On February 3, 2023, a 149-rail-car train in East Palestine, Ohio, USA derailed, and 50 rail cars ignited, 11 of which contained hazardous substances.¹ This event raised concerns about hazardous substances released into neighboring communities including Beaver County, Pennsylvania. Immediately, first responders worked to control the fires and ensure community safety. Responders worked on or near the derailment site, where rail car contents of concern included: vinyl chloride, ethylene glycol, butyl acrylate, isobutylene, and ethylhexyl acrylate.^2,3 On February 3, evacuation orders were issued for residents within a 1-mile radius of the train derailment.⁴ On February 5, vinyl chloride contents of five rail cars became unstable. In response, the evacuation area was extended and a controlled vent and burn^† event was conducted (full timeline of events pertaining to the incident were described at the June 22, 2023, National Transportation Safety Board East Palestine, OH Rail Public Hearing¹), causing a chemical plume over the area.

On February 17, the Ohio Department of Health and the Pennsylvania Department of Health requested assistance from the US Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR) to implement an Assessment of Chemical Exposure (ACE) survey for first responders to systematically collect data to inform further public health action.⁶ An electronic self-administered responder ACE survey was developed in REDCap^7,8 with considerable input from partners including Ohio and Pennsylvania health partners, first responder survey pilot participants, and subject matter experts at CDC, ATSDR and the National Institute for Occupational Safety and Health. The survey began March 5^th and ended March 31, 2023. Eligible responders were those who responded to the East Palestine train derailment and were ≥18 years old. Responders residing in any state were eligible to participate. The survey collected information on demographics, occupation, self-reported health outcomes, personal protective equipment (PPE) use, decontamination procedures, prior training, and other topics. The survey also collected responders’ contact information and consent to be contacted in the future. This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.^§

Three hundred thirty-nine completed surveys were included in the analysis. Over half of responders reported their role as firefighter (61%), of whom 79% were volunteer. Most reported being non-Hispanic White (96%) and male (88%). The median age was 39 (IQR: 30–50) years. Most responders (86%) reported working on response activities within a one-mile radius of the derailment site for at least one day between February third to eighth, the period during which fires were active at the site. Most responders (79%) reported inhaling, touching, or swallowing potentially harmful substances. Of those who reported contact with at least one substance, smoke (84%) was the most frequently reported exposure, while 77% reported being exposed to an unknown/uncertain chemical. Most responders (75%) selected “Never” using a face mask or respirator during the incident. Approximately 48% reported at least one new or worsening physical symptom since responding to the incident. Of responders who reported at least one physical symptom, the most reported symptoms were related to the ears, nose, or throat (82%), heart and lungs (32%), eyes (23%), and skin (12%) (Table 1).

Survey results show responders reported low rates of respiratory protection use combined with high rates of inhalation exposure to unknown substances. Additional findings will be described in more detail in a separate manuscript. A similar train derailment incident involving vinyl chloride occurred in Paulsboro, New Jersey in November 2012 and an ACE investigation was conducted among emergency responders-the investigation found almost a quarter (23%) of emergency responders did not wear PPE during the response activities, as only 21 of 92 emergency responders self-reported donning self-contained breathing apparatus during the response.⁹

The survey design has several limitations. First, the survey aimed to maximize the detail responders may be able to recall but remains subject to recall bias given post-event administration. Secondly, information on specific timing and frequency of PPE use or contact with substances was not captured in this survey, preventing more exact estimates of exposures. Finally, given the cross-sectional nature of the survey, we were unable to examine causal relationships between variables over time.

A hierarchy of controls framework focusing on elimination of hazards, substitution for less hazardous substances, engineering controls, administrative controls, and PPE usage prioritizes other actions over relying on an individual’s behavioral protective practices.¹⁰ This framework should be used to reduce the likelihood and severity of health effects among responders. It is worth noting, however, that for some events, employing the use of a hierarchy of controls framework may not be feasible. For example, during an emergency response, first responders may not be able to eliminate or substitute a hazard and may only be able to rely on their training and PPE to minimize potential exposure to hazards. Further, volunteer fire departments are often under-resourced and have specific challenges (e.g., inadequate equipment) which may impact their ability to respond effectively to disasters and other emergencies.¹¹

Increasing awareness and timely communications between rail operators and first response agencies about the hazardous contents of rail cars can improve response efforts. In addition, increasing responders’ timely access to information on substances in their environment might increase their ability to employ engineering controls and other appropriate protective measures. An existing approach that details pre-, during, and post- deployment activities that can be used in emergency events to protect worker safety and health is the Emergency Responder Health Monitoring Surveillance (ERHMS) framework. It includes recommendations and tools to protect emergency responders, including volunteers, during all phases of a response, as well as protocols for rapid identification and sharing of chemical information.¹² Local and state health agencies and responder groups can continue to support the health of responders to this incident by encouraging routine annual preventive care visits with primary healthcare providers, and training in hazardous substances response and appropriate use of PPE.

Support for the ACE investigation was provided by the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry.