NDMA to prepare guidelines for emergencies in hospitals

It is reported that National Disaster Management Authority (NDMA) will prepare guidelines to handle emergencies in hospitals. This follows the fire incident at AMRI hospital on 09.12.2011 at Kolkata recently that claimed 93 lives. The guidelines include clarity on roles and responsibilities.

Gas cutting - Two workers burnt and four injured during the fire

It is reported that two workers died and four more were injured during gas cutting of an abandoned chemical plant machinery in a resultant fire. The chemical factory not in use for two years was purchased and renovation work was taken up. While cutting the big machinery with gas cutters, the sparks fell on the plastic boxes nearby that contained residual chemicals and quick spread of fire caused the deaths and injuries. The fire was brought under control after four hours of struggle.

To avoid such incidents, ensure:

1. equipment free from chemicals/combustibles inside and outside
2. absence of all combustibles/ inflammable atleast within 15 m radius of proposed hot work to avoid flying sparks falling on these materials
3. sufficient pressure in oxygen and cutting gas cylinders
4. good condition of hoses, torches
5. flashback arrestors in both hose lines
6. use of friction lighter
7. clear means of access/egress
8. availability of minimum numbers of extinguishers
9. sufficient illumination and ventilation
10. training
11. supervision, etc

Welder dies in blast

In an incident on 16.12.2011 Friday at visakhapatnam, a welder died and another person was injured due to gas cylinder explosion in a tinkering painting workshop. Police suspect the blast is due broken knob of a gas cylinder. The deceased suffered a fatal blow to his skull in the blast.
In another report on the same incident, it is stated that explosion occurred when the person was trying to open a carbon machine and the cylinder exploded and hit his head.
From the above two reports, it appears that the person while working on some equipment/machine, an unintentional action led to hitting and breaking of the adjacent gas cylinder knob and flying of the knob (like a rocket?) hit his head causing the death.
Normally welding gas cylinders are kept in the trolley and chained. The broken knob should not have caused explosion unless other wise it is not secured and is acetylene cylinder. As acetylene is not stable and is sensitive to pressure/impact/shock, any fall of unsecured acetylene cylinder can lead to such explosion. May be the broken knob dislodging with great force due to cylinder gas pressure could have hit the skull and led to death.

In a similar incident earlier at another place, it is reported that a broken knob lead to gas release at high pressure and the resultant blast killed a person.

AP Pollution Control Board orders closure of violators

In a recent special drive, the Pollution Control Board of conducted surprise checks on serveral hospitals, manufacturing and pharma units. It found that some of these units are producing beyond the licenced capacity or by using a different process or not having facilities to treat effluents / biohazard wastes. About 10 firms were asked to shut their operations for violation of terms and conditions of consent for operation and proposes to take action on similar violators. Though it is difficult for any regulator to keep an eye on the violators constantly because of wide spectrum of activities and area of operations, these types of actions will act on the right direction and this can be sustained by slapping applicable charges and takeing them to court.
Following the famous saying, " polluter pays" principle, the cost of treating the polluted land/water/air along with penalty should be recovered from the violators. Bank guarantees should be taken from all production facilities and should be encashed in case of violations and no action taken on these violations even after specified time.

http://timesofindia.indiatimes.com/city/hyderabad/PCB-seeks-Rs-10L-bank-guarantee-from-3-hospitals-for-flouting-bio-waste-norms/articleshow/11040034.cms

 

 

Hospitals pose health hazard to city

Tonnes Of Trash Dumped Into Water Bodies In Violation Of Rules - Sudipta Sengupta TNN

