A Blast in the Backyard: The Role of EMS in Hazmat Disasters

On Friday, June 21, 2019, a massive explosion at an oil refinery shook South Philadelphia and portions of southern New Jersey at approximately 0400. Residents woken by the blast reported rattled windows, objects knocked from shelves, and reverberations felt through houses. A leak from a process unit containing various hydrocarbons and hydrofluoric acid (HF) at the Philadelphia Energy Solutions (PES) oil refinery sparked the three-alarm fire, which caused several explosions that produced large mushroom clouds.   

“It was not an ordinary three-alarm fire by any stretch of the imagination,” says Adam Thiel, the Philadelphia Fire Department (PFD) commissioner and director of the Philadelphia Office of Emergency Management. The fire was extinguished after two days but was not considered under control for nearly three months as local, state, and federal agencies worked together to neutralize nearly 340,000 pounds of HF, a chemical used to make high-octane gasoline, refrigerants, pharmaceuticals, and other household materials.¹ “This was a very high-risk, low-frequency type of incident,” says Thiel.

Ready for the Threat of Chemical Incidents

Of course, “low-frequency” doesn’t mean planning and preparation is unwarranted. 

Built in 1870, the 1,400-acre PES facility is the east coast’s largest oil refinery and has a long history of fires dating back to 1931, the most notable being a 1975 blast that killed eight firefighters.^2,3 The threat of hazmat events keeps PFD crews training regularly and ready at all times for large-scale incidents like the 2019 fire. Serving a densely populated city of more than 1.5 million that is home to the busiest ambulance service in the country, a large seaport, and a major international airport, PFD must be prepared for a wide range of incidents.⁴

While the hazardous-materials task force is trained at the technician level and EMTs, paramedics, and firefighters are trained at the operational level, Thiel says it’s critical his department focuses on keeping EMS crews on their toes in training for hazmat injury treatment, given the number of chemicals involved in the PES facility’s oil-refining process. 

“There are some important EMS considerations besides what you typically think of with refineries, which are fires and explosion hazards,” says Thiel. “We had this highly toxic material, so there are concerns around having antidotes and topical treatments for people exposed to the product directly. Going forward we’re continuing to look at what kinds of health and medical impacts hazmat releases could have and making sure we’re prepared for that aspect too.”

PFD responded with approximately 150 firefighters, EMS providers, and other emergency personnel, along with nearly 50 vehicles and apparatus, but operated under a unified command with the refinery’s private fire brigade. Multiple agencies assisted with the response and ongoing management of the incident, such as FEMA, IMAAC (the Interagency Modeling and Atmospheric Assessment Center), PEMA (the Pennsylvania Emergency Management Agency), the EPA, the ATF, the DoD, the fire marshal’s office, and others. “This was a truly multidisciplinary event. We got a lot of great support from our partners,” says Thiel. 

As with any other incident, Thiel says, having good relationships with other players in the field contributed to the successful response to the fire. These included the refinery, its fire brigade, and familiarity with the site itself prior to the fire. Mutual aid plans already existed in anticipation of an incident like this one. He advises fire departments, EMS agencies, and emergency managers to ensure they have subject matter experts on hand in the event their communities experience a hazmat incident, particularly if industrial sites like a refinery are nearby.

Stop the Burn

“If you’re in an industrial community where HF is known to be used, know the risks and understand the treatment,” says Randy Kearns, DHA, assistant professor in the College of Business Administration at the University of New Orleans and retired clinical assistant professor at the University of North Carolina School of Medicine. “Calcium gluconate should be available to the EMS crew… Where [HF] is used in higher concentrations, it’s essential.”

With patients, focus on stopping the burn before relieving the pain—small amounts of HF can be lethal if treatment is delayed, Kearns says. Death can occur from 1% total body surface area (TBSA) exposure to HF with a concentration of 50% or greater.⁵ 

When treating a patient exposed to HF in an industrial setting, the EMS provider should don PPE before initiating treatment. Follow standard decontamination procedures: Remove the patient from the area of exposure, strip soiled clothing, and irrigate wounds with water. Exposure to this highly corrosive agent can cause systemic toxicity secondary to deep tissue damage, resulting in hypomagnesemia, hypocalcemia, and potentially fatal dysrhythmias.⁶ In these cases Kearns notes an ECG reading may mimic a calcium channel blocker overdose. Look for bradycardia and prolongation of the QT interval, which indicate a need for an IV solution of either calcium chloride or calcium gluconate.

An HF burn might not be immediately apparent, so pain is often out of proportion to the appearance of the skin, though skin may eventually present with erythema, edema, and necrosis.⁷ The extent of injury depends on duration of exposure, concentration of the HF, and route of exposure (oral, dermal, ocular).⁸ If a patient has inhaled or ingested HF, provide 100% humidified oxygen with 2.5% nebulized calcium gluconate.^5,6 Topical treatment involves applying a generous amount of calcium gluconate gel on the exposed area (you can also mix 75 mL of K-Y or another water-soluble jelly with 25 mL of 10% calcium gluconate).⁶ This will help prevent further damage to the tissue and helps with pain relief.

With the assistance of local hospitals, Thiel says PFD had previously been equipped with supplies and medications to treat chemical injuries, and crews are provided the most current training available to properly administer these treatments. PFD EMS was on standby 24/7 during and following the event, particularly for the hazmat team performing air-monitoring tests and contractors hired by the refinery to remove HF from the grounds, says Thiel. 

