checklist 8
required standards
Preventative action for future incidents
Identify changes in procedures to improve management in future
Identify preventative action to avoid the occurrence o f similar incidents
Identify specific actions to be taken and a named person responsible for
ensuring completion
Provide information for official reports to enforcement agencies, e.g.
DWI, HSE
Page 6 o f 6
Appendix 8
Chemical Incident Management Guidance Manual - Version 1
Contents
Introduction
Primary objectives of the public health response to chemical incidents
Sequence of events flowchart
Checklist of actions for chemical incident management
Briefings
1. Action taken by organisations involved in chemical incident management
2. Background to the water and wastewater industry
3. Presentation of environmental analyses + Units conversion table
4. Guide to standards for use in chemical incidents
5. Long-term health surveillance
Checklists
1. Chemical water incident checklist for health authorities
2. Suggested resources for chemical incident management
3. Setting up an incident control team
4. Personal decontamination and personal protective equipment
5. Issues involved in biological sampling
6. Issues involved in questionnaire surveys
7. Issues involved in environmental sampling and analysis
8. Remedial action
9. Communications with the public
10. Dealing with the media
Flowcharts
1. Types of chemical incidents
2. Initial detection of a chemical incident
3. Routes to alerting the CCDC to an incident
4. Identifying an unknown chemical
5. Source - pathway - receptor model: method for determining and preventing/minimising health
impact
6. Determining the population at risk
7. Determining the adverse health effects
Forms
1. Pre-planning: Emergency contacts for chemical incidents
2. Pre-planning: Specialist contacts for chemical incidents
3. Pre-planning: Contacting vulnerable groups
4. Incident details
5. Details of the chemical
6. Record o f emergency contacts during an incident
7. Environmental information
8. Record of health/patient information
9. Log of calls and associated actions/decisions taken
10. Log of advice received/provided and decisions/actions taken
11. Post incident report
Appendix 9
Evaluation of Performance
Participant details
Name
Health Authority
Region
Experience/training group
Used manual
Received training on manual
Summary of performance
Issues/Actions Sta;?e 1 Sta;!*e 2 Sta;E*e 3 Post incident

total key total key total key total key
achieved
partially achieved
additional to stage 1
requirements stage 2
stage 3
post inc
extra
Faith G oodfellow 1
2 August 2001
Details of specific actions
1. First few hours
Key actions
Information Achieved Missing N/A

Chemical
Identify name o f chemical, constituents of a mixture, plus unique no.
Identify physical and chemical properties
Determine basic human toxicology o f the chemicals, plus antidotes
Identify current geographical location of contamination source
Identify type o f contaminant source (e.g. fixed installation or transport)
Estimate number of people already exposed and nature o f exposure
Find out if any health effects have been reported to any agency
Determine current weather conditions
Incident status
Action Achieved Missing N/A

authorities, health authority regional office, A&E hospitals, GPs
Alert relevant emergency services, e.g. police, ambulance, fire, Maritime
and Coastguard Agency
Alert National Focus, where relevant
Identify vulnerable populations within current or potential area o f
exposure, e.g. schools, hospitals, nursing homes
Identify nearby vulnerable environmental locations that are or could
Ensure affected population is alerted and those potentially affected if
movement of contaminant is expected, include vulnerable populations
Ensure appropriate advice is provided to prevent/minimise exposure -
e.g. evacuation, sheltering, stop drinking/using drinking water
Faith G oodfellow 2
2 August 2001
Documentation

Record incident details
Record 24 hour contact names and numbers o f all organisations/agencies
involved
Start logs for incoming and outgoing calls and actions/decisions taken
Remaining actions

are unknown)
Identify any nearby populations that may become exposed
identified
Identify all environmental media affected, i.e. air, water and land
Try to establish what the environmental pathway/route o f exposure
between the source o f contamination and the human receptors is
Determine the concentration o f the contaminant in relevant media and
where applicable at various impact points
Obtain predictions of future weather conditions
Incident status
Faith Goodfellow 3
2 August 2001

Alert other relevant departments o f the local authority, e.g. emergency
Alert local water companies, both water supply and sewage, where
relevant
and expertise to be able to take decisions
Confirm location for incident room (should be pre-planned)
support, etc. (should be pre-planned)
Ensure contact numbers for the incident control team are provided to
other relevant parties
Determine scheduling o f meetings
Ensure affected populations understand what actions they need to take
(e.g. stop using water, leave home, consult GP etc.)
Ensure patients/exposed population are being adequately decontaminated
Ensure personnel directly involved in tending to potentially
Alert other water users, where relevant, e.g. food manufacturers,
Ensure actions are being taken to remove or contain the source o f
contamination and appropriate disposal o f chemicals or contaminated
substances
Ensure vulnerable environmental locations are protected, e.g. drinking
Faith G oodfellow 4
2 August 2001
2. Within 24 hours
Key actions

Chemical
Confirm number o f people already exposed or possibly exposed to the
contamination
Conduct a toxicological evaluation o f exposure data to determine
at various locations and times
already available
establish what environmental samples need to be taken: environmental
tested for
Incident status
Faith G oodfellow 5
2 August 2001

Alert relevant government departments, e.g. DH, DETR, MAFF
Define population ‘at risk’ to avoid concern in unaffected individuals
Provide press releases to alert the public and reassure those not affected
and alerted
the level of risk, prepare Q&As for common queries
Confirm that alternative water supplies have been provided where
regular supplies cannot be used
Confirm nearby vulnerable environmental locations that are or could
Confirm action has been taken to remove and dispose o f the chemical(s),
or to remove the exposure pathway, i.e. containment
Remaining actions

Chemical
identification if necessary.
If location of source is in doubt consider use o f modelling to predict
possible sources
Confirm type o f health effects reported
If direction o f movement o f contaminant is in doubt consider use o f
modelling to predict possible areas at risk
Confirm the pathway/route o f exposure between source o f contamination
and human receptors, including food contamination
Ensure most up-to-date analysis results have been received
Incident status
Faith G oodfellow 6
2 August 2001

Consider conducting biological monitoring o f patients and the exposed
population to identify level o f exposure and adverse health effects
Documentation

Continue to record incident details
Keep a current record o f 24 hour contact names and numbers for all
organisations/agencies involved
Continue with logs for incoming and outgoing calls and
actions/decisions taken
Record minutes and agreed actions o f any incident control meetings
Record necessary detail o f actions taken by other organisations involved
Record details o f any health effects reported and how exposure occurred
Where possible obtain names and addresses o f the exposed population,
including visitors to the area
Faith Goodfellow 7
2 August 2001
3. Remainder of management
Key actions

Confirm population within current area o f contamination has been
identified
Ensure all people with health effects have been identified - through GPs,
appropriate
Confirm current concentration o f contaminant in relevant environmental
media
If not already available, establish method for interpreting environmental
analytical data, define limits o f detection, limitations from sampling
procedure, accuracy o f analytical method, relevant standards for
Incident status
Action Achieved M issing N/A

Provide press releases with follow-up information on how the incident is
being managed
Documentation

Ensure records are kept o f any patients, including contact details
Where possible, ensure a register has been compiled o f members o f the
exposed public
Where possible, ensure a register has been compiled o f exposed
emergency responders
Faith G oodfellow 8
2 August 2001
Remaining actions

Determine whether there are other possible causes o f ill health, e.g. viral
infections
Where additional samples have requested, agree financing and establish
Request any necessary repeat sampling and analysis to confirm results or
Incident status

Consider distributing a health questionnaire to identify level o f exposure
Faith G oodfellow 9
2 August 2001
4. Post incident
Key actions

Ensure follow-up information is provided to reassure the public that the
risk to health has been eliminated and appropriate actions have been
Documentation

Write a summary o f the incident
Identify and document the lessons learned regarding management o f the
incident - both negative and positive
Remaining actions

ensuring completion
DWI, HSE
Ensure continued treatment of casualties with long term health effects
Consider the necessity for long term monitoring o f the affected
Consider conducting a follow-up epidemiological study (monitoring o f
Ensure remediation at site of contamination is complete and meets
required standards
Faith G oodfellow 10
2 August 2001
Appendix 10
Evaluation of Exercise Performance
Participant details
Name
Health Authority
Region
Used manual
Issues/Actions Stage 1 Stage 2 Stage 3 Post incident

total = 53 total = 41 total = 18 total = 13
key = 26 key =23 key =11 key = 3
achieved
partially achieved
stage 3
post inc
extra
Faith G oodfellow 1
1 August 2001
1. First few hours
1.1 Key actions

1.1.1 Assess potential public health impact

Chemical
Identify name o f chemical, constituents o f a mixture, plus unique no.
EH Trichloroethene (trichloroethylene) /3
EH Any other solvents/chemicals from drum or previous spills
'—■ Check fo r other chemicals used on industrial estate, particularly
those that react with solvents
EH Trichlorethene is colourless, sweet chloroform odour /3
EH Potentially other solvents with taste/odour.
EH Odour threshold in air
EH General properties from fa c t sheet /3
EH Reactivity with sodium hydroxide may cause fire and explosion
EH Decomposes in flam e or on hot surface, producing phosgene gases
and hydrochloric acid
EH Extract information from fa c t sheet
EH Spill site as shown on map (need to confirm address)
Identify type o f contaminant source (e.g. fixed installation or transport)
EH Spill from fixed industrial unit, metal degreasing
Determine information about the area (e.g. topography, urban/rural) 12
EH Near a town
EH Surrounding area agricultural
EH 2 workers /6
EH Possibly others at unit
EH Those nearby on industrial estate
EH Those in residential area
EH People passing on trunk road
EH Nearby town
□ A& E /4
□ GPs
□ NHS Direct
EH Environmental Health
Faith Goodfellow 2
1 August 2001
Determine approximate amount of the contaminant released
□ Drum size, amount spilt
f~l Wind - fo r direction o f vapour movement 12
l~1 Sunny/rainy, etc - rain may wash spill further and into stream, i f
warm greater evaporation
media, e.g. from Chemet for air) /4
I~1 Check wind direction fo r movement o f windborne vapours -
potentially over industrial estate, residential area or across the
road affecting passing traffic, i f spill was large enough and
weather conditions appropriate may move towards the town
□ Ask fo r Chemet via Fire Service
1~1 Check surface runoff o f solvent from spill - into surface water
drains, runoff into stream
[~1 Movement through soil, check hydrogeology/geology - migration
through soil into groundwater, migration through soil towards
plastic water pipes
Incident status
N.B. Currently limited potential fo r casualties, i f very large spill may
have windborne vapours towards town, or across road affecting passing
traffic.
1.1.2 Action to prevent/mitigate impact or inform others

authorities, health authority regional office, A&E hospitals, GPs 15
EH A&Es (including any additional to the one already involved)
EH GPs and health visitors
□ NHS Direct
EH Neighbouring HAs i f cross boundary
EH HA regional office
N.B. C1RS already know
and Coastguard Agency /3
EH Ambulance service - check aware o f possible contamination
EH Possibly fire to clean up spill
EH Possibly police to close road and advise population to shelter i f
appropriate
Faith G oodfellow 3
1 August 2001
N.B. E H already know, but need to make contact
Alert National Focus, where relevant
N/A (Would be done by CIRS i f cross boundary, large number o f people X
exposed or high media interest)
N.B. May want a site visit
A lert and advise affected population
Identify vulnerable populations within current or potential area o f
exposure, e.g. schools, hospitals, nursing homes /3
I~1 Others on industrial estate
□ Residential area
EH Town nearby
become contaminated, e.g. rivers, aquifers /3
EH Stream
EH Groundwater
EH Agriculture - crops, animals
movement o f contaminant is expected, include vulnerable populations /3
EH Alert others on industrial estate
EH Alert residential area nearby i f appropriate
EH Consider alerting town but unlikely to be ciffected
e.g. evacuation, sheltering, stop drinking/using drinking water /2
f~1 Shelter from vapours i f necessary, turn o f air conditioning on
industrial estate
EH I f stream/river contaminated stop bathing/fishing
1.1.3 Documentation

involved
Faith G oodfellow 4
1 August 2001
1.2 Remaining actions

Chemical
are unknown)
CD Check all the chemicals used at the site and whether the drum
would be mixed waste, check with manager at metal degreasing
unit
CD Others on industrial estate /4
CD Nearby residents
CD Passers by on the road
CD Recreational use in stream/river, e.g. fishing, bathing
CD Town nearby
Estimate the time period of exposure for the population
CD Hours from recent spill
identified
CD Casualties
□ Air /4
□ Soil
CD Potentially stream
CD Potentially groundwater
between the source o f contamination and the human receptors is /4
CD Inhalation o f vapours near spill
ED Bathing in stream/river
ED Vapours on crops, animals
—■ Animals drinking from stream.
■
Determine the concentration of the contaminant in relevant media and
where applicable at various impact points 12
ED Stream samples
ED Soil samples
Obtain predictions o f future weather conditions
Incident status
Faith Goodfellow 5
1 August 2001

Alert other relevant departments o f the local authority, e.g. emergency
Alert local water companies, both water supply and sewage, where
relevant 12
|~1 Alert water companies to check fo r abstractions downstream o f
stream and maybe fo r groundwater abstractions
I | Alert water/sewage companies and ask where surface water drains
go and i f into sewers whether the sewage treatment plant w ould be
affected
and Safety Executive, DWI, Food Standards Agency 13
[~~1 Environment Agency
□ HSE
[~~1 FSA/MAFF (if crops/dairy herd or drinks factory affected)
e.g. HA, EH, EA, water company, plus maybe representative from
industrial estate, fire, HSE, A& E
Determine scheduling o f meetings
(e.g. stop using water, leave home, consult GP etc.) 12
f~l Shelter from vapour, close windows and doors, turn o ff air
conditioning
EH Stop using stream/river fo r recreation
Ensure patients/exposed population are being adequately decontaminated 12
EH A&E casualties should be decontaminated, clothes bagged
EH Is lorry contaminated, i f it is stop it leaving site
I | Treat casualties, make sure A& E and ambulance have the fa c t
sheet
Faith G oodfellow 6
1 August 2001
contaminated patients or cleaning up the hazard do not become 12
n Possibility o f ambulance and s ta ff being contaminated and sta ff
and patients at A&E
[~1 Make sure EHO and other people investigating spill do not become
contaminated\ protective clothing fo r anyone cleaning up the spill
[—1 Agriculture, crop irrigation, livestock watering - i f stream is
contaminated and water being used
Prevent/m inim ise environm ental contam ination
substances
| | Clean up spill to stop continuing contamination, possibly remove
contaminated soil at a later stage
water abstraction points 12
1~1 I f thought stream might be affected would check i f any downstream
intakes and close i f likely to be contaminated
Consider possibility o f any groundwater supplies being affected
Action Stage Key
Faith G oodfellow 7
1 August 2001
2. Within 24 hours
2.1 Key actions