Hyderabad: The recent crackdown on city hospitals by the Andhra Pradesh Pollution Control Board (APPCB) has exposed just how Hyderabad is facing hazards from the healthcare sector. As much as a few lakh litres of contaminated water from the toilets and laundry of these medical institutions, many of them known for their swank interiors and high-profile clientele, are routinely being drained into the Hussain Sagar lake and Musi river.
   And adding to this stink is the appalling solid waste management system in these hospitals, the series of PCB inspections have found. In fact in the past one week alone, officials have unearthed tonnes of trash, including severed parts of a human body, infectious needles and bottles indiscriminately dumped on the premises of most hospitals in the city. So horrific have been the revelations that the PCB has now decided to continue with these intensive checks, expected to last for a few more weeks, to see if hospitals are abiding by the specified bio-medical waste disposal and pollution norms.
   “Chances are that most are flouting the norms,” said a PCB official before disclosing a startling fact: none of the 6,372 hospitals in AP have consent for operation (CFO) certificate from the pollution control board. “Around 15 of them procured CFO in the past but they have lapsed now. Nobody has come forward for renewal since,” the official added. Interestingly, a close look at the rulebook shows that no organisation discharging chemical waste can operate without a CFO certificate from the PCB.
   “These hospitals have been violating all waste management norms citing an array of reasons,” said sources from the health care industry. While they claim they do not have the space to set up sewerage treatment plants (for the liquid waste), they rue that the fee charged by the private companies appointed by PCB to collect the solid waste is very high, the sources added. This, even as the rate chart of these `collection’ houses is just about Rs 3.50 per bed a day.
   “Our charges have always been very nominal. Yet, we do not see many hospitals keen on signing up with us,” said an official of G J Multiclave (India) Pvt Ltd, one of the two companies engaged in collection of solid waste, refusing to comment any further.
   But while such shocking disclosures raise a question on the credibility of hospitals across AP, city environmentalists feel this also puts the PCB in a tight spot. Recollecting a similar drive initiated by the board about six years ago, they say how that initiative too fizzled out after making headlines for a few days. “It is close to impossible to sustain something like this. Now that the board is active, most hospitals are found implementing the norms. But it will all be forgotten in a few weeks time. Hospitals will again go back to their old ways,” said an environmentalist who has been following the drive closely.

The Musi river flows with hazardous medical waste

 What one can learn from the above is that POLLUTER ALWAYS PAYS - If not immediately, time may catch up with you.

PCB got extensive powers to suspend plant operations. Also, it can direct water and power suppliers to stop their supplies to the erring industry. It can cancel the land allotment and can take back whatever land is allotted. It can file charges and drag to courts for suitable punishments. The reason can be as simple as change of raw material or process through some other process, slight modification of the process, and so on.
It is better to adhere to the process and throughput at what we are permitted and keep PCB in good books.

 

 

Reaction to Chemistry Lab Explosion

An explosion leading to burning of students during an experiment is reported. The teacher dropped a match in methanol causing the incident. The following link contains brief description of the incident along with a video about lab safety.

Reaction to Chemistry Lab Explosion

LINK

Fire in a corporate hospital, Kolkata: 93 deaths, several injured

Fire in a corporate hospital, Kolkata: 93 deaths, several injured

There was a fire incident in the midnight/early morning hours in a 190-bed corporate hospital at Kolkata (West Bengal state) on 09.12.2011 (Friday). As per reports, as of now, 93 persons died, including 3 hospital staff and several others were injured. It is reported that all the deaths were due to suffocation/asphyxiation from poisonous gases like carbon monoxide liberated during the fire. One of the deaths reported is jumping from one of the top floors. The fire started from the area close to the pharmacy located in the basement. The basement originally meant to be a car parking area was modified to house a radiotherapy unit and a pharmacy which is part of central stores. But the area is also used without any authorization to store inflammable materials like, chemicals, spirti cans, wooden furniture, heaps of empty packing boxes, cotton, bandage, oxygen cylinders, etc.

The firefighting equipment in the basement like fire extinguishers, smoke alarms and sprinklers are not functional in the basement at the time of the fire.

Though the fire started at 0130 hr (in another report, it is 0330 hr), fire service was informed only after 40 minutes after attempts by hospital staff to extinguish the fire failed and the fire went out of control.

