Baxter P J, Heap B J, Rowland M G, Murray V S
University of Cambridge Clinical School, Addenbrooke's Hospital, Cambridge.
Occup Environ Med. 1995 Oct;52(10):694-8. doi: 10.1136/oem.52.10.694.
To review the role of a medical team in the emergency management of a major polyvinyl chloride (PVC) fire in an urban area.
The district health authority's consultant in communicable disease control (CCDC) was requested to advise on the health impacts of a fire that consumed some 1000 tonnes of plastic, mainly PVC, over 72 hours and which emitted a large smoke plume that threatened the health of local residents and emergency workers alike, constituting one of the largest incidents the local emergency services had dealt with in recent years. A medical team was formed comprising the CCDC, a regional epidemiologist, an occupational physician, and a medical toxicologist. This paper is an account of this team's experience of advising on the medical management of the emergency without having any formally established role or previous training for the task.
The main issues requiring the input of the medical team included: the possible products of combustion and their effects on health; the clinical management of those exposed; the alerting of local hospitals to the type of casualties to expect; the special health risks posed to emergency workers, especially the firemen; the need for evacuation of local residents; the risks of contamination of soil, water, and crops; the potential health impact of the plume; and the provision of expert and authoritative advice on the short and long term health implications to the public. Active surveillance systems, which included the local general practitioners and hospitals, were established and air monitoring instigated. The 46 casualties were restricted to emergency personnel who had inadvertently received exposure to the fire smoke: all recovered within 48 hours. Local residents were unharmed.
The incident showed the need for preventive medical teams trained to fill a formal advisory and investigative role for chemical releases and fires, and which can play an integral part in emergency management.
回顾医疗团队在城市地区重大聚氯乙烯（PVC）火灾应急管理中的作用。
应要求，地区卫生当局的传染病控制顾问（CCDC）就一场火灾的健康影响提供建议。这场火灾在72小时内烧毁了约1000吨塑料，主要是PVC，释放出大量浓烟，威胁到当地居民和应急人员的健康，这是当地应急服务部门近年来处理的最大事件之一。组建了一个医疗团队，成员包括CCDC、一名区域流行病学家、一名职业医师和一名医学毒理学家。本文讲述了该团队在没有任何正式既定角色或先前任务培训的情况下，就该紧急情况的医疗管理提供建议的经验。
需要医疗团队介入的主要问题包括：燃烧可能产生的产物及其对健康的影响；对暴露者的临床管理；提醒当地医院预计的伤亡类型；应急人员尤其是消防员面临的特殊健康风险；当地居民疏散的必要性；土壤、水和农作物污染的风险；烟雾对健康的潜在影响；以及就对公众短期和长期健康影响提供专业权威建议。建立了包括当地全科医生和医院在内的主动监测系统，并启动了空气监测。46名伤亡人员均为意外接触火灾烟雾的应急人员：所有人在48小时内康复。当地居民未受伤害。
该事件表明需要有经过培训的预防性医疗团队，以便在化学品泄漏和火灾方面发挥正式的咨询和调查作用，并能在应急管理中发挥不可或缺的作用。