Information Achieved M issing N/A

Chemical
identified and relevant details on properties and toxicity are determined 13
□ Identify all chemicals from drum
EH Identify chemicals in soil from previous contamination/land uses
EH Taste/odour threshold in water
contamination 11
[~1 Those near spill from vapour
EH Industrial estate —vapours and drinking water
EH Residential area - vapours and drinking water
EH Town - vapours and drinking water
EH Recreational users o f stream/river
EH Soft drink consumers
EH Consumption o f any milk/crops from agricultural use o f water from
affected PWSs
N.B. Population depends on what sources are contaminated
Conduct a toxicological evaluation of exposure data to determine
□ Are taste/odour thresholds in water above or below toxic levels
updates are received to monitor for any changes 12
EH Are chemicals from spill going towards the aquifer?
EH Is any vapour going towards the town?
at various locations and times 14
EH Soil
EH Stream
EH Groundwater
EH Drinking water
already available 14
EH Drinking water
EH Groundwater abstraction point
EH Stream/river
EH Drinks factory quality testing
Faith Goodfellow 8
1 August 2001
establish what environmental samples need to be taken: environmental /5
tested for
□ Soil
EH Stream
EH Groundwater at various abstraction point
EH Drinking water in industrial and residential area
EH Water at other PWSs including factory
Incident status

A lert o ther agencies
EH Environment Agency
Alert relevant government departments, e.g. DH, DETR, MAFF 12
□ DW I
□ FSA/MAFF
N.B. Any occupational health on industrial estate, may have details o f
chemicals used and effects
N.B. Once aquifer fo u n d to be uncontaminated, stream also
uncontaminated and vapours unlikely to reach town, only those on
industrial estate and immediate residential area at risk
Provide press releases to alert the public and reassure those not affected
n Joint press release with other agencies /3
EH Advise people on industrial estate and nearby residential area not
to use water fo r drinking, fo o d preparation or cooking, maybe
should not use fo r showering because o f vapours
EH Alert other water users, any food/drink manufacturer on industrial
estate, soft drinks manufacturer, PW S users
and alerted
e.g. Health status o f those in residential area nearby, any babies, people
on home dialysis, any PW S to hospitals
the level o f risk, prepare Q&As for common queries
N.B. Only limited population so could have direct contact with residents
Faith G oodfellow 9
1 August 2001
1~~1 Bottled water to residents, other employees on industrial estate
should be supplied by employer with water - wait fo r results on
aquifer and abstraction before extending any further
N.B. Need to confirm any contamination o f aquifer or stream
or to remove the exposure pathway, i.e. containment 12
□ Clean up spill, remove other contaminated soil
EH Install metal pipes fo r drinking water


Chemical
EH Other solvents and chemicals used in metal degreasing
If location of source is in doubt consider use o f modelling to predict X
possible sources
N/A
Confirm type o f health effects reported
EH Respiratory effects in workers
N.B.Include any reports to the water company, who may already have a
GIS system with logged complaints
If direction o f movement o f contaminant is in doubt consider use o f
EH Modelling to ascertain i f aquifer is at risk
and human receptors, including food contamination /4
□ Dermal contact with spill or inhalation o f vapours
EH Dermal contact with soil or inhalation o f vapours
EH Water from aquifer used fo r crop irrigation, livestock watering
(food contamination) and drinks factory (food contamination) and
public drinking water supply - ingestion
EH Any food/drink manufacture on industrial estate
Faith Goodfellow 10
1 August 2001
1~1 All water types and soil, maybe air at time o f spill (would have
dispersed quickly)
Incident status
e.g. Set safe drinking water levels

CH Clean up spill 12
□ Remove/remediate soil
Consider conducting biological monitoring of patients and the exposed
population to identify level o f exposure and adverse health effects 12
I | Take blood/urine from those already in hospital
1 1 Consider taking from residents, short h a lf life so need to do before
give alternative water supplies
2.2.3 Documentation

Keep a current record o f 24 hour contact names and numbers for all
Record details o f any health effects reported and how exposure occurred
Where possible obtain names and addresses of the exposed population,
including visitors to the area /3
□ Residential area —including visitors
[Z1 People on industrial estate
D Responders
Faith Goodfellow 11
1 August 2001
Action Stage Key
Faith Goodfellow 12
1 August 2001
3.1 Key actions


Confirm population within current area o f contamination has been
identified
1 1 Population exposed limited to industrial estate and residential area
nearby who are supplied with water in plastic pipes through
contaminated land
populations if exposed for different time periods 12
f~~l Difficult to say fo r long term solvent contamination o f drinking
water as a result o f ground near plastic pipe being contaminated,
but no taste previously
f"~l Short term inhalation exposure fo r workers and anyone near
enough to be exposed to vapours
N.B. Include reports o f adverse health effects to water company
appropriate
ED Confirm not moving towards aquifer
Confirm current concentration of contaminant in relevant environmental
media
EH Stream, groundwater, drinking water, soil, maybe air
analytical data, define limits o f detection, limitations from sampling
procedure, accuracy o f analytical method, relevant standards for
Incident status

being managed
e.g. Bottled water supplies, replacement ofpipes, clean up o f land, water
in taps above guidelines initially but not excessively high and set fo r
lifetime exposures
1 August 2001
3.1.3 Documentation

exposed public


infections
EH Possible other causes fo r nausea/vomiting/headaches in residents
timescales for reporting o f results
to detect changes in concentrations /3
EH Repeat samples on drinking water to try and assess peak
concentration and whether decreasing
EH Repeat samples on connection o f overland pipe and after pipes
replaced
□ Repeat sampling o f public abstraction and maybe also aquifer
Incident status
EH When concentrations in water to residents are reduced to a
satisfactory level

N.B. Could use to try and ascertain consumption o f water in residents
and onset o f symptoms
| | Flushing o f pipes including internal plumbing after installation o f
new pipes
1 August 2001
Action Stage Key
1 August 2001
4. Post incident
4.1 Key actions


CH Pipes replaced and drinking water clean
4.1.2 Documentation



CH HSE to make sure company improves practices
ensuring completion
DWI, HSE
Ensure continued treatment o f casualties with long term health effects
1 1 Possible long term health implications fo r workers, occupational 12
health follow up
I | Possible long term exposure and associated health effects from
contaminated drinking water i f there has been previous undetected
contamination, residents and those on industrial estate
remains, consider permanent re-housing of people in the area affected
□ Replace pipes and re-route
environment/media if remediation is not possible 12
□ Monitor groundwater fo r contamination and at abstraction points
□ EA to monitor any movement o f contamination
Consider conducting a follow-up epidemiological study (monitoring o f
1 August 2001
Ensure remediation at site o f contamination is complete and meets
required standards
LH Remove contaminated soil at industrial estate
Action Stage Key
1 August 2001
Appendix 11
Exercise briefing
Aim
9 The aim o f the exercise is to assess the effectiveness o f the guidance manual for public
health response to chemical incidents.
# In order to be able to assess how effective the manual is we need to score the level o f
response to the exercise, however, the aim is not to measure personal performance but to
assess any improvements brought about by the manual.
Evaluation method
9 The evaluation method specifies actions to be conducted during the incident response.
9 The response is divided into four stages:
o first few hours
o within 24 hours
o remainder o f the management
o post incident
• For each stage several key issues have been identified.
9 Performance will be evaluated on the total actions achieved and key actions missing.
Response to the incident exercise

# In order for the actions you have completed to be included in the evaluation you need to
write down everything you have considered, actions and decisions you would take, people
you would contact and information and resources you would require.
• However, do not just list everything you can think of, you need to prioritise your actions
and consider what is appropriate for the stage o f response and what could practicably be
achieved in the time available. Scores are assigned on the basis o f actions achieved that
are relevant to the particular stage o f response.
• Remember to note down actions you might consider doing even if you decide at a later
stage that it is not necessary.
9 Write your entire response on the forms provided, starting a new page for each stage and
numbering and initialling any extra sheets used.
# The different sections on the forms are only intended to be a guide to ease analysis, do not
worry if you are not sure which box to use or if you think you have written something in
the wrong box.
Please do not discuss the exercise with other participants until it is finished
There will be an opportunity to go through the exercise and discuss the issues raised in the
afternoon session.
Exercise scenario
Stage 1 - Monday morning
Notification
As the on-call public health professional you are alerted to a chemical incident by the
Chemical Incident Response Service (CIRS) at 1000 on a Monday morning. At 0930 that
morning 2 adult males were admitted to your local accident and emergency hospital for
treatment following exposure to solvents, the main constituent is thought to be
trichloroethene.
Incident details
• The incident has occurred at a small metal degreasing company at a unit on an industrial
estate on the edge o f a medium-sized town (spill site is marked by a red cross on the map).
» 2 workers at the metal degreasing company spilt solvents over themselves when a drum of
used solvent was being loaded onto a lorry to be taken for disposal.
• The workers had dermal exposure and inhalation o f vapours and suffered shortness o f
breath and coughing, they were taken to A&E by ambulance.
9 The ambulance staff reported that on entering the industrial estate from the main road
there was a strong smell o f solvents, they have alerted the A&E to the potential o f
additional casualties.
• The local authority environmental health officer (EHO) has gone to the site to investigate
the spill, because previous concerns have been raised about the company’s operating
practices.
• The surrounding area is agricultural, the main town is approximately 1 km from the
industrial estate, however there is a small residential area adjacent to the industrial estate.
• The main road into the town passes the industrial estate.
• There is a small stream running past the industrial estate on the northern side.
Information available
• CIRS have faxed their information sheet on trichloroethene to you.
• A sketch map o f the area is also provided.
Response
For the first few hours after being alerted to the incident, list:
• issues you would consider;
9 actions/decisions you would take;
• people you would contact;
9 further information you require; and
9 resources you require;
You have 25 minutes to write down all the relevant details on the forms provided.
AGRICULTURAL AREA
Stage 2 - Monday afternoon
Further incident details

• The EHO investigating the spill site has found extensive contamination o f the land around
the metal degreasing unit. In addition to the recent spill, there appears to be evidence o f
previous solvent spills in the area.
9 The EHO has reported that the soil near the unit appears to be contaminated with solvent
like substances, however the nearby stream does not appear to be affected on visual
inspection.
9 The Environment Agency has been asked to take samples to check the stream is not
contaminated as it feeds into a river that is abstracted for drinking water purposes.
• To the south o f the industrial estate is a public drinking water abstraction from a
groundwater aquifer (marked by the blue cross on the map).
• There are also other private abstractions from the same groundwater aquifer that are used
for agricultural purposes, crop irrigation and livestock watering.
9 A nearby soft drinks factory also has a private abstraction from the same groundwater
aquifer.
» The local water company has received complaints from the customers in the industrial
estate and the residential area nearby about an unpleasant taste and odour in their drinking
water.
• The water company has taken samples from the customer taps on the industrial estate and
nearby residential area and the water mains outside the industrial estate.
« The water company has also taken samples from the water at the public drinking water
abstraction from the groundwater aquifer.
Response
Continue to record your response within 24 hours o f being alerted to the incident, list:
« issues you would consider;
• actions/decisions you would take;
• further information you require; and
• resources you require;
You have 20 minutes to write down all the relevant details on the forms provided.
Stage 3a - Tuesday afternoon

• The 2 workers that attended A&E have now fully recovered from their acute symptoms.
9 On Tuesday morning there were several complaints to the water company by people in the
residential area, some people have reported they have suffered from nausea, vomiting and
headaches in the last 24 hours.
• In the afternoon o f the Tuesday, you receive some preliminary sample results.
9 Sample results from the Environment Agency:
o initial qualitative analytical results o f the soil at the site o f the spill show it to
be heavily contaminated with trichloroethene and other as yet unidentified
organic chemicals.
o analysis o f the stream samples show it to be currently free o f trichloroethene.
• Sample results from the water company:
0 no contamination has been detected at the public drinking water abstraction
from the groundwater aquifer,
o raised levels o f trichloroethene have been detected in the samples taken from
customer taps at the industrial estate and nearby residential area,
o no contamination has been found in samples taken from the water mains
outside the industrial estate.
9 The water company have confirmed that the water main along the trunk road is o f metal
construction and the pipes to the industrial units and the residential houses are made o f
plastic.
• Results o f drinking water analysis from customer taps on the industrial estate and the
residential area.
9 UK drinking water standard and World Health Organisation (WHO) guideline for
drinking water quality.
Results for water samples taken on Monday

Analysed for trichloroethene
Location Concentration in mg/1

Customer tap on industrial estate - unit 1 0.1
Customer tap in residential house - house 1 U.02
Customer tap in residential house - house 2 0.04
UK drinking water standard

Trichloroethene = 30 ^g/1
WHO provisional guideline for drinking water quality

Trichloroethene = 70 ^g/1
Response
Continue to record your response for the rem aining m anagem ent o f the incident, list:
• issues you would consider;
9 actions/decisions you would take;
» further information you require; and
9 resources you require;
You have 15 m inutes initially to write down all the relevant details on the forms provided and
then a further 10 m inutes after additional drinking water sampling results and incident details
are provided.
Stage 3b (extra information) - Thursday

• Modelling from the Environment Agency shows that contamination o f the groundwater
aquifer is unlikely to have occurred from solvents spilt at the industrial estate due to the
soil and underlying rock conditions.
9 Environmental Health and water company investigations have concluded that solvents
were spilt on the industrial estate on land above plastic drinking water pipes, these
chemicals migrated through the soil and permeated through the plastic pipes
contaminating the drinking water supply.
« The residential area is supplied with water by a plastic supply pipe that passes through the
industrial estate.
• Some residents continue to report symptoms o f nausea, vomiting and headaches and a
10 month old baby is suffering from vomiting and is becoming dehydrated.
• A temporary overland bypass water supply pipe has been installed to avoid the area o f
contaminated land and bottled water has been provided to people in the residential area
since late Tuesday afternoon.
• In the long term, the plastic water supply pipes will be replaced with plastic coated copper
pipes and a separate pipe directly from the iron water mains will be installed to the
residential area that does not pass through the industrial estate.
• Results o f drinking water analysis after connection o f overland bypass water supply pipe
Results for water samples taken after connection o f overland bypass water pipe
Analysed for trichloroethene
Location Concentration in mg/1

Customer tap in residential house - house 1 u.ul
Response
You have 10 minutes to finalise your response.
There will be an additional 10 minutes to consider any post incident issues.

