Search Our Scientific Publications & Authors

Prehosp Disaster Med 2019 Apr 14:1-6. Epub 2019 Apr 14.

2.Department of Emergency Medicine, Division of Disaster Medicine,Beth Israel Deaconess Medical Center,Boston, Massachusetts,USA.

Introduction: The recent increase in natural disasters and mass shootings highlights the need for medical providers to be prepared to provide care in extreme environments. However, while physicians of all specialties may respond in emergencies, disaster medicine training is minimal or absent from most medical school curricula in the United States. A voluntary Disaster Medicine Certificate Series (DMCS) was piloted to fill this gap in undergraduate medical education. Read More

Sci Total Environ 2019 May 14;665:937-943. Epub 2019 Feb 14.

Department of Defence, Technical Support Working Group, Combating Terrorism Technical Support Office, US Government, Virginia, USA; Emergency Response TIPS, LLC, Virginia, USA.

Permeation of oxides of nitrogen and sulfur gases through skin and the consequences of dermal exposure are still poorly understood. We measured the penetration profile of three common industrial gases through skin, for short-term exposures relevant to HAZMAT scenarios. Time variations of gas concentration, clothing effects, temperature and humidity on epidermal absorption and penetration were assessed. Read More

J Med Internet Res 2019 Feb 19;21(2):e12894. Epub 2019 Feb 19.

School of Psychiatry, Faculty of Medicine, University of New South Wales, Randwick, Australia.

Background: A growing body of research suggests that resilience training can play a pivotal role in creating mentally healthy workplaces, particularly with regard to protecting the long-term well-being of workers. Emerging research describes positive outcomes from various types of resilience training programs (RTPs) among different occupational groups. One specific group of workers that may benefit from this form of proactive resilience training is first responders. Read More

J Expo Sci Environ Epidemiol 2019 Feb 15. Epub 2019 Feb 15.

Emergency Response TIPS, LLC, Alexandria, VA, USA.

The toxic release of aldehyde vapours during a hazardous material (HAZMAT) incident primarily results in respiratory concerns for the unprotected public. However, skin absorption may be an important concurrent exposure route that is poorly understood for this scenario. This study provides experimental data on the skin absorption properties of common aldehydes used in industry, including acetaldehyde, acrolein, benzaldehyde and formaldehyde, in gaseous or vapour form using an adapted in vitro technique. Read More

Temperature (Austin) 2018 29;5(4):348-358. Epub 2018 Jul 29.

Institute of Health and Biomedical Innovation, School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia.

Despite extensive documentation directed specifically toward mitigating thermal strain of first responders, we wished to ascertain the degree to which first responders applied cooling strategies, and what opinions are held by the various agencies/departments within the United States. An internet-based survey of first responders was distributed to the International Association of Fire Chiefs, International Association of Fire Firefighters, National Bomb Squad Advisory Board and the USA Interagency Board and their subsequent departments and branches. Individual first responder departments were questioned regarding the use of pre-, concurrent, post-cooling, types of methods employed, and/or reasons why they had not incorporated various methods in first responder deployment. Read More

Emerg Med J 2019 Feb 1;36(2):117-123. Epub 2018 Dec 1.

Research Centre for Topical Drug Delivery and Toxicology, University of Hertfordshire, Hatfield, UK.

The UK is currently in the process of implementing a modified response to chemical, biological, radiological and nuclear and hazardous material incidents that combines an initial operational response with a revision of the existing specialist operational response for ambulant casualties. The process is based on scientific evidence and focuses on the needs of casualties rather than the availability of specialist resources such as personal protective equipment, detection and monitoring instruments and bespoke showering (mass casualty decontamination) facilities. Two main features of the revised process are: (1) the introduction of an emergency disrobe and dry decontamination step prior to the arrival of specialist resources and (2) a revised protocol for mass casualty (wet) decontamination that has the potential to double the throughput of casualties and improve the removal of contaminants from the skin surface. Read More

Bioethics 2019 Feb 27;33(2):267-273. Epub 2018 Nov 27.

