title: Acute health effects after exposure to chlorine gas released after a train derailment.
abstract: In January 2005, a train derailment on the premises of a textile mill in South Carolina released 42 to 60 tons of chlorine gas in the middle of a small town. Medical records and autopsy reports were reviewed to describe the clinical presentation, hospital course, and pathology observed in persons hospitalized or deceased as a result of chlorine gas exposure. Eight persons died before reaching medical care; of the 71 persons hospitalized for acute health effects as a result of chlorine exposure, 1 died in the hospital. The mean age of the hospitalized persons was 40 years (range, 4 months-76 years); 87% were male. The median duration of hospitalization was 4 days (range, 1-29 days). Twenty-five (35%) persons were admitted to the intensive care unit; the median length of stay was 3 days. Many surviving victims developed significant pulmonary signs and severe airway inflammation; 41 (58%) hospitalized persons met PO2/FiO2 criteria for acute respiratory distress syndrome or acute lung injury. During their hospitalization, 40 (57%) developed abnormal x-ray findings, 74% of those within the first day. Hypoxia on room air and PO2/FiO2 ratio predicted severity of outcome as assessed by the duration of hospitalization and the need for intensive care support. This community release of chlorine gas caused widespread exposure and resulted in significant acute health effects and substantial health care requirements. Pulse oximetry and arterial blood gas analysis provided early indications of outcome severity.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; Air Pollution and Respiratory Health Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. Electronic address: vansickle@wisc.edu.
authors.forename: David
authors.initials: D
authors.lastname: Van Sickle
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; Division of Acute Disease Epidemiology, South Carolina Department of Health and Environmental Control, Columbia, SC 29201, USA.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Wenck
authors.affiliation: Division of Acute Disease Epidemiology, South Carolina Department of Health and Environmental Control, Columbia, SC 29201, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Belflower
authors.affiliation: Division of Acute Disease Epidemiology, South Carolina Department of Health and Environmental Control, Columbia, SC 29201, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Drociuk
authors.affiliation: Air Pollution and Respiratory Health Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Ferdinands
authors.affiliation: Air Pollution and Respiratory Health Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; Pulmonary and Critical Care Medicine, Emory University, Atlanta, GA 30322, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Holguin
authors.affiliation: Division of Acute Disease Epidemiology, South Carolina Department of Health and Environmental Control, Columbia, SC 29201, USA; Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Svendsen
authors.affiliation: Division of Acute Disease Epidemiology, South Carolina Department of Health and Environmental Control, Columbia, SC 29201, USA.
authors.forename: Lena
authors.initials: L
authors.lastname: Bretous
authors.affiliation: Air Pollution and Respiratory Health Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: Shirley
authors.initials: S
authors.lastname: Jankelevich
authors.affiliation: Division of Acute Disease Epidemiology, South Carolina Department of Health and Environmental Control, Columbia, SC 29201, USA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Gibson
authors.affiliation: Air Pollution and Respiratory Health Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Garbe
authors.affiliation: Air Pollution and Respiratory Health Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Moolenaar
mesh_terms: D055371:Acute Lung Injury / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D055884:Chemical Hazard Release; D002648:Child; D002675:Child, Preschool; D002713:Chlorine / Q000009:adverse effects*; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D005740:Gases / Q000009:adverse effects*; D015386:Hazardous Substances / Q000009:adverse effects; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011890:Railroads; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D013022:South Carolina; D055815:Young Adult
chemical_list: D005740:Gases; D015386:Hazardous Substances; D002713:Chlorine