The European Journal of Public Health Advance Access originally published online on September 26, 2006
The European Journal of Public Health 2007 17(1):4-5; doi:10.1093/eurpub/ckl078
Viewpoints |
The UK experience with Health Impact Assessment of disasters
David Russell1 and Patrick Saunders2
1 Chemical Hazards and Poisons Division, The Centre for Chemicals, Radiation and Environmental Hazards, The Health Protection Agency Cardiff, Wales, UK
2 Chemical Hazards and Poisons Division, The Centre for Chemicals, Radiation and Environmental Hazards, The Health Protection Agency Chilton, Oxon, UK
Correspondence: David Russell, Chemical Hazards and Poisons Division, The Centre for Chemicals, Radiation and Environmental Hazards, The Health Protection Agency, Cardiff, Wales, UK, e-mail: DRussell{at}uwic.ac.uk
Chemical accidents may occur at any time and place, involving all major environmental media and with significant concerns for community health.1 Such incidents may be the consequence of spillages, leaks, fires, and explosions or the consequence of transportation by road, rail, air, or sea. There have been several high profile incidents, including the Bhopal disaster (1984), the release of dioxins at Seveso (1993), aluminium contamination of water supplies at Camelford (1989), and the Sea Empress oil spillage (1995). Chemical terrorism is also of potential concern, as highlighted by the deliberate release of the nerve agent sarin in Tokyo (1995). The public health implications of all the aforementioned incidents have been extensively investigated and commented upon.2–4
It is apparent that regardless of the nature of a chemical incident whether accidental or deliberate, that acute health effects may typically occur within seconds to minutes of exposure. It is therefore essential that public health structures are established that are capable of providing health impact assessments (HIAs) on a 24/7/365 basis. Therefore, public health risk assessment must be undertaken rapidly, thereby allowing timely intervention, minimizing exposure of casualties, and preventing exposure of wider communities, thus reducing burden of disease. This requires the assessment of available information regarding identification of involved chemicals, environmental interactions and reactions, and their collective toxicity profiles, likely media contaminated and expected levels of contamination. From this, at risk receptors can be ascertained, exposure assessed by a combination of environmental sampling, monitoring, and modelling, as well as biological monitoring. Epidemiological studies supplement HIAs. Therefore, ascertaining public health risk requires collection, collation, and integration of numerous sources of information relating to source, pathway, and receptor. Interpretation and subsequent HIA requires collective expertise in environmental chemistry and toxicology, environmental science, human toxicology, laboratory medicine, and epidemiology.
In the United Kingdom, undertaking such rapid health risk assessments is a function of the Health Protection Agency (HPA). This was established on the 1 April 2003 to protect populations from the threat of infectious diseases, chemical, radiological, nuclear, and other environmental hazards. It is an integrated and holistic structure for advice and support on environmental hazards; one of the key core objectives is to prevent or minimize the public health burden of exposure to environmental chemicals through enhancing, emergency planning and preparedness, thereby ensuring effective and efficient response, and recovery. In accordance with the principles of integrated emergency management, it works as part of a multiagency, multidisciplinary team, including frontline responders, regulators, and other agencies, such that preparedness and subsequent response are co-ordinated and integrated, with the principles of HIA being used to target the HPA's responsibilities in planning for, and responding to, chemical releases.
This role is well illustrated by the Buncefield incident of 11 December 2005. An explosion at a fuel distribution terminal in Hemel Hempstead, Hertfordshire, England, resulted in the largest post-war explosion in Western Europe. A dense black plume 
10 km across dispersed in a south-easterly and south-westerly direction. The temperature at the seat of the fire was estimated to be >3000°C, with the likelihood that the plume would largely consist of products of combustion, soot, and particulates. The plume rose very rapidly due to its high buoyancy. Environmental sampling data from air quality monitoring stations, together with soil and herbage samples were collected, collated, and interpreted. Despite calculations suggesting that large quantities of particulates (up top 8% of UK annual emissions) and other important pollutants including benzo[a]pyrene and nitrogen dioxide had been released, monitoring data showed that the plume had not grounded. The incident had not led to elevated ambient air concentrations of key pollutants, suggesting that the public health impact of the plume was unlikely to be significant. This is in keeping with reports of few if any direct toxicological effects of the incident (shown in the unexceptional levels of hospital admissions and GP consultations). However, the HPA is investigating the potential psychological effects. Although there have been occasional assessments of these effects following incidents,5 this is a largely neglected area in the UK response to incidents. The HPA is developing a portfolio of skills and resources to ensure that this important aspect of individual and community health is not overlooked.
 |
References |
|---|
 Top References |
|---|
1 Olowkure B, Saunders PJ, Dyer JA, Kibble AJ. (2004) Temporal and seasonal variation in the occurrence of chemical incidents. Occup Environ Med 61:177–9.
2 Altman P, Cunningham J, Marsh F, et al. (1999) Disturbance of cerebral function in in people exposed to drimking watercontaminated with aluminium sulphate:retrospective study of the Camelford water incident. BMJ 319:807–11.
3 Dhara VR, Dhara R, Acquilla SD, Cullinan P. (2002) Personal exposure and long term health effects in surviviors of the union carbide disaster at Bhopal. Environ Health Perspect 110:487–500.[Web of Science][Medline]
4 Okumura T, Takasu N, Ishimatsu S, et al. (1996) Report on 640 victims of the Tokyo subway sarin attack. Ann Emerg Med 28:129–35.[CrossRef][Web of Science][Medline]
5 Lyons RA, Temple JM, Evans D, et al. (1999) Acute health effects of the Sea Empress oil spill. J Epidemiol Community Health 53:306–10.[Abstract]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||