Post incident
Final incident details

0 Replacement o f water supply pipes to the industrial estate and residential area has been
completed.
• Samples from customer taps on the industrial estate and residential area after the
installation o f the new pipes show drinking water to be free o f contamination.
9 The Health and Safety Executive is investigating working practices at the metal
degreasing company.
Response
You have 10 minutes to detail any further issues and actions that should be part o f the post
incident review, including any long-term investigations or monitoring that should be carried
out or any changes to the public health response to chemical incidents that should be
implemented as a result o f lessons learnt during the incident.
Appendix 12
add.
00 - ^r - CM in in CM CO ■M" CO CO CM M" CO in ^r o - CO CO - CO CM CO
1
|
|
|
|
T— T“ P CO p p p
zzs
total
p IO M T“ oo
5 6 .5
5 2 .2
CO
| 3 4 .8
3 4 .8
1 5 2 .2
| 3 0 .4
| 3 0 .4
| 4 3 .5
I 5 2 .2
I 5 2 .2
CO O ) oi o> O ) 05 d CD d
%
(d r t CD CD o> cd
in to CO IO CO CO CO CO CM CO CO in in CO
||
M- M"
e' ■O' CO O
■*!■ o p p t '- p CO p p
N- p
2 1 -7
1 21.7
21.7
v?
•rs* "§ o ' CO 1^ CO CO en cd cd 00 cd 1^ cd cd cd CO o o cd 1'-
cn CM CM
c .2 s;
I
o ■C ~
o a -§ o CO CO m CO CM ■O' ■O' CO i n CO CM CO M" ■M" ■M- CO CO i n CO CM CM CO
(0 c - - -
1
|
|
■M- ■M- m r^ p ■M- ^J- p p
h~ p p p
vP o
1 21.7
21.7
1 43.5
1 43.5
® a> o' O O ) CO O O ) cd cd 05 cd cd 1^ N- 05 ■d d cd CO cd ■M- d O ) cd
CO CO CM CO CO CM CM CO CM CO CO M" CO CO CO CO CM
■n "
I
Stage 2
tP ‘-o
2
Results from the validation testing of the guidance manual - No manual
o o o o
o
c
f ' O ) CO 05 m m CO 05 CO CO i n ■M" M" 05 00 o CM CO 0 0 oo |M. O ) CD
8 ro
1
|
|
CO CO CM in OO o p
total
CO o o h - CO 00 CO CO o o p o CO o p 1^ p I ';
1 4 6 .3
| 4 3 .9
CO o> o> CO 05 cd CO CD CM O )
%
O) CD O ) O) T“ cm' o> 05 CD CD T“
CO CO CM CO U> CO « CM CM T}- CM CM CM CO CO Tf CM CM CO CO CO CO CO
vO
CM 0 0 CD o o 00 p p 00 p p CO CO CO CM CM CM M" 0 0 p P oo CO p CO 00 CN1 CM
achieved
CM O ) ■O
’ O) ■d ■O' 05
partially
o' ■O' ■O' O ) M"

05 ■M" 1^ CM CM CM CM 05 M- 1^ 05 csi CM
total actions
o
c
If) 'Cf CO Nf O' CO CO o CO CM CO CO CO m m m - CO CO ■M" CO CM CO M" to in
1
|
I
|
CO in CO p
CO p CM p 00 CO p CO 0 0 CO 0 0 in
completely
sP "U-
| 22.0
| 26.8
| 26.8
| 22.0
| 29.3
I 41.5
achieved
o' oi 05 O) CM ■M- cd ■O' O ) cd cd cd 05
Page 1 of 6
■O' 05
CM CO CM CM CO CM CM CO CM CO
o CO - CO o> h - CM CO !■'. •M- 05 CO i n CO - CO CO CO CM CM m - rr

c - - -
oo
1
1
I|
I|
1
|
I
I
|
|
I
io p CM CM
total
p p p p p p
O'OS
o o 't OO
4 2 .3
%
1 4 6 .2
| 4 6 .2
1 4 6 .2
1 4 6 .2
| 5 3 .8
| 6 9 .2
1 5 7 .7
4 2 .3
4 2 .3
1 4 6 .2
1 4 2 .3
d d id 00 CO CD id d CD o cd o CD
CO IO IO CO CO 5 CO CM T - CO ■O' CO ■n CO 't
|I
|
I
II
in 00 05 CM CM p p p 05 CM CM m CO CM ■^t CM CM CM 00
'P
| 26.9
I 42.3
| 26.9
| 26.9
| 26.9
achieved
d cd cd 05 05 cd 05 05 cd 05 05 05 05 trj
partially
O' CO 00 00 o in o
CM CO CO CM CM CM CO CO CM CO
key actions
- o o
o
c
CO r^ 00 CO r-. 1 '- m m CO CO CO m m 00 CO m ■M" m m m oo
1
1
1
CM p ■O' O" CM p CM M" p CM 05 p ■M

" CM o o o ■M" p
completely
1 26.9
1 26.9
I 26.9
I 42.3
26.9
achieved
o' O) cd •O’ in in in 05 ■M" 05 i n

cd cd 05 cd in 05 d d in cd
CM CO CO CM CM CO m CM
o If) N- ■O' ■O' m 05 - I''. CO M" 00 CO ■M" i". - CO

Stage 1
CM CO O ) m CO m in CO
c
I
CO CM CM CM CM CM p
total
o T“ T“ CM CM T™
2 6 .4
2 6 .4
4 3 .4
3 7 .7
3 5 .8
3 4 .0
3 7 .7
4 1 .5
4 1 .5
4 5 .3
4 3 .4
6 2 .3
3 4 .0
3 7 .7
4 7 .2
id 't d id cm' 1^ I'i

%
05 CO
CO CO CO M- T - CO ■O' 't ■M" CO CM
O) O) p 05 05 o p CM p 05 05 05 05 05 00
24.5
26.4
24.5
22.6
24.5
20.8
00 o p
in
achieved
"5
o' r-^ cd d
partially
00 o CO 00 00 00 00 00 00 CM M- CO id 00 00
CM CM CM CO CM CM
total actions
o CO o M- CO O o O O 05 CO 05 ■st N - CO O O CO O CM 0 0 O CO - O
c - -
CO h- O CO 'Cf 05 CO 05 CO 05 05 p
26.4
20.8
26.4
39.6
26.4
p
45.3
o CM
completely
sP in in
achieved
o' CO i n 00 cd in 05 0 0 CM in in 00 00 0 0 CO ■'3'
CO CM CM CM CM CM
o O) M- CD - o N- 00 CO 05 m ■M" 00 m •M- o CM 00 00 O m o O CO 'S' M'

c CM CM CM
I
a CM CO in CO oo 05 o CM CO ■M- m CO 00 05 O CM CO M- m CD oo
- - CM CM CM CM CM CM CM CM CM
add.
in CO
2 .°
2 .3
2 .°
o o
- o o o o - - CO - CM
CM cm'
|
|
total
x f CM p CO p p p x f T - x f CM P CM
4 3 5
%
| 4 3 .5
| 4 6 .4
© CM (d x f d cd cd cd o cd o cd cm’
CO U ) LO CO CO in IO in CO CM CO X f CO
p M 1 x f x f x f 1'- o 1 '- p p p t^- p p p o p

^ "S 0s cd K h 'i cd 00 cd cd x f 00 x f x f cd cd x f
in CM CM
e •s $
o
o o p in p P
CO X f x f x f x f m CO CM CO CO - CM p
CO c cd cd i n cd cd
>.
|
■SC xf p xf xf p CO Xf p p CO p CO p CD
>s _
| 43.5
vP
£ CD 0 s 1 '- x f CD 1^ cd 1^ cd 1^ c d cd CD cd
CO CO CM xf xf CM CM CM CM CO CM
■s. $
2
p 2
CO CO p xf
X f CO O ) x f CO x f o o
Stage
o - xf m in
o c cd i n x f cd
I
total
p p CO x f CO p o CO CO o p in p p p
%
1 4 1 .5
cd cd xf- d d d x f o> cd CD cd CM CD CD T -
5 CO CM CM CM CO CO CM CM CO CO CO CM CO co
Xf
Vp CO CM CM CM CM p CO CO CO CO p CO CO P CO m
achieved
d d X f O) d
partially
O' CT» CM CM CM CM X f CD CD CD x f
total actions
o p p O p p
X f CO U ) i n in CO X f CO x f x f CM CO
c xf x f cd Xf xf
p xf CM p CO X f in o P o O p CM 00
completely
vO
achieved
o ' x f x f CM ■Cl d x f CD CM c d CM x f d
Page 2 of 6
CO CM CO CM CO CM CM CO CM CM CM CM
CO o xf in O o m
o in h - io CM O CO CD CO
c CD CD c d CO
I|
I
|
total
xf xf m p CO o p CM CO p o o
4 3 .4
I 4 6 .2
I 4 2 .3
%
id id id c d 00 d CM o cd cd cd cd o CD
CO CO CO CM CO CO x f m in xf x f in Xf
CO CD O ) 'ci- x f CM in CO CM CM CO p p
vO
achieved
d CO c d i n i n O ) c d d CD CD c d c d c d
partially
o' cd xf
CO CM CM CM CM CO CM CM CM CM CM
key actions
o o o m in CO
CO 1^ x f x f i n CO CO CO CO i n m
c cd cd If ) i d
p If) If ) h - x f CM <p CD CD p p CM CD CM
completely
>p
achieved
0s x f 00 c d cd in O) CD c d c d c d c d c d CD
CO CO CO CM CO CM CM CM CM CM CM CM CM
CM m CO O
o CD o o
Stage 1
CM CD X f m O ) h~ CO CO I''.
c cd cd in in
I
total
CD CO CO CO CO CO p p CO p
4 1 .5
4 2 .5
4 6 .0
%
o d d cd d id d id CD i d O ) o
CO CO x f CO CO CO xf CO CO 5 Xf CO
CM CO O ) x f CO CO CO CO CD o CO CO CD
'P
achieved
d CM 00 d If) CM d d CD cm'
partially
o ' If) CM 00 in cd CO
total actions
CO CM CM CM CM CM CM CM CM
CO m O p O
CO CM o o
o m CO CM - CO CM m CO d d CM d
c
CM 1 '- CM X f p CM CD x f CO CO CO CO p CO CO p CD
completely
achieved
O' d t'-‘ d CD x f c d 00 cd CM d d d d CD x f 00
CO CO CO CM CM CM CM CM CM CM CM CM
xf p m p o
o CO o CO in CO o X f CM -
c CM - - o cd d
1
IGroup C mean score

|Group D mean score
iGroup A mean score
IGroup B mean score
loverall mean score
Q cd o CM CO x f m CD f ' - CO CD o
CM CO CO CO CO CO CO CO CO CO CO X f
add.
o - o - o o o - o CO CM o o O o - o - o - O st o o O o CM -
Is ; o |S- o
1 0 0 .0
1 0 0 .0
1 0 0 .0
1 0 0 .0
h - |s - Is. IS. Is. is . I s IS. Is.
total
(s. Is . p | S t-- CO N - t~ CO
o
cd o cd o
%
cd o cd cd cd cd cd cd cd cd cd cd cd CD CD cd cd cd cd cd
CO CD o CO CO CO CO CO CO CO CD CO CO o CD CD CD CD CD CD CD CD CD
^ T3 s ° o o o o o o o o o o o o o o o o o o o o o O O o o o o o
Q) 0s d d d o o d d d d o d d o o d d d d d o d d d d d d d d
tn a j >
c •S <D
o
o
(0 S. 8 o
c o o o o o o o o o o o o o o o o o o o o o o o o o o o o
>*
o ls h~ o o is N-
o e' h~ CO N - CO o t-
o r '- h - 1^ |Ss |s- |s |S |s
d CD o cd d d CD cd d d cd d
£ o 0s o CD d CD o o CD CD o
cd en CD cd cd cd cd
CD CO CD CO CD CD CO o CO o
cd cd cd cd cd cd cd cd cd
e d) > CO CO CD CO CD CD CD CO CO
(1) a>
•o
O p 2 o CO csj o
_c O 8 CM CO CO CM CM CO CM CM CM - CM CM - CO CM CO CM CM CM CM CM CM CM CM CM
o c
|
o
CM CSI CM csj CM CM CM CM in in CM in T“ p CO CM CM in in p p p in T™ p p
total
CL CO
o> cd cd cd o> cd cd d cd T— cd 00 cd cd cd cd cd CO T- d T— cd cd cd cd cd
<o St St CO st st CO CO CO CO CM in m CO co CO CD CD CO CM CO in CD CM
is ls o o o o o o o o o o o o o o o o o o O O o o o o o o
^>, T3
<D 0s* N-' d o o o d d d o d o d d d d d d d d d d d d d d d o
^
total actions
(0
•= 0)
tr •=
2 .0 o o o o o o o o o o o o o o o o o o o o o o o o o o o
CO c - -
in m CM CM CM CM CM CM m in CM in CO p CM CM in in CO in p m m 00 p
completely
vP
achieved
0s CO CD CD d CD cd d cd .— cd CO cd cd cd cd cd cd d CO cd 00 cd cd
5 CO S t S t CO s t St CO CO CD s t CO CM in m S t s t CO 5 CO S s CO CM CO m 5 CM
o CO in CD CO o> CD CO 05 m CO CO m CO CD CO m CO St 00 CO m CO in |s CO CO
Page 3 of 6
c
1
|
■a in
TJ CO CO - CM - CM CM CO CM CO s t - st CO CM CM 00 m CO s t CM - CM - CO CO CO
(0
st st IO CO CO in in m CSj in in CM CO st p in in p St St in in p p p St
total
CO CO
in st in cd in id in in in CD cd in in cd St cd cd
%
CO cd id cd cd CO cd cd cd
CO CO St CO CO st in st T- St St CO CO St s t st CM CO CM CO CO s t St CD in CD CO
V© o o o o o o o O O O o o O O o o o o o o o o o o o o
achieved
0s
partially
O) d d d d d o d d o d o d o d o d d d d o d d d d d d d
key actions
o o o o o o o o o o o o o o o o o o o o o o o o o o o
c - -
CO S t in CD in m in m CM in in CM (D s t m m in CO CD CO s t S t in p CD p p st
com pletely
N©
achieved
o^* CD in cd s t in st in cd id id cd cd CD id id id cd cd cd id id cd s t cd cd
CM CO S t CD m st m st st st CD CO s t St st CM CO CM CO CO s t S t CO m CO CO
Stage 3
o CO S t in (S. CD m CO m CM in in CM t-" st m m m CO N- CO s t S t in in CD |s st
c
1
St o o o> p CM p S t CO o p St St 00 st p CD o CO
total
s t CO o CO CM o « 05 o
%
st st o o cd 00 o cm’ cd st 1 ^ o CO St st cd csi o N.’ St cd cd o o id o cd

st CM St m in CO CO in CM CO S t CM in CO st CO CM in CM St CO CO in in m in CO
NP T_: o O CO CO CD CD o O CD CO CO CD CD O CD o O CD CD CD CD o CD o CO CD o
achieved
0s
partially
d d id in in in o d id id id id id d id o d id id id id d id o id id d
total actions
o cm o o o o .— - o o o o o o
c - - - - - - - - - - - - - - -
CO 00 S t S t S t CO CO o CM CO 05 CM s t CO s t 05 CO CM s t CM 05 00 05 s t o o st p
com pletely
vO
achieved
0s* CO N-' S t s t s t cd cd o csi cd CO csi s t cd S t CO cd csi s t CM CO fs.' cd s t d o st cd

