Chemical informatio​n and the Jan 2014 West Virginia Elk River chemical release


You may be aware from multiple news sources that little information was available about 4-methylcyclohexanemethanol at the time of the spill in West Virginia’s Elk River earlier this month. Since the spill, government and private sector scientists have contributed to collecting and verifying information about the chemical. As a result, there is now a page on the Centers for Disease Control (CDC) website about the chemical and the methodology used by CDC to develop its recommendations.

There is also a new record in the NLM Hazardous Substances Data Bank (HSDB) for the chemical 4-Methylcyclohexanemethanol, which has a Chemical Abstracts Service registry number (CASRN) of 34885-03-5. Other terms for the spilled substance are “MCHM” or “crude MCHM” or “4-Methylcyclohexane methanol.”

Please note that in some social media and early news reports, the chemical was MISIDENTIFIED as Methylcyclohexanol (CASRN: 25639-42-3). This is NOT the correct chemical. In chemical incidents, it is unusual for little online information to be available about a substance. Chemicals can often be readily identified using online resources such as TOXNET and WISER. In the absence of published information, local and state officials request consultation with local, state, federal and industry experts. Typically, following such an incident there is immediate, ongoing, extensive consultation and communication among responders and experts to determine appropriate actions. When planning for providing health information following chemical incidents, it is critical for institutions and government agencies to know who to contact in uncommon situations as well as knowing the authoritative published sources of chemical information.


WISER for Windows 4.5 now available

The National Library of Medicine’s WISER for Windows 4.5 is now available. This new version of WISER (Wireless Information System for Emergency Responders) fully integrates Chemical Hazards Emergency Medical Management (CHEMM) content and updates the Emergency Response Guidebook (ERG) content to 2012.

Here is a closer look at What’s New in this release:

  • Full integration of CHEMM content, which includes:
    • New hospital provider and preparedness planner profiles, along with a customized home screen for all WISER profiles
    • Acute Care Guidelines for six known mass casualty agents/agent classes
    • The addition of a wealth of CHEMM reference material
    • CHEMM Intelligent Syndromes Tool (CHEMM-IST), a new help identify tool designed to diagnose the type of chemical exposure after a mass casualty incident
  • ERG content is now updated to the 2012 release. This includes the full ERG 2012 tool.

WISER for Windows 4.5 can be downloaded directly from the WISER Web site.

Coming Soon

  • WebWISER 4.5, which includes CHEMM integration, ERG 2012 updates, and more
  • WISER for Android 3.1, which adds Help Identify Chemical and protective distance mapping to this popular platform

Hospital preparedness and the Boston Marathon bombing

From the CDC’s Public Health Matters Blog:

In the last eight years, Brigham and Women’s Hospital in Boston has conducted 78 large scale emergency drills.  On the afternoon of April 15, immediately following the two bombs set off during the Boston marathon, it was time to put their well-practiced plans into action.

Brigham and Women’s Hospital had prepared for a variety of events, both natural and man-made.  Casting a wide net and taking an all-hazards approach, they ran drills for oil spills, chemical attacks, active shooters, blizzards, train crashes, hurricanes and building evacuations. The hospital ran exercises and responded to real-life events at a division, departmental, hospital, city-wide and state-wide level.  No doubt, the drills helped to establish routines and relationships across departments and across systems.

On Monday, April 15, there was a short turnaround between finding out about the event and implementing a plan.  At 2:54 p.m., when  the call came in about two explosions at the race, the already busy 55-bed emergency department had 66 patients.

Brigham and Women’s Hospital implemented what they call a Code Amber, activating the hospital disaster response system.  The hospital-wide response plan that they practiced regularly started with building capacity and capability in the emergency department, in the operating rooms, and throughout the hospital.  Where possible, patients were discharged or transitioned to other departments to disperse the crowded area.  Multiple operating rooms were rapidly opened and staffed for potential emergency surgeries.

The hospital cared for 39 patients from the bombing, 23 in the first 45 minutes. Staff set up a primary triage team to assess immediate need before a secondary triage team identified patients that needed emergent surgery.   Patients requiring surgery went directly to the operating room from the Emergency Department, just as they had drilled in prior exercises.   Patients were rapidly cared for throughout the hospital.

Read the complete post here.

