CHEMICAL RELEASES ASSOCIATED WITH FLOODS This leaflet provides brief information about Natech and other chemical releases caused directly or indirectly by floods. It is an extract from the WHO publication Chemical releases caused by natural hazard events and disasters – information for public health authorities. The full document provides additional information on the roles of the health sector in prevention, preparedness, response and recovery in relation to Natech events. CHEMICAL RELEASES ASSOCIATED WITH FLOODS 2 WHAT IS A FLOOD? Floods are the most common natural hazard event and are the leading cause of deaths from disasters worldwide (1). The frequency of major flooding events is increasing as a consequence of climate change, urbanization and other factors (2, 3). A flood is a temporary situation where normally dry land is covered with water, e.g. as a result of the following (1, 2): • Gradually rising inland water, such as rivers, lakes and groundwater, due to heavy rainfall or snowmelt. • Coastal flooding caused by a tropical cyclone, storm surge or tsunami. • The accumulation of water on the surface due to prolonged rainfall resulting in water-logging and the rise of the groundwater table above the surface. • The breaching of a dam or levee. • Sudden flooding with short duration as a result of heavy rainfall in a storm or a release from a dam. This is known as a flash flood, and is particularly destructive on a sloping terrain where the water flows very rapidly. Some areas are particularly prone to flooding, for example: The severity of the hazard presented by a flood is influenced by: the flow velocity the duration of the flood and the season (4) the water height and rate of rise Low-lying coastal plains Areas along rivers. These river floods are often seasonal. CHEMICAL RELEASES ASSOCIATED WITH FLOODS3 RISK FACTORS FOR CHEMICAL RELEASE INDUSTRIAL SITE EMERGENCY-RESPONSE PLANS SHOULD INCLUDE FLOOD SCENARIOS, so that workers and managers will be prepared for the specific conditions that exacerbate an emergency situation during and following a flood. • Inadequate warning systems. • Inadequate safety measures or emergency planning. • Lack of public awareness about flood risks. • Location of industrial facilities in flood-prone areas. • High population density around industrial sites. • Land with little capacity for absorbing rain, e.g. because of erosion, deforestation or impermeable coverings such as concrete. Damage to on-site emergency equipment will hamper response, as will damage to essential infrastructure, such as the power supply, water supply and telecommunications. Off-site emergency-response personnel and other resources may not be available as they may be occupied in dealing with the consequences of the flood. The release of hazardous materials may hamper search and rescue operations. An analysis of past events suggests that storage tanks and pipework are particularly vulnerable to damage by floods (5). Location Preparedness and warning systems A FLOOD MAY INCREASE RISKS BY REDUCING RESPONSE CAPACITY IN THE FOLLOWING WAYS (6, 7): Structures • Structures that are not flood resilient. • Inadequate planning and building regulations. FACTORS THAT INCREASE THE VULNERABILITY OF AN AREA TO CHEMICAL RELEASE DURING FLOODS INCLUDE THE FOLLOWING (1, 3): CHEMICAL RELEASES ASSOCIATED WITH FLOODS 4 Damage to power supply Damage to the power supply can cause process upsets and affect safety measures such as temperature and pressure monitors and control valves, potentially resulting in runaway chemical reactions and blow-down. Release of waste from chemical plants, mines and dams Flooding of internal plant drainage systems may release waste oil or other chemical waste if not segregated from surface water drainage systems. Abandoned mines, such as coal mines, may flood, releasing acidic water containing sulfuric acid from the oxidation of sulfides upon exposure of the water to air (9). Tailings dams containing mining waste may burst under the pressure of water, releasing highly toxic waste and mud (4). Toxic runoff The inundation of an area with water can cause chemical release in other ways (2, 9). In rural areas, runoff from flooded areas can carry with it eroded soil containing fertilizers, herbicides and insecticides. Runoff from motorways, roads and bridges may contain heavy metals, petroleum hydrocarbons and polycyclic aromatic hydrocarbons. Runoff from inundated waste sites may contain a variety of toxic chemicals, depending on what was stored on the site (10). MECHANISMS OF CHEMICAL RELEASE Displacement of storage tanks and rupturing of pipework Rising floodwaters can displace and overturn chemical-storage tanks and rupture pipework and pipelines. Drums of chemicals can be lifted and carried in the floodwater. They can get damaged by collisions and release their contents. Toxic reactions and fire Released chemicals can mix and react with the water, potentially generating toxic reaction products or a fire or explosion hazard (5). When flammable hydrocarbons are released into floodwaters, ignition can result in pool fires. These are buoyant flames above a horizontal pool of vaporizing hydrocarbon fuel and can carry a fire to new sources of flammable material or into residential areas (8). They are a particular risk at storage depots or refineries for petroleum products. HEAVY RAIN AND RISING FLOODWATERS CHEMICALS IN FLOODWATERS MAY CONTAMINATE DRINKING-WATER SOURCES and, as floodwaters recede, may be deposited on farmland and in buildings such as homes and schools. Contaminated farmland may remain unfit for agricultural use for many years (3). CHEMICAL RELEASES ASSOCIATED WITH FLOODS5 POTENTIAL IMPACTS ON HUMAN HEALTH Chemical- related Non chemical- related Chemicals released following a flood can cause dermal, respiratory and systemic toxic effects following direct exposure of victims and rescuers. Toxic effects and injuries may also result from environmental contamination, fires and explosions. The general public, rescuers and those involved in clean-up operations may be exposed to a range of hazards, which can be divided into those related to chemicals and those unrelated (10, 11). Examples are given below. • Burns from fires and exposure to corrosive chemicals (formation of toxic and/or flammable