“Make sure you get hazardous-materials expertise on what’s happening in a site like this,” he says. “We made sure the large-scale contingency plans were synced up with questions of, ‘What happens if one of the workers is exposed to HF? How do we decontaminate them? How and where do we treat them? Where do we transport them?’”

Working in a setting as complex as an oil refinery with so many unknowns, Thiel says crews followed the mantra “trust but verify” throughout the incident. “This is what we do: We manage chaos, and this certainly was a chaotic situation,” he says. “I’m very proud of all of our first-arriving firefighters, chiefs, medics, and all the support agencies. They really did a great job.”  

Sidebar: Communications in Crises

Coordinated communication between public safety agencies is vital during a critical incident, but equally important is communication with the public. The Philadelphia OEM alerted the surrounding community early on the morning of the explosion with a shelter-in-place order, and Thiel held regular media briefings to keep the public apprised of the latest on the neutralization process of nearly 340,000 pounds of HF at the refinery.⁹

“A crucial aspect of crisis communication is being timely,” says Carl Cowan, assistant director of emergency management at Harvard Medical School. “Large refineries possess a substantial hazard burden. Any significant incident involving critical infrastructure will generate public interest, and there may be hazards to the community that need to be conveyed.”

Granted, there is a discovery period in the beginning of major incidents, Cowan says, where the scale is being evaluated and additional resources are being mobilized. This is especially true of events involving chemical hazards, so “it’s essential to have emergency managers or public information officers available who are empowered to send emergency alerting or provide community guidance.” 

Sharing logistics and facts is only half of what communications with the public should entail—consider the human part of it too. “Expressing empathy demonstrates caring,” says Cowan. “Communicating through legalese or jargon will not accomplish this. Using clear, relatable language helps the public receive and trust your messaging.”

Timeline of Events

June 21, 2019

• 4:00 a.m.—A Philadelphia Energy Solutions (PES) dispatcher sounds an alarm, broadcasting a warning to workers about a leak in Unit 433. The first explosion occurs in the middle of his transmission.
• 4:05 a.m.—The first alarm is struck by Philadelphia Fire Department (PFD).
• 4:20 a.m.—PFD strikes a second alarm.
• 4:22 a.m.—A second explosion occurs, large enough to be captured by weather satellites.
• 4:24 a.m.—PFD strikes a third alarm.

Early in the incident, an unidentified PES operator in the central control room initiates a rapid deinventory to move the hydrogen fluoride to a different container, likely preventing the release of a deadly cloud of the chemical that could have spread seven miles in 10 minutes. One PES worker calls her a “hero” who might have “saved the city.”

• 5:00 a.m.—Mayor Jim Kenney is alerted to the fire.
• 5:41 a.m.—The Philadelphia OEM advises residents to shelter in place.
• 7:07 a.m.—The shelter-in-place order is lifted.
• 8:30 a.m.—Mayor Kenney meets with city officials at the emergency operations center before announcing a task force would investigate the incident.
• 9:37 a.m.—The Philadelphia Health Department reports Air Management Services determined air samples taken at the scene did not contain hydrogen sulfides, carbon monoxide, or hydrocarbons in the surrounding vicinity.
• 9:57 a.m.—PES informs the media that three explosions occurred at an alkylation unit.
• 2:43 p.m.—PES issues an announcement stating a small fire remained at the unit.

June 23, 2019

• 5:31 p.m.—PES confirms the fire has been suppressed and HF readings are at normal levels.

—Source: McCoy CR, Bender W. Refinery explosion. Philadelphia Inquirer, 2019 Jun 29;  www.inquirer.com/news/philadelphia-refinery-fire-explosion-timeline-hero-rescuers-20190629.html.

References

1. Centers for Disease Control and Prevention, Emergency Preparedness and Response. Facts About Hydrogen Fluoride (Hydrofluoric Acid), https://emergency.cdc.gov/agent/hydrofluoricacid/basics/facts.asp.

2. Goodin-Smith O, Gambardello JA. Philadelphia oil refinery to close: What you need to know. Philadelphia Inquirer, 2019 Jun 28; https://www.inquirer.com/business/philadelphia-refinery-fire-oil-energy-solutions-close-20190626.html.

3. Rush M. In Philly, a history of oil refinery fires going back decades. Philadelphia Inquirer, 2019 Jun 21; www.inquirer.com/news/philadelphia-refinery-fire-history-of-explosions-timeline-20190621.html.

4. EMS World. Firehouse Run Report 2019: The Country’s Busiest Departments and Ambulances, 2019 Dec 1; www.emsworld.com/article/1223594/firehouse-run-report-2019-countrys-busiest-departments-and-ambulances.

5. Murray B, Long B. Hydrofluoric acid: The Burn that keeps on Burning. emDocs, 2016 Dec 5; www.emdocs.net/hydrofluoric-acid-burn-keeps-burning/.

6. Kearns RD, Cairns CB, et al. Chemical burn care: A review of best practices. EMS World, 2014 May; 43(5): 40–45.

7. Wilkes G. Hydrofluoric Acid Burns. Medscape, https://emedicine.medscape.com/article/773304-overview.

8. Denney B. Hydrofluoric Acid: What You Need to Know. EMS World, 2010 Apr 28; www.emsworld.com/article/10319665/hydrofluoric-acid-what-you-need-know.

9. Chinchilla R, Lozano AV. 340K Pounds of Hydrofluoric Acid ‘Neutralized’ Following South Philly Refinery Fire. Philadelphia Inquirer, 2019 Aug 31; www.nbcphiladelphia.com/news/local/refinery-fire-officials-updates-philadelphia-energy-solutions/166123/.

Valerie Amato, NREMT, is the associate editor of EMS World.