Mortality in Yusho patients exposed to polychlorinated biphenyls and polychlorinated dibenzofurans: a 50-year retrospective cohort study.

BACKGROUND: In 1968, the Yusho incident resulted in accidental exposure to polychlorinated biphenyls (PCBs), polychlorinated dibenzofurans (PCDFs), and related compounds in Japan. This study updated the risk of mortality in Yusho patients. METHODS: We obtained updated cohort data for all Yusho patients for the period 1968-2017. We calculated standardized mortality ratios (SMRs) for all-cause and cause-specific mortality over a 50-year follow-up period compared with the general population in Japan. RESULTS: A total of 1664 Yusho patients with 63,566 person-years of follow up were included in the analysis. Among males, excess mortality was observed for all cancers (SMR: 1.22, 95% confidence interval [CI]: 1.02 to 1.45) and lung cancer (SMR: 1.59, 95% CI: 1.12 to 2.19). Among females, increased mortality was observed for liver cancer (SMR: 2.05, 95% CI: 1.02 to 3.67). No significant increase was seen in non-cancer-related mortality compared with the general population. CONCLUSIONS: Carcinogenic risk in humans after exposure to PCBs and PCDFs remains higher among Yusho patients. Our findings suggest the importance of care engagement and optimum management to deal with the burden of Yusho disease.

Multiple Patients With Burn Injury Induced by a Chemical Explosion Managed by Physician-Staffed Helicopters.

On December 1, 2017, the Fuji factory of Arakawa Chemical Industries exploded. Dust that formed as a byproduct from the crushing and packing process of the resin for ink exploded at the facility. The Fuji City Fire Department requested the dispatch of 2 physician-staffed helicopters (known as a doctor helicopter [DH] in Japan). The first party of emergency services established a headquarters and first-aid station. However, this area was feared to be at risk of a second explosion. Physicians performed re-triage for all 11 burned patients. Three severely injured patients were transported to emergency medical service centers either by ground ambulance or the DH without undergoing any decontamination. The physician who escorted the patient by ground ambulance complained of a headache. One of the severely injured patients was treated at a local hospital and then transported to an emergency medical service center after undergoing decontamination and intubation. Fortunately, all patients who were transported to medical facilities obtained a survival outcome. Chemical, biological, radiological, nuclear, and explosive incidents are rare but can be fatal for responders to these types of disaster. Therefore, all who work in these settings should be prepared and trained adequately to ensure that they have the knowledge and skill to both manage patients and protect themselves from harm. (Disaster Med Public Health Preparedness. 2019;13:799-805).

Inhalation Injury and Toxic Industrial Chemical Exposure.

Toxic industrial chemicals include chlorine, phosgene, hydrogen sulfide, and ammonia have variable effects on the respiratory tract, and maybe seen alone or in combination, secondary to inhalation injury. Other considerations include the effects of cyanide, carbon monoxide, and fire suppressants. This Clinical Practice Guideline (CPG) will provide the reader with a brief overview of these important topics and general management strategies for each as well as for inhalation injury. Chlorine, phosgene, hydrogen sulfide, and ammonia are either of intermediate or high water solubility leading to immediate reactions with mucous membranes of the face, throat, and lungs and rapid symptoms onset after exposure. The exception to rapid symptom onset is phosgene which may take up to a day to develop severe acute respiratory distress syndrome. Management of these patients includes early airway management, lung-protective ventilator strategies, aggressive pulmonary toilet, and avoidance of volume overload.

Pattern and nature of Neyshabur train explosion blast injuries.

Background: Explosions are classified as both man-made and complex accidents. Explosive events can cause serious damage to people, property, and the environment. This study aimed to investigate the pattern and nature of damage incurred to the victims of the Neyshabur Train Explosion. Methods: The current study is a descriptive cross-sectional study that was retrospectively performed on 99 individuals using census method and documents victims hospitalized due to the Neyshabur train disaster (February 2004) in 2016. In this study, different variables such as age, sex, type of injury, treatment, etc. were examined using a questionnaire and were analyzed using SPSS16. Results: The results showed that 50.5% of victims were males with mean age of 30.33 ± 4.27 years and most of them were in 20- to 40-year age group. A total of 98 victims were discharged after treatment, and 1 victim died due to the severity of injuries after 3 days of hospitalization. Second type of injuries caused by the explosion accounted for most of the injuries (55.6%), and most treatments (54.5%) were related to the specific field of orthopedics. Conclusion: Handling and transportation of fuels and chemicals via rail transport system is one of the potential hazards that threatens human life. The results showed that the highest numbers of victims were in 20- to 40-year age group, which is the age of economic efficiency. The prevention and reduction of human and financial losses resulting from accidents require proper national planning.

Acute Chemical Incidents With Injured First Responders, 2002-2012.