Philosophy, Northern Illinois University, DeKalb, IL, USA.

According to the causal theory of parenthood, people incur parental obligations by causing children to exist. Proponents of the causal theory often argue that gamete donors have special obligations to their genetic offspring. In response, many defenders of current gamete donation practices would reject the causal theory. Read More

Saf Health Work 2018 Sep 20;9(3):352-355. Epub 2017 Dec 20.

Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, FL, USA.

Hazardous work zones (i.e., , , and ) are typically established by emergency response teams during hazardous materials (HAZMAT) calls but less consistently for fire responses to segment personnel and response activities in the immediate geographic area around the fire. Read More

AEM Educ Train 2018 Jan 26;2(1):40-47. Epub 2017 Dec 26.

Division of Emergency Medicine Boston Children's Hospital Boston MA.

Objective: Emergency department (ED) providers require competency in responding to hazardous materials (HAZMAT) events. The optimal strategies to teach HAZMAT response principles to ED providers and to ensure skill retention are not known. Our aim was to design, implement, and evaluate a multifaceted, interprofessional educational curriculum for pediatric ED staff to improve their skills, knowledge, and confidence in responding to a HAZMAT event. Read More

Am J Emerg Med 2018 Aug 27;36(8):1510-1511. Epub 2017 Dec 27.

New Mexico Poison and Drug Information Center, Albuquerque, NM, USA; Children's Hospital of Michigan Regional Poison Center, Detroit, MI, USA. Electronic address:

JEMS 2017 Mar;42(3):54-8

J Hazard Mater 2017 10 4;340:486. Epub 2017 Jul 4.

Institute of Microbial Technology (CSIR), Sector 39-A, Chandigarh 160 036, India. Electronic address:

Occup Health Saf 2017 Jun;86(6):78-80

Like OSHA and EPA chemical safety trainings, DOT training helps hazmat employees to recognize and identify hazardous materials and learn how their functions ensure that those materials can be transported safely. Read More

MMWR Morb Mortal Wkly Rep 2017 May 19;66(19):498-501. Epub 2017 May 19.

In June 2015, personnel from California's Contra Costa Health Services Environmental Health and Hazardous Materials (hazmat) divisions were alerted to a possible chemical release at a swimming pool in an outdoor municipal water park. Approximately 50 bathers were in the pool when symptoms began; 34 (68%) experienced vomiting, coughing, or eye irritation. Among these persons, 17 (50%) were treated at the scene by Contra Costa's Emergency Medical Services (EMS) and released, and 17 (50%) were transported to local emergency departments; five patients also were evaluated later at an emergency department or by a primary medical provider. Read More

Ann Work Expo Health 2017 Jun;61(5):589-595

Department of Defence, Technical Support Working Group, Combating Terrorism Technical Support Office, US Government, VA, USA.

Ethylene oxide (EO) is a reactive gas used by numerous industries and medical facilities as a sterilant, a fumigant, and as a chemical intermediate in chemical manufacturing. Due to its common use, EO has been involved in a number of leaks and explosive incidents/accidents requiring HAZMAT response. However, the extent of skin absorption under short-term HAZMAT conditions has not been directly assessed. Read More

Ann Work Expo Health 2017 03;61(2):248-259

TNO CBRN Protection, 2280AA Rijswijk, The Netherlands.

A major concern for responders to hazardous materials (HazMat) incidents is the heat strain that is caused by fully encapsulated impermeable (NFPA 1991) suits. In a research project, funded by the US Department of Defense, the thermal strain experienced when wearing these suits was studied. Forty human subjects between the ages of 25 and 50 participated in a protocol approved by the local ethical committee. Read More

J Occup Environ Hyg 2017 06;14(6):448-455

b TNO Earth, Life and Social Sciences , Department of CBRN Protection , Rijswijk , The Netherlands.

