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Management of Chlorine Gas-Related Injuries From the Graniteville, South Carolina, Train Derailment

Published online by Cambridge University Press:  16 September 2014

Emily Mackie ,
Erik Svendsen ,
Stephen Grant ,
Jill E. Michels  and
William H. Richardson
Emily Mackie*
Affiliation:
Palmetto Health Richland, Department of Emergency Medicine, and Palmetto Poison Center, University of South Carolina, South Carolina College of Pharmacy, Columbia, South Carolina
Erik Svendsen
Affiliation:
Tulane University School of Public Health and Tropical Medicine, Department of Global Environmental Health Sciences, New Orleans, Louisiana
Stephen Grant
Affiliation:
North Fulton Hospital, Department of Emergency Medicine, Roswell, Georgia
Jill E. Michels
Affiliation:
Palmetto Health Richland, Department of Emergency Medicine, and Palmetto Poison Center, University of South Carolina, South Carolina College of Pharmacy, Columbia, South Carolina Tulane University School of Public Health and Tropical Medicine, Department of Global Environmental Health Sciences, New Orleans, Louisiana
William H. Richardson
Affiliation:
Palmetto Health Richland, Department of Emergency Medicine, and Palmetto Poison Center, University of South Carolina, South Carolina College of Pharmacy, Columbia, South Carolina
*
Correspondence and reprint requests to Emily Mackie, MD, Palmetto Health Richland, Department of Emergency Medicine, 5 Richland Medical Park Dr, Columbia, SC 29203 (e-mail: [email protected]).
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Abstract

A widely produced chemical, chlorine is used in various industries including automotive, electronics, disinfectants, metal production, and many others. Chlorine is usually produced and transported as a pressurized liquid; however, as a gas it is a significant pulmonary irritant. Thousands of people are exposed to chlorine gas every year, and while large-scale exposures are uncommon, they are not rare. Symptoms are usually related to the concentration and length of exposure, and although treatment is largely supportive, certain specific therapies have yet to be validated with randomized controlled trials. The majority of those exposed completely recover with supportive care; however, studies have shown the potential for persistent inflammation and chronic hyperreactivity. This case report describes an incident that occurred in Graniteville, South Carolina, when a train derailment exposed hundreds of people to chlorine gas. This report reviews the events of January 6, 2005, and the current treatment options for chlorine gas exposure.(Disaster Med Public Health Preparedness. 2014;0:1-6)

Keywords

chlorineinhalationtraindisaster
Type
Brief Report
Information
Disaster Medicine and Public Health Preparedness , Volume 8 , Issue 5 , October 2014 , pp. 411 - 416
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2014 