CO CM s t s t S t CO CO m CM CO CO CM s t CO s t CO CO CM s t CM CO CM CO s t m m st CO
o CD m CO 00 00 CO CO 05 S t CD S t CO CO CO e- CD S t CO st K in |s- CO 05 05 00 CD
c
1
o CM CO s t in CD (s. CO 05 o - CM CO s t in CO h- 00 05 O CM co s t in CO fs CO
- CM CM CM CM CM CM CM CM CM
add.
00 CM p CM s t
CM o - o o st CO CM - - - o
d d
CO o o
cq o
total
N- h~ e-. CO CO T " N; h- in
CO o cd d cd o
%
id (d id cd cd cd c d cd cd csi
CO o CO o CD CO CO CO o CO CO CO CO s CO CO h -
s° o o o o o o o o o o o o o o o o o
^ "8 o d o d d d o d d o d d o o d d d
w
c ■S $
o
o o o o o o
2 - 1 o o o o o o o o o o o o o
CO c o d d d o
>>
AC CO o h- o e- CO o CO h - CO m
>» s°
OJ 0 s* CO o cd d cd cd cd cd d cd cd cd cd cd cd csi
c CO o CO o CO CO CO CO o CO CD CO CO S CO CO
(1)
TJ £ -S ’
O CO o o CM
C o CO CM CO CM CM CM CO - CM CM
i S c - - csi csi csi csi
o
to
O
CO CM CO CO CO in CM
total
Q. i n O ) in CO CO m o> in h - CO
CO o> o d cd cd (d cd cd c d o cd e-i O ' cd

%
O)
LO CO CO CO IO CO s t CO e - CO CO in s t CO St
vO o O o o o o o o o o o o st o o m in
^ "8 0 s o d d d d d o o d d d d o d d d o
CO
C •S m
o "F
o o o o
CO o o o o o o o o o o o o
c o d o o d
"co
o
> _ vO
CO CM CO CO 0 0 in CM m O) m 0 0 CO O ) in CM CD
£ Id 0 s* CO cri d d cd 0 0 cd CO cd 0 0 d cd O ' 00 CO
in CD CO CO m CO s t CO CO CO m S t ' i ' CO s l s t
■§ ™
t o o CO o st
o CD s t st in CD m m st
Page 4 of 6
8 ro c cd in in ed cd
T3 CO CO in CO o
■o CO m CM o CO o in o - - CM s t
CO CM cd c \i csi cd
total
N- in in in CO s t s t i n CO in CM O ) o in CO C--
csi cd i d
%
id d cd cd in s t cd cd in S t T*
|s- CO s t to CM CO CO s t CM i n 't O' st st
vP o o o o o o o o o o o o in o o o
^ "8 0 s* o d o d o d d o o d d o o d o o
co -
c 1 s;
o 'r~
o 2 .1 o o o
CO CO o
c
o o o o o o o o o o o o
d o o o o
>%
CD
AC N- s t in m in CO 'sl st m CO V ) CM O; o m p CD
>*
£ o 0 s* csi CD in in st ed cd in h-‘ ■O' cd cd in ■st d
CO ■sf S t m CM CO CO o CM m ■o- O' ■O' s t S t
CD >
CD
Stage 3
co CM o p in
i ^ o 00 st in in CO CO s t st in CO CO CM
O' in in
8 ra c St st
O ) O ) CO CO
total
T“ CO © O ) o> CO CO O' p CO co
%
T- d co cd cd cd cd e^ cd cd a iT - 00 O ) cd
CO CM m CO CO CM CO CO CO CM CO CO ' t CO CO CO
sP CO CO CO o CO CO CO CO CO o o o CO 0 0 CO N . CD
<D 0 s* in in in d in in in in id d d d cd in cd cd csi
co
c •2 ©
o
-£E
o o f '- m o e^
CO s .H c
o o o
d o d d
to
o
V©
CD CM s t O ) CO CM CO CO CO CO CO e' O) CD p CO
a> ^ 0 s* in CM ■st CO cd CM cd cd 1^ cd en in CO cd in s t
m CM •st CO CO CM CM CO CO CM CO CO CO CO CO CO
a> >
a>
o o- o o m CM
i ^ o
c
s t CO fs> CO s t m CD CO in CO CO
cd e^ cd cd cd
8 ra
score
score
score
score
loverall mean score
g CD o CM CO s t i n CD h - CO CJ) o
mean
mean
mean
mean
CM CO CO CO CO CO CO CO CO CO CO s t
B
D
C
AGroup
IGroup
IGroup
|Group
|
|
I
|
I
|
I
Occupation
| PH scientist
PH nurse
PH nurse
lAIHdOl
o
oaool
o o
oaoo
O
cd O X a a
VH d
o: Cd < Cd Cd Cd Cd D Cd Cd Cd Cd Cd Cd Cd
SHO
a.
Q. a. O a . X CL Q . CL CL O a. CL o o a . CL a . CL CL
CO CO O CO Q. CO CO CO CO O o c0 CO o o CO CO CO CO CO
Trained
z >- z Zz z Zz z z >- z >- z >- z > z >- z >- >- z Z>- >- >- >-
training group incidents
Number
of
o o CO CM o o o o o o o o o CM o o o o
- - St o o o CO o o CO
Experience/
Page 5 of 6
Q O D CO Q Q Q o Q G O a O Q < Q O a o CO < O G G O o O <
|
|
I
I
|
|
o o
total
CT5 05 05 CO t"; CO h - 05
8'0S
49.2
2 22
r-
9'SS
00 00 05
57.1
41.3
38.1
49.2
41.3
| 42.9
17.5 | 44.4
12.7 | 47.6
12.7 | 58.7
| 44.4
csi o o
%
T— CM* CO T“ S t co csj
in CO 5 5 CO CO CM in w m m St
1
|I
|
|
I
I
|
0 '6 t
CO
15.9
19.0
20.6
CO 05 m CO CO CM 19.0
15.9
15.9
17.5
19.0
12.7
17-5
achieved
9-5
9-5
9.5
csi csi
9.5
partially
0s* CO st o
CM n I 05 J
CM CM
key actions
I
I
I
I
o o o
| no.
03 CO CM CM CM CO CO in st -
o> - CO - 05 CD CO CO CO CO CO CO CM
25.4 |
39.7 |
19.0 |
|
17.5 |
27.0 |
31.7 |
42.9 |
34.9 |
39.7 |
34.9 |
o sj- o o o
34.9
34.9
CO
42.9
CO O) h-
completely
CO
23.8
V©
12.7
36.5
19.0
achieved
0s CO o 1^ in CO cd cd
CM CM CO CM CM CO CM CO CM CO st
1
|
|
|
I
I 22
I 22
O
Total score
no.
zz I
ZZ
LZ
00
zz
CO CO CD m
02
CM
1^2
CM m in
41.6 |I 23
- CO csi
56.0 | 29
CM CM CM CM
|
[ 23.2 I
|
1 13.6 | 35.2 ,
I 9 ’ IP
|
I
|
|
|
|
I
46.4 |
45.6 |
© CO o o o o
total
I 43.2
| 14.4 | 36.8
| 12.8 | 40.8
| 39.2
9-6 | 38.4
I 12.8 || 36.8
I 31.2
CM
29.6
32.8
36.0
50.4
42.4
%
CO
in CO CO st cd
st CM CM CM CO S t st CO
I
|
Iv o i
■M
- O cq
| 14.4
I 14.4
CM CM CO CM CO
12.8
vP st CO CO CO CO
12.0
17.6
16.0
12.8
10.4
achieved
0s* CO
9-6
cd cd csi csi
partially
in CO in
00 cd 00 cd
total actions
I
I
I
| no.
CO CO CO CO 05 CO CO s t h - CM O CO
CO CM 05 m
02
22
- CO CO CO CD CO
CM
-
[17.6 1
I 14.4 I
I
I 24.0 |
I 17.6 |
I
I 24.8 |
| 29.6 |
29.6 |
16.8 |
27.2 |
32.8 |
43.2 |
o cq
vzz
CO CM CM O s t CO CO CO
completely
CO CO
16.8
vP CO
[24.8
achieved
[2 1 .6
0s •M1 00 CO C5 s t CO CO CO cd cd in cd
CM CM CM CM CO CM CM CM co CM CO
I
I LZ
I oe
1 zz I
I zz I
| no.
in CO •M- s t in CO CD CO CO N - CD CO s t CM
2fr
CO CO CM CO in CO CM s t CO CM CO CO CO CO CM CO CO CO sr in CM
|
|
Q m 00 o - CM CO S t m CO CO 05 O CM CO
pz
LZ
CM CO in CO CO
- CO 05
|
I
j Total score
| total actions | key actions I Experience/ Number
completely partially total completely partially total of
9
achieved achieved % achieved achieved % training group incidents Trained Occupation
o
£
£
o
o
o
£
'P
o '
o '
O'
-
<
| 62 I
O
O
Q
>-
o
CM
| | 3 4 .9
■M-
cd
cd
53.6 1 1 7 .5 1 52.4 |
-
Q
o o
CO ' t
't
o
z
00
00
00
M -’
| 3 9 .7 I 1 7 .5 I 57.1 |
-
-
CO W
>-
a: a :
CD
CO CO CO
■M- CO
CL Q .
CM CM CM
CO CO CM
I 1 2 .8 | 46.4 I 4 1 .3 I 1 7 .5 58.7
| I 222
Q
o
o
o
00
o>
CO M; CD o o
00
CM IO CO ■M-
CO
cd
I 24.8 | I 1 2 .7 I PH nurse |
o
z z
00
CM
I 2 6 .4 | I 1 1 -2 I| 37.6 | I 3 1 .7 | I 1 2 .7 || 44.4 | PH advisor |
O
o
CO
CM
I 1 7 .6 | I 1 5 .2 | | 2 0 .6 | I 1 5 .9 || 36.5 |
<
CO O
a. O
a: Q
O
't
't
r^
CM CO ' t i n
>- >-
a>
00
CD
0 5 CO
CO
CO
CO
CO CO
CM
■M- CM CO CM CO
CO CM CO
CM
CM
cd
CO CM
CO CO CO CO CO CO
cd
o 05
O
in
a:
05
a>
CO
1 3 1 .2 I 1 3 9 .7 | 1 47.6 |
-
>- >
00 ©
■Ct ' t
't
in m
Tt
o
CO CO
or
CO
CM CM
| 3 9 .7 | I
Q . CL
I 3 0 .4 | I 1 3 .6 | 54.0 I
05 -
I 2 '2 2
O i 00 0 5
CM N - 0 5
|
CO CO CM
| 2 3 .2 | 1 5 .2 | 38.4 I 1 7 .5 | 39.7 | CCDC |
<
I oc I | S ’6 I
O
O
o
o
o
o
00
CO N - CO a>
! 2 4 .0 I 32.0 | 3 0 .2 | 39.7 |
-
I I I
CO CO CO CO ' t
o
in
o
Z'LZ
CO h -
IO
>- >- >-
cd
9'ZC
’M-
o
CO
0 5 CO
CO
CO
PH nurse |
I 9 'S t
't
id
05
00
oo
■M- C5
M-
CO
CM CO
CM
CM
cd
CO
cd
| Overall mean score | 1 2 .5 | 1 9 .5 |
05
V 62 I
in
°0
00
|Group A mean score || 3 2 .8 | 2 6 .3 | 1 5 .3 | 1 2 .3 | 38.5 | 9.3 | 44.2 |
in
cm
CO
CM
cd
|
cd
|Group B mean score | 2 2 .0 | 1 9 .0 | 1 5 .2 | 37.2 1 7 .0 | 2 7 .0 | 47.6 |
cd
CO
|Group C mean score | 3 6 .9 | 2 9 .5 | 1 5 .9 | 1 2 .7 | 42.3 | 2 1 .9 | 3 4 .7 | 8.5 |
00
|Group D mean score | 3 1 .1 2 4 .9 1 5 .1 1 2 .0 36.9 | 2 8 .7 | 9.7 | 1 5 .4 44.1 |
Page 6 of 6
T— m
add.
CO CM CO CM - in ■M- - m - CO CO o CM •M* CM ■o- CO - CM IK m - CD O q

- - - - - - CM in CM CM
in CO CO 0> CO in CD CO in CD CO in CM CM in 00 CD 00 o> 00 q CM CO m OO q o in o>

t o ta l
to
CM ■n cd o |K d CD d |K d cm’
%
CO d o d cd o o cd o O) d cd cd cd yr cd id cd CO
CO CO CO CO co CO CO m CO CO CO in CO in CO CO CO CO CD in m Tf IK in in m in 'd-
V© fK o o o o N- o CO |K- ■M- |k. ^r o o IK. •M- o •M* CO •O' l*K |K CO o o CO

O |K o q N- CD o
i r ' S o'* cd cd cd cd cd cd co* cd ■M- cd |k 00* | k cd cd CO |K cd IK •O' r^ oo 00 IK cd cd cd CO CM 00 d cd
CD CM
c ■? n>
.2 ■e ~
o 2 . oCO o CO CM CO CO CO CO CM CO - CM M1 CM CO CO CM •M- CO 'M* - •o- CM CM ^1* - CO CO - CO CM oo o m o
CO c CM CM csi csi cd
m anual - M an ual
5k
|
•m- cd Ik. CO |K •M* CM ■M- CO in TT CM 'M* m q in in in ■o* •O' ^r m CO CM q CM CO o
4 6 .4
>* ^
| 39.3
ik: o ik d CM IK-* o ik cd o CM o CD cd CD tj- CO* cd cd o d d cd CT> CM tj* in r^ cd in
o <D CO CM M* CM CO m CO CO m CO CO m CO CO •M- •o* CO co CO in CO CO in CO CO ^3* •M- CO
£
Stage 2
rK q CD
o TT M1 in in h- CM tK o |K. CM r^- CD CO CD CO O o o |K IK IK CO CD oo CM CO m oCD o
o§ 2 c - - CD oo
|
1
CO CO q o O CO o |K T“ o o CO q q fK q q in IK q CM o IK 00
Results from the validation testing of the guidance
vvz\
t o ta l
to in in to
[48.8
d cd cd *k d cd cd
%
d cd d CM d d cd CD cd cd cd d CD d cd id id cd cd
CM CM 5 CM CM CO CO in CO in CO CO CO CM CM CO CO 5 CO in CO CO CO
co CO CO 00 CO CO CO q q CM q CM CO oo CO CM CO CM q CM CO CO CM q CO 00 q oo q q CD q o in
a c h ie v e d
ik CM cm IK CD ik CM
* CM •O' CM |k^ r^ csi •O' CD* CD ’O’ CD •O' oo 00 ■M1 cd CD*
partially
1 of 6
ik CD* O) 01 CD |k CD '*T
total a c tio n s
o |k CO Tf M- xr CO 'M- CM CM m CM in CO CO m CM •M- •M- CM •O’ CM q o CO CD

m CM in CO 'M- CO m CO
Page
c cd cd csi cd cd
CM o CO o in |K CM m CD CO h*- o q 00 00 in in m o •O; CD OO 00 CM CO
c o m p le te ly
*d CD cd •o-’ •O’ CD CD* CD* CD* •O' Tj* CD ■M- cd d oo •M- in •M-
a c h ie v e d
CM O) CD CD •M" CM CD* d cd cd cd
CO CO co CO CO CO CO CM co CO •M- CM CM CO CO CO CM CO CO CM •M* CM CO co CO CM
CO CO |k. CM IK q q O
o
c m CO CO CO CO CO Tj- in CO M1 ’M’ 00 - xr 00 oo oo CD O T*- m O oCM csi in •O’ ^r o
- -
I|
I|
CM CO o CO o q in q CO in CM in 00 Ik q q o o CM o CM CO CO q o o CO CM CM CM in
to ta l
in
CM cd in |K cd cd o
%
cd CM o cd d cd cd d cd d cd CM CM cd d o cd cd d CM id d
in in in in CO CO CO CO CO in in to in in in n in Tj* in in in in fK ID in in CD in
CM CO CO CO CM CM CM CD CM CM q •sa CM CD rr q CD oo •m; CD •0- CM •M* CO CM CM CM ■M; CD in IK

cd o> d •O' d CD CD cd CD CO* CD* CD cd CD cd in
a c h ie v e d
in cd d in CD m* CD in in o CD CD csi •O’ CD* cd d

partially
CM CO CO CO CM CM CO CM CM CM CO CM CO CM CM CM CM CM
key actions
■o- CO in m oo
o CO in co CD CO in m CO in h- m m CD ■M" CO m Ik . •m- CO IK CO ^r IK •O' in CO O ^1*
c in cd IK CD* in
CM CM CM <D in q CD CM CD in q q q q in CM CM 00 CD q q q CO o o q oo 00
4 2 .3
c o m p letely
sP cd cd CD CD* ci r t cd Tf* 00 CD CD* o in cd

a c h ie v e d
O'* cd cd cd oo cd tT •O’ •O' cd cd o o CM o oo*

CM CM CO CM CO CM M* CM CO CO CO CM CO CO CO CM co CO CO CM m m CO CO CO CO CM
o CO CO in in m CD - CO CO CD |K. CM h- o CD CD rK CD o in m 00 •M- IK CD CD CD CO •o* CO 00 CO o o m

1
c l*K oo* CD oo IK
Stage
I
CO © CO o> CO CM CM q CO CM CO q co CO CO CO CO CO in 00 o
to t a l
3 9 .6
3 0 .2
4 1 .5
5 6 .6
4 3 .4
4 7 .5
CM |K
%
in cd d o CM CD CD d s CM d CD cd o> d d CM in in in CM* d in to CM* CM

CO co CO in in Tf CO in in CO TT CO CO CO Tj- in Tf in m
CO CO CO oo o CO o o in CO O q o CD q O ■M- q CO CM q CO CD CM CO CM o oo q o in
csi in d csi d |K d r^ | k 'd 00 in t}- |k!
a c h ie v e d
d •"d J* oo cd •M-
CD tCM GO cd in c\ cd r^ 00 d •M* d IK
partially
CM CM CM CM CM CM CM CM CM CM CM CM CM CM CM
total actions
o IK q CD CO
o CM CO CM - CD CD CD CO - CD CO CD O oo CO CD in CO in |K CO CD O |K 00 CM IK CD o
c - - o cd d d
o CO CM CO q o CO CM in CO CO CO CM o q CO CM CM q oo •O' oo •M- CM oo CD q CO CO m q
co m p le te ly
o cd o cd in cd ^j- cd d tT oo o
a c h ie v e d
ik 00 CM CD* d o 00 o cd in* o cd csi o o CD CM cd cd CO* | K tT

CM CM CO CO CM CM CM CO CO CO CO CO CM CO CO CM CM CM CM CO CO CM CO CO CM CO CM CM CM
m |k - IK o q o
o CD o CO CD fK CO m CO oo CO in CO CO o ■o- 00 - |K CO - IK
c - - CM - CM •o* IK in cd
I
a> a> a)
|Group D mean s c o r e
sco re
o o o
o o oCD
0) CO
g CM CO m CO Ik CO CD o CM CO tj- in CO 00 CD o CM CO TT m CD | K OO CD O c c c
’M’ M1 'M- m in m m in m m m in m CO s CD CO CD CD CD CD CD CD | K m CO (0
I O verall mean
0) CD (D
E E E
< CO O
Q a Q
3 3 3
O O O
5 O O
1
|
add.
CM q Is-. q q CO
2 .0
i n CO CM o o
2.5
■M-
4.5
- - csi ■M1 cvi
CM O) CO 0> CM S '9 S CM CO q
9*69
O)
to t a l
5 6 .5
5 6 .5
5 6 .5
4 8 .3
%
cm cd cd 0> © h- cd i d i n i n 0> cm
If) h* CM CO CO N CO m <n m
Is- CO o r - h- O M' O) CO o> q CM q N- o cq

vP
a c h ie v e d
0s <6 cd cd cd cd Is-! cd d i d ■O' cd id CM cd

p a r tia lly
CM CM CM CM CM co
a c tio n s
o O) r*- Is- CO o Is- o CO

CO in - CO CM in CO CO
c cd co* cd cd cd CM csi cd
m an u al - M an u al
key
CM Is- CM oo Is-. O) CO CO CO CO CO CO q o
4 7 .8
c o m p le te ly
d r-! d r f d tj-
a c h ie v e d
cd cvi cd CM h-! d o in
CM in CM CM in ’M- CM CO CO CO CO CO rr CO
2
o CO o CO o CM
o CO CM in CO CM in
S ta g e
c - - d 00* cd d d o cd
I|
|
I o
T“ If)
the validation testing of the guidance
U) in CM CO CO CM 00 1^ co o
to t a l
4 4 .7
3 9 .6
4 5 .9
48.0
d Tf
%
CO cd CO CM in
zz
d
5 m CO 5 W CO Tf S ) 5 CO CO CO
I
If) cq O) CO CO CM CO CM Is- q CO CO CO q CO m
a c h ie v e d
0s O) csi h-’ Is-* csi o d
Page 2 of 6
partially
d Is-! d ■o- cd d
to ta l a c tio n s
o co o CO q q CO o q O)
c
CO CO CM CO m Is- CO i n
cd cd csi cd cd
I
O) o m i n o CM O o q
co m p letely
| 22.0
a c h ie v e d
ss cd ■M* O) d O) o n ! cd d rr cd •O’
CM CO CO ? CO CO CO CO CM CO CO CO CO CM
00 CO CO Is- q q q
o O) CO h- O •M' CO oo Is- CO
CM CM* in o CM •O' d
c
I|
I|
o *t CM CM o in cq N. CO CO CO o
to ta l
5 2 .7
6 1 .5
Results from
| 65.4
%
© in 0 ) n ! cd o cd Is! CM CM h-’ cd o
W CO m Tf If) Is- CO i n m in in in in m
CD i n CO CM q O) O) o>
2 8 .2
2 4 .0
2 0 .2
Vp
a c h ie v e d
0s ^3* CO if) cd cd cd cd in d in CM* in Is-! cvi cd

partially
CO CO CM CM CM CM CO CM CO CM CM CM
key actions
o o> o CO CO CO CO CO CO CO Is- Is-;

O) CO o CM CO
c cd CO* cd in Is-! r-! cd in
I
o> CO cq o o CO CO o> q CO CO q O)
2 9 .8
co m p letely
vP
I 26.9
o o o O) in cd Tl* rr
a c h ie v e d
0s* If) cd T cd
cd tCO d CO* d
CM CM m m CO CM CM CM CO CM CM CO CM
Is- o o m o
o Is- - O) CO Is- CO CO 00 CO Is- CO Is-
1
c Is-! cd r-! CT> r-! r-! d Is-! Is-!

Stage
I
Tf CO Tf If) Is ; CM CM CM CO CO CO CD
to ta l
5 6 .6
4 6 .2
4 2 .9
n ! 0 ) s ! CM
%
cd cd cd d © o cm CO
m CM 5 if) i n CO in m m Tt
I
CO O) O) in CO CM CO CO CO CO ■o- CO in
2 2 .6
2 2 .6
2 4 .5
21.7
a c h ie v e d
oo' 00* CO* o* cd CM* cd cd r-! d d Is !

partially
CM s CM CM CM CM CM CM
total actions
cq CO CO CO CO q o q CO
o CM in o o CO CM - Is- CM
c cvi cm d d cd d
CM CD ■M- q Is - CM
2 0 .8
2 8 .3
2 2 .6
2 3 .9
2 6 .8
2 7 .9
2 8 .9
2 8 .6
2 8 .3
2 5 .4
in
c o m p letely
sp
a c h ie v e d
0s* d CM 0 ) cd T}- Is-! d

CO CO CO t T CM CM CO
h- Is- CO o CM CM o CO q
o in ■M- CM CO
Is- CO CO
c CM CM c\i i n cd in in cd
-
1
Group C mean score (all
Group D mean score (all

Group A mean score (all
(all
IGroup D mean s c o r e
Group C mean s c o r e
Group A mean s c o r e
sco re
sc o re
Group B mean score

(all with m a n u a l)
g CM CO •M- in co Is- CO O)
Is- Is- N- Is- Is- Is- h -
lo v e r a ll mean
O v erall mean
with m a n u al)
with m a n u al)
with m a n u al)
with m a n u al)
1
1 60
1 90
| 00
add.
o IO o o CM - O o o o o CM - o o o o O o o o o o o o CO CO
- - - - o d
1 1 0 0 .0 |
1 0 0 .0 |
CO o Is- ho O i*- O Is- CO o N. o h- h^ o Is- o o h^ o o o Is- q q Is- h- CM
1 1 0 0 .0
N Is; CO
to ta l
CO oo cd ed oo cd oo cd cd oo CD o cd cd do cd do d cd oo d d CD cd CO CD CD 0>
%
cd cd o cd cd o o
CO CD CD CD CD CD CD CO CD CD CO CD CD CD CD o CD h-. CO CD Is- Is-
o o o o o O o O o o O o o O O o o o O O o o o o o o o o o o o o O o O
a c h ie v e d
partially
o d d d d d d d d d d d o d d o d d d d d d d d d d o d d d d d d d d
key a c tio n s
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o O o o
c o o d d o
o d
h-o h-
looot
CO o r- ho o o o o Is- Is- o h-o o o
00011
Is- h- h- CO Is- CO Is- o o Is- CD CD Is- Is- CM

co m p letely
CO oo cd ed do cd d d d d cd cd oo cd d d d o d
a c h ie v e d
cd cd cd cd cd cd cd cd cd GO CO* cd cd oi
CO o o o o CO o o o o o Is
CO CO co CO CO CO CO CO CO CO CO CO CO CO CO CO Is- Is-
Post incident
6
c - CO CM CM CO CM CO CO CM CM CM - CO CM CO CO CM - CM CM CO CM CO CO CO CM CO CO CO CM Is - o co
CM CM CM CM CM
Th
|
N o> CM co CM in tf> in CM CO in in CD CO CD 00 in in q in 0) CM in CM in CO CM CM CM CM in CM q CO CM
to ta l
CD cd CD cd CD 00 d cd d cd cd 00 cd CO cd cd d cd 0> d d d d cd cd h^
h- ** m CO CD CO CD m CD CD 00 in CO m CD CO h- CO h- CD CD CD in CD CD CD CD CD dCD in CD m
o O O o O o o o o o o o o o o o o o o o o o o o o o O O o o o o o o o
ss
a c h ie v e d
partially
o o d o o o d o d d d d d o o d o o d d o d d o d d o o d d d d d d o
total a c tio n s
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
c o o
Page 3 of 6
o d d d d
CM o> CM CO CM tq in in CM CO in in cq CO cq CO iq in o> in o> CM *q CM in CO CM CM CM CM in CM CO CO CM

c o m p le te ly
a c h ie v e d
cd cd cd cd cd cd oi cd cd rh cd cd cd cd cd cd oi cd oi oi oi oi o d cd cd h^
Is- ID 5 CO CO CO m 5 CO CO m 00 m 5 CO Is- CO Is- -M- CO CO CO m CO CO CO CO CO CO in CO in
o
c CO o CO N. CO CO CO m o> h- oo CO - h- -
h- 00 in o m o CO CO CD 00 Is- CD CD CD CD CD 0 o CO
Is-’ 01 Is- CO*
|
|
*D CO CO O CM CO CM o CO CO o cq
T3 - CM CM CM o CM - CM CO - CM - ■M" - CO m CO - ■O' -
TO * CM d
CM cd
IO in in in in N- in in CD iq in in m in m CD m in h- CoD
t o ta l
in in h- Is- in m Is-
d in
%
id cd in CD cd in cd CM in cd in cd in in in in cd in cd CM* CM in d d CM d
in CO m CO CO CO Is- CO CD in in CD in CO m h - h - m CO Is- m
5? o o o o o o o o o O o o o O o o o o o o o o o o o o o o o o o o O o o
a c h ie v e d
partially
o d d o d d d d d o d d d o o d d d d d d d o d d d d o o d o d d d d
key a c tio n s
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
c o d
d d d d
to iq •M" iq in 'M* m 'M- r- in ■M- in CO in in in in m in in cq tq in ■M- in Is- in IO Is- ’M- Is- CO h-

c o m p le te ly
id TT
a c h ie v e d
£ cd TT id cd cd id cd csi id cd id cd
IO CO in ■M* CO CO CO h- CO CO m m
id id id id id cd id
CO
cd CM CM
m CO in h- Is- in
id oi d c\i oi d
CO Is- m
Stage 3
o
c
IO CO co m M- ^r in ^r co in in Is- CO CO m m m in in Is - in CO CO co oo CO in in cq O CO
id tt 00* id id
|
CO T“ CO co q CO o> o> 00 CO o 0) © r - 0) o o o CD o CD q
to ta l
0> tt q CO CD CM
%
1^ T“ K in cd cd 00 00 h-! in o CO d cd CO d d cd CO
CM CD CM in CO CO CO CO CM in m CO in CD CD CO in 3 in 3 dm CD CO 3 in d in in
m m in m 3 cdCO CTtD CD inm CD CD
Tf
o o CD CO co CO CO CO o o o co CO CO CD CO CO O o CO o o o O CO CO o CO CO o CO o CO 00
a c h ie v e d
ON
partially
o o id id id id id id o o o id id id id id id d d id d d o o id id d id id d cd id d cd CM
total a c tio n s
CO m
o
c o o o o o - - - - - - o o - o o o o - - o - - o CO q
o
o
d d o
CD CM o co CO CO CO CO CO o cq CO CO ■M; ’M; o o> o Is- o> o CO o CD CD in Is- CO CO 'M;

co m p le te ly
a c h ie v e d
Is- CM o cd Is-* cd cd id o cd id cd TT o 00 d cd cd r r o id d CO cd cd d id cd cd
CM CO CM in CO CM CO CO CM m m CO in CO CO m CO in CO CO Tf m Th in in CO CO m ■M* Th
o CO 00
o
c to cd CO in CO CO m o o> CO 00 o CO oo CO o> Is- o> CM h- 00 CD CO o CD r^ Is- CO CO d
- - h^ Is-* Is-
|
|
|
|
|
|
|
|Group C mean score
score
score
score
score
g CM CO TT m CO r- CO o> o CM CO m CO h- CO o> o CM co in CO Is- CO CD o

5 ■O’ rh ■M- M1 in m in m m m m m in in CO 5 CO CO CO CO CO co CO CO Is-
D mean
B mean
A mean
|0 v e r a ll mean
IGroup
|Group
|Group
I
|
add.
o O Is- CO CM O co
0 .4
CM o o CM o o o
0.7
- CM d d d d
o K i- r- CO o r- co CO o 00 CO CO CM CO r- p
to t a l
© cd o
%
o CO cd cd cd o cd cd cd cd ■n in in cd cd in
CO CO CO co CO CO CO h- m in Is- CO CO £ h-
o o o o o o p o o o O o o o o o o o
^ "q) d d d d o d o o o d d o o d o d d
key a c tio n s
•S
^ !?=
o o o o o o o o o
f oc
2 . ito o o o o o o o o o o d d o o o d d d
o h- h- h- CO o Is- CO CO o CO CO CO CM CO r- CO tj;
co m p letely
o d CO cd cd o cd cd cd h-i id id
a c h ie v e d
oS o CO o cd id cd cd id
co CO CO Is- m m
CO CO CO CO Is- CO CO
Post in c id en t
Is-
o p co r - Is-; CO in o CM CO
c CO CM CM CM - CO CM - - CM CM CM CM csi CM
I|
in CM CM CM CM CM 0 0 in o o o O r— Is;
to ta l
CO 00
%
C> cd cd cd o> cd cd cd d d 00 d cd CM d
CO CO CO m CM CO in m in 5 in CO in CO in
o o o o o o o o o o o o o o o o o o
s?
a c h ie v e d
partially
d o o d d d d d d o d d d o d d d o
total actions
o o o o o o o o o o o o o o
o o o o o
Page 4 of 6
c o d d d d o d d d
W CM CM CM w CM CO in o o o p CO CO h- h-
co m p letely
a c h ie v e d
d cd d CO d cd cd cd d d cd cd CM Tf
S CO •M* CO in CM 5 m m in 5 m CO m CO in
CO 00 o>
o h- Is- CO CO CO o CM
c CO o> CO CO CO o> r-. cd id cd Is-* 00 i^
1|
|
■o CM CO CO o in 00 p CM o>
*o CM o - CM CO CO CM o CM cd CM cvi
CO CM CM
____ 1
IO CO in o> in CM in m in p CO h- m Is-
t o ta l
00
%
cd cd cd in o in CO d o> cd cd o> in CM cm'

LO CO CO CO o in 5 CO CO Is- in
O o o o o o o o o O o o o o o O o o
a c h ie v e d
partially
o o d d o o o o d o d d d d d d d o
key actions
o o o o o o o o o o
o
c o o o o o o o o
o d d o d d d d o
in CD LO O) in CM LO in in (D CO Is- in Is- ■M- CO

c o m p le te ly
a c h ie v e d
cd cd cd id d id GO d cd cd d id CM CM* i^
IO CO CO CO M- o> m -M- in CO CO ’M- r-. in
Stage 3
o CO r- io o LO CM CO •M- N- o Is- in O o CO co
c id id cd id id cd id id
1I
r- O) p CO CO CO N CO in o CO i*-
to t a l
CO <T> N
cd cd cd in cd cd cd in CO s 00 o in
%
h-
CO s CO CO in CO 3 CM CO in in CO CO in in in 3
CO o o CO CO o O O CO in r - N; o o p o CO
a c h ie v e d
partially
id o o id id o d d id CM cd cd d cd d cd CM
total actions
o o r- N- o IO CO o CO tT
c - o - - o o o - o o d o d o d d o
o> CO o CO CO CM p p o CD CO CO CO Tf
c o m p le te ly
a c h ie v e d
cd cd d cd tT id cd id cd oi
CD CO CO CO io CO CM 5 in in CO CO in
o in CO CM co r- Is- CM CO o r- CO
c r- CO o> in - d d cd CO cd o co
- -
1
(all
Group C mean score (all
Group A mean score (all
(all
IGroup C mean s c o r e
IGroup D mean s c o r e
IGroup A mean s c o r e
sco re
O verall mean s c o r e
Group D mean score

Group B mean score
(all with m a n u a l)
9 CM CO io CO h- CO o>
r^. r- r- h- Is** h- Is- Is-
lo v e ra ll mean
with m a n u al)
with m a n u a l)
with m a n u al)
with m a n u al)
1
1
1
1
I
1
1
1
1
|
|
|
|
|
Clinical m edical officer
O cc u p a tio n
clinical lecturer
senior lecturer
|EP m an ag er
Deputy DPH
PH advisor
|PH nurse
PH nurse
PH nurse
PH nurse
PH nurse
o
oaool
oaool
1/MHdO
oaool
oaoo
o Q_ o
O HS|
OHSI
D 01 01 Hi a: Q 01 01 OI o : o:
o
SpR
O CL CL X CL Q. Q_ CL CL Q.
O CO CO CO o CO CO CO CO CO
T ra in e d
z z Z >- z > z z >- z z >- > z > > > z z >- >- z z z >- z >- z z >-
C
O
in c id en ts
N um ber
o
o o o o o o o o o o o o o o o o o o o
of
- CM - - CO CO CO in CM CO LO
a>
training g ro u p
E x p e rie n c e /
Q Q Q o Q < Q Q a CQ a o < Q o o a Q a o o Q o a < a o a Q o

1
I
|
05 o CO 1^ T“ 05 q CM IO CO © CO o CO q CO CM CO CO CO q r^ h - CO q cq CO
to ta l
44.4
CM 05 cd o i
%
oi cd Is*! CO CO 05 © nI d id 05 i d CM id o cd CM id d o
IO io m CO CO CO IO CO IO i o CO IO IO IO i n m in CO CO CO m m CO i n m
1
o IO o IO h - T—! cq iq cq cq CO cq 'T IO o IO cq Is- i n T“. cq h - in cq cq r-- CO

o
a c h ie v e d
05 05 csi Tj-
5 csi 05* 05 •M- CM 05 5 CM co’ ■M- CO* CO*
partially
05 CM
key actions
o CM h - - CM - CO h - 05 CO 05 05 N. CO Is- 05 Is- - 1^ 00 CM CO 05 oo CO Is- Is- 05 CO h - i n o o CO t T

c 00 05 05 oo* 00*
149.2 |
o M- CO 05 CO cq CM CO 05 cq 05 IO LO 05 a> to CM ID o cq o CM CD CM cq CO CO CO
co m p letely
cd cvi •^r cd 00 o cd cd
a c h ie v e d
& id cd id CO CO TT 1^ cd cd oo csi csi cd cd cd 05* id 05 d h*^

CM CM CO CM CO M
- CM CO M1 CO CO CO CO ■M- CO CO CO CO CO 'M- ? m CO M* •M- ■M- CO
o CO o> CO ■M- CO CM o LO 05 o M* 'M’ N- CO h- CO CO h - CM CO M" 05 CO 05 CO 00 05 m o o CO i n

Total score
c CM CM CM CO CO CM CM CM CM CM CO CM CM CM CM CM CM CM CM CM CM CM co CO Tj- cd d id cd
CM
CM CM CO CM
1
1
|
|
1 V9V
q q q
total
CM CM CM © CO cq cq cq cq CO CO cq CO CM (D 00 CM o CO CO o CM CO CM CM o oo
4 1 .5
| 54.4
44.9
47.2
%
id T“ CO cd 0 ) 0 ) cd 00 05 id T" id cd T“ © h-* od cd cd cm' 00 Is-*

CO CO CO CM co Tf CO IO 5 5 5 IO CO CO m in
|
CM CO CO cq CO CM o CM cq o CO CO CM o CO CM CO o oo o o oo 00 M" CD CO o CO 00 cq CO o (D 05
o' 00 csi cd 00 CM od cd 05 05 csi 05 00
a c h ie v e d
id cd CM cd cm' csi cd CM CM 05 id CM 05 id 05 d
partially
CM CM
total a c tio n s
o 0) - CO CO IO M- io CO CM 05 CO io CM 05 CM o CO o o CO - CO CM CM i n CM
CO o i n CO
c - CM - 'O’ i d id CO*
o ’M' o CM CO o CO cq o M" CM M- CO -M- o oo 00 CM o CO CO CO CO CM CM CO M- CO Is- CO CM CO

co m p le te ly
cd cd cd csi CO 05* cd cd o*
a c h ie v e d
o cd CO TT id cd cd cd id csi Is-' cd cvi cd 00 id CM r t 00 CO* 05 id

CM CO CO CM CO CO CM CO CO CO CO Tf CO CO CO CO CM CO CO CM CM CO CO CO CO CO M- CO CO CO CO CO
o in CO CO CO o M- Is- CO LO CO CO IO CO TT CO h- CD o CO CO - o
■M CO Is- CM 05 ^r r-. CO o Is- o cq cq
c CM M- CM CO rr CM CO M* Tf IO M- IO xf ’M’ CO CO CO M* rr rr •M- in CM 05* cd i d oo*
CO
|
|
|
|
|
|
|
|Overall mean score
|Group C mean score

D mean score
IGroup A mean score
IGroup B mean score
9 CM CO M*
’M*
LO CO Is- CO
’M' M"
05 o
IO
CM CO tJ-
LO IO LO LO
LO CO
LO IO
Is*. CO
io io
05 o
IO CO 5
CM CO m CO Is*. oo 05
CO CO CO CO CO CO CO CO
o
N-
|Group
I
I
I
|
|
O cc u p a tio n
PH nurse
PH nurse
PH nurse
O 2
CCDC
CCDC
Q CH (X X
O Q. Q. 0.
O W w a
T ra in e d
the validation testing of the guidance
z
>- >- Z >- >- >- z >-
in c id e n ts
Page 6 of 6
N um ber
o m O O O
of
o CM O o
training g ro u p
E x p e rie n c e /
< < Q < O O a D a

|
I £'89
I £ 09
|
|
|
total
o CO p CM o> CM
Results from
| 2 3 .8 | 54.0
58.7
| 56.6
59.3
%
o cd cd d CO CO CO m o
CM m co m m in in CO m m
I
CO o> CO h- in o T 0 CO M" h- CM in CO CO CM
20.6
a c h ie v e d
cd N-‘ ’M’* CM
* o> cd CM
partially
01 cd M- h- ■M- CO
CM ' T“
key a c tio n s
T”
o in LO in o> 00 CM CM CD o CO o O o o O CO
c - cd d 00 Oi Oi Oi oo
-
|
CM o CO CM N- CO o
yp p
Oi CO CO y- o
co m p le te ly
47.6
| 42.9
a c h ie v e d
o'' © 05 cd oo* o> O) oo* cd in* 00 oo h- T—

CO co CO "M* CO 5 CO CO CO CO CO ■M- V CO
I
o CO o CO m
LZZ
Total s c o r e
o 05 00 CM 'M’ in CO O Oi CO
| 27.0
c CM CM CM CO CM CO CM csi O in CO
CM CM CM CM CO CM CM
I
|
I
|
O CM
total
CO CM CO CO CO CM in
| 28.8
I 39.2
| 49.6
46.4
48.8
41.6
53.9
%
CO o> 05 o> oi CO LO o 00 a
in m m n in
oo 00 CO o CO CO o M; CM CM 05 r^- OO h- o Oi
| 14.4
cd cd
a c h ie v e d
O) CM* cd cd CO* in cd d T—
partially
cd CO CM CM o
T-
total a c tio n s
T~
o CM m r- 00 o oo CO 0 CO CO h- CM o CM CO
c CM CM 01 cd cd m m CO
' T- T- T~
|
CM CM o CM CO o Oi
1 3 1 .2
Oi r- CO
c o m p le te ly
I 45.6
33.6
a c h ie v e d
ON cvi 05 cd in oo 00* -M- d d CO co CO h- oCO

CM CO CO CO CO CO CO CO CO CO co
I oos
o O) co ^r m h- ^r oo CO CO o Tr CO o CO
c CO in CM CO m Tj* TJ- cd cvi cd CM IO CO CO CO
M- CO M- TT ^r CO
|
|
|
|
|
|
ro ro W lo
0) o a> CD CD
|Group C mean score
|Group D mean score
IGroup A mean score
score
o _ 8 oo 8CO oo
t/> 2 </) < 0 ifi
g CM
Is-
CO
h - N-
in
r^.
CO h -
h- 1^-
CO o>
h - h»
C 3 c co
c C
CO ^
c
CO —*
CO ^
O verall mean
0) *^5
|g i 3 E 5 E l E l
— sz < (0 O ro Q s
E % Q- b
* *= * *=
> = 2 ~ o £ 2 £ O £
O 3. O 3 O 3 O 3 O 5
|
\
)
Appendix 13
Univariable Analysis
Unpaired t test
Mean of OVER_TOT_MANUAL_1 = 45.6