vapours upon reaction of the released chemicals with the floodwaters). • Respiratory tract injury from inhalation of irritant gases, including combustion products. • Poisoning from exposure to spilled toxic chemicals and the consumption of contaminated food or water. Depending on the speed, volume and flow of floodwaters, however, the risk of chemical exposure may be reduced by dilution in the water. • Carbon monoxide poisoning resulting from the incorrect use of fuel- burning generators for electricity, barbeques, braziers or buckets of coal or charcoal for heating and cooking, or petrol-driven pumps and dehumidifiers to dry out flooded rooms (1, 2, 12). • Injuries and poisoning in workers involved in rescue and clean- up, including excessive exposure to pesticides used for vector and rodent control. • Drowning. • Hypothermia from immersion in water at less than 24 °C. • Venomous bites and stings from displaced animals (1). • Injuries and deaths as a result of floating debris. Injuries may also occur during the rescue and clean-up phases, e.g. when cutting and moving fallen debris. • Consequences of evacuation, e.g. increased risk of infectious diseases at the evacuation sites, exacerbation of pre-existing health problems during patient transfer, saturation of health-care facilities reducing ability to provide adequate treatment, potential problems with water supply and sanitation, etc. (13). • Psychosocial effects, including post-traumatic stress disorder (11, 14). CHEMICAL RELEASES ASSOCIATED WITH FLOODS 6 RESPONSE AND RECOVERY CONSIDERATIONS 1. Obtain information on potentially affected hazardous sites, including waste dumps, in order to assess the risks to health and determine the appropriate risk-management measures. 2. Identify the chemicals involved in the accident: check if an inventory is available, e.g. in the site emergency plan; if not use the Flash environmental assessment tool (15). Look for labels with hazard information. 3. Collect and consider any clinical information available from exposed individuals, as this may help to identify some chemicals or chemical groups. 4. If feasible, organize the collection and analysis of environmental samples (air, soil, water, crops) in order to identify and quantify contamination by chemicals. 5. Assess the possibility of contamination of drinking-water sources and foods. Risk assessment Risk assessment Prevention of exposure Prevention of exposure Medical assessment and management Risk and crisis communication B A 1. Based on the risk assessments, provide advice as required to the civil defence, fire or other designated service on the need for: • containment measures • restrictions on access to contaminated sites • the need for personal protective equipment (PPE) • shelter-in-place or evacuation advisories for affected communities. 2. Ensure that people involved in clean-up and rescue operations are adequately equipped with PPE and are aware of the possibility of chemical spills. 3. Organize facilities for decontaminating chemically-exposed individuals. 4. Provide comprehensive information to the general public regarding precautionary measures (see Risk and Crisis Communication below). Key activities for response and recovery are: CHEMICAL RELEASES ASSOCIATED WITH FLOODS7 1. Ensure that chemically-exposed individuals are decontaminated before they enter the health-care facility. 2. Ensure that health personnel follow procedures for wearing PPE when managing chemically-contaminated victims. 3. Conduct triage and patient assessment. Note that chemical injuries or poisoning may be combined with traumatic injuries. 4. Obtain advice on the management of chemical exposure from a poisons centre, if available. 5. Provide specific medical treatment (e.g. antidotal treatment) as required. 6. Consider the need to collect biological samples from chemically- exposed individuals (including first-responders) in order to identify and, if possible, quantify exposure. 7. Register all exposed individuals and ensure adequate documentation and record-keeping in case there is a need for long-term follow-up. 8. Ensure that after the first response, measures are taken in the recovery stage to prevent indirect chemical effects and long-term exposures. Provide mental health and psychosocial support for affected communities. Medical assessment and management Risk and crisis communication D C 1. Provide information, updated as necessary, to the public, first- responders and decision-makers about chemical and other hazards arising from the event. Ensure that the public is informed about: • the Natech event(s) • who is in charge • what is being done • the nature and hazards of the chemicals involved • what individuals should do to protect themselves and their families • when to seek medical attention • how to get further information. 2. Some specific health-protection topics include: • food and water advisories, in case of contamination • prevention of carbon monoxide poisoning • precautions during clean-up, e.g. use of personal protective equipment, safe use of cutting equipment, handling of asbestos cement, etc. • potential hazards in flood-damaged homes. CHEMICAL RELEASES ASSOCIATED WITH FLOODS 8 REFERENCES 1. Doocy S, Daniels A, Murray S, Kirsch TD. The human impact of floods: a historical review of events 1980–2009 and systematic literature review. PLoS Currents Disasters. 2013 April 16; Edition 1. doi: 10.1371/currents.dis.f4deb457904936b07c09daa98ee8171a (http://currents.plos.org/disasters/article/the-human-impact-of-floods- a-historical-review-of-events-1980-2009-and-systematic-literature- review/, accessed 7 July 2017). 2. Menne B, Murray V. Floods in the WHO European Region, health effects and their prevention. Copenhagen: WHO Regional Office for Europe; 2013 (http://www.euro.who.int/__data/assets/pdf_ file/0020/189020/e96853.pdf, accessed 7 July 2017). 3. OECD Studies in risk management: Italy – Industrial hazards triggered by floods. Paris: Organisation for Economic Co-operation and Development; 2006 (https://www.oecd.org/italy/36099995.pdf, accessed 7 July 2017). 4. Krausmann E, Mushtaq F. A qualitative Natech damage scale for the impact of floods on selected industrial facilities. Natural Hazards. 2008;46:179–97. doi: 10.1007/s11069-007-9203-5. 