IntroductionFirst responders, including firefighters, police officers, emergency medical services, and company emergency response team members, have dangerous jobs that can bring them in contact with hazardous chemicals among other dangers. Limited information is available on responder injuries that occur during hazardous chemical incidents. METHODS: We analyzed 2002-2012 data on acute chemical incidents with injured responders from 2 Agency for Toxic Substances and Disease Registry chemical incident surveillance programs. To learn more about such injuries, we performed descriptive analysis and looked for trends. RESULTS: The percentage of responders among all injured people in chemical incidents has not changed over the years. Firefighters were the most frequently injured group of responders, followed by police officers. Respiratory system problems were the most often reported injury, and the respiratory irritants, ammonia, methamphetamine-related chemicals, and carbon monoxide were the chemicals more often associated with injuries. Most of the incidents with responder injuries were caused by human error or equipment failure. Firefighters wore personal protective equipment (PPE) most frequently and police officers did so rarely. Police officers' injuries were mostly associated with exposure to ammonia and methamphetamine-related chemicals. Most responders did not receive basic awareness-level hazardous material training. CONCLUSION: All responders should have at least basic awareness-level hazardous material training to recognize and avoid exposure. Research on improving firefighter PPE should continue. (Disaster Med Public Health Preparedness. 2018;12:211-221).

Chemical incidents resulted in hazardous substances releases in the context of human health hazards.

OBJECTIVES: The research purpose was to analyze data concerning chemical incidents in Poland collected in 1999-2009 in terms of health hazards. MATERIAL AND METHODS: The data was obtained, using multimodal information technology (IT) system, from chemical incidents reports prepared by rescuers at the scene. The final analysis covered sudden events associated with uncontrolled release of hazardous chemical substances or mixtures, which may potentially lead to human exposure. Releases of unidentified substances where emergency services took action to protect human health or environment were also included. RESULTS: The number of analyzed chemical incidents in 1999-2009 was 2930 with more than 200 different substances released. The substances were classified into 13 groups of substances and mixtures posing analogous risks. Most common releases were connected with non-flammable corrosive liquids, including: hydrochloric acid (199 cases), sulfuric(VI) acid (131 cases), sodium and potassium hydroxides (69 cases), ammonia solution (52 cases) and butyric acid (32 cases). The next group were gases hazardous only due to physico-chemical properties, including: extremely flammable propane-butane (249 cases) and methane (79 cases). There was no statistically significant trend associated with the total number of incidents. Only with the number of incidents with flammable corrosive, toxic and/or harmful liquids, the regression analysis revealed a statistically significant downward trend. The number of victims reported was 1997, including 1092 children and 18 fatalities. CONCLUSIONS: The number of people injured, number of incidents and the high 9th place of Poland in terms of the number of Seveso establishments, and 4 times higher number of hazardous industrial establishments not covered by the Seveso Directive justify the need for systematic analysis of hazards and their proper identification. It is advisable enhance health risk assessment, both qualitative and quantitative, by slight modification of the data collection system so as to enable the determination of released chemical concentration and exposed populations. Int J Occup Med Environ Health 2017;30(1):95-110.

Characterization of Chemical Suicides in the United States and Its Adverse Impact on Responders and Bystanders.

INTRODUCTION: A suicide trend that involves mixing household chemicals to produce hydrogen sulfide or hydrogen cyanide, commonly referred to as a detergent, hydrogen sulfide, or chemical suicide is a continuing problem in the United States (U.S.). Because there is not one database responsible for tracking chemical suicides, the actual number of incidents in the U.S. is unknown. To prevent morbidity and mortality associated with chemical suicides, it is important to characterize the incidents that have occurred in the U.S. METHODS: The author analyzed data from 2011-2013 from state health departments participating in the Agency for Toxic Substances and Disease Registry's National Toxic Substance Incidents Program (NTSIP). NTSIP is a web-based chemical incident surveillance system that tracks the public health consequences (e.g., morbidity, mortality) from acute chemical releases. Reporting sources for NTSIP incidents typically include first responders, hospitals, state environmental agencies, and media outlets. To find chemical suicide incidents in NTSIP's database, the author queried open text fields in the comment, synopsis, and contributing factors variables for potential incidents. RESULTS: Five of the nine states participating in NTSIP reported a total of 22 chemical suicide incidents or attempted suicides during 2011-2013. These states reported a total of 43 victims: 15 suicide victims who died, seven people who attempted suicide but survived, eight responders, and four employees working at a coroner's office; the remainder were members of the general public. None of the injured responders reported receiving HazMat technician-level training, and none had documented appropriate personal protective equipment. CONCLUSION: Chemical suicides produce lethal gases that can pose a threat to responders and bystanders. Describing the characteristics of these incidents can help raise awareness among responders and the public about the dangers of chemical suicides. Along with increased awareness, education is also needed on how to protect themselves.

Total and cardiovascular mortality rates in relation to discharges from Toxics Release Inventory sites in the United States.