Mean of OVER_TOT_MANUAL_0 = 39.2
Assuming equal variances

Combined standard error = 1.829265
df = 77
t= 3.5211
One sided P = 0.0004
Two sided P = 0.0007
95% confidence interval for difference between means = 2.798494 to 10.083558
Assuming unequal variances

df = 76.508303
t(d) = 3.525875
Comparison of variances
Two sided F test is not significant
No need to assum e unequal variances
Unpaired t test
Mean of OVER_TOT_EXPERIEN_0 = 40.690909

Mean of OVER_TOT_EXPERIEN_1 =44.502857

df = 77
t= 1.969337
95% confidence interval for difference between means = -7.66632 to 0.042424

df = 76.924855
t(d) = 2.01481
95% confidence interval for difference between means = -7.57933 to -0.044566
No need to assume unequal variances
1
Unpaired t test
Mean of OVER_TOT_TRAINED_0 = 39.5

Mean of OVER_TOT_TRAINED_1 = 45.2

df = 77
t= 3.07072

df = 76.738018
t(d) = 3.069429
Two sided P = 0.003
One wav analysis of variance
Variables: OVER_TOT_OCCUP_MED, OVER_TOT_OCCUP_CONSULTANT,

OVER_TOT_OCCUP_OTHER, OVER_TOT_OCCUP_NURSE
Source of Variation Sum Squares DF Mean Square

Between Groups 392.128814 3 130.709605
Within Groups 5515.038781 75 73.53385
Corrected Total 5907.167595 78
F (variance ratio) = 1.777543 P = 0.1587
OCCUP
Dependent Variable: over total
Mean Std. Error 95% Confidence
Interval
OCCUP Lower Bound Upper Bound
CONSULTANT 44.819 1.855 41.098 48.540
MED 43.274 1.688 39.888 46.660
NURSE 40.029 2.376 35.263 44.794
OTHER 38.640 2.903 32.816 44.464
a Based on modified population marginal mean.
2
Unpaired t test
Mean of 0VER_KEY_MANUAL_1 = 53.154253

Mean of OVER_KEY_MANUAL_0 = 45.793651

df = 77
t= 3.675062

df = 76.756814
t(d)= 3.678921
Unpaired t test
Mean of OVER_KEY_EXPERIEN_0 = 47.691198

Mean of OVER_KEY_EXPERIEN_1 = 51.609977

df = 77
t= 1.831761

df = 76.300779
t(d) = 1.860604
No need to assume unequal variances
3
Unpaired t test
Mean of OVER_KEY_TRAINED_0 = 47.700448

Mean of OVER_KEY_TRAINED_1 = 51.111111

df = 77
t= 1.596497

df = 74.671907
t(d) = 1.593404
One wav analysis of variance
Variables: OVER_KEY_OCCUP_MED, OVER_KEY_OCCUP_CONSULTANT,

OVER_KEY_OCCUP_OTHER, OVER_KEY_OCCUP_NURSE
Source of Variation Sum Squares DF Mean Square

Between Groups 211.945607 3 70.648536
Within Groups 6957.28683 75 92.763824
Corrected Total 7169.232437 78
F (variance ratio) = 0.761596 P = 0.5192
OCCUP
Dependent Variable: OVER_KEY
Mean Std. Error 95%
Confidence
Interval
OCCUP Lower Upper Bound
Bound
CONSULTANT 49.002 1.860 45.294 52.709
MED 51.810 1.621 48.578 55.042
NURSE 46.471 2.529 41.429 51.513
OTHER 47.566 3.369 40.851 54.281
4
Multi variable analysis
Overall total scores

Run 1 with all four dependant variables
Tests of Between-Subjects Effects

Source Type III Sum df Mean Square F Sig. Partial Eta
of Squares Squared
Corrected 1813.777 6 302.296 5.317 .000 .307

Model
Intercept 92351.926 1 92351.926 1624.408 .000 .958
MANUAL 935.929 1 935.929 16.462 .000 .186
EXPERIEN 134.661 1 134.661 2.369 .128 .032
TRAINED 364.981 1 364.981 6.420 .013 .082

OCCUP 182.545 3 60.848 1.070 .367 .043
Error 4093.391 72 56.853
Total 147794.560 79
Corrected 5907.168 78
Total
a R Squared = .307 (Adjusted R Squared = .249)
Run 2 Occup lost as p=0.367 and therefore >0.2 (final model)

of Squares Squared
Corrected 1631.232 3 543.744 9.537 .000 .276

Model
Intercept 140729.319 1 140729.319 2468.395 .000 .971
MANUAL 878.955 1 878.955 15.417 .000 .171

EXPERIEN 110.398 1 110.398 1.936 .168 .025
TRAINED 514.838 1 514.838 9.030 .004 .107

Error 4275.935 75 57.012
Total 147794.560 79
Total
5
Parameter Estimates
B Std. Error t Sig. 95% Partial Eta
Confidence Squared
Interval
Parameter Lower Upper
Bound Bound
Intercept 49.755 1.673 29.748 .000 46.423 53.087 .922
[MANUAL=0] -6.677 1.700 -3.926 .000 -10.064 -3.289 .171
[MANUAL=1] 0
[EXPERIEN=0]-2.471 1.776 -1.392 .168 -6.008 1.066 .025
[EXPERIEN=1] 0
[TRAIN ED=0] -5.305 1.765 -3.005 .004 -8.822 -1.788 .107
[TRAINED=1] 0
a This parameter is set to zero because it is redundant.
6
Key total scores
Run 1 with all four dependant variables

of Squares Squared
Corrected 1809.716 6 301.619 4.052 .001 .252

Model
Intercept 126599.065 1 126599.065 1700.738 .000 .959
MANUAL 1240.458 1 1240.458 16.664 .000 .188

EXPERIEN 315.307 1 315.307 4.236 .043 .056
TRAINED 94.578 1 94.578 1.271 .263 .017

OCCUP 278.367 3 92.789 1.247 .299 .049
Error 5359.516 72 74.438
Total 200171.328 79
Total
Run 2 Occup lost as p=0.299 and therefore >0.2 (final model)

of Squares Squared
Corrected 1531.349 3 510.450 6.790 .000 .214

Model
Intercept 191744.988 1 191744.988 2550.758 .000 .971
MANUAL 1113.108 1 1113.108 14.808 .000 .165

EXPERIEN 192.375 1 192.375 2.559 .114 .033
TRAINED 145.790 1 145.790 1.939 .168 .025

Error 5637.883 75 75.172
Total 200171.328 79
Total
7
Parameter Estimates
B Std. Error t Sig. 95% Partial Eta
Confidence Squared
Interval
Parameter Lower Upper
Bound Bound
Intercept 56.442 1.921 29.389 .000 52.616 60.268 .920
[MANUAL=0] -7.513 1.953 -3.848 .000 -11.403 -3.624 .165
[MANUAL=1] 0
[EXPERIEN=0] -3.262 2.039 -1.600 .114 -7.323 .800 .033
[EXPERIEN=1] 0
[TRAIN ED=0] -2.823 2.027 -1.393 .168 -6.861 1.215 .025
[TRAINED=1] 0
a This parameter is set to zero because it is redundant.
8
Appendix 14
Faith G oodfellow, CIRS DRAFT
12 September 2001 Version 2
Use of the Summary Checklist of Actions for

The target audience for this checklist is public health professionals. The aim is to cover all the
issues and actions involved in the management o f any type o f chemical incident. By working
through the checklist the public health professional will have considered the main aspects o f
managing the public health response to a chemical incident. References are made in the
‘further guidance’ column to additional guidance materials providing more detailed
information on particular chemical incident management issues if required.
To provide an indication o f the priority o f each action, the checklist is divided into four time
periods:
1. first few hours
2. within 24 hours
3. remainder o f management
4. post incident
Each stage is then also subdivided into the three parts o f the public health response to a
chemical incident, namely:
• risk assessment o f potential adverse impact on public health
• communication with other organisations and the public
• action to prevent/mitigate adverse impact on public health
In some cases, the issue/action may be primarily conducted by a public health professional.
However, other aspects are largely the responsibility o f other agencies/organisations although
there will be an interaction with the public health response to a chemical incident. For
example, taking and analysing environmental samples is likely to be conducted by
environmental health officers, the Environment Agency, or in the event o f drinking water
contamination the local water utility. However, public health professionals rely on the
analytical results as part o f their exposure and health impact assessment and therefore will
need to have some involvement in this aspect o f the management. The checklist contains a
column in which the lead agency or agencies are identified, all the issues/actions detailed need
to be considered as part o f the public health response, even where the primary responsibility
for conducting the action lies with another agency.
In order to keep track o f actions that have been completed, a tick column has been provided.
N ot all the actions will be applicable to all types o f chemical incident, therefore, if the action
is not applicable write ‘N A ’ in the tick column. Although the later stages provide the
opportunity to confirm some details of the incident it may still be necessary to review the
earlier checklists in the light o f new information. Progress through the checklist should not be
delayed unnecessarily if some information is not immediately available. The incomplete
actions can be revisited as new information is provided.
Page 1 o f 9
Faith Goodfellow, CIRS DRAFT
Abbreviations
A&E Accident and Emergency Hospital Department
CIPU Chemical Incident Provider Unit
DEFRA Department for Environment, Food and Rural Affairs
DH Department o f Health
DPH Director o f Public Health
DWI Drinking Water Inspectorate
EA Environment Agency
EH Environmental Health
GP General Practitioner
HA Health Authority
HEPA Health Emergency Planning Advisor
LA Local Authority
MCA Maritime and Coastguard Agency
NHS National Health Service
PH Public Health
Q&A Questions and Answers
Page 2 o f 9
Summary Checklist of Actions for Chemical Incident Management
ACUTE PHASE
1. First few hours (or as soon as practicable)
Risk assessment o f potential adverse impact on public health
ACTION Lead Further Complete

agency guidance ✓
Identify name of chemical (common/trade/scientific), unique number, Fire/EH/

constituents of a mixture water utility
Identify taste/odour and visual properties (e.g.colour) Fire/EH/

water utility
Identify physical and chemical properties, e.g. physical state, pH, density, Fire/EH/
boiling point water utility
Section 2
Determine basic human toxicology of the chemicals, including availability of no.8
PH/CIPU
antidotes and no.9
Identify any synergistic or antagonistic effects of multiple chemicals PH/CIPU
Identify manufacturer of product involved (where constituents/properties are
Fire/EH
unknown)
Identify any measures for control or mitigation of impact (including Fire/EH/
water
decontamination techniques) utility/EA
Identify current geographical location of contamination source Fire/EH/
water utility Section 2
Identify type of contaminant source (e.g. fixed installation or transport) Fire/EH no.7 1
Determine information about the area (e.g. topography, urban/rural) EH/EA

Estimate number of people already exposed and nature of exposure PH
Estimate the total potentially exposed population PH
Section 2
Identify any nearby populations that may become exposed, for example if PH
no. 10
contaminant is airborne
Estimate the time period of exposure for the population PH
Find out if any health effects have been reported to any agency PH Section 2
no. 11
Check any symptoms exhibited are consistent with the chemical identified PH/CIPU
and no.22
Determine approximate amount of the contaminant released Fire/EH/
water utility
Identify all environmental media affected, i.e. air, water and land EH/EA (S ec.l no.2)
Determine the concentration of the contaminant in relevant media and where EH/EA/
Sec.2 no. 12
and no. 13
applicable at various impact points water utility
(S ec.l no.5)
Determine current weather conditions, e.g. temperature, wind speed/direction,
Fire
rainfall
Obtain predictions of future weather conditions Fire
Consider direction of movement of the contaminant (in all relevant media, e.g.
Fire/EH/EA
from Chemet for air)
Try to establish what the environmental pathway/route of exposure between the Section 2
PH/EH
source of contamination and the human receptors is no. 18
Incident status
Find out if incident has been declared ‘major’ by any agencies involved All
Decide what status to give the incident within the HA PH
Assess whether the severity of the incident is likely to escalate All
Page 3 o f 9
Communication with other organisations and the public

agency guidance ✓
Alert colleagues within the health authority or region, e.g. DPH, press officer,
PH
chief executive, HEPA, regional epidemiologist
Alert relevant health organisations, e.g. CIPU, neighbouring health authorities, PH
A&E hospitals, GPs, NHS Direct
Alert relevant emergency services, e.g. police, ambulance, fire, MCA First to Section 2
respond no.6
Alert local authority environmental health department, where relevant First to and no. 14
respond
Alert other relevant departments of the local authority, e.g. emergency (Section 1
EH no.3
planning, housing, social services and no.8)
Alert local water utilities - water supply and sewage, where relevant EH
Alert relevant enforcement agencies, e.g. Environment Agency, Health and

Fire/EH
Safety Executive, DWI, Food Standards Agency
Ensure National Focus has been alerted, where relevant CIPU
Make initial contact with local media, press, radio and television All Sec.2 no. 16

Consider forming an incident control team All

organisations involved in the management with the necessary seniority and All
expertise to be able to take decisions, ensure roles are clear Section 2
Confirm location for incident room with security access and adequate parking no.15
All
(should be pre-planned) (Section 1
Ensure necessary facilities are available - telephones, administrative support, no.7)
All
etc. plus toilets and food/drink (should be pre-planned)
Ensure contact numbers are available for incident control team members All
Determine scheduling of meetings All

Ensure affected population is alerted and those potentially affected if PH/police/ Section 2
movement of contaminant is expected. EH no. 17
Identify and alert vulnerable populations within current or potential area of PH/police/ (Section 1
exposure, e.g. schools, hospitals, nursing homes EH no. 10)
Ensure appropriate advice is provided to prevent/minimise exposure - e.g. PH/police/

EH/water
evacuation, sheltering, stop drinking/using drinking water utility Section 2
Ensure affected populations understand what actions they need to take (e.g. PH/police/ no.18
EH/water
stop using water, leave home, consult GP etc.) utility
Alert other water users, where relevant, e.g. food manufacturers, agricultural EH/water Section 2
facilities utility no.5
Page 4 o f 9
Action to prevent/mitigate adverse impact on public health

agency guidance ✓
Refer to pre-prepared emergency plan All
Protect/monitor affected population

Ensure population are prevented from accessing the incident site, where
Police/EH
possible
Ensure appropriate medical treatment is available for patients Ambulance/
A&E
Ensure patients/exposed population are being adequately decontaminated Ambulance/
A&E
Ensure personnel directly involved in tending to potentially contaminated Section 2
patients or cleaning up the hazard do not become contaminated themselves by no.19
Fire/EH/EA
the provision of appropriate personal protective equipment and
decontamination facilities
Identify nearby vulnerable environmental locations that are or could become EH/EA/ (Section 1
contaminated, e.g. rivers, aquifers, agriculture water utility no.2)
Ensure vulnerable environmental locations are protected, e.g. drinking water EH/EA/ Section 2
abstraction points water utility no.5
Ensure actions are being taken to remove/contain source of contamination and Fire/EH/
Section 2
EA/water
chemicals/contaminated substances are disposed of utility
no.18
Page 5 o f 9
2. Within 24 hours (or as soon as practicable)

agency guidance ✓
Consider conducting a site visit to gather further information All
Chemical
identified and relevant details on properties and toxicity are determined Fire/EH/
(including environmental persistency and degradation product, biological water
Section 2
uptake) utility/
CIPU no. 8
N.B. there may be multiple chemicals, reaction products and additional and no.9
chemicals added as part of the management, e.g. fire fighting
Identify common uses of the chemical/product, to aid chemical identification if Fire/EH/
necessary CIPU