5. Cozzani V, Campedel M, Renni E, Krausmann E. Industrial accidents triggered by flood events: analysis of past accidents. Journal of Hazardous Materials. 2010;175:501–9. 6. Krausmann E, Cruz AM, Salzano E. Natech risk assessment and management: reducing the risk of natural-hazard impact on hazardous installations. Amsterdam: Elsevier; 2017. 7. Cruz AM, Steinberg LJ, Vetere Arellano AL, Nordvik J-P, Pisano F. State of the art in Natech risk management. Ispra: European Commission Joint Research Centre; 2004 (EC JRC, UN ISDR EUR 21292 EN. http://www.unisdr.org/files/2631_ FinalNatechStateofthe20Artcorrected.pdf, accessed 7 July 2017). 8. Hamins A, Kashiwagi T, Burch RR. Characteristics of pool fire burning. ASTM special technical publication 1284. 1996. pp. 15–41 (http://fire.nist.gov/bfrlpubs/fire96/PDF/f96068.pdf, accessed 7 July 2017). 9. Euripidou E, Murray V. Public health impacts of floods and chemical contamination. Journal of Public Health. 2004;26(4):376–83 (http://jpubhealth.oxfordjournals.org/content/26/4/376.full.pdf, accessed 7 July 2017). 10. Young S, Balluz L, Malilay J. Natural and technologic hazardous material releases during and after natural disasters: a review. Science of the Total Environment. 2004;322(1–3):3–20 (http://dx.doi. org/10.1016/S0048-9697(03)00446-7, accessed 7 July 2017). 11. Shrubsole D. Natural disasters and public health issues: a review of the literature with a focus on the recovery period. Institute for Catastrophic Loss Reduction (ICLR) Research Paper Series No. 4; Toronto: ICLR; 1999 (http://www.iclr.org/images/Natural_Disasters_ and_Public_Health_Issues.pdf, accessed 7 July 2017). 12. Waite T, Murray V, Baker D. Carbon monoxide poisoning and flooding: changes in risk before, during and after flooding require appropriate public health interventions. PLoS Currents Disasters. 2014 July 3; Edition 1. doi: 0.1371/currents. dis.2b2eb9e15f9b982784938803584487f1 (http://currents. plos.org/disasters/article/carbon-monoxide-poisoning-and-flooding- changes-in-risk-before-during-and-after-flooding-require-appropriate- public-health-interventions/, accessed 20 September 2017). 13. Hasegawa A, Ohira T, Maeda M, Yasumura S, Tanigawa K. Emergency responses and health consequences after the Fukushima accident: evacuation and relocation. Clinical Oncology. 2016;28:237–44 (http://www.sciencedirect.com/science/article/pii/ S0936655516000054, accessed 7 July 2017). 14. Stanke C, Murray V, Amlôt R, Nurse J, Williams R. The effects of flooding on mental health: outcomes and recommendations from a review of the literature. PLoS Currents Disasters. 2012 May 30; Edition 1. doi: 10.1371/4f9f1fa9c3cae (http://currents.plos.org/ disasters/article/the-effects-of-flooding-on-mental-health-outcomes- and-recommendations-from-a-review-of-the-literature/ accessed 29 September 2017). 15. Flash environmental assessment tool (FEAT 2.0): pocket guide. Geneva: United Nations Environment Programme/Office for the Coordination of Humanitarian Affairs Joint Unit; 2017 (http://www. eecentre.org/?p=1596, accessed 7 July 2017). WHO/CED/PHE/EPE/18.02 © WHO 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence (https://creativecommons.org/licenses/by-nc-sa/3.0/igo/). All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Design and layout: Lushomo Communications Ltd.
CHEMICAL RELEASES ASSOCIATED WITH FLOODS This leaflet provides brief information about Natech and other chemical releases caused directly or indirectly by floods. It is an extract from the WHO publication Chemical releases caused by natural hazard events and disasters – information for public health authorities. The full document provides additional information on the roles of the health sector in prevention, preparedness, response and recovery in relation to Natech events. CHEMICAL RELEASES ASSOCIATED WITH FLOODS 2 WHAT IS A FLOOD? Floods are the most common natural hazard event and are the leading cause of deaths from disasters worldwide (1). The frequency of major flooding events is increasing as a consequence of climate change, urbanization and other factors (2, 3). A flood is a temporary situation where normally dry land is covered with water, e.g. as a result of the following (1, 2): • Gradually rising inland water, such as rivers, lakes and groundwater, due to heavy rainfall or snowmelt. • Coastal flooding caused by a tropical cyclone, storm surge or tsunami. • The accumulation of water on the surface due to prolonged rainfall resulting in water-logging and the rise of the groundwater table above the surface. • The breaching of a dam or levee. • Sudden flooding with short duration as a result of heavy rainfall in a storm or a release from a dam. This is known as a flash flood, and is particularly destructive on a sloping terrain where the water flows very rapidly. Some areas are particularly prone to flooding, for example: The severity of the hazard presented by a flood is influenced by: the flow velocity the duration of the flood and the season (4) the water height and rate of rise Low-lying coastal plains Areas along rivers. These river floods are often seasonal. CHEMICAL RELEASES ASSOCIATED WITH FLOODS3 RISK FACTORS FOR CHEMICAL RELEASE INDUSTRIAL SITE EMERGENCY-RESPONSE PLANS SHOULD INCLUDE FLOOD SCENARIOS, so that workers and managers will be prepared for the specific conditions that exacerbate an emergency situation during and following a flood. • Inadequate warning systems. • Inadequate safety measures or emergency planning. • Lack of public awareness about flood risks. • Location of industrial facilities in flood-prone areas. • High population density around industrial sites. • Land with little capacity for absorbing rain, e.g. because of erosion, deforestation or impermeable coverings such as concrete. Damage to on-site emergency equipment will hamper response, as will damage to essential infrastructure, such as the power supply, water supply and telecommunications. Off-site emergency-response personnel and other resources may not be available as they may be occupied in dealing with the consequences of the flood. The release of hazardous materials may hamper search and rescue operations. An analysis of past events suggests that storage tanks and pipework are particularly vulnerable to damage by floods (5). Location Preparedness and warning systems A FLOOD MAY