Recently, there were two major train wrecks in East Palestine, Ohio—one literal, on February 3rd, and the second, figurative—the fumbling response to the disaster.

Vinyl chloride, phosgene and hydrogen chloride gases, as well as volatile organic compounds (VOCs) were released into the air, soil and water. Even though the “all-clear” was sounded on February 8th, residents are still uncertain whether their health has been compromised, if their homes are safe to occupy and if their water is fit to drink—especially given the new concerns about dioxins and acrolein.

The arrest of a reporter at a press conference didn’t help things, and when it came time for the principals of Norfolk Southern to attend a town hall, they were no-shows.

Secretary of Transportation Pete Buttigieg did not acknowledge the disaster until several days had passed, and President Biden also waited before calling the mayor. Despite Gov. Mike DeWine’s multiple requests,  FEMA claimed that the community was not eligible for assistance—fortunately, this decision was reversed, but not until two critical weeks had passed.

Even the Chinese Foreign Ministry mocked Washington’s response, calling it #OhioChernobyl. One would hope there was not some other agenda in play—with more than 70% of Columbiana County voters casting their ballots for President Trump in 2020; this is definitely “MAGA country”. 

With risk communication, you never have a second chance to make a first impression, so it is no surprise that many residents of East Palestine have already “lawyered up,” but when they sought guidance about their personal health issues, they were told to call their medical providers. The average primary care doctor has minimal training in toxicology, and may not know the correct lab tests to order. Although there were potential health concerns almost immediately after the derailment, it took two weeks before a community clinic was set up in a local church by the Ohio Department of Health, initially staffed by nurses and a toxicologist.

This delay is why residents should have been permitted to see independent physicians of their choice right away, specifically, doctors trained in occupational and environmental medicine. It is important to do a baseline exam with lab testing for those exposed to vinyl chloride, as well as VOC’s such as: ethylene glycol monobutyl ether, ethylhexyl acrylate,  isobutylene and butyl acrylate. Vinyl chloride is a known carcinogen after chronic exposure, and high concentrations can cause dizziness, anesthesia and lung irritation. Breath levels of vinyl chloride and urine levels of thiodiglycolic acid (a metabolite) can be measured after an acute exposure, but there is only a brief window of time to detect these chemicals, and it was missed.

In addition to vinyl chloride, ethylene glycol monobutyl ether, ethylhexyl acrylate,  isobutylene and butyl acrylate were released from the rail cars. Ethylhexyl acrylate, can cause burning and irritation of the skin, eyes, and respiratory tract, with shortness of breath and coughing. Inhalation of isobutylene can cause dizziness and drowsiness, while exposure to ethylene glycol monobutyl ether can cause irritation in the eyes, skin, nose and throat; nervous system depression; headaches and vomiting. Butyl acrylate can cause skin, eye and respiratory irritation. Many of these chemicals can also aggravate pre-existing conditions such as asthma, COPD and other respiratory diseases.

In addition to this, the EPA has recently ordered Norfolk Southern to start testing for dioxins, which can be formed as combustion byproducts that are both toxic and carcinogenic. Dioxins were found in Agent Orange, the infamous defoliant/herbicide used during the Vietnam War, and they were also the hazardous chemicals found in Times Beach, MO that led to the eventual abandonment of the entire town which became an EPA Superfund site.

There is a sharp contrast between how toxic exposures are supposed to be handled in the workplace versus exposures involving community members--that is because OSHA standards only govern the workplace.

When railway employees were exposed to toxic chemicals from the wreck, they should have quickly been evaluated, and the required medical surveillance exams performed, per the applicable standard. It is unclear, however, whether this actually happened. Also left out in the cold were public sector employees like fire, EMS, transportation and law enforcement workers. This is because OSHA standards do not apply to them in the states of Pennsylvania and Ohio.

The Chief Medical Officer of Norfolk Southern would have been aware of this, and it would be worthwhile to tap into their expertise to help guide appropriate medical evaluations of community members and public sector employees who were exposed to the same toxins that their employees were.

Given the considerable number of train derailments every year, there will be similar scenarios again. We need to be better prepared for it, and improved collaboration must be facilitated between the railroads’ medical and safety departments; the EPA; OSHA and state and local public health agencies. The chief medical and chief safety officers of every railroad should be made corporate officers, so they will have a voice of equal importance to that of the corporate counsel, CFO and other VPs. Absent this, the popular mantra of “safety first” is no more than empty words on a sign in the break room.

Dr. Williams is a board-certified public health physician, Fellow of the American College of Occupational and Environmental Medicine and former medical consultant for the Wisconsin Central Railroad. He is also a trained first responder who has worked several disasters, including a railroad tank car HAZMAT leak and can be found on Twitter @MedicusOmnibus

Image: Screen shot from CBS video, via YouTube