http://coursematerials.net/emh201/unit6_scenario/index.html#/ Overview: Step 3 of the THIRA process establishes capability targets based on risks previously identified in Step 1 and Step 2. For the Gr
EMH201 – Risk and Vulnerability
Assessment
Course Project: THIRA Step 3 Worksheet
Review the scenario below and use the Target Capabilities List (TCL) document to fill in the worksheet.
Many trains traveled through the quiet mill town each day. A rail spur in the center of the town serviced the Avondale plant, which employed most of the town’s citizens and received daily deliveries of chlorine gas via a Norfolk Southern train for mill operations. The switch connecting the spur to the main line had to be turned manually for deliveries. Contributing to the failure, no feature or mechanism existed to remind crewmembers of the switch position and prompt them to complete the switch before departing the work site. The investigative team of the National Transportation Safety Board (NTSB) concluded that “the distance required for the [moving] train[‘s] crew to perceive the banner of the misaligned switch, react to it, and brake the train to a safe stop was greater than the distance available” (2).
The chlorine spill occurred as the result of a train crash at 2:39 a.m. on January 6, 2005, after someone forgot to toggle the switch to disconnect a spur from the main line (Figure 2). The incorrectly toggled switch mistakenly diverted Freight Train 192 from the main line onto the spur at 47 mph (76 km/h). Train 192 subsequently collided into parked Train P22, derailing three engines and 18 cars (3). Roughly 60 tons of liquefied chlorine gas spilled out of the ninth of 42 freight cars. The liquefied gas rapidly vaporized, with volumetric expansion 450:1 (4).
The engineers were unharmed in the crash; however, the deadly chlorine gas seeped through the air. The crash sound awakened local residents, and initial notification came through a 911 call within 1 min. The Aiken 911 call record indicated reports of a “bleach gas smell and smoke on the ground,” and at least one caller identified chlorine (5). Fire and rescue services responded within 1 min of notification and were enroute within one more minute; however, upon hearing a radio report of a “smell of chemicals,” the fire department chief ordered responders to stand by. Within 6 min, the fire department chief stood 1,000 ft (305 m) from the crash and was forced to withdraw lest he be overcome by chlorine fumes, which were spreading rapidly and approaching critically toxic levels. Within 13 min, the chief recognized the need for a mass evacuation and relocated upwind. Emergency responders marshaled personnel and equipment, established incident command, requested mutual aid, activated Reverse 911 with instructions to shelter in place, and initiated a major evacuation (6). However, these actions did not take place with immediacy and efficiency.
About 5,400 residents were evacuated. The chlorine gas had already affected many people: 554 were treated at hospitals, 75 were admitted, and nine would eventually die from its poison (2): the train’s engineer (who had survived the crash), three workers in the mill, a truck driver sleeping in his cab, a man in a shack one block from the wreckage, two workers who had evacuated the mill on foot into the woods, and one other person (7).
| Risk item | Contextual Description | Core Capability & Mission Area | Critical Task & Page # | Target Capability |
| Residential Alerts & Warnings | Considerable delays alerting the public were encountered after the initial train wreck and subsequent chlorine release. | Public Information & Warning (Response mission area) |
Page 422 | Within 3 months, develop a crisis and emergency risk communications plan that can contact at least 160,000 people on a continuous basis (24/7/365). |
| Emergency Operations Center | The activation of an Emergency Operations Center (EOC) was a slow process due to the early hour of the incident and the lack of a dedicated facility. | Operational coordination (Response mission area) |
Page 210 | Within 1 year, create 1 centrally located EOC, and within 3 months, create a backup EOC that can be activated and manned within 1 hour of initial notification. |
| Emergency Dispatching | Initial incident information sharing was hampered due to incompatible radio frequencies used. | Operational coordination (Response mission area) |
Page 209 | Within 30 minutes of an incident, verify that all critical communications links are fully operational; test every link/circuit/system 3 times per week to ensure availability. |
| Inadequate hazardous chemical detection | Law enforcement and fire personnel lacked adequate chemical detection equipment to classify and monitor toxic levels on scene. | WMD and Hazardous Materials Response and Decontamination (Response mission area) |
Page 361 | Within 3 weeks, develop plans for pre-identified and equipped hazmat personnel to respond to hazmat incidents; once plans are developed, provide initial rapid hazmat incident size-up within 30 minutes from notification (< 2hrs if regional resource) are in place. |
| Inadequate hazardous chemical decontamination | On scene, personnel lacked adequate equipment to decontaminate victims and first responders entering/exiting the hot zone. | WMD and Hazardous Materials Response and Decontamination (Response mission area) |
Page 367 | Within 2 hours of arrival, decontaminate 100% of all persons affected by hazardous materials identified. |
| Inadequate hazardous chemical identification | The incident commander presumed, but could not confirm, a chlorine leak following the train derailment. | On-scene protection, law enforcement, and security (Response mission area) |
| Within 1 hour of arrival on scene, provide on-scene commander a preliminary estimate detailing the number of victims exposed to toxic/hazardous material and source identification obtained from at least 3 different instrument technologies. |
| Inadequate hazardous chemical protective equipment | First responder personnel lacked adequate personal protective equipment (PPE) to rescue, recover, enter, and exit the hot zone. | On-scene protection, law enforcement, and security (Response mission area) | Res.B2b 3.2.6.2 Page 363 | Within 15 minutes from arrival on scene, first responder/hazmat personnel appropriately don and wear personal protective equipment per Incident Action Plan (IAP) |
