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EMSWORLD.com | JULY 2016 33 New Orleans Prime s f or C hemical Disa ster s The Crescent City gets ready for sudden spills I n the middle of the night on January 6, 2005, a freight train collided with a parked train in Graniteville, SC, result- ing in derailment and the puncturing of three chlorine tank cars adjacent to the Avondale Textile Mill. In less than two minutes, an estimated 60 tons of liquid chlorine was released into the air, producing a thick cloud of chlorine gas that quickly spread throughout the unincorporated and medically underserved town. The incident resulted in nine immediate deaths, 72 hos- pitalizations for acute health effects, and some 850 people seeking medical attention. The incident gave pause to EMS per- sonnel in New Orleans, who later that year endured the unprecedented devas- tation from Hurricanes Katrina and Rita. Even though no significant chemical spills were reported from those disasters, leaders wanted to be better prepared to respond to chemical incidents, especially in the world's largest port by tonnage—the lower Missis- sippi River's combined six deep-water ports. Dev D. Jani, chief of planning and pre- paredness for the Office of Homeland Secu- rity & Emergency Preparedness in New Orleans, spearheaded the city's participa- tion in the Chemical Defense Demonstra- tion Project (CDDP), which followed two scenarios of chemical spills: » What would happen if a river barge tank of 2,400 gallons of hydrogen fluoride was breached? » How would the 9-1-1 community respond to 19,000 gallons of organophos- phate released via railcar on the tourist- laden riverfront? "The organophosphate nerve agent was picked to test our countermeasures dis- tribution system," says Jani, noting the Department of Homeland Security's Office of Health Affairs approved New Orleans as one of only four Phase II CDDPs in 2014. "We definitely have a large burden of com- mon toxic inhalational chemicals. We also wanted to really hone in on our localized commodities flow in the port system." Best Practices to Share Jeffrey M. Elder, MD, FAAEM, director and medical director for New Orleans explains. "We deployed medical sta- tions along the anticipated walking routes from public transportation terminals. We had tents at Benjamin Franklin Park, where Pope Francis was going to be, and also on the long walking routes from the major train stations and subway stops." Security Concerns Security measures were a major con- sideration. The U.S. Secret Service (USSS), in charge of security for such special events, determined the location of security checkpoints. "To make our EMS plans, I had to customize them based on those determinations. It created considerable challenges, especially getting our personnel in and out, getting ambulances to patients and patients to ambulances, especially as some security measures were changed on a fairly frequent basis," says Mechem. Recruiting Volunteers Mechem brought in a cadre of ambulances from various EMS agencies from Pennsyl- vania and out of state. He also recruited volunteers from local hospitals while the Philadelphia Department of Public Health helped coordinate Medical Reserve Corps volunteers. As the event drew closer, Mechem was surprised to learn some hospitals were slow to free up staff to volunteer. "It was an interesting phenomenon," he says. "Any time an event of this sort is coming up, people are interested in volun- teering. As time progressed and security measures became more obvious, hospitals realized that freeing up staff to volunteer would impact their own in-house opera- tions. Until the hospital leaders had a better feel for it and ramped up their own internal planning, they were very hesitant to free up staff. In retrospect we probably could've been more aggressive securing outside vol- unteers earlier in the planning process." Mechem planned 24-hour coverage preceding the event, concerned that some attendees would arrive the night before to save a good spot. "In retrospect, the thought process was valid at the time," he says. Patient tracking was somewhat problematic. "We used a barcode- based wristband with Knowledge Center software," he explains. "We'd used it the year before at the city's Fourth of July celebration. Few of us were familiar with the system. We had so many volunteers coming in from so many directions; they got very quick lessons on how to use the tracking sys- tem. Allowing more time for that aspect is a lesson learned." Conclusion On the day of Pope Francis's visit, the city was blessed with good weather. Tempera- tures ranged from 60–72ºF while approxi- mately 800,000 people attended mass. Ten medical tents treated 199 patients, with 21 transports. In "the box," EMS personnel had 423 responses, with 129 transports. Activ- ity for the entire citywide EMS system was "about normal," Mechem notes: "Given the uncertainty of the event, our preparation was appropriate," he says. "We had more than we needed [and were] ready for much more." —Pepper Jeter, Associate Editor Crawford Mechem, MD