Introduction: Over 2.5 million emergency responders in the United States face hazardous exposures while on duty [NIOSH 2013a], and this population has been identified as having the greatest risk of exposure during a disaster [Pak et al. 2008]. Responders to a chemical release following a train derailment must immediately assess the risks by gathering information about the situation, analyzing available options, and taking action to implement decisions to protect themselves, the public, other responders, and the environment [NIOSH 2004]. This report describes the events of a 2012 vinyl chloride release, defines its impact on local emergency responders, and offers recommendations for responder safety and health in similar incidents. On November 30, 2012, around 7:00 a.m., a railway bridge collapsed, derailing a train in Paulsboro, New Jersey. Four tank cars, including a breached tank car carrying vinyl chloride, landed in a tidal creek. Crews responded from city, township, county, state, and federal agencies. A Unified Command (UC) was established to manage the incident, which included the United States Coast Guard, New Jersey Department of Environmental Protection, New Jersey Office of Emergency Management, Paulsboro Fire Department, and Conrail [Conrail 2012]. Shortly after responders arrived on scene, they reported seeing a "cloud of fog" that hovered over the area. Initially, after identifying the "fog" as vinyl chloride, a shelter-in-place order was implemented for residents within a half mile of the incident. Vinyl chloride is peroxidizable, and forms explosive polymeric peroxides in the air [Bretherick 1979], which caused concern that residents starting their vehicles might ignite the vinyl chloride. Around 4:00 p.m. on November 30, UC reported an acute increase in ambient air vinyl chloride levels, thought to be related to changing weather conditions. An evacuation of residents in the immediate area was ordered. Vinyl chloride is a colorless gas with a mild, sweet odor that is used to make polyvinyl chloride for production of plastic goods. Vinyl chloride is an acute respiratory irritant and neurotoxin. Neurological symptoms associated with vinyl chloride exposure include headache, drowsiness, and dizziness. Although studies have revealed that chronic occupational exposures can result in liver damage, accumulation of fat in the liver, tumors (including angiosarcoma of the liver), and death of liver cells [ATSDR 2006], acute exposures have not been well studied. On December 7, 2012, the New Jersey Department of Health (NJ DOH) requested assistance from the Centers for Disease Control and Prevention (CDC), including the Agency for Toxic Substances and Disease Registry (ATSDR) and the National Institute for Occupational Safety and Health (NIOSH). A team from these agencies deployed to New Jersey to assist the NJ DOH with the investigation on December 11. Objectives of the investigation were to (1) characterize exposure to vinyl chloride and resulting health effects; (2) assess the occupational health and safety of emergency personnel who responded to the incident; and (3) describe the response to the incident and develop recommendations for public health preparedness and response to chemical releases with mass casualty potential. This report focuses on the second objective. Conclusions: Acute symptoms of vinyl chloride exposure were common. The most frequently reported symptoms include headache, upper respiratory illness, and lower respiratory illness. Although symptoms of vinyl chloride exposure followed the release, only 23% of respondents sought medical care, indicating that in most cases the symptoms may have been transient. The majority of respondents did not use respiratory protection, but most respondents reported receiving some emergency responder training and felt they had sufficient instruction, indicating a possible gap in perception of risk. Recommendations: On the basis of our findings, we recommend the actions listed below. We encourage the various departments to use a labor-management health and safety committee or working group to discuss our recommendations and develop an action plan. Those involved in the work can best set priorities and assess the feasibility of our recommendations for the specific situation. 1. Promptly implement ERHMS (http://www.cdc.gov/niosh/topics/erhms/).
2. Use respiratory protection until engineering controls and work practices can be implemented that reduce employee exposure to below the appropriate occupational exposure limit (OSHA PEL or NIOSH recommended exposure limit). Implementation should follow the OSHA respiratory protection standard [29 CFR 1910.134]. An SCBA should be used when exposure levels are unknown or until they have been measured to be below the appropriate occupation exposure limit. 3. Evaluate training needs for all emergency response roles.