BACKGROUND: This study analyzed Toxics Release Inventory (TRI) discharges in association with covariate-adjusted total and cardiovascular mortality rates for males and females in US counties. METHODS: Average annual county-level reported releases from TRI facilities measured in pounds per square mile which were calculated for the years 1990-1999, and tested for associations with age-adjusted mortality rates for 2006-2010. Chemicals were grouped into four categories: 1) carcinogens, 2) metals, 3) hazardous air pollutants, and 4) chemicals in the Comprehensive Environmental Response, Compensation and Liability Act. For each of these chemical groups the reported total, water, and air emissions were measured. Age-adjusted mortality rates were found separately for males and females from the Centers for Disease Control and Prevention for total and cardiovascular disease. Covariates included rates of smoking, obesity, high school and college education, race/ethnicity, poverty, unemployment, percent without health insurance, and urban-rural setting. Data were analyzed using multiple linear regression models. RESULTS: Greater average annual TRI releases in 1990-1999 in all four chemical categories were significantly associated with higher mortality rates in 2006-2010 for both total and cardiovascular mortality, and for both males and females, adjusted for covariates. Associations were stronger for air releases than for water releases. CONCLUSIONS: This study provides the first evidence that greater amounts of TRI releases are related to higher population mortality rates for cardiovascular disease. In addition, the study showed that adverse TRI effects were broadly present for both males and females for multiple chemical groups. Further progress is needed to reduce the use and release of harmful chemicals from TRI facilities in the United States.

An approach for estimating toxic releases of H2S-containing natural gas.

China is well known being rich in sulfurous natural gas with huge deposits widely distributed all over the country. Due to the toxic nature, the release of hydrogen sulfide-containing natural gas from the pipelines intends to impose serious threats to the human, society and environment around the release sources. CFD algorithm is adopted to simulate the dispersion process of gas, and the results prove that Gaussian plume model is suitable for determining the affected region of the well blowout of sulfide hydrogen-containing natural gas. In accordance with the analysis of release scenarios, the present study proposes a new approach for estimating the risk of hydrogen sulfide poisoning hazards, as caused by sulfide-hydrogen-containing natural gas releases. Historical accident-statistical data from the EGIG (European Gas Pipeline Incident Data Group) and the Britain Gas Transco are integrated into the approach. Also, the dose-load effect is introduced to exploit the hazards' effects by two essential parameters - toxic concentration and exposure time. The approach was applied to three release scenarios occurring on the East-Sichuan Gas Transportation Project, and the individual risk and societal risk are classified and discussed. Results show that societal risk varies significantly with different factors, including population density, distance from pipeline, operating conditions and so on. Concerning the dispersion process of hazardous gas, available safe egress time was studied from the perspective of individual fatality risks. The present approach can provide reliable support for the safety management and maintenance of natural gas pipelines as well as evacuations that may occur after release incidents.

The relationship between toxics release inventory discharges and mortality rates in rural and urban areas of the United States.

BACKGROUND: Potential environmental exposures from chemical manufacturing or industrial sites have not been well studied for rural populations. The current study examines whether chemical releases from facilities monitored through the Toxics Release Inventory (TRI) program are associated with population mortality rates for both rural and urban populations. METHODS: We used the TRI database, Centers for Disease Control and Prevention age-adjusted mortality data, and additional county-level covariate data to conduct a national study at (N = 3,142) of the association between amounts of on-site TRI air and water releases for the years 1988-2006 and total age-adjusted mortality rates for the years 1999-2006, after controlling for the effects of other risk variables. RESULTS: Results of multiple linear regression analyses indicated significantly higher adjusted mortality rates associated with greater water and air releases in both rural and urban counties. The strongest associations between TRI releases and rural mortality rates were found when 8 or more prior years of TRI release data were used to study subsequent mortality. CONCLUSION: The results support the use of the TRI as a public reporting tool and a research tool, and demonstrate that greater amounts of air and water TRI releases are related to mortality outcomes for both rural and urban populations.

Accidental hazardous material releases with human impacts in the United States: exploration of geographical distribution and temporal trends.

OBJECTIVE: To investigate the circumstances and geographic and temporal distributions of hazardous material releases and resulting human impacts in the United States. METHOD: Releases with fatalities, injuries, and evacuations were identified from reports to the National Response Center between 1990 and 2008, correcting for data quality issues identified in previous studies. RESULTS: From more than 550,000 reports, 861 deaths, 16,348 injuries and 741,427 evacuations were identified. Injuries from releases of chemicals at fixed facilities and natural gas from pipelines have decreased whereas evacuations from petroleum releases at fixed facilities have increased. CONCLUSION: Results confirm recent advances in chemical and pipeline safety and suggest directions for further improvement including targeted training and inspections and adoption of inherently safer design principles.

Accidentes: Programa Nacional de Prevención / Accidents: National Prevention Program

Este documento, surgido de una Reunión Nacional sobre Prevención de Accidentes, realizada en diciembre de 1992, fue diseñado con el objeto de servir de base para unificar criterios de tratamiento del tema de la accidentología y producir los lineamientos generales de un proyecto nacional consensuado. El tema se aborda desde los Riesgos, por definir que ésta es la vía más adecuada a los fines de la Prevención