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References

REFERENCES

1. Mowry, JB, Spyker, DA, Cantilena, LR Jr, Bailey, JE, Ford, M. 2012 Annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 30th annual report. Clin Toxicol (Phila) . 2013;51:949-1229.Google Scholar
2. Cevik, Y, Onay, M. Mass casualties from acute inhalation of chlorine gas. South Med J. 2009; 102(12):1209-1213.Google Scholar
3. Jones, R, Willis, B, Kang, C. Chlorine gas: an evolving hazardous material threat and unconventional weapon. West J Emerg Med. 2010; 11:151-156.Google Scholar
4. Van Sickle, D, Wenck, MA, Melflower, A, et al. Acute health effects after exposure to chlorine gas released after train derailment. Am J Emerg Med. 2009;27:1-7.Google Scholar
5. Winder, C. The toxicology of chlorine. Environ Res. 2001;85:105-114.Google Scholar
6. Balte, PP, Clark, KA, Mohr, LC, Karmaus, WJ, Van Sickle, D, Svendsen, ER. The immediate pulmonary disease pattern following exposure to high concentrations of chlorine gas. Pulm Med. 2013;2013: 325869.Google ScholarPubMed
7. Schwartz, DA, Smith, DD, Lakshminarayan, S. The pulmonary sequelae associated with accidental inhalation of chlorine gas. Chest. 1990;97(4):773-775.Google Scholar
8. Moore, BB, Sherman, M. Chronic reactive airway disease following acute chlorine gas exposure in an asymptomatic atopic patient. Chest. 1992;102(3):984.Google Scholar
9. Das, R, Blanc, PD. Chlorine gas exposure and the lung: a review. Toxicol Ind Health. 1993;9(3):439-455.CrossRefGoogle ScholarPubMed
10. Duncan, MA, Drociuk, D, Belflower-Thomas, A, et al. Follow-up assessment of health consequences after a chlorine release from a train derailment – Graniteville, SC, 2005. J Med Toxicol. 2011;7(1):85-91.Google Scholar
11. US Department of Health and Human Services Public Health Service, Agency for Toxic Substances and Disease Registry. Toxicological profile for chlorine; November 2010. http://www.atsdr.cdc.gov/ToxProfiles/tp172.pdf Google Scholar
12. National Transportation Safety Board. Collision of Norfolk Southern freight train 192 with Norfolk Southern local train P22 with subsequent hazardous materials release at Graniteville, South Carolina; January 6, 2005. Washington, DC, National Transportation Safety Board. http://www.ntsb.gov/doclib/reports/2005/RAR0504.pdf Google Scholar
13. Perez, A, McKay, C. Halogens (bromine, iodine, and chlorine compounds). In: Shannon MW, ed. Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose, 4th ed. Philadelphia, Pennsylvania: Saunders; 2007.Google Scholar
14. Adelson, L, Kaufman, J. Fatal chlorine poisoning: report of two cases with clinicopathologic correlation. Am J Clin Pathol. 1971;56:430-442.Google Scholar
15. Guloglu, C, Kara, I, Erten, P. Acute accidental exposure to chlorine gas in the southeast of Turkey: a study of 106 cases. Environ Res. 2002;88:89-93.CrossRefGoogle Scholar
16. Sexton, JD, Pronchick, DJ. Chlorine inhalation: the big picture. J Toxicol Clin Toxicol. 1998;36:87-93.Google Scholar
17. Aslan, S, Kandis, H, Akgun, M, et al. The effect of nebulized NaHCO3 treatment on “RADS” due to chlorine gas inhalation. Inhal Toxicol. 2006;18:895-900.Google Scholar
18. Bosse, GM. Nebulized sodium bicarbonate in the treatment of chlorine gas inhalation. J Toxicol Clin Toxicol. 1994;32:233-241.CrossRefGoogle ScholarPubMed
19. Vinsel, PJ. Treatment of acute chlorine gas inhalation with nebulized sodium bicarbonate. J Emerg Med. 1990;8:327-329.Google Scholar
20. Douidar, SM. Nebulized sodium bicarbonate in acute chlorine inhalation. Pediatr Emerg Care. 1997;13(6):406-407.Google Scholar
21. Gunnarsson, M, Walther, SM, Seidal, T, Lennquist, S. Effects of inhalation of corticosteroids immediately after experimental chlorine gas lung injury. J Trauma. 2000;48(1):101-107.Google Scholar
22. Jonasson, S, Koch, B, Bucht, A. Inhalation of chlorine causes long-standing lung inflammation and airway hyperresponsiveness in a murine model of chemical-induced lung injury. Toxicology. 2013;303:34-42.Google Scholar
23. Clark, KA, Chanda, D, Balte, P, et al. Respiratory symptoms and lung function 8-10 months after community exposure to chlorine gas: a public health intervention and cross-sectional analysis. BMC Public Health . 2013;13:945 .Google Scholar
24. Vajner, JE, Lung, D. Case files of the University of California San Francisco Medical Toxicology Fellowship: acute chlorine gas inhalation and the utility of nebulized sodium bicarbonate. J Med Toxicol. 2013;9:259-265.CrossRefGoogle ScholarPubMed
25. Pascuzzi, TA, Storrow, AB. Mass casualties from acute inhalation of chloramine gas. Mil Med. 1998;163(2):102-104.Google Scholar
26. Wang, J, Winskog, C, Edston, E, Walther, SM. Inhaled and intravenous corticosteroids both attenuate chlorine gas-induced lung injury in pigs. Acta Anaesthesiol Scand. 2005;49:183-190.Google Scholar
27. Wang, J, Zhang, L, Walther, SM. Administration of aerosolized terbutaline and budesonide reduces chlorine gas-induced acute lung injury. J Trauma. 2004;56(4):850-862.Google Scholar
28. Chen, J, Mo, Y, Schlueter, CF, Hoyle, GW. Inhibition of chlorine-induced pulmonary inflammation and edema by mometasone and budesonide. Toxicol Appl Pharmacol. 2013;272:408-413.Google Scholar
29. Jonasson, S, Wigenstam, E, Koch, B, Bucht, A. Early treatment of chlorine-induced airway hyperresponsiveness and inflammation with corticosteroids. Toxicol Appl Pharmacol. 2013;271:168-174.Google Scholar