A major concern for responders to hazardous materials (HazMat) incidents is the heat strain that is caused by fully encapsulated impermeable chemical protective suits. In a research project, funded by the US Department of Defense, the thermal strain experienced when wearing these suits was studied. One particular area of interest was the fluid loss of responders during work in these suits as dehydration may be an additional health concern to the heat strain. Read More

Occup Health Saf 2017 Mar;86(3):24-6

Toxicol Ind Health 2017 Jul 15;33(7):547-554. Epub 2017 Feb 15.

4 Department of Defence, Technical Support Working Group, Combating Terrorism Technical Support Office, US Government, Virginia, VA, USA.

Accidental or intentional releases of toxic gases or vapors are the most common occurrence in hazardous material (HAZMAT) incidents that result in human injuries. The most serious hazard from exposure to gases or vapors is via the respiratory system. Dermal uptake, as a secondary route, is still a concern, most acutely for the unprotected public. Read More

J Hazard Mater 2017 Feb 9;324(Pt B):472-480. Epub 2016 Nov 9.

School of Management, Universidad de los Andes, Bogotá, Colombia. Electronic address:

This work focuses on the Heterogeneous Fleet Vehicle Routing problem (HFVRP) in the context of hazardous materials (HazMat) transportation. The objective is to determine a set of routes that minimizes the total expected routing risk. This is a nonlinear function, and it depends on the vehicle load and the population exposed when an incident occurs. Read More

Bioethics 2016 11 15;30(9):741-750. Epub 2016 Sep 15.

According to Rivka Weinberg, gametes are like enriched uranium: both are hazardous materials. Exposing human beings to enriched uranium can result in radioactivity and decreased life expectancy, while exposing sperm and ova to each other can result in the creation of needy innocent persons with full moral status. Weinberg argues that when we engage in activities that put our gametes at risk of joining with others and growing into persons, we assume the costs of that risky activity. Read More

Occup Health Saf 2016 Mar;85(3):30-2

Fed Pract 2016 Feb;33(2):24-29

is a physician assistant in the Urology Department at the VA Salt Lake City Health Care System in Utah and a lieutenant colonel in the Utah Air National Guard. is an Emergency Department physician and a major in the Utah Air National Guard. is a training manager and a master sergeant in the West Virginia National Guard.

A tool that identifies heat injuries early can avoid the progression of symptoms from heat stress to heat exhaustion and heat stroke. Read More

Jt Comm Perspect 2015 Dec;35(12):6-8

J Occup Environ Med 2015 Oct;57(10):1092-7

Centre for Human and Applied Physiology, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia (Mr Fullagar, Dr Sampson, Dr Burdon, Dr Taylor, and Dr Groeller); and Fire & Rescue New South Wales, Sydney, New South Wales, Australia (Mr Mott).

Objective: Firefighter physical aptitude tests were administered to unskilled subjects and operational firefighters to evaluate the impact that testing bias associated with gender, age, activity-specific skills, or task familiarity may have upon establishing performance thresholds.

Methods: These tests were administered in sequence, simulating hazmat incidents, ventilation fan carriage (stairs), motor-vehicle rescues, bushfire incidents, fire attacks, and a firefighter rescue. Participants included two unskilled samples (N = 14 and 22) and 143 firefighters. Read More

J Occup Environ Med 2015 Oct;57(10):1083-91

Centre for Human and Applied Physiology, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia (Dr Groeller, Mr Fullagar, Dr Sampson, and Dr Taylor); and Fire & Rescue New South Wales, Sydney, New South Wales, Australia (Mr Mott).

Objective: In this third communication, the processes for converting criterion occupational tasks into bona fide pre-employment selection tests are presented using urban firefighters as the worked example.

Methods: A total of 14 individuals participated in potential screening tests that targeted three loaded movement categories: single-sided load carriage (4 tests), dragging loads (2 tests), and overhead pushing and holding objects (5 tests).