A novel public health app – Plague Inc.

plague_app_iconFrom the CDC’s Public Health Matters blog:

Plague Inc., an app created by James Vaughan, of Ndemic Creationslayers, allows players to select a pathogen and strategize how to evolve symptoms, transmit the disease, and counter actions taken by world governments and scientists.  If the interventions don’t work and the disease is successful, players can watch as governments fall and humanity is wiped out.

Read an interview with Mr. Vaughan that discusses the app as a non-traditional way to raise public awareness on epidemiology, disease transmission, and diseases/pandemic information here.

Solving a communication gap with partners in preparedness

From the CDC’s Public Health Matters blog:

When asked, leaders in communities everywhere will say that communication is by far the biggest problem during an emergency. Communication is such a broad term that it does not pinpoint the problem. Is it actual communication systems like phone lines and cell towers? Is it the communication you receive or try to obtain in an emergency? Is it communication to the people you are responsible for? Is it communication from the people you are responsible for? The question becomes how do we go about addressing these issues?  Start small and focus on one solution to one communication problem.

The New York City Office of Emergency Management (OEM) has instituted the Partners in PreparednessExternal Web Site Icon program. OEM’s Partners in Preparedness program is designed to help organizations in the New York City metro area better prepare their employees, services, and facilities and develop a trusted communication system before disaster strikes. To become a Partner, an organization must complete five preparedness activities (three required and two additional) and report their actions through a partner’s survey. Only then will the organization become an official partner and obtain a Partners in Preparedness seal.

The three required activities are:

1) Stay Connected – Encourage coworkers and volunteers to sign up for Notify NYC, the city’s free real-time emergency notification system.

2) Get Prepared – Set up and test an emergency contact plan or call tree for your organization.

3) Send Preparedness Messages – Use e-mail, Facebook, Twitter, or your website to test and send preparedness messages to your employees.

Read the complete post here.

Advancing a city’s resilience, one neighborhood at a time

From the CDc’s Public Health Matters Blog:

Often a city‘s identity is attached to a significant event in its past, and for San Francisco that event is the Earthquake of 1906.  That fateful event, in which thousands perished and our City burned to the ground, captured the attention of the whole world. Its legacy forged a commitment in the psyche of every San Franciscan – never again.

 San Francisco’s commitment to resilience efforts began as soon as reconstruction commenced. Over 100 years, the City invested billions of dollars in systems and programs that will be invaluable in mitigating the impact of future earthquakes on our communities.

In 1989, as millions watched the World Series, the Loma Prieta earthquake struck. San Francisco had reclaimed its title as the “earthquake” city.  The event presented the City with many lessons learned, but two main priorities: bring older building stock (pre 1970’s) up to a higher seismic performance standard and second and empower residents to participate in the response phases for future events

The City’s efforts to address building performance started almost immediately and ultimately resulted in the creation of the Earthquake Safety Improvement Program.  A major step in protecting our residents occurred on Tuesday, February 5, 2013, when the first mandatory seismic retrofitting legislation for privately owned buildings was introduced at the City’s Board of Supervisors. To address resident empowerment, the San Francisco Fire Department (SFFD) initiated the Neighborhood Emergency Response Team (NERT) program that trained thousands of San Franciscans to support the SFFD’s response to a major event.

Read the complete post here.

The New England blizzard of 2013

From the CDC’s blog, Public Health Matters:

Many of you followed the historic blizzard that hit the Northeast last weekend.  Sure, it was fun to watch the weather reporters with yardsticks ready to measure the torrents of accumulating snow.  For me, what quickly became apparent in the February nor’easter is how many ways public health touches lives in a disaster and how the public health response is affected by factors beyond our control.

As a field assignee (FA) from CDC’s Division of State and Local Readiness, I am attached to the Massacusetts Department of Public Health’s Emergency Preparedness Bureau.  I support the Bureau’s development of medical countermeasure preparedness and response capabilities as outlined in the PHEP (Public Health Emergency Preparedness) agreement between the State and CDC. Field assignees are the “on the ground” eyes and ears of CDC.

Public health was at the forefront of concern in this historical storm. Without power, homes, businesses, and healthcare facilities all lost heat. At my house it was 16 degrees below zero at 8:00 a.m. this past Sunday!

Unfortunately, there were casualties from carbon monoxide poisoning. Without heat, people turned to generators, stoves, and grills to heat their homes. People were also warming themselves up in their cars, but the exhaust pipes were clogged with snow and the CO gas backfilled into the car interior.  Prevention and education are core pieces of what public health does and even though the State and the media got the word out, we tragically still had victims of CO poisoning.