| Freight carrier disruptions; debris blocking routes | Rail cars littered north and southbound tracks of major freight routes for weeks after the incident was resolved. The debris was contaminated and in need of cleaning prior to removal. | Economic recovery (Recovery mission area) | Rec.C3b 3.2 Page 568 | Within 48 hours of the incident occurring, remove debris and restore the area to allow the resumption of safe rail operations. Within 3 months, develop and execute an economic recovery plan, with stakeholder participation throughout |
| Mass victim transport | Local ambulance carriers were overwhelmed by requests for victim transport; school buses were pressed into service, but many residents self-evacuated and/or sheltered in place due to confusion generated by the incident. | Mass care services (Response mission area) | Res.C1b 1.14.1 Page 449 | Within 2 hours of the initial notification, provide evacuation transportation assets and notify receiving facilities with adequate assets. Within 3 months, develop a mass care plan with stakeholder participation throughout |
| Victim treatment at local hospitals | Contaminated victims presenting at the local hospital overwhelmed treatment room capabilities and cross-contaminated emergency rooms; the local hospital had 1 doctor on duty at the time of the incident, and victims began presenting themselves at 3:00 am, Jan. 6, 2005 | Mass care services (Response mission area) | Res.C1b 1.5.1 Page 449 | Within 30 minutes of the initial notification, the healthcare system is ready to receive and appropriately treat specific casualties or illnesses. |
| Exposure to chlorine long-term health effects | Residents of Graniteville were not monitored by public health professionals after the incident was resolved due to a lack of treatment records and patient baselining. | Health & Social Services (Recovery mission area) | Res.C1b 4.6 Page 454 | Within 30 minutes of the initial notification, the healthcare system is ready to receive and appropriately treat specific casualties or illnesses. Within 3 months, develop a mass care plan with stakeholder participation throughout. |
| Resident evacuation | Residents were not provided shelter in place or evacuation procedures; those who immediately evacuated became contaminated, while those who remained near the incident site for up to 7 days after the initial train wreck became contaminated. | Environmental Response/Health & Safety (Response mission area) |
Res.B.3a 1 Page 377 | Informational materials for use in citizen preparedness for evacuation and shelter-in-place have been developed and coordinated with public education/citizen preparedness programs on procedures and guidance for biological and chemical hazards. Within 3 months, develop a mass evacuation plan, with stakeholder participation throughout |
| Law Enforcement lacked protective equipment. | Responding Sheriff Deputies lacked protective clothing and breathing equipment to occupy and enforce a protective zone around the incident scene. | Environmental Response/Health & Safety (Response mission area) |
Res.B1b 2.1.1 Page 251 | Within 3 months, 100% of responders capable of using PPE (e.g., responders are fitted and medically cleared to use necessary PPE) so that they have the necessary health and safety training to perform their anticipated tasks (e.g., awareness level, technician level, etc.) in response to an incident. |
| Local search & rescue | Residents in the immediate area of contamination were unsure of shelter in place, evacuation routes, and safe distance rally points after the incident occurred. | Mass search & rescue operations (Response mission area) | Res.B.3a 1 Page 377 | Informational materials for use in citizen preparedness for evacuation and shelter-in-place have been developed and coordinated with public education/citizen preparedness programs on procedures and guidance for biological and chemical hazards. Within 3 months, develop a mass evacuation plan, with stakeholder participation throughout. |
| Inadequate mutual aid agreements | Graniteville lacked expertise in the development, exercise, and socialization of mutual aid agreements with surrounding communities. | Planning (Response/Mission Area mission area) | ComA 1 Page 22 | Within 3 months, develop Regional and State/local strategic plans including, but not limited to, the national mission areas of preventing, protecting against, responding to, and recovering from man-made and natural disasters and acts of terrorism. Every 12 months, plans are reviewed and updated in accordance with Federal, State, and local regulations and policies. |
| Inadequate rail switch equipment | Workers at Avondale Mill incorrectly set the rail switch to the wrong position, resulting in the train being re-directed to the wrong route where another train was parked. | Critical transportation (Response mission area) | Rec.C3b 3.2 Page 568 | Within 48 hours of the incident occurring, remove debris and restore the area to allow the resumption of safe rail operations. Within 3 months, develop and execute an economic recovery plan, with stakeholder participation throughout |
| On-scene command & control | The incident command for on-scene control of the incident was fractured due to a lack of experienced/trained personnel and equipment. | On-scene security & protection (Response mission area) | Res.B1a 4.2 Page 199 | Within 5 minutes of the first arrival on scene, establish incident command per NIMS guidance and ICS procedures. |
| Evacuee food support | Victims lacked access to food and food preparation facilities after the incident for up to 9 days. | Mass Care (Respond mission area) | Res.C3a 3.7.1 Page 496 | Within 2 hours from initial notification, the mass care plan is activated, and services are acquired. Within 3 months, develop a mass care plan with stakeholder participation throughout. |
| Evacuee water support | Victims lacked access to adequate water after the incident was resolved | Mass Care (Respond mission area) | Res.C3a 3.7.1 Page 496 | Within 2 hours from initial notification, the mass care plan is activated, and services are acquired. Within 3 months, develop a mass care plan with stakeholder participation throughout. |
| Evacuee housing support | Victims lacked adequate housing after the incident was resolved. | Mass Care (Respond mission area) | Res.C3a 3.7.1 Page 496 | Within 2 hours from initial notification, the mass care plan is activated, and services are acquired. |
Resources
US Department of Homeland Security. (2007, September). Target capabilities list
(TCL): A companion guide to the national preparedness guidelines. Washington, DC.
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