CDC Recommends Respiratory Protection for Derailment Responders

The agency's MMWR publication this week featured a report on an assessment of responders following a vinyl chloride release from a New Jersey train derailment in 2012.

CDC's MMWR publication this week featured a detailed report on an assessment of the emergency personnel who responded to the scene of a New Jersey train derailment in November 2012 that resulted in a release of vinyl chloride. The paper's 10 authors work at the CDC's Epidemic Intelligence Service, NIOSH, the New Jersey Department of Health, and the federal Agency for Toxic Substances and Disease Registry.

They describe the evaluations the NJDH, ATSDR, and CDC conducted of health effects experienced by 93 responders after exposure to the chemical, which is used in plastics manufacturing. Four cars had derailed into a tidal creek, and one of them carrying vinyl chloride was breached. "Acute exposure can cause respiratory irritation and headache, drowsiness, and dizziness; chronic occupational exposure can result in liver damage, accumulation of fat in the liver, and tumors (including angiosarcoma of the liver)," according to their report, which said the New Jersey agency sought assistance from the federal ones because the health effects associated with acute exposures have not been well studied.

Teams from the agencies surveyed the responders and found that 26 percent of them experienced headaches and upper respiratory symptoms during the response. Only 22 percent of them said they had worn respiratory protection during the incident, and 21 respondents sought a medical evaluation. Based on these findings, CDC is recommending that response agencies implement the Emergency Responder Health Monitoring and Surveillance system for ongoing health monitoring of emergency responders who are involved in train derailment responses and "ensure that in future incidents, respiratory protection is used when exposure levels are unknown or above the established occupational exposure limits," it states.

The responders included EMS workers, firefighters, police officers, and hazardous materials technicians. The paper says 20 respondents reported donning a self-contained breathing apparatus during the response, "although it is unclear when respiratory protection was used during the response. Of these 20 respondents, one was an emergency medical services worker, one was a police officer, two were hazardous material technicians, and 16 were firefighters. One reported using both a self-contained breathing apparatus and a powered air-purifying respirator, another reported using a full-face air-purifying respirator, and one reported using an air-purifying respirator but did not specify which type. Forty-nine percent (35 of 72) of respondents who reported they did not wear respiratory protection on initial arrival at the site stated that respiratory protection was not required for their work, 24% (17 of 72) stated none was available, 17% (12 of 72) stated they were not advised to wear respiratory protection, and 17% (12 of 72) stated they did not think they needed it. Eight percent (six of 72) of respondents reported they were told respiratory protection was not necessary, and 1% (one of 72) stated that it got in the way of work."

The OSHA PEL for vinyl chloride is 1 ppm, based on an eight-hour time-weighted average, and CDC recommends reducing vinyl chloride exposures to the lowest feasible concentration because it has been designated a potential occupational carcinogen.

The authors noted that personal breathing zone measurements of responders' exposures to vinyl chloride weren't collected, so it is impossible to correlate vinyl chloride exposure levels with symptoms, and the small number of participants who completed the survey made it impossible to meaningfully analyze the associations between respirator use and symptoms.

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