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2023 Ohio train derailment

Courtesy National Transportation Safety Board

Pediatricians ‘a source of stability’ in communities dealing with environmental disasters

March 10, 2023

Families around East Palestine, Ohio, are experiencing a host of health symptoms after the recent train derailment and hazardous material release. And while it’s not clear what’s making them sick, pediatricians still have a role to play.

“The challenge, of course, is how you manage the nausea or headaches or any of the number of complaints that are coming in is not straightforward, but I think we as pediatricians may underestimate our ability to help, to be a source of stability in the communities that are affected,” said Aaron Bernstein, M.D., M.P.H., FAAP, chair of the AAP Council on Environmental Health and Climate Change (COEHCC).

“Health care providers are put in an enormously difficult situation in trying to address the understandable concerns of the families in the communities right now,” he said. “But they can validate the concerns of parents and be as honest as possible when acknowledging that the information is not adequate — while being available to discuss symptoms that come up, being someone who’s willing to listen.”

People in East Palestine and surrounding areas across the Pennsylvania border were exposed to chemicals including vinyl chloride following the Norfolk Southern train crash, spill and fire.

Although about 1,500 evacuated residents were allowed to return to their homes when the immediate danger was deemed to be over, their anger and fears have only grown. Some question whether testing can capture potential risks if chemicals seep into water and soil.

It will take time to assess the full impact of the immediate and possibly long-term effects, and the environmental cleanup may take months, if not years, said Alan D. Woolf, M.D., M.P.H., FAAP, a member of the COEHCC Executive Committee and director of the Region 1 New England Pediatric Environmental Health Specialty Unit.

Children with underlying conditions likely will suffer more.

“Some of the effects will be worse (for them), and it depends on the route of exposure, but in this case there were some airborne chemicals. Kids who have underlying bronchitis or who have underlying asthma — and especially those with known chemical triggers — are going to be the ones who may see their breathing worsen or have wheezing,” Dr. Woolf said.

Infants and children also are more susceptible to the adverse effects of toxic chemicals because of their smaller size, higher respiratory rates, increased daily intake of food and water, developing sensitive organs and immature detoxifying systems, he said.

Clinics have been set up to provide some health assessments and referrals, with families advised to see their primary care physicians to coordinate treatment.

Common symptoms, advice

Most of the 320 individuals — 95% of them over age 18 years — who visited the free clinic or had home visits, reported the most common symptoms as headache (72%), anxiety (57%), coughing (52%), fatigue/tiredness (49%) and irritation/pain/burning of the skin (47%), according to the Ohio Department of Health (ODH).

The clinic visits may involve recommendations for ongoing monitoring that could include bloodwork or other testing done in their medical home,” ODH Medical Director Bruce T. Vanderhoff, M.D., M.B.A., said in a news conference.

“If (patients) don’t have a medical home, we work to ensure that … we’ve established them with a medical home regardless of their economic circumstances. And why is that important? Because when we look at the chemicals involved, especially the primary chemical — vinyl chloride — there is simply not a blood test that we can do or a urine test that we can do that would say, ‘Aha! you had an exposure,’” he said.

Mental health, other concerns

Children’s mental health needs also must not be overlooked, Dr. Woolf said, especially as they can pick up on their parents’ anxieties.

Dr. Bernstein described the disruptions families are dealing with as adverse childhood events, and the more they have to endure dramatically influences their health across the lifespan.

“We know that children can be quite resilient, but the resilience comes from stable relationships, stable communities, predictability of the world, which this kind of thing really disrupts,” he said.

These types of explosions are an environmental justice issue — toxic releases don’t happen in wealthy communities, he added.

To the extent possible, families should try to keep their children up to date on vaccinations and regular checkups, when they also can be screened for mental health symptoms and receive referrals if available, Dr. Bernstein said.

Health care providers in the community are almost certainly strained, as their own family, friends and homes may have been affected, he added.

In the end, better controls on the transport of hazardous chemicals are needed, Dr. Bernstein emphasized.

“I’m sure industry will say it’s too expensive,” …. he said. “Tell that to the folks in East Palestine and especially the parents of children. So you know, it’s a societal choice. This is a choice about whether we value our communities over industrial interest.”



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