DISCUSSION AND CONCLUSIONS

The Hazelwood mine fire produced hazardous conditions for firefighters. Fire services and GDF Suez were initially inadequately prepared to respond to the risk of carbon monoxide exposure to firefighters.

The Incident Controller at the Hazelwood mine fire did not implement any protocols for the protection of firefighters from the risks of exposure to carbon monoxide until late in the evening on 9 February 2014. By this time a number of firefighters had already been exposed to the elevated levels of carbon monoxide that were generated by the mine fire and suffered short-term adverse health effects.

To minimise the risk to firefighters, the Draft Carbon Monoxide Regional Operating Procedure (developed after the 2006 mine fire) should have been formalised prior to the Hazelwood mine fire.

On 14 February 2014, the Draft Carbon Monoxide Regional Operating Procedure and other procedures adopted in response to the mine fire were formalised into the Health Management and Decontamination Plan. The Board considers that the exposure standard adopted in this Plan, although higher than that recommended by the WHO’s threshold levels of carboxyhaemoglobin, was reasonable given that the mine was a workplace for the fire services and mine employees.

However, the Board considers that the Health Management and Decontamination Plan did not take into account that some firefighters may have had pre-existing conditions, which would have put them at an increased risk of adverse health effects from carbon monoxide exposure. The Board considers that it is important that all firefighters are provided information about the potential risks, particularly for HazMat fires, involved in firefighting so that they can make informed choices.

The Board supports the Victorian Government’s intention to improve training for career and volunteer firefighters, and to improve occupational health and safety in emergency response situations.63

Although GDF Suez had a policy in place in relation to carbon monoxide risks, this policy did not contain guidance about a safe level of carboxyhaemoglobin for individuals, nor did it contain any guidance for susceptible individuals about exposure to carbon monoxide.

GDF Suez’s informal carbon monoxide protocol only dealt with the amount of carbon monoxide in the air, and failed to deal with the effect that carbon monoxide has on individuals by measuring levels of carboxyhaemoglobin.

Overall, the Board considers that the carbon monoxide policy and protocol developed by GDF Suez did not provide adequate protection to the mine’s firefighters and operational staff from potential carbon monoxide exposure.

If not for the Health Management and Decontamination Plan, increased carboxyhaemoglobin levels in firefighters would not have been detected until they began to exhibit symptoms, which may have put them at risk of significant adverse health effects.

The Board recommends that the State should revise the firefighter carbon monoxide protocol to ensure that it is consistent with the community carbon monoxide protocol. Any future policy about carbon monoxide exposure should include triggers for action for specific categories, for example relevant to age, pre-existing health conditions and pre-existing risk factors such as smoking. It would also be beneficial for fire services to encourage all firefighters to self-disclose if they have any pre-existing respiratory or cardiac conditions and if females of childbearing age are or could be pregnant. The State’s revised carbon monoxide protocol should also be adopted by GDF Suez. It should be finalised by the end of September 2014 and should be reviewed by an independent panel prior to its implementation.

Before deployment, firefighters should be reminded of the risks of carbon monoxide to enable them to make an informed decision. The CFA, MFB and GDF Suez should provide education on the risks of carbon monoxide poisoning to all firefighters during recruitment, selection, training and deployment of both career and volunteer firefighters. The training should include drawing attention to pre-existing conditions that could place firefighters at increased risk.

The Board notes the concerns of the UFU and the recommendations it asked the Board to make. Exposure to carbon monoxide has been addressed in this report, as has the testing of water used during firefighting efforts. An investigation is already being carried out by VWA in relation to MFB and CFA compliance with the OHS Act.64

There was evidence provided to the Board that there were safety officers and logistics officers deployed for all but the very earliest firefighting shifts at the mine.65 There was also evidence produced to the Board that each shift was staffed with a qualified Incident Controller. The Board therefore does not intend to make any recommendation about staffing. With respect to the UFU’s suggested recommendation that more firefighters be available for firefighting efforts, the Board acknowledges the evidence of the CFA which indicated that had more resources been available, those resources would have been deployed.66 The Board also notes and encourages the implementation of the existing emergency services plan for increased numbers of career firefighters.

The Board notes the concerns of the UFU in relation to decontamination procedures to be implemented in firefighting efforts. The Board has received evidence that risk assessments for the Incident Control Centre, staging area and fireground were undertaken by the Incident Controller.67 Further, the Incident Shift Plans produced requirements for firefighters (and others) to follow the decontamination procedures.

Recommendations

See Chapter 4.6 Health response for recommendations relevant to this Chapter.