Confirm location of contamination source, with postcode and/or grid reference Fire/EH/
where possible water utility Section 2
If location of source is in doubt consider use of modelling to predict possible EH/EA/
no.7
sources, there may be variations in results from different models water utility

Confirm number of people already exposed or possibly exposed PH Section 2
Confirm additional nearby populations that may become exposed PH no. 10
Estimate time period of exposure, differentiating between various populations

PH
if exposed for different time periods
Conduct a toxicological evaluation of exposure data to determine possible and Section 2
PH/CIPU
most likely impacts on health no. 11
and no.22
Confirm type of health effects reported PH
Mark cases reported on a map or in geographical information system PH
Determine a precise case definition PH/CIPU

Confirm amount of the contaminant released Fire/EH/
water utility
Confirm direction of movement of the contaminant and ensure regular updates
Fire/EH/EA
are received to monitor for any changes
If direction of movement of contaminant is in doubt consider use of modelling
to predict possible areas at risk, there may be variations in results from EH/EA
different models
Confirm the pathway/route of exposure between source of contamination and Section 2
PH/EH
human receptors, including food contamination no.18
Confirm any contaminant concentrations available in relevant media and at

EH/EA/
various locations and times, ensure most up-to-date analysis results have been water utility
received
Determine if any routine results from environmental sampling are already EH/EA/
Section 2
available water utility
no.12
If no or inadequate environmental sampling results are available, establish what and no. 13
EH/EA/
environmental samples need to be taken: environmental media, when, where, water utility (Section 1
who will take them and what parameters are to be tested for no.5)
If more environmental sampling is required, ensure an appropriate laboratory
for analysis is identified, ensure the necessary samples are collected and stored EH/EA/
appropriately and appropriate analytical techniques are used and quality control water utility
procedures are adequate
Page 6 o f 9

agency guidance ✓
Incident status
Confirm current incident status All
Assess whether the severity of the incident is likely to escalate All
Determine criteria for incident closure All

agency guidance ✓
Confirm environmental organisations have been informed, e.g. Environment
Fire/EH Section 2
Agency, MCA no.14
Alert relevant government departments, e.g. DH, DEFRA, DWI All
(Section 1
Alert occupational health professionals, where relevant PH no.3,
Alert environmental specialists/consultants, where relevant EH/EA no.8
and no.9)
Consider alerting relevant local volunteer organisations EH/PH

Define population ‘at risk’ to avoid concern in unaffected individuals PH
Section 2
no. 10
Provide press releases to alert the public and reassure those not affected, ensure
PH/all
consistency across all agencies involved
Section 2
Confirm that particularly vulnerable populations have been identified and
PH no. 16
alerted and no. 17
Provide clear and consistent information on the nature of the hazard and the
PH/all (Section 1
level of risk, prepare Q&As for common queries no. 10)
Consider setting up a telephone help-line for enquiries from the public PH/EH
Consider holding a public meeting to keep the public informed EH/PH

agency guidance ✓
Confirm that alternative water supplies have been provided where regular water Sec.2 no.5
supplies cannot be used utility/ EH (S ec.l no.4)
Consider conducting biological monitoring of patients and the exposed PH/A&E/ Section 2
population to identify level of exposure and adverse health effects GPs no.20

Confirm nearby vulnerable environmental locations that are or could become EH/EA/ (Section 1
contaminated, e.g. rivers, aquifers water utility no.2)
Confirm action has been taken to remove and dispose of the chemical(s), or to Fire/EH/
Section 2
EA/water
remove the exposure pathway, i.e. containment utility
no.18
Page 7 o f 9
POST-ACUTE PHASE
3. Remainder of management (before incident is declared over)

agency guidance ✓
Confirm identification of population in current area of contamination PH Section 2
Ensure all people with health effects have been identified - through GPs, PH
no. 10
and no.22
Determine whether there are other possible causes of ill health, e.g. viral PH
Section 2
infections no. 11

Confirm current direction of movement of the contaminant Fire/EH/EA
Confirm current concentration of contaminant in relevant environmental media EH/EA/

water utility
Where additional samples have been requested, agree financing and establish EH/EA/
Section 2
timescales for reporting of results water utility
no.12
If not already available, establish method for interpreting environmental and no. 13
analytical data, define limits of detection, limitations from sampling procedure, EH/EA/
(Section 1
accuracy of analytical method, relevant standards for comparison, including water utility
no. 5
taste and odour and no.6)
Request any necessary repeat sampling and analysis to confirm results or to EH/EA/
detect changes in concentrations water utility
Incident status
Assess progress towards specified criteria for incident closure All
Recognition of when to close the incident All
Ensure that the incident is considered over for all organisations involved in the
management of the incident and all relevant parties are informed the incident is All
over

agency guidance ✓
Provide press releases with follow-up information on how the incident is being Section 2
PH/all
managed no. 16
and no. 17
Ensure the public are informed that the incident is over PH/all

agency guidance ✓
Consider distributing a health questionnaire to identify level of exposure and Section 2
PH
adverse health effects no.21

Ensure property has been adequately decontaminated, including where EH/ Section 2
appropriate, drinking water pipes water utility no.18
Page 8 o f 9
POST-INCIDENT PHASE
4. Post incident (after incident is declared over)

agency guidance ✓
Compile a report on the health management of the incident PH Section 3
no.2
and no.3
Provide information requested by other agencies, particularly for official PH/all
reports by enforcement agencies, e.g., HSE, EA, DWI

Ensure follow-up information is provided to reassure the public that the risk to Section 2
health has been eliminated and appropriate actions have been taken to prevent a PH/all no. 16
and no. 17
similar event

agency guidance
Ensure continued treatment of casualties with long term health effects PH
Section 3
no.l
Where remediation is not possible and a significant risk to health remains, EH
Section 2
consider permanent re-housing of people in the area affected no.18
Consider the necessity for long term monitoring of the affected EH/EA
Section 2
environment/media if remediation is not possible no.12
Consider conducting a follow-up epidemiological study (monitoring of relevant PH

health data e.g. disease registers, hospital admission registers) Section 3
Consider tagging of individual patient notes to identify any future health n o.l
PH/GPs
Ensure remediation at site of contamination is complete and meets required Section 2
EH/EA
standards no.18

Identify changes in procedures to improve management in future All
Identify preventative action to avoid the occurrence of similar incidents All
Identify specific actions to be taken and a named person responsible for Section 3
All no.3
ensuring completion
Identify similar hazards in the area and ensure action is taken to prevent any All
incidents
Page 9 o f 9
Appendix 15
Revised
Evaluation of Performance
Participant details
Name
Health Authority
Region
Used manual
Issues/Actions Sta; E*e 1 Sta; ?e 2 Staj?e 3 Post incident

achieved
partially achieved
stage 3
post inc
extra
Faith G oodfellow 1
5 September 2001
Revised
1. First few hours
Key actions

Chemical
Identify name o f chemical, constituents o f a mixture, plus unique no.
Identify type of contaminant source (e.g. fixed installation or transport)
Consider direction of movement o f the contaminant (in all relevant
Incident status

Alert colleagues within the health authority or region, e.g. DPH, press
officer, chief executive, HEP A, regional epidemiologist
authorities, A&E hospitals, GPs, NHS Direct
and Coastguard Agency
Ensure National Focus has been alerted, where relevant
Make initial contact with local media, press radio and television
movement of contaminant is expected, include vulnerable populations
Identify and alert vulnerable populations within current or potential area
o f exposure, e.g. schools, hospitals, nursing homes
e.g. evacuation, sheltering, stop drinking/using drinking water
Faith G oodfellow 2
5 September 2001
Revised

Ensure population are prevented from accessing the incident site, where
possible
Documentation

involved
Remaining actions
Information Achieved 1 Missing N/A

Chemical
Identify manufacturer of product involved (where constituents/properties
are unknown)
identified
Determine the concentration of the contaminant in relevant media and
where applicable at various impact points
Obtain predictions of future weather conditions
between the source o f contamination and the human receptors is
Incident status
Assess whether the severity of the incident is likely to escalate
Faith G oodfellow 3
5 September 2001
Revised

Alert other relevant departments of the local authority, e.g. emergency
Alert local water utilities, both water supply and sewage, where relevant
Determine scheduling of meetings
(e.g. stop using water, leave home, consult GP etc.)

Ensure patients/exposed population are being adequately decontaminated
substances
Faith G oodfellow 4
5 September 2001
Revised
2. Within 24 hours
Key actions

Chemical
contamination
Conduct a toxicological evaluation o f exposure data to determine
Confirm direction of movement of the contaminant and ensure regular
at various locations and times
already available
establish what environmental samples need to be taken: environmental
tested for
Incident status
Assess whether the severity of the incident is likely to escalate
Faith G oodfellow 5
5 September 2001
Revised

Alert relevant government departments, e.g. DH, DEFRA, DWI
Provide press releases to alert the public and reassure those not affected,
ensure consistency across all agencies involved
and alerted
the level of risk, prepare Q&As for common queries

or to remove the exposure pathway, i.e. containment
Remaining actions

Consider conducting a site visit to gather further information
Chemical
Identify common uses of the chemical/product, to aid chemical
If location o f source is in doubt consider use o f modelling to predict
possible sources
Confirm type of health effects reported
Faith G oodfellow 6
5 September 2001
Revised

If direction o f movement of contaminant is in doubt consider use o f
and human receptors, including food contamination
Incident status

Consider alerting relevant local volunteer organisations
Consider holding a public meeting to keep the public informed

Consider conducting biological monitoring o f patients and the exposed
population to identify level of exposure and adverse health effects
Documentation

Keep a current record of 24 hour contact names and numbers for all
Record details of any health effects reported and how exposure occurred
Where possible obtain names and addresses of the exposed population,
including visitors to the area
Faith Goodfellow 7
5 September 2001
Revised
Key actions

Identification of population in current area o f contamination
Confirm current direction of movement o f the contaminant, if
appropriate
Confirm current concentration o f contaminant in relevant environmental
media
analytical data, define limits of detection, limitations from sampling
procedure, accuracy of analytical method, relevant standards for
Incident status

being managed
Documentation

exposed public
Faith G oodfellow 8
5 September 2001
Revised
Remaining actions

infections
Incident status
Ensure that the incident is considered over for all organisations involved
in the management o f the incident and all relevant parties are informed
the incident is over

Ensure the public are informed that the incident is over

Faith Goodfellow 9
5 September 2001
Revised
4. Post incident
Key actions

Documentation

Compile a report on media handling and communications during the
incident
Provide information requested by other agencies, particularly for official
reports by enforcement agencies, e.g., HSE, EA, DWI
Remaining actions

Ensure continued treatment o f casualties with long term health effects
Consider conducting a follow-up epidemiological study (monitoring of
Ensure remediation at site o f contamination is complete and meets
required standards
ensuring completion
Identify similar hazards in the area and ensure action is taken to prevent
any incidents
Faith Goodfellow U W npSITY O F SURREY L I B R A R Y

5 September 2001

Environmental Management of Chemical Incidents

Uploaded by

Copyright:

Available Formats

You might also like

Environmental Management of Chemical Incidents

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Environmental Management of Chemical Incidents

Uploaded by

Copyright:

Available Formats

Centre for Environmental Health Engineering

School of Engineering, University of Surrey

Improving the Public Health Response

Faith Juliet Lydiard Goodfellow

Portfolio submitted in part fulfilment of the requirements for the degree of

All rights reserved

INFORMATION TO ALL USERS

In the unlikely e v e n t that the a u thor did not send a c o m p le te m anuscript

Published by ProQuest LLC(2018). C opyright of the Dissertation is held by the Author.

All rights reserved.

© Faith Goodfellow, 2001

• Also provides supporting information as appendices.

• Also contains Version 2 of the Chemical Incident Management Guidance Manual,

2. Current State of Knowledge in Chemical Incident Management 13

5. Results and Statistical Analysis from Validation Testing of 105

9. Future Research in Chemical Incident Management 173

10. References 177

Chemical Incident Management Guidance Manual - Version 2

3. The Project in the Context of Environmental Technology xiii

4. Areas of Innovation and Contributions to Knowledge xv

5. Areas of Future Research xvii

2.1 Background Information and Problem Definition

In order to establish the current state of knowledge in chemical incident management,

2.2 Aims and Objectives

2.3 Investigation and Learning from the Management of

Personal involvement in managing actual chemical incidents provided the opportunity to

Table 1: Selected Case Studies

2.4 Methodology for Development of Tools to Improve

2.5 Results and Interpretation from the Validation Testing of

Experience/training group Total/key Improvement in score

The statistical analysis therefore also demonstrated an improvement in the response to

In conclusion, the research project involved the development o f chemical incident

The specific contributions to knowledge achieved have been:

1.1 Background to the Sponsor Company

Unit NHSE Regions Population

1.2 Problem Definition

1.2.1 Chemical Incidents

1994 1995 1996 1997 1998 1999 2000

1.2.2 Role of Public Health Professionals in Managing Chemical Incidents

1.2.3 CIRS Approach to Chemical Incident Management

1.2.4 Preliminary Research Needs

The specific objectives were detailed as:

In addition, in order to establish the current state o f knowledge in chemical incident

2.7 Water-Related Chemical Incidents in the Published

At the start of the research project, a comprehensive literature search of English

Table 2.1: Incident Reports in the Published Literature

Health Effects Management of the Incident

Another paper identified a chronic problem of pollution o f watercourses by

2.2 Chemical Incident Management Procedures in the

A systematic and comprehensive literature search o f a range of electronic databases, and

2.3 Assessment of the Current State o f Knowledge Through a

2.3.1 Survey Methodology

The definition of a chemical incident used for the survey was:

Initially, 77 questionnaires were distributed at the beginning o f July 1998, to CsCDC, or

2.3.2.1 Involvement o f public health in managing chemical incidents

CsCDC and CsPHM were asked if they considered non-infectious environmental

Figure 2.2: Proportion o f Chemical Incidents that are Water-Related (n=66)

2.3.2.2 Types o f contamination involved in water-related chemical incidents

drinking water contam ination