INCREASE RISKS BY REDUCING RESPONSE CAPACITY IN THE FOLLOWING WAYS (6, 7): Structures • Structures that are not flood resilient. • Inadequate planning and building regulations. FACTORS THAT INCREASE THE VULNERABILITY OF AN AREA TO CHEMICAL RELEASE DURING FLOODS INCLUDE THE FOLLOWING (1, 3): CHEMICAL RELEASES ASSOCIATED WITH FLOODS 4 Damage to power supply Damage to the power supply can cause process upsets and affect safety measures such as temperature and pressure monitors and control valves, potentially resulting in runaway chemical reactions and blow-down. Release of waste from chemical plants, mines and dams Flooding of internal plant drainage systems may release waste oil or other chemical waste if not segregated from surface water drainage systems. Abandoned mines, such as coal mines, may flood, releasing acidic water containing sulfuric acid from the oxidation of sulfides upon exposure of the water to air (9). Tailings dams containing mining waste may burst under the pressure of water, releasing highly toxic waste and mud (4). Toxic runoff The inundation of an area with water can cause chemical release in other ways (2, 9). In rural areas, runoff from flooded areas can carry with it eroded soil containing fertilizers, herbicides and insecticides. Runoff from motorways, roads and bridges may contain heavy metals, petroleum hydrocarbons and polycyclic aromatic hydrocarbons. Runoff from inundated waste sites may contain a variety of toxic chemicals, depending on what was stored on the site (10). MECHANISMS OF CHEMICAL RELEASE Displacement of storage tanks and rupturing of pipework Rising floodwaters can displace and overturn chemical-storage tanks and rupture pipework and pipelines. Drums of chemicals can be lifted and carried in the floodwater. They can get damaged by collisions and release their contents. Toxic reactions and fire Released chemicals can mix and react with the water, potentially generating toxic reaction products or a fire or explosion hazard (5). When flammable hydrocarbons are released into floodwaters, ignition can result in pool fires. These are buoyant flames above a horizontal pool of vaporizing hydrocarbon fuel and can carry a fire to new sources of flammable material or into residential areas (8). They are a particular risk at storage depots or refineries for petroleum products. HEAVY RAIN AND RISING FLOODWATERS CHEMICALS IN FLOODWATERS MAY CONTAMINATE DRINKING-WATER SOURCES and, as floodwaters recede, may be deposited on farmland and in buildings such as homes and schools. Contaminated farmland may remain unfit for agricultural use for many years (3). CHEMICAL RELEASES ASSOCIATED WITH FLOODS5 POTENTIAL IMPACTS ON HUMAN HEALTH Chemical- related Non chemical- related Chemicals released following a flood can cause dermal, respiratory and systemic toxic effects following direct exposure of victims and rescuers. Toxic effects and injuries may also result from environmental contamination, fires and explosions. The general public, rescuers and those involved in clean-up operations may be exposed to a range of hazards, which can be divided into those related to chemicals and those unrelated (10, 11). Examples are given below. • Burns from fires and exposure to corrosive chemicals (formation of toxic and/or flammable vapours upon reaction of the released chemicals with the floodwaters). • Respiratory tract injury from inhalation of irritant gases, including combustion products. • Poisoning from exposure to spilled toxic chemicals and the consumption of contaminated food or water. Depending on the speed, volume and flow of floodwaters, however, the risk of chemical exposure may be reduced by dilution in the water. • Carbon monoxide poisoning resulting from the incorrect use of fuel- burning generators for electricity, barbeques, braziers or buckets of coal or charcoal for heating and cooking, or petrol-driven pumps and dehumidifiers to dry out flooded rooms (1, 2, 12). • Injuries and poisoning in workers involved in rescue and clean- up, including excessive exposure to pesticides used for vector and rodent control. • Drowning. • Hypothermia from immersion in water at less than 24 °C. • Venomous bites and stings from displaced animals (1). • Injuries and deaths as a result of floating debris. Injuries may also occur during the rescue and clean-up phases, e.g. when cutting and moving fallen debris. • Consequences of evacuation, e.g. increased risk of infectious diseases at the evacuation sites, exacerbation of pre-existing health problems during patient transfer, saturation of health-care facilities reducing ability to provide adequate treatment, potential problems with water supply and sanitation, etc. (13). • Psychosocial effects, including post-traumatic stress disorder (11, 14). CHEMICAL RELEASES ASSOCIATED WITH FLOODS 6 RESPONSE AND RECOVERY CONSIDERATIONS 1. Obtain information on potentially affected hazardous sites, including waste dumps, in order to assess the risks to health and determine the appropriate risk-management measures. 2. Identify the chemicals involved in the accident: check if an inventory is available, e.g. in the site emergency plan; if not use the Flash environmental assessment tool (15). Look for labels with hazard information. 3. Collect and consider any clinical information available from exposed individuals, as this may help to identify some chemicals or chemical groups. 4. If feasible, organize the collection and analysis of environmental samples (air, soil, water, crops) in order to identify and quantify contamination by chemicals. 5. Assess the possibility of contamination of drinking-water sources and foods. Risk assessment Risk assessment Prevention of exposure Prevention of exposure Medical assessment and management Risk and crisis communication B A 1. Based on the risk assessments, provide advice as required to the civil defence, fire or other designated service on the need for: • containment measures • restrictions on access to contaminated sites • the need for personal protective equipment (PPE) • shelter-in-place or evacuation advisories for affected communities. 2. Ensure that people involved in clean-up and rescue operations are adequately equipped with PPE and are aware of the possibility of chemical spills. 3. Organize facilities for decontaminating chemically-exposed individuals. 