February 16, 2009 By Karen Stewartson
Imagine working in an environment where more than 50 languages are spoken. How would first responders communicate with the victims during an emergency?
In February 2004, this was an issue for more than 2,000 employees at the John Morrell pork plant in Sioux Falls, S.D., when ammonia diffused throughout the facility, causing a mass evacuation during frigid winter temperatures. More than 100 people were injured. Erroneous calls and a major language barrier hindered the Sioux Falls Fire Department's initial stages of response.
"Initially the call was [that] someone was injured in a piece of machinery, and it was later changed to a minor fire," said Jim Sideras, the department's fire chief. "When crews got there it was just one fire truck and then they realized that it was a significant event. The first call always seems to be wrong."
Ammonia - a colorless, pungent gas - is commonly used as a refrigerant and for food preservation at meatpacking facilities. Exposure to the gas usually causes irritation to the respiratory system, eyes and skin. Though the gas is mostly harmless in small doses, inhalation in high concentrations can cause lung damage and even death.
Because ammonia is considered a toxic chemical, the U.S.
Occupational Safety and Health Administration requires that it be handled as a hazardous waste, which meant response needed to be swift, organized and well executed, despite all the obstacles.
With so many variables involved - lack of equipment, communication barriers and weather - emergency responders faced many hurdles to gain control of the situation.
The response was divided into three operations: a rescue operation to evacuate people who were in the plant; a hazardous materials operation to handle the leak; and an emergency medical services (EMS) branch to provide medical treatment.
EMS used START triage - simple triage and rapid transport/treatment - for casualty care. START triage classifies the severity of casualties by the colors red, yellow, green or black using an RPM (respiratory, perfusion and mental status) system.
"When you think about RPMs, you think about cars and what a red line is. When the respirations are over 30 [per minute] they're going to be classified as red. If they have a capillary refill, which means you push down on your thumbnail and it's longer than two seconds [for color to return], that is going to be a red," Sideras said. "What that means is they are not perfusing very well and might have internal bleeding or hemorrhaging. So that's what "P" is: perfusion. The M is mental status. If they can't answer simple questions and squeeze my fingers, they could have a head injury. So those would be classified as red."
START is a simple method, but triage tags are a necessity that was lacking during the pork plant response. "We didn't have a consistent triage tag for our system. It sounds like a minor thing, but it really wasn't," Sideras said. "Having a consistent triage tag ensures that every responder is going off the same triage tags."
Emergency responders worked around this obstacle by using ribbons, but South Dakota has since implemented statewide triage tags, which means care is consistent and responders are on the same page.
The wintry weather and communication barriers - multiple spoken languages and inconsistent radio reception - were other obstacles for first responders. "One of the difficulties was that the incident happened in February and in South Dakota it's about 10 degrees out," Sideras said, adding that responders weren't prepared to handle