(A news report for this delay states that when a minor fire occurred a few months earlier, an alert security employee of the hospital informed fire services. But, before they arrived, hospital staff extinguished the fire. However, insisting for inquiry by fire services, as reported, angered the hospital authorities and the security employee was reprimanded and suspended for two weeks. )

The hospital staff informed that as per protocol, person identifying the fire has to inform night administrator who will alert all wings of the hospital and the same was done during this fire incident.

During the initial period of the fire, hospital staff asked the enquiring inpatients to close the doors and sleep. The smoke, carbon monoxide (CO) and other gases liberated during the fire spread to other floors of seven-floor hospital caused suffocation and slow death.  CO, a flammable, odorless and tasteless gas is fatal at 3200 ppm after few minutes’ exposure. Carboxyhemoglobin (HbCO) formed by combination of CO with hemoglobin in the blood reduces oxygen carrying capacity and affects the exposed persons with serious consequences. Apart from CO, hot gases inhalation also can create respiratory problems. http://en.wikipedia.org/wiki/Carbon_monoxide_poisoning

Exposed patients, unable to open, banged toughened glass window panes to breath fresh air and find means of escape. It is not clear why they did not open doors of the rooms in which they were staying.

Locals in the nearby areas saw the smoke and had burning lungs. These with kin of inpatients tried to enter the hospital to provide help but were stopped by hospital staff. Traffic on the roads led to late arrival of fire service vehicles. When fire service reached, they found the locked gates and getting hydraulic ladder/lift to cross these closed gates took some more time. They found difficulty in opening the toughened glass panes of the windows. Rescue operations were started in full swing only four hours after the incidents when commando teams with masks and hydraulic lift arrived. Chaos during VIP visits hampered some rescue operations.

 At the time of the incident, the staff strength was 130 including 70 nurses and 20 doctors. It is reported that many of these ran for shelter instead of taking part in rescue operations. However, two nurses tried to rescue as many as possible and in the process died due to asphyxiation and heat.

The fire department in their earlier routine inspection objected storage of combustible materials in the basement and hospital authorities promised to clear within three months by November. Though several questioned fire department for not ensuring implementation of their recommendations, it is virtually impossible for any agency when sufficient man power is not allocated. It is easy to say that work and manpower shortage are different and should not be linked. But, the ground reality is that without resources, ineffectiveness creeps in and finally leads to system collapse.

 It is reported after the incident that persons from other agencies will be drawn to conduct regular inspection of public institutions like schools, hotels, hospitals, etc . But, this will affect the work in the department when people are taken for the proposed inspections. Unless otherwise dedicated staff is available, the incidents will continue to occur.

The six directors of the hospital were charged with culpable homicide not amounting to murder and with causing death due to negligence.

What can be done?

Following are some of the measures that will help in preventing/mitigating such incidents.

1.       A pyramid type safety and fire administration should be established in every town/city.

2.       There should be an in-charge for safety and fire for every residential street containing about 10,000 dwelling units or business street containing establishments wherein the total persons employed in various business operations is about 500. These incharges should inspect the areas under their control atleast once in a week for compliance with safety regulations and stop activities in case of violations by issuing a letter with copy marked to their superior and also to local incharges of essential services required to for any dwelling/business like water, power, etc. If the activity continues inspite of notice even after a week, then water, power and other essential services should be stopped immediately by concerned authorities upon receipt of intimation from the safety incharge of the area.

3.       There should be a zonal officer for every 100 area incharges. Zonal officer should monitor activities of area incharges, review their reports, conduct meetings with them in small groups and inspect the areas as required. However, he should visit the areas atleast once in a year and send his report to his superiors.

4.       If there are more zonal officers, then suitably designated and empowered higher level officials should be appointed to monitor these zonal officers and have defined functions as above.