4. Provide comprehensive information to the general public regarding precautionary measures (see Risk and Crisis Communication below). Key activities for response and recovery are: CHEMICAL RELEASES ASSOCIATED WITH FLOODS7 1. Ensure that chemically-exposed individuals are decontaminated before they enter the health-care facility. 2. Ensure that health personnel follow procedures for wearing PPE when managing chemically-contaminated victims. 3. Conduct triage and patient assessment. Note that chemical injuries or poisoning may be combined with traumatic injuries. 4. Obtain advice on the management of chemical exposure from a poisons centre, if available. 5. Provide specific medical treatment (e.g. antidotal treatment) as required. 6. Consider the need to collect biological samples from chemically- exposed individuals (including first-responders) in order to identify and, if possible, quantify exposure. 7. Register all exposed individuals and ensure adequate documentation and record-keeping in case there is a need for long-term follow-up. 8. Ensure that after the first response, measures are taken in the recovery stage to prevent indirect chemical effects and long-term exposures. Provide mental health and psychosocial support for affected communities. Medical assessment and management Risk and crisis communication D C 1. Provide information, updated as necessary, to the public, first- responders and decision-makers about chemical and other hazards arising from the event. Ensure that the public is informed about: • the Natech event(s) • who is in charge • what is being done • the nature and hazards of the chemicals involved • what individuals should do to protect themselves and their families • when to seek medical attention • how to get further information. 2. Some specific health-protection topics include: • food and water advisories, in case of contamination • prevention of carbon monoxide poisoning • precautions during clean-up, e.g. use of personal protective equipment, safe use of cutting equipment, handling of asbestos cement, etc. • potential hazards in flood-damaged homes. CHEMICAL RELEASES ASSOCIATED WITH FLOODS 8 REFERENCES 1. Doocy S, Daniels A, Murray S, Kirsch TD. The human impact of floods: a historical review of events 1980–2009 and systematic literature review. PLoS Currents Disasters. 2013 April 16; Edition 1. doi: 10.1371/currents.dis.f4deb457904936b07c09daa98ee8171a (http://currents.plos.org/disasters/article/the-human-impact-of-floods- a-historical-review-of-events-1980-2009-and-systematic-literature- review/, accessed 7 July 2017). 2. Menne B, Murray V. Floods in the WHO European Region, health effects and their prevention. Copenhagen: WHO Regional Office for Europe; 2013 (http://www.euro.who.int/__data/assets/pdf_ file/0020/189020/e96853.pdf, accessed 7 July 2017). 3. OECD Studies in risk management: Italy – Industrial hazards triggered by floods. Paris: Organisation for Economic Co-operation and Development; 2006 (https://www.oecd.org/italy/36099995.pdf, accessed 7 July 2017). 4. Krausmann E, Mushtaq F. A qualitative Natech damage scale for the impact of floods on selected industrial facilities. Natural Hazards. 2008;46:179–97. doi: 10.1007/s11069-007-9203-5. 5. Cozzani V, Campedel M, Renni E, Krausmann E. Industrial accidents triggered by flood events: analysis of past accidents. Journal of Hazardous Materials. 2010;175:501–9. 6. Krausmann E, Cruz AM, Salzano E. Natech risk assessment and management: reducing the risk of natural-hazard impact on hazardous installations. Amsterdam: Elsevier; 2017. 7. Cruz AM, Steinberg LJ, Vetere Arellano AL, Nordvik J-P, Pisano F. State of the art in Natech risk management. Ispra: European Commission Joint Research Centre; 2004 (EC JRC, UN ISDR EUR 21292 EN. http://www.unisdr.org/files/2631_ FinalNatechStateofthe20Artcorrected.pdf, accessed 7 July 2017). 8. Hamins A, Kashiwagi T, Burch RR. Characteristics of pool fire burning. ASTM special technical publication 1284. 1996. pp. 15–41 (http://fire.nist.gov/bfrlpubs/fire96/PDF/f96068.pdf, accessed 7 July 2017). 9. Euripidou E, Murray V. Public health impacts of floods and chemical contamination. Journal of Public Health. 2004;26(4):376–83 (http://jpubhealth.oxfordjournals.org/content/26/4/376.full.pdf, accessed 7 July 2017). 10. Young S, Balluz L, Malilay J. Natural and technologic hazardous material releases during and after natural disasters: a review. Science of the Total Environment. 2004;322(1–3):3–20 (http://dx.doi. org/10.1016/S0048-9697(03)00446-7, accessed 7 July 2017). 11. Shrubsole D. Natural disasters and public health issues: a review of the literature with a focus on the recovery period. Institute for Catastrophic Loss Reduction (ICLR) Research Paper Series No. 4; Toronto: ICLR; 1999 (http://www.iclr.org/images/Natural_Disasters_ and_Public_Health_Issues.pdf, accessed 7 July 2017). 12. Waite T, Murray V, Baker D. Carbon monoxide poisoning and flooding: changes in risk before, during and after flooding require appropriate public health interventions. PLoS Currents Disasters. 2014 July 3; Edition 1. doi: 0.1371/currents. dis.2b2eb9e15f9b982784938803584487f1 (http://currents. plos.org/disasters/article/carbon-monoxide-poisoning-and-flooding- changes-in-risk-before-during-and-after-flooding-require-appropriate- public-health-interventions/, accessed 20 September 2017). 13. Hasegawa A, Ohira T, Maeda M, Yasumura S, Tanigawa K. Emergency responses and health consequences after the Fukushima accident: evacuation and relocation. Clinical Oncology. 2016;28:237–44 (http://www.sciencedirect.com/science/article/pii/ S0936655516000054, accessed 7 July 2017). 14. Stanke C, Murray V, Amlôt R, Nurse J, Williams R. The effects of flooding on mental health: outcomes and recommendations from a review of the literature. PLoS Currents Disasters. 2012 May 30; Edition 1. doi: 10.1371/4f9f1fa9c3cae (http://currents.plos.org/ disasters/article/the-effects-of-flooding-on-mental-health-outcomes- and-recommendations-from-a-review-of-the-literature/ accessed 29 September 2017). 15. Flash environmental assessment tool (FEAT 2.0): pocket guide. Geneva: United Nations Environment Programme/Office for the Coordination of Humanitarian Affairs Joint Unit; 2017 (http://www. eecentre.org/?p=1596, accessed 7 July 2017). WHO/CED/PHE/EPE/18.02 © WHO 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence (https://creativecommons.org/licenses/by-nc-sa/3.0/igo/). All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Design and layout: Lushomo Communications Ltd.