Read the complete post here.

Extreme weather, extreme outbreaks, and extreme science-based preparedness and response

From the CDC’s blog, Public Health Matters:

In the wake of Hurricane Sandy, the news media has increased discussion and debate about what needs to be done in the future to better prepare our country for emergencies. Whether it’s another superstorm or the next H1N1, disasters are inevitable.

Last year, 11 disasters surpassed $1 billion in losses each, including Superstorm Sandy and  Hurricane Isaac. Tornadoes across the Great Plains, Texas, and the Southeast and Ohio Valley and introduced us to the cool term “derecho.” Some experts link these and other severe weather disasters to climate change. According to NOAA, the average temperature in 2012 for the contiguous United States was 3.2 degrees above normal and a full degree higher than the previous warmest year recorded.

Weather is not the only thing affected by climate. Similarly, the ecologic, social, and microbial factors that drive new and emerging infectious diseases will lead to novel pandemics in the footsteps of HIV/AIDS, influenza, SARS, or healthcare acquired infections. While the world is clearly a safer place, there remain determined individuals who would not hesitate to use biologic, chemical, or radiologic agents for nefarious purposes.

A recent CNN opinionExternal Web Site Icon piece on our nation’s level of preparedness made seemingly sound points, but it does not consider the great strides we’ve made in  public health to protect our nation; and it misses a key point we struggle with – how to get individuals involved.

CDC’s public health preparedness program is just one of the federal investments to secure our nation’s health.

Read more here.

Fungal meningitis outbreak & response in Ann Arbor

St. Joseph Mercy Ann Arbor, MI, has been at the front line of the fight against one of the biggest ever U.S. outbreaks of fungal meningitis, a virulent infection not previously seen in humans, that has been traced to contaminated lots of injectable steroids. St. Joe’s has cared for 25% of the total number of cases seen within the entire country.  The combination of patient surge, illness severity and clinical uncertainty has required the hospital to activate a long-term emergency preparedness plan.  Rob Casalou, President & CEO of the St. Joseph Mercy Health System, will describe the challenges faced, the organization’s response, and ongoing efforts.

  • Date:  2 February 2013
  • Time:  4-5:00pm
  • Location:  1690 SPH 1 (Lane Auditorium)

Sponsored by the Griffith Leadership Center in Health Management & Policy.

Special needs and tornadoes: A Joplin story

From the CDC’s Public Health Matters blog:

It’s been almost two years since a devastating tornado ripped through the town of Joplin, Missouri, and the community continues to rebuild.  Earlier this month, we had the opportunity to visit Joplin to learn more about The Independent Living Center -Joplin (TILC)External Web Site Icon, one of seven programs chosen as a promising example of FEMA’s Whole Community Approach to emergency management.  TILC is a nonprofit organization providing a variety of servicesExternal Web Site Icon and resources to help individuals with disabilities live independently in their own homes.  Some of these services include advocacy and support, in-home care, medical equipment provision, and development of emergency preparedness plans to meet their clients’ special needs.

While in Joplin, we met 29-year-old Shandie Reed Johnson, a past client of TILC and now an employee of TILC working as an administrative assistant.  Her ability to walk is impaired due to a life-long battle with rheumatoid arthritis.  Shandie shares a firsthand account of how the 2011 tornado affected her, the lessons she has learned, and how TILC is helping her heal. . . .

How has the tornado affected your family?

May 22nd  changed our lives forever.  Apparently the first floor of our two-story home had collapsed on top of us, along with parts of other  homes and belongings.  I remember I had an artificial Christmas tree and a large, rolled-up area rug on top of me.  All around me were large boards and parts of the flooring from other houses.  It looked as if a bomb had gone off.  I don’t know how we survived it, but luckily, we did. . . .

My parents ended up renting a small two bedroom house, which is where they live now while they wait on the completion of their new home, which was donated by our church. There is not much room in the rented house, so I do a lot of “couch surfing.”  The home I am in now is not disability-friendly.

In addition to all of that, I now suffer from post-traumatic stress disorder (PTSD).  Hearing a siren will trigger a panic attack.  When I’m triggered, I go into a zombie-like mode and shut down.  The healing process has been ongoing for all of us.

Read the complete story on the CDC’s web site.