Stacy Arnesen emphasized that data sharing is a critical part of the new NLM strategic plan and advised participants on aspects of data collection. (Photo courtesy of Richard Kwok)

What would happen if a train derailed and chemicals were released into a community?

This important question was part of training offered through a collaboration between NLM and the National Institute of Environmental Health Sciences (NIEHS).

The training arose out of the NIH Disaster Research Response Program (DR2), a national framework for research on the medical and public health aspects of disasters and public health emergencies. The DR2 website, provided by NIEHS and NLM, supports disaster science investigators by offering data collection tools, research protocols, disaster research news and events, and more. The program encourages and supports the development of a network of trained, deployable “research responders.” Like all responders, researchers need training to be effective in their disaster roles.

The following story about this training first appeared in Environmental Factor, the NIEHS newsletter.

NIEHS preps for disaster, health research with derailment scenario

A workshop on a mock train derailment—with chemical releases into the community—brought together local, tribal, and international key experts in Tucson, Arizona. The group gathered February 28–March 1 to explore health effects and medical treatment research in the disaster’s aftermath.

The training workshop attracted approximately 135 first responders, health care providers, academic researchers, students, community members, and government representatives. They grappled with how to quickly mobilize data collection and time-critical research while responding to the emergency.

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Joan Packenham, PhD, left, director of the NIEHS Office of Human Research Compliance, and Mariette Marsh, director of the UA Human Subjects Protection and Privacy Program, shared key factors to consider when conducting clinical research. (Photo courtesy of Richard Kwok)

This event was the fourth in a series of tabletop exercises conducted by DR2. NIEHS leads the program, with Senior Medical Advisor Aubrey Miller, MD, at the helm. The institute collaborates with NLM, which was represented in Tucson by Stacey Arnesen, NLM Disaster Information Management Research Center branch chief.

NIEHS, the University of Arizona (UA) College of Medicine–Tucson, the UA Mel and Enid Zuckerman College of Public Health, the UA College of Pharmacy, and the BIO5 Institute at UA jointly sponsored the workshop.

Workshop included many firsts

According to Miller, the Arizona event was the first DR2 training scenario to involve an accident rather than a natural disaster. The mock train derailment and explosion involved the release of chlorine gas, liquid propane, and the organophosphate pesticide malathion. It was the brainchild of organizers from the Tucson area, which has a major rail hub southeast of downtown.

Another first was the dual focus on emergency management and health care responses, and potential community exposures and longer-term health impacts. Organizers also tested rapid development of study protocols through a novel mock-review by UA officials.

University faculty and students addressed mapping data streams, taking care of pets, using emergency alert systems, integrating medical records with community studies, and other challenges.

Participants, such as Sandra Espinoza from the Pima County Office of Emergency Management (OEM), were enthusiastic about the experience. “It’s not that research was something that we at OEM didn’t care about,” she said. “But to find out that there are researchers already in our town studying these things that we ‘what if’ about is great to know.”

Equipping the next generation

UA students (from l) Yoshira Ornelas Van Horne, Johnathon Blohm, and Rietta Wagoner presented posters and a flash talk on environmental and animal sampling. (Photo courtesy of James Remington)

Student posters and flash talks were another new feature. “Through our partnership with the university, student participation was brought in early, and we learned new ways [that] academic partners can be an invaluable resource,” said Miller.

“This [event] inspired me with the innovations on the horizon, such as the student presentations of IPAWS,” said UA pharmacist Chris Edwards, PharmD. The Integrated Public Alert and Warning System (IPAWS) is run by the Federal Emergency Management Agency.

Data and health care

Participants discussed the broad array of information collected by diverse partners. “The exercise was a really ambitious effort,” Miller said. Observations included the following:

• Data on safety and effectiveness of medical treatments support research to improve outcomes.
• Information on the clinical course of the injured sheds light on health resource needs for lung injuries, mental health, and other impacts.
• Indicators of community health in the short and long term help ensure that health effects are addressed and the environment is safe.

“It’s two or three levels beyond what I was thinking, to switch to research [and] the data flow, instead of just getting medicines to patients,” said Edwards.

Kim Janes of the Pima County Health Department said he appreciated new connections with the university: “One important takeaway is how do we get mental health involved from the beginning?”

UA emergency medicine pediatrician Andreas Theodorou, MD, reminded the audience that children’s exposures during and following disasters are different from those of adults.

“NIEHS has long recognized that research conducted in children requires consideration of their unique attributes,” said NIEHS Health Science Policy Analyst Kimberly Thigpen Tart, JD. “So [Theodorou’s] direction that DR2 should identify and develop resources for this vulnerable population was on point and well-taken.”

Dr. Aubrey Miller, at podium, introduced a panel of speakers that included NIEHS and National Toxicology Program Director Linda Birnbaum, PhD, second from left; Joseph “Chip” Hughes, head of the NIEHS Worker Training Program, far right; and others. (Photo courtesy of Jim Remington)

NIH employees and contractors present included (from l) April Bennett; Craig Wladyka; Rich Rosselli; Aubrey Miller, MD; Steve Ramsey; Stacey Arnesen; Thigpen Tart; Jane Lambert; Mark Miller, PhD; Claudia Thompson, PhD; Richard Kwok, PhD; Sara Webb; Linda Birnbaum, PhD; Chip Hughes; Liam O’Fallon; and James Remington. (Photo courtesy of Ross Dubois)

Participants completed sample surveys on their phones during the demonstration of clinical data collection. (Photo courtesy of Betsy Galluzzo)

Keith Mundy of the International Chemical Workers Union Council shared a map showing the hypothetical chemical plume’s spread, to help participants grasp the extent of the area affected. (Photo courtesy of Liam O’Fallon)

O’Fallon, left, and Thompson, both of NIEHS, walked to the meeting through a monument to women on the UA campus. (Photo courtesy of Richard Kwok)

By Kelly Lenox, editor in chief of the Environmental Factor, a product of the Office of Communications and Public Liaison at the National Institute of Environmental Health Sciences, which is part of NIH.