与洪水相关的 化学品泄漏 本宣传册提供有关 Natech 以及其他直接或间接由洪水 引起的化学品泄漏的简要信息。这是世界卫生组织出版 物由《自然灾害事件和灾害引起的化学品泄漏——公共 卫生当局参考》的摘录。关于卫生部门在与 Natech 事 件有关的预防、防备、应对和恢复方面所起的作用，整 个文件提供了更多信息。 与洪水相关的化学品泄漏 2 什么是洪水？ 洪水是最常见的自然灾害事件，也是 在全球范围内因灾害造成死亡的主要 原因 (1)。由于气候变化、城市化和其 他因素，重大洪水事件的发生频率正 在增加 (2, 3)。 洪水通常是一种干地遭水淹的临时情况， 主要由以下原因造成 (1, 2)： • 由于强降雨或融雪而引起河流、湖泊和地下 水等内陆水域的水位逐渐上涨。 • 由于热带气旋、风暴潮或海啸而引起的沿海 洪水。 • 由于长时间降雨导致水涝并且地表水位于地 表以上而引起的地表积水。 • 大坝裂口或者决堤。 • 由于风暴中的强降雨或大坝泄水而导致持续 时间短暂的突发洪水。这被称为山洪暴发， 并且在水流非常迅速的倾斜地形上特别具有 破坏性。 有些地区特别容易发生洪水，例如： 洪水造成的危害严重程度受以下因素 影响： 流速 洪水的持续时间和季 节 (4) 水位高度和上升速度 低洼的沿海平原 沿河地区。这些河流泛滥通常是季节性的。 与洪水相关的化学品泄漏3 化学品泄漏的风险因素 工业场地应急响应计划应该包括洪水情景，以便工人和管理人员能够准备好在洪水期 间和洪水之后应对导致紧急状况恶化的特定情况。 • 预警系统不足。 • 安全措施或应急计划不足。 • 公众缺乏对洪水风险的认 识。 • 洪水易发地区工业设施的位 置。 • 工业场地周围人口密度高。 • 吸收雨水能力小的土地，例 如因为侵蚀、砍伐森林或者 混凝土等不透水的覆盖层。 现场应急设备的损坏将会阻碍 应对行动，因为这会对供电、 供水和电信等重要基础设施造 成损害。 可能无法获得现场外的应急救 援人员和其他资源，因为他们 可能忙于处理洪水带来的后 果。 有害物质的泄漏可能会阻碍搜 救行动。 对以往事件的分析表明，储罐和管道系统特别容易受到洪水的破坏 (5)。 位置 防备和预警系统 洪水可能会在以下方面降低应对能力，增加风险 (6, 7)： 结构 • 不具有抗洪能力的结构。 • 规划和建筑法规不足。 各种因素会使某一地区在洪水期间增加易受化学品泄漏影响的程度，包括以下 方面 (1, 3)： 与洪水相关的化学品泄漏 4 电源损 坏 电源损坏 可能导致流程混乱并影响 安全措施，例如温度与压力 监测器和控制阀，可能会引 发失控的化学反应和泄压。 废弃物从化工厂、 矿场和大坝中泄漏 如果不与地表水排水系统隔离，内部厂区排 水系统的洪水可能会泄漏废油或其他化学废 弃物。废弃的矿场（例如煤矿）可能会引发 洪水，在水与空气接触时泄漏因硫化物氧 化而产生的含有硫酸的酸性水 (9)。 在水的 压力下，含有采矿废弃物的尾矿坝可能会爆 裂，泄漏剧毒的废弃物和泥浆 (4)。 有毒径流 洪水泛滥的区域可能会在其他 方面导致化学品泄漏 (2, 9)。 在农村 地区，源自洪水淹没地区的径流可能会携 带含有肥料、除草剂和杀虫剂的侵蚀土 壤。源自高速公路、道路和桥梁的径流可 能会含有重金属、石油烃和多环芳烃。源 自淹没废弃物场地的径流可能会含有各种 有毒化学品，具体取决于场地中存放的物 品 (10)。 化学品泄漏的机理 储罐 的位移和 管道系统的破裂 不断上涨的洪水会使装有化 学品的储罐发生位移和倾翻并且破坏管路 系统和管道。装有化学品的筒形容器会在 洪水中飘移。它们会因碰撞而受损并泄漏 其内容物。 有毒反应和火灾 泄漏的化学品会与水混合并发 生反应，可能产生有毒反应产 物或火灾或爆炸危险 (5)。当 易燃碳氢化合物泄漏到洪水中时，点火会导 致池火。这些是在汽化碳氢化合物燃料的水 平池上方浮起的火焰，并且会焚烧到新的易 燃材料源或居住区域内 (8)。 它们在石 油产品的仓库或炼油厂中具有特殊 风险。 大雨 和上涨的洪水 洪水中的化学品可能会污染饮用水源，并且随着洪水退去，可能会沉积在农田以及房 屋和学校等建筑物中。经过多年以后，受污染的农田可能仍然不适于农业用途 (3)。 与洪水相关的化学品泄漏5 对人类健康的潜在影响 与化学品 有关的 与 化学品 无关的 受害者和救援人员直接接触洪水后泄漏的化学品后，会产生皮肤、呼吸道和全身毒 性影响。 环境污染、火灾和爆炸也可能会导致毒性影响和伤害。一般公众、救援人员和参与清理行动的人 员可能会受到一系列危害，这些危害可分为与化学品有关的危害和与化学品无关的危害 (10, 11)。 举例说明如下。 • 由于火灾和接触腐蚀性化学品（泄漏的化学品与洪水发生反 应后形成的有毒和/或易燃蒸气）而引起的灼伤。 • 由于吸入刺激性气体（包括燃烧产物）而引起的 呼吸道损伤。 • 由于接触泄漏的有毒化学品而引起的中毒以及摄入受污染的 食品或水而引起的中毒。然而，根据洪水的速度、总量和流 量，通过在水中稀释可以降低化学品接触的风险。 • 由于不正确地使用燃料燃烧型发电机、烧烤炉、火盆或煤炭 桶或木炭桶进行加热和烹饪，或使用汽油驱动泵和除湿机吹 干被淹的房间而引起的一氧化碳中毒 (1, 2, 12)。 • 参与救援和清理的工人受伤和中毒，包括过度接触用于病媒 和啮齿动物控制的杀虫剂。 • 溺水。 • 因浸没于 24°C 以下水中而引起的低温症。 • 遭到流离失所的动物咬伤和叮咬而中毒 (1)。 • 由于漂浮的残骸造成的伤害和死亡。在救援和清理阶段也可 能会发生伤害，例如在切割和移动坠落的残骸时。 • 疏散的后果，例如疏散地点传染性疾病的风险增加、患者 在转移期间已存在的健康问题恶化、医疗护理机构的饱和度 降低了提供适当治疗的能力、供水和卫生方面的潜在问题 等 (13)。 • 社会心理影响，包括创伤后应激障碍 (11, 14)。 与洪水相关的化学品泄漏 6 应对与恢复注意事项 1. 获取有关可能受影响的危险场地的信息，包括废弃物堆放情 况，以评估对健康构成的风险并确定适当的风险管理措施。 2. 鉴定事故中涉及的化学品：检查是否有库存，例如在现场的 应急计划；如果没有，请使用《快速环境评估工具》(15)。查 找带有危害信息的标签。 3. 收集并考虑任何从接触人士处获得的临床信息，因为这可能 有助于鉴定某些化学品或化学基团。 4. 如果可行，安排环境样本（空气、土壤、水、农作物）的收 集和分析，以鉴定和量化化学品的污染。 5. 评估饮用水源和食品污染的可能性。 风险 评估 风险评估 接触的 预防措施 接触的 预防措施 医疗 评估和管理 风险与危机 沟通 B A 1. 根据风险评估，按需向民防、消防或其他指定的服务提供建 议： • 遏制措施 • 限制进入受污染场地 • 需要个人防护装备 (PPE) • 为受影响的社区提供避难所或疏散建议。 2. 确保参与清理和救援行动的人员充分配备个人防护装 备 (PPE) 并且了解化学品泄漏的可能性。 3. 安排为化学品接触人士进行净化处理的设施。 4. 向公众提供有关防范措施的全面信息（参见下面的“风险与 危机沟通”）。 关键的应对与恢复活动为： 与洪水相关的化学品泄漏7 1. 确保化学品接触人士在进入医疗护理机构之前接受净化处 理。 2. 在管理受化学品污染的受害者时，确保医务人员遵循配戴个 人防护装备 (PPE) 的程序。 3. 进行分类和患者评估。请注意，化学品伤害或中毒可能会与 创伤性损伤引起并发症。 4. 从毒物控制中心获取有关化学品接触管理的建议（若有）。 5. 按需提供特定的医疗护理（例如解毒治疗）。 6. 考虑需要从化学品接触人士（包括急救人员）处收集生物样 本以鉴定和（在可能的情况下）量化接触情况。 7. 登记所有接触人士并确保有足够的文件和记录保存，若有需 要可进行长期随访。 8. 确保在急救后采取恢复阶段的应对措施，以防止间接化学品 作用和长期接触。为受影响的社区提供心理健康和社会心理 支持。 医疗 评估和管理 风险与危机 沟通 D C 1. 必要时，向公众、急救人员和决策者提供有关事件引起的 化学危害和其他危害的信息。确保公众了解： • Natech 事件 • 谁负责 • 正在做什么 • 所涉化学品的性质和危害 • 个人应该做些什么来保护自己及其家人 • 何时寻求医疗救助 • 如何获得更多信息。 2. 一些特定的卫生防护主题包括： • 在污染的情况下，食品和水公告 • 一氧化碳中毒的预防措施 • 清理过程中的防范措施，例如使用个人防护装备、安 全使用切割设备、石棉水泥的处理等 • 因洪水受损房屋内的潜在危害。 与洪水相关的化学品泄漏 8 参考文献 1. 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PLoS Currents Disasters. 2012 May 30; Edition 1. doi:10.1371/4f9f1fa9c3cae (http://currents.plos.org/ disasters/article/the-effects-of-flooding-on-mental-health-outcomes- and-recommendations-from-a-review-of-the-literature/ accessed 29 September 2017). 15. Flash environmental assessment tool (FEAT 2.0): pocket guide. Geneva: United Nations Environment Programme/Office for the Coordination of Humanitarian Affairs Joint Unit; 2017 (http://www. eecentre.org/?p=1596, accessed 7 July 2017). WHO/CED/PHE/EPE/18.02/ZH © 世界卫生组织2018年 保留部分版权。本作品可在知识共享署名——非商业性使用——相同方式共享3.0政府间组织（CC BY-NC-SA 3.0 IGO; https:// creativecommons.org/licenses/by-nc-sa/3.0/igo/ ）许可协议下使用。 世卫组织已采取一切合理的预防措施来核实本出版物中包含的信息。但是，已出版材料的分发无任何明确或含蓄的保证。解释和使用材料的责任 取决于读者。世卫组织对于因使用这些材料造成的损失不承担责任。 由My Translation Manager 私人有限责任公司翻译 由 Lushomo Communications Ltd 设计与排版
ХИМИЧЕСКИЕ ВЫБРОСЫ, СВЯЗАННЫЕ С НАВОДНЕНИЯМИ В этой брошюре содержится краткая информация о выбросах химических загрязнителей в результате природно-техногенных чрезвычайных ситуаций (Natech), и других выбросах химических веществ, связанных с наводнениями прямо или косвенно. Это выдержка из публикации ВОЗ Выбросы химических веществ, вызванные опасными природными явлениями и стихийными бедствиями — информация для органов общественного здравоохранения. Полная версия документа содержит дополнительную информацию о роли сектора здравоохранения в организации мероприятий по предотвращению, обеспечению готовности, реагирования на природно-техногенные чрезвычайные ситуации и в восстановлении после них. ВЫБРОСЫ ХИМИЧЕСКИХ ВЕЩЕСТВ, СВЯЗАННЫЕ С НАВОДНЕНИЯМИ 2 ЧТО ТАКОЕ НАВОДНЕНИЕ? Наводнения — наиболее распространенные природные стихийные бедствия, являющиеся основной причиной смертей от стихийных бедствий в мире (1). Частота крупных наводнений возрастает вследствие изменения климата, урбанизации и других факторов (2, 3). Наводнение — это временная ситуация, когда обычно сухая земля покрыта водой, например в результате следующих событий (1, 2): • постепенное повышение уровня внутренних вод, например рек, озер и грунтовых вод из-за сильного ливня или снеготаяния; • прибрежное наводнение, вызванное тропическим циклоном, штормовым нагоном или цунами; • скопление воды на поверхности из-за продолжительного ливня, приводящего к застою воды и поднятию уровня грунтовых вод над поверхностью; • разрушение плотин или дамб; • внезапные наводнения