5.       It should be made mandatory to appoint safety and fire officials of required number in every public institution including multistory buildings of all sorts, hospitals, schools, hotels, administrative buildings, bus/rail/air terminals, warehouses, etc. If there are multiple business houses like shopping complexes, then the owner of the building who rented/leased should be held responsible to appoint these officials. These officials should spend atleast half of their working hours to inspect the areas for unsafe conditions and unsafe acts, checking for availability and functioning of specified number of fire detectors/extinguishers/ fire water, and send daily reports to the top man of the institution who should review it on the following day in his meetings with in-charges of various sections, safety and security and ensure necessary remedial measures. The safety officials of individual establishments apart from inspection should also provide training, prepare emergency plan and conduct mock drills every month.

6.       A compiled report of these inspections and other safety activities along with actions taken should be sent to the concerned direct area-incharge of the government who should review and take necessary action. Area incharge in turn should compile all these reports in his area along with his inspection reports and send a monthly report to zonal officer to whom he is reporting.

7.       All violations found by area incharges, comments/remarks of zonal officers and their superiors should be displayed in the town website for public viewing. The content should be specific to the residence/office/establishment. The website can be designed to enable easier navigation.

8.       The safety incharge of the town, call him as town/city safety director or some other designation should be responsible to coordinate with officials of safety, fire, health, transport, administration, etc; prepare an emergency plan for all types of events and ensure conduct of mock drills in all areas/zones, ensure investigation of all incidents and compliance with recommendations, etc. Town/city safety director should prepare an annual report of all safety activities, incidents, etc and publish the report in the town/city website that also contains inspection reports of various officials, details of essential and emergency services, emergency plan, layout of the town extending upto individual house and establishment, list of incidents and details of investigations, recommendations, actions taken, etc.

9.       Each of the emergency services of the town should have sufficient number trained personnel; tools like hammers that can be used even at a distance, flood lights, thermal imaging cameras, fire extinguishers, etc; vehicles for moving fire water, fire extinguishers, ladders, hydraulic lifts, generators, communication system, personal protective equipment, etc; ambulances with equipped with necessary equipment and paramedical staff; etc

10.   There should be dedicated training centers to train all essential service officials and local communities.

11.   Auditing of safety systems in every town/city by reputed agencies, display of audit findings along with action taken report in the website of the town. 

Some links on the incident:

http://www.youtube.com/watch?gl=IN&v=3w15rPdyvSE 24x7: News report

http://www.youtube.com/watch?v=GGy2rW6hr04&feature=related TIMES NOW: Eye witness account

http://www.youtube.com/watch?v=FqkdLPip_cA&feature=related AP: News report

http://www.youtube.com/watch?v=sdZElyg9C_M&feature=related newsX: Safety Questions

http://www.youtube.com/watch?v=l6ytgbRr-Ck&feature=related NDTV: Sequence of events

http://www.dnaindia.com/india/report_amri-fire-nurses-funeral-held-in-kerala-with-full-state-of-honours_1624889

Today (18.12.2011), Chief of Fire Service Department for Government of Andhra Pradesh during his address to a gathering of State Super Specialty Hospitals cautioned and told about

• display of ‘Fire Unsafe Building' board in front of hospitals by Fire Department, for not taking fire safety measures,
• prohibition of generators, transformers, canteens, etc in cellars of high rise hospitals,
• preparation of emergency plan with roll clarity and conduct of monthly mock drills,
• posting a Fire Safety Officer to look after fire prevention arrangements and conduct mock drills once a month.
• a one-day workshop by Greater Hyderabad Municipal Corporation (GHMC) for fire safety officers.

Fire incident in a chemical factory

In a chemical factory that makes drug intermediates, during chemical reaction, temperature increased uncontrollably leading to release of toxic gases. Two persons who tried to control the temperature and two more got injured in the incident.
It is reported that such incidents are common in small scale chemical factories, where safety standards and procedures are not followed. Contract labour with low wages are recruited who do not know how to operate the plant and even personal protective equipment are not provided. Though, nobody wants to damage their own property, the fact is that incidents do occur regularly and this indicates lack of proper training to the workers engaged on the job.

