BACKGROUND: As one of the most frequently occurring accidents in a chemical plant, a fire accident may occur at any place where transfer or handling of combustible materials is routinely performed. METHODS: In particular, a jet fire incident in a chemical plant operated under high pressure may bring severe damage. To review this event numerically, Computational Fluid Dynamics methodology was used to simulate a jet fire at a pipe of a compressor under high pressure. RESULTS: For jet fire simulation, the Kemeleon FireEx Code was used, and results of this simulation showed that a structure and installations located within the shelter of a compressor received serious damage. CONCLUSION: The results confirmed that a jet fire may create a domino effect that could cause an accident aside from the secondary chemical accident.
Chemical Hazard Release ; Fires* ; Hydrodynamics ; Plants

PURPOSE: The aim of this study was to evaluate the characteristics of Emergency Medical Service (EMS) provider responded chemical, biological, radiological, and nuclear (CBRN) incidents in Korea. METHODS: Nationwide EMS rescue records from Jan 2012 to Dec 2014 were analyzed. All EMS rescue records were integrated according to the unique accident ID. Cases related to animal rescue, hive removal, and suicide-related were excluded. CBRN-associated keywords were extracted by literature review and pilot survey. In-depth review of cases containing CBRN-associated keywords in the activity summary were conducted by trained emergency medical technicians, and predefined information was abstracted. Descriptive analyses were performed to characterize the EMS provider responded CBRN incidents. RESULTS: A total of 1,571,293 cases were included, and 1,335,205 cases had a unique accident ID; 515,417 cases were excluded because of their association with animal rescue, hive removal, and suicide attempts; 19,663 cases contained CBRN-associated keywords in the activity summary, and in-depth review identified 1,862 cases as CBRN incidents. Among them 1,856 cases were chemical incidents, and 6 cases were radiological incidents; 144 cases were resulted to victims. In chemical incidents, ammonia, hydrogen chloride, sulfuric acid, hydrogen fluoride, and nitric acid were the top 5 toxic substances. In chemical incidents with victims, the proportion of explosion/implosion, and suffocation in sealed space was more prevalent than chemical incidents without victims. Median scene time of all CBRN incidents was 41 minutes (interquartile range 18.0-57.0). CONCLUSION: We evaluated the characteristics of CBRN incidents responded by EMS in Korea.
Ammonia ; Animals ; Asphyxia ; Biohazard Release ; Chemical Hazard Release ; Emergencies* ; Emergency Medical Services* ; Emergency Medical Technicians ; Humans ; Hydrochloric Acid ; Hydrofluoric Acid ; Korea ; Nitric Acid ; Radioactive Hazard Release ; Suicide ; Sulfur

This study is to prepare promotional strategies of establishment of the Korea Poison Center based on the chemicals and chemical products and the database (DB) construction status of Chemical Accident Emergency Respond Information System (CEIS) and the DB needs survey of the lay person. The methods of CEIS DB construction and hazard classification are; first, the researchers required material safety data sheet from the manufacturer/distributor and verified its composition/information on ingredients. Second, the researchers conducted the hazard classification of the chemical products by the mixtures classification according to the United Nations Globally Harmonized System of Classification and Labelling of Chemicals (GHS, 3rd edition) guidelines based on the verified composition/information on ingredients. The emergency measures information was established by the Emergency Department healthcare professionals. Health hazards are classified by using 13 reference databases, which include European Chemical Substances Information System (IUCLID) and IARC, and 4 reference books like Emergency Management Guides(ERG). As the result of analyzing the DB construction status of chemical products, it showed in the order of, 180 for vehicle products (15.0%), 162 for printing products (14.0%), 129 for paint (11.0%) and 120 for adhesives (10.0%). Currently in 2013, emergency respond information was established for a total of 2,400 chemicals (includes 1200 chemical products). As the result for conducting a needs survey for the establishment of emergency respond information targeting on the general public and professionals, it showed the highest level of demand for the establishment of emergency respond information on 'household products (2.87 points)' for both lay person and experts. As the result of analyzing the Q&A of the lay person until March 2013, through CEIS, it showed the highest inquiry on disinfectant and germicide products with 11 issues (27.5%). World Health Organization recommends to provide emergency consultation and information on poisoning accidents and operate a 24 hour national poison center able to perform the research functions for every nation. However, there is no such national poison center in Korea, and it can be said fundamental reform of the national poison management system and establishment of national poison center is urgent, considering the fact social demand and citizens from recent consecutive chemical poisoning accidents are increasing.
Adhesives ; Chemical Hazard Release ; Delivery of Health Care ; Emergencies ; Hazardous Substances ; Household Products ; Humans ; Information Systems ; Korea ; Paint ; Reference Books ; United Nations ; World Health Organization