небольшой продолжительности в результате сильного ливня или прорыва плотины. Последнее известно как ливневый паводок и особенно разрушительно на наклонной местности, где вода течет с высокой скоростью. Некоторые территории особенно подвержены наводнениям, например: Тяжесть последствий наводнения зависит от следующих факторов: скорость потока продолжительность наводнения и сезон (4) высота и темп подъема уровня воды низкие прибрежные равнины, территории вдоль рек, где наводнения часто носят сезонный характер ВЫБРОСЫ ХИМИЧЕСКИХ ВЕЩЕСТВ, СВЯЗАННЫЕ С НАВОДНЕНИЯМИ3 ФАКТОРЫ РИСКА В ОТНОШЕНИИ ХИМИЧЕСКИХ ВЫБРОСОВ ПЛАНЫ РЕАГИРОВАНИЯ НА АВАРИЙНЫЕ СИТУАЦИИ НА ПРОМЫШЛЕННЫХ ПРЕДПРИЯТИЯХ ДОЛЖНЫ ВКЛЮЧАТЬ В СЕБЯ СЦЕНАРИИ НАВОДНЕНИЙ, чтобы работники и руководство были подготовлены к конкретным условиям, которые усугубляют чрезвычайную ситуацию во время и после наводнения. • Ненадлежащие системы оповещения. • Ненадлежащие меры безопасности или планирование на случай чрезвычайных ситуаций. • Отсутствие общественной осведомленности о рисках, связанных с наводнениями. • Расположение промышленных объектов в районах, подверженных затоплению. • Высокая плотность населения вокруг промышленных объектов. • Участки с небольшим потенциалом поглощения осадков, например из-за эрозии, вырубки леса или непроницаемых покрытий, таких как бетон. Повреждение аварийного оборудования на местах, а также повреждение основной инфраструктуры, такой как электро- и водоснабжение и телекоммуникации, будет мешать реагированию. Выездные группы экстренного реагирования и другие ресурсы могут быть недоступны, поскольку могут быть задействованы в ликвидации последствий наводнения. Выброс опасных веществ может затруднить проведение поисково- спасательных операций. Анализ событий прошлого показывает, что резервуары для хранения и трубопроводы при наводнениях особенно уязвимы (5). Месторасположение Готовность и системы оповещения НАВОДНЕНИЯ МОГУТ УВЕЛИЧИВАТЬ РИСК, СЛЕДУЮЩИМ ОБРАЗОМ СОКРАЩАЯ СПОСОБНОСТЬ РЕАГИРОВАТЬ НА НЕГО (6, 7): Сооружения • Сооружения, не способные противостоять наводнениям. • Ненадлежащие нормы в отношении планирования и строительства. ФАКТОРЫ, ПОВЫШАЮЩИЕ ОПАСНОСТЬ РАЗЛИВОВ ХИМИЧЕСКИХ ВЕЩЕСТВ ВО ВРЕМЯ НАВОДНЕНИЙ, ВКЛЮЧАЮТ СЛЕДУЮЩИЕ (1, 3): ВЫБРОСЫ ХИМИЧЕСКИХ ВЕЩЕСТВ, СВЯЗАННЫЕ С НАВОДНЕНИЯМИ 4 Повреждение источников энергоснабжения Повреждение системы электроснабжения может вызвать сбои в работе и повлиять на меры обеспечения безопасности, такие как инструменты мониторинга температуры и давления и регулирующие клапаны, что потенциально может привести к неконтролируемым химическим реакциям и выбросу химических веществ. Выбросы отходов за пределы химических заводов, шахт и дамб В результате затопления внутренних дренажных систем предприятия может произойти выброс отработанного масла или других химических отходов, если они не отделены от систем дренирования поверхностных вод. Заброшенные шахты, такие как угольные, могут при затоплении быть источником выброса кислой воды, содержащей серную кислоту как продукт окисления сульфидов при взаимодействии с водой и воздухом (9). Хвостохранилища, содержащие отходы горной промышленности, могут взрываться под давлением воды, высвобождая высокотоксичные отходы и грязь (4). Токсичные стоки Наводнение может приводить к химическим выбросам и другими путями (2, 9). В сельской местности сток с затопленных территорий может переносить эродированную почву, содержащую удобрения, гербициды и инсектициды. Сток с автомагистралей, дорог и мостов может содержать тяжелые металлы, нефтяные углеводороды и полициклические ароматические углеводороды. Сток с затопленных полигонов отходов может содержать токсичные химические вещества в зависимости от того, что хранится на полигоне (10). МЕХАНИЗМЫ ВЫБРОСА ХИМИЧЕСКИХ ВЕЩЕСТВ Смещение резервуаров- хранилищ и разрыв трубопроводов Подъем уровня воды при паводке может приводить к смещению и опрокидыванию резервуаров для хранения химических веществ и разрыву трубопроводов. Потоки воды могут подхватывать и перемещать емкости с химическими веществами. Удары могут приводить к повреждению емкостей и разливу их содержимого. Токсичные реакции и пожары Высвободившиеся химикаты могут смешиваться и вступать в реакцию с водой, потенциально создавая токсичные продукты реакции, а также опасность пожара или взрыва (5). Когда в процессе наводнения высвобождаются легковоспламеняющиеся углеводороды, воспламенение может привести к пожарам разлития. Плавучие очаги возгорания над поверхностью разлитого и испаряющегося углеводородного топлива могут стать причиной новых возгораний и нести огонь к новым источникам горючих материалов и жилым районам (8). Они представляют особую угрозу на складах нефтепродуктов и нефтеперерабатывающих заводах. ЛИВНИ И ПОДЪЕМ УРОВ- НЯ ВОДЫ ХИМИЧЕСКИЕ ВЕЩЕСТВА В ПАВОДКОВЫХ ВОДАХ МОГУТ ЗАГРЯЗНЯТЬ ИСТОЧНИКИ ПИТЬЕВОЙ ВОДЫ. По мере спада наводнения химикаты могут скапливаться на сельскохозяйственных угодьях и в зданиях, например в жилых домах и школах. Загрязненные сельскохозяйственные угодья могут стать непригодными для сельскохозяйственного использования на много лет (3). ВЫБРОСЫ ХИМИЧЕСКИХ ВЕЩЕСТВ, СВЯЗАННЫЕ С НАВОДНЕНИЯМИ5 ПОТЕНЦИАЛЬНОЕ ВОЗДЕЙСТВИЕ НА ЗДОРОВЬЕ ЧЕЛОВЕКА Связанные с химическими веществами Не связанные с химическими веществами Химические вещества, выброс которых произошел после наводнения, могут вызывать повреждение кожи и дыхательной системы, а также оказать системное токсическое воздействие в результате прямого контакта пострадавших и спасателей с опасными веществами. Токсическое воздействие и травмы могут также возникать вследствие загрязнения окружающей среды, пожаров и взрывов. Широкая общественность, спасатели и лица, участвующие в работах по очистке, могут подвергаться воздействию целого ряда опасностей, которые можно разделить на связанные с химическими веществами и не связанные с ними (10, 11). Ниже приведены примеры. • Ожоги от огня и воздействие коррозийных химических веществ (образование токсичных и/или легковоспламеняющихся паров в ходе реакции высвобождаемых химических веществ с паводковыми водами). • Поражения дыхательных путей от вдыхания раздражающих газов, включая продукты горения. • Отравление разлитыми токсичными химическими веществами и загрязненной пищей или водой. Однако в зависимости от скорости, объема и потока паводковых вод риск