Vinyl Chloride

East Palestine, Ohio Train Derailment - February 3, 2023

  • 50 cars of a Norfolk Southern train derailed in East Palestine, Ohio

  • 10 cars were carrying toxic chemicals including vinyl chloride

  • Residents were instructed to evacuate for safety concerns

  • February 6 – crews performed a “controlled release” of chemicals to prevent an explosion

  • The derailment and subsequent “release” resulted in numerous environmental and health concerns, most notably with vinyl chloride

What is vinyl chloride?

  • Industrially produced, colorless gas, used in the manufacturing of different plastics (i.e. PVC pipes, wire/cable coating, packaging materials)

  • Extremely inflammable and potentially explosive

  • People primarily exposed via inhalation

  • Largest exposures come from air around factories producing vinyl products, but also associated with tobacco smoke

  • If contaminates water, household air can be affected when water is used for showering, cooking, laundry, etc.

Acute Exposure

  • Vinyl chloride —> attacks lipids and proteins of neuronal membranes that disrupts signal transmission

  • Neuro: AMS, dizziness, ataxia, fatigue, headache, LOC (high concentrations can cause respiratory depression and death)

  • Respiratory: wheezing, bronchitis

  • Cardiovascular: may lower threshold to dysrhythmia, ECG abnormalities (ventricular ectopy, heart block, T-wave inversions)

  • Skin: redness, blistering, frostbite

  • Ocular: corneal, conjunctival irritation or burns

  • GI: nausea, vomiting, diarrhea, epigastric pain, elevated LFTs

  • Renal: AKI

Chronic Exposure

  • Reactive epoxide metabolites à bind hepatic DNA

  • CNS: sensory-motor polyneuropathy, pyramidal extrapyramidal and cerebellar abnormalities, neuropsychiatric symptoms

  • Skin: purpura

  • GI: portal HTN, cirrhosis, hepatic cancers

  • Immune: thrombocytopenia

  • Reproductive: decreased libido and fertility in men (not considered a developmental toxicant)

Pre-Hospital Management

  • 2 routes of exposure:

    • Inhalation of gas

    • Direct skin contact with liquid form (may pose risk to rescuers)

  • Basic decontamination:

    • Remove clothing

    • Wash exposed skin and hair

    • Handle frostbitten skin gently

    • Irrigate exposed eyes for 15 minutes


Emergency Department Management

  • ABC’s

  • Treat acute bronchitis and bronchospasm as usual

    • Use bronchodilators with caution given increased risk for dysrhythmia

  • Rewarm frostbite in a warm water bath

  • Good eye exam for conjunctival or corneal abrasions if eye exposure

  • No antidote, treatment is supportive

  • Generally observe patients for 6-8 hrs before discharging minor exposures or patients with minor symptoms showing improvement

  • Consider obs admission for patients with severe, persistent or progressive symptoms

East Palestine & Norfolk Southern

  • State of Ohio sued Norfolk Southern over costs of chemical spill cleanup and environmental damage

  • Accident has prompted Congress to engage in railway safety legislation (inspection oversight, stricter standards, etc.)

  • As of April 15 2023, Norfolk Southern has completed excavation of soil at one track of the derailment site, making way to open that track and begin work on a second

    • 25,000 tons of soil

    • 12 million+ gallons of contaminated water

  • Residents remain on edge and concerned for their health and safety

Tox Blog Main Page

AUTHORED BY: VINCENT MARSHALL, DO

FACULTY EDITING BY: LAUREN PORTER, DO

References

  1. Terry, J. What We Know About the East Palestine, Eastern Ohio, Train Derailment, Evacuation, Toxic Chemicals. The (Akron) Beacon Journal. February 7, 2023. https://www.beaconjournal.com/story/news/local/2023/02/07/what-we-know-about-the-east-palestine-eastern-ohio-train-derailment-evacuation-toxic-chemicals/69880223007/

  2. Hamilton J. Health Risks After East Palestine, Ohio Train Derailment. NPR. February 14, 2023. https://www.npr.org/2023/02/14/1156567743/health-east-palestine-ohio-train-derailment-chemicals

  3. Kleinman MT, MacMahon A, et al. Vinyl Chloride. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Updated August 7, 2023. https://www.ncbi.nlm.nih.gov/books/NBK544334/

  4. U.S. Environmental Protection Agency. Vinyl Chloride: Hazard Summary. EPA; 2016. https://19january2017snapshot.epa.gov/sites/production/files/2016-09/documents/vinyl-chloride.pdf

  5. Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological Profile for Vinyl Chloride. U.S. Department of Health and Human Services; 2006. https://www.atsdr.cdc.gov/ToxProfiles/tp20-c1-b.pdf

  6. Centers for Disease Control and Prevention. Vinyl Chloride – Medical Management Guidelines (MMG #278). https://wwwn.cdc.gov/TSP/MMG/MMGDetails.aspx?mmgid=278&toxid=51

  7. National Cancer Institute. Vinyl Chloride and Cancer Risk. Updated July 14, 2021. https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/vinyl-chloride

  8. Vainio H. Vinyl chloride and vinyl benzene (styrene)—metabolism, mutagenicity and carcinogenicity. Chem Biol Interact. 1978;22(1):117-124.

  9. CBS Pittsburgh. Norfolk Southern CEO Testifies Before Ohio Senate on Train Derailment. January 30, 2023. https://www.cbsnews.com/pittsburgh/news/norfolk-southern-ceo-ohio-senate-hearing-train-derailment/

  10. Railway Age. NS Reaches East Palestine Clean-Up Milestone. May 23, 2023. https://www.railwayage.com/mw/ns-reaches-east-palestine-clean-up-milestone/

ToxLauren McCaffertytoxicology, medical toxicology, vinyl chloride