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On April 17, 2013, a fire and massive explosion occurred at the West Fertilizer Company, a fertilizer storage and distribution facility in West, Texas.

EDITOR’S NOTE: The following is the first part of a two part series on responsibilities of communities, companies and first responders when it comes to chemical safety incidents. Next week will show two additional case histories where the community, company and first responders needed to work in sync.

Effective emergency response training and planning, as well as communication between a company, emergency responders, and the community, are critical to preventing injuries and fatalities from chemical incidents.

First responders, companies, and residents all play a crucial role in ensuring risks and hazards present in the community are well-understood, and there are ongoing discussions on how to mitigate or respond to them.

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The Chemical Safety Board (CSB) highlights key responsibilities of first responders, communities, and companies pertaining to responding to chemical incidents:

Responsibilities of first responders
• Have proper hazmat training and equipment
• Conduct frequent drills and exercise plans to respond to possible chemical releases
• Communicate with the companies in their communities that deal with chemicals
• Know the key facility contacts in an emergency

Responsibilities of communities
• Understand the hazards of the chemicals used at the facilities in your community
• Support and maintain active local emergency planning committees (LEPCs) and up-to-date community response plans and teams
• Develop detailed evacuation and shelter-in-place plans that identify when and how community members are to respond to different types of emergencies
• Establish redundant communication systems to notify residents of a chemical emergency

Responsibilities of companies
• Maintain current emergency response plans
• Communicate frequently and openly with residents, businesses, and emergency management officials about chemical hazards in their community and emergency response plans
• Train employees to respond properly to chemical emergencies and to evacuate when appropriate

The following two investigation summaries highlight key findings surrounding these critical areas:

Bayer CropScience pesticide waste tank explosion August 28, 2008: 2 fatalities, 8 injuries

On August 28, 2008, at 10:35 pm, a runaway chemical reaction occurred inside a 4,500-gallon pressure vessel known as a residue treater, causing the vessel to explode violently in the methomyl unit at the Bayer CropScience facility (“Bayer”) in Institute, West Virginia. Highly flammable solvent and toxic insecticide residue sprayed from the vessel and immediately ignited, causing a fire that burned for more than four hours. Two employees died. A shelter-in-place order was issued for approximately 40,000 residents, which was lifted roughly three hours later.

Key Findings
The CSB found poor communications during the incident between Bayer incident command system personnel and the local emergency response agency confused emergency response organizations and delayed the community shelter-in-place notification. The CSB noted Bayer did not assign a Public Information Officer to directly communicate with the public and Metro-9-1-1 (the local 911 dispatch service). The Kanawha Putnam Emergency Management Plan did not adequately address emergency response personnel responsibilities and communications between the facility incident command system personnel and outside emergency response organizations when a facility owner leads the incident command system during an on-site emergency involving hazardous chemicals.

Bayer CropScience pesticide waste tank explosion on August 28, 2008 left two dead and eight injured after a runaway chemical reaction occurred inside a 4,500-gallon pressure vessel.

The Kanawha Valley, where Bayer is located, has many facilities that handle large quantities of hazardous materials. Yet, the CSB noted the local government does not have the authority to directly participate in facility safety planning and oversight even though many community stakeholders have campaigned for such authority. The CSB recommended the local government establish a program to improve stakeholder awareness, evaluate emergency response plans and written safety plans, and provide for public participation and collaboration. That recommendation has not yet been implemented.

West Fertilizer explosion and fire April 17, 2013: 15 fatalities, over 260 Injuries

On April 17, 2013, a fire and massive explosion occurred at the West Fertilizer Company (“West”), a fertilizer storage and distribution facility in West, Texas. The incident killed 12 volunteer firefighters and three members of the public. The blast destroyed the West facility and caused widespread damage to more than 150 offsite buildings. The explosion occurred approximately 20 minutes after the first signs of a fire were reported to the local 911 emergency response dispatch center. Several local, volunteer fire departments responded to the facility, which had a stockpile of between 40 and 60 tons of fertilizer grade ammonium nitrate, or FGAN.

Key Findings
The CSB found this incident demonstrated the need for effective pre-incident planning and firefighter training, noting firefighters are expected to make risk assessments and decisions under time pressure with limited visibility during an actual response to a fire, which is almost impossible without adequate training. The CSB found the West Volunteer Fire Department did not conduct pre-incident planning or response training in West, was likely unaware of the potential for FGAN detonation, did not take recommended incident response actions at the fire scene, and did not have appropriate training in hazardous materials awareness and response or FGAN-related fire emergencies.

CSB identified seven key factors that contributed to the firefighters’ and emergency responders’ fatalities in West:

1. Lack of incident command system. None of the responding emergency response personnel formally assumed the position of incident commander who would have been responsible for conducting and coordinating an incident command system.
2. Lack of established incident management system. Emergency response personnel who responded to the incident did not take time to set up, implement, and coordinate an effective incident management system plan that would have ensured evacuation of nearby residents. In addition, emergency alert systems for the public were not activated before the explosion. Without a formal evacuation order to the entire affected community, residents were unaware of the risk and chose to watch the fire from inside their homes or vehicles, placing them within range of the high-pressure blast wave and in the line of flight of debris.
3. Lack of hazardous materials and dangerous goods training. The CSB found no standardized training requirement applies to volunteer firefighters across the nation, while career firefighters have a standardized basic minimum training requirement. Some volunteer firefighters therefore do not receive any major type of course training, and most of their initial training is usually on-the-job experience.
4. Lack of knowledge and understanding of the detonation hazards of FGAN. The firefighters did not have sufficient time and information to properly assess the West facility and evaluate the behavior of the FGAN-related fire. Consequently, they had no expectation of a possible FGAN explosion. The CSB evaluated training for firefighters in Texas and found FGAN explosion hazards were not covered at all. The lack of adequate hazardous materials training and the lack of FGAN firefighting guidance contributed to the deaths of the emergency responders.
5. Lack of situational awareness and risk assessment knowledge on the scene of an FGAN-related fire. None of the firefighter hazardous materials field training courses provide sufficient information on firefighter situational awareness and risk assessment for the plant, which would have assisted them to make informed decisions while at the fire scene. As a result, the firefighters did not have the tools to effectively perform the situational awareness and risk assessment that would have enabled them to make an informed decision to not fight the fire.
6. Lack of pre-incident planning at the West facility. The fire department did not have a formal pre-incident planning program for FGAN at West, nor did they anticipate a possible FGAN explosion. Onsite pre-incident planning with clear information on the magnitude of the hazards may have identified the possible FGAN explosion hazard.
7. Limited and conflicting technical guidance on ammonium nitrate. Conflicting information in various emergency response guidelines prevented emergency responders from fully understanding the hazards of FGAN.

CSB made several recommendations concerning adequate FGAN training to the Federal Emergency Management Agency (FEMA), the Texas Commission on Fire Protection, the State Firefighters’ and Fire Marshals’ Association of Texas, and the Texas A&M Engineering Extension Services (“TEEX”). In 2016, FEMA awarded two grants of a million dollars each to the Georgia Tech Research Institute and the International Association of Fire Fighters to develop and deliver training focused on FGAN hazards. Due to the responsiveness and speed with which FEMA acted upon the CSB’s recommendations and its responsiveness to the lessons learned from the West investigation, the Board voted to designate the two recommendations to FEMA as “Closed-Exceeds Recommended Action.” In 2017, TEEX finalized extensive training on FGAN which they provide several times a year to firefighters across the state of Texas.

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