Results: Seven tests emerged, one performed as an isolated pass/fail barrier test (ladder raise) and six incorporated into a sequential, timed circuit simulating hazmat incidents, ventilation fan carriage (stairs), motor-vehicle rescues, bushfire incidents, fire attacks, and a firefighter rescue. Read More

Prehosp Disaster Med 2015 Oct;30(5):466-71

1Department of Emergency Medicine,Mayo Clinic,Rochester,MinnesotaUSA.

Objective: Little is known about the overall frequency of hazardous materials (HazMat) events in the United States and the nature of prehospital care for those exposed. The purpose of the current study was to perform a descriptive analysis of Emergency Medical Services (EMS) activations reported to a national EMS database.

Methods: Analysis of the 2012 National EMS Information System (NEMSIS) Public Release Research Data Set v. Read More

Prehosp Disaster Med 2015 Oct 15;30(5):486-90. Epub 2015 Sep 15.

Department of Emergency Medicine,The Ohio State University Wexner Medical Center,Columbus,OhioUSA.

Introduction: Smartphone applications (or apps) are becoming increasingly popular with emergency responders and health care providers, as well as the public as a whole. There are thousands of medical apps available for Smartphones and tablet computers, with more added each day. These include apps to view textbooks, guidelines, medication databases, medical calculators, and radiology images. Read More

EMS World 2015 Jul;44(7):12, 14, 16 passim

Occup Health Saf 2015 Jul;84(7):46, 48

Occup Health Saf 2015 Jul;84(7):40, 42-3

Occup Health Saf 2015 Mar;84(3):28, 30

Prehosp Disaster Med 2015 Jun 11;30(3):259-63. Epub 2015 May 11.

1Department of Emergency Medicine,Mayo Clinic,Rochester,MinnesotaUSA.

Introduction: Management of contaminated patients in the decontamination corridor requires the use of hazardous material (HazMat) personal protective equipment (PPE). Previous studies have demonstrated that HazMat PPE may increase the difficulty of airway management. This study compared the efficiency of video laryngoscopy (VL) with traditional direct laryngoscopy (DL) during endotracheal intubation (ETI) while wearing HazMat PPE. Read More

Prehosp Disaster Med 2015 Jun 27;30(3):288-96. Epub 2015 Apr 27.

Centre for Resilient Communities,Office of Applied Research,The Justice Institute of British Columbia,New Westminster,British Columbia,Canada.

Growing awareness and concern for the increasing frequency of incidents involving hazardous materials (HazMat) across a broad spectrum of contaminants from chemical, biological, radiological, and nuclear (CBRN) sources indicates a clear need to refine the capability to respond successfully to mass-casualty contamination incidents. Best results for decontamination from a chemical agent will be achieved if done within minutes following exposure, and delays in decontamination will increase the length of time a casualty is in contact with the contaminate. The findings presented in this report indicate that casualties involved in a HazMat/CBRN mass-casualty incident (MCI) in a typical community would not receive sufficient on-scene care because of operational delays that are integral to a standard HazMat/CBRN first response. Read More

Ergonomics 2015 15;58(10):1671-81. Epub 2015 Apr 15.

a School of Medicine, Centre for Human and Applied Physiology, University of Wollongong , Wollongong , NSW 2522 , Australia.

The utility of cardiac and ventilatory predictors of metabolic rate derived under temperate and heated laboratory conditions was evaluated during three fire-fighting simulations (70-mm hose drag, Hazmat recovery, bushfire hose drag; N = 16 per simulation). The limits of agreement for cardiac (temperate: - 0.54 to 1. Read More

JEMS 2014 Dec;39(12):46-9

Atmos Environ (1994) 2015 Mar;104:273-283

Chemical and Biochemical Engineering, University of Iowa, Iowa City, IA 52242 ; IIHR Hydroscience and Engineering, University of Iowa, IA.