OBJECTIVES: This study was conducted to report the course of an accidental release of chlorine gas that occurred in a factory in Gumi-si, South Korea, on March 5, 2013. We describe the analysis results of 2 patients hospitalized because of chlorine-induced acute health problems, as well as the clinical features of 209 non-hospitalized patients. METHODS: We analyzed the medical records of the 2 hospitalized patients admitted to the hospital, as well as the medical records and self-report questionnaires of 209 non-hospitalized patients completed during outpatient treatment. RESULTS: Immediately after the exposure, the 2 hospitalized patients developed acute asthma-like symptoms such as cough and dyspnea, and showed restrictive and combined pattern ventilatory defects on the pulmonary function test. The case 1 showed asthma-like symptoms over six months and diurnal variability in peak expiratory flow rate was 56.7%. In case 2, his FEV1 after treatment (93%) increased by 25% compared to initial FEV1 (68%). Both cases were diagnosed as chlorine-induced reactive airways dysfunction syndrome (RADS) on the basis of these clinical features. The most frequent chief complaints of the 209 non-hospitalized patients were headache (22.7%), followed by eye irritation (18.2%), nausea (11.2%), and sore throat (10.8%), with asymptomatic patients accounting for 36.5%. The multiple-response analysis of individual symptom revealed headache (42.4%) to be the most frequent symptom, followed by eye irritation (30.5%), sore throat (30.0%), cough (29.6%), nausea (27.6%), and dizziness (27.3%). CONCLUSIONS: The 2 patients hospitalized after exposure to chlorine gas at the leakage site showed a clinical course corresponding to RADS. All of the 209 non-hospitalized patients only complained of symptoms of the upper airways and mucous membrane irritation.
Chemical Hazard Release ; Chlorine* ; Cough ; Dizziness ; Dyspnea ; Headache ; Humans ; Korea ; Medical Records ; Mucous Membrane ; Nausea ; Outpatients ; Peak Expiratory Flow Rate ; Pharyngitis ; Respiratory Function Tests

Adult ; Chemical Hazard Release ; prevention & control ; China ; Emergency Medical Services ; organization & administration ; statistics & numerical data ; Female ; Health Personnel ; Humans ; Male ; Middle Aged ; Poisoning ; prevention & control ; Surveys and Questionnaires

OBJECTIVE: The aim of this study was to evaluate the characteristics of the emergency medical services (EMS) response and clinical information on mass casualty chemical incidents in Korea. METHODS: This retrospective observational study analyzed the integrated data of the EMS rescue records and EMS-treated severe trauma registry from January 2012 to December 2013. Two databases were integrated using the unique accident identification number. Chemical incidents were defined by an in-depth review of the EMS rescue records according to a previous study. Mass casualty incidents were defined as more than 6 injured individuals. The rescue, EMS, and hospital variables of mass casualty chemical incidents were analyzed. RESULTS: A total of 8 mass casualty chemical incidents and 73 patients were included. The mean responded rescue vehicles and EMS vehicles were 2.4 and 3.5, respectively. The 4 incidents were an oil spill due to traffic accidents and most patients suffered minor trauma. A carbon monoxide leak caused the largest number of patients (23 people). The explosion caused by flammable polyethylene leaks showed the highest severity. In that explosion, the mortality rate was 40% and 8 patients had a disability at discharge. CONCLUSION: This study evaluated the characteristics of the EMS response and clinical information on mass casualty chemical incidents in Korea.
Accidents, Traffic ; Carbon Monoxide ; Chemical Hazard Release* ; Emergency Medical Services ; Explosions ; Humans ; Korea ; Mass Casualty Incidents* ; Mortality ; Observational Study ; Petroleum Pollution ; Polyethylene ; Retrospective Studies

