The St. Louis Fire Department arrived to the site of a chemical accident where a large number of flammable-gas cylinders were involved in a fire. Exploding cylinders became projectiles, flying up to 800 feet, damaging property and starting fires in the surrounding community. Flying debris damaged vehicles and even landed near a yard where children were playing. Firefighters evacuated local residents, directed a water stream on the fire, and extinguished secondary fires that were ignited by cylinders propelled off-site. It took five hours to control fire, which involved 8,000 cylinders. Fortunately, none of the responders was seriously injured by this potentially calamitous event.

Once the fires are out and critical emergency response efforts have concluded at an accident site, the U.S. Chemical Safety Board begins a detailed investigation to determine the causes and make recommendations for future safety improvements. The agency conducted a full investigation of the cylinder fire incident and issued a safety bulletin on gas-cylinder hazards and fire mitigation. One recommendation was that flammable-gas distributors should install fixed fire monitors to prevent small cylinder fires from becoming dangerous conflagrations that threaten firefighters and the public.

The CSB is authorized by the Clean Air Act Amendments of 1990 and became operational in January 1998. The agency is modeled after the National Transportation Safety Board. The CSB is an independent federal agency that investigates chemical accidents across a variety of industries to determine root causes and make safety recommendations to prevent such tragic accidents from reoccurring. The CSB is not a regulatory agency and does not issue fines or penalties.

A five-member board that is appointed by the president and confirmed by the Senate to serve five-year terms heads the agency. The board employs a staff of approximately 40 professionals who have a wide variety of first-hand experience including chemical and mechanical engineering, fire and explosion investigation, chemistry, human factors, and law.

The CSB may deploy investigators to accident sites within fire department jurisdictions across the country; therefore, the agency seeks to inform the fire protection community about the agency's mission, how deployments are determined, and what the agency's on-site activities are to promote successful concurrent investigations.

So how does the CSB determine which accidents are most critical to investigate? The chemical incident screening system helps evaluate hundreds of incidents that occur each year and determines which ones warrant investigation. The CSB receives information about accidents from a variety of sources, including the National Response Center, the NTSB and media reports. Each accident is then scored by evaluating factors such as injuries and fatalities, public evacuation, ecosystem damage, potential for consequences, learning potential, property losses, public concern and the history of the involved company.

Furthermore, the Clean Air Act states, “In no event shall the board forego an investigation where an accidental release causes a fatality or serious injury among the general public, or had the potential to cause substantial property damage or a number of deaths or injuries among the general public.”

Once the CSB decides to deploy an investigative team to an accident site, the agency informs relevant contacts including federal, state and local officials, including fire chiefs and fire marshals. The CSB seeks to coordinate its efforts within the Incident Command System structure. By statute, the board's investigations must remain independent from the activities of other agencies. For example, the agency conducts its own witness interviews, gathers documents and information independently, and exercises its own discretion on the release of information during the lengthy investigative process. In some cases, the CSB reviews the effectiveness of emergency response activities to determine if there are opportunities for improvement or lessons that should be shared with emergency responders across the country.

After arrival at an accident scene, the on-site board member serves as the principal public and media spokesperson for the agency. As soon as it is safe, the investigative team seeks to access the site, examine equipment such as pipes, valves and tanks, take photographs and identify potential critical evidence, and begin interviewing witnesses. The CSB also has subpoena authority to interview witnesses and collect key physical evidence.

The investigative team typically remains on site for several weeks, depending on the severity and complexity of the event, and may return to conduct follow-up interviews and meetings. For example, on March 23, 2005, at 1:20 p.m., the BP Texas City Refinery suffered one of the worst industrial disasters in recent U.S. history. Investigators from the CSB arrived at the facility the very next morning. During the course of this investigation, the CSB reviewed more than 30,000 documents, conducted 370 interviews, tested instruments, and assessed damage to equipment and structures in the refinery and surrounding community.

Final CSB reports are comprehensive and contain key findings, root causes, and safety recommendations voted on by the board. The agency has reported in the past on inadequate local funding for emergency responders' chemical protective equipment and has brought to light outdated fire codes and vague enforcement specifications where these factors could have avoided tragedy.

In 2004, a Georgia fire department ordered an evacuation within a half-mile radius of a chemical manufacturing plant when a runaway chemical reaction released highly toxic vapors into the nearby community. The release forced more than 200 families from their homes. One facility employee sustained minor chemical burns and 154 people underwent decontamination and treatment at the local hospital for chemical exposure, including 15 police and ambulance personnel who were assisting with the evacuation. The reactor continued venting toxic vapor for nearly eight hours and the evacuation order lasted more than nine hours.

The CSB conducted a full investigation that reported on reactive chemicals, process safety, and emergency planning and response capabilities. Inadequate emergency response planning by the city and county was a contributing cause to the number of injuries and exposures among the public and first responders. The city had no automated emergency notification system or evacuation plan, and police officers were instructed to drive into the chemical cloud to alert neighborhood residents to evacuate. None of the responding police officers had proper training or protective equipment to safely enter the toxic vapor cloud. After the toxic vapor forced the unprotected police officers to retreat, firefighters wearing special breathing apparatus were eventually called in to complete the evacuation.

The final CSB investigative report also noted that the federal Emergency Planning and Community Right-to-Know Act of 1986 required the establishment of Local Emergency Planning Committees throughout the country. Under the statute, LEPCs are responsible for helping develop comprehensive emergency response plans that identify hazardous chemical facilities and describe emergency notification, response, and evacuation procedures. The CSB recommended that the Georgia governor clearly define responsibilities for implementing important requirements of EPCRA and recommended that the county establish an LEPC.

The CSB also produces safety videos containing computer animations after the completion of many reports. The safety videos are free and may be viewed and ordered at www.safetyvideos.gov. The Safety Videos DVD compilation provides a graphic overview of the kinds of investigations the CSB does, and the recommendations that have resulted — all aimed at chemical accident prevention. Hundreds of fire chiefs and marshals are already using these videos to train their work forces since the program was launched in December 2005.

The work of the fire protection community is invaluable in quickly responding to accidents and helps to save lives and significantly reduce property damage. Fire chiefs can learn more about the agency's involvement in accidents and assure a closer working relationship with the CSB in preventing future incidents. For more information, visit www.csb.gov.

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Jennifer J. Jones is a public-affairs specialist for the Chemical Safety Board.