Factories engaged in any activity should have,

1. approvals from concerned authorities
2. selection of employees with requisite qualification and skills
3. training program
4. hazard identification and rectification procedures
5. safe operating procedures
6. dos and donts
7. testing and calibration of gauges, monitors, equipment
8. fire detection and control measures
9. emergency procedures
10. personal protective equipment for persons engaged on the work, etc

BLEVE Training Video - Safety Engineering Network (SAFTENG)

A video on BLEVE (boiling liquid expanding vapour explosion) is available at the link below.
BLEVE Training Video Part 1 - EXCELLENT Info - Safety Engineering Network (SAFTENG)
BLEVE Training Video Part 2 - EXCELLENT info - Safety Engineering Network (SAFTENG)

http://www.safteng.net/index.php?option=com_content&view=article&id=1038&Itemid=178 (Part 1)
http://www.safteng.net/index.php?option=com_content&view=article&id=1037%3Ableve-tests-results-1-excellent-info-&catid=52%3Aemergency-response&Itemid=178 (Part 2)
LINK

The video explains about the phenomena of BLEVE, the fire ball radii, the safe distance for emergency responders. We will understand that the safe distance for emergency responders is FOUR times the fireball radius with minimum distance at 90 m. For a 400 lit capacity tank, the fireball radius can be 18 m. We also learn that as the capacity of the flammable storage tank increases by a factor of 10, the fire ball radius doubles. The evacuation distances can be taken as 20 times the fireball radius.

However, these distances are not exact as there are instances of explosion fragments travelling more than 20 times fireball radius. During the incident at New Mexico in 1984, a fragment weighing about 20 T travelled 1200 m.

The water required to cool the exposed hot surfaces 10 lpm/sq.m. It may be noted that inspite of all efforts, if there is whistle/jet engine sound from valves, it is indication of over pressurization inside and all emergency responders should stop their activities and move to safe distances.

Some people assume that BLEVE is possible only with flammable substances. But, as the video explains, BLEVE is possible with any substance that leads to vaporization and pressure rise during external heating/impact and the container rupture leads to BLEVE. Fireball is the result if the substance inside is flammable.

Note: Literature gives following equations:

Fireball radius, R (meters) = 29 M^1/3  where M is mass of flammable in the fireball in tonnes
Fireball duration, t (seconds) = 4.5 M^1/3

Most likely distance for 3^rd degree burns = 80 M^0.42 meters

Maximum distance for 3^rd degree burns = 130 M^0.42 meters

Most likely distance for 2^nd degree burns = 150 M^0.42 meters

Maximum distance for 2^nd degree burns = 240 M^0.42 meters

The heat radiation intensity from the fireball can cause damage to human beings and property. From the literature, it can be seen that 12.5 kw/sq.m heat intensity can be fatal, 8.5 kw/sq.m can cause 1^st degree burns whereas solar radiation gives 0.6 kw/sq.m

10 FACTS ABOUT DRINKING & DRIVING

I thought beer is better than wine with respect to safety but as per the article at the following LINK, fatalities are more with beer consumption than liquor/wine.
10 FACTS ABOUT DRINKING & DRIVING

LINK

Use of TCE - increase in risk of developing Parkinson's disease

A study of 99 pairs of twins with and without Parkinson's disease shows that those exposed to trichloroehylene (TCE) are prone to the risk of developing Parkinson's disease six times more than the other. Study shows exposure to perchloroethylene and carbon tetrachloride also increase the risk of developing the Parkinson's disease. No such evidence was found exposure to toluene, xylene and n-hexane. The data taken is less and requires more studies.
TCE is used as a degreasing agent though it is banned in food and pharma industries long time ago. TCE also results in chopped skin and tremors. Where its use is unavoidable, exposure to persons should be minimized by containment, ventilation, use of personal protective equipment (PPE). Excessive exposure may affect central nervous system, numbness, reduced heartbeat, unconsciousness and eventually death.
Heating of TCE can form phosgene that cause pulmonary edema.

Health effects of TCE: http://www.ccohs.ca/oshanswers/chemicals/chem_profiles/trichloroethylene/effects_trichloro.html