Based on epidemiological studies, an International Agency for Research on Cancer Working Group determined that strong inorganic acid mists containing sulfuric acid are carcinogenic to human even though, sulfuric acid, per se, is not. Accumulative studies indicate that there is a link between chronic occupational exposure to sulfuric acid mists and an increased risk of laryngeal cancer. Unintended, acute exposure to sulfuric acid mists can cause corrosive damage to target tissues depending on the route of exposure. This review compares the toxicity and carcinogenicity of sulfuric acid mists compared to other strong inorganic acid mists. It also examines the routes and duration of exposure (short-term, prolonged, and long-term). In vivo evidence does not support or refute the carcinogenicity of sulfuric inorganic mists even though its co-carcinogenic or promoting potential has been considered. On the basis of existing evidence on sulfuric acid mist toxicity, we suggested a putative adverse outcome pathway (AOP) relevant to carcinogenicity caused by mists containing sulfuric acid. A possible key factor involved in sulfuric acid mist carcinogenesis is the genotoxic effects of low pH since it can increase instability in chromosomes and DNA. A putative AOP for sulfuric acid mist carcinogenicity would help generate better risk assessments and more accurate predictions regarding the risk of developing cancer due to prolonged exposure. Establishing an AOP would also be useful for future studies examining the carcinogenicity of other strong inorganic mists.
Carcinogenesis ; Chemical Hazard Release ; DNA ; Epidemiologic Studies ; Humans ; Hydrogen-Ion Concentration ; International Agencies ; Laryngeal Neoplasms ; Occupational Exposure ; Risk Assessment ; Sulfur ; Sulfuric Acids

PURPOSE: The purpose of this study is to understand what kinds of chemical substances have been used annually and to investigate incidents that occurred due to chemical hazard release and to analyze statistically clinically chemical injury patients who visited one regional emergency medical center in Gumi city with documented references review. METHODS: Annual chemical waste emission quantity (Kg/Year) (Cwep) was reproduced using national web site data governed by the Ministry of Environment and 5 years (from 1 .Jan. 2010 to 31. Dec. 2014) of medical records of chemical injury patients who visited our emergency department were reviewed retrospectively. By applying exclusion criteria, 446 patients of 460 patients were selected. RESULTS: Dichloromethane, Toluene, Trichloroethylene, and Xylene were always included within Top 5 of Cweq. Six cases of chemical incidents were reported and in 3 of 6 cases involving Hydrogen fluoride were included during the study period. Male gender and twenties were the most prevalent group. Injury evoking chemicals were Hydrogen fluoride, unknown, complex chemicals (over 2 substances) in sequence. The most frequent site of wounds and injuries was the respiratory tract. Gas among status, intoxication among diagnosis, and discharge among disposition was most numerous in each group. CONCLUSION: There have been no uniform clinical protocols for chemical wounds and injuries due to various kinds of chemicophysical properties and ignorance of antidotes. Therefore conduct of a multicenter cohort study and experiments for ruling out chemicals according to chemicophysical priority as well as development of antidotes and clinical protocols for chemical injury patients is needed.
Antidotes ; Chemical Hazard Release* ; Clinical Protocols ; Cohort Studies ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Gyeongsangbuk-do ; Humans ; Hydrofluoric Acid ; Male ; Medical Records ; Methylene Chloride ; Respiratory System ; Retrospective Studies* ; Toluene ; Trichloroethylene ; Wounds and Injuries ; Xylenes