The Iowa City Landfill in eastern Iowa, United States, experienced a fire lasting 18 days in 2012, in which a drainage layer of over 1 million shredded tires burned, generating smoke that impacted the surrounding metropolitan area of 130,000 people. This emergency required air monitoring, risk assessment, dispersion modeling, and public notification. This paper quantifies the impact of the fire on local air quality and proposes a monitoring approach and an Air Quality Index (AQI) for use in future tire fires and other urban fires. Read More

Emerg Med Clin North Am 2015 Feb 15;33(1):51-68. Epub 2014 Nov 15.

Center for Toxicology and Environmental Health, L.L.C., 5120 North Shore Dr., North Little Rock, AR 72118, USA.

Accurate identification of the hazardous material is essential for proper care. Efficient hospital security and triage must prevent contaminated victims from entering the emergency department (ED) and causing secondary contamination. The decontamination area should be located outside the ambulance entrance. Read More

J Emerg Manag 2014 Sep-Oct;12(5):407-20

George Washington University, Washington, DC.

In a large-scale outdoor, airborne, hazardous materials (HAZMAT) incident, such as ruptured chlorine rail cars during a train derailment, the local Incident Commanders and HAZMAT emergency responders must obtain accurate information quickly to assess the situation and act promptly and appropriately. HAZMAT responders must have a clear understanding of key information and how to integrate it into timely and effective decisions for action planning. This study examined the use of HAZMAT plume modeling as a decision support tool during incident action planning in this type of extreme HAZMAT incident. Read More

JEMS 2014 Sep;39(9):38-42

The explosion from the passing freight train rocked the nearby buildings, shattering the windows and letting off a thick cloud of poisonous gas. The building inhabitants were smoothly evacuated by commands given over the loudspeakers of the responding emergency workers. They walked quickly through the decontamination tents, following the directions of the hazmat team, and were transported without difficulty by squads and buses to local hospitals and trauma centers, where teams of medical professionals quickly and efficiently cared for them, using familiar protocols and equipment. Read More

Occup Health Saf 2014 Jul;83(7):48

Int J Occup Saf Ergon 2014 ;20(2):281-93

Novant Heart & Wellness, Novant-Health Presbyterian Medical Center, Charlotte, NC, USA.

Unlabelled: U.S. guidance for examining hazmat workers recommends stress testing be considered when heat stress is expected. Read More

JEMS 2014 Mar;39(3):42-5

EMS responders to hazmat incidents face significant challenges; however, integration of medical care providers into the planning process for hazmat incidents can facilitate a more efficient response. The competencies found in NFPA 473 provide thorough guidance for EMS professionals during planning, preparation and response to hazmat/ WMD incidents. JEMS Read More

Occup Health Saf 2013 Dec;82(12):22, 24

Central Prison Healthcare Complex for the North Carolina Department of Public Safety, Raleigh, N.C., USA.

Traffic Inj Prev 2014 ;15(7):762-8

a School of Automobile , Chang'an University , Xi'an Shaanxi , China.

Objective: Due to the sheer size and capacity of the tanker and the properties of cargo transported in the tank, hazmat tanker accidents are more disastrous than other types of vehicle accidents. The aim of this study was to provide a current survey on the situation of accidents involving tankers transporting hazardous materials in China.

Methods: Detailed descriptions of 708 tanker accidents associated with hazmat transportation in China from 2004 to 2011 were analyzed to identify causes, location, types, time of occurrence, hazard class for materials involved, consequences, and the corresponding probability. Read More

Toxicol Mech Methods 2014 Jan 20;24(1):70-2. Epub 2013 Nov 20.

Discipline of Public Health, School of Population Health, University of Adelaide , Adelaide, South Australia , Australia .

This technical note provides details of an experimental technique for in-vitro skin studies with atmospheric chemical challenge. There appear to be major evidence gaps in relation to dermal exposure of gases. We describe a modification of standard OECD protocols for an atmospheric delivery system which can be used to understand interaction of toxic gases and the skin. Read More