химического воздействия может быть уменьшен за счет разбавления веществ в воде. • Отравление угарным газом в результате неправильного использования топливосжигательных установок для получении электроэнергии, жаровен, отопительных печей, работающих на каменном или древесном угле, печей для приготовления пищи, бензиновых насосов и осушителей воздуха, используемых для осушения затопленных помещений (1, 2, 12). • Травмы и отравления у работников, занимающихся спасательными работами и очисткой, включая превышающее допустимое воздействие пестицидов, используемых для борьбы с переносчиками инфекций и грызунами. • Утопление. • Переохлаждение в результате нахождения в воде, температура которой ниже 24 °C. • Укусы потревоженных ядовитых животных (1). • Травмы и смерть в результате воздействия плавающих обломков. Травмы могут также возникать на этапах спасения и очистки, например при резке и перемещении упавших обломков. • Последствия эвакуации, например, повышенный риск инфекционных заболеваний на участках эвакуации, обострение ранее существовавших проблем со здоровьем при перемещении пациентов, переполнение медицинских учреждений, ведущее к сокращению возможности обеспечить адекватное лечение, потенциальные проблемы с водоснабжением и санитарией и т. д. (13). • Социально-психологические последствия, включая посттравматическое стрессовое расстройство (11, 14). ВЫБРОСЫ ХИМИЧЕСКИХ ВЕЩЕСТВ, СВЯЗАННЫЕ С НАВОДНЕНИЯМИ 6 ПРИНЦИПЫ РЕАГИРОВАНИЯ И ВОССТАНОВЛЕНИЯ 1. Соберите информацию о потенциально задействованных опасных объектах, включая свалки отходов, для оценки рисков для здоровья и определения соответствующих мер по управлению рисками. 2. Определите химические вещества, которые могут быть вовлечены в аварии: проверьте доступны ли данные инвентаризации, например в локальном плане действий в аварийной ситуации; если нет, используйте Инструмент быстрой экологической оценки (15). См. маркировку опасности. 3. Соберите и рассмотрите всю доступную клиническую информацию о подвергшихся воздействию людей, поскольку это может помочь идентифицировать некоторые химические вещества или группы химических вешеств. 4. По возможности организуйте сбор и анализ проб объектов окружающей среды (воздух, почва, вода, сельскохозяйственные культуры) с целью выявления и количественной оценки загрязнения химическими веществами. 5. Оцените возможность загрязнения источников питьевой воды и продуктов питания. Оценка риска Оценка риска Предотвращение воздействия Предотвращение воздействия Оценка медицинских аспектов и управление ими Оповещение о рисках и кризисных ситуациях Б А 1. На основе оценки рисков предоставьте рекомендации для службы гражданской обороны, пожарной или другой назначенной службы по следующим пунктам: • меры по сдерживанию; • ограничение доступа к загрязненным участкам; • потребность в средствах индивидуальной защиты (СИЗ); • ближайшие укрытия или оповещения об эвакуации для пострадавших общин. 2. Убедитесь, что люди, участвующие в работах по очистке и спасению, надлежащим образом оснащены СИЗ и знают о возможности разливов химических веществ. 3. Организуйте площадки для деконтаминации людей, подвергшихся воздействию химических веществ. 4. Предоставьте широкой общественности полную информацию о мерах предосторожности (см. ниже раздел Оповещение о рисках и кризисных ситуациях). Основные мероприятия по реагированию и восстановлению: ВЫБРОСЫ ХИМИЧЕСКИХ ВЕЩЕСТВ, СВЯЗАННЫЕ С НАВОДНЕНИЯМИ7 1. Убедитесь, что деконтаминация подвергнутые воздействию химических веществ люди проводится перед отправкой в лечебное учреждение. 2. Убедитесь, что медицинский персонал следует процедурам использования СИЗ при обращении с пострадавшими от химического загрязнения. 3. Проведите сортировку и оценку пациентов. Обратите внимание, что химические ожоги или отравления могут сочетаться с травматическими повреждениями. 4. Получите рекомендации по лечебной тактике при химическом воздействии в токсикологическом информационном центре (если таковые имеются). 5. Обеспечьте требуемое лечение (например, применение противоядия). 6. Рассмотрите необходимость сбора биологических образцов у лиц, подвергшихся химическому воздействию (включая сотрудников аварийных служб), с целью выявления и, по возможности, количественной оценки воздействия. 7. Зарегистрируйте всех подвергшихся воздействию лиц и обеспечите надлежащее документирование и учет в случае необходимости долгосрочного наблюдения. 8. Убедитесь, что после мер неотложного реагирования были приняты меры на этапе восстановления для предотвращения непрямых химических и долгосрочных эффектов. Обеспечить поддержку психического здоровья и психосоциальную поддержку пострадавших общин. Оценка медицинских аспектов и управление ими Оповещение о рисках и кризисных ситуациях Г В 1. Предоставляйте обновляемую по мере необходимости информацию общественности, сотрудникам аварийных служб и лицам, принимающим решения, о химических и других опасностях, связанных с данным инцидентом. Убедитесь, что общественность проинформирована по следующим пунктам: • природно-техногенная чрезвычайная ситуация; • ответственные лица; • предпринимаемые действия; • природа и опасность химических веществ, вовлеченных в аварию; • действия, которые могут предпринять люди, чтобы защитить себя и свои семьи; • когда обращаться за медицинской помощью; • как получить дальнейшую информацию. 2. Некоторые из тем, связанных с защитой здоровья: • рекомендации по продуктам питания и воде (в случае загрязнения); • предотвращение отравления угарным газом; • меры предосторожности при расчистке, например, использование средств индивидуальной защиты, безопасное использование режущего инструмента, обращение с асбестоцементом и т. д.; • потенциальные опасности в домах, пострадавших от наводнения. ВЫБРОСЫ ХИМИЧЕСКИХ ВЕЩЕСТВ, СВЯЗАННЫЕ С НАВОДНЕНИЯМИ 8 СПИСОК ИСПОЛЬЗОВАННОЙ ЛИТЕРАТУРЫ 1. Doocy S, Daniels A, Murray S, Kirsch TD. The human impact of floods: a historical review of events 1980–2009 and systematic literature review. PLoS Currents Disasters. 2013 April 16; Edition 1. doi: 10.1371/currents.dis.f4deb457904936b07 c09daa98ee8171a (http://currents.plos.org/disasters/article/the-human-impact- of-floods-a-historical-review-of-events-1980-2009-and-systematic-literature- review/, accessed 7 July 2017). 2. Menne B, Murray V. 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