There has been a significant decline of infectious disease in childhood due to an improvement of economy, living standard and medicine. But accidents in childhood is rather increased and encountered in major cause of death. The child is not so fully developed mentally and physically, that he is vulnerable to accident. Most accidents have been rocognized as being preventable with a few attention of parents or neighours. Therefore, parental health education should be emphasized as one of the important preventive measures against accidents. The authors reviewed the records on 1,648 accidental pediatric patients in the emergency room of CNUH during 6 years period from Jan. 1976. To Dec. 1981. The results were as follow: 1. The frequency of pediatric accidental patient in emergency room was gradually increased year by year and the monthly distribytion revealed a slightly higher in summer season from May to August. 2. According to the patient's residency, the urban to rural ratio was 1.6:1 and the male to female ratio was 1.9:1. 3. The most common physical accident was traffic accident(25.3%), the second being fall down accident(17.3%), then in decreasing order foreign body aspiration or inoculation(14.8%), burn(13.6%), laceration(12.6%), and bite(5.1%), The most common injury site of body by physical accident was head(56.5%) and next in decreasing order trunk & abdomen(18.1%), left leg(15.3%), right leg(13.9%), left arm(12.4%) and right arm(10.5%). 4. The frequency of chemical accident in decreasing order as follow ; CO poisoning(31.5%), rodenticidal drug poisoning(11.7%), insecticidal drug poisoning(9.1%), organic phosphorus poisoning(9.1%) and DDS poisoning(4.2%). 5. Majority of cases were carried to emergency room within 6 hours after accident. 6. The prevalent age for physical accident were between 3-6 years(28.6%) and 6-12 years(28.7%). 7. The prevalent age for chemical accident were between 1-3 years(30.5%). Comparing period of 1979-1981 with period of 1976-1978, the results were concluded as follow ; 1.Frequency of accidents was remarkably increased with predominant male and urban children. 2. Frequency of traffic accident, bite, head trauma, rodenticidal, insecticidal and organic phosphorus poisoning were decreased while those of fall down, foreign body aspiration, burn, laceration, and CO poisoning rather increased. 3. Patients were carried to hospital more rapidly in cases of physical accidents. 4. Age prevalent for physical accidents was to by younger while for chemical accidents being older. 5. Physical accidents were markedly increased, while chemical accidents being minimally changed.
Accidents, Traffic ; Burns ; Cause of Death ; Chemical Hazard Release ; Child* ; Communicable Diseases ; Craniocerebral Trauma ; Emergencies ; Emergency Service, Hospital ; Female ; Foreign Bodies ; Health Education ; Humans ; Internship and Residency ; Lacerations ; Male ; Parents ; Phosphorus ; Poisoning ; Seasons ; Socioeconomic Factors

OBJECTIVES: This study was conducted to describe the demographic characteristics, and clinical signs and symptoms of patients who visited a general hospital because of the release of chemically hazardous hydrogen fluoride that occurred on September 27, 2012 in Gumi City, Korea. METHODS: The medical records at 1 general hospital 9 km from the accident site were reviewed using a standardized survey format. There were 1,890 non-hospitalized and 12 hospitalized patients exposed to hydrogen fluoride between September 27 and October 13 2012. RESULTS: Among the 12 hospitalized patients, 11 were discharged within 1 week and the other was hospitalized for 10 days. The chief complaints were respiratory symptoms such as hemoptysis and shortness of breath, gastrointestinal symptoms, neurologic symptoms, sore throat, and lip burn. The number of non-hospitalized patients exhibited a bimodal distribution, peaking on the first and twelfth days after the accident. Their chief complaints were sore throat (24.1%), headache (19.1%), cough (13.1%), and eye irritation (9.2%); some patients were asymptomatic (6.2%). Patients who visited the hospital within 3 days (early patients) of the spill more often had shortness of breath (27.0%) and nausea (6.3%) as the chief complaints than patients who visited after 3 days (late patients) (3.5% and 2.6%, respectively). However, cough and rhinorrhea were more common in the late patients (14.0% and 3.3%, respectively) than in the early patients (5.0% and 0.0%, respectively). Patients who were closer to the accident site more often had shortness of breath and sputum as the chief complaints than patients who were farther away. The mean serum calcium concentration was 9.37 mg/dL (range: 8.4-11.0 mg/dL); none of the patients had a decreased serum calcium level. Among 48 pulmonary function test results, 4 showed decreased lung function. None of the patients had abnormal urine fluoride levels on the eighth day after exposure. CONCLUSIONS: Patients hospitalized due to chemical hazard release of hydrogen fluoride had acute respiratory, gastrointestinal, and neurologic health problems. Non-hospitalized patients have acute symptoms mainly related to upper respiratory irritation.
Burns ; Calcium ; Chemical Hazard Release ; Cough ; Dyspnea ; Fluorides ; Gyeongsangbuk-do ; Headache ; Hemoptysis ; Hospitals, General ; Humans ; Hydrofluoric Acid* ; Hydrogen* ; Korea ; Lip ; Lung ; Medical Records ; Nausea ; Neurologic Manifestations ; Pharyngitis ; Respiratory Function Tests ; Sputum